TCM Patterns

Toxic Heat.....................................................................................................................2
Phlegm Heat ................................................................................................................3
Phlegm Damp ..............................................................................................................4
Stomach yin Deficiency..............................................................................................5
Blood Stasis in Lower Jiao .........................................................................................7
Blood Stasis in Liver (qi Stagnation & Blood Stasis) ..............................................9
Liver Fire .....................................................................................................................11
Damp-Heat in Lower Jiao ....................................................................................... 13

Toxic Heat
Pattern Discrimination:
General Descriptions:
This pattern is usually seen in the fastigium or later stage of externally
contracted diseases. In this pattern, Evil Heat is exuberant, Body Fluids, yin
and Blood are injured and functions of zang -fu organs are severely affected. It
belongs to excessive Heat syndrome, but also has the aspect of injured yin.
Main Symptoms:
l High fever, fidget and thirst, skin eruptions;
l or various bleeding.
Clinical Manifestations:
l High fever, hot feeling of the skin, fidget and thirst with desire for dri nks;
l irritability, insomnia or mania, unconsciousness;
l skin eruptions;
l hematemesis, or nose bleeding, or blood in the stool.
l Deep purplish tongue, wiry and rapid or fine and rapid pulse.

Tongue Pictures:

Pictures

dark and purplish,

with tooth prints in the
margins
white, greasy and thick,
Tongue Coat
obvious in the middle part
Tongue
Body

deep-red and purplish,

with scattered and multiple
prickles
thin, white, with scanty
fluids

Phlegm Heat
Pattern Discrimination:
General Descriptions:
This pattern is caused by coagulation of Phlegm and Heat. It can be seen in
different stages of various diseases, such as each stage of externally
contracted febrile diseases, or later stage of miscellaneous diseases. The
pattern is usually of the Heat property and excess type.
Main Symptoms:
l Vexation, thirst, cough with yellow and sticky sputum;
l or vomiting when drinking water, epigastric tenderness when pressing;
l or delirious speech and actions, irritability and insomnia.
Clinical Manifestations:
l Body fever, vexation, thirst, asthma, cough with yellow and sticky sputum;
l or sore throat, hoarse voice, thirst, vexation;
l or body fever and redness, thirst with desire for drinks but vomiting when
drinking, epigastric tenderness when pressing;
l or hectic fever, constipation, accumulation and stagnation of sputum,
asthma and shortness of breath;
l or irritability, insomnia, disturbed mind state, delirious speech and actions.
l Yellow and sticky or yellow and moist-glossy tongue coat, wiry pulse.

Tongue Pictures:

Picture

Tongue
Body

deep-red

Tongue Coat

thin, yellow, sticky and

greasy

slightly dark red, with cracks

on the surface, more on the
right side
yellow, thick, moist and
glossy

Phlegm Damp
Pattern Discrimination:
General Descriptions:
This pattern can be caused either by Spleen deficiency and retention of
Water in the body due to over fatigue, improper diet, externally contracted
pathogens, and internal injuries resulted from emotional disorders, or by
generated Phlegm and Damp due to involved Spleen a nd Stomach in diseases
of other zang-fu organs. Its usually of the Cold property and deficiency
complicated with excess type.
Main Symptoms:
Feeling of fullness in the chest and epigastric region, nausea, and vomiting,
copious sputum.
Clinical Manifestations:
Feeling of fullness in the chest and epigastric region;
poor appetite, nausea, vomiting;
vertigo;
cough with copious sputum;
heaviness of the body;
mental weariness.
Thick and greasy tongue coat, weak-floating and slippery pulse.

Tongue Pictures:

Pictures

Tongue
Body

dark and purplish

Tongue Coat

white, thick and greasy

dark and purplish-red, with tooth

prints in the margins and
petechia
white, thick and greasy,
yellow in some parts

Stomach yin Deficiency

Pattern Discrimination:
General Descriptions:
In externally contracted febrile diseases, exuberant Heat Evil easily injures
Fluids in the Stomach. In the later stage of febrile diseases, other symptoms will
disappear while Fluid cant be restored within a short period. So Stomach yin
deficiency is commonly seen in the later stage of febrile diseases. In chronic
diseases, various prolonged Heat syndromes of Stomach will consume
Stomach Fluid and result in Stomach yin deficiency, and this pattern is usually
seen in the later stage of diseases. In clinic, the pattern is mostly complicated
with other syndromes, and its of the deficiency type of the Stomach and
belongs to Heat syndrome.
Main Symptoms:
l Decreased intake of food, retching, red and bald tongue.
Clinical Manifestations:
l Decreased intake of food, poor appetite, epigastric upset or even
stomachache after meals.
l Thirst with desire for drinks but wont relieve after drinking, retching or
vomiting, dry and hard stools, emaciation, and lusterless complexion.
l Red tongue, without coat or with little fur, thin, wiry and rapid pulse.

