Guest guest Posted October 20, 2004 Report Share Posted October 20, 2004 Hi All, " Treatment is predicated based on pattern discrimination " The above is perhaps the most fundamental statement of fact in TCM and if you would ask any chinese trained practitioner what the most important statement about TCM is, most would repeat this statement. To diagnose a pattern requires the collection of a few symptoms,i.e. more than one as very rarely does a symptom only correspond to one pattern. Here are the patterns for Bruxism mentioned in the TCM literature, specifically " The treatment of disease in TCM " - a 7 volume set by Philippe Sionneau and Lu Gang:- 1. Exuberant fire of the heart and stomach: Grinding of the teeth with sound, vexation(restlessness), bad breath, thirst for chilled drinks, easy hunger, vomiting, clamoring stomach (borborygmus), red tongue with yellow dry coat, slippery and rapid pulse. 2. Accumulation and stagnation of food and drink: Grinding of the teeth during sleep, insomnia, glomus and oppression in the chest and stomach, no thought for food, indigestion, fatigued spirit, inhibited defecation, diarrhea with abdominal pain, or constipation, dark-colored urine, slimy and slightly yellow tongue fur, and a slippery,replete pulse. 3. Roundworms harassing internally: Grinding of the teeth during sleep, glomus in the stomach, intermittent abdominal pain, dirty habits (such as not washing ones hands before eating), adictions to particular foods, a sallow facial complexion, emaciation, possible itching in the nostrils, blue macules or speckles in the whites of the eyes, roundworm macules of white color on the face, translucent milliary eruptions on the insides of the lips, bright red speckled eruptions on the tip of the tongue or on the sides of the midline of the tongue, a pale red tongue with white coat, and a wiry, slippery pulse 4. Qi and blood vacuity: grinding of the teeth with low sound, bright pale facial complexion, reduced qi with disinclination to speak, pale lips and nails, dizziness and vertigo, heart palpitations, tinnitus, a fat, pale tongue with thin, white coat and a fine, weak or vacuous, large pulse. 5. Liver wind stirring internally (with yin vacuity): grinding of the teeth with sound, tremors of the hands and feet, convulsions in severe cases, redness above the cheekbones, nightsweats, vexatious heat in the five hearts, dry mouth and throat, red tongue with little moisture and a fine, rapid, deep pulse As you can see bruxism can be from many patterns, this client may have liver qi stagnation no doubt, but her bruxism may be due to another pattern that she has as well. Also remember that liver qi stagnation over time produces heat, this heat may then either rsult in heat in the heart and stomach pattern or the liver wind pattern. You should look at these patterns and their characteristic signs and symptoms and determine which best fits your client then do the treatment that is suggested for that pattern P.S. The patterns etc. above have all been taken from the book mentioned with very minor modification to facilitate easier understanding of some of the terms Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2004 Report Share Posted October 20, 2004 Hi Feroz, Does the book include point recommendations for the treatment of Bruxism under each of these patterns? Kind regards Dermot - " folatib " <folatib <Chinese Medicine > Wednesday, October 20, 2004 9:29 PM Bruxism/grinding patterns > > > > Hi All, > > " Treatment is predicated based on pattern discrimination " > > The above is perhaps the most fundamental statement of fact in TCM > and if you would ask any chinese trained practitioner what the most > important statement about TCM is, most would repeat this statement. > > To diagnose a pattern requires the collection of a few symptoms,i.e. > more than one as very rarely does a symptom only correspond to one > pattern. > > Here are the patterns for Bruxism mentioned in the TCM literature, > specifically " The treatment of disease in TCM " - a 7 volume set by > Philippe Sionneau and Lu Gang:- > > 1. Exuberant fire of the heart and stomach: > Grinding of the teeth with sound, vexation(restlessness), bad > breath, thirst for chilled drinks, easy hunger, vomiting, clamoring > stomach (borborygmus), red tongue with yellow dry coat, slippery and > rapid pulse. > > 2. Accumulation and stagnation of food and drink: > Grinding of the teeth during sleep, insomnia, glomus and oppression > in the chest and stomach, no thought for food, indigestion, fatigued > spirit, inhibited defecation, diarrhea with abdominal pain, or > constipation, dark-colored urine, slimy and slightly yellow tongue > fur, and a slippery,replete pulse. > > 3. Roundworms harassing internally: > Grinding of the teeth during sleep, glomus in the stomach, > intermittent abdominal pain, dirty habits (such as not washing ones > hands before eating), adictions to particular foods, a sallow