Chapter 8: The Patterns of the Human Landscape the details of the clinical scene

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Chapter 8The Patterns of theHuman
Landscapethe details of the clinical scene
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Qi

• Blood

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Qi is

• Dynamic tension
• Active force
• Transformation
• Creativity

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Deficient Qi

• General weakness/lethargy (weak pulse)
• Paleness of face and tongue
• Passiveness/softness in speech and manner

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Deficient Yang

• Encompasses deficient Qi more profound impact
• Implies a reduction of Fire Excess Cold
• Cold limbs
• Slow movement
• Aversion to cold
• Puffy tongue
• Slow pulse

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Stagnant Qi

• Excess that occurs when Qi is stuck
• Can be preceded by
• Emotional or dietary imbalance
• External pernicious influences
• Trauma
• Deficient Qi

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Stagnant Qi cont.

• Physical symptoms include
• Distention
• Dark/purple tongue
• Stagnant (wiry/tight) pulse
• Soreness or pain that changes severity and
  location

• Psychological symptoms include
• Mental block
• Frustration
• Tension
• Moodiness

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Blood is

• Repose
• Receptivity
• Relaxation
• Nourishment

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Deficient Blood

• Can be preceded by
• Loss of blood
• Insufficient spleen Qi
• Congealed blood
• Inappropriate tension, restlessness, tightness,
  low self esteem

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Deficient blood cont.

• Physical symptoms
• Dizziness/instability
• Problems with vision
• Weak tremors
• Tightness or cramps
• Numb limbs

• Thin pulse
• Dry skin/hair
• Pale face/lips/tongue

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Deficient Yin

• More profound than deficient blood
• Implies inappropriate Heat
• Agitated manner
• Red cheeks/tongue
• Warm palms/soles
• Night sweats
• Rapid/thin pulse

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Congealed Blood

• Self generates a contrary self Severe
  stabbing pain
• Can be preceded by
• Trauma or abuse
• Hemorrhage
• Stagnant Qi
• Cold patterns

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Congealed blood cont.

• Physical symptoms
• Hemorrhages
• Dark complexion
• Purple tongue w/ red spots
• Choppy pulse
• severe pain

• Psychological symptoms
• Suspiciousness
• Terror
• Paranoia

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Hot Blood

• Major symptom Bleeding
• Generated by Heat pernicious influence
• Other symptoms include
• Thirst
• Irritability
• Scarlet tongue
• Rapid pulse
• Delirium (in extreme cases)

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East and West Reconsidered

• Two perspectives on the same subject
• Chinese diagnosis is refined by understanding how
  the disharmony embraces the other organs and the
  entire human being
• Western diagnosis is refined by isolating an
  exact cause or pathological process

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Patterns of Organ Disharmony

• An elaboration of the Eight Principle Patterns,
  patterns of Qi and Blood disharmonies, and
  patterns of Pernicious Influences
• Basic clinical patterns, signs and symptoms
  recognized by Chinese physicians

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Spleen Disharmonies

• Spleen
• Source of sufficient Qi and Blood
• Rules transmutation from state to state
• Controls transportation of Blood, Qi, and Water
  to limbs, muscles and flesh
• Primary organ of digestion
• Source of motivation and creativity
• the zest that moves life

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Spleen Disharmonies

• Two Major Aspects
• Deficiency
• Insufficient Qi
• Excess
• Accumulation of Dampness

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Spleen Deficiencies

• Patterns of Deficient Spleen Qi
• Appetite disorders, abdominal pain, loose stools
• Lethargy, pale tongue with thin white moss, empty
  pulse
• Poor motivation, lack of excitement, boredom,
  despondency, lack of interest and creativity

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Spleen Deficiencies

• Deficient Spleen Yang (with Deficient Qi)
• Deeper and more serious disharmony
• Associated with cold cold limbs, swollen pale
  tongue, slow frail pulse
• Affects movement of water in body
• Lack of resolution or defeatism
• ------------
• Western diagnosis for both
• ulcers, gastritis, hepatitis, dysentery,
  anemia, depression

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Spleen Deficiencies

• Pattern of Spleen Qi Sinking
• Occurs when Qi cannot fulfill its function of
  holding things in place
• Additional signs of falling hemorrhoids, chronic
  diarrhea, urinary incontinence
• Exaggerated sense of disability and catastrophe

