Diagnostics Ii, Exam 1

Front 1

Describe the various (5) methods of diagnosis.

Back 1

1. Eight principles (yin/yang, int/ext, ….)
2. Zangfu syndromes (Liver Qi Stagnation)
3. 6 stages (taiyang…)
4. 4 levels (wei, qi, ying, xue)
5. Clinical studies

Front 2

What are the 8 principles?

Back 2

1/2. Yin/Yang
3/4. Ext/Int syndromes
5/6. Cold/Heat
7/8. Def/Excess

Front 3

What is the highest/cheif principle within the 8 principles and why?

BOARD

Back 3

Yin/Yang is the highest level because they all can be classified into Yin/Yang. When using the 8 principles you would know this first.

Front 4

What does exterior and interior describe?

Back 4

location and stage of disease
(superficial & beginning/deep & chronic)

Front 5

What does cold and heat describe?

Back 5

nature and stage of a disease

clinically you can see a mixed picture (like upper heat and lower cold) or it can be complication with true/false heat and cold

Front 6

What does def/excess describe?

Back 6

the relative strength b/w pathogens and antipathogenic qi

this can also help you to determine the prognosis

Front 7

Where is the location of exterior syndromes?

Back 7

skin, hair, muscles and their interspaces, superficial portion of meridians and collaterals

SUPERFICIAL; beginning stage

Front 8

Where is the location of interior syndromes?

Back 8

5 zang and 6 fu organs

DEEP[er]

Front 9

Define exterior syndrome.

Back 9

Exterior syndromes refer to a group of pathological conditions resulted from the invasion of the SUPERFICIAL portion of the body by EXOGENOUS pathogenic factors.

Front 10

Main etiological mechanism of exterior syndrome?

Back 10

Invasion of exogenous pathogenic factors

Front 11

What are the chief manifestations of exterior syndrome?

Back 11

Temp:
Intolerance to cold (wind)/chills,
Chills/Fever together*
T: Thin coating (usu. pale or light red)
P: Superficial (floating)

*Ex: Back feels cold but forehead is hot.

Front 12

What are the other symptoms of exterior syndromes?

Back 12

headache
general aching (pore/meridian blockage)
nasal obstruction/discharge
sneezing
cough

Front 13

Exterior syndrome must have what symptom?

This is important to know for exams

Back 13

chills and fever together (must have)

Front 14

Exterior syndromes all have what signs?

Back 14

coating: thin
tongue: pale or light red
pulse: superficial

Front 15

T/F On an exam, if there is no chills and fever you can not say the syndrome is exterior.

Back 15

TRUE

Front 16

What is the tx principle for exterior syndrome?

Back 16

Open the meridian, expel exogenous pathogens

Front 17

What are the tx methods for exterior syndrome?

Back 17

1) Cupping on shoulders, upper back
2) Herbs: clear exogenous pathogens; leaves and twigs

Front 18

Describe an interior syndrome.

Back 18

Interior syndromes refer to pathological conditions resulted either from teh transmission of EXOGENOUS pathogenic factors of the interior of the body to affect ZF organs or from the FUNCTIONAL disturbances of ZF organs in the interior.

Front 19

What are the 3 causes of interior syndromes?

Back 19

1) TRANSMISSION of pathogens from the exterior to interior of the body to invade the ZF organs

2) DIRECT ATTACK on ZF organs b exogenous pathogens

3) Drastic emotional changes, improper diet and overstrain and stress, which affect ZF organs directly, leading to functional disturbances.

LOCATION: ZF

Front 20

What are the signs symptoms of interior syndrome?

BOARD

Back 20

1) Mainly appeared in the trunk/ZF
2) Constipation/diarrhea, stomachache, heart palpitation (ex.)

T: relatively thick
Coating: yellow, black
Texture: slippery, greasy
Body: purplish, pale, trembling, deviated...

P: deep, slippery, wiry, choppy

Front 21

What are the tx for interior syndromes?

Back 21

Points: Chest, back, leg, foot
FMu
BShu
Lower He Sea
Source points

Front 22

Fever accompanied by aversion to cold

Back 22

Exterior

Front 23

Fever with no aversion to cold

Back 23

Interior

Front 24

Aversion to cold with no fever

Back 24

Interior

Front 25

Thin white tongue coating

Back 25

Exterior

Front 26

Superficial pulse

Back 26

Exterior

Front 27

Abnormal qualities of tongue coating

Back 27

Interior

Front 28

Deep pulse

Back 28

Interior

Front 29

Pt has cold and fever in the beginning. Several days later slight aversion to cold with a fever then later no aversion to cold but aversion to heat with thirst and dark urine, yellow tongue coating with a rapid pulse.

