Chinese Medicine : Differientation according to Zang-Fu Organs

Differentiating Syndromes According to Zang-Fu Organs

This is an important component of the differentiation of syndromes in traditional Chinese medicine. Differentiating diseases according to the theory of zang-fu organs involves analyzing and identifying the disease condition by collecting clinical data from the four diagnostic methods. Other methods of differentiating syndromes also finally use the theory of zang-fu organs, and clinically this method is closely related to other methods of differentiation according to the eight principles, etiology of qi and blood, etc. Following is a brief description of the main syndromes of each of the zang-fu organs:

1. Differentiating Syndromes of the Heart

Syndromes of heart qi zu and heart yang xu: Palpitation and shortness of breath aggravated by exertion, spontaneous sweating, thready and weak pulse, and regular pulse or irregular intermittent pulse, are the basic symptoms of heart qi deficiency (xu) and heat yang deficiency (xu). If the above symptoms are accompanied with a pale and lusterless complexion, lassitude and a pale tongue proper with whitish coating, they are in the category of heart qi deficiency. If they are complicated with chills, cold extremities, fullness of the chest, pallor, and a pale or dark purplish tongue proper, they are considered as syndromes of the heart yang deficiency.

If heart qi or heart yang is insufficient, then the blood circulation is not promoted and shortness of breath aggravated by exertion will manifest. If heart yang is inadequate to restrict heart fluid, there will be spontaneous sweating. Qi deficiency leads to blood deficiency and weakness of yang qi, so disorders of blood circulation will manifest by thready, weak, irregular or regular intermittent pulses. Heart qi deficiency, or the failure of yang qi and blood to nourish the tongue, face and body, causes a pale and lusterless complexion, pale tongue proper, and lassitude. Heart yang deficiency fails to warm the limbs, which causes chills and cold extremities. Failure of yang qi in the chest causes the improper circulation of qi and blood, manifesting a fullness in the chest and a dark purplish tongue proper.

Syndromes of heart blood deficiency and heart yin deficiency: Palpitation, insomnia, dream disturbed sleep and poor memory. If these symptoms are accompanied with a lusterless complexion, dizziness, pale tongue and lips, and a thready pulse, then these are heart blood deficiency syndromes. If the symptoms are complicated with irritability, thirst, feverish sensation of the palms and soles, tidal fever, night sweating, dry red tongue proper, and a thready rapid pulse, then these are heart yin deficiency syndromes.

The heart dominates the blood and its vessels, so heart blood deficiency and heart yin deficiency both cause malnourishment of the head region, manifesting as malnourishment of the mind, producing symptoms of palpitation, poor memory, insomnia, and dreamed disturbed sleep; malnourishment of the facial region, producing symptoms of lusterless complexion, pale tongue and lips; malnourishment of the brain, manifesting as dizziness and a thready weak pulse. Heart yin insufficiency also leads to heart yang preponderance and internal xu fire disturbances which cause irritability, feverish sensation of the palms, dry red tongue proper with scanty fluid, and thready rapid pulse.

Syndromes of heart fire preponderance: Ulcers of the tongue and mouth, anxiety, insomnia, thirst, yellowish urine, a red tongue tip, and rapid pulse.

The heart opens to the tongue. If there is a preponderance of heart fire, it flares up to attack the tongue causing ulceration. If heart fire causes internal disturbances, it first affects the mind, causing irritability and insomnia. A preponderance of hear fire consumes the body fluids, causing thirst, red tongue tip, and rapid pulse.

Stagnation of heart blood syndromes: Palpitation, paroxysmal pricking pain, or stuffy pain of the precardiac region referring to the shoulder and arm of the left side, cyanosis of the lips and nails, cold extremities, spontaneous sweating, dark red tongue proper, or purplish tongue proper with petechiae, thready rugged pulse, or regular and irregular intermittent pulse.

Obstruction of heart yang leads to unsmooth circulation of qi and blood, and the stagnation of blood in the vessels, causing palpitation and cardiac pain. The small intestine channel of the hand Taiyang is exterior and interior related to the hear channel, so the qi of the two channels affect each other, that is why cardiac pain is related to the shoulder and arm. The stagnation of heart blood may also bring on cyanosis of the lips and nails, dark red tongue proper, or purplish tongue proper with petechiae, thready rugged pulse, or regular and irregular intermittent pulse. Heart blood stagnation blocks the yang qi from spreading over the body surface and the four extremities, so cold extremities and spontaneous sweating result.

