Guest guest Posted September 22, 2004 Report Share Posted September 22, 2004 Jason - as you know the differential diagnoses for each stage are available in the Paradigm, OHAI and Eastland Press versions of Wen Bing. Retention at the qi level will involve retention of the pathogen in the zang fu system. If there is a pathogen at any stage, there should be a corresponding/sign symptom pattern. Tai Yang and Wei stages are precluded. But when patients are aggravated with supplementation, I have to suspect lurking pathogens if they were not apparent initially. These are a few of the considerations I use, clipped from different documents over the years: NeiJing The Nei Jing in chapter 3 states: " If Cold enters the body in wintertime, it comes out as Heat in springtime. " When this occurs after damage in the winter, it is sometimes referred to as “Spring Heatâ€. It is clearly described in the Wen Bing literature for the use of Huo Xiang Zheng Qi Pian (Agastache Formula) when a Summer Heat pathogen remains latent and re-emerges in the Fall. I have seen this in numerous instances and the Li Dong Yuen formulas for summer heat are appropriate for the latent heat that is a product of Summer Heat. The Nei Jing, chapter four states “the essence is the root of the body, if it is guarded and stored, Latent Heat will not occur in the springtimeâ€. The implications of this are two-fold. One, modifying one's behavior such that the essence is guarded and stored helps to prevent latent heat. Two, deficiency signs in the proximal pulse positions may give an indication of those individuals prone to invasion by evil and corresponding development of Latent Heat patterns. Diagnosis The pulse and latent Heat Wave form or the arrival and departure<A HREF= " file://C:\WINDOWS\Desktop\Dell\Courses\CSOMA\%23_edn1 " ></A> Book Five of the Huang Di Nei Jing On the Delicate and Refined Fundamental Principles of Pulse Diagnosis states: “A pulse that arrives quickly and departs slowly is symptomatic of excess in the upper and deficiency in the lower which gives rise to symptoms in the head. A pulse that arrives slowly and departs quickly is symptomatic of deficiency in the upper and excess in the lower region which gives rise to fear of cold.†Pulses may involve a rapid arrival in the waveform while the rate remains fairly normal, this may be described as a pounding sensation by Hammer aficionados. Or, there may be a suspicious slippery quality in the arrival. There may be a tense surface with a slippery turbulence in the blood depth and clear signs of heat in the Blood (the pulse gets wider as you lift from the Organ depth towards the Qi depth). Wang Shuhe states in chapter eleven of the Mai Jing “The classic says that the pulse can be latent or hidden. Then in which viscus is (the evil) hidden when (a pulse) is spoken of as latent? The answer is as follows. (Latency) means that Yin and yang restrain reciprocally and may have to hide in one another. When the pulse located in the Yin (i.e. The chi) presents contrarily a Yang image, this is yang restraining Yin. Even though the pulse may be occasionally deep, choppy, and short, this is but yin hidden within Yang. If the pulse in the Yang (i.e.the cun) presents contrarily a Yin image, this is Yin restraining Yang. Even though it is occasionally floating, slippery, and long, this is but Yang hidden within Yin.†General Points: Most important: signs of latent heat are those subtle heat signs existing inside a larger picture of normalcy. This is pointing to the potential of compensation or encapsulation. Latent heat is identified as a pulse of excess nature in the deeper section, the confined pulse fits this picture. Maciocia describes the pulse and tongue as fine and rapid; this is true after damage to Yin by Latent Heat pathogens over a period of time (this fits with the standard dialogues you are citing for latency). Atherosclerotic pulse A ropy (atherosclerotic) pulse due to heat in the bloodstream may be a result of focal infections or chronic bacterial infections such as gum infection or chronic appendicitis (Dr. Stefan Kiechl, University ofInnsbruck in Austria, Circulation 2001;103:1064-1070.) Bacteria may enter the blood stream through infected gum tissue damaging the intima of the vessels causing plaque formation in an attempt to repair the damage. Special Lung Pulse The Special Lung Pulse (see Hammer) is a record of the history of events taking place in the respiratory system. It can give clues about latent pathology depending on the quality that should reflect qualities described elsewhere in this article such as urgency, slipperiness, or rough sensations in the arrival. Turbulence, roughness, agitation, and/or vibrations in the arrival of the wave are often more consistent significators of latent heat than the Special Lung Pulse (SLP). In addition, the area between the