class 9 SP/LR/KD SYNDROMES

S/S: loss of appetite

abdominal distention that’s especially worse after eating, loose stools, lassitude, shortness of breath, disinclination to speak, sallow complexion or pallor, edema or emaciation, pale tongue 

with white coat, soft and weak pulse

       + ST Qi Disharmony: reduced food intake, discomfort after eating, belching 

      Treatment Principle: reinforce/replenish Qi and strengthen/invigorate Spleen 

      function for deficiency of Spleen Qi

SP QI DEFICIENCY

-most common form of splenic transformation failure and mainly involves poor 

 digestion and assimilation

S/S: emaciation, lack of strength, sagging distention in ST duct +

abdomen, distention or diarrhea after eating, rectum/uterus 

prolapse, pale enlarged tongue, soggy pulse

Treatment Principle: fortify Spleen, supplement the Center to raise Yang and boost Qi

SP QI sinking

-refers to diminished uplift of the Spleen’s Yang Qi and often occurs as one 

 aspect of general Qi Deficiency

S/S: abdominal distention, loss of appetite

abdominal pain that can be relieved by warmth or pressure

loose stools, cold or heavy limbs, general edema, difficult urination,

diarrhea with clear food (undigested) in stool, profuse dilute leukorrhea, bright white facial complexion, feels cold, pale and plump tongue white and slippery coat, and deep, slow, weak pulse

      Treatment Principle: regulate the function of Middle Jiao to eliminate cold, or 

    strengthen Spleen to remove dampness in case of edema

Spleen Yang Deficiency

-devitalized Spleen Yang causes Spleen Qi debilitation—often affects Kidney Yang.  It presents with pronounced cold signs in addition to Spleen Deficiency symptoms

S/S: bloody stools, hematuria, gingival hemorrhage, excessive menstrual flow, uterine bleeding that is often accompanied by sallow/pale complexion, dizziness, palpitations, poor appetite, loose stools, lassitude, weakness, shortness of breath, disinclination to speak, pale tongue with white coat, and thready and weak or soggy pulse

      Treatment Principle: supplement Qi to stop bleeding 

Spleen Fails to Control Blood

-impairment of Spleen’s function of managing the blood resulting in bleeding is 

 called the “Spleen failing to manage Blood.  Since the Spleen is the source of 

 Blood and Qi formation, the patho-mechanism of this disorder may be explained 

 as “Qi failing to contain the Blood”.   

fullness and distending pain in epigastrium and abdomen, 

appetite loss, loose stools, nausea, tasteless mouth, absence of thirst, 

heaviness of head and body, sallow complexion, jaundice, edema, scanty 

urine, pale and plump tongue white and wet coat, and soft and slow pulse

\ Treatment Principle: Dry Dampness and strengthen Spleen; warm the Middle Jiao to 

    eliminate Dampness to cure Yin jaundice 

Disturbance of the Spleen by Cold-Damp 

*Both the disturbance of the Spleen by Cold-Dampness and Spleen Yang Deficiency

  manifest symptoms caused by the dysfunction of Spleen in transporting and 

  transforming, cold symptoms, and symptoms of dampness retention. 

• Disturbance of Spleen by Cold-Damp: invasion of Cold-Damp to the Interior

• Disturbance of Yang in the Middle Jiao: excess in nature, disease has short 

duration, white and sticky tongue coat, and soft slow pulse 

• Deficiency of Spleen Yang: dysfunction in transporting and transforming b/c 

Yang Deficiency, formation of internal Cold-Dampness, disease has long duration, white and slippery tongue coating, and deep slow pulse

fullness in abdomen, loss of appetite, nausea, loose stools, yellow urine, and heaviness of the body and limbs, jaundice, eyes in a fresh bright color like oranges, and itching, or rising and falling fever- not relieved after sweating, red tongue with yellow and sticky coat, and slippery and rapid pulse

Treatment Principle: reduce Heat and resolve Dampness 

Retention of Damp-Heat in the Spleen

dull pain in the epigastrium, anorexia (lack of nourishment/fluids), dry mouth/throat, constipation, or fullness in the epigastrium, nausea, hiccups, no desire for food/drink, red tongue with little moisture, thready and rapid pulse 

