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November: Pivotal Season

Monday, 01 November 2021 09:00

The season of fall continues into November. According to the Nei Jing Su Wen, The Yellow Emperor’s Treatise on Internal Medicine; fall is the pivot in the cycle of the seasons.  The cycle begins with spring. Spring is the time of rebirth after winter. It has an outward energy, expanding energy. It is the beginning of the Yang of the seasonal cycle. This Yang energy continues through summer, the time of abundance. All things in nature reach their full maturity. The heavenly energy cools and the wind stirs. This is when everything on Earth prepares for the winter, a time of hibernation.  Therefore, this is the time of conservation. This is the beginning of the Yin aspect of the year.i

This season belongs to the Lung. With the Yang beginning to give way to the Yin, the Lung Qi can be weaker.  The Lung is the site where Zhen Qi (Zong Qi and Gu Qi ) is refined into Ying Qi and Wei Qi. The Lung Qi both ascends and descends.  The descending function of the Lung Qi directs the Ying Qi down with the Blood in the vessels to nourish the body. It helps the Heart pump Blood from the chest.  It also helps disperse fluid back to the Kidney to moisten them and help the fluid be misted by the Ministerial Fire of the Kidney.  The ascending aspect of the Lung Qi helps disperse the Wei Qi in the space between the muscles and the skin known as the Cou-li. This really pertains to the fascial spaces and planes. The Wei Qi functions to warm the body and to protect the body from invasion by pathogens such as Wind, Cold, Hot, Dry, Damp and Summer Heat.

As the Lung Qi weakens in the month of November, the Wei Qi is less able to protect the body.  Therefore, this is a time of frequently colds and flus. TCVM provides tools to help protect patients during the fall and winter. To help protect the body, it is wise to aid the Lung and improve the descending and dispersing functions. Also tonifying the Spleen which is the foundation of Qi and Blood.

Hypothetical Case

Species: Canine
Breed: Pug
Age: 6 years
Gender: N

Clinical Diagnosis (conventional): Infectious Tracheobronchitis

Conventional Indications:

Diagnosed one week ago with tracheobronchitis after being boarded.  The patient has not yet received any treatment for the diagnosis and the cough has progressed slightly in frequency. The patient is coughing more than 15 times per day. The cough is soft but somewhat productive. The cough is elicitable on palpation of the trachea.  Three views of the thorax reveal a mild bronchial pattern which is most consistent with age related change and possibly some early chronic airway changes. Pulse, respiration and temperature are within normal limits.

Traditional  Indications:

This pet has a good appetite.  Stools are within normal limits.  The patient sleeps well except when awakened by coughing. The cough is soft and somewhat moist.  The patient’s ears are 3 finger cool. There is some mild decrease in energy. The patient feels slightly warm to the touch.

Tongue: Red

Pulse: Rapid and superficial.

TCVM Diagnosis:  Wind-Heat cough

TCVM Assessment:

  • Cough-Rebellious Lung Qi
  • Warm-Fever-Heat
  • Red tongue-Heat
  • Rapid pulse-Heat
  • Superficial pulse-Wind

Treatment Principles:

  • Clear Heat
  • Clear Wind
  • Benefit the Lung
  • Stop Cough

Acupoint Prescription:

GV-14, LU-7, LI-4, GB-20, TH-5, BL-12, BL-13, LU-10, CV-22, Ding-chuan

  • Clear Wind- LI-4, BL-12, GB-20
  • Clear Heat-LU-7, TH-5
  • Benefit the Lung- LU-7, BL-13
  • Stop Cough-CV-22, Ding-chuan

Chinese Herbal Prescription:

  • Yin Qiao San
  • 5g PO BID

Hypothetical Case

Species: Goat
Breed: Saanan
Age: 7 years
Gender: Wether (castrated male)

Clinical Diagnosis (conventional): sinusitis, rhinitis, loss of appetite

Conventional Indications:

Saanan wether, named Bozo, 7 years old, pet goat, approximately 80 lbs, living alongside one more goat in a shared barn with other horses and chickens. Barn is open access concept, where animals can freely move between fenced in enclosure and grouped stalls (by species) to be protected from the elements. This fall has proven to be windier and wetter than usual, following an extraordinarily damp and hot summer in Western PA. Both goats are spending most of their day outside, nibbling on the last bit of grass available for the season. A week ago, we had the first night frost, daytime temperatures are fluctuating between mid-50s and some mid-60s days still.  Over the course of the last week Bozo has shown bilateral, thick mucus discharge from both nostrils, of a moderate degree and slightly yellow in color. No sneezing has been observed, but he seems to be eating less and is more lethargic than usual. His body temperature is 100.1 F.