diaphragm and the plura is very important for evaluating latency. Given the correct quality, a positive " Mo Yuan - membrane source " finding is more consistently indicative of latent dampness and heat bound in that area than the SLP is of latent pathogens in the Lungs. Shang Han Lun Pulse Qualities Latent heat may be a result of the penetration by cold during one season only to arise in another. If this is the case, the pulse descriptions in Zhang Ji's Shang Han Lun may prove useful. Reminder - these pulses take place in the context of a whole pattern. (1) The pulse of the Tai Yin is moderate or weak (deep without force). (2) The Shao Yin pulse is faint and fine (feeble/absent) or faint and rough. (3) The Jue Yin pulse is 'faint and there is reversal' and/or slow. The hot above and cold below reversal will present with a fuller Cun position and a weaker Chi position or there may be a floating quality. These are pulses without root when Yang is floating upward. <A HREF= " file://C:\WINDOWS\Desktop\Dell\Courses\CSOMA\%23_ednref1 " ></A> Wang Shu-he.Translated by Yang Shou-zhang. The Pulse Classic (Mai Jing). Pp. 24. Blue PoppyPress 1997. Shao Yang strategies for management of latent heat pathogens The Shang Han Lun states that any one symptom from the Shao Yang category is sufficient to render a Shao Yang diagnosis. Loss of appetite is one of the more salient symptoms and is a clinical keynote for progression into the Shao Yang. The next step is making the distinction between a Tai Yin pattern and a Shao Yang pattern. Other Shao Yang symptoms include a bitter taste in the mouth, dry throat, dizzy vision, alternating aversion to cold and flushing of heat, chest and rib fullness, taciturnity, heart vexation, frequent retching, and a pulse that is fine and stringlike. Latent Pulses Wang Shuhe Mai Jing Chapter Eleven The classic says that the pulse can be latent or hidden. Then in which viscus is (the evil) hidden when (a pulse) is spoken of as latent? The answer is as follows. (Latency) means that Yin and Yang restrain reciprocally and may have to hide in one another. When the pulse located in the yin (i.e. The chi) presents contrarily a Yang image, this is Yang restraining Yin. Even though the pulse may be occasionally deep, choppy, and short, this is but yin hidden within Yang. If the pulse in the Yang (i.e. the cun) presents contrarily a Yin image, this is Yin restraining Yang. Even though it is occasionally floating, slippery, and long, this is but Yang hidden within Yin. The Nei Jing clarifies the Yin Yang model of wave (the arrival is Yin Within Yang, the peak is Yang within Yang, the departure is Yin within Yang and the trough is Yin within Yin). Clinical experience has confirmed disturbance in the initial portion of the arrival of the wave (Yang within Yin) as an indicator for latent heat. Divergent Meridians The Divergent Meridians travel from the exterior to the interior, they can divert internal or external pathogens away from primary organs. When the Wei Qi is strong enough to stop a pathogen but not strong enough to expel it entirely, one possibility is the lingering of pathogens in the Divergent Meridians. When the Wei Qi or Yang Qi combine with pathogens, heat may result. Over time this may result in frank diseases such as heart attack, uterine tumors, and infertility. A prime features of Divergent Meridian involvement include the presence of organic lesions, chronic/ intermittent symptoms, and emotional disturbances. Pulse and the divergent system: Pulses related to the Divergent meridian system include the diaphragm pulse [the divergents may be construed to traverse the diaphragm. I have found them to be useful for quickly changing a positive diaphragm finding.] and the neuro-psychological pulse which respond to treatment by the divergents most of the time (Van Nghi considers all divergents to converge at Bai Hui [Du 20]). Also, consider deep or superficial pulses-any pulses that reflect a lack of communication from the interior to the exterior. And, course vibrations at the organ depth - especially the lower third of the organ depth - reflect damage to organ tissue (this is consistent with Van Nghi's notion that organic lesions are a reason to use divergent vessels). If the pulse is very deep or superficial, then the use of Luo channels in conjunction with divergents is often a useful intervention. In conclusion Maybe you could describe your clinical experience of latency at the ying or blood level? I am merely citing my clinical experience and as above what I can glean from the classical literature. Will / > > > >Todd - > > > >In my estimation, any pathogen can be retained, compensated for and hence > >become 'hidden.' The most common site is the shao yang in SHL and the qi > >stage in > >Wen Bing > [Jason] > Guo Hui Liu would disagree with this as I would guess that most wenbing > experts also. Meaning I think it is believed that lurking pathogens most of > time 'lurk' on a deeper layer i.e. ying or blood level , kidney yin, or even > to mo yuan. BUT, I would like to here what you mean that the pathogen most > commonly lurks at the qi level. How does one see this in the clinic... > > - > > > William R. Morris, L.Ac., O.M.D., MSEd Dean of Educational Advancement Emperor's College of Oriental Medicine 310-453-8300 phone 310-829-3838 fax will Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 > >WMorris116 [WMorris116] >Wednesday, September 22, 2004 10:20 PM > > Latency! > >Jason - as you know the differential diagnoses for each stage are available >in the Paradigm, OHAI and Eastland Press versions of Wen Bing. Retention at >the >qi level will involve retention of the pathogen in the zang fu system. If >there is a pathogen at any stage, there should be a corresponding/sign >symptom >pattern. Tai Yang and Wei stages are precluded. [Jason] I am unsure where you are getting you information and if you see it in these books could you post where? I.e. A lurking pathogen in the kidney yin IS NOT in the qi level it is the ying or blood levels. So I disagree that just because a pathogen is lurking in the zang-fu you can say that it is lurking in the Qi level. I did not ask for a differential dx of each level I asked " what does a lurking pathogen in the qi level look like, because as I stated it is NOT the most common idea. The most common according to all sources I have read and GHL is that pathogens lurk on a deeper level. If you don't want to type it in, just quote the page or source and I will check it out. Thanx, - But when patients are >aggravated >with supplementation, I have to suspect lurking pathogens if they were not >apparent initially. These are a few of the considerations I use, clipped >from >different documents over the years: > >NeiJing > >The Nei Jing in chapter 3 states: " If Cold enters the body in wintertime, >it >comes out as Heat in springtime. " When this occurs after damage in the >winter, >it is sometimes referred to as " Spring Heat " . It is clearly described in >the >Wen Bing literature for the use of Huo Xiang Zheng Qi Pian (Agastache >Formula) when a Summer Heat pathogen remains latent and re-emerges in the >Fall. I >have seen this in numerous instances and the Li Dong Yuen formulas for >summer >heat are appropriate for the latent heat that is a product of Summer Heat. >The >Nei Jing, chapter four states " the essence is the root of the body, if it >is >guarded and stored, Latent Heat will not occur in the springtime " . The >implications of this are two-fold. One, modifying one's behavior such that >the essence >is guarded and stored helps to prevent latent heat. Two, deficiency signs >in >the proximal pulse positions may give an indication of those individuals >prone >to invasion by evil and corresponding development of Latent Heat patterns. > >Diagnosis > > >The pulse and latent Heat > >Wave form or the arrival and departure<A >HREF= " file://C:\WINDOWS\Desktop\Dell\Courses\CSOMA\%23_edn1 " ></A> Book >Five of the Huang Di Nei Jing >On the Delicate and Refined Fundamental Principles of Pulse Diagnosis >states: > " A pulse that arrives quickly and departs slowly is symptomatic of excess >in >the upper and deficiency in the lower which gives rise to symptoms in the >head. >A pulse that arrives slowly and departs quickly is symptomatic of >deficiency >in the upper and excess in the lower region which gives rise to fear of >cold. " >Pulses may involve a rapid arrival in the waveform while the rate remains >fairly normal, this may be described as a pounding sensation by Hammer >aficionados. Or, there may be a suspicious slippery quality in the arrival. >There may be >a tense surface with a slippery turbulence in the blood depth and clear >signs >of heat in the Blood (the pulse gets wider as you lift from the Organ depth >towards the Qi depth). Wang Shuhe states in chapter eleven of the Mai Jing > " The >classic says that the pulse can be latent or hidden. Then in which viscus >is >(the evil) hidden when (a pulse) is spoken of as latent? The answer is as >follows. (Latency) means that Yin and yang restrain reciprocally and may >have to >hide in one another. When the pulse located in the Yin (i.e. The chi) >presents >contrarily a Yang image, this is yang restraining Yin. Even though the >pulse >may be occasionally deep, choppy, and short, this is but yin hidden within >Yang. If the pulse in the Yang (i.e.the cun) presents contrarily a Yin >image, this >is Yin restraining Yang. Even though it is occasionally floating, slippery, >and long, this is but Yang hidden within Yin. " General Points: Most >important: >signs of latent heat are those subtle heat signs existing inside a larger >picture of normalcy. This is pointing to the potential of compensation