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Guidelines for Differentiating Syndromes of Internal Organs
1. Differentiation of syndromes based on internal organs: This method analyzes and summarizes the physiological functions and pathological manifestations of the internal organs, combining the Eight Principles, etiology, Qi and blood theories, and data collected from the four examinations to deduce the causes and mechanisms of diseases, and to determine the location, nature, and state of Zheng (normal) and Xie (evil) conditions.2. Theoretical basis: The syndromes of internal organ diseases reflect the dysfunction of the internal organs. Different organs have different functions, thus the diseases they reflect are also different. Differentiating syndromes based on the physiological functions and pathological changes of different organs is the theoretical basis for this method. Familiarity with the physiological functions and pathological patterns of each organ is essential for mastering this differentiation method.1. Heart and Small Intestine Syndrome Differentiation
Overview:
1. The physiological function of the heart is to govern blood vessels and mental activity. The heart opens to the tongue and is interior-exterior related to the small intestine, thus heart diseases often manifest as blood circulation disorders and mental abnormalities.
2. Heart syndromes can be either deficient or excess; deficiency syndromes are due to insufficient Qi and blood, while excess syndromes are caused by evil Qi such as fire, heat, phlegm, and stasis.
3. The small intestine governs the separation of clear and turbid, with its diseases primarily manifesting as abnormal urination.
4. Common symptoms of heart disease include palpitations, irritability, chest pain, insomnia with vivid dreams, forgetfulness, and delirium.
(1) Heart Qi Deficiency, Heart Yang Deficiency
Definition: Refers to the symptoms resulting from insufficient heart Qi and weakened heart Yang.
Symptoms: Palpitations, shortness of breath, worsening with activity, spontaneous sweating, weak or irregular pulse. If accompanied by pale complexion, fatigue, pale tongue with white coating, this indicates heart Qi deficiency; if accompanied by cold limbs, chest tightness, swollen pale tongue, and white slippery coating, this indicates heart Yang deficiency.
Etiology: Often due to prolonged illness leading to Qi deficiency, congenital insufficiency, or aging-related organ Qi deficiency.
Analysis: Clinically, if common heart symptoms are present along with signs of Qi deficiency, this indicates heart Qi deficiency; if accompanied by signs of Yang deficiency, this indicates heart Yang deficiency.
1. The heart’s weak contraction fails to propel blood normally, leading to palpitations.
2. Insufficient heart Qi results in weak circulation of the ancestral Qi, causing shortness of breath. Activity consumes Qi, worsening the condition.
3. Qi deficiency leads to an unstable exterior, resulting in spontaneous sweating.
4. Insufficient heart Qi leads to weak blood circulation, failing to nourish the face, resulting in a pale complexion and a pale tongue.
5. Insufficient Qi and blood fail to fill the vessels or connect the pulse, leading to a weak or irregular pulse.
6. Heart vessel obstruction leads to poor circulation of Qi and blood, causing chest tightness and a dark purple tongue.
7. Heart Yang deficiency fails to warm the body, resulting in cold limbs.
Treatment principle: Tonify heart Qi, warm and unblock heart Yang, nourish the heart and calm the spirit.
Representative formula: Heart Qi deficiency – Yangxin Decoction; Heart Yang deficiency – Zhi Gan Cao Decoction.
(2) Heart Blood Deficiency, Heart Yin Deficiency
Definition:
Heart blood deficiency – is due to insufficient heart blood, leading to a lack of nourishment.
Heart Yin deficiency – is due to a deficiency of heart Yin, resulting in internal heat disturbance.
Symptoms: Palpitations, insomnia, forgetfulness, and vivid dreams are common. If accompanied by pale complexion, dizziness, pale lips and tongue, and weak pulse, this indicates heart blood deficiency; if accompanied by irritability, flushed cheeks, tidal fever, five hearts heat, night sweats, red tongue with little moisture, and thin rapid pulse, this indicates heart Yin deficiency.
Clinically, if common heart symptoms are present along with signs of blood deficiency, this indicates heart blood deficiency; if accompanied by signs of Yin deficiency, this indicates heart Yin deficiency.
Etiology:
1. Prolonged illness depleting Yin blood or excessive blood loss.
2. Insufficient Yin blood.
3. Emotional distress depleting heart blood or heart Yin.
Analysis:
1. Insufficient heart Yin and blood fail to nourish the heart, leading to palpitations, forgetfulness, and insomnia with vivid dreams.
