Glossary

The pattern of Bladder Qi vacuity is very similar to Kidney Qi vacuity. Because the Bladder derives most of its Qi from the Kidneys, these patterns have many overlapping symptoms. The main manifestations of Bladder Qi vacuity relate to urine function and include frequent, pale, and copious urination or incontinence and dripping urination. When treating this pattern, one must both tonify Bladder Qi and restrain urine to address the root and branch of the disharmony and classic formulas like Suo Quan Wan & Sang Piao Xiao San (Kan's Restore Integrity) are often first choice formulas.

In both Western medicine and TCM, Blood is the red material fluid circulating the body responsible for nourishment, transportation, and detoxification. However in TCM, the state of Blood directly affects many of the organ networks and their associated qualities. For example, vacuity of Heart Blood can lead to insomnia and anxiety and Liver Blood vacuity is often the cause of headaches and brittle nails. The vitality of the Blood is observed by TCM doctors in a healthy pink tongue color, vibrant skin tone, supple nails, tendons and ligaments, and in women, a healthy, moderate red menstrual flow.
The three organs closely related to Blood are the Heart, which continuously propels its circulation, the Liver, which stores and nourishes the Blood, and the Spleen, which properly retains Blood in the vessels.

Blood vacuity, or deficiency, refers to a pathological state in the body when the Blood supply is insufficient to nourish the organs and viscera properly. Its presence may be sub-clinical, and is not synonymous with anemia. Strong diagnostics for Blood vacuity include the hue of the tongue, which is generally pale, a thready, weak pulse, and reports of weakness and dizziness. Symptoms include a sallow complexion, pale lips, face, and nails.

In TCM, the Spleen engenders Blood, and relates strongly to its ability to extract necessary nutrients from the diet. Spleen Qi vacuity, therefore, is often at the core of Blood Vacuity. Blood vacuity may also overtly develop from excessive loss of Blood, such as following childbirth, surgery, or prolonged menorrhagia, and be deepened by a constitution unable to replenish the Blood properly. A diagnosis of Blood vacuity may be specific regarding the specific organ/s involved, referred to according to appropriate pattern names. Primarily, these are Heart Blood vacuity, and Liver Blood vacuity. If the Heart Blood is affected, there may be insomnia and poor memory. If the Liver Blood is affected, there may be numbness, blurred vision, and dizziness.

Blood Heat is a condition characterized by the TCM qualities of Heat in the Blood. As Heat is active and volatile, conditions that involve the overly free movement of Blood arise, and can cause extravasation of Blood, such as nosebleed, excessive menstrual flow, Blood in the stool or urine, or red papules or macules. Bleeding may be profuse and bright red, or dark in color. Other signs may include, thirst, rapid pulse, and a red tongue body.

Blood is ideally plentiful, vital and flowing rhythmically without blockages, in its proper channels, the circulatory system, nourishing the organs and entire body. Blood stasis is a condition of sluggishness or obstruction in the flow of blood. Numerous causes underlie this condition. Vacuity of Blood can lead to stasis, as there is insufficient volume in the flow. Stagnation of Qi may lead to Blood stasis, due to their intrinsic relationship; the Qi fails to be a vigorous carrier of the Blood. Heat, which dries Blood and Yin, may also be a cause. In internal medicine, Blood stasis is a condition that develops gradually. Blood stasis also ensues from an injury, resolving most successfully when addressed as soon following the trauma as possible. Blood stasis in the individual organs generally afflicts the Heart and Liver. It manifests in the Heart as chest pains, palpitation and Heart disease, and in the Liver disrupts the smooth flow of Liver Blood causing menstrual problems such as clotting, dysmenorrhea and endometriosis.

An injury immediately causes stagnation of Qi and Blood, due to impact on the tissue and the body's response of inflammation or bruising. Chronic Blood stasis often ensues at the site of an old injury, a condition well treated by acupuncture and herbal medicine using techniques to invigorate Blood. Since static Blood is more viscous than stagnated Qi, it obstructs the vessels, and may cause menstrual irregularities characterized by purple, clotted blood.

Blood Stasis in the Lower Burner is a pattern associated with primarily with women, as the lower burner contains the uterus, which stores Blood. Blood Stasis usually develops over the long term, secondarily to Qi stagnation, emotional stress, and/or Blood Vacuity. It causes periods complicated by a dark, clotted flow, with very painful, fixed and stabbing cramps. When Blood Stasis remains unresolved conditions of a substantive nature are common such as endometriosis, myomas, and ovarian cysts. The patient with this pattern will most likely suffer from irritability, restlessness and agitation. The tongue should have a purplish hue, and the pulse is usually wiry, choppy or firm. Many Chinese herbal formulas can assist this condition, certainly best treated in its earlier, sub clinical stage. These include Tong Yu Jian, (Kan's Women's Rhythm), and Giovanni's variation of Ge Xia Zhu Yu Tang, Stir Field of Elixir.

Essentially all Blood invigorating herbs are contraindicated during pregnancy.

Blood Stasis generally has a painful component. Due to the obstructed flow of Qi and Blood through an area afflicted by Blood Stasis, pain ensues. Clinically important is that the nature of Blood stasis pain is sharp and stabbing, often in a fixed location. Blood stasis in the pelvis may lead to severe menstrual cramps in the presence of menstrual clotting or endometriosis; while in the chest, it causes angina pectoris, marked by paroxysmal attacks of pain. Injury causes trauma to the channels and collaterals outright, leading to stasis of Blood and Qi. Timely treatment with acupuncture and herbal therapy can help prevent Blood Stasis pain later. Whether due to External or Internal causes, it is always best to treat Blood stasis in its earliest stages, when symptoms are mild and the condition not yet too tenacious. Tong Yu Jian & Si Wu Tang (Kan's Women's Rhythm) and Ge Xia Zhu Yu Tang (Giovanni Maciocia's Stir Field of Elixir )address menstrual pain due to Blood stasis, Blood's Mansion treats Blood stasis pain of the chest, while Disperse Blood or Purge Blood may be appropriate for a range of related, painful conditions.

Pregnancy is a contraindication for essentially all Blood invigorating herbs.

Body Fluids, or Jin Ye, refer to the liquid substances within the body, including saliva, synovial fluid, cerebrospinal fluid, and gastric secretions, as well as those fluids excreted, such as tears, sweat, urine, and sexual secretions. Thinner body fluids (jin) moisten the skin, muscles, and the orifices of the sense organs (eyes, nose, mouth, and ears) while the heavier fluids (ye) nourish the joints, spine, and organs.

In Western terminology, the brain is the portion of the vertebrate central nervous system that constitutes the organ of thought and neural coordination. TCM shares with Western medicine the view that the brain controls intelligence, memory, concentration, and the five senses. In TCM, the brain is considered an extraordinary organ, in recognition of its unique role in the health and functioning of the human body. It is also called the Sea of Marrow, reflecting the belief that the brain is closely related to the Kidney organ system, which engenders Marrow. According to Chinese medicine principles, the brain, along with the spinal cord, is an outgrowth of the Kidney, and is nourished by Essence. The Kidney Essence produces Marrow, which is conceived of as 'flowing up to the brain and down to the coccyx' Insufficiency of Kidney Essence can diminish cerebral potency, and its extensive range of attributes. Herbs that strengthen Kidney Essence in turn nourish the Brain, generating clarity of thought, memory and concentration. Kidney tonics that nourish the Essence, as well as herbs that calm Shen, are often successful in addressing poor memory, confusion or other mental symptoms.

Meridians are the unseen channels or pathways that carry Qi, Blood, Yin and Yang, throughout the body. Similar to a waterway that nourishes the whole body, the meridian system facilitates interaction between the organs. The word meridian is translated from the Chinese characters Jing, meaning 'to go through' or 'a thread in fabric', and luo, 'something that connects' or 'a net'. Ted Kaptchuk, in his seminal work The Web that has no Weaver, described the meridian system as the 'warp and woof' of the body, unifying all the parts and functions.

There are 12 primary channels, and 8 extra channels. The 12 primary channels include six associated with Yin organs, and six with Yang organs and have their own corresponding acupuncture points. English terms for the regular channels reflect their related organs, such as the Spleen channel or Kidney channel. The primary channels connect the interior of the body with its exterior, following specific pathways along the hands, feet, limbs, torso and head. The Qi of the meridians is accessible through acupuncture points at specific locations articulated along these channels. The extra channels do not relate to specific organs. Two of the extra channels, the Ren and Du, which travel up the midlines of the front and back of the torso respectively, are major channels as well, having their own points.

In Chinese herbal medicine, each herb affects specific channels and transmits its properties through specific meridians and organs in a predictable therapeutic manner. For instance, zi su ye (Perilla leaf) enters the Lung and Spleen channels with a warming quality, dispersing Wind Cold.

One of the Eight Extraordinary Meridians, the Chong Mai, translating as the Penetrating or Thoroughfare vessel, has its origin in the Kidney, and distributes Kidney Jing (Essence) throughout the body. It links Prenatal and Postnatal Qi, due to its connection with the Kidney, Stomach and Spleen. Dysfunction of the Chong may result in a weak constitution, with poor appetite and assimilation. It is noted for its ability to address rebellious Qi, characterized by fullness of the epigastrium or chest, as well as to move the Blood of the Heart, aiding chest pain and palpitations. The Chong channel works with the Ren to regulate menstruation, conception, and pregnancy, and together may address amenorrhea, abnormal bleeding, and miscarriage.

Cold is a pathogenic condition involving reduced metabolic activity which, over time, contributes to disease. Cold may penetrate the body during overexposure to the elements, in the forms of a common cold, or via excessive consumption of cold fluids and foods. The patient may have an aversion to cold with a desire for heat, hypo-activity, lethargy, dullness, somnolence, pallor, lack of thirst, loose stools, profuse clear urine, thin odorless discharges, and a slow pulse. It may also cause pain and hyper tonicity of the muscles. In TCM it is one of the Six Pathogenic Evils, or factors.

Link:
Wind Cold
Cold Uterus

This patterns refers to a condition of an external pathogenic invasion or internal pattern of Kidney Yang vacuity that settles in the Uterus and affects the Blood causing Blood stasis; infertility, dysmenorrhea, or irregular cycle.

Congealed Blood is a term synonymous with Blood stasis. Stagnation of Qi is the most common cause of Blood stasis. Due to the lack of proper circulation of Qi, heat builds up, damaging the fluidity of the Blood, coagulating or congealing it. Other causes of Blood stasis are Vacuity of Qi or Blood, Heat in the Blood, Interior Cold or Phlegm. Congealed Blood may gradually result in masses, such as lumps or tumors. These may be palpable, accompanied by pain and tenderness, or manifesting in numbness or chest pain, if on a circulatory level. Numerous gynecological conditions may be the result of Congealed Blood or Blood stasis, such as dysmenorrhea, dark menstrual blood with clots, uterine fibroids, endometriosis, chronic pelvic inflammatory disease, or ovarian cysts.

Herbs to invigorate Blood have varying degrees of strength. Herbs that Invigorate, Move or Activate Blood include chuan xiong Ligusticum and yan hu suo Corydalis. For masses, such as tumors, myomas and endometriosis, herbs with the aggressive action of Breaking Blood, such as e zhu Curcuma, are required. Safely balancing the invigorating properties of blood moving herbs in an appropriate formula incorporating other indicated energetics is a fine point of Chinese herbology.

Essentially all Blood invigorating herbs are contraindicated in pregnancy.

Consolidating refers to a treatment method which condenses or astringes a vital substance of the body. For example, consolidating moisture means to stop sweating, consolidating the Lungs, stops coughing, and consolidating the Kidneys, stops urinary and genital leakage.

Counter flow Qi refers to energy that is misdirected and flowing in the opposite direction of its normal pathway. In TCM theory, each organ sends energy in a certain direction. For example, the Lungs naturally send energy downward, but when out of balance, the Lung sends energy upward, causing coughing or asthma. The natural energy direction of the Stomach is downward, but when out of balance, it sends energy upward, causing vomiting.

The Dai Mai is often called the Girdle channel as it circles the torso below the waist. It is the only channel to travel horizontally across the body, exerting its influence on the genitals, waist and hips, and affecting Qi in the leg channels. It traverses a number of points on the Liver and Gall Bladder channels, and is used to harmonize these organs, especially in Excess patterns such as evidenced in temporal headaches. Common pathologies of the Dai meridian are; vaginal discharge, burning and difficult urination, abdominal distention, uterine prolapse, poor circulation or weakness of the legs and feet, and hip pain.

The accumulation of Dampness is primarily due to poor functioning of the Spleen, whose job it is to transform and transport fluids efficiently and appropriately throughout the body. The Lung and Kidney also play a role in the transformation of fluids, in the upper and lower burner respectively. Accumulated Dampness may result in chronic sinus congestion or a productive cough, digestive disturbances such as bloating and loose stools, or cloudy urination and a sensation of bladder fullness.

A pathogenic condition consisting of a combination of Dampness and Heat, Damp Heat is diagnosed by the presence of a greasy, yellow tongue coating, and often a slippery, or rolling, excessive quality to the pulse. The patient may have thirst, low grade fever, chest fullness, burning, dark urine, and spontaneous sweating. Damp Heat is common in the Liver/Gallbladder and Bladder channels, manifesting in genital infections/discharges, jaundice, and urinary tract infections. It can also invade the Spleen or Large Intestine channels causing diarrhea with a foul odor, or lodge in the Triple Burner channel, leading to a febrile disease.

Damp Heat affects each of the Three Burners in unique ways. In the Upper Burner, Damp Heat causes pressure or heaviness of the head, glomus, an oppressive sensation in the chest, and low appetite. Damp Heat in the Middle Burner brings a full, distended discomfort to the chest and abdomen, improper digestion, thirst, but with no desire to drink, and fatigue. When Damp Heat 'pours down' into the Lower Burner there are gynecological problems involving yellowish discharge, and urinary dysfunction marked by dark yellow, usually cloudy, urine. Examples: Damp Heat on the skin could be cystic acne or cellulitis; in the Liver it may manifest as hepatitis or gall stones; in the Intestines it could be foul diarrhea with pus or blood; or in the joints could be rheumatoid arthritis or gout.

