Bleeding: a TCVM Bleeding: a TCVM ApproachApproach

CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA

BleedingBleeding•Primary HemostasisPrimary Hemostasis•Complex chain of events Complex chain of events involving interaction ofinvolving interaction of

•PlateletsPlatelets•Vessel WallVessel Wall•von Willebrand’s factorvon Willebrand’s factor•FibrinogenFibrinogen

•Secondary HemostasisSecondary Hemostasis•Complex interaction of the Complex interaction of the intrinsic and extrinsic intrinsic and extrinsic clotting cascadesclotting cascades

•Stabilize the platelet plugStabilize the platelet plug

Primary HemostasisPrimary Hemostasis

•Evaluated by the Evaluated by the bleeding timebleeding time•Platelet numberPlatelet number•Amount and Quality of the Amount and Quality of the von WIllebrand’s factor von WIllebrand’s factor VIII:AgVIII:Ag•Fibrinogen concentrationFibrinogen concentration

•Other alterations due to Other alterations due to vessel wall disordersvessel wall disorders

Secondary HemostatisSecondary Hemostatis

•Assessed byAssessed by

•ACT (activated ACT (activated clotting time)clotting time)

•APTT (activated APTT (activated partial thromboplastin partial thromboplastin time)time)

•PT (prothrombin PT (prothrombin time)time)

TCM PathoetiologyTCM Pathoetiology•HeatHeat•TongueTongue

•Red & DryRed & Dry

•PulsePulse•Superficial (forceful) Superficial (forceful) & fast& fast

•Spleen Qi DeficiencySpleen Qi Deficiency•TongueTongue

•Pale & moistPale & moist

•PulsePulse•Deep & weak Deep & weak (particularly on right)(particularly on right)

Spleen Pathology Spleen Pathology

Damp Hot Damp Hot Food or Food or DrinkDrink

Damp Hot Damp Hot Environmental Environmental ConditionsConditions

Damp-Heat in SpleenDamp-Heat in Spleen

Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow

Accumulated Accumulated Heat & DampHeat & Damp

Heat HemorrhageHeat Hemorrhage•Herbal treatment depends Herbal treatment depends upon locationupon location

•BladderBladder•Red Front DoorRed Front Door

•GI tractGI tract•Sophora PowderSophora Powder

•Great Saussurea CoptisGreat Saussurea Coptis

•Red Back DoorRed Back Door

•PulmonaryPulmonary•Red LungRed Lung

•NoseNose•Single ImmortalSingle Immortal

•UterusUterus•Wu Bei SanWu Bei San

Spleen Not Controlling BloodSpleen Not Controlling Blood

HemorrhageHemorrhage

Spleen Fails to Hold BloodSpleen Fails to Hold Blood

Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs

Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency

DarbyDarby

•SignalmentSignalment•5 yr FS Doberman5 yr FS Doberman

•HistoryHistory•Generalized weaknessGeneralized weakness•EcchymosisEcchymosis•Abdominal bleedingAbdominal bleeding

•TCVM ExamTCVM Exam•Tongue: paleTongue: pale•Pulses: deep & weakPulses: deep & weak

Dx: Spleen Qi Deficiency Dx: Spleen Qi Deficiency (not holding blood in vessels)(not holding blood in vessels)

DarbyDarby

•Western RxWestern Rx

•Compressive Compressive bandagebandage

•Hemorrhage controlHemorrhage control•CryoprecipitateCryoprecipitate•Whole BloodWhole Blood•Thyroid medicationThyroid medication

•TCVM RxTCVM Rx

•APAP•SP Qi TonicSP Qi Tonic

•BL-20/21, SP-6, SP-9 BL-20/21, SP-6, SP-9 & CV-6& CV-6

•Stop HemorrhageStop Hemorrhage•Tian Ping & BL-17Tian Ping & BL-17

•HerbalHerbal•Yunnan Pai YaoYunnan Pai Yao•Huang Tu TangHuang Tu Tang

Huang Tu TangHuang Tu Tang

AtractylodesAtractylodes Bai ZhuBai Zhu Strength Spleen & tonify QiStrength Spleen & tonify Qi

