ACUP 117 Final Exam Review Guide PDF

# ACUP 117 Final Exam Review Guide This guide is intended to be used alongside your midterm review guide from earlier in the term, as this one will only focus on topics covered after the midterm. Not all of the 5-Element organ correspondences will be included in this document, so you will still nee...

# ACUP 117 Final Exam Review Guide This guide is intended to be used alongside your midterm review guide from earlier in the term, as this one will only focus on topics covered after the midterm. Not all of the 5-Element organ correspondences will be included in this document, so you will still need to review those even if they aren't listed here. Keep in mind this guide includes the most important items, but it is impossible to include everything. This should act as a prompt for further study/reading on your own. ## Topics Included - Zangfu Organs - Zang Organ Relationships - Extraordinary Organs - Pattern Differentiation - Eight Principles / Basic Pathology - Basic Channel/Point Theory ## Zang Organs - Yin in nature - "Solid" and "Deeper" - Store, Produce and Transform vital substances - Tend toward deficiency conditions - Have an associated Spirit - Generally thought of as more important ## Fu Organs - Yang in nature - "Hollow" and more "superficial" - In constant "contact" with the exterior - Tend toward excess conditions (accumulation of pathogens) - Excrete waste, move and transport fluids, separate pure/turbid substances - No "spirit" connection, though they do play supporting roles in mental health ## Extraordinary Organs - The Shape of a Fu organ with the Function of a Zang Organ; organs which are "hollow" in their natural resting state but can hold/store a substance (eg. bones-marrow, uterus-fetus, GB- bile) ## The Heart (xin) ### Function - **The Monarch** - processes all emotions - oversees the functioning of the other organs, and the 5-spirits - Houses "Emperor Fire" and Rules the other organs - **The Residence of the Shen (Heart-Mind)** - **The Blood "Factory"** - The site of blood production ### Manifestations - Manifests in the complexion - subtle reddish hue of the face - Related to "Joy" - overexcitement, mania, sudden surprise - Opens into the tongue and controls speech - moreso tongue movement, but also connected to taste. - Controls sweat (fluid) - doesn't control the pores - Pumps Blood and Governs the Blood Vessels - arteries and veins - Loathes Heat -- the heart is quite sensitive to heat/fire disorders - Connected to the Uterus via the Bao Mai (along with the PC) ### Common Signs of Heart Pathology - Palpitations - Chest Discomfort - Circulation issues - Psychoemotional or Sleep Disturbances - Red tongue tip ## The Pericardium (xinbao) - Protects the heart from invasion - Assists in housing the Mind (Shen) -- also allows the Heart to process emotions in a rational way - Helps to regulate the chest via Zong Qi (respiration, HR, etc.) - Often discussed in context of 4-Levels (Warm Disease) theory as a site of disease ## The Liver (gan) ### Function - **The General/Strategist** - In charge of planning, dreams and vision (via the Hun) - Ensures smooth flow of Qi and appropriate emotional expression - Its Wood nature manifests in upward/outward movement, rapid change, flexibility, etc. - **Stores Blood and Regulates Blood Volume** -- where does the body need it blood and how much? - Ensures the **Smooth Flow of Qi** (all directions) & **Emotional Flow** - Manifests in the **Nails**, Opens into the **Eyes** (controls Tears) - Affected by **Anger** -- resentment, irritability, long term emotional stress - Houses the **Hun** (Ethereal Soul) - Controls the **Sinews** - Liver Blood nourishes the sinews/tendons - Susceptible and vulnerable to WIND ### Traits - **A Yin organ with a "Yang edge"** - The largest Yin organ and main storage point for blood, but prone to disorders of Heat/Fire/Yang Rising - **Arises from the Left Side** - **Ascends on the left** (to balance descending of the Lung): "Outer Wheel" ### Common Signs of Pathology - Hypochondriac Pain - Moodiness, irritability - Bitter taste in the mouth (along with GB) - Dry, brittle nails - Issues involving the eyes or vision - Disorders or inflexibility of the sinews/tendons ## The Lungs (fei) ### Function - **The Prime Minister** - Governs Qi and the "100 