Damp Heat in the Gall Bladder is the most common pathological pattern of the Gall Bladder. Linked with the Liver, its' paired Yin organ of the Wood Element, it is inherently affected by stagnation of the Liver organ system and meridian. Over time, the effect of this stasis may implode inwardly, generating Damp Heat. Liver Qi stagnation often results in a Liver-Spleen disharmony, injuring the Spleen, allowing for the buildup of Damp throughout the body, contributing to this pattern. Damp Heat in the Gall Bladder underlies the formation of gallstones. Due to the pathways of both the Gall Bladder and Liver channels through the pelvis and genitalia, this pattern results in problems of stagnation and the chronic holding of infections in this region of the body. Conditions that manifest under this pattern include leukorrhea, especially of an odorous, yellowish quality, chronic vaginal candida, pelvic inflammatory disease, cholecystolithiasis, and urinary tract infections.

Damp Heat in the Large Intestine is a pattern that causes the stools to become violently loose and painful. The Dampness manifests as the watery, loose stools while the Heat brings a burning sensation, yellow color, and foul smell to the disharmony. There can be abdominal pain that is not relieved by a bowel movement and in severe cases mucous and blood in the stools. Possible Western equivalencies to this pattern are bacillary dysentery, food poisoning, or traveler's diarrhea. Herbs that both clear Dampness and Heat such as Huang Lian Su Pian (Kan's Copticlear ) are a safe and effective formulas that should be in everyone's traveling first aid kit.

Damp Heat in the Liver is a combination pattern of Dampness (a thick, sticky, and material substance) and Heat (an inflammatory, coagulating, and immaterial pathogen) which affects the Liver organ and its related meridians. The cause can be from an external invasion of Damp Heat from the environment, such as hot and tropical weather, or from a poor diet consisting of rich, greasy or overly sweet foods. Possible Western equivalencies to this pattern could be any inflammatory disease with a Damp aspect that affects the Liver network such as hepatitis, leukorrhea, prostatitis, or otitis media. The Chinese herbal formula Long Dan Xie Gan Tang (Kan's Quell Fire ) is a popular choice for this condition.

Damp Heat in the Liver and Gallbladder is a combination pattern of Dampness (a thick, sticky, and material substance) and Heat (an inflammatory, coagulating, and immaterial pathogen) which affects the Liver and Gall Bladder organs and their related meridians. The cause can be from an external invasion of Damp Heat from the environment such as hot and tropical weather or from a poor diet and lifestyle consisting of rich greasy or overly sweet foods. Possible Western equivalencies to this pattern could be any inflammatory disease with a damp aspect that affects the Liver network such as gallstones, cholecystitis, hepatitis, leukorrhea, prostatitis, or otitis media. The Chinese herbal formula Long Dan Xie Gan Tang (Kan's Quell Fire) is a popular choice for this condition, but if there is a presence of gallstones, Li Dan Tang (Kan's Li Dan Support ) may be more appropriate.

Damp Heat in Lower Burner is a combination pattern of Dampness (a thick, sticky, and material substance) and Heat (an inflammatory, coagulating, and immaterial pathogen) which affects the lower areas of the body. Because Dampness is heavy, it easily settles in the lower parts of the body making it a very common pattern. This pattern can affect the bowels causing burning diarrhea, the bladder causing painful or frequent urination, or the genitals manifesting as yellow and foul smelling discharge or infections. Herbal formulas such as Ba Zheng San (Kan's Relieving Formula ) contain herbs that clear Heat and promote urination to rid the body of excess Dampness.

Damp Phlegm refers primarily to Dampness which has settled in the Lung, but which does not have Heat properties yet. Although external Dampness may invade the body as a pathogenic factor, it may also develop internally, primarily as the result of weakened Spleen Qi, although vacuity of the Lung and Kidneys also play important roles. Dampness that has lingered long enough to become more substantial is termed Damp Phlegm, and is of a more viscous, substantive quality. It is evident in a patient with little appetite and no thirst, as they have a sensation of satiety due to the retained Damp, a heavy substance. Their chest and epigastrium feel heavy, or stuffy, and there is expectoration of profuse phlegm, which is specifically white and sticky. The tongue will usually reveal a sticky, or greasy coast, and the pulse a slippery quality.

Dampness in TCM is a pathogenic condition involving accumulation of fluid in the tissues of the body, manifesting in a feeling of heaviness and swelling, such as in edema. The manifestations of Dampness are varied according to its location. In the joints and channels, Dampness causes difficult movement, swollen joints, and numbness or pain. In the chest and Lungs it is seen as sinus drainage, or a cough with clear or white phlegm, in the abdomen as low appetite, bloating, and loose stools, or a thick vaginal discharge. Mentally it is reflected in a "clouded mind". It is evidenced in an enlarged tongue, with a coating that appears slimy, slippery or moist. The pulse quality is usually slippery or soggy.

Vacuity, deficiency, or Xu may refer to an insufficiency or an insubstantial quality of any of the vital substances, such as Qi, Blood, Yin or Yang. Vacuity also occurs in specific organ systems, referred to by terms such as Spleen Vacuity, or Kidney Vacuity. In the diagnostic framework of the Eight Principles, Vacuity is opposed to Excess as one of the key pairs of opposites determined by observing the patients' signs and symptoms. General signs of Vacuity are frailty, weakness, fatigue, and pale complexion, dull, lingering pain, or pain relieved by pressure, low appetite, weak voice, and a weak pulse. Any of the pulse positions may be termed Deficient, such as Deficient Heart or Kidney pulses. Vacuity patterns are usually chronic in nature, unlike Excess patterns, which are often acute and involve an invasion of the body by an Exogenous Factor.

Depression, in TCM, is not to be confused with the Western definition of an emotional state of mind. It is a pattern of energy synonymous with Stagnation, or reduced activity, associated with specific organs such as the Liver, Heart, Spleen, Kidney and Lungs. The Six Depressions in TCM are Depression of Qi, Blood, Damp, Heat, Phlegm, and Food. These patterns are caused by difficult emotions, poor diet, stress, and pathology in the free flow of energy throughout the body.

The applications of diagnostic skills provide the information to arrive at a TCM diagnosis. A number of stages are involved in determining the diagnosis, as well as a number of conceptual frameworks with which to work. Most frequently a diagnosis is ascertained by observing, listening to, smelling, palpating, and questioning the patient. Two diagnostic methods central to TCM are inspection of the tongue and feeling the qualities of the radial pulses.

In TCM, the Differentiation of disease ( bian bing) determines the main symptom the patient presents, such as hypochondriac pain, lower abdominal pain, occipital headache or painful menses. Whereas in Western medicine, the predominant symptom may indicate tests needed to determine the diagnostic name of a condition. In TCM the main symptom is itself a major key to Pattern Differentiation, which is the hallmark of TCM diagnosis.

The Eight Principles is an overview diagnostic criterion classifying the patient's condition through four broad sets of opposites: Hot or Cold, Excess or Vacuity, Internal or External, or Yin or Yang. For example an acute sore throat, having begun after exposure to exterior Wind, is classified External. Due to the sore, burning sensation it is considered Hot. The tongue would most likely reveal a Heat condition, in a yellowish coating. As it has a strong, possibly inflamed sensation, and has come on suddenly (all Yang attributes) it is Yang. Therefore, this condition is External, Hot, Excess and Yang. In contrast, a lingering dry throat with occasional soreness, resulting from long-standing insufficient moistness of the Lung and depletion from overwork, is Internal, Hot, Deficient and Yin in this diagnostic framework.

Another example is chronic loose stools from improper eating habits. Because this disharmony arose from a chronic lifestyle imbalance, weakening the Qi, it is considered Internal. That the symptoms improve with warm foods and are exacerbated by cold foods, such as ice cream and salad, points to a diagnosis of Cold instead of Heat. The pulses reflect the vacuity, in a weak quality, and the tongue is swollen, indented with teeth marks, indicating Vacuity and a Yin condition.

The most important parameters clinically for differentiating a pathogenic pattern with the Eight Principles are Excess or Vacuity, and Hot or Cold.

The diagnostic exam, in TCM, involves 4 methods of diagnosis; looking, listening and smelling, palpation, and asking. TCM tongue and pulse examination techniques are unique to this system of medicine, and vital to proper TCM pattern diagnosis.

Looking involves observing the general manner and gait of the patient, hue of body skin, nails, lips, and facial color, sheen of the hair, clarity of the eyes, and the specialized TCM method of tongue diagnosis. The hue of the skin may be remarkable at first glance. Redness points to Fire, or the presence of Heat. A greenish hue is an indication of the Wood element, or Liver imbalance. The manner, response and gaze of an individual reveals a great deal about the state of their Shen, or Spirit, which assists in determining the 'depth' of disease, and prognosis. Tongue diagnosis involves noting the tongue's shape, texture, color or hue, motion, and tongue coating, all parameters revealing significant data contributing to a TCM diagnosis.

Listening to the sound of the patient's voice reveals correlations to the Five Elements. For instance, a patient speaking in a low, nearly groaning voice would alert the practitioner to possible weakness of the Water element, and the Kidney. A voice that has a shouting quality indicates a Liver imbalance. The relative strength of the voice is also important. A loud voice generally accompanies an Excess pattern, and a weak voice or exhaustion from talking, reflects one of vacuity. A person who talks a great deal is more likely to have a Heat condition, in contrast with one who does not offer much verbally, which may indicate a Cold pattern. Listening to breath sounds and coughs, gives pertinent information on the vitality of the Lung, and the possible presence and nature of Phlegm.

Smelling, grouped with listening, is a further observation that occurs naturally to a trained practitioner in the course of the intake. Certain odors noticed about the individual are valuable indicators. For instance, the presence of any strong, foul smell is generally indicative of a Heat, or Damp Heat pattern.

Asking is the straightforward inquiry similar to a western medical history, and regards the patients presenting complaints and general health. This part of the exam includes a specific series of questions useful in TCM diagnosis, including the presence of chills or fever, areas of pain, eliminatory functions, sleep, prominent emotions, food cravings, thirst, menstruation and pregnancy.

Palpation includes any physical examination of areas of complaint, palpation of specific points on the torso that are indicators of imbalance or disease in each organ, and the pulse. TCM pulse taking is an art requiring extensive study and practice, and a key to accurate diagnosis. It varies from the Western medical pulse taking at the radial artery on the wrist for rate. In TCM, the pulse is studied at three positions on each wrist, with both a light touch and a deeper pressure. Besides the rate, the quality of the pulse is determined, according to traditional categories.

The Five Element theory is a method of classifying and explaining the cyclical nature of the world into five main archetypes which are Metal, Water, Wood, Fire, and Earth. These archetypes continually interact and affect each other. Because the underlying assumption of Chinese philosophy is that the forces that govern the external world also affect the human body, diseases can be classified and treated according to these archetypes and their interactions. There are a limitless amount of interactions between these archetypes but some are more frequently seen in clinical practice. For example if the Water element, which relates to the Kidneys, becomes weakened because of an excessive lifestyle, it can fail to nourish other elements such as Wood, causing migraine headaches. This pattern is identifiable by both symptoms of Water (low pack pain, weak knees, fatigue), and Wood (headaches, irritability, anger). In a different state of disharmony, elements can also attack one another. For instance when the Wood element becomes diseased, usually from stress or high emotions, it can attack Earth causing digestive difficulties or Metal causing skin rashes or difficult breathing.

A famous Chinese Medicine saying is:

Different diseases, same treatment,
Same disease, different treatments.

This saying encapsulates a predominant TCM concept; the cause of a particular disease may differ from patient to patient, in terms of the underlying pattern of disharmony at work, therefore requiring different treatment approaches for each patient. Likewise, a certain pattern may produce numerous, seemingly unrelated conditions within a particular individual, and yet one treatment plan and herbal formula addresses them all. Though the western diagnostic name of a condition is useful in understanding the patient's impetus for seeking help, these names are not of critical importance to the TCM practitioner. What is critical is the application of TCM diagnostic skills to determine the pattern differentiation ( bian zheng).

Patients new to TCM are often surprised that their disparate maladies are considered related. For instance, an asthma patient who also complains of a dry skin condition is diagnosed with Lung Yin and Qi vacuity as the underlying cause of both problems, and one herbal formula is prescribed to address them both. The importance of accurately determining the pattern is critical for a creating an effective treatment plan.

The Six Divisions diagnostic method was written about in the Shan Han Lun and is the oldest method of disease pattern identification. It classifies stages and progressions of disease with corresponding symptoms beginning with the Taiyang Stage of a pathogenic Wind invasion. Each division has its own signs, symptoms and corresponding treatment protocol. The Six Divisions are Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin.

Dispelling Stasis is a therapeutic treatment method which is used to invigorate a blockage or accumulation, particularly of Blood. This method can be used at varying strengths depending on the severity of the Stasis. For example a person with a history of heart disease due to mild Blood Stasis can take a mild Blood invigorating formula like Kan's Disperse Blood as a preventative. But someone with a painful injury due to a physical trauma would need stronger Blood invigorating herbs to dispel Stasis such as Shen Tong Zhu Yu Tang (Kan's Meridian Passage) or Huo Luo Xiao Ling Dan (Kan's Invigorate the Collaterals).

Dispersing refers to a treatment method which helps to move, circulate, or distribute substances throughout the body. This therapeutic action is often used when Qi, Blood, or Body Fluids become stagnant the body causing pain, accumulations or any wide array of problems. Unimpeded flow of these vital substances is said to be the root of health. Chinese herb formulas such as Shu Gan Wan (Kan's Liver Flow) and Shen Tong Zhu Yu Tang (Kan's Meridian Passage) are designed to facilitate this circulation.

Dryness is a condition of diminished body fluids and Yin. It is the main climatic factor of autumn when the air is cool and lacks moisture. Because of the dried and impaired the distribution of body fluids, symptoms of dry nose, mouth or lips, chapped lips or dry coughs can appear. Certain organs are more prone to Dryness, but the Lungs are the most affected because they are moist, delicate and come into direct contact with the dry environment. Because the Lungs control the skin and body hair, an invasion of Dryness not only affects the respiratory system with asthmatic conditions, but can cause dry, itchy skin and chapped lips. The Intestines can also be damaged by Dryness resulting in abnormally dry and hard stools.

