Zang Fu I

Week 2
 Pattern Identification (last week)

• Collect all signs/symptoms, determine the

significance of symptoms/signs, and piece them
all together to make a picture.

• Compile Info- How?

• Classify diagnostic info

Pattern Identification-

• Identify what presents right now!

• Identify Relationships between signs and
symptoms

• Even if we do not know the cause of the

disharmony, we can still IDENTIFY the PATTERN
Pattern Identification-

•
• The current pattern shows us:
• the cause or the root
• the location of the dz
• and from this we can extrapolate the treatment
principle
Differential Diagnosis (review)

• Ask various questions about s/sx

• Narrow down the possibilities of patterns that are
responsible
• It ius not necessary to know the western dz to
make a TCM diagnosis, choose a pattern, and
choose a treatment principle and treat!
Illness- what causes disease?

• 1. External causes- 6 external xie/pathogens

• 2. Internal causes- 7 emotions
• 3. Neither External nor Internal Causes: diet,
exercise/activity/work, sloth, sex, trauma… all
easily effect internal organs
• 4. Pathologically-formed evils are internally
produced when there is imbalance, and like a
snowball, they cause further pathology: blood
stasis, qi stagnation, food stagnation, food
stagnation, phlegm, turbid fluids (rheum),
internally generated wind/heat/cold/damp etc…
Diagnosing Illness

• When diagnosing illness, we most commonly

diagnose through Organ Pattern Identification
• This combines:
• Qi, Blood, and body fluid patterns
• Pathogenic (xie) evil patterns
• 8 principle patterns
• Zang Fu diagnosis (5 viscera and 6 bowels)
8-Principle Pattern Identification:

• Determines the nature and location of disease

•
• Location/Depth: Exterior Interior
• Nature: Cold Heat
• Right qi v Evil Qi: Vacuity Repletion
• Category: Yin Yang
Exterior v Interior

• Tells the depth of dz

• Interior more serious

• Tells you about progression and stage of disease

Exterior characteristics-

• Disease in the defensive exterior

• Battle between wei qi and xie

• Disease is shallow while on exterior

Interior characteristics-

• Refers to zang-fu

• Can become life threatening, or affect internal

function
Exterior Characteristics (specific):

• Key signs -mild fever and sl chills, aversion to cold or

wind
• Other signs -HA, body aches, sinus congestion, itchy
throat
• T- thin white TC (no difference from normal T)
• P- floating

• Tx principle: Release exterior.

Exterior Characteristics (specific):

• WC- P- floating and tight

• WH- P- floating and rapid
•
• Exterior Patterns:
• Exterior Repletion (excess)
• Exterior Vacuity (deficiency)
Interior Characteristics (specific): multifaceted

• Key Signs- Feeling internal cold, feeling internal

heat, neither
• Other signs- Depends on which organs are affected,
hot or cold, vacuity or repletion, see ZF patterns….
• Mechanisms- External evil moves interior if not
resolved, or may directly target an organ.
• Emotions, lifestyle, and misc dz also lead to internal
dz

• Tx Principle: Cold- warm it. Heat- clear it. Vacuity-

tonify/supplement it. Repletion/excess- drain it.
Half in Exterior and Half in Interior

• Shao Yang Pattern (Lesser Yang)

• Key signs symptoms- alternating heat and cold, chest
and rib side fullness or distention (hypochondriac
pain) GB channel side of body, bitter taste mouth,
dizziness, vexation, nausea
• P- wiry (tight but also thin) (sometimes called
bowstring)
• Mechanisms- xie caught between interior and
exterior. Can’t go deeper but body cannot expel
• Treatment principle- harmonize the exterior and
interior
Cold v Heat

• Cold and Heat are the Nature of the disease

• Yin excess/repletion- Cold

• Yin vacuity/deficiency- Heat

• Yang excess/repletion- Heat

• Yang vacuity/deficiency- Cold
Cold Patterns

• Key signs/sx- aversion to cold, no taste in mouth, no thirst,

pale face, clear copious urine, thin soft/runny stools
• Other s/sx- lethargy. Other signs vary on deficiency or
excess, and involved organs
• T- pale, white tc, moist
• P- slow or tight
• Mechanisms- yang xu or yin shi cause diminished function
or cold evil
• Treatment principle- Warm the cold, eliminate yin evils
Heat Patterns

• Key signs/sx- fever or heat sensations, prefers cold,

thirsty, red face/eyes/head, agitation, scant dark
urine, dry stool/constipation
• Other s/sx- will vary depending on deficiency or
excess and organs involved
• T- red body, dry yellow tc or no tc
• P- rapid
• Mechanisms- Yang excess/heat evils or yin xu lead to
hyperfunction/movement
• Treatment principle- Clear heat drain fire (excess
yang) or clear heat nourish yin (yin xu)
Mixed Cold/Heat Patterns

