Nei Shang Fa Re (Internal Damage Heat Effusion

[Guest guest]

,

wrote:

> A couple things from the conference. Is there a source I can look in

> for deficient heat coming from other causes than yin xu? I admit, like

> the hypothetical students, confused me.

 

 

Maybe this will help answer some of the questions> Hope it is not too long=

for

this forum, but I am new to the group.I just pasted this from Word. Feedbac=

k is

welcome!

 

The History and Disease Causes and Mechanisms of N¨¨i Sh¨¤ng F¨¡ R¨¨ (Inter=

nal

Damage Heat Effusion), by Bob Damone. Published in the PCOM Newspaper,

sometime in 5/2002

 

In clinical practice, it is not uncommon to encounter patients with complai=

nts

of abnormal heat sensations that may or may not be measurable by a thermome=

ter

and that may be acute or enduring. Upon close observation, these patients =

may

lack all evidence of an external contraction of evil, yet novice practition=

ers

will be tempted to treat the patient as if they did, in large part because =

the

practitioner lacks a deeper understanding of the many possible patterns tha=

t

can lead to abnormal heat sensations. It is of the utmost importance for t=

he

practitioner to grasp the fact that such heat sensations may not be due to =

 

external contraction of evils at all and may in fact arise from interior

viscera-bowel irregularities. In TCM internal medicine textbooks, abnormal=

 

heat sensations that do not result from an external contraction are fully

discussed under the heading of Internal Damage Heat Effusion.

 

As practitioners of Chinese medicine, it is important for us to be equipped=

 

with as much knowledge as possible about the TCM disease category that most=

 

clearly relates to our patient¡¯s chief complaint. Knowledge of the TCM

disease category most relevant for a given complaint organizes our thinking=

 

and reminds us to discriminate patterns more comprehensively. When we

structure our clinical reasoning in this way we can tap into our

predecessors¡¯ experiences on the condition we are intending to treat,

including their recorded thoughts on relevant disease causes and mechanisms=

,

the most commonly encountered patterns and treatments for the disease in

question, and its prognosis. This is the incredibly important information =

 

that is unfortunately rarely translated in English-language TCM textbooks. =

 

For example, although there is a chapter in Wu and Fischer (1997), a

translation compiled from standard Chinese-language TCM textbooks, devoted =

 

to ¡°Internal Damage Fever¡±, the history, and disease causes and mechanism=

s

are not presented. It is my opinion that this is exactly the information t=

hat

TCM practitioners need greater access to in order to progress to a deeper l=

evel

of understanding and practice.

 

In order to provide myself and others with more information on Internal Dam=

age

Heat Effusion, I translated the following material from a standard textbook=

 

used in TCM colleges throughout the People¡¯s Republic of China Zh¨­ng Y¨© =

N¨¨i K

¨¨ Xu & #277;, (Chinese Internal Medicine) which was published by Sh¨¤ng H & #2=

59;i K¨¨ Xu & #277; J

¨© Sh¨´ Ch¨± B & #259;n Sh¨¨ (Shanghai Science and Technology Press) in 1988.=

 

 

Internal Damage Heat Effusion is heat effusion that results from internal

damage. Its disease mechanisms involve q¨¬, blood, y¨©n, and essence deple=

tion

and vacuity and irregularities of viscera and bowel function. Ordinarily, =

 

this disease is insidious in onset and its course is relatively protracted.=

 

Clinically, it usually presents with a low-grade fever but at times there c=

an

be a high fever, but one may have a subjective experience of heat effusion =

and

vexing heat in the five centers without having an elevated body temperature=

;

this also falls within the scope of Internal Damage Heat Effusion.