Treatment Principle: nourish Yin of the Stomach 

Deficiency of Stomach Yin

-occurs during recovery stage of externally contracted febrile disease when 

 Stomach Yin may be damaged from residual heat.  Another common cause is Yin 

 Humor depletion in the course of an enduring illness where impairment of the 

 nourishing and moistening effect of Yin Humor may affect the downbearing of 

 Stomach Qi

epigastric pain that’s continuous in mild cases and shows contracture (tightening of tissues/muscles) which is aggravated by cold and relieved by warmth,

usually occurs with an empty stomach and is relieved by eating, tasteless mouth, absence of thirst, lassitude, weakness, cold limbs, belching, acid reflux, borborygmus, vomiting of clear fluid (sometimes sour), pale enlarged tongue with white and slippery coat, and soggy or slow pulse 

(becomes tight or wiry during pain attacks) 

Treatment Principle: warm the Stomach to dispel Cold

Deficiency Cold in the Stomach

-can be result of damage to ST Qi by excessive consumption of raw and cold 

 foods or other dietary irregularities; may also occur when emotional constraint 

 causes Liver Qi to invade Stomach and in time, damages Stomach Qi; contraction of an external evil is often a trigger 

Western: ulcers, gastric neurosis

*Stomach Qi Deficiency Cold is characterized by pain in the stomach duct can be  brought on by contraction of External Cold but differs from that of a sudden invasion of 

  Cold Evil (catching a common cold or excessive consumption of raw/cold foods) by being less sudden and violent in onset, of longer duration and exhibit prominence of vacuity signs.  Sudden invasion of Cold Evil is associated with pronounced cold sign, less pronounced vacuity signs and a more sudden onset.

burning pain in the stomach duct, gastric discomfort with acid regurgitation, vomiting after eating, thirst with preference for cold drinks, swift digestion with rapid hungering, polyorexia, swelling, pain and ulcers of the gums, gingival hemorrhage, halitosis, bitter taste in mouth, dry mouth, constipation, scanty, dark-red urine, red tongue with dry yellow coat, and smooth rapid or slippery pulse

Treatment Principle: Clear away stomach fire. 

Heat in the Stomach

common Interior Heat pattern, may be caused by interiorization of Evil Heat, 

 damage to the stomach by excessive consumption of rich or hot spicy foods or by 

 Liver Fire invading Stomach

distention, fullness and even pain in the epigastrium and abdomen, belching, and acid regurgitation,

vomiting of sour and undigested food,

distention and pain relieved after vomiting,

intestinal flatus from anus, loose stools, diarrhea with foul stools

thick and sticky tongue coating, smooth pulse 

 Treatment Principle: improve digestion to eliminate the undigested food.

Retention of Food in Stomach

nausea, vomiting, belching, hiccuping

-ST Cold: white facial complexion, vomiting of clear fluid, or vomiting in 

    evening of food ingested in the morning, pale tongue

-ST Heat: vomiting of sour/bitter fluid, immediate vomiting of ingested food, 

     red tongue with yellow coat

-Phlegm: repeated ejection of phlegm-drool and occasionally dizziness are 

    observed, greasy tongue coat

-Foul Turbidity: usually occurs in hot weather, is sudden onset, abdominal pain, 

ungratified desire to vomit, unbearable distention and oppression 

in stomach duct

-Food Stagnation: usually a history of food damage, sour/putrid vomit with 

      improvement brought by vomiting

-GI Qi stagnation: glomus in chest, abdominal pain, belching

  Treatment Principle: harmonized Stomach and downbearing counterflow

Counterflow Ascent of ST Qi

-Disharmonious downbearing of the Stomach and is attributable to a wide variety 

 of causes including cold, phlegm, foul turbidity, food stagnation and gastrointestinal 

 Qi stagnation, basically that can occur in any stomach disease

      

mental depression, bile secretion disorders, plum-pit, goiter, 

breast distention; gastrointestinal disturbances (ulcers), menstrual irregularities, 

distending and wandering pain in the chest and hypochondria/lower abdomen, 

suffocating feeling in the chest, white tongue coat

Liver Qi Stagnation

Binding depression of Liver Qi is commonly observed manifestation of impaired 

 free coursing.  It is Excess in nature and is a Qi dynamic disturbances of the 

 depression or stagnation type.  It may be caused by mental and emotional disorders 

(depression/rashness, impatience, exaggerated emotional response), invasion of 

 external Damp-Heat, or Yin Blood Deficiency deprived Liver of nourishment.  

