DSY Final Review DSY class 13-14

Heart Patterns Differentiation and Treatment

Deficiency patterns

HEART-QI DEFICIENCY Palpitations, shortness of breath on exertion, sweating, pallor, tiredness, listlessness. Tongue: Pale or normal color. Severe cases: midline crack reaching the tip with swelling on either side. Pulse: Empty. Severe cases: Overflowing and Empty (very superficial and somewhat pounding with light pressure but empty with heavier pressure). Key symptoms: palpitations, tiredness, Empty pulse.

HEART-YANG DEFICIENCY Palpitations, shortness of breath on exertion, tiredness, listlessness, sweating, feeling of stuffiness or discomfort in the heart region, feeling of cold, bright-pale face, cold limbs (especially hands). Tongue: Pale, wet, Swollen. Pulse: Deep-Weak or Knotted. Key symptoms: palpitations, feeling of cold, cold limbs, Deep pulse.

HEART-YANG COLLAPSE Palpitations, shortness of breath, weak and shallow breathing, profuse sweating, cold limbs, cyanosis of lips, severe cases coma. Tongue: Very Pale or Bluish-Purple, Short. Pulse: Hidden-Minute-Knotted. Key symptoms: cyanosis of lips, Hidden ‐ Minute pulse, cold limbs.

Palpitations, dizziness, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, dull- pale complexion, pale lips. Tongue: Pale, Thin, slightly dry. Pulse: Choppy or Fine. Key symptoms: palpitations, insomnia, poor memory, Pale tongue. HEART-BLOOD DEFICIENCY

SPLEEN- AND HEART- BLOOD DEFICIENCY Palpitations, dizziness, insomnia, dream- disturbed sleep, poor memory, anxiety, propensity to be startled, dull-pale complexion, pale lips, tiredness, weak muscles, loose stools, poor appetite, scanty menstruation. Tongue: Pale, Thin, slightly dry. Pulse: Choppy or Fine. Key symptoms: palpitations, insomnia, poor memory, Pale tongue.

HEART-YIN DEFICIENCY Palpitations, insomnia, dream-disturbed sleep, propensity to be startled, poor memory, anxiety, mental restlessness, "uneasiness", "fidgetiness", malar flush, feeling of heat especially in the evening, night sweating, dry mouth and throat, 5-palm heat. Tongue: Red, no coating, tip redder and swollen with red points, deep midline crack reaching the tip. Pulse: Floating-Empty-Rapid or Fine ‐ Rapid. May be Overflowing in Front and Weak in Rear positions. Key symptoms: palpitations, mental restlessness, feeling of heat, malar flush, Red-Peeled tongue, deep midline crack.

KIDNEY AND HEART NOT HARMONIZED Palpitations, mental restlessness, insomnia, dream- disturbed sleep, anxiety, poor memory, dizziness, tinnitus, deafness, lower backache, nocturnal emissions with dreams, fever or feeling of heat in the evening, night sweating, 5-heart heat, scanty- dark urine. Tongue: Red-Peeled, tip redder, midline crack reaching tip. Pulse: Floating-Empty, Rapid or Deep weak rear with front Overflowing. Key symptoms: palpitations, insomnia, night sweating, Red-Peeled tongue with redder tip and midline crack.

Excess patterns

Palpitations, thirst, mouth and tongue ulcers, mental restlessness, feeling agitated, "impulsiveness", feeling of heat, insomnia, red face, dark urine or blood in urine and bitter taste. Tongue: Red, tip redder and swollen with red points, yellow coating; may be midline crack reaching to the tip. Pulse: Full-Rapid-Overflowing especially on the left Front position. It could also be Hasty. Key symptoms: tongue ulcers, thirst, palpitations, Red tongue. HEART-FIRE BLAZING

FULL-HEAT IN THE SMALL INTESTINE Mental restlessness, insomnia, tongue/mouth ulcers, pain in the throat, deafness, uncomfortable feeling and heat sensation in the chest, abdominal pain, thirst for cold liquids, scanty and dark urine, burning painful urination, blood in urine. Tongue: Red with redder and swollen tip, yellow coating. Pulse: Rapid, Overflowing, especially in the Front position. Urinary symptoms, will be wiry in rear. Key symptoms: abdominal pain, tongue ulcers, scanty-dark-painful urination.