Channels/Vessels" (microcirculation) - Govern Respiration and the Voice - Control the Pores (via Wei Qi) - **Controls Qi and Breathing** -- via the movement of Qi and connection to Zong Qi - **Descends Qi** - mainly in regards to inhaled air Qi sending down to the Kidneys - **Diffuses Wei Qi and Moisture (Jin Fluids) over the exterior of the body** -- hence the name "Upper Source of Water" - Susceptible to Dryness (via nose/mouth) - Opens into the nose (control nasal mucus), Manfiest in Body Hair/Skin (pores) - House the Po (Corporeal Soul) - Vulnerable to the emotion of Grief ### Traits - **The Lungs are the Delicate Organ** due to constant contact with air / external environment. - **The Spleen generates phlegm The Lungs Store it ("The Container for Phlegm")** - **The Upper Canopy** ### Common Signs of Lung Pathology - Shortness of Breath, Cough, Wheezing, Shallow Breath, and other respiratory issues - Poor immune system, frequent colds, nasal issues, allergies (wei qi issue) - Fatigue (due to connection to Qi) - Chest tightness or Chest "Oppression" ## The Kidneys (shen) ### Function - **The Official; The ROOT** - Balancing act between the dense, inert substance of JING (oil in the lamp) vs. the fiery, active spark of Mingmen Fire (flame in the oil lamp) - The Seed of Potential for growth, change, development - **The ROOT of ALL YIN & YANG of the Body** -- always giving up energy so they can never be excess, only deficient - The Root of Preheaven (due to storing Jing Essence) - Lower Source of Water ("The Kidneys Control Water") - Provide heat to all physiological functions via the Mingmen - Control Receiving of Qi (Grasping from the Lungs) - Control the Lower 2 Yin (Lower Orifices: Anus/Urethra) - Open into the Ears and Control Hearing - Vulnerable to Fear and Cold - Houses the Zhi (Ambition) - Produce Marrow, Control Bones, Manifest in the Teeth and Hair ### Traits - Most sources place the Mingmen between the Kidneys. Some sources state that the LEFT Kidney pertains to Yin and the RIGHT Kidney pertains to Yang. ### Common Signs of Kidney Pathology - Low Back Pain - Weakness of the Low Back/Knees - Bone, marrow, or teeth pathology - Premature Aging, Sexual Dysfunction - Urinary change (quality, frequency) - Constitutional or hereditary issues ## The Spleen (pi) ### Function - **The Granary Official** - The Center of Transformation and Transformation - The Root of Post-Heaven Qi - The Resource Provider (Grain Qi for the production of Qi/Blood) - **Transports and Transforms food/drink into useable Qi** - "Generates" Blood (due to providing resources) and Holds Blood within the Vessels - Ascends Qi upwards (refined Food Essences via Gu Qi) - Lifts and Raises (keeps the organs in place; prone to Sinking) - Controls the Muscles & 4 Limbs, Opens into the Mouth, Manifests in the Lips - Houses the Yi, Damaged by Overthinking/Worry - Vulnerable to Dampness - Controls the sense of taste (assisted by the Heart) - Raises Clear Yang Upwards ### Traits - The Spleen is the root of all post-heaven nourishment, therefore deficiency can easily ripple out into other areas: Lung Qi Xu, Heart Blood Xu, etc. - The Spleen likes dryness and therefore is particularly sensitive to Dampness ### Common Signs of Spleen Pathology - Poor appetite - Mild Nausea - Abdominal Distension - Loose Stools - Fatigue - Prolapse (if sinking) ## Small Intestine (xiao chang) - Controls "Receiving and Transforming": (Further) Separates the Pure from Impure - Separates Fluids - Emotionally, helps us to sift and sort through information and influences mental clarity and discernment ## Triple Burner San Jiao - A separation of the body into three cavities (upper, middle, lower or mist, maceration chamber and drainage ditch) - An important organ in assisting the Qi Mechanism (especially entering and exiting). Also important in facilitating fluid metabolism between the upper and lower body. - A vector for Yuan Qi to work through in the body ## Stomach (wei) - Controls Receiving - The Origin of Fluids - "Ripens and Rottens Food" - Controls the Descending of Qi (mainly in the Fu Organs) - "Steams" and creates the Tongue Coat ## Large Intestine (da chang) - Controls "Passage and Conduction" - Transforms Stools and Reabsorbs Fluid - Facilitates "Letting Go" (literally and figuratively) ## Urinary Bladder (pang guang) - Descends and excretes