Xiao Ke Patterns

Wasting/thirsting and consumptive disorders. Main etiology is yin and yang deficiencies with Interior heat. Common sx = drink, eat, and urinate too
much and have a thin body. Can describe diabetes, but thats not all. Often type 1 diabetes is more likely to have a thin body. Type 2 can have all
other sx depending on jiao affected. Huang jing, shi hu, tian hua fen, huang qi are commonly used in treatment of diabetes.
Upper Jiao (excessive thirst)

Middle Jiao (excessive hunger)

Lower Jiao (excess urination)

Heat impairs body fluids, causing dry mouth and

thirst.

Stomach heat causing excessive appetite.

Kidney yang xu causing frequent urination and thirst

Organs: LU/ HT

Organs: ST

Organs: KI/LV

Sx:
Cun kou pulse at wrist is floating/slow
o Floating=LU/ wei qi too weak to be
rooted.
o Slow= HT insufficient nutrients/yin
essence
Dry mouth, thirst

Sx:
Fu Yang pulse. Taken at ST 41 or so.
o Floating=ST Qi too weak to be rooted
o Rapid=hyperactive ST heat
Frequent urination
Constipation

Sx:
Frequent urination
Thirst

RX: Bai Hu Jia Ren Shen Tang

RX: ???

RX: Jin Gui Shen Qi Wan

Edema/Water Retention Patterns

Edema causing failure of Qi to transform water. 3 basic treatment principles: 1) promote diaphoresis/sweating if above waist, 2) promote urination if
below waist. The 3rd is for emergency below waist retention: purge downward. Harsh. Shui = edema.
Feng/Wind Edema
Pi/Skin Edema
Zheng Edema
Shi/Stone Edema
Location:
LU. Edema in face first, spreads rapidly

Location:
LU, SP. Swelling all over the body,
especially the extremities.
Pathogenesis:
Spleen and Lung qi xu, failing to
transport/regulate water passages causing
water flooding in the superficial body.
Interior of the exterior

Location:
KI, SP, LU. Fullness in ab w/wheezing

Location:
LV, KI. Fullness in ab w/o wheezing

Pathogenesis:
SP/KI yang xu qi transform prob.
Water flows upward to LU which cant
regulate passage. = flooding.
Exterior of interior

Pathogenesis:
Ki yang xu + Lv qi yu = water trapped in
LJ.

Signs/Symptoms:
Acute, very sudden onset, face first,
then rapid spread all over.
Ext syn w/ aver wind
Joint pain
Wind attx LU so may have urticaria
(acute) or impetigo (chronic
w/necrosis)

Signs/symptoms:
Slow onset
Not related to exterior syndrome
more of an internal attack.
Swelling all over the body, especially
the extremities
Water floods superficially, not in deep
tissues
Can have difficult urination because
Sp qi cannot transport fluids, cant
warm urine in bladder
Can have thirst because SP/ST qi xu
fail to transport fluids, cant moisten
mouth
Might have hx of diarrhea/dysentery

Signs/symptoms:
Full ab
Wheezing
LU pulse wiry/tight (cold/cnstrx @
LU=fluids ingested stay in intestines
and cant be dispersed by LU.
Difficult urination b/c KI cant trx
fluids in bladder, cold inhib bladder
qi.
Deep pulse with heavy breathing and
wheezing

Signs/symptoms:
Full ab
No wheezing
Feel water in the belly and hardness

Treatment By Differentiation/Sx
Wind edema + heat
Over whole body, float pulse, thirst ,
possibly no high fever
Yue Bi Tang

Treatment By Differentiation/Sx
Skin edema + Heat
Edema, diff urine, deep pulse

Treatment By Differentiation/Sx
Ma Huang Fu Zi Tang

Treatment By Differentiation/Sx
??

Wind edema + exterior xu

Float pulse, heavy body, sweat, aver wind
Fang Ji Huang Qi Tang

Skin edema + Exterior Excess

No sweating

Pathogenesis:
Exterior wind + interior water in conflict
causing flooding@ skin level
Exterior of the Exterior

Yue Bi Jia Zhu Tang

Yue Bi Tang + bai zhu

Gan Mao Ma Huang Tang

If floating pulse with cough
Xing Zi Tang

Skin edema + Exterior Deficiency

Edema in extrems, trembling limbs
Fang Ji Fu Ling Tang

Interior of the interior

Miscellaneous types of Edema

Huang Han
(Yellow Sweating Edema)

Blood + Water Level Syndrome

Location:
SP, LU. Edema in 4 extremities and face.

Edema following the absence of

menstruation/dysmenorrhea

Location: UJ, MJ, qi and blood

Pathogenesis:
Water damp obstruction in Ying, Wei

Blood level. Blood stasis blocking water

passages. Harder to treat.

Pathogenesis:
UJ/MJ yang qi xu, qi and blood xu
with cold.

