TCM dermatology – Flashcards
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Wai ke xue
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External medicine
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Two disease types in Wai ke xue
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1- Chuang yang 2- Dermatology
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Chuang yang two meanings
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Narrow- superficial infectious disease general- superficial external diseases
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Four categories of Wai ke xue included historically
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Orthopaedics and traumatology, OENT, Anus, masses
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Yong= carbuncle, boil, furuncle
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Acute purulent disease nei yong- internal carbuncle appendicitis, Wai yong- external carbuncle mastitis
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Signs and symptoms of yong
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Red, hot, painful, swollen, 6-9cm
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Ju/ boil differentiation
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Greater than 9cm, You tou ju- on flesh, minute sized head wu tou ju- in bone/joint
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Fa/ bigger carbuncle differentiation
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Located in soft tissue are (cellulitis), red, swollen, itchy, develops very fast
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Jie/furuncle differentiation
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Very superficial, local red, hot, painful, less than 3cm
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Lian Chuang/shank ulcer
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1/3 lower leg, hard to heal b/c poor circulation, need to improve circulation= tonight qi and blood
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Chuang definition
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Superficial Papulas, herpes rashes, eczema break and cause erosion and oozing
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Ban
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Skin colour change
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Zhen
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Rashes, eczema rash
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Xuan
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Tinea ring worm
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Jie
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Scabies, very highly infectious, very itchy
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Feng/wind
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Diseases with an acute onset and develop very quickly
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Du/toxin
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Disease develops very fast and is very serious, very likely contagious
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Tan/phlegm
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Mass/nodule- not to soft or hard, doesn't develop fast, skin coloured, can break and can release sticky or cotton like substance
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Naming principles
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Location ( Chang yong) pt name (ren Zheng ding), organ name (fe yong), pathogen (xi feng) , manifestation (shi tou ding), , colour (dan du), size (yong, jie, ju)
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Ethology and pathology
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Caused by epi, toxin, injury, emotions, diet which create stagnation of qi and blood leading to meridian blockage and organ disorders
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Early stage carbuncle
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Still hard- want to break up stagnation = clear heat and detox, warm and resolve cold or tonify qi and nourish blood to promote circulation
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Middle stage carbuncle
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Hardness breaks and turns to pus and begins to rot area, middle becomes soft to touch dead tissue must be fully drained or cut
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Final stage carbuncle
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Carbuncle breaks and outs drains, new flesh begins to regenerate need to tonify qi and blood and promote circulation
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Yang Ming prognosis
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Easily cured b/c abundant in qi and blood
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Tai yang/ Jue yin prognosis
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More blood, less qi need to move blood and tonify qi
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Shao yang/shaoyin/tai yin
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More qi, less blood need to move qi and nourish blood
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Upper body pathogens
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Wind- wind heat, wind warmth
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Middle body pathogens
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Stagnation- qi, heat, fire, blood
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Lower body pathogens
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Damp- damp cold, damp heat
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Yin syndrome differentiation by palpation
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Unclear border, location uncertain, diffuse, mild heat/warmth, mild pain
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Yang syndrome differentiation by paplation
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Clear border, obvious location, obvious height, hot, painful
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Pus differentiation
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Good- clear, yellow with lustre, thick, no foul smell/maybe fishy Bad- clear, thin, dull, white/red mixed in, continues to grow
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Early stage treatment
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Resolving/xiao- clear blockage, determine deficiency or excess and balance energies
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Middle stage treatment
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Supporting/tuo- tonify Zheng qi to push out toxin,
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Late stage treatment
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Tonify/bu= If tissue continues to be damaged- tonify Zheng qi to fight pathogen If regeneration tissue- tonify SP qi and blood
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Ding chuang
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Deep rooted boil, malignant boil,
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Ding Chuang signs and symptoms
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Acute purulent disease, develops very fast, easily becomes septic, most common on face/head and hands/feet, high fever, restless, spirit disturbed- dizzy, confused, lose consciousness
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Ding chuang etiology and pathology
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1. emotions -qi stagnation- fire 2. Diet- greasy, thick, hot food accumulates and becomes fire 3. Attack by heat, summer heat 4. Toxin invasion- bite, skin rupture infected
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Ding chuang early stage differenetiation
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Tiny millet like pustule head, maybe painful, numb or itchy, red, hot, 3-6cm diameter deep, mild chills, fever,...
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Ding chuang middle stage differentiation
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5-7 days, middle part enlarged, more painful, pustule head may break by itself, high fever, constipated, scanty yellow urine, thirsty
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Ding chuang later stage differentiation
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7-10 days, if Zheng qi strong- pustule breaks, decreases in size, pus drains, softens, symptoms reduce and disappear over 10-14 days. If not treated well or Zheng qi weak- can last longer or become septic. Can move deeper and create abscesses in organs, bones, etc.