PHLEGM-FIRE HARASSING THE HEART Mental restlessness, palpitations, bitter taste, insomnia, dream disturbed sleep, easily startled, incoherent speech, mental confusion, rash behavior, tendency to hit or scold people, uncontrolled laughter or crying, agitation, shouting, muttering to oneself, mental depression and dullness; in severe cases aphasia and coma. Tongue: Red, yellow-sticky coating, midline crack with yellow prickles in it. Tip may be redder and swollen with red points. Pulse: Full-Rapid-Slippery or Rapid-Overflowing- Slippery or Rapid-Full-Wiry.

Mental confusion, unconsciousness, lethargic stupor, vomiting, rattling sound in the throat, aphasia. Tongue: Thick-sticky-slippery coating, midline crack reaching the tip with prickles in it. Tongue ‐ body Swollen. Pulse: Slippery. Key symptoms: mental confusion, rattling sound in throat, sticky-slippery tongue coating. PHLEGM MISTING THE MIND

HEART-BLOOD STAGNANT Palpitations, pain in the heart region which may radiate to the inner aspect of the left arm or to the shoulder, discomfort or feeling of oppression or constriction of the chest, cyanosis of lips and nails, cold hands. Tongue: Purple. Pulse: Knotted. Key symptoms: pain in the heart region, cyanosis of lips, purple tongue.

Liver Patterns

a. Feeling of distension of hypochondrium, chest, epigastrium or abdomen, sighing. b. Melancholy, depression, moodiness, fluctuation of mental state, "feeling wound-up", feeling of lump in the throat. c. Irregular periods, painful periods, distension of breasts before the periods, pre-menstrual tension and irritability. Tongue: the body color may be normal, or with red sides. Pulse: Wiry, especially on the left side. Key symptoms: hypochondriac and chest distension, depression, moodiness, Wiry pulse. STAGNATION OF LIVER-QI

Irritability, propensity to outbursts of anger, tinnitus, deafness, temporal headache, dizziness, red face and eyes, thirst, bitter taste, dream ‐ disturbed sleep, constipation with dry stools, dark-yellow urine, epistaxis, hematemesis, hemoptysis. Tongue: Red body, redder on the sides, yellow coating, dry. Pulse: Full-Wiry-Rapid. Key symptoms: irritability, red face, red eyes, Red tongue with yellow coating. LIVER-FIRE BLAZING UPWARDS

LIVER-YANG RISING Headache which may be on the temples, eyes or lateral side of the head, dizziness, tinnitus, deafness, dry mouth and throat, insomnia, irritability, feeling worked-up, shouting in anger. Tongue: Red, especially on the sides, though may vary with underlying condition. Pulse: Wiry. Key symptoms: headache, irritability, Wiry Pulse.

DAMP-HEAT IN LIVER Fullness and pain of hypochondrium, chest, abdomen or hypogastrium, bitter or sticky taste, nausea, vomiting, poor appetite, feeling of heaviness, yellow vaginal discharge, vulvar eczema or sores, mid-cycle bleeding or pain, pain-redness-swelling of scrotum, vaginal or genital itching or rashes, dark urine, dysuria, burning urination. Tongue: Red body, sticky-yellow coating. Pulse: Slippery-Wiry-Rapid. Key symptoms: fullness in abdomen and hypochondrium, feeling of heaviness, nausea, bitter or sticky taste, sticky yellow coating, Slippery pulse.

STASIS OF LIVER-BLOOD Vomiting of blood, epistaxis, painful periods, irregular periods, menstrual blood dark and clotted, abdominal pain, "masses" in abdomen, purple nails, purple lips, purple complexion, dry skin (in severe cases), petechiae. Tongue: Purple especially on the sides, with purplish spots. Pulse: Wiry. Key symptoms: dark and clotted menstrual blood, Purple tongue.

