PPT HANDOUT SYD 28:05:17 Autoimmune Final

1y ago
7.44 MB
70 Pages
Last View : 1d ago
Last Download : 1m ago
Upload by : Averie Goad

5/17/17Seminar outline1.2.3.4.Autoimmunity and immune functionCM and immunity (autoimmune)Some common herbal formulas used in AIThyroid physiology, function: hypothyroid and hyperthyroid goitre5. Autoimmune conditions: Hashimoto’s and Graves Coeliac, Crohn’s and Ulcerative Colitis Rheumatoid Arthritis SLE (lupus) and Sjögren’sAutoimmunity not specifically covered in the classical texts signs and symptoms described pattern identification accommodates the multi-systemcomplexities of autoimmune disease root (underlying disease) and branch (signs, symptoms)highly relevant in treatment stabilisation of signs and symptoms, medication reductionis a common and possible outcome from treatment Peter Kington for Sun Herbal andChina Books Sydney1

5/17/17Immune function Western medicine includes innate and acquired aspects whichprovide a defence mechanism against: micro-organisms cellular damage caused by toxins abnormal cellular changes leading tomalignancyImmune function Western medicine the body should distinguish between the ‘self’(endogenous substances) and ‘non-self’ (other) innate immunity is acquired in utero or via breastmilk; directed at all non-self substances acquired/adaptive/specific immunity is builtthroughout life and can be active (body makingantibodies to repel an antigen) or passive (inresponse to other stimulus) Peter Kington for Sun Herbal andChina Books Sydney2

5/17/17Immune function Western medicine The immune response is defined by the locationof the response activity: cellular activity takes place whenmacrophages work with leucocytes toeliminate antigens or pathogens humoral activity occurs in blood,tissues and body fluidsImmune function Western medicine Abnormal immune function: hyper-immunity occurs when theimmune system fails to switch itself off(allergic reaction, autoimmunity) hypo-immunity leads to immunedeficiency and failure to respondadequately to stimuli Peter Kington for Sun Herbal andChina Books Sydney3

5/17/17Autoimmune disease auto-antigens are produced by the body as “self”proteins an abnormal reaction is for the immune system torespond to auto-antigens as foreign, “non self” any vital organ can be targeted causing aninflammatory response causing tissue damage when the body is unable to distinguish between the‘self’ and ‘non self’ substances, it attacks its owntissues: autoimmune diseaseUnderstanding immunity inChinese medicine Ben-Biao; root-branch manifestation External layer: Ying-Wei pathogenic attack Cold disease school: six divisional layers Warm disease school: four levels Peter Kington for Sun Herbal andChina Books Sydney4

5/17/17“Most autoimmune disease are chronic diseasesand over time the body gradually becomesDeficient and debilitated, resulting in a situation ofDeficiency of Vital Qi (Zheng Qi) and Excess ofpathogenic factors”Shen Pi’anShen’s Textbook on the Management of Autoimmune Diseases with Chinese MedicineCOMMON AETIOLOGY & PATHOGENESISEarly stageLate stageYin deficiencyHeat/FireYang deficiencyConstitutionalor acquireddeficiency ofthe Zheng QiZang-fuQi def/stagBlood deficiency Blood stasisYing-WeidisharmonyPhlegm fluidsChannels &collateralsExternalpathogenicfactors Peter Kington for Sun Herbal andChina Books SydneyObstructionof the TripleBurner5

5/17/17Prescribing & DosageBroad treatment principles Acute: clear the excess to restore Vital QiChronic: supplement deficiency; move excessOften presentation in clinic is post-acute, thereforedealing with chronic presentationhelping people manage and live with their conditionmanaging flare-ups involves equally treatingexcess and deficiencyacupuncture, cupping, gua sha and tui na Peter Kington for Sun Herbal andChina Books Sydney6

