Course:

Diagnostics II
Combination Symptoms

Combination Syndrome
Qi Deficiency of Heart and Lung

Upper Jiao problem

Deficiency of Heart and Spleen

Specific pattern in TCM!!!
This is spleen qi xu + Heart Blood Xu.
Chief complaint often insomnia.

Middle Jiao problem

Gui Pi Tang is the formula of choice

Date:

Dec 8, 2007

Symptom
Palpitation
Cough with difficult inhalation, worse
on exertion
Chest tightness
Clear phlegm
Pallor of face
Dizziness
Lassitude
Spontaneous sweating
Tongue: pale with thin white coat
Pulse: deep, weak or irregular
Palpitations
Poor memory
Insomnia, DDS (dream disturbed
sleep)
Dizziness and vertigo
Sallow complexion
Reduced appetite
Abdominal distention
Loose stool, diarrhea
Lassitude
Bruising
Scanty and light menses

Tongue: Pale with white coat

Pulse: Thin and weak

Page 1 of 5

Caused by
Indicative of heart problem
Cough = lung, exert = Qi xu
Phlegm ret, Qi congestion,
Dampness MJ, no heat
Qi/Yang/Blood Xu or Cold
Can be excess, or Blood Deficiency
Qi Xu
Qi and Yang Xu
Deep = interior, weak = deficiency
Heart
Blood deficiency
Heart Qi Xu
Heart of Liver Blood Xu (cant stay asleep, esp elder
patients)
Can be excess, or Blood Deficiency
Dampness plus Spleen Qi Xu
Spleen
Spleen
Spleen Qi Xu
Qi Xu
Spleen Xu, Heat, Trauma
Blood Xu (thinner and lighter in color)
Yin Xu (redder)
If heavy can be blood heat or spleen qi xu

Blood Xu in both Heart and Liver

Very specific manifestation

Palpitations
Poor memory
Insomnia, DDS

Heart
Blood Xu
Heart Qi Xu
Heart of Liver Blood Xu (cant stay asleep, esp elder pts)
Can be excess, or Blood Deficiency
Qi/Yang/Blood Xu, Cold
Liver Yin Xu
Liver Yin Xu advanced to Liver Blood Xu
Blood Xu anemia/malnutr cn b due toblood or qi xu
Liver wind

Dizziness and vertigo

Pale face
Dry eyes
Blurred vision
Numb limbs
,Tremors

Different kinds of wind and vertigo belong to liver.

Blood deficiency generates wind.

Another symptom of wind: itching, rashes

Treatment: tonify the blood.
Blood Xu
Yin Xu (+nite sweat, 5palm heat, thirst, dk red tongue, little coat)

Little menses

Yang Xu of Heart and Kidney

Tricky pattern. Do not confuse with
Heart/Kid Disharmony (a yin xu)!
Look for cold signs, swollen face,
chest tightness w/coldness there.
Many chronic ht failure pts have this
Always want covers on chest

Tongue: pale with white coat

Pulse: thin and weak
Palpitations
Pale face
Aversion to cold, cold limbs
Sleepy
Edema in face/limbs, esp lwr legs

Cold, soreness/weakness of lumbar

and knee joints
Pale lips and nails
Early morning Diarrhea
Tongue: pale with slippery coat
Pulse: deep, feeble, slow

Page 2 of 5

Heart
Qi/Blood/Yang Xu, Cold
Yang Xu, extreme anger causing Qi congestion
Heart Qi Xu usually or Spleen Qi xu after meals
Lower limbs = Kidney yang related
All 4 limbs = Spleen related
Edema that doesnt stay depressed = Qi edema
Kidney Yang deficiency
Blood, Qi or Yang Xu
Kidney Yang Xu
Yang and/or Qi xu with water retention
Deep = interior/longterm, Feeble = def, Slow = cold

Disharmony of Heart and Kidney

Yin Xu of heart and kidney, but w/
special name in TCM
Rel between Ht and Kd = fire and
water. One controls the other. When
out of balance gets even more out of
whack.

