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By J. Carlos. Spartanburg Methodist College.

The five phases (wu xing) According to Chinese philosophy purchase clomiphene 25mg on-line, the body organs are related to one of the five phases (or elements): wood buy clomiphene 25 mg low cost, fire order 50mg clomiphene visa, earth clomiphene 50mg generic, metal and water discount clomiphene 25 mg overnight delivery. The five phases have a flow in which they move, called the ‘generating cycle’ (Figure 6. Treating the ‘mother’ organ might provide a route to improving the health of a Earth deficient ‘son’ organ. This is more of a supportive role: the heart is considered to support the spleen, while Fire Metal the spleen supports the lungs, etc. When Wood Water an organ is weak it is unable to exert the control necessary to assist other Figure 6. Thus, if the lungs are weak the liver may become too strong, leading to headaches or hypertension. As water corresponds to the kidney it reflects the importance that Chinese prescribers place on this organ. It is viewed as the centre of all yin and yang energy in the body and its health is therefore vital. The other elements, blood and body fluids, are rather easier to understand, although these also have essential intangible properties. Qi (chee) Qi is usually translated as simply ‘energy’ but there is no one English word that conveys its true meaning. It is considered to be a vital or life force and is carried round the body through the meridians (see below) Qi is responsible for the following day-to-day body functions:11 • Movement, both conscious (voluntary) and unconscious (involuntary) • Transforming food and drink into blood, body fluids and energy • Containment of organs, blood vessels and body tissues in their proper places • Protection from external environmental factors including heat, cold and dampness • Maintenance of body heat. A number of qi disharmonies may be identified: • A deficiency in qi will lead to debilitation, protracted recovery from illness, chronic colds, lethargy and other signs of weakness. An excess of qi is not considered to be detrimental unless it is blocked or it is over-acting on another organ system, e. Feng shui is an ancient Chinese practice believed to use the laws of both heaven (astronomy) and Earth (geography), to help one improve life by receiving positive qi. Most of today’s feng shui schools teach that it is the practice of choosing a place to live or work, arranging objects and using colour to achieve harmony with one’s environment. Jing (essence) The concept of jing, similar to qi, is difficult to convey in a single English word. If jing is lacking then qi will be weak, life will be dull and the person will be susceptible to contracting disease. Jing differs from qi in that the former is responsible for the developmental changes associated with growth through- out life, whereas the latter is associated with day-to-day bodily functions. Jing governs fertility, sexuality and growth, and is believed to have 7-year cycles in men or 8-year cycles in women, during which development and ageing take place. Jing is responsible for: • governing growth, reproduction and development • production of bone marrow • promotion of kidney qi • determining the basic constitutional strength. Deficiency of jing is the only disharmony and is said to be more preva- lent in men than in women. The following symptoms may be identified: • Developmental disorders, including physical, mental and learning problems – as jing deteriorates with age, so symptoms of baldness, deafness, brittle bones and senility may result Traditional Chinese medicine | 127 • Kidney-related disorders • Poor memory and concentration • Constitutional weakness • Low libido. If there is a shen disharmony human thought may be disturbed and the eyes may be cloudy with insomnia, forgetfulness and, in the worse case, incoherent speech. It is closely linked to qi and is considered to have the following important functions: • It nourishes the body by carrying nutrients to all tissues and structures and in so doing it helps to fulfil the nutritive functions of qi. Disharmony may arise from three imbalances: • Deficiency shows in pale face, dry skin, light-headedness and emaciation. Body fluids (jin ye) Body fluids include external light and watery fluids, such as saliva and tears (known as jin), and the dense thicker fluids that circulate inside the body, e. Disharmony due to deficient body fluids results in dryness of the eyes, lips and hair, a dry cough and excessive thirst. Excess body fluids can lead to problems known as dampness and phlegm, characterised by productive coughs, weeping skin rashes and vaginal discharge. They are considered to be closely related to specific emotions and virtues and, if their essential requirements are not fulfilled, ill-health will result. The solid organs (zang) are associated with yin and include the following: • The heart is the centre of shen and also governs the circulatory system. It is positively associated with compassion, love and affection, and negatively with overexcitement.

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Some more information in the history about the circumstances of these falls would be helpful generic clomiphene 50mg fast delivery. On further enquiry purchase clomiphene 100mg without prescription, it emerges that the falls are most likely to occur when he gets up from bed first thing in the morning order clomiphene 50mg without a prescription. The afternoon events have occurred on getting up from a chair after his post-lunch doze generic 25 mg clomiphene fast delivery. This was verified by measurements of standing and lying blood pressure – the diagnostic criteria are a drop of 15 mmHg on standing for 3 min generic 25mg clomiphene fast delivery. This showed a marked postural drop with blood pressure decreasing from 134/84 to 104/68 mmHg. This is most likely to be caused by the antihypertensive treatment; both the alpha-blocker which causes vasodilatation and the diuretic might contribute. Another possible candidate for a cause of the postural hypoten- sion is the diabetes which could be associated with autonomic neuropathy. In this case the diabetes is not known to have been present for long and there is evidence of only very mild peripheral sensory neuropathy. Diabetic autonomic neuropathy is usually associated with quite severe peripheral sensory neuropathy, with or without motor neuropathy. Clinically, it is easily mistaken for atrial fibrillation because of the irregular rhythm and the variation in strength of beats. It may be associated with episodes of bradycardia and/or tachycardia which could cause falls. The positive intrathoracic pressure during coughing limits venous return to the heart. The cough is usually quite marked and he might be expected to remember this since he gives a good account of the falls otherwise. Neck movements with vertebrobasilar disease, poor eyesight and problems with balance are other common causes of falls in the elderly. A neurological cause, such as transient ischaemic episodes and epilepsy, is less likely with the lack of prior symptoms and the swift recovery with clear consciousness and no neuro- logical signs. Another diagnosis which should be remembered in older people who fall is a subdural haematoma. The doxazosin should be stopped and another antihypertensive agent started if necessary. The blood pressure rose to 144/86 mmHg lying and 142/84 mmHg standing, indicating no significant postural hypotension, with reasonable blood-pressure control. On direct questioning she says that she has felt increasingly tired for around 2 years. She was diagnosed with hypothyroidism 8 years ago and has been on thyroxine replacement but has not had her blood tests checked for a few years. Her other complaints are of itching for 2–3 months, but she has not noticed any rash. She says that her mouth has been dry and, on direct questioning, thinks her eyes have also felt dry. There has been no disturbance of her bowels or urine although she thinks that her urine has been rather ‘strong’ lately. She has taken occasional paracetamol for headaches but has been on no regular medication other than thyroxine and some vitamin tablets she buys from the chemist. Examination Her sclerae look a little yellow and she has xanthelasmata around the eyes. In the abdomen, the liver is not palpable but the spleen is felt 2 cm under the left costal margin. The symptoms and investigations are characteristic of primary biliary cirrhosis, an uncommon condition found mainly in middle-aged women. In the liver there is chronic inflammation around the small bile ducts in the portal tracts. Itching occurs because of raised levels of bile salts, and can be helped by the use of a binding agent such as cholestyramine which interferes with their reabsorption.

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