The Du is an extraordinary channel that travels up the center of the spine from the perineum, rounding the vertex of the head ending above the upper lip. The Du influences all the Yang channels since it originates from the Kidneys and is therefore connected to Essence (jing). It is called the ("Sea of Yang channels") since all six Yang channels converge at Du 14. Due to its origin and pathway it also affects the spine, Brain, and Kidney Yang. It is used for treating back pain, releasing External and Internal Wind, and to nourish the Marrow and Brain.

The 8 extraordinary meridians are a group of channels that do not relate to specific organs, as do the primary channels. Two of the extra channels, the Ren and Du, which travel up the midlines of the front and back of the torso respectively, are major channels as well, having their own points. The other six extra channels; the Chong, Dai, Yangwei, Yinwei , Yangqiao and Yinqiao, do not have independent points but their pathways intersect and share points with the primary channels. Clinically, the extra channels most commonly utilized are the Ren, Du, Chong, and Dai. The Extraordinary meridians function as a reservoir of energy for the primary channels and have the ability to absorb energy and transfer it when necessary. They are closely related to Kidney Essence and contribute to circulation of Nutritive ( Ying) and Defensive ( Wei) Qi.

Empty Fire is a condition of apparent Fire properties, such as sensations of feverishness, thirst, flushed face, restlessness, or agitated sleep, but that are milder or more intermittent than true Fire symptoms would be. These may occur mainly in the afternoon, as a malar flush, or during the night, in the case of night sweat. In addition, there are signs of Yin vacuity, such as a cracked tongue. Though the pulse may be rapid, indicating Heat, it may be deficient, especially on deeper palpation, reflecting insufficiency of the Yin organs. This pattern arises out of Yin vacuity of one or more organs. Insufficiency of Yin creates a false elevation of Yang in the body. The water qualities of Yin are unable to control the Fire qualities of Yang. When this occurs, Fire flares up internally, further consuming the Yin. This type of Fire is referred to as a Vacuity Fire, as it is specifically in relation to the depletion of Yin, in the body as a whole, or in a specific Organ, that Yang has flared up, venting in symptoms of warmth. This is as opposed to a true Fire condition, which may cause high fever, and hyperactivity, Due to the depletion of vitality common in modern life due to stress, overwork, insufficient or overly rich diet, or lack of sleep, Yin erodes over time. Yin Fire may flare dramatically during menopause, when vacuity of Yin, as well as depletion of Blood, allows Fire to rise, causing night sweats and erratic emotions. The treatment for Empty Fire is to nourish the Yin while subduing the flaring Fire. The classic formula Zhi Bai Di Huang Wan (Kan's Temper Fire), is an example of the strategy of controlling Vacuity Fire while nourishing Yin.

Endogenous, or Internal, causes of disease in TCM are deleterious emotional states, poor diet and stress in general. Though Western Medicine recognizes the interaction between emotions and body, it is with a view of the brain as the impulse for a series of neurological effects via the hypothalamus, the sympathetic and parasympathetic systems, to the internal organs. However, the TCM view of the internal organs themselves having mental / emotional associations, as well as physical attributes, is the reason for its great emphasis upon the role emotions and mental states play in illness and health. Emotions such as joy, anger, anxiety, preoccupation, sorrow, fear, and fright all have an affinity to a specific organ network and affect the body uniquely.

Essence, or Jing, is part of the Kidney's domain, and often referred to as Kidney Essence. As the Vacuity of this vital substance contributes to poor bone development or deterioration, loose teeth, weakness of the knees, tinnitus, dizziness, impotence, infertility, premature graying of hair, and poor concentration and memory. Though Kidney Essence naturally declines with age, to prevent its untimely loss it is necessary to encourage the balance of Yin and Yang in the body while one is still in good health. Deterioration between Kidney Essence and Heart Shen may cause stresses and difficulties of the Spirit on a psychological and emotional level.

Exogenous, or External, factors or causes of disease refers to the adverse effects of the climate or living environment. They are Wind, Heat, Cold, Summer Heat, Dampness and Dryness. Wind is related to spring in the Five Element Theory, as in the phrase 'spring winds,' but can occur any time of year. Wind has a stirring, disturbing quality and is able to enter meridians, especially those on the exposed head and neck, causing Wind invasions. Heat may invade the body in an excessively hot climate or an overly heated home. Heat may invade via the conduit of Wind, as in the syndrome Wind Heat. Cold, though prominent in winter can occur in any season, or if one is exposed to air conditioning or refrigeration while working, or a draft while sleeping. Summer Heat is a uniquely intense and penetrating Heat, occurring in Summer. Dampness means humidity, or a living environment that is too damp, such as a basement apartment, or a foggy city. The external factor Dryness is exemplified by the parched atmosphere of autumn, after all vestiges of plant life have dried. It also occurs in buildings that are very dry due to central heating, or wood heat.

Exterior refers to the outer levels of the body, and its surface: the skin, body hair, muscle layer, and the superficial pathways of the Channels. It also includes the defensive energies of the body, or the Wei Qi level. Channels and Organs are also regarded in external/internal relation to one another. The most superficial Channels of the Six Divisions are the Bladder and Small Intestine, or the Tai Yang level. Yang organs, such as the Large Intestine and Stomach, are more Exterior than their related Yin organs, the Lung and Spleen. Some illnesses stem from an External cause such as influenza, or poison oak; others originate from an internal cause, such as hypertension.

The color of the complexion has special significance in the visual component of TCM diagnosis. The individual's natural skin tone, hues of color and their location on the face have specific correlates to the internal organs. For instance, a red tipped nose occurs in Spleen Vacuity, or Lung Heat. A bluish color to the center of the forehead reveals that the Heart has suffered a shock. The moistness of the facial skin is also indicative: a clear, shiny appearance is a positive indication of health, while a dry, depleted one points to a poor prognosis. The color of the face reflects the condition of the Blood and Qi, as well as the Shen, or Mind. A reddish tone indicates Heat, and Empty Heat indicated by redness of the cheekbones alone. Yellow hues point to deficiencies of the Spleen or Stomach, or Dampness. A dull, pale face is common with Blood Vacuity, while a whitish hue can also indicate Cold or Yang Vacuity. A blackish hue suggests Cold, or Empty Heat from Kidney Yin Vacuity. Lips indicate health when moist, shiny and pale red. Pale lips indicate Blood or Yang Vacuity, if too red and dry- Heat in the Stomach and Spleen. Purplish or bluish lips point to Blood Stasis.

Fire is a term comparable to the Western ideas of inflammation or infection. It describes a pathogenic condition of excessive Heat in the body, often with a desire for cold liquids and a cooler environment. Symptoms include high fever, hyperactivity, dehydration, restlessness or mania, redness of an area, bleeding, a dry, red tongue and a rapid pulse. Fire originates from an internal disharmony within the body as opposed to Heat, which is an external pathogen that invades the body.

Five elements, phases, or elemental categories are a five-part schema for representing the cyclical nature of the experienced world. The Five Elements correspond to the directions (north, south, east, west, and center) and to Water, Fire, Wood, Metal, and Earth respectively. Along with Yin-Yang theory, Five Element constructs function as the logical structure of correspondence thinking in Chinese medicine, explaining the interaction between the organism and the environment. It is also represented in developmental cycles, emotional and intellectual qualities, interactions between organs, and the natural pathology of disease.

Food Stagnation is a pattern of disharmony caused by eating more food than the body is able to metabolize. Normally when food is eaten, the Stomach "rots and ripens" it into a useable substance for the Spleen. When overeating occurs, food stagnates in the Stomach and becomes turbid and obstructing. The main symptoms of this pattern are low appetite, foul smelling belching and breath, fullness and bloating in the epigastrium, and sour acid regurgitation. Herbs that treat Food Stagnation, like digestive enzymes, help foods breakdown in the body for increased absorption. Some herbs focus on breaking down grains, others on meats and minerals. The formula Bao He Wan (Kan's Meal Mover or Digest Aid), which contains herbs for all types of Food Stagnation, is the most popular remedy for treating this pattern.

The function of the Gall Bladder in TCM is similar to its function in Western medicine. It receives bile from the Liver, which it stores and excretes when needed during digestion. Additionally in TCM, the Gall Bladder controls the capacity to make decisions and gives a person courage and initiative. This idea of courage is reflected in the Western expression when someone "has a lot of gall". For example, a deficient Gall Bladder can lead to a scared or frightened state of mind accompanied by indecision. Along with its paired Yin organ, the Liver, the Gall Bladder affects the ligaments and tendons, and provides Qi for proper movement and agility. The Gall Bladder also has some direct influence on the quality and length of sleep, and when deficient, may lead to insomnia causing early morning waking or dream disturbed sleep.

To harmonize is to ease the tension between organ networks or body constituents. Ordinarily, Blood and Qi are complimentary in their nature and function, as are the Liver, Spleen, Kidney, Heart, and Lungs. However, under duress, these aspects can become contrary or antagonistic. Particular herbal formulas are designed to foster the process of "harmonizing and resolving" such as Wen Dan Tang (Giovanni Maciocia's Clear the Soul), and Kan's CMS formula Harmonize Spleen and Liver.

In TCM, the term Heart not only refers to a physical organ, but to a network of related functions and qualities. Some aspects of it are similar to Western concepts; the Heart is the motive force for blood circulation and controls the blood vessels. One of the primary actions of the Heart is in the storing of Shen; which resembles the Western interpretations for the functions of the cerebral cortex and its capacity of thought, communication, memory, and emotions. Heart Blood roots and anchors the Shen and affects the quality of sleep. If the Heart is weak the Shen may be uprooted, causing inability to fall asleep or disturbed sleep.

Another of the Heart's functions is in the regulation of sweating. If Heart Qi is deficient it may cause spontaneous or unilateral sweating. The Heart is also associated with the tongue, implying that processes involving the tongue such as tasting and speech are related to the state of the Heart Qi. The Heart is associated with the Fire element and paired with the Small Intestine.

Heart Blood stasis refers to the impairment, coagulation, or cessation of the normal flow of Blood throughout the body, and particularly the Heart organ network. This pattern is marked by palpitations, stabbing or needle like pain in the chest that may radiate down the arm, chest tightness, purplish hue to the lips and nails. The patient may also have cold limbs and a choking sensation while drinking. This pattern is very similar to the Western presentation of angina pectoris or a pre myocardial infarction state, historically treated in the Orient by acupuncture and medicinal herbs that invigorate congealed Blood. Certain herbal formulas such as Xue Fu Zhu Yu Tang (Kan's Blood's Mansion) or the CMS formulas Disperse Blood and Purge Blood contain medicinals that may be helpful in alleviating this disharmony.

Heart Blood vacuity is a condition in which the amount of Blood in the body is insufficient and unable to nourish the Heart in particular. As with all types of Blood vacuity, patients will present with a dull pale face, pale lips and tongue, and lusterless nails. However, because the Heart controls one's mental faculties, the key signs for this presentation will be palpitations, insomnia characterized by a difficulty to fall asleep, anxiety, and poor memory. This pattern can be caused by an improper diet, or prolonged worry and concentration, and is often treated by the classic formulas Gui Pi Tang (Kan's Gather Vitality) or Ba Zhen Tang (Kan's Women's Precious).

As the Heart relates to the Fire Element, and the Kidney to Water, the balance between the two is that of the intrinsic balance of Water and Fire. The quality of Water tempers Fire from becoming too warm or flaring excessively upwards; Fire warms and invigorates Water, preventing it from becoming too lax or downward moving. This is borne out in the healthy functioning of the Kidney and Heart. When either organ is Deficient, an imbalance can occur preventing them from communicating, or supporting one another, properly. This may result in deficient Kidney symptoms such as weakness of bladder function, or sexual dysfunction and loss of fluids, combined with emotional or sleep disturbances indicative of Heart problems. Formulas such as Tian Wang Bu Xin Dan (Kan's Celestial Emperor's Blend) or Harmonize Kidney and Heart, of Chinese Modular Solutions, are often effective treatments.

Heart Qi vacuity is a disease pattern in TCM characterized by general symptoms of Qi vacuity such as fatigue, shortness of breath, and a weak pulse as well as Heart specific symptoms such as palpitations and chest distress. Palpitations are one of the main symptoms of any Heart imbalance but palpitations from Qi vacuity occur upon exertion or during the day while those from Yin or Blood vacuity occur at rest or at nighttime. Chinese herbal formulas such as Hu Po Yang Xing Dan (Kan's Compassionate Sage), the CMS formula Strengthen Heart, or Liu Jun Zi Tang (Kan's Six Gentlemen mixed with Schizandra fruit) are all good choices for addressing this syndrome.

The Shen is the spirit of an individual, and thought to reside in the Heart. When disturbed by stress, fright, emotionally traumatic experiences, lack of sleep, or poor health habits, the Heart becomes depleted of vitality, and unable to provide a restful abode for the spirit. This can often lead one to feel ungrounded, unstable, or susceptible to emotional fluctuation.

Heart Yin vacuity is a further progression of Heart Blood vacuity. When the cooling, replenishing qualities of Blood and Yin are insufficient to nourish the Heart, symptoms of vacuity Heat and dryness arise in the tissues associated with the Heart. Besides the key diagnostic signs of palpitations, anxiety, and insomnia that point to the Heart, flushed cheeks, a sensation of heat in the evening, or night sweats, as well as five-palm heat, a lingering heat in the palms, soles, and chest, may occur. The mouth and throat may be dry. As the Heart is the residence of the Shen, or spirit, vacuity of Heart Yin will cause the patient a sense of unease, an anxious manner, and a tendency to be easily startled. During sleep, the heat rising as a result of this vacuity may disturb the Shen, causing repetitive awakening, and excessive dreaming. The tongue will be reddish, especially with redness and swelling of the tongue tip. A midline crack may extend to the tip, and there will be little or no coat. The pulse will reveal heat and vacuity in a rapid, thin pulse. As Kidneys are the source of Yin in the entire body, nourishing Kidney Yin is critical for addressing this pattern. Tian Wang Bu Xin Dan, (Kan's Celestial Emperor's Blend, and Giovanni Maciocia's Heavenly Empress), nourish both Heart and Kidney Yin, while calming the Shen, and clearing Heat.

