Professional Documents
Culture Documents
The art of diagnosis is a lifetime voyage in the interpretation of the presenting signs and
symptoms of the syndrome complexes. A viable diagnosis is totally dependent on
competent knowledge of TCM theory. This cannot be stressed enough. What separates
a good acupuncturist from an excellent one is his understanding of TCM theory and how
to apply this knowledge. On the other hand, a competent TCM theorist means nothing
if they cannot interpret the data correctly.
In TCM, diagnosis of disease is the process of discriminating patterns of disharmony, or
the syndrome complexes. This can be divided into two parts. The first part is to
thoroughly examine the patient, like a crime scene investigator as I mentioned before.
The second part of diagnosis is logically interpreting the information gathered in the
examinations, or to discriminate patterns of imbalance.
Traditionally, TCM examination is divided into four parts, commonly referred to as the
Four Pillars of Diagnosis. These are questioning the patient, observing the patient,
palpating the patient, and auscultation / olfaction. Lets look at these in more detail.
Energy Level
Low energy Indicates deficiency of Qi. If energy is lower in the end of the day Yin
deficiency. If patient is more deficient in the morning Yang deficiency. If the patient is
constantly tired throughout the day, indicates overall Qi deficiency.
Excess or hyperactivity can be possible excess yang heat, excess interior heat, or
excess yang qi rising.
Perspiration
Absence of perspiration in exterior syndromes indicate invasion of pathogenic cold.
Presence of perspiration in exterior syndromes indicate invasion of wind or heat or
both wind/heat.
Perspiration at night (night sweats), which stops upon awakening, indicates Yin
deficiency with hyperactivity of Yang heat.
Frequent Perspiration that worsens with activity deficient Qi and deficient Yang Qi.
Profuse perspiration that is accompanied with high fever, mental restlessness\, thirst,
preference to cold drinks, and a surging pulse indicates excess heat from excess Yang
heat being expelled out by perspiring.
Appetite
Poor appetite is a weakness in Spleen and Stomach Qi. Possible symptoms include
prolonged illness and poor appetite, loose stools, lassitude, pale tongue, white thin
coating on the tongue.
Poor appetite with chest fullness, abdominal fullness, thick and sticky coated tongue
indicates stagnation of Qi of the Spleen and Stomach caused by food retention or
stagnation of dampness.
Increased or excess appetite is typical with excess Stomach heat or Stomach fire.
Increased appetite without a desire to eat is typical of Yin deficiency causing internal
heat.
Tastes
Heat will produce a bitter taste in the Liver or the Heart. In Liver fire,
the bitter taste isnt constant. Heart fire produces a bitter taste in the
morning after a sleepless night and Heart fire is always accompanied
with insomnia.
Sweet tastes indicates Spleen Qi deficiency and / or damp / heat.
Sour tastes indicates food retention in the Stomach or lack of harmony between the
Liver and Stomach.
Salty tastes are caused by Kidney Yin deficiency.
Lack of taste sensation is caused by Spleen Qi deficiency.
Pungent tastes are caused by in-balances in the Lung, usually Lung heat.
Vomit
Vomiting is usually caused by a form of heat.
Thirst
Cold syndromes, or any syndrome in which heat is not noticed causes lack of thirst. In
this case the body fluids are not being consumed because of the cold.
The presence of thirst in a patient indicates heat or retention of damp phlegm in the
interior preventing the body fluids from ascending.
Stools
Constipation is usually due to excess heat or excess usage of body fluids.
Loose stools indicate mainly deficiency of Spleen or dampness invading the Spleen
Watery stools with undigested foods usually means a deficiency of Yang of the
Spleen and the Kidney.
Bloody stools with mucous is usually a result of damp heat in the
Intestines and stagnation of Qi in the Intestines.
Urination
Dark color urine usually indicates heat syndromes.
Clear and abundant amounts of urine usually indicates cold or an absence of heat.
Turbid / Cloudy urine indicates damp heat.
Red urine usually indicates damage of a vessel due to heat.
Clear increased amounts of urine indicates weak Kidney Qi and Bladder controlling the
urine.
Little volume and yellow urine with accompanied urgency and painful urination usually
indicated damp heat in the Bladder.
Dribbling and felling of retention of urine usually indicates Kidney Qi deficiency, possible
damp heat, and stagnation of blood or stones.
Sleep
Insomnia accompanied with dizziness and palpitations is usually caused by the inability
of the blood to nourish the Heart and the Spleen.
Insomnia with restlessness in the mind and a dream disturbed sleep usually
indicates Heart heat or fire.
Dizziness
Dizziness is usually a symptom of deficiency of Qi , blood deficiency, fire, wind or
phlegm.
Pain
Headache
The head is the meeting place of all the Yang pathways. The Qi of all the Zang and Fu
flow to the head. If any of the external pathogenic evils attack the head or neck and
damages the yang pathways, or if Qi and blood stagnates as a result of internal
diseases, the head and brain lack nourishment and a headache is sure to follow.
Recent onset and short duration is usually a result of wind cold.
Gradual onset are usually of interior etiology.
Day-time headaches are usually a result of Qi deficiency or Yang deficiency.
Evening headaches are usually caused by blood deficiency or Yin deficiency.
Cervical spine headaches, especially at the nape of the neck (Greater Yang Channels)
are usually caused by Kidney Qi deficiency or invasion of wind / cold.
Forehead headache Bright Yang Channels) are usually caused by Blood deficiency or
Stomach heat.
