Pneumonia

Western Diagnosis
cute infection of the lung

**Etiology**
1. Bacteria: streptococcus pneumoniae, staphylococcus aureus, hemophilus influenza, klebsiella pneumoniae, mycoplasma pneumoniae 2. Viral (Walking pneumonia) 3. Predisposing Factors -Respiratory viral infections, alcoholism, institutionalization, cigarettes, heart failure, chronic obstructive airway disease, age extremes, debility, immunosuppressive disorders and therapy, compromised consciousness, dysphagia, exposure to transmissible agents 4. 2 miles each year in US: 40-70,000 die. 6th leading cause of death. Most lethal nosocomial (caught in hospitals) infection 5. In developing countries, leadig cause of death or 2nd to diarrhea 6. 30-50% have no identifiable pathogen 7. Sputum cultures contaminate from other areas

**Pneumococcal Pneumonia**
1. Most common cause of bacterial pneumonia: streptococcus pneumoniae 2. Pathology a.inhalation or aspiration of pneumococci b. lodge in bronchioles & proliferate c. inflammation of aveoli d. Protein rich fluid outpouring e. congestion: exudates, vascular engorgement, bacterial proliferation f. red hepatization: -airspaces filled with PMN's - vascular congestion - RBC extravasation g. gray hepatization -fibrin accumulation -inflammation exudate in aveoli h. resolution: exudate resorption

**Signs & Symptoms**
1. preceded by upper respiratory infection 2. sudden onset with a single shaking chill 3. fever, pleurisy, cough, sputum, dyspnea 4. fever, pleurisy, cough, sputum, dyspnea 5. rapid T rise to 105 6. increased heart rate to 140 7. increased respiratory rate to 45 8. blood streaked or rusty sputum 9. tactile fremitus 10. percussive dullness 11. bronchial breath sounds 12. whispered pectoriloquy 13. suspect in anyone with acute febrile illness with chest pain, dyspnea, cough 14. complications 15. sepsis ii. contiguous infections iii. bacteremia

Laboratory
a. leukocytosis with shift to the left- neutrophilia with lymphopenia b. gram stain of sputum c. sputum culture

X-ray
a. pulmonary infiltrate b. dense consolidation

Treatment
a. penicillin G or V b. erythromycin, cephalosporins, clindamycin

Staphylococcal Pneumonia
-2% of infections - 15% of nosocomial pneumonias - often in patients who are more ill

Signs & Symptoms
1. as above 2. can be more fulminant with more prostration 3. recurrent chills 4. tissue necrosis and abscess

Lab and X-ray
as above

Treatment
1. mortality rate 30-40% 2. slow response to treatment 3. produce penicillinase, so must use a penicillinase­resistant penicillin: a.  oxacillin, nafcillin; b. cephalosporin

Etiology
1. 2nd only to strep 2. Hib -can cause meningitis, epiglottitis 3. higher incidence in Native Americans, Eskimos, blacks, low socioeconomic status, Hodgkin’s, sickle cell, children <5 yrs old who attend day care 4. mostly in children about 1 yr old

Signs & Symptoms
 coryza, pleural effusion, bacteremia

Treatment
1. vaccine 2. ampicillin, amoxicillin

Etiology
1. rare in healthy adults 2. very young or old 3. hospital settings 4. immunocompromised 5. alcoholics 6. up to 50% mortality

Signs & Symptoms
1. currant jelly like sputum 2. tissue necrosis and abscess 3. fulminant course

Diagnosis
1. sputum culture

Etiology
1. most common pathogen in ages 5-35

Signs & Symptoms
1. 10-14 day incubation 2. initially resembles influenza: malaise, sore throat, cough 3. gradual progression as signs increase in severity with time 4. paroxysms of cough 5. mucoid, mucopurulent, blood streaked sputum 6. 1-2 weeks with gradual spontaneous recovery

Diagnosis
1. usual 2. serologic assays

Treatment
a. tetracycline, erythromycin b. almost all patients recover with or without treatment

Etiology
1. many viruses cause lower respiratory infection

Signs & Symptoms
1. HA, fever, myalgia, cough with mucopurulent sputum

Diagnosis
-A few bacteria on sputum gram stain with a predominance of monocytes

Treatment
Zinc, elderberry, lomatium, vitamin A, D

May have superimposed bacterial infection
1. strep, staph = =

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================================================= IBIS:

Definition:
An acute infection of the parenchyma (alveolar spaces and/or interstitial tissue) of one or both lungs.

