GESTIÓN DE CLIENTES

Since the human body is an integral whole, the zang–fu organs are physi- ologically interconnected and pathologically interactive. Pathologies of one organ may, under certain circumstances, affect another organ. Pathological transmissions often develop between organs having special connections, such as internal–external connection via meridians, mutual generation/ restriction and overaction/counteraction. Common patterns involving two or more zang–fu organs are as follows:

Disharmony between the heart and kidneys

Overview

Disharmony between the heart and kidneys manifests a condition due to incoordination between the heart and kidneys. The main contributing fac- tors include external pathogens, chronic conditions, sexual indulgence and emotional disturbance.

Clinical manifestations

Restlessness, insomnia, palpitations, vertigo, tinnitus, a poor memory, feverish sensations on the palms, soles and chest, a dry mouth and throat, soreness and weakness of the low back and knee joints, nocturnal emis- sions, leukorrhea, a red tongue and a thready rapid pulse.

Analysis

Failure of kidney yin to control heart fire may cause restlessness, insomnia, palpitations and a poor memory. Failure of kidney water to supplement the

QUESTIONS

1. List the similarities and differences of signs and symptoms due to kidney yang deficiency, kidney yin deficiency, kidney essence insufficiency, weakness of kidney qi and the kidneys failing to receive qi.

2. Describe the clinical manifestations caused by damp–heat in the urinary bladder.

b1547_Ch-04.indd 164

brain may cause vertigo, tinnitus, and soreness and weakness of the low back and knee joints. Kidney yin deficiency may produce internal deficient and subsequent feverish sensations on the palms, soles and chest, a dry mouth and throat, a red tongue and a thready rapid pulse. Deficient fire may further disturb the essence chamber, leading to nocturnal emissions and leukorrhea.

Differentiation

This pattern should be distinguished from hyperactivity of heart fire, which is characterized by restlessness and insomnia alone without kidney yin deficiency symptoms.

Distinctive notes

This pattern is distinctively marked by hyperactivity of heart fire and deficiency of kidney yin.

Deficiency of the heart and spleen

Overview

Deficiency of the heart and spleen manifests a condition due to deficiency of spleen qi and heart blood. The main contributing factors include an improper diet, overexertion, anxiety and chronic conditions or chronic bleeding.

Clinical manifestations

Mild or severe palpitations, insomnia, dream-disturbed sleep, a lusterless complexion, a poor appetite, bloating, diarrhea, dizziness, a poor memory, mental fatigue, scanty menstruation in a pale color, a pale tongue and a thready weak pulse.

Analysis

Failure of heart blood to nourish the heart may cause mild or severe pal- pitations. Failure of heart blood to nourish the heart–mind may cause

b1547_Ch-04.indd 165

insomnia or dream-disturbed sleep. Failure of qi and blood to ascend to nourish the brain may cause dizziness and a poor memory. Spleen qi defi- ciency causes a lusterless complexion, a poor appetite, bloating, diarrhea and mental fatigue. Deficiency of qi and blood may cause scanty or drib- bling menstruation in a pale color, a pale tongue and a thready weak pulse. The spleen is the source of qi and blood generation. The heart dominates blood and blood vessels, and the spleen controls blood in the vessels. Spleen qi deficiency may cause insufficient generation of blood. Failure of spleen qi to control blood in vessels may cause loss of blood. Likewise, blood deficiency may worsen qi deficiency.

Differentiation

This pattern should be distinguished from deficiency of qi and blood, which is characterized by general qi and blood deficiency.

Distinctive notes

This pattern is distinctively marked by symptoms due to heart blood defi- ciency and spleen qi deficiency, coupled with general qi and blood deficiency.

Blood deficiency of the heart and liver

Overview

Blood deficiency of the heart and liver manifests a hypofunction of the heart and liver due to blood deficiency. The main contributing factors include chronic conditions, loss of blood and conditions of other zang–fu organs.

Clinical manifestations

Mild or severe palpitations, insomnia, dream-disturbed sleep, a poor memory, dizziness, tinnitus, a lusterless complexion, dry eyes, blurred vision, dry nails, numbness of the limbs, amenorrhea or scanty menstrua- tion in a pale color, a pale tongue and a thready weak pulse.

b1547_Ch-04.indd 166

Analysis

Failure of heart blood to nourish the heart and heart–mind may cause mild or severe palpitations, insomnia and dream-disturbed sleep. Failure of heart and liver blood to ascend to nourish the brain may cause a poor memory, dizziness, tinnitus and a lusterless complexion. Since the liver opens into the eyes, dominates tendons and its luster manifests in the nails, liver blood deficiency may cause dry eyes, blurred vision, dry nails, and numbness of the limbs. Insufficient blood in the liver may also cause amenorrhea or scanty menstruation in a pale color. A pale tongue and a thready weak pulse are typical signs of blood deficiency.

