Syndrome

differentiation of
Zang-Fu organs
Pathologic changes of
the heart
a. Insufficiency of cardiac Qi

 The symptoms commonly seen in deficiency of

cardiac Qi are characterized by general
hypofunction of the heart
2. Pallor, shortness of breath, disinclination to talk,
spontaneous sweating,lassitude, weakness, pale
tongue, white tongue coat, and thready and weak
pulse.
3. Deficiency of cardiac Qi affects the function of the
heart in housing the mind and then causes
palpitation, anxiety, insomnia, and amnesia.
 Treatment: reinforce the cardiac Qi
 b. Insufficiency of cardiac
blood
 The main points for differentiation are the common
symptoms of heart and the symptoms of blood deficiency.
2. Deficiency of the heart blood causes failure in nourishing the
mind, causing palpitation or anxiety.
3. Disturbance of the mind due to deficiency of blood give rise
to irascibility, insomnia and dreaming.
4. If the brain marrow is malnourished, amnesia, dizziness,
and blurring of vision may occur.
5. The pale and lusterless complexion, and pale tongue and
lips are due to deficiency of blood which causes failure in
nourishing the part s of the body.
6. The weak and thready pulse results from insufficiency blood
in the vessels.
 Treatment: replenish the cardiac blood, tranquilize the mind
 c. Excess of cardiac fire
 The main points for differentiation are the symptoms which
show excess fire in the heart, tongue, pulse, and other
related tissues.
2. The heart houses the mind, once the mind is disturbed by
fire, mental uneasiness, insomnia take place.
3. Thirst, flushed face, dark color urine, and rapid pulse are
all signs of internal heat.
4. The heart open into the tongue, if the heart fire is
hyperactivity and flare up, red tongue and oral ulcer may
result.
5. The heart control the blood vessels, in cases where fire is
excessive, there will be blood extravasation.
 Treatment: dissipate cardiac fire
d. Phlegm confuses the mind
 Mental disorder due to pathologic changes
in which “phlegm” as pathologic product
mingles and disturbs the mind.
2. Depressive mental disorder
3. Epilepsy
 The main points for differentiation are loss of
consciousness, rattle in the throat, and white
and sticky tongue coat.
 Signs of heat and deficiency should be excluded
from consideration.
 Treatment: resolve phlegm for resuscitation
e. Phlegm and fire disturb the
mind
 The main points for differentiation are the
symptoms such as high fever, excessive
phlegm, and loss of consciousness.
 Main manifestations: raving, delirium,
abusing or hitting people, flushed face, pink
eyes, thirst, coarse breath, sleeplessness,
red tongue with yellow thick coat.
 Treatment: clear away the cardiac fire,
resolve phlegm, open the cardiac portal
Pathologic changes of
the lung
 a. Deficiency of the pulmonary
Qi
 The main points for differentiating deficiency of pulmonary
Qi are feeble cough, short breath, and general
hypofunction.
2. Deficiency of Qi leads to cough wearily, shortness of
breath, hush and feebleness.
3. Deficiency of pulmonary Qi fails to disperse the defensive
Qi to the muscle and skin, spontaneous sweat occurs.
4. Since the defending function is hypoactive, the body is
likely to attacked by exogenous pathogenic factors, and
thus is susceptible to cold.
5. Pale tongue with white coat, weak pulse are signs of Qi
deficiency.
 Treatment: reinforce the pulmonary Qi
 b. Deficiency of lung Yin
 The main points for differentiating deficiency of lung Yin
are the common symptoms of lung diseases and
symptoms of deficiency of Yin lead to internal heat.
2. dry cough with little or no sputum,
3. Afternoon fever is due to deficiency heat
4. Night sweat results from disturbance of nutrient Yin by
heat
5. Malar flush is caused by flaring-up of deficiency heat
6. In severe case, once the blood vessels of the lung are
damaged, cough with bloody sputum occurs.
7. Red tongue less moist, thready rapid pulse are of
deficiency of Yin lead to internal heat.
 Treatment: enrich Yin, moisten lung
c. Pathogenic wind-cold attack
the lung
 The main points for differentiating pathogenic wind-cold attack the
lung are cough accompanied by the exterior symptoms of wind-
cold.
2. The invasion of body surface by wind-cold impairs the lung’s
function in dispersing and descending, thus producing cough.
3. Since cold pertains to Yin, the sputum is dilute and white.
4. The dysfunction of lung in dispersing gives rise to nasal
obstruction or runny nose.
5. The obstruction of defensive Qi leads to aversion to cold.
