CMK6 SHL Final Exam Review

SUBJECT MA
TTER
EX • Original Treatise on Cold Damage and Miscellaneous Diseases – 16 scrolls.
• Lin Yi compiled and proofed Treatise on Cold Damage had 10 scrolls divided
into
22 sections.
• Some sections frequently omitted from Ming Dynasty.
• 10 remained sections – 398 lines of statements and 113 formulas(one is
missing)
• Make up their own system with a complete set of formulas and corresponding
patterns.
 THE MEANING OF ‘COLD DAMAGE’
• Broad meaning - all externally contracted febrile diseases.
BF
• Narrow meaning - conditions specifically associated with externally
contracted pathogenic cold.
• 58 Classic of Difficult Issues states(58th),‘There are five types
of cold damage: there is wind (strike) , cold damage, warm-damp, (heat)
disease, and warm disease.’(BF)
• In Shang Han Lun mostly refers to an exterior invasion of pathogenic cold
(MCQ).
• Biomedical disease of typhoid(Shang Han) ? MCQ
 BASIC INTRODUCTION TO THE SIX JING-CHAN
NEL PATTERN DIFFERENTIATION SYSTEM (Rea
EX
d)
 BASIC INTRODUCTION TO THE SIX JING-CHAN
NEL PATTERN DIFFERENTIATION SYSTEM (Rea
EX d)
 TRANSMISSION and TRANSMUTATION OF TH
E SIX JING-CHANNEL DISEASES (SQ 5 points)
SQ

• 4 MAIN FACTOR AFFECTING

1 Strength of right qi.

2 Severity of evil qi.
3 Whether or not appropriate treatment is applied.
4 Whether or not there is a pre-existing illness present and the general
state of health of the individual at the incurrence of the evil qi.
EX TAIYANG DISEASE I N T R O

• General TP = promote sweating + resolve exterior.

• Wind strike = dispel wind, resolve flesh + regulate ying & wei = Gui Zhi Tang.
• Cold damage = promote sweating, resolve exterior, diffuse LU + calm panting
= Ma Huang Tang.
• Concurrent patterns: apply variations to the main indicated formulas. (blog)
• Transmuted patterns:‘observe the pulse and signs, know what mistakes
have been made, and treat according to the presenting pattern’ (blog)
• Outcome - ???
 GUI ZHI TANG 桂枝湯 ( C I N N A M O N T W I G D E C O C T I O N ) FORMULA
EX

Gui Zhi 3 liang Bark removed. small pieces

Shao Yao 3 liang Into small pieces
Zhi Gan Cao 2 liang Into small pieces About Dosage
Sheng Jiang 3 liang Into slices •One jin=250 grams
Da Zao 12 pcs Broken •One liang=15.625
grams
• Use 7 sheng of water. Boil over a mild flame to get three •One zhu=1/24 of a
sheng liang
and remove the dregs. Take one sheng at moderate •One ge=20 milliliters
temperature. •One sheng=200milliters
• Shortly after taking the first dose drink approximately one •One dou=10 sheng
sheng of hot, thin gruel/porridge to reinforce the strength of
the medicinals.
• Warm the body by covering with a blanket for a short period (2
hours?), ideally until the whole body is moist , as if sweating very
lightly.
 MCQ G U I Z H I J I A G E G E N TA N G 桂枝加葛根湯
(CINNAMONTWIGDECOCTION PLUS PUERARIA)
(14) Taiyang disease + nape & back stretched stiffness with abnormal sweating and aversion
to wind, Gui Zhi Jia Ge Gen Tang is indicated. (MCQ)

Gui Zhi 2 liang Bark removed. Cut into small pieces

Shao Yao 2 liang Cut into small pieces
Taiyang wind +
Zhi Gan Cao 2 liang Cut into small pieces
channel-qi inhibition.
Sheng Jiang 3 liang Cut into slices
Da Zao 12 pcs Broken
Ge Gen 4 liang
• Decoct the Ge Gen with one dou of water until 8 sheng remains.
• Scoop off the foam, and add the other medicinals. TP: resolve flesh, dispel
• Decoct until 3 sheng remains.
• Discard the dregs.
wind, uplift fluids and
• Take one sheng warmly. Cover the patient to promote slight continuous soothe the channels.
sweating.
• **No need to take porridge.
• The other care-taking methods and prohibitions are as those of Gui Zhi
 CASE STUDY
MCQ