Fullness and distension of the hypogastrium with pain which refers to the scrotum and testis. Straining of the testis or contraction of the scrotum. In women there can be shrinking of the vagina. The pain is alleviated by warmth. Tongue: Pale, wet, white coating. Pulse: Wiry-Deep-Slow. Key symptoms: hypogastric pain referring to scrotum, Wiry-Deep-Slow Pulse. STAGNATION OF COLD IN THE LIVER CHANNEL

Deficiency Patterns

DEFICIENCY OF LIVER- BLOOD Dizziness, numbness of limbs, insomnia, blurred vision,"floaters" in eyes, scanty menstruation or amenorrhea, dull-pale complexion, pale lips, muscular weakness, muscle spasms, cramps, withered and brittle nails, dry hair and skin. Tongue: Pale especially on the sides which can assume an orange color, and Dry. Pulse: Choppy or Fine. Key symptoms: blurred vision, scanty periods, dull-pale complexion, Pale tongue.

LIVER-YIN DEFICIENCY Dizziness, numbness or tingling of limbs, insomnia, blurred vision,"floaters" in eyes, diminished night vision, scanty menstruation or amenorrhea, dull-pale complexion without luster but with red cheekbones, muscular weakness, cramps, withered and brittle nails, very dry hair and skin, depression, feeling of aimlessness. Tongue: normal color, no coating or with rootless coating. Pulse: Floating Empty. Key symptoms: blurred vision, dry eyes, uncoated tongue.

KIDNEY- AND LIVER-YIN DEFICIENCY Dizziness, tinnitus, deafness, dull occipital or vertical headache, insomnia, numbness of limbs, malar flush, dry eyes, blurred vision, lower backache, dry throat, dry hair and skin, vaginal dryness, night sweating, dry stools, nocturnal emissions, scanty menstruation or amenorrhea, delayed cycle, infertility. Tongue: Normal or Red with rootless or no coating. Pulse: Floating-Empty (or Choppy). Key symptoms: dry eyes, dry throat, night sweating, scanty menstruation, Red-Peeled tongue.

Deficiency/Excess Patterns

The general clinical manifestations of Liver ‐ Wind are: tremor, tic, numbness, dizziness, vertigo, headache and convulsions or paralysis. Internal Wind signs are characterized by movement or the absence of it, hence the tremor and convulsions or paralysis (as in Wind-stroke). LIVER-WIND

High temperature, convulsions, rigidity of the neck, tremor of limbs, opisthotonos, in severe cases coma. Tongue: Deep-Red, Stiff, thick yellow coating. Pulse: Wiry-Rapid-Full. Key symptoms: high temperature, convulsions, Stiff tongue. EXTREME HEAT GENERATING WIND

LIVER-YANG RISING CAUSING WIND Maciocia gives three subtypes of this pattern: a) Liver ‐ Yang Rising deriving from Liver ‐ Yin Deficiency b) Liver ‐ Yang Rising deriving from Liver ‐ and Kidney-Yin Deficiency c) Liver ‐ Yang Rising deriving from Liver ‐ Blood Deficiency

a) Liver ‐ Yang Rising deriving from Liver ‐ Yin Deficiency Tremor, facial tic, severe dizziness, tinnitus, headache, hypertension, dry throat, dry eyes, blurred vision, numbness or tingling of limbs, poor memory Tongue: Normal colored without coating Pulse: Wiry-Fine

b) Liver ‐ Yang Rising deriving from Liver ‐ and Kidney-Yin Deficiency same as above but with backache, scanty urine, night sweats Tongue: Normal colored without coating Pulse: Wiry-Fine

c) Liver ‐ Yang Rising deriving from Liver ‐ Blood Deficiency Tremor, dizziness, tinnitus, headache, hypertension, dry throat, blurred vision, numbness or tingling of limbs, poor memory, insomnia Tongue: Pale and Thin Pulse: Wiry-Fine

