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Consumptive Disease

Consumptive disease includes various chronic debilitating disorders in which the deficiency of zang-fu organs and the insufficiency of qi, blood, yin and yang constitute its basic pathogenesis. Its manifestations vary a lot and may be seen in the disorders of many systems, such as auto-immuno-deficiency, disturbance of endocrine glands and hematopoietic system, metabolic disorders, malnutrition, over-inhibition of the nervous system and other organic degenerative diseases. Therefore, many chronic diseases manifested as hypofunctioning or asthenic hyperfunctioning may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

The cause of consumptive disease is miscellaneous and may be grouped under three headings, i.e., constitution, life and disease.

A. Constitution: Congenital defects, prenatal and postnatal malnutrition, birth trauma, etc., may lead to a constitution which is susceptible to consumptive disease.

B. Life: diet, living conditions, emotion, stress and indulgence all affect the function of zang-organs. For example, mental stress may impair the heart and spleen, sexual indulgence may damage the kidneys and immoderate diet and drinking may weaken the spleen and stomach. When one organ is diseased, the others may be involved.

C. Disease: A serious or longstanding disease, whether endogenous or exogenous in origin, may impair the organs and consume qi, blood, yin and yang, resulting in consumptive disease. In short, a deficiency of qi, blood yin or yang is the major pathological cause of the disease, and the disease affects the zang-organ, especially the kidneys and the spleen.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between the primary and the secondary diseases: In a mild case of consumptive disease with either preexisting abdominal mass or phlegm or blood-stasis syndrome, the latter is the primary disease and the former is the secondary. In a case complicated by an attack of exogenous evil, consumptive disease is primary and the affection of exogenous evil is secondary. When consumptive disease involves the spleen and kidneys, the deficiency of the spleen and kidneys is primary and that of other organs is secondary. In a case with deficiency of yin involving yang, yin deficiency is primary and yang deficiency is secondary; in a case with deficiency of yang involving yin, yang deficiency is primary and yin deficiency is secondary. This differentiation is very important for the determination of therapeutic strategy.

(b) Estimation of the prognosis: The prognosis is favorable when the patient is not emaciated, his primordial-qi not yet exhausted, his appetite still good, his fever not very high and relievable by medications, his respiration peaceable, the function of spleen and kidneys not yet exhausted, his pulse calm and regular and tonics acceptable. But when the patient becomes cachetic, his primordial-qi is exhausted, and he displays loss of appetite, sustained diarrhea, continuous fever, rapid respiration, and hoarse voice, he is irritable and absentminded, various organs are involved and tonics are unacceptable, the prognosis is unfavorable.

B. Therapeutic principles Tonic therapy is the basic therapeutic principle for consumptive diseases, but the application of tonics with strong, mild or moderate action should be determined according to the condition of the individual case. For acute and serious cases, large dosages of strong tonics should be applied in order to relieve the consumptive status in a short time. For chronic cases or those unacceptable to tonic therapy, moderate dosages of mild tonics may be given to alleviate the degree of consumption gradually. For the mild cases, tonics of moderate action should be employed to avoid over-invigoration. As for serious cases with involvement of the upper and lower jiao more significant than that of the middle jiao and no response to the tonics, the therapy of supporting spleen-qi and stomach-qi should be adopted first, so as to increase appetite and promote the restoration of yin and yang and qi and blood.

Classification and Treatment

A. Qi deficiency

(a) Deficiency of lung-qi

Manifestations: Shortness of breath, spontaneous sweating, low voice, alternate feeling of heat and cold, susceptibility to common cold, pale complexion and tongue and feeble pulse.

Therapeutic principles: Benefit lung-qi.

Prescription: The Modified Decoction for Invigorating the Lungs

Radix Codonopsis Pilosulae 12 g
Radix Astragali 12 g
Radix Rehmanniae Praeparata 10 g
Fructus Schisandrae 6 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 10 g
Radix Ophiopogonis 10 g
Pericarpium Citri Reticulatae 10 g

(b) Deficiency of spleen-qi

Manifestations: Fatigue, poor appetite, epigastric discomfort after food intake, loose stool, sallow complexion, pale tongue with thin coating and feeble pulse.

Therapeutic principles: Strengthen the spleen and benefit qi.

Prescription: The Modified Powder of Codonopsis Pilosulae, Poria and Atractylodis Macrocephalae

Radix Codonopsis Pilosulae 12 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Astragali Praeparata 12 g
Poria 15 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Dioscoreae 12 g
Pericarpium Citri Reticulatae 10 g
Semen Amomi 5 g
Fructus Hordei Germinatus (fried) 10 g
Fructus Oryzae Germinatus (fried) 10 g

Remarks: For cases with abdominal distention and fullness, eructation and vomiting, add Rhizoma Pinelliae and Radix Aucklandiae to regulate the stomach and qi. For cases with diarrhea and abdominal pain, add Cortex Cinnamomi and Rhizoma Zingiberis Praeparata to warm middle jiao and expel cold. For cases with diarrhea and prolapse of rectum, add Rhizoma Cimicifugae, Radix Bupleuri and Radix Puerariae to lift up the collapsing yang.