Phlegm fire heart-disturbing syndrome: Mental disorder, weeping and laughing without apparent reason (emotional liability), mania, redness of face, thirst, coarse breath, yellowish urine, yellow and sticky tongue coating, slippery, rapid, and forceful pulse.

Phlegm-fire disturbs the heart mind and exhausts the body fluid, so the above symptoms and pulses appear.

2. Differentiating Syndromes of the Liver

Syndromes of liver blood insufficiency: Dizziness and vertigo, distending pain, redness of the eyes and face, anxiety and hot temper, dryness of the eyes, blurred vision, night blindness, numbness of the limbs, spasm of the tendons and muscles, scanty menstrual flow or amenorrhea, pale tongue proper, and thready pulse

Insufficiency of liver blood brings about malnutrition of the head and eyes, and manifests as dizziness, dryness of the eyes, and blurred vision. Consumption of liver blood causes malnourishment of the tendons, manifested by numbness of the limbs, and spasms of the tendons and muscles. The chong channel's "sea of blood" dries up due to an insufficiency of liver blood, so scanty menstrual flow or amenorrhea appears. Blood insufficiency also causes a pale tongue proper and a thready pulse.

Liver fire flare up syndromes: Dizziness, distending pain redness of the eyes and flushed face, irritability and irascibility, dryness and bitter taste in the mouth, deafness, ringing in the ears, burning pain of the costal and hypochondriac regions, yellowish urine, constipation or vomiting blood (hematemesis), and nose bleeds (epistaxis), red tongue proper with yellow coating, wiry and rapid pulse.

Liver fire flares up to attack the head and eyes causing dizziness, distending pain, redness of the eyes and flushed face, bitter taste and dryness in the mouth, deafness and ringing in the ears. Fire injures the liver causing a dysfunction of the qi flow and since the liver is related to emotional activities, depression and anger can result. As the liver channel passes through the costal and hypochondriac regions, it causes pain in these areas.

Liver fire exhausts the blood and injures the vessels, so hematemesis and epistaxis occur. Yellowish urine, constipation, yellow tongue coating, and a rapid pulse are also signs of excessive liver fire.

Liver qi stagnation syndromes: Fullness of the chest, mental depression, sighing, distending pain of the chest and hypochondrium, irascibility, anorexia, belching, abnormal bowel movements, irregular menstruation, dysmenorrhea, premenstrual distending pain of the breasts, thin and white tongue coating, and wiry pulse.

Stagnation of liver qi leads to the dysfunction of the liver causing an unrestrained flow of qi, so symptoms such as mental depression, fullness of the chest, irascibility, and sighing appear. Liver qi can also flow transversely to attack the stomach and spleen, causing disorders of the ascending and descending stomach and spleen qi. Symptoms of belching, anorexia, and abnormal bowel movements result. The liver stores blood, so liver qi stagnation will certainly affect menstruation causing irregularity, dysmenorrhea, or pre-menstrual distending pain of the breasts. A wiry pulse is also caused by liver qi stagnation.

Liver wind stirring syndromes: There are three conditions commonly seen in the clinic. a) Extreme heat stirring up endogenous wind, manifesting as high fever, convulsion, neck rigidity, contracture of the four limbs, opisthotonos, red tongue proper and a wiry rapid pulse. b) Yin deficiency leading to yang preponderance, this extreme yang then turns into wind and manifests as sudden temporary loss of consciousness (syncope), convulsion, deviated mouth and eyes, tongue rigidity, hemiplegia, wiry, slippery, and forceful pulse. c) Insufficiency of liver blood causes the malnutrition of tendons and muscles, and produces wind, manifesting as numbness of the limbs, tremor of muscles or spasms of the extremities, tremor of the hands, pal tongue proper, a wiry and thready pulse, etc.

The first condition is a group of shi syndromes caused by extreme heat producing wind, the wind and fire then stir each other. The second condition originates from a loss of liver and kidney yin which leads to liver yang preponderance and an upward flow of qi and blood. The root of this disease is therefore xu, but symptomatically the syndromes appear as shi type. The third condition is also a xu condition due to insufficiency of blood which leads to malnutrition of the tendons and muscles.

Stagnation of cold in the liver channel syndromes: Distending pain of the lower abdomen, swelling and distension of the testis with a bearing down pain, pain and contracture of the scrotum referring to the lower abdomen, a white slippery tongue, and a wiry slow pulse.