Fine tremor, dizziness, blurred vision, numbness or tingling of limbs, poor memory, insomnia, scanty periods Tongue: Pale and Thin Pulse: Wiry-Fine LIVER-BLOOD DEFICIENCY GENERATING WIND

Irritability, abdominal distension and pain, alternation of constipation and diarrhea, stools sometimes dry and bitty and sometimes loose, flatulence, tiredness. Tongue: Red on the sides or Pale. Pulse: Weak on the right and Wiry on the left. Key symptoms: alternation of constipation and diarrhoea, abdominal distension and pain. LIVER INVADING THE SPLEEN

Lung Patterns DSY class 4

Deficiency Patterns

LUNG-QI DEFICIENCY Slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike of speaking, bright-pale complexion, propensity to catching colds, tiredness, dislike of cold. Tongue: Pale. Pulse: Empty, particularly in the right Front position. Key symptoms: shortness of breath, weak voice, Empty Pulse.

KIDNEYS FAILING TO RECEIVE QI Shortness of breath on exertion, rapid and weak breathing, difficulty in inhaling, cough, asthma, sweating, cold limbs, cold limbs after sweating, swelling of the face, thin body, mental listlessness, clear urination during asthma attack, soreness of the back. Tongue: Pale. Pulse: Weak, Tight, Deep. Key symptoms: shortness of breath on exertion, sweating, clear urination.

Cough which is dry or with scanty sticky sputum, weak and/or hoarse voice, dry mouth and throat, tickly throat, tiredness, dislike of speaking, thin body or chest, night sweating. Tongue: Normal color, dry without coating or rootless coating in front. Pulse: Floating-Empty and Rapid. Key symptoms: dry cough, weak-hoarse voice, dry throat, night sweating. LUNG-YIN DEFICIENCY

KIDNEY- AND LUNG-YIN DEFICIENCY Dry cough which is worse in the evening, dry throat and mouth, thin body, dizziness, tinnitus, breathlessness on exertion, lower backache, night sweating, 5-heart heat, scanty urination. Tongue: Normal or Red with rootless or no coating. Pulse: Floating-Empty, possibly rapid. Key symptoms: dry cough, tongue with rootless or no coating.

Excess Patterns

INVASION OF LUNGS BY WIND-COLD Aversion to cold, fever, cough, itchy throat, slight breathlessness, blocked or runny nose with clear-watery discharge, sneezing, occipital headache, body aches. Tongue: thin-white coating. Pulse: Floating-tight. Key symptoms: aversion to cold, sneezing, Floating pulse.

INVASION OF LUNGS BY WIND-HEAT Cough, fever, aversion to cold, cough, sore throat, blocked or runny nose with yellow discharge, sneezing, headache, body aches, slight sweating, slight thirst, swollen tonsils. Tongue: slightly Red on the sides or tip, possibly thin white or yellow coating. Pulse: Floating-Rapid. Key symptoms: Fever, aversion to cold, sore throat, Floating-Rapid pulse.

INVASION OF LUNGS BY WIND-WATER Sudden swelling of eyes and face, gradually spreading to the whole body, bright-shiny complexion, scanty and pale urination, aversion to Wind, fever, cough, slight breathlessness. Tongue: White-sticky coating. Pulse: Floating-Slippery. Key symptoms: sudden swelling of face, aversion to Wind, Floating-Slippery pulse.

