Hematology in Traditional Chinese Medicine Cardiology
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INTRODUCTION
The companion course which is required for study with this textbook edi-
tion can be found on the Elsevier website and at www.niambiwellness.com.
APPROVING AGENCIES
The course with this textbook is entitled, Integrative Study of
Hematology in Cardiology.
This course is approved by the National Certification Commission for
Acupuncture and Oriental Medicine (NCCAOM), and is listed as course
#1053-007 for 9 PDA points.
This course is approved by the Florida State Board of Acupuncture,
and is listed as course # 20-334886 for 10 CEU credits.
COURSE DESCRIPTION
This course briefly covers the basic sciences of blood and immune sys-
tem from the Western medicine and Traditional Chinese Medicine per-
spectives. The focus is on laboratory values for diagnosing and
monitoring cardiovascular diseases.
COURSE OBJECTIVES
Understand the 5 parts of blood and blood development, genetic blood
disorders found in cardiovascular diseases, essence, qi and blood, the
immune system including the TCM 6 stages and 4 levels.
Learn the laboratory results and values used for diagnosing and
management.
CHAPTER 1
Biomedicine Perspective of Blood and Lymph
CHAPTER OBJECTIVES
After studying this chapter, you should be able to:
1. Explain the components of blood.
2. Describe key details about the lymphatic system.
3. Explain the genetic blood disorders and how they affect the cardio-
vascular system.
1.1 PART 1: BLOOD
Blood carries and delivers oxygen, hormones, and other nutrients to cells
and helps maintain the body temperature and the immune system. It also
removes waste products and carbon dioxide. The components of blood
include plasma, erythrocytes, thrombocytes, leukocytes, and lymphocytes.
1.1.1 Plasma
Plasma is the yellowish clear fluid component which makes up about
55% of blood.
It includes:
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
Visit the course to find the answers.
Hematology in Traditional Chinese Medicine Cardiology. DOI: http://dx.doi.org/10.1016/B978-0-12-800124-0.00001-4
© 2014 Elsevier Inc. All rights reserved.
4 Hematology in Traditional Chinese Medicine Cardiology
1.1.2 Erythrocytes
Erythrocytes are the red blood cells, and they make up about 50% of
blood volume, and 3 million cells are continuously produced per
second from stem cells located in the bone marrow. Hemoglobin is an
iron rich, oxygen attracting protein molecule which creates the red
color, and makes up 95% of the erythrocyte. Erythrocytes move and
deliver oxygen and other plasma components to all cells, tissues, and
organs and carry carbon dioxide and other waste products to the rele-
vant deposit centers of the body. Specific antigens are protein mole-
cules on the surface of erythrocytes which identify the blood type. The
antibodies bind to the antigens, and when this happens the process of
agglutination occurs which clumps millions of red blood cells together.
10. What is the difference between clumping and clotting?
___________________________
Visit the course to find the answers.
1.1.3 Thrombocytes
Thrombocytes are also called platelets and are cell fragments which
circulate within the blood with a life span of about 10 days. The
middle of the night and morning hours are time of platelet activation,
when they can be a causative factor of serious cardiovascular disease
such as in myocardial infarction or stroke. Generally, they are useful
in cases of injury and will adhere at the site of a wound or to the walls
of damaged vessels to release chemicals which clot and close the
wound or vessel. Immediately the 13 different clotting factors are
triggered in a cascading sequence.
11. Which factors do hemophiliacs lack?
___________________________
Visit the course to find the answers.
1.1.4 Leukocytes
Leukocytes are white blood cells which make up 0.5 1% of blood,
liver, spleen, liver, and lymph nodes. They are produced in bone mar-
row from stem cells and the thymus gland and have a life span of
about 20 36 h.
12. Leukocytes are part of what?
___________________________
Visit the course to find the answers.
Biomedicine Perspective of Blood and Lymph 5
1.1.5 Lymphocytes
Lymphocytes are white blood cells which also make up about 0.5 1%
of circulating blood. They are produced in the stem cells in bone
marrow and function to produce antibodies to pathogenic antigens
such as bacteria, viruses, and parasites. This provides immunity to
future invasions of the same kind of pathogenic antigen.
13. What is the benefit?
___________________________
Visit the course to find the answers.
