Introduction to Aetiology. Terminology 1. Terminology 2. Aims. Aetiology Clinical manifestations Pattern Pathology Diagnosis

Transcription

1 Introduction to Aetiology Aims to learn about the three classic divisions of aetiology reflect on emotions and feelings Terminology Aetiology Clinical manifestations Pattern Pathology Diagnosis Terminology Treatment Principles Treatment Plan Patient goals Pathology diagram

2 Life stages Childhood Adolescence Young adulthood (0-0) Middle age (0-) Old age ( and older) 7

3 8 Early o Weak hereditary constitution o Irregular feeding o Climate (short-term unless residual pathogenic factor) Later o Diet o Climate o Emotions o Traumas Childhood Adolescence Deficiency of Blood o Headaches o Skin problems o Period problems Cold in the uterus Emotions 9 Young adulthood (0-0) Leaving home o Diet Emotional stress Sexually active 0

4 Middle age (0-) Overwork Diet General decline Things beginning to catch up on us Unreasonable expectations Aetiology. External. Internal. Miscellaneous External - climate Pathogenic factors o Wind o Damp o Cold o Heat o Summer Heat o Dryness

5 Internal: emotions Normal Excessive To be expressed Rarely simple Issues o Contact Empathy o Avoid confusion Need to express What we need to know Feelings Normal Need to be expressed through... Socialisation Constipation Behaviour patterns Develop from ERSI as well as early trauma Stress Stress Stress can be good Stress is frequently old feelings What we felt then and then and then and now we feel overwhelmed Triggers don t have to be unpleasant Sympathetic nervous system Located in the body

6 7 Active listening Giving good attention Putting aside your own concerns Communicating empathy rather than sympathy Giving space to allow the patient to say their piece and not finishing their sentences for them Recapping and summarising words and feelings Cueing in to significant expressions Accepting the release of emotions Recognising your own feelings resulting from your interaction with the patient Not assuming particular events affect everybody in the same way Contact Feelings What we can be is accepting of them as they are now Trauma hunt They haven t opened up!! 8 Emotions in Chinese Medicine CM systematises the emotions into simple form and associates them with specific organs... but human emotions are rarely simple! Complex emotions can affect more than one organ In particular, any emotion can affect the Heart 9

7 Release of emotions Grief - tears Irritations - laughter, hot sweating Nervousness - laughter, hot sweating Anger - raging, tantrums, hot sweating Boredom - yawning Physical stress - yawning and stretching Fear and terror - shaking, trembling, cold sweating 0 Emotions 7

8 Miscellaneous Constitution Lifestyle o Work, exercise and relaxation o Sex Chance factors o Trauma o Parasites o Epidemics Heredity and constitution Parents o General health o Health at time of conception o Condition of mother s pregnancy Constitutional o Weak Spleen o Weak Lung o Weak Heart o Weak Liver o Weak Kidney Diet Choice of food Cold food Hot food Greasy food Not eating enough Eating habits o In a hurry o Standing up o While working / driving / meeting o Without routine o Late o Affects Stomach Qi Stomach Yin 8

9 Trauma Local stagnation of Qi and Blood Drugs Medicinal Recreational 7 Excessive sexual activity Men o Depletion of Kidney Essence Female equivalent o Menstrual Blood 8 9

10 Why? Aetiology is often conjecture o We can t know for definite It can tell us when it started o How long it will take to treat If there is useful lifestyle advice we can offer 9 Learning outcomes 0 To know: that the Six External Pathogenic Factors are causes of disease (aetiology) that they can also be called: o Six Climates o Six External Evils o Six Pernicious Influences o Various other similar exotic names Learning outcomes () To know that: Pathogenic factors can be internally generated o There are some similarities/some differences They are always EXCESS (as opposed to deficiency of the body) To be able to name the PFs and know their main characteristics 0

11 Six external pathogenic factors Wind Cold Heat and Fire Damp Summer-heat Dryness Internally generated pathogenic factors Wind Cold Heat and Fire Damp Phlegm Characteristics of Wind Yang in nature o Moving o Associated with Spring o Sudden and changeable Involves upward and outgoing dispersion, affecting the upper part of the body Wind makes things shake and sway Internal Wind - always a result of pathological processes

12 External Wind: clinical manifestations Patterns of Wind-Cold, Wind-Heat Twitches/stiff neck/sudden headaches/sudden joint aches/pains that move around Internal Wind: clinical manifestations Tremors, tics, severe dizziness, vertigo, numbness Convulsions, unconsciousness, paralysis, fits Characteristics of Cold Yin in nature Damages Yang body functions Associated with Winter Cold restricts movement Cold impairs warmth Cold causes contraction Cold is white, clear, copious and watery 7

13 External Cold: clinical manifestations 8 Channels: o Fixed, severe, tight or biting pain Invades at the Wei level o Aversion to cold o Chills (some fever) o Clear, watery secretions Internally o Stomach chills and vomiting o Spleen pain/diarrhoea o Uterus dysmenorrhoea, better for heat Generally o Feeling cold o White, clear, copious, watery secretions Cold: clinical manifestations Kidney Spleen Lung Heart 9 Feelings of cold Characteristics of Damp Yin Associated with Late Summer Damp is slow and heavy Damp is wet, sticky and turbid Damp is stubborn and lingering Damp can affect the Spleen Damp combines easily with Cold or Heat 0