5/17/17Integration of drugs andherbs Western medicine effective in treating and arrestingacute ‘flare ups’ associated with AI:immunosuppressants, NSAIDs, drugs which targetsspecific immune responses (biologics), antimalarialsto reduce inflammation quickly. Chinese medicine: reducing humeral immunity andenhancing cellular immunity, adrenocortical function(Kidney Yin & Yang), vascular permeability (BloodHeat), blood viscosity, smooth muscle function, centralnervous system (diurnal clock), cardiovascular systemChinaMed capsules MODERATE:2-3 capsules, 2-3 times/day chronic conditions, weak and sensitive patients MEDIUM: 3-4 capsules, 3 times/day - generaluse in the initial stages of treatment HIGH: 6 capsules, 3-4 times/day - acuteinfections VERY HIGH: 10-12 capsules, 3 times/day for 3-4days: severe and acute infection in a robustpatient Peter Kington for Sun Herbal andChina Books Sydney7

5/17/17Black Pearl pills MODERATE:8 pills, 3 times/day - chronicconditions, weak and sensitive patients MEDIUM: 12 pills, 3 times/day - general use in theinitial stages of treatment HIGH: 12-15 pills, 3-4 times/day - acute infections VERY HIGH: 18-20 pills, 3-4 times/day for 3-4days: severe and acute infection in a robustpatient develop your own experiences contraindications in manualCommonly used formulas Peter Kington for Sun Herbal andChina Books Sydney8

5/17/17Yin Tonic (CM118), Liu Wei Di HuangWan/Rehmannia 6 (BP015)TCM actions: Nourishes Kidney andLiver Yin, enriches the Kidney Essence,reduces deficiency FireTCM syndromes: Kidney and Liver YinDeficiencySigns & symptoms: pain andweakness of lower back and knees, Heat, drymouth, night sweats, tinnitus or hearing loss,dizziness, hot palms and soles of feet, redtongue and scant coat, thready rapid pulse.Empty Heat (CM135), Zhi Bai Di HuangWan/A,P&R (BP038)TCM actions: Nourishes the Kidney(and Liver Yin), enriches the Kidney Essence,reduces deficiency Fire and drains DampHeatTCM syndromes: Kidney YinDeficiency with Fire flaringSigns & symptoms: flushed face, redcheeks, malaria flush, low grade or tidal fever,dry mouth and thirst, night sweats, LBP, hothands and fee, red tongue with scanty coat;thready rapid pulseYIN DEFICIENCYZou Gui Wan/Left Returning (BP039)TCM actions: Nourishes the Kidney(and Liver) Yin, enriches Kidney EssenceTCM syndromes: Kidney Yindeficiency; Kidney Essence DeficiencySigns & symptoms: pain, weakness ofthe lower back and knees; dry mouth andthroat, night sweats, dizziness, tinnitus orhearing loss, red tongue with scant coating,thready and rapid pulseMing Mu Di Huang Wan/RehmanniaFormula to Brighten the Eyes (BP075)TCM actions: Nourishes the Liver andKidney Yin, nourishes the Blood and Essence,calms the Liver and subdues the hyperactiveYang, sends Essence and Blood to the eyes.TCM syndromes: Liver-Kidney Yin def,Liver Blood def, Liver Yang hyperactivitySigns & symptoms: poor vision, dryeyes, pressure behind the eyes yin xu S&S;dry tongue with no coat (thin, red) andthready/wiry, rapid pulse.Clear Vision (CM181), Qi Ju Di Huang Wan(BP017)TCM actions: Nourishes the Liver andKidney Yin, nourishes the Liver Blood andsends Essence to the eyes.TCM syndromes: Kidney Liver Yindeficiency, Liver Blood deficiencySigns & symptoms: dry and sore eyes,loss of visual acuity, excessive lacrimation,photophobia, dry mouth and throat, dizziness,tinnitus, hots palms and soles of feet, threadypulse, red and dry tongueYIN DEFICIENCYZhi Yin Gan Lu Yin/Rehmannia &Asparagus (BP052)TCM actions: Nourishes the Yinand regenerates the Body Fluids,clears heat, reduces Fire, regulatesthe QiTCM syndromes: Yin deficiency,Deficiency of the body fluids, Heat/FireSigns & symptoms: Drynessaffecting the eyes, mouth, throat, noseand skin, oral ulceration, inflamedgums, sore and chronically swollenthroat, dry cough, malar flush, drytongue and red body, thready/wiryrapid pulse. Peter Kington for Sun Herbal andChina Books Sydney9

