Exterior/Interior Patterns

Question 1

EXTERIOR PATTERNS

• Invasion of __________?
• Struggle b/w ________ and _________?
  FEVER and CHILL (aversion to ____ and ____) present simultaneously

Answer 1

• Invasion of external pathogen
• Struggle b/w Upright Qi and Evil (EPF)
• Fever and chills aversion to WIND/COLD

Question 2

Fa Re

Answer 2

To feel hot to the touch, but does not necessarily indicate elevated body temperature; “heat effusion”; “fever”

Question 3

Taiyang Wind Strike

Fever? Chills?

Answer 3

1. Aversion to wind (kind of chill), slight feverishness, sweating
   - exterior wind invasion with deficiency
   - headache, stiff neck
   PULSE: floating (exterior) and moderate (normal)
   TONGUE: thin, white fur

Question 4

Taiyang Cold Damage

Fever? Chills?

Answer 4

2. More chills than fever, no sweating
   - exterior wind-cold excess
   - headache, body aches, wheezing
   TONGUE: thin white coating
   PULSE: floating and tight

Question 5

Exterior-wind-heat attaching the Defensive level (Exterior wind-heat invasion)
Fever? Chills?

Answer 5

3. More fever than chills
   - fever, slight aversion to wind or slight chills, slight or no sweating, dry mouth, slight thirst, headache, general body ache (heat affects body fluids), sore throat
   TONGUE: red tip with thin white coat
   PULSE: floating and rapid (heat)

Question 6

INTERIOR PATTERNS

Answer 6

• External pathogen has moved from the exterior and entered into the interior of the body
  OR
• Endogenous cold or heat from excess or deficiency is present in the interior
  *Here there is typically no mingling hot and cold sensations simultaneously – one or the other is present

Question 7

HIGH fever or feeling hot

Answer 7

Interior Heat Pattern– Interior heat excess
- high fever, red complexion, thirst with desire to drink cold water, profuse sweating
TONGUE: red body, thick, dry, yellow coat
PULSE: surging (excess) and rapid

Question 8

Low Grade Fever

Answer 8

Interior Heat Pattern – Yin deficiency patterns (deficient heat)
- feeling hot mostly at night or in flushes, red cheeks, thirst with only slight desire to drink and a preference for cold water, night sweating, five-palm heat
TONGUE: red body, little or no coat
PULSE: thin, weak, rapid

Question 9

Name the 3 causes of Tidal Fever

What is tidal fever?

Answer 9

1. Yangming Fu (St, LI) disease
2. Damp Heat Patterns
3. Yin Deficiency Patterns
   Tidal Fever - a fever that gets worse or occurs only at certain times

Question 10

Yangming Fu disease (tidal fever)

Answer 10

Interior Heat Pattern
- high fever that gets worse between 3-5 pm, constipation with dry stool, abdominal fullness and distention, scant yellow urine
TONGUE: red body, dry yellow coat
PULSE: rapid, forceful

Question 11

Damp Heat Patterns (tidal fever)

Answer 11

Interior Heat Pattern
- fever that gets worse in the afternoon (not as high as Yangming fever) and that does not abate with sweating
- clammy, heaviness of head and body
TONGUE: red body, greasy yellow coat
PULSE: rapid, slippery (damp)

Question 12

Yin Xu Patterns (tidal fever)

Answer 12

Interior Heat Pattern
- low grade “fever” that gets worse in afternoon or evening, steaming bone (sensation of heat in the bones), 5-Palm heat, malar flush, night sweats, emaciation dry mouth and throat
TONGUE: thin and red body with little to no coating
PULSE: thin (yin Xu), rapid, [weak: added in class]

Question 13

Yang Deficiency (deficiency cold)
Interior Cold Pattern

Answer 13

• aversion to cold, cold body and limbs, spontaneous sweats, other yang deficiency symptoms
• chronic diseases
  TONGUE: pale, wet
  PULSE: deep (interior), slow (cold), weak (Xu)

