Patterns Syndromes 2
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What are the three types of pathological processes?
- -Disharmony of yin and yang
- -Conflict between right qi and evil qi -abnormal descending and ascending of qi
How does disharmony of yin and yang manifest?
- -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)
How do you treat disharmony of yin and yang?
In the absence of an evil, treatment focuses on supplementation
What causes heat?
Heat is from yang repletion or yin vacuity
What causes cold?
Cold is from yin repletion or yang vacuity
What is false heat syndrome?
when yin repletion walls off yang
What is false cold syndrome?
when yang repletion walls off yin.
When is the imbalance of yin and yang within the body predominant?
- -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
What is right qi?
-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.
What is evil qi?
-opposes right qi and refers to the various causative factors of disease
What happens when evil qi invades?
There is repletion
what happens if evil qi invades and right qi is insufficient?
What are the external causes of disease and what happens?
Wind, Cold, Damp, Dryness, Fire, Summerheat attempt to invade. The struggle is always between evil and the right qi.
What are some of the symptoms of external disease?
aversion to cold, fever, shivering, sweating.
If an externally contracted disease is not resolved (neither the evil nor the right qi wins) what happens?
-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
What are the defining symptoms of exterior illness?
Sensations of cold and heat (feels hot but wants to keep covered up) 'fever and chills'
Patient has gastroenteritis and has nausea and vomiting, which one is affected?
A) Yin Yang
B) Ascending and descending
C) Right v. evil qi
B) Ascending and descending
(this multiple choice question has been scrambled)
In chronic diseases what do you treat?
Treat the root -this is appropriate if the clinical manifestations are not too severe
In acute disorders what do you treat?
Treat the branch first then find out why and treat the cause (root) after the situation is under control.
What is the general mode of treatment in clinic (in reference to root and branch)?
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.
If patient has fever and chills, which one is affected?
A) Yin Yang
B) Ascending and descending
C) Right v. evil qi
C) Right v. evil qi
(this multiple choice question has been scrambled)
Which organs are the most important in regulating ascending and descending of qi?
The spleen and stomach are most important: they are central - pivot of the body also provide the material basis for post-heaven nourishment
Describe the relationship of root and branch when there is illness:
- -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.
If insufficient spleen qi leads to bleeding, which one is the root and which is the branch?
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
If a patient with vacuity receives a wind attack, what is the treatement?
- 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, do you treat the root or branch?
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).
What are the eight principles of pattern identification?
- Yin / Yang
- Interior / Exterior
- Vacuity / Repletion
- Cold / Heat
Exterior - Interior
-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)
What does interior mean? (eight principle patterns)
Interior means organs, bones, etc. Can be hot or cold, vacuity or repletion.-Interior eat,-interior cold,-interior vacuity,-interior repletion
What does an interior repletion mean?
An evil is present
What does interior vacuity mean?
Interior vacuity means insufficient qi, blood, fluids, yin, or yang (right qi).
What are the symptoms of interior patterns?
- 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
What is interior repletion heat and what are the symptoms?
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.
What are the causes of interior repletion heat?
- 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.
What is the treatment principle for interior repletion heat?
Clear heat or drain fire.
What is interior vacuity heat?
Interior vacuity [causing] heat. Heat due to deficiency. Yin is insufficient - Yin vacuity (heat is there but a more subtle form).
What are the symptoms of interior vacuity heat?
-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)
What is the tongue and pulse of interior vacuity heat?
Pulse: fine, rapid Tongue: red peeled tongue (b/c stomach yin makes the coating and there is yin vacuity)
What is the treatment principle for interior vacuity heat?
Nourish yin, clear heat.
What is interior repletion cold?
A cold evil is present.Repletion of yin.Excess condition.
what are the symptoms of interior repletion cold?
- -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.)
What is the pulse and tongue of interior repletion cold?
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)
What is the treatment principle for interior repletion cold?
Dissipate cold evil and warm coldness.
Someone eats a lot of ice cream, cold drinks, or uncooked fruits and vegetables. They get a stomach ache due to coldness. What kind of exterior-interior condition do they have?
Interior repletion cold.
What is interior vacuity cold?
Yang vacuity.Yang is insufficient.
What is the treatment principle for interior vacuity cold?
Fortify yang and warm coldness.
A long-time vegetarian who eats a lot of cold raw foods over time. They have chilliness, cold limbs, listlessness, spontaneous sweating, loose stools. What kind of problem do they have?
Interior vacuity cold.
What does exterior mean (in relation to the eight principle patterns)?
Skin, flesh, channels, defense qi, sometimes lungs (they govern the
exterior).– The lungs govern defense qi and the skin, so they are the most exterior of the organs. -in strictest sense means external invasion
What are the two types of exterior problems? (these may overlap)
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.
What are the symptoms of external invasion (Wind attack)?
- - 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).
A patient feels hot and cold at the same time. He puts on a sweater, he feels hot, he takes it off, he feels cold. What kind of condition does he have (eight patterns)?
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.
What are important symptoms that help in differentiation whether external invasion is cold/heat, repletion/vacuity?
- -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).
What are the symptoms of exterior cold?
- - 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)
What is the tongue and pulse of exterior cold?
PULSE: floating tight pulse (tight because cold contracts). TONGUE: thin white tongue coat (unchanged from normal because disease hasn’t done in deeply yet)
What are the symptoms of exterior heat?
- -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)
What is the pulse and tongue of exterior heat?
PULSE: floating rapid pulse (heat speeds up activity). TONGUE: thin yellow (or white) tongue coat (heat darkens the coat)
What is exterior repletion (not combined with vacuity)? What are the symptoms?
