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Module 5   Lesson 12   Chang, Dan, Pang Guang

Intestines, Gall-Bladder and Bladder

Four Fu, one rule: a Fu is healthy as long as it passes things on. Which finding tells you whether it is blocked, overheated, chilled or leaking?

After this lesson you know the patterns of ch. 39 to 42 by their headings, with signs, tongue, pulse, cause and principle; you see where they coincide with the Heart, Spleen, Liver and Kidneys, and you know the red flags that weigh most with the Fu. Heart-Fire (15), Damp-Heat (9) and Kidney-Yang deficiency (12) from module 1 come back as they were.

Small Intestine 小肠 ch. 39 p. 677 Large Intestine 大肠 ch. 40 p. 687 Gall-Bladder 胆 ch. 41 p. 703 Bladder 膀胱 ch. 42 p. 713 Full-Heat Qi pain Qi tied deficient and cold worms Damp-Heat (9) Heat Heat obstructing Cold invading Dryness Collapse cold (deficient) Damp-Heat (9) Gall-Bladder deficient Phlegm-Heat Damp-Heat (9) Damp-Cold deficient and cold interstitial cystitis: separate section, p. 720 Shao Yang: ch. 44 p. 759 Yang Ming: ch. 44 p. 757 WHO IS BEHIND IT Heart (15), Spleen (7) Spleen, Lung (16), Liver (5) Liver (1, 2) Kidneys (12)
Schematic. Fill: red excess, blue deficiency, orange with a red border a picture that calls for emergency care first; border: red Heat, blue Cold; dotted border: textbook knowledge, check whether it is in the book. Arranged after the headings of ch. 39 to 42; the order within a column is textbook knowledge.

Know by heart

  • A Fu wants to pass things on. Blocked, overheated or tied is excess, worse with pressure; leaking, sunk or chilled is deficiency, better with pressure and warmth.
  • Small Intestine (ch. 39). Full-Heat: Heart-Fire (15) via the urine; Qi pain: twisting, pulls towards the testicles, the Liver; Qi tied: severe, vomiting, no stools, emergency care first; deficient and cold: dull pain, profuse pale urine, the Spleen (7).
  • Large Intestine, excess (ch. 40). Damp-Heat (9): mucus, blood, urgency; Heat: dry hard stools, dry yellow coating; Heat obstructing: Yang Ming, fever in the afternoon, an abdomen that does not tolerate pressure; Cold invading: sudden pain with diarrhoea, thick white coating.
  • Large Intestine, deficiency. Dryness: dry pellet stools, Blood or Yin; Collapse: chronic diarrhoea and a prolapsing anus, the Spleen that sinks; cold: loose stools, pale. mnemonic: dry, dropped, cold.
  • Gall-Bladder (ch. 41). Damp-Heat (9): pain under the right ribs, bitter taste, poor tolerance of fat, sometimes jaundice; red, sticky yellow, especially on the sides; slippery-rapid, also wiry. Deficiency: indecisive, easily startled, timid; pulse weak.
  • Bladder (ch. 42). Damp-Heat (9): burning, urgent, cloudy; red, sticky yellow, especially on the root; slippery-rapid. Damp-Cold: heavy, pale and cloudy, sticky white on the root. Deficient and cold: profuse pale urine, leaking; the Kidneys (12).
  • Red flags. Severe abdominal pain with vomiting and no stools or wind; fever with a rigid abdomen; blood in the stool or urine; jaundice; fever with flank pain; acute pain in a testicle: see a doctor first.

The rest of this lesson is reference.

Intestines, Gall-Bladder and Bladder: Four Fu, one rule: a Fu is healthy as long as it passes things on. Which finding tells you whether it is blocked, overheated, chilled or leaking?
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Three practice questions from this lesson

Case. Student in exam week: mouth ulcers, restless, sleeps badly, sore throat, scanty dark burning urine; the urine dipstick at the GP is clear. Tongue red with a redder, swollen tip and a yellow coating; pulse rapid and overflowing.
  1. Small Intestine Full-Heat
  2. Damp-Heat in the Bladder
  3. Empty-Heat blazing

Answer: Small Intestine Full-Heat. Heart-Fire (15) leaving via the Small Intestine and the Bladder. Damp-Heat in the Bladder has a sticky yellow coating on the root and no tongue ulcers; Empty-Heat has no coating.

Case. Man, 19: for an hour, severe pain in the right testicle and lower abdomen, nauseous. He thinks of 'Small Intestine Qi pain'. What first?
  1. Straight to the emergency department
  2. See the GP later today
  3. Move Qi and harmonise the Liver first

Answer: Straight to the emergency department. Acute testicular pain is a torsion until proven otherwise; every hour counts, so not later in the day and not treatment first. The textbook picture comes afterwards, if it turns out to be something else.

Case. Woman, 72: since yesterday severe cramping abdominal pain, a distended abdomen, vomiting, no more stools and no wind. Tongue with a thick white coating.
  1. Small Intestine Qi tied: move the Qi first
  2. Cold invading: expel Cold and warm
  3. Emergency services: a bowel obstruction

Answer: Emergency services: a bowel obstruction. Textbook knowledge calls this Small Intestine Qi tied; medicine calls it a bowel obstruction, and that is an emergency.

The rest of this lesson

In the course you get the step-by-step explanation, 15 case-based practice questions, 22 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.

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