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Zang Fu I

Week 6
Zang Fu Pattern Identification- What is it?

Allow us to generalize s/sx of disease according to

physiological function and pathological characteristics of the
Zang-Fu organs. In this way we can:
• infer the etiology of the pathology,
• determine the location and judge the nature of the
pathological changes,
• and determine the state of the vital qi in relation to the
pathological evils/factors
Zang Fu Pattern ID
Relationship with other Identification methods:
Pattern ID:
• Location- ZF Pattern ID
• Property- QI, Blood, body fluid Pattern ID
• Nature- 8 Principle Pattern ID
• Pathogen- Etiology Pattern ID
• We must know the Property, Nature, and Pathogen to
compile our ZF Pattern ID
Zang Fu Pattern ID
When identifying a pattern, we must consider the following:

• Nature, character, and pathological changes of the ZF and its

related meridian
• The relationship with other organs and tissues
• The relationship with other ZF organs

Pattern Identification Process

Heart and Small Intestine

Heart- Xin the Emperor

Heart: Physiological Function

• Govern blood and control blood vessels

• Houses spirit
• Belongs to Fire element,
• Related to Summer, Red Color, Bitter taste, Emotion Joy
Heart- Xin the Emperor

• Opens orifice of Tongue, Manifests on Face,

• Internal-External connection Small intestine
• Spirit- Shen,
• Sweat is the fluid of the heart- blood and body fluids have a
common origin
• Heart- Shao Yin channel – Hand Lesser Yin
Heart- Xin the Emperor

Heart patterns are usually due to

• emotions
• diet (example hot spicy food agitates, or cold damp food
makes phlegm)
• taxation
(* PC patterns are generally due to external evils moving
inwards towards the heart)
Heart Deficiency Patterns:

• Qi Xu
• Xue Xu
• Yin Xu
• Yang Xu
Heart Blood Deficiency/Vacuity

• Key s/sx: palpitations (often at night) , insomnia, dream-

disturbed sleep, forgetfulness
• Other s/sx: anxiety, easily startled, vexation, dizzy head/eyes,
pale lusterless face, pale lips and nails
• T: Thin pale body, white TC
• P: Fine, weak, or rough
Heart Blood Deficiency/Vacuity

• Mechanisms: Due to diet, emotional taxation, blood loss,

liver blood vacuity
• Can lead to heart yin vacuity
• Blood nourishes spirit and anchors spirit
• Blood is the mother of qi; xue xu leads to palpitations

• Treatment principle: Supplement heart blood, calm spirit

Heart Yin Vacuity/Deficiency

• Key s/sx: palpitations, vexation, insomnia, dream-disturbed

sleep, tidal fever or low fever, 5-heart heat, night sweats
• Other s/sx: anxiety, easily startled, forgetfulness, dry
lips/throat, bitter taste, yellow urine, bound stools. More
heat may develop, leading to more heat signs
• T: red body, dry, no TC or thin yellow TC
• P: fine, rapid
Heart Yin Vacuity/Deficiency
• Mechanisms: Due to emotional or physical taxation, heat
damaging yin, KD or LV yin xu
• Symptoms are of heart blood vacuity plus heat due to yin

• Treatment principle: Enrich yin, calm spirit. Clear heat if it is

Heart Blood Xu v Heart Yin Xu
Heart Blood Xu v Heart Yin Xu
• Both in common: palpitations, vexation, insomnia
• Pale face Red cheeks
• Little or no heat s/sx Heat s/sx
• Pale T Red, dry T
• Fine weak P Fine rapid P
• Combines with: SP qi xu, LV xue xu KD, LV, or LU yin xu
Heart Qi Deficiency

• Key s/sx: palpitations (light, occasional, more in daytime),

tired, difficulty falling asleep, pale face
• Other s/sx: Fatigued spirit, easily frightened, forgetful, SOB
upon exertion, dislikes speaking, spontaneous sweating, lack
of strength
• T: Pale body, white TC
• P: fine, weak
Heart Qi Deficiency
• Mechanisms: generally due to emotional taxation or blood
loss. Can lead to heart yang xu. General qi xu symptoms plus
loss of heart function. Heart qi keeps the regular heart beat