Cough, slight breathlessness, feeling of heat, chest ache, flaring of nostrils, thirst, red face. Tongue: Red with yellow coating. Pulse: Overflowing-Rapid. Key symptoms: cough, feeling of heat, thirst, red tongue with yellow coating. LUNG HEAT

Breathlessness, asthma, fullness and stuffiness of the chest and hypochondrium, cough, yellow or blood-tinged sputum, headache, dizziness, red face, thirst, bitter taste, scanty-dark urine, constipation. Tongue: Red, redder on the sides, swollen in the front part, yellow coating. Pulse: Wiry and Slippery. Key symptoms: breathlessness, asthma, fullness of hypochondrium, headache, Wiry pulse. LIVER-FIRE INSULTING THE LUNGS

PHLEGM-HEAT IN THE LUNGS Barking cough, profuse sticky yellow or green sputum, shortness of breath, wheezing, feeling of oppression of the chest, feeling of heat, thirst, insomnia, agitation, dizziness and heaviness of the head. Tongue: Red, swollen, thick-sticky yellow coating. Pulse: Slippery-Rapid-Full. Key symptoms: cough, yellow or green sputum, thick-sticky yellow coating, Rapid- Slippery pulse.

DRY-PHLEGM IN THE LUNGS Dry cough with occasional expectoration of scanty sputum, shortness of breath, feeling of oppression of the chest, scanty phlegm in the throat, heaviness in the head, dizziness, dry throat, wheezing, pasty-dry complexion. Tongue: swollen with dry-sticky coating. Pulse: Fine-Slippery. Key symptoms: Dry cough with occasional expectoration of scanty sputum, feeling of oppression of the chest.

DAMP-PHLEGM IN THE LUNGS Chronic cough coming in bouts, profuse white sticky sputum which is easy to expectorate, white- pasty complexion, phlegm in the throat, feeling of oppression of the chest, shortness of breath, dislike of lying down, wheezing, nausea, feeling of heaviness, dizziness and heaviness of the head. Tongue: Swollen with sticky white coating. Pulse: Slippery or Soggy. Key symptoms: Chronic cough with profuse white sputum, thick-sticky white tongue coating.

Cough with expectoration of white ‐ watery sputum, aggravated by exposure to cold, cold feeling, cold hands, phlegm in the throat, dizziness, feeling of oppression and/or cold in the chest, feeling of heaviness, heaviness in the head. Tongue: Swollen, wet with sticky white coating. Pulse: Slippery-Slow. COLD-PHLEGM IN THE LUNGS

PHLEGM-FLUIDS OBSTRUCTING THE LUNGS Cough with expectoration of of white-watery sputum, breathlessness, splashing sounds in the chest, vomiting of white-watery-frothy sputum, feeling of oppression of the chest, dizziness and heaviness of the head, cough which may be elicited by a scare. Tongue: Pale body, thick-sticky white coating. Pulse: Fine and Slippery or Weak-Floating. Key symptoms: cough with white-watery-frothy sputum.

KIDNEY-YANG DEFICIENT, WATER OVERFLOWING Edema especially of legs and ankles, cold feeling in legs and back, fullness and distension of abdomen, soreness of lower back, feeling cold, scanty-clear urination. Water overflowing to the Lungs: the above symptoms plus thin-watery-frothy sputum, cough, asthma and breathlessness on exertion.

Spleen Patterns DSY class 5

Deficiency patterns

SPLEEN-QI DEFICIENCY Poor appetite, abdominal distension after eating, tiredness, lassitude, desire to lie down, pale complexion, weakness of the limbs, loose stools, depression, tendency to obesity. Tongue: Pale. Pulse: Empty. Key symptoms: Poor appetite, tiredness, loose stools.

SPLEEN-YANG DEFICIENCY Poor appetite, slight abdominal distension after eating, tiredness, lassitude, desire to lie down curled up, pale complexion, weakness of the four limbs, loose stools, edema, feeling cold, cold limbs. Tongue: Pale, wet. Pulse: Weak, Deep. Key symptoms: loose stools, feeling cold, cold limbs and tiredness.

KIDNEY- AND SPLEEN-YANG DEFICIENCY Lower backache, cold weak knees, desire to lie down, abdominal distension, poor appetite, feeling cold, cold limbs, abundant ‐ clear or scanty-clear urination, loose stools, diarrhea at dawn, edema of the legs, feeling of cold in the back, chronic diarrhea, borborygmi, watery diarrhea. Tongue: Pale, wet. Pulse: Deep, Weak. Key symptoms: chronic diarrhea, feeling of cold in the back, Deep-Weak pulse.

