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Zang Xiang Theory

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Concept

• Zang- Zang organs

• Xiang-manifestation, phenomenon

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WOOD E SPRING WIND Liv GB

FIRE S SUMMER SUMMER-H H(P) SI(SJ)

EARTH M LONG-SUMMER DAMP SP ST

METAL W FALL DRY L LI

WATER N WINTER COLD K B

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Liv EYES TENDON TEAR SHOUT ANGERY SOUR

H(P) TONGUE VESSLES SWEAT LAUGH JOY BITTER

SP MOUTH FLESH DIGESTIVE FLUID

SING WORRY SWEET

L NOSE SKIN NASAL DISCHARGE

CRY SAD PUNGENT

K EARS BONE SALIVA FEAR & FRIGHT

MOAN SALTY

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•心 肝 脾 肺 肾• Xīn Gān Pí Fèi Shèn

• H Liv Sp L K

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1.HEART

• 1-1 心部于表• The heart regulates the yang qi that circula

tes on the exterior.---52 CONTRAINDICATIONS IN ACUPUNCURE

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• CASE 1– Female 51 March-2– The patient suffered from severe impalpable

stabbing pain all over skin since Jan. 20, especially around waist and neck. She described the feeling is like having a straw rope on waist.

– She can not bear the inner folds of her under wares.

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• Panic, restlessness, night sweating, bad sleep• Appetite, stools, urine---OK• T-a bit dark tongue body with thin white a bit

greasy coating• P-irregular pulse, wiry thin a bit rapid on Left,

wiry slippery on Right

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• H channel oppressed heat

• Huang Lian 8, Dan Pi 12, Dan Shen 12• Chao Zhi Zi 10, Chi Shao 12, Chan Tui 6• Jiang Can 10, Qing Hao 10, Sang Bai Pi 1

2• Di Gu Pi 10, Zhi Ke 10, Zhu Ru 8• Gan Cao 6

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• March-9– After 6 bags of formulas above, the pain in skin ha

s almost vanished. Restlessness, panic, night sweating have gone.

– A bit edema in face and lower limbs, requires for treatment.

• Take out Di Gu Pi, Qing Hao, Zhi Ke• Add Dong Gua Pi 10 Ma Huang Rong 3, Fa

ng Feng 4• After another 6 bags decoction, the patient’s

completely cured.

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• 1-2 心肺有病而鼻为之不利• If illness occurs in the heart or lung, it wi

ll manifest in the nose.• --11 FURTHER DISCOURSE ON THE FIVE ZANG VISCERA

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• Case 2 • Female 60• Oppressed chest with pain for 10 years. The pain

occurred in left side, but the right chest has been influenced recently too. It used to have onset in Winter, but it often happens in all seasons now. the pain radiates to left shoulder

• Dry stools, once bowel movement in 2 days, bad sleep• She can’t distinguish smelling this spring. The ENT tests

are clear.• T-dark tongue body with white greasy coating• P-wiry slippery• ECG—ST descending, coronary atherosclerotic heart

disease

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• Phlegm damp accumulation with blood stagnation

• Rou Gui 2, Chao Zhi Ke 12, Yu Jin 10• Zhe Bei Mu 10, Fu Ling 15, He Geng 10• Xing Ren10, Yi Yi Ren 5, Qian Cao 10• Hong Hua 10, Xuan Fu Hua 10• Zhi Gan Cao 6, Chen Xiang Fen 1

• 20 bags of formula before cured

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2 LIVER

• 2-1 肝主目……在窍为目• Liver connects with the eyes through its ch

annels, and thus it is said that the upper orifice of the liver is the eyes.

--5 MANIFESTATION OF YIN AND YANG

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• Case 3– Female, 39– 1 month ago, the patient’s left eye vision getting blurri

ng, and leads to blind in couple of days.– The ophthalmology hospital diagnosed as Retrobulbar

neuritis and gave her eye injection (unknown injection).

– Now her left eye is blind but has light perception.– Restlessness, bad sleep. Intermittent tachycardia ons

et 2~3 times per week, which is closely related with emotions.

– Observation: red conjunctiva on left eye, purplish swollen lower eyelid caused by injection ?

– T-red tongue body with thin white coating– P-wiry slippery rapid

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• Live qi stagnation transformed into heat

• Ling Yang Jiao Powder 0.3, Pu Huang 10• Chi Shao 12, Dan Pi 10, Tian Hua Fen 12• Yi Mu Cao 15, Zhe Bei Mu 10, Chen Pi 6• Qing Xiang Zi 6, Dang Gui 15, Jin Yin Hua 12• Sang Ye 10

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– After 6 bags, her sleep, tachycardia get better. In this week she only had once tachycardia onset and did not last long time. Her left eye’s still blind, but redness and swollen almost vanished. P-wiry a bit rapid; T-red tongue body with thin white coating.