1.2 PART 2: LYMPHATIC SYSTEM
The functions of the lymphatic system are to assist the immune system
by stimulating an immune response, removal of interstitial fluid from
tissues, and transporting of white blood cells. The anatomy of the lymph
node includes connective tissue and afferent and efferent compartments
called lymph nodules. The afferent vessel allows lymph fluid to enter
and flow through the node. The fluid exits the lymph node through the
efferent lymphatic vessel, located at the hilum.
14. What is important to know about capillaries?
_______________________
Visit the course to find the answers.
The lymphatic system lacks a pumping mechanism such as in the
cardiovascular system, so the movement depends on respiratory move-
ment, skeletal muscle movement, and smooth muscle contraction
which is located in vessel walls.
There are three bilateral regions on each side of the body where
lymph nodes are located.
15. _______________________
16. _______________________
17. _______________________
Visit the course to find the answers.
1.3 PART 3: GENETICS
1.3.1 Thalassemia
Thalassemia is a genetic blood disorder in which the body makes an
abnormal form of hemoglobin, which destroys erythrocytes causing
anemia. There are two main types of thalassemia.
6 Hematology in Traditional Chinese Medicine Cardiology
18. What organ failures does thalassemia major cause?
___________________________
Visit the course to find the answers.
Copyright r 2014 Anika Niambi Al-Shura. Published by Elsevier Inc. All rights reserved.
1.3.2 Hereditary Hemochromatosis
Hereditary hemochromatosis is a mutation of the C282Y and H63D
genes which primarily affects males. It involves an excessive accumula-
tion of iron, which causes damage to the heart, liver, joints, and the
testicles.
NOTES
CHAPTER
Essence, Qi, and Blood
2
CHAPTER OBJECTIVES
After studying this chapter, you should be able to:
1. Explain the two types of essence.
2. Describe the origin and action of the six types of qi.
3. Explain the relationship between the zang organs for the production
and movement of blood.
2.1 PART 1: ESSENCE
Essence is described in two aspects: the innate and the acquired.
Copyright r 2014 Anika Niambi Al-Shura. Published by Elsevier Inc. All rights reserved.
1. What are the two noted differences between innate and acquired
essence?
_______________________
_______________________
Visit the course to find the answers.
2.2 PART 2: QI
Qi represents the basic energy which animates regular life processes and
is created partially from acquired essence. It moistens the skin surface to
allow antipathogenic qi remain on active duty, helps maintain body
temperature, internal blood circulation, and secretion of body fluids.
Hematology in Traditional Chinese Medicine Cardiology. DOI: http://dx.doi.org/10.1016/B978-0-12-800124-0.00002-6
© 2014 Elsevier Inc. All rights reserved.
8 Hematology in Traditional Chinese Medicine Cardiology
There are mainly four types of qi: primordial, pectoral, nutritive, and
defensive. Two additional types are controlling qi and propelling qi.
Copyright r 2014 Anika Niambi Al-Shura. Published by Elsevier Inc. All rights reserved.
2. Which forms of qi are manifested from exterior factors?
_______________________
3. Which forms of qi control internal functions?
_______________________
2.3 PART 3: BLOOD
In Chinese medicine, blood is a yin substance. Proper generation and
circulation is contingent upon the smoothness of the vessels, the
temperature, quality, and the cooperation between the spleen, liver,
lung, and heart zang viscera.
Copyright r 2014 Anika Niambi Al-Shura. Published by Elsevier Inc. All rights reserved.
Essence, Qi, and Blood 9
NOTES
Module Review Questions
1. Describe the components of blood.
2. Describe key details about the lymphatic system.
3. Explain the genetic blood disorders and how they affect the cardiovas-
cular system.
4. Explain the two types of essence.
5. Describe the origin and action of the six types of qi.
6. Explain the relationship between the zang organs for the production
and movement of blood.
Log on at www.niambiwellness.com to access the companion course
and quiz for Module 1.
CHAPTER
Red Blood Cell Development
3
CHAPTER OBJECTIVES
After studying this chapter, you should be able to:
1. Explain the process of erythropoeisis.
2. Describe the stages of erythrocyte development.
3. Describe the dimensions of the mature red blood cell and the
number count in adults.
3.1 PART 1: RED BLOOD CELL DEVELOPMENT
3.1.1 Erythropoeisis
The cells develop in the bone marrow where erythropoietin (EPO)
assists in the formation and later the potential for accumulation of
oxygen on its surface.
1. How many days to mature erythocytes circulate the blood?
___________________________
Visit the course to find the answers.