• Treatment Principle: Supplement and boost heart qi

Heart Yang Vacuity

• Key s/sx: palpitations, bright pale face, cold limbs (esp hands),
• Other s/sx: easily frightened, difficulty falling asleep despite desire to sleep,
forgetfulness, dusky/dark lips, tired, SOB upon exertion, stuffiness in heart
region, dislikes speaking, spontaneous sweating, fatigued spirit, lack of
strength, fear of cold
• If severe (collapse of yang) copious dripping sweat, reverting cold of the 4
limbs, clouded spirit, weak shallow breathing, blue-purple lips, grey-pale
complexion, possible stupor, faint pulse almost expiring, bound or regularly
• Rescue yang, restore consciousness, stop sweating
• Phlegm may accumulate due to lack of yang, with phl in throat, cloudy
thinking, slippery p…
Heart Yang Vacuity
• T: pale moist body, white TC
• P: fine, weak, slow, deep
• Mechanism: generally due to emotional taxation, blood loss,
or KD yang xu
• It can lead to heart qi stagnation or blood stasis, Phlegm
accumulation, or yang collapse
• Symptoms are Heart qi xu plus cold and the beginnings of
• Treatment principle: Warm and supplement heart yang
Heart Qi Xu v Heart Yang Xu
• Heart Qi Xu v Heart Yang Xu
• In common: palpitations, easily frightened, difficult falling asleep,
forgetfulnessSOB, dislikes speaking, spontaneous sweat, fatigued
spirit, lack strength
• Disease: Gradual, moderate, mild Can be quick, critical, violent
• Face: pale bright pale
• Temp: normal or sl cold cold
Excess pattern
Heart Qi Stagnation:
(or Constrained Heart Qi or Heart Qi Depression)
• Key s/sx: palpitations, vexation, insomnia, unregulated joy
and anger, sorrow for no reason
• Dislikes light, chest oppression, frequent sighing, yawning
and stretching (attempt to move qi)
• Other s/sx: slight lump in throat, slight SOB, poor appetite,
dislikes lying down, weak cold limbs, slightly purple lips, pale
• T: pale or pale purple body
• P: deep weak or deep rough
Heart Qi Stagnation:
(or Constrained Heart Qi or Heart Qi Depression)
*HT qi stagnation/constraint is due to emotions, usually
involving the LV. Also called restless organ, visceral organ, or
hysteria. Zang zao.
*Historically, associated with xue xu in the uterus, drawing
parallels with the western disorder of hysteria in women,
which is how zang zao is sometimes translated
Heart Qi Stagnation:
(or Constrained Heart Qi or Heart Qi Depression)
• Mechanisms: due to emotions, LV qi constraint, heart qi xu.
Can lead to xue stasis
• Symptoms are due to non-movement of HT qi
• Long-term depression/constraint can injure qi, blood, or yin
• (Maciocia treats this as repletion) (Deng treats this as
vacuity/repletion mixed)
• Treatment principle: Nourish heart, calm spirit, boost qi,
release/open constraint (Deng)
• Move heart qi, open chest, calm spirit (Maciocia)
Deficiency-Excess Pattern
Heart Blood Stasis:
• Key s/sx: dull stagnant-looking complexion, blue-purple
lips/nails, palpitations
• Glomus blocking of heart, stifling oppression and stabbing or
pricking pain at Ren 17, possible radiating to back and
shoulder, rising to neck or descending to abdomen. Pain
• Other s/sx: SOB, cold hands. When severe pain, sweating and
reverting cold of limbs
Heart Blood Stasis:

• T: Dull red or purple body, stasis macules

• P: Fine rough and/or bound or regularly interrupted
(irregular). If serious: faint/expiring
• Mechanisms: Due to emotions, heart yang xu, heart qi
stagnation, or LV qi constraint
• Symptoms vary according to the root, but most are due to
non-movement of blood
• Treatment principle: Free yang, move blood, transform stasis
Excess Pattern
Heart Vessel Obstruction/Heart Vessel Irregularity
• Also called: Stasis Obstruction of HT Vessels (HT Bi)
• S/Sx: palpitations, SOB, chest oppression, stuffiness or pain
• Expectoration of phlegm, heavy feeling, spirit lassitude
desire to sleep, cannot lie down
• Restlessness, dislikes speaking, dizzy head and eyes, pale
face, cold hands, sighing
• T: pale or purple body
• P: skipping, bound, or regularly interrupted (all irregular
Heart Vessel Obstruction/
Heart Vessel Irregularity
• Mechanisms: complex pattern of qi stagnation, blood stasis,
cold, phlegm (emotions/diet/taxation)

• Treatment Principle: Move heart qi and blood, eliminate

stasis, open chest, resolve phlegm, expel cold, calm spirit
(Deng considers this to have underlying yin and yang xu)

Constrained HT QI/Heart Qi Stagnation-emotional s/sx; qi

Heart Blood Stasis- physical symptoms esp pain, purple color
Heart Vessel Obstruction/Stasis Obstruction- phlegm, heavy,
cold (vacuous)

All: Palpitations, SOB, cold hands, limbs, chest oppression

Heart Fire Blazing/ Flaring Upward

• Key s/sx: mouth or tongue sores, erosion and scorching,

thirst, pain on tip of tongue, palpitations, insomnia, dream
disturbed sleep
• Other s/sx: red face and lips, feels hot, vexation, thirst
• T: red body yellow TC
• P: rapid
Heart Fire Blazing/ Flaring Upward
• Mechanisms: due to emotional excess, diet, LV fire
• Can lead to HT yin xu
• This is repletion heat in the heart, fire flaring upward
• Heat agitates and damages fluids
• Tongue is the sprout of the heart