– Therapy: keep using the former formula

– After taking another 6 bags of the formula, her left eye can see several fingers 70cm in front of her. Still bad sleep.

• P- wiry, a bit rapid

– Modification: Fu Ling15, Chao Zhi Zi 10

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• Case 4– Female 50– She had insomnia, dry eyes, dry mouth, night

sweating for 1 year.– Uncomfortable epigastrium, beltching.– 2 Estazolam Tablets can only help her to slee

p 2~3 hours– T-red tongue body with thin yellow coating– P-wiry rapid

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• Qi stagnation transformed into fire with yin injury

• Yi Guan Jian modi– Sheng Di 12, Shu Di 12, Sha Shen 15, – Gou Qi Zi 10, Mai Dong 15, Dang Gui 12, – Chuan Lian Zi 6, Chao Zhi Zi 10, Cao Guo 10, – Shi Chang Pu 15, Chuan Bei Mu 10,– He Geng 10, Chao Suan Zao Ren 15,– Fu Ling 15, Long Gu 15, Mu Li 15

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– After taking 6 bags of former formula, her epigastrium, sleep get better. 1 Estazolam Tablet can help her to sleep well for 3 hours. But still dry mouth , dry eyes.

– Modification: Take out Cao Guo, add Qing Hao 8, Ju Hua 10

– After taking another 12 bags, her dryness has gone, better sleep without Estazolam Tablet. T- dark red tongue body, a bit yellow coating; P-Right wiry thin, Left wiry slow

– Therapy: 6 bags the prescription, 1 bag every other day.

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• 2-2 肝为语• Each individual zang organ when diseas

ed has its own symptomatology…the liver in talkativeness.

23 THE PARADIGM OF THE FIVE ELEMENTAL PHASES

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• Case 5– Female 37, April 2007– April 2005---the patient started to have insom

nia, unwilling to talk, unwilling to meet people, unreasonably crying, vomiting, diarrhea, slow response , even didn’t go to work. She took Amitriptyline in Mental Hospital.

– Nov. 2005—she became excited, talkative, less sleep , energetic (self evaluation). She can’t play table tennis, but she like to instruct others. Likes spending money, go shopping. Sudden smile, sudden cry.

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– After being treated with western medicine from mental hospital. Her situation turns to regularly spring quiet, autumn talkative.

– When she arrives at clinic, she’s in depression state, quiet, crying, willing to suicide,

– P-wiry– T- red tongue body with thin yellow coating

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• Liv GB qi stagnation, phlegm heat disturbance

• Chai Qin Wen Dan Tang modi– Cu Cai Hu 8, Huang Qin 12, Chen Pi 6– Ban Xia 10, Qing Pi 6 , Fu Ling 15– Zhi Shi 10, Xing Ren 10 Zhe Bei Mu 10– Zhi Gan Cao 6

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• She’s taking the formula for 6 weeks, while reducing the dose of western medicine. She finally get rid of western medicine in Sept. 2007. Her emotion gets stable.

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• Case 6– Female 20 Dec. 28 2007– (Her father described her situation ) the patien

t becomes quiet since Sept. 2006, depressed, getting worse day by day. Unwilling to read, nor watching TV. Bad sleep. She likes sitting quietly the whole day.

– Dry stools, 45 days absent of period.– She’s now taking 6 tablets of Sulpiride

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• She didn’t talk at all while in clinic. Refused to show her tongue to doctor.

• With her father’s help, the pulse was taking.• P-deep wiry

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• Liv GB qi stagnation, phlegm blood stagnation

• Chai Qin Wen Dan Tang modi– Cu Cai Hu 8, Huang Qin 12, Ban Xia 10– Fu Ling 15, Qing Pi 6, Zhi Shi 10– Chao Zhi Zi 10, Zhu Ru 10, Zhi Gan Cao 6– Shi Chang Pu 15, Zhi Mu 10 , Chi Shao 12– Zhe Bei Mu 10, Gui Zhi 6, Xing Ren 10

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• Advice: no spicy, greasy food. If the patient’s situation would be stable, reduce 1 tablet Sulpiride. Then reduce 1 tablet every other day.

• After 18 bags formula, the patient can describe her symptoms all by herself. Emotions, appetite get better. She feels uncomfortable when hears loud sound. She’s willing to cry but can’t cry out.