Turbid Fluids ("Removes Water by Qi Transformation") - Related to jealousy, grudges and suspicion ## Gall Bladder (dan) - Stores and excretes Bile - Controls decisiveness and courage - Controls the Sinews (alongside LR) ## Organ Relationships ### Relationships of Blood - **Heart/Liver, Liver/Spleen, Spleen/Heart** - The Heart governs blood, The Spleen generates blood, The Liver stores blood and regulates blood volume. - Heart blood nourishes the Spleen, Liver Blood nourishes the Heart - Liver blood deficiency can lead to Heart Blood deficiency and vice versa. - The Heart houses the Shen, the Liver houses the Hun - Blood deficiency can effect both spirits. - If the Spleen fails to hold blood then the Heart and Liver can easily become blood deficient as a result. - The HT/LR/SP are 3 major channels in treating irregular cycles. - Honourable mention to the Kidneys which provide the Yuan (Original) Qi needed to make blood, as well as Tian Gui ### Relationships of Qi - **Lungs/Spleen, Liver/Spleen, Lungs/Kidneys, Spleen/Kidneys** - The Spleen makes Grain Qi (Gu Qi), The Lungs inhale Air Qi (Qing Qi). The Spleen is the root of Post-Heaven Qi, The Lungs Govern Qi. Spleen and Lungs often become deficient together. The Spleen can also generate dampness/phlegm and store it in the Lungs. - The Liver governs the smooth flow of Qi. The Spleen governs transformation and transportation. If Liver Qi stagnates - the Spleen may be unable to T&T adequately. - The Lungs descend Qi downwards and the Kidneys grasp it in order to complete a full inhalation. - The Spleen is the root of Post Heaven Qi and the Kidneys are the root of Pre-Heaven Essence (Qi helps to maintain our stores of essence) - Apart from the common issues listed, it is important to note that a Spleen Qi, Kidney Qi or Lung Qi deficiency can lead to a deficiency of Qi in most other organs eventually. On the excess side, Liver Qi stagnation can easily cause stagnation in pretty much any other organ as well. ### Relationships Outside of Qi/Blood: Movement and Communication and Fluid Metabolism - **Heart/Lungs** - The Liver ascends on the left, the Lungs descend on the right (Outer Wheel) - this shows up mainly in pathologies of Qi movement and issues of ascending/descending of Liver/Lung Qi - **Heart/Kidneys** - Heart Qi Descends to communicate with the Kidneys (by sending warmth; fire to water), to influence the menstrual cycle, and also descends to assist the Spleen in its role of T&T. - **Spleen/Kidneys** - Kidney Yang provides warmth to facilitate the Spleen's role of T&T. The Spleen also assists the Kidneys in their transformation and excretion of fluids. A dual Kidney Yang Deficiency and Spleen Yang deficiency is common for this reason. The Kidneys also send warmth (Yang) and fine vapor (Yin) upwards to keep the organs warm and moist (namely the Heart/Lungs) - The Liver and the Kidneys are both storehouses of Yin substances (Blood and Essence, respectively). Through these substances they mutually nourish one another. They are the first organs to decline with age. - The Kidneys are the Lower Source of Water, the Lungs are the Upper Source of Water ### Relationships of Qi AND Blood - **Heart/Lungs, Liver/Lungs. Spleen/Heart** - The Heart governs Blood, The Lungs Govern Qi. If Qi stagnates, blood stagnates. If Blood is weak, Qi cannot be nourished. Healthy circulation relies on the rhythmic breath of the Lungs and the rhythmic pumping of the Heart - The Heart and Lungs are both in the upper jiao. If one is deficient, the other often follows. If one stagnates, the other stagnates. - The Lungs "drive" blood through the vessels (via their movement of Qi / the propelling action of Zong Qi (Gathering). This also pertains to Liver Blood, which relies on the Lungs to move. - The Lungs govern Qi and the Liver governs the smooth flow of Qi in all directions. If Liver Qi stagnates, Qi can stagnate in the Chest - The Heart relies on Spleen Qi to make blood. Dual deficiency of Spleen Qi/Heart Blood due to poor diet is very common. ## Basic Pattern Overview: Qi & Blood - **NO SPECIFIC ORGAN PATTERNS TESTED IN FOUNDATIONS I - HOWEVER YOU SHOULD KNOW THE CARDINAL SIGNS OF EACH ORGAN IMBALANCE (EG. LOSS OF APPETITE AND LOOSE STOOLS FOR SPLEEN)** ### Qi Stagnation - Very common, but not a cause of major disease on its own - Often the precursor to