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ASM 102

Lecture Week 3

Structure by which you can diagnose in TCM:


8 principles
6 pathogens
7 emotionals

Zang-fu-yin/yang organs and their pathologies

Pathogenic Factors
- repeated throughout TCM
- attacks from the outside
- wind=yang, cold=yin, heat=yang, damp=yin, dryness=yang, summerheat=yang
(summer heat is for only one aspect of time…in the summer…no guff)
- you can get these 6 external pathogens in combination (ie heat-damp)
- a pathology that is more yang in nature is sudden, acute and short lived
- yin disorders tend to be internal disorders
- WIND tends to be the carrier of most of these pathological factors

6 External Pathologies: Yang is more external in nature

1) Wind
- aids in the movement of all other factores = the CARRIER – brings pathologies along
with it
- heat does not have a portal of entry in to his body – it can only attack the nape of the
neck
- in the summer-you will see more wind-cold due to airconditioning
- in the winter you will see a lot of wind-heat because people are inside more often with
the heat on
- used as a carrier for other factors to enter the body…we are very susceptible to wind
invasion around the occiput and the nape of the neck
- wind rarely comes along (often seen with heat or cold)
- wind moves around rapidly, however wind-cold does not move as fast as wind-heat
- Lungs are affected first (Wei qi is distributed by the lungs). This is why :
(1) The lungs send wei qi to the surface, where it is the first area of attack
(2) the upper burner is more yang in nature-wind is yang in nature as well so
it tends towards more yang organs because it wants to stay in Yang
environment
(3) The lung is the highest situated organ (Yang) and the closest to the nape
therefore will see Lung pathologies first

Wind Cold Sxs


• KI is the most susceptible organ to cold in the body. Vitality fire burns between
the two kidneys (MING MEN) and creates warmth in the body – therefore if cold
wind affects the KI, then they need to work harder to keep Mingmen burning
• Pulses react more acutely than tongue diagnosis, which shows more chronic signs
• Wind-cold can easily turn in to wind-heat
• sneezing occurs because the nose is an outlet of the lungs (sending wei-qi to the
surface). The nose is the first outlet area because it is the most exterior, even
more so than the throat.
• refined qi is ying qi and wei qi
• discharge from a runny nose can also be clear, and tends to be in a larger amount
because wind-cold than in wind-heat because cold is more yin in nature (and yin
is more material)
• floating, tight pulse can be evident even without symptoms. this indicates wei qi
moving towards the surface
• occipital stiffness and aches are very superficial – Wei qui competing with
external pathogent
• thin, white coat on the tongue means it is cold and not an internal problem
• wind-cold can turn into wind-heat in the body.
• NO SWEATING is key to external pathology with cold influence
 Wei Qi closes pores during cold invasion – cold causes contraction

Wind Heat Sxs


• AVERSION to cold is key
• sneezing and coughing is present with ANY external pathogen
• slight sweating is different from internal pathology presentation
• sore throat is also characteristic – heat will dry fulid from the throat, causing it to
become dry and sore
• Thirsty – heat will dry oral buccal membranes
• floating and rapid pulse is more yang in nature
• excess = excess heat

2) Cold
- contracts with both external and internal pathogens
- twisting ie. Cramps in women
- CONTRACTING key factor
- has no affinity for chest because heart and lung very Yang in nature
- lower back VERY susceptible – KI belt
- severe localized pain is keynote with pain due to cold
- lack of thirst- you already have enough yin and water is Yin
- loose stool- stools have more fluid (Yin) – most common indicator
- sleepiness
- severe localized pain – keynote because not moving (LOCALIZED) – Yang
moves around a lot

3) Heat
- true opposite of cold
- slight sweating occurs even with high fever
- thirst-result of evaporating fluids…you need replenishment
- constipation- result of evaporating fluids as well
- scanty, dark, yellow urine is due to more concentrated urine due to evaporated

4) Dampness
- Yin in nature
- synonymous with spleen
- stools are sticky and difficult to get rid of, stain the bowl or are harder to wipe
- HEAVY AND SLOW - very characteristic - patient will experience these
sensations in head, limbs, etc…
- lower body invasion- similar to cold because it is more yin in nature