14 External Damp: clinical manifestations Channels: o Swollen / puffy / stiff Penetrating to interior o Fatigue o Heaviness o Sensitivity to damp weather Internal Damp: clinical manifestations Head Eyes Mouth Stomach and Spleen Lower Jiao Skin Joints Channels Damp: clinical manifestations Head o Feeling of heaviness, muzziness Eyes o Swollen eyelids, oozing fluids, styes Mouth o Ulcers on gums, swollen red lips Stomach and Spleen o Poor appetite o Feelings of fullness after eating a small amount o Sticky taste o Loose stools o Soggy/slippery pulse

15 Damp: clinical manifestations Lower Jiao o Excessive vaginal discharge o Painful periods o Infertility o Turbid urine o Scrotal sweating/genital eczema/itching Skin o Vesicles/papules/greasy sweat/oozing skin lesions/puffiness Joints o Swollen, painful joints Channels o Numbness/loss of sensation Characteristics of Heat/Fire Yang Associated with Summer Damages Yin functions Can transform from Cold Fire flares upwards Fire tends to accumulate in localised areas Heat is an excess of Yang Heat and Fire are drying Can cause bleeding Can generate Wind Affects the Mind Redness Fire Heart Liver Stomach Lungs Intestines Discuss Yin Xu heat

16 7 (Internal) Heat Full Red face and eyes Feelings of heat Dry mouth Bitter taste Constipation Thirst Intense agitation Red tongue with yellow coat Full rapid pulse Empty Malar flush Night sweats Dry mouth Five-palm heat Heat in the pm Mild restlessness Red tongue/no coat Rapid, forceless pulse Dryness Yang Associated with late Autumn in China Mostly Lungs affected 8 Summer Heat Yang Associated with height of Summer o e.g. sunstroke, etc. 9

17 Phlegm Visible phlegm o Mucus from nose or coughed up from lungs Invisible phlegm o Affects thinking/mind o Lumps under the skin 0 Patterns of visible Phlegm Phlegm-Cold o Excretions are watery and white. Aversion to cold, cold limbs, white or white-sticky tongue coat, wiry slippery pulse or deep thready wiry pulse Phlegm-Damp o Profuse and usually white excretions which are easy to expectorate, stuffiness in chest, lassitude, thick sticky tongue coat, wiry slippery pulse Phlegm-Heat o Yellow thick excretions, difficult to expectorate, sometimes blood-tinged (when severe), fever, stuffiness in chest, tongue coat yellow, possibly red body, rapid pulse. Phlegm-Heat tends to come from long-term retention of Phlegm-Cold or Phlegm-Damp Patterns of invisible Phlegm This type of Phlegm is not actually seen but the clinical manifestations imply its existence and the treatment methods are based on the same approach. The problems caused by invisible Phlegm are categorised according to area affected. 7

18 Patterns of invisible Phlegm Upward disturbance of Turbid Phlegm Misting of the Heart: o By Phlegm o By Phlegm-Fire Retention of Phlegm o o In the channels In the four limbs o In the throat Phlegm-Wind Invisible Phlegm Upwards disturbance of Turbid Phlegm o Dizziness, vertigo, stuffiness in chest, nausea and vomiting, hypertension, restlessness, bitter taste in the mouth, sticky or yellow-sticky tongue coat, wiry or wiry-slippery pulse Invisible Phlegm Misting of the Heart By Phlegm: o Mental dullness, blank expression, depression, mental confusion, speaking to self, sleeping a lot, sitting woodenly, abnormal behaviour, confusion, gurgling in throat, drooling or spitting white frothy saliva, white sticky tongue coat, slow slippery pulse By Phlegm-Fire: o Restlessness, thirst, insomnia, dream-disturbed sleep, manic behaviour, sensation of heat in the chest, coarse breathing, constipation, scanty deep yellow urine, trembling tongue, yellow sticky tongue coat, slippery wiry pulse. Severe cases: babbling, laughing and crying inappropriately 8

19 Invisible Phlegm Retention of Phlegm In the channels o Soft lumps which are not painful with palpation and are moveable when pushed sideways (seen in hyperthyroidism, goitre, rheumatoid nodules, tuberculosis, some cases of fibroids in the uterus, etc). Sticky tongue coat, slippery pulse. (Note that, confusingly, lumps and nodules are classified as Invisible Phlegm) In the four limbs o Numbness of the four limbs, paralysis, aching limbs, heavy limbs, sticky tongue coat, slippery pulse In the throat o Foreign body sensation in the throat, feels like a plumstone that cannot be swallowed or cleared, stuffiness in the chest, thin sticky tongue coat, wiry slippery pulse Internal generation of pathogenic factors Internal Wind Internal Cold Internal Damp Internal Heat/Fire Phlegm 7 (Internal) Wind Results from: Extreme heat Liver Yang Rising/Yin deficiency Liver Fire Liver Blood 8 9

20 (Internal) Cold Results from: External invasion Full Cold Yang Xu - Empty Cold Organs affected include Kidney 9 (Internal) Damp Results from: Spleen deficiency Kidney deficiency 0 (Internal) Heat/Fire Results from: Miscellaneous causes Internal causes Internal pathology o Transformation of pathogens o Liver Qi Stagnation o Yin Xu 0

21 Phlegm Results from: Condensation of body fluids Heat Combination of both Phlegm Originates in the Kidneys, is produced in the Spleen and stored in the Lungs