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TCM Methodology
Bian Zheng Lun Zhi = Treatment is based on pattern discrimination
Yi Bing, Tong Zhi-Tong Bing, Yi Zhi =
Different diseases, same treatment Same disease, different treatment...
Pattern discrimination: In multi-organ patterns, the 1st element stated is the most important
Treatment principles: 1st element in pattern should be mirrored in 1st element in treatment
principles
Guiding Formula: must be taken from the category of formulas corresponding to the 1st element
in the treatment principles
Additions & subtractions: depend on the exact presenting signs & symp.
Pattern discrimination
Must have a firm grasp of the basic "statements of fact"
Must memorize the signs and symptoms of each simple pattern
Search for the signs and symptoms in a focused way

A Pattern is NEVER established based on a single sign or symptom!

***** By it's very name, pattern means more than a single thing
In complex, real-life cases, there will be more than one pattern involved. One will not see all of the
signs & symptoms given in the book. Therefore, it is crucial to study KEY signs for each pattern.
Treatment principles
These are theoretical statements about what needs to be done to rectify the imbalance implied by
the name of the pattern

Most of the time, treatment principles are addressed to the ben or root of the imbalance implied in
the pattern's name
Sometimes the biao or branch must also be addressed and are stated in the treatment principles. For
example, vomiting involves a loss of fluids, the finest essence of the digestate, and qi. Therefore,
vomiting is a branch symptom that must be dealt with. So, one must add: "stop vomiting"
Treatment principles are the bridge between the pattern discrimination and the treatment plan.
They are quite important!!!! You will always be expected to give them to me!!!!
Disease Causing Factors
In TCM theory, health is seen as dynamic movement and transformation in a balanced and
harmonious manner. We see the various stages of opposition and interdependence seen in Yin Yang relationships.
When a person is in dynamic harmony with the environment, there is health. When this harmony is
lost, there is disease. Those factors that cause this imbalance are Bin Yin (disease causing factors)
These factors can be weather changes, epidemic qi, emotional, dietary, taxation, sprain & strain,
weapon injuries, insect/animal bites.
Pathological changes result from these causative factors and can become new causative factors.
History
Nei Jing
Nan Jing
Shan Han Lun
Wen Bing
TCM
Holistic View
TCM as a style
Yi Bing Tong Zhi, Tong Bing Yi Zhi
4 methods
Looking -- Listening/smelling -- Inquiry -- Palpation
Pattern Differentiation
Yin-yang -- 5 phase -- Zang Fu -- Qi, Blood, Fluids Channels & Vessels
Diagnosis
8 principles = Yin - yang -- Internal - External -- Cold - Heat -- Xu - Shi
Treatment Principles
Based on the pattern "...if there is cold, warm it..."
Basic Concept of Yin & Yang
Yin~Yang
YANG
Light
Sun
Activity
Heaven
Time

YIN
Darkness
Moon
Rest
Earth
Space

Immaterial
Energy
Insubstantial
Ascending
Fire
Transformation
Restless

Material
Form/Matter
Substantial
Descending
Water
Storage
Quiet

4 Aspects of Yin~Yang
1) Opposition
2) Interdependence
3) Mutual consumption
4) Inter-transformation

In the human body, Yin is represented by the Blood....Yang by Qi

1500 BC - Shang Dynasty

Agricultural
Animal & Plant world
Animal ~ respected, but also killed & eaten
Killed, consumed, worn as clothes
Lead to a covenant between human & animal
~~ Give life through taking life
Plant ~ also killed and eaten
ORDER OF NATURE
Seasonal festivals
NOT to control nature
Bring us IN ACCORD WITH NATURE
To bring forth the fruits of nature, one lives properly in relation to what has to be done
COSMIC ORDER
High civilization
Writing
Mathematics
Astronomy
Extreme attention to the cycle of the planets through the constellations
Combination of these allowed knowledge to be passed from generation to generation
Lead to the notion of a COSMIC ORDER!!
Cycle of the Heavens
Idea to bring society into accord w/ Heaven
Heavenly signs are signs of spiritual world

Something transcends our existence

Something drives the cycles of nature
The deities are manifestation of this transcendent
THE DAO
There is something obscure
which is complete before heaven and earth arose;
tranquil, quiet,
standing alone without change,
moving around without peril.
It could be the mother of everything.
I don't know its name,
and call it DAO.
The great DAO flows everywhere...
...All things depend on it to exist,
From Dao arises One, from One arises Two, from Two arises Three, from Three arises Ten
Thousand [all] things
The Dao that can be spoken of is not the Absolute Dao
Cheng Yi (1033-1107)
Yin and yang are everywhere.
In front and behind,
To our left and to our right,
Above us and below us,
Darkness is the same as diminished light,
Light is the same as diminished darkness,
They are complementary, Universal counterparts,
Yin does not exist without yang and yang does not exist without yin,
Two in one and one in two
Su wen 5
Yin and yang, they are the Way of heaven and earth
The fundamental principles governing the 10,000 beings
Father and mother to all changes and transformations,
The basis and beginning of generating and killing,
The palace of spirit brilliance
Heaven and earth
They are the above and below of the 10,000 beings
Yin and yang,
They are the beginning of the 10,000 beings
Mawangdui
4

Heaven is yang, earth is yin

Spring is yang, fall yin
Summer is yang, winter is yin
Daytime is yang, nighttime yin
All of the yang categories emulate heaven. Heaven exalts proper order.
All of the yin categories emulate the earth.
The virtue of the earth is being placid and quiet,
properly ordered and tranquil
Su wen 6
Heaven is yang
The earth is yin
The sun is yang,
The moon is yin.
Su wen 5
Yin is tranquility
Yang is agitation
Yang gives life
Yin stimulates growth
Yang transforms qi
Yin completes physical appearance.
The clear yang is heaven;
The turbid yin is earth
Water is yin
Fire is yang
Yang is qi
Yin is wei (flavor)
Su wen 7
That which leaves is yin; that which arrives is yang.
That which is quiet is yin; that which moves is yang.
That which is retarded is yin; that which is accelerated is yang.

Su wen 4
Speaking of the yin and yang of Man,
Then the outside is yang, the inside is yin.
Speaking of the yin and yang of the human body,
Then the back is yang, the abdomen is yin.
Speaking of the yin and yang among the viscera and bowels
Then the viscera are yin and the bowels are yang
The liver, the heart, the spleen, the lung, and the kidneys
All these 5 viscera are yin
The gallbladder, the stomach, the large intestine,
the small intestine, the bladder and the triple burner
all these 6 bowels are yang.

Su wen 6
Those in the outer region, they are yang
Those inside, they are yin.
Su wen 1
The people of high antiquity, those who knew the Way
They modeled their behavior after yin and yang
In high antiquity there were the true men.
They upheld the patterns of heaven and earth, and
They grasped the regularity of yin and yang
Su wen 25
The physical appearance of human life,
It doesnt leave yin and yang.
Su wen 4
In yin is yin; in yang is yang.
From dawn to noon, this is the yang of heaven;
It is the yang in the yang.
From noon to dusk, this is the yang of heaven;

It is the yin in the yang.

From early evening to the crowing of the cocks, this is the yin of heaven;
It is the yin in the yin.
From the crowing of the cocks to dawn, this is the yin of heaven;
It is the yang in the yin
Su wen 4
The back being yang, the yang in the yang is the heart.
The back being yang, the yin in the yang is the lung.
The abdomen being yin, the yin in the yin are the kidneys.
The abdomen being yin, the yang in the yin is the liver.
The abdomen being yin, the extreme yin in the yin is the spleen.
Huang di nei jing tai su
In yin there is yang, in yang there is yin.
When one is knowledgeable about yin and yang, he can apply needle treatment methodically.
When the origins of illness have been comprehended, the application of needles can be carried out
on the basis of the proper principles.
Carefully assess the causes of the affliction and the correspondences to the four seasons.
The human body consists of an inner region, comprising of the 5 viscera and the six bowels, and an
outer region, containing sinews, bones and skin.
Thus yin and yang are present in both inner and outer regions.
In the inner region the five viscera belong to the yin and the six bowels to the yang.
In the outer region, the sinews and bones belong to yin and the skin to yang.
Medicinals
Su wen 5
That which is of strong flavor is yin;
That with weak flavor is yang of yin.
That which is of strong qi is yang;
That with weak qi is yin of yang.
Acrid flavor and sweet flavor effuse and disperse and are yang,
Sour flavor and bitter flavor cause gushing up and outflow and are yin.
Su wen 5
Yin and yang, they are
The way of heaven and earth,
The fundamental principles governing the myriad beings
Father and mother to all changes and transformations
The source and origin of generating and killing