Differentiation

This pattern should be distinguished from either heart blood deficiency or liver blood deficiency alone.

Distinctive notes

This pattern is distinctively marked by blood deficiency symptoms and symptoms involving both the heart and liver.

Yang deficiency of the heart and kidneys

Overview

Yang deficiency of the heart and kidneys manifests internal cold retention due to yang–qi deficiency of the heart and kidneys. The main contributing factors include external contraction of cold, constitutional yang defi- ciency, chronic conditions and overexertion.

Clinical manifestations

Mild or severe palpitations, mental fatigue, lassitude, cold intolerance, cold limbs, dysuria, facial puffiness or edema in the lower limbs, pale- gray or bluish lips and nails, a pale-purple tongue with a white slippery coating and a deep thready pulse.

b1547_Ch-04.indd 167

Analysis

The heart dominates the heart–mind and mental activities. Failure of heart yang to warm and nourish the heart may cause mild or severe palpitations, mental fatigue, and lassitude. Kidney yang deficiency causes cold intoler- ance and cold limbs. Kidney yang deficiency may impair the qi transforma- tion of the urinary bladder, resulting in dysuria. Yang–qi deficiency may cause water retention and subsequent facial puffiness and edema in the lower limbs. Failure of heart and kidney yang to circulate qi and blood may cause blood stasis, leading to pale-gray or bluish lips and nails and a pale- purple tongue. A white slippery tongue coating and a deep thready pulse are typical signs of internal exuberance of yin cold due to yang deficiency.

Differentiation

This pattern should be distinguished from either heart yang deficiency or kidney yang deficiency alone.

Distinctive notes

This pattern is distinctively marked by yang deficiency (with internal yin cold) symptoms and symptoms involving both the heart and kidneys.

Qi deficiency of the heart and lungs

Overview

Qi deficiency of the heart and lungs manifests a hypofunction of the heart

and lungs due to qi deficiency. The main contributing factors include chronic lung conditions, aging and anxiety.

Clinical manifestations

Mild or severe palpitations, coughing, panting and shortness of breath that can be aggravated by physical exertion, mental fatigue, a bright pale com- plexion, spontaneous sweating, a low voice, chest tightness, production of clear thin sputum, a pale tongue with a white coating and a deep weak or regularly/irregularly intermittent pulse.

b1547_Ch-04.indd 168

Analysis

Failure of heart qi to nourish the heart may cause mild or severe palpita- tions. Lung qi deficiency causes coughing, panting and shortness of breath that can be aggravated by physical exertion. Qi deficiency of the heart and lungs causes mental fatigue, a bright pale complexion, sponta- neous sweating and a low voice. Failure of lung qi to distribute fluids may cause thin clear sputum. A pale tongue with a white coating and a deep weak or regularly/irregularly intermittent pulse are typical signs of impaired circulation of qi and blood.

Differentiation

This pattern should be distinguished from either heart qi deficiency or lung qi deficiency alone. Heart qi deficiency is marked by mild or severe palpitations, while lung qi deficiency is marked by weak coughing or panting.

Distinctive notes

This pattern is distinctively marked by general qi deficiency and symptoms involving both the heart and lungs.

Qi deficiency of the lungs and spleen

Overview

Qi deficiency of the lungs and spleen manifests a hypofunction of the lungs

and spleen due to qi deficiency. The main contributing factors include chronic lung conditions, overexertion and other chronic conditions.

Clinical manifestations

Persistent coughing and panting, shortness of breath, fatigue, production of profuse white thin sputum, a poor appetite, bloating, diarrhea, a low voice with reluctance to talk, a bright pale complexion, facial puffiness, edema on the feet, a pale tongue with a white coating and a thready weak pulse.

b1547_Ch-04.indd 169

Analysis

The spleen is known as the source of phlegm, while the lungs are the con- tainer of phlegm. Failure of spleen qi to transport and transform may cause a poor appetite, bloating and diarrhea. Spleen deficiency may pro- duce internal phlegm dampness, resulting in profuse white thin sputum. The phlegm dampness may, in turn, affect the lungs, resulting in persistent coughing and panting. Qi deficiency of the lungs and spleen may cause shortness of breath, fatigue, a low voice with reluctance to talk and a bright pale complexion. It may also cause water retention and subsequent facial puffiness or edema on the feet. A pale tongue with a white coating and a thready weak pulse are typical signs of qi deficiency.