Qi Deficiency of Lung and Spleen

Liver Fire Insulting Lung

Palpitations
Insomnia
Restlessness, irritability
Poor memory
Dizziness and vertigo
Tinnitus
Dry throat
Tidal fever
Night sweating
Soreness of lumbar and waist
Spermatorrhea in dreams
Tongue: red with little coating
Pulse: thin and rapid
Chronic, constant cough with profuse,
clear phlegm
Shortness of breath
Poor appetite
Abdominal distention
Loose stools, diarrhea
Burning pain or distention in
costal/hypochondriac region
Quick temper, irritability
Restlessness
Dizziness
Red eyes
Bitter taste in mouth
Violent, intermittent cough
Little sticky yellow phlegm,
spitting blood
Hot sensation in chest
Tongue: red w/thin yellow coat
Pulse: wiry, rapid

Page 3 of 5

Heart
Blood deficiency
Heart fire/liver fire
Heart yin/blood Xu
Yin def in L. Jiao so yang goes upward
Kidney yin deficiency
Kidney channel which goes to bk of throat
Yin Xu
Yin Xu
Kidney
Kidney Xu
Deficient heat
Deficiency + heat
Cough = Lung, phlegm = Spleen
Chronic = deficient, clear = no heat
Lung Xu
Spleen
Spleen
Spleen Qi Xu
Indicates Liver
Liver + heat
Liver fire longterm affects Heart/shen (Mother/son rel)
Wind due to the heat
Liver fire. If sclera is red liver fire is insulting the lung
Liver, stomach, or GB fire
Violent = excess condition
All indicates heat

Heat
Wiry = liver, rapid = heat

Yin Xu of Lung and Kidney

Yin Xu of Liver and Kidney

*Dont let the heart looking symptoms

throw you offis blood/shen relation.

Difference between this & Heart and

Kidney Disharmony:
-no palpitations
-presence of dry eyes, hypochon pain

Cough + little or bloody sputum

Dry mouth, sore/dry throat
Hoarseness
Losing weight, emaciation
Soreness/weakness of lumbar and
knee joints
Tidal fever, malar flush
Night sweats
Nocturnal emissions
Less menses
Possibly, tinnitus w/high pitch
Tongue: red with little coating
Pulse: thin and rapid
Dizziness and vertigo
Tinnitus
Dull hypochondriac pain
Poor memory
*Insomnia, DDS
Dry throat, eye, mouth
Loosing weight, emaciation
Soreness/weakness of lumbar or knee
joints
Malar flush, night sweats, 5 palm heat,
etc.
Nocturnal emissions
Scanty menses flow
Tongue: red with little coat
Pulse: Thin, rapid

Page 4 of 5

Cough = lung, little = deficient, bloody = def heat

Dry = yin or body fluid xu, sore throat = lu/kd meridian
Lung yin Xu
Yin Xu
Kidney Xu
Yin Xu
Yin Xu
Kidney Yin Xu
Yin Xu
Kidney Yin Xu
Red = heat, little coating = deficiency
Thin = deficiency, rapid = heat
Wind blood xu, yin xu, or heat excess
Kidney deficiency
Dull = deficiency, hypochondriac area = liver
If short term memory: Heart Bld xu
If long term memory: Kidney xu
Liver Blood Xu or Heart Blood Xu
Liver
Yin xu
Kidney
Yin Xu
Kidney yin xu
Yin xu of kidney and perhaps liver
Red = heat, little coating = deficient
Thin = deficiency, rapid = heat

Yang Xu of Spleen and Kidney

Pallor of face
Poor appetite
Aversion to cold, cold limbs
Cold, soreness and weakness of
lumbar and knee joints
Loose stools or diarrhea at dawn
Chronic diarrhea
Incontinence of urine
Facial puffiness or edema of limbs

Tongue: pale, swollen, slippery white

coat
Pulse: deep, feeble, slow
Group the following 2 together
Disharmony of Liver/Spleen

Liver overacting on spleen

Disharmony btwn Liver/Stomach

Can be 1) liver qi stag fire and
affecting st or 2) retained cold
affecting liver and stomach

Distention/fullness, pain in costal

and/or hypochrondriac area
Sighing
Poor appetite
Abdominal distention
Depression, irritability
Loose stools/constipation
Tongue: white or greasy coating
Pulse: wiry
Distention/fullness, pain in costal
and/or hypochondriac area
Belching, hiccupping, acid reflux
Should also have constipation
Irritability
Tongue: red body, thin yellow coating
Pulse: wiry and rapid

Page 5 of 5

Yang/Qi/Blood /Xu, cold

Spleen Qi Xu
Cold limbs = Spleen Yang Xu
Kidney and Kidney Yang Xu
Dawn = Kidney Yang Xu
Chronic = interior/long term
Kidney Qi or Yang Xu
Edema of limbs = Spleen
Edema above waist = yang edema. Lung, Spleen
Edema below waist = yin edema. Spleen, Kidney
Spleen Qi Xu Spleen Yang Xu Sp/Kid Yang Xu
Deep = interior, feeble = defic, slow = cold
Liver
Liver Qi Stagnation
Spleen Qi Xu
Spleen Qi Xu
Liver fire
Spleen Qi Xu
Liver

Stomach Qi cannot go down, rebelling upwards

heat
Wiry = liver, rapid = heat