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Spleen Deficiencies

• Pattern of Spleen Unable to Govern the Blood
• Occurs when Yang of Spleen Qi cannot hold blood
  in place
• Various chronic bleeding in stool, nose,
  hemorrhaging, excessive menstrual or uterine
  bleeding
• ------------
• Western diagnosis functional uterine bleeding,
  bleeding hemorrhoids, hemophilia

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Spleen Excesses

• Pattern of Dampness Distressing the Spleen
• Symptoms resemble Deficient Spleen, but with
  heaviness and clutter
• Appetite disorders, sticky-watery stool, nausea,
  feeling of fullness in head and abdomen
• Excessive worry, feelings of being trapped,
  indecision, procrastination, caring for others
  but not self, fatigue without hindering
  performance
• ------------
• Western diagnosis chronic gastroenteritis,
  chronic, dysentery, chronic hepatitis,
  obsessive-compulsive disorders

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Spleen Excesses

• Pattern of Dampness Obstructing
• Occurs when Dampness is an External Pernicious
  Influence
• Same symptoms, but more acute with a sudden onset
  and often a low fever

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Spleen Excesses

• Damp Heat Collecting in the Spleen
• Usually the result of External Pernicious
  Influence, also associated with consuming fatty
  foods and excessive alcohol
• Signs of Heat and Dampness, obstructed bile
• -----------
• Western diagnosis acute gastric inflammation,
  acute hepatitic infection, cirrhosis of the liver

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Spleen Excesses

• Patterns of Mucus
• Spleen is the mother of mucus, a form of
  concentrated Dampness
• More severe than Dampness with a fixed location
• Mucus in stool, swellings or tumors, or phlegm,
  greasy thick tongue moss, slippery pulse
• Deep confusion, mental blocks

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Liver

• - Stores the Blood and responsible for the
  smooth movement of Qi.
• - Exquisitely reactive to being blocked and
  obstructed and sensitive to the distinction of
  self and others
• - Disharmonies - associated with stagnation,
  confrontation, and distortions in boundaries
  between and self and other.

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Liver Disharmony Patterns

• Constrained Liver Qi
• Deficient Liver Blood
• Liver Fire Blazing Upward
• Deficient Liver Yin
• Liver Wind Moving Internally
• Cold Stagnating in the Liver Meridian

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Constrained Liver Qi

• Like feeling a wall in the pathway of movement
• Most common form of Stagnant Qi
• Signs Pain and feeling of frustration or being
  blocked can present as mainly emotional problem
• Spleen effect has signs of Spleen Disharmony
  pattern but must see then in the context of the
  landscape of Liver Invading Spleen

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Constrained Liver Qi in the West

• Possible Diagnosis
• Mastitis - inflammation of the breast
• Scrofula form of tuberculosis that affects the
  lymph nodes
• Digestive disorders
• Psychological problems
• Various menstrual problems
• Stress of ordinary life

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Pattern of Deficient Liver Blood

• Responsible for rest, unhurried cyclical
  movement, absence of a need to go anywhere and
  the easy sense of self-acknowledgement.
• Accompanied by nervous habits, tight tendons or
  stiff joints.
• Can be accompanied by Stagnant Qi.
• In sufficient Blood wants to make things
  different and causes a person to tense up or
  excessively resist or react to inevitable pain.

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Deficient Liver Blood in the West

• Possible Diagnosis
• Anemia
• Menstrual problems
• Emotional conflicts
• Chronic muscular skeletal problems
• Chronic pain syndromes
• Various eye problems

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Liver Fire Blazing Upward

• Presents when the Livers Blood loses its
  softening quality and/or the Livers Qi is
  obstructed.
• Leads to agitated and pressured movement which is
  usually upward and outward.
• Presents with deafness, dizziness, headaches, ear
  pain or inability to control anger.
• Could also have general signs of Excess/Heat.

