Medical Dialogue
医学会话
Review of Vieceral Disease Pattern Differentiation
脏腑疾病辨证
John Martinez and Gloria Smith are first-year students at Pacific Acupuncture College in the United States. They are reviewing the course on differentiation of syndromes for their final examination.
| john: | Hi, Gloria. |
| gloria: | Hi, John. How are you doing today? |
| john: | I feel pretty good, how about you? |
| gloria: | I am fine, thank you. |
| john: | So, what would you like to start on today? |
| gloria: | I would like to review spleen syndromes first, OK? I have a hard time remembering them. |
| john: | Sure. It is easier if you think of the functions of the spleen when you try to remember the signs and symptoms. Do you remember what the main functions of the spleen are? |
| gloria: | Yes, I do. The spleen controls transporting and transforming food and water. |
| john: | One more, something relating to blood. |
| gloria: | Oh, yes. The spleen keeps the blood flowing within the vessels. |
| john: | You are correct. Now, what happens when the spleen is weak? |
| gloria: | I am not sure. |
| john: | Let's think about it this way. If the spleen fails to transport and transform food, what does the patient have? |
| gloria: | I know that. The patient may have poor appetite, abdominal distension or pain, loose stool, edema, and a feeling of a heavy body. |
| john: | What might the patient's symptoms be, if the spleen fails to transport and transform water? |
| gloria: | The patient might show edema, retention of water, heavy body feeling, and swollen tongue. |
| john: | What symptoms and signs might the patient have if the spleen has the dysfunction of upbearing clear substances and internal organs? |
| gloria: | The patient might present with prolapse of internal organs, such as prolapse of the stomach, uterus or anus. |
| john: | Can you recall what the term is for prolapse of internal organs in Western medicine? |
| gloria: | I am sorry. I forget. Could you give me a clue? |
| john: | It starts with the letter "V". |
| gloria: | Oh, yes. Visceroptosis. |
| john: | That's right. What is meant by "spleen fails to keep the blood flowing within the vessels?" |
| gloria: | The patient may present with bleeding. |
| john: | Do you remember what the manifestations are for qi deficiency? |
| gloria: | Yes, I do. |
| john: | Please describe them. |
| gloria: | They include fatigue, pale face, pale tongue, and shortness of breath. |
| john: | What kind of pulse does the patient have? |
| gloria: | Weak pulse. |
| john: | You are right. Do you notice that you can remember all the signs and symptoms for spleen qi deficiency now? |
| gloria: | Yes, I do. |
| john: | How do you feel now? |
| gloria: | It is not too hard to remember them if I do it the way that you showed me. Thank you. |
| john: | It's my pleasure. |
| gloria: | So, John. What would you like to review today? |
| john: | You know, Gloria, I am good at individual syndromes, but I am having trouble remembering combined syndromes. |
| gloria: | I think I can help you with that. Let's take disharmony of the heart and kidney, as an example. Which element does heart belong to, based on five elements theory? |
| john: | Heart belongs to fire. |
| gloria: | How about kidney? |
| john: | Water. |
| gloria: | Do you remember what happens if kidney has some dysfunction? |
| john: | It causes all kinds of deficient syndromes. |
| gloria: | What is the change in fire element when water element is weak? |
| john: | Fire becomes in excess. |
| gloria: | Now, what occurs if there is disharmony between heart and kidney? |
| john: | There would be kidney deficiency and heart fire. Is that correct, Gloria? |
| gloria: | Yes, you are absolutely right. See, now you know about disharmony of heart and kidney. |
| john: | Oh, that was not too difficult. Would you mind giving me another example? |
| gloria: | No, not at all. How about disharmony of liver and spleen? What elements do liver and spleen belong to? |
| john: | Liver belongs to wood and spleen belongs to earth. |
| gloria: | What happens when wood is in excess? |
| john: | Wood often overacts on earth and counteracts on metal. |
| gloria: | What is the most common syndrome for liver? |
| john: | Of course, it is liver qi stagnation. |
| gloria: | Yes. What occurs when liver qi is stagnated and overacts on the spleen? |
| john: | It results in spleen qi deficiency. |
| gloria: | Yes, you have answered all my questions correctly. Do you know more about disharmony of liver and spleen now? |
| john: | Yes, I do. Thanks. Can we discuss more about when wood counteracts on metal? |
| gloria: | That brings about another syndrome, liver counteracting on lung. |
| john: | Does that mean liver qi stagnation causes lung qi deficiency? |
| gloria: | No, you are wrong this time. |
| john: | So, what kind of syndromes do they present? |
| gloria: | They often show liver fire counteracting on lung. |
| john: | Liver fire? |
| gloria: | Yes, liver fire, not liver qi stagnation in clinical practice. So what happens when there is fire in excess? |
| john: | It often causes yin deficiency. |
| gloria: | Good, John. What does it mean when we talk about liver counteracting on lung? |
| john: | It refers to liver fire with lung yin deficiency. |
| gloria: | Very good. Do you need more examples? |
| john: | No, I think I understand it. Many thanks. |
| gloria: | You know, I feel that it is fun and effective to review this way. |
| john: | Yes, I agree. |
| gloria: | Would you like to get together again for final exams? |
| john: | Sure. How about 2 pm this Friday? |
| gloria: | I am available. See you this Friday at 2 pm, John. |
| john: | See you then, Gloria. |