SPLEEN-QI SINKING Any of the symptoms and signs of Spleen-Qi deficiency with the addition of: bearing down sensation in the abdomen, prolapse of stomach, uterus, anus or vagina, frequency and urgency of urination, menorrhagia. Tongue: Pale. Pulse: Weak. Key symptoms: bearing down sensation, Weak Pulse.

SPLEEN NOT CONTROLLING BLOOD Any of the Spleen-Qi deficiency manifestations, plus: blood spots under the skin, blood in the urine or stools, excessive uterine bleeding. Tongue: Pale. Pulse: Weak or Fine. Key symptoms: Fine Pulse, Pale tongue and bleeding.

Excess Patterns

COLD-DAMPNESS INVADING THE SPLEEN Poor appetite, feeling of fullness of the abdomen and epigastrium, feeling of cold in the epigastrium which improves with the application of warmth, feeling of heaviness of the head and body, sweetish taste or absence of taste, no thirst, loose stools, white vaginal discharge, lassitude, tiredness, nausea, edema, dull-white complexion. Tongue: Pale with sticky-white coating. Pulse: Slippery-Slow. Key symptoms: abdominal fullness, feeling of heaviness, sticky tongue coating.

DAMP-HEAT INVADING THE SPLEEN Fullness of epigastrium & lower abdomen, poor appetite, feeling of heaviness, thirst without desire to drink, nausea, vomiting, loose stools with offensive odor, burning sensation of the anus, scanty dark-yellow urination, feeling of heat, low- grade fever, dull headache with heaviness of the head, yellow complexion, yellow sclera of eyes, oily sweat, bitter taste, itchy skin or skin eruptions, sweating which does not reduce fever. Tongue: Red, sticky-yellow coating. Pulse: Slippery-Rapid. Key symptoms: abdominal fullness, feeling of heaviness, sticky-yellow coating.

Combined Patterns

SPLEEN-(QI) AND HEART- BLOOD DEFICIENCY Palpitations, dizziness, insomnia, dream- disturbed sleep, poor memory, anxiety, propensity to be startled, dull-pale complexion, pale lips, tiredness, weak muscles, loose stools, poor appetite, scanty menstruation. Tongue: Pale, Thin, slightly dry. Pulse: Choppy or Fine. Key symptoms: palpitations, insomnia, poor memory, Pale tongue.

Kidney Patterns DSY class 6

Lower backache, cold weak knees, sensation of cold in the back, feeling of cold, weak legs, bright-white complexion, tiredness, lassitude, impotence, premature ejaculation, decreased libido, abundant- clear urination, night urination, apathy, edema of the legs, infertility in women. Tongue: Pale, Wet. Pulse: Deep-Weak. Key symptoms: cold in the back, abundant- clear urination, Pale tongue, Deep Pulse. KIDNEY-YANG DEFICIENCY

KIDNEY-QI NOT FIRM Soreness and weakness of the back, weak knees, clear frequent urination, weak-stream urination, abundant urination, dribbling after urination, incontinence of urine, enuresis, urination at night, nocturnal emissions without dreams, premature ejaculation, spermatorrhea, chronic vaginal discharge, recurrent miscarriage. Tongue: Pale. Pulse: Deep-Weak especially in the Rear positions. Key symptoms: dribbling after urination, nocturnal emissions without dreams.

KIDNEY-YANG DEFICIENT, WATER OVERFLOWING Edema especially of legs and ankles, cold feeling in legs and back, fullness and distension of abdomen, soreness of lower back, feeling cold, scanty-clear urination. 1. Water overflowing to the Heart: the above symptoms plus palpitations, breathlessness, cold hands. 2. Water overflowing to the Lungs: the above symptoms plus thin-watery-frothy sputum, cough, asthma and breathlessness on exertion.