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Ding chuang treatment
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Clear heat, drain fire, detoxify. DU, yang Ming, tai yang. Reducing technique, bleeding, cupping, guasha pts- du10, du12, li4, li11, ub40 (reduce with acu then cup to drain bl), look for rashes along vertebrae (sterilize and break to clear heat), lI face area- li1, li2 ST face area- St45, st44, st41 GB face area- gb43
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Yong
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Carbuncle, acute purulent disease
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Yong signs and symptoms
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Local- red, swollen, hot, painful, 6-9cm diameter, heat toxin stuck in body
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Ru yong
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Mastitis nei chui ru Yong- during pregnancy Wai chui ru Yong- during breastfeeding
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Ru Yong etiology and pathology
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1. Diet- eat too much think, greasy, hot, spicy food after birth, heat stagnates in foot yang Ming 2. Emotions/nervousness-liver qi stagnation especially around breast 3. Nipple/breast damaged and toxin enters 4. Depressed nipple- milk gets stuck
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Ru Yong early stage differentiation
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Swollen, painful masses in breast, milk doesn't flow well, maybe milk general symptoms
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Ru Yong middle stage differentiation
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More painful, hot, red, chills, fever, etc. Later part turns to pus
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Ru Yong later stage differentiation
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If pus clears well, symptoms reduce and skin heals. If pus not cleared well, symptoms will remain
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Ru Yong prevention
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Late pregnancy- bath nipples/breasts in warm water. If nipples sunken- begin to pull outwards. After delivery- if mother has excess milk express it completely after feeding, treat any injury/wound to breast immediately
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Ru Yong treatment
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ST heat accumulation- clear heat, resolve accumulation, reducing technique, yang Ming channels. Pts- st16, st39, st40, li7 +li4, gb20- headache, fever +rn17, pc6, si1- milk ducts blocked. LV qi stag- soothe liver to relieve constraint, reducing technique jue yin channels. Pts- lv14, lv2, pc6, pc1, gb21
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Ru Yong Tui na
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Use tips of fingers to push from base of breast to nipples. avoid hard, steady pressure or circling. Before apply warm towel to breast. After Tui Na gently stretch/pull the nipple to expel milk
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Ru pi
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Breast lump/fibroid
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Ru Pi signs and symptoms
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Common, chronic, benign condition resulting in lumps/masses in breasts. One of more masses in breast with hard texture with smooth surface and clear border, movable, no pain, maybe mild distending ache, no change to skin or general symptoms, masses will not break, commonly change size with emotions, menses and pregnancy, size from pea to egg.
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Ru Pi differentiation
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LV qi stag- emotions, change in size, LV channel pain, distending pain, st qi rebellion, painful or late menses, wiry pulse. Phlegm/turbid accumulation- dizzy, nausea, bloating, distension, greasy tongue, slippery pulse, may have other lipomas. LV/KD yin xu- typically patient has chronic disease, tidal fever, night sweats, Malar flush, dizziness, tinnitus, lumbago, scanty/late menses or amenorrhea, red thin tongue.
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Ru Pi treatment
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LV qi stag- soothe liver, regulate qi- st15, st16, pc6, rn17, gb34, lv3 + rn6, sp6- period disorders. Phlegm- resolve phlegm unblock collaterals- st15, st40, rn17, ub22, rn12, pc6 +yintang, sishencong- dizziness. LV/KD yin xu- nourish yin, clear empty fire, kd5, lv5, st18, ub23, kd3, bailao, ub43
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Ru xian Zheng shang
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Hyperplasia of mammary gland
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Ru xian Zheng Shang signs and symptoms
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Very common 70-85% of women aged 30-40, endocrine disorder, usually both breasts, variable size masses with unclear border, size and pain change with menses, LV, Chong, ren involved
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Ru li
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Gynecomastia
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Ru li signs and symptoms
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Common among men, sue to obesity and exposure to environmental estrogens, also young children and girls, may be one sided or bilateral
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Breast cancer signs and symptoms
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Most common in women, genetic risk. 40-60 years, chronic fibroids may change, very rarely men may develop, pregnancy and breastfeeding reduce risk,
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Breast cancer differentiation
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LV/ST disorder- accumulating qi, phlegm and blood stasis - move qi. Ching/REN disorder- manifests in breast area, common in perimenopause, Toxic accumulation. Qi/BL xu- late stage, body is depleted by cancer
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Ding chuang
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Deep rooted boil, malignant boil,
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Ding Chuang signs and symptoms
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Acute purulent disease, develops very fast, easily becomes septic, most common on face/head and hands/feet, high fever, restless, spirit disturbed- dizzy, confused, lose consciousness
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Ding chuang etiology and pathology
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1. emotions -qi stagnation- fire 2. Diet- greasy, thick, hot food accumulates and becomes fire 3. Attack by heat, summer heat 4. Toxin invasion- bite, skin rupture infected
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Ding chuang early stage differenetiation
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Tiny millet like pustule head, maybe painful, numb or itchy, red, hot, 3-6cm diameter deep, mild chills, fever,...
