Bleeding: a TCVM Approach

1
Bleeding a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

2
Bleeding

• Primary Hemostasis
• Complex chain of events involving interaction of
• Platelets
• Vessel Wall
• von Willebrands factor
• Fibrinogen
• Secondary Hemostasis
• Complex interaction of the intrinsic and
  extrinsic clotting cascades
• Stabilize the platelet plug

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Primary Hemostasis

• Evaluated by the bleeding time
• Platelet number
• Amount and Quality of the von WIllebrands factor
  VIIIAg
• Fibrinogen concentration
• Other alterations due to vessel wall disorders

4
Secondary Hemostatis

• Assessed by
• ACT (activated clotting time)
• APTT (activated partial thromboplastin time)
• PT (prothrombin time)

5
TCM Pathoetiology

• Heat
• Tongue
• Red Dry
• Pulse
• Superficial (forceful) fast
• Spleen Qi Deficiency
• Tongue
• Pale moist
• Pulse
• Deep weak (particularly on right)

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Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
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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

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Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
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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)
10
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

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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
12
Muscle Wasting a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

13
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

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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

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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
16
Jake

• History
• Progressive weakness in rear legs
• Cool seeking
• Rear leg muscle atrophy
• Dry hair skin
• TCVM Exam
• Pulses deep weak (lt R)
• Red dry tongue

DX Qi/Yin Deficiency
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Jakes Treatment

• AP
• EA
• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui
• DN
• BL20, BL23, BL26, KID3
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Jia Bing Fang

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Jia Bing Fang
Astragalus Huang Qi Tonify Qi Condonopsis Dang
Shen Tonify Qi Polygonum He Shou Wu Nourish
Blood and Jing Rehmannia Shu Di Huang Nourish
Blood, Yin and Jing Paeonia Bai Shao Yao
Nourish Blood and soothe Liver Qi Dioscorea
Shan Yao Tonify Qi and nourish Jing Prunella
Xia Ku Cao Soothe Liver Qi, clear Heat Cyperus
Xiang Fu Move Liver Qi and relieve
nodules Bupleurum Chai Hu Soothe Liver
Qi Sargassum Hai Zao Transform phlegm, clear
Heat, soften the hardness Laminaria Kun Bu
Transform phlegm, soften the hardness,
drain water
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Sam

• History
• Chronic rear leg weakness and muscle wasting
• Dry hair
• Weight loss
• TCVM Exam
• Red dry tongue
• Weak thready pulses (lt R)

DX Qi/YinDeficiency
20
Sams Treatment

• AP
• DN
• GV20, BL20, BL23, BL26
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Hindquarter formula (tea pills)

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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