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136 Cards in this Set

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What is the Eight Principle Pattern of identification?
Yin / Yang
Interior / Exterior
Cold / Heat
Vacuity / Repletion
What does the Eight Pattern of identification tell you?
Aids in understanding the location and nature of the disease, and the stregth of right vs evil.
Help untangle your diagnosis of a complicated disease.
In Wind-Cold syndromes, aversion to cold is:
a) strong
b) light, or aversion to wind
Wind-Cold is Exterior Cold Pattern, aversion to cold is STRONG
If px is suffering from Wind-Heat, his aversion to cold is:
a) strong
b) light, or aversion to wind
Wind-Heat is an Exterior Heat Pattern with light, or aversion to wind.
Fever in Wind-Cold Syndrome is ______ (light/strong).
Fever in Wind-Cold syndrome, an Exterior Cold Pattern is light (more chills than fever).
Fever in Wind-Heat Syndrome is _______ (light/strong)
Fever in Wind-Heat Syndrome is STRONG. More fever than chills.
What is the pulse for px suffering with Wind-Cold Syndrome?
floating and tight
What pulse does px have if she suffers from Wind-Heat Syndrome?
floating and rapid
What are the functions of Qi?
Promoting (pushing)
Warming
Protection
Consolidation
Transforming
Nourishing
What are the different types of Qi?
Primary (original) Qi - Yuan Qi
Center Qi - Zhong Qi
Gathering Qi (Ancestral Qi) - Zong Qi
True Qi - Zhen Qi
What is Source or Yuan Qi?
Before-heaven qi. Transformed from jing essence, associated with kidneys or life gate (ming men).
What is Center Qi or Zhong Qi?
Sp/St qi, digestive qi.
What is Gathering (Ancestral) Qi?
Combination of Grain or Gu Qi and Great (air) or Qing Qi. Gathers in the chest. It is the ancestor of true qi.
What is True Qi?
Gathering qi is transformed by source qi into true qi, which is what most of the body uses in the channels and organs. Consists of:

Construction (or nutritive) Qi - Ying Qi
Defense Qi - Wei Qi
_______ qi is responsible for human growth, development and reproduction.
Pre-natal Qi - Primary Qi (Yuan Qi)
stored in the Kidney, inherited from parents
Postanatal Qi is formed by _______.
Food essence (Gu Qi) combined with Great (air) or Qing Qi.
Describe Qi movement.
Ascending
Descending
Exit
Enter
Qi movement in Zang Fu organs.
Ht & Lu - descending
Lv & Kd - ascending
Sp/St - pivot & hinge

Lung exhale (Exit), descending
Kidney inhale (Enter)
Liver - ascending & dispersing
Sp ascending the clear
St descending turbidity
Px has shortness of breath, doesn't like to talk, complains of fatigue, worse with exhaustion. Tongue is pale and tender, with a deficient and weak pulse (or thin pulse). What is the pattern identification?
Qi deficiency
worse with exertion
Qi deficiency
pain comes and goes
Qi stagnation
cold limbs extending up past the elbows and up the body past the knees
Qi deficiency resulting in Yang deficiency
cold fingertips
Qi deficiency resulting in qi stagnation???? Check
pain better after exercise and movement
Qi stagnation
pain worse after movement
Blood stagnation
What are the symptoms of Qi deficiency?
*Shortness of breath* Worse with exertion*
*spontaneous sweating* fatigue*
dislike talk, listlessness, dizziness, blurry vision

Tongue: Pale and tender
Pulse: deficient and weak
What are the two types of pathological change of Qi?
Quantity change (Qi deficiency, Qi sinking, Qi Collapse);
Movement change (Qi stagnation, Qi rebellious, Qi obstruction)
What does Qi deficiency mean?
primary Qi (Yuan Qi) is insufficent
What are the major reasons causing Qi deficiency?
insufficient production (improper diet, congenital); excessive consumption (disease, long term physical and mental strain); aging
What is does a tender tongue indicate?
Deficiency syndrome:
tender & dry - Qi & blood deficiency
tender & glossy - Yang Qi deficiency
What are the similarities and differences between Qi deficiency and Yang deficiency?
Many common symptoms and signs (fatigue, SOB, spontaneous sweating, pale & tender tongue, forceless pulse).