The liver channel curves around the external genitalia and passes through the lower abdominal region. Pathogenic cold is characterized by contraction and stagnation when it inhabits the liver channel. This results in the stagnation of qi and blood and causes the above symptoms.

3. Differentiating Syndromes of the Spleen

Spleen failure to carry out transportation and transformation syndromes: Anorexia, abdominal distension after meals, lassitude, sallow complexion, feeble breathing, loose stool, pale tongue proper with white thing coating, retarded and weak pulse.

Spleen xu causes a failure of transportation and transformation, and insufficiency of qi and blood, so the above symptoms appear.

Sinking of spleen qi syndromes: Prolapse of the uterus, gastroptosis, nephroptosis, chronic diarrhea, feeble breathing, yellowish complexion, pale tongue proper with white coating, and xu type pulse.

Spleen qi should ascend, however, spleen xu causes the qi to sink. If the spleen qi is too weak to elevate the zang-fu organs, then the prolapse of internal organs and symptoms showing spleen qi insufficiency occur.

Spleen blood control failure syndromes: Excessive menstruation, uterine bleeding, hemotochezia, bloody urine, purpura, pale complexion, lassitude, pale tongue proper, and a thready weak pulse.

The spleen control blood. If it is unable to carry out this function, then the extravasation of blood occurs, plus the bleeding symptoms mentioned above. Bleeding affects the function of transportation of qi and blood, resulting in a pale complexion, lassitude, a pale tongue proper, and a thready weak pulse, which are signs of qi and blood xu (deficiency).

Pathogenic damp invasion of the spleen syndromes: Distension and fullness of the epigastrium and abdomen, anorexia, stickiness in the mouth, heaviness of the head, absence of thirst, swelling of the face, eyes, and four extremities, loose stool, dysuria, excessive and this leukorrhea, white and sticky tongue coating, and soft thready pulse.

The spleen is adverse to dampness, therefore excessive dampness is liable to affect spleen yang leading to a dysfunction of transportation and transformation, resulting in the symptoms of distension and fullness of the epigastrium and abdomen, and anorexia. Pathogenic damp, which is sticky and stagnant in nature, easily blocks the flow of yang qi, causing a sensation of heaviness of the head. If dampness and fluid pour into the skin and muscles, swelling of the face, eyes, and extremities occurs. If the spleen fails to remove the damp, the stool becomes loose and the urine abnormal. A white and sticky tongue coating and a soft thready pulse are signs of excessive pathogenic damp.

Spleen yang xu syndromes: Dull pain of the epigastrium and abdomen ameliorated by warmth, chills with cold extremities, poor appetite, loose stool, pale tongue proper with white coating, and deep, slow pulse.

Spleen yang deficiency causes the stagnation of cold in the middle jiao, obstructing the functions of qi. Warmth can remove the obstruction, so the pain of the epigastrium and abdomen is ameliorated. Deficiency of spleen yang leads to a dysfunction of transportation and transformation, thus the failure of spleen yang to warm the body surface and extremities, and the occurrence of anorenxia, and loose stool. A pale tongue proper with a white coating and a deep slow pulse are signs of xu cold.

Spleen and stomach damp heat syndromes: Yellow-orange complexion, distension and fullness of the epigastrium and abdomen, nausea, vomiting, poor appetite, aversion to greasy food, heaviness of the body, yellowish urine, loose stool profuse and yellowish leukorrhea, yellowish and sticky tongue coating, soft and rapid pulse.

Damp heat accumulates in the skin causing a yellow-orange complexion. It also blocks the middle jiao causing symptoms of distension and fullness of the epigastrium and abdomen, nausea, vomiting, anorexia, and version to greasy food. Excessive damp causes heaviness and tiredness of the body. Damp heat descending leads to profuse yellowish leukorrhea. Deep yellow urine, loose stool, yellowish and sticky tongue coating, and soft pulse are signs of excessive damp heat.

4. Differentiating Lun Syndromes

Qi Deficient of the Lung: Feeble coughing, shortness of breath, clear and thin sputum, feeble breathing, speaking in a low voice, spontaneous sweating, pale and lusterless complexion, lassitude, pale tongue proper with thin white coating, xu and forceless pulse.

The lung dominates qi and controls respiration, so qi deficiency causes a weak cough, shortness of breath, and feeble breathing. Qi deficiency of the lung also leads to a failure of lung qi descent causing an accumulation of body fluid with resulting phlegm. There are also symptoms of cough with thing sputum, spontaneous sweating, pale and lusterless complexion, lassitude, pale tongue proper with white and this tongue coating, and xu type pulse.