Temporal headaches ( Lesser Yang Channels) are usually a result of invasion of wind /
heat, wind / cold, or from interior Liver and Gall Bladder Fire rising.
Top of the head headache (Terminal Yin Channels) are usually a result of Liver blood
deficiency.
Whole head headache is usually a result of invasion of wind / cold.
Heavy feeling headache is a result of either phlegm or dampness.
Headache that is inside the head is usually a result of Kidney Qi deficiency.
Throbbing headache is usually a result of Liver Yang rising.
A dull, boring headache is usually a result of blood stagnation.
Back pain
Continuous and dull pain in the back is usually a result of Kidney Qi deficiency.
Recent, severe, and stiff back pain is usually a result of Blood stagnation.
Severe pain that is aggravated by cold and damp weather and is comforted by heat is
usually a result of pathogenic cold and dampness invading the back.
Boring pain is usually a result of Blood stagnation.
Pain in the shoulders and upper back is usually a result of exterior conditions wind /
cold, wind / heat, etc.
Pain in the Joints
Pain in the joints that moves from joint to joint is usually a result of Wind.
Fixed joint pain that is very painful is usually a result of invasion of Cold.
Fixed joint pain that is associated with swelling and numbness is usually a result of
invasion of dampness
Numbness
Bilateral arm and leg numbness, or hand and feet numbness is usually a result of blood
deficiency.
Unilateral numbness of fingers, elbows, and arm (especially the first three digits) is
usually a result of Wind and Phlegm.
Pain in the entire body
A rapid, sudden onset that is associated with chills and fever is usually a result of Wind /
Cold.
Pain that I felt all over with associated tiredness is usually a result of Blood deficiency.
Pain that is in al the muscles and has an associated hot sensation is usually a result of
Stomach Heat.
Pain all over that is associated with a feeling of heaviness is usually a result of Invasion
of dampness in the muscles.
Ears
Most all ear conditions are due to Kidneys because the Kidneys open to the ear. All the
Lesser Yang pathways flow to the ear and therefore external pathogenesis of these
pathways such as Heat, Dampness, and Phlegm can affect the ear.
Tinnitus A sudden onset is usually a condition of Liver-Fire or Liver-Wind. A gradual
onset is usually a condition of Deficiency of Kidneys.
A loud high pitch noise is usually a condition of Liver Yang rising, Liver Fire, or Liver
Wind.
A low pitch noise is usually a condition of Kidney Qi deficiency
Deafness that is chronic in nature is usually a condition of Kidney Qi deficiency. Blood
and Heart deficiency, deficiency of Qi, and Yang Qi deficiency
Eyes
Pain in the eyes is usually a condition of Liver because of the relationship to the opening
of that viscera.
Observation
This is the process in which the practitioner gathers information by the observation of
changes in the patients body. The most common parts that are inspected are the
tongue and the face. Changes in the appearance of the body can give the practitioner
clues in the nature of disease and pathology.
Observation of the Face
One part of the observation examination is face diagnosis. This was written in the
Huang Nei Jing. In TCM the face is another landmark, like tongue, or the vital organs.
Impairment of the organs can therefore reflect in the face. This can manifest in facial
complexion, texture, or moisture in the corresponding area.
Flabby Tongue: A flabby tongue body with teeth marks on the margin and pale in color
indicates a yang deficiency of the spleen and kidney leading to accumulation and
obstruction of phlegm-dampness. A flabby tongue with a deep red color indicates
excessive pathogenic heat attacking the heart and spleen.
Thin and Small Tongue: This indicates consumption and deficiency of blood and yin. A
thin and small tongue with a pale color denotes deficiency of both qi and blood. A thin
dry tongue with a deep red color is mainly due to a preponderance of fire and great
exhaustion of body fluids.
Rigid Tongue: Seen in febrile diseases due to the invasion of exogenous pathogenic
heat transmitted into the pericardium or due to an obstruction of pathogenic phlegm. It
may also be seen in high fever leading to consumption of body fluids and
preponderance of pathogenic heat. It is a prodrome of wind-stroke (cerebral stroke).
Deviated Tongue: This is a prodrome of wind-stroke.
Cracked Tongue: Cracks on the tongue with deep red color indicate excessive heat. A
cracked pale tongue indicates insufficiency of yin and blood. However, a cracked tongue
of long term duration without any other symptoms can be considered normal.
Tongue Coating
Thinness and Thickness: Generally, if substantial pathogenic factors such as damp,
phlegm or food accumulation occur and cause obstruction, they further affect the spleen
and stomach leading to the ascent of turbid qi and forming of a thick tongue coating. A
white thin tongue coating is formed if non substantial pathogenic factors such as wind,
heat, dryness, or cold attack the body; or if the pathogenic factors stay on the body
surface; or if body resistance is weak during the disease development.
Moistness and Dryness: The normal tongue coating is moist, which indicates that plenty
of body fluid is flowing upward. If the tongue coating is dry, it is due to body fluids failing
to moisten the tongue. A dry tongue coating may also be present in some febrile
diseases where pathogenic heat consumes the body fluid. A slippery tongue coating
may be due to pathogenic damp-humor floating over the tongue surface.
Sticky and Curdled Tongue Coating: A sticky coating is due to hyperactivity of
endogenous pathogenic phlegm and damp rising tot he tongue, and is mostly seen in
diseases caused by pathogenic damp-heat or phlegm-humor. A curdled tongue coating
is the outcome of food accumulation in the stomach leading to the ascent of turbid qi to
the tongue surface. It is also seen in disease caused by phlegm-damp.