Blood Stagnation (but also heat, if longstanding) - We see common Liver signs in basic Qi Stagnation because the Liver governs free flow of Qi in the entire body so it will be affected in cases of stagnation regardless. - A feeling of distension, gloominess or melancholy (on one end of the spectrum) or, irritability. Mood swings, frequent sighing (to try and "move" qi), a wiry pulse, a normal tongue body (because Qi/Blood have not been depleted) OR a slightly red hue to the SIDES of the tongue because the sides of the tongue correspond to the LR/GB ### Qi Sinking - Derangement of the "Raising" function of Qi - often a result of longstanding Qi Deficiency - A bearing down sensation or organ prolapse, tiredness, listlessness, lethargy, mental depression, an empty pulse, other Qi deficiency signs ### Qi Deficiency - A common pattern due to overwork, poor diet, inadequate rest, etc. - Often a precursor to YANG Deficiency (Empty Cold) - Qi is a Yang substance, so this makes sense - We see common Lung/Spleen signs even in a general Qi Deficiency, given the close relationship of these organs to the production of Qi - Shortness of breath, weak voice, spontaneous sweating, poor appetite, loose stools, empty pulse, fatigue ### Rebellious Qi / Counterflow of Qi - Qi flowing in the wrong direction along a channel (counterflow) OR Qi moving opposite to the organ's general movement (eg. Stomach Qi ascending, rather than descending) -- symptoms will vary depending on the organ or channel affected. ### Blood Stagnation/Stasis - Often a cause of major diseases like cancer, tumors, etc. - Pain is often fixed/"stabbing" in nature. Often caused by either physical trauma, cold or Qi Stagnation - Dark dusky complexion, purple lips, boring fixed or stabbing pain, abdominal masses which are fixed/hard, purple nails, clotted menstruation, purple tongue + accompanying organ symptoms ### Loss of Blood - Not necessarily a pattern in itself, but a symptom of blood loss from any area: epistaxis (nosebleed), hematemesis (vomiting blood), hemoptysis (coughing blood), meno/metrorhaggia (heavy cycles), hematuria (blood in the urine), hematochezia (blood in the stool) ### Blood Heat - A combination of standard heat signs + Shen disturbance signs: feeling of heat, skin eruptions, thirst, bleeding, red tongue, rapid pulse ### Blood Deficiency - A common pattern due to poor diet. Also common in Vegans/Vegetarians. More common in patients who menstruate. A combination of deficiency signs, dryness, and psychoemotional signs due to Shen losing its anchor. - Dull white or pale white complexion, poor memory, dizziness, numbness, tingling, blurred vision, insomnia, pale lips, scanty periods, amenorrhea, depression, slight anxiety, pale and slightly dry tongue, pale nales, dry skin + specific organ symptoms ### Deficiency of Body Fluids - Dryness of any tissue or mucus membrane or any tissue that requies moisture. Pretty much synonymous with the symptoms of pathogenic dryness. Here though, the cause is a lack of fluids and not a pathogen. - Not necessarily a "pattern" on its own, but often a consequence of deficiency (esp of the kidneys) - Key symptomology is water retention or edema, excess fluids where they shouldn't be. ### "Overflowing" of Fluids - Not necessarily a "pattern" on its own, but often a consequence of deficiency (esp of the kidneys) - Key symptomology is water retention or edema, excess fluids where they shouldn't be. ## Empty (xu) Conditions - **Empty / Deficient Qi:** pale face, weak voice, slight sweating during the day, shortness of breath, tiredness, lack of appetite, empty pulse - **Empty / Deficient Blood:** dull pale face, pale lips, blurred vision, dry hair, tiredness, poor memory, numbness or tingling, insomnia, scanty periods, fine/choppy pulse, pale thin tongue. - **Empty / Deficient Yang:** Chilliness, tiredness, bright pale face, desire for hot drinks, loose stools, pale profuse urination, frequent urination, weak pulse, pale wet tongue, other qi xu signs - **Empty Yin:** Feeling of heat in the afternoon or evening, five-palm heat, malar flush, night sweating, thin tongue, red peeled tongue coat, dry tongue ## Hot (re) – Cold (han) - Refers to the energetic nature of a pathology - We know that heat and cold can be either full or empty - therefore their presentation depends on which category