Metrorrhagia+(Flooding+&+Trickling)

=Flooding & Trickling (Metrostaxis & Metrorrhagia)=

Etiology & Pathogenesis
Blood Heat Excess Heat Deficient Heat Kidney Deficiency

Kidney Yin deficiency
Kidney Yang deficiency Spleen Deficiency Blood Stasis

Differential Diagnosis
Rule out early periods (preceded menstruation), irregular menstrual period, long periods, heavy periods (menorrhagia), and intermenstrual bleeding Rule out uterine bleeding caused by diseases associated with pregnancy such as threatened abortion and ectopic pregnancy Rule out abdominal masses (uterine fibroids, myoma)

Pattern Identification & Treatment
Differentiation of cold, heat, deficiency, excess Four treatment strategies for stopping bleeding

-Stopping Bleeding: Pu Huang, Xian He Cao, Di Yu, Qian Cao Gen, Ai Ye -Eliminate Blood Stasis: Pu Huang, San Qi, Qian Cao Gen, Chuan Xiong, Yi Mu Cao, Tao Ren, Hong Hua -Calm Blood: Bai Shao, Sheng Di Huang, Han Lian Cao, Mu Dan Pi -Nourish Blood: Dang Gui, Shu Di Huang, E Jiao
 * A. Harmonize Blood**

-Blood Heat: Shan Zhi Zi, Huang Qin, Huang Lian -Blood Deficient Heat: Qing Hao, Han Lian Cao -Qi Deficiency: Huang Qi, Dang Shen, Dang Gui Bu Xue Tang -Kidney Deficiency: Xu Duan, Du Zhong for KI Yang xu; Nu Zhen ZI, Han Lian Cao for KI Yin xu -Blood Stasis: Pu Huang, San Qi, Qiao Cao Gen, Yi Mu Cao, Hong Hua, Tao Ren Yang deficiency & Cold: Ai Ye
 * B. Treat the Root Cause**

-Shan Zhu Yu, Bai Shao Yao, DI Yu, Long Gu, Mu Li
 * C. Astringe**

-Tonify and consolidate qi: Huang Qi, Ren Shen, Fu Zi, Mu Li, Zhi Gan Cao -Raise Qi: Sheng Ma, Chai Hu, Xu Duan
 * D. Treat Qi**

-Shore up the flow -Settle the source -Restore the old
 * 3 Steps to Treatment**

stop bleeding points: Xi-Cleft points, Sp-1, LR-1, GV-20

Blood Heat of Deficiency Type
Irregular uterine bleeding with dribbling of blood from the uterus or sudden massive hemorrhage which is bright red and thick in quality Vexation, tidal fever, insomnia, or dark and scanty urine, dry stools [Sheng Di Huang, Shu Di Huang, Bai Shao, Huang Qin, Huang Bai, Xu Duan, Shan Yao, Gan Cao]
 * Tongue:** Red tongue; thin yellow coat
 * Pulse:** Fine, rapid
 * Treatment Principles:** Nourish Yin, clear heat, stop bleeding and regulate periods
 * Acupuncture Treatment: SP-1, SP-6, SP-8, SP-10, KI-2**, LR-1, KI-5, KI-10
 * Herbal Treatment:** Bao Yin Jian (Protect Yin Decoction)

Blood Heat of Excess Type
Sudden massive uterine bleeding or persistent dribbling of blood from the uterus, dark red, or bright red, viscous, or with clots Thirst, restlessness, red face, fever, or lower abdominal pain, scanty and dark urine, dry stools [Huang Qin (10g.), Zhi Zi (8g.), Di Gu Pi (10g.), Sheng Di Huang (10g.), Sheng Di Yu (10g.), Sheng Ou Jie (10g.), Zong Lu Tang (10g.), Zhi Gui Ban (10g.), Duan Mu Li (10g.), Sheng Gan Cao (6g.), E Jiao (8g.)]
 * Tongue:** Red tongue; yellow or yellow greasy coat
 * Pulse:** Full, rapid
 * Treatment Principles:** Clear heat, cool blood, stop bleeding, regulate periods
 * Acupuncture Treatment: SP-1, SP-6, SP-8, SP-10, CV-6, LI-11**, KI-5, LR-1
 * Herbal Treatment:** Qing Re Gu Jing Tang (Clear Heat, Astringe Menses Decoction)