Yellow EarthYellow Earth Zao Xin TuZao Xin Tu Warm Spleen & stop diarrheaWarm Spleen & stop diarrhea

AconiteAconite Fu ZIFu ZI Warm SpleenWarm Spleen

AsinumAsinum Er JiaoEr Jiao Nourish BloodNourish Blood

RehmanniaRehmannia Sheng Di HuangSheng Di Huang Nourish YinNourish Yin

ScutellariaScutellaria Huang QinHuang Qin Stop bleeding & prevent excess heatStop bleeding & prevent excess heat

LicoriceLicorice Gan caoGan cao HarmonizeHarmonize

Muscle Wasting: a TCVM Muscle Wasting: a TCVM ApproachApproach

CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA

TCM Muscle ViewTCM Muscle View

•Muscle volume & Muscle volume & strength is under the strength is under the domain of the Spleendomain of the Spleen

•Spleen transforms food Spleen transforms food and transports it to the and transports it to the body to provide energy & body to provide energy & building blocks.building blocks.•Spleen Qi provides Spleen Qi provides muscle strengthmuscle strength

•Liver blood provides Liver blood provides enduranceendurance

•Continued delivery of Continued delivery of Spleen Qi to musclesSpleen Qi to muscles

Western View of Muscle Western View of Muscle WastingWasting

•Generalized WastingGeneralized Wasting

•MalnutritionMalnutrition•Insufficient intake of materials Insufficient intake of materials to support Spleen Qito support Spleen Qi

•Cardiac CachexiaCardiac Cachexia•Heart failure leads to stagnation Heart failure leads to stagnation of bloodof blood•Liver is unable to support Liver is unable to support distribution of blood & Qidistribution of blood & Qi•Leads to accumulation of Damp Leads to accumulation of Damp in Spleenin Spleen•Results in Spleen Qi Deficiency Results in Spleen Qi Deficiency with failure to provide energy with failure to provide energy and building materials to the and building materials to the musclesmuscles

•Cancer CachexiaCancer Cachexia•Tumor Necrosis Factor poisons Tumor Necrosis Factor poisons metabolism leading to Spleen Qi metabolism leading to Spleen Qi DeficiencyDeficiency

•Diminished effective delivery Diminished effective delivery of energy to musclesof energy to muscles

•Localized WastingLocalized Wasting

•TraumaTrauma•Local damage of muscleLocal damage of muscle

•Disuse AtrophyDisuse Atrophy•Local stagnation results in Local stagnation results in Liver failure to support Liver failure to support Spleen/StomachSpleen/Stomach•Accumulation of Damp alters Accumulation of Damp alters Spleen functionSpleen function•Local stagnation decreases Local stagnation decreases delivery of nutrientsdelivery of nutrients

•Neurogenic AtrophyNeurogenic Atrophy•Denervation leads to local liver Denervation leads to local liver stagnationstagnation•Results in failure to support Results in failure to support spleen Qispleen Qi•Leads to decreased delivery of Leads to decreased delivery of local channel energylocal channel energy

Wei SyndromeWei SyndromeDamp HeatDamp Heat •Earth personalityEarth personality

•ObesityObesity•History of damp heat in skin or GIHistory of damp heat in skin or GI•Muscle atrophyMuscle atrophy•WeaknessWeakness•LethargyLethargy•Greasy wet tongueGreasy wet tongue•Fast pulseFast pulse

Si Miao SanSi Miao San

Qi/Yang Qi/Yang DeficiencyDeficiency

•Lethargy, shortness of breath, Lethargy, shortness of breath, weaknessweakness•Too weak to get up to walkToo weak to get up to walk•Loose lipsLoose lips•Loose stoolLoose stool•Anorexia & EmaciationAnorexia & Emaciation•Dry-burnt hairDry-burnt hair•EdemaEdema•Heat seekingHeat seeking•Pale wet tonguePale wet tongue•Thready & weak pulseThready & weak pulse

