Tuesday, February 21, 2012

Symptomatic Diagnosis: Limbs & Extremities

The channels that pass through the extremities can be functionally regulated via the internal organs. This article describes the differentiation, treatment principles, and formulas of common health concerns associated with the limbs and extremities.
Edema of the extremities – Stiffness of the extremities – Flaccid paralysis of extremities “wei syndrome” – Varicose veins of the lower extremities – Feet pain

Edema of the extremities

  • Accumulation of Heat and damp (“Heat Bi”)

    Clinical Manifestations
    • Edema in small joints
    • Acute achy swollen arthritis
    • Combined with fever, thirst and irritability
    • T: Red body with yellow greasy coat
    • P: Slippery and rapid
    • Bai Hu Tang (White Tiger Decoction) + Gui Zhi (Rm. Cinnamoni) and Cang Zhu (Rz. Atractylodis)
  • Accumulation of Cold and damp (“Cold Bi”)

    Clinical Manifestations
    • Cold, achy arthritis with edema
    • T: Greasy white coat
    • P: Slow
    • Wu Tou Tang (Aconite Decoction)
  • qi Stagnation

    Clinical Manifestations
    • Pitting edema
    • Chest constriction and hypochondriac distending pain
    • T: Pale with white coating
    • P: Wiry
    • Because this a channel pathology, the etiology is often an external pathogen associated with wind.
    Treatment Principle
    • Harmonize ying and wei qi
    • Xiang Ru San (Elsholtzia Powder)
    • + Xiang Fu (Rz. Cyperi) which activates qi
    • + Zi Su Ye (Fo. Perillae) which expels wind
  • Qi and blood Stagnation (post stroke sequelae, paralysis, hemiplegia)

    Clinical Manifestations
    • Edema (mostly lower extremities), weakness, numbness
    • Color of the skin at affected site is purple
    • T: Pale with purple spots
    • P: Wiry, choppy
    • phlegm remaining in channels after stroke
    • Huang Qi Gui Zhi Tang (Astragalus and Cinnamon Twig Decoction)

Stiffness of the extremities

  • Wind Cold and damp

    Clinical Manifestations
    • Cold, achy arthritis
    • T: Greasy white coat
    • P: Slow
    • Gui Zhi Tang (Cinnamon Twig Decoction)
    • Ge Gen Tang (Kudzu Decoction)
  • Heat and phlegm

    Clinical Manifestations
    • High fever, stiffness of extremities
    • Irritability, delirium
    • Possibly associated with convulsions, muscle spasms
    • “Extreme Heat leads to Liver Wind”
    • Ling Yang Ge Gen Tang (Antelope Horn and Kudzu Decoction)

Flaccid Paralysis of Extremities “Wei Syndrome”

Usually without pain.
  • Body Damaged by Lung Heat

    Clinical manifestations
    • Follows febrile disease
    • Usually affects the lower extremities
    • Low grade fever and yin impairment
    • T: Red with yellow or scanty coat
    Treatment Principle
    • Tonify yin and jin-ye
    • Sha Shen Mai Men Dong Tang (Glehnia and Ophiopogonis Decoction) + San Miao Wan (Three Marvel Pill)
    • Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lungs Decoctions)
    Acupuncture points:
    • yang ming points. Stomach channel for legs, Large Intestine channel for arms.
  • Qi deficiency of the Spleen/Stomach

    Clinical manifestations
    • Weakness (not paralysis) of limbs, normal movement, but very weak.
    • Bloating, indigestion, loose stool, aversion to cold, pale complexion.
    • T: Pale
    • P: Thready and weak
    • Prevalent during post illness recovery period.
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Deficiency of Liver and Kidney

    Clinical manifestations
    • Old age, or following illness.
    • Hyposensitivity of extremities leading to weakness leading to paralysis
    • Sore lower back, dysmenorrhea, premature ejaculation
    • Dizziness, vertigo, fatigue
    • T: Pale
    • P: Deep, thready, weak
    • jing deficiency, sometimes combined with qi or yin deficiency.
    Treatment Principle
    • Tonify jing and Liver (for tendons)
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • You Gui Yin (Restore the Right (Kidney) Decoction)
    • Da Bu Yin Wan (Great Tonify the Yin Pill)
  • Blood Stagnation

    Clinical manifestations
    • Weakness leading to numbness
    • Possible spasm leading to paralysis
    • T: Purple
    • P: Choppy, thready
    • Post stroke sequelae or tissue trauma
    • Phlegm remains in channels after stroke
    Treatment Principle
    • Promote blood circulation.
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)

Varicose Veins of the Lower Extremities

    • Varicose veins are combined with red, swollen legs. Veins are hot and burning
    • Fever, bitter taste in the mouth, irregular bowel movements
    • T: Red with yellow greasy coating
    • P: Wiry/rapid
    • excessive alcohol intake, damp and heat producing foods
    • Clear heat, drain damp
    • San Miao Wan (Three Marvel Pill)
    • Local points are inserted around the varicose veins like Hua Tou Jia Jie Points around the spine. Needles are considered more effective than herbs for this sort of varicose condition.
  • Accumulation of heat and damp (acute condition)

    Clinical manifestations Etiology Treatment Principle Formula Points
  • Accumulation of cold and damp (chronic condition)

    Clinical manifestations
    • Varicose veins are combined with heavy extremities and distention.
    • Blue or purple veins, chronic
    • Copious urine, loose stools
    • T: White Greasy coat
    • P: Soft
    • Standing up too much, working environment
    Treatment Principle
    • Remove cold and damp
    • Ji Ming San (Powder to Take at Cock’s Crow)
  • Qi deficiency and blood stagnation

    Clinical manifestations
    • Chronic physical weakness or qi deficiency
    • Etiology: Chronically carrying heavy things and/or standing for a long time.
    • Purple veins. Not as “big” as in damp/cold accumulation.
    • Achy, but not distended.
    • Fatigue, shortness of breath, pale complexion.
    • T: Pale
    • P: Weak
    Treatment Principle
    • Harmonize ying, tonify qi, activate blood
    • Bu Yang Huan Wu Tang (Tonify the Yang to Restore Five (Tenths) Decoction)

Feet Pain

  • Liver and Kidney deficiency (old age, jing deficiency)

    Clinical manifestations
    • Pain in heal (key symptom)
    • No skin change
    • Pain worsened by walking or fatigue
    • Tinnitus, Sore back
    • Hu Jian Wan (A pre-made formula, unknown translation)
  • Accumulation of cold and damp

    Clinical manifestations
    • Achy joints exasperated by cold and damp
    • T: White coat
    • P: Soft
    • Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities)

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