• Normal stools, already had period.• P-wiry thin• T-red with stasis• She’s taking the western medicine 2 tablets per

day

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• 2-3 肝在声为呼• Liver produce the shouting of the voice

--5 MANIFESTATION OF YIN & YANG

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• Case 7– Female 61– When the weather gets raining gloomy or

being provoked, the patient has restlessness, belching. Then she shouts and screams during sleep. Oppressed chest. Lassitude during daytime. Normal stools & urine

– T-dark red with thin white greasy coating– P-wiry rapid

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• Liv GB qi stagnation, with damp disturbance

• Chai Hu 8, Chao Zhi Zi 10, Yu Jin 10• Huang Qin 12, Dan Pi 12, Chi Shao 12• Cao Guo 10, Hou Pu 8, Bin Lang 10• Zhi Mu 10, Shi Chang Pu 15, Qiang /Du Huo

ea.6• Gan Cao 6

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• 2-4 胆移热于脑，则辛頞鼻渊。鼻渊者，浊涕不下止也

• Gallbladder heat moving to the brain causes sinusitis with burning of the sinuses

--37 DISORDER OF HEAT AND COLD

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• Case 8– Female 48, Aug. 23 2005– She had runny nose, sneezing, itchy eyes in autumn f

or 3 years.– She was taking Chlorpheniramine, but she can’t stand

for the sleepy fatigue caused by the drug.– The symptoms relieved in winter.– The patient has cholecystitis , when the symptoms oc

curs in autumn, her cholecystitis gets worse. Pain in ribs, poor appetite.

– Her symptoms reoccur recently and accompanied with cough, little phlegm, distention in head

– T-red tongue body with thin white coating– P-wiry, a bit rapid

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• Shao Yang stagnated heat, Metal overstrain.

• Chai Hu 8, Huang Qin 12, Chao Zhi Zi 10• Jing Jie 10, Zhe Bei Mu 10, Qian Hu 10• Jie Geng 10, Tian Hua Fen 12, Wu Wei Zi 10• Sang Ye 10, Sang Bai Pi 10, Di Gu Pi 10• Gan Cao 6

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3 SPLEEN

• 3-1 脾为涎• Five zang organs also have their correspo

nding body fluids…digestive fluid is the manifestation of the spleen.--THE PARADIGM OF THE FIVE ELEMENTAL PHASES

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• Case 9– Male 11– The patient had encephalitis at age 2. sequel

with dysfunction of speaking. Watery saliva flows out of edge of mouth which makes his collar always wet.

– Pale face, thin body shape– T- pale tongue body with thin white coating

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• Qi deficiency

• Si Jun Zi Tang modi– Chao Bai Zhu 6, Dang Sen 8, Fu Ling 10

– Zhi Gan Cao 5, Gui Zhi 4, Shi Chang Pu 6

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• Case 10– Male 24– The patient suffers from too much saliva for 2

months. He swallows the saliva during daytime, but it causes wet pillow during sleep.

– He describes that the saliva is a bit bitter. It makes shirt hard when it dries.

– T-light red tongue body with thin white coating– P-a bit wiry

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• SP heat

• Xie Huang San modi– Fang Feng 6, Chao Zhi Zi 10, Shi Gao 15– Dan Pi 10, Huo Xiang 10, Mu Li 15

• After taking 3 bags decoction, his saliva gets normal during daytime. But he still has large amount of saliva in the morning before get up.

• Modifications: Chai Hu 6, Yin Chen 6

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• 3-2 帝曰：有病口甘者，病名为何？何以得之？• Huang Di said, ”Some people often have a sweet taste in their mout

hs. What is the cause of this?”• 岐伯曰：此五气之溢也，名曰脾痹。夫五味入口，藏于胃，脾为之行

其精气津液在脾，故令人口甘也，此肥美之所发也，此人必数食甘美而多肥也。肥者，令人内热，甘者令人中满，故其气上溢，转为消渴。治之以兰，除陈气也。

• Qi Bo answered,” this is a condition that is due to the essence of the five flavors spilling upward. It is called pi tan or digestive heat. The stomach receives the food, and the spleen extracts the essence of the food. The spleen should then distribute the essence throughout the body. However, in this case, there is heat in the spleen. This causes the food essence to be detained in the spleen. Since the spleen is connected with the mouth, this essence spills upward. This condition is usually caused by a diet rich in fatty food, which generates internal heat. Indulgence in sweets also weakens the spleen, leading to chest and abdominal fullness. This is known as xiao ke, or diabetic exhaustion. One must use lan cao (Euphorbiae) here.”

--UNUSUAL ILLNESS

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• Case 11– Male 48– He suffers from coronary disease and he’s

been treated by herbs. He’s situation gets better after herbal treatment, but only sweet sensation in mouth remains.