6. Because pathogenic factors have not been transmitted into interior,
the tongue coat remain unchanged.
7. Superficial pulse indicates exterior syndrome and tense pulse
implies cold syndrome.
 Treatment: expel pathogenic wind-cold, promote dispersion
function of lung.
 d. Pathogenic wind-heat invades
the lung
 The main points for differentiating pathogenic wind-heat attack the
lung are cough accompanied by the exterior symptoms of wind-heat.
2. The invasion of body surface by wind-heat impairs the lung’s function
in dispersing and descending, thus producing cough.
3. Since heat pertains to Yin, the sputum is yellow and and thick.
4. The dysfunction of lung in dispersing gives rise to nasal obstruction
and thick and yellow nasal discharge.
5. The obstruction of defensive Qi leads to aversion to cold.
6. A thin and yellow tongue coat is a sign of the presence of heat.
7. Superficial pulse indicates exterior syndrome and rapid pulse implies
heat syndrome.
 Treatment: clear away the heat, dissolve phlegm, relieve cough,
sooth asthmatic breathing.
Pathologic changes of
the spleen
a. Deficiency of spleen Qi
 The main points for differentiating deficiency of spleen
Qi are hypofunction of digestion and transportation and
the symptoms of Qi deficiency.
2. Loss of appetite, diarrhea, abdominal distention more
remarkable after having meal, lassitude, sallow
complexion,
3. due to the descent of Qi in the middle Jiao, frequent
urination, chronic diarrhea, prolapse of the rectum and
of the uterus in woman, gastroptosis, dizziness;
4. if the spleen fails to control blood, the following
symptoms are often seen: hematuria, hemafecia,
metrorrhagia, subcutaneous bleeding.
 Treatment: replenish spleen, reinforce Qi.
Pathologic changes of
the liver
 a. Depression of hepatic Qi
 The main points for differentiating depression of hepatic Qi
are mental depression, distension and pain along the course
of the liver meridian, and abnormal menstruation in females.
2. Stagnation of liver Qi leads to retardation of Qi circulation,
thus causing distending or wandering pain in the chest and
hypochondrium, in the breasts, or in the lower abdomen.
3. Stagnation of Qi impairs the function of the liver in promoting
the free flow of Qi and blood, thus mental depression appear.
4. Stagnation of Qi produces phlegm, which goes upward with
the adverse Qi along the meridian, and then combines in the
throat, hence goiter globus hystericus.
 Treatment: disperse the depressed hepatic Qi and sooth the
liver.
 b. Upward-flaming of hepatic
fire
 The main points for differentiating upward-flaming of
hepatic fire are symptoms caused by excess fire in the
head, eyes, ears, and hypochondriac region, through
which the liver meridians travels.
2. The liver fire attacks the head along the meridian,
headache, vertigo, flushed face, pink eyes will happen.
3. When the liver fire attacks the ear along the meridian,
tinnitus like the sound of waves may occur.
4. The consumption of fluid by excessive heat results in
constipation, red dark urine.
5. Red tongue with yellow coat, wiry pulse are signs of
excess fire in the liver meridian.
 Treatment: clear away the hepatic fire, sooth the liver.
c. Deficiency of liver blood
 The main points for differentiating Deficiency of liver
blood are the undernourishment of the tendons, nails,
eyes, muscles, and skin by blood, and symptoms
caused by general deficiency of blood.
2. Deficiency of liver blood causes failure in nourishing the
head and face and brings about dizziness and vertigo,
as well as pale and lusterless complexion.
3. And dryness of eyes, night blindness, spasm of
tendons, numbness of limbs, failing of vision, in woman,
irregular menstruation with scanty light discharge, pale
tongue, thready pulse.
 Treatment: nourish the liver blood.
Deficiency of liver Yin
 The main points for differentiating Deficiency of
liver Yin are the symptoms of liver diseases and
the symptoms caused by deficiency of Yin.
1. Deficiency of liver Yin causes failure in nourishing
the head and eyes and brings about dizziness,
tinnitus, and dryness of the eyes.
2. The flaring-up of deficiency-fire results in a
sensation of heat on the face, flushed face.
3. Dull pain in hypochondriac region,
4. Steaming of deficiency-heat in the interior leads to
feverish sensation in palms, soles, and chest,
afternoon fever
5. The disturbance of nutrient Yin by deficiency-fire
creates night sweat
6. Deficiency of Yin fluid leads to failure in nourishing