KIDNEYS FAILING TO RECEIVE QI Shortness of breath on exertion, rapid and weak breathing, difficulty in inhaling, cough, asthma, sweating, cold limbs, cold limbs after sweating, swelling of the face, thin body, mental listlessness, clear urination during asthma attack, soreness of the back. Tongue: Pale. Pulse: Weak, Tight, Deep. Key symptoms: shortness of breath on exertion, sweating, clear urination.

KIDNEY-YIN DEFICIENCY Dizziness, tinnitus, vertigo, poor memory, deafness, night sweating, dry mouth / throat at night, 5-palm heat, thirst, lower backache, ache in bones, nocturnal emissions, constipation, dark-scanty urine, infertility, premature ejaculation, anxiety. Tongue: Normal or Red with no coating, cracks. Pulse: Floating-Empty and Rapid Key symptoms: dry mouth at night, night sweating, Red-Peeled tongue.

KIDNEY-YIN DEFICIENT, EMPTY-FIRE BLAZING Malar flush, mental restlessness, night-sweating, low-grade fever, afternoon fever, feeling of heat in the afternoon/evening, insomnia, scanty-dark urine, blood in the urine, dry throat especially at night, thirst with desire to drink in small sips, lower backache, deafness, tinnitus, nocturnal emissions with dreams, excessive sexual desire, dry stools. Tongue: Red-Peeled, cracked, red tip. Pulse: Floating-Empty, Rapid. Key symptoms: malar flush, mental restlessness, dry throat at night, feeling of heat in the afternoon, Red-Peeled tongue.

KIDNEY-ESSENCE DEFICIENCY In children: poor bone development, late closure of fontanelle, mental dullness or retardation. In adults: softening of bones, weakness of knees and legs, poor memory, loose teeth, falling hair or premature greying of hair, weakness of sexual activity, lower backache, infertility (M/F), dizziness, tinnitus, dull mental function. Tongue: Pale (Yang xu) or no coating (Yin xu). Pulse: Floating-Empty or Leather. Key symptoms: children: poor bone development; adults: weak knees, falling hair, weak sexual activity.

Tongue: Pale, Swollen, wet with white coating. Pulse: Deep-Weak-Slow. Key symptoms: edema of ankles, Deep- Weak pulse, Pale-Swollen tongue. a. Water overflowing to the Heart: all the above plus palpitations. b. Water overflowing to the Lungs: all the above plus thin-watery-frothy sputum.

COMBINED PATTERNS

KIDNEY- AND LIVER-YIN DEFICIENCY Dizziness, tinnitus, deafness, dull occipital or vertical headache, insomnia, numbness of limbs, malar flush, dry eyes, blurred vision, lower backache, dry throat, dry hair and skin, vaginal dryness, night sweating, dry stools, nocturnal emissions, scanty menstruation or amenorrhea, delayed cycle, infertility. Tongue: Normal or Red with rootless or no coating. Pulse: Floating-Empty (or Choppy). Key symptoms: dry eyes, dry throat, night sweating, scanty menstruation, Red-Peeled tongue.

KIDNEY AND HEART NOT HARMONIZED Clinical manifestations Palpitations, mental restlessness, insomnia, dream- disturbed sleep, anxiety, poor memory, dizziness, tinnitus, deafness, lower backache, nocturnal emissions with dreams, fever or feeling of heat in the evening, night sweating, 5-heart heat, scanty-dark urine. Tongue: Red-Peeled, tip redder, midline crack reaching tip. Pulse: Floating-Empty, Rapid or Deep weak rear with front Overflowing. Key symptoms: palpitations, insomnia, night sweating, Red-Peeled tongue with redder tip and midline crack.

KIDNEY- AND SPLEEN-YANG DEFICIENCY Lower backache, cold weak knees, desire to lie down, abdominal distension, poor appetite, feeling cold, cold limbs, abundant ‐ clear or scanty-clear urination, loose stools, diarrhea at dawn, edema of the legs, feeling of cold in the back, chronic diarrhea, borborygmi, watery diarrhea. Tongue: Pale, wet. Pulse: Deep, Weak. Key symptoms: chronic diarrhea, feeling of cold in the back, Deep-Weak pulse.