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Liver Fire Blazing Upward

• Possible Western Diagnosis
• Hypertension
• Eye diseases
• Menopausal complaints
• Migraine headaches
• Upper digestive tract bleeding
• Ear disturbances
• Serious psychological problems

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Deficient Liver Yin

• Often overlaps with Deficient Liver Blood but has
  distinct signs and is said to be deeper.
• Empty Fire pattern combined with the usual signs
  of Deficient Yin.
• Turbid Mucus Disturbing Head Deep Spleen
  pattern often accompanies Liver Fire, Yang and
  Yin patterns. Signs are extreme dizziness,
  thick, greasy tongue moss, and slippery aspects
  of the pulse.

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Deficient Liver Yin in the West

• Essential hypertension
• Nervous disorders
• Chronic eye ailments
• Menopausal complaints

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Arrogant Liver Yang Ascending

• Combination of a pattern between Liver Fire
  Blazing Upward and Deficient Liver Yin
• Physicians must combine the signs from various
  patterns and put them together based on skill,
  experience and sensitivity to prioritize.

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Liver Wind Moving Internally

• Occurs when Liver Fire or Liver Yang precipitates
  uncontrollable and/or sudden movement or rigidity
  in the body.
• Wind usually develops out of an extreme form of
  some other Liver pattern.

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Pattern of Cold Stagnating in the Liver Meridian

• Cold obstructs in the meridian in the groin area
• Signs pain and distention, moist tongue, deep,
  wiry, slow pulse.
• In the West hernia, urogenital disorder.
• Can affect head and emotions causing headache,
  inability to express anger, hostility towards
  oneself.

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Kidney disharmonies

• Kidneys are the root of Water (Yin) and Fire
  (Yang). They allow for the inexorable unfolding
  of the life cycle.
• Kidneys Water and Fire are the foundation of the
  deep substratum that ultimately shapes the stages
  oh human life.

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Pattern of Deficient Kidney essence
(shen-jing-bu-zu)

• The Essence is the source of Yin and Yang. It is
  also a source of the inevitable movement of human
  life through birth, development, maturation,
  decline, and death.
• Deficient Kidney Essence displays signs relating
  to development, maturation, or reproduction.

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Pattern of Deficient Kidney essence
(continued)

• In a child, symptoms might include slow
• physical or mental development, or poor general
  skeletal development.
• Sexual dysfunctions such as sexual anxiety and
  pain or discomfort with intercourse often belongs
  to essence deficiency.
• Other symptoms include premature aging or
  senility, bad teeth, poor long-term memory, and
  brittle bones.

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Pattern of Deficient Kidney Yin

• The Yin of the Kidney is the source of the
  quiescence and deepest tranquility in a persons
  long-term being and behavior. The Yin is the
  ultimate stillness.
• Deficient Kidney Yin is a condition of Empty
  Fire. The stillness is reduced and there is
  relative excess of movement.
• Specific signs might include ringing in the ears
  or loss of hearing, sore back, premature
  ejaculation, long-term forgetfulness, and
  vertigo.

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Deficient Kidney Yin continued

• Person with deficient Kidney Yin prefers a cooler
  room, few extra clothes, and winter to the
  summer.
• Other signs are thin or shriveled constitution,
  dry throat, dry skin, hot palms and soles, red
  cheeks, heat flashes, night sweats, reddish
  tongue with little moss, and a thin, rapid pulse.
  
• Western doctors might correlate deficient Kidney
  Yin with essential hypertension, lumbago, chronic
  ear problems, diabetes, chronic urogenital
  infections, menopausal complaints ets.

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Pattern of Deficient Kidney Yang(also called
Weak Life Gate Fire)

• The Kidney Yang is the Fire of human life. It is
  the ultimate resolution and the most powerful
  assertion of will.
• Its signs include a bright white or darkish face,
  wet skin, subdued quiet manner, fear of cold, and
  cold limbs.
• Constitutional long-term tendency drives patients
  to turn the thermostat up, wear extra clothes,
  and prefer summer to winter.
• Cold and sore lower back, lack of libido, sexual
  anxiety, sterility, loose teeth, clear urine,
  night urination.

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Pattern of Deficient Yang continued

• Person can be paralyzed by fear, the unknown
  incapacitates his or her ability to move and
  mobilize. Such person will tend toward passivity.
  They can easily be controlled by other people,
  easily take blame, and feel guilty.
• He or she experiences a disproportionately large
  sense of responsibility for a comparatively small
  amount of volition.