Signs/symptoms:
Edema in extrems, face
Yellow sweating, stains white
clothing damp + heat like Hep A
No aversion to wind
P=deep, slow

Edema preceding the absence of

menstruation/ dysmenorrhea

Signs/symptoms:
Slow/choppy pulse in 1st
Feeble slow fu yang pulse
Cold limbs, chills d/t yang qi
obstrx.
Fullness in abdomen
Bone pain d/t blood obstruction

Signs/symptoms:
Pregnancy
Heavy sensation in body
Difficult urination
Chills
Dizziness

Treatment by diff/sx
Wei Obstrx + Ying Heat
Exterior xu + damp obstrx. Sx above.
Similar to wind edema.
Huang Qi Shao Gui Ku Jiu Tang

Treatment by diff/sx
Yang Xu + Yin Coagulation
Hardness in epigastria d/t water ret
Gui Zhi Qu Shao Yao Jia Ma
Huang Xi Xin Fu Zi Tang

Treatment
Food therapy works best. Winter melon
and wax melons

Qi Xu + Damp Obstrx Yang Qi@upper

Fever with cold lower limbs.
Gui Zhi Jia Huang Qi Tang

Spleen Qi Xu + Qi Obstruction
Zhi Zhu Tang

Kui Zi Fu Ling San

Water level. Water pathogen blocking

blood flow. Easier to treat.

Qi Level Syndrome

Pregnancy Edema
Edema related to pregnancy

Convulsion (Jing) Patterns

Internally can be due to either constitutional body fluid (BF) insufficiency or improper BF transportation
Externally can be from external wind cold or improper treatment of disease. Location is in the tendons and sinews. Main sx for convulsions/Jing are
1) body fevers and cold feet, fevers in head, red face and blood shot eyes with head trembling 2) neck rigidity, trismus (jaw spasms), and
opisthotonos, 3) aversion to cold. Dont promote heavy sweating for this patient! This leads to cold and damp, weakens wei Qi and makes cold
aversion worse. Look for a snake or uneven pulse. Danger, Will Robinson!
Rou Jing

Gang Jing

Jing d/t Interior Heat

Wind cold deficiency, Taiyang syndrome

Wind cold excess

Yangming organ disease + Jing syndrome

(heat consumes BFs)

Signs/Symptoms:
Rigidity throughout body (opisthotonos)
Fever
Sweating
No aversion to cold
P=deep and slow d/t BF insufficiency

Signs/Symptoms:
Trismus (jaw clench/spasms, cant open fully)
Fever
No sweating
Aversion to cold
Scanty urine d/t BF depletion
Qi rushes up to chest

Signs/Symptoms:
Fullness in the chest, retained internally
Trismus
Opisthotonos
Cramps in feet/legs
Grinding of teeth

RX: Gua Lou Gui Zhi Tang

(Gui zhi tang + tian hua fen)

RX: Ge Gen Tang

(Gui zhi tang + ma huang and ge gen)

RX: Da Cheng Qi Tang

(purge to rescue BFs)

Chest Bi
The most common pattern is chest Bi, obstruction, heart pain and shortness of breath. Yang xu of upper jiao with excess yin cold leading to chest
yang obstruction. Cun pulse will be weak due to UJ yang xu. Guan pulse will be wiry due to yin cold evil with fluid retention. The root is yang xu,
the branch is the yin cold. There are exceptions to this typical type shown below. All are still forms of chest bi.
Yang Xu + Yin Excess in UJ

Phlegm and Turbid Excess

Typical pattern

Qi Obstruction in Chest
Excess type

Signs/Symptoms:
Chest pain radiating to shoulder
Panting/dyspnea (SOB) and coughing
P: 1st = deep/slow, 2nd=wiry/tense

Signs/Symptoms:
Chest pain radiating to back
Cannot lie down and breathe

Signs/Symptoms:
Fullness in chest
Hypochondriac distention

RX: Gua Lou Xie Bai Bai Jiu Tang

RX: Gua Lou Xie Bai Ban Xia Tang

RX: Zhi Shi Xie Bai Gui Zhi Tang

Other patterns to recognize, but dont really have to memorize? They werent highlighted on the to know formula sheet, so might ignore.
Qi Obstruction in Chest
Water Retention > Qi Stagnation Qi Stagnation > Water Retention
Acute
Deficient type

Mild pattern

Mild pattern

Signs/Symptoms:
Not discussed in slides/class

Signs/Symptoms:
Not discussed in slides/class

Signs/Symptoms:
Slight damp accumulation

Signs/Symptoms:
Pain and damp leading to Bi

RX: Ren Shen Tang

RX: Fu Ling Xing Ren Gan Cao Tang

RX: Ju Zhi Jiang Tang

RX: Yi Yi Fu Zi San

Xin Tong
Location is the epigastriumThis is not chest bi, but will feel similar to the patient. Pain is in the heart and epigastrium are due to deficiency of yang
and excess of yin. This shows in the pulse, too.
Adverse Upflow of Qi
Cold Coagulation
Due to cold with water retention and coagulation
Signs/Symptoms:
Epigastric and heart pain
Fluid retention

Signs/Symptoms:
Severe pain from heart to chest and from chest to heart (?)

