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Chapter 9. Selected Patterns of Disharmony

In TCM alone, there are scores of possible patterns of disharmony. The previous chapter introduced the three main criteria used in pattern identification. There may be only one or more than one organ involved in a pattern, and there can be complex presentations, in which Heat and Cold or Dry and Damp appear together, for example.

The Five Element system relies on some of the same criteria but has its own approach to pattern identification. There are patterns based on Qi and body fluids, along the spectrum of Yang, Qi, blood, and Yin. Other systems briefly introduced, Four Level and Six Stage, have their own patterns, as do other less common systems.

There can be some overlap among patterns, as Phlegm Misting the Heart is both a Zangfu and a body fluid pattern, and Spleen Qi Deficiency is both a Zangfu and a Qi pattern. This common pattern feature allows for great refinement and discrimination in pattern identification.

Some contemporary approaches may use Western disease names as an entry point to pattern identification, in part as an appeasement to the prevalence of Western medicine, in part because most Western-oriented patients are more comfortable with familiar terminology, and in part because the Western diagnosis offers one set of symptoms that can be included in a Chinese diagnosis. A pattern of disharmony will ultimately be used to differentiate among the many possible causes of the Western disease.

All of these patterns are important to the health professional. For our purposes, I’ll share a few patterns here to give you a better idea of what they are and how they work. Pattern diagnosis is extensive and fairly complex to try to include in your self-care assessment. Still, it’s useful to have some understanding of it both to further your knowledge of Chinese medicine and to have a frame of reference should you consult a Chinese physician for any health challenge. Readers wanting more detailed information about patterns are directed to Ted Kaptchuk’s The Web That Has No Weaver for an accessible succinct account or to Giovanni Maciocia’s The Foundations of Chinese Medicinefor a comprehensive and professional yet still very approachable textbook presentation. (See Bibliography.)

These selected patterns are among the most common, and there is one for each Yin organ. The relevance of the included tongue and pulse diagnosis is discussed in Chapter 10.

1. Wind Cold Invading the Lungs

Main Symptoms

Cough, itchy throat, possible fever, aversion to cold, sneezing, nasal congestion or a runny nose with clear or white mucus, headache, most commonly at the back of the head, body aches, a reduced or absent ability to sweat, a thin, white tongue coating, and a floating (superficial) pulse, especially in the front (Lung and Heart) position.

Explanation

This is a common cold caused by the EPFs Wind and Cold attacking the Lungs.

The Lungs are the most external of the internal Yin organs. They are the canopy of the organs, protecting the other five Yin organs. They govern Qi (with a special connection to Weiqi, defensive Qi, which primarily circulates just under the skin) and respiration, open to the nose, and dominate the skin. Anatomically, they connect more or less directly with the throat via the trachea.

Being relatively external and protective, they are usually the first Organ System attacked by EPFs. As Wind and Cold obstruct the Lungs, their descending function is impaired, causing cough due to Qi rising inappropriately. That also obstructs the nose, causing nasal congestion or runny nose with sneezing. Wind is irritating, which contributes to the sneezing and causes the itchy throat.

If the EPF is strong and the Weiqi is strong, Weiqi will rise to fight off the EPF, causing the floating pulse, and the struggle between Qi and the EPF causes fever. If the EPF is not very strong or the Weiqi is weak or unresponsive, there will be no fever, as this EPF is primarily Cold. Aversion to cold will be stronger than fever if fever is present. The combination of Cold and obstruction of the Lung channel closes the pores of the skin, leading to reduced sweat. The channel obstruction further causes headaches and body aches. (Any obstruction of Qi or Blood causes pain.) The warming aspect of the Weiqi is impaired, causing aversion to cold. While a thin, white tongue coating is generally considered normal, here white indicates Cold, and the thin quality only means that the EPF has not yet penetrated deeply to become Excessive.