Peeled Tongue Coating: Mostly due to deficiency of qi and yin. If peeled tongue is
accompanied by a sticky coating, it indicates a complicated disease condition to which
the body resistance is weakened.
No Tongue Coating: Changes in the tongue coating indicate fluctuation in the disease
condition. For example, if a qi deficiency of the stomach is manifested by a lack of
tongue coating at an early stage, the tongue coating will reappear after the stomach qi is
recovered. If a disease has no tongue coating, then suddenly appears, this indicates a
perverse flow of stomach qi, or excessive pathogenic heat. If a disease has a tongue
coating at the beginning, which disappears abruptly, this indicates stomach yin fluid has
decreased. If a thick coating gradually turns into a thin white coating, this indicates that
pathogenic qi is being gradually weakened, and the disease condition is becoming
milder.
Generally, an observation of the thinness and thickness of the tongue coating will
indicate the depth of pathogenic qi. The tongue's moistness or dryness shows the body
fluid condition. The degree of stickiness of the tongue coating indicates the dampness of
the stomach and spleen. The appearance or disappearance of tongue coating signified
the cure or worsening of the disease condition.
Color of Tongue Coating
White Coating: Indicates exterior-cold syndromes. A white and thin coating is seen
mostly in exterior syndromes, while a white and thick coating appears in interior-cold
syndromes. If there is a powder-like whitish coating covering the tongue surface, it is
caused by the internal accumulation of summer-humid heat and is usually seen at the
onset of pestilential diseases.
Yellow Coating: Indicates interior and heat syndromes. A light yellow tongue coating is
seen in cases of slight fever. A deep yellow color indicates high fever. Brownish tongue
coatings represent an accumulation of pathogenic heat.
Grayish Coating: Denotes interior-heat syndrome or interior-cold syndrome. A grayish
black and slippery coating on the tongue usually indicates symptom-complex due to
cold-damp in the interior. A greyish, yellow, and sticky tongue coating usually indicates
the accumulation of damp-heat. Greyish and dry tongue coatings are usually due to the
consumption of body fluid by excessive heat.
Black Coating: This is often seen at the serious and dangerous stage of disease, and
indicates extreme heat or cold. A black, yellow, and dry coating with thorns on the
tongue surface usually denotes consumption of body fluid by extreme heat. A black and
slippery tongue coating shows excessive cold due to yang deficiency.
Palpation
The pulse is an invaluable diagnostic procedure. If done properly, it can provide the
doctor with instructions in their course of treatment. Pulse diagnosis is crucial for all
aspects in acupuncture. The pulses can determine which organ and pathway is
imbalanced, where the disease is located in the body, how far to insert the needles, how
to manipulate the needles, how long a session should last, and the patients prognosis.
Ultimately, with tongue diagnosis, pulse palpation can be the major determining factor
and basis of treatment
The Heart is obviously noted as regulating the pulses. However, it is much more
complex, or integrated than this. In TCM, the pulses are associated with the internal
organs, Qi, and blood. For example, blood circulation is a cooperative effort brought on
by the Heart, Lung, Liver, and Spleen Zang. The Heart controls the circulation of blood,
the Spleen controls the containment of the blood in the blood vessels, the Liver stores
the blood, and the Lung and Spleen contribute to the pushing of blood though out the
vessels and body. The Qi and blood has almost a symbiotic relationship. It is said that
the blood is the mother of Qi, and the Qi is the ruler of blood. This explains how the
blood nourishes the Qi and Qi regulates, or pushes the blood in the blood vessels.
Without nourishment Qi cannot function and without the Yang function of movement that
the Qi provides, of blood cannot function. You can therefore see how the state of Qi and
blood can influence the pulses.
There is nothing easy about mastering pulse palpation. It takes years to fully appreciate
the art of feeling the Qi in the radial artery. However, with in a few years of palpating
pulses, your fine touch and pulse perceptions become easier and the images will
become much more clear. Initially it is encouraged to spend more time in pulse
palpation. In China it is not uncommon to spend twenty to twenty-five five minutes in
evaluating the pulses. Obviously, this is not time effective in a busy clinic. Five to ten
minutes is sufficient enough time when learning pulse diagnosis.
When taking the pulse, clear your thoughts and focus entirely on the patients Qi. Try to
zone in on the radial pulse and start to decipher the images. It is said in ancient texts
that the doctor doesnt palpate the pulse, but rather listens to the pulses. This reflects
the importance of concentration and focus.
Taking the Pulse
In classic Chinese texts, the pulses should be taken under optimal conditions. Providing
the proper setting assures the doctor of true and clear findings.
Patient Position
The pulses should always be taken in the recumbent, or sitting position. The wrist
should be at the same level as the heart. Make sure the patient is comfortable. If the
patient cannot sit, take the pulses standing with the elbow bent and relaxed and the wrist
at the heart level.
Doctor Position
It is important to note that the doctor must be comfortable when taking the pulse. If the
doctor is uncomfortable, their concentration isnt optimal and the pulse palpation is
hurried and sloppy. Traditionally, the doctor takes the pulses sitting on a desk or table.
The doctors arm is rested on the desk or table with their arms at 90 degrees to the
patients. The doctors right hand interprets the patients left radial artery, and the
doctors left hand interprets the patients right radial artery. There should be no
switching of positions. After a while of taking pulses, your index finger, middle finger,
and ring finger will become very sensitive and comfortable in their respected positions.