Heat is one of the Six Pathogenic Factors, linked to the season of summer and the element Fire. When Heat has invaded the body, the individual experiences an abnormal sensation of warmth, which may coexist with inflammation or infection. It creates a state of hyper metabolic activity and flames upwards to attack the upper portions of the body resulting in a red face, bloodshot eyes, and mental restlessness. Other symptoms of Heat include: fever, hyperactivity, thirst, aggressiveness, red tongue and a rapid pulse. Heat and Fire are terms often used interchangeably but in fact, are different disharmonies. Fire originates from an internal imbalance within the body as opposed to Heat, which is an external pathogen that invades the body.

Heat and Toxins are also referred to as "Toxic Heat" or "Fire Toxins" describing a depressive Heat condition whereby Blood has become poisoned by Internal or External influences. Manifestations may include an inflammatory rash, boils, sores, swelling, or purulent discharges with foul smell or appearance. Long term Heat and Toxins may contribute to tumor growth, or cancer. This refers to a condition comparable to the Western medical term, sepsis, an inflammatory syndrome affecting the entire body.

Internal refers to the deeper layers of the body: the organs, bone marrow, and the deeper tissues of the body. A condition or pattern arising from within the interior of the body is endogenous in nature and considered an Internal medical condition. Exterior refers to the outer levels of the body, and its surface: the skin, body hair, muscle layer, and the superficial pathways of the Channels. It also includes the defensive energies of the body, or the Wei Qi level.

Internal refers to the deeper layers of the body: the organs, bone marrow, and the deeper tissues of the body lying beneath the external layers of muscle and skin. A condition, or pattern, at an internal level arising from within the interior of the body is endogenous in nature. For instance, chronic Blood vacuity may lead to Blood stasis or Yin vacuity may lead to insomnia. This is in marked contrast to a damaging force from outside the body, such as the Six Pathogenic factors, which in turn invade the exterior aspect of the body.

The health of the Liver organ system, in TCM, is reliant on the fine balance between Liver Yin and Yang, and a free flowing quality of the Liver Qi. When Liver Qi is constrained, or Liver Yin becomes depleted, both easily accomplished by the stresses of modern life as well as emotional intensity, Liver Yang may rise upwards. This upward movement further depletes Liver Yin, laying the arid foundation for Liver Yang to transform into Liver Wind. This causes vertex headaches, orbital tension and hypertension, and an increased danger of Wind Stroke.

Acupuncture and herbal formulas that subdue excessive Yang, dispel the rising Wind, as well as nourishing the Yin of the Liver and Kidney, are of paramount importance for preventing these serious medical conditions. Kan's Gastrodia and Uncaria, and Anchor the Yang, as well as CMS's Purge Internal Wind, are formulas in this treatment category.

Invigorating is a therapeutic action that circulates, distributes, moves, or quickens a blocked substance in the body, such as Qi or Blood. In TCM theory, all substances (Qi, Blood, Body fluids, or Phlegm) need to flow freely through the Meridians to avoid disease and when a substance or channel becomes blocked, pain, growths, clots, or deposits can occur. Invigorating these blockages with acupuncture or medicinals such as Disperse Qi or Purge Phlegm can help to eliminate the stagnation. Chinese herb formulas such as Shu Gan Wan (Kan's Liver Flow) and Ge Xia Zhu Yu Tang (Giovanni Maciocia's Stir Field of Elixir ) are designed to invigorate and unblock circulation of Qi and Blood respectively.

Essence is the most refined and precious substance of the body forming the biological basis of all tissue, especially male and female reproductive secretions including sperm and ova. Essence and Original Qi are similar and closely related; Essence is a rarified physical fluid coursing through the body, "The original material substance that forms the basis of all other tissues." (Between Heaven and Earth, Korngold and Beinfield) Inherited by one's parents at conception and stored in the Kidneys, Essence is responsible for healthy growth, natural development, and constitutional vitality.

Though this substance naturally declines with age, excessive utilization of Kidney Essence from an unbalanced lifestyle contributes to poor bone development or deterioration, loose teeth, weakness of the knees, impotence, infertility, premature graying of hair, and poor memory. Ancient texts state that Kidney Essence may not be able to be added to, but can be conserved by care in lifestyle with balance between work and rest, proper eating habits, and restraint in excessive sexual activity.

The Kidneys are the reservoir of Essence (the root of Pre-Heaven Qi), and primarily governs growth, development, reproduction and aging. Healthy Kidney Qi manifests in strong bones and teeth, normal hearing, and hair growth, all signs of standard development which tend to decline with age. Another one of the Kidney's main functions is metabolizing and controlling the excretion of fluids. When the Kidneys are healthy, fluids are easily transformed into urine and discharged by their paired organ the Urinary Bladder. When weakened, Kidney Qi cannot properly retain fluids resulting in incontinence or leukorrhea.

The Kidneys are unique among the organs as they are the root of both Water and Fire, primary forms of Yin and Yang; Kidney Yin and Yang are the root of the Yin and Yang of all the Organs. The Kidneys store Pre and Post Heaven Essence and are the source of Fire in the body called "Life Gate Fire, or ming men" the motive force behind all functional activities of the body. Kidney Yang is vital in warming the body, as well as supporting the Yang of the Lung, Spleen, Heart, and sexual functioning. When the Kidneys become depleted, the proper interaction of the Kidney and Lung may be disrupted, causing respiratory insufficiency often associated with aging.

The Kidneys are associated with the Water element, and pair with its Yang counterpart the Urinary Bladder. Psychologically, healthy Kidney Qi translates into strong will power, drive, and determination. Herbal Kidney tonics are an extremely important in the Chinese pharmacopoeia. They augment longevity and strengthen one's constitution, support life stages such as fertility and menopause, and aid in securing bone density.

Decline of Kidney Essence contributes to poor bone development or deterioration, loose teeth, weakness of the knees, tinnitus, dizziness, impotence, infertility, premature graying of hair, and poor concentration and memory. Though Kidney Essence naturally declines with age, to prevent its untimely loss it is necessary to encourage the balance of Yin and Yang in the body while one is still in good health. Deterioration between Kidney Essence and Heart Shen may cause stresses and difficulties of the Spirit on a psychological and emotional level.

The Kidneys provide the foundational energies for life, maturation, and reproduction. Their energy is received congenitally from the parents and, like all organs, declines with age and improper lifestyle. Kidney Qi vacuity is one of the first stages of diminishing Kidney energy manifesting as weakness and pain of the lower back, frequent or inhibited urination, sexual dysfunction, or diminished hearing. It can occur as a congenital weakness if the parents have deficient Kidneys at the time of conception, excessive sexual activity, or after a long-term chronic illness. One of the main herbal formulas for treating Kidney Qi vacuity is the classic Jin Gui Shen Qi Wan (Kan's Dynamic Warrior) but because this pattern can manifest in different ways, a more specific formula may be indicated. For instance, if there is urinary incontinence, Sang Piao Xiao San (Kan's Restore Integrity) should be used, or if there is more soreness of the back and knees use Du Huo Ji Sheng Tang (Kan's Meridian Circulation ).

Kidney Yang vacuity is a deeper and more progressed stage of illness of Kidney Qi vacuity where the inner fire of the body diminishes. It has the same symptoms of Kidney Qi vacuity (low back and knee pain, urinary or sexual dysfunction, and diminished hearing) but much more severe. Cold sensations in the torso and extremities, impotence or infertility, edema, and early morning diarrhea are key signs for this pattern. Like Kidney Qi vacuity, the causes are from chronic illness, congenital vacuity, or an excessive lifestyle but can arise naturally, as we age and the Kidneys reach their peaceful sunset. Herbal formulas that nourish the Kidney's warming Yang energy such as Jin Gui Shen Qi Wan (Kan's Dynamic Warrior ) or You Gui Wan (Giovanni Maciocia's Strengthen the Root) are both suitable choices for this pattern.

Symptoms of warmth and dryness accompany Kidney Yin or Essence vacuity, such as dry mouth, heat in the evening, 5- palm heat (warmth of the palms, soles of the feet and over the heart), and dry hair and skin. Insufficient rest, excess emotional stress, overwork, and substance abuse are lifestyle factors that deplete rather than replenish the Yin. Aging depletes Kidney Yin and Essence naturally. In women, the menopausal syndrome is a result of the diminishment of these vital substances. Numerous classic formulas nourish Kidney Yin and Essence, including Zuo Gui Wan (Giovanni Maciocia's Nourish the Root), and Liu Wei Di Huang Wan (Kan's Quiet Contemplative ). Herbs that "secure Essence" help astringe Essence, preserving the leakage of Essence via premature ejaculation, or excessive vaginal discharge, through excess sweating, or frequency and dribbling of urination.

Because the Kidneys are the root of both Yin and Yang or Fire and Water of the body, their weakened state can manifest as both a Yin and Yang vacuity. Though a deficient Kidney condition may have a predominance of a Yin type, including heat signs, dry mouth and throat, or flushed cheeks, there can be a subtle vacuity of Kidney Yang at the same time. In the same respect, a deficient Kidney Yang condition has classic signs of a cold body and urinary sexual dysfunction, but may still have underlying Kidney Yin vacuity symptoms such as hot flashes and night sweating. Chinese herbal formulas such as Kan's Quiet Contemplative based on the classic Liu Wei Di Huang Tang strengthen Kidney Yin and contain gentle Yang tonics such as Tu Si Zi (Dodder Seed). Also Er Xian Tang (Kan's Two Immortals) illustrates this dual vacuity syndrome by using Kidney Yang tonics with Yin nourishing and heat clearing herbs as well.

Intestinal Dryness is a common pattern exemplified mainly by dry, hard stools that are difficult to move. There may also be dryness in the mouth and lips or abdominal distention. The Yin fluids of the Large Intestine may be damaged by improper diet, post partum, in the aftermath of a febrile disease, or even naturally as we age. Foods or herbal formulas containing oil-rich nuts and seeds can be helpful in moistening the bowels. The classic formula Run Chang Wan (Kan's Smooth Response) contains flax seeds and peach kernels as well as peristalsis activating herbs to make it one of the most popular formulas for treating Intestinal Dryness.

Lips indicate health when moist, shiny and pale red. If too pale, there is Blood or Yang Vacuity, if too red and dry, Heat in the Stomach and Spleen. Purplish or bluish lips point to Blood Stasis.

The Liver's primary function is to foster the smooth flow and proper direction of Qi throughout the body to help regulate all body functions; digestive, endocrine, reproductive, and emotional. A healthy flow of Liver Qi confers a happy, spontaneous, expressive disposition. Blockage or impairment of Liver Qi leads to repressed emotions, resentment, frustration, irritability and anger. Psychologically, the Liver is associated with inspiration and foresight regarding planning and decision making.

The Liver is responsible for storing Blood. It also regulates the volume of circulating Blood according to activity and menstruation. Liver Qi and Blood have special relevance to gynecological/menstrual problems such as dysmenorrhea, amenorrhea, metrorrhagia, and mid-cycle bleeding.

The Liver controls the sinews, or tendons, which may lack suppleness and become prone to injury when malnourished. Liver imbalances can be diagnosed when fingernails are pale, brittle or striated. The Liver nourishes the eyes, promotes normal vision, and moisture of the eyes.

The Liver and Kidney are closely related and interdependent, nourishing and supporting each other. The Liver is the primary organ of the Wood element and paired with the Gall Bladder, in a Yin/Yang relationship.

One of the main functions of the Liver in TCM is to store Blood. Blood is a part of Yin and as such has a moistening, cooling, nourishing quality. Liver Blood nourishes the eyes, and healthy vision is contingent of sufficiency of this substance. As the Liver controls the sinews, Liver Blood is the foundation substance that nourishes the sinews, or tendons and ligaments. The nails also reflect the health of the Liver, ideally in a strong, yet supple texture and a light rosy, glowing color.

As the Liver opens into the eye, when Liver Blood is deficient, it does not properly nourish the eyes, leading to conditions as night blindness, photophobia, floaters, dry eyes, or blurry vision. As the Liver controls the sinews, insufficient Liver Blood weakens the sinews, or tendons and ligaments. As the nails also reflect the Liver, paleness here is indicative of vacuity of Liver Blood. Vacuity of Liver Blood may lead to amenorrhea (blocked menstruation) or oligomenorrhea (beng-lou). Contrarily, if Liver Blood is hot, or in excess, there may be menorrhagia or metrorrhagia. Treating this pattern requires using herbs that nourish Liver Blood, as well as tonics to the Kidney Yin and Essence, which nourish the Liver via the Generating cycle.

Liver Fire is a TCM pattern commonly caused by an excessive build up of Qi in the Liver. Over time, stagnant Liver Qi slowly turns into Fire and accumulates in the body. The main signs and symptoms to look for in this pattern are those of Heat, such as flushed face, red eyes, thirst, and distending headaches as well as Liver signs such as a bitter taste in the mouth, irritability, outbursts of anger, and hypochondriac pain. Other causes for this pattern can be from longstanding pent up emotions, excessive stressful environments, or from long-term consumption of alcohol and energetically "hot" foods. Chinese herbal medicinals that Clear Heat and soothe the Liver can be used, such as Dan Zhi Xiao Yao San (Kan's Relaxed Wanderer), the CMS formula Purge Heat, or Long Dan Xie Gan Tang (Kan's Quell Fire).

This pattern appears as the combined Yin deficient symptoms of both the Liver and Kidney, and is common in depleted or older patients. Aging, reproduction, and excessive sexual activity deplete the Kidney, while the stresses of life and emotional challenges tax the Liver. Together, the diminishment of these two vital substances is responsible for numerous natural phases such as menopause, and the overall aging process. Deficient Yin of these combined organs will result in dryness of all their associated bodily tissues, including the skin, hair, eyes, and diminishment of sexual fluids. As the Liver rules the eyes, visual problems such as loss of acuity, blurry vision and dry eyes result. As the Kidneys rule the ears hearing problems, such as tinnitus or hearing loss develop. Other symptoms include dizziness, dry mouth and throat, seminal emission, insomnia, and low back or knee ache. Also included will be heat signs due to Empty Fire rising out of Yin vacuity, such as warmth in the palms of the hands, soles of the feet or the chest center. The tongue will be red, possibly with cracking, and have little coating. The pulse will be fine and weak.

This is by far the most common pattern in Liver pathology, as well as one of the most commonly presented patterns of disharmony seen in the practice of TCM, especially in modern life. Synonymous terminology is Liver Qi stagnation, Liver Qi depression or just Qi stagnation.