Traditional Indications:

Bozo is a very curious and outgoing wether, making everybody laugh with his antics. He notoriously runs full speed and jumps onto obstacles (Fire constitution). He is also quite flighty and more anxious than his companion. Recently he has been more subdued and lethargic and his appetite is poor. The nasal discharge is thick and yellow.

Tongue: appears pale, lavender with a white film

Pulse: difficult to assess in a non-cooperative individual, jugular veins are notoriously deep in goats and he kicks and escapes when palpating femoral pulses.

TCVM Diagnosis: 

Nasal Damp Cold with Qi Deficiency and Blood Stagnation

TCVM Etiology and Pathology:

The upper respiratory tract is susceptible to invasion of Cold and Damp. Wei Qi and Lung Qi may be injured by prolonged Summer Heat and Damp, enabling external pathogens like Wind, Cold and Damp. Seasonal changes can be challenging for Wei Qi as well, as temperature fluctuations and fairly sudden changes from Hot to Cold can cause imbalances.

The quality of the nasal discharge suggests Cold with Damp and Blood Stagnation, as it is thick and yellow.  The white coating of the tongue also indicates Cold Damp.

Bozo’s decrease in appetite indicates Spleen Qi Deficiency.

The pale tongue and lethargy correspond with Qi Deficiency.

The slightly low body temperature is a sign of Cold and Qi Deficiency. (Goats are usually 100.5 – 103.5 F)

Treatment Principles:

  • Warm the body and expel Cold
  • Break up Blood Stagnation
  • Remove Damp
  • Support Spleen Qi and Qi overall
  • Support Wei Qi

Acupoint Prescription:

Dry needle acupuncture was not feasible for this flighty goat, as needle retention was an unsurmountable issue. Aquapuncture was chosen as an alternative, using a total of 3 cc Vitamin B12 (1000 ug/ml) diluted in 3 cc of normal saline. 0.3 – 0.5 cc of liquid were deposited into each acupuncture point:

  • GV 20 – permission point
  • Long Hui – classical point, local point, clear sinuses
  • Bi Tong – classical point, local point, clear nasal passages/sinuses
  • LI-4 – masterpoint of the head – attempted, but unsuccessful, goat kicking
  • GV-14 – supports Wei Qi
  • LI-11 - clear the Exterior, alternative point to LI 4
  • BL 13 – Lung association point
  • GV 4 – support Qi
  • Bl21 – support Spleen Qi

Food Therapy:

  • Crimped oat - cooked overnight in slow cooker, served warm twice a day, ½ cup each feeding
  • Cinnamon – 1 teaspoon sprinkled over oats, warming
  • Ginger, dried powder – 1 dash mixed in with oats, very warming
  • Tried fresh ginger, which is less warming than dried ginger, but goat reluctant to eat

Chinese Herbal Prescription:

Huey’s Formula – Formula to clear both Wind Heat and Wind Cold, open the nose

  • 10 grams PO BID for one week, then decrease to 5 grams PO BID for 3 more weeks
  • Sweetened with a teaspoon of molasses and mixed in with oats for better acceptance. Alternatively mix with applesauce or mash in with bananas.

Herbs included in this formula:

  • Yu Yin – radix curcumae, Tumeric, invigorates blood, breaks up stasis, warming
  • Dan Shen – radix salvia, Sage – invigorates bloods, breaks up stasis,
  • Chi Shao – radix paeoniae ruba, red Peony – breaks of up stasis,
  • Sheng Di Huang – radix rehmanniae, Qi and Yin tonic, clears the Exterior
  • Huang Bai – cortex phellondendri, Phellodendron bark, dries Damp
  • Di Fu Zi – fructus cochiae, expels Wind, clears Damp
  • Xuan Shen – radix scophulariae, Scrophularia, clears the throat
  • Mai Men Dong – radix ophiopogonis, Ophiopogon, Qi and Yin tonic
  • Mu Dan Pi – cortex radicis Moutan, Mountain peony - activates blood, dissolves stasis

Four Gentlemen – general Qi Tonic, Spleen Qi Tonic

  • 5 grams Bid for 4 weeks
  • Same process of “hiding” herbal formula in food. Four Gentlemen is slightly sweet and more easily accepted.

Herbs included in this formula:

  • Dang Shen – radix codonopsis, Codonopsis, general Qi tonic
  • Bai Zhu – radix atractylodes, Atractylodes, general Qi and Spleen Qi tonic
  • Huang Qi – radix astraguli, Astragulus, supports Wei Qi
  • Fu Ling – radix poriae, Poria, drain Damp, strengthen Spleen

iNi, Maoshing. The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary (p. 7). Shambhala. Kindle Edition. 

 

Written by Greg Todd, DVM, CVA. Cases by Greg Todd, DVM, CVA and Alex Kintz-Konegger, DVM, CVA, CVTP