Yang deficiency pattern developed from Qi deficiency pattern. Yang deficiency is more SEVERE.

Yang deficiency - there is fear of cold, cold limbs, flabby tongue, white moist coating, deep & slow pulse.
What is more severe, Qi deficiency or Yang deficiency?
Yang deficiency
What organ is most involved in Yang Deficiency? Qi deficiency?
Yang deficiency - Kidney
Qi deficiency - Spleen
What is the tx strategy and method for Qi deficiency?
Tonify and supplement the Qi
What is the governing formula used for Qi deficiency?
Si Jun Zi Tang
(Four Gentlemen Decoction)
Px has dizziness, blurred vision, low energy, chronic loose stool, sagging and distended sensation in abdominal area. Px also has prolapsed of the rectum. What is the pattern identification?
Qi Sinking Pattern
aka middle Qi sinking or Spleen Qi Sinking
What is the reason that Qi sinking occurs?
Qi is severely deficient and unable to perform its lifting and holding function. Clear Yang Qi is sinking downward instead of rising upward. This may result in prolapse of the Zang Fu organs.
prolapse of the organs
Qi sinking pattern
If px has organ prolapse plus Qi deficiency signs and symptoms, what pattern of disease is indicated?
Qi sinking pattern
What is the etiology behind the symptoms of dizziness & blurry vision, chronic diarrhea or loose stools?
What is the reason why organs are prolapsed?
Failure of clear yang to rise because of qi deficiency.
When Qi deficiency gets worse, Spleen qi is especially affected. Spleen Qi has fxn of lifting and holding, so if deficient, causes clear yang NOT to rise.

Organ prolapse occurs in Qi sinking. If Sp Qi fails to hold, then it results in internal organ prolapse.
What is the herbal formula used for Qi sinking?
Bu Zhong Yi Qi Tang
(Tonify the Middle & Augment the Qi Decoction)
Px suddenly collapses after profuse bleeding. He has feeble breath, profuse spontaneous sweating, hand open, limb flaccid. He has incontinence. The tongue is pale. Pulse is floating without root.
Qi collapse pattern
What are the symptoms of Qi collapse pattern?
Sudden loss of consciousness with eye closed but mouth open, feeble breath, profuse spontaneous cold sweating, open hands, flaccid limbs, incontinence

Tongue: pale
Pulse: floating pulse without root, or scattered, or minute pulse
What are the possible pulses for Qi collapse pattern?
floating pulse without root, or
scattered, or
minute pulse
What kind of pain is associated with Qi stagnation pattern?
Distention;
pain moves from place to place;
or throbbing pain;
paroxysmal pain;
tightness pain; or
distention pain.
What are key symptoms of Qi stagnation pattern?
Distention and unfixed pain, depression, irritability, wiry pulse. Symptoms induce or aggravated by emotional stress.
Px has throbbing pain on the side of his chest that comes and goes. He is frequently irritable, has mood swings and sighs a lot, with a wiry pulse. He says his symptoms are worse when he is stressed. What is the most likely pattern identification?
Qi stagnation
What are the primary pathogenic factors that cause Qi stagnation?
Emotional stress; improper diet; exopathogenic factors; or traumatic injury or surgery.

