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 that’s 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 can’t
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, can’t
warm urine in bladder
 Can have thirst because SP/ST qi xu
fail to transport fluids, can’t 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 can’t be dispersed by LU.
 Difficult urination b/c KI can’t 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. Don’t 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 BF’s)
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, can’t 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 BF’s)
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 don’t really have to memorize? They weren’t 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 can’t 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
Rx’s for Pregnant (PG) Patients
These are theoretical…wdn’t 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 Q’s:
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 Q’s. 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 Rx’s.
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.