Stomach Patterns DSY class 7

Deficiency patterns

STOMACH DEFICIENT AND COLD Discomfort or dull pain in the epigastrium, better after eating and better with pressure or massage, no appetite, preference for warm drinks and foods, vomiting of clear fluid, no thirst, cold weak limbs, tiredness, pale face. Tongue: Pale, wet. Pulse: Deep, Weak, Slow, especially on the right Middle position. Key symptoms: discomfort in the epigastrium which is better after eating, tiredness, cold limbs.

COLD INVADING THE STOMACH Sudden pain in the epigastrium, feeling cold, preference for warmth, vomiting of clear fluid, feeling worse after swallowing cold fluids which are quickly vomited, preference for warm liquids. Tongue: thick-white coating. Pulse: Deep, Slow, Tight. Key symptoms: sudden pain in epigastrium, vomiting, feeling cold, Deep- Tight Pulse.

STOMACH-YIN DEFICIENCY No appetite or slight hunger with no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon, desire to drink in small sips, slight feeling of fullness after eating. Tongue: Peeled in the centre, or with coating "without root" Pulse: Floating-Empty on the right Middle position.

STOMACH-FIRE (OR PHLEGM-FIRE) Burning epigastric pain, intense thirst with desire to drink cold liquids, excessive hunger, mental restlessness, swelling and pain in the gums, bleeding gums, sour regurgitation, dry stools, nausea, vomiting soon after eating, bad breath, feeling of heat. In case of Phlegm-Fire: feeling of oppression of epigastrium, less thirst, mucus in stools, expectoration of phlegm, mental derangement.

Tongue: Red center, yellow-dry coating (in case of Phlegm-Fire: yellow-sticky coating). Pulse: Rapid Overflowing right middle position (in case of Phlegm ‐ Fire: Slippery, Overflowing, Rapid). Key symptoms: burning sensation in epigastrium, thirst with desire to drink cold liquids, thick ‐ yellow coating, Red tongue.

Irritability, distension and pain in epigastrium and hypochondrium, fullness in epigastrium, sour regurgitation, belching, nausea, vomiting. Tongue: Red on the sides or Pale. Pulse: Weak on the right and Wiry on the left. LIVER INVADING THE STOMACH

DAMP-HEAT IN THE STOMACH Fullness and pain of the epigastrium, feeling of heaviness, facial pain, blocked nose or thick sticky nasal discharge, thirst without desire to drink, nausea, feeling of heat, yellow complexion, sticky taste. Tongue: Red, sticky-yellow coating. Pulse: Slippery-Rapid. Key symptoms: epigastric fullness, feeling of heaviness, nausea, sticky-yellow coating.

FULL-HEAT IN THE SMALL INTESTINE Mental restlessness, insomnia, tongue/mouth ulcers, pain in the throat, deafness, uncomfortable feeling and heat sensation in the chest, abdominal pain, thirst for cold liquids, scanty and dark urine, burning painful urination, blood in urine. Tongue: Red with redder and swollen tip, yellow coating. Pulse: Rapid, Overflowing, especially in the Front position. Urinary symptoms, will be wiry in rear. Key symptoms: abdominal pain, tongue ulcers, scanty-dark-painful urination.

RETENTION OF FOOD IN THE STOMACH Fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite Tongue: thick coating (which could be white or yellow). Pulse: Full, Slippery. Key symptoms: epigastric fullness, sour regurgitation, thick coating.

STASIS OF BLOOD IN THE STOMACH Severe stabbing epigastric pain, may be worse at night, dislike of pressure, nausea, vomiting of blood, vomiting of food looking like “coffee grounds”. Tongue: Purple. Pulse: Wiry. Key symptoms: stabbing pain in the epigastrium, vomiting of dark blood.