Abdominal Diagnosis
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2/27/11
Abdominal Diagnosis and Herbal Medicine With Sharon Weizenbaum
Kiiko Matsumoto
1
2/27/11
Nigel Dawes
Abdominal Slides are taken from Nigel Dawes Kanpo Class.
Dr. Huang Huang
2
2/27/11
Excess
Deficiency
Zang
Fu
Blood Stasis
Glomus
6 Levels
Nan Jing Abdominal Diagnosis 16th Difficulty
3
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Liver “Consider feeling a movement in the vessels that is associated with an illness in the liver. External evidence of such an illness includes a tendency towards Udy appearance, a dark greenish face, and an inclinaUon to become angry. Internal evidence of such an illness is the presence of moving influences to the leY of the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of swollen and sUff limbs, dripping urine and difficult stools, as well as twisted muscles. If this evidence is present, the liver is afflicted. If it is not present, the liver is not afflicted”.
Nan Jing Abdominal Diagnosis 16th difficulty: Heart “Consider feeling a movement in the vessels that are associated with an illness in the heart. External evidence of such an illness includes a red face, a dry mouth and a tendency to laugh. Internal evidence of such an illness is the presence of moving influences above the navel which, if pressed respond with firmness and pain. The Illness, as perceived by the paUent, consists of uneasiness of the heart and of heartache. The center of the palms is hot, and dry vomiUng occurs. If this evidence is present, the heart is afflicted. If it is not present the heart is not afflicted”.
4
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Spleen “Consider feeling a movement in the vessels that are associated with an illness in the spleen. External evidence of such an illness includes a yellow face, a tendency to belch, a tendency to ponder, and a fondness of tasty food. Internal evidence of such an illness is the presence of moving influences right at the navel which, if pressed respond with firmness and pain. The illness, as perceived by the paUent, consists of a swollen and full abdomen; his food is not digested; his body feels heavy and the joints ache. He is Ured and weary, desires to lie down, and is unable to pull his four limbs together. It this evidence is present then the spleen is afflicted. If it is not present, the spleen is not afflicted.
Nan Jing Abdominal Diagnosis 16th difficulty: Lung “Consider feeling a movement in the vessels that are associated with an illness in the lung. External evidence of such an illness includes a white face, a tendency to sneeze, grief without joy, and an inclinaUon to cry. Internal evidence of such an illness is the presence of moving influences to the right of the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of panUng and coughing, and of shivering from fits of cold and heat. If this evidence is present, the lung is afflicted. If it is not present, the lung is not afflicted.
5
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Kidney “Consider feeling a movement in the vessels that are associated with an illness in the kidney. External evidence of such an illness includes a black face and a tendency to be fearful, as well as yawning. Internal evidence of such an illness is the presence of moving influences below the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of influences moving contrary to their proper course, tensions and pain in the lower abdomen and diarrhea, linked with a feeling as if something heavy was moving down, as well as a feeling of cold and reversed moving influences in the feet and shinbones. If this evidence is present, the kidneys are afflicted. If it is not present, the kidneys are not afflicted”.
Nan Jing Abdominal Diagnosis 16th difficulty: Kidney
6
2/27/11
3 Warmer Abdominal Diagnosis
Herbal Diagnosis is based on the Shang Han Lun Basics Moisture Color Resilience Density PaUent’s experience
Temperature Texture PulsaUons Water sounds SubstanUality
7
2/27/11
Moisture
Temperature
8
2/27/11
Color
Texture
9
2/27/11
Resilience
PulsaUons
10
2/27/11
1. Lax & Powerless Fu Bu Ruan Ruo Wu Li 腹部軟弱無力 !The abdominal wall is either thin, weak and without tonus or there may be excessive layers of fatty tissue which are flaccid and atonic. There is a marked decrease in abdominal pressure. ! !
LAX !
1. Lax & Powerless Fu Bu Ruan Ruo Wu Li 腹部軟弱無力 Even when the abdomen is lax it is not always powerless and when there IS strength in the depths then this is a sign of excess (Shi Zheng 實 証). If at the same time there is constipation, the pulse is deep and has strength and the abdomen has strength in the depths, irrespective of the lax abdomen, this is an indication for the use of a purgative!