• Qi dynamic disturbances manifest in scurrying pains or distending pain in the chest and rib-side, oppression in the chest and wiry pulse

• Bile secretion disturbances, which are dealt with in a greater detail under head-jaundice and vomiting of bitter fluid or yellow bile

Liver Qi invading Stomach: Liver Qi can “move cross counterflow” to invade the Spleen and Stomach.  If there are signs such as nausea, vomiting, acid regurgitation, and acute abdominal pain and distention.  If there is additional distending pain and diarrhea, it’s called “Liver-Spleen Disharmony”

• Liver Qi can also ascend counterflow, carrying phlegm upwards, which may cause plum-pit qi, characterized by sensation of a lump in the throat that can’t be swallowed nor brought up; if Qi and Phlegm obstruct each other and accumulate in neck -> gives rise to goiter (thyroid enlargement) which is characterized by soft swelling on both sides of the laryngeal prominence that move up and down when patient swallows

• Binding Liver Qi depression may also affect CHONG and REN vessels leading to menstrual pain/block/irregular, painful breast distention, breast lumps

Treatment Principle: course the Liver and rectify Qi

 severe headache, dizziness and vertigo, red face/eyes, bitter taste in the mouth, dry mouth, irritability, rashness, impatient, insomnia with dream-disturbed sleep, burning pain of the costal and hypochondriac regions, vomiting of sour/bitter fluid, constipation (dry hard stool), yellow urine, sudden tinnitus/deafness, swelling pain with pus discharge in the ear, hematemesis, epistaxis; red tongue with dry yellow coat, wiry or slippery and rapid pulse

If Blood storage is affected: expectoration of blood, nosebleed, profuse menstruation

Flaring up of Liver Fire

-Liver-Gallbladder Heat depression pattern; it may be caused by transformation of 

 Liver Qi depression into Fire, by severe emotional disturbance or by Damp-Heat 

 accumulated in the inner body.  Up-flaming of Liver Fire manifests as Qi and Fire 

 rising to the head, giving rise to pronounced Heat signs.  Blood storage is frequently 

affected which leads to hemorrhage. *Essential characteristic of Liver Fire flaming upward is exuberant Fire in the upper body.  In general, there is no lower body pattern indicating Yin-Blood Deficiency.  It differs  from Liver Yin Deficiency and Liver Yang rising which are both Excess Above and Deficient Below patterns.

dizziness and vertigo, tinnitus, pale and lusterless complexion, withered nails, dreaming, floaters, blurry vision or night blindness, numbness of the body and limbs, contracture of the joints, tremor of the limbs, muscular twitching, hypomenorrhea, pale or scanty menstrual flow, and even amenorrhea in females, alternating flooding and spotting, pale tongue with white coat, 

wiry and thready pulse 

 In severe cases, Liver-Kidney Jing-Blood depletions: aching lumbar, seminal emission, 

sterility, menstrual block, emaciation, tidal fever

    Treatment Principle: nourish the Liver Blood

Deficiency Liver Blood

Damage to Yin-Blood in the course of enduring illness which deprive Liver Blood for 

 storage and of adequate nourishment or due to continual expectoration of blood, 

 nosebleed, or profuse menstruation from blood storage failure.

dizziness and vertigo, tinnitus, pale and lusterless complexion, withered nails, dreaming, floaters, blurry vision or night blindness, numbness of the body and limbs, contracture of the joints, tremor of the limbs, muscular twitching, hypomenorrhea, pale or scanty menstrual flow, and even amenorrhea 

in females, alternating flooding and spotting, pale tongue with white coat, 

wiry and thready pulse 

In severe cases, Liver-Kidney Jing-Blood depletions: aching lumbar, seminal emission, sterility, menstrual block, emaciation, tidal fever

 Treatment Principle: nourish the Liver Blood

Deficiency of Liver Blood

dizziness, tinnitus, dryness of the eyes, hot sensation of the face, burning pain in the costal and hypochondriac regions, burning sensation in the chest, palms, and soles, afternoon fever, night sweating, dryness of the mouth and throat, involuntary movement of the limbs, dry red tongue, wiry, thready, and rapid pulse