facial > complexion, emaciation, possible itching in the nostrils, blue > macules or speckles in the whites of the eyes, roundworm macules of > white color on the face, translucent milliary eruptions on the > insides of the lips, bright red speckled eruptions on the tip of the > tongue or on the sides of the midline of the tongue, a pale red > tongue with white coat, and a wiry, slippery pulse > > 4. Qi and blood vacuity: > grinding of the teeth with low sound, bright pale facial complexion, > reduced qi with disinclination to speak, pale lips and nails, > dizziness and vertigo, heart palpitations, tinnitus, a fat, pale > tongue with thin, white coat and a fine, weak or vacuous, large > pulse. > > 5. Liver wind stirring internally (with yin vacuity): > grinding of the teeth with sound, tremors of the hands and feet, > convulsions in severe cases, redness above the cheekbones, > nightsweats, vexatious heat in the five hearts, dry mouth and > throat, red tongue with little moisture and a fine, rapid, deep pulse > > As you can see bruxism can be from many patterns, this client may > have liver qi stagnation no doubt, but her bruxism may be due to > another pattern that she has as well. Also remember that liver qi > stagnation over time produces heat, this heat may then either rsult > in heat in the heart and stomach pattern or the liver wind pattern. > > You should look at these patterns and their characteristic signs and > symptoms and determine which best fits your client then do the > treatment that is suggested for that pattern > > P.S. The patterns etc. above have all been taken from the book > mentioned with very minor modification to facilitate easier > understanding of some of the terms > > Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2004 Report Share Posted October 21, 2004 Hi Yes, the book does give point recommendations as well as herbs suggestions but before I mention them I came across a note by the author regarding bruxism, he says that bruxism is a common symptom among female patients in western countries who either complain of 'tmj' or grinding their teeth at night. The author goes on to say that they also commonly suffer from neck and shoulder tension and restless sleep and insomnia and typically from a thorough investigation and questioning going through the ten questions etc. the most common pattern in his opinion is a complex pattern of " spleen vacuity leading to qi and blood vacuity, liver depression (stagnation) with depressive heat, and an element of underlying kidney vacuity " (i.e a combination of the third and fourth pattern with the addition of spleen vacuity and liver qi stagnation) and that they usually do not manifest the full blown signs of the liver- wind pattern. That said here are the point recommendations as well as the suggested herbal formulas both of which should be suitably modified to fit the other characteristics of the patient's pattern. 1. heart and stomach fire: P7, H7, P6, CV12, ST44 herbs: Qing Wei San 2. Accumulation and stagnation of food and drink: CV15, CV10, CV21, ST36 + moxa CV8 (if there is cold pain in the abdomen) herbs: Bao He Wan 3. Roundworms harassing internally: CV12, Sp15, P6, Sp4, St36, Bai Chong Wo (this is a special point for worms (and itching as well) 1 cun superior to Sp10) herbs: Wu Mei Wan 4. Qi and blood vacuity: St36, Sp6, BL15, BL20, BL17 herbs: Ba Zhen Tang (although i would prefer Xao Yao Wan in this case) 5. Liver wind stirring internally: Liv3, GB20, Ki3, Sp6 herbs: Zhen Gan Xi Feng Tang Of course it would be a matter of principle to add local points around the region of the mouth, TMJ etc in addition to the above point formulas. This is what is mentioned in the book, I personally would also add some ear points, probably the tranquiliser point, ear-Shenmen and a third point found by reflex sensitivity in the corresponding mouth/teeth/facial/tmj area of the ear using one ear per treatment, the right for female, left for male. Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 folatib wrote: > > Hi > > Yes, the book does give point recommendations as well as herbs > suggestions but before I mention them I came across a note by the > author regarding bruxism, he says that bruxism is a common symptom > among female patients in western countries who either complain > of 'tmj' or grinding their teeth at night. The author goes on to say > that they also commonly suffer from neck and shoulder tension and > restless sleep and insomnia and typically from a thorough > investigation and questioning going through the ten questions etc. Hi Feroz! Ten questions? We had over a hundred when I trained. Ten would be very efficient, if that approach worked. What are the ten questions? Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 Chinese Medicine , Pete Theisen <petet@a...