B. Blood deficiency

(a) Deficiency of heart-blood

Manifestations: Palpitations, amnesia, dizziness, insomnia, dreamfulness, lusterless complexion, pale tongue, thready or slow and irregular pulse.

Therapeutic principles: Nourish blood and calm the mind.

Prescription: The Modified Decoction for Nourishing Heart

Radix Codonopsis Pilosulae 10 g
Radix Astragali 12 g
Poria 10 g
Radix Glycyrrhizae Praeparata 6 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 6 g
Semen Ziziphi Spinosae 12 g
Radix Polygalae 10 g
Fructus Schisandrae 6 g

(b) Deficiency of liver-blood

Manifestations: Dizziness, lusterless complexion, numbness and spasms of extremities, muscular twitching, irregular menstruation or even amenorrhea, pale tongue and thready and wiry or uneven pulse.

Therapeutic principles: Tonify blood and nourish liver.

Prescription: The Modified Decoction of Four Drugs

Radix Rehmanniae Praeparata 12 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 10 g
Rhizoma Chuanxiong 6 g
Fructus Lycii 10 g
Radix Polygoni Multiflori 10 g
Caulis Spatholobi 15 g
Radix Astragali 12 g
Pericarpium Citri Reticulatae 10 g

C. Yin deficiency

(a) Deficiency of lung-yin

Manifestations: Dryness of throat, dry cough, hemoptysis, dysphonia, hectic fever, night sweating, flushed cheeks, red and dry tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin and moisturize lungs.

Prescription: The Modification of Adenophorae Strictae and Ophiopogonis Decoction

Radix Adenophorae Strictae 10 g
Radix Ophiopogonis 10 g
Rhizoma Polygonati Odorati 10 g
Radix Trichosanthis 10 g
Cortex Lycii Radicis 10 g
Radix Stemonae 10 g
Radix Asteris 10 g
Radix Glycyrrhizae 6 g

(b) Deficiency of heart-yin

Manifestations: Palpitations, irritability, insomnia, dreamfulness, hectic fever, night sweating, aphthae, flushed cheeks, dry tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin and regulate the stomach.

Prescription: King of heaven Tonic Pill for Mental Discomfort

Radix Rehmanniae 12 g
Radix Scrophulariae 10 g
Radix Ophiopogonis 10 g
Radix Codonopsis Pilosulae 12 g
Fructus Schisandrae 10 g
Radix Salviae Miltiorrhizae 15 g
Semen Ziziphi Spinosae 15 g
Poria 12 g
Plumula Nelumbinis 3 g

Remarks: For cases with irritability and aphthae, add Rhizoma Coptidis, Caulis Akebiae and herba Lophatheri to clear away heart-fire and guide the heat evil downward.

(c) Deficiency of spleen-yin and stomach-yin

Manifestations: Dryness of mouth and lips, constipation, poor appetite, retching, hiccups, flushed cheeks, dry tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin and regulate the stomach.

Prescription: The Modified Decoction for Benefiting the Stomach

Radix Adenophorae Strictae 12 g
Radix Ophiopogonis 10 g
Rhizoma Polygonati Odorati 10 g
Radix Trichosanthis 10 g
Rhizoma Dioscoreae 10 g
Radix Rehmanniae 10 g
Semen Dolichoris Album 10 g
Fructus Hordei Germinatus (fried) 10 g

Remarks: For cases with retching and hiccups, add Caulis Bambusae in Taeniam and Semen Canavaliae to regulate the stomach and keep the adverse-qi downward.

(d) Deficiency of liver-yin

Manifestations: headache, dizziness, dryness of eyes, tinnitus, blurred vision, irritability, numbness of limbs, muscular twitching and cramps, flushed cheeks, red and dry tongue and thready and wiry, rapid pulse.

Therapeutic principles: Nourish liver-yin.

Prescription: The Modified Decoction for Invigorating the Liver

Radix Rehmanniae 10 g
Radix Rehmanniae Praeparata 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 10 g
Fructus Lycii 10 g
Fructus Chaenomelis 10 g
Radix Glycyrrhizae 6 g
Fructus Mori 15 g
Flos Chrysanthemi 10 g

(e) Deficiency of kidney-yin

Manifestations: Lumbago, nocturnal emissions, dizziness, tinnitus or even deafness, dryness of mouth, sore threat, weakness of the lower limbs, or hectic fever, flushed cheeks, red and dry tongue and deep and thready pulse.