Question 14

Interior Cold Excess

Interior Cold Pattern

Answer 14

• exogenous cold which has moved to interior
• strong aversion to cold, absence of thirst, cold and painful abdomen, cold and pain in local areas
  PULSE: deep (interior), slow (cold), tight (excess cold), forceful (excess)

Question 15

Shaoyang Disease

Answer 15

• Alternating chills and fever****
• exogenous cold which is half in the exterior and half in the interior and transforming to heat
• alternating chills and fever, bitter taste, dry mouth, dizziness, blurry vision, fullness and oppression in the costal and hypochondriacal regions, poor appetite (wood overacting on earth), mental restlessness, nausea or vomiting
  PULSE: wiry
  [constrained Shaoyang Fire (ministerial fire), transforms to pathological heat

Question 16

Key points when inquiring about SWEAT (5)

Answer 16

• presence or absence
• location
• nature
• time
• quantity

Question 17

SWEAT and Exterior Patterns

No sweat (1)
Sweat (2)

Answer 17

No sweat
- Taiyang Cold Damage (ext wind-cold excess)
- no sweat, chills more than fever, still and painful nape and neck, headache, floating and tight pulse
Sweat
- Taiyang wind-strike
- sweating, aversion to wind, slight feverishness, floating and moderate pulse
- Exterior Wind-Heat Invasion
- sweating, fever more than chills, headache, sore throat, floating and rapid pulse

Question 18

SWEAT and Interior Patterns

What are the 3 types?

Answer 18

1. Spontaneous sweating (“self sweat”)
2. Night Sweating (“thief sweat)
3. Whole body sweating

Question 19

Spontaneous Sweating (self sweat)

Answer 19

Interior Pattern

• sweating in the daytime that is not related to emotions, temperature or exercise, but is worse with exertion
• QI/YANG DEFICIENCY
• sweating during the day that is worse with exertion
• aversion to wind and cold, weak immunity (easy catching colds), pale complexion, listless and fatigued, thin and weak pulse [deep added in class]

Question 20

Night Sweating (thief sweat)

Answer 20

• sweating that occurs during sleep
• YIN DEFICIENCY
• night sweats, tidal fever, malar flush, five-palm heat, thin red tongue with little to no coat, thin and rapid pulse
• sleep occurs when yang “enters” yin – when yin is deficient, yang is relatively more and steams the yin, causing night sweats

Question 21

Whole Body Sweating

2 types

Answer 21

Interior Heat Excess
- (profuse) sweating that occurs over the entire body, fever, thirst with a desire to drink, constipation, dark urine, rapid and forceful pulse

Collapse of Yang, Desertion of Yang Qi
- profuse sweating over entire body, cold limbs, faint pulse
Tongue: ready body, yellow coat
(SEVERE Yang Xu)

Question 22

Dizziness and Deficiency

Answer 22

QI AND BLOOD XU
- dizziness aggravated by overwork or postural changes, blurry vision, pale complexion, palpitations (not receiving enough Qi and blood), insomnia (blood not nourishing Shen), pale tongue with thin coat, weak [thin] pulse
KIDNEY ESSENCE DEFICIENCY
- dizziness, tinnitus (Kid opens to ear), nocturnal emission, poor memory, sore and weak low back and knees, pale tongue, weak pulse
*Kid stores Essence, Essence generates Marrow, Brain = Sea of Marrow

Question 23

Dizziness and Excess Patterns

Answer 23

LIVER YANG RISING-POSSIBLY WITH STIRRING OF LIVER WIND
- dizziness, dis tending headache, red complexion and eyes, tinnitus, bitter mouth, dry throat, wiry pulse
PHLEGM DAMP OBSTRUCTING CLEAR-YANG FROM ASCENDING TO NOURISH HEAD – turbid yin
- dizziness, heavy and foggy head, stuffy chest, nausea, vomiting phlegm, greasy tongue coat [puffy, wet]

Question 24

HEADACHE - Excess and Xu patterns, general

Answer 24

Excess - sudden onset, short duration, constant and more intense pain (e.g. Headache from Exterior wind-cold invasion)
Deficiency - slow, gradual onset, chronic, lingering, intermittent, interior patterns (e.g. Qi and Blood Xu, overtime becomes deficient)

Question 25

Headache 1. Heavy feeling? 2. Pain in the Brain? 3. Distending, throbbing? 4. Sharp, fixed, boring pain? 5. With Muzziness, heaviness, and dizziness?