they fall under. That said, heat and cold both have qualities that are constant across all presentations. ### Qualities of Heat - extreme or erratic activity, rising, flaring up, feelings of warmth, burning, inflammation, hyperactivity, thirst, redness, fever, potential bleeding, red eyes/face, yellow discharge, dryness "bright/jumpy" ### Qualities of Cold - congealing, cramping, contraction, slowing, fixed, feelings of cold, aversion to cold, desire for warmth, hypoactivity, paleness, chills, clear or white discharge "cloudy in nature" - Can also be combined or simultaneous ## Common Symptoms of Organ Pathology | Organ | Symptoms | |---|---| | Liver | Irritability, Hypochondriac Pain (Headache), High Blood Pressure, Bitter Taste | | Heart | Palpitations, Changes in the Pulse (quality/rate) / arrhythmias, "Shen Disturbances" (anxiety, insomnia, etc.) | | Spleen | Loss of Appetite or taste, Change in Weight, Loose Stools/Diarrhea, Abdominal distension/pain | | Lung | Cough/Wheezing, Shortness of Breath, Chest Oppression, Changes in the quality or strength of the voice | | Kidney | Low Back or Knee Pain / Weakness, Change in Urination, Premature Aging, Hearing Loss | | Gallbladder | Timidity/nervousness, Issues with bile production/flow, Bitter Taste | | Pericardium | Difficult to distinguish from Heart. Often comes with heat signs | | Stomach | Acid reflux, Epigastric Pain, Nausea, vomiting | | Large Intestine | Changes with bowel movements (often in absence of other symptoms) | | Urinary Bladder | Changes in urination (often in absence of other symptoms) | ## Box 27.4 Internal Wind - Tremors - Tics - Severe dizziness - Vertigo and numbness - Convulsions - Unconsciousness - Opisthotonos - Hemiplegia and deviation of mouth ## Box 27.6 Cold - Pain of a crampy nature that is alleviated by the consumption of hot drinks or the application of heat - A feeling of cold - The absence of thirst - Thin clear discharges - Cold limbs - Bright-white complexion - White tongue coating - Slow pulse ## Box 27.7 Essential manifestations of Phlegm - Tongue and pulse: Swollen tongue body with sticky tongue coating; Slippery or Wiry pulse - Other symptoms: a feeling of oppression of the chest, expectoration of phlegm, nausea, a feeling of heaviness, a feeling of muzziness (fuzziness) of the head and dizziness ## Box 27.5 Dampness - Feeling of fullness in the abdomen - Feeling of heaviness - Lethargy - Turbid urine - Excessive vaginal discharge - Muscle ache - Sinus problems - Sticky taste - Sticky tongue coating - Slippery or Soggy pulse ## Box 27.8 Heat - A feeling of heat, red face, thirst, mental restlessness, Red tongue, Overflowing-Rapid pulse. Other clinical manifestations depend on the organ involved and whether it is Full- or Empty-Heat ## Box 27.9 Main characteristics of Fire (as opposed to Heat) - It blazes upwards - It is very drying - It damages Blood and Yin - It may cause bleeding - It has the potential to general Wind - It affects the Mind - It causes ulcers with swelling ## Full (shi) - Full Pathology implies the presence of a pathogenic factor contracted externally, or generated interiorly. (Wind, Heat, Cold, Damp, etc.) – in purely full conditions the body's Qi is relatively intact ## Empty - Empty Pathology implies a deficiency of some form of Zheng Qi (Yin deficiency, Yang deficiency, Qi deficiency, Blood deficiency, etc.) – in purely empty conditions there is no pathogenic factor ## Mixed Conditions - Mixed Conditions arise when there is a pathogenic factor that isn't very strong, or the body's qi isn't reacting properly against it. ## General examples of manifestations of Full Disease are: - acute illness, restlessness, irritability, strong voice, coarse breathing, aggravation by pressure, full pulse, high pitched tinnitus, etc. ## That said, type and nature of full disease is extremely varied, and some of the above symptoms can also be caused by deficiency (e.g. restlessness). ## Empty/Deficient conditions commonly belong to 4 categories (Empty Qi, Yang, Blood and Yin) ## Quick Guide - Is there a pathogenic factor like heat or Qi Stagnation? --> It's a **Full Pattern** - Is there a lack of a vital substance like Yin, Blood or Qi? --> It's an **Empty Pattern** - Are there signs of BOTH? > It's a **Mixed Pattern** ## Summary of Phrases - 'One Chinese Disease, Many Western diseases; One