Tongue Pictures:

Pictures

Tongue
Body

bright-red,
with prickles in the tip

Tongue Coat

thin

deep-red, with multiple

longitudinal deep cracks,
bright as mirror
none

Formulations / Herbs:
5

Mai Men Dong Tang

Mai Dong, Dang Shen, Ban Xia, Geng Mi, Da Zao, Gan Cao

Long term Stomach Yin Xu creates Spleen Yin Xu:

Yi Pi Tang
Tai Zi Shen, Fu Ling, Bai Zhu, Jie Geng, Shan Yao, ian Zi Rou, Y Yi Ren,
ian Shi, Bai Bian Dou, Shi Hu, Gu Ya, Zhi Gan Cao
Stomach Heat / Yin Vacuity
Pattern Discrimination:
General Descriptions:
When Stomach Heat endures for a long time, it will injure the Yin of Kidney and
Stomach.
Main Symptoms:
Toothache, loose teeth, bleeding gums, frontal headache, irritability and a
low-grade fever with desire to drink cold drink.
Tongue: A dry red body with yellow coat
Pulse: Floating, empty and large

Pictures

Tongue
Body

Stomach Heat/Yin Xu:

Dry red

Tongue Coat

Thin yellow in centre

Phlegm and water

retention - Spleen Yin Xu:
Red
yellow, greasy and curdy

Blood Stasis in Lower Jiao

Pattern Discrimination:
General Descriptions:
Evil Heat usually causes this pattern and Blood coagulate in the Intestine or
Bladder after exogenous Evils invade Lower Jiao deeply. Evil Heat can also
directly invade the Blood Room (Uterus) before mens truation or after delivery
and block the channels to cause this pattern. Emotional disorders can result in
dysfunction of zang -fu organs which may lead to abnormal functional activities
of qi and stagnated Blood, and forms Blood stasis in the Lower Jiao. This
pattern is of Heat property and excess type.
Main Symptoms:
l Pain in the lower abdomen which is relieved by cold and aggravated by
warmth or pressing;
l Hot feeling of the skin;
l Irritability, or frantic mind state.
Clinical Manifestations:
l Fixed pain in the lower abdomen, which is aggravated by pressure and
warmth and relieved by cold, hot feeling of the skin, dysphoric expression,
mental weariness, or frantic mind state.
l Or blood in the stools or urine, or absence of menstruation, amenorrhea,
uterine bleeding,
l Or hectic fever, emaciation, squamous and dry skin.
l Rapid or fine and rapid pulse, dark-red or purple-dark tongue body with
possible petechia.

Tongue Pictures:

Pictures

Tongue
Body

Dark, with petechia

Tongue Coat

Thin and white

Bright-red, with petechia in

the margins and red points
in the tip
Thin and yellow
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Formulations / Herbs: Shao Fu Zhu Yu Tang

Xiao Hui Xiang, Gan Jiang (with internal cold), Yan Hu Suo, Dang Gui,
Chuan Xiong, Mo Yao, Guan Gui,Chi Shao, Pu Huang, Wu Ling Zhi
Add Dang Shen, Shu Di and E Jiao for enduring lower abdominal pain
Add Mu Xiang and Bai Shao for sever menstrual pain
Blood Heat / Blood Stasis
Pattern Discrimination:
General Descriptions:
This pattern is due to Toxic Heat in the Blood (Xue) aspect. The Heat stews the
Fluids and causes congelation and Blood Stasis.
Main Symptoms:
Vexation, restlessness and possible delirium. Various forms of bleeding
Tongue: Dry, crimson
Pulse: Fine and Rapid

Pictures

Tongue
Body
Tongue Coat

Dark, with petechia

No coat

Formulation / Herbs:
Qing Yi ng Tang Jia Jian
Shui Niu Jiao, Sheng Di, Mai Men Dong, Jin Yin Hua, Lian Qiao, Huang
Lian, Dan Zhu Ye, Dan Shen
Add Sha Shen and Gou Qi Zi if Yin Fluids have been severely depleted
Add Gou Teng, Di Long and Ling Yang Jiao if there is stirring of internal
Wind with tremors and spasms.