LAX !
11
2/27/11
2. Abdominal Fullness Fu Man 腹
滿
Caused by occlusion of gas or feces. This sensation of fullness can occur in the chest and / or abdomen and causes discomfort and pressure. There may be breathing difficulties (from restricted movement of the diaphragm), gas pain and generalized aching as well as indigestion and constipation.! !
FULL!
2. Abdominal Fullness Fuku Man 腹
滿
Inside the Full Abdomen there is Deficiency Xu Zheng 虛 証 and Excess Shi Zheng 實 証. With a Full Abdomen when there is constipation it is often Excess Shi Zheng 實 証 but there are exceptions. Examples of a full abdomen with constipation which are Deficiency are many such as peritonitis. Diarrhea and a swollen abdomen together seem like an unlikely combination but they exist in the Deficiency patterns. Due to ascites the abdomen can appear full and this is often Deficiency. When the abdomen is full and has strength in the depths and there is constipation where the pulse has strength this is Excess. In the case of a Full Abdomen which may be tight on the surface and powerless in the depths and where the pulse is fine and weak, this is Deficiency. ! !
12
2/27/11
3. Epigastric Obstruction Hardness Xin Xia Pi Ying
心 下 痞 硬 Palpable resistance in the epigastric area generally neither accompanies tension of the abdominal muscles such as the rectus abdominus, nor tenderness. The patient sometimes feels pressure pain however.! !
!
!
3. Epigastric Obstruction Hardness Xin Xia Pi Ying
心 下 痞 硬 This means that when the physician palpates, they can feel tightness and resistance which conforms with the patient’s subjective complaint of a feeling of obstruction under the ribs.
!
!
!
13
2/27/11
4. Epigastric Obstruction Xin Xia Pi 心 下 痞 !
!Subjective feeling of obstruction in the pit of the stomach (epigastrium). Often accompanied by heaviness and distention.!
4. Epigastric Obstruction Xin Xia Pi 心 下 痞 This is the same Pattern 証 as for #3 without the objective feelings of tightness.!
!
!It refers to complaints of a “stuffed” feeling in the pit of the stomach when, upon examination of the area, there is neither resistance nor obstruction nor pain with pressure.!
14
2/27/11
5. Hypochondriac Painful Fullness Xiong Xie Ku Man 胸
脅
苦
and the feeling of fullness (Ku 苦 and Man 滿 ) in the hypochondriac area can occur in the subcutaneous structures outside the peritoneum, such as the muscles and fascia of the diaphragm, the greater pectoral muscles, and the upper portions of the rectus abdominus muscles. There have been reports on the relationship of 胸 脅 苦 滿 with the morbid states of splenoma, pleurisy, chronic hepatitis and hepatomegaly. It must be related to those organs in the thorax or below the diaphragm, such as the liver, stomach, spleen and pancreas. It can occur also when lymphocyte functions accelerate.! !
滿
!Tenderness
!
5. Hypochondriac Painful Fullness Xiong Xie Ku Man 胸
脅
苦
滿
!Abdomen #5 :"
There is a feeling of fullness in the hypochondrium as well as distress and pain. This may occur on both sides at the same time or on either side separately. It can be verified objectively as pressure pain and resistance. !
!
!This Pattern is clearly an indication for the use of formulas containing: 柴 胡 Chai Hu.! !
15
2/27/11
6. Hypochondriac Obstruction Hardness
Xie Xia Bi Ying 脅 下
痹 硬
Morbid State:! ! !Palpable resistance in the hypochondriac area very similar to abdomen #3 Epigastric Obstruction Hardness ! 心 下 痞 . One report says a slight swelling of the left lobe of the liver found with ultrasound examination.! ! ! !
!
7. Epigastric “Splash” Xin Xia Bu Zhen Shui 心 下 部 振 水 !When the stomach wall is relaxed and there is a certain amount of gastric juices and air in the stomach, sloshing sounds come form inside the stomach. The cause of the sound is thought to be conditions where the smooth muscles of the stomach are relaxed, as in the case of gastroptosis. In these cases peristalsis of the stomach is decreased, and gastric juices and air cannot be excreted and accumulate in the stomach lumen.! !These are signs of functional deterioration of the vagus nerve, and they usually accompany other signs of autonomic nervous system disorders.! !The sounds could occur not only in the stomach but also in the horizontal area of the duodenum, and in the jejunum when intestinal juices have accumulated.! ! !
