Patterns Syndromes 2

• -Disharmony of yin and yang
• -Conflict between right qi and evil qi -abnormal descending and ascending of qi

• -heat or cold (qty of yin and yang and their balance w/each other)
• -disharmony between the viscera (yin) and bowels (yang)
• -qi (yang)and blood (yin)
• -construction (yin) and defense (yang) -exterior (yang) and interior (yin)
• -ascending (yang) and descending (yin)

In the absence of an evil, treatment focuses on supplementation

Heat is from yang repletion or yin vacuity

Cold is from yin repletion or yang vacuity

when yin repletion walls off yang

when yang repletion walls off yin.

• -internally caused disease(caused by emotions)
• -disease caused by the not-internal not-external factors (mostly lifestyle) -
• b/c there is no conflict b/w right and evil

-sum of all healthy qi & substances in the body that can resist disease -includes various physiologic activities of the body, natural flux of yin and yang, production of qi and blood, and flow of construction & defense.

-opposes right qi and refers to the various causative factors of disease

There is repletion

repletion/vacuity

Wind, Cold, Damp, Dryness, Fire, Summerheat attempt to invade. The struggle is always between evil and the right qi.

aversion to cold, fever, shivering, sweating.

-disease can go deeper inside and may become chronic -disease may be eliminated, but yin-yang and qi-blood may be damaged and need significant time and care for recovery

Sensations of cold and heat (feels hot but wants to keep covered up) 'fever and chills'

B) Ascending and descending

Treat the root -this is appropriate if the clinical manifestations are not too severe

Treat the branch first then find out why and treat the cause (root) after the situation is under control.

In most cases, the root and branch are treated simultaneously, but one or the other will be emphasized depending on whether it is acute or chronic.

B) Right v. evil qi

The spleen and stomach are most important: they are central - pivot of the body also provide the material basis for post-heaven nourishment

• -the root is the strength of right qi, the branch is the invasion of evil qi
• -the root is the cause or pattern, the branches are the symptoms -the earlier diesease is the root. Later progression is the branch.
• -the root is a chronic disease and the branch is an acute disease.

Spleen qi vacuity is the root. Bleeding is the branch

fast, rapid, tense, violent, urgent, emergency, impatient. So it is often translated as acute

slow, unhurried, relaxed. So it is often translated as chronic

• You may treat both conditions in one formula:
• -If vacuity is extreme, it is more important to supplement the patient.
• -If vacuity is mild, but the wind attack is severe, then the formula should focus more on expelling the evil.

In trauma, the root and branch may be the same: stagnation of qi and stasis of blood are both the essential nature, and the symptom (pain) is nothing other than stagnation of qi and stasis of blood (nonmovement).

• Yin / Yang
• Interior / Exterior
• Vacuity / Repletion
• Cold / Heat

-Depth of disease within the body -ex: an external invasion begins as exterior, but if it goes in deeper, it becomes interior.-There can be simultaneous exterior and interior patterns or -Patters that are stuck between the exterior and interior (shao yang)

Interior means organs, bones, etc. Can be hot or cold, vacuity or repletion.-Interior eat,-interior cold,-interior vacuity,-interior repletion

An evil is present

Interior vacuity means insufficient qi, blood, fluids, yin, or yang (right qi).

• In interior patterns, there may be:
• – fever (sensation of heat in heat conditions) OR
• – chills (sensation of cold in cold conditions),
• – but NOT both simultaneously.
• If fever and chills are simultaneous, it means it is an exterior pattern

A heat evil is present. Full blown symptoms of heat:- feverish feeling, no chills, (heat makes patient hot)- sweating, (heat steams the fluids out)- thirst, (heat damages fluids)- full rapid pulse, (Heat speeds things up. Full pulse means repletion.)- red face, red tongue with yellow coat, (Heat makes things red, like a burn. It also darkens the tongue coat.)- plus symptoms of the affected organ.