The palace of spirit brilliance

Lao zi
The Dao that can be expressed is not the unchanging Dao;
The name that can be defined is not the eternal name.
Hence the wise man depends on non-action (wu wei)
Continues teaching his lessons of silence
Yet the multitudinous creatures are influenced by him;
He does not reject them.
He nurtures them, but claims no possession of them,
Oversees them, but puts no pressure on them.
Accomplishes his purpose, but does not dwell on his achievements;
And precisely because he calls no attention to his actions
He is not banished from the completion of his tasks.
Nothing under heaven is weaker and softer than water,
Yet nothing surpasses it in battling the hard and strong.
Look at it, but one sees nothing,
It is called illusory.
Listen to it, but one hears no sound,
It is called undetectable.
Feel for it, but one touches a void,
It is called minuscule.
These three, because they elude us,
Meld to become one.
Existence and non-existence are dependent on each other,
Difficult and easy give rise to the same concept,
Long and short are derived by comparison,
High differs from low only by position,
Sound and echo blend into one harmony
Front and back follow one another sequentially
Thirty spokes are joined at the nave to build a wheel,
But it is the space between the wheels that provide the function.
Chunks of clay are fashioned into a vessel,
But is it the emptiness within that renders it useful.
Windows and doors are cut to build a room,
But it is the enclosure that furnishes shelter.
As we benefit from that which exists,
Let us recognize the utility of that which does not.
Lao zi

Something nebulous and yet compositely formed,

Existing before heaven and earth
Inaudible and limitless,
Independent and never changing
Presiding over all constantly,
She may be regarded as the mother of everything
I do not know its name
Dao is what I call it.
If pressured to assign it a title
I dub it Great
Dao de jing
Man emulates earth for the order of his ways,
While earth emulates heaven,
Heaven acts according to the laws of the Dao,
But the Dao does that which is natural to itself.

Zhuang zi
How do I know that wanting to be alive is not a great mistake?
How do I know that hating to die is not like thinking one has lost ones way, when all the time one
is on the path that leads to home?
While a man is dreaming, he does not know that he dreams; nor can he interpret a dream till the
dream is done.
It is only when he wakes, that he knows it was dream.
Not till the great wakening can he know that all this was one great dream
Kwang zu
The 10,000 things come into being,
and I have watched them return.
No matter how luxuriantly they flourish
Each must go back to the root from which it came.
This returning to the root is called quietness.
It is the fulfillment of ones destiny.
That each must fulfill his destiny is the eternal pattern.
5 PHASES
WOOD:
"Wood is the bending and the straightening" having the characteristics of upbearing and effusion
(upward and outward movement)

Liver-Wood The liver's physiologic characteristic is that it thrives by orderly reaching. It governs
upbearing and stirring and is like the "sprouting of trees and plants in Spring" Spring corresponds
to wood in 5 phases, so that the liver is ascribed to wood.
FIRE
"Fire is the flaming upward," having the quality of heat and upward movement
Heart-Fire: The physiologic characteristic of the heart is that it governs the blood vessels. It has the
function of propelling qi and blood to warm and nourish the whole body. It is likened to the heat of
summer, when the whole of creation thrives. Summer corresponds to fire, and so the heart is
ascribed the quality of fire
EARTH
"Earth is the sowing and reaping" representing the planting and harvesting of crops and the
bringing forth of phenomenon
Spleen--Earth: The spleen's physiologic characteristic is that it governs movement and
transformation of the essence of grain and water and is the basis of the formation of blood and qi.
IF is associated with late summer and humid weather, when the whole of nature is at its peak. Late
summer corresponds to earth, so that the spleen is ascribed to the attribute of earth
METAL
"Metal is the working of change" having the qualities of purification, elimination, and reform
Lung-Metal: The physiologic characteristic of the lung is that it thrives by purity and governs
downbearing. It is likened to the clear fresh air and purifying frost frosts of autumn, when nature is
withdrawing into itself For this reason, it is ascribed the attribute of metal
WATER
"Water is the moistening and descending to low places" having the qualities of moistening,
downward movement, and coldness
Kidney-Water: The kidney has the physiologic function of storing essence and of governing fluids.
It is associated with the bitter cold of winter, when nature is dormant
The five phases,
The first is water,
The second is fire,
The third is wood,
The fourth is metal,
The fifth is earth.
Water is moistening that which is below.
Fire is flaming upward.
Wood is bent and straight.
Metal is compliance and resistance.
Earth, then, is sowing and reaping.

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Moistening that which is below generates salty flavor.

Flaming upward generates bitter flavor
Bent and straight generates sour flavor.
Compliance and resistance generates acrid flavor.
Sowing and reaping generates sweet flavor.
Su wen 4
The eastern region; green-blue color.
Having entered, it communicates with the liver;
Its orifice opens in the eyes.
It stores essence in the liver.
Its flavor; sour;
Its class: herbs and tress;
Its anima: chicken;
Its grain: wheat.
Its correspondence with the four seasons, above it is Jupiter.
Hence the qi of spring is in the head.
Hence one knows that its diseases are located in the sinews.
Su wen 5
The east generates wind;
Wind generates wood.
Wood generates sour flavor.
Sour generates the liver.
The liver generates the sinews.
The sinews generate the heart.
The liver rules the eyes.
The spirit,
In heaven it is wind,
On the earth it is wood,
In the body it is sinews.
Among the zang it is the liver;
Among the color it is qing
Among the voices it is shouting;
Among the changes and movements of the body it is grasping;
Among the portals it is the eyes
Among the flavors it is sour;
Among the states of mind it is anger.
If anger causes harm, it harms the liver; sadness dominates anger.
If wind causes harm, it harms the sinews; dryness dominates wind.

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If sour flavor causes harm, it harms the sinews; acrid flavor dominates sour
Su wen 25
When wood meets metal, it is felled.
When fire meets water, it is extinguished.
When earth meets wood, it is penetrated.
When metal meets fire, it is destroyed.
When water meets earth, it is interrupted in its flow.
These five processes apply to the interactions among all the myriad beings;
Their validity is never exhausted.
Su wen 19
If a massive depletion results from joy,
Then the qi of the kidneys takes advantage.
From anger,
The then qi of the liver takes advantage
From sadness,
Then the qi of the lung takes advantage
From fear,
Then the qi of the spleen takes advantage
From anxiety,
Then the qi of the heart takes advantage
Su wen 65
In the case of a heart disease, first the patient experiences heartache.
After one day he coughs.
Within the next three days the flanks experience propping fullness and pain
Within the next five days there is obstruction (no passage), the body aches and the limbs are heavy.
If the disease has not ended within the next three days the patient will die,
Su wen 9
The heart,
Its fullness manifests in the vessels
The lung,
Its fullness manifests in the skin
The kidneys,
Its fullness manifests in the bones
The liver
Its fullness manifests in the sinews
The spleen
Its fullness manifests in the muscles
Su wen 10
The tissue of the heart is the vessels,
Its splendor appears in the complexion
The tissue of the lung is the skin,

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Its splendor appears in the body hair

The tissue of the liver is the sinews,
Its splendor appears in the nails
The tissue of the spleen is the flesh,
Its splendor appears in the lips
The tissue of the kidneys is the bones;
Its splendor appears in the head hair.
Su wen 23
The heart generates sweat.
The lung generates snivel.
The liver generates tears.
The spleen generates saliva.
The kidneys generate spittle.
Su wen 11
As for the so-called five zang,
They store the essence qi and do not drain it.
Hence, even if they are full, they cannot be replete.
As for the six fu,
They transmit and transform things but do not store them.
Hence they may be replete, but they cannot be full.
The reason is as follows.
When water and grain enter the mouth,
Then the stomach is replete and the intestines are empty.
When the food moves down,
Then the intestines are replete and the stomach is empty.
Hence the text states; replete but not full, full but not replete.
Su wen 17
The vessels, they are the mansion of the blood.
The head, it is the mansion of essence brilliance.
The back, it is the mansion of that which is in the chest.
The lower back, it is the mansion of the kidney.
The knees, they are the mansion of the sinews.
The bones, they are the mansion of the marrow.
Dong Zhong Shu (179-104 BCE)
Within the universe exists this qi of yin and yang in which man is constantly immersed, just as fish
are immersed in water. The only difference between qi and water is that water is visible whereas qi
is not. But mans existence is as much dependent on this qi as fishs life is dependent on water. Qi is