2. Heart blood deficiency fails to nourish the vessels, leading to dizziness, pale lips and tongue, and weak pulse.
3. Heart Yin deficiency leads to excessive heart Yang, causing internal heat disturbance, resulting in irritability, flushed cheeks, tidal fever, night sweats, dry red tongue, and thin rapid pulse.
Treatment principle: Nourish heart Yin, tonify heart blood, calm the spirit.
Representative formula: Heart blood deficiency – Si Wu Decoction; Heart Yin deficiency – Tian Wang Bu Xin Decoction.
(3) Heart Blood Stasis
Definition: Refers to the symptoms resulting from blood stasis and phlegm obstructing the heart vessels.
Etiology: Often secondary to heart Qi deficiency or heart Yang deficiency. Due to insufficient Yang Qi, blood circulation is weak, leading to blood stasis or phlegm accumulation, causing obstruction of the heart vessels. Often triggered or worsened by emotional agitation, overexertion, exposure to cold, or excessive consumption of rich foods and alcohol.
Symptoms: Palpitations, anxiety, chest tightness or stabbing pain, pain radiating to the shoulder and inner arm, intermittent episodes, purple or dark tongue with stasis spots, weak or irregular pulse; in severe cases, intense pain, cyanosis of lips, cold limbs, faint pulse.
Analysis:
1. Insufficient heart Yang leads to poor circulation of Qi and blood, causing heart blood stasis, resulting in palpitations, anxiety, and chest tightness or stabbing pain.
2. The heart meridian runs through the shoulder and back, hence the pain can radiate to these areas.
3. Blood stasis leads to purple or dark tongue with stasis spots, weak or irregular pulse.
4. Severe heart Yang deficiency leads to blood stagnation, resulting in intense pain, cyanosis of lips, cold limbs, and faint pulse.
Treatment principle: Unblock Yang and resolve stasis.
Representative formula: Guo Lou Xie Bai Gui Zhi Decoction.
(4) Small Intestine Heat Excess
Definition: Refers to the symptoms resulting from heart fire descending and causing excessive heat in the small intestine.
Etiology: Often due to the invasion of heart heat evil descending to the small intestine.
Symptoms: Irritability, thirst with preference for cold drinks, mouth sores, painful urination, hematuria, red tongue with yellow coating, rapid pulse.
Analysis:
1. The heart and small intestine are interrelated; when heart heat descends to the small intestine, its function is affected, leading to symptoms of painful urination.
2. Excessive heat can injure the blood vessels, leading to hematuria.
3. Intense heart fire disturbs the spirit, causing mild irritability; in severe cases, insomnia.
4. Heart fire can cause mouth sores.
5. Excessive heat can injure fluids, leading to thirst with preference for cold drinks.
6. Red tongue with yellow coating and rapid pulse indicate excessive internal heat.
Treatment principle: Clear heart and guide out the heat.
Representative formula: Dao Chi San.
2. Lung and Large Intestine Syndrome Differentiation
Overview:
1. The lung governs Qi, controls respiration, and regulates the water pathways. The lung governs the skin and opens to the nose, and is interrelated with the large intestine.
2. Lung syndromes can be either deficient or excess; deficiency syndromes are often due to Qi deficiency and Yin deficiency; excess syndromes are caused by invasion of evil Qi such as wind, cold, dryness, heat, or phlegm damp obstructing the lungs.
3. Common symptoms of lung disease include cough, asthma, and chest pain.
4. The large intestine governs the conduction and excretion of waste. The causes of large intestine diseases include unclean diet and loss of fluids after febrile diseases.
(1) Lung Qi Deficiency
Definition: Refers to the symptoms resulting from insufficient lung Qi.
Etiology:
1. Prolonged cough or asthma.
2. Congenital insufficiency.
3. Changes in other organs affecting the lungs.
Symptoms: Weak cough and asthma, shortness of breath with exertion, pale complexion, fatigue, weak voice, clear thin phlegm, spontaneous sweating, aversion to wind, susceptibility to colds, pale tongue, weak pulse.
Analysis:
1. Lung Qi deficiency leads to poor transformation and transportation, resulting in weak cough and asthma.
2. Deficient Qi leads to weak function, causing shortness of breath, pale complexion, weak voice, and spontaneous sweating.
3. Deficient Qi leads to a weak exterior, making it easy to be invaded by external pathogens, resulting in frequent colds.
4. The lung is the source of water; lung Qi deficiency weakens the distribution of fluids, leading to excessive clear phlegm.
5. Pale complexion, fatigue, weak voice, pale tongue, and weak pulse are all signs of lung Qi deficiency.
Treatment principle: Tonify lung Qi.
Representative formula: Si Jun Zi Tang.