A related pattern for comparison is a Wind Heat cold, which will be similar but with the following differences. The cough may be productive, and the phlegm, along with the nasal mucus, will be yellow instead of white. (Yellow indicates Heat, due to a “burning” of the mucus.) The throat will be sore instead of just itchy. There will be fever, possibly with aversion to cold, but the fever will be stronger. There will be some sweat and an aversion to Wind. The tongue may appear slightly red (indicating Heat) with a thin yellow coating. The pulse is still floating but rapid. All these changes are due to Heat replacing Cold as the EPF.

With the proper presentation, some Western diagnoses that may fit this pattern include bronchitis and emphysema.

Some common Lung patterns include Lung Qi Deficiency and Lung Yin Deficiency.

2. Heart Blood Deficiency

Main Symptoms

Heart palpitations, forgetfulness, anxiety, insomnia, excessive or very vivid dreaming, causing disturbed sleep, dizziness, a pale complexion, pale and possibly dry tongue, and a thready and weak pulse.

Explanation

This pattern can be caused by poor nutrition, either due to inadequate quantity or quality of food consumed, to a poorly functioning Spleen and Stomach that are unable to properly digest and absorb nutrition from any food that is eaten, or to extended periods of anxiety or stress that disturb the mind, eventually impairing Heart functions. It can also be caused by severe blood loss from any cause.

We’ve seen that Blood is the primary material foundation for Qi within the body, according to the Chinese phrase, “Blood is the mother of the Qi.” Whenever Blood is deficient, there will inevitably be some Qi deficiency, and this is what causes palpitations—a tangible disturbance in the heart’s functional energy.

As the Heart houses the mind, any weakening of the Heart will disturb the mind, as it is less securely housed. This causes the restlessness of insomnia, dream-disturbed sleep, and anxiety or generalized feelings of unease. The insufficiency of Heart Blood fails to nourish the brain, causing poor memory and dizziness.

The pale complexion and tongue—the Heart opens to the tongue—indicate Heart Blood Deficiency. Similarly, the thready pulse indicates insufficient blood, and the weakness indicates Deficiency.

A related pattern for comparison is Heart Yin Deficiency, which shows many of the same symptoms—remember that Blood is a Yin substance—with some differences. There will be some Deficiency Heat symptoms, since the Yin deficiency will allow for the warming aspect of Yang to go unchecked. This causes feelings of warmth in the palms of the hands, soles of the feet, and the center of the chest and feelings of agitation, all worse in the afternoon and evening. There may be night sweats. The tongue will appear light red and dry, and the pulse will be rapid.

With the proper presentation, some Western diagnoses that may fit this pattern include arrhythmia, tachycardia, high blood pressure, anemia, and some psychological disorders.

Some common Heart patterns include Heart Qi Deficiency, Heart Yang Deficiency, Phlegm Misting the Heart, and Heart Blood Stagnation.

3. Liver Qi Stagnation

Main Symptoms

Emotional: Irritability, frustration, inappropriate anger, and depression, possibly accompanied by sighing and a feeling of “a lump in the throat.”

Gastrointestinal: Poor appetite, hiccups, belching, acid reflux, nausea, vomiting, abdominal distension and discomfort or pain often extending to just below the ribs, and diarrhea.

Menstrual irregularities: Long, short, or variable cycles, cramps, pain, premenstrual breast distension and tenderness, mood swings, and irritability.

The tongue may be normal or have a dusky, slightly purplish appearance, and the pulse is bowstring (strong, pounding, with a slight hardness).

Explanation

Due largely to its emotional correspondences and the menstrual problems that affect so many women, this Excess pattern is one of the most pervasive in the modern world.

Since the emotions associated with the Liver are anger and depression along with related emotions, Stagnant Liver Qi alters Liver function in ways that cause these emotions to become prevalent. In a Five Element context, sighing is the sound associated with the Spleen, which is easily affected by Liver Qi Stagnation. Sighing is also one of the body’s ways to release or disperse Qi stagnation. When people get emotional, they often feel a sense of having a lump in their throat. When the emotions linger as they do in Qi stagnation, the sense of that lump will also linger, resulting in the Chinese designation “plum-pit Qi,” the feeling of having a plum pit stuck in the throat. An internal branch of the Liver meridian runs through the throat, contributing to this sensation.