• Heat Above, Cold Below

• -heat above: foul breath, thirst, swollen painful gums
(st heat)
• -cold below: abd pain better w warmth, loose stools
(cold ints)

• Cold Above, Heat Below

• -cold above: epigastric pain, cold abd, vomiting
• -heat below: frequent painful pee, hot burning
smelly diarrhea (DH LJ)
Mixed Cold/Heat Patterns

• Exterior Cold, Interior Heat

• -ext cold: aversion to cold, sl fever, body aches (ext
wc)
• -interior heat: vexation, thirst, abd pain (food
stagnation)

• Exterior Heat, Interior Cold

• -ext heat: fever, thirst, sweating (ext wh)
• -int cold: poor appetite, abd distention/bloating,
sloppy stool (sp/st xu cold)
How does cold/heat penetrate body?

• Long term imbalances or penetration…

• heat penetrating
• -cold xie lingering
• -qi stagnation
• -emotional shi
• -dietary imbalances
True Heat False Cold

• Extreme heat that appears cold

• True Heat- dry throat, foul breath, thirst, craving
cold drinks, delirious speech, scant dark urine
• False Cold- Cold limbs/hands feet, patient lying
still
True Cold False Heat

• Extreme cold appears as heat

• True Cold- Faint weak voice, desire to be covered
up, wants hot fluids, cold limbs, clear copious
pee, sloppy stool
• False Heat- hot body, red face, thirst, agitated
shen
True/False Heat/Cold

• -The false usually manifests on exterior or upper-

limbs, skin, face
• -The true is what we see related to the organs
• -“False” symptoms slightly different from those
same s/sx when real
Vacuity and Repletion

• Vacuity- reduced Right Qi- qi, blood, jing, jin/ye

fluids, yin, yang
• Vacuity- easier for xie to enter or for xie
substances to accumulate and become turbid
• (vacuity<->repletion)
• Tends to be chronic
Vacuity and Repletion

• Repletion- Evil qi is present (exterior or interior xie, also including

qi stag, blood stasis, phlegm…)
• Repletion- easier for right qi to then become damaged
• (vacuity<->repletion)
• Tends to be acute
Vacuity

• Key s/sx- listless, fatigue, weak, emaciated

• (lacking strength or substance)
• Yang (cold sx) Yin (hot sx)
• Pale complexion malar flush
• Cold limbs 5 heart heat
• Spontaneous sweat night sweat
• T- Pale, thin TC Red, no TC
• P- Forceless (no strength) Thin (no substance)
Vacuity

• Other s/sx- palpitations, SOB, loose stools, frequent pee,

others depends on organs affected
• Mechanisms- cold or hot depending on yin or yang xu.
Structure or function due to particular deficiency
• Treatment Principle- Supplement vacuity, nourish right
• Pre-heaven vacuity rooted in:
• Post-Heaven vacuity rooted in:
Vacuity

• Vacuity Heat (Interior)

• Yin Vacuity (not enough coolness)
• Heat due to a vacuity of yin- DRAW
•
• Vacuity Cold (Interior)
• Yang Vacuity (not enough warmth)
• Cold due to a vacuity of yang- DRAW
Repletion

• Key s/sx- agitated, excited, vexed shen, rapid breathing,

distention/fullness, pain worse w pressure
• Other s/sx- rough/inhibited urination, constipation
• T- thick TC
• P- forceful, strong
• Mechanisms- exterior evils invade/ lack of organ regulation or
function, creates build up/stagnation/blockages
• Treatment principle- drain repletion, expel evils
True & False, Vacuity and Repletion

•
• True Repletion, False Vacuity
• Food stagnation, Phlegm accumulation -> heat
binding ST/INTS -> pt loss appetite, shen quiet, cold
limbs
• Mechanism- MJ blockage -> qi cannot circulate freely,
shen inhibited
• Tx principle- Treat the true: Disperse accumulation
clear heat
True & False, Vacuity and Repletion

• True Vacuity, False Repletion

• SP qi xu -> abdominal fullness, distention, pain
• Tx principle- Treat the true: Tonify SP (also want
to move qi)
Yin and Yang

