Diagnostic o

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General Compiler-in-Chief ZUOYanfu
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Translators-in-Chief
ZHU Zhongbao, HUANG Yuezhong ,TAO Jinwen, Li Zhaoguo
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hanghai University of Traditional Chnese Medicini
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Hit I Inglish-Chinese Library
|*iIi(ional Chnese Medicine
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Compiled by Nanjing University of

Traditional Chnese Medicine
Translated by Shanghai University
of Traditional Chnese Medicine
iHniitl < mpler-in-Chief ZUOYanfu
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mi.i.i<ii in-Chief
Hhon()t)<io, HUANG Yuezhong ,TAO Jnwen, Ll Zhaoguo
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D IA G N O S T IC S O F T R A D IT IO N A L C H IN E S E
Examiner-in-Chief
Compiler-in-Chief
Vice-Compilers-in-Chief
Translators-in-Chef
Vice-Translators-in-Chief
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Ll Guoding
WANG Lufen
YUE Peiping
TANG Chuanjian
Ll Zhaoguo
BAO Bai
DONG Jing
CAO Lijuan
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SliMtixhni Pujian# Education Press (Shanghai University of Traditional ('hiese Medicine

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I00 C'aiLun Koad Shanghai, 201203, China
I )MKnostics of Traditional Chnese Medicine

( ompiler-in-Chief Wang Lufen
Translator-in-Chief Li Zhaoguo
Bao Bai
( A Nt'wly Compiled Practical English-Chinese Library of TCM General Compiler-in-Chief

Zuo Yanfu)
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise* without the prior permission in writing of the Publisher.
H 3 J ttS (C iP )jH tS
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Compilation Board o f the Library

Honorary Director
General Advisor
Advisors
Zhang Wenkang
Chen Keji
(Listed in the order of the number of strokes in the Chinese ames)
Gan Zuwang
You Songxin
Liu Zaipeng
Xu Zhiyin
Sun Tong
Song Liren
Zhang Minqing
Jin Shi
Jin Miaowen
Shan Zhaowei
Zhou Fuyi
Shi Zhen
Xu Jingfan
Tang Shuhua
Cao Shihong
Fu Weimin
International Advisors
Scarsella (Italy)
Maciocia (Britain)
(Japan)
S. Khan (Ireland)
Raymond K. Carroll (Australia)

David Molony (America)
Alessandra Gul (Italy)
Secondo
Shulan Tang (Britain)
Glovanni
Tzu Kuo Shih (America)
Isigami Hiroshi
Helmut Ziegler (Germany)
Director
Xiang Ping
Executive Director
Zuo Yanfu
Executive Vice-Directors
Vice-Directors
Members
Ma Jian
Du Wendong
Huang Chenghui
Wu Kunping
Chen Diping
Cai Baochang
Li Zhaoguo
Liu Shenlin
Wu Mianhua

Wan Lisheng
Wang Xu
Wang Lingling Wng Lufen
Lu Zijie
Shen J unlong
Liu Yu
Liu Yueguang
Yan Daonan
Yang Gongfu
Min Zhongsheng
Wu Changguo
Wu Yongjun
Wu Jianlong
He Wenbin
He Shuxun (specially invited)
He Guixiang
Wang Yue
Wang Shouchuan
Shen Daqing
Zhang Qing
Ding Anwei
Ding Shuhua
Wang Xudong
Yu Yong
Chen Tinghan (specially invited) Shao J ianmin
Chen Yonghui
Lin Xianzeng (specially invited)
Lin Duanmei (specially invited)
Yue Peiping
Jin Hongzhu
Zhou Ligao (specially invited)
Zhao Xia
Zhao Jingsheng
Hu Lie
Hu Kui
Zha Wei
Yao Yingzhi
Yuan Ying
Xia Youbing
Xia Dengjie
Ni Yun
Xu Hengze
Guo Haiying
Tang Chuanjian
Tang Decai
Ling Guizhen (specially invited)
Tan Yong
Huang Guicheng
Mei Xiaoyun
Cao Guizhu
Zeng Qingqi
Zhai Yachun
Fan Qiaoling
Jiang Zhongqiu

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Translation Committee o f the Library

Advisors
Shao Xundao
Translators-in-Chief
Ou Ming
Zhu Zhongbao
Executive Translator-in-Chief
Vice-Translators-in-Chief
Huang Yuezhong
Tao Jinwen
Li Zhaoguo
(Listed in the order of the number of strokes in the Chinese
ames)
Xun Jianying
Li Yongan
Zhang Qingrong
Zhang Dengfeng
Yang Hongying
Huang Guoqi Xie Jinhua

Translators
Yu Xin
Wang Ruihui
Tian Kaiyu
Shen Guang
Lan Fengli
Cheng Peili
Zhu Wenxiao
Zhu Yuqin
Zhu Jinjiang
Zhu Guixiang
Le Yimin
Liu Shengpeng
Li Jingyun
Yang Ying
Yang Mingshan
He Yingchun
Zhang Jie
Zhang Haixia
Zhang Wei
Chen Renying
Zhou Yongming
Zhou Suzhen
Qu Yusheng
Zhao J unqing
Jing Zhen
Hu Kewu
Xu Qilong
Xu Yao
Guo Xiaomin
Huang Xixuan
Cao Lijuan
Kang Qin
Dong Jing
Qin Baichang
Zeng Haiping
Lou Jianhua
Lai Yuezhen
Bao Bai
Pei Huihua
Xue Junmei
Dai Wenjun
Wei Min
Office of the Translation Committee

Director
Yang Mingshan
Secretaries
Xu Lindi
Chen Li
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Approval Committee o f the Library

Director
Li Zhenji
Vice-Directors
Shen Zhixiang
Chen Xiaogu
Gan Zuwang
Jiang Yuren
Zhou Zhongying
Wang Canhui
Members ( Listed in the order of the number of strokes in the Chinese ames)
Ding Renqiang
Ding Xiaohong
Wang Xinhua
You Benlin
Shi Yanhua
Qiao Wenlei
Yi Sumei
Li Fei
Li Guoding
Yang Zhaomin
Lu Mianmian
Chen Songyu
Shao Mingxi
Shi Bingbing
Yao Xin
Xia Guicheng
Gu Yuehua
Xu Fusong
Gao Yuanhang
Zhu Fangshou
Tao Jinwen
Huang Yage
Fu Zhiwen
Cai Li
General Compiler-in-Chief
Zuo Yanfu
Executive Vice-General-Compilers-in-Chief
Ma Jian
Du Wendong
(Listed in the order of the number of strokes in the
Vice-General-Compilers-in-Chief
Chinese ames)
Ding Shuhua
Wang Xudong
Wang Lufen
Yan Daonan
Wu Changguo
Wang Shouchuan
Wang Yue
Chen Yonghui
Jin Hongzhu
Zhao Jingsheng
Tang Decai
Tan Yong
Huang Guicheng
Zhai Yachun
Fan Qiaoling
Office of the Compilation Board Committee

Directors
Ma Jian
Vice-Directors
Publisher
Du Wendong
Wu Jianlong
Zhu Changren
Zhu Bangxian
Chinese Editors
( Listed in the order of the number of strokes in the Chinese ames)
Ma Shengying
Wang Lingli
Wang Deliang
He Qianqian
Shen Chunhui
Zhang Xingjie
Zhou Dunhua
Shan Baozhi
Jiang Shuiyin
Qin Baoping
Qian Jingzhuang
Fan Yuqi
Pan Zhaoxi
English Editors
Shan Baozhi
Cover Designer
Wang Lei
Layout Designer
Xu Guomin
Jiang Shuiyin
Xiao Yuanchun
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Foreword
As we are walking into the 21st century,
x m m m A 2i t * a , A A
'health for all is still an important task for the

World Health Organization (W H O) to accomplish in
w & M m w i& o
the new century. The realization of health for all

requires mutual cooperation and concerted efforts of
various medical sciences, including traditional medi
cine. W HO has increasingly emphasized the development of traditional medicine and has made fruitful
sm'Simu
efforts to promote its development. Currently the

spectrum of diseases is changing and an increasing
number of diseases are difficult to cure. The side
effects of chemical drugs have become more and
more evident. Furthermore, both the governments
and peoples in all countries are faced with the problem of high cost of medical treatment. Traditional
Chinese medicine (T C M ), the complete system of
traditional medicine in the world with unique theory
and excellent clinical curative effects,
basically
feJ)tSIKjfg<, Sil
'* s ts* e n
meets the need to solve such problems. Therefore,

bringing TCM into full play in medical treatment and
healthcare will certainly become one of the hot
points in the world medical business in the 21st cen
tury.
Various aspects of work need to be done to pro

mote the course of the intemationalization of TCM,
especially the compilation of works and textbooks
suitable for international readers. The impending
new century has witnessed the compilation of such a
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Foreword
21 it t f i." A A
As we are walking into the 21st century,

health for all is still an important task for the
World Health Organization (W H O) to accomplish in
the new century. The realization of health for all
rcquires mutual cooperation and concerted efforts of
various medical sciences, including traditional medi
cine. W H O has increasingly emphasized the development of traditional medicine and has made fruitful
efforts to promote its development. Currently the
spectrum of diseases is changing and an increasing
number of diseases are difficult to cure. The side
0 ,I b # t i
effects of chemical drugs have become more and
rft
more evident. Furthermore, both the governments

and peoples in all countries are faced with the problem of high cost of medical treatment. Traditional
Chinese medicine (T C M ), the complete system of
traditional medicine in the world with unique theory
and excellent clinical curative effects,
a * .# # *
basically
meets the need to solve such problems. Therefore,

bringing TCM into full play in medical treatment and
healthcare will certainly become one of the hot
points in the world medical business in the 21st cen
tury.
Various aspects of work need to be done to pro
mote the course of the intemationalization of TCM,
especially the compilation of works and textbooks
suitable for international readers. The impending
new century has witnessed the compilation of such a
series of books known as A Newly Compiled

Vractical English-Chinese Library o f Traditional
Chinese Medicine published by the Publishing House
of Shanghai University of TCM, compiled by Nanjing University of TCM and translated by Shanghai
University of TCM.
Professor Zuo Yanfu,
the
general compileiîn-chief of this Library, is a person

who sets his mind on the intemational dissemination
of TCM. He has compiled General Suruey on TCM
Abroad, a monograph on the development and state
of TCM abroad. This Library is another important
works written by the experts organized by him with
the support of Nanjing University of TCM and
Shanghai University of TCM.
The compilation of
this Library is done with consummate ingenuity

and according to the development of TCM abroad.
The compilers, based on the premise of preserving
the genuineness and gist of TCM , have tried to
make the contents concise, practical and easy to
understand, making great efforts to introduce the
abstruse ideas of TCM in a scientific and simple
way as well as expounding the prevention and
treatment of diseases which are commonly encountered abroad and can be effectively treated by
TCM.
This Library encompasses a systematic summarization of the teaching experience accumulated in

Nanjing University of TCM and Shanghai University
of TCM that run the collaborating centers of tradi
tional medicine and the intemational training centers
on acupuncture and moxibustion set by WHO. I am
sure that the publication of this Library will further
promote the development of traditional Chinese med-
Foreword
k ine
abroad and enable the whole world to have a
j f c j f B|p] 0
l tter understanding of traditional Chinese med

icine.
Professor Zhu Qingsheng
Vice-Minister
of
Health
Ministry
of
the
Peoples Republic of China

Director of the State Administrative Bureau of
TCM
December 14, 2000 Beijing
2000 ^ 12 ^ 14 B T & M
Foreword n
Before the existence of the modern medicine,
Imman beings depended solely on herbal medicines
mid other therapeutic methods to treat diseases and
#, & Mr mtuif g ira it,r
preserve health. Such a practice gave rise to the esl/iblishment of various kinds of traditional medicine
s e ^ r & ie # ^ .
wilh unique theory and practice," such as traditional
A &
( hiese medicine,
+ e # j
f* SE E rn + W -
Indian medicine and Arabian
medicine, etc. Among these traditional systems of

medicine, traditional Chinese medicine is a most ex-
? A 21 m S.
traordinary one based on which traditional Korean

medicine and Japanese medicine have evolved.
Even in the 21st century, traditional medicine is
siill of great vitality. In spite of the fast develop
* i 3 ,A t] J tN IM tE # M flH I
M T IS U M fl P M .
ment of modern medicine, traditional medicine is

f
lili disseminated far and wide. In many developing
nmntries, most of the people in the rural areas still
depend on traditional medicine and traditional medi
M iM S * . 3 S ft E ^ i # ilf e
cal practitioners to meet the need for primary healthnirc. Even in the countries with advanced modern
medicine' more and more people have begun to acci'pt traditional medicine and other therapeutic meth-
Aw m g
<kIs , such as homeopathy, osteopathy and naturopa-
ihy, etc.
With the change of the economy, culture and

living style in various regions as well as the aging in
the world population,
the disease spectrum has
chnnged. And such a change has paved the way for

the new application of traditional medicine. Besides,
g E # r T * fW ffl.li5 fl f
the new requirements initiated by the new diseases

and the achievements and limitations of modern med
. a re -# * * o
icine have also created challenges for traditional med
m R-f-E 20 f i f i 70
icine.
WHO sensed the importance of traditional medi
cine to human health early in the 1970s and have
1976
made great efforts to develop traditional medicine.

At the 29th world health congress held in 1976, the
jL t k m m M x m f M o
item of traditional medicine was adopted in the

working plan of WHO.
In the following world
health congresses, a series of resolutions were passed to demand the member countries to develop, utilize and study traditional medicine according to their
specific conditions so as to reduce medical expenses
for the realization of health for all.
W HO has laid great stress on the scientific content, safe and effective application of traditional
medicine. It has published and distributed a series of
l>ooklets on the scientific, safe and effective use of
herbs and acupuncture and moxibustion. It has also
made great contributions to the intemational stand
ardizaron of traditional medical terms. The safe and
effective application of traditional medicine has much
to do with the skills of traditional medical practitioners. That is why W H O has made great efforts to
train them. W H O has run 27 collaborating centers
l& n m 27
in the world which have made great contributions to

the training of acupuncturists and traditional medical
practitioners.
Nanjing University of TCM
and
Shanghai University of TCM run the collaborating

centers with WHO. In recent years it has, with the
mm
coo|>eration of W H O and other countries, trained
is*
x m t f t jiZ m m & L m *
al>oiit ten thousand intemational students from over
f . 1 l l l T 5 T 4 5 * a 90
Koreword II
DO countries.
In order to further promote the dissemination of
i m * E 2 ? ; * : # ] S
traditional Chinese medicine in the world, A Newly

( \mpiled P radical English-Chinese Library o f
Traditional Chinese Medicine, compiled by Nanjing
f ' f i K
University of TCM with Professor Zuo Yanfu as the
m m . m sm & * e s ma &.
#
a--m m m s t % * e na*
Hii(*ral compileHn-chief and published by the Pub-
i S
I ,
linlung House of Shanghai University of TCM, aims

Al Mystematic, accurate and concise expounding of
Irwliiional Chinese medical theory and introducing
H +E
Itocording to modern medical nomenclature of disea-
ftff # * % * en4>E m w% n tt
t.
. Undoubtedly, this series of books will be the
IR lE & lf
Mlnical therapeutic methods of traditional medicine
k iic tical text books for the beginners with certain

Bn^lish level and the intemational enthusiasts with
Mrtnin level of Chinese to study traditional Chinese
tlirdicine. Besides, this series of books can also
irrvr as reference books for W H O to internationally
I
(Inndiirdize the nomenclature of acupuncture and
Moxihustion.
The scientific. safe and effective use of tradi-
ftloruil medicine will certainly further promote the deV*lopment of traditional medicine and traditional
lunlicine will undoubtedly make more and more conIrlliutions to human health in the 21st century.
Zhang Xiaorui
* *
W H O Coordination Officer
December, 2000
2000 i f 12|]
Pre face
The Publishing House of Shanghai University
O TCM published A Practical English-Chinese Li-
1 9 9 0 ^ i ) K T - * < ( ( ^ M ) $
brury o f Traditional Chinese Medicine in 1990.
, ? t 10
A.XfltS +EI
nhe Library has been well-known in the world ever

llce and has made great contributions to the disletnination of traditional Chinese medicine in the
World.
In view of the fact that 10 years has passed
lince its publication and that there are certain errors

Iti the explanation of traditional Chinese medicine in
the Library, the Publishing House has invited NanjiiiK University of TCM and Shanghai University of
TCM to organize experts
to recompile and transate
m 0
lile Library.
Nanjing University of TCM and Shanghai Uni[VrMity of TCM are well-known for their advantages
* # * J 7 lM C + E
in liigher education of traditional Chinese medicine

mui compilation of traditional Chinese medical textIxKks.
The compilation of A Newly Compiled
W H O f g tlk
Jpradical English-Chinese Library o f Traditional

( lmese Medicine has absorbed the rich experience
ncc umulated by Nanjing University of Traditional
( lmese Medicine in training intemational students
n i
traditional Chinese medicine. Compared with the
l'i'evious Library, the Newly Compiled Library has

fllide great improvements in many aspeets, fully
iUSifefl1
+ E f f B f c t r f t . tfW
il. iuonstrating the academic system of traditional

( hiese medicine. The whole series of books has
nyMtcmatically introduced the basic theory and thera-
m frZ B T 236 #<*>25,152 t #1(1

loo
peutic methods based on syndrome differentiation,

expounding traditional Chinese pharmacy and prescriptions; explaining 236 herbs, 152 prescriptions
and 100 commonly-used patent drugs; elucidating
7o
264 methods for differentiating syndromes and treating commonly-encountered and frequently-encountered diseases in internal medicine, surgery, gyne-
38
% m R 20 &##jALSHEift + Ef!f
cology, pediatrics, traumatology and orthopedics,
flms 296m.
ophthalmology and otorhinolaryngology; introducing

the basic methods and theory of acupuncture and
mm 3o
moxibustion, massage (tuina), life cultivation and
m m jp :h , % m sm m ufe
rehabililation, including 70 kinds of diseases suitable
2 g lW S W ilfe E f# + E # * ,
for acupuncture and moxibustion, 38 kinds of disea
fta
ses for massage, examples of life cultivation and
A .
,k
f m
+ E ^ j I ll r J ? ,
over 20 kinds of commonly encountered diseases

treated by rehabilitation therapies in traditional Chi
nese medicine. For better understanding of tradition
al Chinese medicine, the books are neatly illustrated. There are 296 line graphs and 30 colored pietures in the Library with necessary indexes, making
it more comprehensive, accurate and systematic in
disseminating traditional Chinese medicine in the
countries and regions where English is the official
language.
This Library is characterized by following features:

1. Scientific
( 1)
10
Based on the development of
* + E * m # B F & ftS r *
TCM in education and research in the past 10 years.
fe + e # *
efforts have been made in the compilation to highlight the gist of TCM through accurate theoretical
(Sj t i ? # m * m um
exposition and clinical praetice, aiming at introdu
E l ? # * ( 2)
cing authentic theory and practice to the world.
e i * E * BB m. ife h i + E & r
2. Systematic
This Library contains 14 sepa-
m m w 4
ni ir fascicles, i. e. Basic Theory o f Traditional

hiese Medicine,
i hiese Medicine,
Diagnostics o f
+ E * M 4 * M * E J4
Traditional
Science o f Chinese Materia
#,+e re#k i +e^ # m
Medica, Science o f Prescriptions, Intemal Medi

cine o f Traditional Chinese Medicine, Surgery o f
-rftM,XM
+E
Traditional Chinese Medicine, Gynecology o f Tra

dicional Chinese Medicine, Pediatrics o f Tradition
al ( hiese Medicine, Traumatology and Orthopedics
o f Traditional Chinese Medicine, Ophthalmology
iST * * 6 9 i l S U # , f c t S i
of Traditional Chinese Medicine, Otorhinolaryn-
200
gology o f Traditional Chinese Medicine, Chinese

Acupuncture
and
Moxibustion,
Chinese Tuina
( Massage) , ara/ Lz/e Cultivation and Rehabilita

ron o f Traditional Chinese Medicine.
3. Practical
mmi%, # wir m# e$
M i(4 ) M
Compared with the previous Librar-
y, the Newly Compiled Library has made great im-
& & ? ,X f > E i 8 8 i$ M T T M
pi'ovements and supplements, systematically introducing therapeutic methods for treating over 200 kinds of
commonly and frequently encountered diseases, foCusing on training basic clinical skills in acupuncture
mui moxibustion, tuina therapy, life cultivation and
Khabilitation with clinical case reports.
4. Standard
This Library is reasonable in
(tructure, distinct in categorization, standard in terminology and accurate in translation with full considrrnlion of habitual expressions used in countries and
rcgions with English language as the mother tongue.
This series of books is not only practical for the

licginners with certain competence of English to
n u * e # %
xtudy TCM, but also can serve as authentic textlxx>ks for intemational students in universities and
colleges of TCM in China to study and practice
T( M For those from TCM field who are going to go
m m m . isjfftffc * e tba am it
abroad to do academic exchange, this series of books

will provide them with unexpected convenience.
Professor Xiang Ping, President of Nanjing

University of TCM, is the director of the Compila
I f i
tion Board. Professor Zuo Yanfu from Nanjing Uni

versity of TCM, General Compiler-in-Chief, is in
charge of the compilation. Zhang Wenkang, Minister of Health Ministry, is invited to be the honorary
director of the Editorial Board. Li Zhenji, Vice-Di-
,a
* B25HS $ Sl I'm I
tfistia
km
rector of the State Administrative Bureau of TCM,

is invited to be the director of the Approval Commiti c. Chen Keji, academician of China Academy, is
invited to be the General Advisor. International ad
visors invited are Mr. M. S. Khan,Chairman of Ireland Acupuncture and Moxibustion Fund;
Miss
Alessandra Gul, Chairman of Nanjing Association

in Rome, Italy; Doctor Secondo Scarsella, Chief Ed
itor of YI DAO ZA ZHI; President Raymond K.
,m H * E
Carroll from Australian Oriental Touching Therapy

College; Ms. Shulan Tang, Academic Executive of
ATCM in Britain; Mr.
+'ll'iS
,18a +E 4
Glovanni Maciocia from
Britain; Mr. David, Chairman of American Associa

tion of TCM; Mr. Tzu Kuo Shih, director of Chi
nese Medical Technique Center in Connecticut, A-
m.t5t 4
# jm^ %t t
merica; Mr. Helmut Ziegler, director of TCM Cen

ter in Germany; and Mr. Isigami Hiroshi from Japan. Chen Ken, official of W H O responsible for the
Western Pacific Regin, has greatly encouraged the
>w h o
compilers in compiling this series of books. After

the accomplishment of the compilation, Professor
Zliu Qingsheng, Vice-Minister of Health Ministry
i.
and Director of the State Administrative Bureau of
w ti * i " i v mi in, i ', 0 ''h ';U P5fc
TCM, has set a high valu on the books in his fore-
i iKii+iViMWi'fir
Proface
Word for the Library.
Zhang Xiaorui, an official
front W H O s Traditional Medicine Program, has

|mid great attention to the compilation and written a
forcword for the Library. The officials from the edunilmnal organizations of China in other countries
hit ve provided us with some useful materials in our
compilation. They are Mr.
Zhang Yiqun, China
Cnsul to Manchester in Britain; Miss Yan Meihua,

Cnsul to Houston in America; Mr. Wang Jiping,
l'irst Secretary in the Educational Department in the
Knibassy of China to France; and Mr. Gu ShengyiriK the Second Secretary in the Educational Departmnit in the Embassy of China to Germany. We are
Kinteful to them all.
The Compilers
December, 2000
2000 p 12 ) j
Note for Compilation

Diagnostics of TCM is a subject concentrating on
diagnosis of diseases and differentiation of syndromes
(hrough examination based on the theory and methodology of TCM. It serves as a bridge to connect the
l>asic theory of TCM with clinical specialties and is
the essential course for all clinical subjects.
E ffi# :# # s u .
% 4* e
This book, focusing on elucida tion of the theory

and methods of TCM in examining pathological conditions as well as analyzing and differentiating syn
dromes, is composed of introduction,
diagnostic
methods and syndrome differentiation. It is a sys
3fctt*M -5'*E*IJSifc>2k
tematic in itself and, at the same time, keeps a cise

association with the clinical specialties so as to pre
serve the systematic and integral characteristics of
TCM.
In the compilation, the authors have tried to
preserve the unique features of TCM and demn
strate the profound conten of TCM diagnostics on
one hand, and unite theory and practice so as to
Kiiide the clinical practice on the other. In the com
pila tion, the authors have also tried to make it coni ise, easy to read, fluent and accurate. For this pur-
a # ,
|x)se, some illustrations and colour pictures are included. We hope that this book will be beneficial to
lx>th the intemational students with certain level of

Chinese in learning traditional Chinese medicine and
lite readers in China who are studying traditional Ch
nese medicine or going abroad.
t b a m
Contents
Introduction
................................................................................. ..................................... i
1.......................................................................................................... Diagnostic m ethods ..... 7

1.1
Inspection.................................................................................................................. 8
1.1.1
Inspection of the whole body............................................................................ 8

.................................................................... .............. 9
1. 1.1.1 Inspection of spirit
1. 1. 1. 2 Inspection of complexin
1. 1. 1. 3 Inspection of body
........................................................................ 12
.................................................................................... 17
1. 1. 1. 4 Inspection of postures................................................................................ 19
1. 1. 2
Inspection of local regions
............................................................................ 22
1. 1. 2. 1 Inspection of head and hair
.................................................................... 22
1. 1. 2. 2 Inspection of the five sense organs
......................................................... 25
1. 1. 2. 3 Inspection of neck
.................................................................................... 30
1. 1. 2. 4 Inspection of skin
................................................................................... 31
1.1. 2. 5 Inspection of infantile index finger veins ................................................. 35

1.1. 2. 6 Inspection of excreta
1.1. 3
................................................................................ 38
Inspection of tongue ....................................................................................... 42
1. 1. 3.1 Methods for inspection of tongue ............................................................ 42

1. 1. 3. 2 Normal states of the tongue .................................................................... 44
1. 1. 3. 3 Inspection of the tongue body
................................................................ 44
1. 1. 3. 4 Inspection of tongue fur ............................................................................ 52

1. 1. 3. 5 Comprehensive analysis of the body of the tongue and tongue fu r .......... 58
1. 2
Listening and olfaction ........................................................................................... 60
1. 2. 1
Listening to sounds ....................................................................................... 60
1. 2. 1. 1 Speech ....................................................................................................... 61
1. 2. 1. 2 Respiration ............................................................................................... 63
1. 2. 1. 3 Cough
....................................................................................................... 65
1. 2. 1.4 Hiccup and belching

1.2.2
Olfaction
................................................................................ 66
..................................................................................................... *67
1. 2. 2.1 Smelling body odor .................................................................................... 68
&
..................................................................................................................................... i
* - *
................ *........................................................................................ 7
.....................................................................................
mmm.............................................................8
(-) a # .................... ....................................... 9
( ) SESfe................................................................................................... 12
( = ) S B ft ................................................................................................... 17
( 0 ) a & & .................................................................................................................19
mmmm u
_ >
................................................................................................22
< - ) a t - % .............................................................................................................22
( - > a s t ................................................................................................... 25
(= )
MMtfi.................................................................................................................30
(ES) a & a * ................................................................................................... 31

( 1 ) a/W
................................................................................................. 35
( * > mm t i ................................................................................................38
=> a
.........................................................................................................................42
< - ) a s w * - .........................................................................................................42
C ) i E # S ^ ............................................................................................... 44
( = ) a f t ................................................................................................................44
era) a s ^ .............................. ................................................................................. 52
(3D
% ^-f
........................................................................... 58
qfy...................................................................................................... 60
JP# ..................................................................................................... 60
( *) ifl s .............................*................... *............ *........... ............. ............ 61
( - ) Bf...................................................................................................... 63
(H ) &0C...................................................................................................... 65
(0 )
....................................................................................................... 66
l ^ f : ........................................................................................ ............. 67
( - > v& m frZK ...........................................................................................................68
!('x>ntents
1. 2. 2. 2 Odor in the room....................................................................................... 69

1.3
Inquiry
.................................................................................................................. 69
1.3.1
General information ....................................................................................... 70
1. 3. 2
Inquiry of chief complaint and history of present illness .............................. 71
1. 3. 2. 1 Inquiry of chief complaint ........................................................................ 71

1. 3. 2. 2 Inquiry of the history of present illness
1. 3. 3
Inquiry of the present symptoms
................................................. 72
................................................................ 73
1. 3. 3. 1 Inquiry of fever and coid............................................................................ 73

1. 3. 3. 2 Inquiry of sweating ................................................................................... 80
1. 3. 3. 3 Inquiry of pain ........................................................................................... 84
1. 3. 3. 4 Inquiry of sleep
....................................................................................... 90
1. 3. 3. 5 Inquiry of diet and partiality .................................................................... 92

1. 3. 3. 6 Inquiry of urination and defecation
........................................................ 97
1. 3. 3. 7 Inquiry of the head and face.................................................................... 102

1. 3. 3. 8 Inquiry of chest and abdomen ................................................................ 106
1. 3. 3. 9 Inquiry of the symptoms over the loins, back and four limbs .............. 108
1. 3. 3. 10 Inquiry of symptoms in andropathy ..................................................... 109
1. 3. 3. 11 Inquiry of symptoms in gynecology
..................................................... 111
1. 3. 3. 12 Inquiry of symptoms in pediatrics ........................................................ 114