Western disease, Many Chinese diseases' - 'One Disease Many Treatments, Many Diseases Same Treatment - 'One Disease Many Patterns, Many Patterns Same Disease' ## Etiology - The cause of disease (eg. emotional stress, poor diet, etc.) ## Pathogenesis - The progression of a disease over time (eg. long term stagnation untreated eventually turned into pathogenic heat). ## Pathognomonic - The key or "feature" symptom of a disease that is consistent across all cases. - For example: the pathognomonic symptom of headache is pain in the head - anyone complaining of headache will have some form a head pain. What differs across cases is the intensity, quality of pain, location, duration etc. ## Pattern - A unique collection / constellation of signs and symptoms that fall under the same umbrella of pathology. (eg. fatigue, shortness of breath and spontaneous sweating all fall under the Pattern of Qi Deficiency.) ## Pathomechanism - The specific physiological action or mechanism that became disrupted - generally including the pathogenic factor that caused the disruption (eg. Dampness obstructing the Spleen inhibiting the functions of Transportation and Transformation. (tldr: Dampness inhibiting T&T) ## Pathogenic Factor - A specific factor (internal or external) which leads to disease or disruption within the body. - External Cold is an example of a pathogenic factor - Internal Heat is an example of a pathogenic factor - Qi and Blood stagnation are examples of patterns, but also pathogenic factors - they might not be an environmental factor - but they are a cause or aggravator of disease in their own right. - Emotions are not generally discussed in this category. Emotions usually fall under "etiology" and can often cause "pathogenic factors" -- for example emotional stress leading to Qi Stagnation. Or Anger leading to Heat. ## Disease - In the context of CM - Disease refers to the Western Biomedical Diagnosis (eg. IBS, Rheumatoid Arthritis, etc.) ## TCM Illness - A unique category of slightly arbitrary listings that fall into the realm of both symptoms like Abdominal Pain, or Epigastric Pain as well as "diseases" like asthma, infertility and depression - they are all considered TCM Illnesses. There are 143 of these total listed in your Pan-Canadian exam blueprint. ## The 8 Principles - More often in reference to the "Yin" or "Yang" feel of all the symptoms at play, especially if there are obvious hot/cold signs. ### YANG (IN REFERENCE TO THE SUM CATEGORY OF THE THREE PRINCIPLES BELOW) ### EXTERIOR - LOCATION (DEPTH) OF A DISEASE - A disease located in the exterior level of the body within the interstices (cou li), skin, channels or muscles. Internal organ function not affected. - General Symptoms: simultaneous fever/aversion to cold, achiness, stiff neck, floating pulse. (e.g. invasion of wind-cold, invasion of wind-heat) ### HOT - ENERGETIC QUALITY OF A DISEASE (NOT ALL DISEASES WILL HAVE ONE - FOR EXAMPLE "QI STAGNATION" IS NEITHER HOT OR COLD) - A pathology which has signs markedly skewed towards the "hot" end of the spectrum on either the excess or deficient side: extreme or erratic activity, rising, flaring up, feelings of warmth, burning, inflammation, hyperactivity, thirst, redness, fever, potential bleeding, red eyes/face, yellow discharge, dryness "bright/jumpy" ### YIN (IN REFERENCE TO THE SUM CATEGORY OF THE THREE PRINCIPLES BELOW) ### INTERIOR - A disease located in the interior of the body which disrupts the functioning of internal Zang Fu organ functioning. Organ-related symptoms are necessary to diagnose at this level. - Symptoms depend on the organ affected ### COLD - A pathology which has signs markedly skewed towards the "cold" end of the spectrum on either the excess or deficient side: congealing, cramping, contraction, slowing, fixed, feelings of cold, aversion to cold, desire for warmth, hypoactivity, paleness, chills, clear or white discharge “cloudy in nature” ### FULL - STRENGTH/PRESENCE OF A DISEASE OR PATHOGENIC FACTOR (IN RELATION TO ZHENG QID - The presence of a pathogenic factor. Simple as that. Remember, pathogenic factors include the 6 evils like Heat, Cold, and Dampness but also Qi Stagnation, Blood Stagnation, Phlegm, Food Retention, etc. ### EMPTY - A deficiency of a vital substance. Also can be considered a deficiency of our "Upright Zheng Qi" - A