Due to the Liver's role of maintaining the flowing and spreading of Qi throughout the body when the Liver fails in this function, the effects are far-reaching. The movement of Blood in the body, of the Qi in the channels, and the flow of Qi enabling the activity of all the organs, is affected. Problems in the emotional life are the most important cause of Liver Qi stagnation. When Liver Qi stagnates, it may lead to constraint in the costal and chest region, headache, abdominal pain and indigestion, diarrhea or constipation, muscular tension, anger, irritability, and frequent sighing. Stagnation of Liver Qi may in turn lead to stagnation of Liver Blood, causing premenstrual tension and dysmenorrhea, and dark menstrual clotting.

The herbal treatment for Liver Qi stagnation is to disperse, circulate, smooth or release Qi. Herbs that fulfill this action include Bupleurum chai hu and White Peony Root bai shao.

The Liver and Spleen ideally have a harmonious relationship, based on the interrelationships between the Five-Elements. The Liver is in the role of 'controlling' the Spleen; by its function of modulating the flow of Qi, it prevents stagnation in the Spleen, and the Dampness that might otherwise develop. However, if the influence of the Liver is too strong due to pent up Liver Qi not properly flowing, it may attack, or 'invade' the Spleen. This disrupts the Spleen's role of transporting and transforming substances in the process of digestion, causing a plethora of digestive maladies. Key symptoms of this common pattern are alternating constipation and diarrhea, abdominal pain, distension, and flatulence, as well as irritability and fatigue. The tongue may be pale, show a purplish hue, or have redness on the sides. The pulse will generally reveal the Liver Qi stagnation in a wiry Liver pulse, and weakness, or softness in the Spleen pulse.

When Liver Qi is constrained, instead of constructively acting within the Shen, or generating cycle, and nourishing the Heart, it may become disharmonious with the Spleen/Stomach, and 'invade' the Stomach, adversely affecting digestion. Symptoms include irritability and anxiety when associated with indigestion, stomach fullness after eating, nausea or vomiting, epigastric pain, abdominal distention, belching, hiccups, flatulence, and poor digestive strength. The pulse will be wiry, with fullness in the middle position on both hands. The tongue will most likely reveal redness, and possibly a greasy coat. Formulas that regulate the dynamic between the Liver and Spleen/Stomach include variations on Chai Hu Shu Gan Tang ( Kan's Liver Flow or Break Into A Smile)

In the Liver, as in other organ systems, the fine balance of Yin and Yang is of paramount importance. Liver Yang has its natural, healthy role in the activity of the Liver, but when it is elevated due to insufficient Liver Yin, or due to factors such as emotional stress or dietary irregularities, problems arise.

As Yang has an ascending, warm energetic, its imbalanced rise when left unchecked by moistening Yin energy, leads to numerous symptoms of the upper body and head, including sensations of heat, thirst, headache, expressive anger, high blood pressure, and restlessness. Acupuncture and herbal formulas that send the excessive energy downward can often alleviate these symptoms. The treatment principle for this syndrome is to nourish Kidney Yin while simultaneously anchoring excessive Liver Yang, exemplified in the TCM formula Tian Ma Gou Teng Yin, or Kan's Gastrodia & Uncaria.

The Yin of the Liver refers to the Yin qualities of suppleness, moistness, and coolness of the Liver. It is essential for the suppleness and strength of the tendons, ligaments, and nails. Due to the Liver's association with the eye, Liver Yin is responsible the moisture of the eye and clarity of vision. Liver Yin, as well as Kidney Yin, gradually depleted by aging, is responsible for numerous natural phases, such as menopause, and the overall aging process.

When the Yin of the Liver is deficient, the tissues nourished by the Liver become depleted, dry, and weakened. The ligaments and tendons become taut, stiff and prone to injury. As the Liver rules the eyes, visual problems such as loss of acuity, blurry vision and dry eyes result from Yin vacuity in the Liver. In pulse diagnosis, the Liver pulse will generally be thin or weak on deeper palpation. Formulas such as Yi Guan Jian (Kan's Gracious Power or Linking Decoction) are designed to nourish the moisture and fluids of the Liver network.

The Lower Burner is part of the Triple Burner system, a concept unique to TCM theory that describes how the upper, middle and lower regions of the body work together. The Lower Burner refers to the lower torso, and to the Kidney, Bladder and Intestines. The Lower Burner is entrusted with the function of transforming, separating and excreting fluids appropriately, and is likened to a 'drainage ditch'. If these processes of the Lower Burner are impaired there will be improper retention of fluids resulting in patterns such as Damp Heat in the Bladder or Small Intestine, or Kidney Yang vacuity. Malfunction of the Lower Burner usually results in urinary or bowel dysfunction.

In TCM the Lungs are similar to Western medicine in their function of respiration, and connection with the external environment through the nose, control of the voice and interconnection with the Heart and blood vessels. The Lungs receive Nutritive Qi from the Spleen where it mixes with inhaled air to form Gathering Qi (Zong Qi), or "Big Qi of the Chest", which is disseminated throughout the entire body like a fine mist. This fine mist functions to nourish the skin and hair, helps regulate opening and closing of the pores, and sweating. The Lungs also help to disperse the Defensive (Wei) Qi and fluids throughout the body to the spaces between the muscles and skin.

The Lung Qi has a descending action, interacting with the Kidneys by aiding them in grasping the Qi. Impairment will cause wheezing, coughing or shallow breathing especially upon inhalation. Lung Qi also helps send body fluids to the Kidney and Urinary Bladder for excretion which are then vaporized and returned to moisten the Lungs. The Lungs house the Corporeal Soul (Po) which is the mental-spiritual aspect of the organ, affected by sadness and grief. The Lungs are associated with the Metal element and paired with the Large Intestine.

Lung Qi vacuity refers to a diminished vitality of the Qi of the Lungs. Chronic imbalances such as long-term coughing, hereditary weakness, or poor posture can easily contribute do a vacuity of Lung Qi. Because the Lungs control respiration, symptoms such as shortness of breath, chronic weak cough, and asthma are common with this pattern. The patient may have a weak voice and a dislike of speaking. Additionally, the Lungs are an integral part of the body's defensive network and have a close relationship with Defensive or Wei Qi. When weakened, the Lungs cannot regulate Defensive Qi and the pores of the skin causing spontaneous sweating, susceptibility to External invasions, and allergies. Chinese herbal formulas such as Ren Shen Ge Jie San (Kan's Ginseng and Gecko Formula), and the CMS formula Strengthen Lung can be effective formulas in treating this disharmony.

In practice, most clinical presentations are not solely one pattern and patients often present with combinations of different disharmonies. Lung Yin Vacuity can easily lead to Lung Qi Vacuity and vice versa so knowing which pattern instigated the other can be helpful in treatment. In this dual vacuity pattern, Lung Qi vacuity symptoms such as shortness of breath, difficult breathing, and fatigue will also be seen with a dry cough, tidal fever, and reddened cheeks from Lung Yin Vacuity. While an herbal formula solely for Lung Qi Vacuity may be too drying, and a formula for Lung Yin Vacuity may be too heavy and cloying, formulas such as Kan's Wise Judge or Li Fei Wan (Kan's Li Fei Lung Support) address both aspects of this combined pattern.

Lung, Stomach, and Kidney Yin Vacuity is a combined pattern manifesting by a strong thirst or hunger, dry mouth and lips, hot flashes, and frequent urination. Often grouped together, this set of symptoms, termed "wasting and thirsting disorder" or xiao ke, is equivalent to the western presentation of diabetes. The dry mouth, lips and throat stem from the vacuity of Lung Yin while a weakened Stomach Yin causes the strong appetite, and craving for sweet foods. The Kidneys, which regulate the body's water metabolism, are a crucial element in this pattern, their weakness causing frequent urination. Ingested liquids are not properly and thoroughly metabolized, but rapidly excreted. Thus, formulas such as Yu Quan Wan (Kan's Jade Spring Nourishing Formula ) are effective by nourishing the body's Yin fluids and restraining fluid leakage.

Lung Yin vacuity is an internal disharmony between the Lungs and the amount of Yin fluids in the body. When there is insufficient moisture to nourish the Lungs they become dry and irritated producing a dry cough, or cough with blood- streaked sputum, hoarse voice, night sweats, tidal fevers, and sensations of heat in the palms and soles. This type of condition can arise gradually from smoking, improper diet of dry or spicy foods, a stressful lifestyle without proper rest, or the aftermath of a febrile disease, which injures Lung Yin.

This pattern can look similar to that of Lung Dryness, but the key signs in this pattern are those of general Yin vacuity such as night sweats, tidal fevers, and sensations of Heat in the palms and soles. Lung Dryness is an External invasion that usually occurs in autumn or in dry environments.

The Luo Mai are branches of the primary channels that permeate and integrate the body. Some of the luo mai are actual blood vessels; others are purely energetic. Each of the 12 primary channels has a luo/connecting channel that diverges from the primary channel and connects at the luo/connecting point. For example, Lung 7, Large Intestine 6, Stomach 40 and Spleen 4. There are three other connecting points, Ren 15, Du 1 and Spleen 21(the great luo connecting point of the Spleen). Luo points are used in clinical application for their status as points that lie "in-between" paired channels, therefore able to treat both. For example, LU-7 is important for exterior diseases because it is the luo/connecting point of the Lung channel and thus activates its paired Yang channel, the Large Intestine. Luo points are also recognized as treating psycho-emotional disorders and disorders in the region of the luo vessels.

Though the term Marrow in TCM includes bone marrow, its meaning is expanded beyond this definition. Marrow is viewed as the common substance forming the bone marrow, spinal cord and brain. In fact, the brain is called the "Sea of Marrow" in TCM.

Marrow forms from Kidney Essence (Jing) during gestation, so Essence is primary in the production of sufficient Marrow for the strength and resilience of Bone, a well-developed skeletal system and functioning and intelligence of the Brain. Herbal treatment to address issues relating to Marrow, such as osseous weakness, developmental delay or insufficient mental functioning is generally directed towards the Kidneys and Jing.

The Middle Burner is part of the Triple Burner system, a concept unique to TCM theory that describes how the upper, middle and lower regions of the body work together. The Middle Burner refers to the organs primarily of digestion; the Spleen and Stomach. Its function is compared to that of the 'rotting and ripening' of food that goes on in nature. When afflicted, there are difficulties with digestion resulting in TCM patterns such as Dampness in the Middle Burner, manifesting in malabsorption, or improper retention of food in the Stomach.

The Gate of Life, translated from ming men (life gate), is the area on the lower back between the two Kidneys regarded as the place where the vitality of life arises. This area generates the warmth for organs and tissues and is the motive force for all physiological activities, especially reproductive and sexual.

This is a combination pattern seen commonly in the clinic. An injury immediately causes stagnation of Qi and Blood, due to the impact on various bodily tissues, and the inflammatory response, or bruising. Acupuncture, topical applications, and herbal medicines can encourage the flow of Qi through the affected area, preventing the progressive stagnation of Qi and Blood that might otherwise occur. These techniques treat chronic stagnation of Qi and Blood, as well, as in the discomfort and stiffness of an old injury.

In modern life, emotional tension, daily stress, and insufficient exercise diminish the proper circulation of Qi, and thereby Blood, to the Organs. Qi stagnation manifests as a distended sensation of the abdomen and hypochondriac region, emotional lability, muscular tension, and numerous women's health conditions such as PMS. Blood stasis refers to the impairment, coagulation, or cessation of the normal flow of Blood, as in masses, swelling, bruising and bleeding.

In the TCM view of internal medicine, the Liver is responsible for providing a smooth, rhythmic, flow of Qi to the entire being; body, mind and emotions. Diminishment of this function is usually at the core of internally obstructed Qi. Due to the intrinsic interdependence of Qi and Blood, prolonged stagnation of Qi leads gradually to Blood stasis, as well. This obstruction may arise in various areas of the body, from angina pectoris, to gynecologic conditions such as menstrual irregularities, cramping with clotted menstrual blood, or the formation of masses, such as fibroids.

Pathogenic Qi is another word for the external climatic influences that can initiate imbalance and illness.

Pestilential Qi is a pathogenic factor recognized in the Ming dynasty, which refers to contagious diseases not attributable to the traditional Six Pathogenic Factors, but to those transmitted through the mouth or nose. They are the most serious and contagious pathogenic factors corresponding to epidemics such as diphtheria, scarlet fever, or smallpox.

Accumulated Body Fluids may amass in the creation of Phlegm, a frequently encountered and far-reaching pathological condition. Manifestations of Phlegm include lung congestion, lumps under the skin, numbness, gall or bladder stones, as a precursor to Wind stroke and can affect the Mind.

Phlegm, a thick and viscous pathogenic substance, is difficult to dissolve and can congeal anywhere in the body. When the digestive energies of the Spleen are weakened, food cannot be properly broken down and becomes Dampness or in severe cases, Phlegm. Spleen causes an overproduction of Phlegm, which is stored in the Lungs, but may accumulate in different parts of the body causing diseases such as stroke or epilepsy. When Phlegm accumulates in the meridians it manifests as lumps under the skin, in the Lungs as thick sputum or chest tightness, or in the Stomach at nausea and vomiting. Formulas often address Phlegm accumulation in two ways. Firstly, they directly address the Phlegm with herbs that transform or dissolve Phlegm and secondly they move Qi to prevent further coagulation of Phlegm. Er Chen Tang (Kan's Lucid Channel) is a clear illustration of this idea.

Phlegm Heat in the Lungs is a combined pattern of Phlegm (a thick, sticky, and material substance) and Heat (an inflammatory, coagulating, and immaterial pathogen) which affects the Lung. It presents as a cough with very thick and yellow or blood-streaked sputum that is difficult to expectorate. Heat coagulates Phlegm into a thicker and more viscous substance giving it a yellowish color. In cases of extreme Heat, the sputum can have a greenish hue. Other symptoms include pain in the chest, heat sensations, thirst, and a red face. This pattern is often seen after a cold or flu and can be similar to the Western presentations of bronchitis or pneumonia. Herbal formulas that both dissolve Phlegm and clear Lung Heat such as Qing Qi Hua Tan Wan (Kan's Pinellia Phlegm Dispersing Formula) are especially effective in treating this condition.