Aging or chronic illness can cause yang Qi insufficiency, or cold accumulation can slow down Qi movement.
What are secondary pathogenic factors of Qi stagnation?
phlegm, blood stagnation, or stones
masses or lumps that do not move
Blood Stagnation
Px has distended pain in an unfixed location. He suffers from frequent belching, gas, and borborygmi. He is irritable and suffers from depression. Symptoms are worse with stress. What is the most likely pattern identification?
Qi stagnation - Lv Qi stagnation
What is the tx strategy and method for Qi stagnation?
Rectify and move the Qi
Which organ is most likely involved if Qi stagnation symptoms include lower abdominal twisting pain, which may extend to back, distention, dislike pressure, borborygmi and flatulence?
Small Intestine Qi Stagnation
Which organs are the most affected by Qi rebellion?
Lung, Stomach, Liver
What are the symptoms of Liver Qi rebellion?
headache, dizziness, or fainting. In serious cases there can be nosebleed, vomiting of blood.
What are the symptoms of Lung Qi rebellion?
cough, panting, hasty breathing
What are symptoms of Stomach Qi rebellion?
nausea, vomiting, belching and hiccups
What is Qi obstruction pattern?
Severe; interior EXCESS pattern; acute onset, quick & severe, change is manifested w/ coma, fainting & cold limbs.
What are the symptoms of Qi obstruction?
Sudden loss of consciousness, fainting, or coma; harsh breathing; gurgling w/sputum; clenched fist and jaws; no urinary or bowel incontinence.

Pulse: forceful, slippery and rapid; or wiry and rapid pulse; or hidden pulse
Px lost consciousness and is in a coma. His mouth and hands are open; he has incontinence and has no control over his bowel movements; feeble breath, profuse sweating, minute and scattered pulse. What is the pattern identification?
Qi collapse
-due to severe DEFICIENCY causing an inability to nourish, promote movement and consolidate the body.
- Spirit (Shen) is not nourished and Body Fluid leaks out
Px lost consciousness and is in a coma. His jaws are clenched, mouth and hands are closed tightly; no urinary incontence or BM; harsh breath; little or no sweating; forceful pulse.
Qi obstruction
- EXCESSIVE amounts of Qi stagnation prevents circulation inside the body.
- Heart orifice congested, leading to fainting or coma.
What is blood and what is it composed of?
Blood is part of yin, a very dense form of qi.

Composed of:
Nutritive Qi (Ying Qi)
Body Fluids (Jin Ye)
*What are the functions of blood?
Nourishes the body.
Moistens (eyes, sinews, skin, hair)
Material foundation for Shen (spirit, mind). Ht blood houses and anchors the shen.
Hair is surplus of blood
What are the materials for blood generation?
food essences, Ying qi (nutritive qi), Jin Ye (body fluids), & Kidney essences
Which Zang Fu organ keeps blood inside the vessels?
Spleen - controls blood
Which Zang Fu organ soothes qi and stores blood?
Liver
soothes qi - promotes blood circulation
storage blood - regulates blood volume
Which Zang Fu organ governs the blood and promotes blood circulation
Heart
Which Zang fu organ assists the heart to promote blood circulation?
Lungs - helps heart qi circulate blood.

Governs the qi of the whole body. Qi moves blood.
Lungs are in charge of orderly flow (prime minister) - Pushes qi-blood through the vessels and channels.
What are the symptoms and signs of Blood Deficiency?
*Pale face* without luster;
or withered yellow face;
pale lips and nails;
dizziness; blurry vision;
palpitations, insomnia;
numbness & tingling sensation in hands & feet;

Women - there may be abnormal menses (light, scanty, delay or even absent)

Tongue: Pale
Pulse: thready and weak
What are the indications if someone has numbness and tingling sensation:
(a) in both hands and feet; and
(b) only on one side
(a) Blood deficiency
(b) Blood stagnation
What are the organs that are most affected by blood deficiency?
Heart and Liver
Px suffers from palpitations, restlessness, insomnia, dream disturbed sleep and poor memory. He has a pale face, pale lips and nails, pale tongue with a thready and weak pulse. What is the pattern identification?
Blood Deficiency Pattern
What are symptoms associated with Liver Blood deficiency?
Pale and sallow complexion, pale lips & nails, pale tongue, thready and weak pulse.

