Four Level Pattern Differentiation

Question 1

What are the 7 warm pathogens?

Answer 1

wind-warmth
Spring-warmth
summer-warmth
dampness-warmth
lurking summer heat
autumn dryness
warmth - toxins

Question 2

What is the general aetiology & pathogenesis of wind-warmth?

Answer 2

Contract of external wind-heat during Spring & Winter through nose and mouth, affects Lung organ and channels

manifests as fever, aversion of wind, cough, slight thirst

Question 3

What is the general aetiology & pathogenesis of spring-warmth?

Answer 3

Contract of external wind-heat during Spring with internal Qi or Jing depletion.

Manifest as strong heat, vexation, strong thirst in a very short period of time

Question 4

What is the general aetiology & pathogenesis of summer-warmth?

Answer 4

Contract of Summer heat pathogen during summer with internal Qi deficiency, progression can be really quick with strong heat,

profuse sweating, vexation, strong thirst, red complexion, tidal pulse.

Question 5

What is the general aetiology & pathogenesis of dampness-warmth?

What are 3 manifestations?

Answer 5

Contract of Dampness pathogen during mid-late summer, possibly with underlying SP&ST Qi deficiency.

Usually manifest as limbs heaviness, lack of appetite, no desire to drink.

Question 6

What is the general aetiology & pathogenesis of lurking summer heat?

What would the S&S be at Qi and ying level?

Answer 6

Summer & Dampness heat remained in the body and cause disease during late autumn to winter. Progressions can be quick with severe.

If pathogens are in the Qi level, it manifests as high fever, vexation, thirst, lack of appetite;

If it’s in the Ying (nutrient) level, it manifests as fever, vexation, maculae in the skin and bleeding.

Question 7

What is usually a factor involved with latent heat?

Answer 7

underlying kidney xu, induces a weak response to pathogen, hence lack of symptoms

Question 8

What are the 9 main clinical manifestations of the emergence of latent heat?

Answer 8

acute onset
thirst
irritability
insomnia
sudden tiredness & lassitude
weary limbs
dark urine
red tongue
rapid pulse

Question 9

What are the 3 main patterns of latent heat?

Answer 9

qi level
- shao yang type
- yangming type
Blood level
- shaoyin type

Question 10

What is the general aetiology & pathogenesis of Autumn dryness?

5 usual manifestations that come with it

Answer 10

Contract of dryness pathogen during autumn period, usually happens at the beginning of Autumn.

Usually manifest as dryness at the skin, mouth, nose, throat and lips.

Question 11

What is the general aetiology & pathogenesis of warmth - toxins?

Answer 11

Contract of Warmth-toxin toxins, highly transmittable.

Manifest as strong heat, maculae with all types of disorders.

There is a strong correlation between the Upright Qi and Pathogenic Qi, those with strong upright Qi might not shows S&S immediately, but in a progressive manner.

Question 12

What are the general signs and symptoms of pathogen at Wei level?
Pulse
Tongue
Is it external/internal?

Answer 12

External pathogen

Fever & Chills
headache (ex. dry-heat)
slight aversion to wind
slight thirst
(Dampness heat may feel sticky at the oral cavity & thirst cannot be quenched)

Pulse: floating (except dampness-heat -> soggy)
Tongue: red tip

Question 13

Why is there an aversion to cold in the Defensive Qi level?

Answer 13

Because the Zheng Qi is reacting in the exterior, causing aversion to cold

Question 14

What are the general signs and symptoms of pathogen at Qi level?
Pulse
Tongue
Is it external/internal and to what layer?

Answer 14

Internal - most superficial, pathogen has transformed into heat
High fever, no chills, aversion to Hot/Warmth,
Pulse: rapid
Tongue: red body, yellow coating

Question 15

Why is there no aversion to cold in the Qi level?

Answer 15

because the Upright Qi reacts interiorly = no aversion to cold

Question 16

What are the general signs and symptoms of pathogen at Ying level?
Pulse
Tongue
Is it external/internal & to what layer?

