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PERITONEAL TUBERCULOSIS

GENERAL

Clinical Manifestations	Peritoneal tuberculosis, a form of abdominal tuberculosis, occurs in three forms: 1. the wet type with ascites, 2. the dry type with adhesions, and the fibrotic type with omental thickening and loculated ascites. Clinically, peritoneal tuberculosis is characterized by fever, abdominal pain, anorexia, weight loss, and ascites. However, none of these symptoms is specific for the disease, so it is commonly misdiagnosed, especially as carcinomatous peritonitis in the elderly. Early diagnosis is of major importance in the control of the disease. Chest X-rays show evidence of concomitant pulmonary lesions in less than 25 per cent of cases. Laparoscopy with direct biopsy is an excellent diagnostic method and must be considered for every patient with unexplained ascites. A definitive diagnosis requires identification of bacilli in ascitic fluid or peritoneum tissue. However, acidfast staining is usually negative and cultures are positive in 30-40% of cases, making bacteriological confirmation of the disease very difficult. Recently, advances in molecular techniques have provided a new approach to the rapid diagnosis of tuberculosis by nucleic acid probes and polymerase chain reaction.
Treatment Principle
Herb Formulas
Points

YANG MING FU

Clinical Manifestations	High fever (sometimes rises and falls) Great thirst Profuse perspiration Aversion to Heat Abdominal pain (worse with pressure) Abdominal distension Dryness Constipation (hard dry knots) Dislikes pressure Restlessness Irritability Mental disturbance: Mentally unclear Delirious speech T: Red and dry, or black and moist C: Thick yellow or dry yellow P: Deep, strong and forceful
Treatment Principle	Purge
Herb Formulas	Da Cheng Qi Tang
Points	For Heat: DU-14, LI-4, LI-11, SJ-5, ST-44 For Stagnation: REN-12, ST-34, ST-36, ST-37, ST-39 For Constipation: SJ-6, ST-25, UB-25

SPLEEN QI DEFICIENCY

Clinical Manifestations	Sallow complexion Fatigue Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient
Treatment Principle	Strengthen the Spleen Benefit Qi
Herb Formulas	Si Jun Zi Tang
Points	LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

LIVER QI STAGNATION INVADING THE SPLEEN

Clinical Manifestations	Cold fingers and toes with Heat in the Interior Irregular fever Hypochondriac fullness and distention Distention, pain or a stuck feeling in the Stomach, lower abdomen or intercostal regions Abdominal pain Severe diarrhea Dysentery Costal pain Menstrual complaints Depression Cough A slight sensation of warmth in the body Body hot and feverish due to lack of harmony of the Liver Qi Thirst Mild constipation A sense of irritability and fullness in the chest and epigastrium Mild obstruction and hardening beneath the Heart A visible white line running from the navel to the tip of the breastbone Mild abdominal distention Abdominal spasms Dry, swollen eyes Tenesmus Dysuria Diarrhea Dark yellow urine T: Red or pale C: Thin yellow or white or Greasy yellow or white P: Wiry or Wiry and tight or Wiry and slippery
Treatment Principle	Release the Exterior Regulate Liver and Spleen Relieve Stagnation Spread Liver Qi Eliminate Heat in the Interior
Herb Formulas	Si Ni San
Points

BLOOD STAGNATION

Clinical Manifestations	Chronic stabbing pain in the chest Pain in the hypochondrium Chronic, stubborn headache with a fixed, piercing quality Palpitations Chronic incessant hiccups Five Sole Heat Choking sensation when drinking Dry heaves Depression or low spirits with a sensation of warmth in the chest Chest distention Dry, scaly skin Dark rings under the eyes Spider naevi on the cheeks, nose, trunk, inner knee and ankle Dizziness Chronic tinnitus Chronic gum disease with dark, purplish, patchy or dark, red atrophic gums Loose teeth Painful receding gums Frequently bleeding gums Vomiting after intake of water Palpitations Persistent daytime drowsiness Insomnia (persistent with much dreaming) Restless sleep Forgetfulness Irritability Fidgeting A bad temper Extreme mood swings Evening tidal fever Dark or purplish lips, conjunctiva or nail beds Dark complexion Dark sclera Hair loss on the head and body T: Dark-red with purple spots on the edges P: Choppy or Wiry and tight or Wiry and choppy or thready or Deep and choppy or Wiry
Treatment Principle	Activate the Blood Dispel Blood Stasis Spread Liver Qi Unblock the channels
Herb Formulas	Xue Fu Zhu Yu Tang
Points

BLOOD AND YANG DEFICIENCY WITH COLD

Clinical Manifestations	Localized painful swellings without a head that bleed into the surrounding tissues and do not affect the color or texture of the skin The swellings are not hot to the touch No thirst Swollen and painful joints Wasting of the muscles of the thigh and calf T: Very pale or Pale-pink C: White P: Thready and forceless or Deep and slow
Treatment Principle	Warm the Yang Tonify the Blood Disperse Cold Eliminate Stagnation
Herb Formulas	Yang He Tang
Points

FOOD STAGNATION

Clinical Manifestations	Focal and generalized distention Fullness, distention and pain in the epigastrium and abdomen with constipation or Red and white dysenteric diarrhea with tenesmus Pus-like bloody stool Difficult defecation Difficult urination T: Normal C: Yellow and greasy P: Deep and Excess
Treatment Principle	Promote the movement of Qi Guide out Stagnation Purge accumulations Drain Heat
Herb Formulas	Mu Xiang Bing Lang Wan
Points