Dry eyes, blurred vision or night blindness, dizziness, muscle twitching, numbness of limbs, scanty light menses, or amenorrhea, brittle and fragile nails.
What is the pulse for person that has blood deficiency?
thready and weak pulse -
blood fails to fill vessels
What is the treatment strategy for Blood Deficiency?
Tonify and replenish blood.
If px has sharp and fixed pain that is resistant to pressure; she has a dark complexion, with a purple tongue and a choppy pulse. What is the most likely pattern identification?
Blood stagnation
What are the characteristics of pain due to Blood Stagnation?
Pain (piercing, boring, or stabbing);
WORSE at night,
resistant to pressure,
fixed location
**worse with movement**
What are symptoms of blood stagnation?
Pain (piercing, boring, or stabbing), aggravated at night, resistant to pressure, fixed location;

Dark complexion
Purple lips
Masses or lumps that do not move
Bleeding with dark blood and dark clots
Squamous and dry skin
Menorrhagea, amenorrhea or dysmenorrhea

Tongue: purple or dark spot on the side of tongue, possibly distended and purple veins under tongue
Pulse: choppy, irregular pulse
What can cause blood stagnation?
Qi stagnation, Qi deficiency, trauma injury, Blood deficiency, Cold, Heat
Px is suffering from stabbing or pricking pain n the chest, palpitations, cyanosis of lips and nails, cold limbs. She has a dark complexion, with a purple spot on front of the tongue with a choppy pulse. What is the pattern identification?
Heart Blood stagnation
What are the key points in identifying a Bloo-Heat Pattern?
bleeding; deep red tongue; wiry and rapid, forceful pulse

other symptoms and signs: hemoptysis, hematemesis, all kinds of bleeding, hematuria, hematochezia, preceded mens cycle, menorrhagia, vexation, thirst, fever
What are the symptoms and signs of Blood-Cold Syndrome?
Pain & coldness in the hands, feet, & lower abdomen, can be relieved by warmth;
irregular menstrual cycle; dysmenorrhea, menses in dark purple color with clots

Tongue: pale
Pulse: deep & slow or wiry & choppy
Px has severe local pain on his leg, with swollen or blue purple color in that area, relieved by warmth. His pulse is deep and slow. What is the pattern identification?
Blood-Cold Syndrome
What is the main difference between Blood Stagnation pattern and Blood-Cold Syndrome?
Blood-Cold Syndrome is part of blood stagnation pattern, only happens when exopathogenic cold attacks the vessels; and only hands and feet or Chong/Ren channels are involved.
What are the key points for identifying a combined pattern of Qi stagnation and Blood stagnation?
Distention, migratory pain or masses w/ fixed location & sharp pain following liver channel, purple tongue & choppy pulse
Px complains of fullness and distended pain in the chest and hypochondrium. She has a mass on her abdomen which is painful and resistant to pressure. She has irritability and depression. She gets PMS with painful periods. Her tongue is dark purple with petchiae. Her pulse is choppy. What is the pattern identification?
Qi & Blood Stagnation
What does it indicate when pain is resistant to pressure?
blood stagnation
Sharp fixed pain.
blood stagnation
Px has pale dark complexion and suffers from fatigue, listlessness, shortness of breath, & dislikes talking. She has sharp fixed pain in the chest that is resistant to pressure. She has a purple tongue with a deep and choppy pulse. What is the pattern identification?
Qi deficiency with blood stagnation
- key points: Qi deficiency symptoms plus blood stagnation signs
Px has dizziness and vertigo, fatigue, SOB, dislikes to speak, spontaneous sweating with palpitations, insomnia, pale or sallow complexion, pale tender tongue, with a thready and feeble pulse. What is the pattern diagnosis?
Qi & Blood deficiency Pattern

Qi deficiency: fatigue, SOB, spontaneous sweating, dislike speaking

Blood deficiency: Palpitations, insomnia; pale nails, lips & face; dizziness, vertigo
What causes bleeding due to Qi deficiency?
Bleeding arises from the failure of deficient qi to govern blood.
What are the signs and symptoms of Bleeding due to Qi deficiency?
Hemafecia (purulent bloody stools);
Hematemesis (vomiting of blood);
Ecchymoses (bruise);
Teeth & gum bleeding;
Metrorrhagia (bleeding b/w menstrual periods);
Metrostaxis (continous uterine bleeding)
with
Shortness of breath;
Spontaneous sweating;
Fatigue
Pale complexion