pure deficiency occurs in absence of a pathogenic factor. It is simply an "emptiness" or a "lack of" - Qi, Blood, Yin, Yang, Essence, Body Fluids, Wei Qi, Ying Qi, etc. ### MIXED PATTERNS - Presence of a FULL and EMPTY pattern simultaneously. One is often generated by the other. Symptoms will include both excess and deficient signs together - Examples: Qi deficiency leading to Qi/Blood Stagnation. Internal Dampness leading to Spleen Qi Deficiency. ## Pathology of the Qi Mechanism: ### Ascending/Descending in the ORGANS - The Stomach should descend and assist all other Fu organs in descending. If it ascends/rebels it can lead to nausea, vomiting, acid reflux, etc. - The Lungs should also descend (mainly) to inhale air down to the Kidneys. It has a minor ascending/diffusing function when it comes to Wei Qi. That said, if Lung Qi ascends when it should be descending it can lead to cough, breathlessness, etc. - The Liver assists with the free flow of Qi in all directions it also ascends towards the heart/lung and eyes. It can fail to ascend, but more commonly ascends excessively (Liver Yang Rising) - leading to headache, irritability, anger, and dizziness. - The San Jiao, secondarily, plays a key role in entering/exiting of Qi from tissues, joints, etc. - The Heart descends to keep in communication with the Kidneys. The Kidneys ascend to warm/nourish and moisten the other organs. Both of these organs need to ascend/descend properly in order for menstruation to run smoothly. ### Key Points to Remember ### Ascending/Descending in the CHANNELS - In Hand Yin channels Qi descends from the chest/thorax into the fingers/hands. then, in Hand Yang channels Qi ascends from the fingertips/hands up to the head/face. After that, Foot Yang channel Qi descends from the head/face down to the feet. Lastly, in Foot Yin channels Qi ascends upwards from the feet and returns to its starting point at the chest/thorax to begin the cycle again. - If Qi flow is blocked along a channel - pathology depends on the direction of Qi flow. Ahead of the blockage - the tissues will be stiff/tense due to Qi/Blood collecting in the area. Beyond the blockage tissues will be lax/loose due to malnourishment from a lack of Qi/Blood. - Qi + Clear Yang needs to ascend to the sense organs while Turbid Yin simultaneously needs to descend out of the head. Both of these processes are integral for clear, sharp senses. If Clear Yang can't reach the head the senses will be dim. If Turbid Yin can't leave the head we'll see build up of Yin substances in the sense organs like earwax, phlegm, etc. ### The Four Key Movements of the Qi Mechanism 1. Ascending (Yang) 2. Descending (Yin) 3. Entering (Yin) 4. Exiting (Yang) ### Entering/Exiting - Qi can enter/exit from many different areas: the organs, channels, sense organs, tissues, joints, orifices, etc. Rather than memorizing specific symptoms of each area - it is better to understand the general result of what pathological entering/exiting looks like all across the board. - Excessive Exiting into joints, or tissues: tends to lead to stiffness, tightness, hardening, contraction or dryness due to a lack of nourishment, pain due to rigidity, etc. Excessive Entering into joints, or tissues: tends to lead to laxity, looseness, flaccidity, potential swelling or oedema - When it comes to the Cou Li and pores - Excessive entering (yin) will lead to laxity and Wei Qi won't flow well leading to compromised immune function. Excessive exiting (yang) will lead to tension of the underlying muscles, inability of opening of the pores and therefore reduced sweating and a high fever. - When Qi "enters and exits" from channels you should imagine it as moving between the various depths of the Six Great Channels (Superficial Taiyang --> Deep Jueyin), this is more of a "horizontal" movement - not to be confused with the vertical ascending/descending of Channel Qi. This horizontal movement also occurs between the skin / cou li and muscles. - (When it comes to entering and exiting from the Shen/Po, Gao/Huang and the individual sensory organs - this is more advanced and you are free to memorize it if you wish, but you will not be tested on it. It is also not something commonly included in the licensing exam.) ## Meridian Types - Meridians (jing) are the primary thoroughfares of Qi - think arteries/veins of Qi