TCM Campus

All lessons   Module 1: Foundations   Lesson 6

Module 1   Lesson 6   Gan and Pi

Patterns 1 to 10: the Liver, the Spleen and what the Spleen leaves behind

Ten patterns, five pairs of neighbours: which finding decides each time?

After this lesson you know two keys for each pattern, plus the tongue, the pulse and the principle, and for each pair of neighbours you can name the finding that decides. Points and formulas are anchors for later. The features are simplified learning anchors, not validated criteria, and patterns overlap.

EMPTY FULL empty, cold empty mixed full full, hot Liver 肝 Wood Spleen 脾 Earth Dampness, Phlegm 湿 痰 4 Blood xu 3 Yang rising 1 Qi stagnation 2 Liver-Fire 5 Liver invading Spleen 7 Yang xu 6 Qi xu 8 with Damp 10 Damp-Phlegm 9 Damp-Heat gives Damp gives Phlegm gives Blood deficiency root
Schematic; xu is the Chinese for deficiency. Fill: blue deficiency, red excess, white with a dotted border a mixed picture; border: blue Cold, red Heat. Solid arrows, the fixed chains of this lesson: 1 leads to 5; 6 gives Dampness (8), Dampness gives Phlegm (10); 6 gives Blood deficiency (4); the root of 3 is Yin or Blood deficiency. Dotted, textbook transitions: stuck Qi turns warm (1 to 2), Qi deficiency becomes Yang deficiency (6 to 7).

Know by heart

  • 1 Liver-Qi stagnation. Distension that moves with the mood, sighing; tongue normal or red sides; pulse wiry; move Liver-Qi.
  • 2 Liver-Fire and 3 Liver-Yang rising. Fire: red eyes, bitter taste; tongue red with yellow coating; wiry-rapid; clear Liver-Fire. Yang rising: throbbing headache, tinnitus; tongue follows the root; wiry; subdue Yang and nourish the root. mnemonic: yellow coat and a fast pulse is Fire; a tongue that shows the empty root is Yang rising.
  • 4 Liver-Blood deficiency. Dry eyes and blurred vision, cramps and brittle nails, scanty periods; tongue pale and thin; pulse choppy or thin; nourish Liver-Blood.
  • 5 Liver invading the Spleen. Stress-related abdominal pain, alternating stools; pulse wiry on the left (Liver), weak on the right (Spleen); harmonise the Liver, tonify the Spleen.
  • 6 Spleen-Qi deficiency and 7 Spleen-Yang deficiency. Qi: tired and bloated after eating, loose stools; tongue pale with teeth marks; pulse empty; tonify Spleen-Qi. Yang: add cold and watery stools; tongue pale, wet, swollen; pulse deep, weak, slow; warm Spleen-Yang, moxa. mnemonic: 7 is 6 with no fire under the pot; the wet tongue gives it away.
  • 8 Spleen deficiency with Dampness and 10 Damp-Phlegm. Dampness: heaviness, sticky loose stools; tongue swollen with sticky white coating; pulse slippery or soggy; tonify the Spleen, resolve Dampness. Phlegm: muzzy head, chest oppression; thick sticky coating; pulse slippery; resolve Phlegm, tonify the Spleen. mnemonic: Damp sinks, Phlegm climbs; thin and white is 8, thick is 10.
  • 9 Damp-Heat. Foul-smelling and burning, thirst without desire to drink; tongue red with sticky yellow coating; pulse slippery-rapid; clear Heat, drain Dampness.

The rest of this lesson is reference.

Patterns 1 to 10: Ten patterns, five pairs of neighbours: which finding decides each time?
The chart as an image, to save or share

Three practice questions from this lesson

Case. Man, 35. Abdominal pain and a bloated abdomen when work is busy; stools sometimes loose, sometimes hard; a lot of wind; tired. Pulse taut on the left, weak on the right.
  1. 1 Liver-Qi stagnation
  2. 6 Spleen-Qi deficiency
  3. 5 Liver invading the Spleen

Answer: 5 Liver invading the Spleen. Symptoms linked to stress and Spleen signs (alternating stools, tired), with a pulse that says it: wiry left, weak right. Pure 1 has no Spleen signs, pure 6 no link with stress.

Case. Woman, 29. In the week before her period, tense breasts, irritable, sighs a lot; abdomen bloated with tension, stools normal, not tired. Tongue normal. Pulse wiry.
  1. 1 Liver-Qi stagnation
  2. 2 Liver-Fire
  3. 5 Liver invading the Spleen

Answer: 1 Liver-Qi stagnation. Distension that changes with emotions, PMS and sighing, without Heat and without Spleen signs: 1. No red eyes and no yellow coating: no Fire. Normal stools and not tired: the Spleen is not (yet) involved.

Case. Man, 50. Feels heavy, tired, slightly nauseous; sticky loose stools that stick to the bowl, with no smell, not burning. Tongue swollen with sticky white coating. Pulse slippery and soft.
  1. 7 Spleen-Yang deficiency
  2. 8 Spleen deficiency with Dampness
  3. 9 Damp-Heat

Answer: 8 Spleen deficiency with Dampness. Heaviness and stickiness on a Spleen deficiency, white coating and a soggy pulse. No Heat: not 9. No cold, no watery stools and no wet tongue: not 7.

The rest of this lesson

In the course you get the step-by-step explanation, 19 case-based practice questions, 37 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 1: Foundations.

Try three lessons freeSee the course