Menstruation problems - women expect women doctors to be able to help them 

2 pts. : blood and lung.  Nutritional essence (+ blood) up to age 12 used to develop body.  Dries up at 50, therefore mens. ceases. 
3 Major classifications, diagnosis - General, Specific, and Temperature (8 different ailments) 
Problems of uterus, menstruation - must fix before it becomes chronic. Veins - affected for LONGER, combined with ung.  TIME FACTOR (important) not the only problem.  How long has problem been around? - important factor in diagnosis. 
Blood symptoms - backache, pain in genitals, intensity is greater when connected with blood.  Sometimes small pimples around general area.  Excess flow.  No regular flow, stuck in uterus, results in pus. 
Lung symptoms - chronic, pain in joints of upper body, basic meridians of lung throacic vertebrae.  Burning sensation on flesh, irritability, giddiness, head should be kept warm, shivering, SWELLING AT CALF AND ANKLE, numbness of legs, blurring vision, restlessness  (characteristic of Lung) 
amnesia, lack of sleep.  Hot palms, feet. lack of appetite, indigestion, white discharge, absence of mens, heavy body, 

Dual humoural effect, 3 humours, ONE ONLY RARE - Treatment has to be long-term. 
Lung types tend to be:  teens, unmarried women, married women who are childless (menopausal?) 
Flow is irregular, clots form - infection of uterus - palpate the uterus area, patients feel pain (strong) 
discharge is yellowish, smelly, headache, lack of appetite, tightness 
PULSE; infection, fever - small pimples all over body with sharp edge, most pimples on forehead,get up abruptly and room spins, constipation (pulse thick and taut). Urine is checked after seeing these signs. Red, tinge of yellow, bubbles  disappear quickly, very bad colour, disease of BLOOD.  This particular problem greatly helped by TM (?) Dual cause must be remedied - 1st 3 medicines for INFECTION: YOUKHAR and KHUN NYA - mens. becomes normal, and flow is regularized.  Patient still have symptoms, but less infection so:   YOURIL 13 and KHUN NYA (milder).  for LUNG: GYA RU 14 and SHE JE  6 AGAR 35  (Last (or all 3?) is DOWNWARD VOIDING  medicine - expelling generally For BLOATING AND INDIGESTION -  SHE RU, (caused by dual humour, then GAK SEL 8 to enhance dig. potential. 
First give medicine for infection, if calmed down, give 2nd medicines. 
ANAEMIA must also be treated for LETHARGY, LOSS OF ENERGY, VERY TIRED :  KURU 25, JANGCHOE 37, AGAR 20 
Vital and vessel organs involved: Heart, back pain, burning, piercing pain at heart:  SEDU 5 and AGAR 8 
Dr. should check veins at neck, sciatica, spongelytis (possibly) 
Further treatment for LUNG: MOXABUSION, FOMENTATION ON 4th vetebrae, Golden Hammer 
Infection - CHU GANG 25, irritability JANGCHOE 37, Digestion AGAR 20(LUNG?) May not be in right order after first, check in books.  3 Main medicines (above)  not all together, but rotating. 
LIVER - Conjuction (?) gets red, or yellowish (urine)  palpate area of liver - pain, headache, so GHE-RANG 9, MEN SIL, HO SEL 25, alternately, roating, body constitution, pulse and urine  TIPA: complains of thirst, complexion yellow, indig, flatulence so: SER DAK 5, SHESEL, GARNAK 10 
KIDNEY; Itchiness of genital, pain in lower parts of body,  MORE HEAT FOR KIDNEY: 
ARU 10 and DAK SHUN 9 (cool)  PA RAK (mild) GOYOU 28 (hot) GURGUM 13 (mild) and NYENPO 18 (mild) 

LUNG - irritability, anxiety, depression 
New case history(?) 
Poor, many children, lot of mental tension and stress, active sexually, excess of mens. flow. 
Malnutrition, lack of essential nutriments. Cramps in lower abdomen, excess of while discharge, thick, palpitations of heart, backache, moving about - giddiness, voice ringing in ears (tinnitus?), cold breeze on head, forgetfulness, amnesia, insomnia, pain in points, numbness and contraction of limbs, swelling of face, pulse - sunken and weak, not evident, have to press hard.  Urine spec:  whitish, stirred, big thick bubbles.   Must regularize the mens. flow. 
Excess flow: GUR GUM 8  Not too much flow  THANG CHEN 25  Depletion of energy:  YOU KAR, THANG CHEN  25 (4 pills)  SENDU KUN DE.  All for 1-5 weeks, by 2 weeks, good progress, change med accordingly to other problems present.  Primary meds. very important, even though other conditions exist.  Keep LUNG in mind, when there is excess flow, tension, forgetfulness, insomnia, med to help Lung: AGAR  35, SOK ZIN 11, SAMDAY  (give alternately) 