Back 29

Exterior-> Internal Heat->

Front 30

What are reasons that the evil can move from external to internal?

Back 30

1) Weakened body resistance to Dz
2) Hyperactivity of pathogens
3) Improper care
4) Incorrect or delayed Tx
5) Prognosis NOT good

Front 31

Cold and heat tell you what again?

Yang
Sheng4 (excess)
Ze (then)
Re (heat)

Back 31

Nature and stage

Front 32

Describe cold syndromes?

Back 32

Cold syndromes are pathological conditions resulted eitehr from exposure to EXOGENOUS pathogenic cold or from Def of Yang in the interior of the body.

External: W/C
Internal Cold: Excess (ice water)
Internal Def: Yang Def (overweight, pale face, tongue with teeth marks, water retention)

Front 33

Heat will have what taste

Back 33

Bitter (like heart heat)

Front 34

Tastelessness in the mouth indicates what?

Back 34

Cold

Front 35

Cold will tend to have what type of stools?

Back 35

loose

Front 36

Cold will tend to have what color of urine?

Back 36

clear and may have an increase in volume [profuse]

Front 37

Cold will or will not manifest as thirst

Back 37

NOT; cold will not feel thirsty

Front 38

Pulse in cold syndrome

Back 38

Slow or tense

Front 39

Aversion to cold and a preference for warmth?

Back 39

Aversion to cold, preference for warmth

Front 40

Pallor face?

Back 40

Cold syndrome

Front 41

Moist tongue

Back 41

Cold

Front 42

Exterior cold syndrome

Back 42

W/C

Front 43

Interior cold syndrome

Back 43

drinking ice water

Front 44

Treatment plans for cold syndromes?

Back 44

Exterior: expel cold
Interior: warm
Excess: expel cold
Def: warm

Front 45

Tx protocols for cold syndromes?

Back 45

1) warm needle
2) moxa (incl ginger and moxa on RN8) or KI1 moxa (tonify KI)
3) Warm cupping
4) Herbs: warm in nature
EXT: Disperse (Ma Huang, GuiZhi, XiXin, FangFeng)
INT: warm and expel cold (Fuzi*, rougui, ginger, xiaohuixiang)

* Toxic: Separate and cook for at least 1 hour.

Front 46

Def of heat syndrome?

Back 46

Heat syndromes are pathological conditions caused by invasion of EXOGENOUS pathogenic heat or by DEF of Yin in the INTERIOR of the body.

SARS - high fever; internal excess hat

Front 47

Fever

Back 47

Heat Syndrome

(if external could have chills together)

Front 48

Preference for coolness

Back 48

Heat Syndrome

Front 49

Thirst (with pref for cold drinks)

Back 49

Heat Syndrome

This is often a great question if the heat syndrome is not obvious

Front 50

Redness of face and eyes

Back 50

Heat Syndrome

Front 51

Irritability (cold/heat)

Back 51

Heat Sx

Front 52

Restlessness

Back 52

Heat Sx

Front 53

Constipation

Back 53

Heat Sx

Front 54

Dark-yellow and scanty urine

Back 54

Heat Sx

Front 55

Red tongue with yellow and dry coating

Back 55

Heat Sx

Front 56

Rapid pulse

Back 56

Heat Sx

Front 57

Clinical manifestations of heat

Back 57

External: Wind/Heat
Internal: High fever, SARS
Excess: Whole face red; ST heat (bitter taste, very hungry, does not like pressure)
Def: Chronic STache, gastritis (likes pressure)

Front 58

Tx protocol for heat?

Back 58

1) Plum blossom needle
2) Three edged needle
3) Cupping (can also bleed then cup)

Front 59

Herbs for exterior heat?

Back 59

Yinhua
Liangqiao
BanLanGen

Front 60

Herbs for internal heat?

Back 60

Huanglian
Huangqin

Front 61

What is the relationship btwn cold and heat syndromes (cold-> heat)?

Back 61

The cold Sx occurs first and then gradually changes into a heat Sx.

Ex. External cold syndrome (chills/fever together) produces sx like fever, aversion to cold, general aching, no sweating (b/c cold), white tongue coating and superficial and tense pulse.