Answer 16

Internal - penetrated deeper and has begun to injure yin
Fever worse at night,
changes in mental state -> as heat obstructs the mind (which can cause delirium/even coma)
Pulse: narrow (fine) & rapid
Tongue: crimson red without coating (the without coating is key to differentiating it from Qi level)

Question 17

What are the general signs and symptoms of pathogen at Xue level?
Pulse
Tongue
Is it external/internal?

Answer 17

internal - deepest energetic layer, affecting the blood
Fever worse at night. Significant purplish discolouration, haematemesis, haematuria, hematochezia, epistaxis.
Pulse: rapid, choppy/surging pulse
Tongue: crimson red with purple spots

Question 18

What are Wei patterns?
What is the most common one?

Answer 18

wind-heat is the most common
summerheat
dampness-heat
dryness-heat

Question 19

What are 6 differentiating S&S of wind-heat?

Answer 19

Slight sweating
Body aches (obstruction of muscles due to exterior wind)
Runny nose with yellow discharge
Sore throat (due to invasion of wind in the lung channel of the throat. Note that a sore & red throat is a distinctive sign of wind-heat vs wind-cold)
Swollen tonsils
headache (due to exterior wind obstructing channels)

Tongue: Red tip or sides with white coat (white because the pathogen is on the exterior)
Pulse: Rapid & floating

Question 20

How does one differentiation between wind-cold (6 divisions) and wind-heat (4 levels)?
pathology
penetration
fever
shivers & aches
headache
sweating
thirst
urine
tongue
pulse

Answer 20

pathology
- wind-cold on exterior obstructing Wei-Qi
vs. wind-heat injuring Wei Qi & impairing descending of Lung-Qi
penetration
- through skin vs. through nose & mouth
fever
- slight/absent vs. higher
shivers & aches
- severe vs. slight
headache
- occipital vs. deep inside, severe
sweating
- no sweating in prevalence of cold, sweating only on top with prevalence of wind
vs. slight sweating
thirst
- absent vs. slight
urine
- clear vs slightly dark
tongue
- body colour normal, thin white coat
vs. red sides and/or front, thin white coating
pulse
- floating-tight vs. floating-rapid

Question 21

What are the S&S of summer-heat?

Answer 21

Sweating
Heavy sensation & epigastric discomfort (as it frequently combines with dampness)
Irritability
Thirst
Tongue: Red tip or sides with white sticky coat Pulse: Soggy and rapid

Question 22

What does summer-heat have a tendency to do?

Answer 22

it tends to move straight to the Qi level almost from the beginning hence the symptoms of interior heat
eg. irritability, thirst, red tongue and rapid pulse

Question 23

What are 7 S&S of dampness-heat?

Answer 23

Fever worse in afternoon
Body hot to touch
Swollen glands (distinctive sign for this pattern)
Epigastric oppressions & discomfort (as it tends to obstruct the middle jiao & muscles)
Sticky taste in mouth
Thirst with no desire to drink (typical of damp-heat)
frontal headache (due to damp in ST channel)

Tongue: Sticky white coat
Pulse: soggy

Question 24

What are the S&S of dryness-heat?

Answer 24

Slight aversion to cold
Slight sweating
Dry skin, nose, mouth, throat & cough (due to dryness injuring Jinye)
Sore throat
Tongue: Dry with thin white coat
Pulse: Floating, rapid

Question 25

What are the treatment principles of Wei patterns?

Answer 25

For all four "release exterior & clear heat" plus restore the D&D function of lung-qi (wind-heat) Expel summer heat, promote fluids (summer heat) Resolve dampness (dampness-heat) Promote fluids (dryness-heat)

Question 26

What are Qi level patterns? think - here the pathogen has penetrated and transformed into heat

Answer 26

lung heat stomach heat dryness-heat in the intestines Gallbladder heat Dampness-heat in the spleen

Question 27

What are the general S&S of Qi level, which are characterised by Full Interior Heat symptoms?