WATER / GAS!
16
2/27/11
8. Chest and Abdomen Pulsations Xin Ji/ Xin Xia Ji/ Qi Xia Ji 心 悸
/ 心
下
悸 / 臍 下 悸
!These are pulsations of the aorta abdominalis. This is divided into the left and right common ileac arteries at the level of the umbilicus. Xin Ji 心 悸 is the pulsation of the aorta abdominalis itself. Xin Xia Ji 心下悸 could be the pulsation of the furcation of the aorta abdominalis, above the umbilicus. Qi Xia Ji 臍下 悸 could be the pulsation of a furcation below the umbilicus. In a healthy condition, the artery is situated on the floor of the abdomen and is impossible to palpate with light touch. But in the case of a patient with Deficiency Kyo Sho 虛 証 where the abdominal wall is thin and lax, it can be felt. ! !Also, in a patient with Excess 實 証 who has sympathetic nervous system strain, the pulsation of the abdominal aorta will become strong and refers to the abdominal wall where it can be felt at the surface. !
Abdomen #8 :" 1. Pulsations of the cardiac area (Xin Ji心 悸 ) when an area in the epigastric region (under the heart) is excited – the apical pulse ! 2. Epigastric pulsations (Xin Xia Ji心 下 悸 ) when the area around Ren.9 (Shui Fen) is excited. ! 3. Lower umbilicus pulsations (Qi Xia Ji 臍 下 悸 ) also known as the “movement between the Kidneys. They are all obvious pulsations of the abdominal arteries which are observable and easily palpable.! !They can be identified by looking or by palpation with a light touch of the hand. ! !Generally, when you find such pulsations in these places, it means that the heart is accelerating and the patient will soon be deficient so that diaphoretics, emetics and purgatives are forbidden (ie: anything draining the lower portion of the body)!
17
2/27/11
9. Inside Emergency Li Ji Fig.1 !
裡
急
!Due to the cold, digestive functions have deteriorated and gas and intestinal fluids are occluded or flow in the intestines causing them to expand. These vermiculations are sporadic and they do not excrete the contents of the intestines.! Fig. 2! !As neither pain on palpation nor deep pain are found generally, this strain is not related to muscle contraction such as in the reflection of an organ’s movement. Rather Li Ji 裡 急 is a result of overly strained rectus abdominus compensating for low abdominal pressure.!
Fig.1! !
Fig.2
Abdomen #9:" This Li Ji 裡 急 is detected when on the inside of the abdominal wall the skin below the surface can be seen as a spasm or felt as a contraction – Fig.1. ! If the abdominus rectus muscle goes into spasm this can be included inside this Presentation- Fig.2.! The term Li Ji 裡 急 includes both spasms of the rectus abdominus and any stiffness, spasm, jerk or “jump” that you may illicit upon pressure.! This Li Ji 裡 急 is only seen in Deficient (Xu Zheng虛 証 ) patients. !
18
2/27/11
10. Lower Abdomen Tight Contraction Shao Fu Ju Ji 少
腹
拘
急 !
!Very similar findings to the abdomen #9 Inside Emergency Li Ji裡 急 .
In this case the location of the spasms or contractions are along the rectus abdominis muscles of the lower abdomen.! !As previously stated, Li Ji裡 急 is a result of overly strained rectus abdominus compensating for low abdominal pressure.! ! !
Abdomen #10:! The site of the “small abdomen” (Shao Fu 少 腹 ) is the lower abdomen. Here, the contractions of the rectus abdominus are in the area between the navel and the pubic bone and that is where you will see the spasms. Such a case is often referred to as: “lower burner deficiency. It may also be called “Kidney Deficiency”! !This is commonly called the八味丸 Ba Wei Di Huang Wan Presentation!