13

found everywhere in the universe but is less visible than water. Thus, although the universe seems
to be empty, yet there is substance at the same time. Man is engulfed in this vortex and, regardless
of whether he is orderly or disorderly, is carried along on and on, in a common current.
Tang Rang Chuan (1865-1918 CE)
A persons body is composed of nothing outside of yin and yang, and the two words yin and yang
mean water and fire, respectively.
Further, the two words water and fire in terms of the human body mean qi and blood, for water
transforms the qi and fire transforms the blood.
One might ask, how can it be that water transforms the qi?
Qi resides in all material things, and all revert to water.
The Basic Concept of Qi, it's Formation, Movement and Classification
1) Basic concept of Qi
Qi is the basic substance by which all movement and all mutations of phenomenon in the
universe arise
Qi means all of the physiological functions or activities of the internal organs and channels
and network vessels
2) The formation of Qi
Former Heaven Qi is inherited from our parents, it is finite in amount and treasured by the
kidneys
Latter Heaven Qi is transformed by the Spleen from the water and grains consumed daily.
3) Qi movement = Qi Ji
The dynamic of qi is its capacity to undertake the four primary movements that occur in the
organs and channels: upbearing, downbearing, outward & inward movement
Su Wen "there is
no organ in which upbearing, downbearing, outward and inward movement of original qi does not
occur" When this movement stops, life ceases.
In a healthy normal situation, the Qi movement is harmonized and balanced, otherwise,
pathological movement = Qi stagnation, Qi counterflow, central qi fall, etc
4) Different forms of original Qi, manifesting as physiological activity
Organ Qi : each organ has its own qi, which is the basis of its physiologic activity and manifests as
a major aspect of its physiologic function.
Channel Qi: movement is seen in the channels' functions of transmission and conveyance
Construction Qi: the qi that forms the blood and flow with it in the vessels, helping to nourish the
entire body
Defense Qi: flows outside the vessels ... it is fierce, bold and uninhibited, so it cannot be contained
by the vessels. Its main function in the chest and abdomen is to warm the organs. Its function on the
exterior is to flow through the skin and flesh, regulate the opening and closing of the interstices
(cou li), protect the exterior, keep the skin lustrous and healthy, and prevent invasion of external
evils

14

Ancestral Qi: gathers in the chest, the "sea of qi" (qi hai ). It ascends to the trachea and descends
into the qi thoroughfare.
Ling Shu: "ancestral qi accumulates in the chest, issues through the throat, goes through the heart
and vessels, and moves respiration"
Main Functions: enters the respiratory tract and controls breathing: its health is reflected in the
strength of respiration and in the voice. It also causes the qi derived from the breath to descend into
the qi thoroughfare. Breath control in qigong makes use of this function.
Ancestral qi penetrates the heart and vessels, driving the heart and regulating the pulses. Thus, the
circulation of qi and blood and the temperature and movement of the limbs are largely dependent
on it.

5) Functions of Qi -- 5 Fx are interrelated

Activation: human growth and development, physiologic activity and metabolism, are
manifestations of the activation of qi
Warming: body temperature and the ability of the organs and tissues to perform their functional
activities are dependent on the warming action of qi
Defense: Qi is the outer defense of the body and prevents evil influences from entering.
Transformative action: formation of blood and fluids, distribution of fluids, and conversion of
fluids into sweat and urine are all the result of the transformative action of qi.
Containment: extravasation of blood or loss of body fluids is prevented by the containing function
of qi.
6) Pathologies of qi... main pathologies are qi vacuity and qi stagnation
Qi vacuity: may be caused by enduring illness, old age, weak constitution, malnutrition, or taxation
fatigue. Characterized by fatigue, weakness and loss of strength but affects each of the viscera and
bowels differently
Lungs = shortness of breath and a faint voice
Spleen-Stomach = poor appetite and loose stools
Kidneys = frequent, long voidings of clear urine
Qi stagnation: normally the qi flows smoothly and freely throughout the body. If the qi dynamic is
disturbed, it is known as qi stagnation. It may be caused by emotional constraints, dietary
irregularities, contraction of external evils, and external injury.
The main signs are local distention and possibly pain, feelings of oppression or distending
pain of fluctuating intensity and unfixed location.
Liver channel there may be distention and pain in the rib-side, premenstrual breast distention and
pain or perhaps pain and heaviness in the lateral aspects of the lower abdomen

15

Qi Counterflow denotes stagnation and counterflow ascent of qi that normally bears downward.
Lungs shortness of breath, panting or cough
Stomach nausea, belching or vomiting
Central Qi fall: The Qi of the spleen normally bears upward. If the spleen becomes vacuous and
weak, it may fail in its duty to upbear the clear yang qi and may lead to dizziness, enduring
diarrhea, prolapse of the rectum or uterus

SPIRIT - SHEN: The spirit is what normally makes us conscious and alert during the day. It is
what becomes inactive during sleep.
Thus, the spirit is abundant qi in the Heart....
"The Heart stores the spirit"
Storage is a yin function (?), it is primarily the Heart Blood and yin that have the function of
nourishing the Heart and providing the material basis for the Heart to house the spirit(?)
MIND - ZHI: Presence of mind or concentration power
The mind is the experience of Qi and the movement of Qi
It is similar in meaning to the spirit shen, with which it is often combined to form shen zhi
Shen disturbances: insomnia, profuse dreaming, dream disturbed sleep,forgetfulness, feeblemindedness, vexation and agitation, irritability, etc
Full condition = something "harassing the heart spirit"
Empty condition = "Heart failing to keep its abode"

Full/Replete/excess Vs. Empty/Vacuous/deficient

Full = characterized by the presence of a pathogenic factor of any kind
Empty = characterized by weakness of the body's Qi
Essence is the basis of the body"
Broad Sense: Blood, Qi & Fluids
Acquired essence = Latter heaven essence
That which is essential to maintain life
Absorbed by the body after birth
Synonymous with "essence of water & grain".. nutrients absorbed by Sp/St
Narrow Sense: stored by Kidneys and controls birth, growth, aging & death

16

Reproductive essence:
What male & female combine to produce offspring
Congenital essence = Former heaven essence
Received from parents
From birth it's gradually strengthened by

ACQUIRED ESSENCE
Body grows to full stature & reproductive maturity
After Prime essence wains.....body decays

BLOOD FORMATION
From essential Qi from food derived by Spleen/Stomach
Becomes red blood after transformation by constructive Qi
Blood flows through the vessels and is pumped around the whole body by the heart
Blood is treasured and regulated by the Liver
Blood is prevented from spilling out of the vessels by the containing power of the Spleen

Blood's relationship to internal organs

Heart governs the blood & vessels
Lungs govern Qi~~ "Qi is the commander of blood"
Spleen is the latter heaven root of engenderment and transformation of Qi & Blood
Spleen "manages" or contains blood in the vessels
The Liver treasures Blood and regulates its volume
Kidneys are the former Heaven root of the engenderment and transformation of Blood
Kidneys Treasure Jing (Essence)
"Blood and essence share a common source"

Relationship of Qi & Blood

Qi engenders Blood
Qi is the commander of Blood
If Qi moves, the Blood moves
If Qi stops, the Blood stops
Qi is the commander of Blood
It is the Qi that contains the Blood in its vessels

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Qi & Blood flow together. Therefore, the Qi deserts with the Blood
Blood is the Mother of Qi, it is the material basis to anchor the Qi

Blood's Function
Nourish the whole body
Moisten body tissues
The material foundation to House the Spirit
Blood is the Mother of Qi

Blood Pathology
Stasis = the impairment or cessation of the normal freeflow of Blood
Emptiness or Vacuity = the manifestation of insufficiency of the Blood
Blood Heat = characterized by HEAT & Blood signs
Blood Cold = Congealing cold and Qi stagnation inhibiting movement of Blood

Blood stasis
PAIN stabbing, fixed, boring in character and fixed in location
Masses fixed, palpable
Bleeding recurrent, purple/black with clots Gynecology
Complexion dull, dark facial complexion
Tongue static macules on the tongue
Skin spider nevi -- bruises -- "dry lusterless skin"
"...in curious diseases, think of stasis...."
"new diseases are in the channels, enduring diseases are in the network vessels

Blood vacuity
Dizziness
Palpitations
PALE sallow complexion tongue, lips, nails
Fine pulse
Flowery vision (blurry)
Hypertonicity (stiffness, tension, spasms)
DRY ~skin... lifeless hair

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Blood heat
"primarily" due to febrile disease
"primarily" due to Liver Heat

Blood Stasis
"knocks & falls" = Trauma
Bleeding
Qi Stagnation
Qi vacuity (emptiness)
Blood Cold
Blood Heat

Blood Vacuity
Heavy Blood loss
Diminished production
Failure to eliminate stasis & engender new Blood

Blood Heat
Ejection of bright, red Blood
Maculopapular eruptions
Vexation (p206)
Crimson Tongue
Delirious Mania
Coma

Fluids = Jin Ye
All normal fluid substances flowing within the human body
Sweat, saliva, stomach juice, urine, etc
FUNCTIONS
MOISTEN -- organs, sinews, flesh, skin, mucous membranes, orifices
LUBRICATE -- Joints
NOURISH -- Brain, Marrow, Bones
JIN (fluids, liquids) -- relatively thin, more mobile & yang
Locate -- surface of flesh, mucous membranes
Function -- moisten flesh, skin, hair, eyes, ears, nose, mouth & other

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YE (humours) -- thicker, less mobile, yin