 

The Inner Classic contains a relatively detailed coverage of Internal Damag=

e

Heat Effusion within its discussion of y¨©n vacuity interior heat. Simple =

 

Questions, On Regulating Channels (Su Wen, Tiao Jing Lun, Chapter 62),

states: ¡°Y¨©n vacuity produces interior heat¡±. Concerning its disease

mechanisms it states: ¡°When there is taxation fatigue, debilitated and

diminished physique and q¨¬ result. [As a result], grain q¨¬ will lack

exuberance and the upper burner will lack movement. [This leads to] lower =

 

stomach duct stoppage, stomach q¨¬ , and hot q¨¬ steaming within the chest;=

 

this [is how] interior heat [comes about].¡± With respect to treatment,

Simple Questions, The Great Treatise on the Extremely Important (Zhi Zhen Y=

ao

Da Lun, Chapter 74), advanced the principle of ¡°obtaining y¨©n when heat

disease becomes hotter after cooling [treatments]¡± Simple Questions, On =

 

Needling [For the Treatment of] Heat, (Ci Re, Chapter 32) has a detailed

discussion of the symptoms, signs, and prognosis of heat diseases of the fi=

ve

viscera which established the foundation of the discrimination of heat

diseases of the five viscera used by later generations of physicians.

Essential Prescriptions of the Golden Coffer, Blood Impediment and Vacuity =

 

Taxation Disease (Chapter 6), placed ¡°hand and foot heat vexation¡± within=

 

the realm of Vacuity Taxation and advocated treatment with Xi & #259;o Ji¨¤n =

Zh¨­ng T¨¡

ng (Minor Center-Fortifying Decoction). This was the first mention of usin=

g

sweet and warm medicinals to eliminate heat.

 

On the Origin and Symptoms of Diseases contains many discussions of Intern=

al

Damage Heat Effusion, for example, in Symptoms [of] Vacuity Taxation Guest =

 

Heat it states: ¡°A person with vacuity taxation [has] extreme weakness of=

 

blood and q¨¬, [and thus a] profound vacuity of y¨©n and y¨¢ng. Taxation e=

ngenders

heat; [therefore], it is because of taxation that heat is being engendered¡=

±.

This passage advanced the unique idea that taxation causes heat. Symptoms =

 

[of] Vacuity Taxation discusses the disease mechanisms of y¨©n vacuity heat=

 

effusion in the following passage: ¡°Vacuity Taxation and heat are [due to=

] y¨©

n q¨¬ insufficiency [and a] surplus of y¨¢ng q¨¬, so [in this condition], h=

eat is

engendered in the interior and [moves outward to the] exterior; [this is] n=

ot

evil q¨¬ overwhelming via the exterior.¡±

 

Both the 16th chapter of Essential Secrets from Outside the Metropolis and=

the

29th chapter of Sagacious Benevolent Formulas recorded formulas for the

treatment of Vacuity Taxation Heat Effusion. Craft of Medicinal Treatment =

for

Pediatric Conditions , based on the Inner Classic¡¯s theory of five viscera=

 

heat disease, proposed using D & #259;o Ch¨¬ S & #259;n (Red-Abducting Powder) =

for heart

heat, Xi¨¨ Q¨©ng W¨¢n (Green-Blue-Draining Pill) for liver heat, and Xi¨¨ H=

u¨¢ng

S & #259;n (Yellow-Draining Powder) for spleen heat. It also recommended red=

ucing Sh

¨¨n Q¨¬ W¨¢n (Kidney Qi Pill) down to Li¨´ W¨¨i D¨¬ Hu¨¢ng W¨¢n (Six-Ingred=

ient

Rehmannia Pill) and thus provided a very important formula for the treatmen=

t

of y¨©n vacuity interior heat.

 

In the J¨©n-Yu¨¢n period, L & #301; D¨­ng-Yu¨¢n, in On the Spleen and Stomach=

, Treatise

on the Initiation of Heat in the Center Due to Damage by Food and Drink and=

 