Then aversion to cold will subside but FEVER persists and other heat signs such as irritability, thirst and yellow tongue, etc.

Front 62

What is the relationship btwn cold and heat syndromes (heat->cold)?

Does not happen often

Back 62

Ex. Pt with high fever, profuse sweating, thirst, irritability, surging and rapid pulse

Ex. SUNSTROKE

Front 63

High aversion to cold with low fever

Back 63

Exterior cold syndrome (they are together but cold is more)...pt might feel cold on their back; maybe the pt is not aware of a fever

Front 64

Fever with a slight aversion to wind and cold

Back 64

Exterior heat syndrome

Front 65

Talkative, talkative, talkative

Back 65

Interior heat syndrome (likely HT heat; HT controls the tongue)

Front 66

Describe internal, def/xu cold Sx

Back 66

Yang Def
Fatigue, SOB, pale face, cold limpbs, ab cold pain (prefer pressure), loose stool, profuse and clear urine, pale tongue, deep, slow and weak pulse

NOTE: Relieved by warmth

Front 67

Describe internal, excess/shi cold Sx

Back 67

Cold limbs and prefer warmth, pale face, ab pain (WORSE with pressure), loose stool, bland taste with profuse saliva, clear urine, pale tongue, white coating deep slow and tight pulse.

Front 68

What are the 3 ways to determine def vs excess cold?

Back 68

1) Relieved by warmth (Xu)
2) Pulse is weak (Xu) vs tight [both are slow]
3) Prefers pressure (Xu)

Front 69

Describe internal heat excess/def

Back 69

see slide

Front 70

How to distinguish true heat with false cold?

Back 70

They are thirsty, don't like covering body is hot, throat is dry, stools are dry, scanty urine, deep red tongue and dry-yellow fur, forceful pulse.

False Cold Sx: Pale face, limbs are cold and pulse is deep.

Front 71

How to distinguish true cold with false heat?

Back 71

True Cold: Likes warm drinks, prefers covering, body is cold, throat is not dry, stools are loose, urine is clear and profuse, tongue is pale/white-moist with fur, weak pulse.

False Cold: Is thirsty (likes warm drinks), face is red, limbs are hot, pulse is LARGE.

NOTE: Internal is always true (thirst, urine...). So body is cold (true) but limbs are hot (false). All the false Sx are distal areas (face, limbs).

So you need to tx the cold b/c the heat is false.

Front 72

What is one reason you can have core heat and cold hands?

Back 72

Clinically can be due to qi stagnation

Front 73

Chills and fever together

Back 73

External

Front 74

Only chills or only fever

Back 74

Internal

Front 75

Which Ext Sx have sweating?

Back 75

Ext heat and Ext Xu (spontaneous)

Front 76

Which Ext Sx have no sweating?

Back 76

Ext cold, Ext Shi

Front 77

Which Ext Sx have thirst?

Back 77

Ext heat

Front 78

Which Ext Sx have mildly red tongues?

Back 78

Ext cold, Ext Shi

Front 79

Which Ext Sx have thin white coatings?

Back 79

Ext cold, Ext shi

Front 80

What is the diff btwn Ext Cold Sx and Ext Shi

Back 80

Ext Cold is floating-tight and Ext Shi is floating-strong

Front 81

What is another way to say Internal Xu Cold?

Back 81

Yang Def

Front 82

What is another way to say Internal Xu Heat?

Back 82

Yin Def

Front 83

External excess or def, one key difference?

Back 83

Excess no sweating
Def sweating

Front 84

Characteristic of ext to int?

Back 84

Move from fever and chills together to only fever or only chills

Prognosis: worse

Front 85

What is the main diff Sx btwn exterior and interior syndromes?

Back 85

Aversion to cold

Front 86

Which special Sx are always present with an exterior Sx?

Back 86

Fever and aversion to cold; a floating pulse

Front 87

Cold and heat Sx indicate what about the Dz?

Back 87

The nature

Front 88

Def & Excess, Define

Back 88

Def and excess are the 2 principles which are used to generalize and distinguish the relative strength of the antipathogenic qi and pathogenic factor.

Front 89

Dr. Luo believes that 90% of xie (external pathogens) is due to what?

Back 89

Poor dietary habits, poor sleeping

The other 10% is Li Qi (contagious); recovery is still related to Zheng Qi (your antipathogenic Qi)

Front 90

If we know Zheng and Xie we know what?