(2) Lung Yin Deficiency
Definition: Refers to the symptoms resulting from insufficient lung Yin and internal heat disturbance.
Etiology:
1. Prolonged cough injuring Yin.
2. Tuberculosis invading the lungs.
3. Heat evil injuring the lungs.
Symptoms: Dry cough without phlegm, or scanty sticky phlegm, or blood-streaked phlegm, dry throat and mouth, hoarse voice, weight loss, tidal fever, flushed cheeks, night sweats, five hearts heat, red tongue with little moisture, thin rapid pulse.
Analysis:
1. Insufficient lung Yin leads to internal heat, causing cough.
2. Heat injures fluids, leading to scanty sticky phlegm.
3. Internal heat injures the lung vessels, leading to blood-streaked phlegm. Insufficient fluids fail to moisten the throat, leading to dry throat and mouth.
4. Internal heat leads to afternoon tidal fever and five hearts heat.
5. Internal heat leads to night sweats.
6. Red tongue with little moisture and thin rapid pulse indicate excessive internal heat.
Treatment principle: Nourish Yin and moisten the lungs.
Representative formula: Bai He Guo Jin Tang.
(3) Wind-Cold Binding the Lungs
Definition: Refers to the symptoms resulting from the invasion of wind-cold, leading to the loss of lung function.
Etiology: External invasion of wind-cold, leading to loss of lung function.
Symptoms: Cough and asthma, thin white phlegm, nasal congestion with clear discharge, or chills and fever, body aches, thin white coating on the tongue, floating tight pulse.
Analysis:
1. Loss of lung function leads to cough.
2. Cold is Yin, leading to thin white phlegm.
3. The nose is the orifice of the lung, and the throat is the portal; loss of lung function leads to nasal congestion with clear discharge.
4. Closed pores lead to absence of sweating. Thin white coating and floating tight pulse indicate wind-cold binding the exterior.
Treatment principle: Disseminate the lungs and disperse cold.
Representative formula: Xing Su San.
(4) Wind-Heat Invading the Lungs
Definition: Refers to the symptoms resulting from the invasion of wind-heat into the lung.
Etiology: External invasion of wind-heat.
Symptoms: Cough, expectoration of yellow thick phlegm, aversion to wind and fever, thirst with dry throat, red eyes and headache, nasal congestion with yellow discharge, red tongue tip, thin yellow coating, floating rapid pulse.
Analysis:
1. Loss of lung function leads to cough.
2. Heat injures lung fluids, leading to yellow thick phlegm.
3. Lung defense is invaded, leading to fever.
4. The throat is the portal of the lung; wind-heat obstructs the throat, leading to thirst and dry throat.
5. The lung opens to the nose; if lung Qi is obstructed, nasal discharge is yellow.
6. The lung is located in the upper body, and the tongue tip reflects changes in the upper body; thus, a red tongue tip indicates lung invasion by wind-heat.
7. Red eyes, body aches, thin yellow coating, and floating rapid pulse indicate wind-heat invading the lungs.
Treatment principle: Clear and disseminate lung heat.
Representative formula: Sang Ju Yin.
(5) Phlegm-Heat Obstructing the Lungs
Definition: Refers to the symptoms resulting from heat evil combined with phlegm obstructing the lungs.
Etiology: Warm-heat evil.
Symptoms: Cough and asthma, rapid breathing with flaring nostrils, expectoration of yellow thick phlegm or blood-streaked phlegm, or purulent blood-streaked phlegm with a foul odor, fever, chest pain, irritability, thirst, yellow urine, constipation, red tongue with yellow greasy coating, rapid slippery pulse.
Analysis:
1. Heat evil obstructs the lungs, causing fluids to congeal into phlegm, leading to cough, asthma, and rapid breathing with flaring nostrils.
2. Phlegm-heat obstructs the lung vessels, leading to chest pain. Blood and pus can form, leading to expectoration of foul-smelling blood-streaked phlegm.
3. Internal heat leads to fever, thirst, yellow urine, and constipation.
4. Phlegm-heat disturbs the spirit, leading to irritability. Red tongue with yellow greasy coating and rapid slippery pulse indicate phlegm-heat obstructing the lungs.
Treatment principle: Clear the lungs, transform phlegm, stop cough, and calm asthma.
Representative formula: Ma Xing Shi Gan Tang.
(6) Large Intestine Damp-Heat
Definition: Refers to the symptoms resulting from damp-heat accumulating in the large intestine.