• Male, 14 years-old
• Chief complaint: aversion to cold and fever for 5 days.
• Manifestations and history:Western medicine to resolve fever and pain were
applied along with Jiu Wei Qiang Huo Tang (Nine Ingredients
Notopterygium Decoction) with no observable effect.There was aversion
to cold, fever (39.1°C), headache, generalized pain with no sweating, joint
pain, a painful expression, vexation, agitation, restlessness, and an
occasional weak cough.
• Red tongue with slightly yellow coating; pluses were floating and tight.
• Pattern differentiation:
• Formula: Da Qin Long Tang (MCQ)
 CASE STUDY MCQ

• Female, 25 years-old.
• Chief complaint: dribbling urinary blockage after her first childbirth.
• History and present: the condition was temporarily relieved by
three catheterizations. Sweating, a slight fever, aversion to wind,
lower abdominal distention, tension of the abdominal wall, an
inability to urinate, thirst, and profuse fluid intake.
• Pale tongue with thin white coating; pluses were floating + rapid.
• Pattern differentiation: Water Amassment (MCQ)
• Formula: Wu Ling San
BF
HEAT PATTERN - ZHI ZI CHI TANG 梔子湯 PATTERN
• After sweating-promoting, ejection, and purgation, deficiency vexation occurs with an
inability to (sleep) . If the condition is severe, the person will toss and turn incessantly with
anguish in the heart. Zhi Zi Chi Tang is indicated. With shortness of breath, Zhi Zi Gan Cao
Chi Than (Gardenia, Licorice and Fermented Soybean Decoction) is indicated. With
(retching ), Zhi Zi Sheng Jiang Chi Tang is indicated (line 76) (MC Q or BF)
• (76) 発汗後，水薬不得入口為逆。若更発汗，必吐下不止。発汗吐下後，虚煩不得
眠，若劇者，必反復顛倒，心中懊，梔子湯主之。若少気者，梔子甘草湯主之；若
嘔者，梔子生姜湯主之。
• Ex = what’s the pathogenesis / mechanism) of Zhi Zi Chi Tang? = Heat harassing chest +
diaphragm following sweating, ejection and/or purgation methods.
• Function = clear constrained heat in the chest and treat deficiency vexation with
anguish.
• Patterns of heat constraint in chest + diaphragm: esophagitis, gastritis, cholecystitis, and
neurosis.
MCQ CASE STUDY

• Female, 31 yrs. Initial consultation: 26/March/1998

• CC: lumbar and abdominal pain for three years with recently increasing episodes.
• History and present: At each onset there was throbbing in the left lower abdomen foll
owed by qi rushing upward to the epigastria. There were also unbearable nausea, swe
ating from the head, and lassitude. A few seconds after the initial onset, there would
be qi surging from the lumbus along the back that would descend to the lumbus after
ten minutes. It felt as if something was oppressing the lumbus, and only rubbing and p
ressure could bring temporary relief.
Accompanying symptoms included irregular menstruation, frequent urination, and loos
e stools two or three times a day.
• Pale tongue with white coating, wiry pulses.
• Pattern differentiation:
• Formula: Gui Zhi Jia Gui Tang 桂枝加桂湯 (MCQ)
 Treatment principles of Yangming disease BF

• The general treatment principle for yangming disease is to dispel the pathogenic qi. Clear
ing and purging methods are most commonly applied.
• The key principle is to ‘preserve stomach qi and save ( fluids ).
• Yangming heat = clearing = Bai Hu Tang or the like.
• Yangming excess = purging = Cheng Qi Tang or the like.
• Fluid depletion + constipation = moistening + purging = Ma Zi Ren Wan.
• Damp-heat steaming + yellowing = clear heat + disinhibit dampness = Yin Chen Hao Tang.
• Yangming blood amassment = clear heat + move blood + resolve stasis.
• Yangming cold patterns = warm middle + dispel cold.
 Tiao Wei Cheng Qi Tang調胃承気湯

SQ
• In yangming disease, with no application of the ejection or purgation methods, if there is vexati
on, Tiao Wei Cheng Qi Tang can be applied. (line 207) 陽明病，不吐，不下，心煩者，可与
調胃承気湯。
• Three days after the onset of taiyang disease, if promoting sweating does not resolve the condi
tion, and there is steaming heat effusion, this is ascribed to the stomach, Tiao Wei Cheng Qi Tan
g is applied. (line 248) 太陽病三日，発汗不解，蒸蒸発熱者，属胃也，調胃承気湯主之。
• In Cold damage, if there is abdominal distention and fullness following ejection, apply Tiao Wei
Cheng Qi Tang. (line 249) 傷寒吐後，腹脹満者，与調胃承気湯。
Zhi Gan Cao 2 liang Relaxes tension and harmonizes the middle
Mang Xiao 0.5 sheng Drains heat and moistens dryness with saltiness and coldness
Da Huang 4 liang Flushes excess heat with bitterness and coldness

