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Diagnosis of Combined Patterns in Chinese Medicine

Diagnosis of Combined Patterns in Chinese Medicine

Liver Invading the Spleen

Signs:

  • Alternating diarrhea and constipation
    Due to the Liver invading the Spleen, or the Qi of the Spleen being to weak to withstand the energy of the Liver.
  • Sloppy, loose, or small pebble like stools
    Due to the Liver Qi stagnating in the Intestines and then invading the Spleen
  • Abdominal distention and pain
    Due to Liver Qi stagnating in the abdomen
  • Fatigue
    Due to Deficient Spleen Qi

Etiology/Pathology:

Long term emotional problems cause Liver Qi to stagnate, which will eventually invade the Spleen. Other attributing factors include, overwork and irregular diet, which cause Spleen Qi to become Deficient. Liver is responsible for smooth flow of Qi throughout the entire body. When Qi stagnates in the abdomen it disturbs the Spleen's function of transformation and transportation.

This pattern can also be described as the Liver and Spleen not being harmonized, or Liver attacks the Spleen.

In the 8 principles diagnosis, this is excess and deficiency mixed (Qi Stagnation is excess and Spleen Qi Deficiency is deficiency)

In Five Elements, this is "Wood attacking Earth"

Either the Excess Qi Stagnation or the deficiency of the Spleen can be predominate in this pattern. In both cases, the Qi Stagnation causes distention in the abdominal region. When stagnation of Liver Qi predominates there is constipation with dry and pebble like stools, the Liver Qi is in excess and actively invading the Spleen. There would be marked abdominal distention and more pain.

When Spleen Qi Deficiency predominates, there is diarrhea or loose stools because the Spleen Qi is deficient and cannot withstand the Liver Qi (the focus here is on the deficiency). There would only be slight abdominal pain in this case. When the liver attacks the Spleen, it is common to have alternating constipation and diarrhea.

The tongue landscape varies according to which pattern predominates.

Treatment Principle:

General: Harmonize Liver and Tonify Spleen
Acupuncture: Sedate Points that harmonize the Liver and tonify Points that increase the Spleen energy

Points:

  • LIV-14 (Qimen)
    Harmonizes Liv/restores flow of Liv Qi
  • LIV-13 (Zhangmen)
    Harmonizes Liv and Spleen
  • GB-34 (Yanglingquan)
    Promotes smooth flow of Liv Qi
  • LIV-3 (Taichong)
    Promotes smooth flow of Liv Qi and calms abdominal pain
  • REN-6 (Qihai)
    Calms abdominal pain
  • REN-12 (Zhongwan)
    Tonify Spleen
  • ST-36 (Zusanli)
    Tonify Spleen
  • SP-6 (SanYinjiao)
    Tonify Spleen, regulate Liver, harmonize Liv and Spleen, stop abdominal pain. (tonify)

Liver Invading the Stomach

Signs:

  • Irritability, distention and pain in epigastrium and hypochondrium
    Due to Liver Qi Stagnation
  • Fullness in the epigastrium
    Due to the Stomach's "rotting and ripening" function being impaired
  • Sour regurgitation, belching, nausea, vomiting
    Due to rebellious Stomach Qi

Pulse: Weak Stomach pulse (middle right), Wiry Liver pulse (middle left)

Etiology/Pathology:

Emotional problems over long time causing Liver Qi to stagnate, plus irregular diet and overwork, weakening Stomach Qi.
Stagnation of Liver Qi invades Stomach and interferes with Stomach Qi descending. Stomach Qi then rebels upward causing belching, nausea and vomiting. Stomach cannot "rot and ripen" food, hence fullness in epigastrium and sour regurgitation. Stagnation of Liver Qi causes distention, pain, irritability. Tongue varies according to whether the Stagnation predominates or the Deficient Stomach Qi predominates.

Treatment Principle:

General: Harmonize Liver and Tonify Stomach
Acupuncture: Sedate Points that harmonize the Liver. Tonify Points that tonify Stomach.

Points:

  • LIV-14 (Qimen)
  • LIV-13 (Zhangmen)
    Harmonize Liv in Middle Burner
  • GB-34 (Yanglingquan)
    Harmonize Liv, stimulate smooth flow of Liv Qi esp. in hypochondriac region
  • REN-13 (Shangwan)
    Subdue rebellious Stomach Qi
  • REN-10 (Xiawan)
    Stimulates descending of Stomach Qi
  • ST-36 (Zusanli)
    Tonifies Stomach
  • BL-21 (Weishu)
    Tonify Stomach, especially in chronic cases

Liver Fire Injuring the Lungs

Signs:

  • Breathlessness, Asthma, Cough
    Liver Fire prevents the downward movement of Lung Qi
  • Blood streaked sputum
    Liver Fire rises to injure the vessels
  • Fullness in the hypochondrium, stuffiness in the chest
    Due to Liver Qi Stagnation
  • Headache, dizziness, red face, bitter taste, thirst
    Due to rising Liver Fire
  • Scanty and dark urine, constipation
    Due to Heat

Tongue: Red, redder on sides, swollen in front, yellow coat
Pulse: Wiry and Slippery

Etiology/Pathology:

The Liver controls the smooth flow of Qi. This influences the descending function of the Lungs. When Liver Qi stagnates over long period of time, it gives rise to Liver Fire, which rebels upwards toward chest, causes hypochondriac fullness, stuffiness in the chest, and prevents the Lung Qi from descending. Rising Liver Fire can also create headache, dizziness, red face, thirst, bitter taste, scanty dark urine, constipation, blood tinged sputum, and deep red Tongue color on sides, all which are excess heat signs.

