Full-Heat in the Small Intestine

Small Intestine PatternFull (Excess) Pattern

Clinical Presentation

Mental restlessness, insomnia, tongue and/or mouth ulcers, pain in the throat, deafness, uncomfortable feeling and heat sensation in the chest, abdominal pain, thirst with desire to drink cold liquids, scanty and dark urine, burning pain on urination, blood in urine.

Tongue: Red with redder and swollen tip, yellow coating. Pulse: Overflowing-Rapid, especially in the Front position. If there are urinary symptoms, the pulse would be Wiry on the Left-Rear position.

Important symptoms: abdominal pain, tongue ulcer, scanty, dark and painful urination.

Arises from: Heart-Fire may lead to Full-Heat in the Small Intestine as the Heart and Small Intestine are related within the Fire Element.

Typically develops into: Full-Heat in the Small Intestine may lead to Heart-Fire.

Easy clinical tip: Abdominal pain, tongue ulcers and scanty, dark, painful urination are enough to diagnose Full-Heat in the Small Intestine.

Treatment

Principle: drain Heart-Fire and Small Intestine-Fire

S.I.-2 ↓Clears Small Intestine-Heat.

S.I.-5 ↓Also clears Heat in the Small Intestine and calms the Mind. Very effective in helping the person gain clarity and discriminate among choices. Affects the tongue — used if there are tongue ulcers.

HE-5 ↓With HE-8, drains Heart-Fire.

HE-8 ↓With HE-5, drains Heart-Fire.

ST-39 ↓Lower Sea point for the Small Intestine — stops abdominal pain.

Combination Points (and notes)

This pattern is the Small Intestine's own version of the Heart-Small Intestine interior-exterior relationship: Heart-Fire overflows into its paired Small Intestine channel, which is why tongue ulcers, insomnia and mental restlessness (Heart signs) appear alongside scanty, dark, burning urination (Small Intestine/Bladder-region signs).
S.I.-5 carries an unusual dual role worth remembering beyond its Heat-clearing action: it is credited with helping a person 'gain clarity and discriminate among choices' — a mental-emotional function tied to the Small Intestine's job of separating the pure from the turbid.

Small Intestine-Qi pain

Small Intestine PatternFull (Excess) Pattern

Clinical Presentation

Lower abdominal twisting pain, which may extend to the back, abdominal distension, dislike of pressure on the abdomen, borborygmi, flatulence, abdominal pain relieved by emission of wind, pain in the testis.

Tongue: White coating. Pulse: Deep-Wiry, especially on the Rear positions.

Important symptoms: lower abdominal twisting pain, borborygmi, Deep-Wiry pulse.

Arises from: Liver-Qi stagnation is the most common precursor of this pattern.

Typically develops into: This pattern may lead to Liver-Qi stagnation.

Easy clinical tip: Even just abdominal twisting pain is enough to diagnose Small Intestine-Qi pain.

Treatment

Principle: move Small Intestine-Qi, promote the smooth flow of Liver-Qi

Ren-6 ↓In combination with G.B.-34, moves Qi in the Lower Burner and relieves pain.

G.B.-34 ↓In combination with Ren-6, moves Qi in the Lower Burner and relieves pain.

LIV-13 ↓Harmonizes the Liver and Spleen — used particularly in chronic patterns.

ST-27 ↓With ST-29, moves Qi in the lower abdomen, stimulates the Small Intestine's functions and stops abdominal pain.

ST-29 ↓With ST-27, moves Qi in the lower abdomen, stimulates the Small Intestine's functions and stops abdominal pain.

SP-6 ↓Stops abdominal pain.

LIV-3 ↓Relieves stagnation of Liver-Qi.

ST-39 ↓Lower Sea point of the Small Intestine — specific to stop abdominal pain.

Combination Points (and notes)

Pain relieved by passing wind is a clean, memorable clinical marker distinguishing this from Small Intestine-Qi Tied, where the obstruction is far more severe and unrelieved.
Moxa is conditionally applicable here (only if Cold signs are present) despite the overall reducing method — a reminder that reducing an Excess pattern and warming a Cold component are not mutually exclusive.

Small Intestine-Qi Tied

Small Intestine PatternFull (Excess) PatternEmergency

Clinical Presentation

Severe abdominal pain, dislike of pressure, abdominal distension, constipation, vomiting, borborygmi, flatulence.

Tongue: Thick white coating. Pulse: Deep, Wiry.

Important symptoms: sudden severe abdominal pain, constipation, vomiting, Deep-Wiry pulse.

Arises from: Liver-Qi stagnation and Cold in the Intestines may be precursors of this pattern.

Typically develops into: This pattern may lead to Liver-Qi stagnation.

Easy clinical tip: Sudden severe abdominal pain, constipation, vomiting and a Deep-Wiry pulse are enough to diagnose Small Intestine-Qi Tied.

Treatment

Principle: remove obstruction from the Lower Burner, move Qi of the Small Intestine

ST-39 ↓Stops abdominal pain and moves Small Intestine-Qi.

Lanweixue ↓Extra point between ST-37 and ST-36, corresponding to the appendix — used (at the most tender spot between ST-36 and ST-37) if appendicitis is suspected.

Ren-6 ↓With G.B.-34, stops abdominal pain.

G.B.-34 ↓With Ren-6, stops abdominal pain.

ST-25 ↓Stops abdominal pain.

SP-6 ↓Stops abdominal pain.