Etiology:
Pneumonia is classified by the extent of lung involvement: • Lobar: One entire lobe is involved • Segmental or lobular: Parts of one lobe are involved. • Bronchopneumonia: When it affects the alveoli next to the bronchi.

Pneumonia is also classified by the associated microorganism involved in creating the infection: under the main listings of bacterial or nonbacterial:

• Bacterial: Pneumococcal pneumonia (the most common), Strep pneumoniae, Staph aureus, Group A hemolytic strep, Klebsiella pneumoniae, Hemophilus influenzae, Francisella tularensis

• Non-bacterial: Viruses, fungi, rickettsias.

Risk factors for developing pneumonia include URI; malnutrition; hospitalization; debility or immobilization; alcoholism; exposure; coma; hypostasis; foreign object aspiration into the lungs; decreased cough reflex (e.g. from smoking); COPD; major bony abnormality or deformity (e.g. severe kyphoscoliosis); bronchial tumor; and treatment with immunosuppressive drugs.

Nutrition:
eating principles: • increase fluids: diluted vegetable juices, broths, herbal teas • increase foods rich in Vitamins A and C • vegetable juice fasts • low sugar

therapeutic foods: • foods that tonify the Lung • garlic, onions, leeks, turnips, grapes, pineapple, honey, green leafy vegetables (Jensen, p. 61) » Wind-Cold Invading the Lung: • increase Warming foods, easily digested foods: soups, porridges, meat broths » Phlegm Shi (Excess): • marjoram, mustard greens, mushroom, strawberry, string bean, papaya, potato, pumpkin, radish, agar, garlic, fresh ginger, Job's tears, kohlrabi, tuna » Lung Heat without Phlegm Shi (Excess): clears Heat from the Lung: • white fungus, agar, celery, asparagus, apple, pear, carrot, duck, Job's tears, mango, shark meat, mushroom, nori, octopus, papaya, peach, persimmon, pumpkin, radish, rice congee with carrot or adzuki bean » Lung Yin Xu (Deficiency); moisten and nourish Lung Yin: • dairy foods, pears, applesauce, seaweed in small quantity, shark meat, watermelon, mutton, tangerine, pinenut, chicken broth, clam, barley malt, walnut, yam, peanut, chicken egg » Lung Qi Xu (Deficiency): support the Middle Warmer, nourish the Righteous Qi: • Astragulus or Codonopsis cooked in soups, carrot, duck, celery, garlic, fresh ginger, grape, Job's tears, kohlrabi, tuna, barley malt, mango, mushroom, marjoram, mustard greens, olive, papaya, peach, peanut, pork, pumpkin, rice, yam

fresh juices: • carrot (Walker, p. 150) • carrot and spinach (Walker, p. 150) • carrot, beet, and cucumber (Walker, p. 150) • horseradish and lemon (Walker, p. 150) • carrot, celery, and radish (Walker, p. 150)