5/17/17QI & YIN DEFICIENCYSheng Mai San/Dangshen &Ophiopogon (BP045)TCM actions: Tonifies the Qi andregenerates the body fluids, stopsexcessive sweatingTCM syndromes: Lung Qideficiency (or generalised Qideficiency), Lung Yin-Fluids defieicny(or generalised Yin-Fluids deficiency)Signs & symptoms: Fatigue,dyspnoea, dry mouth, thirst,hyperhydrosis, chronic and nonproductive cough, palpitations,tachycardia, dry tongue with a scantcoat, thready and weak pulseQI & YIN DEFICIENCYHair Growth (CM136)/Qi Bao Mei RanDan (Jia Wei) (BP057)TCM actions: Nourishes the Kidneyand Liver Yin, replenishes the KidneyEssence, tonifies the Qi and nourishesthe BloodTCM syndromes: Kidney- Liver Yindeficiency, Kidney Essence deficiency,Qi-Blood dual deficiencySigns & symptoms: Fatigue,muscular weakness, postural dizziness,dry lustreless skin, dry mouth and throat,dry eyes, blurred vision, insomnia, dullheadache, hair loss, normal or light redtongue, thready pulse Peter Kington for Sun Herbal andChina Books Sydney10

5/17/17YANG DEFICIENCYYou Gui Wan/Right Returning (BP066)TCM actions: Warms-tonifies theKidney Yang, nourishes the Blood andEssenceTCM syndromes: Kidney Yangdeficiency; Kidney Essence def.Signs & symptoms: Intolerance ofcold, lower back pain, cold extremitiesand lower abdomen, polyuria withclear and pale urine, severe fatigue,dizziness and tints, apathy and lack ofwill power, poor appetite and loosestools, pale complexion with pale,swollen tongue, deep and weak pulseYANG DEFICIENCYFu Zi Li Zhong Wan (BP070)TCM actions: Warm-tonifies themiddle Jiao, dispels Cold from theMiddle JiaoTCM syndromes: Spleen-Stomachdeficiency-Cold; Cold stagnation inthe middle JiaoSigns & symptoms: Abdominalpain better for warmth and pressure,watery diarrhoea or loose stools,vomiting or nausea, intolerance of thecold, cold extremities poor appetiteand loss of taste, pale tongue with awhite coating. Peter Kington for Sun Herbal andChina Books Sydney11

5/17/17QI DEFICIENCYEnergy Tonic (CM), Bu Zhong Yi QiTang/Ginseng & Astragalus (BP005)TCM actions: Tonifies the Spleen andStomach Qi, raises the Yang Qi of the MJ,augments the Lung and Wei QiTCM syndromes: Spleen and StomachQi deficiency, Spleen Qi sinkingSigns & symptoms: Faituge, muscularweakness, muscular hypotonia, spontaneousperspiration, poor appetite, cold intolerance,thirst, chronic diarrhoea, dyspnoea, paletongue with teethmarks, weak pulseQI & BLOOD DEFICIENCYShi Quan Da Bu Tang/Ginseng & Dang-gui10 (BP021)TCM actions: Tonfies the Qi and nourishesthe Blood, warms the YangTCM syndromes: Qi-Blood dualdeficiencySigns & symptoms: Fatigue and muscularweakness, poor appetite, exertional dyspnoea,weak and low voice, palpitations, pale or sallowcomplexion, postural dizziness, dry andlustreless skin and hair, cold extremities,parasthesia or numbness of the extremities,pale tongue and white coat, thready and weakpulseCOOL FIRE, CALM LIVERAnti-Inflamm (CM119), Long Dan XieGan Tan/Gentiana Combination(BP016)TCM actions: Drains excess Fire fromthe Liver-GB, cleans Damp-Heat from thethree JiaoTCM syndromes: 1. Liver-GB Fire, 2.Damp-Heat in the triple Jiao (lower)Signs & symptoms: Headache andfacial flushing, bitter taste in the mouth,conjunctivitis, swollen nd painful ears,hair dry stool, inflammation of thegenitalia, groin rashes. Red tongue witha yellow greasy coat, wiry-slippery rapidpulse Peter Kington for Sun Herbal andChina Books Sydney12