• It is caused by:
• - eating hot-natured food
• -emotional excesses
• -qi stagnation or
• -an exterior evil moving inwards.
• This is also called yang repletion. Ex: someone who drinks a lot of alcohol and eats hot spicy greasy food.

Clear heat or drain fire.

Interior vacuity [causing] heat. Heat due to deficiency. Yin is insufficient - Yin vacuity (heat is there but a more subtle form).

-low-grade afternoon fever -no chills -feeling of heat in the palms, soles, and chest (five-heart heat); (sensations of heat, but more mild b/c due to vacuity). -dry mouth and throat (heat damages fluids) -dark urine, dry stool -afternoon fever, night sweating (when yin damaged, symptoms appear in the afternoon or night) -malar flush (heat makes redness, but small area due to vacuity) -emaciation (yin is substance)

Pulse: fine, rapid Tongue: red peeled tongue (b/c stomach yin makes the coating and there is yin vacuity)

Nourish yin, clear heat.

A cold evil is present.Repletion of yin.Excess condition.

• -chilliness, cold limbs, (The evil is cold.)
• -no thirst, clear abundant urine, (Fluids are not damaged. In fact, they overflow.)
• -desires warm drinks, (To help warm up, not because of thirst.)
• -pale face (If heat makes redness, cold makes paleness.)

PULSE: deep full tight pulse (Deep means interior, full means repletion. Cold contracts, so it tightens the pulse.) TONGUE: pale tongue with thick coat (thick coat means repletion)

Dissipate cold evil and warm coldness.

Interior repletion cold.

Yang vacuity.Yang is insufficient.

Fortify yang and warm coldness.

Interior vacuity cold.

Skin, flesh, channels, defense qi, sometimes lungs (they govern the

External invasion - Wind invades through the skin and pores and carries other evils with it. Channel problems - The channels are still quite exterior when compared to the organs.

• - Acute onset, short duration, (Wind gusts up quickly and changes rapidly. Wind cannot continue to blow for a long time.)
• - simultaneous fever (feels hot) and chills (aversion to cold or wind),
• - but the rest of the symptoms vary depending on cold or hot, repletion alone or vacuity and repletion combined.PULSE: floating pulse (all the qi moves to the surface of the pulse because in the body, the battle is happening on the surface (the exterior).

Exterior invasion. FEVER is from the defense qi fighting against the evil invader. The battle is hot. CHILLS are because, while defense is fighting the evil, it cannot take care of its other function of warming the surface. In addition, the patient feels vulnerable to attack, so they want to stay covered up.

• -sweating or not (no sweating in cold, sweating in heat or vacuity of defense)
• -pulse (besides being floating, rapid is heat, tight is cold)
• -the severity of body aches (cold has more body aches than heat).

• - slight fever, severe chills (cold is predominant)
• - no thirst (no heat to damage fluids)
• - no sweating (cold contracts the pores, so no sweat can leave)
• - headache, muscle aches (pain because cold contracts and obstructs the movement of qi)

PULSE: floating tight pulse (tight because cold contracts). TONGUE: thin white tongue coat (unchanged from normal because disease hasn’t done in deeply yet)

• -more fever, slight chills (heat is predominant)
• -thirst (heat damages fluids in the upper jiao)
• -sore throat (heat inflames the throat)
• -sweating (heat steams the fluids outward, and there is no cold to contract the pores)

PULSE: floating rapid pulse (heat speeds up activity). TONGUE: thin yellow (or white) tongue coat (heat darkens the coat)

Same as exterior cold or exterior heat. Evil qi is repletion. Can be excess cold or excess heat

• Defense qi (this is the only type of exterior vacuity)
• -Vacuity of defense qi but no invasion at this time (pure vacuity): easy to catch cold, sweats easily even when cold (defense is not strong enough to hold the pores shut and protect the body, and sweat leaks out through the open pores)
• -Vacuity of defense qi with wind evils invading (combined vacuity of defense and repletion of wind evils).