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• SP heat with damp turbidity

• Lan Cao Tang– Pei Lan 10, Hong Ze Lan 10

• 7 bags, drink as tea

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• 3-3 脾……在声为歌• The spleen manifests in … as is a singing,

melodic voice.--MANIFESTATION OF YIN & YANG

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• Case 12– Female 17– The patient has restlessness, acousma for 1 year. – She often hears someone curses her outside the wind

ow. She locked herself in room and she keeps singing. When teenager guest visits, she gets abnormally excited and active. When the guest leave, she lock herself in room again. This problem influenced her school study. She’s been diagnosed as hebetic schizophrenia

– T-red tongue body with yellow coating– P-wiry a bit rapid

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• 1st DD: Liv heat with minister fire flaming

• Cu Chai Hu 8, Huang Qin 12, Chi Shao 12• Fu Ling 15, Shi Jue Ming 20 Long Gu 20 • Mu Li 20, Zhi Mu 10, Huang Bo(Bai) 10 • Gan Cao 6

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• After 6 bags of formula, restlessness, hallucination relived a little. But the patient still said, “I’m always willing to sing.”

• Modification: Chao Zhi Zi 15, Fang Feng 5, Shi Gao 20, Huo Xiang 10

• The schizophrenia was controlled after 3 months’ treatment and the singing problem also disappeared .

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• 3-4 脾生肉• 清阳实四肢• The spleen qi is then able to nourish the m

uscles and flesh

• The pure yang qi expands and strengthens the four extremities

--5 MANIFESTATION OF YIN & YANG

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• Case 13– Male 60– His upper extremities atrophy for 2 years. He f

eels both hands lack of strength, numbness in small fingers and ring fingers.

– Dreamy sleep, normal appetite, stools, urine.– Both Yu Ji of his hands are vanished with hall

ow shape. He can’t stretch his fingers which causes problem to his daily life.

– Thin body shape– T- thin white coating– P-deep slow, weak

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• SP deficiency failed to form flesh, with K deficiency

• Si Jun Zi Tang modi– Dang Sen 10, Chao Bai Zhu 10, Fu Ling 12– Zhi Gan Cao 10, Xu Duan 12, Huang Qi 20– Dang Gui 12, Rou Cong Rong 12, Gou Qi Zi 10– Sang Zhi 10, Gui Zhi 10, Jiang Huang 10– Long Gu 30, Mu Li 30, Lu Lu Tong 10

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Metal

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4 LUNGS

• 4-1 五脏六腑皆令人咳，非独肺也• When any of the five zang and six fu organ

s are imbalanced, one can begin to cough. It is not limited to the lungs.

--38 ETIOLOGY, DIAGNOSIS, AND TREATMENT OF COUGH

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• Case 14– Male 45– The patient was diagnosed as allergic asthma

6 years ago. He’s taking 6 tablets Chlorpheniramine every day to control asthma onset. Once he reduce the dose, the asthma occurs.

– Bitter taste, dampness feeling around scrotum– T- red & a bit dark tongue body with slight yell

ow greasy coating– P- wiry, a bit rapid

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• Liv channel damp heat

• Long Dan Xie Gan Tang modi– Long Dan Cao 10, Chao Zhi Zi 10, Chai Hu 10– Sheng Di Huang 10, Dang Gui 10, Huang Qin 12– Che Qian Zi 10, Ze Xie 10, Xing Ren 10– Zhe Bei Mu 10, Gan Cao 6

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5 KIDNEYS

• 5-1 冬气者，病在四肢 ……冬善痹厥 • The northern winds of winter will affect the

kidneys and limbs, manifesting in bi syndrome.

--4 TRUTH FROM THE GOLDEN CHAMBER

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• Case 15– Female 32– The patient has cold and painful fingers with purplish

dark color about 3 years.– At beginning, her fingers are cold with stabbing pain, i

ntermittently onset, severer in winter while relieved in summer. It’s getting severe in recent 1 year that the symptoms occurs every season. Ulceration on right middle finger. She was diagnosed as Raynaud’s Disease

– T- white greasy coating– P-deep wiry

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• K yang deficiency with cold coagulation

• Zhen Wu Tang modi– Shu Fu Pian 10, Fu Ling 20, Bai Zhu 15– Chi Shao 10, Chao Bai Shao 10, Sheng Jiang 3pc– Sang Zhi 5, Gui Zhi 5, Dan Sen 10– Jiang Huang 10, Chuan Mu Tong 5, Xi Xin 3

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• After 6 bags of decoction, the cold fingers are getting better. She complains about nausea, dizziness during formula taking, but disappeared 40min later.

• Modification: increase Xi Xin to 5• After another 6 bags, her right middle finger’s ulceration

healed, no cold fingers, the pain also gets relieved, the color of fingers are getting to normal red. But she complains of frequent belching.

• Modification: increase Xi Xin to 7, Zi Su Geng 10• Caution: Never try large dose of toxic herbs in US