Locate -- Zang Fu, Brain, Bones
Function -- lubricate joints
Relationship to QI & BLOOD
QI -- Production, distribution & discharge of Fluids relies on ^ v >< <> movement of QI
Intimate relationship on the D action of San Jiao (waterways) & other rel organs
DISTURBANCE OF QI MECHANISM FLUID DISORDER
Abnormal accumulation of fluids = water Qi
Insufficiency of the source of fluid formation
Vacuous Qi fails to perform containing function => heavy fluid loss => => Qi desert
HOW?~~ great sweat, long voidings of urine
BLOOD - Important constituent of Blood.. the richest part of JinYe & Ying Qi travels via vessels
of Lung > Heart and D to Blood
"When fluids are harmonious, they transform into Blood
"Blood & Fluids share the same source"
Fluid depletion leads to Blood insufficiency
Pathologies of Jin Ye
WATER SWELLING (SHUI ZHONG) &PHLEGM-RHEUM (TAN YIN)
Abnormal accumulations of body fluids
ORGANS
Lung
Spleen
Kidney
Water Swelling
Impairment of Lu Fx of Diff. & Downbear
Impairment of Sp Fx of Move & D
Impairment of transformative action of Kidney Qi
affects the upbearing of the clear & the downbearing of the turbid
& the production & discharge of urine
Phlegm Rheum
Causes are similar to water swelling
"The spleen is the source of phlegm engenderment and the lungs are the
place where phlegm is stored"
Pathologies of Jin Ye
Damage to Jin (fluids) and desertion of Ye
Damage to Jin = minor
Damage to Ye = major
Causes ~ great fever, enduring fever, great sweat, profuse urine, vomiting and diarrhea
Common pathomechanisms ~ scorching fluids by evil Heat, wearing of fluids from enduring
illness
Iatrogenic~ Inappropriate or over use of:
Sweat effusing agents, urine disinhibitors, draining purgatives, warm, drying agents

20

Damage to Jin (liquids) = temporary

Signs = thirst, rough dry tongue coat, dry throat/lips/tongue/skin/ stool, short
voidings of scant urine
Depletion of Ye (humors) = serious
Signs = more pronounced slower Tx
poor general health, dry mouth with strong desire for fluids

ZANG - FU
5 ZANG/VISCERA
HEART-SPLEEN-LUNG-KIDNEY-LIVER
PERICARDIUM IS CONSIDERED 6TH VISCUS IN CHANNEL THEORY
FX = PRODUCE AND STORE ESSENCE
6 FU/ BOWELS
SM. INTEST-STOMACH-LG. INTEST-UB-GB[-SAN JIAO
FX = DECOMPOSE FOOD AND CONVEY WASTE
"... 5 viscera store essential qi and do not discharge waste. Thus they are full, but cannot be filled.
The six bowels process and convey matter, and do not store. Thus, they are filled, but are not full"
6 EXTRAORDINARY ORGANS
BRAIN, MARROW, BONES, VESSELS, UTERUS, GB[
DISTINGUISHED FROM THE BOWELS IN THAT THEY DO NOT DECOMPOSE FOOD AND
CONVEY WASTE.
DISTINGUISHED FROM THE VISCERA IN THAT THEY DO NOT
PRODUCE AND STORE ESSENCE.
GB Is an exception and is classed as both a bowel and an extraordinary organ.
It plays a role in the processing and conveyance of food, and stands in an interior-exterior
relationship with a viscus, the liver. The bile that it produces is regarded as a "clear fluid" rather
than as waste.
LIFE GATE FIRE = The basic fire of life
Lives within Kidney Yin*
The basis of sexual and reproductive function
Warms and nourishes the 5 viscera and 6 bowels
Intimately involved in growth, development, and aging
The Spleen requires the warming action of lifegate fire to perform its' function of moving
and transforming
Qi Movements

21

"...yang floats.." -- Yang by nature upbears and effuses (ascends and thrusts outwards)
"...yin sinks..." -- Yin by nature is turbid and heavy and downbears or descends
"...yang descends..." Interaction of Heaven and earth, yin&yang... classical Chinese
anatomical position...yang channels descend. Heart fire must descend to interact with Kidney water
"...yin ascends.." Yin channels ascend the body...
Kidney water ascends to interact with Heart fire
Zang-Fu
Spleen upbears the clear Yang -- Stomach descends the turbid
Lungs diffuse and downbear Qi -- Lg Int. conveys dregs downward
Kidney Qi contains & astringes -- UB descends for excretion
Liver Qi bears up& out like branches of a tree -- GB ?
Heart qi descends -- Sm Int. descends
Spleen - Stomach
"the latter heaven root of the engenderment of Qi & Blood"
"spleen upbears the finest essence of food and drink to the Lungs & Heart where it is
transformed into Qi & Blood"
"Stomach rottens and ripens the food and drink taken in and descends the turbid down the
Sm Int... it is the source of body fluids

Pathology of Qi Transformation
Spleen upbears the clear, if the spleen is vacuous and weak, it may fail its' duty and the clear
will descend mixed with the turbid. OR, if a yin turbid substance (evil damp, phlegm, etc) obstructs
the flow of qi, it may also cause a failure of the arisal of the clear.
Stomach descends the turbid, if, for any reason, the qi mechanism of the stomach is
inhibited, it may counterflow upward (belching, acid regurg., etc)
Liver governs free coursing and discharge of the Qi, if the liver is damaged, it may fail in
its' duty and counterflow upward to the lungs or horizontally to the Sp/ ST
The lungs diffuse and downbear the Qi. If, for any reason, the qi mechanism of the lungs is
inhibited, the lung qi may counterflow (cough, hasty panting)
The Kidney yin is supposed to check heart yang and maintain the proper balance between
heart fire and kidney water. Being vacuous, kidney yin fails in that function and heart fire may
consequently become exuberant. Heart fire flares upward in the upper Jiao, disquieting the heart
spirit.

The Liver governs coursing & discharge (shu xie)

The Liver stores the Blood
The Liver thrives on orderly reaching (tiao da)
The Liver governs the sinews
The Liver opens at the eyes
The Liver governs fright

22

The Liver stands in interior-exterior relation with the Gall Bladder

The Liver, it's bloom is in the nails
The Liver is averse to wind
The Liver forms tears
The Liver holds the office of general, whence strategies emanate
The Liver stores Blood
The Liver is capable of retaining blood and regulating the amount of blood in the body.
"When the body moves, the blood flows through the channels, and when the body is at rest,
the blood flows back to the liver where it is stored"
"..the legs receive blood and walk, the hands receive blood and grip.."
2 scenarios from loss of blood storing function......
1 tissues are undernourished and fail to function
2 cause a tendency towards bleeding
The Liver governs free coursing and discharge (shu xie)
1) Reflected in the regularity and smoothness of the qi mechanism. When this function is normal, qi
dynamic is smooth and regular, so that qi and blood remain in harmony, the channels are kept free,
and the organs all function normally
2) Production and secretion of bile depends on surplus of qi from the liver being channeled into the
Gall Bladder.
3) Emotional disturbances may affect the qi dynamic...impairment of free coursing can lead to
emotional disturbances such as mental depression, rashness, impatience or irascibility
Shu = to enhance flow (of qi, esp. depressed liver qi)
to free (the liver or digestive tract of qi stagnation and depression)
to eliminate (evils such as wind in the exterior)
to free (the exterior of channels from evils such as wind)
Chinese Character contains a picture of water and is used in the combination shu jun to
dredge...course = freeing the course of qi
xie = spontaneous or induced outward (or downward) movement
{coursing the Liver & rectifying the Qi shu gan li qi}
restoring the normal free coursing of liver qi in the treatment of liver
depression
{The Liver thrives on orderly reaching (tiao da) }
{The Liver governs upbearing effusion (sheng fa) }
Liver qi bears upward &outward like the branches of a tree stretch up and out

Gall Bladder
Gall Bladder holds the office of justice, from which
decision emanates
The ability to maintain balanced judgement in the face of adversity
Gall Bladder stands in exterior-interior relationship with the Liver
Gall Bladder governs secretion of Bile
The gallbladder is a "curious organ" since it's Bile is considered a "clear fluid"

HEART

Ling Shu Chapter 8 The heart holds the office of lord and sovereign. The radiance of the spirit
stems from it.

23

The Heart governs blood and vessels

The Heart stores the spirit
The Heart opens at the tongue
The Heart stands in interior-exterior relation with the Small Intestine
The Heart governs the tongue
The Heart governs speech
The Heart governs sweat
The Heart, it's bloom is in the face
The Heart is averse to heat

Small Intestine
Ling Shu Chapter 8 The small intestine is responsible for receiving and making things thrive.
Transformed substances stem from it

The Small Intestine governs separation of the clear and the turbid
Diseases of the small intestine are attributable to failure to separate the clear and the turbid,
manifesting as stool and urinary disturbances
It receives water and grain that has been decomposed in the stomach.
It transforms this food further, extracting nutrients for the body.
It passes waste on to the large intestines and "clear" to the bladder

SPLEEN
Ling Shu Chapter 8 The spleen and stomach are responsible for the storehouses and granaries.
The five tastes stem from them
From Wang Kentang and Wu Mianxue, The Compendium of Traditional Diagnosis (Gu Jin
Yitong Zhengmai Quanshu), 1601:

The Spleen governs movement and transformation

The Spleen is the latter heaven root
Sheng hua zhi yuan = the source of engendering transformation
The basis of qi and blood
The Spleen governs upbearing of the clear
The Spleen governs the management of the Blood
The Spleen governs the flesh and limbs
The Spleen stands in interior-exterior relation with the Stomach
The Spleen opens at the mouth
The Spleen, it's bloom is in the lips
The Spleen is averse to dampness
The Spleen forms drool

Stomach
The Stomach governs intake
The Stomach receives ingested foods and perform the initial stage of digestion

24

The Stomach governs rotting and ripening

Allows the essence to be extracted by the Spleen

The Stomach governs downbearing of the turbid

The Stomach sends food down to the Small Intestine
The Clear is upborne by the Spleen, the turbid is downborne by the Stomach

LUNG
Ling Shu Chapter 8 The lung holds the office of minister and chancellor. The regulation of the
life-giving network stems from it.