Differentiation

This pattern should be distinguished from either lung qi deficiency or spleen qi deficiency alone. Lung qi deficiency is marked by persistent coughing, panting, shortness of breath and fatigue, while spleen qi defi- ciency is marked by a poor appetite, bloating and diarrhea.

Distinctive notes

This pattern is distinctively marked by general qi deficiency and symp- toms involving both the lungs and spleen.

Yang deficiency of the spleen and kidneys

Overview

Yang deficiency of the spleen and kidneys manifests a condition due to yang–qi weakness of the spleen and kidneys. The main contributing fac- tors include external contraction of cold, chronic conditions, chronic diarrhea and deficiency of other organs.

Clinical manifestations

Diarrhea mixed with undigested food, fecal incontinence, diarrhea before dawn, cold intolerance, cold limbs, lower abdominal pain with a cold

b1547_Ch-04.indd 170

sensation, soreness and weakness of the low back and knee joints, dysuria, a bright pale complexion, facial puffiness or edema in the limbs, a pale swollen tongue with a white slippery coating and a deep thready pulse.

Analysis

Failure of spleen and kidney yang (qi) to warm, transform and hold may cause diarrhea mixed with undigested food, fecal incontinence and diar- rhea before dawn. Yang–qi deficiency may produce internal yin cold, resulting in cold intolerance, cold limbs, lower abdominal pain with a cold sensation and a bright pale complexion. Failure of kidney yang to perform qi transformation of the urinary bladder may cause soreness and weakness of the low back and knee joints, and dysuria. Yang–qi deficiency may also cause water retention and subsequent facial puffi- ness or edema in the limbs. A pale swollen tongue with a white slippery coating and a deep thready pulse are typical signs of yang deficiency with internal cold.

Differentiation

This pattern should be distinguished from either spleen yang deficiency or kidney yang deficiency alone. Also, it needs to be distinguished from water retention due to yang deficiency, which is mainly characterized by edema.

Distinctive notes

This pattern is distinctively characterized by yang deficiency of both the spleen and the kidneys, coupled with internal exuberance of yin cold.

Yin deficiency of the lungs and kidneys

Overview

Yin deficiency of the lungs and kidneys manifests a condition of insuffi- cient liquids in the lungs and kidneys. The main contributing factors include external contraction of pathogens (later transforming into heat), chronic lung conditions and sexual indulgence.

b1547_Ch-04.indd 171

Clinical manifestations

Unproductive coughs or coughing with scanty sputum containing blood, a dry mouth and throat, weight loss, soreness and weakness of the low back and knee joints, bone-steaming tidal fever, rosy cheeks, night sweats, nocturnal emissions, irregular menstruation, a red tongue with a scanty coating and a thready rapid pulse.

Analysis

Lung yin deficiency may cause internal heat to impair the descending of lung qi, resulting in unproductive coughs or coughing with scanty sputum. Deficient heat damaging the lung collaterals may cause blood in the spu- tum. Internal deficient heat causes a dry mouth and throat. Failure of the lungs and kidneys yin to nourish muscles and tendons may cause weight loss and soreness and weakness of the low back and knee joints. Internal deficient heat may also cause bone-steaming tidal fever. Ascending of deficient fire may cause rosy cheeks and night sweats. Deficient fire dis- turbing the essence chamber may cause nocturnal emissions. Deficient fire affecting the chong and ren meridians may cause irregular menstrua- tion. A red tongue with a scanty coating and a thready rapid pulse are typi- cal signs of internal heat due to yin deficiency.

Differentiation

This pattern should be distinguished from either lung yin deficiency or kidney yin deficiency alone.

Distinctive notes

This pattern is distinctively marked by general yin deficiency and symp- toms involving both the lungs and the kidneys.

Yin deficiency of the liver and kidneys

Overview

Yin deficiency of the liver and kidneys manifests a condition due to insuf- ficient liquids in the liver and kidneys. The main contributing factors include chronic conditions, sexual indulgence and emotional disturbance.

b1547_Ch-04.indd 172

Clinical manifestations

Soreness and weakness of the low back and knee joints, dry eyes, blurred vision, tinnitus, a poor memory, pain in the hypochondriac regions, fever- ish sensations on the palms, soles and chest, rosy cheeks, night sweats, a dry mouth and throat, insomnia or dream-disturbed sleep, nocturnal emissions, scanty menstruation or uterine bleeding, a red tongue with a scanty coating and a thready rapid pulse.

