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Bleeding: a TCVM Approach. CAPT R.M. Clemmons, DVM, PhD, 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 - PowerPoint PPT Presentation
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Bleeding: a TCVM Bleeding: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
BleedingBleeding•Primary HemostasisPrimary Hemostasis•Complex chain of events Complex chain of events involving interaction ofinvolving interaction of
•PlateletsPlatelets•Vessel WallVessel Wall•von Willebrand’s factorvon Willebrand’s factor•FibrinogenFibrinogen
•Secondary HemostasisSecondary Hemostasis•Complex interaction of the Complex interaction of the intrinsic and extrinsic intrinsic and extrinsic clotting cascadesclotting cascades
•Stabilize the platelet plugStabilize the platelet plug
Primary HemostasisPrimary Hemostasis
•Evaluated by the Evaluated by the bleeding timebleeding time•Platelet numberPlatelet number•Amount and Quality of the Amount and Quality of the von WIllebrand’s factor von WIllebrand’s factor VIII:AgVIII:Ag•Fibrinogen concentrationFibrinogen concentration
•Other alterations due to Other alterations due to vessel wall disordersvessel wall disorders
Secondary HemostatisSecondary Hemostatis
•Assessed byAssessed by
•ACT (activated ACT (activated clotting time)clotting time)
•APTT (activated APTT (activated partial thromboplastin partial thromboplastin time)time)
•PT (prothrombin PT (prothrombin time)time)
TCM PathoetiologyTCM Pathoetiology•HeatHeat•TongueTongue
•Red & DryRed & Dry
•PulsePulse•Superficial (forceful) Superficial (forceful) & fast& fast
•Spleen Qi DeficiencySpleen Qi Deficiency•TongueTongue
•Pale & moistPale & moist
•PulsePulse•Deep & weak Deep & weak (particularly on right)(particularly on right)
Spleen Pathology Spleen Pathology
Damp Hot Damp Hot Food or Food or DrinkDrink
Damp Hot Damp Hot Environmental Environmental ConditionsConditions
Damp-Heat in SpleenDamp-Heat in Spleen
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Accumulated Accumulated Heat & DampHeat & Damp
Heat HemorrhageHeat Hemorrhage•Herbal treatment depends Herbal treatment depends upon locationupon location
•BladderBladder•Red Front DoorRed Front Door
•GI tractGI tract•Sophora PowderSophora Powder
•Great Saussurea CoptisGreat Saussurea Coptis
•Red Back DoorRed Back Door
•PulmonaryPulmonary•Red LungRed Lung
•NoseNose•Single ImmortalSingle Immortal
•UterusUterus•Wu Bei SanWu Bei San
Spleen Not Controlling BloodSpleen Not Controlling Blood
HemorrhageHemorrhage
Spleen Fails to Hold BloodSpleen Fails to Hold Blood
Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs
Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency
DarbyDarby
•SignalmentSignalment•5 yr FS Doberman5 yr FS Doberman
•HistoryHistory•Generalized weaknessGeneralized weakness•EcchymosisEcchymosis•Abdominal bleedingAbdominal bleeding
•TCVM ExamTCVM Exam•Tongue: paleTongue: pale•Pulses: deep & weakPulses: deep & weak
Dx: Spleen Qi Deficiency Dx: Spleen Qi Deficiency (not holding blood in vessels)(not holding blood in vessels)
DarbyDarby
•Western RxWestern Rx
•Compressive Compressive bandagebandage
•Hemorrhage controlHemorrhage control•CryoprecipitateCryoprecipitate•Whole BloodWhole Blood•Thyroid medicationThyroid medication
•TCVM RxTCVM Rx
•APAP•SP Qi TonicSP Qi Tonic
•BL-20/21, SP-6, SP-9 BL-20/21, SP-6, SP-9 & CV-6& CV-6
•Stop HemorrhageStop Hemorrhage•Tian Ping & BL-17Tian Ping & BL-17
•HerbalHerbal•Yunnan Pai YaoYunnan Pai Yao•Huang Tu TangHuang Tu Tang