Most of the gastrointestinal symptoms in this pattern come from the stagnant, excessive Liver Qi moving horizontally to affect the Spleen and Stomach. This is a secondary pattern called Liver Invading the Spleen, commonly but not always found in cases of Liver Qi Stagnation. The hiccups, belching, acid reflux, nausea, and vomiting are due to the pattern of Rebellious Stomach Qi, an abnormal rising of Stomach Qi due to its being compromised by the invasion of Liver Qi. Poor appetite and diarrhea are due to a weakening of Spleen Qi, again caused by the invading Liver Qi.

The abdominal distension, discomfort, and pain extending to the sides and just below the ribs is due to the Qi stagnation in the Liver meridian, which runs through the abdomen and below the eleventh rib along the flanks. The organ may feel swollen or congested due to the primary stagnation occurring there.

Most of the menstrual concerns are caused by the Liver’s function of storing Blood, which becomes impaired from Liver Qi Stagnation. This deranges (interrupts) Blood movement in the Chong and Ren meridians (see Chapter 2), directly affecting the uterus and causing menstrual irregularities and pain. Breast distension and tenderness are caused by the Qi stagnation in the Liver and Chong meridians, which have internal branches that run through and influence the breasts.

The tongue may appear dusky due to Stagnant Liver Qi poorly moving the Blood —“the Qi is the commander of the Blood”—causing the dark, purplish appearance common to Blood Stasis. The pulse is bowstring due to obstruction by Liver Qi. More force is required to move through, or against, the obstruction. Likewise pain, also caused by obstruction, produces a bowstring pulse.

With the proper presentation, some Western diagnoses that may fit this pattern include cervical lymphadenitis, mastitis, and various gastrointestinal, gynecological, and emotional disorders.

Some common Liver patterns include Internal Liver Wind, Flare-Up of Liver Fire, Liver Yang Rising, and Liver Blood Stasis.

4. Spleen Qi Deficiency

Main Symptoms

Poor appetite, low energy, fatigue, weak arms and legs, loose stool or diarrhea, heaviness after meals, abdominal distension, nausea, bruising easily, speaking in a very soft voice, a pale tongue with tooth marks on the sides, possibly enlarged (if Spleen Qi Deficiency engenders Damp), and a weak, forceless, and thin or thready pulse.

Explanation

As with Liver Qi Stagnation, Spleen Qi Deficiency is a very common pattern, caused by overwork, overthinking and worry, poor dietary choices, and irregular daily schedules.

The Spleen governs transformation and transportation, converting food and drink into useable substances and transporting nutrition and Qi throughout the body. When those functions are compromised by Qi deficiency, this causes the digestive symptoms of poor appetite, abdominal distension, heaviness after meals, nausea, and loose stool or diarrhea. A weak Spleen is not well able to transform fluids and causes internally generated Damp, contributing to the heavy sensations and nausea due to its obstructive qualities. In that case, this becomes a complex pattern, as it exhibits signs of both Deficiency from the primary pattern and Excess from the localized or systemic presence of Damp.

Qi is the body’s functional energy, and when it is deficient, there are various signs of weakness, such as low energy, fatigue, speaking very softly and generally avoiding talking, and weak arms and legs. The Spleen dominates the muscles and the four limbs, so weakness appears there most obviously. If Damp is present, it causes the limbs to feel heavy.

The Spleen controls Blood. Part of that function means it is responsible for holding blood within the vessels. With Spleen Qi Deficiency, that function is impaired and a person will bruise easily.

A pale tongue with tooth marks along the sides indicates Qi Deficiency. Spleen Qi generates Blood, which is reduced in deficiency, so the tongue appears pale. The presence of Damp causes the tongue to enlarge. While it’s easy to see how an enlarged tongue can have tooth marks, in Spleen Qi Deficiency without Damp, a normal-sized tongue can have tooth marks. With Damp from other causes and no Spleen Qi Deficiency, the tongue may be enlarged with no tooth marks.

The forceless pulse quality comes from Qi deficiency, and the threadiness is due to the Spleen’s inability to generate adequate Blood.