There are eight stages in the development of a red blood cell where gradu-
ally through each stage the cell increases in size and volume of cytoplasm.
Copyright r 2014 Anika Niambi Al-Shura. Published by Elsevier Inc. All rights reserved.
Hematology in Traditional Chinese Medicine Cardiology. DOI: http://dx.doi.org/10.1016/B978-0-12-800124-0.00003-8
© 2014 Elsevier Inc. All rights reserved.
14 Hematology in Traditional Chinese Medicine Cardiology
3.1.2 The Mature Red Blood Cell in the Human Body
• The disk diameter is approximately 6.2 8.2 µm.
• The thickest point is about 2 2.5 µm.
• An adult has about 20 30 trillion erythrocytes.
• Women have about 2._____________ erythrocytes per microliter of
blood.
• Men have about 5 6 million erythrocytes per microliter of blood.
Visit the course to find the answers.
NOTES
CHAPTER
Hemoglobin
4
CHAPTER OBJECTIVES
After studying this chapter, you should be able to:
1. Describe the protein subunits of a hemoglobin.
2. Describe the heme group and the role of iron.
3. Describe the Bohr effect in pulmonary and systemic gas exchange.
4.1 PART 1: PROTEIN SUBUNITS
Hemoglobin (Hgb) is the protein in blood which is rich in iron and
gives it the red color.
It makes up about 95% of a red blood cell and has an oxygen-
binding capacity of 1.34 mL O2/g, which satisfies the need for the aver-
age adult consumption of 250 mL of oxygen per minute. Hemoglobin
transports the following gases:
4. __________________
5. __________________
6. __________________
7. __________________
Visit the course to find the answers.
Hgb is a globular protein which is structured as an alpha helix or
beta helix. Amino acids, also known as histidine, are hydrogen bonded
to one of the aNH groups residues or the O in the aCO group.
4.2 PART 2: THE HEME GROUP
Heme groups are the role of iron on hemoglobin. A group contains
one iron atom which bonds to the nitrogen molecule of a histidine resi-
due on one end, and on another end bound to one oxygen molecule,
allowing a hemoglobin protein to bind to four oxygen molecules.
Hematology in Traditional Chinese Medicine Cardiology. DOI: http://dx.doi.org/10.1016/B978-0-12-800124-0.00004-X
© 2014 Elsevier Inc. All rights reserved.
16 Hematology in Traditional Chinese Medicine Cardiology
4.3 PART 3: THE BOHR EFFECT
The Bohr effect is the gas-exchange mechanism in the body. Oxygen
which is needed by all cells and tissues in the body remains bound to
hemoglobin in the arteries but is released in capillaries. Here, the
release of O2 causes the binding of CO2 on hemoglobin. In the lungs,
the release of CO2 causes the binding of O2 on hemoglobin.
8. Who discovered this phenomenon?
___________________________
Visit the course to find the answers.
NOTES
Hemoglobin 17
Module Review Questions
1. Explain the process of erythropoeisis.
2. Describe the stages of erythrocyte development.
3. Describe the dimensions of the mature red blood cell and the number
count in adults.
4. Describe the protein subunits of a hemoglobin.
5. Describe the heme group and the role of iron.
6. Describe the Bohr effect in pulmonary and systemic gas exchange.
Log on at www.niambiwellness.com to access the companion course
and quiz for Module 2.
CHAPTER
The Six Stages
5
CHAPTER OBJECTIVES
After studying this chapter, you should be able to:
1. Explain the purpose of the pathogenic stages in cardiovascular
Chinese medicine.
2. List the pathogenic stages.
3. Describe the symptoms associated with each stage.
5.1 PART 1: PURPOSE OF THE SIX STAGES IN
CARDIOVASCULAR CHINESE MEDICINE
The purpose of the six stages in cardiovascular Chinese medicine is to
consider the patterns associated with pathogenic invasion on such
patients. For example, pathogenic invasions and resulting conditions
such as in pneumonia can have a serious effect on the lungs.
Complications have the potential to reduce the amount of available
oxygen which may lead to cardiac and systemic complications.
1. What is the role of inflammation?
___________________________
Visit the course to find the answers.
Hematology in Traditional Chinese Medicine Cardiology. DOI: http://dx.doi.org/10.1016/B978-0-12-800124-0.00005-1
© 2014 Elsevier Inc. All rights reserved.