ASTHMA

CAUSES; Earth element - heavy, stable, smooth, blunt, cool, heavy, oily 
Indigestion + Phelgm:  Phelgm in chest, blockage in air passage            HUK SA - ease breathing 
Sweet, heavy, cool, bitter ingredients food, heavy food, sitting around causes indigestion, sleeping during daytime in damp places. Cover body after cool showers,  bad food: - freshly harvested grain, unripened fruit, radish, old/stale veges., unboiled food, deeply roasted, deep fried food, refigerated food, unboiled cold milk, sour curd, strong tea, excess intake of food and drink - takes a long time to digest. 
Contributing factors: chronic influenza, pollution, heart disorder, allergy, smoking, dirty environment, oedema  weak b.c.ís, lungs disorder. Due to  lack of dig. heat. decomposing badkhen cannot do its work, no dig. tipa, nor fire-like lung. Increment in digestive tract, deposit - channels become smaller and blocked. 
INDIGESTION IS THE ROOT OF ALL THE CHRONIC DISEASES.
Types of asthma: 1. Tren Tseg (minor) 2. Munchen - cloudy(big cloud) 3. Ug chee (stoppage of breathing) 4. Chenpo (acute) 5. Gyen Byung (exhale) 
Gen. symptoms: General heaviness, difficulty in breathing, weak breathing, dryness of mouth, excess of sputum, whistling sound while breathing.    Pulse, weak and empty, urine, white, cloudy, when stirred, big bubbles. 
Spec. symptoms: 1. After eating, drinking, activity, (exacerbated) 2. Obstruction of gas and respiratory tract due to sputum, hoarseness of voice, difficulty of breathing, discomfort while sleeping, pain and heaviness in upper back.  3. Excess of Badkhen, weakness of ascending lung. difficulty in exhaling, weakness of voice (whispering) difficulty in breathing. 4. dryness of throat, shortness of breath while walking or exercising, sputum expectorated 5. Excess Badkhen obstructing wind pipe, problem of inhaling, relief in exhaling. 
URINE:  Whitish and frothy - disturbed fever of the heart, blood in - pulmonary infection, yellowish, strong - liver infection, Dark brown - spleen, Reddish brown - kidney, clear yellowish - gall bladder, bluish frothy - lung/ disturbed fever. 
Asthma patients have other problems beside asthma - the disturbed fever remains in the body for a long time - comes and goes. 

TREAMENT 
For all asthma patients - avoid oily/fried food, chilled drinks, refrig. food/drink, daytime sleep.  Dirt, smoke, heavy physical activity, protect body from cold, keep chest warm.  Breathing exercises in the morning,  less rice and spicy foods, avoid alcohol. 
DIET 
Bread made from grains grown in dry land, not heavy and cool. Fish, stomach ailments, improve appetite, good for cancer and badkhen.  Lamb (not mutton) - oily and warm good for lung and badkhen. Honey - good for fluids and badkhen and lung. 
Patient should inhale over jug of honey, mix honey and milk - good for asthma (year-old honey) 
Fresh curd, quite sweet - IMPROVES DIG. HEAT AND APPETITE. BOILED WATER - INCREASE BODY HEAT AND DIGESTION. 
HOT BOILED WATER PERFECT MEDICATION FOR NEWLY CAUGHT COLD. 
Fresh juice of ginger, fenugeek, - chop and boil, take a glass, add honey - loosens sputum 
Orange juice, pinch of salt, teaspn of honey - good for asthma,. common cold, bronchitis, dry cough, excess of alcohol and physical activity 
Bitter guourd, seeds inside, good for cold, bronchitis. 
Garlic - warm, help to sleep well, lung and badkhen - 3 cloves garlic boiled with glass of milk, drink in evening. 
Grapes/raisins: all lung disease and fever 
Garlic - not good for nervous system (?), nor sinusitis/paralysis 
Mint- warm good for stomach digestion - 1 teaspn. mint jce. 4 teaspns carrot jce. 1 malt vinegar, 1 honey 3 times a day after food. 