The Lung governs Qi

The Lung governs diffusion
The Lung governs depurative downbearing
The Lung governs regulation of the waterways
The Lung governs the exterior of the
entire body
The Lung governs the skin & {body} hair
The Lung governs the voice
The Lung stands in interior-exterior relation with the Large Intestine
The Lung is the delicate viscus
The Lung is the florid canopy
The Lung opens at the nose
The Lung, it's bloom is in the {body} hair
The Lung is averse to cold
The Lung forms snivel

Large Intestine
Ling Shu Chapter 8 the large intestine is responsible for transit. The residue from transformation
stems from it.

The Large Intestine governs conveyance

25

The Large Intestine conveys waste downward and out of the body, transforming it into stool
as it does so

The Large Intestine governs liquids

Absorbs fluid from the food waste to form firm stool

The Large Intestine hold the office of conveyance, whence transformation

emanates

KIDNEYS
Ling Shu Chapter 8 the kidneys are responsible for the creation of power. Skill and ability stem
from them
From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637:

The Kidneys govern Water

The Kidneys store Essence (Jing)
The Kidneys are the root of former heaven
The Kidneys govern the bones and engender marrow
The Kidneys open at the 2 yin
The Kidneys open at the ears
The Kidneys govern fear
The Kidneys stand in interior-exterior relation with the Urinary Bladder
The Kidneys govern qi absorption
The Kidneys are the gate of the Stomach
The Kidney, it's bloom is in the {head} hair
The Kidneys are averse to dryness
The Kidneys form spittle
The Kidneys hold the office of labor, whence agility emanates

Urinary Bladder

Ling Shu Chapter 8 the bladder is responsible for regions and cities. It stores the body fluids.
The transformations of the qi then give out their power
Urinary Bladder holds the office of Regional Rectifier
Su Wen "Bladder...stores fluid, and by Qi Hua {Qi Transformation}

26

let's it out

Pericardium
Xin Bao = Heart "wrapper"
The outer cover of the heart.
Evils invading the heart 1st affect the pericardium...
high fever --> delirium = heat entering the pericardium
phlegm turbidity --> mental derangement = phlegm clouding the pericardium
Pericardium stands in interior-exterior relationship with the San Jiao

San Jiao
Ling Shu Chapter 8 The triple heater is responsible for the opening up of passages and
irrigation. The regulation of fluids stems from it
San Jiao manifests as waterways
The main functions of the San Jiao are the processing of fluids and ensuring free flow
through the waterways.
Qi transformation in the San Jiao is a global expression for the roles played by the lung, spleen,
kidney, stomach, small intestine, large intestine and bladder in regulating the bodys water
metabolism.
San Jiao refers to specific body areas:
The upper refers to the head & chest, the heart & lungs
The middle refers to the upper abdomen the stomach & spleen
The lower refers to the lower abdomen inferior to the umbilicus
San Jiao stands in exterior-interior relationship with the Pericardium
San Jiao is also a concept in pattern identification
Know this!!!
The Heart governs the Blood and the spleen manages blood
The heart governs blood while the spleen is the latter heaven root of the engenderment and
transformation of blood and manages the blood within its vessels
Mental-emotional disturbances wear the blood taxing the spleen
Spleen vacuity may cause an insufficiency of blood leading to heart blood vacuity not nourishing
the spirit leading to shen disturbances
The heart and the kidneys interact
The heart fire and the kidneys water contribute to the normal balance between fire (yang) and water
(yin) in the body. If heart and kidney yin are vacuous, their interaction may be broken and
exuberant fire and vacuous water result. In this case, the heart spirit will become disquieted
The lungs govern qi and the heart governs blood
The blood in all the channels of the body must pass through the lungs.
"The lung faces the hundred vessels"
Only after being combined with and diffused by lung qi can blood nourish the organs and convey
essence to the skin and [body] hair
Zong Qi {ancestral qi}, which gathers in the upper jiao, pervades heart vessels and powers
respiration
The lung governs qi and the kidneys are the root of qi

27

The lungs draw in the Da qi from the environment, but cannot do so unless the essential qi of the
kidney is exuberant {Lungs govern qi kidneys governs qi absorption}
The spleen is the source of phlegm engenderment and the lungs are the receptacle that holds the
phlegm
This relationship centers around fluid distribution. The spleen governs the movement and
transformation of body fluids and the lungs ensure the regulated flow of fluids through the
waterways.
Liver qi influences spleen-stomach movement and transformation
The normal function of the stomach and spleen is related to the liver's governing of free coursing.
"When there is liver disease, first treat the spleen"
Kidney yang influences spleen-stomach movement & transformation
The normal activities of the spleen and stomach are greatly dependent upon yang which is
supposed to supply warmth and movement. The process of digestion in Chinese medicine is a
process of warm transformation likened to cooking and distillation.
The liver stores blood and the heart governs blood
The blood is produced by the spleen, stored by the liver and propelled throughout the body by the
heart.
Mental-emotional disturbances wear the blood taxing the spleen.
Spleen vacuity may cause an insufficiency of blood leading to heart blood vacuity not nourishing
the spirit leading to shen disturbances
The liver can only function, ie, only course and discharge, as long as it receives sufficient
nourishment from blood. Therefore, liver depression and blood vacuity mutually reinforce one
another.
"When there is liver disease, first treat the spleen"
The liver stores the blood and the kidneys store essence.
Blood and essence share the same source. Liver and kidneys share the same source.
The kidneys are the former heaven root of the engenderment and transformation of the blood. It
takes essence to make blood.
Liver diseases such as hyperactivity of liver yang or liver fire may consume yin blood and,
ultimately, the kidney essence
The liver governs free coursing and the kidneys govern storage
Manifest as menstruation in females and discharge of semen in males

Categories
1174 CE Jin Dynasty ---- Chen Yen =
San Yin Ji Bing Zheng Fang Lun
Treatise on 3 categories of Path. factors & symptoms
Nei Yin -- Internal Causes
Wai Yin -- External Causes
Bu Nei Bu Wai Yin -- Neither Internal nor External Causes
Wai Yin = Liu Yin -- 6 evils...wind, cold, heat, summerheat, dry , damp
Nei Yin = 7 emotions
Bu Nei Bu Wai Yin -- Diet, talking/shouting, violence, strains, anything beyond human control
Wai Yin = Liu Yin ... under normal conditions, these are simply 6 Qi. When these qi happen too
suddenly, too strongly, out of season or the person`s righteous qi is empty and weak, the normal qi
become pathologic.
28

6 evils are mostly environmental... dry diseases in autumn, dry diseases when living in a dessert
etc.
6 evils are promiscuous and may attack in combinations..wind-cold.... damp-heat...etc
6 evils may transform into each other... cold D heat etc
6 evils attack from the surface.... skin, nose, mouth

ZHENG vs XIE
Zheng=

1) True qi -- especially in opposition to disease

2) The active aspect of all components in maintaining health and resisting disease
including: Zang-Fu, Xue, Jing, JinYe, Qi
3) Forces that maintain normal Fx and seek to re-establish them when evil is present
Zhen = "True qi is the product of that which is received from Heaven combined w/ grain qi, and
which makes the body full" (Heaven=congenital)
Xie = 1) Any entity in its active aspect of harming the body -- especially in opposition to right
2) Since evil actively fights right or summons activity of right to eliminate it, it is often
called evil qi
3) Su Wen "for evil to encroach, the qi must be vacuous"
Zheng vs. Xie
1) Relationship between disease and the potential of the Zheng
A)If Right qi is strong, the fight between Right & Xie will also be strong
B)If Right qi is weak, it can't fight Xie
A tends to be of repletion type
B tends to be of vacuity type or mixed vacuity and repletion
2) Relationship between disease and the quality of the Xie
A) If Xie is Yang type, it will tend to injure the body's Yin
B) If Xie is Yin type, it will tend to injure the body's Yang
A tends to manifest as replete heat type
B tends to manifest as replete cold type or damp-cold type
3) Relationship between disease and the degree of the Xie
A) If Xie is virulent, the disease is more serious
B) If Xie is not, the disease is easier to treat
4) Relationship between disease and the location
A) Most Xie have a tropism to certain areas of the body

WIND

Wind is a Yang evil which is opening & discharging by nature.... it is light & buoyant and
most easily invades the upper & outer parts of the body.