Cut the three ingredients above. Decoct two medicinals with 3 sheng of water, reduce to one sheng and remove the
dregs.
Add the Mang Xiao; bring to one or two boils over low heat.
Take warm as a single dose to regulate stomach qi.
These 3 ingredients combined can drain yangming dryness-heat in the stomach and large intestine, soften
hardness, and free defecation without harming stomach qi.
 Xiao Cheng Qi Tang 小承気湯

SQ
• In yangming disease, if the person sweats profusely, as the fluids exit outwardly the stomach will become
dry inside and there will be hard stools. With hard stools, there will also be delirious speech. Xiao Cheng Qi
Tang is indicated. If the delirious speech ceases after taking one portion, do not take more (line 213) 陽明
病，其人多汗，以津液外出，胃中燥，大便必，則譫語，小承気湯主之。若一服譫語止者，
更莫復服。
• For yangming disease with delirious speech, tidal fever, and slippery racing pulses, Xiao Cheng Qi Tang is a
pplied. (line 214) 陽明病，譫語，発潮熱，脈滑而疾者，小承気湯主之。因与承気湯一升，腹中転気者，
更服一升；若不転気者，勿更与之。明日又不大便，脈反微渋者，裏虚也，為難治，不可更与承気湯也。

Da Huang 4 liang Flushes excess heat with bitterness and coldness

Hou Po 2 liang Move qi and disperse fullness to assist Da Huang in promoting
defecation
Zhi Shi 3 large pcs

Decoct the 3 ingredients above with 4 sheng of water until one sheng and two ge remains. Remove the dregs. Take
warm in two divided portions.
After taking the first portion, there should be defecation; otherwise, take the remainder.
If defecation occurs, do not take more.
A Xiao Cheng Qi Tang pattern is milder than that Da Cheng Qi Tang, and the dosages of Zhi Shi and Hou Po
are also smaller. Therefore, this formula is referred to as “Minor” one.
 Tiao wei, xiao, da Cheng qi tang SQ

** 調 Purging heat.
TWCQT Exuberant dryness-heat
(herbs & actions)
** 小 XCQT Free bowels.
Bowel-qi obstruction
(herbs & actions)
大 DCQT Drains heat + frees bowels.
Intense dryness-heat + bowel-qi obstruction.
 Treatment Principles of Shaoyang Disease
BF
• (Harmonizing) (BF).
• Prohibited = Sweating, ejection and purgation.
• + Taiyang exterior pattern, apply the exterior-resolving method.
• + Yangming interior excess, apply drainage method.
• Impaired sanjiao qi transformation and fluids distribution, use qi-transformi
ng and fluids-moving method.
• With the spreading of pathogenic qi, deficiency-excess complexes, and dual
disease of the exterior and interior, treat by freeing yang, discharging heat,
settling fright and calming the spirit/shen.
 BF
Section 1 Outline of Shaoyang Disease
• The disease of shaoyang manifests with a bitter taste in the mouth
, dry throat, and dizzy vision. (line 263) 少陽之為病，口苦，咽
乾，目眩也。 =General pattern
• For shaoyang wind strike with deafness in both of the ears, red ey
es, and (fullness)in the chest with vexation, ejection and purgation
are prohibited; other wise there will be (palpitations) and (fright) .
(264) 少陽中風，両耳無所聞，目赤，胸中満而煩者，不可吐
下，吐下則悸而驚。 =Contraindications
 Pathodynamic and origins of Taiyin Disease
• Constitutional SP-ST Def + cold-damp obstruction.
MCQ
• Cold-dampness invading taiyin directly.
• Inappropriate treatment of the three yang diseases.
• Manifesting = abdominal fullness, vomiting, inability to ingest food
normally, diarrhea, and occasional abdominal pain along with grea
sy tongue coating and weak pulses.
• Characterized = SP yang Def + cold dampness(MCQ) stagnation .
• Basic nature = internal, Def + cold (MCQ).
BF
Section 1 Outline of Taiyin Disease
• The disease of taiyin manifests with abdominal (fullness),
vomiting, inability to ingest food normally, aggravated sp
ontaneous (diarrhea), and frequent (abdominal pain). If
(purgation) is applied, there will be binding and hardness
below the (chest). (273) 太陰之為病，腹満而吐，食不
下，自利益甚，時腹自痛。若下之，必胸下結。 = Bas
ic outline + contraindications.
Li Zhong Wan (Tang) = chief for Taiyin def-cold.
 Section 1 Outline of Shaoyin Disease
(ex = outline 281-285-286)