TCM pulse taking is an art requiring extensive study and practice, and is crucial to accurate diagnosis. It varies from the Western medical pulse taking at the radial artery for rate. In TCM, the practitioner palpates the pulse at three positions on each wrist, in both the superficial and deeper levels. Further, the quality of the pulse is a carefully observed and uniquely differentiated study in TCM. The pulse is critical for determining imbalances, weakness and excesses of specific organ systems, as well as patterns of disharmony and illness between the various organ systems. The patient should be sitting upright or lying supine during pulse taking.

The front position of the pulse on each wrist relates to the Upper Burner. The left-hand front pulse accesses the Heart pulse on deep palpation, and the Small Intestine or Pericardium superficially. The right handed front pulse accesses the Lung on deep palpation, and the Large Intestine when pressed superficially.

The middle position of the pulse on each wrist relates to the Middle Burner area, and primarily the digestive system. The right hand middle position reflects the Spleen, on deep palpation, and it's paired Earth element organ, the Stomach, when pressed superficially. The left-hand middle pulse relates to the Liver, on deep palpation, and the Gall Bladder superficially.

The rear, or lower pulse position, relates to the Lower Burner, specifically to the Kidneys on both hands. The left hand reflects the condition of Kidney Yin, the right of Kidney Yang. The right rear position also reflects the Pericardium on deep palpation and Triple Burner superficially while the left rear reflects the Urinary Bladder superficially. There are variations on assignment of these positions according to different texts and scholars.

A normal pulse has a steady, even beat with about four beats per breath. It is neither floating nor sunken, and has an effortless quality, arriving and departing without hesitation. The pulse is appropriately strong on deep palpation. The healthy pulse naturally varies according to age, constitution and time of the year. For instance, a child's pulse is softer and more rapid than an adult's. A woman's pulse is softer and slightly more rapid than a man's.

The floating pulse is pronounced on light touch at the superficial level, but diminishes markedly when further pressure is applied. It is descriptively referred to as feeling "like wood floating on water", and when pressed down, escapes from beneath one's finger. It is classically associated with Exterior patterns such as Wind Cold or Wind Heat. However, a floating pulse may also occur during a chronic illness or following a major loss of Blood.

This pulse is palpable at the deep level of pulse taking. It is generally associated with internal conditions arising from imbalances within the internal organ systems. A sunken pulse that requires considerable pressure to feel is called 'hidden,' and is due to cold in the interior and desertion of Yang Qi, which can occur with severe vomiting and/or diarrhea.

A weak pulse is palpable mainly on the deep level of pulse taking, and is without force. It is associated with deficient Qi and Blood.

A pulse that has more than six beats per full breath is considered rapid; five to six beats per breath is slightly rapid. It is associated with Heat, but may sometimes indicate vacuity, or emptiness. A pulse with seven or more beats per breath is a 'racing pulse,' and it represents a condition of greater vacuity. A forceful and rapid pulse is generally felt in an externally contracted condition, with fever, such as a Wind Heat invasion. A rapid pulse that is fine, without much force, indicates extreme Heat or Fire due to Yin vacuity. A rapid pulse with beats that feel large beneath one's fingers indicates Qi vacuity. Rapid pulses are normal in healthy infants.

This pulse is classically described as being like 'pearls rolling in a dish.' The beats have a rounded, smooth, easily flowing cadence, and a viscous quality. A slippery pulse usually indicates pathological Damp or Phlegm, as well as food stagnation. It is normal in pregnancy, especially in the early months, indicating abundant Qi and Blood.

Also referred to as a rough pulse, this pulse does not flow smoothly. Nearly opposite in quality to the slippery pulse, the choppy pulse has a difficult quality, feeling short and dry. It is seen in patterns of Blood stasis and Qi and Blood vacuity.

This pulse resembles a string of a musical instrument, it is translated as string-like, or bowstring. When palpating, the pulse rises clearly and strongly up to meet one's finger. This clinically common pulse points to Liver Qi stagnation, and ascendant Liver Yang, and may indicate disease of the liver and gall bladder. It is also felt in patients experiencing pain. If a wiry pulse feels forceless instead of strong, it indicates vacuity of Yin, and hyperactivity of Yang.

A tight pulse is wiry and forceful, and feels like a twisted rope. It is associated primarily with internal Cold and chronic pain.

The soft pulse, also called a soggy pulse, has a soft quality with a diminished force. It tends to be 'floating,' or easily palpable on light touch and feels like wet cotton. It is associated with both Qi and Blood vacuity with Damp accumulation.

This pulse feels like a small, well-defined thread rising under the fingers. It indicates vacuity of Qi, Blood, Yin or Yang, and often specifically, Yin and Blood.

These three types of pulse indicate a Heart disharmony. They also point to the presence of Blood stasis or phlegm turbidity obstructing the Yang Qi of the chest. However, these erratic types of pulses may also occur in healthy persons, or those suffering from emotional depression.

This is a relatively fast pulse with irregular pauses indicative of excessive Heat or stagnant Qi, Blood, Phlegm, or food.

A slow, irregularly interrupted pulse which can indicate a stagnation of Qi, Cold, Blood, or Phlegm.

A slow pulse with missed beats at regular intervals reflects either an exhaustion of Qi, painful or highly emotional situations, or Internal Wind.

A deficient pulse is forceless, but its palpable pulse is large, rather than fine and indicates Qi and Blood vacuity.

This pulse feels forceful at the front and back of the pulse beat, and indicates a condition due to excess Heat or other excess patterns such as Liver Fire, or Qi and Blood Stagnation, depending on the particular qualities.

This pulse feels extremely fine and is without force and distinction. It is almost imperceptible. It presents in serious Qi and Blood vacuity.

A flooding or big pulse feels broad, large, and forceful at all levels, especially the superficial. The front of each beat is forceful and long, contrasted with a softer ending. It surges over the whole of the palpating fingertip. It indicates Heat, generally of an Excess nature.

Qi, pronounced 'chee', is the dynamic rarified substance constituting and animating the natural world, also referred to as life force, or vital energy. Conceptually, it is the point 'where matter becomes energy, and energy becomes matter,' and is intrinsically in constant movement. In the human body, Qi flows in distinct pathways, called Channels or meridians, and its free and abundant flow is essential to optimal health.

There are numerous types of Qi within TCM, carrying out various functions in the body. Qi holds bodily tissues and substances in their proper place, such as maintaining Blood in its vessels, thereby preventing varicosities, and it has an overall lifting or raising property, preventing organ prolapse. Qi is also responsible for protecting the body from invasion by exterior pathogens such as influenza and allergies. Finally, the transformation of food and fluids into useable energy, warming the body, and circulating substances throughout the individual are all functions of Qi as well.

Qi vacuity is a condition marked by insufficient Qi, or vital energy. General all-over vacuity of Qi results in symptoms such as fatigue, poor digestion, loose stools, lethargy, or apathy. Clinically, the specific organ system or systems suffering Qi vacuity may be determined, such as Spleen Qi vacuity, or Heart Qi vacuity. This type of diagnosis is much more useful, allowing for a more targeted treatment approach. The depletion of Qi occurs due to numerous life factors including lack of sleep, sexual excess, childbirth, stress, and poor diet.

Qi vacuity often leads to Qi stagnation, as there is insufficient Qi to circulate. It also may contribute to Blood vacuity or Blood stasis, due to the interrelationship of these two vital substances.

Qi Level Heat is External Heat that has penetrated to the level of the Qi, in the theory of the Four Levels. This may occur if a Wind Heat invasion does not resolve naturally, nor benefit from acupuncture or herbal therapy, as in the case of incorrect diagnosis or incomplete treatment; it then pushes beneath the superficial level, into the deeper Qi level. The Heat passes the superficial level of the defensive Wei Qi, reaching the Qi level. This level exists between the Wei Qi (Defensive Qi) and the deeper Ying Qi (Nutritive Qi) and Blood (Xue) levels. Here the body's Qi struggles with the invasion, fighting to keep it from penetrating more deeply into the body, resulting in the fierce symptoms of Heat or Fire.

Qi Level Heat is famed for its 'four big' symptoms of high fever, profuse sweating, intense thirst, and a full, rapid pulse. Qi Level Heat manifests in Lung Heat, Stomach Heat, Stomach and Intestines Dry Heat, Gall Bladder Heat, and Stomach and Spleen Damp Heat.

Original Qi, like Essence, is a vital substance received at conception from one's parents. Original Qi has a more energetic nature, while Essence is more fluid or viscous. Stored in the Kidney, this type of Qi is finite in measure and determines what constitution and mental capacity is given at birth. It is also responsible for the development of the body, sexual maturation, and reproduction. The preservation of Original Qi is of paramount importance in TCM, it is viewed as the root of all Qi. It is not tapped into during the usual course of daily life, but rather reserved in the Kidney for the rare severe trauma, illness, or extreme stress that may require an inordinate amount of Qi to withstand. In a careless, 'burn-out' lifestyle, or one of malnutrition or hardship, Original Qi may unfortunately be drawn from excessively and a person may suddenly seem to age very rapidly.

Historically, TCM masters placed great emphasis on the study and cultivation of Chinese tonic herbs, which build Qi and immunity and strength, thereby protecting this precious substance.

Postnatal Qi is derived from the nutrients extracted during the process of digestion, and from the Lungs' utilization of clean air. Healthy Postnatal Qi provides protects the essential Original Qi, and Jing, whose preservation is of paramount importance in TCM. Chinese herbs that strengthen digestion and nourish the Kidney help to supplement Postnatal Qi.

The stagnation, or obstructed flow, of Qi is one of the most common imbalances of modern life. Emotional tension, daily stress, and insufficient exercise diminish the proper circulation of Qi, causing it to gather and impede the further flow of Qi of various organs, and the flow of Blood. Qi stagnation contributes to a distended sensation of the abdomen, especially the hypochondriac region, emotional lability, numerous women's health conditions such as menstrual cramps and PMS, and muscular tension.

Wei Qi, translated as Protective or Defensive Qi, correlates roughly to the modern concept of the immune system of the body. Original Qi and Postnatal Qi are both involved in its production.

Wei Qi is responsible for defending the body against pathogenic influences in the environment. It is conceptually similar to one's resistance to illness. Wei Qi circulates between the skin and muscles, regulating the pores and sweat glands, and providing a shield from exterior conditions such as cold, wind, heat or other pathogens. General exhaustion weakens this type of Qi, rendering an individual open to recurrent respiratory infections, persistent allergies, or spontaneous sweating. There are numerous herbal formulas that bolster Wei Qi, such as the classic Jade Windscreen.

The Ren Mai, which translates as Conception, or Directing Vessel, originates deep in the Kidneys, flows down through the uterus and perineum, then up the anterior center of the torso, to the mouth. It is the "Sea of the Yin channels", nourishing all Yin channels, the reproductive system, and influencing the flow of Blood, especially in women. Due to it's origin and pathway it has a strong influence on regulating menstruation, fertility, conception, pregnancy, childbirth, and menopause. The Ren Mai functions with the Chong Mai and together may address many gynecological disorders. The Ren can also stimulate the Lung Qi's descending action and the Kidney's ability to grasp the Lung Qi.

Resolving the Exterior refers to a treatment method used to eliminate a pathogen from the exterior or superficial areas of the body. This treatment is accomplished by inducing diaphoresis. In TCM theory, an external pathogen (virus, bacteria, etc.) invades the body through the pores of the skin, or exterior layer of the body and should be resolved by sweating using specific medicinals or acupuncture.

Sedating is a therapeutic treatment which has an anchoring, calming, or grounding effect on the body. Uncontrolled Yang energy tends to rise up to the head, shoulders, and neck when left unchecked by the cooling energy of the body's Yin. Symptoms of hypertension and migraines can often be alleviated by sending the excessive energy downward. Minerals, which are heavy in nature, are often the medicinals of choice for this method. Chinese herb formulas such as Jiang Ya Wan (Kan's Anchor the Yang) and Tian Ma Gou Teng Yin (Kan's Gastrodia and Uncaria Wind Relief) are designed to have a sedating effect when the body's Yang energy ascends excessively.

Shao Yang disharmony is a stage of disease progression within the Six Stages theory of illness. This framework developed by doctor Zhang Zhong Jing in 200 AD discusses the progression of External pathogens as they penetrate deeper into the body. The Shao Yang stage is considered "half internal, half external" stalemate where the body is too weak to expel a pathogen and the pathogen is unable to penetrate to a deeper state of disease. This leads to symptoms that alternate between latency and activity, and come and go. The classic symptoms of this pattern are alternating chills and fever, nausea, vomiting, bitter taste in the mouth, and fullness in the chest and hypochondria. Modern uses of this formula are for conditions such as chronic fatigue syndrome, recurring colds and flu, and even manic depression that alternates between intense sadness and extreme joy. The hallmark formula for this disharmony is Xiao Chai Hu Tang (Kan's Minor Bupleurum).

Shen, translated as Spirit or Mind, has a subtle energetic quality. It is an ephemeral quality revealed in the expression, manner and speech of an individual. In the examination of a patient, observing the state of the Shen is an important component. Gestures, tone and syntax of the speech, appearance of the eyes, and general impressions perceived by the physician are useful to determine this. A healthy condition of the Shen is reflected by emotional stability, vibrant appearance, clear and concise thoughts, eyes with a "glitter", and will make recovery from any condition easier. Contrarily, lifelessness, lethargy, and dull or opaque eyes as one may find with depression or fatigue can reflect a weakened Shen. This may play a strong role in the individual's condition and interfere with adherence to health practices. Shen disturbance is comparable to psychiatric disorders that involve agitation or delusion and treating the Shen is as important as the 'physical' condition for which the patient seeks treatment. In TCM, the integration of mind and body is always considered.

In Chinese medical theory, the Shen resides in the Heart, and has both spiritual and mental connotations. Though the Brain was understood to 'be the seat of the original spirit' by many ancient scholars, cognitive abilities including consciousness, thinking, ideation, insight and memory, were traditionally considered controlled by the Heart, and the state of the Shen. The Shen is reliant upon, and reflects the fullness of the Qi and Blood.