rather than blood.. They are also called: channels, or vessels. Tip: "jing" refers to the crossing lines in weaving; the warp and the weft. - Collaterals (luo) are more diffuse connections of Qi flow - think of microcirculation or a capillary network. They run transversely and superficial to the meridians, connecting tissues not reached by the primary channels. Tip: "luo" means "loose cotton wadding" ### The Function of all meridians and collaterals (jingluo) in general is to: 1. To connect and integrate the body: the exterior/interior, upper/lower, left/right of the body, organs to each other and their corresponding tissues, etc. 2. To regulate: the levels of Yin/Yang, Qi/Blood, in any given area/meridian/tissue. 3. To facilitate: Qi flow through the meridians helps to keep blood running smoothly in the blood vessels, and allows warmth to reach the organs/tissues. 4. To transport: it is through the channels that Qi is transported around the body. 5. To nourish: it is through the channels that moisture and nutrition is able to reach different body areas. 6. To protect: the more superficial channels/collaterals help to prevent external pathogens from invading. 7. To respond to disharmony: by giving visual information on the surface of the body that pertains to the type of disharmony occurring interiorly. 8. To transmit Qi to the diseased area: By needling a channel we can "transmit" Qi to the area of pathology - allowing Acupuncture treatment to work. ### The Primary Channels (12) - Run vertically, bilaterally and symmetrically - They each correspond to a Zang or Fu organ - They contain both superficial and deep pathways ### The Extraordinary Channels (8) - Deep reservoirs of Qi/Blood/Yin/Yang - They are highly linked to embryological development - They can absorb excess or supplement deficiency from other channels. - The Governing Vessel (Du Mai) and Conception Vessel (Ren Mai) are the only EVs with Acupuncture points of their own. ### The Divergent Channels (12) - Branch out from the 12 primary channels and have no points of their own. - They strengthen the relationship/connection between Yin/Yang paired organs (eg. Sp/St) - The distribute Qi and Blood to the head/face ### The Luo Connecting Channels (15) - Branches of the primary channels; these branches occur at the Luo Connecting Points. - There are 12 regular Luo channels that correspond to the Zang Fu, as well as "special" Luo channels for the Du/Ren, and an extra "Great Luo Connecting Channel" of the Spleen (you'll cover these in Meridians Class). ### The Sinew Channels (12) - Areas of muscular tissue that are governed by each of the primary channels. - They broadly follow the external path of their corresponding primary channel. - These channels don't have "points" - we instead target them with manual therapies like cupping, gua sha, Tui Na massage, etc. ### The 12 Cutaneous Regions - The area of skin that corresponds to a primary channel, similar to the Sinew Channels but with skin rather than muscle. - Often manifest with color changes when an organ or channel becomes diseased. - Often targeted with superficial therapies like topical lotions/ointments, plum blossom needling, bleeding, etc. ## Acupoints ### Ashi Points - Tender points, when pressed, the patient exclaims "Ah, Shi! (Oh, Yes!). These points can be needled, but don't necessarily fall along a primary channel ### Xi-Cleft Points - The points where Qi and Blood "gather and plunge more deeply" - These points are used to treat ACUTE conditions. On YIN CHANNELS, they have the added effect of treating BLOOD DISORDERS. ### Heavenly Star Points - A group of 12 points that physician Ma Dan Yang believed were particularly effective in clinical practice. ### Window of Heaven Points - Points near the neck/head that have a strong effect on our sensory organs and blood flow to the head. ### Ghost Points - A rarely used category, a group of 13 points which can be utilized in the treatment of severe psychoemotional disturbance or mental illness. ### Command Points - A group of 4 clinically useful points that "command" or "govern" a specific body area. These body areas are: - The Head/Face - The Nape/Neck - The Abdomen - The Lower Back ### Yuan Source Points - Strongly tonifying points where original Qi "bubbles up" to the surface. These points fall on each primary channel.