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Bleeding: a TCVM Approach

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

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Bleeding: a TCVM Approach

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  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 Willebrand’s factor • Fibrinogen • Secondary Hemostasis • Complex interaction of the intrinsic and extrinsic clotting cascades • Stabilize the platelet plug

  3. Primary Hemostasis • Evaluated by the bleeding time • Platelet number • Amount and Quality of the von WIllebrand’s factor VIII:Ag • 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)

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

  7. 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

  8. Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage

  9. 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. 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 Darby

  11. 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

  14. 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 Western View of Muscle Wasting

  15. Wei Syndrome

  16. Jake • History • Progressive weakness in rear legs • Cool seeking • Rear leg muscle atrophy • Dry hair & skin • TCVM Exam • Pulses deep & weak (< R) • Red dry tongue DX: Qi/Yin Deficiency

  17. Jake’s 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

  18. 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

  19. Sam • History • Chronic rear leg weakness and muscle wasting • Dry hair • Weight loss • TCVM Exam • Red dry tongue • Weak thready pulses (< R) DX: Qi/YinDeficiency

  20. Sam’s Treatment • AP • DN • GV20, BL20, BL23, BL26 • Aqua • SP6, ST36, BL23, BL26 • Herbal • Hindquarter formula (tea pills)

  21. 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

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