Answer 25

1. Dampness or phlegm 2. Kid deficiency 3. Liver Yang Rising 4. Blood Stasis 5. Dampness 6. Phlegm

Question 26

HEADACHE - YANG LEVELS | Taiyang, Shaoyang, Yangming Channels

Answer 26

TAIYANG - Occipital, radiate to neck and upper back, stiff neck/shoulders YANGMING - Frontal, pain in forehead and eyebrows SHAOYANG - temporal, pain in temples, sides of head, ears

Question 27

HEADACHE - YIN LEVELS | Taiyin, Shaoyin, Jueyinb Channels

Answer 27

TAIYIN - headache with dizziness and heaviness of head, diarrhea, spontaneous sweating SHAOYIN - headache with pain in brain and teeth (kidney) JUEYIN - Vertex headache, radiating to sides of head and behind eyes, sensation of Qi rising, possible nausea and vomiting - Running Piglet, Wood overacting on Earth

Question 28

PAIN IN WHOLE BODY 1. Sudden onset, with fever and chill 2. Ache all over with fatigue 3. Post-partum dull pain 4. Post-partum severe pain 5. Dull ache in muscles, especially limbs, with heaviness

Answer 28

1. Exterior wind invasion 2. Qi and blood Xu 3. Blood deficiency 4. Blood stasis 5. Dampness

Question 29

BACKACHE 1. Continuous, dull, better with rest 2. Recent onset, severe, with stiffness 3. Pain that is aggravated by cold and damp, alleviated by warmth 4 Fixed, stabbing pain 5. Pain in the upper back, shoulders, neck

Answer 29

1. Kid deficiency 2. Blood Stasis due to sprain/strain 3. Cold damp 4. Blood Stasis 5. Exterior Wind invasion

Question 30

CHEST - Heart disorders 1. Stabbing pain 2. Chest oppression, pain radiating to back and shoulders

Answer 30

1. Blood stasis in heart | 2. Heart vessel blocked by blood stasis, phlegm damp, cold, Heart yang deficiency

Question 31

CHEST - Lung disorders 1. Chest pain, cough, high fever, dyspnea, wheezing, nasal flaring 2. Chest pain, cough with blood-tinged sputum, night sweats, tidal fever 3. Chest oppression, cough with copious white phlegm, dyspnea 4. Chest oppression, cough with copious yellow phlegm, dyspnea 5. Chest oppression, weak cough, dyspnea, fatigue

Answer 31

1. Excess heat in Lung 2. Lung yin Xu 3. Phlegm damp accumulating in Lung 4. Phlegm heat accumulating in Lung 5. Lung Qi deficiency

Question 32

HYPOCHONDRIUM (flanks: Liv, GB) [or Shaoyang] 1. Distending pain in the chest and hypochondrium, sighing, irritability, wiry pulse 2. Burning pain in hypochondrium, red complexion and eyes, wiry and rapid pulse 3. Dis tending and heavy or burning pain in hypochondrium, yang-type jaundice, wiry and slippery pulse 4. Fixed and stabbing hypochondrium pain that is worse at night 5. Fullness and oppression in hypochondrium, alternating fever and chills, bitter mouth, dizziness, blurry vision, restlessness, nausea, wiry pulse

Answer 32

1. Liver Qi stagnation 2. Depressed-fire from Liver Qi stagnation 3. Damp heat in Liver and GB 4. Blood Stasis 5. Shaoyang Disease