Blood Stasis in Liver (qi Stagnation & Blood Stasis)

Pattern Discrimination:
General Descriptions:
This pattern is caused by stagnated qi; its an excessive syndrome.
Anything that can lead to qi stagnation and result in this pattern.
Main Symptoms:
l Distending,
fullness and pain, which are unfixed in the chest,
hypochondriac and epigastric regions, or the abdomen, while, fixed stabbing
pain areas, which are aggravated by pressing, or masses.
Clinical Manifestations:
l Depressed mood, or irritability, pain in the chest, hypochondriac and
epigastric regions, abdomen or breasts, which is unfixed or fixed stabbing
pain, which is aggravated by pressing.
l Masses or swelling in the hypochondriac regions or abdomen.
l Amenorrhea, painful periods with dark menstrual blood with dark clots,
premenstrual pain.
l Purple nails, dark face.
l Purplish and dark tongue especially on the sides, possible petechia, deep
or uneven pulse.

Tongue Pictures:

Pictures

Tongue
Body

Dark and purplish

Dark and purplish

Tongue Coat

White, thick, greasy and

dry, with cracks, peeled
coat in the middle part

White and thick coat similar

to sand grain

Formulation / Herbs:
Ge Xia Zhu Yu Tang plus Ben Tun Wan
9

Wu Ling Zhi, Dang Gui, Chuan Xiong, Tao Ren, Dan Pi, Chi Shao, Wu
Yao, Yan Hu Suo, Gan Cao, Xiang Fu, Hong Hua, Zhi Ke, Chuan Lian Zi,
Fu Ling, Li Zhi He, Xiao Hui Xiang, Mu Xiang, Ju He

10

Liver Fire
Pattern Discrimination:
General Descriptions:
Liver Fire is the further development of Liver qi depression. Depressed Liver
qi will transform into Fire and this Fire will flame up along the channel. In clinic,
the main manifestations are hot symptoms of the head and face. In addition,
over indulgence in tobacco and alcohol, or pungent, hot and greasy food will
result in the internal accumulation of Damp and Heat Evils, which will transform
into Fire.
Main Symptoms:
l Headache, red eyes, irritability.
Clinical Manifestations:
l Headache, vertigo, tinnitus, red complexion, redness, pain and swelling of
eyes, bitter taste, dry throat, dry mouth, thirst;
l Constipation, deep-colored urine;
l Irritability, insomnia, dream-disturbed sleep, pain in the hypochondriac
regions with hot feelings;
l Haematemesis, nose bleeding, advanced menstruation with increased
amount of bright menses;
l Mania.
l Red tongue with yellow and dry coat, wiry and rapid pulse.

Tongue Pictures:

Pictures

Tongue
Body

Red

Red

Tongue Coat

Yellow, dry and thick, with

transverse cracks

Yellow, thick and dry, with

transverse cracks

11

Formulation / Herbs:
Long Dan Xie Gan Tang, Huang Lian Jie Du Tang,

12

Damp-Heat in Lower Jiao

Pattern Discrimination:
General Descriptions:
This pattern refers to lingering Damp-Heat blocking in the Lower Jiao and
result in the disorders of Large Intestine and Bladder. In some cases, Damp
Heat Evils attack the Liver Channels and will flow into the private parts along
the channels. This pattern is of interior and excessive Heat syndrome.
Main Symptoms:
l Body fever, hardness and fullness of the lower abdomen, constipation,
thirst that will be relived by small amount of water.
l Scanty and deep-color urine, hot, difficult and painful urination.
l Oozing and itching in the private parts, hot and painful feeling of the
testicles, or odorous vaginal discharge.
Clinical Manifestations:
l Lingering body fever, hardness and fullness of the lower abdomen,
constipation, or difficult urination, thirst, which will be relieved by small
amount of Water.
l Frequent, urgent and painful urination, scanty and deep-colored urine,
distension and pain in the lower abdomen, possibly accompanied with
lumbago and fever.
l Blood in the urine, or urinary calculus, or turbid urine.
l In severe cases, unconsciousness.
l Oozing and itching or skin rashes in the private parts, swelling, pain and
hot feeling of the testicles, white or yellow or red sticky and odorous vaginal
discharge.
l Red tongue with yellow and greasy coat, slippery and rapid pulse.

Tongue Pictures:

Pictures

Tongue
Body

Red

Red
13

Tongue Coat

Yellow, thick and greasy

Yellow, greasy and thick,

obvious in the right and
middle part

Formulation / Herbs: Damp Heat in the uterus:

Qing Re Li Shi Tang
Bi Xie, Qu Mai, Shan Zhi Zi, Huang Qin, Zhi Mu, Dan Pi, Ou Jie, Xian He
Cao,
Add Gui Ban for Yin Xu

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