Back 90

Shi shi, xu xu
Excess, Excess, Def, Def

By improper tx, you can make excess more excess or Def more Def.

Front 91

What is a primary Sx of Yin Xu?

Back 91

Emaciation (thin/slender)

Front 92

Why does Yin Def present in the afternoon?

Back 92

Afternoon is the start of Yin time. It can also happen at night.

Front 93

Why would Yin Xu manifest as dry throat?

Back 93

LU opens through the throat
KI also goes to the throat (old people)
LV also goes to the throat

Front 94

Pulse of Yin Def?

Back 94

Thin and rapid

Front 95

What BM would you expect from Yin Def?

Back 95

Dry stool

Front 96

What is the diff btwn body fluid xu, yin and blood xu?

Back 96

It's a process...the heat may attack and at first, it will attack the superficial areas. This is BF. So 1st manifestation will be body fluid xu. The key point is that they are all dry.

Yin Def will have heat signs/fever. Yang is rising. BF def will not have Yang rising. BF xu just means that it will not nourish you.

If it gets deeper, then it may create blood xu.

Front 97

What are the Sx of Yang Def?

Back 97

1) Chills
2) Cold limbs (in all extremities; if only in the lower jiao - then it's KI; SP controls 4 extremities)
3) Listlessness (qi def)
4) Lassitude (qi def)
5) Spontaneous sweating
6) Absence of thirst (already has abnormal water retention so not thirsty)
7) Clear urine increased in volume (profuse and clear is typical...winter you will urinate more; Dr. Luo explains this as UB contracting due to cold, makes you pee more and profuse b/c yang cannot steam the water, so there is more water)
8) Loose stools (or early 5AM diarrhea, it's colder in the morning and Yang Qi is weaker)
9) Pale tongue with white coating (can also be swollen)
10) Weak pulse [if it's cold it should also be slow....Yang Def is deeper as well]; only Yang Def is *deep, slow and weak*. Def is why it's week. Slow due to cold.

Key: Qi Def + Cold=Yang Def

Front 98

What are the Sx of Qi Def?

Back 98

1) Fatigue
2) SOB
3) Lassitude
4) Weak voice
5) Spontaneous sweating
6) Swollen tongue with white coating (could be pale)
7) Weak and soft pulse

Front 99

What are the Sx of Blood Def?

Back 99

1) Dizziness
2) Pallor
3) Poor memory (HT Blood)
4) Poor concentration (HT Blood)
5) Pale eyelids, mouth, lips, gum, nails (if you press and release the nail, blood xu will take a while to come back - often will have scanty menstruation - LV=nails)
6) Fatigue
7) Irregular menstruation
8) Pale tongue with white coating
9) Weak and soft pulse

Could also have blurred vision - LV Blood Xu.

Front 100

Blood Xu or Yin Xu could cause?

Back 100

Wind; can also cause itching (due to the wind)

Front 101

What would be one Diff Sx btwn LV Blood Xu and LV Yin Xu?

Back 101

Yin Def would manifest as dry eye and could transform into blurred vision -> Blood Def

Go Qi Zi would be helpful!

Front 102

How to Tx for Xu?

Back 102

Source Pt
Mu Points
Back-Shu

RN4 & DU4 (KI Yang); Ren6 (Sea of Qi)

Acupuncture for Xu works well. AIDS, low energy, it helps.

Front 103

Define Excess Syndrome

Back 103

EXCESS refers to HYPERactivity of pathogenic factor.

Syndromes of EXCESS refer to pathological conditions in which the pathogenic factor is HYPERactivee, while the ANTIpathogentic qi remains strong.

*Pathological
*Pathogenic factor is hyperactive
*Antipathogenic qi remains strong

Front 104

What are the reasons for Excess?

Back 104

1) External evil attack
2) Dysfunction of internal organs (phlegm, water, damp, blood stasis)

Front 105

What are the symptoms of excess?

Back 105

1) Agitation (could be LV fire or HT heat)
2) Sonorous voice
3) Coarse breathing
4) Distension and fullness in the chest and abdomen
5) Pain aggravated by pressure
6) Constipation or tenesmus (due to damp heat)
7) Dysuria (could be lower jiao damp heat; either frequent or difficult)
8) Thick (damp or water) and sticky tongue coating
9) Pulse of excess type

NOTE: Yin Def or BF Def can also cause constipation.