19
2/27/11
11. Lower Abdomen Flaccid Shao Fu Bu Ren 少
腹
不
仁
Fig. 1 - This Pattern 腹 証 is composed by dropped tension of the linea alba in the lower abdomen and relatively exacerbated tension of the rectus abdominus muscles, backed by deterioration of abdominal pressure.! ! Fig. 2 - The structure of Median Plane Core below the umbilicus is plica umbilicalis mediana, which is felt on the median plane. On the other hand the structure above the umbilicus is ligamentus teres hepatis, the debris of the umbilical artery and the vein. Usually it cannot be palpated from the surface of the body due to adipose tissue, but when adipose tissue reduces its size and tension of the linea alba is dropped, causing a drop in abdominal pressure, it may be palpated.! !
Fig.1!
Fig.2
12. Lower Abdomen (Resistant) Fullness Shao Fu Man / Shao Fu Ying Man 少 腹 滿 / 少 腹 硬 The kind of resistance and obstruction felt by both patient and practitioner is similar to that in Otsuka abdomen #2 Abdominal Fullness. Here however the location is specifically in the lower abdomen. ! In both these Patterns, the lower abdomen is said to be inflated but in the Lower Abdomen Fu# and Hard(Fig.2) it is also hard and resistant.! ! !
滿
Fig.1
Fig.2
20
2/27/11
13. Lower Abdomen Tightly Knotted Shao Fu Ji Jie 少
腹
急
Oketsu Point! !There is hyperalgesia due to referred pain and the strain of the abdominal wall. The types of pain are strong internal organ pain and referred pain related to the internal organ perceptive reflex. The area by the left ileac fossa in a woman is known to be equivalent to the hypersensitive zone referred to the left ovary and uterine duct; the area in the right ileac fossa is often associated with the ileocecal valve, appendix and ascending colon.! Terasawa Okestu point – Tenderness around the umbilicus !This area is crowded with micro-circulation vessels such as small intestine, mesentary and caul. This suggests the existence of a morbid state of blood occlusion due to deterioration of micr-circulation such as hemostasis or hyperemia. Even though, as caul has a limited number of pain receptors, pain could be from the small intestine or mesentary due to a morbid state of blood occlusion.! ! !
結 !
21
Abdominal Diagnosis and Herbal Medicine With Sharon Weizenbaum
Kiiko Matsumoto
1
2/27/11
Nigel Dawes
Abdominal Slides are taken from Nigel Dawes Kanpo Class.
Dr. Huang Huang
2
2/27/11
Excess
Deficiency
Zang
Fu
Blood Stasis
Glomus
6 Levels
Nan Jing Abdominal Diagnosis 16th Difficulty
3
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Liver “Consider feeling a movement in the vessels that is associated with an illness in the liver. External evidence of such an illness includes a tendency towards Udy appearance, a dark greenish face, and an inclinaUon to become angry. Internal evidence of such an illness is the presence of moving influences to the leY of the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of swollen and sUff limbs, dripping urine and difficult stools, as well as twisted muscles. If this evidence is present, the liver is afflicted. If it is not present, the liver is not afflicted”.
Nan Jing Abdominal Diagnosis 16th difficulty: Heart “Consider feeling a movement in the vessels that are associated with an illness in the heart. External evidence of such an illness includes a red face, a dry mouth and a tendency to laugh. Internal evidence of such an illness is the presence of moving influences above the navel which, if pressed respond with firmness and pain. The Illness, as perceived by the paUent, consists of uneasiness of the heart and of heartache. The center of the palms is hot, and dry vomiUng occurs. If this evidence is present, the heart is afflicted. If it is not present the heart is not afflicted”.
4
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Spleen “Consider feeling a movement in the vessels that are associated with an illness in the spleen. External evidence of such an illness includes a yellow face, a tendency to belch, a tendency to ponder, and a fondness of tasty food. Internal evidence of such an illness is the presence of moving influences right at the navel which, if pressed respond with firmness and pain. The illness, as perceived by the paUent, consists of a swollen and full abdomen; his food is not digested; his body feels heavy and the joints ache. He is Ured and weary, desires to lie down, and is unable to pull his four limbs together. It this evidence is present then the spleen is afflicted. If it is not present, the spleen is not afflicted.