Yin deficiency of the lung: Dry cough without sputum or with a little sticky sputum, dryness of the mouth and throat, hoarseness of voice, emaciation, dry red tongue proper, thready and forceless pulse. If yin deficiency leads to a preponderance of fire, there may be cough with bloody sputum, tidal fever, night sweating, malar flush, red tongue proper, and a thready rapid pulse.

The symptoms of lung yin deficiency are actually the manifestations of an insufficiency of lung yin fluid, i.e., dry cough without sputum, or cough with a little stick sputum, dryness of the mouth and throat, hoarseness of voice, emaciation, dry red tongue proper, thready and forceless pulse. If yin xu fails to restrict yang, then xu fire is formed and flares up to the damage the vessels of the lung, producing the symptoms of tidal fever, night sweating, malar flush, hematesis, red tongue proper, thready rapid pulse.

Lung wind-cold retention syndromes: Cough, asthma, thin white sputum, absence of thirst, nasal obstruction, runny nose, chills and fever, no sweating, pain of the head and body, thin white tongue coating, superficial and tense pulse.

Exogenous pathogenic wind-cold obstructing the lung leads to the dysfunction of lung qi spreading and descending, causing symptoms of cough with thin white sputum. The lung opens into the nose, which is then also troubled by nasal obstruction or discharge. The lung dominates the skin and hair, when exogenous pathogenic wind and cold invade the lung leading to the dysfunction of defensive (wei) qi, the symptoms are an aversion to cold, fever, pain of the head and body, absence of sweat, thin white tongue coating.

Lung win-heat invasion syndromes: Cough with yellowish and thick sputum, thirst, sore throat headache, fever, aversion to wind, yellowish and thin tongue coating, floating and rapid pulse.

The lung is attacked by exogenous pathogenic wind-heat, so the spreading and descending functions are affected, causing cough with a yellowish and thick sputum. Pathogenic heat consumes the body fluid, causing thirst. Wind and heat flow upward to cause a sore throat. Headache, fever, aversion to wind, yellowish and thin tongue coating, floating and rapid pulse are signs indicating wind-heat invasion of the defensive (wei) qi of the body surface.

Lung phlegm damp obstruction syndromes: Cough with excessive and white sticky sputum, expectoration, stuffiness of the chest, asthma, white sticky tongue coating, slippery pulse.

Pathogenic phlegm damp obstructing the lung leads to the impairment of qi circulation causing the above symptoms. White sticky tongue coating and slippery pulse are signs of pathogenic phlegm damp.

A long-standing obstruction of phlegm damp in the lung will change into heat, blocking qi circulation and manifesting as asthmatic cough, stuffiness of the chest, etc. In addition, other symptoms may occur, such as cough with yellowish, sticky and thick sputum, or cough with bloody and pussy sputum. Fever, thirst, yellowish urine, constipation, red tongue proper with yellow sticky coating, and slippery pulse, are signs of heat syndromes.

5. Differentiating Syndromes of the Kidney

Kidney yang deficiency syndromes: Chilliness, cold extremities, aching and weakness of the lumbar region and knee joints, impotence, praecox ejaculation, excessive and thin leukorrhea, infertility, profuse and clear urine or enuresis, pale tongue proper with white coating, keep, slow and forceless pulse.

The kidney stores essence which is the original source of reproduction, therefore kidney yang deficiency will influent the genital system and sexual activities. Symptoms seen in men are impotence and praecox ejaculation, and in women excessive and clear leukorrhea, and infertility. The kidney dominates the bones and is the site of primary yang qi convergence. Insufficient yang qi of the kidney fails to warm and nourish the body and extremities, causing chilliness, aching and weakness of the lumbar region and knee joints. The kidney dominates water metabolism, so kidney yang deficiency causes a dysfunction of urinary bladder restriction, manifesting enuresis or profuse and clear urine. A pale tongue proper with white coating and a deep, slow and forceless pulse are signs of yang deficiency.

Kidney yin deficiency syndromes: Dizziness, vertigo, ringing in the ears, deafness, hair loose, loosening teeth, soreness and weakness of the lumbar region and knee joints, insomnia, poor memory, dryness of the throat, night sweating, feverish sensation of palms and soles, low fever, malar flush, red tongue proper, thready, rapid pulse, etc.