Etiology:
1. Unclean diet.
2. Summer heat and dampness invading the large intestine.
Symptoms: Abdominal pain, diarrhea with foul stools, or dysentery with pus and blood, urgency with a feeling of heaviness in the anus, burning sensation in the anus, thirst, yellow urine, red tongue with yellow greasy coating, rapid slippery pulse.
Analysis:
1. Damp-heat accumulates in the large intestine, obstructing Qi movement, leading to abdominal pain and urgency.
2. Damp-heat injures the intestines, leading to pus and blood in the stool.
3. Damp-heat obstructs the large intestine, leading to diarrhea with foul stools and burning sensation in the anus.
4. Fever and thirst, red tongue with yellow greasy coating, and rapid slippery pulse indicate damp-heat accumulation.
Treatment principle: Clear and drain damp-heat.
Representative formula: Ge Gen Qin Lian Tang.
(7) Large Intestine Heat Accumulation
Definition: Refers to the symptoms resulting from heat evil accumulating in the large intestine.
Etiology: Internal heat accumulation.
Symptoms: Dry stools, fever, thirst, abdominal distension and pain, tenderness upon palpation, increased fever in the afternoon, mouth sores, red urine, red tongue with yellow dry coating, deep rapid pulse.
Analysis:
1. Heat accumulation in the stomach and intestines leads to constipation.
2. Obstruction of Qi leads to abdominal distension and pain.
3. Internal heat leads to fever and thirst.
4. Increased fever in the afternoon indicates Yang Qi is strong, competing with the evil heat.
5. Heat injures fluids, leading to red urine.
6. Heat accumulation leads to mouth sores.
7. Red tongue with yellow dry coating and deep rapid pulse indicate internal heat accumulation.
Treatment principle: Clear heat and resolve accumulation.
Representative formula: Da Cheng Qi Tang.
3. Spleen and Stomach Syndrome Differentiation
Overview:
1. The spleen governs transportation and transformation, and controls blood. The stomach governs reception and digestion. The spleen and stomach are interrelated, with the spleen ascending and the stomach descending, working together to digest, absorb, and distribute food, serving as the source of Qi and blood, the foundation of postnatal life.
2. Spleen and stomach syndromes can be differentiated into cold, heat, deficiency, and excess. Spleen diseases are often deficiency syndromes, commonly due to spleen Yang deficiency, dysfunction in transportation, internal dampness, and Qi sinking; stomach diseases are often excess syndromes, primarily due to dysfunction in reception and digestion, and stomach Qi rebellion.
3. Common symptoms of spleen diseases include food stagnation, abdominal distension, diarrhea, and edema; common symptoms of stomach diseases include epigastric pain, vomiting, belching, and hiccups.
(1) Spleen Qi Deficiency
Definition: Refers to the symptoms resulting from insufficient spleen Qi.
Etiology:
1. Irregular diet or imbalance.
2. Excessive fatigue.
3. Influence of other diseases.
Symptoms: Poor appetite, bland taste, abdominal distension, loose stools, pale complexion, fatigue, weakness, and a pale tongue with white coating, weak pulse.
Analysis:
1. Spleen Qi deficiency leads to dysfunction in transportation, resulting in poor appetite and bland taste.
2. Spleen deficiency leads to slow digestion, causing abdominal distension after eating.
3. Spleen deficiency leads to dampness, causing loose stools.
4. Spleen deficiency leads to insufficient nourishment, resulting in pale complexion, fatigue, weakness, and a pale tongue with weak pulse.
Treatment principle: Tonify the spleen and benefit Qi.
Representative formula: Liu Jun Zi Tang.
(2) Spleen Yang Deficiency
Definition: Refers to the symptoms resulting from weakened spleen Yang and internal cold accumulation.
Etiology:
1. Prolonged spleen Qi deficiency damaging spleen Yang.
2. Excessive consumption of cold foods or cold herbs.
3. Decline of Mingmen fire, failing to warm the earth.
Symptoms: Poor appetite, abdominal distension with cold pain, preference for warmth and pressure, aversion to cold, pale complexion, bland taste, or heaviness in the limbs, or generalized edema, loose stools, or excessive thin white discharge, pale swollen tongue, white slippery coating, weak pulse.
Analysis:
1. Spleen Yang deficiency leads to weakened transportation, resulting in poor appetite and abdominal distension.
2. Middle Yang is weak, leading to internal cold, causing cold pain in the abdomen, preference for warmth and pressure.
3. Yang deficiency leads to excess Yin, causing cold limbs.
4. Weak Yang leads to internal dampness, causing loose stools.
5. Excess dampness can lead to generalized edema or excessive thin white discharge.
6. Pale swollen tongue, white slippery coating, and weak pulse indicate spleen Yang deficiency.
Treatment principle: Warm the middle and tonify the spleen.