PILES

SHEL (rectum) DRUM (pimples, lumps).  If worsen, may become incurable.  Patient in crital state, may become cancerous 

Unwholesome food, bad behaviour.  Various types of parasites in the body.  Parasite resides at rectum, gets disturbed, swelling in rectum area.  Humoural factor, along with blood (Tipa).  Constant diarhoea. 
Presence of constipation, very hard.  strains to being out excrement, cuts arteries.  Wearing very thin clothes, sits on hard stool or floor, sitting sleeping on damp area.  When straining to excavate, no stool, downward descending  Lung is disturbed.  Occurrence of pimples or scars around anus. Scars around anus get infected, could be hamorrage, Lung disturbed.  Affects general harmony of body, lose oneís body heat and temperature.  Pains in arms and legs. Reverse movement of downward voiding Lung, flatulence, bloating.  Disturbance of Lung, more pain in boney area.  Lung is on the BONE (Tipa - Blood, Badkhen - Body fluids)  Polyurea (with const.). Function of d.v. Lung infection checks movement.  Infection  around anus, checks d.v. stool, d..v. Lung affects urinary bladder, affects urine, colour of stool - yellowish (Tipa). Acute pain around anus.  See relation between Lung, Tipa/blood and Badkhen. 
PILES RELATED TO BADKHEN - WATER AND EARTH degenerates -  dig. heat weakened. Flatulence, loss of appetite, susceptible to cold, lots of saliva, unsatisfactory feeling on passing urine, pain on bones, loose motion, colour of stool - whitishg, due to weak digestion, food particles, not digested  properly.  Stool has same character as food consumed - therefore weak dig. heat.  Mucus in stool. Itching, Has to scratch very hard to relieve.  Nails, eyes, complexion pale.  Blood more than Badkhen - Lung would have hard stool, burning sensation at anus.  Rumbling tum. Giddy, breeathing no regular.  Problem with Life-channel, body heat very low.  Badkhen - low body temp., weak dig.  heat, Lung, cool body temp.  Nail colour, eyes, no radiance, dark.  Scars around anus, blackish - Lung. Tipa scar red colour, sharp edge, red, colour like Tibetan coral, dark red.  Ladahk coral, paler. 
Burning sensation, irrestible constantly inflamed.   Patient complains of fever, profuse sweating. 
Scars and pimples around anus, pale red, not dark red (like Tipa). Thin blood/skin, eyes, nails - yellowish. Treatment acc. to humours present. 
3 categories this type of disease: not possible to heal, hard to heal, possible (easier) to heal. 
Piles judged  acc. to position in anus. 3 areas - External - White; Medium - Neutral; Internal - Black. 
Piles on White - external, influenced by 1 humour - fairly new condition. Piles on Neutral, dual humour factor, more than 1 year, harder to heal, Piles on Black - 3 humour combination, very hard to heal. 