1.3.4
Inquiry of anamnesis ................................................................................... 116
1. 3. 4. 1 Inquiry of past physique

1. 3. 4. 2 Inquiry of previous illness
I. 3. 5
1.4
Inquiry of family history
........................................................................ 117
.................................................................... 117
............................................................................ 117
Iulse-taking and palpation ................................................................................... 118
1. 4. 1 Pulse-taking................................................................................................... 118
1.4. 1. 1 Regions and methods for taking pulse..................................................... 119
1. 4.1. 2 Normal pulse .................................................................................. ........ 123
1. 4.1. 3 Morbid pulse ........................................................................................... 125
1.4.2
Palpation ...................................................................................................... 131
1. 4. 2. 1 Methods for palpation ........................................................................... 132

1. 4. 2. 2 Pressing the chest and abdomen ............................................................ 133
1. 4. 2. 3 Palpation of the four limbs .................................................................... 136
1. 4. 2. 4 Palpation of acupoints ........................................................................... 137
@ a
(- )
...................................................................................................... 69
w * ........................................................ ............................................. 69
r a - H t s , ................................. ....................................................................... 7fl
................................................................................................... 71
(- )
.............................................................................................................. 71
(.-) nim*............................................................. 7s
H , ( q S E S S tt .......................................................................................................... 7!
( - ) |S15S^.............................................................................................................. 7( - ) R ?T ..................................................................................................................80
(H )
84
( 0 ) N8S8R.............................................................................................................. 90
(E )
...................................................................................................... 92
(7 n)
.............................................................................................................. 97
(- t)
.................................................................................... 102
(A ) ffi])WM .................................................................................... 10<
( * ,) N S iW 0 S K ........................................................................................... O
(+) fsiz m & t k .................................................................... ios

(+-)
.................................................................. lll
(+ -)
................................................................................. 114
0 , (sjBEfeA.............................................................................................................. 116
(- )
........................................................................................... 117
( n ) .fp is !ta ,s ^ ifa ............................................................................. 117

s , (smm$............................................................................................... 117
gra? fe;#- ............................................................................ lia

................................................................................................................... na
( - ) .................................. ....................................................................................... lis
( ~ ) # n ................................................................................................................ 12;
(H) ^) ............................................................................ 12S

,
......................................................................................................................131
( )
( ) ffiJ M
..................................................................................................
132
.......................................................................................................... 133
CH) J0 Jft .......................................................................................................... 136

( 0 ) & J A .......................................................................................................... 137
Differentiation of syndrome ............................................................................... 138

2. 1 Syndrome differentiation with eight principies .................................................... .138
2. 1. 1
Extemal and internal differentiation of syndromes ..................................... .139
2.1. 1. 1 Extemal syndrome
............................................................................... .140
2.1. 1. 2 Internal syndrome ....................................................................................141

Appendix: Half external and half internal syndrome
2. 1. 2
Syndrome differentiation of coid and heat
................................. ........142
..................................................142
2. 1. 2. 1 Coid syndrome ....................................................................................... .143

2. 1. 2. 2 Heat syndrome ....................................................................................... .144
2. 1. 3
Syndrome differentiation of asthenia and sthenia
2. 1. 3. 1 Asthenia syndrome
..................................... .145
............................................................................... .145
2. 1. 3. 2 Sthenia syndrome .................................................................................. .147

Z. 1. 4
Syndrome differentiation of yin and yang.................................................... .148
2. 1. 4. 1 Yin syndrome and yang syndrome
........................................................ .148
2. 1. 4. 2 Yin asthenia syndrome and yang asthenia syndrome ...............................150

2. 1. 4. 3 Yin depletion syndrome and yang depletion syndrome ...........................152
2. 1. 5
Relationship among the eight principal syndromes ..................................... .154
2. 1. 5.1 Relationship between two principies in a pair
..................................... .154
2. 1. 5. 2 Relationship between different pairs of principies ................................. .167

2. 2
Syndrome differentiation of qi, blood and body fluid ......................................... .172
2. 2. 1
Syndrome differentiation of qi disorders .................................................... .172
2. 2. 1. 1 Qi asthenia syndrome
........................................................................... .173
2. 2. 1. 2 Qi sinking syndrome ............................................................................... .173

2. 2. 1. 3 Qi stagnation syndrome
.........................................................................174
2. 2. 1. 4 Qi reversin syndrome ...................................................................... ......175

2. 2. 2
Syndrome differentiation of blood disease
..................................................176
2. 2. 2. 1 Blood asthenia syndrome .........................................................................176

2. 2. 2. 2 Blood stasis syndrome ........................................................................... .177
2. 2. 2. 3 Blood coid syndrome ............................................................................... .179
2. 2. 2. 4 Blood heat syndrome............................................................................... .180
2. 2. 3
Syndrome differentiation of simultaneous disorder of qi and blood
.......... .181
2. 2. 3.1 Asthenia of both qi and blood .................................................................181

2. 2. 3. 2 Qi asthenia and hemorrhagia syndrome ..................................................182
2. 2. 3. 3 Depletion of qi with bleeding syndrome ..................................................183
2. 2. 3. 4 Qi nmhenifl and blood stasis syndrome
..................................................183
% -%
mvE
............................
/VraWtf.
.............
iRMUfiE......................
( - ) S E ........................
( ) ME ........................
Kh
.................
......................
(-> mw..............
( ) &E ......................
H> J$iE......................
( - ) f f i ........................
( _ ) m v E ........................
0 , mmm.......................
( - ) fflffifn r a ffi.............
( ) RAEfllSBtfE ....
( = ) tK E tP B iE ....
s, AMwmsm%:%.....
(-) n-Xt!mttS
( >
%=-f
^ jk ^ ^ E .
.........
, ^ v J ^ iiE ......................
C )
....................
( - ) n p g ffi ....................
(H ) 'n.ffiiiE ..................
( 0 ) 'tS E ....................
JLîWE.....................
() jfiLriE .................
(- :) f f i ...................
(= ) J t* E
....................
(E ) m
...................
= , 'n.jflllHlîiiE................
( - ) ^JfilWiiE ..........
( ~ ) ^ K iL iiE ............
( = ) ^M iJIftE ..........
( 0 ) ^JU&ijE ..........
2. 2. 3. 5 Qi stagnation and blood stasis syndrome

2.2.4
Syndrome differentiation of fluid disorder
2. 2. 4. 1 Insufficiency of body fluid
............................................. 184
................................................. 185
.................................................................... 185
2. 2. 4. 2 Phlegm syndrome ............................................................ ...................... 186

2. 2. 4. 3 Fluid-retention syndrome ........................................................................ 188
2. 2. 4. 4 Edema...................................................................................................... 189
B 2.3 Syndrome differentiation of viscera

1 2. 3.1
............................................................. 191
Syndrome differentiation of heart disease....................................................
192
2. 3. 1.1 Asthenia of heart qi ............................................................................... 192

2. 3.1. 2 Heart yang asthenia syndrome................................................................ 193
2. 3. 1. 3 Sudden loss of heart yang syndrome
2. 3. 1.4 Heart blood asthenia syndrome
.................................................... 195
............................................................ 196
2. 3. 1. 5 Heart yin asthenia syndrome ................................................................ 196

2. 3. 1.6 Heart vessels obstruction syndrome
..................................................... 197
2. 3. 1.7 Exuberance of heart fire syndrome ........................................................ 199

2. 3. 1. 8 Mind confusion by phlegm
.................................................................... 200
2. 3. 1. 9 Disturbance of the heart by phlegmatic fire

2. 3. 2
......................................... 201
Syndrome differentiation of lung disease .................................................... 202
2. 3. 2. 1 Pulmonary qi asthenia syndrome ............................................................ 203

2. 3. 2. 2 Lung yin asthenia syndrome.................................................................... 204
2. 3. 2. 3 Syndrome of wind coid encumbering lung ............................................. 205
2. 3. 2. 4 Wind heat invading lung syndrome ........................................................ 206
2. 3. 2. 5 Syndrome of dryness attacking lung
.................................................... 207
2. 3. 2. 6 Syndrome of accumulation of pathogenic heat in lung
.......................... 208
2. 3. 2. 7 Syndrome of phlegmatic dampness retention in lung ............................. 209

2. 3. 2. 8 Syndrome of confliction of wind and fluid in lung ................................. 210
2. 3. 3
Syndrome differentiation of spleen disease ................................................. 212
2. 3. 3. 1 Syndrome of asthenia of splenic qi ........................................................ 212

2. 3. 3. 2 Syndrome of asthenia of splenic yang .................................................... 213
2. 3. 3. 3 Syndrome of sinking of splenic qi
........................................................ 215
2. 3. 3. 4 Syndrome of failure of the spleen to govern blood................................. 216

2. 3. 3. 5 Syndrome of coid and dampness encumbering the spleen ...................... 217
2. 3. 3. 6 Syndrome of damp heat encumbering the spleen
2. 3. 4
................................. 218
Syndrome Differentiation of liver disease .................................................... 219
2. 3. 4. 1 Asthenia syndrome of liver blood
........................................................ 220
(E )
JLF E .................................................................................... 18
0 . # # E .......................................................................................................... 181
()
mtlKJS.SE .................................................................................... 18!
(- )
.............................................................................................................. 18(
(= ) tfcE .............................................................................................. 18
(0 ) *W
.............................................................................................................. 181
#.=.-
....................................................................................... 19
.............................................................................................................. 191
(-> AMHE ....................................................................................... 19|

< ) -iL'PBSffi ...................................................................................................... 19|
(= ) 4>PBMBfiE .................................................................................... 191

( 0 ) -ll'JfiLaE ...................................................................................................... 191
(E ) -OBHdlE ....................................................................................... id
( a)
................................................................................................... 19|
(-fc) '(>^C/LfiE .................................................................................................. 19!
(A ) gSj&t'SfiE .................................................................................... 20j

( A ) mAUt'-E .................................................................................................. 2<
..............................................................................................
201
( - ) B K W . ...................................................................................................... 2CH
( - ) >H*iE ....................................................................................... 20|

( H ) )xl3^)WiiE .................................................................................................. 2(M
(0 ) R M
# I
...................................................................................................20|
(1) mmw......................................................... 2
7*0
................................................................................................................................................................ 20!
(-fc)
.................................................................................... 20|
(A ) fl,*JWSE .................................................................................... 21
(
H , W ^D f E .............................................................................................................. 21
( - ) m ^ w ..........................................................................................................2i
(-)
wt-m&w....................................................................................... 2i
(= )
(0 ) w ^
.................................................................................................. 21
m
.................................................................................................. 2ii
(E ) M U $iE .................................................................................... 21
(A ) I f f i l S t t .................................................................................... 211
0 , ........................................................................................................................... f F ^ E
() JMllftSE ....................................................................................... 22(
2. 3. 4. 2 Syndrome of liver yin asthenia.................................................................221

2. 3. 4. 3 Syndrome of liver qi stagnation
............................................................ .222
2. 3. 4. 4 Syndrome of liver fire hyperactivity
.................................................... .223
2. 3. 4. 5 Syndrome of liver yang hyperactivity .................................................... .225

2. 3. 4. 6 Syndrome of endogenous liver w ind........................................................ .226
2. 3. 4. 7 Syndrome of coid stagnation in the liver meridian ................................. .230
2. 3. 5
Syndrome differentiation of kidney disease ..................................................231
2. 3. 5. 1 Syndrome of kidney yang asthenia ........................................................ .232

2. 3. 5. 2 Syndrome of edema due to kidney asthenia
......................................... .233
2. 3. 5. 3 Syndrome of kidney yin asthenia ............................................................ .234

2. 3. 5. 4 Syndrome of kidney essence insufficiency
..............................................235
2. 3. 5. 5 Syndrome of kidney qi weakness ............................................................ .236

2. 3. 5. 6 Syndrome of kidney failing to receive qi ..................................................238
2. 3. 6
Syndrome differentiation of stomach disease
..............................................239
2. 3. 6.1 Syndrome of stomach coid
.....................................................................239
2. 3. 6. 2 Syndrome of stomach heat
.....................................................................241
2. 3. 6. 3 Syndrome of food retention in the stomach
..........................................242
2. 3. 6. 4 Syndrome of asthenic stomach yin ........................................................ .243

2. 3. 7
Syndrome differentiation of gallbladder disease ......................................... .244
Syndrome of gallbladder stagnation and phlegm disturbance

2. 3. 8
Syndrome differentiation of small intestinal disease
............................. .245
................................. .246
Sthenic heat syndrome of small intestine ............................................................ .246

2. 3. 9
Syndrome differentiation of large intestinal disease..................................... .247
2. 3. 9. 1 Syndrome of large intestinal fluid consumption ..................................... .248

2. 3. 9. 2 Syndrome of large intestinal damp-heat ................................................ .249
2. 3. 10
Syndrome differentiation of bladder disease ..............................................250
Syndrome of damp heat in the bladder .................................................................250

2. 3. 11
Syndrome differentiation of accompanying diseases of viscera ...................251
2. 3. 11.1 Asthenia syndrome of heart and lung qi
..............................................252
2. 3. 11. 2 Asthenia syndrome of heart and spleen..................................................253

2. 3. 11. 3 Asthenia syndrome of heart and kidney yang ..................................... .254
2. 3. 11.4 Syndrome of disharmony between the heart and kidney .......................255
2. 3. 11. 5 Syndrome of lung and spleen qi asthenia ..............................................256
2. 3. 11. 6 Syndrome of spleen and kidney yang asthenia ..................................... .257
2. 3. 11.7 Syndrome of kidney and liver yin asthenia
..........................................258
( - ) SFBJffi (= )
(0 )
(2D fFPB/CE
(7a) IF K rtSliiE
(-fc) ffFJiiE
2 , ^HtfiE...........
( - ) ffP aîE ( - ) ft fc & v E
(=> m m u E (0 ) 'Jfffi*E
(2 )
(A )
7\, S ^ l f f E ..........
( - ) # E .......
( - ) B & E .......
( = ) t S S iE
(0 )
nmm -
- t, M ^ U f E ..........
f fiW & ttf fi .......
A , /J'mvE......
A-m ^m e ......
L, -fcffffliE.......
( ) ^ ( f ^ E
(- )
~K ^ P E .......
M ffi& iiE .......
+ - , K 9S *^ E
( - ) ' ^ iiE
( ) <l>lWiE
<=) i'tP B lfiE
( 0 ) -C /H ^ E
(3D M ID A S E
( A ) I PBffi
(-fc) JIFfflPlMME
I i
J
Control
11
22
2. 3. 11. 8 Syndrome of liver fire invading lung .................................................... .260
22
2. 3. 11. 9 Syndrome of imbalance between liver and spleen................................. .261
22
2. 3. 11. 10 Syndrome of incoordination between liver and stomach.......................262
22 !
2. 3. 11. 11 Syndrome of damp-heat in liver and gallbladder................................. .263
22
Other syndrome differentiation methods
............................................................ .265
23
23!
23!
'l, 4. 1 Introduction to six-meridians syndrome differentiation ...............................265
23
2. 4. 1. 3 Shaoyang syndrome ............................................................................... .270
. 2. 4. 1.1 Taiyang syndrome ....................... ;.......................................................... .266

2. 4. 1. 2 Yangming syndrome ............................................................................... .268
................................................................................... .271
23i
f 2. 4. 1. 4 Taiyin syndrome
23j
I 2. 4. 1. 5 Shaoyin syndrome ................................................................................... .271
23
23
23
23
24|
24!
241
2. 4. 1. 6 Jueyin syndrome
X. 1.2
................................................................................... .273
Introduction to syndrome differentiation of defensive qi, qi,

nutrient qi and blood ................................................................................... .274
2. 4. 2. 1 Defensive phase syndrome

, 2. 4. 2. 2 Qi phase syndrome
........................... ........................................ .275
............................................................................... .275
2. 4. 2. 3 Nutrient phase syndrome .........................................................................276

2. 4. 2. 4 Blood phase syndrome ........................................................................... .277
24 PNxrtscript ......................................................................................................................279
24
24i
24
241
24!
241
25
25(
25J
2S
251
254
2s|
25J
25a
(A ) fM W v E
............................................................................................................. 21
(A)
................................................................................. 21
(+ ) J f f g ^ f t E .................................................................................................. 21
(+ - > fF M S ^ fiE .............................................................................................. 21
$c?T
........................................................................ 2(
A & # H 0 !E iS ...................................................................................................... 21
( ) i;PHjîjE ...................................................................................................... 21
( ) (PJÊ ...................................................................................................... 21
<H)
................................................................................................................. 2?
( K ) ;fcS# tfiE ................................................................................................................................................................. 2?
(5 ) ?KjH E .................................................................................... 21
(A )
...................................................................................................... 21
.............................................................................................. 27
( - ) HÊ ....................................................................................... 27
( )
(H )
..................................................................................................................... 27
27j
( 0 ) JfiL#iE ..................................................................................................................... 271
S iE ............................................................................................................ 27|
Introduction
&
I )iagnostics of TCM is a subject concentrating on dihHIidun of diseases and differentiation of syndromes

iIihmikIi examination based on the theory and methodology
mI |l M. Correct diagnosis and prognosis require thorough
niHflft t # & m w m S'J ^ -
Utttk'i'Mtanding of the nature of the disease in question.

llioiHore, correct diagnosis is prerequisite to the treatiiit ni, prognosis and prevention of disease. So diagnostics
\k
iR , til st 'J& M
^ m 95 Hj
To
ni IVM serves as a bridge to connect the basic theory of
n. m
IVM with clinical specialties and is the essential course

Im ull clinical subjects, playing a very important role in
* E i f W * B , % * E-
H M.
The diagnostics of TCM has been developed under
llw fuidance of the basic theory of TCM and based on the
i ||ni( ii I practice done by numerous doctors in the past
U m h in u ik I s
iiii'IIhkIs
of years. It is mainly composed of diagnostic
and syndrome differentiation. Diagnostic meth-
ml iiic the methods used to examine patients and collect
a s # . i^ a ,g p
|Ml|lological data, mainly including inspection, listening

mihI olaction, inquiry and pulse-taking, known as the four
illii(HOHtic methods. Syndrome differentiation means to
ivnllifsize and analyze the pathological data so as to decide
lht> imlure of the syndrome. The theory and methods for
nyinhome differentiation include syndrome differentiation
wllli i*ight principies, syndrome differentiation of causes,
ylidime differentiation of qi, blood and body fluid,
yndrome differentiation of viscera, syndrome differentia-
,:e n
i t j . m
i ig h i n
IItii| ol meridians, syndrome differentiation of six meridiin. syndrome differentiation of defensive qi, qi, nutrient
Iff,
I r * M M a i fo ir
qi and blood as well as syndrome differentiation of triple

energizer. Various ways to differentiate syndrome are the
theory and methods for analyzing and understanding the
na ture of disease. They, though with their own characteristics and specific range, supplement each other and together form the syndrome differentiation system in TCM.
Concept of organic wholeness is the main characteristics of the theoretic system of TCM which is thoroughly
demonstrated by the diagnostics of TCM. In diagnosing
pathological condi tions, deciding the category of disease
and differentiating syndrome, TCM emphasizes the entirety.
1. Examination of entirety
i.
The human body is an organic whole and constantly

communicates with the extemal environment TCM lays
much stress on the characteristics of the human body,
such as the integrity, unity and association with the outer
world. This idea is summed up as concept of organic
wholeness which is reflected as examination of entirety
in the diagnostics of TCM.
Firstly, the human body is composed of various organs, viscera, meridians, constituents and orfices as well
as essence, qi, blood and body fluid. Though possessing
different functions, they are not isolated. Such an integral
association of the human body is accomplished through the
domination of the five zang-organs, supplementation of
the six fu organs, association of the five constituents and
five sensory organs and nine orfices, the extensive distri
bution of the meridians and the transportation of essence,
qi, blood and body fluid by the net of meridians. Therefore disorder of the viscera, essence, qi, blood and body
fluid can be manifested on the superficial tissues and or
gans. The local pathological changes can affect the whole
tf c .A M w z m
Imdy and vice versa. So by observing the changes of the

five aensory organs, shape of the body, complexin and
S it t ,
|H,ilrir states, we can get to know the pathological changes

tif the viscera, essence, qi, blood and body fluid. From
v A T m m m e i i >f #%
Iim mI changes one can get to know the pathological changes

ni Ihe whole body. In this way correct diagnosis can be
mude.
>M. [fif^
jE a ^ S o
Secondly, there is a cise relationship between man

MHil nature. Weather changes and geographical changes
muiv
e l
affect the human body. On the other hand. the hu-
MMti Ixxly is subjectively adaptable to the natural environ-
t t A f r r & v m ;x m i T
(HtMl. Ilowever, the dysfunction of the regulating ability

ni Ihe human body or sudden violent changes of the na tu
lm jjo
r A f r i fflTj]b#i1
mi environment may lead to diseases. Besides, social en-
vlronment frequently brings about stimulation to the mind

lid Hpirit of human beings, which may affect the visceral
m.
hllictions and lead to diseases. Therefore, natural and soi lu actors must be taken into consideration in the diagno-
j W Si n[ol M i t i rfn a fe ^
Ih ni diseases.
i .
& M T m n ^ ff
Thus, clinical diagnosis of disease must be done un-
0 ilt , ilS ffi i# f
^ 04
ilet Ihe guidance of concept of organic wholeness and with

Inll nlien tion given to the unity and integration of the hulitiin body as well as its cise relationship with the enviinninental factors. Only comprehensive inspection and extVIMlve collection of data with thorough analysis ensures
t? m m w & *
innei l diagnosis.
2.
Combination of disease differentiation and
2.
ayndrome differentiation
I his ineans to decide the ame of the disease and to
illllei entiate the manifestations of the disease.
m m m m ,
Disease means a pathological development course
y&f,
s s e o s
it
4
with certain rules caused by destruction of the healthy
state due to certain pathogenic factors. This pathological
development course manifests several special symptoms
$ a e .
and syndromes corresponding to certain stages. Each dis
e M M
# RfrgMfiEISe.
ease has its own occurrence, development and varia tion

principies. The disease ame is the label of the disease in
question. suchas dysentery, measles and asthina, etc.
Symptom refers to various abnormal manifestations
e .
EP JE
of a disease, including the subjective sensation, such as

headache, dizziness and thirst, etc. , and the signs observed by other people, such as reddish tongue, yellowish
i n-3k- M W , n '1 ^ - n i& M
fur and rapid pulse, etc.
tfc A ifc % PJ Kj ULf ^ w $ t
Syndrome is a summarization of the development of a

disease at a certain stage, including cause, location, na-
nm
ifisn a g * i -ita w
ture, pathogenesis and the relevant symptoms and signs.

Take external syndrome due to exogenous wind and coid
for example. It suggests that the cause is the invasin of
W W #t J i U M ffl p
jxl
MV-&Z i \
>;
t t IM
wind and coid; the location is in the superficies; the nature is coid; the pathogenesis is wind and coid encumbe
{'/
ring the superficies and the pulmonary qi failing to dis
M;
llf JL
perse. The main symptoms brought about are mild fever,
ikm . ;
anhidrosis, pain of head and body, stuffy nose with clear
& , %j t ,%#
bT BUS m & &

# m m ?#
nasal discharge, or cough, thin whitish fur as well as

floating and tense pulse, etc. This problem can be relieved by expelling wind and dispersing coid or dispersing
the lung and relieving superficial pathogenic factors. Otherwise, coid pathogenic factors may enter into the body
and transform into heat, therefore worsening the prob
lem.
Symptoms are the evidences for the differentiation
of disease and syndrome.
Both disease and syndrome
j& m
ffio
, w w. m m
1i iil . f ilU 1 <'J Vk 'IiM 4- )S
wlect the understanding of llir tinturo ol disenso, liowevt't. they emphasize on diforeni aspeis. Disease reflects
lile
M iR, M't; i Wf i ; iii i i 'h

^ N ^ , 5. ^ 'A&
4 '&
general principies and characteristics of a disease.
which is the primary contradiction of a disease. While

nyndiome reflects the contradiction of a disease at the
! > ie s c n t
o vti& Q & '& f

3 if0 r4 b l
stage. At different stages, a disease may manifest
miveral different syndromes known as the same disease

With
different syndromes. While different diseases at a
i e l liiin
stage may manifest the same syndrome, known as
"(lili erent
diseases with the same syndrome. Therefore,
differentiation of disease and the differentiation of
m w - M u m m s .. 4 rm ai
M #1 N M jE fS tP If1^ N
PHM' is beneficial to the understanding of the nature of a
iiE o Mili:- M *-i y til- AA

T' N ft Jf i iR M W # o
i* -f f T JA ^
i s
M.Wii: i .a
w
^
ilinease and the grasping of the developing tendeney and
rn I s ; Wt
lite
yudrome refer to the understanding of the nature of a

dlwase from different angles. The differentiation of dis-
proKnosis from the whole developing course and charac-
em m* m & m i t a
Ui iHtics. The differentiation of syndrome emphasizes on

lite changes of a disease at a certain stage and the under-
tWiMM'6i,
i|5JAA M ^ ')%r&w
nliinding of the nature of a disease according to the present
^ f i M t
i lltiical manifestations to provide evidence for present

llrjitment
te
^ m uen t & u *s
ffiL
^ 4-I. M M/K i# M %
> /#: vfa. WJ in f f M ^ #f
M&. o
Clinically, combined use of the di-fferentiation of

(linease and the differentiation of syndrome is made of so
im lo make them supplement each other for the benefit of
i . W rt
fJio
lovealing the nature of the disease in question and making

llie diagnosis more accurate, correct and specific.
What should be made clear here is that the differentinIion of disease is the main work of all clinical specialties,
wlik h is not discussed in detail in this book.
3. Synthetic use of all diagnostic methods
This means that, in diagnosing a disease, one must
3. i# ;- r #
'n # , J i h SiE t
try to collect as detailed as possible the data for comprehensive analysis of the disease. The manifestations of a
disease are mltiple and complicated. The data collected
m m n& m gw M W
with the four diagnostic methods are the evidences for the
differentiation of both disease and syndrome. Whether the
data collected with the four diagnostic methods is accurate
or not directly affect the accuracy of the differentiation of
xm m m *
lx>th disease and syndrome. The four diagnostic methods

are used to examine disease and collect data from different
angles. They are significant in diagnosis, however, they
m m fc m m m m rs m i
still have some limitations and cannot replace each other.

So it is improper to stress on one of them and neglect the
others. In order to fully understand the pathological con
di tions of a disease and collect reliable and detailed data,
these four methods should be used together and the data
collected should be analyzed synthetically.
im ,
SjJ
1 Diasnostic methods
^ c r
Diagnostic methods are the methods used to collect

dula related to pathological conditions, including inspectlon. listening and smelling, inquiry and pulse-taking. In-
ffl i # , l'n]i# fn tjj i # ,
H|H-clion means to examine the external manifestations and
i r o
excreta; listening and smelling means to examine the
-g-
zy
jti
H|X'ech, breath and odor of the patient; inquiry means to

el to know the occurrence, development and treatment
of the disease as well as the present symptoms and other
st s ai m ^ i* a
Information relevant to the disease by asking the patient

Or the people accompanying the patient; pulse-taking
means to examine the pulse and the related regions of the
IKitient.
I r x B -# <j J t fn W
i# ,
The human body is a organic whole. Under morbid
conditions, local pathological changes may affect the

Whole body; internal pathological changes can be manifeslr<l Ihrough the five sensory organs. the four limbs and
e t >m h m ^ & m a *
lile superficies. With the examination of the symptoms
m iu m a m >m , eo, w ra i # ,
lid signs of a disease by means of the four diagnostic

methods, one can understand the cause of the disease and
^ E , i
niilyze the pathogenesis of the disease so as to provide

pvideuce for deciding treatment based on syndrome differ-
ff iif c & ilt J M f c ig .
ciiliation.
The four diagnostic methods are used to examine disciisc l'rom different angles and they cannot. replace each
iw] kj t i % M ^ 'ft w ra # h
nther in diagnosis. So in clinical practice, they are usually

liNed in combination for systematic understanding of a disrnse in order to ensure comprehensive analysis and correct
0 jIfc,i|jî:;& M B i# n m\
s
'Mfc r KM* *
diagnosis.
jii. n m un
% m a i r w ^ jM .i- ^ a n E
m m .
1.1
Inspection
*&
Inspection means that the doctor use his or her eyes
. i?
i T,
to examine the vitality, colour, shape and posture of the

patients whole body or local regin as well as inspect the
colour, quantity and texture of the excreta for the purpose
of understanding pathological conditions.
7 /
p
ilift
f+
iM
lir&
o
Inspection is a convenient and important method for

diagnosing disease. It not only enables the doctor to get
necessary data, but also provides trace for further diagno

sis. Therefore, doctors must have keen powers of observation in clinical practice.
m m M
Inspection should be done in the place with full light,
especially natural light. If done in the light of lamp, cares
should lx; takeii to avoid the influence of the light itself.
The rango for inspection is extensive, including all

iih|xv !h visible
lo the naked eyes. In general, the aspects
for inspection include the whole body, local regin and

tongue.
1. 1. I
Inspection of the whole body
Inspection of the whole body, also known as general

inspection, refers to purposeful examination of the spirit,
colour, shape and posture of the whole body so as to have
a general understanding of the disease.
B P -^j
1.1.1.1
Inspection of spirit
( - ) mw
Spirit refers to the general manifestations of life acllv ltic s .
including mental states and mental activities.
^ SE -ffcfi # t t
The material base of spirit is essence. The congenital

pnnoikv
depends on the cereal nutrients to nourish and
piomote as well as the normal visceral functions to proIm l That is why the spirit is said to be the external man|frntations of the conditions of visceral essence. Inspec-
iit . j f i i i n % & m m
I Ion of spirit can enable one to understand whether the es-
lE#>0
wini e is exuberant or deficient and whether the visceral

functions are strong or weak. Such an understanding is
m m w g a ,m m
lin|X)rtant to the analysis as whether the pathological conililions are light or serious and whether the prognosis is
Irnign or malignant.
Inspection of spirit mainly focuses on the examination
ni Hit' mental states and emotional conditions, including
Itilnl expressions, complexin, eye expressions, speech,
fe J H
, in W ^
lircath, physical conditions and response to the external
pS ' $ $
f i
llmulation, etc. Since the visceral essence infuses upwnnl into the eyes and the ocular system is connected with
Br VI,
llir brain, and also because the eye is the orfice related to
lili' liver, governed by the heart and housing the spirit the
#
+*'t
i i .
Itmpi'ction of eye expressions is very important. Inspecllnn of spirit means, by examining of the aspects menllont'd above, to differentiate whether the spirit is in ex-
m iE K w & n ffi s i j m w 3s
lnli'iice, deficient, lost, false or in disorder for the pur|Mii4c of deciding whether the healthy qi is abundant or dellcieiil, the visceral functions are strong or weak, the
INithological conditions are light or serious and the progno
sis is Ix-nign or malignant.
1 .1 .1 .1 .1
Existence of s p irit
The manifestations are mental consciousness, normal

vitahly. natural facial expressions. ruddy complexin,
i. m n
flexible eyes with brightness and vitality, accurate verbal
a & . l A f e $ l'fJ M R
expression and reply, normal voice and breath, normal

and natural movement of the limbs. These manifestations
suggest non-impairment of healthy qi, normal visceral
iPo
functions, mild pathological conditions, or favourable
JKJi?|
, S r ti
,M
i s =
prognosis even for serious diseases.