Representative formula: Li Zhong Tang.
(3) Spleen Qi Sinking
Definition: Refers to the symptoms resulting from weakened spleen Qi and loss of lifting function.
Etiology: This syndrome often arises from prolonged illness, fatigue damaging the spleen, or further development of spleen Qi deficiency.
Symptoms: Sensation of heaviness in the abdomen, worsening after eating, frequent urge to defecate, heaviness in the anus, persistent diarrhea, possible prolapse of the rectum, or internal organ prolapse, or cloudy urine resembling rice wash. Accompanied by dizziness, fatigue, weakness, poor appetite, loose stools, pale tongue, white coating, weak pulse.
Analysis:
1. Spleen Qi deficiency leads to loss of lifting function, causing heaviness in the abdomen, frequent urge to defecate, and possible prolapse.
2. Inability to hold leads to persistent diarrhea and cloudy urine resembling rice wash.
3. Insufficient Yang leads to dizziness, fatigue, weakness, poor appetite, loose stools, pale tongue, white coating, and weak pulse, indicating spleen Qi deficiency.
Treatment principle: Benefit Qi and lift.
Representative formula: Bu Zhong Yi Qi Tang.
(4) Spleen Failing to Control Blood
Definition: Refers to the symptoms resulting from spleen Qi deficiency failing to control blood.
Etiology: Often due to prolonged spleen Qi deficiency.
Symptoms: Blood in stool, blood in urine, skin bleeding, gum bleeding, or excessive menstrual bleeding, accompanied by poor appetite, loose stools, fatigue, weakness, pale complexion, pale tongue, weak pulse.
Analysis:
1. Spleen Qi deficiency fails to control blood, leading to bleeding.
2. Blood can overflow into the intestines, leading to blood in stool.
3. Blood can overflow into the bladder, leading to blood in urine.
4. Spleen Qi deficiency fails to control blood, leading to excessive menstrual bleeding.
5. Poor appetite, loose stools, fatigue, weakness, pale complexion, pale tongue, and weak pulse indicate spleen Qi deficiency.
Treatment principle: Tonify Qi and stabilize blood.
Representative formula: Gui Pi Tang.
(5) Spleen and Stomach Damp-Heat
Definition: Refers to the symptoms resulting from damp-heat accumulating in the spleen and stomach.
Etiology:
1. Invasion of damp-heat evil.
2. Irregular diet, excessive consumption of rich foods and alcohol.
Symptoms: Abdominal distension, poor appetite, vomiting, sticky sweet taste, heaviness in the limbs, loose stools, yellow urine, jaundice, or itchy skin, or fluctuating fever, sweating without relief, red tongue with yellow greasy coating, rapid slippery pulse.
Analysis:
1. Damp-heat evil accumulates in the spleen and stomach, leading to poor appetite and abdominal distension.
2. Damp-heat rises, leading to sticky sweet taste.
3. The spleen governs muscles; dampness weighs down the spleen, leading to heaviness in the limbs.
4. Damp-heat obstructs the spleen, leading to loose stools and yellow urine.
5. Damp-heat can lead to jaundice and itchy skin.
6. Fluctuating fever and sweating without relief indicate internal damp-heat.
7. Red tongue with yellow greasy coating and rapid slippery pulse indicate internal damp-heat accumulation.
Treatment principle: Clear heat and transform dampness.
Representative formula: Gan Lu Xiao Du Dan.
(6) Food Stagnation in the Stomach
Definition: Refers to the symptoms resulting from food stagnation in the stomach.
Etiology: This syndrome often arises from irregular diet, overeating, or pre-existing spleen and stomach deficiency.
Symptoms: Abdominal distension or pain, sour belching, or vomiting of sour food, relief of abdominal pain after vomiting, aversion to food, foul-smelling gas, loose stools with foul odor, thick greasy coating on the tongue, slippery pulse.
Analysis:
1. Food stagnation in the stomach obstructs Qi movement, leading to abdominal distension or pain.
2. The stomach loses harmony and descends, leading to sour belching and vomiting of sour food.
3. Relief of abdominal pain after vomiting indicates removal of food stagnation.
4. Food stagnation leads to foul-smelling gas and loose stools with foul odor.
5. Thick greasy coating and slippery pulse indicate food stagnation.
Treatment principle: Digest food and resolve stagnation.
Representative formula: Bao He Wan.