Kidney Yang Deficiency
Irregular uterine bleeding, suddenly with massive loss of blood or persistent dribbling of blood from the uterus Aversion to cold, cold limbs, dark complexion, severe soreness of loins as if broken, clear & profuse urine [Shan Yao (15g.), Shan Zhu Yu (12g.), Shu Di Huang (10g.), Du Zhong (10g.), Lu Jiao Jiao (10g.), Fu Zi (6g.), Tu Si Zi (15g.), Gui Zhi (10g.), Gou Qi Zi (12g.), Dang Gui (10g.)]
 * Tongue:** Pale tongue; thin, white coat
 * Pulse:** deep, fine
 * Treatment Principles:** Warm kidney, sonsolidate Chong, stop bleeding, regulate periods
 * Acupuncture Treatment:** **SP-1, SP-6,** **CV-4,** **GV-4, BL-23**, KI-8, KI-7, CV-6
 * Herbal Treatment:** You Gui Wan

Kidney Yin Deficiency
Irregular menstrual period with massive hemorrhage or persistent dribbling of blood from the uterus, bright red color, a little bit thick, Dizziness, tinnitus, soreness & weakness of the loins and knees, 5-palm heat, vexation [Shan Yao (15g.), Shan Zhu Yu (12g.), Shu Di Huang (10g.), Du Zhong (10g.), Lu Jiao Jiao (10g.), Gui Ban Jiao (10g.), Tu Si Zi (15g.), Niu Xi (10g.), Gou Qi Zi (12g.)]
 * Tongue:** Red tongue; little coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Nourish water, supplement Yin, stop bleeding, regulate periods
 * Acupuncture Treatment: SP-1, SP-6, KI-2, CV-4, BL-23**, KI-8, CV-6, KI-10
 * Herbal Treatment:** Zuo Gui Wan & Er Zhi Wan

Spleen Deficiency
Massive uterine bleeding out of the menstrual period, or persistent dribbling of blood from the uterus, light color, no clots Pale & puffy face, edema of face and limbs, palpitations, shortness of breath that is worse with exertion, listlessness, lassitude, cold limbs, poor appetite, loose stools [Ren Shen (10g.), Huang Qi (10g.), Chao Bai Zhi (12g.), Shu Di Huang (10g.), Pao Jiang (8g.), Dang Gui (10g.)]
 * Tongue:** pale puffy tongue; thin, white coat
 * Pulse:** deep, weak
 * Treatment Principles:** Supplement Qi, hold blood, nourish blood, regulate periods
 * Acupuncture Treatment: SP-1, SP-6, CV-6, ST-36, BL-20**, GV-20, BL-43, CV-12
 * Herbal Treatment:** Gu Ben Zhi Beng Tang (Stabilize the Root and Stop Excessive Uterine Bleeding Decoction)

Blood Stasis
Persistent dribbling of blood from the uterus or recurrent uterine bleeding, or sudden massive hemorrhage followed by persistent dribbling of blood from the uterus, dark purplish color mixed w/ blood clots Pain in the lwer abdomen which is relieved after the clots are discharged
 * Tongue:** dark red or purplish tongue; ecchymosis in the margin
 * Pulse:** deep, choppy
 * Treatment Principles:** Invigorate blood, eliminate blood stasis, stop bleeding, regulate periods
 * Acupuncture Treatment: SP-1, SP-6, SP-8, SP-10, CV-4**, CV-6, ST-30, SP-12
 * Herbal Treatment:** Si Wu Tang & Shi Xiao San; Can consider Tao Hong Si Wu Tang

=Dysfunctional Uterine Bleeding=

Formula 1
Shu Di Huang (12g.), Shan Yao (12g.), Huang Jing (9g.), Yin Yang Huo (12g.), Bai Ji Tian (12g.), Shan Zhu Yu (9g.), Bu Gu Zhi (12g.) Modifications: Internal heat: + Zhi Mu (12g.), Hua g Bai (12g.), Huang Qin (12g.) Qi deficiency: + Dang Shen (12g.), Bai Zhu (9g.), Pao Jiang (3g.) Yang deficiency: + Fu Zi (9g.), Rou Gui (3g.), Lu Jiao Jiao (3g.)