specific remedies: • Add 1-2 dried persimmons to rice gruel. Eat first thing in the morning for five days (Yin-fang and Cheng-jun, p. 63) • turnip pack externally on chest • carrots and apricot kernels cooked with rice porridge, three times daily for 30 days (Ni, p. 113) • 2-3 pears, reinvigorate the core and fill with honey and eat before bed every day for l month (Ni, p. 113) • juice from pineapple and lemon, drink before meals for relief (Ni, p. 113) • to expel phlegm: mix honey and apple cider vinegar • cough syrup made from soaking chopped onions (or garlic) in honey overnight, covered, until a syrup has formed (Shefi) • 6 oz. chestnuts, 5 oz. pork. Braise together and eat 3-4 oz. twice daily (Butt and Bloomfield, p. 124) • 1 pear, 7 scallions, 3 oz. raw brown sugar. Boil in 1 pt. water until reduced by half. Eat and drink twice daily using half each time (Butt and Bloomfield, p. 152) • take 10-15 g loquat fruit stones and crush them. Add 3 g fresh ginger, cover with water and simmer 1 hour. Serve twice daily (Yin-fang and Cheng-jun, p. 48) • cough with thick phlegm: take 2 dried persimmons and 30 g candied honey. Add water, steam in a covered pot, mash and eat twice daily (Yin-fang and Cheng-jun, p. 63) • take a fresh lemon or orange, slice and add 15 g sugar. Steam in water until soft, mash and serve, including the skin, twice daily (Yin-fang and Cheng-jun, pp. 64, 84) • take 50 g of shelled peanuts, add water and boil, then mash. Drink the broth and eat the peanuts twice daily (Yin-fang and Cheng-jun, p. 97) • burning cough with Phlegm Shi (Excess): simmer bamboo shoots in water and serve (Chao-liang, Qing-rong, Bao-zhen, p. 23) • Hot cough with Phlegm Shi (Excess): simmer bok choy in water and serve (Chao-liang, Qing-rong, Bao-zhen, p. 33) • burning in lungs with frequent cough: simmer watercress in water and serve (Chao-liang, Qing-rong, Bao-zhen, p. 37)

avoid: • cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: tofu, meat, ice cream, heavy protein foods, fats, meats, vinegars, shellfish Wind-Cold Invading the Lung: • Cooling foods, eggs Excess Lung Phlegm: • dairy, soy products, coconut, sugar, sweet rice, persimmon, pork, almond, honey, peanut Hot Lung Phlegm: • garlic, fresh ginger, pork, mustard green, sweet rice, sugar, walnut

Botanicals
• Aconitum napellus (toxic): early stage, controls inflammation (Felter and Lloyd, p. 105) • Allium sativum • Asclepias tuberosa: early stage with indications (Felter and Lloyd, p. 290) • Aspidosperma quebracho-blanco: chronic, with cyanosis (Ellingwood, p. 248) • Atropa belladonna (toxic): early stage, congestion, fever (Ellingwood, p. 180) • Bryonia alba (toxic ): later stages to control the inflammatory process (Felter and Lloyd, p. 105) • Creosotum: purulent expectoration (Ellingwood, p. 490) • Digitalis purpurea (toxic): for heart after pneumonia with indications for Digitalis (Ellingwood, p. 216) • Eriodictyon californicum: chronic pulmonary difficulties (Felter and Lloyd, p. 729) • Eucalyptus globulus: foul, purulent condition (Felter and Lloyd, p. 736) • Ligusticum porterii: viral (NCNM Botanicals) • Rhus toxicodendron (toxic): irritable, gastric irritation with (Felter and Lloyd, p. 1673) • Selenicereus grandiflorus (toxic ): feeble heart action following pneumonia, advanced interstitial pneumonia (Felter and Lloyd, p. 375: Ellingwood, p. 214) • Sticta pulmonaria: dry hacking cough, soreness (Felter p. 655) • Veratrum viride (toxic): early stage, full bounding pulse, sedates (Felter and Lloyd, p. 2053) • Zingiber officinale: prevents cold from worsening to pneumonia (Sherman)