RX: Gui Zhi Sheng Jiang Zhi Shi Tang

RX: Wu Tou Chi Shi Zhi Wan

Masses versus Fetus in the Abdomen

Zheng Disease

Pregnancy

Mass in the abdomen, might be mistaken for a fetus

No period for less than 3 months
Bloody vaginal discharge
Palpate around and above the umbilicus. Fetus cant be felt here early in pregs.
If feels movement above umbilicus, early in PG probably not a fetus, but zheng

3 months of normal period prior to absence of menses (PG)

Can palpate/feel fetus in about 6th month.

RX: Gui Zhi Fu Ling Wan

Rxs for Pregnant (PG) Patients

These are theoreticalwdnt really use these. Too harsh. Know the highlighted ones and what they treat.
Morning Sickness
Morning Sickness
Ab Pain

Ab Pain

Mild

Severe

Diff: Yang Xu with Deficient Cold

Diff: Disharmony of Lv/Sp

Nausea, no vomiting, No fever or chills

P: normal, cd be weak in 1st

Nausea with vomiting

Preg for 6-7 months, Fever, Ab pain with

cold, Chills in lower abdomen, P=wiry

Preg with dull chronic ab pain

Gui Zhi Tang

Gan Jiang Ren Shen Ban Xia Tang

Fu Zi Tang

Dang Gui Shao Yao San

Bao Zu

Urinary Difficulty

PG Edema

Vag bleeding, ab pain with PG

Blood xu with heat retention

Chronic bleeding, miscarriage

Diff urination during PG, normal appetite.

Heavy all over body, difficult urination,

chills, dizziness

Jiao Ai Tang

Dang Gui Bei Mu Ku Shen Wan

Kui Zi Fu Ling San

Restless Fetus

Restless Fetus

Blood Xu with Damp Heat

Spleen Xu with Damp Cold

Dang Gui San

Bai Zhu San

Know Post Partum ab pain due to interior cold with blood xu = Dang Gui Sheng Jiang Yang Rou Tang

Shi Syndromes
Humidity fever, heavy body, joint pain. Can be external due to damp heat or due to yang deficiency and Spleen deficiency. M/C Qs:
Exterior Damp Cold
Exterior Wind Damp
Excess type
See more below
Ma Huang Jia Zhu Tang

Exterior Wind Damp Xu

Deficiency type
See more below
Fang Ji Huang Qi Tang

Excess type
See more below
Ma Xing Yi Gan Tang

Exterior Wind > Damp

Exterior Damp > Wind

Exterior W/D + Yang Xu

Deficiency type

Deficiency type

Deficiency type

Gui Zhi Fu Zi Tang

Bai Zhu Fu Zi Tang

Gan Cao Fu Zi Tang

Essay Qs. Know these comparisons and ingredients.

Ma Huang Jia Zhu Tang

Ma Xing Yi Gan Tang

Fang Ji Huang Qi Tang

Differentiation: Exterior Cold Damp Excess type

Exterior cold leads to interior damp, obstructs
Yang in external channels/collaterals

Differentiation: Exterior Wind Damp Excess

Wind obstruction with damp accumulations
which obstruct Yang qi and lead to
accumulations of heat.

Differentiation: Wind Damp Exterior Deficiency

Wei Qi deficiency with Spleen deficiency and
an exterior wind damp invasion.

Rx promotes sweating, harmonizes ying and wei. Has

warm pungent herbs to dissipate cold and dispel damp.

Rx resolves exterior and dispels damp. Dispersing herbs

and eliminate exterior will elim damp and fortify spleen.

Rx strengthens qi, eliminates dampness. When px feels

sensation of bugs crawling under skin shows wei qi is
invigorated.

Ingredients:
Ma huang
Gui Zhi
Xing Ren
Gan Cao
Bai Zhu
Can add cang zhu also. Rx is based on Ma Huang Tang.

Ingredients:
Ma huang
Yi Yi Ren
Xing Ren
Gan Cao

Ingredients:
Fang ji
Gan Cao
Bai Zhu
Huang Qi

Sx:

Sx:
Fever from 3-5pm (Yangming time)
Worse sx with changes in humidity, rain

Sx:

Vexation
Heavy fixed pain
Both morning and night fevers
No sweating
Long term dampness conditions

Sweating
Aversion to wind
Heavy sensation
Dampness w/o pain
P: floating

Vomiting
Know the differences between these Rxs.
Xiao Ban Xia Tang

Ban Xia Gan Jiang San

Treats vomiting, both hot and cold types. Can be used in low doses to treat morning
sickness.

Faster, stronger and warmer than Xiao Ban Xia Tang. This rx is powdered herb for
faster and more complete absorption. Better to disperse cold than Xiao Ban Xia Tang.

Contains ban xia and gan cao

Contains ban xia and gan jiang.