Yin deficiency produces internal heat, so symptoms such as low fever, malar flush, feverish sensation of the palms and soles, and night sweating occur. Yin deficiency also leads to insufficiency of body fluid manifested by dryness of the throat. Consumption of kidney yin causes soreness and weakness of the lumbar region and knee joints, hair loss and loosening teeth. Yin deficiency also causes the kidney to fail in its function of producing marrow, and with it filling out the brain. Manifestations are dizziness, vertigo, poor memory and insomnia. Yin deficiency is unable to nourish the upper orifices, and is manifested by ringing in the ears and deafness. Red tongue proper, and thready and rapid pulse are also signs of yin deficiency.

Kidney qi deficiency syndromes: Shortness and weakness of breath, asthmatic breathing aggravated by exertion, perspiration, cold extremities, swelling of the face, pale tongue proper, xu type pulse, etc.

The kidney dominates the reception of qi, so its weakness causes the qi to lose its function of controlling reception. The symptoms of shortness and weakness of breathing result. Asthmatic breathing aggravated by exertion is due to the consumption of qi. The xu condition of the kidney brings on yang deficiency leading to the weakness of wei (defensive) qi, so symptoms of perspiration appear. Cold extremities are due to yang qi failing to reach and warm the four extremities. yang deficiency also has difficulty in promoting qi circulation and water metabolism, so there is swelling of the face. Pale tongue proper and xu pulse are also signs of kidney qi deficiency.

Kidney xu leading to excessive water: General edema with greater severity in the lower extremities, abdominal distention, scanty urine, short breathing, cough and asthma with sputum gurgling in the throat, palpitations, asthma aggravated by exertion, chilliness and cold extremities, flabby tongue body with white coating and deep thready pulse.

The declining of kidney yang causes a dysfunction of the urinary bladder qi activity, manifesting as scanty urination. General edema is due to the water and fluid overflowing into the skin and muscles. Retention of water and fluid in the abdominal cavity gives rise to local distension. Excess water and fluid converts into phlegm, manifesting as cough and asthma with sputum gurgling in the throat. If water and fluid overflow upward they attack the heart and lung causing symptoms of palpitation and shortness of breath. yang deficiency fails to warm and nourish the extremities, so it causes chilliness and cold extremities. Flabby tongue body, white tongue coating, deep and thready pulse are signs of yang deficiency causing an overflow of water and fluid.

Unconsolidated kidney qi syndromes: Frequent and clear urination, incontinence, dribbling of urine, nocturnal enuresis, involuntary seminal discharge without dreams, praecox ejaculation, soreness and weakness of the lumbar region, wan complexion, pale tongue proper with white coating, thready and weak pulse.

The kidney stores essence, if kidney xu fails to consolidate the source of semen involuntary seminal discharge and praecox ejaculation occur. Kidney xu causes the dysfunction of urinary bladder restriction seen in the symptoms of frequent and clear urination, dribbling of urine, incontinence, and nocturnal enuresis. The waist is the house of the kidneys, deficiency causes soreness and weakness of the lumbar region. Wan complexion, pale tongue proper with white coating, and thready weak pulse are signs of yang xu in the kidney.

Syndromes a,c,d, and e are based on the insufficiency of kidney yang. However, each has its own emphasis on pathological changes and clinical manifestations. The non-consolidation of kidney qi mainly indicates syndromes of yang xu of the kidney which causes uncontrollable seminal emissions and the dysfunction of the urinary bladder restriction. Kidney yang xu also leads to an inability to receive qi from the lung. Kidney xu, resulting in the overflow and subsequent retention of water, derives from dysfunction syndromes of the kidney, which normally controls water metabolism and qi activity. The declining of kidney yang also shows the syndromes of hyperactive sexual function.

6. Differentiating Syndromes of the Small Intestine

Syndromes of shi heat in the small intestines: Scanty yellowish urine; burning pain of the urethra, or hematuria; ulceration and pain of the mouth and tongue; a feverish sensation with irritability in the chest.

The heart has an exterior and interior relationship to the small intestine, so a preponderance of heart fire will transmit to the small intestine resulting in shi heat syndromes of the small intestine.

7. Differentiating Syndromes of the Large Intestine

Large intestine damp-heat syndromes: Abdominal pain, dysentery or stool containing blood and pus, tenesmus, burning sensations of the anus, scanty and yellowish urine, yellow and sticky tongue coating, wiry, slippery and rapid pulse.

