Bleeding a TCVM Approach CAPT R M Clemmons
Bleeding: a TCVM Approach CAPT R. M. Clemmons, DVM, Ph. D, CVA
Bleeding • Primary Hemostasis • Complex chain of events involving interaction of • Platelets • Vessel Wall • von Willebrand’s factor • Fibrinogen • Secondary Hemostasis • Complex interaction of the intrinsic and extrinsic clotting cascades • Stabilize the platelet plug
Primary Hemostasis • Evaluated by the bleeding time • Platelet number • Amount and Quality of the von WIllebrand’s factor VIII: Ag • Fibrinogen concentration • Other alterations due to vessel wall disorders
Secondary Hemostatis • Assessed by • ACT (activated clotting time) • APTT (activated partial thromboplastin time) • PT (prothrombin time)
TCM Pathoetiology • Heat • Tongue • Red & Dry • Pulse • Superficial (forceful) & fast • Spleen Qi Deficiency • Tongue • Pale & moist • Pulse • Deep & weak (particularly on right)
Spleen Pathology Damp Hot Food or Drink Accumulated Heat & Damp Hot Environmental Conditions Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder
Heat Hemorrhage • Herbal treatment depends upon location • Bladder • Red Front Door • GI tract • Sophora Powder • Great Saussurea Coptis • Red Back Door • Pulmonary • Red Lung • Nose • Single Immortal • Uterus • Wu Bei San
Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage
Darby • Signalment • 5 yr FS Doberman • History • Generalized weakness • Ecchymosis • Abdominal bleeding • TCVM Exam • Tongue: pale • Pulses: deep & weak Dx: Spleen Qi Deficiency (not holding blood in vessels)
Darby • Western Rx • Compressive bandage • Hemorrhage control • Cryoprecipitate • Whole Blood • Thyroid medication • TCVM Rx • AP • SP Qi Tonic • BL-20/21, SP-6, SP-9 & CV-6 • Stop Hemorrhage • Tian Ping & BL-17 • Herbal • Yunnan Pai Yao • Huang Tu Tang
Huang Tu Tang Atractylodes Bai Zhu Strength Spleen & tonify Qi Yellow Earth Zao Xin Tu Warm Spleen & stop diarrhea Aconite Fu ZI Warm Spleen Asinum Er Jiao Nourish Blood Rehmannia Sheng Di Huang Nourish Yin Scutellaria Huang Qin Stop bleeding & prevent excess heat Licorice Gan cao Harmonize
Muscle Wasting: a TCVM Approach CAPT R. M. Clemmons, DVM, Ph. D, CVA
TCM Muscle View • Muscle volume & strength is under the domain of the Spleen • Spleen transforms food and transports it to the body to provide energy & building blocks. • Spleen Qi provides muscle strength • Liver blood provides endurance • Continued delivery of Spleen Qi to muscles
Western View of Muscle Wasting • Generalized Wasting • Malnutrition • Insufficient intake of materials to support Spleen Qi • Cardiac Cachexia • Heart failure leads to stagnation of blood • Liver is unable to support distribution of blood & Qi • Leads to accumulation of Damp in Spleen • Results in Spleen Qi Deficiency with failure to provide energy and building materials to the muscles • Cancer Cachexia • Tumor Necrosis Factor poisons metabolism leading to Spleen Qi Deficiency • Diminished effective delivery of energy to muscles • Localized Wasting • Trauma • Local damage of muscle • Disuse Atrophy • Local stagnation results in Liver failure to support Spleen/Stomach • Accumulation of Damp alters Spleen function • Local stagnation decreases delivery of nutrients • Neurogenic Atrophy • Denervation leads to local liver stagnation • Results in failure to support spleen Qi • Leads to decreased delivery of local channel energy
Wei Syndrome Damp Heat • Earth personality • Obesity • History of damp heat in skin or GI • Muscle atrophy • Weakness • Lethargy • Greasy wet tongue • Fast pulse Si Miao San Qi/Yang Deficiency • Lethargy, shortness of breath, weakness • Too weak to get up to walk • Loose lips • Loose stool • Anorexia & Emaciation • Dry-burnt hair • Edema • Heat seeking • Pale wet tongue • Thready & weak pulse Bu Yang Huan Wu Qi/Yin Deficiency • Emaciation • Weakness in lumbar region • Heat seeking • Dry skin • Pale or red & dry tongue • Weak & thready pulse Hindquarter formula
Jake • History • Progressive weakness in rear legs • Cool seeking • Rear leg muscle atrophy • Dry hair & skin • TCVM Exam • Pulses deep & weak (< R) • Red dry tongue DX: Qi/Yin Deficiency
Jake’s Treatment • AP • EA • SP 6 -SP 9 (b), ST 36 (b), LI 10 (b), GV 14 -Bai hui • DN • BL 20, BL 23, BL 26, KID 3 • Aqua • SP 6, ST 36, BL 23, BL 26 • Herbal • Jia Bing Fang
Jia Bing Fang Astragalus Condonopsis Polygonum Rehmannia Paeonia Dioscorea Prunella Cyperus Bupleurum Sargassum Huang Qi Dang Shen He Shou Wu Shu Di Huang Bai Shao Yao Shan Yao Xia Ku Cao Xiang Fu Chai Hu Hai Zao Laminaria Kun Bu Tonify Qi Nourish Blood and Jing Nourish Blood, Yin and Jing Nourish Blood and soothe Liver Qi Tonify Qi and nourish Jing Soothe Liver Qi, clear Heat Move Liver Qi and relieve nodules Soothe Liver Qi Transform phlegm, clear Heat, soften the hardness Transform phlegm, soften the hardness, drain water
Sam • History • Chronic rear leg weakness and muscle wasting • Dry hair • Weight loss • TCVM Exam • Red dry tongue • Weak thready pulses (< R) DX: Qi/Yin. Deficiency
Sam’s Treatment • AP • DN • GV 20, BL 23, BL 26 • Aqua • SP 6, ST 36, BL 23, BL 26 • Herbal • Hindquarter formula (tea pills)
Hindquarter Formula Eucommia Du Zhong Tonify Kidney & strengthen back Achyranthes Niu Xi Tonify Kidney & strengthen the hind limbs Lindera Wu Yao Move Qi and relieve pain Astragalus Huang Qi Tonify Qi Apis Feng Hua Fen Tonify Qi and Yin Morinda Ba Ji Tian Warm and strengthen the back Angelica Dang Gui Nourish Blood Rehmannia Shu Di Huang Nourish Yin and Jing Cinnamon Gui Zhi Warm the Channels and benefit the limbs
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