Through observation of nature and human health, certain climatic forces have been determined to confer detrimental effects on the human body, especially under excessive exposure. There are six major adverse environmental forces in TCM, each relating to a specific season, region, and Element. They are Cold, Wind, Heat, Summer Heat, Dampness, and Dryness. An additional factor, Pestilential Qi, recognized in the Ming dynasty, refers to contagious diseases not attributable to the Six Factors, but to those transmitted through the mouth or nose. Though they originate outside the body, Exogenous Factors may invade the body if there is over-exposure during cold and windy weather, or when one's resistance or Wei Qi is weak. Each Exogenous Factor causes unique detrimental effects, inducing various disease states.

The Chinese term for these six factors, xie qi has been translated into numerous descriptive and colorful terms reflecting the recognition of their penetrating and damaging powers. Exogenous Factors, Pathogenic Factors, Pernicious Evils, and Climatic Excesses are some of these translations. Within the body, these Six factors behave in ways that reflect the activities of the environmental factor in nature; Wind is disruptive of the Qi, Cold congeals, Dampness is heavy.

The correlates of the Exogenous Factors to other aspects of TCM are far reaching. Each Exogenous Factor is related to one of the Five Elements, and the associated season. Winter, Northern regions, and the element Water, are associated with the Exogenous Factor Cold. One is most susceptible to Cold in winter. But additionally, due to Water's association with the Kidney, the Kidney's are especially affected by Cold.

These external factors may also combine forces, such as in Wind Cold, a potent combination of Cold driven in to the body by Wind, causing chills, sneezing, and runny nose. The lengthier one's exposure to a harmful factor, or that the factor has acted untreated within the body, the more serious the repercussions in terms of health and illness. The invading pathogens may transform once inside the body to more tenacious influences, or remain combined with other pathogenic factors. For instance, an untreated common cold may penetrate the Lungs as a chest cold and progress to bronchitis, a condition where the initial chill has turned to Heat, and Dampness has congealed into Phlegm.

Just as the phrase 'spring winds' indicate, Wind is a prominent feature of spring. After the constrictive cold has lifted, spring releases much vitality. In the body the Wood element is related to the Liver and is a pathogen which initially affects the upper and outer parts of the body; lungs, head, and skin. Wind invasions are usually abrupt and rapid, causing twitching, migrating pain, itching and dizziness. Wind combines easily with other exogenous factors, Cold, Heat, and Damp. Wind tends to injure the Blood and Yin.

Heat is predominant in summer, the domain of the Fire element, relating to the Heart and other Fire organs - the Pericardium, Small Intestine, and Triple Warmer. Heat causes symptoms such as thirst, fever, inflammation and a rapid pulse.

An extreme type of Heat, Summer Heat, is also related to the Fire element, and tends to injure Yin. It specifically occurs in the summer, leading to sweating, headache, scanty-dark urine, thirst, and a rapid pulse.

Dampness relates to the Earth element and the organ systems of Spleen and Stomach. Dampness is sticky, heavy and difficult to eliminate. Symptoms of Dampness include; no appetite, a heavy feeling in the body, and a sticky taste in the mouth. Signs are a greasy tongue coating, and slippery pulse. Dampness can manifest with vaginal discharge, loose stools, foggy head, fatigue, epigastric fullness, and systemic conditions, such as fibromyalgia, in which Dampness has lodged in the muscles and channels.

In autumn, Dryness prevails as vegetation divests itself of leaves and fruit, and winds presage the winter. This season, notoriously challenging to the respiratory system, is the time related to the Metal element, and its organs, the Lung and Large Intestine. It can arise from overly dry weather or from exposure to over-heated buildings. Manifestations are dry throat, skin, and stools.

Cold which appears mostly in winter can easily afflict the Kidneys. But it is most often combined with Wind to cause symptoms of a common cold (see Wind Cold. It invades the hands, arms, feet, knees, lower back and shoulders, and contracts the tissues and flow of Blood. It can also invade the Intestines, leading to diarrhea, the Stomach, causing epigastric pain and vomiting, and the Uterus, causing painful menstruation.

Spleen in TCM is the equivalent to the body's digestive process and enzymatic production. Together with the Stomach and Small Intestine, the Spleen is responsible for extraction, assimilation, and distribution of nutrients from food. Because of its importance in providing nutrients for Qi and Blood production, it is referred to as the source of Qi and Blood production and the root of Postnatal Qi. When Spleen Qi is deficient or compromised from over thinking, excessive intake of sweet, cold or raw foods, nutrients are not properly extracted and symptoms of fatigue, loose stools, and poor appetite are seen.

In TCM the Spleen is associated with the muscles, mouth and lips. Muscles and their movement depend on nourishment by essential substances derived from food by the Spleen. When healthy, limbs are strong and muscles are sound but if Spleen Qi becomes impaired, emaciation, weak limbs, or even paralysis can occur. The Spleen also has the capacity of lifting or raising the Qi, and holds organs in their proper place such as the Uterus, and Bladder, thereby preventing prolapses. The Spleen influences our ability to concentrate and memorize, holds Blood in the vessels and, along with the Heart and Kidney, is influential in Blood production. The Spleen is associated with the Earth element and is paired with the Stomach.

As a primary role of the Spleen is maintaining the integrity of the digestive process by transforming and transporting the nutrients and fluids properly and completely, insufficient strength of the Spleen allows for a buildup of the byproducts of digestion, and Dampness.

Spleen Qi vacuity refers to a diminished vitality of the Qi of the Spleen, the organ and channel system primarily responsible for extracting nutrients and Qi from food, and viewed as the 'origin of Blood'. Not surprisingly, it arises from unhealthy eating habits, in which TCM includes irregular meal times, over and under-eating, excess consumption of cold, frozen, raw, sweet foods and beverages, all of which contribute to the formation of Dampness. Additionally, excessive thinking, worrying, anxiety, and overwork damage the Spleen Qi. This pattern causes low energy, loose stools, a lack of appetite, and abdominal distension after eating. In TCM, the Spleen has the function of transporting and transforming fluids, therefore when its Qi is weak Dampness is able to develop.

Spleen Qi and Heart Blood vacuity is a mixed pattern often seen in overworked and mentally fatigued individuals. Spleen Qi vacuity not only comes from improper eating habits, but over concentrating, excessive memorizing, or prolonged mental deliberation. In this situation, a deficient Spleen (loose stools, low energy, and diminished appetite) fails to transform food into nutrients that build Blood. Over time, Heart Blood can become deficient causing insomnia, palpitations, and poor memory. Because one of the main causes of Blood vacuity is the inability of the Spleen to transform food into usable nutrients, solely using Blood tonics does not address the whole picture so a formula like Gui Pi Tang (Kan's Gather Vitality ) can be an effective treatment.

In TCM, when an organ is healthy is directs its Qi in a certain direction. For example, when the Spleen in healthy and harmonious with other organs it sends Qi upward to the Lungs and upper body. The Stomach has a natural downward direction sending food and wastes to the lower body. When organs become diseased, their ability to control Qi flow is impeded and a counterflowing of Qi can occur. In a Spleen and Stomach disharmony Spleen Qi, which naturally flows upward, has descended causing diarrhea, indigestion, and prolapsed organs. On the other hand Stomach Qi, which naturally flows downward, rebels upward causing nausea, vomiting, and dizziness. Proper treatment of this pattern by acupuncture and herbal formulas such as Ban Xia Xie Xin Tang (Kan's One Mind and Drain the Middle) reestablishes the natural direction of Qi flow in the middle Jiao and "harmonizes" the Spleen and Stomach.

Stagnation refers to a reduction or sluggishness in the flow of a vital substance, such as Qi, Blood, Phlegm or food. Certain organs are more prone to stagnation of a certain type. For example, the Liver is inclined to Qi stagnation resulting in irritability and menstrual irregularities, whereas the Heart is prone to Blood stagnation causing chest pain and other symptoms of heart disease. These patterns are caused by difficult emotions, poor diet, stress, and pathology in the free flow of energy throughout the body.

The function of the Stomach in TCM parallels the western medical view, of receiving and beginning the breakdown of foods and fluids and passing them along to the small intestine for further digestion. TCM links the Stomach with Spleen, the paired organs of the Earth Element together occupying the Middle Burner and being intrinsically associated with digestion. They form the root of Post Natal Qi, the source of all the various types of Qi produced by the body after birth. Qi from the Stomach descends, moving digested food downward, while Qi of the Spleen ascends, creating a complimentary cycle of energy. The Spleen uses a 'pure' aspect or essence of food in the formation of Qi and Blood. If the Stomach's functions of receiving and descending are impaired, distention, nausea, belching, stomachache or vomiting may occur. If the Yin of the Stomach is deficient, heat ensues and there is excessive appetite. Due to the pathway of the Stomach channel, the mouth may reflect an overheated Stomach, in the form of mouth sores and inflammation of the gums.

Because the Stomach is the first organ to come into contact and render food and drink, it is the origin of fluids. When the Yin of the Stomach becomes deficient, a vacuity of Body Fluids will result. Symptoms include a dry mouth, thirst with little or no desire to drink, and a dry tongue marked by horizontal cracks. Stomach Yin vacuity also contributes to a constant, ravenous hunger but an inability to eat large amounts of food. Chinese formulas such as Yu Quan Wan (Kan's Jade Spring Nourishing) or the CMS formula Tonify Moisture contain medicinals which help to nourish Stomach Yin.

TCM is the acronym for Traditional Chinese Medicine, the ancient medicine native to China that originated approximately 2,500 years ago. Contemporary TCM is comprised of several treatment modalities, with acupuncture and herbal medicine being the most recognized and practiced worldwide.

The three treasures are three vital substances, Jing, Qi and Shen. Giovanni Maciocia has described them as different densities of Qi, Jing being the most substantial, Qi more rarefied, and Shen the subtlest. The integrated view of the body and Mind in Chinese Medicine is linked to the interrelationship of these essential substances. Each of the three treasures relies on the others for health and balance. If Jing and Qi are flourishing, the Mind will be balanced and alert. If depleted, the Mind will be afflicted with a clouding of perception, anxiety, or depression. Shen disturbed by emotional stress, or unhappiness, first affects the Qi, later weakening the Jing if the mental state is prolonged. Jing, Shen, and Qi are interrelated and essential to life and death.

The TCM methods of examining the tongue, along with pulse taking, are essential to diagnosis. As the tongue is very reliable diagnostically, it is useful to determine the basic underlying pattern in complex cases that have seemingly contradictory symptoms. It is also much easier to learn than pulse diagnosis, and therefore a cornerstone diagnostic for entry-level practitioners. When viewing a patient's tongue, the practitioner must look at four main features; tongue body color, shape and size, tongue coating, moisture and texture.

The tongue body color primarily reflects the condition of Blood, as well as the Yin organs and Nutritive Qi (Ying Qi). TCM practitioners make a clear distinction between the tongue body and the tongue coating, or fur, which is clearly a material on the surface of the tongue. A healthy tongue is pale red with a thin white coating, somewhat moist and of normal proportion, neither puffy nor especially thin.

The pale red color is due to abundant Blood, carried to the tongue by smoothly flowing Qi. The proper size is due to sufficient Blood and Qi, nourishing the tongue but not allowing swelling. The coating is thin and appears to be rooted on the tongue body.

The regions of the tongue reflect the state of the internal Organs. Noting the qualities of each area assists greatly in arriving at a TCM diagnosis. For example, the tip of the tongue relates to the Heart. Just behind the tip, the upper tongue is reflective of the Lung. The center of the tongue reflects the Stomach and Spleen. The sides of the tongue relate to the Liver and Gall Bladder, the rear, or base of the tongue, to the Kidney, Urinary Bladder and Intestines. Paleness, redness, dryness, or the color of the coating - all these have specific diagnostic meanings depending on where it occurs.

A pale tongue is lighter than pale red and displays shades of pink or white, or almost devoid of coloration. A pale tongue may indicate Blood or Qi Vacuity, or Excess Cold in the body.

A normal tongue is a uniform, pale-red color. Excessively red indicates an Interior Heat condition. A deep red or scarlet tongue points to an extreme Heat condition. A red tip indicates Heart Fire, or Heart Empty Heat. Red sides indicate Liver Fire or Heat in the Gall Bladder.

The tongue can also have raised red papillae, which indicate Heat in various organs. Red points are frequently seen on the tip indicating Heart Fire. Red on the sides of the tongue indicates Liver Fire, while red in the rear position indicates Heat in the Lower Burner and in the central area Stomach Heat. Large red points, called thorns, indicate Heat with Blood Stasis or Toxic Heat.

A deep red or scarlet tongue points to an extreme Heat condition or a warm, febrile disease.

The appearance of a thin, white coat is normal. However, it may also be present in a Wind Cold invasion and help differentiate between a Wind Cold or Wind Heat invasion.

A yellow tongue coat is a sure indication of a Heat condition. As heat naturally condenses moisture, the tongue coating reflects this in a darker, more viscous quality. A thin coat may indicate an external Wind Heat invasion, as in the early stage of a common cold with feverish flushing, thirst and sore throat. Yellow coating may also be present chronically in numerous conditions with a Heat component, including respiratory or digestive problems.

A greasy tongue coating has a uniquely viscous, or slimy, surface appearance. The coating is difficult to scrape off, and not altered much by brushing. It indicates phlegm, dampness, and food stagnation.

A tongue that appears thin indicates Blood vacuity, if it is also pale, or Yin vacuity, if it is red or the surface peeled. A normal tongue usually corresponds proportionately to a person's size and constitution. A large, strong person would have a bigger tongue than a petite person.

This tongue body appears larger than normal (puffy) and usually has some scallop-like indentations (teeth marks) along the sides. A swollen tongue indicates weakened or deficient Spleen Qi.

The tongue appears to have insufficient moisture, which is due to lack of Body Fluids or an accumulation of Heat.

The absence of any coating is referred to as a peeled or glossy surface. The tongue or a portion of it looks devoid of any coating, creating a shiny appearance. This is a sign of Deficient Yin or Fluids, usually of Stomach or Kidney.

Cracking of the tongue surface indicates that the Yin, or moisture of the body is insufficient. The location of the cracking is diagnostic, as each part of the tongue corresponds to different organs. A deep crack indicates severe depletion of Yin, whereas faint cracking is due to Yin depletion in the early stages.