The Pulse Positions
There are many different opinions on the six pulse positions. The most popular comes
from Li Shi-Zhen described in his text, Pulse Diagnosis written in 1564. The three
pulse positions are cun front/distal position, guan middle position, and the chi
last/proximal position.
Cun
Lung
Right Arm
Guan
Chi
Spleen/StomachKidney Yin
Cun
Heart
Left Arm
Guan
Liver
Chi
Kidney Yang
These positions are located at the radial artery at the styloid process of the radius on
both wrists. It is believed that the patients Qi and blood in the pathways and its
associated organ are felt at these positions. Therefore, the status of a patients health is
reflected in the pulses.
Feeling the Pulses
When examining the pulse, the doctor should always use his index finger for reading the
cun position, middle finger to read the guan position, and ring finger to read the chi
position. This was discussed earlier in the doctor positioning. It is mentioned again
because of its significance.
The Three Depths
When taking the pulses. The doctor must Asses the qi and blood in all positions as well
as all three depths. The pulses can be interpreted in three depths, superficially, slightly
deeper, and deep. In classic texts, these are referred to a heaven, man, and earth. The
depths describe where the Qi and blood are located at, where the disease is located at,
and what part of the body is affected.
Pulse Depths
Upper Body - External
Superficial
Influences
Middle
Middle Body - Pathway level
Deep
Lower Body - Organ level
If the pulse is predominant in the cun position, it is said that the Qi and blood is
superficial, just underneath the epidermis. This is usually indicative of external evils like
wind and heat or Yang excess. The cun position can diagnose disease from the
diaphragm to the head.
If the pulse is located in the guan position, the Qi and blood is located in the pathways
where it is supposed to be. This is located between the epidermis and the muscles.
The guan position diagnoses disease from the umbilicus to the lower diaphragm.
If the pulse is felt in the chi position, the Qi and blood is at the visceral level. This means
that the Qi is very weak and the organ is either involved or is diseased itself. The chi
position diagnoses disease from the below the umbilicus.
The level in which the Qi and blood are manifesting determines needling depths. If the
pulses are very superficial, the Qi is flowing superficially and therefore needling should
be shallow. If the pulses are located in the middle position, the Qi and blood are flowing
in their respected pathways and needling is deeper. If the pulses are deep, to the bone,
the Qi and blood is located in the organs and needling is deep. When you look at
references in acupuncture texts on needling depths, the determining factor is where the
Qi and blood is located. This is rarely discussed. For example, when reviewing
needling depths of Hegu (LI-4) the range is from 0.3 cun to 1.0 cun. A superficial pulse
will be needled at 0.3 cun , the middle pulse is needled 0.5 cun, and the deep pulse is
needled at 1.0 cun.
Normal Pulses
To determine pathological pulses, one must establish normal images (Ping Mai). The
following characteristics of a normal, healthy pulse are as follows:
1. Spirited (You Shen): This means if the pulse is strong and patterns of its beat
is distinct. If the can be felt coming and going with good force, it has spirit. If it is
faint, irregular, choppy, or once and a while ceases, it is said that the pulse is
without spirit.
2. Rooted (You Gen): If the pulses at the last, Chi position and it is felt all the way
to the radial bone, it is said to be strongly rooted. In classics it states that if the
pulses are rooted, the patients health is good. Just as the roots of a tree that
deeply plants and anchors deep in the ground, the patients health is deeply
anchored.
3. It has Stomach (You Wei): The pulses should posses some slippery quality.
When one feels comfortable in feeling all the pulse images, identifying this slightly
slippery quality will be appreciated. If the pulses feel tense or large and not
slightly slippery, it looses its harmony, and is said to lack Stomach Qi.
Harmonious pulses of the Seasons
A persons pulses are subject to the ever changing environment. To maintain the
balance between the interior and the exterior, the body changes and is reflected in the
normal pulse. During the springtime the Yang Qi becomes more prominent. The pulse
will be increasingly stronger and slightly wiry. During the summertime the heat will
cause the pulses to be overflowing. During the autumn the Yang Qi slowly weakens and
the pulses will become empty, floating, and fine. During the winter the pulses sink deep
because of the cold climate and they become deep and strong.
Pathological Pulses
When imbalances of body, mind, and spirit inflict the body, physical changes
immediately follow. A person can suffer with pain, fatigue, and organic dysfunction.
Fortunately, physical changes are also present in the pulse images. In TCM, they label
these pathological changes as Bing Mai and categorize them into twenty-nine pulse
images. The twenty-nine images are classified into four easily felt categories. In
the Bing Hu Mai Xue, it states that there are four principles, or essential images that
nearly all pulses poses. They are fast, slow, floating / superficial, and deep.
When a beginning student of TCM starts to tackle these pulse categories, it seems
overwhelming and even impossible to feel all twenty-nine images. If one sticks to the
four categories of pulses, pulse diagnosis can be less of a headache and more of a
wonderful tool of ancient wisdom.
Lets look in more detail on some of the pathological pulses. Remember that feeling the
pulses takes time. Dont get discouraged in the beginning. Pulse palpation is an art as
well as a science. With that in mind, be diligent, patient, and determined and success is
sure to follow.