• Interior, Cold, vacuity are all YIN

• Diseases where these are prominent are YIN
diseases
•
• Exterior, heat, and repletion are all YANG
• Diseases where these predominate are YANG
diseases
Yin and Yang
• Yin and Yang can refer to:
• Yin and Yang aspects of the body
• Example:
• -Blood is ---, Qi is ---
• -Zang are ---, Fu are ---
•
• The yin and yang aspects of various organs
• Example:
• -lung yin, liver yin, kidney yin
• -spleen yang, kidney yang
• -diseases involving yin or yang vacuity, liver yang rising…. Etc…
Yin and Yang

• Yin Patterns
• -have a predominance of cold
• -Yang vacuity or Yin evil repletion
•
• Yang patterns
• -have a predominance of heat
• -Yin vacuity or Yang repletion
Yin patterns

• Key signs/sx: Cold body/limbs, pale face or dark

sullen somber face, shen lacking vital energy,
bland taste, no thirst or a desire for warm drinks,
clear profuse urination, sloppy stools
• Other s/sx: depends on vaciuity cold or cold
repletion, and location
• T: Pale, white moist TC
• Pulse: slow, deep
Yin Patterns

• Mechanisms: Yin patterns include vacuity cold or cold

repletion
• Coldness means function is slowed down or
reduced
• Caused by external cold evils- excessive intake of
cold food/drink/meds
• Taxation or enduring disease
• Aging or pre-heaven vacuity
• Treatment Principle: warm the cold, disperse cold,
fortify yang as needed
Yang Patterns

• Key signs/sx: sensation of heat or fever, dislikes

heat, red face and eyes, vexation/agitation, lots
of movement, bitter taste, thirst, prefers cold
liquids, dark or concentrated urine, constipation
• Other s/sx: depends on repletion heat or vacuity
heat, and location
• T: Red, dry, yellow coat or no coat
• P: Rapid
Yang Patterns

• Mechanisms: Yang patterns include heat repletion or vacuity heat

• Heat means function or movement becomes hyperactive
• Caused by exterior heat evil
• Exterior evil that moves interior and turns into heat
• Excessive intake of acrid, dry, hot food or medicine
• Excessive emotions
• Taxation or enduring disease
• Aging or pre-heaven vacuity
• Treatment Principle: clear heat, drain fire, nourish yin as needed
Yin Vacuity

• Key s/sx: thin body, sallow complexion with red

cheeks, dizziness, tinnitus, dry mouth/throat
• Other s/sx: 5 heart heat, tidal fever), night
sweating
• T: Red, with little or no TC
• Pulse: fine
Yin Vacuity

• Mechanisms: Due to insufficiency of yin (blood, fluids,

essence)
• Yin nourishes and moistens, so this is lost
• Caused by febrile disease damaging yin fluids
• Losses through bleeding, sweating, vomiting, diarrhea
• Enduring disease, taxation, excessive sex, long term
emotion
• Excessive consumption of warm dry food or medicine
• Treatment principle: nourish yin, clear heat, drain fire,
subdue yang as needed
Yang Vacuity

• Key Signs/sx: Bright pale face, fatigue, lack of

strength, shortness of breath, dislikes cold, cold
limbs, curls up, spontaneous sweating, bland
taste, clear copious urine, sloppy stools
• T: pale and fat
• Pulse: slow, forceless
• Mechanisms: insufficiency of yang
• Treatment Principle: Warm yang, dispel cold
Collapse of Yin

• Key Signs and Symptoms: Copious sweating, sweat

hot and sticky, hot skin, warm hands and feet,
thirst, wants cold fluids, rapid breathing, malar
flush (tidal reddening of cheeks)
• T: Red dry
• P: fine rapid forceless
Collapse of Yin

• Mechanism: exhaustion of yin fluids

• Due to serious loss of fluids or blood
• Caused by high fever with copious sweating,
vomiting, diarrhea, or bleeding
• Or more gradual depletion of yin over time
• Treatment principle: Rescue yin
Collapse of Yang

• Key Signs and Sx: Profuse sweating of cold clear

sweat, cool skin, counterflow cold of hands and
feet (***reversal cold of the extermities), bland
taste, no thirst, or desire for warm drinks, faint
breath
• T: pale, dusky
• P: faint or expiring
Collapse of Yang

• Mechanisms: Exhaustion of yang qi

• Caused by extreme evils damaging yang
• Long term yang xu becomes critical
• Collapse of yin may also lead to collapse of
yang, as yin anchors yang
• Treatment principle: Rescue counterflow, return
yang to its source
Homework

• Reading Homework:
• CAM Chapter 2 pg 12-20
• CAM Chapter 13 pg 286-296 Section I Differention of Syndromes
According to 8 Principles
• Maciocia “The Foundations of Chinese Medicine” 3rd edition
Part 6 Identification of Patterns pgs 440-466: Introduction to
Patterns and section 30 Identification of patterns according to 8
principles