Front 106

How do you Tx Excess?

Back 106

Acu: Expel excess pathogen
Bleeding: 3-Edged Needle & Plum Blossom
Cupping: Can also use with bleeding to pull the blood out

Herbs: leaves, twigs, trunks, roots, seeds

Leaves+twigs: Excess heat
Trunks: Dampness, phlegm
Roots/Seeds: Constipation

Front 107

When do we see Def and Excess together?

Back 107

Def of Zheng Qi and excess of pathogens manifest at the same time.

Simple Ex: SP Qi Def - gas and bloating with water and damp retention (excess).

In clinic Dr. Luo sees about 70% with both excess and def.

Front 108

When do we see Excess to Def?

Back 108

Heat Syn: High fever, thirst, sweating and rapid pulse

Then showing emaciation, feebleness, little tongue coating or no coating and thready and weak pulse - causing YIN XU

Front 109

When do we see from Def to Excess?

Back 109

SP Qi Xu: fatigue, fullness after eating, SOB, loose stool, white tongue coating, weak pulse

Then showing cough with clear phlegm, edema in legs and forehead, thick and greasy coating, slippery pulse. EXCESS

Front 110

What is the diff btwn Exterior Def or Excess?

Back 110

Def-> Sweating
Excess -> No sweating

Front 111

According to Nei Jing - Yang hua qi and Yin Cheng xing, what is the meaning?

Back 111

Yang consumes qi and Yin forms shape at night, this is why baby sleeps for a longer time

Front 112

What is the first importance according to the 8 principles?

Back 112

Yin/Yang

Front 113

What is the board on Yin Collapse?

BOARD

Back 113

Similar to Yin Def but more severe (generally incapacitated).
*sweat is sticky (burned fluid) and salty (burned the fluid)
* Fever is in the body and warm limbs
* Restless and irritable

Front 114

What is the board on Yang Collapse?

BOARD

Back 114

Similar to Yang Def but more severe (generally incapacitated).
*Profuse sweating, cold and no taste

*Sunstroke (for ex) but other near death conditions.

Front 115

Describe Yang Exterior

Back 115

1) Aversion to cold w/ fever
2) Aching in head and body

T: Thin-white/yellow fur
P: Floating

Front 116

Describe Yang Heat

Back 116

1) Fever, thirst, like cold drinks
2) Flusehd face and red eyes
3) Scanty and yellow urine
4) Constipation

T: Red tongue, dry-yellow fur
P: Rapid

Front 117

Describe Yang Excess

Back 117

1) Hyperactive
2) Hoarse breath
3) Pain and fullness in the AB and chest (painful to the touch)
4) Dry stool
5) Dysuria

T: Thick-greasy fur
P: Solid

Front 118

What is Taiyang Zhong Feng and Taiyang Shang Han?

BOARD

Back 118

Taiyang syndrome has two conditions: Zhong Feng (wind attack), which is an exterior xu (sweating); Shang Han (cold injury) that can be both exterior excess or exterior cold.

Front 119

Describe the functions of the HT.

Back 119

1) Govern Blood
2) Conrtol the blood vessels
3) House the mind (psycho)
4) Manifest in the complexion (qi hua zai mian; HT manifestation show up through the face)
5) Joy
6) Open into the tongue
7) Control sweat
8) Loathe heat

Front 120

What is the cardinal sign of HT Dz?

Back 120

Palpitations (also reported as irregular HT-beat)

Front 121

Explain why spontaneous sweating could be a heart problem?

Back 121

Sweat=Yin + Yang

Yin= Body Fluids
Yang= Lung Qi or HT

If spontaneous sweating for too long, could be body fluid xu.

Front 122

What is the difference btwn a HT Qi Xu and Heart Yang Xu?

Back 122

Heart Yang Xu T will be swollen (damp retention) and slippery (water retention); HT Qi Xu is pale and white

Front 123

What is the diff in pulse btwn HT Qi Xu and HT Yang Xu?

Back 123

HT Yang Xu has a deep pulse (internal). It indicates more chronic condition b/c it is developed from HT Qi Xu.

Western: Heart Failure process

Front 124

What is the key Diff Dx question btwn HT Qi and HT Yang Xu?

Back 124

Is the pt cold? In HT Yang Xu the pt will feel cold.

Front 125

HT failure pt will have what type of T?