Deficiency
If the floating pulse is also forceless and empty in deep position it is indicative of
Deficiency
Positions Felt:
Cun Position: This is mainly felt in the cun (front) position. This is in the upper jiao. The
Lung and Heart Zang occupy these positions. The Lung is the most vulnerable organ to
the exterior. It is therefore subjective to wind, heat, and cold. If the Lung is weak, these
pathogens invade the body and can yield a floating pulse. As we mentioned earlier,
Lung controls the Wei Qi, or the immune system. A floating pulse in the right cun
position almost always means a flu / cold is present, in progression, or ending.
Guan Position: When the Spleen is deficient and it affect the entire middle jiao, a
floating pulse will appear in this position on the right arm. If the Liver Qi is overabundant a floating pulse in the left guan position will be present.
Pulse Image: Pulse has most strength at lowest level and requires deep pressure to
feel. It is said to feel like a cotton ball on sand in the superficial position and very strong
and rigid in the deep position.
Pulse Image: Pulse is less than 60 beats per minute or if the pulse beats three times in
a respiration.
Slippery Pulse:
Pulse Image: Pulse feels like pearls coursing through the pulse, with a definitive rolling
quality. The pulse quickly hits each individual finger and just as quickly rolls away. It
feels like slippery little balls that remain even. A slippery pulse usually occurs with a
rapid pulse.
Pathology: Dampness of any variety, phlegm, pregnancy, heat.
A slippery pulse indicates a mild illness. It is a result of an abundance of Yang Qi in the
body. It also can be caused by heat from the Liver or the Kidney fire that cause the
blood to heat up. It is seen very often in pathologies with increased dampness and
phlegm. Pregnant females very often have a slippery pulse reflecting abundant Qi and
blood in the body. Healthy people that have abundant Qi and blood can also present
with a slight slippery pulse.
Positions Felt:
Cun Position: A slippery pulse at this position reflects when the Qi accumulates in the
chest and diaphragm, interfering with the descending function. This leads to symptoms
of acid reflux, vomiting, stiff tongue, and coughing.
Guan Position: A slippery pulse at this position reflects Liver heat t and Spleen
dampness. This is very common in this position on both the right and left arms.
1. 9.
Long Pulse:
Pulse Image: This pulse feels long in its beat rate. If it is long , soft, and calm it
indicates health. If it is long tight, like a string it indicates disease.
Pathology: This pulse image can reflect the strong health of an individual. In diseased
patients, this pulse reflects excess Yang heat in the blood, wind phlegm, or internal heat
in the Stomach or Large Intestines.
1. 10. Short Pulse:
Pulse Image: This pulse image feels short and its beats are strong, but it rises and falls
abruptly.
Pathology: Qi and blood deficiencies
This pulse is felt when Qi becomes weak and is not able to circulate evenly.
1. 11. Wiry Pulse:
Pulse Image: This pulse image feels taught, long, and strong in nature. It can be felt in
light or heavy palpation. It is said to feel like a bow string, very firm and fixed. It can
also be compared to a sting instrument, very springy and elastic in nature. It feels like a
thin musical string that bounds up against the fingers evenly but with force. This is very
commonly felt, especially in the Liver (Guan) position.
Pathology: Qi stagnation, especially in Liver, can also be phlegm
This is commonly found in cases of liver Qi stagnation. It can also be present if there is
excess heat (fast pace) and cold (slow pace). Patients that have spasms, stiffness, and
pain in the body will also yield a wiry pulse. Excess phlegm can lead to a wiry pulse. In
general, if the disease is mild, the pulse is wiry and soft. If the disease is sever, the
pulse is wiry and hard.
Positions Felt:
Cun Position: A wiry pulse at this position reflects accumulated phlegm in the chest and
diaphragm.
Guan Position: A wiry pulse at this position reflects Liver and Gall Bladder disease,
primarily Qi stagnation. Excess cold in the Stomach can also yield a wiry pulse in this
position.
Guan Position: A thin pulse at this position reflects Spleen / Stomach deficiency.
Smells
Any foul odor usually indicated the presence of heat. This can be seen in the case of
body odor. A foul and sour odor can be caused by food retention. Metal smells are
commonly seen in Lung impairment.
Wind
Cold
Damp
Heat
Summer Heat
Dryness
Wind
(Associated with Liver, Wood, Spring, Yang evil)
Wind is involved with movement and activity, and brings other evil Qi in with it. It is the most
important evil as it is the cause of the "100 diseases".
Disperses Qi upward and outward
Illnesses manifest in upper and outer parts of the body in early stage: head, sense organs and
skin
Stroke
aversion to cold
occipital headache
stiff neck
sneezing
runny nose
Little or no sweating
Ma Huang Tang
Xu Type External Wind
Sweating
Wei Qi is weak. There is sweating but it does not release the Exterior
Harmonize Ying and Wei Qi. Ying nourishes Wei to gently strengthen it, without tonifying Evil Qi
sore throat
sinusitis
earache
red face
Tongue: slightly red in early stage, yellow coat, thorns on lung area
3.) Wind-Damp
sensitivity to wind
sinus headache
Pulse: slippery
Arthritis, nerve pain, and numbness that is worse with cold and damp
weather
Pulse: slippery
disruption of Jin-Ye
acute onset
Pulse: slippery
6) Wind-Rash
acute onset
Associated with the Liver, and causes diseases of shaking and abnormal body positions.
It combines easily with phlegm, as in Deviation (Wind blows it out of position and the phlegm
makes it stick in an abnormal position).
