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The process of diagnosing a morbid condition as a disease pattern of the bowels and/or the viscera. The main simple (i.e., not combined) patterns are as follows:

Heart pattern identification

• Heart qì vacuity
• Heart yáng vacuity
• Vacuity desertion of heart yáng
• Heart blood vacuity
• Heart yīn vacuity
• Hyperactive heart fire
• Phlegm clouding the heart spirit
• Phlegm fire harassing the spirit

Lung pattern identification

• Lung qì vacuity
• Lung yīn vacuity
• Wind-cold fettering the lung
• Wind-heat invading the lung
• Dryness evil invading the lung
• Intense lung heat
• Phlegm-heat congesting the lung
• Cold phlegm obstructing the lung
• Rheum collecting in the chest and rib-side
• Wind and water contending with each other

Spleen pattern identification

• Spleen qì vacuity
• Spleen yáng vacuity
• Spleen vacuity qì fall
• Spleen failing to control the blood
• Cold-damp encumbering the spleen
• Damp-heat brewing in the spleen

Liver pattern identification

• Liver blood vacuity
• Liver yīn vacuity
• Depressed liver qì
• Ascendant hyperactivity of liver yáng
• Liver fire flaming upward
• Liver wind stirring internally
  • Liver yáng transforming into wind
  • Extreme heat engendering wind
  • Blood vacuity engendering wind
  • Yīn vacuity stirring internally
• Cold stagnating in the liver vessel

Kidney pattern identification

• Kidney yīn vacuity
• Kidney yáng vacuity
• Kidney vacuity water flood
• Insufficiency of kidney essence
• Insecurity of kidney qì

Stomach pattern identification

• Stomach cold
  • Stomach vacuity cold
  • Stomach repletion cold
• Stomach yīn vacuity
• Intense stomach heat
• Cold rheum collecting in the stomach

Small intestine pattern identification

• Small intestine repletion heat

Large intestine pattern identification

• Large intestine vacuity cold
• Large intestine humor depletion
• Large intestinal damp-heat
• Worms accumulating in the intestinal tract

Gallbladder pattern identification

• Liver-gallbladder damp-heat
• Depressed gallbladder and harassing phlegm

Bladder pattern identification

• Bladder damp-heat

Triple burner pattern identification

The bowels and viscera are prone to morbidity resulting from the causes of disease and general disturbances of yīn, yáng, qì, blood, and fluids. However, because they each have unique functions, they are affected in unique ways. Thus, each bowel and viscus is susceptible to:

• specific causes of disease (disease evils, or affect-mind disturbances);
• specific disturbances of yīn, yáng, qì, blood, and fluids;
• disturbances of their specific functions;
• specific developments from preexisting conditions; and
• specific diseases.

The spleen, for example, is prone to:

• dampness;
• insufficiency of qì and yáng rather than of yīn blood;
• digestive disturbances, such as poor appetite and distension and fullness in the stomach duct and abdomen;
• spleen yáng vacuity developing when it loses the warming influence of kidney yáng in kidney yáng vacuity;
• gān disease.

Susceptibility to Causes of Disease

The various causes of disease affect the bowels and viscera in the following ways:

Susceptibility to external and internal evils

• External wind-cold, wind-heat, and dryness affect the lung.
• External heat affects the lung or the heart.
• External cold affects the lung.
• External dampness can affect the spleen.
• Internal heat affects the liver, lung, heart, gallbladder, or stomach.
• Internal dampness arises from splenic dysfunction and affects the spleen further.

Susceptibility to affect-mind disturbances: Susceptibility to affect-mind disturbances is a feature of the viscera, each viscus being prone to different affects. Examples:

• Anger and frustration affect the liver.
• Thought and preoccupation affect the spleen and often the heart.
• Worry and sorrow affect the lung.

Effects of yīn and yáng evils

• Yīn evils reduce activity and obstruct qì, blood, and fluids, foster cold, and reduce normal fluid loss. When dampness affects the spleen and stomach, it affects their normal downbearing and upbearing, giving rise to fullness and distension in the stomach duct and abdomen.
• Yáng evils cause increased movement, give rise to heat, and reduce fluids. When fire affects the heart, there is vexation and agitation as well as a racing pulse.

How General Pathologies Affect the Bowels and Viscera

Susceptibility to yīn-yáng, qì-blood, and fluid disturbances

• Yīn-yáng disturbances are essentially associated with the kidney (the kidney is the root of qì and yáng) but can affect all the viscera.
• Qì disturbances are associated with the spleen, lung, liver, and kidney among the viscera and the stomach, gallbladder, and large intestine among the bowels.
• Blood pathologies are mostly associated with the liver or heart. They are often rooted in the spleen, which is the source of qì and blood formation (although there is no condition of spleen blood vacuity).
• Fluid disturbances are associated with the spleen, lung, and kidney.