1 .1 .1 .1 .2
2.
Lack of spirit, also known as insuf-
ficiency of spirit
The manifestations are mental consciousness, dispiritedness, pal complexin, dull expressions of eyes, short
of breath. no desire to speak and low voice. These mani
festations suggest mild consumption of healthy qi, weak
visceral functions, more serious disease and better prog
nosis. These manifestations are usually seen in patients at
? # j j
the rehabilitating stage or with weak constitution.
1 .1 .1 .1 .3
3.
Loss of spirit, also known as deple-
tion of spirit
The manifestations are dispiritedness, pal complex
in, dull eye expressions, weak breath or dyspnea, emaciation, difficulty in'movement, retard response or even
unconsciousness; or coma with delirium and floccitation.
The former suggests great impairment of the primordial qi
and decline of the visceral functions, usually seen in chronic disease and serious disease with unfavourable progno
sis. The latter suggests exuberance of pathogenic factors
s i -0 ja t n
and serious disturbance of the viscera, often seen in criti-
f S .iW J n A ' 8.; J5 '# zH ?[
x j j #|
cal pathological conditions with unfavourable prognosis.
1 .1 .1 .1 .4
False spirit
4. PI#
False spirit is usually seen in prolonged disease, seri

ous disease and extreme exhaustion of essence with the
talse manifestations in disagreement with the na ture of the
disease. For example, dull or pal complexin suddenly
(IV%'
(HIHH * lilfMliH',^^
ilmuges into reddish cheeks; or extreme dispiritedness,

mental derangement and retard response suddenly change
, S; iR t i H
lllto excitation but with restlessness; or no desire to

*|>enk. low and weak voice and incoherent speech sudden-
M 'F* 3c; iJc
lv change into incessant, but simply repeated talking.
ig ,
fi; K 'F ifc a
t , 04 TS ^
^ ^
I lese phenomena indcate declination of essence and

flonting of yang due to failure of yin to control yang. This
M - ft
condition is clinically known as the last radiance of the

Milting sun and sudden spurt of vitality before death ,
m
iI
lile premonitory signs of death.
S * M ^
h]
Clinically cautions must be taken to differentiate false

l i # ? ! M S 'J o
M|)irit and improvement of pathological conditions. The

nmnifestation of false spirit is sudden improvement in
cdrtain aspect which is not in agreement with the whole
ffi
iwilhological conditions and immediately turns worse. The
* ffi n . M is m m
Improvement of spirit depletion takes place in the course

ni
the improvement of the whole pathological conditions.
HWft.iJn
1 .1 .1 .1 .5
Mental derangement
This condition is usually seen in the case of mania.
5. m i
E P f ttjS iR m .t L T
I'lie usual manifestations are indifferent expression, taci-
liirn and depression, followed by being in a trance, now
ia
W M % m
0 0
iMlighing and then crying due to stagnation of phlegm

Which confuses the mind; the manifestations like dyspho-
Ifi
rln. running wildly, shouting, fighting against people or

even lamily members are usually due to disturbance of the
,T A S # f ,
lieurt by phlegmatic fire; the manifestations like sudden

n n ig f;,W
inina, drooling, staring upwards, convulsin of limbs and

gl'iwining like pig and goat usually indicate epilepsy due to
S l, E J & M .
eiiilngenous liver wind and phlegm confusing the mind

Which can heal automatically.
tm alo
It should be pointed out that the symptoms of mania

and mental derangement correspond to the cause and occurrence of these diseases. The clinical syndrome differ
,JiE
3
S
0^
entiation of these manifestations is different from serious

dysfunction of viscera at the advanced stage of serious dis
D? E M Si. 5 M & 'M fs )$ B
ease and spirit depletion due to exhaustion of essence.
1.1.1.2
Inspection of complexin
(z ) u s e
Inspection of complexin includes the changes of the

colour and luster of the facial skin. The visceral essence
flows to the face. So the facial colour and luster are the
signs of visceral essence. The facial skin is soft and thin,
the luster is visible and easy to observe. Therefore the inspection of complexin is an important part of inspection
examina tion.
The colours of the facial skin are red, white, blue,

yellow and black. The changes of these colours can reveal
pathological changes of viscera of different nature. The
lustre of skin refers to the bright, moist or dull and dry
manifestations which can reveal the states of the visceral
. m i
essence. So inspection of the changes of facial luster can

enable one to understand the states of visceral essence,
the nature of diseases, the conditions and development of
diseases.
'It W i o
1 .1 .1 .2 .1
Normal complexin
i.
The normal and healthy complexin is ruddy and lustrous. indicating exuberance of visceral essence and nor
mal functions of the viscera. Due to difference in constitution and the influence of clima tic and environmental
J S .& tf c IR IR W 'C f c . !
factors, the normal complexin is further divided into
JV;ffli il t .
ili l I * Mi
Iimtlimnt complexin and varied complexin.
Dominant complexin refers to the colour of the skin

mil
luce lliat never changes due to racial and constitution-
JEft,
ll fuctors.
Vmied complexin refers to the changes of the facial
(2>
color in correspondence to the variations of the
mil nliin
H'iiwins and climates. For example, the complexin is

liluish in the spring. reddish in the summer, yel-
illll h lly
liwllli in the late summer, whitish in the autumn and

in the winter. Varied complexin is temporary
tlm'lush
mil
nuclear.
5HHM.
Ilesides, drinking liquor, excitement and sports ac-
ilt
, ik ffl, -t 'f $J ffl, is
Ivllv may also lead to the changes of complexin. But

llene changes are not morbid.
1 .1 .1 .2 .2
Morbid complexin
'-m
2.
Facial colour during the course of diseas is called

IMM'bid complexin marked by dry and dull colour, or obulnim bright colour, or a single colour alone.
s s fe,
l^ ia fe + fP h
The key point in inspecting morbid complexin is to
lllfpi'entiate favourable and unfavourable manifestations of
lie Uve kinds of colour and the diseases manifested by
lese live kinds of colour.
hivourable and unfavourable m anifestations of
Ihat five kinds o f co lo u r: Bright and moist colour, no
mil le
fe ,/ iM # ^ # fe ,m
what colour it is, indicates mild illness, normal
illtilllio ii
H'llei
(1)
of the visceral essence, easiness to cure and
prognosis. While dull and dry colour is malignant
iilmn and indicates serious illness, impairment of the
l .M i] F ;J W tf
visceral essence, difficulty to cure and unfavourable prog

nosis.
(2)
Diseases indicated by the fiv e kinds o f colo ur:

According to the theory of TCM and clinical experience,
E f: E
the five kinds of colour correspond to disorders of the five

zang organs, i. e. blue colour-corresponding to the liver,
JS'C. a n j e a n MU 51
red colour to the heart, white colour to the lung, yellow
'fo
colour to the spleen, and black colour to the kidney. The

disorders of the five zang organs are manifested in correspondence to the kinds of complexin related to them.
While the five kinds of colour also demnstrate different
nature of diseases. The following is the detailed description:
Red colour; Red colour indica tes heat syndrome, also
ftjE ,^J;
seen in real coid and false heat syndrome.

Red colour results from sufficient blood circulating in
the meridians and skins. With heat, blood flows fast.
Since heat tends to rise and disperse, the meridians and
vessels are dilated and become full. That is why the com
plexin appears red.
Flushed face is a sign of sthenic heat syndrome due to
hyperactivity of visceral yang heat resulting from exoge-
if f i a L,
&
MU
!,
nous fever. Flushed and delicate cheeks indicates asthenia

heat syndrome due to endogenous heat resulting from yin
asthenia. Pal complexin with occasional migratory reddish luster like makeup in the patient with prolonged illness and serious disease indicates real coid and false heat
syndrome due to upward floating of yang caused by predominant yin rejecting yang.
White colour: Indicating asthenia syndrome and coid
syndrome.
White colour indicates decline of qi and blood. Pal
fi % % III. 4' -fc 7> M o I
complexin is caused by insufficiency of qi and blood in the
''CJ# ft:. jJ ji III I . 'Jfg i 1 l
face due to failure of insufficient yangqi to transport blood
**ll(ll
)#.
Tll:
fct i l
llLlH
lo nourish the face, or due to failure of the asthenia of qi

ind hlood to fill the vessels, or due to coagulation of coid
lli llit* meridians and vessels which prevent qi and blood to
i irruate freely.
Ploating whitish complexin and facial dropsy are uminlly due to insufficiency of yangqi. Light whitish com
plexin and emaciation are often caused by consumption of
i|l und blood. Pal complexin is often seen in sthenic coid
yndrome, such as interior coid syndrome with sharp ab
dominal pain. Sudden pal complexin with profuse coid
nweating, coid limbs and indistinct pulse is a sign of sudiltll loss of yangqi.
Yellow colour; Indicating asthenia syndrome and
M : i^ E J S E o
tlmnpness syndrome.
Yellow colour indicates asthenia of the spleen and aci ilfnulation of dampness.
CRUSed
Yellow complexin may be
fif- J ^
35 ,
- 'F
, IJl
either by malnutrition of muscles due to insuffi-
i'lrni y of qi and blood resulting from failure of the spleen
IS ffe .
lo transport, or due to intemal accumulation of dampness.

Light yellow, dry and lusterless complexin is called
willow complexin due to gastrosplenic qi asthenia and iniiilii iency of qi and blood, also seen in chronic hemoriltoge, ascariasis and malnutrition, etc. Yellowish complrxion with facial dropsy is called yellowish obesity, usunllv caused by asthenia of splenic qi and intemal accumulaiiimi of dampness. The state of yellow complexin, eyes
f f i.S
'iiiil nkitis is called jaundice due to failure of bile to flow in

lis normal duct and extravasates in the skins. If the colour
lw un yellow as tangerine peel, it is called yang jaundice
ilur In steaming of accumulated damp heat and dysfunction
ni llic liver and gallbladder. Sudden onset of disease with
i|m i* |)
yellow face, eyes and body, high fever and coma, or
i vi'ii with vomiting, nosebleed and macules, is called

Mente jaundice or pestilent jaundice, usually caused by in-
mmm,
vasion of damp heat and pestilence deep into blood which

steams the liver and gallbladder. Yellowish complexin
like being fumigated is called yin jaundice, usually caused
by stagnation of coid and dampness or prolonged stagnation of the liver and gallbladder.
Bluish complexin: Indicating coid syndrome, pain
syndrome, blood stasis syndrome and convulsive syn
U f e : F .,* j
. ^ jE O'I'IxI o
drome.
Bluish colour is a sign of inhibited flow of qi and blood
and stagnation of vessels and meridians. The invasin of
W fe Je K Ja is ' ^ % >
B m m im o
mm
coid factors causes contraction and stagnation, leading to

spasm of meridians and vessels and stagnation of qi and
ta
blood. It may be caused either by deficiency of yangqi
l b , il 'u m. m ; & k m I
which fails to warm and transport qi and blood, or by qi

stagnation and blood stasis which block meridians and ves
U/cai'iw.jBXgtffifesw-o
sels, or by exuberance of pathogenic heat which stagnates

blood vessels. Besides, the stagnation of qi and blood in
-f m m , &t m * lis ^ A 0
the meridians and vessels will inevitably result in pain.

Therefore clinically stagnation of qi and blood is often accompanied by pain syndrome.
Pal and bluish complexin, or accompanied by chest
pain and abdominal pain, is often due to invasin of coid or
ra j
yang asthenia and coid exuberance. Bluish and greyish
M I . f f i f e t l . P j
complexin with purplish black lips and chest pain is usual

ly caused by inaction of heart yang and stagnation of heart
ffife P
blood. Cyanotic complexin and lips with asthmatic breath

is usually due to stagnation of pulmonary qi, or asthenia of
cardiopulmonary qi, or asthenia of pulmonary and kidney
d
i. ffifeJt^W
,^*
qi. Yellowish complexin mingled with bluish colour is
M 'g 'iT m m w .w ik
called dull jaundice, usually seen in subjugation of the
/h J L ^ R o /JnJ L I I ' h] , # !
spleen by the liver, tympanites and infantile malnutrition.

Cyanotic colour over the part between infantile brows,
nose bridge and lips accompanied by high fever is the premonitory signs of convulsin, usually due to exuberance of
(dltoRenic heat.
Blackish complexin: Indicating kidney asthenia synilinliit', coid syndrome, blood stasis syndrome and fluid
Ife :
iJEiflS fu E ffl 7jctfcffi
IfUMition syndrome.
hlackish complexin is the sign of kidney asthenia, yin
prtdomination and exuberance of water or stagnation of qi
n M E io
n $ J 7 k :k
ilid blood. The kidney is the organ associating closely

Wllli water and fire and is the source of yangqi. Asthenia
7jciX ^
i*t kidney yang and retention of fluid will lead to intemal
# , l JicJ j . ifil f f
, II
, ifiL
iHUlxirance of water coid, loss of warmth in blood, spasm

nf Vi'ssels and meridians and inhibted flow of qi and
IiIikmI. Blackish complexin may also be caused by con-
mimption of yin by asthenic fire and failure of essence to
i .
llimrish the face, or by prolonged stagnation of blood in

llir Ixidy.
Light blackish complexin is often caused by asthenia
ul kidney yang. Dry blackish complexin is usually due to
(irolonged consumption of kidney essence and asthenic fire
Onsuming yin. Blackish complexin with squamous and
ill v skin often results from internal retention.of blood sta-
b im
RlN, Blackish colour of the area around the eye socket indi-
7 jc
i ules retention of fluid due to kidney asthenia and fluid ex-
rm
m, & m m t
a w
U'Hvasation or leukorrhagia due to downward migration of

inlil dampness.
1 .1 .1 .3
Inspection o f body
(= ) mwM
Inspection of body means to diagnose the patient by
i w
- a
i i i i
nmmiining the physical conditions of the patient.
$ 1 # , V jm m m w - #
M
The body depends on visceral essence to nourish,
wliile the functions of the viscera and the conditions of
VIm'eral essence may be reflected by the body. Therefore,
lliipection of the body may help doctors to understand the
Imictional states of the viscera, the current conditions of
cji, blood, yin and yang as well as the conflict between

healthy qi and pathogenic actors which may suggest the
possibility of contracting certain disease.
1 .1 .1 .3 .1
i. m m m
Physical strength and weakness
Inspection of physical strength and weakness may enable one to know the functions of the viscera and the con
M
f
%
ditions of qi and blood. Generally speaking. the conditions
f
f
i
t(
D
f
JM
3
f
i^\
tu-
of the body correspond to the conditions of visceral func

tions and the states of qi and blood. That means internal
ii H.Jii W ^ K J S M i
exuberance ensures external strength and internal decline

leads to external weakness.
(1) 5:
Strength: Strength refers to the strong physique,

the manifestations of which are lustrous skin, strong muscles. wide chest and thick bones which indcate sufficiency
of qi, powerful functions of the viscera, exuberance of qi
and blood and healthy body. Strong body means strong resistance against pathogenic invasin, no liability to con-
mW
'J ,t S1
tract disease, quick recovery from illness and favourable

prognosis.
(2)
Weakness; Weakness refers to decline of body
strength, the manifestations of which are dry skin, lean

muscles, thin chest and bones which indcate insufficiency
of qi, weak functions of the viscera, deficiency of qi and
blood and weak physique. Weakness of the body indicates
weak resistance against pathogenic invasin, easiness to
catch disease, difficulty in healing and unfavourable prog
nosis.
1 .1 .1 .3 .2
2.
Physical obesity and em aciation
mmm
m m m w w - M ' r|
Inspection of physical obesity and emaciation may

suggest the possibility to contract certain diseases.
( i ) pf-,
Obesity: Obesity is characterized by round head,

short and thick neck. wide and fat shoulders, wide-short-
fc' XB.
round chest, big belly, smaller body. flabby muscles,
5F
dispiritedness and lassitude which are the signs of predo-
'J'. '>l>MV,l)fr.!|)Ll:lf4Mtc
- , W f i l i t e : S IM i
mina!ion of the body and asthenia of qi, suggesting insuffii'lcncy of yangqi and internal exuberance of phlegmatic
dnmpness as well as susceptibility to vrtigo, apoplexy and
ilhltructive syndrome of the chest. That is why it is said
lilil "tese people are predominant in dampness and
" oIh'sc people are susceptible to wind stroke.
Emaciatiori: Emaciation is characterized by long
<2> A s
. ta
IunkI. thin and long neck, narrow shoulders, narrow and

lint chest, small belly, higher body, thin muscles and dry-
% w b
urss of skin which suggest asthenia of blood and internal
% w iimts, u i rî s sy
i'Xiik'rance of asthenic fire usually seen in patients with
i ffl ifiL ^ ) , i t k
pulmonary tuberculosis and internal impairment by asllu'iiic overstrain. That is why it is said that thin people
iiiv
# o i t S A # ^ / A
predominant in fire and thin people are susceptible
zm m rzL .
10 cough due to pulmonary tuberculosis.

11
the whole body is extremely emaciated and the pa-
lleut lies in bed and cannot rise up again. it is usually

mused by chronic disease, severe disease and declination
,<-ft'J
M
^ h' 'k
WB
nf visceral essence as well as unfavourable prognosis.

1 .1 .1 .3 .3
Deformity
3.
mn
Deformity includes chicken chest and tortoise back

riic lormer refers to the evident protrusion of the lower
|*n t of sternum marked by longer posterior and anterior
dinmeter and shorter left and right diameter of the thorac-
^ < W Stf i f
fs S
11 cavity, usually seen in children. The latter refers to

(ifotrusion of the spinal column. Both cases are caused by
roiigenital defects or postnatal malnutrition which lead to
IlliulTiciency of kidney essence and maldevelopment of the
I n iiic s .
1.1.1.4
Inspection of postures
Inspection of postures means to examine the patients

| k in I
tires in tranquility and action as well as abnormal ac-
llvilies.
The postures of the patient in tranquility and action is
(0 ) 2 5
fe M
T 5
closely related to the conditions of yin and yang of the
15JTPB^ t ti
S :
body as well as natures of the illness as being coid or heat

or asthenia or sthenia. The movement of the limbs is un-
'L'W W ffi >#
der the control of the heart spirit and in cise relation with
m j m m m # t w $ m % i
M ll
the functions of the bones, muscles, tendons and vessels.

Therefore, the postures of the patient in tranquility and
action as well as the abnormal activities are all the external manifestations of disease. Different diseases may be
M tb ^ IhI Kj fl 5I &
reflected by different postures and activities. Inspection

of postures is helpful for deciding the natures of diseases
and diagnosis of certain diseases.
1 .1 .1 .4 .1
inspection of postures in tranquility
l.
and action
Yang governs action and yin tranquility. The sitting,
p r ^, m * # .
lying and walking postures of the patient may be summarized like this: movement, supination and extensin indicate that the disease of yang na ture, usually manifesting
as extemal syndrome, heat syndrome and sthenia syn
drome; quietness, pronation and bending indcate the dis
af
jE . j j Eo
ease of yin nature, usually manifesting as internal syn

drome, coid syndrome and asthenia syndrome.
S ittin g : Sitting with the head bending down. short-
(1)
ness of breath and no desire to speak usually indicates as

thenia of pulmonary qi or failure of the kidney to receive
qi; sitting with the head rising up and asthmatic breath
signifies adverse flow of qi due to pulmonary sthenia;
asthma with inability to lie down indicates pulmonary dis
tensin and retention of fluid in the chest and abdomen.
Lying: Lying on bed facing the outward with the
(2) BH:
ability to turn the body freely usually indicates yang syn

drome, heat syndrome and sthenia syndrome; lying on
bed facing the inward with inability to turn the body freely
indicates yin syndrome, coid syndrome and asthenia
W. t 'hi!i) i i i . % i; , $ H b
sydrome; lying on a supine position with the extensin of
H'J (i)i Ift M i l * . M
#4**81
Ihe limbs and refusal to cover quilt and put on clothes indinilcs the syndrome of predominant yang and sthenic heat;
huddling up when lying on bed with preference to put on
mote clothes indicates yin sthenia and yang asthenia or ab
dominal pain; inability to lie down due to cough usually oci ni s in autumn and winter, often caused by internal retenllon of fluid; lying on bed with inability to sit up (sitting
ii|> causes dizziness) indicates asthenia of both qi and
blood.
W alking: Unstable walking with tremor of the limbs
(3)
imually occurs together with dizziness. usually caused by

llltcrnal disturbance of liver wind or impairment of tendons and bones.
Resides, deformity of the lower limbs, trauma and
llljury of joints all can lead to abnormal walking postures.
m - * m w ni ? i m # & #
In lilis case, diagnosis should be made with the aid of othrr ways of examination.
1 .1 .1 .4 .2
Inspection of abnormal movements
\mo
2. w .'x iz m 't
Abnormal movements of the patients limbs usually

Indcate the signs of certain diseases. For eXample, spasm
of the limbs, stiff necks and opisthotonus indcate internal
disturbance of liver wind due to extreme heat generating
wind, usually seen in exogenous febrile disease at the
tinge of exuberant heat; tremor or peristalsis of fingers
mui loes indicates internal disturbance of asthenic wind,
j], H T
S 'M
drvn at the advanced stage of exogenous febrile disease

due lo deficiency of body fluid and malnutrition of tendons
iitxl vessels. Such a problem seen in chronic disease due to
llllci nal impairment is often caused by insufficiency of qi
mui blood and malnutrition of the tendons and vessels.
I'tiin of the limbs and joints, inflexibility of the joints or
upasin of the hands and feet as well as swelling, stiffness
mikI
deformity of the joints usually suggest obstructive
nyndrome. Flabbiness of the limbs and difficulty in moving
iJ te $ f f
f ' sJtJ#^ 'fi
or atrophy of muscles are usually of flaccidity syndrome.

Difficulty in moving or numbness of unilateral limbs indicates hemiplegia due to wind stroke.
1 .1. 2
Inspection of local regions
Inspection of local regions is used to closely examine

some regional areas to obtain necessary clinical data on
the basis of general inspection according to the pathologi
5d
cal conditions in question.
sm .
The pathological changes of the tissues and organs in
the human body are mainly reflected by external manifes
$,
( f t -, i
tations (such as luster. color and postures), functions and

sensation. These external manifestations indica te either
it.
the disorders of the tissues and organs or the regional ref leetion of the pathological changes of visceral qi and
blood. Theret'ore, inspection of local regions is not only
helpful for diagnosing the pathological changes of the local
t\m
pmmust
m "i va r m m
tissues and organs, but also helpful for understanding the

pathological conditions of the viscera.
Inspection of local regions include various aspeets,
among which the inspection of tongue is discussed in another section. The other aspeets are discussed in the following.
1 .1 .2 .1
Inspection of head and hair
(- )
The head is the regin where all yang meridians con

verge. Besides, the conception vessel, thoroughfare vessel and many branches or collaterals of the yin meridians
extend to the head. Therefore, essence of all viscera
come up to nourish the head. Inside the head stores the
M ^nm U o
'i? x f .
brains (cerebral marrow) and marrow. which is governed

by the kidney. The kidney also governs bones. The devel-
*;iai z f c - n z n
npment of the skull and brains all depend on kidney es-
J$ P? ^/^Cifii'fc t Z Kl
nrmo to nourish. The hair is the extending part of blood

hikI
tho external manifestation of the kidney. The spleen
illd the stomach are the sources of qi and blood. There-
loiv. inspection of head and hair is helpful for understandIllH the conditions of the kidney, spleen and stomach as
well as qi and blood.
1 .1 .2 .1 .1
Inspection o f head
Inspection of head means to examine the external

lihape and movement of the head.
Shape o f head: Bigger head with smaller face,
^ i# M
^ fn
5J;So
(1 )
tlownward looking of the eyes and low intelligence in children is usually caused by insufficiency of kidney essence
and retention of fluid, often seen in children with fluid reUsntion in the brain. Smaller head with round top, earlier
W J L /FJL
closure of fontanel and low intelligence in children is frequently caused by insufficiency of kidney essence and
maldevelopment of the brain. Protrusion of forehead and
U'mporal regions with fat top of head in children often re
&I t .
' M L ^ A I hj
m , m m ^ ^ & , & n m. m
un ts from congenital insufficiency of kidney essence, or

postnatal improper regulation of the spleen and stomach
iiikI maldevelopment of the sktill, usually seen in rickets.
W'&fi S fr% , # E f f n J #
^ tJL o
Fontanel: Inspection of fontanel must be done in ex-
(2) j i : i
umining the infants under the age of 1 year and a half.
a n
Sunken fontanel indicates asthenia syndrome, usually

ciiused by excessive vomiting which impairs body fluid, or
lV
weakness of the spleen and stomach and prolapse of the
nstrosplenic qi, or by congenital insufficiency and malnu-
W SL
# Ai ' i ' t
li ilion of the brains. Protrusion of fontanel indicates stheina syndrome, usually caused by virulent heat in exoge-
!Jt.
lions febrile disease attacking the upper part of the body,
n jS
AJ 1*17jt tf i i & m a
,#
-n , W 'h W
o by fluid retention and blood stasis in the skull. Retard

closure of fontanel and non-closure of the bone fissure is
n-hiM kj K fm n .,
frequently caused by congenital insuficiency of kidney es

sence, or by chronic disease and malnutrition after birth.
Shakng: Involuntary shaking or tremor in both chil-
(3)
: JtifcA A s
dren and adults means intemal disturbance of liver wind.