Taxation Fatigue pointed out that when spleen and stomach q¨¬ become decre=

pit

and original q¨¬ becomes insufficient, y¨©n fire is internally engendered. =

He

proposed the following treatment guidelines: ¡°The only choice is to emplo=

y

acrid, sweet, and warm ingredients to supplement the center and upbear y¨¢n=

g

along with sweet and cold (ingredients) to drain fire¡± . L & #301; drafted =

B & #365; Zh¨­ng

Y¨¬ Q¨¬ T¨¡ng (Center-Supplementing Q¨¬-Boosting Decoction) as the principa=

l

formula for this condition thus solidifying the treatment method of using

sweet and warm medicinals to eliminate heat. In so doing, L & #301; made an =

important

contribution to the pattern discrimination and the treatment of q¨¬ vacuity=

 

heat effusion. In Clarifying Doubts about Injury from Internal and Externa=

l

Causes , Master Li3 proposed D¨¡ng Gu¨© B & #365; Xu¨¨ T¨¡ng (Tangkuei Blood-=

 

Supplementing Decoction) as a treatment for blood vacuity heat effusion and=

 

clarified the differences between Internal Damage Heat Effusion and Externa=

l

Contraction Heat Effusion.

 

Zh¨± D¨¡n-X¨©¡¯s discussion of y¨©n vacuity heat effusion was one of the fi=

rst and

was relatively deep. Dan Xi¡¯s Experiential Methods , Six Depressions ,

advanced the idea that ¡°many diseases of the human body are engendered

through depression¡±. His discussion established the theory of the six

depressions and named them q¨¬ depression, blood depression, dampness

depression, phlegm depression, heat depression, and food depression. This =

 

supplemented the existing knowledge of the disease mechanisms and treatment=

s

of Internal Damage Heat Effusion.

 

In the M¨ªng Dynasty, Q¨ªn J & #301;ng-M¨ªng was the first to clearly promote=

¡°Internal

Damage Heat Effusion¡± as a distinct disease name. Pathoconditions, Causes=

,

Pulses, and Treatments, Internal Damage Heat Effusion , divided Internal

Damage Heat Effusion into the two broad categories of ¡°Q¨¬ Aspect Heat

Effusion¡± and ¡°Blood Aspect Heat Effusion¡±. Instead of relying on ancie=

nt

formulas for the treatment of Internal Damage Heat Effusion, he added four =

 

formulas for its treatment, including Xu¨¨ X¨± Ch¨¢i H¨² T¨¡ng (Blood Vacui=

ty

Bupleurum Decoction).

 

Supplement to Diagnosis and Treatment , Heat Effusion, labeled externally

contracted heat effusion as external heat effusion, and differentiated

eleven other types of heat effusion: depressive fire heat effusion, y¨¢ng =

 

depression heat effusion, bone-steaming heat effusion, internal damage heat=

 

effusion (primarily indicating blood and q¨¬ vacuity heat effusion), y¨¢ng =

 

vacuity heat effusion, y¨©n vacuity heat effusion, blood vacuity heat

effusion, phlegm pattern heat effusion, food damage heat effusion, static

blood heat effusion, and sore-toxin heat effusion. This text also listed

separate formulas for the treatment of each type of heat effusion and gave =

a

relatively complete summary of the topic. Medical Insights , Explanation o=

f

the Character Fire, called externally contracted fire ¡°enemy fire¡±, and

internally engendered fire ¡°child fire¡±. It described four main methods =

of

treatment for internal fire which are listed below:

 

1. Reaching- ¡°This indicates reaching wood depression with [formulas] such=

 

as Xi¨¡oY¨¢o S & #259;n (Free Wanderer Powder).¡±

 

2. Enriching- ¡°This mainly indicates invigorating water [and] settling y¨¢=

ng

brightness with [formulas] such as Li¨´ W¨¨i T¨¡ng (Six Flavor Decoction).¡=

±

 

3. Warming- ¡°[The] classic states that taxation should be warmed. [it]

also states that sweet warm [medicinals] can eliminate fire and heat. [use=

 

formulas] such as B & #365; Zh¨­ng Y¨¬ Q¨¬ T¨¡ng (Center-Supplementing Qi4-Bo=

osting

Decoction).¡±

 

4. Leading- Using acrid hot medicinals combined with water-invigorating

medicinals to abduct and move [fire] downward. This is called abducting th=

e

dragon into the sea and leading fire back to the source; use [formulas such=

as] B

¨¡ W¨¨i T¨¡ng (Eight Flavor Decoction)