How insufficiency affects the bowels and viscera

• Qì vacuity affects a bowel or viscus by reducing its ability to perform its functions.
• Blood vacuity deprives a bowel or viscus (or related body parts) of nourishment.
• Insufficiency of yīn deprives a bowel or viscus of yīn’s calming and cooling effects, causing hyperactivity of functions and heat signs to arise.
• Insufficiency of yáng deprives a bowel or viscus of its invigorating and warming effects, causing reduced functional activity and cold signs.

Disturbances of bowel and visceral functions: Disease of the bowels and viscera manifest in disturbance of specific functions.

• Lung: Breathing; impairment of diffusion and downbearing, manifesting in chest, nose, exterior, and waterway disorders.
• Large intestine: Abnormalities of stool.
• Heart: Spirit; blood and vessels.
• Small intestine: Disturbance of separation of the clear and turbid, manifesting in urinary signs.
• Spleen: Impairment of movement and transformation, manifesting in abdominal discomfort; disorders of appetite and stool.
• Stomach: Impairment of intake, ripening and rottingand downbearing of stomach qì, manifesting in disorders of appetite; discomfort in the stomach duct; stomach qì ascending counterflow manifesting in belching, hiccup, vomiting, or acid upwelling.
• Liver: Impaired free coursing manifesting in qì stagnation or qì counterflow; impaired blood storage manifesting in sinew disorders (spasm), eye problems, and menstrual irregularities.
• Gallbladder: Disturbances in the movement of bile; disturbances of decision-making.
• Kidney: Impairment of water-governing function, manifesting in urinary disorders; and impairment of essence storage, manifesting in slow development, early aging, and reproductive problems.
• Bladder: Urinary disturbances.

Recap of General Pathologies

Qì Vacuity

• Tongue: Tender-soft, attributable to qì failing to move the blood. The tongue has a normal thin white fur.
• Pulse: Vacuous, attributable to failure of qì to move the blood adequately.

Blood Vacuity

• Tongue: Pale, attributable to the blood failing to provide nourishment.
• Pulse: Fine, attributable to blood failing to fill the vessels.

Yīn Vacuity (Vacuity Heat)

• Tongue: Red, attributable to vacuity heat causing greater movement of blood.
• Pulse: Fine and rapid. Fineness is attributed to blood failing to fill the vessels; rapidity is attributed to vacuity heat causing greater movement of blood.

Yáng vacuity (Vacuity Cold)

• Tongue: Pale and enlarged with dental impressions. Paleness is due to yáng qì failing to move the blood adequately; enlargement is attributable to failure to move water-damp.
• Pulse: Vacuous large or faint fine pulse, owing to yáng qì failing to propel the blood.

Qì stagnation (Qì Depression)

• Tongue: Normal color with normal thin white fur.
• Pulse: Stringlike, attributable to the tenseness caused by qì stagnation.

Blood Stasis

• Tongue: Stasis speckles; in severe cases dark-purple general coloration. Both are attributed to the inhibited movement of blood.
• Pulse: Rough pulse, attributed to inhibited movement of blood.

Repletion Cold

• Tongue: Pale with moist white fur.
• Pulse: Slow and tight or slow and sunken, attributed to inactivity of yáng qì and contraction of the vessels.

Repletion Heat (Fire)

• Tongue: Bright red or crimson, with yellow fur.
• Pulse: Forceful rapid, attributed to evil heat forcefully accelerating the blood.

Dampness

• Tongue: Pale enlarged tongue; glossy or slimy white tongue fur.
• Pulse: Moderate or soggy pulse.

Phlegm-Rheum

• Tongue: Pale tongue with white slimy or white glossy tongue fur.
• Pulse: Slippery, sometimes stringlike pulse, attributed to the sliminess and stickiness of phlegm-rheum.

Manifestations

Organ-specific signs: A small number of signs are the direct reflection of a disturbance in the function of a specific bowel or viscus. Bear in mind that in the case of the viscera, this includes the function of intimately related body parts, notably body constituents and external orifices.

• Cough is a disturbance of lung qì that occurs in any lung pathology.
• Nasal congestion and sneezing reflect non-diffusion of lung qì.
• Convulsions and other types of spasm are associated with the liver.
• Manic agitation reflects derangement of the spirit by heart fire.
• Slow development in infants reflects poor development of kidney essence.
• Stones in the urine are a sign of bladder damp-heat.

Less specific signs: Some signs are less specific in their significance and are interpreted by a process described in biomedicine as differential diagnosis.

• Oppression and pain in the chest: Heart disease; lung disease.
• Dizziness: Liver disease; kidney disease; heart disease; spleen disease.
• Tinnitus: Liver disease; kidney disease.
• Painful urination: Bladder disease; small intestine disease.

Specific diseases often involve more than one viscus or bowel, but many are associated closely with a specific one. Examples:

• Mania and withdrawal: Heart.
• Pulmonary consumption (TB): Lung.
• Gān accumulation: Spleen.
• Goiter: Liver.
• Dispersion-thirst: Kidney.
• Strangury: Bladder.