Back 125

Purple and will have had water retention.

Front 126

HT Yang Xu you would expect what type of pulse?

Back 126

Slow (so you should think cold!), deep (chronic) and weak (deficiency)

Front 127

Pt is suddenly profuse cold sweating, cold limbs, feeble respiration, pale face, purple lips, unclear mind or coma, pale/purple/watery tongue and a feeble pulse; what is the Diff Dx?

Back 127

HT Yang Collapse (which is more severe and urgent than HT Yang Xu)

Tx: Survive the Yang - Moxa on Ren 8 (for example people with sunstroke) but if the pt has profuse sweating and their skin is cold.

After the Yang Qi is inside then don't need to moxa anymore.

Front 128

Why is there difficulty falling asleep?

Back 128

If pt cannot fall asleep within 30 minutes it is considered to be insomnia.

Reason: Qi is Xu so it cannot go in or Qi is stagnated (stress).

If pt frequently wakes up it is Blood Def.

Front 129

What can cause wind?

Back 129

Excess: LV Fire
Def: Yin Xu or Blood Xu

Front 130

What is the diff in memory Fx btwn HT Blood Def and KI Xu?

Back 130

KI Xu affects long-term memory; HT Blood Def will affect short-term memory.

Front 131

Heart Blood Xu will lack what key sign that HT Yin Xu has?

Back 131

HT Blood Xu doesn't have heat signs; HT Yin Xu will have heat signs (like dry mouth, heat sensation in the palms/soles), tidal fever, night sweating and red tongue.

Front 132

99% of the time, when your tongue has an ulcer what is Diff Dx?

Back 132

HT Fire Flaring Up
Fresh red is excess heat
Dull red means chronic Def Fire

Tx: Clear HT Fire

NOTE: if it is a mouth ulcer could also be due to SP or ST.

Front 133

FM pt, 32 y/o, presents with irritability, sleeplessness, flush faced, thirsty, painful/dark/frequent urination, red tongue, yellow coating and fast pulse.

Back 133

HT Fire Flaring Up (HT fire -> to SI)

TX: HT8 (reduce)

If it is an ulcer: Xi Gua Shuang (watermelon frost), it comes in tablets or spray.

Front 134

Nei Jing: Guai bing duo tan.

Back 134

Strange Dz mostly phlegm.

Ex. Epilepsy
Tx for Epilepsy: Die Tan Tang (push phelgm decoction)

Front 135

Male pt, 40 y/o, dizziness with heavy feeling in the heat. Suffocating sensation in the chest with vomiting.

Back 135

Phlegm stagnation

Phlegm could block the middle jiao and cause ST Qi rebellion (vomiting/nausea)

Front 136

Cardiac pain (stabbing or stuff in nature in the precordial region or behind the sternum)?

Back 136

Stagnation of HT Blood

Front 137

Which HT Diff Dx has a purplish tongue with purple spots?

Back 137

HT Blood Stagnation

Front 138

Describe the 3 irregular pulses

Back 138

Abrupt: Fast and irregular
Knotted: Slow and IRRegular
Intermittent: Slow and regular

Front 139

FM pt, 40 y/o teacher. CC: Insomnia for 2 years, worse in past 5 weeks.

Present Hx: Slept 4-6 hours/night, always disturbed by vivid dreams, heavy body, restless, irritable, occasionally feeling unclear in mind, thirst, stuff chest (more freq occurred), poor appetite, full abdomen, normal BM, dark urine, hyperactive and hypoactive alternatively, sweating sometimes.

Phys Exam: Several ulcers in mouth and tongue, red color, feeling painful, hot feeling when palpating skin, hesitant and dark urine.

T: Red tongue, red tip with several red prickles; yellow and greasy coating in the UPR/MD jiao.

BP: 140/90mm Hg, HB 84/min, rapid, slippery pulse, stronger on the 1st position.

Back 139

Phlegm fire disturbed HT
HT fire txfom to SI
SP Def
LV Fire
****
HT Fire Flaring Up (insomnia, sweating)
HT Fire -> SI (dark urine)
HT Fire (prickles)
SP Def (poor appetite)
Phlegm/Damp retention: full abdomen, feeling unclear in the mind
Phlegm heat (yellow, greasy coating) disturbed shen
HT Heat (stronger in 1st position)

Front 140

What is visible phlegm?

Back 140

Damp stored in the LU (has sputum)