5/17/17COOL FIRE, CALM LIVERChai Hu Shu Gan Wan/Bupleurum &Cyperus, Qi Mover (CM193)TCM actions: Soothes the Liver,actives the Blood and dispels stasis,alleviates painTCM syndromes: Liver Qi constraint,Qi stagnation and Blood stasisSigns & symptoms: pain distensionin the flanks, chest and/or breasts,intercostal and epigastric pain,hypochondriac pain, symptomsworsened by steps, wiry pulse, normaltongue/purple spotsThyroid physiology Peter Kington for Sun Herbal andChina Books Sydney13

5/17/17ThyroidReleasingHormone Factor (TRH/F)HYPOTHALAMUS Thyroid StimulatingHormone (TSH) T3: triiodothyronineT4: thyroxine-ANTERIORPITUITARYTHYROIDThyroid hormones increase base metabolic rate (how the bodymakes functional energy from proteins, fatsand carbohydrates)affects protein synthesisregulates bone growth and developmentneural developmentincreases the body’s response to adrenalinethermoregulation Peter Kington for Sun Herbal andChina Books Sydney14

5/17/17The thyroid hormones: T4 Thyroxine (T4) pro-hormone to T3 synthesised from iodine in food up to 80% of thyroid hormone is T4 40% of T4 is converted to T3 T4 has a half-life of 7-8 days; T3, 1-2 days: T3 greater ability to enter cellsThe thyroid hormones: T3 Triiodothyronine (T3) synthesised from iodine uptake as secondaryto T4 accounts for 20% of thyroid hormone 80% of T3 is derived from kidney and liver more metabolically active than T4 Type I: liver, kidney, thyroid and pituitary Type II: CNS, pituitary (mediates TSHnegative feedback), brown adipose tissue,heart vessels Type III: placenta, CNS and hemangioma Peter Kington for Sun Herbal andChina Books Sydney15

5/17/17rT3 reverse T3synthesised from unused T4inactive T3can indicate uptake of T4 to T3 and if highsuggest low uptake as a marker of subclinicalthyroid dysfunction (controversial)Thyroid dysfunction thyroid dysfunction can be: primary - thyroid gland dysfunction secondary - anterior pituitary/hypothalamicdysfunction subclinical autoimmuneall autoimmune dysfunction involves either: hypothyroid hyperthyroidnot all hypo/hyperthyroid involves autoimmunedysfunction Peter Kington for Sun Herbal andChina Books Sydney16

5/17/17Goitre enlarged thyroid gland diffuse nontoxic goitre/simple goitre/colloid goitre: goitre without nodules and hyperthyroidism iodine deficiency ( 5% of population:endemic goitre)diffuse, nodular goitre iodine deficiency early in life Goitre causes include: hypothyroidism due to iodine deficiency (increasedTSH production) - Hashimoto’s thyroiditis hyperthyroidism due to TSH receptor antibodystimulation of the thyroid - Graves disease multi nodular goitre thyroid cancer cigarette smoke contains goitrogens and is known toexacerbate autoimmune thyroid disease in iodine andselenium deficient people raw foods: soybeans, cassava and cruciferousvegetables Peter Kington for Sun Herbal andChina Books Sydney17

5/17/17Goitre Kilpatrick grading: 0: not visible with extended neck; notpalpable 1: not visible; palpable 2: visible when neck extended and onswallowing 3: visible in all positions 4: large goitreGoitre nodules present?serum TSH normal or elevated USS positive: fine needle aspiration low radioisotope scan and USS cold nodule: FNA hot nodule: medication/surgery Peter Kington for Sun Herbal andChina Books Sydney18

5/17/17HypothyroidPrimary hypothyroiddysfunctionRoyal Australian College of GPs: serum TSH normal (euthyroid) low (hyperthyroid) high (hypothyroid) retest (2-8 weeks later) serum TSH (hypothalamicpituitary function) Free T4 (thyroid function) where TSH is normal but clinical observation ofthyroid-like S&S presents, test Free T4 (subclinicalhypothyroid) Peter Kington for Sun Herbal andChina Books Sydney19