Huang Tu TangHuang Tu Tang
AtractylodesAtractylodes Bai ZhuBai Zhu Strength Spleen & tonify QiStrength Spleen & tonify Qi
Yellow EarthYellow Earth Zao Xin TuZao Xin Tu Warm Spleen & stop diarrheaWarm Spleen & stop diarrhea
AconiteAconite Fu ZIFu ZI Warm SpleenWarm Spleen
AsinumAsinum Er JiaoEr Jiao Nourish BloodNourish Blood
RehmanniaRehmannia Sheng Di HuangSheng Di Huang Nourish YinNourish Yin
ScutellariaScutellaria Huang QinHuang Qin Stop bleeding & prevent excess heatStop bleeding & prevent excess heat
LicoriceLicorice Gan caoGan cao HarmonizeHarmonize
Muscle Wasting: a TCVM Muscle Wasting: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
TCM Muscle ViewTCM Muscle View
•Muscle volume & Muscle volume & strength is under the strength is under the domain of the Spleendomain of the Spleen
•Spleen transforms food Spleen transforms food and transports it to the and transports it to the body to provide energy & body to provide energy & building blocks.building blocks.•Spleen Qi provides Spleen Qi provides muscle strengthmuscle strength
•Liver blood provides Liver blood provides enduranceendurance
•Continued delivery of Continued delivery of Spleen Qi to musclesSpleen Qi to muscles
Western View of Muscle Western View of Muscle WastingWasting
•Generalized WastingGeneralized Wasting
•MalnutritionMalnutrition•Insufficient intake of materials Insufficient intake of materials to support Spleen Qito support Spleen Qi
•Cardiac CachexiaCardiac Cachexia•Heart failure leads to stagnation Heart failure leads to stagnation of bloodof blood•Liver is unable to support Liver is unable to support distribution of blood & Qidistribution of blood & Qi•Leads to accumulation of Damp Leads to accumulation of Damp in Spleenin Spleen•Results in Spleen Qi Deficiency Results in Spleen Qi Deficiency with failure to provide energy with failure to provide energy and building materials to the and building materials to the musclesmuscles
•Cancer CachexiaCancer Cachexia•Tumor Necrosis Factor poisons Tumor Necrosis Factor poisons metabolism leading to Spleen Qi metabolism leading to Spleen Qi DeficiencyDeficiency
•Diminished effective delivery Diminished effective delivery of energy to musclesof energy to muscles
•Localized WastingLocalized Wasting
•TraumaTrauma•Local damage of muscleLocal damage of muscle
•Disuse AtrophyDisuse Atrophy•Local stagnation results in Local stagnation results in Liver failure to support Liver failure to support Spleen/StomachSpleen/Stomach•Accumulation of Damp alters Accumulation of Damp alters Spleen functionSpleen function•Local stagnation decreases Local stagnation decreases delivery of nutrientsdelivery of nutrients
•Neurogenic AtrophyNeurogenic Atrophy•Denervation leads to local liver Denervation leads to local liver stagnationstagnation•Results in failure to support Results in failure to support spleen Qispleen Qi•Leads to decreased delivery of Leads to decreased delivery of local channel energylocal channel energy
Wei SyndromeWei SyndromeDamp HeatDamp Heat •Earth personalityEarth personality
•ObesityObesity•History of damp heat in skin or GIHistory of damp heat in skin or GI•Muscle atrophyMuscle atrophy•WeaknessWeakness•LethargyLethargy•Greasy wet tongueGreasy wet tongue•Fast pulseFast pulse
Si Miao SanSi Miao San
Qi/Yang Qi/Yang DeficiencyDeficiency
•Lethargy, shortness of breath, Lethargy, shortness of breath, weaknessweakness•Too weak to get up to walkToo weak to get up to walk•Loose lipsLoose lips•Loose stoolLoose stool•Anorexia & EmaciationAnorexia & Emaciation•Dry-burnt hairDry-burnt hair•EdemaEdema•Heat seekingHeat seeking•Pale wet tonguePale wet tongue•Thready & weak pulseThready & weak pulse