 

W¨¢ng Q¨©ng R¨¨n made a very important contribution to the diagnosis and

treatment of static blood heat effusion. In Corrections of Errors Among

Physicians, Section on the Treatment of the House of Blood Stasis-Expelling=

 

Decoction Pattern, Master W¨¢ng explained that static blood can manifest wi=

th

¡°body exterior cold [and] heat within the heart¡± ,¡°evening heat

effusion¡±, and ¡°fever in the afternoon and before midnight¡±. He drafted=

a

new formula and called it Xu¨¨ F & #365; Zh¨² Y¨² T¨¡ng (House of Blood Stasi=

s-

Expelling Decoction) to be the main formula to treat this condition. On Bl=

ood

Patterns , Heat Effusion, also discussed many different manifestations of

static blood and their treatments. The diagnosis and treatment of Internal=

 

Damage Static Blood Heat Effusion was perfected through the efforts of mast=

ers

W¨¢ng, and T¨¢ng,

 

Disease Causes and Disease Mechanisms

 

This disease results from non-exterior causes such as irregularities of

affect-mind and diet and taxation fatigue. A minority of cases begin with =

an

external contraction which over time causes viscera-bowel vacuity

detriment. The common disease mechanisms occurring in Internal Damage Heat=

 

Effusion are depletion and vacuity of q¨¬, blood, y¨©n, and essence and los=

s of

regulation of viscera and bowel function. The viscera-bowel related causes=

of

Internal Damage Heat Effusion are discussed in the differentiation below. =

 

 

 

Liver Channel Depressive Heat

 

When there is affect-mind repression and depression, the liver cannot order=

ly

reach; as a result, q¨¬ depression transforms fire and heat effusion ensues=

..

Excessive anger and indignation cause internal exuberance of liver fire and=

 

heat effusion. These disease mechanisms and pathophysiology are well state=

d

in D¨¡n-X¨©¡¯s Experiential Methods, Fire where it states: ¡°[When] any q¨=

¬ is

[in] surplus, there is fire¡±. This type of heat effusion is intimately

related to affect-mind and is also called ¡°five minds¡¯ fire¡±.

 

Static Blood Obstruction

 

This is caused by phenomena such as affect-mind damage, taxation fatigue,

trauma, and bleeding. Static blood obstructs the channels and network vess=

els

and inhibits the flow of q¨¬ and blood. As a result, q¨¬ and blood become =

 

obstructed, stoppage and lack of free flow develop, and heat effusion arise=

s.

This is the main disease mechanism behind static blood heat effusion. The =

 

Spiritual Pivot, Welling Abscess (Yong1 Ju1, Chapter 81) discussed the

disease mechanisms of blood astringency and lack of free flow causing heat =

 

effusion in the following passage: ¡°[When] construction and defense are

detained within the channels and network vessels, the blood weeps and doe=

s not

move. Because of this lack of movement, the defensive q¨¬ is inhibited.

Obstruction, stoppage, and lack of movement cause heat.¡± Static Blood Hea=

t

Effusion is also related to blood vacuity and lack of nourishment. Accordi=

ng

to Precepts for Physicians , On Vacuity Taxation, ¡°blood impediment causes=

 

non-engendering of new blood. Blood accumulation and lack of movement, [th=

at

is], blood stasis, causes construction vacuity, and construction vacuity

causes heat effusion.¡±

 

Middle Q¨¬ Insufficiency

 

Excessive taxation and fatigue, dietary irregularities, and loss of

regulation from enduring disease lead to spleen and stomach q¨¬ vacuity,

internal engenderment of y¨©n fire, and heat effusion. Currently, this is =

also

called Q¨¬ Vacuity Heat Effusion.