A filio
1 .1 .2 .1 .2
Inspection o f hair
2. M &
The inspection of head and hair mainly examines the

luster, shape, growth and loss of hair.
Luster and shape: In the yellow race, black, dense
(1)
M A ft
and lustrous hair is the sign of sufficient kidney essence

and exuberance of qi and blood. Yellowish, dry, thin, soft
and brittle hair is the sign of insufficiency of kidney es
sence and asthenia of qi and blood which fail to nourish
hair. White hair in young people without pathological
changes is usually related to congenital constitution and is
not a morbid condition. If white hair is accompanied by
aching and weak loins and knees, tinnitus and amnesia, it
is caused by asthenia of liver and kidney yin and lack of
essence. If white hair is accompanied by insomnia and
'hJL
poor appetite, it is caused by overstrain of the heart and

spleen as well as deficiency of qi and blood. Appearance of
infantile hair like tassels with yellowish lusterless dryness
is usually seen in malnutrition due to impairment of the
spleen and stomach by improper feeding.
Loss of hair: Sparse, yellow and dry hair is caused
by insufficient kidney essence, asthenia of qi and blood
which fail to nourish hair, usually seen in patients after
serious illness and chronic disease. Sparse hair in young
people often results from blood heat or consumption of
kidney essence. Greasy hair with obvious loss of hair at
the top of the head accompanied by pruritus and desquamation is usually caused by internal accumulation of damp
heat. Sudden patch loss of hair with round or elliptic exposed head scalp is known as alopecia areata due to blood
(2)
Mlthenia and wind attack, or caused by anxiety and ner-
^ 0 JL g M PJf $L.
vousness which Iead to qi stagnation and fire depression as

well as blood heat generating wind.
1.1.2.2
H l i l i
(Z) E ^
Inspection of the five sense organs
The five sense organs refer to the eyes, ears, nose,

motilh and tongue which are closely related to the viscera.
2 lt- g rt f l^
I'llii h organ itself is directly or indirectly related to several

vlNcera and its functions are also associated with the heart
# ^ ^ t at
m#
mi m
wpirit. Therefore, the inspection of the five sensory or iiiis
is not only helpful for the selection of treatment of
lile sensory organs themselves based on syndrome differrntiation, but also helpful for understanding the pathologiidl changes of the viscera. The inspection of tongue is dis-
m m m w jm Q ',
i ussed in another section. The following is the discussion
,Jg JKfllPHBg;
nf the inspection of the eyes, ears, nose, mouth, lips,

Miitns and throat.
1.1.2.2.1
Inspection of the eyes
1. as
The eyes are the orfices related to the liver. HowPVer. all the visceral essence flows upward into the eyes.
, ht a 2
In the ancient time, people divided the eye into five parts
ll) the "theory of five wheels , corresponding to the five
Mlig organs, i. e. the eyelids pertaining to the spleen
liliown as muscle wheel, the canthi pertaining to the heart
Itfjown as blood wheel, the white part pertaining to the
lllliK known as qi wheel, the black part pertaining to the
* * ffc .J iE .
llver known as wind wheel and the pupil pertaining to the

lildney known as water wheel. According to the theory of
n a T fflig E jfi fw
Uve wheels, inspection of the abnormal changes of differI parts of the eyes can reveal the disorders of the relatwl viscera.
Colour of the eyes: Redness of the eyes indicates

ii'.il
To be specific. red eanthus indicates heart fire,
( 1) 0 &
.
t'lilt #
'J'J''
-A, 1*1Hi'r#
1 i ll'li
redness of the white part indicates pulmonary fire, red-
M .gL& ftW l'VK.,
ness of the white part with reddish veins signifies exuberant fire due to yin asthenia, redness of the whole eyes
shows wind heat in the liver meridian, and red, swelling
and ulcerated eyelids indicates splenic fire or damp heat.
For example, yellowish change of the white part is a sign
of jaundice and pal canthus and eyelids shows insufficien
cy of blood.
Shape o f the eyes: Sunken orbit is often due to loss
(2)
g & f ,:
of body fluid resulting from excessive vomiting and diarrhea, or due to decline of visceral essence resulting from
chronic diseases. Dropsy of the eyelids and cheeks usually

indicates edema; prolapse of the lower eyelid in the middle-aged is not morbid. Exophthalmus accompanied by
swelling neck is goiter.
Movements o f the eyes; Staring straight upward
(3)
s i a s t
and obliquely during the course of a disease mostly indicates internal disturbance of liver wind. Immobile straight
o w ii
staring is a severe condition of the declination of visceral

essence. Slight fixation of the visin is usually due to in
MfiE, H it
ternal retention of phlegmatic heat. Open eyes during

sleep is often caused by weak functions of the spleen and
ti) o iis ~ Jz ,
yt & fk $
stomach. Platycoria and no reaction to light are critical

signs of kidney essence exhaustion, also seen in poison-
ii.tfe ja T ^ & ^ o
H ttj
ing. Miosis results from exuberant fire in the liver and

gallbladder or asthenic impairment of the liver and kidney
and up-flaming of asthenic fire, or poisoning. Anisocoria
suggests blood stasis or phlegm and fluid retention in the
$Sj4l
brain.
1 .1 .2 .2 .2
Inspection of the ears
The ears are the orifices related to the ears and the
places where all meridians converge. Besides, the shaoyang meridians of both the hand and the foot flows anterior
2. I ?
B*;
to (he ears and the taiyang and yangming meridians disIrihute over the ears. So the ears are closely eonnected
with the whoie body through meridians and collaterals.
Therefore, many visceral disorders can be reflected over
the ears. Generally speaking. inspection of the ears is
l'hiefly helpful for understanding the conditions of the kid
ney essence and the pathological changes of the gallbladd t'i.
Inspection of the ears should concntrate on the colOUi
. shape and inner part of the ears.

Colour and shape of the ears: Ears of healthy peo-
ple
(1)
are characterized by rich flesh, slight yellow, reddish
Itiid moist luster, which are the signs of sufficiency of kidliey essence. Whitish colour of the whole ears indicate
t f e a m ff i; f e w i ? n i i
rold syndrome; bluish and blackish colour of the ears is u-
IT Iffi.
^ l^ lf ^ r f n T tt , H
lually seen in pain syndrome. Thin and dry ears are a sign
of insufficiency of kidney essence; scorching dry and black
colour of the ears signifies extreme loss of kidney esO'iice.
Pathological changes inside the ears: Pathological
(2 )
^[*5
l'hanges in the ears are mainly otorrhea of pus. Otorrhea
n m
% %
o yellowish pus and white pus is all due to prolonged stagIWtion of damp heat in the liver and gallbladder.
1 .1 .2 .2 .3
Inspection of the nose
3. i *
The nose is the orfice related to the lung, corre-
m x \m
|Xmding to the spleen meridian and connecting with the

lomach meridian. So inspection of the changes of the
lise
is helpful for understanding changes of the lung,
I f l M
ipleen and stomach.

Inspection of the nose mainly concentrates on examining
lile excreta as well as the colour and shape of the nose.
Colour and shape o f the nose: Reddish swelling

willi sore of the nose is usually caused by exuberant heat
In llie stomach or blood heat. Enlargement of the nose tp
(I)
ff*WV$dcifiL
with thickened skin. bulging surface like acn or wart is
It f e , M
* . 'Xbu
called rosacea caused mostly by accumulation of heat in

the lung and stomach. Ulceration and sinking of the nose
bridge is usually seen in syphilis; sinking of nose bridge
with the loss of brows is usually a critical condition in leprosy.
Asthma with flapping nose wings is usually caused by
%o ffn
retention of pathogenic heat or phlegm in the lung in new

disease and is a critical condition of the exhaustion of pul
monary and renal essence in chronic disease.
KiiF.o
Nasal excreta; See the section of inspecting excre

ta.
(2)
m m ,
1 .1 .2 .2 .4
Inspection of mouth and lips
4. M C L H
The spleen opens to the mouth. flourishes on the lips

and is internally and externally related with the stomach.
The spleen and the stomach are the production source of
:# l
m v i, & m P
qi and blood. So, inspection of mouth and lips is helpful

for understanding the functions of the spleen and stomach
as well as the pathological changes of qi and blood in the
whole body.
Inspection of mouth and lips mainly focuses on in
specting the luster, colour, dryness, moisture and shape.
Colour, lu ste r, dryness and m oisture: The nor
(1)
JSfeU
mal colour of lips is reddish. fresh and moist. Deep red

and dry lips indicates consumption of fluid by exuberant
heat; purplish and brownish dry lips indicates extreme ex
uberance of stagnant heat; bright red lips indicates yin as-
|5J M k HE; B & t L n M il
thenia and exuberant fire; lips as red as cherry usually in

dicates poisoning by coal gas; pal lips is caused by asthe
^JM %JLMM t M fe l
nia of both qi and blood; purplish lips indicates qi stagna

tion and blood stasis; blackish colour around the mouth in
dicates kidney qi on verge to exhaust; dry and fissured lips
indicate impairment of fluid; swelling and painful lips or
lips with ulceration and sores are often caused by fumiga-
m m ni
(ion of heat accumulating in the spleen and stomach.

Shape: During the course of a disease, constant oIM'iiing of mouth indicates that pulmonary and splenic qi is
on verge to exhaust and that the syndrome is asthenic;
(2)
%P
MZxftt'MJ&vE;
P ff fff^FfI
JIM
P rfi
(llfficulty in opening mouth is lockjaw seen in convulsin in

Mil
lenia sydnrome.
1 .1 .2 .2 .5
5. 1 I
Inspection of gums
Gums are connected with the collaterals of yangming

meridian. So inspection of gums is helpful for understand
ing the pathological changes of the stomach. Inspection of
jiums mainly concentrates on examining the colour of
(jums. Nomrally, gums are light red and moist. Pal gums
m.r.7 m - % je #. gg
Indicates blood asthenia; reddish swelling and painful

gums indcate exuberance of gastric fire; slight swelling
gums without pain indcate up-flaming of asthenic fire;
H M X
h ^ o trS
bleeding and reddish swelling gums indcate impairment of
th jfitia i'3, J iB k ilb-, i4
the collaterals by gastric fire; bleeding gums without red
dish swelling suggest impairment of the collaterals by asthenic fire.

1 .1 .2 .2 .6
Inspection of throat
6. MH0P
The throat is the door to the lung and stomach. the

palliway for breathing and eating and the regin over
wluch the kidney meridian circulates. So inspection of
lliroat is helpful for examining the pathological changes of
(lie lung, the stomach and the kidney.
Inspection of throat mainly concentrates on the colitui and shape of the throat. Reddish swelling and pain of
lliroat is due to virulent wind heat attacking the upper or
llue lo stagnant heat in the lung and stomach to fumigate
Ihe upper; reddish swelling and ulceration of the throat
Indicates extreme exuberance of heat virulence; bright

iimI and tender throat with slight swelling and pain is due
lo up-flaming of asthenic fire resulting from deficiency of
kidney yin; unilateral or bilateral reddish and painful
i'w
lumps like mastoid process is due to accumulation of heat

iu the lung and stomach or due to wind heat attacking the
upper; reddish swelling and ulceration with erasable yel
lowish white pus-like substance or suppurative points is
SSc.
called tonsillitis due to exuberant virulent heat as well as
^ ,1 1
heat fumigation and muscle decaying; false whitish mem-
, pj
itiJi.fiSBPg
brane on the throat that is not erasable, bleeding when

rubbed heavily and reappearing is diphtheria due to accu
mulation of pestilent factors in the lung and stomach that
fumigates the throat and must be treated in isolation.
1.1.2.3
(= )
Inspection of neck
Neck is the part connecting the head with the trunk

of the body; the anterior part is called neck and the poste
rior part is called nape. Normal neck should be erect and
jE # A f 3 9 S S .m i
symmetrical with the trachea located on the middle. Laryngeal protuberance is prominent in the male and invisible in the
female. The neck can be rotated, bent and raised freely in
standing and sitting position. So inspection of neck con-
M#
centrates on the shape and movement of the neck.

1 .1 .2 .3 .1
i.
Changes of the shape
The commonly seen changes are:

m -.
G o ite r: Goiter refers to unilateral or bilateral lumps
( i)
like tumor below the laryngeal protuberance which is either
Klffl'J^ W ffl'JM W $ i P , i
small or large and movable with swallowing, usually caused
, ni 15 A0$
by stagnation of liver qi and retention of phlegm, sometimes
MMo
due to local climate and environment.
Wt,
Scrofula: Scrofula refers to cervical clustered nod-
Jfeis
(2)
:M o
m f : w m & t w
ules, usually caused by asthenic fire scorching phlegm into

nodules due to asthenia of lung and kidney yin, or by accu
mm.
mulation of qi and blood in the neck due to attack by wind

fire and seasonal pestilence.
1 .1 .2 .3 .2
Changes of movement
Abnormal changes of the movement of the neck
2.
M xh& M
it
Indude the following aspects:

F laccidity o f the neck: Weakness of the neck na
( i) =
nle lo support the head is called flaccidity of the neck.

Flaccidity of the neck in the babies over 4 months od is
tluc to congenital deficiency, insufficiency of essence and

marrow, or due to postnatal improper feeding which leads
lo asthenia of qi and blood and malnutrition of the skeleton. Flaccidity of the neck with dispiritedness in chronic
iin<l severe diseases is due to exhaustion of essence.
S tiff neck: Stiff neck refers to spasm of the muscles
nnd sinews over the neck, making it difficult for the neck
(2)
m ttssifraji
m m fe # *&
to bend. raise and rotate. Stiffness of the neck after sleep

is due to improper posture in sleep or due to wind coid at-
9 f f l.
B8R
m . as-
lacking the neck. Stiffness of neck with high fever, headache and vomiting is usually due to heat virulence in fe-
g s m g * '-'i.
brile disease attacking the upper; stiffness of neck and
mmwo
back with posterior bending of the head, stretching of the
w,
trunk, bending of the spine and spasm of the limbs is
im
called opisthotonus, usually seen in tetanus and exogenous
ir e .f lr w s f lr in ^ .iE ia jR
ik ini fe m . m r
fcbrile disease with wind generated by extreme heat.

"5 MI ^
&a # tu
m u
1.1.2.4
Inspection of skin
(E3) M R ;
Skin is distributed over the surface of the body, connected with the lung with weiqi circulating inside. Skin is
the defending barrier of the body and nourished by qi,
blood and body fluid through meridians. So the disorders
of the skin itself and the disorders of viscera can be reflec
tad by the skin. Inspection of the skin is not only helpful
for diagnosing skin disorders, but also helpful for underNtanding the nature of the disease, the conditions of the
viscera and the states of qi and blood.
Hi
The normal skin colour of the yellow race is similar

to complexin and appears reddish and yellowish. moist
and lustrous. elastic and smooth, which are signs of sufficiency of body fluid and essence.
m ftm ,
Inspection of skin mainly concentra tes on the colour,

shape and pathological changes of the skin, such as mac
ules, eruption. miliaria alba, abscess, carbuncle, boil and
furuncle.
1 .1 .2 .4 .1
iu fr
Inspection of colour
1. M f e j f
The diagnostic significance of inspection of skin is

similar to that of inspection of complexin.
1 .1 .2 .4 .2
Inspection of shape
2.
Dropsy of skin is due to spreading of dampness; dry

skin is due to consumption of body fluid or depletion of es
'ilM
; & K T M
sence and blood; dry and rough skin like scales is called
squamous skin due to mixture of blood asthenia with blood
stagnation and malnutrition of the muscles and skin.
J U lte fg ,^ E im i M ,l
te # 0 r L
1 .1 .2 .4 .3
Inspection of skin disorders
3.
Many skin diseases and general diseases may bring

about the changes of the colour and shape of the skin. The
following are some of the commonly encountered ones.
m , iis ^
ja iw i r m i
J ift:
Inspection o f macules; Macules refer to reddish or
( i)
purplish uneven patches on the skin and can be divided in

to yang macules and yin macules.
Reddish or purplish and silk texture or cloud like

macules with fever. dysphoria and fast pulse is called yang
macules, usually seen at the exuberant heat stage in
K m .,#
E te tB iM d
pxogenous febrile disease due to exuberant heat scorching

lllood and driving blood to extravasate. Bright red macules
tippearing on the chest and abdomen first and gradually ex-
it iM T m M iJ s m R m B ,
ttinding to the four limbs with freshment of the spirit after

batement of fever is the sign of outgoing of pathogenic
fnctors, suggesting favourable prognosis. Thick, deep red
fe m o
or purplish macules, or appearing first on the four limbs

nnd gradually extending to the chest and abdomen with
i'ontinuous high fever and even coma, is a sign of extreme
rxuberanee of virulent heat and internal sinking of pathoHCiiic factors, suggesting unfavourable prognosis.
Light colored or purplish thin macules with varied
Hze, unfixed location, occasional appearance and disapIH'arance, pal tongue and weak pulse are yin macules, u-
M , SS 5 ^ ifc.>E $ ^
Nually seen in miscellaneous diseases of internal impair-
H H,
IIK'iit resulting from failure of qi to control blood and exinivasation of blood.

Inspection of eruptions: Eruptions refer to reddish
points like millet or petis that can be felt by hands and
S ifo. . S Jfc ^
.
(2)
^ s fe la :,
/h M , M in ie n ,
b|de when pressed. Eruptions may appear in various dis

tases, such as measles, rubella and urticaria.
0 ! J lT g f t 'f iiE , n
Measles is an acute epidemic eruptive disease in pediiiIl ies, usually due to attack by exogenous morbillous toxln. Measles is characterized by pink pockmarks which ap
licar first over the hairline and face, gradually extending
lo Ihe Irunk and four limbs and disappearing after full eI npl ion. Pink-colored and evenly-distributed measles with
orderly eruption, orderly disappearance, abatement of fe-
f .
vn and desquamation after eruption is favourable, sug-
% M t}
rsting that healthy qi dominates over pathogenic factors

lid lliat the prognosis is favourable. Deep red or purplish
mi id
Ihick or evenly mixed or unevenly erupting or sudden
VMinshing measles accompanied by high fever and asthmatic
, $1th IE#t (5p, M fr*
breath is unfavourable, suggesting that pathogenic factors

domnate over healthy qi and that the prognosis is un
favourable.
U lE d l
Rubella is a commonly encountered acute epidemic

disease in pediatrics, usually caused by exogenous virulent
heat. Rubella is characterized by light red colour, small
size, sparse distribu tion, more distribution on face and
/ h M ,
neck, less distribution on four limbs, itching skin and no

desquamation after disappearance of eruption.
Urticaria is a cutaneous disease caused by internal accumulation of damp heat complicated by invasin of pathogenic wind which is stagnated in the skin. It may be
m rfn ,
caused by allergy. Its eruption is marked by various size
m Bt& o
of macules which are in the size of pockmarks or soybean,

protruding on the skin, occasionally emerging and disappearing. It is quite itching and appears in patches after being scratched.
M iliaria alba: Miliaria alba refers to a kind of small
(3)
-fJft&K I:
whitish blisters on the skin characterized by brightness

like millet, protrusion over the skin and unchanged colour
over the root. There is serous fluid in miliaria alba which
!* !# H
comes out when scatched. The blisters are distributed over the neck, chest and abdomen, occasionally over the
four limbs and never on the head. There is desquamation

after disappearance of miliaria alba. It is usually caused by
retention of exogenous damp heat in the skin and inhibited
sweating, often seen among patients with damp and fe
brile disease. Miliaria alba with bright colour and full se
rous fluid is called crystal miliaria alba, suggesting sufficiency of fluid, capability of healthy qi to domnate over
pathogenic factors, outgoing of damp heat and favourable
prognosis. Miliaria alba with white and dry colour and no
serous fluid is called dry miliaria alba, suggesting insufficiency of fluid, failure of healthy qi to domnate over path-
m* ti,
ogenic factors and unfavourable prognosis.

Carbuncle, phlegmon. bol and furuncle: Carbun-
(4 )
H\R,
cle. phlegmon, boil and furuncle appear on the surface of

the body and are usually treated in surgery.
Carbuncle; Carbuncle refers to local swelling with
: Ja W & W iB fjg .f ffl
tense root and accompanied by hot sensation and pain.

Carbuncle is of yang syndrome and is characterized by
quick onset, susceptibility to ulceration and liability to
healing. It is usually caused by internal accumulation of
^ 0 & X % l*l H . % J.
damp heat and virulent heat, stagnation of qi and blood as

well as exuberance of heat and decaying of muscles.
Phlegmon: Phlegmon refers to extensive swelling
L:
without tip, changes of skin, fever and pain. It is of yin
S $ -~S 'P m # ,
syndrome marked by gradual onset, longer duration, diffi-
K ffi.
. JR
culty in dispersing, ulcerating and healing. It is usually

caused by asthenia of qi and blood, stagnation of coid and
ifi.1? , ^ fM M i f , JeM, # rt
phlegm, or internal accumulation of virulence of wind

which migra tes in the muscles, deepens into tendons and
lames as well as stagnates qi and blood.
Boil: Boil appears like millet at first with liard deep
rf:
root, numbness or itching, white top and pain, followed

liy bright redness, pyrexia, aggravation of swelling and
, m e m jk , m
m m i
sharp pain. It is usually caused by accumulation of heat in

the viscera, complicated by virulence attacking the skin,
resulting in stagnation of qi and blood.
li^fifnjio
Furuncle: Furuncle appears superficially on the skin

with small and round size, red swelling, pyrexia, mild
m m , rw a
* g , & jk ^
|um, susceptibility to suppurate and ulcerate and liability

to healing after ulceration. It is usually caused by intemal
luvumulation of virulent heat, or by stagnation of summer-
T jy it t ,
lic.it dampness in the skin which stagnates qi and blood.
fnfiKo
1.1.2.5
Inspection of infantile ndex finger
(E)
veins
Inspection of infantile ndex finger veins means to
ffl/J'JLtffilIJcft.tfc#
examine the length, colour and shape of the veins along

the palmar margin to detect pathological changes. This
method is applicable for the diagnosis of infants under the
age of three. Since artery over cunkou in infants is short
ttfr & fe is fflT 3 m r t w
and infants tend to cry in clinical examination and affect

the accuracy of pulse taking, inspection of index finger
veins is usually used to help diagnose because infantile
skin is thin and tender and veins are visible.
K M .E M M M o
ifo
Infantile index finger vein is divided into wind pass,

qi pass and life pass. The first stem of the index finger,
the part between metacarpophalangeal transverse lines
and the transverse lines on the second stem, is wind pass;
the second stem, the part between the transverse line on
the second stem and the transverse ine on the third stem,
is qi pass; and the third stem, the part between the trans
verse line on the third stem and the top of the index fin
(Effl 1)
ger, is life pass (see Fig. 1).
L ife pass
Qi pass
Wind pass
Fig. 1
Three passes of infantile index finger vein
ffll
The normal infantile index finger vein is light red and
slinhtly purplish. dimly visible within the wind pass, usu
ally not quite clear or even indistinct. The vein usually
IE#/hJL
ppears oblique, singular, modera te in thickness, thicker

und longer in hot weather, thinner and shorter in coid
Weather. It is longer in infants under the age of one and
So i
becomes shorter with the increase of age.
-IxrFn^f&L
1. M / J ' J L t - l M f i
Methods for inspecting infantile index finger

vein. The parent carries the infant to the place with full
J j)
li^ht and the doctor grasps the end of the infantile index
finger with the left hand and pushes the infantile index
finger from the anterior palmar margin of the index finger
lo the palm direction for several times with the side of the
hkB JLlstH $ S B U S i \
i
right thumb. The pushing should be moderate in strength

and make the vein clearer for observation.
Content of the inspection of infantile index fin
2. S / J 'J L & f J f t & f
ger vein. The inspection mainly concentrates on the

length, colour, f loating or sinking, lightness or stagnancy
and shape of the vein.
Length; During the course of a disease, appearance
KM:
of the index finger vein on the wind-pass indicates that the

disease is mild; if it extends to the qi-pass, it means that
the disease is serious; if it extends to the life-pass, it
dhows that the disease is very serious; if it stretches directly to the tip of the finger, it indicates critical conaition
and unfavourable prognosis.
Colour: Light-coloured and whitish vein indicates in-
Hufficiency of qi and blood; reddish vein indicates exogenous wind and coid; deep red or purplish vein indicates intemal exuberance of heat; bluish vein indicates pain syn
drome or convulsin; cyanotic or purplish dark vein indicates stagnation of blood collaterals and critical condition.
Floating and sinking: Visible and floating vein indicates that the pathogenic factors are in the superficial and
that the disease has just occurred; deep and indistinct vein
means that the pathogenic factors are in the interior as in
n-.
the case of internal invasin of pathogenic factors or inter
mvEo
nal impairment.
Lightness and stagnancy: Light-coloured vein indicates insufficiency of qi and blood; deep and dull colour of
vein indicates excess of pathogenic factors and stagnaton
of qi and blood.
Form: Thin vein indicates asthenia and coid syn
dromes; thick vein indicates sthenia and heat syndromes;
single and oblique vein indicates mild disease; mltiple
E,#ViiEo i
and curled vein indicates serious disease; gradual exten
sin of vein indicates progression of disease; gradual
&B
; ^
i l , ^
II
0:
shrinkage of vein indicates alleviation of disease.

In a word, inspecting infantile index finger vein includes three aspects: estima tion of the state of diseases by
inspecting three passes, discrimina tion of coid and heat by
m i i r t U f i . m ffi Se m %
inspecting color reddness and purpleness, and determina-
If .
tion of asthenia and sthenia by inspecting lightness and

stagnancy.
1.1.2.6
Inspection of excreta
(A ) m m m
Excreta refers to the secretion and excreta from the

human body, including tears, spittle, snivel, sweating.
WWlVnKj &
. i: g fe t m,
saliva, urie, stool, menstruation, leukorrhea, sputum

and vomitus, etc. Excreta is produced by the functional
ie #|
activities of the viscera. Normally, the excretion of tears,

spittle, snivel, sweating, saliva, urie, stool, menstrua
tion, leukorrhea and sputum follow certain rules. However, under morbid conditions, there may be some changes
in its colour, quality, volume and form. The production of
sputum and vomitus is due to the dysfunction of the vis
m\
cera. So inspection of excreta is helpful for understanding

the location and nature of disease as well as the functional
yu. l a i i t . i i t M t t i . si]
states of the viscera.
vat
Inspection of excreta mainly includes examination of
W M tiW n . 1:
lis colour, quality, volume and form. Generally speaking,

whilish or light-coloured and thin excreta indicates coid
lyndrome and asthenia syndrome due to retention of
(lilinpness resulting from stagnation of pathogenic coid or
Insufficiency of yangqi and weakness in transportation and
transformation; yellowish or deep-coloured and thick ex
creta indicates heat and sthenia syndrome due to fumiga
ron by pathogenic heat which condenses body fluid.
Inspection of excreta is rich in content, the following
mainly describes the inspection of sputum, snivel, spittle,
Miliva and vomitus. Sweating, urie, stool, menstruation
nd leukorrhea will be discussed in the chapter of inquiry.
1 .1 .2 .6 .1
Inspection of sputum
i.
Sputum is a kind of sticky fluid, substance produced

by disturbance of fluid metabolism, excreted from the
lung and trachea due to dysfunction of the lung and the
npk'c-n. That is why it is said that the spleen is the
& fi& fc # 0 a ,tt h u a ^ W
KOurce of sputum, while the lung is the container of sputuin. The production of sputum may bring about various
(lineases. So it is said that sputum is produced by disea-
&x *r & mm4
*s. but sputum further worsens diseases.

Yellowish and sticky. or hard and coagulated sputum
In heat-sputum produced by exogenous wind-heat, or by
lu'cumulation of endogenous heat which fumigates the
lung. Whitish, thin or blackish sputum is cold-sputum due
lo ronsumption of yangqi by coid, failure of qi to transforni fluid and accumulation of dampness. Thin and frothy
n|iulum is wind-sputum due to pathogenic wind attacking
lile lung.
Whitish,
slippery and easily expectorated
ipulum is damp-sputum due to asthenia of the spleen and

exuberance of dampness. Scanty, sticky sputum difficult
lo expectrate, or with unproductive cough, is dry sputum
iliic to pathogenic dryness attacking lung and consuming
fluid in exogenous disease; in diseases due to internal
l i f f i , l i 'A^'tWo
>
it
40
-si
impairment, sputum results from consumption of pulmo

nary yin and asthenia-fire scorching the lung. If sputum is
* E ,J il| r * jiL & S U 0 j
mingled with fresh blood, it means that the pulmonary

collaterals are impaired due to invasin of dry-heat into
the lung as well as asthenia of yin and exuberance of fire.
If sputum appears like purulent blood or chyle with foul
smell, it is usually seen in pulmonary a^scess due to accu
mulation of heat toxin in the lung and suppuration of the
decayed resulting from blood stasis.
1 .1 .2 .6 .2
2. W M M
Inspection of spittl and saliva
Spittle refers to thick secretion in the mouth, while

saliva refers to the thin part of
secretion
in the mouth.
Spittle is related to the kidney and alsc to the spleen and

stomach; while saliva is related to the spleen.
Reduced spittle and dry mouth anc throat are usually
caused by exhaustion of body fluid or fjilure of body fluid
to flow upwards, often seen in consuirption of body fluid
in exogenous disease, or internal impairment and prolonged disease marked by asthenia of spleen qi, failure of
/ J 'J L g # P
qi to transform fluid or insufficiency o kidney yin. Frequent salivation from the corners of the mouth in infant is
&
usually due to failure of the asthenic spleen to control fluid

or due to attack of wind-heat. Distorted mouth with ina
g # p g j
bility to cise the mouth and spontaneo(S drooling in adult

is usually seen in wind stroke. Freque't regurgitation of
clear and thin fluid in the mouth is oftei caused by asthen
to
ic coid in the middle energizer; or insficiency of kidney

yang and disorder of qi transformation; 3r by internal exuberanee of coid dampness and upward low of pathogenic
dampness.
1 .1 .2 .6 .3
Inspection of snive
3. a s
Snivel refers to sticky fluid disharged from the

nose. Snivel is related to the lung. Ins>ection of snivel is
helpful for understanding the condition of pulmonary qi
w di
m r m % m % fft
mui the nature of the pathogenic factors.

Stuffy nose with clear snivel indicates exogenous
wind-cold.
Turbid
and
yellowish
snivel
indicates
rxogenous wind-heat or wind-cold transforming into heat.