4. Liver and Gallbladder Syndrome Differentiation
Overview:
1. The liver stores blood, regulates Qi, and governs tendons. The liver opens to the eyes and is interrelated with the gallbladder. The gallbladder stores and excretes bile to assist digestion and is related to emotions.
2. Liver syndromes can be either deficient or excess; deficiency syndromes often present as liver Yin or liver blood deficiency; excess syndromes often present as Qi stagnation, excessive fire, cold stagnation in the liver meridian, liver-gallbladder damp-heat, liver Yang rising, or internal wind.
3. Common symptoms of liver disease include distension and pain in the chest and flanks, irritability, tremors, spasms, eye diseases, menstrual irregularities, and testicular pain.
(1) Liver Qi Stagnation
Definition: Refers to the symptoms resulting from liver Qi stagnation.
Etiology: This syndrome often arises from emotional distress leading to liver Qi stagnation.
Symptoms: Emotional depression or irritability, sighing, distension and pain in the chest and flanks, or a sensation of a lump in the throat, or masses in the hypochondrium, breast tenderness, dysmenorrhea, menstrual irregularities, or even amenorrhea, purple tongue or tongue with stasis spots, wiry pulse.
Analysis:
1. The liver governs Qi; emotional distress leads to stagnation, causing depression and irritability.
2. The liver meridian runs through the hypochondrium; liver Qi stagnation leads to distension and pain in the chest and flanks.
3. Qi stagnation can lead to phlegm, which can cause a sensation of a lump in the throat, commonly referred to as “plum pit Qi.”
4. Liver Qi stagnation leads to poor circulation of Qi and blood, causing menstrual irregularities and breast tenderness.
5. Prolonged liver Qi stagnation can lead to blood stasis, resulting in masses or dysmenorrhea.
6. Purple tongue or tongue with stasis spots and wiry pulse indicate blood stasis.
Treatment principle: Soothe the liver and relieve stagnation.
Representative formula: Chai Hu Shu Gan San.
(2) Liver Fire Rising
Definition: Refers to the symptoms resulting from liver fire rising.
Etiology:
1. Emotional distress leading to liver Qi stagnation transforming into fire.
2. Excessive consumption of rich foods and alcohol.
3. External invasion of fire heat.
Symptoms: Headache, dizziness, flushed face and eyes, irritability, bitter taste in the mouth, dry throat, insomnia, nightmares, pain in the hypochondrium, tinnitus, yellow urine, constipation, or vomiting blood, nosebleeds, or red eyes, red tongue with yellow coating, wiry rapid pulse.
Analysis:
1. Liver fire rises to the head, causing headache, dizziness, flushed face and eyes.
2. Liver fire can affect the ears, leading to tinnitus.
3. Liver fire can lead to emotional instability, causing irritability and insomnia.
4. Excessive heat can lead to blood heat, causing vomiting blood and nosebleeds.
5. Bitter taste and dry throat indicate liver fire.
6. Red tongue with yellow coating and wiry rapid pulse indicate excessive liver fire.
Treatment principle: Clear and drain liver fire.
Representative formula: Long Dan Cao Gan Tang.
(3) Liver Yin Deficiency
Definition: Refers to the symptoms resulting from liver Yin deficiency and internal heat disturbance.
Etiology: Often due to emotional distress leading to Qi stagnation, which transforms into fire, injuring Yin fluids.
Symptoms: Dizziness, headache, tinnitus, dull pain in the hypochondrium, dry eyes, blurred vision, irritability, insomnia, five hearts heat, tidal fever, night sweats, dry throat, red tongue with little moisture, thin rapid pulse.
Analysis:
1. Liver Yin deficiency fails to nourish the head and eyes, leading to dizziness, headache, and tinnitus.
2. Liver Yin deficiency fails to nourish the liver meridians, leading to dull pain in the hypochondrium.
3. Liver blood deficiency fails to nourish the eyes, leading to dry eyes and blurred vision.
4. Internal heat disturbance leads to irritability, insomnia, five hearts heat, tidal fever, and night sweats.
5. Dry throat and red tongue with little moisture indicate Yin deficiency.
Treatment principle: Nourish Yin and calm the liver.
Representative formula: Qi Ju Di Huang Wan.
(4) Liver Yang Rising
Definition: Refers to the symptoms resulting from excessive liver Yang or liver and kidney Yin deficiency, leading to Yang rising and disturbing the head.
Etiology: Often due to excessive Yang or emotional distress.
Symptoms: Irritability, headache, dizziness, or facial flushing, bitter taste, dry throat, yellow urine, constipation, red tongue with yellow coating, thin rapid pulse.
