Course: Diagnostics II Date: Dec 8, 2007

Combination Symptoms

Combination Syndrome Symptom Caused by

Qi Deficiency of Heart and Lung Palpitation Indicative of heart problem
Cough with difficult inhalation, worse Cough = lung, exert = Qi xu
on exertion
Chest tightness Phlegm ret, Qi congestion,
Clear phlegm Dampness MJ, no heat
Upper Jiao problem Pallor of face Qi/Yang/Blood Xu or Cold
Dizziness Can be excess, or Blood Deficiency
Lassitude Qi Xu
Spontaneous sweating Qi and Yang Xu
Tongue: pale with thin white coat
Pulse: deep, weak or irregular Deep = interior, weak = deficiency
Deficiency of Heart and Spleen Palpitations Heart
Poor memory Blood deficiency
Specific pattern in TCM!!! Insomnia, DDS (dream disturbed Heart Qi Xu
This is spleen qi xu + Heart Blood Xu. sleep) Heart of Liver Blood Xu (cant stay asleep, esp elder
patients)
Chief complaint often insomnia. Dizziness and vertigo Can be excess, or Blood Deficiency
Sallow complexion Dampness plus Spleen Qi Xu
Reduced appetite Spleen
Abdominal distention Spleen
Loose stool, diarrhea Spleen Qi Xu
Lassitude Qi Xu
Middle Jiao problem Bruising Spleen Xu, Heat, Trauma
Scanty and light menses Blood Xu (thinner and lighter in color)
Yin Xu (redder)
If heavy can be blood heat or spleen qi xu
Tongue: Pale with white coat
Gui Pi Tang is the formula of choice Pulse: Thin and weak

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Blood Xu in both Heart and Liver
Very specific manifestationÆ
Yang Xu of Heart and Kidney
Tricky pattern. Do not confuse with
Heart/Kid Disharmony (a yin xu)!
Look for cold signs, swollen face,
chest tightness w/coldness there.
Many chronic ht failure pts have this
Always want covers on chest
Palpitations Heart
Poor memory Blood Xu
Insomnia, DDS Heart Qi Xu
Heart of Liver Blood Xu (cant stay asleep, esp elder pts)
Dizziness and vertigo Can be excess, or Blood Deficiency
Pale face Qi/Yang/Blood Xu, Cold
Dry eyes Liver Yin Xu
Blurred vision Liver Yin Xu advanced to Liver Blood Xu
Numb limbs Blood Xu – anemia/malnutr cn b due toblood or qi xu
,Tremors Liver wind
“Different kinds of wind and vertigo belong to liver.”
“Blood deficiency generates wind.”
Another symptom of wind: itching, rashes
Treatment: tonify the blood.
Little menses Blood Xu
Yin Xu (+nite sweat, 5palm heat, thirst, dk red tongue, little coat)
Tongue: pale with white coat
Pulse: thin and weak
Palpitations Heart
Pale face Qi/Blood/Yang Xu, Cold
Aversion to cold, cold limbs Yang Xu, extreme anger causing Qi congestion
Sleepy Heart Qi Xu usually or Spleen Qi xu after meals
Edema in face/limbs, esp lwr legs Lower limbs = Kidney yang related
All 4 limbs = Spleen related
Edema that doesn’t stay depressed = Qi edema
Cold, soreness/weakness of lumbar Kidney Yang deficiency
and knee joints
Pale lips and nails Blood, Qi or Yang Xu
Early morning Diarrhea Kidney Yang Xu
Tongue: pale with slippery coat Yang and/or Qi xu with water retention
Pulse: deep, feeble, slow Deep = interior/longterm, Feeble = def, Slow = cold
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Disharmony of Heart and Kidney Palpitations Heart
Insomnia Blood deficiency
Yin Xu of heart and kidney, but w/ Restlessness, irritability Heart fire/liver fire
special name in TCM Poor memory Heart yin/blood Xu
Dizziness and vertigo Yin def in L. Jiao so yang goes upward
Rel between Ht and Kd = fire and Tinnitus Kidney yin deficiency
water. One controls the other. When Dry throat Kidney channel – which goes to bk of throat
out of balance gets even more out of Tidal fever Yin Xu
whack. Night sweating Yin Xu
Soreness of lumbar and waist Kidney
Spermatorrhea in dreams Kidney Xu
Tongue: red with little coating Deficient heat
Pulse: thin and rapid Deficiency + heat
Qi Deficiency of Lung and Spleen Chronic, constant cough with profuse, Cough = Lung, phlegm = Spleen
clear phlegm Chronic = deficient, clear = no heat
Shortness of breath Lung Xu
Poor appetite Spleen
Abdominal distention Spleen
Loose stools, diarrhea Spleen Qi Xu
Liver Fire Insulting Lung Burning pain or distention in Indicates Liver
costal/hypochondriac region
Quick temper, irritability Liver + heat
Restlessness Liver fire longterm affects Heart/shen (Mother/son rel)
Dizziness Wind due to the heat
Red eyes Liver fire. If sclera is red liver fire is insulting the lung
Bitter taste in mouth Liver, stomach, or GB fire
Violent, intermittent cough Violent = excess condition
Little sticky yellow phlegm, All indicates heat
spitting blood
Hot sensation in chest
Tongue: red w/thin yellow coat Heat
Pulse: wiry, rapid Wiry = liver, rapid = heat