Tonification is a therapeutic treatment that builds Qi, Essence, Blood, Yin or Yang when they are impaired or weakened. The tradition of Chinese herbal medicine has long been immersed in the pursuit of formulations to prevent, or at least slow, the loss of the vital essences, or build up a weak constitution. Tonics are to preserve and boost health. They are not to be taken if one is ill with a condition stemming from an External Pathogen, such as a common cold, as the deeply tonifying properties of the herbs could drive the pathogen into the body.

As one reaches middle age, a judicious approach is to utilize a tonic to preserve the Yin and Essence still flourishing in one's Kidneys, in order to mitigate the effects of aging as much as possible. Examples of Kidney Yin and Essence tonics are Liu Wei Di Huang Tang (Kan's Quiet Contemplative) and Zuo Gui Wan (Maciocia's Nourish the Root), or our CMS formula Replenish Essence.

Blood tonics are used when there are symptoms of Blood vacuity, an often sub-clinical state evidenced in such signs as a pale tongue, dry, pale skin, brittle nails, or a pantheon of symptoms such as dizziness, fatigue, scanty menstrual flow, or tendomuscular aches and weakness. Blood tonics are traditionally used during the prenatal phase, and postpartum care may involve the use of Blood, as well as Qi tonics. Blood tonics may be used in the first half of the menstrual cycle, to replenish the Blood following menses. A popular Blood and Qi tonic for women is Ba Zheng Tang, available from Kan as Women's Precious or Precious Sea.

Spleen tonics are formulas that strengthen the digestion and the transformation and absorption of nutrients from food and fluids by the Spleen, which is key to the formation of postnatal Jing. An example of a Spleen tonic is Liu Jun Zi Tang, (Kan's Six Gentlemen or Prosperous Farmer).

Formulas referred to as Yin tonics often tonify the cooling and moistening Yin aspects of the Liver and Kidney, two organs very prone to depletion of Yin. Tonics for Kidney and Liver Yin are used to temper the onset of the perimenopausal and menopausal life phase. As well, Yin tonics may ameliorate the Yin consuming lifestyle of insufficient sleep, stress, and eyestrain from excess computer work common in today's world. Deficient Yin of the Heart may be at the root of some cases of insomnia or nervous energy, and benefited by a Heart Yin tonic, such as Tian Wang Bu Xin Dan (Kan's Celestial Emperor's Blend. Lung Yin may be replenished in cases of chronic dry cough with a formula such as Li Fei Wan (Kan's Li Fei Lung Support.)

Yang tonics tend to be warming in nature and focused on building the Yang energy of the Kidney. Kan's Dynamic Warrior, derived from the 'golden cabinet' formulary classic Jin Gui Shen Qi Wan, or You Gui Wan, Ease the Journey Yang, are examples. Yang tonics are especially indicated for symptoms of Cold such as chilliness, edema, impotence, and pale urination.

The San Jiao, or Triple Burner, is one of the 12 primary meridians, however, it is a concept unique to TCM. This theory recognizes a tri-level thermal system in the body that cohesively controls the transportation, transformation and excretion of food and fluids. This theory incorporates the organ and meridian systems; the Triple Burner, though insubstantial, is considered one of the Yang organs, and has an associated channel.

Each of the three Burners is associated with specific organs and their channels; Upper Burner-Lung/Heart, Middle Burner- Spleen/Stomach, Lower Burner-Kidneys/Urinary Bladder, Small and Large Intestine. The Triple Burner contributes to the production and release of Wei Qi and Nutritive Qi, and the release of Body Fluids. Dysfunction of the Triple Burner results in blockages of the various types of Qi or fluids including; sneezing, ear ache, abdominal distention and urinary retention.

The Triple Burner pairs with the Gall Bladder channel in the Six Divisions theory; comprising the Shao Yang, which is an intermediary level midway between an exterior level of the body and an internal one.

The Upper Burner is part of the Triple Burner system, a concept unique to TCM theory that describes how the upper, middle and lower regions of the body work together. The Upper Burner refers to the organs in the chest, the Heart, Pericardium and Lungs, as well as the throat and head. The Upper Burner diffuses, humidifies and disperses fluids throughout the body, including the skin, in the form of a fine vapor and directs Wei Qi to the Lungs. This area of the body is susceptible to invasion from exterior influences, through chill, Wind or Heat to the channels of the neck, head and shoulders. When blocked by an exterior pathogenic factor, such as Wind Cold or Wind Heat, the circulation of Wei Qi is impaired and the pores are blocked, leading to common Wind invasion. symptoms such as sneezing, runny nose, and body ache. When an invasion directly attacks the Triple Burner channel, along the pathway up the sides of the neck and head-- earache, deafness, or swelling of the outer canthus or cheeks may result.

The Uterus is the most important of the 6 Extraordinary Organs, as it stores Blood, and is responsible for conception and pregnancy. The Uterus is closely linked to the Kidneys, which rule reproductive power, and the Chong and Ren Mai, which originate from the Kidneys and flow through the Uterus, nourishing it with Qi and Blood. If Kidney Essence (Jing) is deficient, the Chong and Ren Mai will be depleted as well, and unable to properly supply and replenish the Uterus.

Vitality of the Blood is also paramount to the health of the Uterus, and its three essential activities: menstruation, conception and pregnancy. The provision of ample healthy Blood is, in turn, strongly related to the activities of the Spleen, Heart and Liver.

Herbal formulas to strengthen Kidney Jing, fortify the Blood, and regulate the Chong and Ren Mai, benefit the Uterus.

Visceral Agitation, or restless organ syndrome, was first mentioned in the Essentials of the Golden Cabinet (Jin Gui Yao Lue) in 219 AD. The main symptoms include those of mental distress such as crying spells, increased or decreased emotional sensitivity, sadness, restless sleep, and disorientation. In TCM, the organ patterns related to his disharmony are Qi and Yin vacuity of the Heart, Liver and Spleen and is treated by the principal formula Gan Mai Da Zao Tang (Kan's Rescue Formula).

Wei Qi is similar to resistance to or immunity from illness. General depletion weakens Wei Qi, leaving an individual open to invasion by the Six Pathogenic factors, each of which produce their own range of symptoms. Deficient Wei Qi results in an unusual sensitivity to the weather, recurrent respiratory infections, persistent rhinitis or allergies. Spontaneous sweating on exertion is a symptom of Wei Qi vacuity. Numerous herbal formulas bolster Wei Qi, such as the classic Yu Ping Feng San (Kan's Jade Windscreen).

Wind Cold is the combination of the pathogenic agents Wind and Cold that has invaded the body producing symptoms of the common cold, or sinus congestion. Important clinically, however, is that TCM differentiates the common cold into Wind Cold and Wind Heat.

Symptoms of Wind Cold include sudden onset of chills, shivering and aversion to cold, body aches and occipital headache and stiffness, and low fever. A runny nose with white or clear, watery secretions is a hallmark of Wind Cold, as well as a stuffy nose and sneezing. The throat may be scratchy, as opposed to sore - a symptom of Wind Heat, and there is no thirst or sweating. The pulse is usually floating and tight, the tongue moist with a thin, white coating.

Invasion by Wind Cold may occur in chilly, wet or windy weather or due to exposure to a draught. Air conditioning or employment involving time in refrigerated rooms, are artificial versions of this pathogenic factor. TCM believes Wind Cold invades the body at certain vulnerable points, such as the nape of the neck (at point feng chi, wind pond), or the meridians on the face near the sinuses. The invasion of the body by Wind Cold is also due to the relative weakness of the Qi of the body, specifically Wei Qi, at that time. In this regard, actual exposure to cold is not required for the symptoms of Wind Cold to occur. Indeed, common colds of the Wind Cold type can also occur in summer.

In order to dispel a Wind invasion it is most effective to start herbal treatment as early as possible following the onset of symptoms, in frequent, generous dosages. Treatment for Wind Cold is to release the pathogen from the surface of the body, using herbs of a dispersing, warming, diaphoretic nature. It is also important to discontinue any tonifying, constitutional herbal formulas the patient might be on, during treatment for Wind Cold. Otherwise, the pathogenic influence may itself actually be strengthened.

The window of opportunity to treat most effectively with Wind Releasing formulas is usually only a few days following initial onset of illness. After this period, the pathogen may have penetrated to a deeper level of the body, requiring another herbal approach, such as formulas to Resolve Phlegm and Cough. Especially notable is that Wind Cold, when left untreated or treated unsuccessfully, often transforms into Heat. Much as air in a closed room becomes stale and warm, Wind Cold confined in the meridians, sinuses or throat transforms into Heat. Careful observation of presenting symptoms is critical to differentiating the type and stage of the 'common cold', or sinus congestion. For this reason, a few formulas that are effective for Wind Heat or Wind Cold, such as the CMS formula Purge External Wind and Bi Yan Pian, are especially assessable clinically for the entry-level herbalist.

The Pathogenic factors of Wind and Heat combine to create this pattern. Wind indicates its Exterior origin, and Heat its temperature. Wind Heat may enter one of the channels of the head, neck or face during exposure to Heat, in the form of a hot, dry climate, or overly hot, dry air due to central heating. The symptoms produced by Wind Heat are similar to those from Wind Cold, but with a drier, a more pronounced sore throat or fever. As Heat is a Yang quality, it also carries the Yang attribute of swiftness, and the condition often progresses rapidly and more virulently than does Wind Cold. Symptoms are similar to those of Wind Cold, except that feverish sensations predominate over chills. Sudden onset of symptoms may include sore, swollen throat and tonsils, stuffy or runny nose with yellow mucus, headache and body ache, slight sweating, and increased thirst. The pulse will have a rapid quality, and felt most in the superficial level, the tongue dry and reddish, especially at the tip, with a thin, yellowish coat.

As with Wind Cold, early treatment is critical to the success of releasing this exterior pathogen before it invades the respiratory system more deeply, or turns into a stronger pathogen, such as Toxic Heat, or Phlegm Heat. It is often most effective to prescribe frequent, generous dosages.

Herbal treatment releases the pathogen from the surface of the body by the use of pungent and cooling herbs. It is also important to discontinue any tonifying, constitutional formulas the patient may be on during treatment for Wind Heat, to avoid actually strengthening the pathogenic action itself.

The TCM term wind stroke corresponds to four possible Western medical conditions: cerebral hemorrhage, cerebral thrombosis, cerebral embolism, and spasm of a cerebral vessel, all of which come under the general term cerebral vascular accident (CVA). Stroke often involves a sudden loss of consciousness, temporary or permanent neurological impairment, or apoplexy, and possible impairment or loss of speech, or aphasia.

As in the Western medical view, TCM considers contributing factors to this disease process to be detrimental lifestyle habits whose effect builds over many years. These include overwork, especially under stressful conditions and with insufficient rest, or heavy physical labor, excessive sexual activity, and improper diet. Prevention of the disease process is by far more effective than treating the symptoms that may follow a CVA.

In TCM, the major imbalances for the formation of wind stroke lie with the Kidney and Liver organ systems. Liver and Kidney Yin, Essence and Marrow depletion enables Liver Yang to stir and ascend to the head, precipitating the formation of Internal Wind. Depleted Marrow fails to nourish the Blood, as well, leading to Blood stasis. An irregular or excessively fatty and sweet diet weakens the Spleen, leading to the production of Phlegm. Over time, this may combine with Fire to form Phlegm Fire. Overwork, even excess exercise, weakens the Spleen, muscles and channels. Either preexisting Internal Wind penetrates the depleted channels, or External Wind interacts with the Internal Wind, leading to paralysis. Following the initial attack, increased Yin vacuity with combinations of Phlegm, Heat and Blood stasis may accumulate, causing progressive damage.

Chinese herbal treatments can be extremely helpful preventively, or to counteract the various stages that may present themselves in the sequelae of wind stroke. Maintenance of Liver and Kidney Yin is a critical strategy for prevention of CVA. It is important to address the early signs of Ascendant Liver Yang, and Internal Liver Wind, as well as Internal Phlegm.

The theory of Yin and Yang is one of the pivotal philosophies of Chinese Medicine. It recognizes the pairing of mutually complementary and opposing principles inherent in all natural phenomena, including the human body. In a healthy individual, there is a constantly transforming, but balanced ratio of Yin to Yang. As either increases or weakens, illness ensues. Generally, illnesses are more Yang if they are acute, rapidly changing, and associated with heat whereas chronic diseases with gradually changing symptoms, feelings of cold, and weakness characterize Yin illnesses.

The qualities of Yang are active, expanding, moving and should be in a balanced relationship with Yin. In the human body, it includes functional activities such as warming, circulating, and moving of the individual. Without Yang energy, Yin fluids such as Blood and lymph cannot circulate, muscles cannot move, and symptoms with cold sensations, lethargy, and impotence can appear. When Yang is in excess, heat symptoms such as migraines, hypertension, and irritability can occur.

Qi and Yang are intrinsically interrelated, in that Qi is a part of Yang. Therefore, symptoms of Yang vacuity include those of Qi vacuity, such as fatigue, low appetite, and a pale face, as well as those indicating the lack of the warming, protecting qualities of Yang. These include chilliness, cold limbs, and little thirst with a desire primarily for hot drinks. In terms of elimination, the stools are loose, and urine is frequent and pale, both indicative of in sufficient Yang Qi in the metabolism of nutrients. The Organs most inclined to Yang vacuity are the Spleen, Kidney, Lung, Heart and Stomach, each featuring issues unique to that organ system.

The qualities of Yin are cooling, fluid, nourishing, material, and should be in a balanced relationship with Yang. In the human body, Yin includes the material substances such as tissue, blood, and fluids from which the body is built. Without the material foundation of Yin, Yang's moving and warming energy goes unrestrained leading to symptoms of dryness and heat. When Yin is in excess, symptoms of water retention and phlegm appear.

Yin vacuity is a vacuity of the cooling, moistening properties of Yin with symptoms of Dryness and Heat. Dryness can manifest in the hair, eyes, mouth, skin, and lack of sexual fluids. For instance, as the Liver rules the eyes, visual problems such as dry eyes point to a Yin vacuity in the Liver. A chronic dry cough with little or no phlegm indicates Lung Yin vacuity. Moreover, as the Lung rules the skin, chronic dry skin may be due to deficient Lung Yin. The warming energy of Yang, if not kept in check by Yin fluids, can arise out of control causing mild Heat symptoms such as malar flush, afternoon fever, thirst, or night sweats.