In Five Elements, this is "Wood insults Metal"

Etiology: Anger and repressed Emotions cause Liver Qi to stagnate. After a long period of time, Liv Qi stagnation turns into Liver Fire. This is worsened by excessive consumption of hot and greasy foods; these create Heat.

Treatment Principle:

General: Clear Liver Fire, Harmonize Liver Qi, Descend Lung Qi
Acupuncture: Sedate

Points:

  • Liv 2 (Xingjian)
    Clears Liver Fire
  • Liv 14 (Qimen)
    Harmonize Liver Qi in chest
  • Ren 17 (Shanzhong)
    Stimulates descending of Lung Qi
  • Ren 22 (Tiantu)
  • PE 6 (Neiguan )
    Harmonizes Liv Qi in chest, Stimulates descending function of the Lungs
  • Lu 7 (Lieque)
    Stimulates descending of Lung Qi
  • LI 11 (Quchi)
    Clears Heat

Spleen and Lung Deficiency

Signs:

  • No appetite
    Spleen Qi Deficiency
  • Fatigue
    Qi Deficiency
  • Slight shortness of breath
    Lung Qi Deficiency
  • Loose stools
    Spleen Qi fails to transform digestate
  • Weak voice
    Lung Qi Deficiency
  • Bright white complexion
    Qi Deficiency
  • Slight spontaneous perspiration
    Lung Qi Deficiency: Wei Qi fails to control perspiration

Tongue: Pale
Pulse: Empty, especially on the right

Etiology/Pathology:

The Spleen and Lungs are both vital to Qi production and mutually influence each other. It is said, "The Spleen is the source of Qi, and the Lungs are the pivot of Qi". Poor diet, such as excess cold food or drink may weaken Spleen which may fail to send enough Food Qi to Lungs. Poor breathing, lack of exercise, bending over desks and impairing movement in chest weaken Lung Qi which may then result in a lack of production of Zhen Qi (also called True Qi = Ying and Wei Qi)

Treatment Principle:

General: Tonify Lung and Spleen Qi

Points:

  • ST 36 (Zusanli)
    Tonifies Spleen Qi
  • SP 3 (Taibai)
    Tonifies Spleen Qi
  • BL 20 (Pishu)
    Tonifies Spleen Qi
  • BL 21 (Weishu)
    Tonifies Spleen Qi
  • LU 9 (Taiyuan)
  • BL 13 (Feishu)
    Tonifies Lung Qi
  • Du 12 (Shenzhu)
    Tonifies Lung Qi, good for chronic cases

Spleen and Liver Blood Deficiency

Signs:

  • Dizziness
    Due to Blood Deficiency
  • Tiredness and fatigue
    Due to Qi and Blood Deficiency
  • Sallow complexion
    Due to Blood Deficiency and Spleen Qi Deficiency
  • Blurred vision
    Due to deficient Liver Blood
  • Numbness and/or tingling of the limbs
    Due to Liver Blood failing to nourish the muscles

Tongue: Pale with paler sides, orange sides in severe cases
Pulse: Choppy

Pathology

Food Qi produced by Spleen is the basis for formation of Blood. When the Spleen Qi is deficient, not enough Blood is produced. The Liver stores the Blood, so deficient Blood results in lack of Blood in Liver, hence the dizziness, numbness and pale/orange color of the sides of the Tongue.

Etiology/Pathology:

Usually due to poor diet, lack of nourishment, or excessive cold/raw foods.

Treatment Principle:

Tonify Spleen Qi, nourish Blood, tonify Liver Blood

Points

  • ST 36 (Zusanli)
    Tonifies Spleen Qi
  • SP 3 (Taibai)
    Tonifies Spleen Qi
  • BL 20 (Pishu)
    Tonifies Spleen Qi
  • BL 21 (Weishu)
    Tonifies Spleen Qi
  • Liv 8 (Ququan)
    Tonifies Liver Blood
  • BL 18 ( Ganshu)
    Tonifies Liver Blood
  • BL 17 (Geshu)
    Nourishes Blood, Tonifies Liver Blood (moxa)
  • SP 6 (SanYinjiao)
    Tonifies Spleen Qi, nourishes Blood

Method

  • Tonify points, Moxa where applicable

Spleen Dampness with Liver Stagnation

Signs:

  • Stuffiness/fullness Of Epigstrium
    Due to Damp obstruction
  • Nausea, poor appetite
    Due to Dampness obstructing the descending Stomach Qi
  • Loose Stools
    Due to Dampness obstructing the Spleen's function
  • Feeling of Heaviness
    Due to Dampness obstructing the Spleen's function
  • Thirst for small amounts of liquid
    Due to Dampness
  • Sallow Complexion
  • Hypochondriac Pain
    Due to Liver Qi Stagnation
  • Jaundice
    Due to Dampness and Stagnation impairing bile flow
  • Bitter Taste
    Due to Qi Stagnation and Heat

Tongue: Thick, sticky, yellow coat
Pulse: Wiry and Slippery

Etiology/Pathology:

Deficient Spleen fails to transform/transport fluids, which accumulate to form Dampness. Dampness obstructs Qi flow in Middle Burner and interferes with Qi flow (Spleen Qi should ascend and Stomach Qi should descend), and smooth flow of Liver Qi in middle burner. Eventually, obstruction of Dampness turns into Heat. Dampness obstructs the smooth flow of Liver Qi and bile. Liver Qi stagnates in Middle burner and Gallbladder cannot secrete bile. Over-consumption of greasy foods that cause Dampness in Spleen plus any of the causes of Liver Qi Stagnation (Emotions).

Treatment Principle:

  • Tonify Spleen, Resolve Damp, promote smooth flow of Liver Qi

Points:

  • Ren 12 (Zhongwan)
    Tonifies Spleen to resolve Dampness
  • BL 20 (Pishu)
    Tonifies Spleen to resolve Dampness
  • SP 6 (SanYinjiao)
    Tonifies Spleen to resolve Dampness
  • SP 3 (Taibai)
    Resolve Dampness
  • Liv 13 (Zhangmen )
    Promotes smooth flow of Liver Qi and resolves Dampness from Middle Burner
  • Liv 14 (Qimen)
    Promotes smooth flow of Liver Qi
  • GB 24 (Riyue)
    Promotes smooth flow of Liver Qi& secretion of bile
  • GB 34 (Yanglingquan)
    Promotes smooth flow of Liver Qi in Middle Burner

Turbid Phlegm Affecting the Head

Signs:

  • Severe Dizziness
    Phlegm is more formed than Dampness, so rather than just having a feeling of heaviness in the head, there is severe dizziness
  • Heavy limbs, numbness, clumsy movement
    Phlegm interfering with the flow of Qi
  • Congested feeling in the chest, palpitations
    Phlegm obstruction the chest
  • Nausea and vomiting
    Phlegm impairs the Stomach's descending function

Tongue

  • Thick greasy coat

Pulse

  • Slippery

Etiology/Pathology:

This pattern develops from Spleen Dampness.
It is often associated with hypertension due to obstruction by Phlegm & Dampness.

Treatment Principle:

General: Transform Phlegm, open chest, pacify Stomach
Acupuncture: Sedate

Points:

  • P 6 (Neiguan)
    Opens chest, calms mind, pacifies Stomach
  • ST 40 (Finagling)
    Transforms Phlegm
  • SP 9 (Yinlingquan)
    Resolves Dampness

If accompanied by hypertension:

  • LI-11 (Quchi), ST-36 (Zusanli)
    These eliminate Wind, regulate circulation of Qi and Blood Drain Excess from Yang channels. Major Points for hypertension
  • GB 20 (Fengchi)
    Pacify Liver Yang rising and subdue Liver Wind
  • LIV-3 (Taichong)
    Calms the Shen

References Used

The TCM information presented here has been referenced from numerous sources; including teachers, practitioners, class notes from Five Branches University, the following books, as well as other sources. If you have benefited from this information, please consider supporting the authors and their works by purchasing the books below.

TCM Diagnosis Books/References

Browse All Chinese Medicine Reference Texts ▶

General Diagnosis

Diagnosis Home Tongue Diagnosis in TCM 11 Treatment Methods in TCM

4 Pillars of Diagnosis

1. Looking 2. Listening 3. Asking 4. Pulse/Palpation The 29 Pulses Pulse Indications Table

Zang Fu Organ Patterns

Bladder Patterns Heart Patterns Kidney Patterns Large Intestine Patterns Liver Gallbladder Patterns Lung Patterns San Jiao Patterns Small Intestine Patterns Spleen Patterns Stomach Patterns Zang Zu Combined Patterns

Differentiation of Syndromes

By the 4 Levels By the 8 Principles (Ba Gong) By Qi, Blood, & Fluids By San Jiao Patterns By the Six Stages

TCM Gynecology

Amenorrhea Dysmenorrhea Early Menses Extended Menses Flooding & Trickling Menses Heavy Menses Irregular Menses Late Menses Scanty Menses Spotting Menses Associated Symptoms

General TCM

Symptoms & Diagnosis Yin & Yang Diagnosis Table