or >encapsulation. Latent heat is identified as a pulse of excess nature in the >deeper >section, the confined pulse fits this picture. Maciocia describes the pulse >and >tongue as fine and rapid; this is true after damage to Yin by Latent Heat >pathogens over a period of time (this fits with the standard dialogues you >are >citing for latency). > >Atherosclerotic pulse >A ropy (atherosclerotic) pulse due to heat in the bloodstream may be a >result >of focal infections or chronic bacterial infections such as gum infection >or >chronic appendicitis (Dr. Stefan Kiechl, University ofInnsbruck in Austria, >Circulation 2001;103:1064-1070.) Bacteria may enter the blood stream >through >infected gum tissue damaging the intima of the vessels causing plaque >formation >in an attempt to repair the damage. Special Lung Pulse The Special Lung >Pulse >(see Hammer) is a record of the history of events taking place in the >respiratory system. It can give clues about latent pathology depending on >the quality >that should reflect qualities described elsewhere in this article such as >urgency, slipperiness, or rough sensations in the arrival. Turbulence, >roughness, >agitation, and/or vibrations in the arrival of the wave are often more >consistent significators of latent heat than the Special Lung Pulse (SLP). >In >addition, the area between the diaphragm and the plura is very important >for >evaluating latency. Given the correct quality, a positive " Mo Yuan - >membrane source " >finding is more consistently indicative of latent dampness and heat bound >in >that area than the SLP is of latent pathogens in the Lungs. Shang Han Lun >Pulse >Qualities Latent heat may be a result of the penetration by cold during one >season only to arise in another. If this is the case, the pulse >descriptions in >Zhang Ji's Shang Han Lun may prove useful. Reminder - these pulses take >place >in the context of a whole pattern. (1) The pulse of the Tai Yin is moderate >or >weak (deep without force). (2) The Shao Yin pulse is faint and fine >(feeble/absent) or faint and rough. (3) The Jue Yin pulse is 'faint and >there is >reversal' and/or slow. The hot above and cold below reversal will present >with a >fuller Cun position and a weaker Chi position or there may be a floating >quality. >These are pulses without root when Yang is floating upward. ><A HREF= " file://C:\WINDOWS\Desktop\Dell\Courses\CSOMA\%23_ednref1 " ></A> >Wang Shu-he.Translated by Yang Shou-zhang. The Pulse Classic (Mai Jing). >Pp. 24. Blue PoppyPress 1997. > > > >Shao Yang strategies for management of latent heat pathogens The Shang Han >Lun states that any one symptom from the Shao Yang category is sufficient >to >render a Shao Yang diagnosis. Loss of appetite is one of the more salient >symptoms and is a clinical keynote for progression into the Shao Yang. The >next step >is making the distinction between a Tai Yin pattern and a Shao Yang pattern. >Other Shao Yang symptoms include a bitter taste in the mouth, dry throat, >dizzy vision, alternating aversion to cold and flushing of heat, chest and >rib >fullness, taciturnity, heart vexation, frequent retching, and a pulse that >is >fine and stringlike. > >Latent Pulses Wang Shuhe Mai Jing Chapter Eleven The classic says that the >pulse can be latent or hidden. Then in which viscus is (the evil) hidden >when (a >pulse) is spoken of as latent? The answer is as follows. (Latency) means >that >Yin and Yang restrain reciprocally and may have to hide in one another. >When >the pulse located in the yin (i.e. The chi) presents contrarily a Yang >image, >this is Yang restraining Yin. Even though the pulse may be occasionally >deep, >choppy, and short, this is but yin hidden within Yang. If the pulse in the >Yang (i.e. the cun) presents contrarily a Yin image, this is Yin >restraining >Yang. Even though it is occasionally floating, slippery, and long, this is >but >Yang hidden within Yin. The Nei Jing clarifies the Yin Yang model of wave >(the >arrival is Yin Within Yang, the peak is Yang within Yang, the departure is >Yin >within Yang and the trough is Yin within Yin). Clinical experience has >confirmed disturbance in the initial portion of the arrival of the wave >(Yang within >Yin) as an indicator for latent heat. > >Divergent Meridians The Divergent Meridians travel from the exterior to the >interior, they can divert internal or external pathogens away from primary >organs. When the Wei Qi is strong enough to stop a pathogen but not strong >enough >to expel it entirely, one possibility is the lingering of pathogens in the >Divergent Meridians. When the Wei Qi or Yang Qi combine with pathogens, >heat may >result. Over time this may result in frank diseases such as heart attack, >uterine tumors, and infertility. A prime features of Divergent Meridian >involvement include the presence of organic lesions, chronic/ intermittent >symptoms, and >emotional disturbances. Pulse and the divergent system: Pulses related to >the >Divergent meridian system include the diaphragm pulse [the divergents may >be >construed to traverse the diaphragm. I have found them to be useful for >quickly changing a positive diaphragm finding.] and the neuro-psychological >pulse >which respond to treatment by the divergents most of the time (Van Nghi >considers all divergents to converge at Bai Hui [Du 20]). Also, consider >deep or >superficial pulses-any pulses that reflect a lack of communication from the >interior to the exterior. And, course vibrations at the organ depth - >especially the >lower third of the organ depth - reflect damage to organ tissue (this is >consistent with Van Nghi's notion that organic lesions are a reason to use >divergent vessels). >If the pulse is very deep or superficial, then the use of Luo channels in >conjunction with divergents is often a useful intervention. > >In conclusion >Maybe you could describe your clinical experience of latency at the ying or >blood level? I am merely citing my clinical experience and as above what I >can >glean from the classical literature. > >Will > > >/ > > >> > >> >Todd - >> > >> >In my estimation, any pathogen can be retained, compensated for and >hence >> >become 'hidden.' The most common site is the shao yang in SHL and the qi >> >stage in >> >Wen Bing >> [Jason] >> Guo Hui Liu would disagree with this as I would guess that most wenbing >> experts also. Meaning I think it is believed that lurking pathogens most >of >> time 'lurk' on a deeper layer i.e. ying or blood level , kidney yin, or >even >> to mo yuan. BUT, I would like to here what you mean that the pathogen >most >> commonly lurks at the qi level. How does one see this in the clinic... >> >> - >> >> >> > > >William R. Morris, L.Ac., O.M.D., MSEd >Dean of Educational Advancement >Emperor's College of Oriental Medicine >310-453-8300 phone >310-829-3838 fax >will > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 , WMorris116@A... wrote: But when patients are aggravated > with supplementation, I have to suspect lurking pathogens if they were not > apparent initially. I was thinking the same thing. Many patient do not tolerate tonics and this may be one reason. gu syndrome is another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 , " " <@c...> wrote: A lurking pathogen in the kidney yin IS > NOT in the qi level it is the ying or blood levels. Or at least all patterns in Liu that refer to lv/kd yin damage from a lurking pathogen are classified as ying or blood patterns. all the qi level wind warmth patterns are excess except for lung yin damage, but this is not as deep as lv'kd. most spring warmth qi level patterns are also excess. the ones that are not affect the qi in one case. Dryness of fu organs and lung/st yin xu can also present. I could see some of these as chronic patterns. but again, all the lv/kd yin xu patterns refer to ying and blood. lurking summerheat has no vacuity patterns. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2004 Report Share Posted September 23, 2004 > > >Thursday, September 23, 2004 9:34 AM > > Re: Latency! > > > , WMorris116@A... wrote: >But when patients are aggravated >> with supplementation, I have to suspect lurking pathogens if they were >not >> apparent initially. > > >I was thinking the same thing. Many patient do not tolerate tonics and >this may be one >reason. gu syndrome is another. [Jason] I think there are many reasons, and one should not IMO jump to a LP scenario. I.e. Spleen cannot digest the 'greasy' tonics. The Rx could also not be written for the proper % of stagnation and supplementation, hence further clogging the system... If some does takes tonics and one thinks there is a LP, how does this help you treat the patient (meaning from a LP theory perspective?) Can you give some examples. -Jason > >Todd > > > > >Chinese Herbal Medicine offers various professional services, including >board approved continuing education classes, an annual conference and a >free discussion forum in Chinese Herbal Medicine. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 Hi pardon my naivete, but what is gu syndrome? , " " wrote: > , WMorris116@A... wrote: > But when patients are aggravated > > with supplementation, I have to suspect lurking pathogens if they were not > > apparent initially. > > > I was thinking the same thing. Many patient do not tolerate tonics and this may be one > reason. gu syndrome is another. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2004 Report Share Posted September 24, 2004 , " heylaurag " <heylaurag@h...> wrote: > Hi pardon my naivete, but what is gu syndrome? I am busy for a few days. can someone else field this? Quote Link to comment Share on other sites More sharing options...
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