Analysis:
1. Liver Qi stagnation leads to excessive Yang rising, causing headache and dizziness.
2. Excessive Yang leads to emotional instability, causing irritability.
3. Yang rising leads to dry throat and bitter taste.
4. Red tongue with yellow coating and thin rapid pulse indicate excessive Yang.
Treatment principle: Nourish Yin, calm the liver, and subdue Yang.
Representative formula: Tian Ma Gou Teng Yin.
(5) Liver-Gallbladder Damp-Heat
Definition: Refers to the symptoms resulting from damp-heat accumulating in the liver and gallbladder.
Etiology: Often due to invasion of damp-heat evil, excessive consumption of alcohol and rich foods.
Symptoms: Distension and pain in the hypochondrium, bitter taste, poor appetite, nausea, abdominal distension, yellow urine, irregular bowel movements, yellow greasy tongue coating, rapid pulse; may also present with jaundice, fever, or scrotal eczema, testicular swelling and pain, vulvar itching, or yellow foul-smelling discharge.
Analysis:
1. Damp-heat accumulation leads to poor liver and gallbladder function, causing distension and pain in the hypochondrium.
2. Damp-heat can lead to a bitter taste and poor appetite.
3. Damp-heat can lead to jaundice and skin itching.
Treatment principle: Clear heat and drain dampness.
Representative formula: Yin Chen Hao Tang.
5. Kidney and Bladder Syndrome Differentiation
Overview:
1. The kidneys store essence, govern water, nourish bones and marrow, and govern respiration. They open to the ears and the two Yin. The bladder stores and expels urine.
2. Kidney diseases are often deficiency syndromes; bladder diseases often present with damp-heat syndromes.
3. Common symptoms of kidney diseases include soreness and weakness in the lower back and knees, low back pain, hearing loss, premature graying or hair loss, loose teeth, impotence, nocturnal emissions, low sperm count, menstrual irregularities, amenorrhea, and infertility.
Common symptoms of bladder diseases include frequent urination, urgency, painful urination, urinary retention, incontinence, and bedwetting.
(1) Kidney Yang Deficiency
Definition: Refers to the symptoms resulting from kidney Yang deficiency.
Etiology: Often due to congenital Yang deficiency or aging-related kidney depletion.
Symptoms: Soreness and weakness in the lower back and knees, cold limbs, especially in the lower body, dizziness, tinnitus, fatigue, impotence, infertility, scanty urine or nocturnal emissions, pale complexion, pale swollen tongue, weak pulse.
Analysis:
1. Kidney Yang deficiency leads to insufficient nourishment of the bones and marrow, causing soreness and weakness in the lower back and knees.
2. Insufficient Yang fails to warm the body, leading to cold limbs.
3. Insufficient Yang leads to excessive Yin, causing more severe symptoms in the lower body.
4. Insufficient Yang leads to insufficient nourishment of the brain, causing dizziness and tinnitus.
5. Insufficient Yang leads to reproductive dysfunction, causing impotence or infertility.
6. Insufficient Yang leads to insufficient Qi transformation, causing scanty urine or nocturnal emissions.
7. Pale swollen tongue and weak pulse indicate Yang deficiency.
Treatment principle: Warm and tonify kidney Yang.
Representative formula: Jin Gui Shen Qi Wan.
(2) Kidney Yin Deficiency
Definition: Refers to the symptoms resulting from kidney Yin deficiency and internal heat disturbance.
Etiology: Often due to prolonged illness, excessive sexual activity, acute febrile diseases, or emotional distress depleting kidney Yin.
Symptoms: Dizziness, tinnitus, insomnia with vivid dreams, dry throat and mouth, soreness and weakness in the lower back and knees, weight loss, five hearts heat, tidal fever, night sweats, nocturnal emissions, menstrual irregularities, amenorrhea, or excessive menstrual bleeding, red tongue with little moisture, thin rapid pulse.
Analysis:
1. Kidney Yin deficiency fails to nourish the bones and marrow, leading to dizziness, tinnitus, and soreness in the lower back and knees.
2. Insufficient Yin leads to weight loss and dryness.
3. Internal heat disturbance leads to five hearts heat, insomnia with vivid dreams, tidal fever, and night sweats.
4. Insufficient Yin leads to reproductive dysfunction, causing nocturnal emissions or menstrual irregularities.
5. Red tongue with little moisture and thin rapid pulse indicate Yin deficiency.
Treatment principle: Nourish Yin and tonify the kidneys.
Representative formula: Liu Wei Di Huang Wan.