5/17/17Primary hypothyroiddysfunctionPrimary hypothyroidism high TSH low T4Subclinical hypothyroidism high TSH normal T4Secondary hypothyroidism normal TSH low T4(pituitary failure mRI; post illness, retest when well)Non thyroid illness normal TSH low T4 (adrenalfailure)Subclinical hypothyroiddysfunctionSubclinical hypothyroidism (moderately) highTSH normal range T4 3-8% of the population precursor to primary hypothyroid disease (25%/year) pituitary response (TSH) to thyroid hormoneproduction (T4) is profound (and sensitive).Small increases in T4 will account for hyperproduction of TSH Peter Kington for Sun Herbal andChina Books Sydney20

5/17/17Aetiology of subclinicalhypothyroidismSame as non subclinical (overt) hypothyroidism: most common: chronic autoimmunethyroiditis (Hashimoto’s thyroiditis) responsive treatment to hyperthyroidism post operative iatrogenic - lithium or amiodarone head, neck surgery; radiotherapyDiagnosisTHYROID FUNCTION TEST RESULTS tests/Pages/default.aspx Peter Kington for Sun Herbal andChina Books Sydney21

5/17/17Hashimoto's thyroiditis Autoimmune thyroiditis or chronic lymphocyticthyroiditis Inflammation and enlargement of the thyroid dueto underproduction of the thyroid hormonesthyroxine (T4) and triiodothyronine (T3). Middle aged women are are 10-20 times morelikely to develop HT, than men. Familialconnection.Hashimoto's aetiology Thyroid inflammation and failure closely associated withautoimmune processes Auto-antibodies are produced in opposition to: thyroglobulin thyroid stimulating hormone (TSH) receptors thyroid peroxidase (TPO) (involved in T3 and T4production)Atrophy and fibrosis of thyroid gland Peter Kington for Sun Herbal andChina Books Sydney22

5/17/17Hashimoto'ssigns & symptoms EYES become puffy (not protruding) and the lids droop.FACE becomes puffyTHROAT may house a swollen and firm goiterVOICE becomes deep and hoarseSKIN becomes dryHANDS AND WRISTS are prone to arthralgia, carpal tunnelBODY TEMPERATURE is cold; peripheries are coldHAIR is dry and brittleNERVOUS SYSTEM is prone to depression, poor memory and fogginessCARDIOVASCULAR experiences bradycardia, hypertension, heart failureGIT suffers with reduced appetite, weight gain and constipationGENERAL, non specific fatigue (anaemia), muscles weakness and slowreflexesDifferential diagnosis Graves’ disease: exophthalmos Thyroid tumour: small nodules and rarely theentire gland would swell Subacute granulomatous thyroiditis: suddenpain and tenderness, radiating to the jaw and noauto antibodies Peter Kington for Sun Herbal andChina Books Sydney23

5/17/17Thyroid in Chinese medicine not explicitly recognised in the TCM framework, the thyroid’s ‘metabolic’function ties it to the Kidneys it’s location is influenced by the Chong and Renvia the Stomach and Conception vessels it’s transformative function (T4-T3) is tied to theSpleenChinese medicine Ddx1. Depression and binding of the Liver Qi dueto emotional frustration and unresolved stressproduces a soft or firm goitre which is painlessand fixed2. Chronic Yin Deficiency generates internalHeat producing a firm, painless goitre withpalpitations, night sweats, insomnia etc3. Coexisting Qi and Yin Deficiency produces amild or moderate and smooth swelling withfatigue, insomnia, weight gain, dry mouth Peter Kington for Sun Herbal andChina Books Sydney24

5/17/17Chinese medicine Ddx4. A Deficiency of Heart and Kidney Yangproduces a swelling in the neck accompaniedby arthralgia and myalgia, weakness andfatigue, cold limbs and body, bradycardia, puffyswelling in the eyes and face, physical andmental listlessness5. A Deficiency of Spleen and Kidney Yangproduces swelling in the neck, cold limbs andbody, lower back discomfort with mental fatigue,somnolence, poor appetite, loose stoolsThyrotone (CM171)TCM actions: Tonifies the Qi andstrengths the Spleen, warm-tonifiesthe Kidney, nourishes the BloodTCM syndromes: Spleen-KidneyYang deficiencySigns & symptoms: fatigue andmuscular weakness, pallor, coldintolerance, low basal bodytemperature, constipation, dry andflaking skin, hair loss, depressedmood and emotional ability, irregularmenstruation, pale tongue (swollen),deep and weak pulse that is slow Peter Kington for Sun Herbal andChina Books Sydney25