Nan Jing Abdominal Diagnosis 16th difficulty: Lung “Consider feeling a movement in the vessels that are associated with an illness in the lung. External evidence of such an illness includes a white face, a tendency to sneeze, grief without joy, and an inclinaUon to cry. Internal evidence of such an illness is the presence of moving influences to the right of the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of panUng and coughing, and of shivering from fits of cold and heat. If this evidence is present, the lung is afflicted. If it is not present, the lung is not afflicted.
5
2/27/11
Nan Jing Abdominal Diagnosis 16th difficulty: Kidney “Consider feeling a movement in the vessels that are associated with an illness in the kidney. External evidence of such an illness includes a black face and a tendency to be fearful, as well as yawning. Internal evidence of such an illness is the presence of moving influences below the navel which, if pressed, respond with firmness and pain. The illness, as perceived by the paUent, consists of influences moving contrary to their proper course, tensions and pain in the lower abdomen and diarrhea, linked with a feeling as if something heavy was moving down, as well as a feeling of cold and reversed moving influences in the feet and shinbones. If this evidence is present, the kidneys are afflicted. If it is not present, the kidneys are not afflicted”.
Nan Jing Abdominal Diagnosis 16th difficulty: Kidney
6
2/27/11
3 Warmer Abdominal Diagnosis
Herbal Diagnosis is based on the Shang Han Lun Basics Moisture Color Resilience Density PaUent’s experience
Temperature Texture PulsaUons Water sounds SubstanUality
7
2/27/11
Moisture
Temperature
8
2/27/11
Color
Texture
9
2/27/11
Resilience
PulsaUons
10
2/27/11
1. Lax & Powerless Fu Bu Ruan Ruo Wu Li 腹部軟弱無力 !The abdominal wall is either thin, weak and without tonus or there may be excessive layers of fatty tissue which are flaccid and atonic. There is a marked decrease in abdominal pressure. ! !
LAX !
1. Lax & Powerless Fu Bu Ruan Ruo Wu Li 腹部軟弱無力 Even when the abdomen is lax it is not always powerless and when there IS strength in the depths then this is a sign of excess (Shi Zheng 實 証). If at the same time there is constipation, the pulse is deep and has strength and the abdomen has strength in the depths, irrespective of the lax abdomen, this is an indication for the use of a purgative!
LAX !
11
2/27/11
2. Abdominal Fullness Fu Man 腹
滿
Caused by occlusion of gas or feces. This sensation of fullness can occur in the chest and / or abdomen and causes discomfort and pressure. There may be breathing difficulties (from restricted movement of the diaphragm), gas pain and generalized aching as well as indigestion and constipation.! !
FULL!
2. Abdominal Fullness Fuku Man 腹
滿
Inside the Full Abdomen there is Deficiency Xu Zheng 虛 証 and Excess Shi Zheng 實 証. With a Full Abdomen when there is constipation it is often Excess Shi Zheng 實 証 but there are exceptions. Examples of a full abdomen with constipation which are Deficiency are many such as peritonitis. Diarrhea and a swollen abdomen together seem like an unlikely combination but they exist in the Deficiency patterns. Due to ascites the abdomen can appear full and this is often Deficiency. When the abdomen is full and has strength in the depths and there is constipation where the pulse has strength this is Excess. In the case of a Full Abdomen which may be tight on the surface and powerless in the depths and where the pulse is fine and weak, this is Deficiency. ! !
12
2/27/11
3. Epigastric Obstruction Hardness Xin Xia Pi Ying
心 下 痞 硬 Palpable resistance in the epigastric area generally neither accompanies tension of the abdominal muscles such as the rectus abdominus, nor tenderness. The patient sometimes feels pressure pain however.! !
!
!
3. Epigastric Obstruction Hardness Xin Xia Pi Ying
心 下 痞 硬 This means that when the physician palpates, they can feel tightness and resistance which conforms with the patient’s subjective complaint of a feeling of obstruction under the ribs.
!
!
!
13
2/27/11
4. Epigastric Obstruction Xin Xia Pi 心 下 痞 !
!Subjective feeling of obstruction in the pit of the stomach (epigastrium). Often accompanied by heaviness and distention.!
4. Epigastric Obstruction Xin Xia Pi 心 下 痞 This is the same Pattern 証 as for #3 without the objective feelings of tightness.!