The retention of damp-heat in the large intestine causes a dysfunction of qi activity with resulting abdominal pain and tenesmus. Damp-heat injures the qi and blood of the intestinal tract, so dysentery, or bloody and purulent stool occur. Burning sensation of the anus is a characteristic manifestation of "downward pouring of damp-heat into the large intestine." Scanty yellowish urine, yellow sticky tongue coating, and wiry, slippery, and rapid pulse are signs of internal retention of damp-heat.

Large intestine fluid exhaustion: Constipation, difficult defecation of dry stools, dryness of the mouth and throat, red tongue proper with a yellow dry coating and a thready or rough pulse are all signs of fluid consumption.

8. Differentiating Syndromes of the Urinary Bladder

Syndromes damp of heat in the urinary bladder: Frequency, urgency and pain of urination; dribbling urination; turbid urine of bloody and purulent urine; urine with stones; a yellow sticky tongue coating; and rapid pulse.

The accumulation of damp-heat in the urinary bladder blocks qi activity, causing dribbling urination. A downward driving of damp-heat into the urinary bladder brings about frequent, urgent and painful urination. Bloody or purulent urine is due to the injury of blood vessels by damp-heat.

9. Differentiating Syndromes of the Stomach

Loss and deficiency of stomach yin: Dryness of the mouth and throat, stomach-ache and hunger without desire to eat, dry stool, red tongue proper with scanty fluid, thready and rapid pulse.

Insufficiency of stomach yin makes the body fluid fail to support the upper organs, causing dryness of the mouth and throat. Insufficiency of stomach fluid leads to the dysfunction of stomach reception manifested by hunger without desire to eat. Deficiency of stomach yin also gives rise to the disturbances of xu fire, manifesting as stomach pain. Insufficiency of stomach yin causes dry stool. Red tongue proper with scanty fluid and a thready rapid pulse are signs of yin deficiency producing heat.

Preponderance of stomach fire: Burning pain of the epigastric region, vomiting, nausea, acid regurgitation, constipation, thirst with preference for cold drinks, swelling, pain, ulceration and bleeding of the gums, hunger with excessive eating, foul breath, red tongue proper with yellow coating, slippery and rapid pulse.

Accumulation of heat in the stomach leads to a dysfunction of qi activities resulting in a burning pain of the epigastrium. Preponderance of heat in the stomach consumes the yin of the stomach causing thirst with a preference for cold drinks. Since pathogenic fire accelerates food, there is hunger with excessive eating. Branches of the stomach channel travel up to the gum, therefore when pathogenic stomach heat flows upward, it causes welling, pain, ulceration and bleeding of the gums. An accumulation of stomach heat leading to a dysfunction of stomach qi descent causes foul breath, vomiting, nausea, and acid regurgitation. A red tongue proper with yellow coating and a slippery rapid pulse are signs of stomach heat.

Retention of Food in the Stomach
Distension or pain in the epigastrium, foul belching, acid regurgitation, no desire to eat, vomiting, abnormal bowel movements, diarrhea or constipation, thick sticky tongue coating, and slippery pulse.

Retention of blood in the stomach blocks the qi activities of the middle jiao, so there is distension or pain in the epigastrium. Foul belching, acid regurgitation, no desire to eat, and vomiting are caused by a dysfunction of stomach qi descent, which then causes the upward flow of turbid qi. Retention of food in the stomach affects the transportation and transformation functions of the spleen, producing abnormal bowel movements, i.e., diarrhea or constipation. A thick sticky tongue coating and a slippery pulse are signs of food retention.

10. Differentiating Gall Bladder Syndromes

Phlegm disturbing the gall bladder: Dizziness, vertigo, bitter taste in the mouth, nausea, vomiting, irritability, insomnia, fright, fullness of the chest, sighing, slippery and sticky tongue coating, wiry pulse.

The gall bladder channel travels up to the head and eyes, so dizziness and vertigo are caused by pathogenic phlegm disturbing the brain along the course of the gall bladder channel. Internal phlegm disturbances lead to a restlessness of gall bladder qi resulting in irritability, insomnia, and fright. Stagnation of gall bladder qi affects the free flow of qi, this causes fullness of the chest and sighing. Since bile streams upward, there is a bitter taste in the mouth. Qi stagnation of the gall bladder also disturbs the stomach qi's descent leading to nausea and vomiting. A sticky and slippery tongue coating and wiry pulse are signs of phlegm obstruction.