Iersistent discharge of turbid yellowish pus-like snivel
w i lli foul smell indicates nasosinusitis due to accumulation
miiiI retention of damp-heat. Snivel mingled with blood is

imually caused by dry-heat impairing collaterals; frequent
discharge of snivel with bloody streaks probably indicates
inalignant syndrome of nasal cavity and further examinalion is necessary.
1 .1 .2 .6 .4
Inspection of vomitus
4. MPR!$J
Vomiting is caused by upward adverse flow of gastric
qi. Inspection of vomitus is helpful for understanding the
tK u m m y jT ff
cause of upward adverse flow of gastric qi and the nature

o disease.
Thin vomitus without foul smell indicates coid syn
drome due to consumption of gastrosplenic yang or invanion of pathogenic coid in the stomach. Turbid and sour
vomitus indicates heat syndrome due to exuberant heat in
the stomach or liver fire attacking the stomach. Sour and
fetid vomitus with indigested food accompanied by unpresible abdominal distensin and pain is caused by retention
O food due to intemperance of food and indigestin. Vomiling of indigested food without sour and fetid smell is
Caused by asthenic coid in the spleen and stomach. Vomiling of clear fluid, sputum and saliva is usually due to dysunction of the spleen due to retention of fluid in the stomncli. Vomiting of yellowish and greenish bitter fluid is due
lo accumulation of damp heat in the liver and gallbladder
ni due to adverse flow of liver and gallbladder qi which in
vades the stomach. Vomiting of fresh blood or purplish
hlood with clot or with food dregs is often due to impairmi'iit of the collaterals by stomach heat and liver fire or
fP E g 0 r& . Pgn
blood stasis in the epigastrium. Vomitus with pus and

blood indicates stomach abscess due to accumulation of
heat toxin in the stomach and putrefaction of blood stasis.
1.1. 3
Inspection of tongue
Inspection of tongue, an important part of inspection

diagnosis in TCM, is a diagnostic method by means of observing the changes of the body and fur of the tongue.
The tongue is closely related to the viscera and me
'>m'ii'&zsi
ridians. The tongue is the extemal part of the heart and is

connected with the heart meridian. The tongue also manifests the conditions of the spleen because it is connected
with the spleen meridian. The kidney stores essence and
the kidney meridian reaches both sides of the tongue. The
liver stores blood and governs tendons, the liver meridian
also extends to the tongue. The lung reaches the throat
and is connected with the tongue. The tongue fur is produced by gastric qi fumigating cereal nutrients.
The tongue depends on qi and blood to nourish and
body fluid to moisten. So the form, texture and color of
the tongue are closely related to the State and circulation
OT 5
Jfil
^ fu )S f
of qi and blood. The moisture and dryness of the tongue

coating and body are related to the quantity and distribu
tion of body fluid. That is why the tongue can reveal the
@ jtt, A t t M W S
states of the viscera, qi, blood, yin, yang, pathogenic

factors and healthy qi as well as the progress of diseases.
m & .m t i w * m -^
So examination of the tongue can enable one to understand
mx
internal pathological changes.
1.1.3.1
Methods for inspection of tongue
The patient is asked to sit down or lie in supination,

exposed to the light source. The tongue is protruded naturally and the tip of the tongue is kept slightly downwards.
( - ) M S M B
The mouth is opened wide to make the tongue exposed

fully.
The sequence of inspection of the tongue begins from
the tip of the tongue, then the middle and margin of the
r 4=, # # r
, r ffi, k m >
tongue, and finally the root of the tongue. The inspection

Ix'gins with the tongue body first and then moves to the
tongue fur. The inspection should be complete and quick.
In the inspection of tongue, triis should be made to
exelude various false manifestations, such as dyed tongue
fur due to light, diet and drugs.
KJSi uf, tfc # & M ah
Inspection of the tongue mainly includes the examination of the tongue proper and the tongue fur.
The body of the tongue is composed of muscles and
Vessels. In the ancient times some people believed that
m m o hu
the surface of the tongue corresponded to the viscera.
E W iift.
That is to say the tip of the tongue reflects the pathologit'iil changes of the heart and lung, the center of the tongue
reflects the pathological changes of the spleen and stom-
i x efe
k m n w m $ , s- m m
Mth, the root of the tongue reflects the pathological chan
^ s u f e f f F . i a w ^ d L 2).
ces of the kidney and the margins of the tongue reflect the
&#
pnthological changes of the liver and gallbladder (see Fig.
-JEMA
2) Such an idea about the correspondence of the tongue

lo the viscera is clinically practical. However, the analyH n
should be comprehensive and based on the changes of
Ihe tongue body and tongue fur.

Fork groove
. / , L
K id n ey '|f
M dium groove
Spleen ( s t o m a c h ) ( P f )
L iv er (gallbladder) f f g i
Heart (lung)'ll'(/J$)
Fig. 2
Correspondence of the tongue to the viscera

B0 2
m m it m iiitR-tr
Inspection of the body of the tongue includes the col

our, shape, texture and movement of the tongue, which
reflect the conditions of the viscera, qi and blood.
The tongue fur or coating refers to the lichen-like
material formed on the surface of the tongue. Inspection
of the colour of the tongue and fur can reveal the condi
tions and nature of pathogenic factors as well as the interaction between healthy qi and pathogenic factors.
1.1.3.2
(Z ) E 5 i
Normal states of the tongue
The conditions of the tongue among healthy people

are the normal states of the tongue marked by suitable
IE #
size, softness, flexibility. light-red colour, luster and

moisture; even and whitish thin fur which is neither dry
sfr S i n . ^ fe
or greasy and slippery, closely attached to the surface of

the tongue, distributed more 011 the center and root and
less on the margins and tip. The normal conditions of the

tongue is usually described as light-reddish tongue with
thin and whitish fur Csee colour Fig. 1), suggesting nor
( ' J i m 1 Do
mal functions of the viscera, sufficiency of qi, blood and

body fluid as well as superabundance of gastric qi.
1.1.3.3
Inspection of the tongue body
The body of the tongue is in cise relation with the
(= ) a s *
i f
visceral qi and blood through meridians. By means of in

spection. one can understand the conditions of the visce
ra, qi and blood.
Inspection of the body of the tongue includes the col
our, shape and movement of the tongue.
1.1.3.3.1
Colour of the tongue
i-
It includes the four changes as follows:
Light-reddish tongue: The tongue is light-reddish.
( 1) j&r--:
% tfc US-o
moist and lustrous. Such a condition of the tongue is
I I ifiS # ,
usually seen among healthy people. suggesting sufficiency
J E ^ A ^ ^ u ii^ M ^ f
of qi and blood. Sometime it is also seen in mild cases,
JE -
Mdch as primary stage of exogenous disease, mild pathological conditions, or mild internal impairment. indicating
Ihiil qi, blood, yin, yang and viscera are not involved.
L ig h t-w h itis h tongue: The colour of the tongue is
(2)
f r S iE #
llj(hter than that in normal condition, more white and less

m i, or even showing no signs of blood (see colour Fig.
2 )a
Z). Such a condition suggests deficiency of qi and blood or

Mthcnia of yangqi.
Malnutrition of the tongue due to asthenia of qi and
H. IL% i , ^ k 5#; sjc
lilood: The tongue is light-white due to asthenia of qi and

hlood or asthenia of yangqi which fails to transport blood
li) nourish the tongue. For example, light-white and thin
anease
f f f i'h # , M
loiigue is due to deficiency of qi and blood; light-white and

hulfiy tongue is due to asthenia of yangqi.
Red and deep-red tongue: The tongue is redder
(3)
JE#-S
Iluin that in the usual condition ( see colour Fig. 3). The
ilffcp or dull red tongue is called deep-red tongue (see
( J a l s i3 )0 m i f i M M
lOlour Fig. 4). Red and deep-red tongue both indicates

lirnt syndrome. The redder the tongue, the severer the
4 )o
Irnl.
M tiE /K W fe o
Red or deep-red tongue is caused by superabundance
uf blood in the vessels of the tongue due to hyperactivity
/ l , $ ^.li a i ,
.tS T fr ,
WJ m I S
E; fkl
ni Ihe tongue. Slightly red tongue or reddish margins and

llp of the tongue indicates exogenous superficial heat synilrome; reddish tongue tip indicates up-flaming of heart
llK i deep-red tongue with fur indicates sthenia-heat syn-
fOme frequently seen at the superabundant heat stage of

PXogenous disease, or in relative predominant visceral
licnt in miscellaneous diseases due to internal impairment;
il#cp-red tongue with scanty fur or without fur indicates
^ P n:sSc% ^ # JS A ft fiE,
ii'lthonia-heat syndrome seen at the advanced stage of extillcnous febrile disease with consumption of yin fluid or in
IMlicnts with yin asthenia and superabundance of fire due
lo Internal impairment and chronic disease.
E & JX t t M
Cyanotic and purplish tongue: The tongue is com-
(4)
pletely cyanotic or purplish, or cyanotic and purplish or

purplish macules on the surface of the tongue (see colour
, skin
Fig. 5), indicating inhibited circulation of qi and blood.
5), $
Cyanotic and purplish tongue is caused either by in

ternal exuberance of yin coid and obstruction of vessels;
;j 0 T & 2 f l5 JtP>,
or by superabundance of pathogenic heat and obstruction
liE H if H f P H I S .
of vessels; or by decline of yangqi. weak transporta tion of

blood and inhibited flow of blood; or by failure of the liver
to disperse and convey as well as qi stagnation and blood
!ll ' t$ % Jc % B M
#3 # JU
stasis. Light-purplish or dull purplish tongue with moisture is caused by inhibited flow of qi and blood due to yang
asthenia and yin exuberance; purplish red or deep-purplish
and dry tongue is caused by superabundant heat consuming
fluid and stagnation of qi and blood; dull purplish tongue
z'u e.
or tongue with purplish macules is caused by internal re

tention of blood stasis. Besides. cyanotic and purplish
tongue is also seen in cases of congenital heart disease or
intoxication by drugs or food.
1 .1 .3 .3 .2
Shape of tongue
2.
Shape of tongue mainly includes severa l changes as

follows;
Rough tongue and tender tongue: Rough tongue is
IUTJL#:
(1)
marked by rough or curved texture, dry surface and dull

colour; while tender tongue is characterized by fine tex
ture, moistened and lustrous surface, light colour and
bulgy appearance.
Inspecting to see whether the tongue is rough or ten

der is helpful for understanding whether the disease is of
asthenia or sthenia. Rough tongue usually indicates sthe
nia syndrome and heat syndrome due to hyperactivity of
yang-heat and consumption of body fluid. Tender tongue
mm
imually signifies asthenia syndrome and coid syndrome due

lo failure of asthenia yang to transport dampness, or due
tn qi asthenia and deficiency of yin-essence, which fail to
nourish the tongue.
Bulgy tongue: The tongue is bigger than usual (see
(2) #*.--!
mm
colour Fig. 6 ), usually indicating internal retention of

(Umpness and phlegm.
ISulgy tongue is caused either by qi asthenia or yang
Mlthenia which fail to warm and transform fluid, leading to
JtV U t
. 7jc M f f f f l, M
HtiiKnation of fluid or accumulation of dampness into

phlegm in the tongue collaterals. Light-white and bulgy
tongue with moist and slippery fur is due to asthenia of
Ipleen and kidney yang which fails to transform body fluid
iilid leads to internal retention o dampness and phlegm.
I Ight-red or red and bulgy tongue with yellowish greasy
fui is usually due to damp-heat in the spleen and stomach.
Swollen tongue; Swollen tongue means that the
(3) fltL--s
Migue is swollen, usually suggesting sthenia syndrome.
Swollen tongue is either caused by

supera hundant
licat in the heart and spleen. or by mixture of febrile
wu a m m m m # t *, s s
pmhogenic factors with alcoholic toxin attacking on the
-s- m m m
Up|xT,
iillil
or by intoxication which leads to stagnation of qi
tu (u-U i l M fi't'K*
blood in the tongue collaterals. Deep-red and swollen
lifclgue is due to superabundant heat in the heart and
- fH S
tipleen. Purplish, dull and swollen tongue is due to alcoholism or intoxication.

Thin and emaciated tongue: The tongue is thinner
(4)
Ulan usual (see colour Fig. 7 ), indicating asthenia of qi
fi'S 'hl}i,
mui blood or consumption of yin fluid.
mm 7).
S 'ÎE 'M '
MW
-r(BL
Thin tongue is usually due to asthenia of qi and

IiIinkI. or consumption of yin fluid and insufficient mois-
cansas#,
liiir and nutrition of the tongue. Light-coloured and thin
in K 'f iJ s i rfi S M
iii
longue is caused by deficiency of qi and blood; deep-red

and thin tongue is caused by exuberant heat consuming yin
or by superabundance of fire due to yin asthenia.
Fissured tongue; There are various fissures on the
(5)
tongue (see colour Fig. 8 ), indicating deficiency of fluid

or essence and blood.
8 ). -
a *
Fissured tongue is usually due to consumption of body

Huid or asthenia of essence and blood. Deep-red and fis
A m is ta :, n
sured tongue is due to exuberant heat consuming fluid;

light-coloured and fissured tongue is due to asthenia of es
sence and blood.
However, fissured tongue may be seen in some
healthy people, known as congenital fissured tongue.
Such a tongue is marked by fine fissures and covered with
s . g ^ & m m . iit % m v
tongue fur.
Prickly tongue; The tongue is covered with reddish
(6) #']-:
prickles (see colour Fig. 9), suggesting superabundance of

pathogenic heat.
9 ).
Prickly tongue is due to superabundance of heat in

the viscera, invasin of heat into blood and accumulation
of heat in the tongue collaterals. The location of prickles
e m ffi
may indcate the location of pathogenic heat. Prickles on

Ihe tongue tip indcate hyperactivity of heart fire; prickles
'll'A /L ; f f 4 ^ f M * !
on the tongue center indcate superabundance of heat in

the stomach and infestines; prickles on the margins ind
JfFJEA,
cale exuberance of liver and gallbladder fire. The more

the prickles and the deeper the colour, the severer the
pathogenic heat.
Tooth-marked tongue: The margins of the tongue
(7)
are printed with tooth marks (see colour Fig. 10), indicaling qi asthenia or yang asthenia and internal retention of
(m m w o
(lumpness.
The spleen govems transportation and transformatlon. The decline of the spleen qi or spleen yang will lead
Id dysfunction in transportation and transformation as well
>if internal retention of dampness in the tongue, resulting

ill bulgy tongue which is squeezed by teeth. That is why
liKilh-marked tongue and bulgy tongue appear simultaneugly.
However, tooth-marked tongue is also seen among
Ruine
healthy people, characterized by constant existence
uf tlight tooth-marks and no bulging manifesta tion.
1 .1 .3 .3 .3
Movement of the tongue
This mainly includes the examination of the changes

of movement of the tongue. Normally the tongue is soft
3. -S-&
it'#?
f, <4- 4}W
it . iE t s & m m z j
uliil flexible, indicating sufficiency of qi and blood, normal

t In ni ation
of vessels and meridians as well as normal
ftllictions of the viscera. There are four kinds of different
bfil Bi o 1$ L Ni 1?f jS ' 1t W
nVivcment of the tongue.
VI K J L # :
Stiff tongue: The tongue is not soft; it is inflexible
(1) M
ni Itiff and immobile. Such a change of the tongue is usunlly seen in exogenous diseases due to exuberant heat con-
MLT1
Miming body fluid, or due to invasin of heat into the peri-
m , sjc m
inidium, or due to phlegm and turbid substance confusing
JtL
llu heart. It is also seen in miscellaneous diseases due to

lilltirnal impairment caused by wind phlegm obstructing
lllr collaterals.
Stiff tongue seen in exogenous diseases is caused eillit'i by hyperactivity of pathogenic heat which consumes
lnnly fluid and leads to malnutrition of the tongue and inUt'Hibility of the tongue; or by invasin of heat into the
|Hi irardium involving the spirit; or by phlegm and turbid
lulmlance confusing the heart and affecting the tongue.
Ntlfl longue seen in miscellaneous diseases due to intemal
impairment is caused by obstruction of the tongue collater

als due to liver wind complicated by phlegm. Deep-red
stiff tongue with scanty fluid is due to exuberant heat
consuming body fluid or invasin of heat into the pericardium, frequently seen at the severe heat stage of exoge
nous diseases. Stiff tongue with greasy and thick fur seen
in miscellaneous diseases due to internal impairment is
caused by wind-phlegm obstructing collaterals.
If the
tongue suddenly becomes stiff, accompanied by aphasia,

numbness of the limbs and dizziness, it is the premonitory
sign of wind stroke.
Shivering tongue: The tongue is involuntarily trem-
(2) M $j4 r
oring, indicating endogenous liver wind.
)\m
Shivering tongue is caused either by consumption of

blood or body fluid which fails to nourish the tendons and
#,
/ L
, A M M
vessels; or by extreme heat generating wind due to exu

berant heat scorching the liver meridian; or by liver yang
To SP'S'fefclMIK^Jj.JS^
transforming into wind.
t t . MIrt -s/j, !aLT ^
Light-whitish and shivering
tongue is due to asthenia of qi and blood and endogenous

asthenia-wind. usually seen in internal impairment, chro
rfifV' W 11
nic diseases and severe diseases; reddish shivering tongue
, frl K M '7 J5,
# , ffi MI
with scanty dry fur is due to consumption of yin fluid,
, JaL=f
fifi ;
malnutrition of the tendons and vessels and endogenous

wind, usually seen at the advanced stage of exogenous fe
brile diseases; deep-red and shivering tongue is due to ex
i) , JAl f
, # ik s ,
treme heat generating wind, frequently seen at the severe

heat stage of exogenous diseases; reddish and shivering
tongue is due to liver yang transforming into wind, often
seen in miscellaneous diseases due to internal impairment
accompanied by headache and dizziness.
Deviated tongue: The tongue is deviated to one
(3)
&
side (see colour Fig. 11), suggesting wind stroke or pre
# -s- is-m
fa ffi, # * a
monitory sign of wind stroke due to liver wind complicated
I 4 ^ ( J aL
ii>-, iiJ'PJxUH
by phlegm or liver wind complicated by stagnation in the

Collaterals of the tongue.
s .
Flaccid tongue: The tongue is too weak to protrude
(4)
#nd withdraw. suggesting extreme consumption of fluid or
decline of qi and blood.

flaccid tongue is caused by extreme consumption of
yin fluid, or by decline of qi and blood as well as malnutrition of musculature and vessels of the tongue. Deep-red
Hiid flaccid tongue with scanty fur in chronic disease due to
'P
Tffi
4t % !>] J t k Bi B
Intemal impairment is due to extreme predominance of

fire resulting from yin asthenia; light-whitish and flaccid
I I .
tongue is due to decline of qi and blood. Reddish dry and
i S T
fina :id tongue at the advanced stage in exogenous febrile
m vu
a i i t ,
diseases is due to consumption of yin by heat.

Shrunk tongue: The tongue is contracted and cannot
(5)
protrude. or cannot even reach the teeth, usually indicatnn critical condi tion. Such a syndrome is either of coid or
O heat nature.
*S IS-
f e * w ffi
&wm
Shrunk tongue is caused either by invasin of patho

genic coid; or by stagnation of endogenous coid in the
musculature and vessels of the tongue; or by extreme heat
m m ; si M
consuming fluid and causing spasm of the musculature and

vessels; or by stagnation of liver wind with phlegm in the
'M
se a u m M . a
fr ttiftM o
U ur& n
Vessels of the tongue. Light-whitish or cyanotic, pur|)|lsli. moist and shrunk tongue is due to stagnation of coid
In the musculature and vessels of the tongue; deep-red,
iliy and shrunk tongue is due to extreme heat consuming
fluid; bulgy and shrunk tongue with greasy fur is due to
llVri wind complicated by phlegm.
However, congenital short sublingual frenum also

|ilrvents the tongue from protruding.
Protruding and wagging tongue: The tongue that
j;
km m m ,
m m m m m m s k ',
protrudes out but is unable to retreat is called protruding

tongue; the tongue that frequently protrudes out but im-
B s M f t t i n A s A R P i
mediately draws back or licks the lips or corners of the

mouth is called wagging tongue. Both conditions suggest
heat in the heart and spleen. In severe cases, protruding
tongue indicates invasin of pestilence into the heart or
, nir H /K I f t
lie jE %
healthy qi on the verge to exhaust. Wagging tongue is the

premonitory sign of endogenous wind, also seen in children with maldevelopment of intelligence.
1.1.3.4
Inspection of tongue fur
(0 ) M S S
Normally the tongue fur is caused by fumigation of

the gastric qi and moistening of gastric fluid. Morbid
tongue fur is caused by upward flow of gastric qi with
pathogenic factors. Inspection of the tongue fur is helpful
m i T m m w m m jm m
for understanding the location and nature of disease as

well as the relation between healthy qi and pathogenic fac
tors. Inspection of the tongue fur includes examination of
the nature and colour of the tongue fur.
1 .1 .3 .4 .1
Nature of the tongue fur
i.
This includes examination of the thickness, moist-
t f
ness, greasiness, putridity, dryness, exfolia tion and root

of the tongue fur.
Thickness; The standard for examining the thick

ness of the tongue is whether it is bottom visible or
( i ) 4J$x s f lftW WP
4aL ft o ** 4 ' RL te
')'} te . l
bottom invisible . That means the tongue fur with dimly

visible body of the tongue is thin fur, while the tongue fur
with invisible body of the tongue is thick fur.
The thickness of the tongue fur reflects the degree

and severity of the pathogenic factors as well as the devel
opment of disease. Generally speaking. thin tongue fur is
Jfcfc,
seen at the primary stage of exogenous disease, sugges

ting that the pathogenic factors are superficial and the dis
ease is mild; it is also seen in diseases due to internal
ff (aLT11*1> TE ^ 'I7 1#, i t
Impairment with deficiency of healthy qi, especially with

hypofunction of the spleen and stomach. Thick tongue fur
In
the sign of exuberance of pathogenic factors. frequently
due to intemal invasin of exogenous pathogenic factors,

or due to intemal stagnation of phlegm, dampness and
food retention as well as fumigation of gastric qi with tur|)id substance and pathogenic factors.
During the course of a disease, the change of the
tongue fur from thinness to thickness indicates gradual exlllx'rance of pathogenic factors, development of pathogenic
factors from the exterior to the interior and progress of
pathological conditions from mildness to severity; the
change of the tongue fur from thickness to thinness suggests predomination of healthy qi over pathogenic factors.
rlimination of pathogenic factors internally and externally
lis well as development of the pathological conditions from
noverity to mildness.
Moistening and dryness of tongue fur: The
longue fur that is moist with moderate dampness is called
(2 )
W -uftljVA KJL#:
moist tongue fur. The tongue fur with excessive dampness

tnd slipperiness is called slippery tongue fur. The tongue
t 7jc # i f J Z M ', $
fur that is dry. without fluid or even fissured is called dry

tongue fur. The tongue fur that is dry, rough and sandy is
S H U N T S * .#
called rough tongue fur.
The moistening and dryness of the tongue fur reflect

the conditions and distribution of body fluid. Moist tongue
m -k/t<
fur indicates sufficiency and upward distribution of body

fluid. Slippery tongue fur indicates cold-dampness, or relention of fluid and internal invasin of cold-dampness, or
nslhenia of yangqi and failure of qi to transform fluid. Dry
nnd rough tongue fur indicates consumption of fluid by ex
uberant heat or consumption of yin fluid. The drier and
f .f / K i I i'li ft f I; I'J V ia:
rougher the tongue fur. the severer the consumption of
ffc
tdy fluid. Such a condition is usually seen at the mdium

and advanced stages of exogenous febrile diseases.
Besides, internal stagnation of pathogenic dampness,
obstruction of yangqi or asthenia of yangqi and failure of qi
T'J
to transform fluid may also lead to dry tongue fur, the

manifestation of which is light-whitish tongue accompanied
by chest oppression and dry mouth without desire to drink.
During the course of a disease, the change of the
tongue fur from moisture to dryness indicates consumption
of body fluid and severity of heat; while the change of
tongue fur from dryness to moisture suggests abatement
? '
fl'l >PJ M /S $ P i$r
iI.i W 8 .
of pathogenic heat and gradual restoration of body fluid.

Greasy and p utrid tongue fu r : Tongue fur compact
(3) M :
and difficult to exfolate which is thick on the center and

thin on the margins is called greasy tongue fur (see colour
m z s u M M 'f Z iM & a a
Fig. 12). While the tongue fur loose, sparse and easy to
mm i2) ;M M * M
exfolate with thickness on both the center and margins is

called putrid tongue fur.
The greasiness and putridity of the tongue fur reflect
the decline and development of yangqi and turbid damp
ness. Greasy tongue fur is usually caused by internal exu
berance of dampness and obstruction of yangqi. often seen
in syndromes due to dampness. phlegm, retention of food
and damp-febrile factors. Putrid tongue fur is usually
caused by fumiga tion of excess of yang-heat, often seen in
syndromes due to retention of food in the stomach and intestines or accumulation of phlegm and turbid substance.
E xfoliating tongue fu r : Exfolia ting tongue fur
(4)
means that the fur on the tongue has exfoliated partially or

completely during the course of a disease. Partial exfoliation of tongue fur is divided into anterior exfoliated tongue
fur. mdium exfoliated tongue fur and patched exfoliated
tongue fur (see colour Fig. 13). If the tongue fur is com
pletely exfoliated, it is called mirror-like tongue.
m & c & m m i3). ^

m f rA )t
ftn ,
M lS o
Exfoliation of the tongue fur is usually due to failure
til deficient gastric qi to fumigate the tongue or due to failurc of the exhausted gastric yin to moisten the tongue.
Therefore the exfoliation of the tongue fur can tell whethPl
the gastric qi and yin still exist or not and how the
/a-.
prognosis of a disease will be. Exfoliated tongue fur and

diH-'p-red tongue indcate consumption of yin by exuberant
htfnl; exfoliated tongue fur and light-coloured tongue indiultc consumption o both qi and yin; mirror-like tongue
lUKKcsts severe consumption of gastric qi and is a sign of
lite
exhaustion of gastric yin. If the tongue fur is.patched
iiOd greasy, it suggests that phlegm is not resolved,

lipnltliy qi is consumed and the pathological conditions are
BOniplicated. LXiring the course of a disease, if the tongue
lili
is completely exfoliated, it means insufficiency of gas-
li'lt (|i and yin, gradual decline of healthy qi and gradual

Braetiing of the pathological conditions; if the tongue fur
IWppears thin and white after exfoliation, it indicates
gtutlual restoration of gastric qi and favourable recovery
from the disease.
The tongue fur with or without root: The tongue fur
xi fe: 4'
rThk M
Wllh root means that the fur is closely attached to the surlili it
o the tongue and is not easy to exfolate. It is also
|Nllr<l
lilil
leal tongue fur. The tongue fur without root means
'If $r M ; S-? f] M
J s .M k m
Ihe tongue fur appears floating or painted on the
HtliKiic and is easy to exfolate. It is also called false

iMIgoc fur.
(5)
The tongue fur w ith root is formed by accumulalln n o f g a s tric qi w ith turbid pathogenic factors on
Ifw tongue: the tongue fur without root is due to failure
uf nimli ic qi too exhausted to produce new fur and inability
uf llic original fur to continu on the tongue. Inspecting
Whilhei the tongue fur is with or without fur is helpful for
ir ,
f'r
understanding whether gastric qi still exists or not and

whether the pathogenic factors are exuberating or declining. Such an understanding enables one to know whether
the disease is serious or not and whether the prognosis is
favourable or unfavourable. The tongue fur with root at
the primary and mdium stages of a disease indicates that
pathogenic factors are in predomination but the healthy qi
is still vigorous enough to resist pathogenic factors and
that the prognosis is favourable.
The appearance of
s i.
i SE
JWiua
1
tongue fur with root at the advanced stage or in chronic

disease suggests that gastric qi is still in predomination or
gradually restores, signifying favourable prognosis. If the
tongue fur without root appears in such a case, it indicates
a te rra # ,
deficiency of gastric qi, decline of healthy qi, severity of
r fc g .M fjg iiiS l
pathological conditions and unfavourable prognosis.
1 .1 .3 .4 .2
The colours of tongue fur
2. g fe
The colours of tongue fur commonly seen are white,
yellow and grayish black which may appear singularly or

simultaneously. The examination of the colours of tongue
fur should be done together with the analysis of the texture, colour and shape of the tongue proper.
f.
W h ite tongue fu r ; Apart from normal tongue fur,
( 1)
white tongue fur is usually seen in extemal syndrome and
2/3o
coid syndrome. But white tongue fur is not only confined

to external syndrome and coid syndromes.
Thin and white tongue fur is often seen at the prima
ry stage of exogenous disease and diseases due to internal
impairment without fever. At the primary stage of exoge
nous diseases, pathogenic factors attack the superficies
but have not invaded the interior, the tongue fur does not
have obvious changes. That is why thin and white tongue
fur indicates external syndrome. Light-red tongue with
thin, white and moist tongue fur indicates wind-cold
P, rj4c
^ %J M I* ^ l:
rlt
al
external syndrome; tongue with reddish margins and tip

km well
m .
as thin, white and moistless fur indicates wind-
heal external syndrome. Light-white tongue with thin and

wlute fur is usually seen in internal asthenia-cold syn
drome.
Whitish greasy tongue fur is usually due to internal
retention of damp turbid substance, phlegm and fluid or
due to food retention without transforming into heat (see
a i4).
colour Fig. 14). Powder-like thick and white tongue fur

llit does not feel dry is called powder tongue fur, fre-
m m M
quently caused by mixture of exogenous fetid pathogenic
w. rtM-uiW ii.
liictors and heat toxin, usually seen in pestilence and in(irnal abscess.
Yellow tongue fur: Yellow tongue fur usually indiCBles internal syndrome and heat syndrome.
(2)
S U M 'f o
^ S H ^ Ho
During the course of a disease, the change of tongue

lu from white to yellow suggests that the pathogenic fac
tors liave transformed into heat and transmitted to the in
terior. The yellower the tongue fur, the severer the pathogniic factors. Light-yellow tongue fur indicates mild
ln'iit. deep-yellow tongue fur signifies severe heat and sal-
15).
Inw tongue fur suggests extreme heat. That is why yellow

liftxue fur usually appears simultaneously with red and
pep red tongue (see colour Fig. 15).
Thin and yellow tongue fur indicates mild pathogenic
IipiiI , usually seen in wind-heat external syndrome, or in-
Wttitl invasin of heat transformed from wind-cold, or mild