Wind is swift &changeable. Wind diseases are characterized by changeability & symptoms
of unfixed location.

Wind is blusterous, violent, and impetuous it can cause severe damage within a short time.

Wind, although associated with movement, has the power to check normal movement. Wind
diseases may cause stiffness like facial paralysis

Wind is a promiscuous evil and readily combines with other evils.

29

Wind Disease
1-Nature = Wind is a Yang evil which is opening & discharging by nature.... Wind is light and
buoyant by nature and most easily invades the upper body and the fleshy exterior.
Area =
Tends to affect the head and face, causing HA, dizzy, red swollen face and eyes
Often first invades the lung => nasal congestion, sore pharynx & cough
2 - Nature - Wind is swift and changeable by nature... wind diseases are characterized by
changeability and symptoms of unfixed location
Signs =
wandering pain in the muscles and joints, itching of unfixed loc., fluctuating papular
outthrusts
3 - Nature
Wind is blusterous, violent, and impetuous...cn cause severe damage with short
space of time....
Signs =
Deviated mouth and eyes, clenched jaw, rigidity of limbs....
Skin is tissue of the Lung...WH evils often invade mouth & nose which connect w/ Lu. If WH
congests in Lu may D Heat =>force Qi to move frenetically Wind is nothing more than frenetic Qi.
If it forces the qi in & out through the interstices =>itchy skin

Dryness

"When dryness prevails, there is aridity" In Autumn, the weather is dry and dry air entering
the lung can cause damage to the liquid (JinYe) of the lung.

Signs/symptoms = dry cough with no phlegm or scant sticky phlegm dry lips, tongue,
pharynx and nose

Summerheat

ALWAYS from external cause

Summerheat - heat ---- associated with torrid weather... basically heat stroke or sun stroke
Signs/symptoms = high fever, thirst, heart vexation, absence of sweat surging pulse (Hong

mai)
*** High fever... "Fire eats Qi" & damages JinYe => lack of strength, short hasty breathing,
dry tongue coat

Summerheat-damp --- associated with hot, humid weather

Signs/symptoms = fluctuating generalized heat effusion, fatigued limbs, poor appetite, chest
oppression, nausea & vomit, sloppy diarrhea with ungratifying defecation soggy pulse (ru mai)
thick, slimy coat

Summerheat-warmth --- infectious encephalitis B

HEAT
Fire is a yang evil, its nature is upbearing and moving which can lead to non-constrainment. Fire
consumes yin fluids. When Fire causes movement of Blood, it leads to reddening. Yellow
excretions are ascribed to Heat

30

Heat is yang Qi, qi moves fluids up and out leading to sweating

COLD

Cold causes Qi to contract

When cold Qi damages the skin and flesh, the pores close, yang qi contracts, and sweat
ceases to flow.
When it damages the sinews, the sinews become contracted and tense -- this indicates that
the evil has invaded the channels...."Cold is associated with contracture and tautness"
Cold causes contracture and tension
Similar to first statement but also explains cold's tendency to cause qi to stagnate and blood
to become static leading to severe pain.
"When cold prevails, there is pain"
"All disease with watery humors that are clear, pure and cold are ascribed to cold"
Zhu bing shui ye, sheng che qing leng, jie shu yu han
Signs & Symptoms: Cold, thin, clear excreta
e.g. runny nose with clear mucus
clear phlegm
watery vomitus
long voidings of clear urine
clear watery diarrhea
The nature of cold as and it's clinical manifestations are similar to those of cold in the
natural environment
Signs & symptoms: low temperature, deceleration of activity, and congealing
Generalized or local signs of cold =
desire for warmth
aversion to cold
pronounced lack of warmth in the extremities
cold and pain in the lower abdomen
Differentiate invasion of cold evil and insufficiency of yang qi

DAMP
Dampness is heavy and turbid -Heavy -- "All heavy sensations are ascribed to dampness"
e.g. heavy-headedness, general heaviness, poss. general aches and soreness
Turbid -- excretions and discharges associated with dampness are turbid or unclear
e.g. abnormal discharges of the facial orifices, diarrhea or BM when it is sticky, cloudy
urine, vaginal discharge, weepy skin rashes
Dampness is a Yin pathogen -- Damp is heavy, turbid and it's nature is watery...all attributed to
Yin
Substantial-- Yin pathogens are substantial and will obstruct the Qi Ji or Qi mechanism
e.g. oppression of the chest, epigastrium, or abdomen MAY be attributed to dampness, scant
urination, uncomfortable bowel movements
Mutual consumption of Yin & Yang -- Dampness as a Yin pathogen tends to damage
Yang. Spleen likes dry and is averse to damp, damp evil obstructs the Qi Ji of the spleen (a Yang
aspect) and damages the spleens movement and transformation function...which can lead to more
dampness
Dampness is clammy, viscous and persistent --

31

Discharge -- discharges due to dampness are usually viscous and turbid

Damp diseases -- dampness is persistent so diseases involving dampness are lingering and
become chronic
e.g. Damp Bi (painful obstruction) eczema, excess body weight
Dampness percolates in the body as in nature -In nature, dampness percolates and seeps down into the ground. In the body, internal
dampness seeps down to the lower burner to cause problems there
e.g. edema of the lower extremities, diarrhea, abnormal vaginal discharge
Heavy-headedness Dampness is a yin evil and is heavy and sticky in nature, while wind is a yang evil and
tends to attack the upper part of the body. When wind and dampness attack in combination, they first affect
the head and block the clear yang, making the clear portals cloudy. If the clear portals become clouded and
dampness accumulates, heavy-headedness occurs.
Heavy Body Dampness causing heavy body usually arises form enduring exposure to water dampness, such
as working in the water, repeatedly being caught in the rain, or from living in a damp environment.
Dampness is a yin evil which is sticky, stagnant, heavy and fixed by nature. If dampness invades the body
and fixes in the fleshy exterior, the tissues will be filled with more fluid than usual and therefore will be
heavier. Thus a feeling of heaviness of the body may occur.
drowsiness and fatigue after eating -- The spleen is the latter heaven root of qi and blood engenderment
and transformation. It governs the 4 limbs and the flesh and muscles. It also upbears the clear to boost the
spirit. If, for any reason, spleen qi becomes vacuous and weak, the spleen will fail to move and transform
water and grains or upbear the clear efficiently. As a result, first the spleen will engender less qi and blood,
providing less nourishment to the limbs and muscles and giving rise to fatigue and lack of strength.
Secondly, the spleen will not upbear the clear to boost the spirit, leading to drowsiness. Water dampness is a
yin evil which can obstruct yang, also resulting in drowsiness. When we eat the food adds a load to the
vacuous spleen and thus gives rise to drowsiness and fatigue after eating.
Phlegm and dampness are yin turbid evils and are, by nature, heavy and sticky. If phlegm and
dampness accumulate in the middle burner, they may encumber the spleen and obstruct or depress spleen
yang. if the spleen is encumbered, it will engender less qi and blood, thus providing the limbs...
IF spleen yang is encumbered and depressed, the clear yang...Therefore, if there is phlegm and
dampness encumbering the spleen, drowsiness...

6 depressions: qi, blood, damp, food, phlegm, fire. Since Qi is responsible for the
movement and transformation of blood, damp, phlegm, and food, if qi becomes depressed, this may
result in the stoppage and accumulation of any of these other 4. Any of these 4 yin substances
accumulate and obstruct the flow of qi which is yang, this will tend to transform into heat. Qi and
blood as the 2 most important. Qi and therefore blood flow is closely related to emotions. Treat
diseases by jie yu resolving depression.
PHLEGM-RHEUM
Tan Yin
Tan = Phlegm Wider meaning than Western idea of sputum
Denotes a viscus fluid that can accumulate anywhere in the body causing a variety of disease
Yin = Rheum
Denotes a thinner, clearer form of accumulated fluid
Production -1) Impaired movement and transformation of fluids associated with disease of the Lung, Spleen &/or Kidney
"The spleen is the root of phlegm engenderment"