Formula 2
Dang Shen (12g.), Bai Zhu (9g.), Shu Di Huang (12g.), E Jiao (9g.), Bai Shao (12g.), Xian He Cao (15g.), Yin Yang Huo (12g.), Ce Bai Ye (12g.), Di Yu (12g.), Qiao Cao Gen (12g.), Hai Piao Xiao (12g.), Huai Hua Mi (12g.)

Acupuncture
It is appropriate to induce ovulation in young patients: SP-6, CV-4, CV-3, Zi Gong



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 * IBIS:**

Definition:
Uterine bleeding, usually of normal or slight amount, occurring at completely irregular or regular intervals outside of the normal menstrual flow.

Etiology:
There are many causes for metrorrhagia: endometrial cancer; endometrial polyps; atrophic endometritis; exogenous estrogen therapy; uterine fibroids; foreign bodies (such as IUDs); cancer of the fallopian tubes; ovarian cancer; ovarian cysts; blood coagulation disorders (with vaginal and other area bleeding); spontaneous abortion; cervical polyps; endometriosis; adenomyosis; and adenomyomas.

Nutrition:
eating principles:

• vegan diet

therapeutic foods: » Spleen unable to hold Xue (Blood):

• foods that tonify Yang, Spleen/Stomach and ascending foods • foods rich in Vitamin A, C, K and E, and Iron specific remedies:

• irregular menstruation: boil 3 oz. raw brown sugar, 3 oz. dried dates and 1/2 oz. ginger in l pt. of water until reduced to half. Drink per day (Butt and Bloomfield, p. 148)

Botanicals
• ** Alchemilla vulgaris  **: anti-hemorrhagic, especially when used prophylactically; use in a menstrual balancing formula (Heron) • ** Chamaelirium luteum  **(Helonias): irregular menstrual cycles (Heron) • ** Vitex agnus castus  **: irregular menstrual cycles, normalizes hormones (Heron) hormonal balance
 * ensure adequate estrogens with estrogen precursor herbs, as insufficient or unbalanced hormones may cause breakthrough bleeding. Balance the menstrual cycle with phytoestrogens in the first half of the cycle and phytoprogesterones in the second half.

phytoestrogens
 * __phytoprogesterones__:

• ** Angelica sinensis  ** • **Dioscorea villosa** • ** Arctium lappa  ** • **Lithospermum officinalis** • ** Cimicifuga racemosa  ** • **Lithospermum ruderale** • ** Glycyrrhiza glabra  ** • **Smilax sarsaparilla** • ** Humulus lupulus  ** • **Tanacetum vulgare** • ** Medicago sativa  ** • **Vitex agnus castus** • ** Vitex agnus castus  ** alteratives
 * Use with liver-cleansing herbs to facilitate metabolism of hormones

(Stansbury) • ** Arctium lappa  **: general alterative • ** Berberis aquifolium  **: hepatic tonic •** Chelidonium majus  **      (toxic)       : general alterative • ** Rumex crispus  **: general alterative • ** Taraxacum officinale  **: general alterative Chinese Formulae •** Bupleurum and Tang Kuei F. (Xiao Yao San)  **(available as patent): Liver Invading Spleen with Xue Xu (Blood Deficiency): //headache, vertigo, bitter taste in mouth, dry mouth, fatigue, reduced appetite, wiry deficient pulse// (Hsu, 1980, p. 94; Yeung, p. 263; Dharmananda, 1986, p. 228; Bensky and Barolet, p. 147) • Bupleurum and Peony F. (Dan Zhi Xiao Yao San or Jia Wei Xiao Yao San): Long-standing Liver Qi Stagnation causing Heat and Xue (Blood) Heat: // headache, red eyes, dysmenorrhea with excessive flow, fidgety, thirst, tidal fever  // (Bensky and Barolet, p. 148; Yeung, p. 72; Hsu, p. 87) • ** Tang Kuei and Ginseng Eight C. (Ba Zhen Tang)  **: Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): //pallid complexion, palpitations, reduced appetite, easily fatigued extremities, pale tongue with white coat, continuous spotting from uterine bleeding// (Hsu, 1980, p. 248; Yeung, p. 33; Bensky and Barolet, p. 259) • Shao Fu Zhu Yu Tang: Xue Yu (Blood Stasis): // frequent menstruation (3-5 times per month) with dark or purple menstrual blood, usually with clots; or abnormal uterine bleeding accompanied by lower abdominal soreness and pain  // (Yeung, p. 195; Bensky and Barolet, p. 316) • ** Tang Kuei and Evodia C. (Wen Qing Tang):  **Chong Mo Cold and Xu (Deficiency): //mild persistent uterine bleeding, irregular menstruation, extended or continuous menstrual flow, bleeding between periods, infertility, dry lips and mouth// (Hsu, 1980, p. 588; Yeung, p. 242; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 324) • Gui Pi Wan (patent): Xue Xu (Blood Deficiency) (Zhu, p. 274) • ** Tang Kuei 18  **(patent): Xue Yu (Blood Stasis) with Xue Xu (Blood Deficiency): //spontaneous bleeding// (Dharmananda, 1990, p. 25) Acupuncture after assessing the person and palpating, consider these patterns