Itcnt progress in internal heat syndrome. Yellow and white
((Migue fur suggests that the pathogenic factors are trans
miti! from the exterior to the interior and coid transImins into heat in exogenous disease. Yellow and greasy
tongue fur is usually due to accumulation of damp-heat, or
iluc lo phlegm and fluid retention transforming into heat,
ni due to food retention and heat putrefaction. Yellow and
w a ts .
rough tongue fur is often caused by pathogenic heat consuming body fluid or by retention of heat in the intestines.
But if the tongue fur is yellow. slippery and moist and the
tongue is light-white and bulgy, it is due to decline of yan
gqi and failure of dampness and water to transform.
Grayish black tongue fu r : Grayish black tongue fur
(3)
suggests severity of internal heat syndrome or internal

coid syndrome. The moisture and dryness of the tongue
jE W
S E,
texture are the evidences to differentiate the nature of

coid and heat (see colour Fig. 16 and 17).
16,17)
Grayish tongue fur is light-black tongue fur. So gray

ish tongue fur and blackish tongue fur are the same. The
colour of the tongue fur corresponds to the degree of the
pathological conditions. The deeper the tongue fur colour,
t itir a ,
the severer the pathological conditions. Grayish black

tongue fur in coid syndrome usually develops from white
tongue fur. For example, grayish black and moist tongue
m m n
fur with light-white tongue signifies yang asthenia and

coid exuberance, or coid dampness and internal retention
of phlegm and fluid. Grayish black tongue fur in heat syn-
a n is a n ] ,
drome evolves from sallow tongue fur. For instance,

grayish black and dry fur with deep-red tongue or even
prickly tongue is due to extreme heat consuming fluid.
1.
1. 3. 5
Comprehensive analysis of the
(35) S t t S S S M f a
body of the tongue and tongue fur

Disease is a complicated course. The changes of the
tongue and the tongue fur are the reflections of the com
plicated pathological conditions of the body. These chan
, fi'e n j ij j
ges reflect different aspects of the disease in question. As

mentioned before, the body of the tongue mainly reflects
the conditions of the viscera, qi and blood; the tongue fur
mainly indicates the degree and nature of the disease and
the relation between the pathogenic factors and healthy
qi. So after fully understanding the common changes of
M % ,
Jl fj $ M ; ^ ^
Ule body of the tongue and the tongue fur and their indicatlons, we have to further understand the relation between
lile body of the tongue and the tongue fur and make com|)H'lii'!isive analysis of the changes of the body of the
nigue and the tongue fur.
I Isually the changes of the body of the tongue and the
tongue fur are the same, and so is their pathogenesis and
W $ t S M
illdications. For example,
|W !,^-SCo p M i
the tongue is red and the
M #L +11
Jungue fur is yellow and dry in sthenia-heat syndrome; the

ltligue appears light-white and the tongue fur appears
Wlute and moist in asthenia-cold syndrome. But some
jt.m
timos the changes of the tongue and the tongue fur are difliirunt. In such a case, comprehensive analysis should be
HhmIc of the causes, pathogenesis and the interrelation.
Pin example, if the tongue is light-white and the tongue
ifiLV J; ^ M M , % ffi $
lili In yellow and greasy, light-white tongue indicates defii IriU'y of qi and blood, while yellow and greasy tongue fur
nT n . ift fM% Jfii ^
lti X i
Mlggests internal accumulation of damp-heat. ComprehenpVtf nnalysis shows that such changes of the tongue and
M B 2: JfPWj $ %
3 U ii:
&a m
mm m & x
Un longue fur suggests asthenia-sthenia complex syn-
D I; g M % 'M M rt $
dfimik* due to deficiency of qi and blood complicated by ex-
MiLo
1k R
Igi'iions damp-heat attack. For instance, if the tongue is

(fox1)) red and the tongue fur is white and greasy, deep-red
lltllgiK' indicates exuberance of internal heat or yin asthe-
B.,XieM, &tfcrfRfllL
MIh nnd fire superabundance, while white and greasy
*u tn ^ i
(tingue fur suggests internal exuberance of phlegm-dampor internal retention of food. In exogenous febrile
illuoimc. such an analysis indicates heat in the nutrient
filiiido .ind dampness in the qi phase; in miscellaneous dis-
due to intemal impairment, it suggests frequent yin

ftftllirm a
|!m i i I|IK'S s
tiltil
and fire exuberance accompanied by phlegmor retention of food. The above analysis shows
'lili erence of changes in the tongue and the tongue fur
iHlimlly suggests two or more pathological changes in the
SCH,
# & m #
l-J
m # va w m 'i!
tii.
body. Syndrome differentiation of such a complicated case

should be careful analysis of both aspects of pathological
changes.
1.2
Listening and olfaction
3 ? -^
Listening and olfaction means listening to various
m - ip
a t #
sounds and noises made by the patient and smelling the

odor and excreta from the body of the patient so as to un
derstand the pathological conditions of the patient. Since
various sounds and noises as well as odor all come from
the activities of the viscera, listening to sounds and smell
ing odors are helpful for examining the morbid conditions
w rm m m m m x m
#15j * 4 d
# # T * t fP K
ffi m ts ih , ffi vjl 3S a nif r ' ^ n

nj V
of the viscera.
1. 2. J
Listening to sounds
Voice is produced by vibration of air in the cavity and
r* t it;
1*1 ftfl H Mt
tube organs. The voice made in the mouth is in cise rela-
filil
tion to the lung, throat, epiglottis, tongue, teeth, lips

and nose. All kinds of voice ( sounds) are made by means
of the activities of the lung and the lung governs qi and
respiration. That is why the ancient people believed that
the lung is the governor of qi and the kidney is the root
of qi , the lung is the door of voice and the kidney is
k ' c , m1i
. w i- n 'rc .f t
A f f f M t ,
the root of voice . Since the pathological changes of the

other viscera may affect the functions of the lung and the
kidney in producing sounds and because the other viscera
are under the domination of the heart spirit, listening to
sounds not only can examine the conditions of the organs
directly related to voice, but also further diagnose visceral
disease according to the changes of voice (sounds).
$ i t . m# tffisij m j 'S-li'#
1 . 2. 1 .1
(- ) mm
Speech
In listening to speech, cares should be made to detect

WluMlier the speech is strong or weak, whether the words
lfr coherent and whether the expression is clear and flu-
j E
i f t
iMtl. The speech of normal people is natural in pronunciallun. smooth in tone, clear in expression and consistent in
IWtids. Since the viscera, constitution and physical build-
j&.
ItlK nro different from person to person, the voice is either

lilUli or low, loud or small and clear or full. For example.
Illlilt* voice is low and full, female voice is high and clear,
iHIdrens voice is sharp and melodious, and voice of the
Ifff-/# , J L S W
Igwl is low and deep. Generally speaking, high and sono-
z x m p w m ecjt. - u
ho voice in healthy people is a manifestation of sufficien-
, iE S A
j6
p ^
t c
l'V itl primordial qi and pulmonary qi.

There is cise relation between speech and emotions.
Por example, the voice in joy is lively and cheerful, the
^llii'r in rage is stern and quick, the voice in sorrow is sad
ftn<l (lisjointed. These are the normal changes of voice.
1.2.1.1.1
Voice
, ;i m b wj p ;i m
^ ,s
1.
Tlu- abnormal changes of voice are either strong

f weak, heavy or deep, hoarseness or aphonia.
Strong and weak v o ic e : Generally speaking, sono-
(1 ) # 5 # !
fltnl voice with restlessness and polylogia indicates sthenia
ij /l # in r f S n, W i l , M
SS
iVliiliome and heat syndrome; low. weak and disjointed
g r , J a f iE ,& f iE ; j* f
Vitli r willi quietness and oligologia indicates asthenia synoine and coid syndrome.
Doop and heavy v o ic e : Deep and heavy voice is u-
(2) t M f c : f P W M
Miitllv caused by failure of pulmonary qi to disperse and obliliclion ol Ihe nose due to exogenous pathogenic wind,
imlil nuil dampness, or by obstruction of the airway due to
litMlMlion of dampness.
Honrseness and aphonia; Hoarseness means harshVtilrr. while aphonia means complete ioss of voice.
(3)
t f ,
ft. ffi/
Hoarseness is similar to aphonia in pathogenesis.
If
hoarseness is very serious, it will develop into aphonia.
1rW M 0 'J#1S ^ ffl 1^1*^ a I
Hoarseness or aphonia in new disease pertains to sthenia
'fy P # m LS . S ^ r J
syndrome due to exogenous pathogenic factors attacking

on the lung or due to failure of the pulmonary qi to dis
U'f, sX
fi. S ffi,
perse resulting from stagnation of phlegm. Such a patho
ir, e p f t n r ^ o
logical condition is known as "a solid bell cannot ring
W Di S %
# ,
J E, #
vm m
(dysphonia or hoarseness due to sthenia syndrome of the

lung) . Hoarseness or aphonia in a chronic disease per
xm
ttM -fw
ii KP }jffin
tains to asthenia syndrome due to exhaustion of fluid and

impairment of the lung caused by asthenia of lung and kid-
. ma
ney yin and asthenia-fire scorching metal (lung). Such a

pathological condition is known as a broken bell cannot
* m asa
^ na
ring (hoarseness due to impaired function of the lung).

Hoarseness or aphonia may be caused by prolonged speaking or singing or shouting with rage, which impairs both qi
and yin and deprives the throat of moisture. Hoarseness at
the advanced stage of pregnancy is due to pressure of the
fetus on the uterine collaterals which obstructs the kidney
meridian and prevents kidney essence to be transported to
the upper. It will heal automatically after delivery.
1 .2 .1 .1 .2
Paraphasia
Del i rium : Delirium means raving with high and sono-
2. f s fg S L
% b P
, in
rous voice in coma. Such a morbid condition pertains to

sthenia syndrome due to heat disturbing the mind seen in
( 1 ) i^ ia -:
invasin of pathogenic factors into the pericardium in seasonai febrile disease or sthenia syndrome of yangming
fu-organ.
Fading murmurng; Fading murmuring is marked by
(2) % p ,
unconsciousness. repeated and incoherent murmuring in a

low voice. It is caused by excessive consumption of heart
qi and is an asthenia syndrome of mental derangement,
usually seen in patients with chronic and prolonged diseases.
Solloquy: Soliloquy is marked by mental depres-
l i l i .
(3) m :
m fn SL
Ion.
talking to oneself,
murmuring and incoherent
m i
* ffc. in % ffc A .
Ipocrli, usually caused by coagulation of phlegm confusing

lile mind or by severe impairment of heart qi. Such a mor-
% hm
Ht'fkin >f ift
, s 'l> 7 (, k *
lllil condition is usually seen in epilepsy.

Ravng: Raving is marked by manic movement,
(4 ) t :
ouling and sonorous voice usually due to phlegm fire atIflt'king the heart.
SL=f19Lk$tL'#i&m.
(5)
Paraphasia: Paraphasia means that the patient
|x','il<s nonsense in consciousness and is aware of it after-
m H SL. m fs S 5a A lt ,
Wnrds. Such a morbid state is often due to insufficiency of

iN rt qi and malnutrition of the spirit. Such a morbid conflltlon is often seen among patients with chronic disease or
til the aged.
1.
2 .1 .1 . 3
Slurred speech
3.
Slurred speech is marked by unclear and slow exllh'ssion without fluency, usually seen in wind stroke
m m m w . w ^ @ mrnm, %
ni equela of wind stroke. It is due to obstruction of
E T ^ J4
4 114 Js iS S , M M
lili' collaterals by wind-phlegm and malnutrition of the

iDURue musculature and vessels, which make the
IWlIRue inflexible.
Slurred speech at the advanced
ol febrile disease is due to heat consuming yin
pIRil malnutrition of the tongue.

1 .2 .1 .2
R espiration
( Z ) B?}
The lung governs qi and respiration. while the kidney

(m'rrns the reception of qi. So the disorders of respiration
I* usually due to the pathological changes of the lung and
Itlililry. The following is a brief description of the abnor-
J l# :
liml changes in respiration.

1 .2 .1 .2 .1
Rapid and weak respiration
1-
(ienerally speaking. the disease with acute onset

iiml rapid breath and high voice pertains to heat syn-
arete:, z
tlhiuir and sthenia syndrome; the disease with long durallmi. weak breath and shortness of breath in movement
|i Imiis
lo asthenia syndrome and coid syndrome.
JS E ,S iiE 0
1 .2 .1 .2 .2
2.
Dyspnea and bronchial wheezing
Dyspnea refers to difficulty in breath, shortness

'a n d rapidity in breath, or even opening the mouth,
PEh
raising the shoulders and flapping the nose wings in

breathing as well as inability to lie fat. Dyspnea is ei
ther of asthenia or sthenia nature. Sthenia-dyspnea is
m m ,it m n m * $ , & m a
marked by rapidity, deep breath and quick exhala u*,
tion, usually due to sthenia pathogenic factors in the

lung and inhibited flow of qi; asthenia-dyspnea is
marked by slow and weak breath, less inhala tion and
more exhala tion, discontinued breath, dyspnea in
m m $ io
movement and preference for deep breath. usually

caused by asthenia-impairment of the lung and kidney
as well as insufficient reception of qi.
Bronchial wheezing is marked by rapid breath like
ng,i
dyspnea, stridor in the throat, repeated relapse and diffi

culty in cure, usually caused by intemal retention of
phlegm complicated by exogenous pathogenic factors attacks which stirs up the latent retention of fluid; or by excessive intake of sour, salty, uncooked and coid food.
Clinically dyspnea is not necessarily to occur together
a se.I
with wheezing. Simultaneous appearance of dyspnea and

wheezing is called asthma.
1 .2 .1 .2 .3
Shortness of breath and weak breath
3.
Shortness of breath means that the breath is not

continuous like dyspnea and that the patient raises the
shoulders when breathing. Usually there is no spu
tum. Such a morbid condition is usually seen in various diseases of asthenia or sthenia nature. The asthe
nia syndrome is marked by shortness of breath and
low voice, usually accompanied by dispiritedness, lassitude and spontaneous sweating due to weakness and
chronic disease which consumes primordial qi and thoracic qi; sthenia syndrome is marked by shortness of
ni!
Imtnth and hoarseness of voice accompanied by chest

#|i|re8sion, cough and dyspnea due to stagnation of
(ihlfgni and retention of fluid as well as inhibited flow
til qi.
Weak breath is marked by feeble and short breath and
IllW voice. It is not discontinuous like the manifestation in
kluil lness of breath. Weak breath is usually due to insuffil lrm y of visceral qi, especially asthenia of lung and kid-
Wy qi.
Hesides, This conditions is accompanied by sighs due
ti) i'host oppression and depression resulting from emoliiMinl upsets and depression of liver qi.
1.2.1.3
Cough
{= .) m u
I Cough is due to failure of the lung to disperse and deIfftH iil
and upward adverse flow of pulmonary qi, usually
HMi in lung disorders. Cough may be caused by the disor-
i,
$ , is tu ni m n
&
lltMtt of other viscera. Cough is usually related to sputum.

I In diagnosis, cares should be taken to analyze the char-
w ^ , & ffl i# w &
^ 1 p
*i li'iislics of voice in cough, understand the time and duhtllnn of cough and differentiate the syndromes in the
llKlH of Ihe colour, nature and quantity of sputum as well
ollicr
complications.
Deep cough with whitish thin sputum and nasal ob-
1% F f i
M # , t-
llllli tion is usually due to wind-cold attacking the lung. or

lili lo if tention of pathogenic coid in the lung which preHllllN Ihe lung from normal dispersing and descending.
IffIW cough with profuse whithish sputum easy to expectoWlr meompanied by chest oppression and epigastric full-
j M - i a is $ M o
|HNn In often due to stagnation of phlegm and dampness in

ilm lung which stop the lung from normal dispersing and
^''iiding. Low cough with yellowish thick sputum easy
EM
MI expectrate accompanied by dry pain of throat and hot
a .
PMNitu>n in the nose in breathing is due to invasin of

|*tlioKone heat into the lung which consumes pulmonary
S ^ , JU
>fij ;VT
fluid and inhibits flow of pulmonary qi. Dry cough without

sputum or with scanty and sticky sputum and dry throat is
due to invasin of pathogenic dryness into the lung or due
to deficiency of pulmonary yin, consumption of pulmonary
fluid and failure of the lung to deprate and clear. Weak
cough accompanied by shortness of breath or dyspnea is
due to lung asthenia or due to consumption of pulmonary
qi in chronic diseases.
Besides, cough like barking of a dog accompanied by
hoarseness usually indicates diphtheria due to asthenia of
@ H d l
lung and kidney yin, pestilent factors attacking the throat

and obstruction of the airway. Infantile paroxysmal and
continuous cough like the crying of an egret in the end is
called whooping cough or pertussis, usually caused by
mixture of pathogenic wind with latent phlegm which
transforms into heat and obstructs the airway.
1.2.1.4
Hiccup and belching
. M
F r L
(eg) niE j5 ig n
Hiccup and belching are all caused by upward adverse

flow of gastric qi.
1 .2 .1 .4 .1
Hiccup
1. i
Hiccup is marked by upward rise of qi and involuntary gurgling noise in the throat. Syndrome differ
entiation of hiccup is done according to the hiccup
sounds, dura tion and other complications.
IW J K &
nm vE .
Repeated hiccup with sonorous voice is due to reten

tion of pathogenic heat in the stomach. Deep, long and
weak hiccup is due to weakness of the spleen and stom
ach. Sonorous hiccup with normal sounds, short dura tion
and no other complications is due to urgency in eating or
due to postcibal attack by wind-cold. This kind of hiccup is
regarded as normal. Sudden hiccup with weak voice and
long intermittence in chronic diseases or serious diseases
indicates decline of gastric qi and worsening of pathological
p\ m .
iW* |s]
Qonditions.
1 .2 .1 .4 .2
Belching
2. t n
Belching refers to deep, long and slow noise

(linde in the throat due to upward rise of qi from the
a m
m w j*
Uimach. Syndrome differentiation of belching should

|i| made according to whether the voice is high or
Imw. whether there is acid and putrid odor and whethpr Hiere are other complications.
Sonorous belching with acid and putrid odor accompaftlfil by unpressable epigastrio and abdominal distending
Mlil is well as thick and greasy tongue fur is due to reten-
& r h ij .
llnn o food in the stomach. Repeated sonorous belching

HttNnpanied hypochondriac and epigastrio pain and taut
jWluo to be alleviated after belching is due to emotional up-
K i.iS M
titH J s fo
g , m
plH caused by invasin of liver qi into the stomach. BelclllHK With deep voice and acid-putrid odor accompanied by
Hm tanto for food, light-coloured tongue and weak pulse is
l to weakness of the spleen and stomach, usually seen
||l ilhronic diseases or the aged. Occasional belching after
IMiil is usually due to overeating and is not morbid.
m te .
i , 2. 2
- x
lfaction
Normally there is no abnormal odor in the healthy
mnm
]E'AffiJDfmtjE'ft\
Mtiplo whose visceral functions are normal and circulation

Hl
I iIikmI
and qi is smooth. Under pathological conditions,
Vlmcral functions are affected, qi. blood and body flu -
AL*
lil ill r oncumbered and fumigated by pathogenic factors.

M l|it< li.msportation and transformation of food and water
Ktco s j k .
li Kilni' ibnotmal, giving rise to the production of strange

mliii
So smelling the patients body and the excreta is
Rpl|ilnl l'ur understanding the pathological changes.

Allrntion should be paid to different odors so as to
MtHtalNluiid their nature. Generally speaking, slight stinMiiiI mIui or odor without foul smell indicates asthenia
m&m.
syndrome, coid syndrome or cold-dampness syndrome.

Heavy stinking or foul odor indicates sthenia syndrome,
heat syndrome or dampness syndrome. Sour and putrid
odor usually suggests retention of food. Blood smell sug
gests bleeding disease. Putrid odor suggests ulceration
tJ
and sore.
I t l W
In difierentiating odors, attention should be paid to

examine the source of odors so as to decide the location of
the disease. And syndrome differentiation should be made
in the light of the difference in odors.
1.2.2.1
Smelling body odor
1 .2 .2 .1 .1
(- )
Foul breath
1.
Foul breath is seen in oral diseases, such as
5 iL f
caries. Foul breath is usually due to stomach heat.

Sour odor from the mouth indicates retention of food;
Afiff [; P
putrid odor from the mouth suggests internal abscess.
f t iP J ilS
Wrto
1 .2 .2 .1 .2
2.
Sputum and snivel odor
Stinking and foul sputum with pus and blood is usually seen n exuberance of heat toxin or accumulation of heat toxin into lung abscess. Odorless thin
m.
sputum and snivel are usually seen in exogenous dis

ease due to windcold. Frequent discharge of foul and
thick snivel suggests nasosinusitis due to lung heat or
mm,
damp-heat in the gallbladder meridian.

1 .2 .2 .1 .3
Body odor
3.
Foul and putrid body odor suggests ulceration and

sore. Bromhidrosis is due to fumiga tion by dampheat.
1 .2 .2 .1 .4
Odor of feces and urie
Clear urie without stinking odor indicates asthe
m m m tm m ,
Ar
4.
~\
'
'
nia and coid syndrome, also seen among healthy

people. Scanty reddish and stinking urie indicates
/J' M k ifii JH&-
/V.
tlowiiward migration of damp-heat. Loose and stin-
a o
MhK stool suggests asthenia-cold in the spleen and inliINtincs. Sour, putrid and foul odor of stool or foul
lliilus indicates retention of food and indigestin.
1 .2 .2 .1 .5
Z o
5. m & Z H
Menstruation odor
l'hin and stinking menorrhea and leukorrhea indicate

llllvnia-cold or cold-dampness syndrome. Yellowish thick
nuil foul leukorrhea is due to downward migration of
i lilil >-heat.
In dealing with leukorrhea with stifling foul
HoTi cares should be taken to exelude the possibility of
e M
I hL
WllK'cr.
1 .2 .2 .2
O dor in the room
(z) m m mzt
Putrid and foul odor or corpse odor in the

|iMlrnts room suggests deterioration of the viscera
w . * a # m w % , m Ai
tilld critical pathological conditions; blood smell in the
L 'f'i;
4\1ILM /=l , /K B
t i i H . jit A ~ $
l'ltllnits room suggests hemorrhage. Besides, strong

lllifII of urie in the patients room is usually seen at
lllr lidvanced stage of edema; bad apple smell is usual
a t- /Kw m m m & # ; m n &
ly imvii in severe diabetes, indicating critical patho|i)Wh ni conditions.
1.3
Inquiry
Iii(|uiry means investigating into the occurrence,
M F><
lpvt*lo|>uicnt and treatment of the disease as well as the
M N !&
T IS if M
|>Mw'iil nianifestations and other related problems by

Bptlim of inquiring the patient or other people accompanVlni llic patient.
5t,l
The occurrence, development and treatment of the

illnwiw as well as the present manifestations are important
tVlilrim-s for diagnosis. Such information can only be obItilm il by inquiry. So inquiry is the main method used to
tiniliMNlaud Ihe medical history and subjective symptoms of
Jft.f]^J&
flffi K l'l
the patient.
In doing inquiry, the doctor should comprehen-sively

and purposefully ask the chief complaint and the related
aspects. It is forbidden to suggest and induce the patient
i J f .B E
in doing inquiry. The doctor should use simple language to

talk with the patient, avoiding using medical terms.
'f- A i % M . i i Bb tj fn
# . W S M 'l l ,
wk m w a !
vi m
'S. k M ,
fin i
% t o
Inquiry includes general inormation, chief com

plaint, present disease history, present symptoms, past
U > #\ M M i , M -Se$
medical history and family history.
1.3.1
General information
r a - M
General information includes ame, sex, age, mari

tal status, nationality, profession, ones place of origin.
present address and date of first visit.
The information mentioned above is helpful for doc-
T < f f f l a . E # B r iJ
tors to get necessary data related to the disease and pro

vides evidences for the diagnosis and treatment. For example, woman tends to have problems related to menstruation, leukorrhagia, pregnancy, delivery and child-feeding; man tends to have problems of seminal emission,
spontaneous spermatorrhea, immature ejaculation and impotence; infants are delicate in viscera and tend to contract measles, variella and diphtheria; young people and
people in the prime of life are superabundant in qi and
îJE ? ^ A ^ JiLt !>, JS
blood and tend to develop sthenia syndrome; the aged are

deficient in qi and blood and tend to have asthenia syn
drome because their viscera are weak; the middle-aged
ftllil
UKi'd are easy to have cncer, chest oppression and
tyllid
stroke; those who are engaged in a certain kind of

loi a long time tend to have profession disease; and
P mime specific areas certain kinds of endema and epii. mu diseases are commonly encountered.
Ik'sides, the information mentioned above is also imftltlmi! for writing medical record, recording and surveyyi Ihe procedure of diagnosis and treatment as well as
vpmg contact with the patients and their relatives.
[i ti. 2
Inquiry of chief complaint and history

of present illness
I Chief complaint and history of present illness are the
y? -j m m 't
Mull nspeets included in inquiry and are important for di-
fsi ' w
^ , |n]
H ^ ns. treatment and syndrome differentiation.

ix .
1.3.2.1
( - ) q liiJ f
Inquiry of chief complaint
Chief complaint refers to the most serious symptoms

Itlil kIjjiis and their duration felt by the patients when they
mimc to the doctor. Chief complaint is the main reason
m i l la!
the patient comes to the doctor and the chief sympB R til the illness.
fs .g p E o
Accurate chief complaint is key to further underHfKlllig of the pathological conditions of the patient. So
complaint is helpful for primary classification and di-
j lu
of the disease. And it is also an important eviPli> for mvestigation, cognition, analysis and treatment
t .
|| illwnses.
Ciireliil recording must be made of the symptoms inillulnl ni ihe chief complaint or the location, nature, deiilid lime of signs. The recording to the chief comU|tii||l must be concise and avoid any ambiguity.
f iE W W f M B L ig f iM t tf
1.3.2.2
Inquiry of the history of present ill
(z)
ness
The history of present illness refers to the whole
course of the onset, development and changes of illness
from its occurrence to the time that the patient comes to
the doctor. The inquiry of the history of present illness
a w i g a i.
includes three aspects: occurrence, pathological changes

and course of diagnosis and treatment.
1 .3 .2 .2 .1
1- swtHyi
Occurrence
Occurrence includes the time of onset, whether

the onset is sudden or gradual, cause of onset, initial
symptoms and their nature and location as well as pri
mary treatment. The understanding of such aspects is
important for differentiating the cause and location
TM
and nature of disease.

m m ,
1 .3 .2 .2 .2
Development of disease
2-
Inquiry of the development of disease includes

the pathological changes from the onset of disease to
the time that the patient comes to the doctor. Specifically speaking, it includes the nature, degree and
changes of the main symptoms. the time of alleviation
or aggravation,
when there are new pathological
changes, and whether there is any rules in the patho

logical changes. Such an inquiry is important for the
understanding of the struggle between healthy qi and
pathogenic factors as well as the tendency of the de
velopment of pathological changes.
1. 3 .2 . 2. 3
Procedure of diagnosis and treat
3.
ir& vt
ment
Inquiry of the procedure of diagnosis and treat
E .f lf t M t S S t .S S f f l
ment includes whether the patient consults the doctor

after onset, what test has been made, what the result
s. wlial the diagnosis is made, what treatment has
i-:fWa.fi v i
mi
bren taken and what the curative effect is, etc. Such
fiMi.t al)ove the diagnosis and treatment made in the

can be taken as a reference for the present diagRiin n
and treatment.
I, l. 3
Inquiry of the present symptoms
Inquiry of the present symptoms includes the present

ffrrings, discomfort and other information related to the
@m t m m
m ,w
ll .IIINC.
fr
I The present symptoms are the reflections of the
f/L^ ^ lu f
MU-nt pathological changes and are the important evifpiHCH for the diagnosis and syndrome differentiation. InlUlrv of the present symptoms (including the location. na-
f., iHifij"]
degree, occurrence and dura tion as well as the conHIII m
h h
for aggravation or alleviation) is helpful for under-
llftllilllig the cause, location and nature of disease as well
M M &M
M II' Hlate of healthy qi and pathogenic factors.
. I K 7 m
m
.. m t t , m ih
WSWfTITL
K.i, I, disease has its specific main symptoms and secHltilHiv symptoms. So inquiry of the present symptoms
ptlilil concntrate on both the systemic content of inquiry
^|fl lile basis of chief complaint and the main symptoms.
H jH:.
I] M #. ni
H' S W T M N %
f tf'l % M I , X W
S M
, 4i 0 'j, T i: * itkiU fe] o

1
Inquiry of the present symptoms includes inquiry of
PVim Alid coid. sweating, pain, sleep. diet and appetite,
'/F J
bulln and urie and symptoms over the head and face
u ipfc,
Mtypll ns back and limbs. It also covers the symptoms in
mmm , n
B Mluli i.ili y. gynecology and pediatrics.
fs] ^
I 1.3.1
Inquiry of fever and coid
lliqury of fever and coid means asking the patient
> 1 B&J 'n m ft

r.{> >ln] y< t:
. "l
.
l'o]#314
f>l
( - ) p I S ^
f J M & B iJ M f h.
whether he or she has the sensation of fever and aversin

to coid. Fever and coid are the common symptoms seen in
the course of a disease and are the evidences for differentiating the nature of pathogenic factors and the states of
IW IifitS .
yin and yang in the body.