Answer 27

fever thirst feeling of hot mental restlessness Tongue: red with thick yellow coating Pulse: rapid-full

Question 28

What are 6 S&S of lung heat?

Answer 28

High fever No chills Cough, wheeze, SOB (heat impairing the descending of Lung-qi) thin yellow sputum (phlegm) Thirst Sweating Tongue: Red with yellow coat Pulse: Slippery, rapid

Question 29

What are the 5 shared signs and symptoms b/w Stomach heat (heat) & intestines Dry-heat (fire)?

Answer 29

fever (worse in afternoon), feeling of heat, thirst, red tongue with thick yellow coating, rapid pulse

Question 30

What are 4 differentiating S&S of stomach heat? Represents heat in stomach & is equivalent to Yangming channel pattern

Answer 30

No chills Dry throat Profuse sweating Restlessness Tongue: red with yellow coating Pulse: Overflowing, rapid * Big thirst, sweating, fever, pulse*

Question 31

What are 6 differentiating S&S of dryness-heat in the intestines? represents fire & is equivalent to Yangming Organ pattern

Answer 31

Constipation & dry stools Abdominal fullness/pain Burning sensation in anus Irritability Delirium Dry mouth Tongue: Red with thick, yellow, DRY coat Pulse: Full-deep, rapid (deep reflects deeper location of fire compared to heat)

Question 32

What are 7 S&S of Gallbladder heat?

Answer 32

Alternating chills & fever (more fever) Bitter taste Thirst Dry throat Nausea Hypochondriac pain Scanty yellow urination Tongue: Red with yellow coat Pulse: Rapid, wiry

Question 33

What are 5 S&S of dampness-heat in the spleen & stomach?

Answer 33

Persistent fever (sweating alleviates it but rises again) Heavy sensation of head & body (damp obstructing the muscles) Chest oppression Nausea Loose stools (damp has impaired the Spleen's T&T) Tongue: Red with sticky, yellow coat Pulse: Soggy, rapid

Question 34

What is the treatment principles for these qi level patterns: Lung heat Stomach heat Dryness-heat in the intestines Gallbladder heat Dampness-heat in the spleen and stomach

Answer 34

Lung heat - clear lung heat, resolve phlegm & restore the descending function of the lung Stomach heat - clear stomach heat Dryness-heat in the intestines - drain heat, descend & moisten the stomach & intestines Gallbladder heat - clear the GB heat & harmonise the Shaoyang Dampness-heat in the SP & ST - clear heat in the SP/ST & resolve dampness

Question 35

What the patterns associated with Ying level?

Answer 35

heating entering the ying level heat entering the pericardium

Question 36

What are 3 (plus tongue & pulse) S&S of heat entering the ying level?

Answer 36

Vexing insomnia Dry mouth with no desire to drink Impaired consciousness Tongue: Crimson (no coat because yin is injured) Pulse: Rapid, fine

Question 37

What are 5 S&S of heat entering the Pericardium?

Answer 37

-Mental confusion -Delirium -Incoherent speech or aphasia -Body feels hot but cold limbs (this is false cold, due to heat being so intense -> stops circulation of Qi to hands & feet) -Macules Tongue: Red without coat Pulse: Fine, rapid

Question 38

What is the shared symptom between heat entering the ying level and entering the pericardium?

Answer 38

Fever worse at night macules

Question 39

What is the treatment principles of heat entering the nutrient level?

Answer 39

Transform the heat to the Qi level, Cooling the Ying level & nourish Yin with light and cool herbs

Question 40

What is the treatment principles of heat entering the Pericardium?

Answer 40

Transform the heat to the Qi level, Cooling the Ying level & nourish Yin with light and cool herbs Restore consciousness, Clear PC heat and promote fluids

Question 41

What are the patterns at the blood level?

Answer 41

Exuberant heat with bleeding Exuberant heat with stirring wind Blood stasis & heat at the lower jiao Collapse of yin

Question 42

What are 6 S&S of Exuberant heat with bleeding?