 

Blood Vacuity and Loss of Nourishment

 

Loss of nourishment occurs in enduring disease with liver and heart blood

vacuity, in spleen vacuity not engendering blood, when there has great bloo=

d

loss (such as after surgery), and after parturition. The root of blood is =

y¨©n;

when y¨©n and blood are insufficient, y¨¢ng cannot be constrained and heat =

 

effusion arises. According to Supplement to Diagnosis and Treatment, Heat =

 

Effusion, ¡°blood vacuity heat effusion may be due to blood ejection,

hemafecia, post-partum flooding and leaking, and blood desertion. [As a

result, there is] an inability to join with y¨¢ng, hyperactive y¨¢ng, and h=

eat

effusion; treatment requires nourishing blood.¡±

 

Y¨©n Essence Depletion and Vacuity

 

This pattern results from factors such as constitutional bodily y¨©n vacuit=

y,

enduring heat consuming and damaging y¨©n humor, and inappropriate or

excessive use of warm drying medicinals. When y¨©n is debilitated, y¨¢ng

overcomes, water is unable to restrain fire, y¨¢ng q¨¬ becomes effulgent, a=

nd

heat effusion results. According to J & #301;ng-Yu¨¨¡¯s Great Compendium , F=

ire

Conditions, ¡°y¨©n vacuity can engender heat effusion. This is caused by t=

rue y

¨©n depletion-detriment and an inability of water to restrain fire.¡±

 

Of the fore-mentioned disease causes and disease mechanisms, q¨¬ depression=

 

and blood stasis are ascribed to repletion and q¨¬ vacuity and blood vacuit=

y

and y¨©n vacuity are ascribed to vacuity. In the majority of cases, howeve=

r,

heat effusion results from a combination of disease mechanisms such as q¨¬ =

 

depression and blood stasis, dual vacuity of q¨¬ and y¨©n, and dual vacuity=

of q

¨¬ and blood. Additionally, conversion among these various disease

mechanisms may occur. For example, in enduring cases, repletion commonly

converts to vacuity, mild cases convert to severe cases, and enduring cases=

 

may involve static blood. Detriment reaches q¨¬, blood, y¨©n, and y¨¢ng, a=

nd

although there is differentiation between q¨¬ vacuity, blood vacuity, y¨©n =

 

vacuity, and y¨¢ng vacuity, it is more common to encounter combinations of =

 

vacuity and repletion patterns. Other common combinations include enduring=

q

¨¬ depression heat effusion with correct q¨¬ vacuity; if heat then damages =

y¨©

n, the condition converts to q¨¬ depression with y¨©n vacuity heat effusion=

..

When enduring q¨¬ vacuity heat effusion and detriment reaches y¨¢ng, y¨¢ng =

q¨¬

becomes debilitated and weak, and y¨¢ng vacuity heat effusion develops.

 

References.

 

Bensky, D., Barolet, R. (1990). Chinese Herbal Medicine; Materia Medica. =

 

(Rev. Ed.). Seattle, WA: Eastland Press

 

L & #301;, D¨­ng-Yu¨¢n. (1993). The Treatise on the Spleen and Stomach. (Y=

ang, S.Z.,

Li, J.Y., Trans.). Boulder, CO: Blue Poppy Press. (Original work publish=

ed

13th. c.).

 

Wiseman, N., Ye, F. (1998). A Practical Dictionary of . =

 

Brookline, MA.: Paradigm Publications.

 

Wu, N.L, Wu, A.Q. (1999). Yellow Empero¡¯s [sic] Canon [sic] Internal

Medicine. Beijing, PRC: China Science and Technology Press.

 

Wu, Y. and Fischer, W. (1997). Practical Theraputics of Traditional Chine=

se

Medicine. Brookline, MA. Paradigm Publications

[Guest guest]

oops!My apologies for the length and formatting. I guess the best way to send

stuff like this would be as an attchment.

 

The new guy,

 

Bob Damone

[Guest guest]

At 6:21 PM +0000 6/18/03, Bob Damone wrote:

oops!My apologies for the length and

formatting. I guess the best way to send

stuff like this would be as an

attchment.

--

Bob,

 

Yes, please do send it as an attachment

 

TIA

 

Rory

--

[Guest guest]

Bob, can you send the word doc as an attachment instead??

Etiservices, including board approved online continuing education.