Treatment Principle: nourish the Liver Yin 

Deficiency of Liver Yin

dizziness and headache, distending pain of the head and eyes, red face/eyes, irritability, inclination to become angry, palpitations, amnesia, insomnia, dreaming, blurry vision, tinnitus, soreness and weakness of the lumbar region and knee joints, heaviness of the head and unsteady feet, red tongue, wiry and forceful or taut thready and rapid pulse 

Treatment Principle: nourish the Water (Kidney) to calm the Wood (Liver)

Hyperactivity of Liver Yang

-associated w floating & ascendant hyperactivity & LV Fire is with transformation of Qi stagnation. LV Yang Rises when LV Yin is insufficient & unable to counterbalance the upstirring of its complement. 

dizziness and vertigo, feeling of falling, neck rigidity, inhibited speech, unsteady gate, seizures and tremors 

Stirring of Liver Wind in the Interior (Gan Feng Nei Dong)

Internal Wind arise when excessive depletion of Liver and Kidney Yin humor 

 deprives the Liver’s Yang Qi of its nourishment an counterbalancing => Liver Yang 

 upbears and stirs unchecked

dizziness and vertigo, feels full, headache with shaking of the head, stiff neck, shaking and numbness of the limbs, dysphasia, staggering gait, sudden collapse, loss of consciousness, deviation of the mouth and eyes, hemiplegia, stiff tongue, gurgling sound in the throat, red tongue with white dry or sticky coat, wiry. and forceful pulse

Treatment Principle: calm Liver to subdue Yang and calm the Wind to remove Phlegm 

Liver Yang Turning into Wind

high fever, unconsciousness, mania, clonic convulsions of the limbs, rigidity of the neck, opisthotonos with upward staring of the eyes, locked jaw, red or crimson tongue, wiry and rapid pulse 

Treatment Principle: remove Heat from the Liver to calm Wind 

Extreme Heat Producing Wind

-resulting from the stirring of Wind caused by the failure of Blood in nourishing the 

 tendons. This syndrome is ascribed to excessive chronic hemorrhage or to deficiency of blood after a prolonged illness. 

For clinical manifestations and analysis, please refer to the syndrome of deficiency 

 of Liver Blood. 

Deficiency of Blood Producing Wind 

distending cold pain in lower part of the abdomen accompanied by a bearing-down sensation in the testes, contraction and pain of the scrotum  that can be aggravated by cold and alleviated by warmth, white and slippery tongue coating, deep and wiry or slow pulse

Treatment Principle: warm the Liver to dispel Cold 

Retention of Cold in the Liver Meridian

distention and burning pain in the right hypochondrium, masses, anorexia, abdominal distention, bitter taste in the mouth, nausea, abnormal defecation, scanty and deep-yellow urine, or alternating chill and fever, or 

icteric skin and eyes, eczema of the scrotum, unbearable itching, swelling and burning pain in the testis, yellow foul leukorrhea, and pruritus vulvae; red tongue with yellow and sticky coat, wiry and rapid pulse

Treatment Principle: reduce Heat and eliminate Dampness, soothe Liver and Gallbladder 

Damp Heat in the Liver & Gallbladder

palpitations, insomnia, irritability, bitter taste in the mouth, nausea, fullness of chest and distention of the hypochondrium, dizziness, vertigo, tinnitus, yellow and sticky tongue coating, wiry and smooth pulse

Treatment Principle: reduce Heat and dispel Phlegm, clear away Liver Fire, 

   harmonize Stomach

Depression of the GB with disturbance by phlegm

soreness and weakness of the lumbar region and knee joints, aversion to cold, cold limbs especially worse at the lower limbs, tinnitus, vertigo, listlessness, loose teeth, pallor or sallowness (bright white facial confirmation), cold uterus, menstrual irregularities, sterility, impotence, lack libido, copious clear urine, 

urination difficulties, (block, nocturia, scanty), chronic diarrhea with undigested food, diarrhea at dawn, pitted edema that is especially worse below the lumbar region, abdominal distention, general edema, palpitations, cough, asthma, tinnitus, deafness, fearful, feels guilty