5/17/17Nei Xiao Luo Li Wan, Prunella &Scrophularia (BP043)TCM actions: Clear Heat,resolves Phlegm, breaks up Bloodstasis to soften and reduce massesTCM syndromes: Nodules due toPhlegm-Heat, Qi stagnation andBlood stasisSigns & symptoms: Palpablemass or nodules, location under theskin, neck or breast, mass may besoft or firm, painless or tender, wirypulseNei Xiao Luo Li Wan/Prunella & Scrophularia (BP043)Depression & binding of the Liver QiQi Mover Formula (CM193)Chai Hu Shu Gan Wan/Bupleurum & Cyperus (BP006)Internal Heat due to Yin DeficiencyEmpty Heat Formula (CM135)Zhi Bai Di Huang Wan/Anemarrhena, Phellodendron & Rehmannia(BP038)Heart and Kidney Yang DeficiencyYou Gui

Black Pearl pills MODERATE: 8 pills, 3 times/day - chronic conditions, weak and sensitive patients MEDIUM: 12 pills, 3 times/day - general use in the initial stages of treatment HIGH: 12-15 pills, 3-4 times/day - acute infections VERY HIGH: 18-20 pills, 3-4 times/day for

Related Documents:

Faculty use anecdotal notes to remember observations . Handout 2 – Sample Adequate Nursing Care Plan, pages 14-15 Handout 3 – Faculty Evaluation of Sample Nursing Care Plan, page 16 Handout 4 – Poor Concept Map, page 17 Handout 5 – Faculty Evaluation of Poor Concept Map, page 18 Handout 6 – Concept Care Map, page 19 Handout 7 – Faculty Evaluation of Good Concept Map, page 20 For .

Day 2 1. PB&J Algorithm handout 2. Algorithmic Bias handout 3. Reflection handout 4. Cats and Dogs Dataset cards 5. Playing Cards 6. Instructor Laptop and Projector 7. Student Laptops 8. Robots 9. USB Webcams Day 3 1. Ethical Matrix handouts 2. Final Project Brainstorm handout 3. Final Project Research handout 4. Reflection handout 5.

El manual del guionista. Syd FieldSyd Field. Plot. Plot Prácticas con cuatro guiones . Syd FieldSyd Field. Plot. Plot El guión clásico de Hollywood. Mario Mario Onaindía. Paidós PCOnaindía. Paidós PC La narración en el cine de ficción. David BordwellDavid Bordwell. Paidós . P

a) Diet b) Supplements c) Other considerations d) Clinician Handout: GERD Treatment Summary 6. IBD/IBS-D a) Diet b) Supplements c) Medications d) Patient handout: Paleo Low-FODMAP Diet e) Patient handout: GAPS Diet f) Patient Handout: How to Manage Your Stress g) Clinician Handout: IBD Remiss

Lesson 7: Identifying Skills 50 handout: Skills Identification 51 Lesson 8: things I Am Good At 53 handout: things I Am Good At 54 handout: List of 246 Skills as Verbs 55 Lesson 9: Skills Auction 56 Lesson 10: Identifying Job Values 58 handout: Job Values Inventory 60 handout: work Values Clarification 61 Lesson 11: Prioritizing Job Values 62

Lenten Journey Manual Contents Overview Handout A1: Beginning My Lenten Patterns Handout A2: Family Prayer Leader's Guide for Sessions 1, 2 and 3 Handouts for Sessions 1,2 and 3 Leader's Guide for Session 4 Handout 4a Lectio Divina Practice Handout 4b Lectio Divina Practice Handout 4c Lectio Divina Process Leader's Guide for Session 5

The Story of Monetary Policy comic book Handout 1: Prices: The Marketplace's Communication System Reading 1: Prices: The Marketplace's Communication System Handout 2: Prices in the Galaxy Handout 3: A Class Basket Handout 4: The Interest Rate Lever Handout 5: Monetary Policy Review

Show PPT 1-1 as you refer participants to Page 1 in Module 1 of their Participant Guides. Introduce the module by saying that before they learn the specifics of electrical safety, you want to make sure everyone has a common understanding of electrical basics. This module will cover the basics. PPT 1-2 through PPT 1-4 Show PPT 1-2 through PPT 1 .