Symptoms of Internal Wind
convulsions
Parkinson's
post-stroke squeal
seizures(epilepsy)
Liver Yin Xu, Yang Kan - Long-standing Yin deficiency with Heat
brain disorders
Alzheimer's, senility
Stroke
brain tumours
Fire and Phlegm occurring together
red face
Cold
(Associated with Kidney, Winter, Water element, Yin evil)
Feeling of cold
causes Qi and Blood to contract and congeal which creates stagnation, pain, stiffness
Syndromes of Cold
Wind Cold
aversion to cold
occipital headache
stiff neck
runny nose
sneezing
little or no sweating
sweating
diarrhoea
loose stools
watery stools
bloating
poor digestion
nausea
vomiting
loss of appetite
fatigue
Pulse: slow
Tongue: pale
Cold evil damaging both spleen and Kidney Yang
Can be acute, as in hypothermia, or chronic, as in a cold climate damaging spleen and kidneys.
Symptoms as in previous syndrome with:
watery stools
bird stools
aversion to cold
strong fatigue
pale face
abdominal bloating
depression, irritability
Pulse: wiry
Pulse: choppy
endometriosis
hernia
testicular problems
sperm production
may be infertility
Pulse: choppy
Damp
(Associated with spleen, late summer, Earth element, Yin evil)
Dampness is heavy, tenacious, difficult to treat, and lasts a long time. It tends to move
downwards in the body.
Sticky, greasy, oily, dirty, bad smell
bad smelling diarrhoea with mucous (if mixed with heat, there can be cloudy urine)
oedema or swelling
Syndromes of Damp
Wind-Damp
Acute condition, but has the slowest onset of all winds. It is affected by damp and cold weather.
Symptoms can reflect a respiratory infection with copious phlegm or a gastrointestinal flu.
sneezing
afternoon fever
nausea, vomiting
swelling of joints
oedema
Pulse: slippery
Bronchitis
Hepatitis
Virginities
Prostitutes
Colitis
Tongue: red, thick yellow coat, swollen (how thick, how swollen, how red?)
Internal dampness arising in the body
Dampness arising from Spleen Xu: Dampness is the main factor, the Xu is secondary. It often
compromises immunity due to congestion of lymphatic system, autoimmune conditions in
particular. If severe, it becomes Phlegm. A long term chronic situation is often due to damp, cold,
raw foods.
Symptoms may be associated with a wide variety of diseases: Chronic Fatigue, Fibromyalgia,
Candida, Lymphoma, Etc.
bloating
nausea
vomiting
diarrhoea
dizziness
low appetite
Heat
(Associated with the Heart, summertime, Fire element, Yang Evil)
Damages Yin
agitation, restlessness
Syndromes of Heat
Wind-Heat
sore throat
big thirst
sinus infection
Damp Heat
big thirst
redness
restlessness
Syndromes of Fire
Lung fire
can be loud, forceful cough with blood (fire has burnt off protection of mucous membranes so
capillaries have burst)
Stomach channel problems: toothache (infection), frontal headache strong pain or burning on
channel
Heart fire
strong anxiety
restlessness
insomnia
mania
Liver fire
anger
dysentery
bone infection
severe restlessness
slight bleeding
Tongue: scarlet
Summer Heat
(Associated with the Heart, Fire Element, Summer, Yang Evil)
high fever
restlessness
dizziness
blurred vision
headache
constipation
coma
Yin collapse
profuse sweating
nausea
vomiting
dizziness
heavy head
foggy thinking
tightness in chest
Dryness
(Associated with the Lung, Autumn, Metal Element, Yang evil)
Exterior in origin (not yin Xu, not internal)
Easily damages body fluids
Dry skin
Dry hair
Dry eyes
Dry lips
Dry stools
Scant urine
Thirst
Easily damages lungs
Syndromes of Dryness
Warm Dryness
Symptoms
Fever
Headache
Thirst
Dry Mouth
Pulse: rapid
Treatment
Sensitive to cold
Chills
Mild fever
Headache
Dry cough
Dry mouth
Yin Xu - Chronic
(Deficient Heat
Condition)
Yang Xu Chronic
(Deficient
Cold
Condition)
Pulse
Normal:
Moderate
Rapid, Strong.
Rapid, Weak.
Slow.
Slow, Weak.
Tongue
Normal:
Pink/Light Red
Pale/Pink Or
Purplish/Bluish
Body.
Pale Body,
Thin/White
Coat
(Normal),
Flaccid.
Face
- Could Be
Thinner
Notes:
Yellow Due To
Heat Burning
Body Fluids.
Red.
Red Body,
Thin/No Coat
Notes:
Light Mild
Heat/Slow Boiling
Heat.
Map Coating
(Partial Peel: Only
Part Of Tongue
Has Coat).
Pale.
- Poss. Teeth
Marks Over
Months Or
Years
Notes:
Not Excess Or
Additive Cold,
More Of A Xu
Cold.
Has Nothing
To Do W/Yin
Fluids.
Water
Metabolism
Slows,
Causing
Chronic Water
Retention
Problem.
Pale.
Quality of:
Eyes
Skin
Yin Xu - Chronic
(Deficient Heat
Condition)
- Poss. Dryness
- Poss. Dryness
- Poss. Swollen
Red.
Red, Dry.
Notes:
If Inflammation Is
Involved There
Will Be Burning
Sensation.
Any Burning
Sensation Is
Usually
Associated
W/Heat.
Notes:
Dryness Due To
Fluid Xu, And
Heat Excess.
Edema Around
Eyes.
Red, Inflamed.
Dry Skin.