Aversin to coid is a subjective sensation, including
disliking coid and fearing coid. If the patient feels coid and
such sensation cannot be relieved after putting on more
clothes and quilt or staying near fire, it is called disliking
coid; if the patient feels coid and such sensation can be reiieved after putting on more clothes and quilt or staying
near fire, it is called fearing coid. Fever means that the
body tempera ture is higher than usual, also including sub
jective sensation of general or local fever like feverish
, in H 'L 'M
sensation over the five centers (palms, soles and chest)

which does not necessarily mean the increase of body temperature. The occurrence of fever and coid lies in the na
ture of pathogenic factors as well as decline and predomi
nation of yin and yang in the body, reflecting or signifying
the result of the struggle between healthy qi and patho
genic factors as well as the changes of yin and yang. Generally speaking, in the disease due to pathogenic factors,
PHSSj
pathogenic coid leads to disliking of coid and pathogenic

heat leads to fever; in the coid and fever caused by the
predomination and decline of yin and yang in the body, ex
uberance of yang leads to fever and superabundance of yin
leads to coid, asthenia of yin brings about fever and asthe
nia of yang results in coid. So inquiry of coid and fever is
helpful for undrstanding the nature of pathogenic factors
and differentiating the states of yin and yang in the body.
In inquiring fever and coid. the doctor should make
sure whether there is coid and fever or not, whether coid
and fever appear simultaneously, whether fever and coid
is serious or mild, what time it appears and how it lasts as
% , m & w m w aj a .1
& W g f i , iU i W b m fq j f
Well as other complications.

Clinically the types of coid and fever include aversin
i| M & W M
!*)
|n cold and fever, coid sensation without fever, fever

Without cold sensation, and alternate cold and fever.
1 .3 .3 .1 .1
Aversin to cold and fever
i.
Aversin to cold and fever means that the patient

fllulikes cold and the body temperature increases, usu-
s]0^?a-J+ifi5ifn & . 5L F
Hllv seen at the primary stage of exogenous disease

Which pertains to external syndrome due to retention
uf pathogenic factors in the superficies and struggle

|i#tween defensive yang and pathogenic factors. Aver-
u n
rUiii to cold is caused by invasin of pathogenic factors

ll| the skin which affects the function of defensive
ymiK to warm the muscles; fever is caused by pathoPliic factors encumbering the superficies and resist-
|f|<T of defensive qi against pathogenic factors. When
SiJo
lile pathogenic factors are in the superficies, there is

llllln ence in aversin to cold and fever due to the
llllln ence of pathogenic factors in nature. Generally
lIliTe are three types of aversin to cold and fever acBlllding to their degree.
Serious aversin to cold and mild fever Serious
( 1)
ItorMon to cold and mild fever indcate external syndrome

tille to wind-cold. Cold is a pathogenic factor of yin naItlKI, When pathogenic cold invades the superficies, de|ii||i)lvt yang is stagnated and the superficies lacks
Wmitull, leading to serious aversin to cold. Cold tends to
pwKitlale. So when defensive yang is stagnated and when
IHllingrnic factors struggle with healthy qi,
fever is
|Nll'(l.
Serious fever and m ild aversin to c o ld : Serious
InviM and mild aversin to cold indcate external syndrome
(lm< lo wind-heat. Wind-heat is a pathogenic factor of yang

UMIui<*. When pathogenic factor of yang nature causes
mm;
mm m%
disease, yang is usually superabundant. That is why fever

is serious. When wind-heat invades the superficies, the
muscular interstices become loose. That is why aversin
to cold is mild.
M ild fever and aversin to w in d : Mild fever and
(3)
aversin to wind indcate external syndrome due to wind

attack. Aversin to wind means sensation of cold in contact with wind and is relieved after avoiding wind, usually
caused by exogenous pathogenic wind. Since wind tends to
,m
va &
open, muscular interstices become loose when attacked by

wind. That is why there are mild fever and aversin to
wind.
The degree of aversin to cold and fever in external
syndrome is not only related to the nature of pathogenic
factors, but also to the relation between pathogenic fac
tors and healthy qi. For example, if both the pathogenic
factors and healthy qi are in predomina tion, aversin to
cold and fever are all serious, signifying drastic struggle
M iE ll
between healthy qi and pathogenic factors. When both

pathogenic factors and healthy qi are deficient, aversin to
cold and fever are all mild, indicating slight struggle be
iEi l
tween healthy qi and pathogenic factors. When pathogenic

factors are superabundant and healthy qi is deficient, aversion to cold is serious and fever is mild, suggesting
failure of healthy qi to control pathogenic factors.
1 .3 .3 .1 .2
Cold without fever
2. U S T O
Cold without fever means that the patient only feels

cold but there is no fever. It is usually caused by direct in
vasin of pathogenic cold into the interior which stagnates
yangqi and prevents it from moving otwards; or by
decline of yangqi and lack of warmth of the body.
According to the onset, dura tion, cause and pathogenesis,
% ^ IS i *
cold without fever can be further divided into aversin to

cold in new disease and fear of cold in chronic disease.
ES'Jo
M M M SI
Aversin to coid in new disease: Aversin to coid
(1)
In new disease is caused by serious invasin of coid

ilinvtly into the viscera which stagnates yangqi and de-
M M fc & T M f l rg C o
All A
(n'lvt's the body of warmth. Sudden aversin to coid with

tnild limbs accompanied by coid abdominal pain or dyspnea
With sputum rale pertains to coid syndrome of internal
(lumia.
Fear o f coid in chronic disease: Fear of coid in
(2)
g m '%
Htonic disease is usually caused by decline of yangqi and
ai
llti'k of warmth of the body. The patient frequently fears

Wild and the limbs are not warm, usually relieved with
Knrinth, with light-coloured and tender tongue as well as
M|r|>, slow and weak pulse. Such pathological conditions
pglllfy coid syndrome of internal asthenia.
1 .3 .3 .1 .3
Fever without coid
3.
Fever without coid means that the patient only

Ii|n
fever and does not feel coid or, on the contrary,
llulilus heat. Such a problem usually pertains to in(pinal heat syndrome caused by exuberance of yang or
tatlrnia of yin. According to the degree, time and
liWlures. fever can be further divided into high fever,
(lilil ever and mild fever.
High fe v e r: High fever means that the patient suf-
( 1)
ftMN from serious high fever hard to be relieved with the

fiilptoms of aversin to heat instead of to coid. It is usu-
i .
z m jA m A m t 's U M
Ntlv caused by wind-cold invading into the interior and

ftliufoi ming into heat, or by transmission of wind-heat
su
lili o Ihe interior, struggle between pathogenic factors and

liMlhy <|i and internal exuberance of yang-heat, the
llpiltiiing of which manifests externally. High fever is usuhIIv
Ncen at the qi phase stage of exogenous febrile dis-
W'i>, |Hi laining to internal sthenia-heat syndrome, usual|y mcompanied by flushed cheeks, profuse sweating, dys(tltulin. tliirst and preference for coid drinks.
m & ' i m m e.
Tidal fe v e r: Tidal fever is marked by regular
(2)
% m m & zk
occurrence or regular worsening. According to its cause

and pathogenesis, it can be further divided into the following categories.
Yangming afternoon fever: It is marked by continuous fever and severity in the afternoon ( 3 - 5 oclock in
the afternoon)
when
qi
in yangming meridian is
(T^F 3 5
superabundant, accompanied by constipation and unpressable abdominal hardness and pain due to invasin of path
ogenic heat into yangming, retention of dry-heat in stom
ach and intesties as well as obstruction of intestinal qi.
M W a flr a .
Damp-warm tidal fever: Damp-warm tidal fever is

marked by fever, worsening in the afternoon or evening
and dull fever ( that means that it does not feel feverish
when the hand touches on the skin at first, but after a
while the hand feels scorching hot). usually accompanied
by epigastric and abdominal fullness and oppression, nau
sea and vomiting, heavy sensation of the head and body,
loose stool and diarrhea as well as thick and greasy tongue
fur, often caused by retention of damp-heat in the middle
energizer, stagnation of dampness and latency of heat and
failure of heat to get out of the body as well as stagnation
of dampness and steaming of heat.
Yin-asthenia tidal fever: It is marked by fever in the
afternoon or evening and feverish sensation over the five
centers (palms, soles and chest) or steaming fever in the
bones), usually accompanied by flushed cheeks, night
sweating, dry mouth and throat as well as reddish tongue
with scanty fluid, often caused by consumption of yin flu
id, failure of yin to control yang and endogenous astheniaheat.
Besides, one of its major symptoms is worsening of
fever in the night due to invasin of heat into nutrient phase
^ B P ^ * W ) > ;M .M f
mui consumption of nutrient yin in febrile disease.
W Z o
M ild fe v e r: Mild fever, also known as low fever,

hum us
(3)
X f ft fa '
that the fever is slight or indistinct or subjective
iBlisation of fever with normal temperature. Mild fever is
f i, M
RWrked by longer duration. The cause and disease in-
k m
volved are complicated. For example, internal heat due to
tP
yin asthenia leads to prolonged low fever; prolonged mild

liivci , also known as fever due to qi asthenia, is usually
Uted by asthenia of spleen qi, sinking of gastrosplenic qi
lllil failure of lucid yang to rise which stagnate into heat;
# * ! * & til
tilllil l'ever may be caused by emotional upsets and failure

4*1
Ihe liver to disperse and convey, leading to fever due to
l|| Ntagnation.
1 .3 .3 .1 .4
Alternate coid and fever
4.
m r n *
Alternate coid and fever means that aversin to

(Ktltl and fever occur alternately due to struggle beIWi'en healthy qi and pathogenic factors, signifying
n a
llvelopment and abatement of coid and fever. Irregul.ii li ltrnate coid and fever is seen in shaoyang disease
# 3 t4 M itE ,0 3 f| $ JE * 0 ^ ,1 5
(KMtaining to semi-internal and semi-external syn-
IftW JiE S lE .IE IttM g ^.W jE
llluine due to struggle between healthy qi and patho-
k b
. , m va m m H
tH'iix factors. The predomination of pathogenic faclui* leads to aversin to coid, while the predomination
a u n ,
Hf llie healthy qi leads to fever. If pathogenic factors

tltil healthy qi predominate alternately, it leads to alhMlinte coid and fever. Regular coid and fever, once a
W A A f r 'V t m T m & Z
ilV m once two and three days, accompanied by se[|>ie headache, thirst and profuse sweating, pertains
lll miliaria.
When pathogenic factors invades the
llv . Ihey stay in the semi-internal and semi-external

f||lini When they get inside, they struggle with yin;
MHl when they get out, they struggle with yang. That is
Wliy ( hills and high fever appear alternately and continualhi
a .ttf w & .
1.3.3.2
Inquiry of sweating
(Z )
Sweating is transformed from body fluid by yangqi

and excretes from the sweat pores. Normally sweat func
tions to reglate yingqi and weiqi and moisten the skin.
Under pathological conditions, sweating becomes abnormal due to the invasin of pathogenic factors and imbalance between yin and yang inside the body. Inquiry of
iJ I 'W
sweating can enable one to understand the nature of the

pathogenic factors and the conditions of yin and yang in
side the body. Inquiry of sweating includes hidrosis and
anhidrosis as well as time, regin and quantity of swea
ting.
o
% n , & ?r w m i's]. m
% 'P W l,
1 .3 .3 .2 .1
Anhidrosis
Anhidrosis when there should be sweating is usu
i.
^nwww m
ally caused by exogenous cold or insufficiency of yin

blood and body fluid or asthenia of yangqi.
Anhidrosis in external syndrome-, This condition is
( 1) A i f c i t :
often seen in external sthenia syndrome due to exogenous

cold. Since cold tends to stagnate and contract, the mus
cular interstices become tense and the sweat pores are
closed up, preventing sweating from excreting. The usual
m m jm 'm o
symptoms are serious aversin to cold, mild fever and

floating and tense pulse, etc.
Anhidrosis in internal syndrome This condition is
(2) M.iZLrh DLT-
usually seen in blood asthenia syndrome and yang asthenia
ifiL . E, PH di i l
syndrome due to insufficiency of body fluid. If it is accom

panied by such symptoms like dry skin, dry mouth, dry
feces, it is usually caused by depletion of body fluid due to
exhaustion of the sweat source; if it is accompanied by
pal complexin and lips, whitish pal toilgue, it is usually
caused by insufficiency of yin blood and exhaustion of
sweat source; if it is accompanied by aversin to cold and
cold limbs. it is usually caused by insufficiency of yangqi
and hypofunction to transform qi.
I
1 .3 .3 .2 .2
Hidrosis
2. W f
Sweating can be caused by exogenous coid atlit'k. or wind-heat invading the superficies, or exulirrnnce of endogenous heat, or endogenous heat due
lo yin asthenia, or weakness of weiqi due to qi astheliln. or excretion of body fluid due to sudden loss of
y.mgqi.
Hidrosis in external syndrome: This condition is
( 1)
ilBUally seen in external asthenia syndrome due to

i'NoKcnous wind attack, or external heat syndrome due to
KoKi'tious wind-heat and diseases due to weakness of
Wt'tc|i complicated by exogenous wind attack. Wind tends
10 upen and leak, while heat tends to rise and disperse.
Attm:ked by wind and heat. the muscular interstices berOtne loose and sweat excretes. Sweat tends to excrete if
To t $ : g ; J x L J ) * v
Wi'lfM is weak and the muscular interstices are loose. If
l\'
companied by fever, aversin to wind and floating and

low pulse, it is external asthenia syndrome? if accompalllt d by high fever, light aversin to coid, sore-throat and
iRNIting and rapid pulse, it is external heat syndrome.
Hidrosis in internal syndrome; This condition is
minlly seen in exuberance of endogenous heat syndrome,
(2)
^JALTM
-fMRiiiE
ftlilogenous heat syndrome due to yin asthenia, weakness

M weiqi due to qi asthenia and sudden loss of yangqi.
Spontaneous sweating: Spontaneous sweating refers
ll t'onstant sweating, especially after physical movement,
sî .<i fs m a ^
% i ff o
Itllen seen in qi asthenia syndrome and yang asthenia synllmrrie. Since asthenia of yangqi fails to protect the superlli les, the sweat pores will become loose and body fluid
Will excrete. That is why sweat is constant. Since physi-
ihe
l'itl movement further consumes yangqi, sweating becomes
H M f tBMSc
lljltre serious.
Night sweating: Night sweating refers to sweating
iMitniing when the patient falls asleep but stopping after
intff: A fcfcjgffM i.
( S W iJ fF it.ft^ fe ff. f 'AL
the patient wakes up. It is usually seen in endogenous

heat syndrome due to yin asthenia, or asthenia syndrome
ffio
si
of both qi and yin. It is caused by endogenous heat due to

yin asthenia. When people fall asleep, yangqi enters into
the body, the muscular interstices become loose and as
thenic heat steams the body fluid to excrete. That is why
sweating occurs during sleep. After people wake up. yan
it ,
gqi returns to the superficies, the muscular interstices become tense. Under this condition, endogenous heat with
yin asthenia cannot steam the body fluid to excrete. That
is why sweating stops after people wake up. Asthenia of
both qi and yin usually lead to both spontaneous sweating
and night sweating.
AfF:
Profuse sweating: Profuse sweating is either asthenic

or sthenic. Profuse sweating with high fever, flushed
complexin, thirst, preference for cold drinks and full
large pulse is seen in sthenic heat syndrome due to exu
berance of endogenous heat which drives body fluid to ex
& % , M
crete. If profuse sweat occurs in patients with prolonged
fr'x m n . m & # % na # t
i t 0f i
illness accompanied by symptoms like pal complexin,

cold limbs and indistinct pulse, it is yang exhaustion syn
drome due to sudden loss of yang which leads body fluid to
excrete.
Sweating following shivering: Sweating following
@ $ T :
shivering is usually seen during the course of exogenous

febrile disease, marking the turning point of conflict be
tween healthy qi and pathogenic factors and the develop

ment of pathological conditions. If fever abates, pulse
calms down and the body tums cool after sweating, it is a
sign that pathogenic factors are being expelled; if there
T di ili 05
are restlessness and rapid pulse after sweating, it is a

critical sign of domination of pathogenic factors and de
cline of healthy qi.
Head sweating: Head sweating means that sweat only
* t , is ir a iix jB
h|)|kmi s
over the head. The causes of head sweating are
V m io u s ,
including exuberant heat in the upper energizer
wln* li drives body fluid to excrete in the upper, often acl'ompanied by reddish complexin and thirst; accumulation
ni damp heat in the middle energizer in which the stagnatlnn of dampness and steaming of heat drive the body fluid
10 excrete in the upper, often accompanied by abdominal
tull ess, heaviness of the head and body; prolonged and
UPiious disease with primordial qi on the verge to exhaust
lli which asthenic yang floats upward and the body fluid
tfltcretes in the upper together with yang, often accompaitlcd by pal complexin and coid limbs. Besides. exuberifli e of yangqi due to extravagant intake of pungent food
ni hot soup and drinking of wine may drive heat to steam
lli the upper and lead to head sweating. But head sweating
l|i this case is not pathological.
Ilemihidrosis; Hemihidrosis means sweating appears
KVir half of the body, either the upper or the lower, the
l|t side or the right side. The location of disease is on the
ffi'l, b J c f >6'i 1
!
IHrl of the body without sweat. This problem is usually
t m w / p
toen in apoplexy. flaccidity and hemiplegia, often caused
k t u.
x-/r-t<j t # o ^ jal
Ity wind phlegm or stagnant phlegm and obstruction of the

meridians by wind dampness which prevent weiqi and
|flllK<|i from flowing as well as qi from normal circulation.
k - i- m m & o
Sweating over palms and soles: If it is accompanied
l|y dry mouth and throat, restless feverish sensation over
lile |xilms. soles and chest as well as thin and rapid pulse,
11 in usually caused by steaming of stagnant heat in the yin
Hielidians; if it is accompanied by restless thirst, prefer-
Ti;,
mire lor coid drinks. brownish urie, constipation and full

mui rapid pulse, it is usually caused by exuberant heat in
lile yangming meridian; if it is accompanied by heaviness
Hl Ihe liead and body, dull fever and yellowish greasy fur.
I W lfJ ft.
it is usually caused by steaming of damp heat in the middle

energizer.
Chest sweating: Chest sweating is usually of asthenia
syndrome. If it is accompanied by iassitude. anorexia,
palpitation and insomnia, it is usually caused by simultaneous asthenia of the heart and spleen; if it is accompanied
by palpitation.
dysphoria,
insomnia,
dreaminess and
aching waist and knees, it is usually due to imbalance be

tween the heart and the kidney.
Besides, it is also necessary to know the tempera ture
i l f c ^ . M T l S v T Mi
and colour of sweating. Generally speaking. cold sweating

is due to decline of yangqi, while feverish sweating is due
to exogenous wind heat or steaming of endogenous heat.
/iMl&sK l*l
fr SS[o
Yellowish sweating is often due to interaction of wind,

dampness and heat.
1 .3 .3 . 3
Inquiry of pain
Pain is a commonly encountered subjective symptom
( = ) ftm m
?
& lltfi
_t
llL frj I
in clinical treatment. Pain may appear at any part of the

body. It may be caused by sthenia, such as invasin of ex
ogenous pathogenic factors, or qi stagnation and blood sta
sis. or stagnation of phlegm, or retention of food. or parasitic infesta tion which obstruct the meridians, prevent qi
and blood from normal circulation and consequently bring
%. T'i ay
about pain. It may also be caused by asthenia, such as in

sufficiency of qi and blood, or consumption of yin essence
which deprives the viscera and meridians from nutrition
and cause pain.
Inquiry of pain includes such aspects like the loca
tion, nature, degree and time of pain as well as personal
aversin and preference.
1 .3 .3 .3 .1
Inquiry of the pain location
This can enable one to understand which viscus

or meridian the pain is located.
Headache; The three yang meridians of both the
(1)
ik t :
I hitnd and oot are directly connected with the head, the
llvt r meridian also extends to the head, the other yin meI fldians are indirectly connected with the head. The loca-
i K
I (ion of pain over the head can enable one to decide which
M - ^ ffiM f .
^ m
+a
An A f f i i 1!! ,
\meridian and which viscus are involved. For example, if

l fleck is involved in headache, it is a problem related to the
M t i % ffi, m 'p ra , ^ j n
liiiyang meridian; if pain appears on both sides of the
i Irnd. it is a problem related to the shaoyang meridian and

Ino
connected with the gallbladder and triple energizer; if
|iilin appears over the forehead and supraorbital bone, it is

n problem related to the stomach and infestines; if pain
IIPIKM
rs over the vertex, it is a problem related to the ju-
| pyin meridian and connected with the liver. The causes of
a ^fitP iii X
Ni 1 ff i . %J I %f fi; %Jfll ^JE.
liendache are various. Headache of sthenia syndrome is ummlly caused by such factors like attack by exogenous
5m m s a m a w
Wllid. coid, summer-heat, dampness, pathogenic fire as
tE o
n u k ffi
ffi. m
jjg R
' Well as obstruction or disturbance of the upper orfices by

l'hli gm and blood stasis. Headache of asthenia syndrome
| usually due to insufficiency of qi and blod and depletion
li( essence and marrow which fail to nourish the head. The
chunos
and the types of headache should be analyzed ac-
Aording to the nature of headache and the accompanied

lymptoms.
Chest pain; The lung is located in the chest, so
(2) f&It:
frcordial pain or pain involving the inner side of the arm
@ , tic Pe ffi ^ JE T >i> M M M

P l m . S . t f fit ffi sJc ffi
Indcalos that the location of the pain is in the heart due to
31rt If, M i E>ll', 0 @ P0
Hlt'Mt pain is usually seen in heart and lung problems. The
iVllicnia of heart yang and qi as well as stagnation of qi
Nllil blood; distress and puncturing pain over the precordi
tm
a l is usually due to blood stasis in the heart vessels. Pain
, ffi An i t m , 0 % iil m
o
nP
ffi, w/i-:
Itvn tlic chest means that the location of pain is in the

liillK cluo to exogenous pathogenic factors invading the lung
S ,
in1rolenlion of phlegm and fluid in the lung which prevent
iiI.IK iilW
/L
% PJi $ C ; W ffi lili l'i

^ ^ , M M iil.W
qi from smooth flowing; chest pain with expectora tion of
foul sputum mingled with pus and blood indicates lung ab-
fr o
f t j j r
l .
' (
lili
f f i .
scess due to exuberance of pathogenic heat in the lung

which stagnates qi and blood and putrefies blood to cause
abscess.
Hypochondriac pain: The liver and gallbladder are
tocated in the hypochondrium. The liver and gallbladder
meridians circuate to the sides. Therefore, hypochondri
(3 ) M
)\m m t M r T . ffi VA,

m m $ 4 jff m ^
m .
p
ac pain is often related to liver and gallbladder disorders.

For example. hypochondriac pain is often seen in such dis
orders like liver depression and qi stagnation, damp heat
B S J M
if] o
in the liver and gallbladder, exuberant heat in the liver

and gallbladder and retention of fluid in the hypochondri
um, etc.
Epigastrio pain: Epigastrium refers to the part be-
(4)
low the xiphoid process where the stomach is located. Epigastric pain is usually caused by failure of the stomach to
descend food and stagnant flow of qi due to cold, heat. re
tention of food in the stomach and qi stagnation, etc.
Stagnation leads to pain. If pain becomes worsened after
intake of food, it is a sthenia syndrome; if pain becomes
alleviated after intake of food, it is an asthenia syndrome.
Abdominal pain Abdomen may be further divided
eI jE.
(5> tuf-, m m m m
into large abdomen, small abdomen and lower abdomen.

The part between the epigastrium and the navel is large
s u # , i^TJRr
abdomen; the part between the navel and the margin of

pubic regin is the small abdomen where the kidney, blad-
/M u .
der, intestines and uterus are located; the two sides of
# ?/M m m
the small abdomen are lateral part of small abdomen
M .'p m
where the liver meridian pene trates. Besides, pain over

the lateral parts of the small abdomen is also related to the
large intestine disorder. The causes of abdominal pain are
various. Sthenia syndrome of abdominal pain is usually
E ;n > I L
caused by cold stagnation, heat retention, qi obstruction.
zm m vE .
blood stasis, retention of food and parasitic infestation,

while asthenia syndrome of abdominal pain is usually
emised by asthenia of qi, blood and yang, etc. In the exiimination of patients with abdominal pain. inquiry should
Ik1done together with pulse taking in order to exactly l
cate the regin of pain and decide the viscera involved and
di! lerenda te the cause and nature of the problem.
Backache: Backache with inability to stretch or bend
(6 )
fM :
the back is often caused by impairment of the governor

Vcssel;
backache involving the neck is usually caused by
retention of wind cold in the taiyang meridian; aching pain
x ph*5i* fn ; m
o Ihe shoulder and back is usually caused by obstruction of

wind and dampness which obstruct the meridians.
Lumbago: Pain over the spine or over the waist and
(7) m k-. w f t m
Hitcrum is often caused by obstruction of cold and damp-
, ki
%m
liess, or obstruction of the meridians by blood stasis, or

HNthenia of the kidney. Lumbago involving the lower limbs
In
often caused by retention o cold dampness in the me
ridians which stagnates qi and blood. Stiff and painful loins

due to falling or sprain marked by immobility and inflexi-
Dfffp a -m , m m ti m m *
liility is usually caused by obstruction of blood stasis. Dull

|Miin over the sides of waist with slow onset is usually due
lo asthenia of the kidney.
Pain o f the lim bs: Pain of the limbs is usually
(8> w /jt# ,: z m r m u
l'nused by invasin of wind, cold and dampness, or by ac umulation of damp heat which obstruets the circulation of
<|l and blood. Pain of the limbs may result from weakness
W f f c & T MU*
ol Ihe stomach and the spleen which fail to transport cere-
& m & um
id nutrients to the four limbs. Pain over the heel or aching

|ni ni over the legs and knees is usually due to asthenia of
^ t% o
tlie kidney, often seen in the aged and weak people.

General pain: General pain in the new disease is uttiially of sthenia syndrome due to attack by pathogenic
w iiiiI ,
cold and dampness. General pain in prolonged
(9)
n m , m % a . vX $ % mi%
SflSjg- :
l'Ji] lili )A|
disease is of asthenia syndrome due to deficiency of qi and

r L
blood which fails to nourish the body.

1 .3 .3 .3 .2
Inquiry of the nature of pain
2.
'['he nature of pain varies due to the cause and

pathogenesis. So the inquiry of the nature of pain is
tfl
H 0 ffi & W &
#>
helpful for differentiating the cause and pathogenesis

of disease. Generally speaking, pain in new disease is
serious, constant and impalpable. Since it is caused
by sthenic pathogenic factors, it is of sthenia syn
drome. While pain in chronic disease is mild, inter-
H A *
mittent and palpable. Since it is caused by asthenic
t.ttS-H&.HiN&B i h . J S i
, % SI J S f f i , M liffio I
pathogenic factors, it is of asthenia syndrome.