5) Dryness
- Yang in nature
- sxs include dry eyes, dry skin, dry nose, etc
- will not feel anything with it, just dry
- internal dryness is from yin deficiency; lacking substance/moisture/yin…but its
not like heat symptoms
- post menopausal women-many women have yin deficiency…treatment would be
to tonify YIN. For example eating yin foods (raw, fat and protein)
- note: carbs are very yang, must be turned into yin (fat) to be stored

6) Summer-Heat
- only in summer…like a heat stroke or sun stroke, only provided by the sun
- treatment- remove from heat and apply cold compresses

Emotional Factors
- emotional balance is key to healthy organ function – need to have a bit of emotion
to see how an organ is functioning
• eg. Suppressing emotions – ie anger – may be a liver pathology, but
expressing emotions too much can also lead to pathology
- above and beyond the typical symptoms
- around exam time: diet is SOOOOO important people!!! It keeps spleen in better
health…spleen is associated with pensiveness

8 Principles
- yin and yang principles apply still, just broken down that much further
- exterior=yang, interior=yin, excess=yang, deficiency=yin, cold=yin, heat=yang

1) Exterior/interior
- referes to location – inside or outside
- channels mentioned are the superficial meridians (the ones we are locating in
practicals)
- does not mean external pathogens make external symptoms and internal
pathogens make internal symptoms – can have both at same time
• ie – Arthritis is internal pathology, but has external symptoms; keep this in
mind with diagnosis!!!
- very specific - chills without fever and fever without chills – if have one or the
other, most likely to be internal Px

Exterior patterns
- can be wind-cold or wind-heat

Interior patterns
- fever without chills is a heat patient, chills without fever is a cold patient
- tongue body changes are more gradual
- zang-fu organ pathologies are organ changes
- ie patient will feel temperature more intensely

2) Excess/Deficiency (full/empty)
- measure of too much or too little
- can be in varying degrees
- need to see what type of heat: yin deficiency or yang excess
- no sign of a weakened body – if there is no weakness, then it’s probably excess

Excess
- no voids
- rule excess in only after you look at deficiency and determined they did not exist
- ask the patient: what type of heat are they expressing? thirst-wise- do they gulp
(xs heat) or do they sip (yin deficiency)
- characterized by anything aggravated by pressure
• ie. Worse with pressure, better by heat – excess cold, but whole body does not
have to have excess cold

Deficiency
- feeble voice; as opposed to boisterous
- listlessness; lack of desire, apathetic
- ANYTHING ALLEVIATED BY PRESSURE; filling in gap by applying pressure
(think of balloon analogy and the idea that you want to feel more full)
- spontaneous sweating because pores cannot stay closed, sweating even without
stimulus such as physical exertion

3) Yin/Yang
- qi deficient is yang in nature and blood is yin
- yang deficiency = qi def + cold sxs may be more subtle and slow at first
- if yin is unopposed yang will rise
Yin/Yang Pathologies
- yang deficiency will show cold sxs, interior cold deficiencies
- there is no such thing as a heat deficiency: heat is always in an excess pattern…
you will only have heat sxs
Exterior cold
- ABSENCE OF sweating
- Exterior pathogen: attacks wei qi and cold closes pores

Exterior heat-

Exterior Deficiency
- very rare…not a heat deficiency
- wei qi is deficient (usually keeps ying qi inside vessels)
- since wei qi is deficient here, it cannot keep ying qi in vessels: results in lots of
sweating
- ying qi can escape if wei qi is deficient. Shown in people who are affected with
colds or flus constantly…they are depleting qi and essence
- you cannot go further with labeling because there are no other exterior
deficiencies except for this one

Exterior Excess (cold, heat)


- general and hard to label cold or heat
- symptoms are excess and exterior but not enough information to diagnose
otherwise
- can label as a general excess condition

Interior Cold
- can be excess yin= strong, cold, worse with pressure
- or yang deficiency
- ie interior cold deficiency is essentially a yang deficiency internally
- ie. Interior cold excess is essentially a yin excess internally

Interior Heat
- can be excess yang or yin deficiency

*** only ime you can have yang deficiency is on the interior! no external deficiencies
except for the one
eg. external excess cold = excess YIN, but not yang deficiency because you can’t
have a deficiency externally