Analysis

Failure of liver and kidney yin to nourish tendons and muscles may cause soreness and weakness of the low back and knee joints. The liver opens into the eyes, so liver yin deficiency causes dry eyes and blurred vision. The kidneys open into the ears, so kidney yin deficiency causes tinnitus. Failure of liver and kidney yin to supplement the brain may cause a poor memory. The liver meridian passes through the hypochon- driac regions, so failure of liver yin to nourish the meridians may also cause pain in the hypochondriac regions. Internal deficient heat due to yin deficiency of the liver and kidneys may cause feverish sensations on the palms, soles and chest, rosy cheeks, night sweats, and a dry mouth and throat. Deficient heat disturbing the mind may cause insomnia or dream-disturbed sleep. Deficient fire disturbing the essence chamber may cause nocturnal emissions. Deficient fire affecting the chong and

ren meridians may cause scanty menstruation or uterine bleeding. A red

tongue with a scanty coating and a thready rapid pulse are typical signs of internal heat due to yin deficiency.

Differentiation

This pattern should be distinguished from either liver yin deficiency or kidney yin deficiency alone. Also, it needs to be distinguished from yin deficiency of the lungs and kidneys.

Distinctive notes

This pattern is distinctively characterized by internal heat due to yin defi- ciency and deficient fire, as well as symptoms involving both the liver and the kidneys.

b1547_Ch-04.indd 173

Disharmony between the liver and the spleen

Overview

Disharmony between the liver and the spleen manifests a condition due to failure of the spleen to transport and transform and failure of the liver to maintain the free flow of qi. The main contributing factors include liver qi stagnation, an improper diet and overexertion.

Clinical manifestations

Distension, fullness or wandering pain in the chest and hypochondriac regions, frequent sighing, emotional depression or restlessness, irritability, a poor appetite, bloating, diarrhea, paroxysmal abdominal pain and diar- rhea, a white or greasy tongue coating and a wiry pulse.

Analysis

Liver qi stagnation may cause distension, fullness or wandering pain in the chest and hypochondriac regions. Failure of the liver to maintain the free flow of qi may cause frequent sighing, depression or restlessness and irritability. Failure of the spleen to transport and transform may cause a poor appetite, bloating, diarrhea and paroxysmal abdominal pain and diar- rhea (often related to emotions). A white or greasy tongue coating is indicative of dampness in the middle jiao. A wiry pulse is indicative of a liver condition.

Differentiation

This pattern should be distinguished from either liver qi stagnation or spleen deficiency with dampness retention alone.

Distinctive notes

This pattern is distinctively characterized by symptoms due to liver qi stagnation and manifestations due to spleen deficiency.

b1547_Ch-04.indd 174

Disharmony between the liver and the stomach

Overview

Disharmony between the liver and the stomach manifests a condition due to failure of the liver to maintain the free flow of qi and failure of stomach

qi to descend. The main contributing factors include liver qi stagnation

and cold attacking the liver and stomach.

Clinical manifestations

Liver qi affecting the stomach may cause distension, tightness and pain in the stomach and hypochondriac regions, belching, acid reflux, hiccups, vomiting, restlessness, irritability, a red tongue with a thin yellow coating and a wiry pulse.

Cold attacking the liver and stomach may cause parietal headache, vomiting of saliva, cold limbs, cold intolerance, a pale tongue with a white coating and a deep wiry pulse.

Analysis

Liver qi stagnation may transform into fire and affect the stomach, leading to distension, tightness and pain in the stomach and hypochondriac regions. Failure of the stomach qi to descend may cause belching, acid reflux, hic- cups and vomiting. Liver fire causes restlessness, irritability, a red tongue with a thin yellow coating and a wiry pulse. After attacking the liver and stomach, pathogenic cold may ascend along the pathway of the liver meridian, causing parietal headache. Pathogenic cold may impair the descending of stomach qi and result in vomiting of saliva. Cold may dam- age yang and result in cold limbs and cold intolerance. A pale tongue with a white coating and a deep wiry pulse are typical signs of yin cold.

Differentiation

Liver qi attacking the stomach in this pattern should be distinguished from damp–heat in the spleen and stomach alone. Both can have gastric disten- sion and pain, belching, acid reflux, hiccups and vomiting; however,

b1547_Ch-04.indd 175

damp–heat in the spleen and stomach may not produce symptoms involv- ing liver qi stagnation affecting the stomach. Also, cold attacking the liver and stomach needs to be distinguished from cold attacking the stomach. Both can have gastric pain and vomiting; however, cold attacking the stomach may not produce symptoms involving liver cold and qi

In document BASES DE LICITACIÓN CONCESIÓN RUTA 160 TRAMO TRES PINOS ACCESO NORTE A CORONEL (página 180-185)