• – slight or no fever (defense is not strong enough to fight back)– aversion to wind (the body feels vulnerable)
• – slight body-aches (wind invades, disrupting the flow of qi in the channels, but doesn’t need to team up with cold, so the aches are not too strong)

• PULSE: floating pulse.
• TONGUE: thin tongue coat.

Painful obstruction (bi impediment) is obstruction of the flow of qi-blood in the channels and the joints by an evil, causing pain.Wind, cold, dampness, heat, or a combination Often no fever and chills because the evil bypasses the defensive exterior of the body

Pain moves from place to place. Ex: facial paralysis or pain (Bell's palsy or trigeminal neuralgia) is caused by wind invading the channels of the face.

Severe, fixed pain, better with heat

lingering, swelling, heaviness, ache

Swollen, hot, red

Weakness of right qi versus the strength of evil qi

• -Some aspect of the body (yin, yang, qi,blood, fluids, etc.) is weak.
• -There is no evil (unless it is a combined pattern).

Weakness, listlessness, curling up, quietness, weak breathing, weak pulse, chronic condition, dull lingering pain which is better with pressure, slight sweating. The more chronic the disease, the more likely it involves vacuity. (Even if it started as repletion, it wears down the body over time).

• – There are symptoms of qi vacuity plus coldness and copious fluids.
• – There is insufficient yang to warm and activate the body.
• -Symptoms are worse in the daytime, especially the morning.
• - Daytime physiology relies on yang. If yang is weak, physiology cannot keep up in the daytime.

• –There is insufficient yin to cool and nourish the body.
• -Symptoms are worse in the afternoon, evening, or night.
• -Night time physiology relies on yin. If yin is weak, physiology cannot keep up in the night time.

• -The body’s right qi is still strong.
• -Yin evils damage yang. Yang evils damage yin.

• -Acute condition, strong pain worse with pressure.
• -If face is red, it is red all over; if sweating, it is profuse, coarse breathing, strong voice
• -thick tongue coat, strong pulse.

• A person can have both at the same time, for example:
• - cold on the exterior and heat on the interior or vice versa,
• - or they can have heat above and cold below.

• - These have contradictory signs and symptoms in extreme conditions.
• - Contradictory symptoms arise because the weaker aspect has deserted to the exterior. Since it is on the exterior, it is visible.
• - Careful examination (especially tongue and pulse) will yield the appropriate diagnosis.
• - It is important to treat true heat with cold medicinals and true cold with hot medicinals. Otherwise, you will make the patient worse.
• - This only happens in critical cases. Both of these conditions are getting close to separation of yin and yang: death.

the interior is so cold that all the yang (heat) is pushed to the exterior. (It starts with yang vacuity. As yang becomes weaker and weaker, it gets pushed to the surface, so it becomes visible. But the patient is really cold inside. These symptoms of heat are false because they do not reflect what is going on inside).

True cold-false heat. This alertness was false heat."The flicker of a candle as it is about to burn out.”

The interior is so hot that all the yin (cold) is pushed to the exterior. (It starts with yin vacuity. As yin becomes weaker and weaker, it gets pushed to the surface, so it becomes visible. But the patient is really hot inside. These symptoms of cold are false because they do not reflect what is going on inside.)

True heat-false cold. Extreme yang is turning into yin.

• - Yin and yang are general categories which embrace the other six principles.
• - They are also two aspects of the body.

Yin patterns have more yin than yang:- a repletion of yin- a vacuity of yang- a predominance of COLDNESS, vacuity, or interior conditions

• Yang patterns have more yang than yin:
• - a repletion of yang
• - a vacuity of yin
• - a predominance of HEAT, repletion, or exterior conditions.