Indian Patient - 60 yrs. middle class, patient is weak, supported by his son, has had no. of treatments already,  if condition goes on, may turn cancerous.  Constipation, constant itching, no appetite, heaviness in head, esp. heaviness in upper body, great weight on shoulders, dry palate. High fever, thirsty at noon -  profuse sweating in groin area, armpits, froth at corner of mouth, cracked lips. 
Case History: Drank ice-cold water, at night stomach upset, very loose motion, after good diet, didnít get rid of diarrhoea. Number of days, loose motion, weak and tiredness.   Doctor (allo.) prescribed, got a little better. Relapse - doc. again prescribed, increasing treatment. Relapse again, advised to go to bigger town, see another doctor.  Hospitalized in town, medication for 10 days, not better. Has endoscopy to check if tumour present. negative.  Goes to another big hospital. Hospitalized for 15 days, has drip, med. to check loose motion. Disease still present.  1 months med - no relief. Has blood in stools after 5 days, itching. Not able to understand development of piles problem.  25 days pass.  Blood droplets in piles.  7 months med. from Hospital. Rectum inflamed, infected, scars.  Came to Tibetan Clinic.  Also has hypertension. (Tipa).  Pulse: Hot/fever, pressed, began to disappear - Lung. 
Problem with TIPA (chiefly). Doc. (Tib.) didnít inspect rectum, based diag. on symptoms. Anaemia at  60 yrs. of age, might not recover quickly.  Medicine: DASEL (strong) a.m. GURGUM 8  -noon, NILA (strong) -  night. (Normal dose NILA 4, gave 3, gentler).  No medicine for blood, although hypertension.  Pulse: Lung, 60 yrs. weak, without nutritious food. Rise in blood problem is due to this, not due to blood problem.  No apparent changes, but better appetite, blood reduced, Pulse - same.  Doc. inspects rectum. Pimples very red (Tipa) due to continuous loose motion there is prolapse, thought to be more related to Tipa.  Change medicine:  DASEL, GURGUM 8, AGAR 35 (for Lung) - 1 week.   One week later, appetite has come back, blood from stool stopped, fever gone, backache disappeared.  Took Blood Pressure, diastolic 85: rise in b.p. due to constant loose motion, and loss of appetite, no good nutritious food, DASEL for Digestive Heat (he drank ice-cold water.  Too cold water - causes cold problems in addition to hot problems). Plus GURGUM 8 and ARU 10 (3 pills)(Lung) and NILA (2). Change night medicine, bring down infection - GURGUM 8 to check bleeding. 1 months med. - Patient much better. med. suits him, he is responding. Check urine, pulse, consultation - improvement.  Anus, improved, patient canít sit for long. He has daughterís wedding wants to sit at the ceremony.  Continue with same medicine and RINCHEN MANJOR - Precious pill. General med. - 12 days. Every 3 days, 1 RINCHEN MANJOR. He is very happy, he can squat at the wedding. Visits to show gratitude to doctor, thoght not finished with med. She checked urine spec. - noon med was changed and RINCHEN MANJOR 1 a week. 
Diet and Behaviour on 1st visit.  Tipa and Blood. No hot or sharp property foods, avoid  fruity/putrid things, sweet and sour. chilli and pickles, raw fruit and veges.  RAW FRUITS NOT GOOD FOR TIPA - SHARP.  No sitting on cement floor without mat, no hard mattress, no sex. relations with wife till recovered, no swimming,  excessive bathing, sunbathing or sitting near fire. Try not to apply pressure while evacuating, get med. for expelling, Avoid food with extreme properties, extreme Hot or Cold. Consume warm, mild food (like Lung). Buttermilk, etc. 
After 5 months and 15 days - complete cure.  Back pain (Lung) present, alternation in night to AGAR 35, loss of appetite to noon THANGCHEN 25.  Complains of cold - noon changed to THUL-THANG decoction - mild, luke-warm.  Sinusitis, noon GUR KHANG/KHUNG (strong), reduce NILA which is strong.    Ice-cold water was prime cause, it degenerated dig. heat, prolonged  loose motion which further aggravated Blood(Tipa) and Lung 
 

ARTHRITIS - GRUM BU/DUM BU 
Lung/Badkhen - extremely good results obtained from T.M. on arthritis and rheumatism 

Patient: Sherab Rinchen - due to improper diet and behaviour fluid has accumulated on joints. 
Staying in cold and wet place for a very long period. Excess of bathing in cold water. Eating excess of nutritional and oily foods. Nutritional essence did not convert into blood. Blood instead converts to serous  fluid. 

6 types: 

1.  SHA TEM   muscle arthritis 
2.  RU TEM     bone arthritis 
3.  TSA TEM    nerve 
4.  CHU TEM   ligament 
5.  TEM KAR   white 
6.  TEM NAG   black 

Feeling chilled, shivering, pricking pain in muscles and bone, oily face, pain in head, waist, hip region.  Weakness, lethargy, loss of body weight.  Pain and burning sensation in big joints and muscles.  Stiffness fo ligaments and tendons. Intolerable pain in body movement.  Colour of urine:  RED. Characteristic pulse, thin, fast and deep inside muscle, have to press very hard. 

1.  Muscle Arthritis: BADKHEN & TIPA - discoloration of skin, blackish, swelling of muscle, numbness of limb, discomfort in lung and heart region, excess of nose-bleeding, great pain. 