32

 Phlegm Rheum (tan yin) usually arises from dietary irregularities or vacuous yang which
fails to transform dampness.
2) Depressive fire (aka transformative fire) "stewing or boiling the juices" (body fluids) may form
phlegm but not rheum
6 depressions all transform Fire
Overeating spicy, hot, fried foods which ferment dampness, engender heat, and damage
the spleen may lead to formation of phlegm
Fire may "stew the juices" causing them to congeal into phlegm
Phlegm-Rheum in clinic
Any form of rheum arising as a result of disturbances of the lung, spleen &/or kidney
preventing the movement and transformation of fluid
Treatment =
Warming & supplementing the spleen & kidney (root)
Disinhibiting water & expelling tan yin (branch)
The method of transforming phlegm takes different forms depending on the location and cause
of the phlegm pattern
Transform phlegm and suppress cough
Diffuse the Lung and transform phlegm
Dry Damp and transform phlegm
Dispel cold and transform phlegm
Clear heat and transform phlegm
Disperse phlegm and soften hardness
Treatment for Dampness
Dispel Dampness = Qu Shi
Any method used to eliminate dampness... each Jiao has a specific method
Upper = Transform Dampness
Middle = Dry Dampness
Lower = Disinhibit Dampness
Transform Dampness Hua Shi -- treat Damp Evil with aromatic medicinals
Dry Dampness Zao Shi -- drying Damp Evil with dry bitter medicinals
Disinhbit Dampness Li Shi -- cause Damp Evil to pass out in the urine by the use of dampness-percolating waterdisinhibiting medicinals

Yin & Yang

Yin = interior, cold, emptiness (vacuity)
Yang = exterior, heat, fullness (repletion)
Yin Pattern = Any interior, cold &/or vacuity pattern
Yang Pattern = Any exterior, warm &/or repletion pattern
Yin Evil = Any evil that is yin in nature e.g. cold, dry, damp, phlegm
Yang Evil = Any evil that is yang in nature e.g. wind, heat, summerheat
Yin Exuberance with Yang debility = Exuberant yin cold with resulting debilitation of yang qi.
A) Water-damp damaging yang
B) Excessive use of cold or cool medicinals
Yin Exuberance with Yang vacuity = Exuberant internal yin cold with emptiness of yang qi

Characteristic signs = aversion to cold, cold limbs, diarrhea, water swelling (?) and
pale glossy tongue

33

Yang Vacuity
Insufficiency of Yang Qi. This is a reduction of the warming and activating power of the body
Signs& Symptoms
Fatigue
Lack of strength
Shortage of Qi & laziness to speak
Fear of Cold
Cold Limbs
Spontaneous Sweat
Pale complexion
Long voidings of clear urine
Sloppy stool
Tongue: pale, tender
Pulse: large, empty or faint,fine
Treatment Principle
Warming yang and boosting qi
Occassionally watery diarrhea
The spleen is the latter heaven root and the Kidneys are the
former heaven root. The former heaven warms and steams the spleen yang, promoting its function
of dispersing and transforming water and grains. Thus, if, for any reason, kidney yang becomes
vacuous and weak, then the spleen will not be warmed and steamed sufficiently and it will not be
able to disperse and transform properly. In that case, clear and turbid will not be separated but will
pour downward into the intestines. Since Kidney yang also plays a role in the movement and
transformation of water fluids, a kidney yang vacuity will only make such water dampness all the
worse. In addition, the kidney qi seals and stores, opens and closes, and governs the 2 lower yin. If
Kidney Yang qi becomes vacuous and weak, the kidneys may lose control of the securing and
astringing of the rear yin or anus. Thus for all of these reasons, there may be diarrhea
Long, clear urination Urine is a form of body fluids. It is a turbid fluid not needed by the body and
thus excreted. the formation and distribution of fluids depend mainly on the spleen and lungs, while
the excretion of the fluids depends mainly of the kidneys. "the kidneys are the water viscus and
govern the liquids" It is the qi transformation of kidney qi and yang that steams and evaporates
liquids, dividing them into the clear and the turbid. The evaporated clear flows along with qi to
moisten the body, while the turbid remainder is excreted as urine. Thus, if for any reason, the
kidney yang becomes vacuous and weak, it may not be able to evaporate the clear,. This then will
be excreted together with the turbid, giving rise to long, clear urination.
Fear of Cold Yang vacuity usually develops from constitutional insufficiency, aging, enduring
disease, etc. Yang is responsible for warming the body. Therefore, if yang becomes vacuous and
insufficient, it may not be able to warm the body, thus leading to a fear of cold. "Yang Vacuity
causes external cold"
Fatigue
Yang qi is responsible for activity, movement and warming. If, for any reason, the
yang qi becomes vacuous, the functions of the Zang Fu lessen and the spirit and the body are not
supported. This then leads to fatigue
Cold hands & feet Yang is supposed to warm the body." The spleen governs the 4 limbs" and
the kidneys are where the original yang stays. IF there is yang vacuity, the hands and feet won't get
sufficient warmth

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White complexion Yang qi is responsible for promoting the movement of blood. If there is a
yang vacuity, the blood circulation will consequently lack its dynamism and cannot circulate
normally.
Somnolence If yang is vacuous while yin is exuberant, yang will be repressed and cannot be
upborne to warm the spirit light, As it is said, "Yang exuberance leads to insomnia, while yin
exuberance leads to hypersomnia"
disinclination to speak
"the spleen is the source of qi and blood engenderment and
transformation" Therefore, if there is spleen qi vacuity, water and grain can't be transformed into
essence. Without the finest essence of water and grain, there is nothing from which to make the qi
and blood. "the lungs govern qi and control breathing" if there is lung qi vacuity, there will be
weak breathing and a disinclination to speak
loss of strength in the 4 limbs
"the spleen governs the 4 limbs -- the stomach is the sea of the
five viscera and six bowels and is responsible for nourishing the sinews" The spleen & stomach are
the latter heaven root of the engenderment of qi and blood...if the spleen and stomach become
vacuous and weak there will be insufficient qi and blood leading to weakness of the 4 limbs
Yin Vacuity
The manifestation of insufficiency of the yin aspect and depletion of liquids and blood
Signs & Symptoms
Low-grade fever
Heat in the hearts of the palms and soles
Postmeridian heat effusion
emaciation
night sweating
dry mouth and throat
short voidings of "reddish" urine
Tongue: red with little or no coat
Pulse: Forceless, fine, rapid
Treatment PrinciplesEnrich Yin (clear heat)
Vexation & agitation
Yin vacuity easily leads to effulgent yin vacuity fire if vacuous yin
fails to check yang. IF this vacuity fire flames upward and disturbs the heart spirit, vexation and
agitation will occur.
night sweats yin vacuity arises from the loss of blood &/or essence, enduring disease, excessive
sexual activity or aging. "yin vacuity causes internal heat, and over-strong yang causes failure to
constrain" If internal heat is strong enough to cause non-constrainment of the interstices and forces
fluids out, sweating may occur. Yang flows outward when awake and inward when sleeping.
Therefore, yin vacuity with internal heat may cause night sweats because any internal heat will
become even stronger when yang flows inward at night..."the kidneys store the original yin
*vexatious heat in the 5 centers
Yin is responsible for controlling yang. If yin becomes
vacuous and weak, yang typically becomes hyperactive, thus giving rise to internal heat. The palms
of the hands, soles of the feet and the heart and chest all pertain to yin and the interior from the
point of view of Chinese anatomy. Therefore, vexatious heat due to yin vacuity manifests in those
areas described as anatomically yin
* chronic dry sore throat May be due to congenital insufficiency, sexual taxation, chronic
disease or aging. IF there is kidney yin vacuity, the throat will not be sufficiently nourished. In

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addition, yin vacuity fire may ascend, congesting in and burning the throat. Therefore sore swollen
throat
If there is kidney yin vacuity, yang will not be checked properly ad the frenetic
movement of ministerial fire may ensue. If this fire flames upward and burns the throat, fluids there
will be damaged and thus a dry throat may occur.
* wasting & thirsting disorder
If for any reason, yin becomes vacuous, yang may become
hyperactive, giving rise to internal heat. Heat is a yang evil which may consume and damage yin. If
internal heat continuously consumes already vacuous fluids, yin fluids will become even more
vacuous. Therefore, doubly damaged yin fluids will be even less able to control yang and hence
give rise to even more effulgent yin vacuity fire. This then forms a pathological loop or cycle -heat damages yin giving rise to more heat which damages yin even more. Blood and fluids share
the same source, and both are responsible for nourishing and moistening the flesh. If the above
pathological chain reaction continues to deteriorate, yin fluids will become exhausted, and the flesh
will not receive sufficient nourishment and moistening, thus emaciation may occur.
EPIDEMIC QI & FIRE TOXINS
Epidemic disease - transmissible disease affecting many in a community
Pestilential Qi - any disease that is highly contagious... formerly believed to be the result of
abnormal weather conditions.
Fire Toxin - Evil Qi due to Fire that causes painful reddening and swelling, suppuration, or weeping
discharge

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Internal Damage by 7 Affects