Tongue: pale and swollen with white coat Pulse: deep, slow and weak

in serious cases, water-rheum may flood upward, intimidating the Heart and 

  shooting into the Lung; palpitations, rapid panting with inability to lie flat

Treatment Principle: warm and reinforce Kidney Yang 

Deficiency of Kidney Yang

characterized by both vacuity and cold signs; Kidney Yang is the Fire in human life, 

  the deep resolution that propels and targets the major episodes in the life cycle; 

  also called Weak Ming Men Fire

soreness of the lumbar region and knee joints, dizziness, tinnitus, vertigo, long term forgetfulness, loss of hearing, insomnia, fear, angst, dread of death, dreaming, frequent erections, premature ejaculations, nocturnal emission, oligomenorrhea, anemia, or uterine bleeding, emaciation, afternoon 

fever, dry skin, hot flashes, night sweating, burning sensation in chest/palms soles, dry mouth/throat, malar flush, yellow urine, constipation

Tongue:  red tongue with scanty coat Pulse: thready and rapid

Treatment Principle: nourish Kidney Yin 

Deficiency of Kidney Yin

(yin is stillness, nourishment, rest-think lack of kd yin=no rest in genital area (ruled by kd=emission, ejaculation etc)

 microsoma, action and mental retardation, brittle bones, spermacrasia and infertility, anemia, sterility, hyposexuality, sexual dysfunction (anxiety or pain/discomfort with intercourse), premature aging, alopecia, loose teeth, dizziness, tinnitus, deafness, amnesia, weakness of the feet, sore low back/knee

Tongue: pale Pulse: weak 

-children: developmental and growth delays, short stature, low intelligence, 

    sluggish of physical movement, weak bones, late closing of the fontanels

-elderly: premature senility, weak legs, difficulty in walking, dull Jing-Shen, 

  slow physical movement

-anguished fear of death, not bing able to experience old age as a ”ripening’ into

 self-awareness or the absence of trustful recognition are signs that Kidney’s Essence 

 hasn’t enabled the Zhi to find an ultimate Wisdom of life

    

Treatment Principle: reinforce Kidney and nourish the Essence 

Deficient Kidney Essence

stems from enduring illness or from improper development during fetal stage;   

   may lead to signs of Jing-Marrow depletion and Sea of Marrow Deficiency; 

   no prominent cold/heat signs

-tends to display signs relate to development, maturation or reproduction

Essence is the source of the inevitable and almost imperceptible movement of human 

  life through birth, development, maturation, decline and death; is the source of the 

  Yin and Yang so includes both and not one or the other

pallor, listlessness, poor hearing, soreness and weakness of the lumbar region and knee joints, frequent urination with clear urine or dribbling of urine after urination, enuresis, incontinence, frequent nocturia,

spermatorrhea, premature ejaculation, clear and dilute leukorrhea, fetal mvt

Tongue: pale with white coat Pulse: deep and weak

Treatment Principle: consolidate the Kidney Qi to arrest seminal emissions, reduce 

  urination, and prevent miscarriage. 

Deficiency of Kidney Qi 

mild cold signs; chronic cough and asthma, less inhalation and more exhalation, discontinuous breath that becomes aggravated on exertion, spontaneous sweating, lassitude of Spirit, listlessness, feeble voice, soreness and weakness of the lumbar region and knee joints

urinary disturbances-fq. and long voidings of clear urine, incontinence, enuresis, dribbling)

reproductive dysfunction (seminal emission, seminal efflux, premature ejaculation)

Tongue: pale with white coat Pulse: deep and weak, fine

-dyspnea, cold profuse sweating, cold limbs, cyanosis of the face; 

   T: pale with white coat; P: superficial and large

-short breath, flushed face, irritability, dryness mouth/throat; 

  T: red; P: thready and rapid

Treatment Principle: strengthen the Kidney's function to receive Qi 

Failure of the Kidney in Receiving Qi 

Kidney Qi is said to be “insecure” when it fails to perform its function of regulating discharge of urine and semen. 

-results from debilitation in old age or mal-development of Kidney Qi in childhood. 

It may also result from damage cause by sexual intemperance or by early commencement of sexual activity.

frequent and urgent urination, burning pain in the urethra, 

deep yellow and scanty urine, and distention and fullness of the abdomen, 

fever, lumbago, hematuria, stones in the urine

Tongue: red with yellow and sticky coat Pulse: rapid 

 Treatment Principle: reduce Heat and resolve Dampness

Damp-Heat in the Bladder