Same as exterior cold or exterior heat. Evil qi is repletion. Can be excess cold or excess heat
What is exterior vacuity?
- 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).
What are the symptoms of vacuity of defense with wind evils invading?
- – 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)
What is the pulse and tongue of vacuity of defense with wind evils invading?
- PULSE: floating pulse.
- TONGUE: thin tongue coat.
What are channel problems?
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
What is the characteristic of Wind Bi?
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.
What is the characteristic of Cold Bi?
Severe, fixed pain, better with heat
What is the characteristic of Damp Bi?
lingering, swelling, heaviness, ache
What is the characteristic of heat Bi?
Swollen, hot, red
What is vacuity-repletion?
Weakness of right qi versus the strength of evil qi
What is vacuity?
- -Some aspect of the body (yin, yang, qi,blood, fluids, etc.) is weak.
- -There is no evil (unless it is a combined pattern).
What are the symptoms of vacuity?
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).
What are the characteristics of yang vacuity?(same as internal vacuity cold):
- – 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.
What is Yin vacuity? yin vacuity (same as internal vacuity heat, above):
- –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.
What is repletion? -Includes interior or exterior evils.(See exterior category, and interior repletion heat and cold)
- -The body’s right qi is still strong.
- -Yin evils damage yang. Yang evils damage yin.
What are the symptoms of repletion?
- -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.
Heat-cold "nature" of disease
- 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.
What is true cold-false heat or true heat-false cold?
- - 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.
What is true cold-false heat?
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).
A patient has been sick for a long time. He lapses into a coma. Then one day, he wakes up, and there is a little color on his cheeks. He recognizes his family and talks to them with a clear mind. Then suddenly he relapses into a coma and dies in a day or two. What type of condition did he have?
True cold-false heat. This alertness was false heat."The flicker of a candle as it is about to burn out.”
What is true heat-false cold?
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.)
A very sick patient is agitated and restless in his bed. He tosses and turns and cannot sleep. He is feverish and thirsty. Suddenly he seems to calm down and he dozes off. But actually, he is lapsing into a coma and is near death. What type of condition does he have?
True heat-false cold. Extreme yang is turning into yin.
Yin - Yang
- - Yin and yang are general categories which embrace the other six principles.
- - They are also two aspects of the body.
What is the characteristic of yin patterns?
Yin patterns have more yin than yang:- a repletion of yin- a vacuity of yang- a predominance of COLDNESS, vacuity, or interior conditions
What is the characteristic of yang patterns?
- Yang patterns have more yang than yin:
- - a repletion of yang
- - a vacuity of yin
- - a predominance of HEAT, repletion, or exterior conditions.
What is collapse of yin?
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
What are the symptoms of collapse of yin?
- - 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)
What is the pulse and tongue of someone who has collapse of yin?
- 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).
What is collapse of yang?
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.
What are the symptoms of collapse of yang?
- -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).
What is the pulse and tongue of collapse of yang?
- 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).
Collapse of yin and collapse of yang
Both of these conditions are getting close to separation of yin and yang: death.
What are the characteristics of cold?
- 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.
What season and element is associated with Dampness? What organ is affected?
Late Summer Earth Spleen
What kind of evil is Dampness?
Yin evil, impairs yang.
What are the characteristics of Dampness?
- 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
Px has dull ache, swelling, lingering pain in the knees. What is it most likely due to?
Dampness in the channels and joints
What is the cause of interior dampness?
Spleen vacuity leading to poor transportation and transformation. Fluids accumulate and becomes dampness and digestion is disturbed.
What are the characteristics of exterior dampness?
Aching of the whole body, possibly acute digestive upset.
What is the season and element associated with Dryness? What organ does it affect?
Autumn Metal Lungs
What kind of evil is Dryness?
Yang evil, affects yin and blood
Px has constipation, scant urine, and has a dry cough and dry nose. What is the cause?
Px has fever, thirst, has aversion to heat, redness and a rapid pulse. What is the cause?
Fire, burning hot, rapid changes
What are the characteristics of Fire invasion?
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.
What are the characteristics of Summerheat?
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.
Px has loose stools, has nausea and dizziness, lassitude, soggy pulse, and thick slimy tongue coat. what is the evil invading this person?
Summerheat combined with dampness.
Which emotion causes the qi to slacken?
Joy causes qi to slacken (move slowly or relax). Excessive joy scatters the spirit.
Anger damages which organ?
Which emotion causes qi to rise? What organ does it affect?
Which emotion causes qi to disperse? What organ does it affect?
- Sorrow (disperses, dissolves, scatters).
- Lungs - sorrow leads to lung qi vacuity: breathlessness, fatigue, crying, sighing
What organ is affected by thought? How does it affect the qi and the body?
Spleen - weakens fxn Spleen and causes fatigue, loss appetite, loose stools, phlegm. Causes qi to bind (knot).
What organ is affected by anxiety? What does it do to qi?
- 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.
What emotion causes the qi to descend? What organ does it affect?
Fear Kidneys - depletes Kidney qi causing bed wetting, incontinence
What emotion causes qi to be chaotic?
Fright causes derangement of qi
What organ is affected by fright? What are the symptoms?
Kidneys and heart; Palpitations, breathlessness, insomnia, night sweating, dry mouth, dizziness, tinnitus.
What are neither external nor internal causes of disease?
Improper diet. Improper work and rest. Sexual taxation. Trauma. Improper medical treatment. Parasites and toxins.
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