Chinese Formulae
» lobar/lobular: • Lonicera and Forsythia F. (Yin Qiao San) (available as patent): Lung Invaded by Wind-Heat: early stage pneumonia. (Lonicera: Hsu, 1980, p. 83; Yeung, p. 275; Bensky and Barolet, p. 44; Yin Qiao: Zhu, p. 46) • Ma Huang and Apricot Seed C. (Ma Xing Shi Gan Tang); Zhi Sou Ding Chuan Wan (patent): Lung Invaded by Wind-Heat: fever with or without sweating, thirst, wheezing, coughing, labored breathing, yellow tongue coat. (Ma Huang: Hsu, 1980, p. 68; Yeung, p. 157; Dharmananda, 1986, p. 126; Bensky and Barolet, p. 88; Zhi Sou: Zhu, p. 92) • Qing Qi Hua Tan Wan (Pinellia Expectorant Pills) (patent): Lung Obstructed by Phlegm-Heat (Zhu, p. 78) • Ma Hsing Chih Ke Pian (patent): Lung Invaded by Wind-Heat (Zhu, p. 73) • San Jia Fu Mai Tang plus Qing Ying Tang: Lung Yin Xu (Deficiency): fever especially at night, restlessness, insomnia. (San Jia Fu Mai Tang: Yeung, p. 185; Bensky and Barolet, p. 405; Qing Ying Tang: Yeung, p. 178, Bensky and Barolet, p.75) • Four Major Herbs (Si Jun Zi Tang) plus citrus (chen pi) (Yi Gong San): Spleen Qi Xu (Deficiency): pallid complexion, weak limbs, loose stools, reduced appetite, pale tongue. (Four Major Herbs: Hsu, 1980, p. 264; Yeung, p. 214; Dharmananda, 1986, p. 103; Bensky and Barolet, p. 236; Yi Gong San: Yeung, p. 214, Bensky and Barolet, p.238) • Hui Chun Dan (patent): Lung Obstructed by Phlegm-Heat: in children (Zhu, p. 195) • Coptis and Scute C. (Huang Lian Jie Du Tang): Fire Toxin in all three Warmers (Jiao): fidgeting, dry mouth, insomnia, vomiting with blood, rashes, carbuncles, boils, infectious diseases with high fever (Bensky and Barolet, p. 75; Yeung, p. 178) • Gypsum C. (Bai Hu Tang) plus Wei Jing Tang: Lung Obstructed by Phlegm-Heat with Heat in Yang Ming Level (Heat in the Qi Level): high fever with profuse sweating and aversion to heat, red face, severe thirst, irritability, cough with foul-smelling sputum which may be streaked with blood. (Gypsum C.: Hsu, 1980, p. 185; Yeung, p. 38; Dharmananda, 1986, p. 369; Bensky and Barolet, p. 70; Wei Jing Tang: Yeung, p. 239; Bensky and Barolet, p. 91)

» mycoplasma: • Apricot Seed and Perilla F. (Xing Su San): Lung Invaded by Wind-Cold-Dryness: slight headache, chills without sweating, cough with watery sputum, stuffy nose, dry throat, dry white tongue coat. (Hsu, 1980, p. 46; Yeung, p. 267; Bensky and Barolet, p. 158) • Morus and Chrysanthemum C. (Sang Ju Yin): Lung Invaded by Wind-Heat. (Hsu, 1980, p. 78; Yeung, p. 191; Bensky and Barolet, p. 44) • Minor Bupleurum C. (Xiao Chai Hu Tang): Liver Qi Stagnation: alternating fever and chills, dry throat, bitter or sour taste in the mouth, irritability, reduced appetite. (Hsu, 1980, p. 91; Yeung, p. 255; Dharmananda, 1986, p. 133; Bensky and Barolet, p. 136) • Astragalus 16 (patent): chronic lung disorders (Dharmananda, 1990, p. 80)

Acupuncture
after assessing the person and palpating, consider these patterns: Lung Invaded by Wind-Heat; Lung Invaded by Wind-Cold; Lung Obstructed by Phlegm-Heat; Yin Xu (Deficiency); Spleen and Lung Qi Xu (Deficiency); dysfunction of the Ren Mai (Conception Vessel)