• Treatment principle: Clear the heart, drain fire, calm spirit

Phlegm Misting the Mind
(Phlegm Confounding the HT Orifice)
• Key s/sx: Feeble-minded spirit-affect, stupor, somnolence,
dull eyes, incoherent speech, gurgling phl in throat
• Other s/sx: aphasia (impairment of language), muttering to
self or catatonia, vomiting phlegm-drool
• T: pale body white slimy TC
• Pulse: slippery
Phlegm Misting the Mind
(Phlegm Confounding the HT Orifice)
• Mechanisms: Due to constitution, diet, SP xu leading to
• Phlegm causes confusion.
• Can be in children (retarded mental activity), after
windstroke, or mental illness

• Treatment principle: Dispel Phlegm, open orifices

Phlegm Misting Mind v Phlegm-Fire Harassing HT
• Phlegm Misting Mind v Phlegm-Fire Harassing HT
• In common: phlegm, clouded orifices, changed spirit
• Feeble-mind Agitated
• Slimy white TC Slimy yellow TC
• Slippery P Slippery rapid P
• Repletion or combined Repletion only
• Cold or Neutral Hot
Small Intestine Patterns


Controls receiving and transforming

• receiving chime from stomach
• transforms so body can re-absorb food-essence

Separates Fluids: clear from turbid

• clear fluids sent to SP
• turbid liquids to UB; turbid solids to LI
Small Intestine
Fire element; paired with HT
Hand Greater Yang (Tai Yang Channel)
Small Intestine Patterns
Full/Repletion Patterns:
-Full Heat in Small Intestine
-Small Intestine Qi Pain
-Small Intestine Qi Tied
-Infestation of Worms in the SI

Deficiency/Empty Patterns:
-Small Intestine Deficient Cold
Full (Repletion) Heat in SI

Heat of Heart -> to Small Intestine

• Key s/sx: Tongue and mouth sores, abdominal pain, short red rough
painful urination
• Other s/sx: red face and lips, vexation, insomnia, thirst
• T: Red body yellow TC
• P: Bowstring (wiry) rapid
Full (Repletion) Heat in SI

• Mechanisms: Due to diet, emotions, Heart fire

• Can also lead to HT fire
• Heat agitates, damages fluids, causes blood to move
• Small intestine sends the clear to the UB

• Treatment Principle: Clear heat (drain HT and SI Fire), abduct

the redness (reddish urine)
Small Intestine Qi Pain

• Key s/sx: Mounting Qi (shan qi) distention and twisting pain, binding
stagnation of the lower abdomen, sometimes severe, worse with cold
and pressure, better with heat
• T: white glossy TC
• P: deep bowstring (wiry) slow
Small Intestine Qi Pain

Mechanisms: Due to diet, emotions, LV qi constraint

• Non-movement causes pain
• Cold contracts, causing pain
*Shan qi- no translation in English
• Hernia-like protrusion of organ or tissue
• Diseases of the external genitals with swelling and pain
• Severe abdominal pain with problems in urine and stool
Treatment Principle: Move qi, stop pain, soften hardness,
disperse the binds
Small Intestine Qi-Tied
• S/sx: severe abd pain, aversion to pressure, abdominal distension,
vomiting, borborygmus, passing gas, constipation
• T: thick white TC
• P: Deep, Wiry
• Mechanism: SI qi obstruction leads to acute and severe stagnation,
leading to pain and constipation. Stomach qi cannot descend leading
to vomiting
• Resembles an acute appendicitis, but can occur without appendicitis
• Differs from previous pattern (qi pain) in that Qi-Tie is always ACUTE
• Treatment principle: remove obstruction from LJ, move SI qi
Infestation of Worms in Small Intestine
Key s/sx: Abd pain/distension, bad taste in mouth, sallow complexion
-Roundworms: abd pain, vomiting of roundworms, cold limbs
-Hookworms: desire to eat abnormal objects ie dirt, wax, uncooked
rice, tea leaves, clay, paper, chalk. Creates iron deficiency anemia
-Pinworms: itchy anus, worse in evening
-Tapeworms: constant hunger
Mechanism: cold condition of SP and INTS allows worms to thrive (cold
raw foods). Easily leads to SP Qi xu
Treatment: Expel Parasites/
Small Intestine Deficient and Cold
• S/sx: dull abd pain better with pressure, desire for warm drinks,
diarrhea, borborygmus, pale copious urine, cold limbs
• T: pale body white TC
• P: deep weak slow
• Mechanisms: excessive consumption of cold raw food creates SP yang
xu. Key s/sx differentiating Sp yang xu from SI xu cold is Borborygmus.
Cold obstructs SI causing pain. Empty-cold in SI inhibits SI from
separating clear from turbid
• Treatment Principle: expel cold, warm INTS, tonify SP yang
Homework/ Reading

Section 32 Heart
• p 489-513 plus assessment outcomes and questions p 513
Section 39 Small Intestine
• p 677-685 plus assessment outcomes and questions p 685