Shaoyin = faint + thread pulses, and a desire only to sleep. (line 281)
少陰之為病，脈微細，但欲寐也。 = General Pattern.
SQ

‘Faint pulse’ = weak, forceless, indistinct.

‘Thready pulse’ = thin, small, and thread-like.
‘desire only to sleep’ = fatigue with a desire for sleep as well as an ina
bility to sleep.
These manifestations indicate heart and kidney yang debilitation and
qi and blood deficiency.
 SQ
Section 1 Outline of Shaoyin Disease
In shaoyin disease, thready, deep and rapid pulses reflect that th
e disease resides interiorly. Promoting sweating is prohibited. (lin
e 285) 少陰病，脈細沈数，病為在裏，不可発汗。 = Contraindicatio
n = sweating method.

But there are exceptions. If shaoyin yang deficiency is accompanied by ex

terior excess with no sweating, promoting sweating and warming the cha
nnels can be used together with yang-restoring method. However, after t
he exterior is resolved, if only the shaoyin pattern remains, promoting sw
eating should be prohibited.
 SQ
Section 1 Outline of ShaoyinDisease
In shaoyin disease with faint pulses, promoting sweating is
prohibited because yang will collapse. If yang is already de
ficient, and pulses are weak and rough at both chi position,
purging is also prohibited. (line 286) 少陰病，脈微，不可
発汗，亡陽故也。陽已虚，尺脈弱渋者，復不可下之。
= Prohibited= Sweating + purging.

Faint pulses reflect deficiency of yang qi; weak and rough pulses at
the chi positions reflect scanty yin-blood. Promoting sweating will l
ead to yang collapse, and purging will lead to yin exhaustion.
 Ma Huang Fu Zi Xi Xin Tang 麻黄細辛附子湯 EX
Pattern
In the initial stage of shaoyin disease, when for the contradictory presence of fever
and deep pulses, Ma Huang Fu Zi Xi Xin Tang is indicated. (line 301) 少陰病，初得
之，反発熱，脈沈者，麻黄細辛附子湯主之。

Ma Huang 2 liang Dissipates wind-cold to resolve the taiyang exterior pathogenic qi

Fu Zi 1 pc Warm and supplements kidney yang to dispel the shaoyin cold
Xi Xin 2 liang helps Fu Zi to warm the channels and supplement yang, while also assisting Ma
Huang to release the exterior cold

Decoct the Ma Huang with 1 dou of water until 8 sheng remains.

Scoop the foam, and add the other ingredients.
Decoct until 3 sheng remains, the discard the dregs.
Take 1 sheng warm, 3 times a day.

Shaoyin disease + exterior pattern.

Warming shaoyin channel and promoting sweating at same time.
 Ma Huang Fu Zi Xi Xin Tang 麻黄細辛附子湯 T or F

This formula is widely applied in clinic, not only for shaoyin disease with
exterior patterns, but also for any condition associated with yang qi defic
iency and stagnation of internal cold. **It is indicated for LU conditions =
common cold, bronchitis, pneumonia, emphysema, and bronchial asthm
a; also for various types of pain or paralysis such as sciatica, vascular or n
ervous headache, muscle neuralgia, facial paralysis, and lumbar spondyli
tis.** It can be used to treat renal and urogenital disorders such as acute
and chronic nephritis, urinary retention and renal colic, heart diseases su
ch as arrhythmia, rheumatic heart disease, and sick sinus syndrome, as w
ell as urticaria, allergic rhinitis, and aphonia, etc.
 Treatment Principles for JueYin BF