the upper part of the body, thus dryness in the
mouth and throat
7. Red tongue less moist and wiry rapid pulse imply
Yin deficiency.
 Treatment: nourish liver Yin.
Rise of excessive liver Yang
 The main points for differentiating Rise of
excessive liver Yang are the symptoms of
hyperactivity of liver Yang in the upper part of
the body.
 Main manifestation:
1. The upward rushing of Qi and blood results in dizziness,
tinnitus, extending pain in the head and eyes, flushed face,
pink eyes.
2. The loss of the liver’s softness leads to irritability and
inclination to become angry.
3. Undernourishment of the heart due to deficiency of Yin
disturbs the mind, thus palpitations, amnesia, excessive
dreaming, insomnia occur.
4. The lumbar region is the place where the kidneys are
located, and the knees are regarded as the residence of
the tendons. Deficiency of Yin of the liver and kidney
deprives the tendons of nourishment, hence soreness and
weakness of the lumbar region and knees joints.
5. Red tongue, wiry forceful pulse and wiry thready and rapid
pulse.
 Treatment: nourish Yin, sooth the liver, check Yang.
Pathologic changes of
the kidney
Deficiency of kidney Yin
 The main points for differentiating Deficiency of
kidney Yin are the symptoms of kidney
diseases and internal heat due to Yin deficiency.
 Deficiency of kidney Yin leads to deficiency-
heat, therefore, dizziness, tinnitus, emission,
dry mouth, sore throat, amnesia, insomnia,
constipation, in woman, scanty menstruation,
amenorrhea, red tongue with little or no coat,
rapid but thready and weak pulse appear.
 Treatment: nourish kidney Yin
Deficiency of kidney Yang
 The main points for differentiating Deficiency of kidney
Yang are the general hypofunction associated with
cold.
2. The lumbar region is the place where the kidneys are
located, and the kidney dominates the bones, kidney
Yang, when deficient, may fail to warm up the lumbar
region and bones, thus soreness and weakness of the
lumbar region and knees joints result.
3. If the kidney fails to warm up the skin, aversion to cold,
cold limbs may occur.
4. Pale tongue and weak pulse are signs of deficiency of
kidney Yang and weakness of Qi and blood circulation.
 Treatment: mildly warm and invigorate kidney Yang
Three-Jiao
 Inthe whole process of the transportation
and transformation of water and food,
 the three-Jiao dominates Qi transformation
and Qi movement of the whole body.
 And the book also advanced a viewpoint that
"The three-Jiao exists in name only but is not
the entity".
 Its main functions are to pass various kinds of
Qi and to serve as the pathway for body fluid.
 It is divided into three parts:
 upper Jiao
 middle Jiao
 lower Jiao
Upper Jiao
 The upper Jiao refers usually to the part above the
diaphragm,
 including the heart, lungs and head as well.
 Its main physiological function is to distribute
essence-Qi throughout the body.
 In other words, in combination with the heart and the
lung, the upper jiao distributes essence-Qi to the
whole body to warm and nourish the skin and
muscles, tendons and bones.
Middle Jiao
 The middle Jiao refers mainly to the abdominal part
between the diaphragm and umbilicus,
 and includes such Zang-Fu organs as the spleen,
stomach, liver and gallbladder.
 Its main physiological functions are to decompose
food and transform nutrient substances into Qi and
blood, and to discharge the wastes and steam body
fluid.
Lower Jiao
 The lower Jiao refers, generally, to the
portion located below the stomach,
 including the small intestine, large intestine,
kidneys, urinary bladder,etc.
 Its main function is to discharge food
residues and urine.
Conclusion
 In short, the three Jiao dominates all kinds of
Qi and Qi transformation of the human body,
and serves as the pathway for water.
 Therefore, Essential Questions says: "The
three Jiao, as the waterways, is an organ in
charge of the water circulation, flowing along
the waterways."
The Physiologic and Pathologic
Relations Among the Zang-Fu
Organs
 The heart and kidney under
communication failure
 Normal state
 Heart belongs to fire category
 Kidney belongs to water category
 They are communicating and regulating each other.
 Abnormal state:
 If heart Yang is excessive, which is known as “the
excessive cardiac fire” and fails to descend to the
kidney.
 The kidney water is insufficient and can not ascend
to the heart, then it will lead to a breakdown of the
normal physiologic coordination between heart and
kidney.
 The heart and kidney under
communication failure