2.  Bone Arthritis: Predominance of LUNG - thirst, increasing heat in bone, bones become thinner, pain spreads to joints.  Serious pain.  Patient doesnít want to move.  Patient feels intolerable pain. Joints make a lot of noise.

3.  Nerve Arthritis: TIPA  - complexion loses brightness. Discomfort in heart and lungs, intolerable pain in hip region. Nerves become hard and painful.  Sometimes visible with the eyes. 

4.  Ligament Arthritis: LUNG & Cold - hardness and stiffness. Crooked, shivering, ligament and tendons become very dry. 

5.  White Arthritis (Chronic) - white serous fluids/predominance of cold. Colour of swelling is white, no reddish colour.  Colour of urine also white, pulse weak and beats very deeply. 

6.  Black Arthritis (Chronic) - TIPA/BADKHEN - black serous fluid, transformation to essence and waste did not occur. Hot, colour and swelling is black, severe pain, nose-bleeding, depression, urine red, pulse fast and strong. 
 
 

Classify into two types: 
1. TSA GRUM      - Hot arthritis 
2. DANG GRUM - Cold Arthritis 

TSA GRUM (Hot) is due to common cold and epidemic disease which increases serous fluid in big joints, elbows, shoulders, knees. Muscles, nerves, tendons.
Causes and conditions: 

Improper diet and behaviour, not taking prooper treatment for common cold or fever, unwholesome behaviour, feeling  chilled for a long time.  Light clothes in winter, damp places. 

Symptoms: 

Fever, pain on shoulder joints, knee jts. pain at right or left, alternating, pain increases with fever. Swelling on the joints.  17/18 after illness caused by a strep. infection colour becomes reddish brown 
serious pan in joints, numbness  just below elbow jt. When this becomes chronic, pain increases in jts. and muscle.  Spring and Autumn and change of season, late evening, after feeling chilled.  After proper treatment it will return to proper shape. 

How to prevent 
Proper treatment for common cold, some people get very often prone to and must take treatment for asthma or arthritis.  Fever, epidemic disease. Avoid staying in cold damp places and cool, heavy, light, oily food and spec. sweets. In Winter, avoid cold showers, getting cold. 
DANG GRUM (Cold) 
Due to weakness of  digestive heat, nutritional essence can not ripen and turn to blood, serous fluids increase.  Therefore BADKHEN diseases can ripen.   Small joints, hands and feet, muscle, tendons, ligaments,bone.  White arthritis 

Causes and Conditions 
Staying in cold and damp places for a long time.  Cold showers, feeling chill, excess intake of heavy food, heavy to digest, unwholesome diet. Diet to which one is not used. 
Symptoms 
Lethargy (not fever like other) weakness, loss of appetitie, pain in muscle, tendon and ligaments, numbness of limb, pricking pain in joints, pain on small jts. alternately or at same time. 
Discomfot in Body Movement 
Gradual swelling, swelling and pain changes to big jts. Affects big jts.  Heat in affected area, hands affected, wrists too.  Colour becomes reddish, serious pain in body movement.  Limbs, neck and vertabrae.  Bones become soft, deformity takes place, swelling.  Weakness in muscle becomes senseless.  Stiffness of tendons and ligaments.  Pimples under the affected skin area.  Eventually bedridden.  Long treatment.   Weakness of general body.  Blood level goes down. Anaemia. 
Prevention 
Feeling  chilled, protect dig. heat, esp. in Winter. 

DIET (Both types) 

No potatoes  or cabbage -sweet and heavy and cool. Cold milk, cold drinks from fridge, salad, raw tomatoes, mutton (lamb is OK). Hot food is good, protect dig. heat, boiled hot water and hot tea, apple jelly  - no sugar added - apply to sore part, reduce pain and swelling, eat garlic or make paste and apply to affected area.  Take tomato, whole plant, leaves and stem and root (not fruit). Cut, chop , half kilo, equal amount of sesame oil, boil thoroughly until all liquid dissolved.  Airtight cntr. Preserve, apply on any affected area. 

BEHAVIOUR 

Not to take cool shower, near to cool sea breeze, high windy places, keep body  warm. Light exercise. 