Tongue: Pale
Pulse: Thready & Feeble
How can you differentiate the pattern of bleeding due to Qi deficiency?
Chronic bleeding plus Qi deficiency signs and symptoms.
Px has an acute onset of fever and is irritable and restless. He is constantly thirsty. His nose is bleeding and the color is bright & thick. His tongue is deep red, with a wiry and rapid pulse. What is the pattern diagnosis?
Excess heat in the blood
(see p. 85 ppt comparison chart)
What are the symptoms of Qi collapse due to bleeding?
Heavy bleeding;
Face sudenly turns pale;
Profuse sweating;
Cold limbs;
Feeble breath, even syncope;

Tongue: Pale
Pulse: Thready & Minute or Scattered
What is body fluid?
Basic material that makes up the body and maintains life activities of the body.
What is the function of body fluids?
Moisten first;
Nourish secondarily
also helps anchor qi
Jin
thin & clear;
strong mobility;
Skin, muscles & orifices;
able to permeate into blood vessels;
MOISTENS
Ye
thick and turbid;
weak mobility;
Joints, viscera, brain & marrow;
NOURISHES
Zang Fu organ that transforms water into body fluids; distributes body fluids to entire body; and transfers body fluids up to the Lungs.
Spleen
Zang Fu organ that is in charge of descending and dispersing qi and body fluids.
Lungs - upper source of water;
- descends fluids to the Kidneys & UB & helps with urinary function;
- Lungs dispers fluids to moisten the skin,
like a mist
Zang Fu organ governs the water of the whole body; governs fluid metabolism; evaporates and transforms.
Kidney - water organ
Zang Fu organ that is the passage for distributing body fluids.
San Jiao
Zang Fu organ that governs blood; body fluid is a major component of blood.
Heart
Zang Fu organ that ensures the smooth flow of qi, "water moves when qi moves;" promotes body fluid circulation.
Liver
also stores blood
What is the Qi action on body fluids?
Qi generates body fluid
Qi promotes body fluid circulation
Qi consolidates body fluid (failure will cause profuse & spontaneous sweating; polyuria or incontinence)
What is the body fluid action on Qi?
Body fluids generate qi (nourishing and moistening)
Body fluids carry qi
Fluid Pattern Identification
Two types:

Insufficiency (Body Fluid Insufficiency)

Stagnation or accumulation of fluids
Excess: (Phlegm & Rheum)
What are the symptoms and signs of Body Fluid insufficient pattern?
Internal dryness pattern.
Dry mouth & throat, dry & cracked lips; dry & rough & itchy skin; dry hair;
thirst & desire to drink;
Scanty & dark yellow urine, dry stool, flaccidity;