 The main points for differentiating The heart and

kidney under communication failure are hyperactivity
of cardiac fire and deficiency of kidney water.
 Insomnia is the main symptom

 Principle of treatment: nourish Yin, reduce

fire.
 Deficiency of both heart and
spleen
 Normal:
 spleen is the source of Qi and blood formation, and
its function is to control blood.
 Heart control blood and vessels.
 Illness:
 Splenic Qi is deficiency, the blood formation will be
reduced and become insufficiency.
 Deficiency of slpenic Qi fails to control the blood,
then the blood may extravasate, and this may result
in the depletion of cardiac blood.
 Deficiency of both heart and
spleen
 The main points for differentiating Deficiency of
both heart and spleen are palpitation, insomnia,
sallow complexion, lassitude, anorexia,
abdominal distension, loose stools, and chronic
hemorrhage.
 Principle of treatment: replenish both heart
and spleen.
 Depletion of both cardiac blood and
liver blood
 Normal:
 the heart governs blood and vessels
 the liver stores blood.
 Illness: if the liver has got not enough blood to store,
or its blood storage function is impaired, then the
amount of blood inside the vessels will become less,
causing the depletion of cardiac blood and disorder
of blood circulation, and finally it will lead to the
depletion of both cardiac blood and liver blood.
 Depletion of both cardiac blood and
liver blood
 The main points for differentiating Deficiency of
both heart and spleen are the symptoms of heart
and liver diseases, in addition to the symptoms
of deficiency of blood.
 Principle of treatment: nourish liver blood and
cardiac blood.
 Depletion of both pulmonary Qi and
splenic Qi
 The relationship between lung and spleen
focus on the formation of Qi and body fluid,
and the distribution of fluid.
 The main points for differentiating Depletion of both
pulmonary Qi and splenic Qi are cough, asthma,
poor appetite, abdominal distention, and loose
stools, in addition to the symptoms of deficiency
of Qi.
 Principle of treatment: reinforce spleen,
resolve damp and phlegm, replenish lung.
 Deficiency of both splenic Yang and
renal Yang
 Normal:

 spleen is the capital of the acquired

constitution
 kidney is the origin of the congenital
constitution.
 Abnormal: They are influencing each other.
 Deficiency of both splenic Yang and
renal Yang
 The main points for differentiating Depletion of both
pulmonary Qi and splenic Qi are cold pain of lumbar
region and knee joints or the lower abdomen,
chronic diarrhea, and edema, in addition to the
cold syndrome.
 Principle of treatment: mildly invigorate and
warm kidney and spleen.
 Deficiency of both liver Yin and
kidney Yin
 Normal:
 liver and kidney are from the same source, they are
under mutual promotion.
 They are influencing each other, because of theirs
“mother-child” relationship.
 Abnormal:
 Deficiency of liver Yin may affect kidney Yin, the
disorder of son organ involves the mother
 If kidney Yin is insufficient and fails to nourish liver
wood, then liver Yin may also become deficient, the
disorder of mother organ affects son.
 Deficiency of both liver Yin and
kidney Yin
 The main points for differentiating Deficiency of
both liver Yin and kidney Yin are hypochondriac
pain, burning sensation in the chest, palms, and
soles, malar flush, night sweating, nocturnal
emissions, oligomenorrhea, red tongue with little
coating, and thready and rapid pulse.
 Principle of treatment: enrich kidney water,
replenish liver Yin.
Disharmony between liver and spleen
 Normal:
 The discharge and free-flowing function of the liver are
beneficial to the transportation and transformation functions of
the spleen;
 On the other hand, if the transformation and transportation
functions of the spleen are normal and Qi dynamic is free, it is
helpful to the discharge and free-flowing functions of the liver.
 Abnormal
 If the discharge and free-flowing function of the liver are
impaired and Qi dynamic is disturbed, then the transportation
and transformation functions of the spleen may be affected
 The splenic transportation and transformation malfunction,
cause Qi retardation in the middle and damp retention in the
body, and lead to discharge and free-flow failure.
Disharmony between liver and spleen
 The main points for differentiating Disharmony
between liver and spleen are distension, fullness
and wandering pain in the chest and
hypochondriac region, irritability, poor appetite,
abdominal distension, and loose stools.
 Principle of treatment: sooth liver, promote spleen.
 Incoordination between liver and
stomach
 normal:
 the function of the liver is to discharge and ensure
free-flowing of Qi,
 while the function of stomach is to receive and to
propel downward motion.
 The normal function of hepatic Qi is quite helpful to
the downward motion of gastric Qi
 Abnormal:
 Disharmony of the liver and stomach often occurs
when the stomach is rather poor and hepatic Qi is
depressed,
 For the discharge and free-flowing impairment may
affect the downward of motion of the gastric Qi
 Incoordination between liver and
stomach
 The main points for differentiating Incoordination
between liver and stomach are burning pain of the
chest and hypochondrium, irritability, red eyes,
bitter taste of the mouth.
 Principle of treatment: sooth liver, harmonize
stomach.