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Heart Disharmonies

• Heart is responsible for a human beings timely
  interaction in time and place. It allows for
  manners, ceremony and propriety.
• The heart stores the Heart Spirit and also rules
  the blood and is responsible for the evenness of
  the pulse.

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Pattern of deficient Heart Blood

• When Blood (Yin) is unable to embrace the Qi
  (Yang), these signs occur heart palpitation,
  sweating, forgetfulness, insomnia, anxiety with
  situation or people.
• We must distinguish between the Blood pattern and
  the Yin pattern Blood forgets routine things
  while Yin forget names of people or places, Blood
  pattern includes pale face and a thin pulse while
  Yin pattern will have a reddish face, rapid pulse
  and other signs of heat.
• Sometime the two overleap and are hard to
  distinguish. Western doctors often find this
  deficiency as cardiovascular disorders
  characterized by anemia, hypertension and anxiety
  disorders.

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Patterns of Deficient Heart Qi and Heart Yang

• These patterns can be associated with the absence
  of the tension or assertion needed to make a
  connection with people. Signs may include lacking
  warmth in connecting to people, being unable to
  sustain a conversation, being unable to
  communicate ones meaning or intention, or being
  too slow to express oneself.
• With these deficiencies, western doctors often
  observe cardiac insufficiency, coronary
  atherosclerosis, angina pectoris, or anxiety
  disorders.

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Patterns of Congealed Heart Blood

• Congealed Heart Blood will manifest Yang signs of
  stabbing pain and purple face and tongue, along
  with such Yin signs as lassitude, palpitations,
  and shortness of breath.
• Patients manifesting the pattern of Congealed
  blood are often diagnosed in Western terms as
  suffering from angina pectoris, pericarditis, or
  coronary artery disease.
• Chinese doctor needs to determine it the pattern
  is one of excess or deficiency and what other
  organs are involved.

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Patterns of Cold Mucus Confusing the Heart
Opening and Mucus Fire Agitating the Heart

• Person with this disharmony is disoriented and
  not relating to ordinary reality. From a Western
  perspective, these mucus patterns imply serious
  mental disease.
• Cold mucus inward, restrained, foolish manner,
  muttering to oneself, delusions, staring at walls
  and sudden blackouts.
• Mucus Fire assertive, agitated and aggressive
  person, may incessantly talk.

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Lung Disharmonies

• The Lungs are the most susceptible to External
  Pernicious Influences
• They rule respiration and animated reactivity

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Cold Violating the Lungs

• Cold signs
• Chills, fever, head and body aches, and lack of
  perspiration
• Other signs
• Floating, tight pulse, stuffy or runny nose Thin,
  white tongue moss, asthma or cough

• Western relatives
• Common cold
• Bronchitis
• Bronchial asthma
• Emphysema

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Heat Clogging the Lungs

• Heat signs
• Fever, chills, perspiration, thirst,
  constipation, dark urine, red tongue with dry
  yellow moss, and a fast pulse
• Lung specific signs
• Red/sore/swollen throat, asthmatic breathing,
  full cough, runny nose with thick yellow phlegm

• Western relatives
• Common cold
• Bronchitis
• Pneumonia
• Tonsillitis
• Pulmonary abscess

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Mucus Dampness Hindering the Lungs

• Common signs
• Full, high pitch cough
• Wheezing
• Asthma w/ lots of phlegm
• Chest and side soreness
• Difficulty breathing lying down
• Thin, greasy tongue moss

• Western relatives
• Chronic bronchitis
• Bronchial asthma

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Deficient Lung Yin

• Common signs
• Dry cough w/ little or no phlegm
• Bloody sputum
• Emaciated appearance
• Low voice
• Red cheeks
• Afternoon fever
• Night sweats

• Reddish tongue
• Thin, rapid pulse
• Western relatives
• Pulmonary tuberculosis
• Pharyngitis
• Bronchiectasis
• Chronic bronchitis

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Deficient Lung Qi

• Common signs
• Exhausted appearance and spirit
• Low voice and lack of desire to talk
• Weak respiration
• Daytime sweats

• Western relatives
• Emphysema
• Chronic bronchitis
• Pulmonary tuberculosis
• Allergies
• Longstanding depression
• Chronic bereavement