MEDICINES (General) 

LETEY 5       both hot and cold properties 
POEKAR 10 
POEKYUNG 
SAMNOR 
SAM KYUNG 
NGU CHU 8 
KYUNG NGA 
SENG DHEN 25 
LU DU 18 
SENG DENG 28 

MEDICINES (Specific) 

TSA GRUM 
Big jts., fever, inflammation, redness.  Reduce inflammation and swelling, pain and fever 

NGULCHU 18 and LUDU 18  Take in evening, directly after dinner. Very strong. Look at physical constitution first - big size, good appetite, 2 pills may be OK 
LETEN 5 
TRUL THANG - asthma too, good for fever.  Decoction. 

If patient gets dizzy, take warm milk, go to bed, keep warm. 
To reduce fever and inflammation, NGUL CHU - VERY STRONG. Take a rest, see how patient is, if OK can in increase. 
After fever is reduced, SENG DANG 23 (mild) POE KYUNG - quite strong, 2 pills (is combination of POEKAR 10(mild) and KYUN NGA- very small black pills (4) and can increase dosage 
DIN TSEL  25

After swelling subsides, no more swelling, medicinal bath, moxa. on affected jts. VERY GOOD for all arthritis, esp. TSA GRUM - returns to normal shape. 

THANG DRUM (Cold) treatment for a long time, 1 or 2 years, gradual from small jt. to large jt. 

THANG DANG - 5-6 months normal time of treatment 

POE KAR 10 
SEDU DANG NEY 
SERU 5 
SENG DENG 23 and 25 
SAM KYUNG 

For severe pain:
LETEY 5 
POEKYUNG 15 
NGUL CHU 18 

Moxa (on specific pts.) hot springs, med. baths. 
 

NERVE DISORDER - KELMA (BADKHEN) 
19 major nerves - major functions, nerve disorders - toxic poisoning, pollution, disturbance of lung and blood, external influences affect the nerves and cause disorder. 
Disintergration of various channels. External - visible under skin, cerebulum and brain  (immobility, numbness, abnormality of nerves) Internal - ëcurtain fallingí connected to various vital and vessel organs, not visible.  Loss of appetite, loss of sleep, not functioning properly. (Different types of symptoms) 
CAUSES OF NERVE  DISORDER 

CAUSED BY excessive physicsal activity, spreading the morbid humours throughout the body. Hard labour or physical exercise, epidemics, poisoning and fever - descend on channelks, trauma by weapons, accidents, falling, brutally beaten. 
CLASSIFICATIONS 
GENE RAL - Hot, TipaMorbid humour spreads through channels, Epidemics, poisoning. Cool - Lung and Badkhen, Time, new and old  cases 
SPECIFIC 
Locations: Head, chest, arms and legs 
Humouralî Lung, Tipa Badkhen amalgamated.  External nerves affected, swelling, inability to move due to dryness, immobility of limbs, joints and muscles, SWELLING AND BULGING OF  JOINTS. 
Headache, giddiness, backache, mental capacity affected, delusion, numbness of arms and legs, partial paralysis, loss of feeling to lower extremitites, frequent urination, constipation. 
Temperature hot, excrutiating pain, less pain, more swelling, temp. low. 
LUNG influence, patient shivers, yawns, tongue dry, feeling of illusion, dizziness, insomnia, manifests like Lung. 
TIPA - Hot signs.    Due to amalgamated humour, presence of all the 3 symptoms are mixed. 
Nerve disorder with 1 humour is easier to treat, 3 humoural disorder ( of nerves) is hard to treat - Look at INTENSITY - Badkhen - gradual arising, gradual diminishing, SLOWNESS  in treatment 
Tipa - quick to arise and respond, Lung - mobility, look for either Tipa or Badkhen, whichever is influencing.                 TIPA IS MAJOR FIELD OF TREATMENT 
Badkhen is fire-consuming.  When we give medicine for counteraction of Lung , it is HEAVY HOT WARM - so simultaneously counteracts Badkhen problem.  Tipa treated with cool properties. 

NERVE  disorder on the HEAD, manifests in dgiddiness, impaired mental capacity, patient does not sit erect, lack of sleep, vomit after food,  cannot speak, delusion, itching, intolerance of noisy atmosphere. 

NERVE  disorder on the CHEST - talks a lot, trembles, shivers, hunger and thirst (continual), inactivity, feeling of swelling, temp. rising, very cold, stooped, canít bend down, restricted in movement. 