» illustrative combinations: • Lu-6, GV-14 and UB-13 for pneumonia (Shanghai, p. 242) • LI-11, UB-13, Lu-7, Lu-11(bleed) and LI-1(bleed) for pneumonia; also consider LI-11 with fever; St-40 with profuse Phlegm; PC-6 and CV-17 with chest pain (Liu, p. 262) • Lu-7 and Kd-3; CV-17; Kd-24, Kd-25, Kd-26, Kd-27, St-16, St-15, St-14 and St-13; UB-42/47, UB-43/48, UB-44/49, UB-36/41 and UB-37/42; LI-4 and LI-13; Sp-21, Lv-14, Sp-17 and Sp-18 for pneumonia (Mann, p. 94) • Lu-7 and Kd-6: open and regulate the Ren Mai (Conception Vessel); nourish Yin; induce Xu (Deficiency) Fire downward; clear the Lung; ease the throat; stop cough (Finkelstein, p. 3) • Needle painful points on Bladder and Gall Bladder channels on the head to treat invasion of Wind-Cold. After recovery, tonify Lung and Wei (Protective) Qi by using LI-4, Lu-7, St-36. (Fan and Dunbar, p. 22) • Lu-5 and Lu-7: spread Lung Qi to treat cough and hemoptysis (Finkelstein, p. 2) • Lu-5, Lu-6 and LI-4: treat hemoptysis (Finkelstein, p. 2) • UB-11, UB-13, CV-22, Lu-5, Lu-8, TW-5 and Sp-6 (daily) for bronchitis (Shanghai, p. 584) • Lu-5 and St-40: clear Phlegm (and Heat) of bronchitis or pertussis • Lu-5 and Lu-10 (-): clear Heat from the Lung (Finkelstein, p. 2) • Lu-5 and Kd-7: clear Lung and nourish Yin when Lung Heat has injured the Body fluids (Maciocia, p. 370) • Lu-7, Lu-9, Lu-5 and UB-13: treat cough and stuffy chest (Flaws, 1989, p. 97) • CV-22 and CV-17: treat dyspnea and cough (Ellis, et al, 1988, p. 363) • CV-22 and St-40: pacify breathing and dissolve Phlegm (Finkelstein, p. 93) • Lu-7 and Lu-9: strongly spread the Lung Qi and stop coughing (Finkelstein, p. 3) • St-40 and UB-13 for cough with abundant phlegm (Shanghai, p. 274) • UB-13, St-40 and CV-22: relieve cough (Finkelstein, p. 22) • St-40 and GB-40: treat stabbing pain in the chest (Shanghai, p. 274) • St-40 and PC-6: dissolve Phlegm, expand chest, harmonize the center, and relieve congestion (Finkelstein, p. 22) • PC-6, St-40 and Lv-3: expand the chest (Finkelstein, p. 22) • UB-20, PC-6, CV-12, CV-14 and St-40: treat chest, epigastric distention, plentiful, suffocating Phlegm (Flaws, 1989, p. 97) • Kd-27 and St-18: treat productive Qi cough and Phlegm dyspnea (Ellis, et al, 1988, p. 263) • UB-13, GV-12, Lu-9 and St-40: regulate the Lung (Finkelstein, p. 22) • St-40 and CV-22: dissolve Phlegm, smooth Qi circulation and pacify breathing (Finkelstein, p. 22) • St-40 and CV-14: dissolve Phlegm (Finkelstein, p. 22) • UB-20, CV-12 and St-40: regulate the Qi, dissolve Dampness, and reduce Phlegm (Finkelstein, p. 22) • GV-12, Lu-9 and St-40: restore order to the Lung and still cough (Finkelstein, p. 22) • CV-12, St-36 and St-40: clear Internal Heat and dissolve stubborn Phlegm (Finkelstein, p. 22) • UB-38/43 and CV-4 (+): tonify Yin of whole body (Eisen) • UB-23 and Kd-3 (+): tonify Kidney Yin (Eisen) • PC-6 and CV-17 (-): relieve chest pain (Eisen)