Answer 42

Various forms of blood loss Flushed face Thirst Delirium Red eyes Skin rashes Pulse: Wiry, surging Tongue: crimson

Question 43

What are 6 S&S of Exuberant heat with stirring wind?

Answer 43

Coma Convulsions with neck rigidity, Opisthotonos & clenching of teeth (due to heat affecting liver = forrest fire generating strong winds = internal wind) Eyes turning up Lockjaw tongue: crimson Pulse: Wiry, rapid

Question 44

What is the shared sign between exuberant heat with bleeding vs with stirring wind?

Answer 44

high fever crimson tongue

Question 45

What are 5 S&S of Blood stasis & heat at the lower jiao?

Answer 45

Constipation Dry black stools Hardness and pain in lower abdomen Dry mouth Normal urination Tongue: Purple or purple spots on Pulse: Deep, forceful, or choppy

Question 46

What are 7 S&S of Collapse of Yin? The final consequence of heat at blood level (along with collapse of yang)

Answer 46

Low grade fever Night sweats Restlessness Dry mouth with desire to sip fluids Five hearts hot Malar flush Emaciation Tongue: Dark red dry Pulse: Fine, rapid, feeble

Question 47

What are the treatment principles of Exuberant heat with bleeding?

Answer 47

Clear blood heat & stop bleeding

Question 48

What are the treatment principles of Exuberant heat with stirring wind?

Answer 48

Clear blood heat, nourish KD & LR yin, Subdue the internal wind

Question 49

What are the treatment principles of blood stasis & heat at the lower jiao?

Answer 49

Drain heat, invigorate blood and remove blood stasis

Question 50

What are the treatment principles of collapse of yin?

Answer 50

Rescue Yin, Restore consciousness

Question 51

What are 5 characteristics of warm diseases caused by external wind-heat?

Answer 51

- manifest with fever - pathogenic factor enters via nose & mouth - infectious - the development is rapid - the pathogenic factor has a strong tendency to injure yin

Question 52

What are the 6 distinguishing features of fire compared to heat?

Answer 52

- more intense (intense thirst, high fever, intense feeling of heat) - affects the mind more (mental restlessness, delirium) - dries up more (intense thirst, dry stools, constipation, very dry tongue coating) - deeper pathogenic layer than heat (deep pulse compared to Overflowing in heat) - may cause bleeding - Acute febrile diseases in children may cause internal wind quickly

Question 53

How does fever present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 53

Wei - slight fever, aversion to cold Qi - high fever, feeling of heat Ying/Blood - fever at night

Question 54

How does thirst present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 54

Wei - slight Qi - intense, desire to drink cold drinks Ying/Blood - dry mouth, desire to sip liquids

Question 55

How does mental state present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 55

Wei - unchanged Qi - may be delirium, generally mind clear Ying/Blood - delirium, fainting, mind confused

Question 56

How does sweating present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 56

Wei - slight Qi - profuse Ying/Blood - night sweating

Question 57

How does the tongue present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 57

Wei - red sides/front, thin white coating Qi - red body, thick yellow coating Ying/Blood - red body, not coating

Question 58

How does the pulse present in relation to the 4 levels? Wei Qi Ying/Blood

Answer 58

Wei - floating-rapid Qi - big-rapid, deep-full-rapid or slippery rapid Ying/Blood - fine-rapid

Question 59

What would be the relevant 8 principles diagnosis in relation to the 4 levels? Wei Qi Ying/Blood

Answer 59

Wei - exterior pattern Qi - interior pattern, upright qi strong Ying/Blood - interior pattern, upright qi weak

Question 60

What do Papules (red, solid spots) indicate?

Answer 60

generally indicate heat at Qi level, esp. lungs & stomach

Question 61

What do Macules (discoloured skin that can't be palpated) indicate?

Answer 61

indicate heat either at Ying or blood level

Question 62

What do vesicles (blister-like spots filled with clear fluid) indicate?

Answer 62

always indicate dampness