Question 33

EPIGASTRIUM (Cold and Heat) 1. Cold and paroxysmal epigastric pain relieved by warmth and aggravated by cold 2. Burning pain in epigastrium, excessive hunger, foul breath, constipation with dry stool

Answer 33

1. Invasion of pathogenic cold in Stomach | 2. Stomach fire

Question 34

EPIGASTRIUM (Qi and Blood) 1. Distending pain aggravated by anger/stress/emotions, belching, hiccough 2. Stabbing pain in fixed location that is worse at night

Answer 34

1. Liver Qi stagnation with liver overacting on Stomach | 2. Blood stasis in Stomach

Question 35

EPIGASTRIUM (Yin and Yang) 1. Dull, epigastrium pain relieved by warmth and pressure 2. Burning sensation in epigastrium, hunger but inability to eat much, red tongue with little to no coating, thin rapid pulse

Answer 35

1. Stomach yang Xu | 2. Stomach yin Xu with deficiency heat

Question 36

``` ABDOMEN Excess Deficiency Cold Heat Blood Stasis Liver Qi Stagnation ```

Answer 36

Excess - pain: acute, more severe, worse with pressure Xu - pain: chronic, less severe, better with pressure Cold - worse with cold, better with heat Heat - worse with heat, better with cold Blood Stasis - fixed and sharp/stabbing pain, worse @ night Liv Qi stagnation - dis tending and moving pain, possibly worse with stress/emotional upset

Question 37

EARS (tinnitus) 1. Begins gradually, low pitch, off and on, reduced when cover ears with hands (pressure) 2. Sudden onset, loud, louder when cover ears with hands

Answer 37

1. Kidney Xu | 2. Liver and GB fire

Question 38

EARS (deafness) 1. Gradual hearing impairment or deafness that occurs after long illness or in elderly 2. Sudden hearing loss or deafness, with bitter mouth and rib-side/flank/hypochondrium pain

Answer 38

1. Kidney deficiency | 2. Liver and GB fire

Question 39

EYES 1. Red and painful 2. Red without much pain 3. Blurry vision, dry eyes

Answer 39

1. Excess heat 2. Deficient heat 3. Liver yin or blood deficiency, Kidney yin or essence deficiency

Question 40

THIRST and fluid intake 1. No thirst 2. Dry mouth with little to no desire to drink, or only desire to sip (4)

Answer 40

1. Cold patterns 2. - Yin Deficiency (deficient-heat, deficiency so not want to drink to much) - Damp Heat (heat makes dry/thirst, damp subdues desire to drink) - Retention of phlegm fluids (body fluids not evenly distributed leads to thirst, retention of fluids, subdues desire to drink) - Blood Stasis (body fluids not evenly distributed leads to thirst, stasis of fluids subdues desire to drink)

Question 41

``` APPETITE and food intake Reduced Appetite (3) No appetite (2) ```

Answer 41

Reduced - spleen and stomach Qi Xu - accumulation of dampness in spleen - damp heat in liver and GB No appetite - food stagnation - morning sickness

Question 42

APPETITE and food intake 1. Excessive Hunger 2. Hunger without much desire to eat, or can only eat a small amount 3. Cravings for strange things

Answer 42

1. Stomach Fire -- thirsty, can eat 2. Stomach Yin Xu 3. Parasites, Pregnancy

Question 43

Insomnia 1. easily waking in the middle of the night, palpitations, poor memory, poor appetite, fatigue, digestive weakness, loose stools, pale tongue, weak pulse 2. Difficulty falling asleep, mental restlessness, dream disturbed sleep, tidal fever, night sweats, sore and weak lumbar region and knees

Answer 43

1. DEFICIENCY OF SPLEEN QI AND HEART BLOOD 2. HEART AND KID NOT COMMUNICATING - Ht and Kid YIN Xu - Kid water not nourishing/controlling Heart fire