- Poss. Skin
Rashes
Notes:
If Patient Sweats,
It Will Be A
Profuse Sweat.
Yang Xu Chronic
(Deficient
Cold
Condition)
Dark Circles.
Notes:
Dark Circles
Due To
Slow/Poor
Circulation.
Kidney
Involved:
Kidney Qi Xu,
Or Kidney
Yang Xu.
Spontaneous
Sweat W/Wo
Exertion.
Notes: Door Is
Open,
Functional
Yang Energy
Xu, So Sweat
Leaks Out.
Quality of:
Yin Xu - Chronic
(Deficient Heat
Condition)
Yang Xu Chronic
(Deficient
Cold
Condition)
Benefiting Fever
Condition.
Lungs
Strong/Loud
Cough W/Phlegm.
- Poss. Yellow,
Green, Or Brown
Phlegm. Indicates
Infectious Disease
Weak/Dry Cough.
- Poss. Aftermath
Of Illness
Profuse Thick
White/Clear
Phlegm.
Notes:
Smokers Cough.
Notes:
Asthma Has
Both Lung
And Kidney
Xu.
- Poss. Blood
Heart
Very
Rapid/Strong
Beat.
Notes:
Stimulants Such
As Coffee &
Cigarettes Are
Excess Yang
Additives Into The
System.
Shortness Of
Breath,
Difficulty
Breathing, Or
Weak Shallow
Breathing.
Rapid/Weak Beat.
- Poss.
Discomfort/Pain
Around The Heart
Weak Heart
And Low
Functional
Energy, Lots
Of Heart
Problems.
- Poss.
Skipping
Heart Rates
- Poss.
Cardiac Pain,
And Cardiac
Failure
Quality of:
Yin Xu - Chronic
(Deficient Heat
Condition)
Yang Xu Chronic
(Deficient
Cold
Condition)
Appetite
High.
Very Low
Appetite.
Very Low
Appetite, No
Energy To
Eat/Digest.
Notes:
Patient May Eat A
Lot, But Do Not
Gain Weight
Notes:
- Poss. Gas,
Bloating,
Abdominal Pain,
Nausea,
Vomiting,
Diarrhea
Notes:
Deficient Fluids
(Insufficient To
Digest Food).
- Poss.
Undigested
Food In Stool
Thirst
Might/Might Not
Have Low Thirst.
Low Thirst,
Likes Warm
Water.
Digestion
Bloating, Stool
Will Be Dry,
W/Difficult Bowel
Movement,
Extending Pain,
Sharp Pain, Does
Not Like Pressure,
Does Not Like
Heat.
Sticky Stool
W/Mucus, Poorly
Formed.
Abdominal Pain.
Does Not Like
Pressure. Likes
Heat.
Weak/Slow
Digestion.
Mild, Dull,
Achy
Abdominal
Pain. Likes
Heat, Likes
Pressure.
- Poss. Burning
Diarrhea
Associated
W/Damp Heat Or
From Extreme
Heat Stagnation.
- Poss. Diarrhea
- Poss. Early
Morning
Diarrhea.
Lowest
Environmental
Yang.
Quality of:
Yin Xu - Chronic
(Deficient Heat
Condition)
Yang Xu Chronic
(Deficient
Cold
Condition)
Scant, Light
Yellow Urine,
Low Grade UTI.
Copious Urination,
Light/Whitish
Colour.
- Poss. Chronic
- Poss. Cloudy Or
W/Puss Due To
Dampness
Copious,
Clear,
Frequent,
Usually Night
Urination.
Truly A
Constipation
Condition Where
Only Fluids Can
Be Passed
(Appears To Be
Diarrhoea), But
Solids Are Not
Passed
Notes:
Do Not Give
Patients Warm
Water Or Spicy
Foods.
Kidney /
Bladder
(Water
Metabolism)
Dark, Scant,
Yellow Urine,
Strong Urinary
Track
Inflammation
(UTI).
- Poss.
Extending/Sharp
Pain
Notes:
UTI Symptoms:
Urgency,
Frequency, And
Burning
Sensation.
Reproduction
Strong/Excess Sex
Drive
- Poss. High
- Poss. Feeling
Of Not Being
Finished, Due
To Lack Of
Functional
Energy
Notes:
Kidney Yang
Deficiency
Problem.
Slightly Higher
Sex Drive, But
Tires Easily (Hard
Prone To STD's,
Yeast, Infections,
Warts, Cysts.
Low Sex
Drive, Can't
Perform.
Quality of:
Yin Xu - Chronic
(Deficient Heat
Condition)
Chance Of
Contracting
Illness (Fatigue,
PID's, STD's,
Prostatitis)
Time Performing).
- Poss.
Infertility,
Premature
Ejaculation,
Nocturnal
Emissions,
Low Sperm
Count
- Poss. Vaginal
Dryness
- Poss. Hormone
Imbalance
Menses
Normal:
Regular, No
PMS, No
Cramps, No
Clots, No
Spotting
Brown Or Dark
Red, Scanty.
- Poss. Early
Menstruation (5
To 7 Days)
Notes:
Dark Purplish,
Long Period Or No
Period Due To
Excess Fluids Or
Cold Respectively
Long Cycle,
Thin, Or Light
Colored,
Delayed
Menstruation.
- Poss.
Skipping
Cycle (No
Cycle)
Wants To Sleep,
Groggy After
Sleep.
Wants To
Sleep A Lot,
Likes To Take
Naps, And
Always Feels
Better After
Sleep.