Damp-Heat in Lower Warmer; Qi Stagnation and Xue Yu (Blood Stasis) (Stagnation); Spleen Qi Xu (Deficiency); Kidney Yin and/or Yang Xu (Deficiency); Heat in the Xue (Blood); Shi (Excess) of the Chong Mai (Penetrating Vessel) and/or Ren Mai (Conception Vessel); Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel); Heat; Cold » __illustrative combinations__:

• Sp-8 and Sp-10: regulate menses (Ellis, et al, 1988, p. 154) • CV-6, CV-3 and Kd-6 for // irregular menstruation  // (Shanghai, p. 671) • CV-3, zi gong and Sp-6 for // irregular menstruation  // (Shanghai, p. 188) • CV-4 and Sp-6 for // irregular menstruation  //; also consider: St-36, Sp-10, Lv-2, Sp-4, Lv-3, GV-4 and/or PC-6 (Shanghai, p. 670) • GB-26 and Sp-10 for // irregular menses  // (Shanghai, p. 187) • GB-34 and Lv-3 (+/-): soothe Liver, resolve Qi Stagnation and Xue Yu (Blood Stasis) • CV-6, Lv-1, Kd-10, CV-4, Lv-3, Kd-2, Sp-6, CV-3, Sp-2, St-12, St-10, Ht-1, PC-3 and UB-54/40 for // irregular menstruation  //(Shanghai, p. 669) //and/or uterine bleeding (Shanghai, p. 673)// • Sp-4 (needle first); then CV-4, CV-6, St-25 and Sp-6 for // irregular periods  //; can also add: GB-26 (  D  ) and/or CV-3 (Shanghai, p. 669) • Sp-6, Sp-10, St-25, CV-4 and CV-6; Sp-4 and PC-6; UB-23 for // irregular menstruation  // (Mann, p. 145) • CV-4 and Sp-6 for // irregular menstruation  //; add Sp-10 and Lv-2 for //shortened menstruation period//; add St-36 and Sp-4 for //lengthened menstruation period//; add GV-4 for Kidney Qi Xu (Deficiency) (Lee and Cheung, p. 337) • Kd-5 and St-25: treat menstrual disorders (Finkelstein, p. 53); "when the monthly tide fails to keep its time" (Ellis, et al, 1988, p. 250) • Sp-10 and Lv-2 for // early menstruation  // (Shanghai, p. 670) • Lv-3, GV-4 and/or PC-6 for// menstruation that is early one month and late the next  // due to Kidney Xu (Deficiency) and Depressed Liver Qi (Shanghai, p. 670) • CV-4 and Sp-1: stop uterine bleeding (Finkelstein, p. 86) • Lv-3 and Sp-6 for // continuous uterine bleeding  //(Shanghai, p. 293) • Lv-1 and Sp-6 (+): stop bleeding and capture blood back into the channels (Finkelstein, p. 72) • Sp-1, Sp-6, St-36, Sp-10, CV-4 and CV-6 for // uterine hemorrhage;  //also consider Sp-1 (  D  ) and CV-4 (  D  ) (Liu, p. 390) • GV-20, CV-4, Sp-10, St-36 and Sp-6 for // vaginal bleeding  // due to both Xue (Blood) and Qi Xu (Deficiency) (Jirui and Wang, p. 273) • CV-4, Sp-6, UB-23 and Kd-8 for // uterine bleeding  // of Xu (Deficiency) type; add CV-6, UB-20, UB-17 and St-36 if due to Spleen Qi Xu (Deficiency); add CV-6, GV-4 and Kd-7 if due to Kidney Yang Xu (Deficiency); add Kd-2 and Kd-10 if due to Kidney Yin Xu (Deficiency) (Qiu and Su, p. 12) • CV-6, Sp-6, Sp-1 for // uterine bleeding  //of Shi (Excess) type; add Sp-10 and Kd-5 if due to Heat in the Xue (Blood); add Lv-3, Lv-1 and TW-6 if due to Accumulation of Heat; add CV-3 and Sp-9 if due to Damp-Heat (Qiu and Su, p. 10) • CV-4, CV-6, Lv-1, Kd-10, Lv-3, Kd-2, Sp-6, CV-3, Sp-2, St-12, St-10, Ht-1, PC-3 and UB-54/40 for // irregular menstruation  // (Shanghai, p. 669) and/or //abnormal uterine bleeding// (Shanghai, p. 673); • Sp-4 and PC-6: open the Chong Mai (Penetrating Vessel) for which metrorrhagia is a specific symptom of Shi (Excess), menstrual disorders are a general symptom of Shi (Excess), and reproductive disorders are a general symptom of dysfunction • Lu-7 and Kd-6: open the Ren Mai (Conception Vessel) which nourishes the Uterus and regulates menstruation; usually indicated by head and neck pain, abdominal distension, vaginal discharge and other symptoms of congestion; menstrual disorders are usually a part of Shi (Excess) effecting the Ren Mai (Conception Vessel) • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which gynecological problems are a Xu (Deficiency) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which gynecological problems are a Shi (Excess) symptom • CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep (Finkelstein, p. 84) • St-28 and St-29 (=): regulate menstruation and facilitate the Lower Warmer • UB-58 and Kd-8: for women with Qi Xu (Deficiency) and // scant uterine bleeding  // (Ellis, et al, p. 230) • Kd-10 and Kd-8 (+): cool Heat in the Xue (Blood); tonify Kidney Yin; regulate menses • CV-15, CV-16, CV-19, Kd-13, Sp-6, Kd-11, UB-47/52, GB-37, GB-5, UB-60 and CV-10: influence the pituitary (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • Kd-13, UB-67, Kd-7, GB-37, Sp-6, Kd-2, GV-4 and Lv-3: influence the ovaries (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • UB-31, Sp-6 and GB-3: has strong hormonal action on women (Finkelstein, p. 46)

Homeopathy
• ** Aconitum napellus:  ** gushing bright red with overwhelming fear of death • ** Aletris farinosa  **: profuse and premature due to atonic uterus; debility from loss of fluids, sterility; large clots; disgust for food, nausea and indigestion • ** Ambra grisea:  ** bleeding on slightest strain in nervous women; too early and too profuse; seven days early with itching, soreness and swelling of genitals • ** Ammonium carbonicum  **: too soon, blackish, often clots; colic before menses; bleeding from rectum • ** Belladonna  **: premature and profuse menses with sensation everything will fall out; foul smelling coagulated blood; throbbing headache • ** Calcarea carbonica  **: large clots mixed with bright red flow which is copious; mental shock starts flow • ** Carbo vegetabilis  **: too early, long and copious; prostration with every menstrual flow; burning in vagina • ** Cinchona:  ** excessive bleeding of long duration; weak, debilitated; dark clots and abdominal distention • ** Ferrum metallicum  **: too early, too profuse, too long, causing debility • ** Folliculinum  **: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • ** Ignatia  **: every two weeks of long duration with cramps and hardness of abdomen; hysteria; nausea with fainting; intolerance of light; vision blurred • ** Ipecacuanha  **: bright red blood with prostration, does not coagulate easily; pale, nausea • ** Kreosotum  **: bleeding brought on by lifting, overexertion, following coitus; constant dull aching in back; terrible left-sided headache a day after flow; flows only when lying down, ceases on sitting or walking • ** Lachesis  **: excessive flow with dark clots and severe pains, > as soon as flow starts,< heat, warm weather, > cold; profuse unpleasant perspiration • ** Mitchella repens  **: bleeding with frequent urination, not very free or satisfactory; bright red blood with painful urination • ** Phosphorus  **: bleeding with uncontrolled thirst for cold water • ** Platina  **: 4-6 days early and very profuse •** Ratanhia  **: bleeding with pains in abdomen and loins, bearing down towards genital organs, followed by leukorrhea •** Sabina  **: bleeding with bearing-down sensation; at times may not stop before next menses starts •** Secale cornutum:  ** profuse bleeding of black color with icy cold extremities; woman wants to uncover and to be cool; blood thin and fetid • ** Stramonium  **: profuse black, coagulated blood; drawing pains in abdomen, thighs, limbs; talkative • ** Thlaspi bursa pastoris  **: starts slowly then abundant and women becomes very weak; slow to regain strength and next flow starts •** Trillium pendulum:  ** bright red and profuse with faint feeling at epigastrium, pain in back; cold extremities; prostration with rapid feeble pulse • ** Ustilago maydis  **: bright red, partly thin and partly clotted; uterus soft and spongy •** Viscum album:  ** profuse bleeding following cold foot bath