Tongue: Red w/ dry yellow coat
Pulse: Thready & Rapid
What is Retention of Fluid pattern?
Pattern due to water accumulation inside the body, which may result from exopathogen attack or emotional stress, leads to internal organ dysfunction, affects the body fluid distribution and excretion.
What are the two types of Retention Fluid Patterns?
Edema (Yang edema & Yin edema)
Phlegm & Rheum
What is edema?
Swelling caused by fluid retention - excess fluid is trapped in the body's tissues.
What is pitting edema?
After pressing finger on the swollen area, an indentation persists for some time after the release of pressure.
Indicates water retention.
What is "baloon" edema?
If you press on the swollen area, does not make an indentation but goes back like a "balloon."
Indicates qi stagnation.
If px has acute onset of edema that starts from face, with heavy limbs, and abdominal distention. He has chills & fever. Tongue has white greasy coat, and pulse is superficial. What is the pattern identification?
Retention of Fluid Pattern - Yang Edema
- heat, excess
Px has chronic illness and physical overstrain. He suffers from edema that starts from the ankles. He has intolerance of cold, fatigue, low back ache, and poor appetite. His tongue is pale and tender, with slippery coating. His pulse is deep, slow, and forceless. What is the pattern identification?
Retention of Fluid Pattern - Yin Edema
- chronic; cold, deficiency
What does intolerance of cold mean, and what does it indicate?
Intolerance of cold - cannot tolerate cold, sensation relieved by more clothes or external heat source.
Indicates interior cold due to yang deficiency.
Px has edema, acute onset, starts from eyelid and then spreads to the whole body. She has difficulty urination. She has fever, aversion to cold with NO sweating. Tongue has white coat and a superficial and tight pulse. What is the pattern identification?
Retention of Fluid Pattern - Yang Edema -
Wind Water Pattern
Px has edema, acute onset, starts from eyelid and then spreads to the whole body. She has difficulty urination. She has fever, with sore throat, with a red tongue and superficial and rapid pulse. What is the pattern identification?
Retention of Fluid Pattern - Yang Edema -
Wind Water Pattern
Px has pitting edema in the entire body, sub-acute onset, body, limbs are heavy and weak; scanty urine, abdominal distention, poor appetite, nausea & vomiting. Tongue has white greasy coating, with a deep pulse. What is the pattern identification?
Retention of Fluid Pattern - Yang Edema -
Dampness accumulates in Spleen Pattern
Px has pitting edema in the entire body, sub-acute onset, body, limbs are heavy and weak; with yellow scanty urine, abdominal distention, poor appetite, nausea & vomiting. Px has a red tongue w/ yellow greasy coating. Pulse is deep and rapid. What is the pattern identification?
Retention of Fluid Pattern - Yang Edema -
Dampness accumulates in Spleen Pattern
Edema that is more chronic
Yin edema
Edema that is accompanied by exterior syndromes.
Yang edema - acute; heat, excess
Phlegm is ______ (thick/thin) fluid.
Phlegm is thick & turbid fluid;
created when there is qi or fire steaming;
affects entire body & many locations;
can combine with other pathogens, causes variety of symptoms;
Long course & difficult to treat
yin type pathogen
Rheum is ______ (thick/thin) fluid.
Rheum is clear & thin fluid;
flows easily & accumulates in space within organs & tissues;
yin type pathogen -impairs & obstructs yang qi;

Tongue: White greasy or slippery coating
Pulse: slippery & wiry
Px is 50 year olds and overweight. He has profuse thin white sputum that is easy to expectorate, worse at night and in late summer. What is the pattern due to phlegm?
Damp Phlegm Pattern
- Spleen qi deficiency leads to accumulation of damp, which transforms into phlegm
Thin white/clear sputum, easy to expectorate, worse at night and in winter, often seen in elderly patient.
Cold Phlegm Pattern
- Sp or Kd yang deficiency causes dysfunctions of water metabolism
Thick yellow sputum, difficult to expectorate.
Heat Phlegm Pattern
- Intense fire scorches the fluids & transforms into phlegm
Viscous white sputum, possibly blood-streaked, very difficult to expectorate, worse in Autumn, most often seen in older patients, or in yin deficiency condition.
Dry Phlegm Pattern
- Lu dryness or Lung and Kd deficiency w/ deficiency heat, which consumes the fluids and produces phlegm
Copious, foamy white sputum, easy expectoration, cough, chills & fever
External Wind-Phlegm Pattern
- External wind invades the lungs, disrupts fluid distribution & produces phlegm.
Copious, foamy white sputum, dizziness, vertigo
Internal Wind-Phlegm Pattern
- Sp deficiency causes phlegm that accumulates with the stirring of Liver wind
Chest oppression, cough with profuse clear, thin sputum, shortness of breath or dyspnea and inability to lie down flat. Edema worse on the legs. (Congestive heart failure in biomedicine)
Propping Rheum Pattern - Lung
Chest pain & distention, induced or aggravated by cough, sneezing or deep breath, maybe only one side or both.
(Pleurisy in biomedicine)
Suspended Rheum Pattern - Chest & rib
Abdominal bloating & distention, borborygmus, vomiting w/ clear & sticky fluids.
Phlegm-rheum Pattern - St/Intestine
Limbs edema, heaviness of body, no sweating, scanty urination.
(Uremia in biomedicine)
Spillage Rheum Pattern - Skin & Muscle
Abdominal swelling & distention, taut, and navel is flat or even pushed out. Scanty urine.
(Ascites in biomedicine)
Abdominal Water Pattern - Abdomen