Homeopathy
• Aconitum napellus: first stage in robust persons; chill followed by intense fever; hot dry skin, quick and hard pulse; accelerated, labored, incomplete respiration; restlessness; fear of death; hard, painful, cough; soreness, sputum thin, frothy, tinged with blood; percussion sounds still clear, crepitating rales audible • Antimonium tartaricum: with hepatic congestion, pleuropneumonia; must sit up to breathe; dyspnea with desire to cough, and though chest is full of mucus, inability to bring it up; great thirst, tendency to diarrhea; pneumonia of drunkards, with bilious complications; suitable to infants or cachectic people • Arsenicum album: extreme prostration, clammy perspiration, urgent thirst, drinking little but often; shortness of breath, on slight exertion, ichorous expectoration fetid or dingy green • Bryonia: pleuropneumonia, indicated after acon., when hepatization stage of exudation has set in; oppression with feeling of anxiety, heavy pressure just above sternum, bruised feeling and shooting pains in chest, < by every motion; pains more bearable when lying on affected side; abdominal breathing; thirst for large quantity of water • Carbo vegetabilis: spasmodic cough with deep, rough voice or else aphonia; burning in chest, profuse, yellow fetid expectoration, especially in aged patients; great deal of rattling in chest, < on turning over in bed, and on dropping off to sleep; tongue dry with little or no thirst; craves fresh air; foulness of all secretions; pneumonia complicated with failure of right heart • Chelidonium: infantile pneumonia, bronchitis with hepatic symptoms; face deep red, oppression of chest; fanlike expansion of alae nasi; one hot, one cold foot; lethargy during the day; severe chills; anxious mood; irregular palpitation of heart; bright-yellow stools; straining cough < morning, with expectoration deep from lungs; violent stitches in right lung going to lower edge of right shoulder-blade • Ferrum phosphoricum: first stage of infantile pneumonia, esp. caused by checked perspiration on hot summer's day; pneumonia of adults, as long as no exudation has taken place; very little thirst; profuse expectoration of almost pure blood, or frothy pink mucus • Hepar sulphur: mild suppurative stage, extending only over small part of lung; chronic pneumonia; profuse purulent expectoration; weakness of chest preventing talking; late stage of croupous pneumonia • Lycopodium: maltreated or neglected pneumonia, passing into a typhoid stage, right side mostly affected; night-sweat, extensive hepatization; diaphragmatic breathing and fanlike motion of nostrils; great dyspnea, expectoration of whole mouthful of light rust-colored mucus, not thick, more stringy; coldness of right foot, while other is warm or hot • Phosphorus: dryness of air passage; great weight on chest, or tightness; chest sore, bruised, hepatization of lower half of right lung, winglike motion of alae nasi; < from lying on left side, hepatization with mucus or bloody sputum; coughing increases difficulty of breathing, pleuropneumonia • Pulsatilla: bronchopneumonia in achlorotic and anemic women; loose cough lingers after the resolution of a severe inflammation; debility and inertia of mind and body; free yellowish-green sputum • Rhus toxicodendron: tearing cough and restlessness; rest aggravates pain and dyspnea; tongue dry, sooty, red at tip; loss of strength; dryness and heat of skin, dyspnea < from distention of pit of stomach; sputum bloody, brickdust, or green with putrid smell • Sulphur: slow solidification of the lungs; frequent weak, faint spells and flushes of heat; feels suffocated, wants doors and windows open; constant heat on top of head; short rapid breathing, a mere heaving of the chest; cough and expectoration nearly impossible, < about midnight; hepatization mostly heard on back; pneumonia of infants and old people • Veratrum album: Frothy serous sputum; blue face; dry, spasmodic cough; hurried and small pulse, cold skin and cold sweat with excessive debility; edema of lungs, suitable often for old people

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F, G, G#

• chords: dominant 7th, diminished 7th, diminished 8th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

Mind/Body
• Lung represents the ability to take in life. (Hay, 1984, p. 173) • Desperate; tired of life; emotional wounds that are not allowed to heal. (Hay, 1984, p. 179)

Chinese psychophysiology: • Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; and relates to strength and sustainability. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; and inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold. Chronic Lung Yin Xu (Deficiency) increases susceptibility to acute Shi (Excess) conditions such as Phlegm, Wind, Heat and Cold. » Lung Shi (Excess) signs include panting; yawning; sneezing (Seem, p. 28); pain in the upper back, shoulder, and chest; colds with stuffed nose; hoarseness; wheezing respiration; frequent urination with small amounts; heavy chest; reduced lung capacity; coughing; and nasal discharge.

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines.

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Dietary Recommendations
Drink plenty of water and juice. Avoid eating big meals, and avoid eating milk products because they thicken mucous.