NERVE  disorder of  LIMBS - Numbness, tingling sensation, swelling, contractions of muscle, can-t raise hands and move legs, inability to hold utensils, not steady walking, if cold wind blows pain is aggravated, canít  extend arms. 
Intense problem,  hard to treat. Not too serious - determination and perseverance,  New problem, pain intense, easier to treat, old problem, pain not too intense, hard to treat. 

EPILEPSY/STROKE 
5 types, connected with nerves.  Causes, class, signs and symptoms vary. 
Classified according to 5 cosmo-physical elements 
Epilepsy - Earth, water, air, heat, space.  Fire element - cool and hot (Blood) 
Epilepsy/Stroke due to hypertension, cool.  Due to lack of blood, improper CIRCULATION of blood. 
Fire: excess of blood pressure, increase in heat of body, ultimately haemorrage of brain, cranial haemorrage, stops nerve functioning.   Epilepsy - partial paralysis, facial paralysis, similar signs, so check  whether nerves or epilepsy. 

Inability to co-ordinate physical body due to hypertension and brain haemorrage, bring down blood pressure, symptoms of stroke begin to disappear.  Give new medicine to stimulate the functioning of various nerves. Hot property, have to be careful, quick/fast activity control fever. 
NERVE DISORDERS AND EPILEPSY - look similar, may lead to mistreatment, important to go through each and every detail. 

SAM NOR,  DALI 16, MUTIK 25 are mild medicines, not too hot, not too cold. 
If more TIPA is present, add  SAM KHONG A (controls infection and fire) 
SAM NOR and KUNG A combination straight after food.  JURMA 25 (Precious Pill)  1  a week 

LUNG on top of nervous symptoms: AGAR 20, JANGCHOK 37, AGAR 15  AGAR 35.  Plus HEATING medicines for morning, SENDU DANG NAY  SENDU NI KIL  SENDU KUN DE 

5 Nectar Medicines also very effective,  Nerve disorder with cool properties, also hot properties when fever eliminated. 

Accesory therapies:  TSA CHUK  powder in butter/mustard/sesame oil.  Apply to any portion of the body which has a problem e.g. torso and arms and legs.  Take patient into sun and apply pressure, not too gently.  4th Tantra for massage, esp. for Lung and old-age, depleted energy, lack of body heat, very exhausted, be careful with young, may have tipa problem, may aggravate. 
Golden Needle - 4 finger span from depression at back of neck.  Moxa and Golden Hammer, shoulder, elbow point, cough point. BE CAREFUL ABOUT VITAL ORGANS - may be problem there. 
Take care with HOT SPRINGS - should know what kind of minerals are in it before prescribing. 

MADNESS - Causes 
1. LUNG 2. TIPA  3. BADKHEN  4.  ALL 3  TOXINS   4. WORRY, ANXIETY AND GRIEF. Due to external influences and impulses: ablity to sustain oneself but cannot face problems, due to weakened mind.   Separation from loved ones, worry about loved ones. Excitedness, depletion of aura, loss of appetite and sleep, frequent yawning, shivering, desire to stay still and not move, person may develop insanity or madness. 
SIGNS AND SYMPTOMS; 
Lung:  emaciated, dark skin colour, constant tendency to vomit, froth, talkative, cries for no reason, suddenly starts to laugh, dancing and singing. 
Tipa:  fearful expression, worried, may attack physically, distrusts all around.  Remedy: foods which are cool, cool house, eyes aand lips look yellow, urine yellow 
Badkhen: sleeps a lot, lack of appetite, saliva dripping. 
Amalgamated: all symptoms 
Worry and Anxiety: - see above 
Poisoning: Weakened, complexion radiance lacking, health weakened, emaciated 
TREATMENT:  clear the various channels;    Lung- massage and baths  Tipa - purgatives  Badkhen - emetics 
SPECIFIC TREATMENT;  LUNG massage with med. butter (Aconitum), age-old meat, thick chang(fermented barley wine, oily and heavy) sleep a lot, disturbed channels get rested, nutritious food, Golden Hammer.  Massage on lung point, last cervical vertebrae (7th), (6th and 7th thoracic vert. solar plexus).  TIPA ëSwastikaí (dried)  CHITATA/TIK TA.  Purgatives: DEN TA 5, TIK TA 7. BADKHEN Powder GESHER 3  Mix with calfís milk - massage, fresh meat of wild yak, cereal grown in dry lands. Medicines:  SENDU 5 and SENDU 4. Moxa. 2n and 3rd thoracaci vert.  MUTIK 28, AGAR 8 SOKZIN 11.  Medicinal incense and AGAR 31, PAWO 6 and RINCHEN MANJOR - restores life and energy. 