Therapeutic principles: Nourish kidney-yin

Prescription: The Modification of Zuogui Bolus

Radix Rehmanniae 12 g
Radix Rehmanniae Praeparata 12 g
Fructus Lycii 10 g
Rhizoma Dioscoreae 10 g
Fructus Ligustri Lucidi 10 g
Herba Ecliptae 15 g
Fructus Corni 10 g
Radix Achyranthis Bidentatae 10 g
Colla Plastri Testudinis 10 g

Remarks: For cases with marked dryness of mouth, sore throat, flushed cheeks and hectic fever, add Rhizoma Anemarrhenae, Cortex Phellodendri and Cortex Lycii Radicis to nourish yin and suppress fire. For cases with marked lumbago and frequent emissions, add Concha Ostreae Usta, Semen Euryales and Fructus Rosae Laevigatae to strengthen the kidneys and restore its astringent function. For cases with deafness and flaccidity of lower limbs, add Placenta Hominis and Spinal cord of Pigs to tonify blood and essence.

D. Yang deficiency

(a) Deficiency of heart-yang

Manifestations: Palpitations, spontaneous sweating, chest upset or pain, fatigue, somnolence, coldness of limbs, pale complexion, pale or dark purplish tongue, thready and weak or slow and irregular or deep and slow pulse.

Therapeutic principles: Benefit qi and warm yang.

Prescription: The Modification of Recuperating the Depleted yang and Relieving Fatigue

Radix Codonopsis Pilosulae 10 g
Radix Astragali 12 g
Radix Glycyrrhizae Praeparata 10 g
Ramulus Cinnamomi 6-10 g
Fructus Schisandrae 6 g
Rhizoma Atractylodis Macrocephalae 10 g
Pericarpium Citri Reticulatae 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 9 g

Remarks: For cases with severe chest upset and pain, add Radix Curcumae, Radix Salviae Miltiorrhizae and Radix Notoginseng to activate blood circulation and relieve pain. For cases with coldness of limbs and deep, slow pulse, add Radix Aconiti Lateralis Praeparata, Radix Morindae Officinalis, Rhizoma Curculinginis and Herba Epimedii to warm and reinforce yang-qi.

(b) Deficiency of spleen-yang

Manifestations: Fatigue, sallow complexion, poor appetite, shortness of breath, loose stool, abdominal pain and creased borborygmus aggravated by improper food intake, cold, pale tongue with white coating and weak pulse.

Therapeutic principles: Warm the middle jiao and strengthen the spleen.

Prescription: The Modification of Aconiti Lateralis Praeparata Bolus for Regulating Middle Jiao

Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Zingiberis (dried) 6 g
Radix Aconiti Lateralis Praeparata 6-10 g
Poria 10 g
Radix Aucklandiae 10 g
Pericarpium Citri Reticulatae 10 g

Remarks: For cases with severe cold pain in the abdomen, add Rhizoma Alpiniae Officinarum and Radix Aconiti Lateralis Praeparata or Flor Caryophylli and Fructus Evodiae to warm the middle jiao, regulate qi and relieve pain. For cases with diarrhea, add Fructus Psoraleae and Semen Myristicae to warm the spleen and relieve diarrhea.

(c) Deficiency of kidney-yang

Manifestations: Lumbago, backache, nocturnal emissions, impotence, lienteric diarrhea or morning diarrhea, nocturia, pale complexion, aversion to cold, coolness of limbs, pale and corpulent tongue with teeth marks on its margin and white coating and deep and slow pulse.

herapeutic principles: Warm kidney-yang and nourish essence and blood.

Prescription: The Modification of Yougui Bolus

Radix Rehmanniae Praeparata 12 g
Fructus Corni 10 g
Rhizoma Dioscoreae 10 g
Cortex Eucommiae 10 g
Semen Cuscutae 10 g
Radix Aconiti Lateralis Praeparata 6-10 g
Cortex Cinnamomi 3-6 g
Fructus Lycii 10 g
Radix Angelicae Sinensis 10 g
Poria 10 g

Remarks: For cases with frequent nocturnal emissions, add Fructus Rosae Laevigatae, Ootheca Mantidis and Stamen Nelumbinis to strengthen the kidneys and restore their astringent function. For cases with licenteric diarrhea or morning diarrhea, add Rhizoma Atractylodis Macrocephalae and fructus Psoraleae and omit Rehmanniae Praeparata and Angelicae Sinensis to strengthen the spleen and kidneys and relieve diarrhea. For cases with oliguria and edema, add Rhizoma Atractylodis Macrocephalae and Rhizoma Alismatis to promote diuresis and reduce edema. For cases with dyspnea aggravated by movement, add fructus Psoraleae, Fructus Schisandrae and Gecko to improve inspiration by invigorating the kidneys.

Copyright 1995 Hopkins Technology


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