Bu Yang Huan WuBu Yang Huan Wu

Qi/Yin DeficiencyQi/Yin Deficiency •EmaciationEmaciation•Weakness in lumbar regionWeakness in lumbar region•Heat seekingHeat seeking•Dry skinDry skin•Pale or red & dry tonguePale or red & dry tongue•Weak & thready pulseWeak & thready pulse

Hindquarter Hindquarter formulaformula

JakeJake

•HistoryHistory•Progressive weakness in Progressive weakness in rear legsrear legs•Cool seekingCool seeking•Rear leg muscle atrophyRear leg muscle atrophy•Dry hair & skinDry hair & skin

•TCVM ExamTCVM Exam•Pulses deep & weak (< R)Pulses deep & weak (< R)•Red dry tongueRed dry tongue

DX: Qi/Yin DeficiencyDX: Qi/Yin Deficiency

Jake’s TreatmentJake’s Treatment

• APAP• EAEA• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai huiSP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui

• DNDN• BL20, BL23, BL26, KID3BL20, BL23, BL26, KID3

• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26

• HerbalHerbal• Jia Bing FangJia Bing Fang

Jia Bing FangJia Bing Fang

Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify QiCondonopsis Condonopsis Dang Shen Dang Shen Tonify QiTonify QiPolygonum Polygonum He Shou Wu He Shou Wu Nourish Blood and JingNourish Blood and JingRehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Blood, Yin and JingNourish Blood, Yin and JingPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Blood and soothe Liver QiNourish Blood and soothe Liver QiDioscorea Dioscorea Shan Yao Shan Yao Tonify Qi and nourish JingTonify Qi and nourish JingPrunella Prunella Xia Ku Cao Xia Ku Cao Soothe Liver Qi, clear HeatSoothe Liver Qi, clear HeatCyperus Cyperus Xiang Fu Xiang Fu Move Liver Qi and relieve nodulesMove Liver Qi and relieve nodulesBupleurum Bupleurum Chai Hu Chai Hu Soothe Liver QiSoothe Liver QiSargassum Sargassum Hai Zao Hai Zao Transform phlegm, clear Heat, softenTransform phlegm, clear Heat, soften

the hardnessthe hardnessLaminaria Laminaria Kun Bu Kun Bu Transform phlegm, soften theTransform phlegm, soften the

hardness, drain waterhardness, drain water

SamSam

•HistoryHistory•Chronic rear leg Chronic rear leg weakness and muscle weakness and muscle wastingwasting•Dry hairDry hair•Weight lossWeight loss

•TCVM ExamTCVM Exam•Red dry tongueRed dry tongue•Weak thready pulses (< R)Weak thready pulses (< R)

DX: Qi/YinDeficiencyDX: Qi/YinDeficiency

Sam’s TreatmentSam’s Treatment

• APAP• DNDN• GV20, BL20, BL23, BL26GV20, BL20, BL23, BL26

• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26

• HerbalHerbal• Hindquarter formula (tea pills)Hindquarter formula (tea pills)

Hindquarter FormulaHindquarter Formula

Eucommia Eucommia Du Zhong Du Zhong Tonify Kidney & strengthen backTonify Kidney & strengthen back

AchyranthesAchyranthes Niu Xi Niu Xi Tonify Kidney & strengthen the hind limbsTonify Kidney & strengthen the hind limbs

Lindera Lindera Wu Yao Wu Yao Move Qi and relieve painMove Qi and relieve pain

Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify Qi

Apis Apis Feng Hua Fen Feng Hua Fen Tonify Qi and YinTonify Qi and Yin

Morinda Morinda Ba Ji Tian Ba Ji Tian Warm and strengthen the backWarm and strengthen the back

Angelica Angelica Dang Gui Dang Gui Nourish BloodNourish Blood

Rehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Yin and JingNourish Yin and Jing

Cinnamon Cinnamon Gui Zhi Gui Zhi Warm the Channels and benefit the limbsWarm the Channels and benefit the limbs