!
!It refers to complaints of a “stuffed” feeling in the pit of the stomach when, upon examination of the area, there is neither resistance nor obstruction nor pain with pressure.!
14
2/27/11
5. Hypochondriac Painful Fullness Xiong Xie Ku Man 胸
脅
苦
and the feeling of fullness (Ku 苦 and Man 滿 ) in the hypochondriac area can occur in the subcutaneous structures outside the peritoneum, such as the muscles and fascia of the diaphragm, the greater pectoral muscles, and the upper portions of the rectus abdominus muscles. There have been reports on the relationship of 胸 脅 苦 滿 with the morbid states of splenoma, pleurisy, chronic hepatitis and hepatomegaly. It must be related to those organs in the thorax or below the diaphragm, such as the liver, stomach, spleen and pancreas. It can occur also when lymphocyte functions accelerate.! !
滿
!Tenderness
!
5. Hypochondriac Painful Fullness Xiong Xie Ku Man 胸
脅
苦
滿
!Abdomen #5 :"
There is a feeling of fullness in the hypochondrium as well as distress and pain. This may occur on both sides at the same time or on either side separately. It can be verified objectively as pressure pain and resistance. !
!
!This Pattern is clearly an indication for the use of formulas containing: 柴 胡 Chai Hu.! !
15
2/27/11
6. Hypochondriac Obstruction Hardness
Xie Xia Bi Ying 脅 下
痹 硬
Morbid State:! ! !Palpable resistance in the hypochondriac area very similar to abdomen #3 Epigastric Obstruction Hardness ! 心 下 痞 . One report says a slight swelling of the left lobe of the liver found with ultrasound examination.! ! ! !
!
7. Epigastric “Splash” Xin Xia Bu Zhen Shui 心 下 部 振 水 !When the stomach wall is relaxed and there is a certain amount of gastric juices and air in the stomach, sloshing sounds come form inside the stomach. The cause of the sound is thought to be conditions where the smooth muscles of the stomach are relaxed, as in the case of gastroptosis. In these cases peristalsis of the stomach is decreased, and gastric juices and air cannot be excreted and accumulate in the stomach lumen.! !These are signs of functional deterioration of the vagus nerve, and they usually accompany other signs of autonomic nervous system disorders.! !The sounds could occur not only in the stomach but also in the horizontal area of the duodenum, and in the jejunum when intestinal juices have accumulated.! ! !
WATER / GAS!
16
2/27/11
8. Chest and Abdomen Pulsations Xin Ji/ Xin Xia Ji/ Qi Xia Ji 心 悸
/ 心
下
悸 / 臍 下 悸
!These are pulsations of the aorta abdominalis. This is divided into the left and right common ileac arteries at the level of the umbilicus. Xin Ji 心 悸 is the pulsation of the aorta abdominalis itself. Xin Xia Ji 心下悸 could be the pulsation of the furcation of the aorta abdominalis, above the umbilicus. Qi Xia Ji 臍下 悸 could be the pulsation of a furcation below the umbilicus. In a healthy condition, the artery is situated on the floor of the abdomen and is impossible to palpate with light touch. But in the case of a patient with Deficiency Kyo Sho 虛 証 where the abdominal wall is thin and lax, it can be felt. ! !Also, in a patient with Excess 實 証 who has sympathetic nervous system strain, the pulsation of the abdominal aorta will become strong and refers to the abdominal wall where it can be felt at the surface. !
Abdomen #8 :" 1. Pulsations of the cardiac area (Xin Ji心 悸 ) when an area in the epigastric region (under the heart) is excited – the apical pulse ! 2. Epigastric pulsations (Xin Xia Ji心 下 悸 ) when the area around Ren.9 (Shui Fen) is excited. ! 3. Lower umbilicus pulsations (Qi Xia Ji 臍 下 悸 ) also known as the “movement between the Kidneys. They are all obvious pulsations of the abdominal arteries which are observable and easily palpable.! !They can be identified by looking or by palpation with a light touch of the hand. ! !Generally, when you find such pulsations in these places, it means that the heart is accelerating and the patient will soon be deficient so that diaphoretics, emetics and purgatives are forbidden (ie: anything draining the lower portion of the body)!