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Ding chuang middle stage differentiation
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5-7 days, middle part enlarged, more painful, pustule head may break by itself, high fever, constipated, scanty yellow urine, thirsty
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Ding chuang later stage differentiation
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7-10 days, if Zheng qi strong- pustule breaks, decreases in size, pus drains, softens, symptoms reduce and disappear over 10-14 days. If not treated well or Zheng qi weak- can last longer or become septic. Can move deeper and create abscesses in organs, bones, etc.
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Ding chuang treatment
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Clear heat, drain fire, detoxify. DU, yang Ming, tai yang. Reducing technique, bleeding, cupping, guasha pts- du10, du12, li4, li11, ub40 (reduce with acu then cup to drain bl), look for rashes along vertebrae (sterilize and break to clear heat), lI face area- li1, li2 ST face area- St45, st44, st41 GB face area- gb43
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Yong
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Carbuncle, acute purulent disease
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Yong signs and symptoms
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Local- red, swollen, hot, painful, 6-9cm diameter, heat toxin stuck in body
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Ru yong
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Mastitis nei chui ru Yong- during pregnancy Wai chui ru Yong- during breastfeeding
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Ru Yong etiology and pathology
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1. Diet- eat too much think, greasy, hot, spicy food after birth, heat stagnates in foot yang Ming 2. Emotions/nervousness-liver qi stagnation especially around breast 3. Nipple/breast damaged and toxin enters 4. Depressed nipple- milk gets stuck
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Ru Yong early stage differentiation
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Swollen, painful masses in breast, milk doesn't flow well, maybe milk general symptoms
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Ru Yong middle stage differentiation
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More painful, hot, red, chills, fever, etc. Later part turns to pus
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Ru Yong later stage differentiation
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If pus clears well, symptoms reduce and skin heals. If pus not cleared well, symptoms will remain
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Ru Yong prevention
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Late pregnancy- bath nipples/breasts in warm water. If nipples sunken- begin to pull outwards. After delivery- if mother has excess milk express it completely after feeding, treat any injury/wound to breast immediately
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Ru Yong treatment
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ST heat accumulation- clear heat, resolve accumulation, reducing technique, yang Ming channels. Pts- st16, st39, st40, li7 +li4, gb20- headache, fever +rn17, pc6, si1- milk ducts blocked. LV qi stag- soothe liver to relieve constraint, reducing technique jue yin channels. Pts- lv14, lv2, pc6, pc1, gb21
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Ru Yong Tui na
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Use tips of fingers to push from base of breast to nipples. avoid hard, steady pressure or circling. Before apply warm towel to breast. After Tui Na gently stretch/pull the nipple to expel milk
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Ru pi
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Breast lump/fibroid
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Ru Pi signs and symptoms
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Common, chronic, benign condition resulting in lumps/masses in breasts. One of more masses in breast with hard texture with smooth surface and clear border, movable, no pain, maybe mild distending ache, no change to skin or general symptoms, masses will not break, commonly change size with emotions, menses and pregnancy, size from pea to egg.
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Ru Pi differentiation
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LV qi stag- emotions, change in size, LV channel pain, distending pain, st qi rebellion, painful or late menses, wiry pulse. Phlegm/turbid accumulation- dizzy, nausea, bloating, distension, greasy tongue, slippery pulse, may have other lipomas. LV/KD yin xu- typically patient has chronic disease, tidal fever, night sweats, Malar flush, dizziness, tinnitus, lumbago, scanty/late menses or amenorrhea, red thin tongue.
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Ru Pi treatment
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LV qi stag- soothe liver, regulate qi- st15, st16, pc6, rn17, gb34, lv3 + rn6, sp6- period disorders. Phlegm- resolve phlegm unblock collaterals- st15, st40, rn17, ub22, rn12, pc6 +yintang, sishencong- dizziness. LV/KD yin xu- nourish yin, clear empty fire, kd5, lv5, st18, ub23, kd3, bailao, ub43
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Ru xian Zheng shang
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Hyperplasia of mammary gland
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Ru xian Zheng Shang signs and symptoms
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Very common 70-85% of women aged 30-40, endocrine disorder, usually both breasts, variable size masses with unclear border, size and pain change with menses, LV, Chong, ren involved
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Ru li
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Gynecomastia
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Ru li signs and symptoms
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Common among men, sue to obesity and exposure to environmental estrogens, also young children and girls, may be one sided or bilateral
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Breast cancer signs and symptoms
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Most common in women, genetic risk. 40-60 years, chronic fibroids may change, very rarely men may develop, pregnancy and breastfeeding reduce risk,
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Breast cancer differentiation
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LV/ST disorder- accumulating qi, phlegm and blood stasis - move qi. Ching/REN disorder- manifests in breast area, common in perimenopause, Toxic accumulation. Qi/BL xu- late stage, body is depleted by cancer