> wrote: > > Hi Feroz! > > Ten questions? We had over a hundred when I trained. Ten would be very > efficient, if that approach worked. > > What are the ten questions? > > Regards, > > Pete Ten Questions Song Zhang Jiebin (1563-1640) First ask hot and cold, second ask sweat, Third ask head and body, fourth ask stools and urine, Fifth ask food and drink, sixth ask chest, Seventh ask hearing, eighth ask thirst, Ninth ask old disease, tenth ask cause. In taking medicinals, what changes appear. Women especially, ask the time of menses, slow, fast, block or flood. For children, add experience with measles and chicken pox. (*Practical Diagnosis in Traditional , Deng Tietao, 1999 p.64) since the Ming period, the questions have changed and expanded somewhat but the classic 10 questions is still the standard format for the asking examination in TCM. frankly speaking, i'm kind of surprised you weren't exposed to this in differential diagnosis class. robert hayden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 Hi May I add, from personal experience, the pattern of Blood Stasis. I had a patient who went round and round with the below diagnoses until I finally ventured into a strict pattern identification of the patient and treated her with Xue Fu Zhu Yu Tang to which she responded beautifully and immediately. Liver Qi stag. can also turn into Blood Stasis over time. She also had mood swings and severe shaking of arms and legs when upset but few other symptoms of Blood Stasis proper. You just never know until you think for yourself sometimes--or keep trying new things. Shanna Chinese Medicine , " folatib " <folatib> wrote: > > > Hi All, > > " Treatment is predicated based on pattern discrimination " > > The above is perhaps the most fundamental statement of fact in TCM > and if you would ask any chinese trained practitioner what the most > important statement about TCM is, most would repeat this statement. > > To diagnose a pattern requires the collection of a few symptoms,i.e. > more than one as very rarely does a symptom only correspond to one > pattern. > > Here are the patterns for Bruxism mentioned in the TCM literature, > specifically " The treatment of disease in TCM " - a 7 volume set by > Philippe Sionneau and Lu Gang:- > > 1. Exuberant fire of the heart and stomach: > Grinding of the teeth with sound, vexation(restlessness), bad > breath, thirst for chilled drinks, easy hunger, vomiting, clamoring > stomach (borborygmus), red tongue with yellow dry coat, slippery and > rapid pulse. > > 2. Accumulation and stagnation of food and drink: > Grinding of the teeth during sleep, insomnia, glomus and oppression > in the chest and stomach, no thought for food, indigestion, fatigued > spirit, inhibited defecation, diarrhea with abdominal pain, or > constipation, dark-colored urine, slimy and slightly yellow tongue > fur, and a slippery,replete pulse. > > 3. Roundworms harassing internally: > Grinding of the teeth during sleep, glomus in the stomach, > intermittent abdominal pain, dirty habits (such as not washing ones > hands before eating), adictions to particular foods, a sallow facial > complexion, emaciation, possible itching in the nostrils, blue > macules or speckles in the whites of the eyes, roundworm macules of > white color on the face, translucent milliary eruptions on the > insides of the lips, bright red speckled eruptions on the tip of the > tongue or on the sides of the midline of the tongue, a pale red > tongue with white coat, and a wiry, slippery pulse > > 4. Qi and blood vacuity: > grinding of the teeth with low sound, bright pale facial complexion, > reduced qi with disinclination to speak, pale lips and nails, > dizziness and vertigo, heart palpitations, tinnitus, a fat, pale > tongue with thin, white coat and a fine, weak or vacuous, large > pulse. > > 5. Liver wind stirring internally (with yin vacuity): > grinding of the teeth with sound, tremors of the hands and feet, > convulsions in severe cases, redness above the cheekbones, > nightsweats, vexatious heat in the five hearts, dry mouth and > throat, red tongue with little moisture and a fine, rapid, deep pulse > > As you can see bruxism can be from many patterns, this client may > have liver qi stagnation no doubt, but her bruxism may be due to > another pattern that she has as well. Also remember that liver qi > stagnation over time produces heat, this heat may then either rsult > in heat in the heart and stomach pattern or the liver wind pattern. > > You should look at these patterns and their characteristic signs and > symptoms and determine which best fits your client then do the > treatment that is suggested for that pattern > > P.S. The patterns etc. above have all been taken from the book > mentioned with very minor modification to facilitate easier > understanding of some of the terms > > Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 Hi Pete You're right actually there aren't only ten questions and what it actually means is the ten categories of traditional questions of which there are slight variations but I usually go through