• TP = ‘(warm cold + clear heat)’. Sometimes, warming and (clearing) can be ap

plied simultaneously.
• Upper heat & lower cold = clear upper & warm lower = Wu Mei Wan.
• Cold pattern = warm channels + nourish blood = Dang Gui Si Ni Tang, or war
m ST + downbear countflow = Wu Zhu Yu Tang.
• Heat pattern = cool LV + resolve toxins = Bai Tou Weng Tang.
Prognosis
• Exterior-interior relationship of jueyin and shaoyang = may pass from one to
the other.
• From shaoyang to jueyin = aggravation.
• From jueyin to shaoyang = favourable.
 Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang Case
当帰四逆加呉茱萸生姜湯 **Case
If the person has chronic internal cold, Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tan
g is recommended. (352) 若其人内有久寒者，宜当帰四逆加呉茱萸生姜湯。
Dang Gui 3 liang Nourish blood and harmonize ying.
Shao Yao 3 liang
Gui Zhi 3 liang Warm the channels and dissipate cold.
Xi Xin 3 liang
Zhi Gan Cao 2 liang
Da Zao 25 pcs
Supplement the middle qi.
Tong Cao 2 liang Frees the blood vessels.
Wu Zhu Yu 2 sheng Warm the middle and dissipate cold in the internal organs.
Sheng Jiang 0.5 jin

**Decoction = all herbs + water(6 sheng) + **clear wine (6 sheng) until 5 sheng remains  discard dregs  take warm in 5
portions.
Syndrome = Blood def + cold reversal with chronic internal cold.
 Case Study Case
• Female, 18 years old.
• CC: abdominal pain before and during menstruation for 5 years.
• Painkillers could bring temporary relief; however, the condition had become aggravated. In the past 4 months, menstr
uation started arriving early with intense abdominal pain usually accompanied by vomiting. The pain could be relieved
by heat temporarily. The menses were scant and dark purple with clots. Her complexion was pale white.
• Pale red and dusky tongue with slimy yellow coating; pulses were wiry and thready.

• TCM disease name: abdominal pain or dysmenorrhea

• Syndrome(6 channel & zang fu, 8 principle, etc.): Jueyin disease / Blood stasis + blood def + internal reversal cold.
• TP: Remove blood stasis, warm the internal cold and tonify blood.
• Formula: Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang 当帰四逆加呉茱萸生姜湯
• Special decoction methods: Decoct all herbs + water(6 sheng) + **clear wine (6 sheng) until 5 sheng remains  disca
rd dregs  take warm in 5 portions.
• Case analysis: work out as above or text book.
• Explanation of formula: see previous page or text book.
• Life style advise: see text book.
• Precaution + contraindication: see text book.
 Ma zi ren wan 麻子仁丸 pattern **Case Case

• When the fuyang pulse is floating and rough, floating reflects strong stomach qi, and roug
hness reflects frequent urination. Floating contends with roughness, the stools becomes h
ard and the spleen constrained. Ma Zi Ren Wan is indicated (line 247) 趺陽脈浮而渋，浮
則胃気強，渋則小便数，浮渋相搏，大便則，其脾為約，麻子仁丸主之。
Da Huang 1 jin Breaks stagnation and frees the stool.
Hou Po 0.5 jin
Zhi Shi 1 chi
Ma Zi Ren 2 sheng Moistens the intestines and free the stool.
Shao Yao 0.5 jin Nourishes yin and harmonizes yin-blood.
Xing Ren 1 jin Downbears lung qi and moistens the intestines.

Grind the 6 ingredients above into powder and make pills the size of a tung tree seed with processed honey. Take
10 pills with water, 3 times a day.
Gradually increase the dosage until the stool is freed.

‘strained spleen’ pattern: pulse, pattern and treatment

Case study Case

• Female, 60 years old.

• CC: No defecation for 5 days.
• 18 years history of diabetes. Had been fatigue with no obvious cause for a half month. Thirst, profuse drinking, dry bound stools, abnorm
al distention, frequent urination, and a soft abdomen with no tenderness. Her tongue was dark red with dry yellow coating. Pulses were
wiry + floating.

• TCM disease name: constipation.

• Syndrome(6 channel & zang fu, 8 principle, etc.): Yangming disease: spleen constrained / ST heat + Spleen yin deficiency .
• TP: nourish and moisten the intestines, break the stagnation and free the stool / clear ST heat & nourish spleen yin
• Formula: Ma zi Ren Wan 麻子仁丸
• Special decoction methods: Grind all into powder + processed honey  make into tung tree seed size pills .Take 10 pills with water, 3 tim
es a day. **Gradually increase the dosage until the stool comes out.
• Case analysis: work out as above or text book.
• Explanation of formula: see previous page or text book.
• Life style advise: see text book.
• Precaution + contraindication: see text book.