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Yin Xu of Lung and Kidney
Yin Xu of Liver and Kidney
*Don’t let the heart looking symptoms
throw you off…is blood/shen relation.
Difference between this & Heart and
Kidney Disharmony:
-no palpitations
-presence of dry eyes, hypochon pain
Cough + little or bloody sputum Cough = lung, little = deficient, bloody = def heat
Dry mouth, sore/dry throat Dry = yin or body fluid xu, sore throat = lu/kd meridian
Hoarseness Lung yin Xu
Losing weight, emaciation Yin Xu
Soreness/weakness of lumbar and Kidney Xu
knee joints
Tidal fever, malar flush Yin Xu
Night sweats Yin Xu
Nocturnal emissions Kidney Yin Xu
Less menses Yin Xu
Possibly, tinnitus w/high pitch Kidney Yin Xu
Tongue: red with little coating Red = heat, little coating = deficiency
Pulse: thin and rapid Thin = deficiency, rapid = heat
Dizziness and vertigo Wind – blood xu, yin xu, or heat excess
Tinnitus Kidney deficiency
Dull hypochondriac pain Dull = deficiency, hypochondriac area = liver
Poor memory If short term memory: Heart Bld xu
If long term memory: Kidney xu
*Insomnia, DDS Liver Blood Xu or Heart Blood Xu
Dry throat, eye, mouth Liver
Loosing weight, emaciation Yin xu
Soreness/weakness of lumbar or knee Kidney
joints
Malar flush, night sweats, 5 palm heat, Yin Xu
etc.
Nocturnal emissions Kidney yin xu
Scanty menses flow Yin xu of kidney and perhaps liver
Tongue: red with little coat Red = heat, little coating = deficient
Pulse: Thin, rapid Thin = deficiency, rapid = heat

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Yang Xu of Spleen and Kidney
Group the following 2 together
Disharmony of Liver/Spleen
Liver overacting on spleen
Disharmony btwn Liver/Stomach
Can be 1) liver qi stag Æ fire and
affecting st or 2) retained cold
affecting liver and stomach
Pallor of face
Poor appetite
Aversion to cold, cold limbs
Cold, soreness and weakness of
lumbar and knee joints
Loose stools or diarrhea at dawn
Chronic diarrhea
Incontinence of urine
Facial puffiness or edema of limbs
Tongue: pale, swollen, slippery white
coat
Pulse: deep, feeble, slow
Distention/fullness, pain in costal
and/or hypochrondriac area
Sighing
Poor appetite
Abdominal distention
Depression, irritability
Loose stools/constipation
Tongue: white or greasy coating
Pulse: wiry
Distention/fullness, pain in costal
and/or hypochondriac area
Belching, hiccupping, acid reflux
Should also have constipation
Irritability
Tongue: red body, thin yellow coating
Pulse: wiry and rapid
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Yang/Qi/Blood /Xu, cold
Spleen Qi Xu
Cold limbs = Spleen Yang Xu
Kidney and Kidney Yang Xu
Dawn = Kidney Yang Xu
Chronic = interior/long term
Kidney Qi or Yang Xu
Edema of limbs = Spleen
Edema above waist = yang edema. Lung, Spleen
Edema below waist = yin edema. Spleen, Kidney
Spleen Qi Xu Æ Spleen Yang Xu Æ Sp/Kid Yang Xu
Deep = interior, feeble = defic, slow = cold
Liver
Liver Qi Stagnation
Spleen Qi Xu
Spleen Qi Xu
Liver fire
Spleen Qi Xu
Liver
Stomach Qi cannot go down, rebelling upwards
heat
Wiry = liver, rapid = heat