Collapse of yin is an acute critical form of yin vacuity.Excessive yang pushes out the last remaining bit of yin, like a pot that is boiling dry. All of yin is leaving the body

• - abundant perspiration, dry mouth, desire to sip cold drinks, (yin is damaged and is being pushed out of the body)
• - no loss or urine or stool, (urine and stool are dried, and there is plenty of yang to hold the lower orifices shut)
• - hot skin, hot limbs, (yang is excessive and yin is insufficient to cool)

• PULSE: floating vacuous rapid pulse, (rapid is heat, vacuous is vacuity, floating is because yin is moving to the surface and leaving).
• TONGUE: red peeled short dry tongue. (red is heat, coating comes from stomach Yin, tongue is short like a dry sponge is smaller than a wet one).

Collapse of yang is an acute critical form of yang vacuity.Excessive yin pushes out the last remaining bit of yang, like rising flood waters carry away things in its path.All yang is leaving the body.

• -chilliness, cold limbs, (yin is cold, not enough yang to warm)-weak breathing, (breathing takes qi and yang)
• -profuse but cold sweating, (yin is overflowing, no yang to hold the pores shut)
• -no thirst, frequent profuse urination or incontinence, loose stool or incontinence, (yin fluids flooding, no yang to hold the lower orifices shut).

• PULSE: minute deep pulse, (pulse is extremely weak and about to expire).
• TONGUE: pale wet swollen tongue. (pale and wet are due to Coldness, fluids overflow so it is swollen like a wet sponge).

Both of these conditions are getting close to separation of yin and yang: death.

• Low temp; Slows down activity (fxns decline like river freezing over)
• - fluids not transformed
• - watery fluids and slow pulse; Congeals, stagnates and contracts
• - obstructs circulation of qi and blood
• - severe pain, spasms, no sweating, stiffness.

Late Summer Earth Spleen

Yin evil, impairs yang.

• Heavy and moves downward;- affects lower body, i.e. legs and lower burner
• - feeling of heaviness; Turbid, sticky, stagnant, thick, clammy, dirty, and causes persistent diseases:
• - Chronic diseases
• - fixed location
• - turbid discharges; Obstructs qi circulation

Dampness in the channels and joints

Spleen vacuity leading to poor transportation and transformation. Fluids accumulate and becomes dampness and digestion is disturbed.

Aching of the whole body, possibly acute digestive upset.

Autumn Metal Lungs

Yang evil, affects yin and blood

Dryness

Fire, burning hot, rapid changes

Burning hot, moves upward, disturbs spirit (headache, red eyes, delirium, agitation, coma, mania). Consumes yin fluids. Can stir up internal wind (High fever, coma, convulsions). Can disturb blood (bleeding, skin diseases). Other evils can transform to heat or fire in the body.

Hi temp, upward movement, consumes body fluids and damages qi. Severe summerheat: sunstroke, sudden collapse, coma, disturbed consciousness, delirium, slurred speech. Frequently combines with dampness.

Summerheat combined with dampness.

Joy causes qi to slacken (move slowly or relax). Excessive joy scatters the spirit.

Liver

Anger Liver

• Sorrow (disperses, dissolves, scatters).
• Lungs - sorrow leads to lung qi vacuity: breathlessness, fatigue, crying, sighing

Spleen - weakens fxn Spleen and causes fatigue, loss appetite, loose stools, phlegm. Causes qi to bind (knot).

• Damages Lungs and Spleen:
• - Spleen: fatigue, loss appetite, loose stools.
• - Lung qi binding: breathlessness, stiff shoulders and neck. Excessive thinking and anxiety leads to qi binding.

Fear Kidneys - depletes Kidney qi causing bed wetting, incontinence

Fright causes derangement of qi

Kidneys and heart; Palpitations, breathlessness, insomnia, night sweating, dry mouth, dizziness, tinnitus.

Improper diet. Improper work and rest. Sexual taxation. Trauma. Improper medical treatment. Parasites and toxins.