Subtle Support
• __ notes __: A, A#, B, C, C#, D, E, F, G, G# • __ chords __: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• Female problems represent a rejection of the feminine principle; denial of the self; rejecting femininity; guilt; fear; belief that genitals are sinful or dirty. (Hay, 1984, p. 165, 174) • Many beliefs, attitudes, and conflicts can affect the individual woman's menses. Some may be due to anxiety and role conflict related to feminine sexual identity. The culprits for one woman may bear no resemblance to the problematic issues for another woman. We cannot generalize findings about one woman to fit all women. (Mehl, p. 173) Chinese psychophysiology

• ** Liver ~ Gan  ** is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; **stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood)**; **has an intimate relationship with the genitals and Lower Warmer**; and reflects emotional harmony and movement.

» Healthy expressions are » Liver Xu (Deficiency) signs include **frigidity**; **pain in thighs, pelvic region, and throat**; **ready tendency to "the blahs"** (Seem, p. 28); **timidity**; **depression**; **irritability; vertigo**; pruritus; **dry eyes, skin, and/or tendons**; asthma; **aching at the waist**; **hernia**; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis) and Xue (Blood) Heat. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating **smooth flow in the body is constricted**. Stagnation is **associated with frustration, irritability, tension, and feeling stuck**. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, **abdominal tension or distension**, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation.
 * kindness, spontaneity, and ease of movement.**

• ** Heart ~ Xin  **houses the Shen (Spirit) and reveals itself through the brightness in the eyes; **governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation**; and relates to the integration of the organs and the personality.

» Healthy expressions are » » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.
 * warmth, vitality, excitement, inner peace, love, and joy.**
 * Heart Xu (Deficiency)** signs include **sadness; absence of laughter; depression; fear; anxiety; shortness of breath** (Seem, p. 28); cold feeling in the chest and limbs; **palpitations**; cold sweat; inability to speak; memory failure; and **restless sleep**. Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic.

• ** Spleen ~ Pi  **governs digestion and manifests in the muscle tissues; **transforms food into Qi and Xue (Blood)**; **governs the Xue (Blood) and holds it in the vessels; maintains upbearing**; and relates to the ability to assimilate, stabilize, and feel centered and balanced.

» Healthy expressions are **fairness, openness, deep thinking, and reminiscence**. » »
 * Spleen Xu (Deficiency)** signs include **slightness (deficient "form")**; abundant elimination; **morning fatigue**; cold, wet feet (Seem, p. 28); **abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema**; memory failure; **heavy feeling in legs; pale lips**; **loose stools**; muscular weakness; and, indirectly, obesity.
 * The excessive use of the mind** in thinking, studying, concentrating, and memorizing over a long period of time **tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis)**. This also includes **excessive pensiveness and constant brooding**. (Maciocia, p. 241) Likewise, **inadequate physical exercise and excess consumption of sweet and/or Cold foods will also deplete the Spleen**. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.