A related pattern for comparison is Spleen Yang Deficiency, which includes all the signs of Spleen Qi Deficiency, but, as it is more severe and as Yang is a warming energy, there are additional signs. Fatigue and listlessness are worse. The person becomes easily chilled and feels cool or cold to the touch. Stool is watery and contains bits of undigested food as the Spleen’s transformation and transportation functions are further impaired. This may cause edema, as fluids can accumulate under the skin, and the tongue can appear wet from excess fluid. The pulse is weak, slow from the Cold, and deep from the pathology moving deeper into the interior.

With the proper presentation, some Western diagnoses that may fit this pattern include ulcers, gastritis, enteritis, hepatitis, and dysentery.

Some common Spleen patterns include Sinking Spleen Qi, Damp Cold Invading the Spleen, Damp Heat Invading the Spleen, and Spleen Not Controlling Blood.

5. Kidney Yang Deficiency

Main Symptoms

Cold and sore low back, cold and weak knees, premature ejaculation, impotence, frequent profuse or scant clear urination, loose stool, a bright white complexion, aversion to cold, cold and weak arms and legs, low energy, fatigue, edema, a quiet voice, being withdrawn, listlessness, and apathy. If chronic, loose teeth and hearing loss are possible. The tongue is moist, swollen, and pale with tooth marks on the sides, and the pulse is thready, weak, deep, and slow.

Explanation

This Deficient pattern of Interior Cold is also called Deficiency of Mingmen (Gate of Vitality) Fire. It reflects numerous depletions most frequently caused by prolonged illness, excess sexual activity, or old age. As deficient Kidney Yang fails to warm the body, Cold signs are a prominent feature, including cold low back, knees, and limbs and an aversion to cold with a preference for warm environments, foods, and beverages. A bright white complexion indicates Cold. When prolonged, this condition may alternatively present pallor, which is a sickly, colorless, ashen complexion.

Kidney Yang Deficiency includes Kidney Qi Deficiency. With inadequate Qi, the Kidneys are unable to support the bones, low back, and knees—the kidneys are located in the low back and have a special relationship with the knees—so there is soreness there and weakness in the limbs. Since the Kidneys dominate the bones and open to the ears, teeth (an extension of bone) may become loose, and hearing diminishes. Deficient Qi and Yang cause low energy, fatigue, and a weak or quiet voice and make a person listless, apathetic, and withdrawn.

The Kidneys govern reproduction. The decline of Kidney Yang and Mingmen Fire fails to warm Jing (essence), and so sexual energy diminishes, causing premature ejaculation and impotence in men and infertility in women.

The Kidneys control the two lower orifices (urethra and anus) and urination, are the Origin of Water, and are involved with every aspect of fluid metabolism. When Kidney Yang is deficient, it loses its ability to effectively transform fluids and control the urethra, resulting in frequent profuse clear urination from the accumulation of fluids. Sometimes the Yang may be so deficient that it is unable to supply the power necessary to urinate, and in that case there will be scanty clear urination. The clear quality indicates Cold. Fluid buildup under the skin causes edema, which here will be more pronounced in the legs.

The Kidneys provide warmth, energy, and functionality to every organ—they have more patterns of disharmony involving other organs than any other individual organ—but here their inability to warm and nourish the Spleen is most prominent. That contributes to the weakness in the limbs and loose stool, as seen in Spleen Qi Deficiency symptoms.

The tongue is moist and swollen due to a buildup of fluids and pale due to insufficient Blood from weakened Spleen functions. Tooth marks indicate Qi deficiency. The pulse is thready and weak due to Qi and Blood deficiency and slow due to Cold. Deep indicates an interior condition.

With the proper presentation, some Western diagnoses that may fit this pattern include lumbago, arthritis, benign prostatic hypertrophy, adrenal fatigue, hypothyroidism, nephritis, and various sexual and urinary tract conditions.

Some common Kidney patterns include Kidney Yin Deficiency, Kidneys Failing to Grasp the Qi, and Kidneys and Heart Failing to Communicate.