the following (i.e after getting as much information as possible about the chief complaint): 1. Asking about hot and cold (some authors say asking about the patient's subjective sensation of temperature) for eg. Do they have an aversion to cold, prefer cold drinks or hot drinks, have alternating chills and fever etc. 2. Asking about perspiration night sweating, spontaneous sweating, sweating during an external pathogen, from which parts of the body do they sweat excessively etc. 3. asking about sleep difficulty falling off to sleep or staying asleep? profuse dreaming/no recollection of dreams etc. 4. asking about stools/urine quantity, form, pain, lack of atc. 5. asking about appetite cravings, rapid hungering etc. 6. asking about the menses in women 7. asking about mental/emotional status 8. asking about the head and body pains, paralysis, numbness, tremors etc. 9. asking about the chest feeling of constriction, pain etc 10.asking about thirst thirst without drinking, thirst for chilled drinks and drinking in sips, no thirst etc. within each category you could ask at least ten questions which would = 100 and this should give you the overall pattern of your client. there is variation in these questions between authors but they generally follow the same basis, i hope to post a list soon of about 50 questions(+/- 5 per category) which can be easily memorised and could facilitate an efficient diagnosis of the pattern in combination with the tongue and pulse findings, unfortunately i dont think only ten questions would be sufficient to determine the patients pattern but i do believe that if we observe keenly, listen and smell properly, ask the right questions and palpate with concentration it would be possible to form a diagnosis from ten or less questions - until then in the interests of the best care for our clients, it may have to be 50 to 100. Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 Hi Shanna Thank you for sharing your experience, this is exactly what TCM is about, the patterns suggested for any illness are not exhaustive and they themselves have come from the combination of the classics and the experience and observation of practitioners who did a thorough examination putting all the signs and symptoms, appearance, pulse and tongue and determined that their patient presenting with whatever problem had for eg. blood stasis, and then it happened again, another patient came in with the same chief complaint and after putting all the signs and symptoms etc together = blood stasis again and therefore blood stasis came to be known as a pattern associated with disease X just as today from your experience we know that blood stasis is associated with bruxism in addition to the other patterns that other experienced practitioners have found to be associated with it. In China symposia and conferences are regularly held to discuss and refine the signs and symptoms of the classic patterns as well as the patterns of different diseases bringing together the experiences of professional practitioners from all over the country and the world. TCM is an evolving medicine but in its evolution it is important to keep in mind that its basis is still the classics upon which new knowledge is built and the fundamental statement of fact that I mentioned in my initial posting on this topic will still remain the cornerstone of TCM, that " treatment is predicated based on pattern discrimination " and to get to a pattern we require a group of symptoms that come together to form a pattern like you recognised in your client. Thank you for your post, I really appreciate it and will definitely keep it in mind when the next patient comes in with bruxism, i'll immediately (hopefully) bring up the now 6 patterns in my mind and see whether they fit into any sufficiently enough to warrant the diagnosis of that pattern and if they dont I'll go through the entire examination to determine what pattern or combined patterns they are presenting with and I will base my treatment on that pattern discrimination. Another thing I would like to say is that it is important to consider the evidence of why we have chosen a particular diagnosis when we do so as this will infinitely refine our practice skills and knowledge and provide a basis for other practitioners to understand why we have chosen that pattern, for eg. in the case of blood stasis it is relatively easy as most disease will cause blood stasis over time as it is said in the classics " new diseases are in the channels, old diseases are in the network vessels " and what is meant is that old diseases result in blood stasis in the network vessels, but as well other signs of blood stasis should be present albeit just one eg. localised severe pain/black sooty facial complexion/mood bordering on paranoia/pain worse at night/ presence of varicose veins or superficial purple venules in the local area/ choppy pulse etc/ dark menstrual clots/ dysmenorrhea etc