LIV-3 ↓Stops abdominal pain and spasms, and promotes the smooth flow of Liver-Qi.

Combination Points (and notes)

Lanweixue's inclusion is a direct signal that this pattern's clinical picture overlaps with suspected appendicitis — tenderness at this specific point between ST-36 and ST-37 is used as a diagnostic marker, not just a treatment point.
Electrical stimulation is explicitly noted as applicable here — one of the few patterns here where a specific modern adjunct technique is named alongside classical needling.

Infestation of worms in the Small Intestine

Small Intestine PatternFull (Excess) Pattern

Clinical Presentation

Abdominal pain and distension, bad taste in mouth, sallow complexion. Roundworms (ascarid): abdominal pain, vomiting of roundworms, cold limbs. Hookworms: desire to eat strange objects such as soil, wax, uncooked rice or tea leaves. Pinworms: itchy anus, worse in the evening. Tapeworms: constant hunger.

Tongue: Not given in the source text. Pulse: Not given in the source text.

Important symptoms: abdominal pain and distension, bad taste in mouth, sallow complexion, plus symptoms specific to the type of worm.

Arises from: A Cold condition of Spleen and Intestines deriving from excessive consumption of cold and raw foods is often the precursor of this pattern or, rather, the background that favours the invasion of worms.

Typically develops into: This pattern may easily lead to deficiency of Spleen-Qi.

Easy clinical tip: The type-specific symptom (vomiting of roundworms, pica for hookworms, itchy anus for pinworms, constant hunger for tapeworms) identifies which worm is responsible.

Treatment

Principle: acupuncture is not applicable in this case — herbal treatment is the treatment of choice

Combination Points (and notes)

This is the one pattern explicitly marked as outside acupuncture's scope: the text states plainly that herbal treatment (e.g. Li Zhong An Hui Tang, Hua Chong Wan) is the treatment of choice, not needling — worth teaching as a reminder that not every TCM pattern is an acupuncture case.
This pattern's aetiology traces to a pre-existing Cold condition of the Spleen and Intestines (often from excessive cold/raw food) that allows worms to thrive — and notes it can progress to Spleen-Qi deficiency if the malnourishment from infestation continues.

Small Intestine Deficient and Cold

Small Intestine PatternEmpty (Deficiency) Pattern

Clinical Presentation

Dull abdominal pain alleviated by pressure, desire for hot drinks, borborygmi, diarrhoea, pale and abundant urination, cold limbs.

Tongue: Pale body, white coating. Pulse: Deep-Weak-Slow.

Important symptoms: dull abdominal pain, borborygmi, diarrhoea.

Arises from: Deficiency of Spleen-Yang is nearly always the pathological precursor of this pattern.

Typically develops into: Although this pattern may derive from a deficiency of Spleen-Yang, it may equally lead to Spleen-Yang deficiency. A long-term condition of Deficiency and Cold in the Small Intestine may also lead to Kidney-Yang deficiency.

Easy clinical tip: Dull abdominal pain, borborygmi and diarrhoea are enough to diagnose Small Intestine Deficient and Cold.

Treatment

Principle: expel Cold, warm the Intestines, tonify Spleen-Yang

Ren-6 ↑With moxa cones on ginger, specific for Empty-Cold in the Intestines.

ST-25 ↑Stops diarrhoea and alleviates abdominal pain.

ST-39 ↑Lower He-Sea point of the Small Intestine — specific to stop abdominal pain.

ST-36 ↑With moxa, tonifies Yang and expels Cold.

BL-20 ↑Tonifies Spleen-Yang.

BL-27 ↑Back-Transporting point of the Small Intestine — expels Cold from this organ.

Combination Points (and notes)

Pain alleviated by pressure is the clean differentiator from Small Intestine-Qi pain and Small Intestine-Qi Tied, both of which dislike pressure — a quick bedside test to distinguish Deficiency-Cold from the Excess Qi patterns here.
BL-27, the Small Intestine's own Back-Transporting point, is specific to expelling Cold from this organ — worth pairing mentally with ST-39, its Lower He-Sea point, as the two channel-specific anchors of this pattern's treatment.

Small Intestine Patterns — At a Glance

Diagnostic Tip, Pattern by Pattern

Full-Heat in the Small Intestine	Abdominal pain, tongue ulcers and scanty, dark and painful urine.
Small Intestine-Qi pain	Lower abdominal twisting pain, borborygmi and a Deep-Wiry pulse.
Small Intestine-Qi Tied	Sudden severe abdominal pain, constipation, vomiting and a Deep-Wiry pulse.
Infestation of worms in the Small Intestine	Abdominal pain and distension, bad taste in the mouth, sallow complexion, plus symptoms specific to the type of worm.
Small Intestine Deficient and Cold	Dull abdominal pain, borborygmi and diarrhoea.

How to Think About It (reasoning framework)

Full-Heat in the Small Intestine is the pattern most 'related to the Heart' here: tongue ulcers, insomnia and mental restlessness are Heart-Fire signs overflowing into its paired organ, distinguishing it from the other four patterns, which are purely local to the Small Intestine/abdomen.
The three Qi/obstruction patterns form a severity gradient worth teaching together: Small Intestine-Qi pain (twisting pain relieved by wind) is milder than Small Intestine-Qi Tied (severe pain, constipation, vomiting, possible appendicitis) — both Excess, both needing reducing method, differing mainly in acuity.