Anger causes Qi to rise (is Qi rising) & damages the Liver
Liver qi thrives by orderly reaching and is averse to repression. Excessive emotional stimulus
violates the doctrine of the mean and damages the liver causing it to fail to perform it's duty of
coursing and discharge.
Signs & Symptoms Those of liver depression qi stagnation gan yu qi zhi
Treatment Principles Course the liver rectify the qi & RELAX!!!
Fear causes Qi to precipitate & damages the kidney (xia)
Kidneys govern securing and astringing the two lower yin. Fear causes precipitation of qi and
damages kidney qi.
Signs & Symptoms Those of Kidney qi vacuity shen qi xu
Treatment Principles Supplement & Boost Kidney Qi
Fright causes derangement of Qi & damages the Heart & Kidneys (luan)
Fright upsets the qi dynamic and throws qi & blood into disorder causing disquietude of the heart
spirit and even mental derangement
Signs & Symptoms & Treatment Principles depends on the damage
Joy causes qi to slacken and damages the heart (huan)
Excessive joy leads to a dissipation of the essence-spirit
Signs & Symptoms Those of heart qi vacuity xin qi xu
Treatment Principles Supplement & Boost heart Qi
Sorrow disperses qi and damages the lung (xiao)
Excessive sorrow and grief cause depression in the upper burner that transforms into heat, which
disperses and wears the lung qi
Signs & Symptoms crying, heat vexation and agitation, insufficient spirit qi
Treatment Principles clear depressive heat in the lungs
Thought & worry bind the qi and damage the spleen & lungs (jie)
Excessive thought causes binding depression of spleen qi, affecting movement and transformation
In TCM, excesses of the 7 affects is seen to cause disturbances of the qi and depletion of the true
yin of the viscera & bowels (ZangFu) causing heat signs... "the 5 minds transform fire" wu zhi hua
huo
206

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DIET
Former Heaven Essence -- finite amount received from parents determines the length and quality of life
Latter Heaven Essence -- manufactured from the food and drink ingested and bolsters the Former Heaven
At night, when we sleep, the excess qi and blood that was not consumed during the day is
converted to latter heaven essence and stored in the kidneys. This is why proper diet and good
digestion as well as proper rest and sleep are so important!!!
Digestion -- The stomach is like a cooking pot where the food "rottens and ripens" The spleen is
the fire beneath the pot and the "distillation mechanism" to which the pot is attached.
The clear (qing)& the turbid (zhuo) The spleen "distills" the purest part of food and drink and sends
this upwards. The pure of foods goes to the lungs and the pure part of the liquids goes to the heart.
The stomach descends the turbid part of the food to the large intestine for further absorption and the
turbid part of the liquids to the small intestine for further separation of the clear and the turbid.
The stomach is averse to dryness -- the stomach wants to create a soup in the pot
The spleen is averse to dampness -- too much water or dampness can douse the fire

Cooked vs Raw Cooking is predigestion and makes food more digestible. Most people, most of
the time, should eat cooked food. This begins the "rottening and ripening"
Cold food & drinks -- All transformation in the body is warm transformation as the host qi of the
body is warm. Thus, to "cook" the mash in the stomach, the spleen must expend more Qi to warm
the cold food to the proper temperature. This weakens the spleen/stomach which then fail to
adequately move and transform foods and liquids and a type of sludge accumulates. This sludge is
stagnated food and dampness.
Damp & Phlegm -- Too large portions, too much cold food and drinks or too much difficult to digest foods cause
the spleen/stomach to weaken and lead to accumulation of stagnant food in the stomach.
The stomach heats up in an attempt to burn off the accumulation and may become chronically hot. This heat in
the stomach is sensed as hunger.
The stagnant food tends to obstruct the qi ji of the spleen, further weakening the spleen which may fail in it's duty to
move and transform body fluids. These body fluids may accumulate to form evil dampness and when combined with
heat (perhaps from the stomach) may then congeal to form evil phlegm.

Qi & Wei All foods (all things) are a combination of qi and wei. Qi is the light, airy, aromatic and
yang part of a thing. Wei literally means taste and refers to the heavier, more substantial, more
nourishing, yin aspect
Dairy products, meats, nuts, eggs, oils and fats are rich is Wei and thus can nourish the yin aspect of
the body. In excess, they damage the spleen and lead to the accumulation of evil dampness and
phlegm.
Flavors & Spices -- We think of all things as a combination of 5 flavors: sweet, acrid, salty, bitter,
sour...sometimes we acknowledge a 6th flavor = bland
Small amount of sweet is good and supplements Qi (nobody does this either)
Most spices are acrid and warm or hot. In moderation, they aid digestion by strengthening the
middle burner fire
Good ones = cardamom, cinnamon, ginger, nutmeg, mace, cloves
Spices are rich in Qi and less wei
Moderate use is good for the spleen....overuse heats up and dries the stomach (doesn't like it)
Sum it up -- Humans are omnivoires and should consume a wide variety of foods. Eat mostly
vegetables and grains and small amounts of everything else
Dietary Therapy -1)Treat based on the PATTERN!!!!!
2) Protect and promote the Spleen & Stomach
3) Avoid prohibited foods
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Damage by the 5 Taxations

Prolonged vision damages the blood
Prolonged lying damages the Qi
Prolonged sitting damages the Flesh
Prolonged standing damages the bones
Prolonged walking damages the sinews
Damage by the 5 Flavors
Too much sour causes the liver qi fullness with consequent spleen qi xu
Too much salt taxes the qi of the large bones and wither the flesh in addition to repressing the heart
qi
Too much sweet causes the heart qi to be full and stuffy, the facial color blackish, and the kidney qi
not balanced
Too much bitter causes the spleen qi to lose its moisture and the stomach qi to become too broad
(distended)
Too much acrid causes the sinews to be slack and the vessels stopped up while the essence spirit
suffers disaster.
7 Damages
Great overeating damages the spleen
Great anger and qi counterflow damages the liver
Exertion or lifting heavy weights and long sitting on wet ground damages the kidney
Cold in the body and cold drinks damage the lung
Anxiety, worry, and thought and cognition damage the heart
Wind, rain, cold and summerheat damage the body
Great fear damages the mind

Loss of harmony of qi & blood: the main cause of disease

Qi & Blood disharmony of the heart = palpitations and shortness of breath aggravated by
movement. The heart spirit will not be quiet and there will be insomnia, poor memory, and
excessive dreams
Qi & Blood disharmony of the lungs = cough and panting with copious phlegm worse with
movement as well as spontaneous sweat
Qi & Blood disharmony in the spleen = sallow yellow complexion, weakness and fatigue of the 4
limbs, abdominal distention after eating, loose stools, poss. uterine bleeding or bloody stools
Qi & Blood disharmony of the liver = emotional depression, timidity, dry eyes or diminished
vision, numbness in the extremities, lusterless nails, and spasms of the sinews and vessels
Qi & Blood disharmony of the kidney = low back soreness, weak knees, tinnitus, deafness, poor
memory
Loss of harmony of the qi and blood manifests pathologically as disease within the human body
and loss of regulation of viscera and bowels. These both have a close relationship with the
production of various pathological metabolic products, such as blood stasis and phlegm turbidity
By coursing, freeing the flow, regulating, and harmonizing the qi and blood, one can regulate the
functions of the viscera and bowls and the body's tissues, disperse and eliminate static blood,
phlegm turbidity and other such evils and convert a pathological situation into normal
Qi & Blood vacuity weakness
Qi vacuity is a diminishment of the function of the ZangFu and a lowering of the resistance to
disease. The production and spread of qi are closely related to the lungs, spleen and kidneys

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Blood vacuity means an insufficiency of constructing and nourishing blood in the body.
Pathological changes in the blood are most prominent in the liver, spleen and kidneys
Qi & Blood vacuity weakness refers to the pathological condition of blood vacuity caused by qi
vacuity...the vacuous qi is unable to engender blood
Qi vacuity & Blood stasis
Qi vacuity results in the movement of the blood being inhibited. Qi vacuity is the root and blood
stasis is merely a branch symptom, this is repletion in the midst of vacuity.
After taxation and fatigue, the symptoms of blood stasis become worse. The over-taxation
aggravates the qi vacuity, making it more difficult to propel the blood
Qi stagnation & blood stasis
There is not only qi stagnation leading to blood stasis...but also blood stasis leading to qi
stagnation. Commonly observed to do with loss of the liver's coursing and discharge. Liver
depression leads to qi stagnation. If qi stagnation endures, it will lead to the formation of blood
stasis
Qi counterflow & Blood counterflow
There is confusion and chaos of the qi mechanism. The qi mechanism counterflows and does not
flow normally which results in pathological symptoms of reckless movement of the blood. This
mostly manifests as diseases of the cerebral blood vessels
Qi not containing the Blood
Vacuous qi in not able to contain and restrain the blood which exits causing various types of
hemorrhagic conditions. This in mostly due to enduring illness damaging spleen qi.
Joining and binding of phlegm & stasis
This is qi stagnation and phlegm obstruction resulting in the blood's not moving uninhibitedly. If
blood stasis stagnates internally, it may cause stoppage of the fluids and humors and this may also
cause the pathological pattern of phlegm and stasis mutually binding together
Phlegm is a yin turbid evil and will cause stagnation in the coming and going of the qi. This will
gather and the blood will congeal and even more phlegm will be produced.
Static blood obstructing internally may also affect the functioning of the viscera and bowels leading
to their loss of command of the spread of fluids and humors with the subsequent engenderment of
phlegm turbidity

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