which can be confirmed by a TCM patterns book. Yeah, I know, I write too much..sorry for going on and on, Thanx again Feroz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2004 Report Share Posted October 23, 2004 within each category you could ask at least ten questions which would = 100 and this should give you the overall pattern of your client. there is variation in these questions between authors but they generally follow the same basis, i hope to post a list soon of about 50 questions(+/- 5 per category) which can be easily memorised and could facilitate an efficient diagnosis of the pattern in combination with the tongue and pulse findings, unfortunately i dont think only ten questions would be sufficient to determine the patients pattern but i do believe that if we observe keenly, listen and smell properly, ask the right questions and palpate with concentration it would be possible to form a diagnosis from ten or less questions [Jason] This is an important skill that many practitioners were never exposed to. I had a great teacher that always wanted us to come up with the dx within 5 minutes. If one understands the possible pathomechanisms that can be causing a given condition one can easily eliminate or confirm patterns with key questions instead of asking every question under the sun. This focus also allows one to stay focused and not get to involved with extrenous information. (Just my opinion) -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2004 Report Share Posted October 23, 2004 kampo36 wrote: <snip> > frankly speaking, i'm kind of surprised you weren't exposed to this > in differential diagnosis class. > Hi Robert! Well, yes, but . . . They didn't call it " 10 questions " and there were many more than ten. Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2004 Report Share Posted October 23, 2004 folatib wrote: > > Hi Pete > > You're right actually there aren't only ten questions and what it > actually means is the ten categories of traditional questions of > which there are slight variations but I usually go through the > following (i.e after getting as much information as possible about > the chief complaint): > > 1. Asking about hot and cold (some authors say asking about the > patient's subjective sensation of temperature) > for eg. Do they have an aversion to cold, prefer cold drinks or hot > drinks, have alternating chills and fever etc. > 2. Asking about perspiration > night sweating, spontaneous sweating, sweating during an external > pathogen, from which parts of the body do they sweat excessively etc. > 3. asking about sleep > difficulty falling off to sleep or staying asleep? profuse > dreaming/no recollection of dreams etc. > 4. asking about stools/urine > quantity, form, pain, lack of atc. > 5. asking about appetite > cravings, rapid hungering etc. > 6. asking about the menses in women > 7. asking about mental/emotional status > 8. asking about the head and body > pains, paralysis, numbness, tremors etc. > 9. asking about the chest > feeling of constriction, pain etc > 10.asking about thirst > thirst without drinking, thirst for chilled drinks and drinking in > sips, no thirst etc. > > > within each category you could ask at least ten questions which > would = 100 and this should give you the overall pattern of your > client. there is variation in these questions between authors but > they generally follow the same basis, i hope to post a list soon of > about 50 questions(+/- 5 per category) which can be easily memorised > and could facilitate an efficient diagnosis of the pattern in > combination with the tongue and pulse findings, unfortunately i dont > think only ten questions would be sufficient to determine the > patients pattern but i do believe that if we observe keenly, listen > and smell properly, ask the right questions and palpate with > concentration it would be possible to form a diagnosis from ten or > less questions - until then in the interests of the best care for > our clients, it may have to be 50 to 100. Hi Feroz! This is great, thanks. Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2004 Report Share Posted October 23, 2004 Chinese Medicine , Pete Theisen <petet@a...> wrote: > > Hi Robert! > > Well, yes, but . . . > > They didn't call it " 10 questions " and there were many more than ten. > > Regards, > > Pete just out of curiosity, what school did you go to? rh Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2004 Report Share Posted October 24, 2004 kampo36 wrote: > > > Chinese Medicine , Pete Theisen <petet@a...> wrote: > > >>Hi Robert! >> >>Well, yes, but . . . >> >>They didn't call it " 10 questions " and there were many more than ten. >> >>Regards, >> >>Pete > > > just out of curiosity, what school did you go to? > Hi RH! Florida Institute of Traditional , St. Petersburg. Regards, Pete Quote Link to comment Share on other sites More sharing options...
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