(3) Bladder Damp-Heat
Definition: Refers to the symptoms resulting from damp-heat accumulating in the bladder.
Etiology: Often due to external invasion of damp-heat or irregular diet leading to internal damp-heat.
Symptoms: Frequent urination, urgency, burning pain during urination, scanty dark urine, hematuria, or cloudy urine, or low back pain, lower abdominal tightness and pain, fever, red tongue with yellow greasy coating, rapid slippery pulse.
Analysis:
1. Damp-heat accumulation leads to dysfunction in bladder Qi transformation, causing frequent urination and urgency.
2. Damp-heat can lead to burning pain during urination and hematuria.
3. Damp-heat can lead to low back pain and tightness in the lower abdomen.
4. Fever indicates internal damp-heat.
5. Red tongue with yellow greasy coating and rapid slippery pulse indicate damp-heat accumulation.
Treatment principle: Clear heat and drain dampness.
Representative formula: Ba Zheng San.
6. Concurrent Syndromes of Internal Organs
The internal organs of the human body are physiologically interconnected, and when diseases occur, they influence each other. When two or more organs are affected simultaneously, it is referred to as concurrent syndromes.
(1) Heart and Spleen Deficiency
Definition: Refers to the symptoms resulting from deficiency of heart blood and weakness of spleen Qi.
Etiology: Often due to prolonged illness, chronic blood loss, or excessive worry leading to heart blood depletion and spleen Qi damage.
Symptoms: Palpitations, forgetfulness, insomnia with vivid dreams, reduced appetite, abdominal distension with loose stools, fatigue, pale complexion, or subcutaneous bleeding, excessive menstrual bleeding with pale blood, or menorrhagia, amenorrhea, or infertility, pale tongue, weak pulse.
Analysis:
1. Spleen Qi deficiency leads to insufficient blood production or failure to control blood, leading to heart blood deficiency. Heart blood deficiency leads to spleen Qi deficiency, forming a concurrent syndrome of heart and spleen deficiency.
2. Heart blood deficiency leads to insufficient nourishment of the spirit, causing palpitations, forgetfulness, and insomnia with vivid dreams.
3. Spleen Qi deficiency leads to poor digestion, causing reduced appetite, abdominal distension, fatigue, and pale complexion.
4. Spleen Qi deficiency leads to failure to control blood, causing subcutaneous bleeding and excessive menstrual bleeding.
5. Insufficient Qi and blood lead to amenorrhea or infertility.
6. Pale tongue and weak pulse indicate concurrent deficiency of heart and spleen.
Treatment principle: Tonify and nourish the heart and spleen.
Representative formula: Gui Pi Tang.
(2) Heart and Kidney Disharmony
Definition: Refers to the symptoms resulting from disharmony between heart and kidney Yin and Yang.
Etiology: Often due to prolonged illness damaging Yin, excessive sexual activity, or excessive worry.
Symptoms: Irritability, insomnia, palpitations, forgetfulness, dizziness, tinnitus, dry throat, soreness in the lower back and knees, vivid dreams with nocturnal emissions, tidal fever, night sweats, scanty dark urine, red tongue with little coating, thin rapid pulse.
Analysis:
1. Kidney water is insufficient to nourish heart Yin, leading to excessive heart Yang, or heart fire rising, damaging Yin fluids, resulting in kidney Yin deficiency.
2. Insufficient kidney water leads to heart fire rising, causing irritability and insomnia.
3. Kidney Yin deficiency leads to soreness in the lower back and knees.
4. Internal heat disturbance leads to nocturnal emissions and tidal fever.
5. Scanty dark urine indicates kidney Yin deficiency.
6. Red tongue with little coating and thin rapid pulse indicate internal heat disturbance.
Treatment principle: Harmonize the heart and kidneys.
Representative formula: Huang Lian E Jiao Tang.
(3) Liver and Stomach Disharmony
Definition: Refers to the symptoms resulting from liver Qi stagnation affecting stomach function.
Etiology: Often due to emotional distress leading to liver Qi stagnation, which invades the stomach.
Symptoms: Distension and pain in the chest and flanks, abdominal distension and pain, hiccups, sour belching, nausea, irritability, or emotional instability, thin yellow coating on the tongue, wiry pulse.
Analysis:
1. Liver Qi stagnation leads to obstruction of the stomach, causing abdominal distension and pain.
2. Liver Qi stagnation leads to emotional instability, causing irritability.
3. Thin yellow coating and wiry pulse indicate liver and stomach disharmony.
Treatment principle: Soothe the liver and harmonize the stomach.
Representative formula: Xiao Yao San.
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