Spreading of Disease

Disease spreads from one part of the body to another in specific ways. Examples:

• Liver qì depression often affects the spleen or stomach.
• Damp-heat spreads from the spleen to the lower burner.
• Liver fire can affect the lung or heart.
• Heart fire can affect the small intestine.
• Kidney yīn and yáng disturbances can affect all the other viscera.

Disease-Evil, Yīn, Yáng, Qì, and Blood Patterns Affecting the Viscera

Disease evils and disturbances of qì, blood, yīn, and yáng can affect specific bowels and viscera. In such cases, there are general signs together with organ-specific signs. Here are some examples of general pathologies affecting the viscera: Wind: Disease of sudden onset affecting the upper and outer parts of the body. Wind-cold fettering the lung: Cough and panting with clear thin white phlegm; wind-cold exterior signs. Wind-heat invading the lung: Cough, expectoration of yellow phlegm; wind-heat exterior signs. Cold: External cold causes cold sensations, clear nasal mucus, long voidings of clear urine, and pain. Apart from wind-cold fettering the lung, it can play a contributory role in: Cold phlegm congesting the lung: Cough; panting; easily expectorated copious white phlegm; cold signs. Heart vessel obstruction: Heart palpitation; intermittent stifling oppression and pain in the chest. For internal cold, see yáng vacuity below. Dampness: Pale enlarged tongue; glossy or slimy white tongue fur; moderate or soggy pulse. Dampness encumbering the spleen (developing into cold-damp or damp-heat): Heavy cumbersome limbs, abdominal fullness, sloppy stool. Damp-heat pouring down into the large intestine: Dysentery or diarrhea. Damp-heat pouring down into the bladder: Strangury. Dryness: Dryness invading the lung: Dry cough with little phlegm; dry nose and mouth; mild exterior signs. Fire (repletion heat): Heat effusion; thirst with desire for cold drinks; short voidings of reddish urine; in some cases, constipation. Liver fire flaming upward: Red eyes; dizzy head and vision; impatience, agitation, and irascibility. Hyperactive heart fire: Heart vexation and agitation or manic agitation; delirious speech; mouth and tongue sores; red-tipped tongue. For internal heat, see yīn vacuity below. Phlegm: Slimy tongue fur; slippery, sometimes stringlike pulse. Phlegm clouding the heart spirit: Disturbances of the spirit seen in diseases such as epilepsy or withdrawal. Phlegm-heat congesting the lung: Cough and rapid panting; expectoration of thick yellow phlegm. Qì vacuity: Fatigue and lack of strength; faint low voice; faint breathing; tender-soft tongue; vacuous pulse. Heart qì vacuity: Heart palpitation; lassitude of spirit. Lung qì vacuity: Faint breathing; forceless cough. Insecurity of kidney qì: Involuntary loss of urine, semen, or fetus; copious vaginal discharge. Spleen qì vacuity: Reduced eating; distension and fullness in the stomach duct and abdomen; sloppy stool. Yáng vacuity: Scantness of breath (mild breathing difficulty); laziness to speak; bright-white facial complexion; cold signs (fear of cold and cold limbs); sloppy stool; long voidings of clear urine; pale enlarged tongue with glossy white fur; vacuous large or faint fine pulse. Heart yáng vacuity: Heart palpitation; oppression in the chest. Spleen yáng vacuity: Continuous abdominal pain that likes warmth and pressure; reduced eating; sloppy stool. Kidney yáng vacuity: Cold aching lumbus and knees; impotence; premature ejaculation; long voidings of clear urine. Blood vacuity: Lusterless or withered-yellow complexion; dizziness; pale tongue; fine pulse. Heart blood vacuity: Heart palpitation; insomnia; forgetfulness. Liver blood vacuity: Hypertonicity of the sinews with inhibited bending and stretching; lusterless dry nails; dry eyes; dizziness; night blindness. Yīn vacuity: Dry pharynx and mouth; emaciation; postmeridian tidal heat; vexing heat in the five hearts; reddening of the cheeks; night sweating; red tongue; rapid fine pulse. Heart yīn vacuity: Heart palpitation; heart vexation; insomnia. Liver yīn vacuity: Dull scorching pain in the rib-side; dizziness; tinnitus; blurred vision. Kidney yīn vacuity: Limp aching lumbus and knees; dizziness; tinnitus. Qì stagnation: Distension and fullness; glomus and oppression; scurrying pain; signs are intermittent, of unfixed location. It is a contributory factor in several spleen, stomach, and intestinal patterns, causing distension and fullness often relieved by belching, or passing of flatus; stomach qì ascending counterflow. Blood stasis: Bruises; abdominal masses; varicose veins; stabbing pain of fixed location; stasis speckles on the tongue; rough pulse. Heart vessel obstruction: Stabbing heart pain.

For details of pattern identification of specific bowels and viscera, see the following:

• Heart pattern identification
• Lung pattern identification
• Spleen pattern identification
• Liver pattern identification
• Kidney pattern identification
• Stomach pattern identification
• Small intestine pattern identification
• Large intestine pattern identification
• Gallbladder pattern identification
• Bladder pattern identification
• Triple burner pattern identification

chest and rib-side.

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