Bu Yang Huan WuBu Yang Huan Wu
Qi/Yin DeficiencyQi/Yin Deficiency •EmaciationEmaciation•Weakness in lumbar regionWeakness in lumbar region•Heat seekingHeat seeking•Dry skinDry skin•Pale or red & dry tonguePale or red & dry tongue•Weak & thready pulseWeak & thready pulse
Hindquarter Hindquarter formulaformula
JakeJake
•HistoryHistory•Progressive weakness in Progressive weakness in rear legsrear legs•Cool seekingCool seeking•Rear leg muscle atrophyRear leg muscle atrophy•Dry hair & skinDry hair & skin
•TCVM ExamTCVM Exam•Pulses deep & weak (< R)Pulses deep & weak (< R)•Red dry tongueRed dry tongue
DX: Qi/Yin DeficiencyDX: Qi/Yin Deficiency
Jake’s TreatmentJake’s Treatment
• APAP• EAEA• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai huiSP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui
• DNDN• BL20, BL23, BL26, KID3BL20, BL23, BL26, KID3
• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26
• HerbalHerbal• Jia Bing FangJia Bing Fang
Jia Bing FangJia Bing Fang
Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify QiCondonopsis Condonopsis Dang Shen Dang Shen Tonify QiTonify QiPolygonum Polygonum He Shou Wu He Shou Wu Nourish Blood and JingNourish Blood and JingRehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Blood, Yin and JingNourish Blood, Yin and JingPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Blood and soothe Liver QiNourish Blood and soothe Liver QiDioscorea Dioscorea Shan Yao Shan Yao Tonify Qi and nourish JingTonify Qi and nourish JingPrunella Prunella Xia Ku Cao Xia Ku Cao Soothe Liver Qi, clear HeatSoothe Liver Qi, clear HeatCyperus Cyperus Xiang Fu Xiang Fu Move Liver Qi and relieve nodulesMove Liver Qi and relieve nodulesBupleurum Bupleurum Chai Hu Chai Hu Soothe Liver QiSoothe Liver QiSargassum Sargassum Hai Zao Hai Zao Transform phlegm, clear Heat, softenTransform phlegm, clear Heat, soften
the hardnessthe hardnessLaminaria Laminaria Kun Bu Kun Bu Transform phlegm, soften theTransform phlegm, soften the
hardness, drain waterhardness, drain water
SamSam
•HistoryHistory•Chronic rear leg Chronic rear leg weakness and muscle weakness and muscle wastingwasting•Dry hairDry hair•Weight lossWeight loss
•TCVM ExamTCVM Exam•Red dry tongueRed dry tongue•Weak thready pulses (< R)Weak thready pulses (< R)
DX: Qi/YinDeficiencyDX: Qi/YinDeficiency
Sam’s TreatmentSam’s Treatment
• APAP• DNDN• GV20, BL20, BL23, BL26GV20, BL20, BL23, BL26
• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26
• HerbalHerbal• Hindquarter formula (tea pills)Hindquarter formula (tea pills)
Hindquarter FormulaHindquarter Formula
Eucommia Eucommia Du Zhong Du Zhong Tonify Kidney & strengthen backTonify Kidney & strengthen back
AchyranthesAchyranthes Niu Xi Niu Xi Tonify Kidney & strengthen the hind limbsTonify Kidney & strengthen the hind limbs
Lindera Lindera Wu Yao Wu Yao Move Qi and relieve painMove Qi and relieve pain
Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify Qi
Apis Apis Feng Hua Fen Feng Hua Fen Tonify Qi and YinTonify Qi and Yin
Morinda Morinda Ba Ji Tian Ba Ji Tian Warm and strengthen the backWarm and strengthen the back
Angelica Angelica Dang Gui Dang Gui Nourish BloodNourish Blood
Rehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Yin and JingNourish Yin and Jing
Cinnamon Cinnamon Gui Zhi Gui Zhi Warm the Channels and benefit the limbsWarm the Channels and benefit the limbs