Moxa. on joint (proturberance, NOT between) -  size of fingertip. 

SPECIFIC METHODS OF TREATMENT 
Diet/ Behaviour /Medicines /Therapies (Accessory) 

1. Techniques of treating doubtful diagnosis.
2. Techniques of treating a disorder which is confirmed  
3. Methods of correct remedies 
4. Treating disorders when patient does not respond  
5. Acute problems according to nature  
6. Treating diseases step by step  
7. Specific disorders  
8. Treating combined humour disease  
9. Methods of treating disorders by suitable advice 

1.If there is doubt whether dis. is Lung or Tipa, give oily soup last thing at night - did patient sleep better, deeper, more relaxed?  If so, problem is Lung.   Headache could be Lung or Tipa, so give decoction of Swertia Chirata - (sic) more Tipa (?)   Doubt re Badkhen - Decoction of Hedychium Spicatum, rock salt and terminalia chebula - boil together, ask patient to drink. 
2. Diagnois is confirmed, patient has confidence in decoction (means above decoc. is good remedy for Badkhen?) 
3. When there is strong fever, clear up fever, then nature of disease is uncovered.  MANU 4 is a CLARIFYING decoction - fever gone, everything is balanced. 
3 MYROBALAN FRUITS;  1. Terminalia Chebula, 2 Terminalai Balercia, 3. Phyllanthus Embilica - all known as DEBU SUM TON.    For ? 
4. Patient does not respond - was diagnos is right or wrong - 
i) Correct DIAGNOSIS or not  ii) whether TREATMENT is  right or wrong  iii) If treatment is right, whether DOSAGE is right or not, too little, too much  iv) If it is wrong  and patient CHANGED from previous doctor, look at previous doctors prescription, dosage maybe too little, too much. v) See exactly what is wrong with the patient, then pounce ìlike a kingfisher diving for fishî. 
5. High fever, hot disorder, 4 methods Cold-natured treatment - diet, behaviour, medicine, ext. therapy.  Cold-natured disorder, 4 methods Hot; cold kidney, keep kidney area warm. Arthritis, rheumatism, keeping warm, living in warm places.  Moxa. is best. 
6. Techniques fore treating disorder step by step.  Take care of diet, take care of behaviour.  Come back for moxa. or Golden Needle. Donít give treatment all at once - kalli kalli.  
7. Techniques for spec. disorders. Treat without producing secondary disorder - 12 reactionary imbalances.   Lung treatment in excess - too much wind, sweet and salty, too much sweet and Badkhen arises, salty - Tipa arises.   Tipa treatment is excess - sweet and bitter, too much sweet - Badkhen, too much bitter - Lung.  Badkhen in excess - sour and pungent, sour - Lung, pungent (hot)  - Tipa arises.  Wrong treatment for Lung is bitter and pungent.  Lung is not controlled, and Badkhen and Tipa arise.  Wrong treatment for Tipa is salty and pungent, Tipa not controlled, Lung and Badkhen arise. Wrong treatment for Badkhen - bitter, salty, sweet.  Badkhen not controlled, Lung and Tipa arise.   Pharmacists must prepare properly, doctors must prescribe properly.  
8. Combined disorders - balance the combined humours - I)  balanced medicines having both cold and hot power should be prescribed  ii) Balancing individual disorders by supplementary ingredients; Lung and Liver are both cold and hot - Saffron (good for Liver) and Marsala (chai?)   Lung and Kidney - Cardoman (Elaichi chai) - good for kidney.  POMEGRANATE 5 and SEDU 5  1st one hot and second more hot - easy to take in Winter, very warming but watch for hot disorder from overheating. 
9.  Time of day to prescribe:  Lung - morning and bedtime, Tipa - noon and midnight, Badkhen - dusk and morning.  
10. Find suitable treatment, everyone different - Body constituents, excretions, environment, time of arisal (of disease).  Age: infant, adult, old-age. Nature of disorder: Lung, Tipa or Badkhen. Location of disorder. Digestive Heat - is there enought for patient to digest? Habitat.  
11. Strength of patient.