17
2/27/11
9. Inside Emergency Li Ji Fig.1 !
裡
急
!Due to the cold, digestive functions have deteriorated and gas and intestinal fluids are occluded or flow in the intestines causing them to expand. These vermiculations are sporadic and they do not excrete the contents of the intestines.! Fig. 2! !As neither pain on palpation nor deep pain are found generally, this strain is not related to muscle contraction such as in the reflection of an organ’s movement. Rather Li Ji 裡 急 is a result of overly strained rectus abdominus compensating for low abdominal pressure.!
Fig.1! !
Fig.2
Abdomen #9:" This Li Ji 裡 急 is detected when on the inside of the abdominal wall the skin below the surface can be seen as a spasm or felt as a contraction – Fig.1. ! If the abdominus rectus muscle goes into spasm this can be included inside this Presentation- Fig.2.! The term Li Ji 裡 急 includes both spasms of the rectus abdominus and any stiffness, spasm, jerk or “jump” that you may illicit upon pressure.! This Li Ji 裡 急 is only seen in Deficient (Xu Zheng虛 証 ) patients. !
18
2/27/11
10. Lower Abdomen Tight Contraction Shao Fu Ju Ji 少
腹
拘
急 !
!Very similar findings to the abdomen #9 Inside Emergency Li Ji裡 急 .
In this case the location of the spasms or contractions are along the rectus abdominis muscles of the lower abdomen.! !As previously stated, Li Ji裡 急 is a result of overly strained rectus abdominus compensating for low abdominal pressure.! ! !
Abdomen #10:! The site of the “small abdomen” (Shao Fu 少 腹 ) is the lower abdomen. Here, the contractions of the rectus abdominus are in the area between the navel and the pubic bone and that is where you will see the spasms. Such a case is often referred to as: “lower burner deficiency. It may also be called “Kidney Deficiency”! !This is commonly called the八味丸 Ba Wei Di Huang Wan Presentation!
19
2/27/11
11. Lower Abdomen Flaccid Shao Fu Bu Ren 少
腹
不
仁
Fig. 1 - This Pattern 腹 証 is composed by dropped tension of the linea alba in the lower abdomen and relatively exacerbated tension of the rectus abdominus muscles, backed by deterioration of abdominal pressure.! ! Fig. 2 - The structure of Median Plane Core below the umbilicus is plica umbilicalis mediana, which is felt on the median plane. On the other hand the structure above the umbilicus is ligamentus teres hepatis, the debris of the umbilical artery and the vein. Usually it cannot be palpated from the surface of the body due to adipose tissue, but when adipose tissue reduces its size and tension of the linea alba is dropped, causing a drop in abdominal pressure, it may be palpated.! !
Fig.1!
Fig.2
12. Lower Abdomen (Resistant) Fullness Shao Fu Man / Shao Fu Ying Man 少 腹 滿 / 少 腹 硬 The kind of resistance and obstruction felt by both patient and practitioner is similar to that in Otsuka abdomen #2 Abdominal Fullness. Here however the location is specifically in the lower abdomen. ! In both these Patterns, the lower abdomen is said to be inflated but in the Lower Abdomen Fu# and Hard(Fig.2) it is also hard and resistant.! ! !
滿
Fig.1
Fig.2
20
2/27/11
13. Lower Abdomen Tightly Knotted Shao Fu Ji Jie 少
腹
急
Oketsu Point! !There is hyperalgesia due to referred pain and the strain of the abdominal wall. The types of pain are strong internal organ pain and referred pain related to the internal organ perceptive reflex. The area by the left ileac fossa in a woman is known to be equivalent to the hypersensitive zone referred to the left ovary and uterine duct; the area in the right ileac fossa is often associated with the ileocecal valve, appendix and ascending colon.! Terasawa Okestu point – Tenderness around the umbilicus !This area is crowded with micro-circulation vessels such as small intestine, mesentary and caul. This suggests the existence of a morbid state of blood occlusion due to deterioration of micr-circulation such as hemostasis or hyperemia. Even though, as caul has a limited number of pain receptors, pain could be from the small intestine or mesentary due to a morbid state of blood occlusion.! ! !
結 !
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