Blood Is Either
Dried Up In A
Short Cycle, Or
Heavy Due To
Pushing Force Of
Heat.
Sleep
Energy
High Level Of
Trouble Falling
Asleep,
Symptoms Worse
At Night.
- Poss. Day Time
Naps, Easier To
Fall Asleep
Yang Xu Chronic
(Deficient
Cold
Condition)
Notes:
Clear Yang Gets
Pulled Down By
Dampness.
Notes:
Blood Deficiency.
Restless, But
Exhausted. Tired,
Weak, Due To
No Functional
Quality of:
Emotions
Yin Xu - Chronic
(Deficient Heat
Condition)
Yang Xu Chronic
(Deficient
Cold
Condition)
Energy, Restless.
Motivation.
Energy, True
Weakness.
Angry, Anxious,
Agitated, Restless
All The Time.
Angry And
Anxious, But Less
Energy Behind
The Emotion.
Clinical, Mental,
Or Neurological
Disorders.
Sad,
Depressed, No
Motivation,
Cannot
Interact,
Afraid, Low
Self Esteem.
Notes:
Two Types Of
Mental Illness.
Phlegm Misting
The Heart: Not
Social, Hide In A
Corner. Phlegm
Heat
Attacks/Invades
The Heart.
Speech
Loud, Rapid,
Talks A Lot.
Speaks Quickly,
But Not Loud Or
Strong.
Slow Speech,
Heavy Or Phlegmy
Voice, Speech
Disorders, Esp.
W/Tongue
Swelling.
Slow And
Weak. Mainly
Yes Or No
Answers.
Body
Temperature
Cold, Sensitive To
Cold.
Very Cold,
Sensitive To
Cold.
Appearance
Perspiration
Eyes
Nose
Ears
Pain
Gums
Sleep
Menses
Throat
Colours of the Face
Meaning
Yang Qi Xu
Withered White
Blood Xu
Jaundice
Bright Orange
Meaning
Smoky Dark
Blood and Qi Xu
Infantile Convulsion
Kidney Yang Xu
Appearance
Meaning
Exhaustion of Essential Qi
Blood Xu
Extended Neck
Facing Downward
Appearance
Meaning
Wei Syndromes
Bi Syndromes
Eyes
Meaning
Yellow Sclera
Jaundice
Ulceration or Canthus
Damp Heat
Liver Wind
Nose
Meaning
Clear Discharge
Wind Cold
Turbid Discharge
Wind Heat
Ears
Meaning
Purulent Discharge
Gums
Meaning
Pale Gums
Blood Xu
Stomach Fire
Meaning
Pale Lips
Blood Xu
Excess Heat
Xu
Excess
Throat
Meaning
Throat
Meaning
Meaning
Chills Accompanied by Fever (External Pathogen Fighting with Antipathogenic Qi (Zheng Qi))
Severe Chills, Mild Fever, Absence of Sweating,
Headache, General Aching, and a Superficial Tight
Pulse
Wind Cold
Wind Heat
Intermediate Syndrome
Malaria
Tidal Fever
Yin Xu
Meaning
Yangming Fu Syndrome
Interior Cold Xu
Perspiration
Meaning
Qi and Yang Xu
Meaning
Meaning
Sour Regurgitation
Tastelessness
Spleen Xu
Meaning
Loose Stools
Yellow Urine
Heat Syndrome
Meaning
Turbid Urine
Red Urine
Pain
Meaning
Qi Stagnation
Blood Stagnation
Colicky Pain
Liver Wind
Pain
Meaning
Xu Cold Syndrome
Headaches
Chest Pain
Hypochondriac Pain
Abdominal Pain
- Upper is SP
- Lower is KI, BL, LI, SI, Uterus
- Sides are LIV
Lumbago
Pain
Meaning
Excess Condition
Xu Condition
Sleep
Meaning
Menses
Meaning
Blood Xu
Menses
Meaning
Qi and Blood Xu
Weak Constitution
Over Exertion
Common cause of disease in West.
Need to have balance of rest and exercise.
When we work or exercise we use up Qi; when we rest we restore Qi.
(Post-Heaven Qi, i.e., Qi transformed from food and drink on a daily basis).
In daily activities we use Qi: Jing provides material base for long term changes but is foundation of
our inner strength and vitality.
Qi used in normal work and exercise is quickly replenished by proper food and rest. (If your patient
appears weak and depleted, ask about recent excesses of work or study or lack of sleep).
Qi is used up quickly but rapidly restored.
If overwork occurs over months or years, Qi cannot be restored quickly enough by Spleen. Person
then draws on the Jing as a reserve. This way the Jing can become depleted and signs of Deficiency
of Yin may begin to appear. This situation takes a long time to remedy.
Mental Overwork
Very common in western society: long hours of stress and mental activity very common together
with irregular meals taken in hurry. These things affect Stomach, Spleen and Kidneys. Irregular diet
(or eating late at night) can cause deficient Stomach Qi or Stomach Yin.
Physical Overwork
Depletes primarily Spleen Qi (SP dominates flesh and muscles). However, excessive physical exercise
also demands that the Liver supply its Blood and Yin to the tendons/muscles; therefore excessive
exercise can deplete Liver Blood and Yin (including workouts).
Excessive use of one part of body (i.e., repetitive movement) can cause Qi to stagnate in that part.
Excessive lifting weakens Kidneys and lower back.
Excessive standing weakens the Kidneys.