D isten din g p a in : Pain accompanied by distensin is
caused by qi stagnation. If distending pain appears now
<l) IM S :
M r i I t . M-H f W
and then over the chest, hypochondrium, epigastrium and

ojdl
abdomen, it is caused by qi stagnation. However, disten

ding pain of the head and eyes is usually seen in hyperactivity of liver yang or upflaming of liver fire.
(2 ) M :
Stabbing pan: Stabbing pain is a sign of blood sta
sis, usually appearing over the chest, hypochondrium, ep

igastrium and abdomen due to blood stasis.
-o
(3) A ' J ) : t m m
W andering p a in : Wandering pain means that the
pain is not fixed and is migratory. Wandering pain of

joints is usually seen in obstructive disease due to wind
and dampness attack. Wandering pain over the chest. hy
S o
P )K K | S |
pochondrium , epigastrium and abdomen is often caused by

qi stagnation.
Fixed p a in : Fixed pain over the chest,, hypochondri
(4) 1
um, epigastrium and abdomen is often caused by blood

jl^ o k *
stasis. While fixed pain of the limbs and joints is usually
seen in the obstructive disease caused by coid and damp

ness.
C oid p a in : Coid pain means that the pain is
(.r,)
i,1i'VffiHl
ureompanied by coid sensation and
preference
for
ttamith, aggravated by coid and alleviated by warmth.
m iir i# n s ,ji w ija ,^ u

is .
I prious and unpalpable coid pain is caused by sthenic coid

Wlileli obstruets the meridians; while mild coid pain with
Itlitfrrence for warmth is caused by asthenic coid due to
IHMifficient yangqi which fails to warm the body.
Scorching pan: Scorching pain refers to pain with
(6>
Imi'iung sensation, preference for coid and aversin to

INI. Serious and unpalpable scorching pain is of sthenic
l|tml Nyndrome, usually caused by invasin of pathogenic
Un) into the meridians; mild scorching pain with preferMliv for palpation is of asthenic heat syndrome, often
H'Wttd by exuberant fire due to yin asthenia which impairs
Uh Viscera and meridians.
(7 )
Colic pain: Colic pain means sharp pain, often

by substantial pathogenic factors obstructing the
m am o
B K ll y of Cji or coagulation of pathogenic coid obstructing

1(1<14tlvity. The examples are angina pectoris due to obli inIlion of the heart vessels, small abdominal or lumbar
Hilli |Niin due to obstruction of the urinar.y duct by calcu-
is mm,
1*1mnmm
ll, i olic pain of the epigastrium and abdomen due to in!'" i O pathogenic coid into the stomach and intestines.
f Dull pan: Dull pain means that the pain is not sharp
ll'l lnlcrable, but constant. Dull pain often appears over
(8) :
m -f ni e w -i m % * w .
Iiiiid. chest, hypochondrium, epigastrium and abdotyl din' lo consumption of essence and blood. or msuffipH v o yangqi and endogenous exuberance of yin coid
a ,
Mili (lipi ves the body of warmth.
I I M
Hn/ivy pain: heavy pain usually appears over the
rt is. tr,
(J
o ) m -. m m m m
PMil. Iiinbs and loins due to pathogenic dampness preven

i d *|l lioni llowing. However, heavy pain of the head
M y nl'io be caused by hyperactivity of liver yang and acJgitlliliilioii of qi and blood in the upper.
DrlJfling pain: Dragging pain usually involves other
0
fFP
E
I
/l,H . J
(10)
ftr .
parts of the body due to malnutrition of the meridians or
iitMM , & M
R ifc
obstruction of the meridians. Since the liver governs the

tendons, dragging pain is often caused by liver disorder.
ib
Ifffl
Vacuous pain; Vacuous pain usually appears over
( 11)
the head or small abdomen, often caused by consumption

of qi, blood, essence and marrow as well as malnutrition
of the viscera and meridians.
1 .3 .3 .4
Inquiry of sleep
m .
(ES)
r]fillS
Sleep is in cise relation with the circulation of weiqi

and the conditions of yin and yang. Sleep is also, to a cer
tain degree, in relation with the conditions of qi and blood
itt,
H Jfli M M VI 7k - 6 , %
sai
as well as the functions of the heart and kidney. Inquiry of

whether the sleep time is long or short, whether the sleep
N IS IR
|'h] M
, A B 1*1
is easy or difficult and whether there is dream or not is

helpful for understanding whether yin, yang, qi and blood
are predominant or declined and whether the functions of
jffiW SU S.
the heart and kidney are strong or weak.

1 .3 .3 .4 .1
Insomnia
i.
Insomnia is characterized by difficulty in sleeping, or

easiness to wake up and difficulty in falling asleep again,
or shallow sleep or easiness to be disturbed in sleep. or even inability to sleep all night, usually accompanied by
frequent dreaming. The pathogenesis of insomnia is the
failure of yang to enter into yin and failure of spirit to
u iih ^ a w .# ^ # .
maintain calm. The causes of insomnia are various and the

nature of insomnia is either asthenic or sthenic. -Asthenic
syndrome of insomnia is usually caused by depletion of
blood or exuberance of fire due to yin asthenia and malnu
trition of heart spirit; while sthenic syndrome of insomnia
is caused by exuberance of phlegmatic heat inside, or
retention of food and disturbance of the heart spirit. If
insomnia is accompanied by palpitation, dysphoria and
S ifii ^ M W \ ;k $ , L- W \
reddish longue with scanty fur, it is caused by insufficienl'y of heart yin; if difficulty in sleeping is accompanied by
inllpitation and aching flaccidity of the loins and knees, it
In caused by imbalance between the heart and the kidney;
II easiness to wake up is accompanied by palpitation, reiluced appetite, pal tongue and weak pulse, it is caused
liy asthenia of both the heart and the spleen; if insomnia is
Itcompanied by profuse sputum and yellowish greasy fur,
II 8 caused by phlegmatic heat disturbing the heart; if disliirk'd sleep is accompanied by dizziness, timidity, nausea
mui bitter taste in the mouth, it is caused by gallbladder
drpression and phlegm disturbance.
1 .3 .3 .4 .2
Dreaminess
2.
l'he cause and pathogenesis of dreaminess are alItliit the same as that of insomnia. Dreaminess and
lliHomnia usually appear at the same time and can be
in ated with the same kind of drugs. Therefore, diagIKims of dreaminess can be made according to that of
luuomnia.
1 .3 .3 .4 .3
Somnolence
3 . P f is
Somnolence refers to sleepiness in both daytime

MiliI night. Somnolence is often seen in diseases of
yitiiK asthenia and yin predomination as well as interiml (xuberance of phlegmatic dampness. For exam
ine, somnolence accompanied by lassitude, heaviness
uf head and eyes, oppression and fullness of the chest
Nlid heaviness of the limbs is usually caused by interlutl exuberance of phlegmatic dampness and failure of
lili Id yang to rise; postcibal somnolence accompanied
tlV upiritual lassitude, reduced appetite and indiges11<ni is often due to insufficiency of gastrosplenic qi
nlid failure of the spleen to transform and transport;
|ilritual lassitude and somnolence following serious
lllwNiNe are signs of healthy qi failing to be restored.
t& m .
3P.
i#
Besides, the condition of extreme spiritual lassitude

and half-sleep and half-waking is known as tendency to
sleep caused by asthenia of heart and kidney yang and internal exuberance of yin coid. High fever and lethargy in
m ti a s & t i s . J i & A ' i i ' i i
exogenous febrile disease are signs of invasin of heat into
ZM
. :
ti B E H
f f i
the pericardium. Lethargy with snore and rale of sputum

in the patient with apoplexy is caused by phlegm and stasis
confusing the mind. This morbid State is actually coma.
1 .3 .3 .5
( ) fqltK & nifc
Inquiry of d ie t and p a rtia lity
Inquiry of diet and partiality includes the inquiry of

thirst, drinking of water, intake of food and partiality.
The doctors should pay attention to inquiry of thirst,
'j] JZ
: $J N f t P ' -t
quantity of drinking of water, preference for coid or hot
'!: 'P , h n % & . (i A. f %
drinks, appetite. quantity of the intake of food, partiality
ftlttlM
11
di
and aversin of food, abnormal taste and odor in the

mouth. Inquiry of diet can enable one to understand
whether the disease is of heat or coid, or of asthenia or
sthenia, whether the functions of the spleen, stomach,
liver and the gallbladder are strong or weak, whether the
body fluid is sufficient or insufficient and whether the distribution of the body fluid is normal or abnormal. Such information is very important in clinical diagnosis.
1 .3 .3 .5 .1
l.
Thirst and drinking of water
P iS J ig P T S W M
Thirst means the desire for water and drinking

water means the quantity of water being drunk. Generally speaking, the patient with thirst likes to drink
water and the patient without thirst does not want to
P S ^ S t f c P 'F f
wm
drink water. But it is not always the case. In clinical

diagnosis, doctors should try to inquire the characteristics of thirst and
the accompanied symptoms.
vrx? k m
Whether there is thirst or not and whether the water

drunk is more or less are the signs of the conditions of
body fluid and its distribu tion.
No th irs t but desire for drinking o f w a te r; This
(1) a :f X) V :: P ^ w
iSoiulition indicates that the body fluid is not consumed,

UftMiilly seen in coid syndrome, dampness syndrome or
# j , E T- m Id:, M
ffi, c%
ft fj f ffi
, lynrirome without evident dryness and heat.

T hirst w ith desire to drink w a te r: This condition
(2 )
a M iik
IR a sign of the consumption of body fluid, often seen in

dryness syndrome, heat syndrome; also seen in diseases
$tvE; ft Oj IaL i'-
IfttuTked by non-consumption of body fluid, dysfunction in

l|l transformation and failure of body fluid to flow to the
ifti
ll|>per part of the body. Extreme thirst with preference

Ini coid drinks accompanied by reddish complexin, sweallliK and surging and rapid pulse is usually caused by exulaiHilce of internal heat and serious consumption of body
(llilili thirst with much drinking of water, accompanied by
T asase;
, philuse urination, polyphagia and frequent hunger and

|l urinal emaciation, is consumptive disease usually caused
f fxcretion of fluid from the lower resulting from failure
Wdney to transform body fluid due to asthenia; thirst
, El
pî p i ,
M ili preference for hot drinks but without much drinking

W water is usually due to internal retention of phlegmatic
or asthenia of yangqi and failure of body fluid to
lluill.
to the upper part of the body; thirst without much

dlliiMiig of water accompanied by dull fever, heaviness of
Mly and head and oppression in the epigastrium is usually
MlW'd by internal stagnation of damp heat, failure of body
lluiil lo transform qi and to flow to the upper part of the
Îtlyi thirst without much drinking of water accompanied
|||l WoriK'ned fever at night and crimson tongue is yingfen
aifinlitinir in seasonal febrile disease due to invasin of
)HtlliiiUi'iii('
factors into yingfen which steams ying yin to
llow lo the upper, leading to less thirst and less drinking

K Waln i dry mouth with desire to gargle but not to drink
fcalri,
accompanied by purplish ecchymosis on the
tNUMin'- is usually caused by internal retention of blood

HrmIm. lailure of qi to transform body fluid and failure of
% l &
, *
-fi ffi i r
E , gl
M ifi X /K S g
8k t HaTf. $ ; p g ,
P f , {O
ja
# $
Ikkly fluid to flow to the upper.

1 .3 .3 .5 .2
Appetite and repast
2.
Appetite refers to the demand for food and enjoyable sensation of taking food. Repast refers to the ac
tual amount of food being taken. Inquiry of appetite
and repast is significant in understanding the condi
tions of the spleen and stomach and the prognosis of
m w m u R m m w m is n
disease.
Reduced a p p e tite ; The meaning of reduced appetite
( i)
includes anorexia, poor appetite and indigestin which are

similar to each other but are not totally the same. Re
f lw .0 x * f 5 ^ | s ] o ff
duced appetite in new disease is a sign of healthy qi fighting against pathogenic factors, indicating mild morbid con
dition and favourable prognosis. Reduced appetite in pro
longed disease accompanied by spiritual lassitude, sallow
complexin, pal tongue and weak pulse is usually caused
by weakness of the stomach and spleen to transport and
transform. Reduced appetite and indigestin accompanied
by heaviness of head and body, distending oppression of
the epigastrium and abdomen as well as yellowish greasy
fur is often caused by failure of the spleen to transform
and transport due to dampness encumbering the spleen.
Anorexia: Anorexia means aversin to food or to the
(2) B U t:
smell of food, often due to retention of food in the stom

ach, accumulation of damp heat in the liver, gallbladder,
spleen and stomach. Anorexia accompanied by acid regurgitation, distending fullness of the epigastrium and abdo
men is usually caused by indigestin due to retention of
food in the stomach and intestines. Disliking oil and greasy l(X)d accompanied by chest oppression, vomiting and
distending fullness of the epigastrium and abdomen is ofleii caused by indigestin due to retention of food in the
stomach. Disliking greasy and rich diet accompanied by
distending pain of the hypochondrium and bitter taste in
ris
lile mouth is frequently caused by internal accumulation of
i . ih m s l . u r m z t o M
ililinp heat in the liver and gallbladder. Anorexia in the

Kni vida is due to upward adverse flow of qi in the thornilghlare vessel which prevents the stomach qi from de
dvnding. This is a normal phenomenon. However, seri01 in
morning sickness is a commonly encountered disease
IPrn in the course of pregnancy.

Polyphagia and frequent eating Polyphagia and
BTquent eating refers to hyperorexia and hunger not long
(3)
B tJ L
nller eating, usually caused by exuberance of stomach fire

N lid
fast digestin. Polyphagia and frequent eating with e-
)% & * & & m .
Hipciation is often seen in consumptive disease.
Excessive eating and frequent hunger w ith loose

lool: This condition indicates strong function of the
(4 ) P i t i b U L , * . *
at*
Dmach and weak function of the spleen. Strong function

h| Ihe stomach causes fast digestin which leads to excesWVti eating and frequent hunger; while weakness of the
Imiten prevents it from performing normal transportation
lllil transformation, therefore leading to loose stool.
Hunger w ith o u t desire to e a t: This means that the
(hiIhni feels hungry, but has no desire to eat or just eats a
(5)
ti m
lllllr lood. It is usually due to insufficiency of gastric yin

llld internal disturbance of asthenic fire. Internal disturb-
i*Jtt0 o .X\HHi W
UM T
lliro of asthenic fire leads to easiness to feel hunger;

pKfliilr failure of asthenic yin to moisten the stomach leads
E7jc Q - M tl i l ,
liypofunction of the stomach to digest food. That is why

(llrn* is no desire to eat.
Hesides, during the course of a disease, restoration
ni n||)i'tite and increase of appetite are the signs of gradual
M , # M iff i f , J S % ff\
fWloration of gastric qi and tendency of healing. While

|rndunl anorexia and decrease of appetite are the signs
jff'F M . # M fif W, -J i W-i1/ jJj
lilil II ie functions of the stomach and the spleen gradually

U>i orne weak, suggesting aggravation of disease. Sudden
in o X f !>T((j \ . )ii 4-
increase of appetite or even crapulence in the patients suffet ing from prolonged illness or serious disease with ano
rexia or even inability to eat is known as exhaustion of
the gastriosplenic qi .
1 .3 .3 .5 .3
Taste
Taste refers to the sense in the mouth. Abnormal
3.
nm
p ^ J if p tW .
taste in the mouth may reflect the disorders of the

spleen and stomach as well as other viscera.
Bland ta s te in the m outh: Bland taste means hypo-
(1) trj*.: B P f t jg g j lf l
geusesthesia due to asthenia of gastrosplenic qi or seen in

cold syndrome.
B itte r ta s te in the m outh; This condition is usual
J % j B %
*iIE,&JLT#ffio
(2) o # :
ly seen in syndromes due to exuberance of liver and gall

bladder fire and upward adverse flow of gallbladder qi.
Sweet ta s te in the mouth Sweet and sticky sen
sation in the mouth is usually caused by damp heat resul
ifiJ3fSC.
(3) o # : B P gftntl
SUR*,
ting from excessive intake of rich and sweet food; or by

accumulation of exogenous damp heat in the spleen and
P M o PSHI
stomach, the confliction of which with the cereal qi

steams the mouth. Sweet taste in the mouth with thin fur
and drooling is often caused by failure of the spleen to
9zMJJxWio
transport due to asthenia.

Sour ta s te in the m ou th: Sour taste in the mouth,
or acid regurgita tion, is usually caused by stagnation of
(4) o
BP S & t
^ W K I c . a E P S * . ili
liver qi attacking the stomach which leads to disharmony

between the liver and the stomach and failure of the gas
tric qi to descend.
Sour and putrid ta s te in the m ou th: Sour and
putrid taste in the mouth is usually caused by failure of the
(5) o t t :
B P S II
M\
stomach and the spleen to digest, transport and transform, or

by retention of food which putrefies and leads to acid re
gurgita tion.
Puckery ta s te in the m outh: Puckery taste in the
mouth usually appears simultaneously with dryness of the
(6) ViZL: B P P ^ g
tMlguc. usually caused by dryness and heat consuming
|J]0ih91o
hwlv fluid, or by predominant yang heat in the viscera and

ypWiird adverse flow of qi and fire.
0 ra.
Salty ta s te in the m o uth: Salty taste in the mouth
(7) & j^. gp
'M i
Ir inually due to asthenia of the kidney and upward flow of

(Mild water.
S ticky and greasy ta s te in the mouth Sticky and
<8) 17
fpnsy taste in the mouth is usually accompanied by thick

NImI greasy tongue fur, often caused by retention and stagJBllon of phlegm and damp turbidity. Sticky and greasy
|Mlr in the mouth with sweetness is usually due to damp
hnii in the spleen and stomach; sticky and greasy taste in
IC,
Wk mouth with bitterness is often due to damp heat in the
y~j
1*1
^ jfnft, 'J
fei ind gallbladder; sticky and greasy taste in the mouth

Hunpanied by chest oppression, epigastric fullness and
toldsc and sticky sputum is due to internal accumulation
dftmp phlegm.
1.3.3.6
Inquiry of urination and defecation
( A
p I ^
Defecation, though directly governed by the large in(pnlliir. is closely related to the functions of the spleen
M i FJr f] R
^ ^ jfij Sil
til the stomach to digest, transport and transform, the
t J f Wes,tii;, ^ n w
Ptf'lnns of the liver to convey and disperse, the func-
^
/j'
of mingmen (vital gate) to warm and the functions
iii
til tf
F/r
Hl llir lung to cleanse and descend. Urination, though dilllv governed by the bladder, is in cise relation with
M f, 8$ iW%
fq
||
i l ]
P* luiu tion of the kidney to transform qi, the functions of

PP npleen to transport, transform and distribu te, the
(Mili itons of the lung to cleanse and descend as well as the
&)itfe. &
Hlllillons of the triple energizer to reglate water pasfty* So the inquiry of urination and defecation not only is
MUDV lo directly understand the digestive function of the
lolv Mid metabolism of fluid, but also is an important eviWlt
*' lo determine whether the disease is coid or heat and
co
^ ii
'|fr
, /jl'
Inquiry of urination and defecation includes the na
l'].JI'5] A '
ture, colour, odor, time, quantity, frequency, sensation

and the accompanied symptoms of urination and defeca
tion. The following is detailed discussion on the nature,
yf-
frequency and quantity of urie and stool as well as the

sensation in urination and defecation.
1 .3 .3 .6 .1
Defecation
l.
Normally a person defecates once a day and the
i E # A - M 0 A f-
stool is marked by normal shape, no dryness, proper

dampness, smooth discharge, yellow colour without
pus, mucus and indigested food.
Abnormal frequency o f defecation;
(1 )
Constipa tion: Constipa tion means difficulty in defeca
(D M
J if A W
tion or prolonged defecation or even no defecation in several days due to dry feces. Constipation is usually caused
by retention of heat in the intestines, or consumption of
51 -
body fluid, or insufficiency of yin blood which fails to

moisten the intestines and causes excessive dryness in the
intestines. Sometimes constipation also results from fail
ure of asthenic qi to propel. or from obstruction of the in
m.
testines due to cold coagulation due to yang asthenia. Con

stipation, accompanied by abdominal fullness, distending
M . i?
pain and unpalpable pain. fever and yellowish dry fur, is
S .
due to heat retention in the intestines which prevents qi in
S , * P 0 I ^ 5 , l ^ F J
*%^
ifi;
HM
the fu organ to flow; constipation, accompanied by cold

pain in the abdomen, cold extremities, pal tongue with
whitish fur and deep and slow pulse, is due to failure of
asthenic yang to transport and internal exuberance of yin
cold which stagnate the intestinal qi; constipation, accom
panied by shortness of breath, spiritual lassitude, pal
tongue and weak pulse, is usually due to qi asthenia; con
stipation,
accompanied by pal complexin,
lips and
tongue, dizziness and palpitation, is usually due to blood

asthenia; constipation, accompanied by dry mouth. red
t i , Wi}c
M % j
,1 , 1 , frM S ,
* jfill ; ,P P g m *.
t Iwc'ks and reddish tongue with scanty fur, is usually due

to consumption of body fluid resulting from yin asthenia.
I)iarrhea: Diarrhea refers to loose, water-like and
mm-.
hrquent discharge of stool, usually due to improper diet,

pWKenous pathogenic factors, insufficiency of yangqi in
tlu' body and emotional disorders which lead to failure of
llir spleen to transform and failure of the small intestine
lo separate lucidity from turbidity, resulting in direct
OWtiward flow of water and failure of the large intestine
lt| transmit. Generally speaking, acute diarrhea in new
iltwase is usually of sthenia syndrome; slow diarrhea in
pfOlonged disease is often asthenia syndrome. Diarrhea,
nliiked by fulminant discharge, yellowish chyle, abdomiftfil pain and scorching heat sensation of the anus, is usual
ly due to internal accumulation of damp heat in the intesllliiS; clear loose stool mingled with water and feces, acIpinpanied by abdominal pain, borborygmus and whitish
(jpfrasy tongue fur, is caused by internal invasin of coid
pmpncss which encumbers the spleen yang to separate
lilcdity from turbidity; diarrhea foliowing abdominal pain,
it'ked by putrid and foul odor like decayed eggs, alleviaIlimi of pain after diarrhea and acid regurgitation is usually
ilue to retention of food which damages the spleen and
Utilnach and leads to failure of the intestines to transmit;
Itoiim' stool following dry feces, accompanied by abdominal
ension, reduced appetite, worsened distensin after
iihmI and
lassitude, is often caused by asthenia of splenic
|| nnd failure of the spleen to transport and transform; diIfrliea ollowing abdominal pain before dawn, marked by
Idlihe stool with indigested food, is called moming diarrtli'H. usually resulting from decline of fire in mingmen
l VIInl gate) and internal accumulation of yin coid and
ilmii|>turbidity; diarrhea following abdominal pain and of(>li worsened by emotional upsets is frequently caused by
H ,# a i
nlxilance between the liver and the spleen.
(2 )
Abnormal te x tu re o f s to o l; Besides dryness and

>oseness, the texture of stool is also marked by indigestil f(K)d. looseness complicated by dryness, feces with pus
nd blood and hematochezia, etc. Stool with indigested
>od is usually due to asthenia cold in the spleen and stomch or kidney asthenia and decline of fire in the vital gate.
g m w w & m m n f n
)ceasional dry and loose stool is called looseness compli-
t .
ated by dryness usually caused by liver depression and

ipleen asthenia as well as imbalance between the liver and
he spleen; loose stool following dry feces in defecation is
m m n fto
>ften due to weakness of the spleen and the stomach;
. $
, f-F % ffc l I , M *
itool mingled with pus, blood and mucus is known as pus

ind blood stool, usually seen in dysentery due to accumuation of damp heat in the intestines which damages the
lJJ t Wlo X ti lrt.
neridians and coagulates qi and blood into pus blood;
ifiL-feM/p
blood in stool is known as hematochezia which is divided
jffi JL; 5fclftt f s
-!
ifil U a J
into distal bleeding marked by bleeding following stool

with purplish blood and proximal bleeding marked by
bleeding preceding stool with fresh blood; loose stool with
black colour like pitch is usually due to damage of the
stomach collateral and retention of blood stasis.
Abnormal sensation in defecatio n; Scorching sen-
(3)
sal ion of anus is often caused by downward migration of

damp heat or invasin of stagnant heat in the large intestine into the rectum, usually seen in diarrhea due to heat
or dysentery due to damp heat. Abdominal pain with fre
quent desire to defecate, prolapsing sensation of the anus
and obstructive defecation is called tenesmus,
often
caused by internal retention of damp heat and obstruction

of intestinal qi seen in dysentery. Difficult and astringent
sensation in defecation accompanied by abdominal pain,
distensin and frequent flatus is caused by liver qi attac
king the spleen and obstruction of intestinal qi; incontinence
lij
tiifii
H rIihiI is usually due to asthenia of the spleen and the

iMtlm y failing to control the anus, often seen in patients
Wllli weakness due to prolonged illness and senility or
diarrhea. Fulminant diarrhea in new disease or
a ir
Bwilimcous defecation with coma is also due to failure of

mus to control, but is not necessarily caused by weak-
fe & & rfff A H S f U ,
kN o the spleen and kidney. Prolapsing sensation of the

or even prolapse of the anus is known as qi prolapse
N| lile mus which often occurs after overstrain or becomes
Ooiwrned after defecation, usually due to prolapse of the
HUlosplenic qi and seen in patients with chronic diarrhea
B|holonged dysentery.
[ 1 .3 .3 .6 .2
Urination
I Normally a person urinates 3 - 5
2. /Jn
times in the
Hhfltnu- and 0-1 time in the night, and the volume of
0|bJ # 3 ~ 5
film discharged in a day and a night is 1,200 Olio mi. The frequency and volume of urie are af-
o~
200 -
2000 mi0 j^ n ^ M ^ :t :7 c ,
fcklrd by such factors like drinking of water, body

Ppf!i|irrature, sweating and age.
IPfo
[ Urie is transformed from body fluid. The inquiry of
'h m jm m f t k 'T M 'b
Mli' s helpful for understanding the conditions of body

Hllil nnd qi transforming functions of the concerned vis*iR
Abnormal volume o f urie: Clear and profuse urie
(1)
/hfiiHsc
piiminlly due to asthenic coid syndrome. Profuse urie is

un important evidence in diagnosing other diseases,
Hpli lih |K)lyuria in diabetes marked by emaciation, polyBmIh and polyphagia. Reduced urie is often caused by
Ulieinit heat consuming body fluid, or sweating, vomiWtK nd diarrhea which over consume body fluid and
ff
w a fls
mI rus Ihe transformation source. Polyuria may also be

Hinrd by dysfunction of the lung, spleen and kidney as
nH*ll un improper transformation of qi.
Abnormal frequency o f urine: Frequent urination
(2 )
:w m m
means increased times of urination and frequent desire to

urinate. Frequent urination marked by brownish scanty
So
f ilm a d
and urgent urie is usually due to damp heat in the lower

energizer and failure of the bladder to transform qi; fre
quent urination with profuse discharge, clear colour and
aggravation in the night is due to asthenic cold in the low
er energizer resulting from insufficiency of the kidney
yang, weakness of kidney qi and failure of the bladder to
M 'F ti
control. Obstructive urination with dripping discharge is
a s t r a l
known as retention of urie; blockage of urie is called

obstruction in urination; the conditions of both are collectively called retention of urie. The retention of urie due
to downward migration of damp heat or blood stasis and
E.
obstruction by calculus is of sthenia syndrome; while re

tention of urie due to insufficiency of kidney yang, im
proper transforma tion of qi or insufficiency of kidney yin
and deficiency of body fluid is of asthenia syndrome.
Abnormal sensation in urination:
Obstructive
urination with pain, often accompanied by urgency and
(3)
K * fe i i
'M M
scorching heat, is often due to accumulation of damp heat

in the bladder and improper function of the bladder to
transform qi. usually seen in stranguria. Dripping urina
0 r a .J / M o
/hfJSd
tion is usually due to asthenia of kidney qi and failure of

the kidney to manage elosure and opening, often seen in
od and weak patients with prolonged illness. Inability to
control urie and spontaneous discharge of urie is called
incontinence of urie, usually due to insufficiency of kid
ney qi and weakness of kidney function. If coma i accom
panied by incontinence of urie, it is a critical pathological
condition. Spontaneous urination during sleep is called
enuresis, usually caused by insufficiency of kidney qi and

failure of the bladder to control urie.
1 .3 .3 .7
Inquiry of the head and face
Many of the symptoms appearing on the head and
(t)
il
Ini't' are also the manifestations of diseases of the whole
a i#
Iftly. l'he following is a brief discussion.

1 .3 .3 .7 .1
Vrtigo
i.
k m
Vrtigo means that the patient subjectively feels

llml liis or her body or the things in sight are swirHliH Vrtigo may be caused by up-flaming of liver
ffFAiJT|SH
Ufe. hyperactivity of liver yang, encumbrance and

llflgnation of phlegmatic dampness, insufficiency of qi
llil blood as well as deficiency of kidney essence.
M A S IS # . ,
ftr tig , accompanied by distensin, flushed cheeks

-h'l red eyes, dysphoria, susceptibility to anger, hypliondriac pain and bitter taste in the mouth, is due
In up-llaming of liver fire; vrtigo, accompanied by
5 ti,
, il ^ H S , 0
B tru d in g pain, tinnitus and aching flaccidity of loins

m
, ffi J
knees, is usually caused by hyperactivity of liver
(iitilKi vrtigo, accompanied by head heaviness like
H ^ F r r fn iiJ r ,
biiiK bound, chest oppression, nausea and heaviness

limbs, is often caused by internal retention of
Idiiwn atic dampness and failure of lucid yang to rise;
vtHftlRo,
accompanied
by
lassitude,
shortness of
iMtli, lethargy to speak, pal complexin, light collll nf tongue and aggravation after overstrain, is due
||lnI iislhenia and blood deficiency which fail to nourMii lile upper part; vrtigo, accompanied by vacuity
PlNnImn. tinnitus. amnesia and aching flaccidity of
loins and knees, is frequently caused by asthenia
klilney essence.
1 .3 .3 .7 .2
Tinnitus
Tinnitus refers to noise in the ears like chirping
2. 5 1 ^
J if M p W M Q W
H cicada or tidal sound. Fulminant tinnitus like the

lllH made by frog or tide, which cannot be reduced
liY |iirNHure , is of sthenia syndrome due to exuberant
w|, ^ A fti i , sS ba
p , tk
z ^ p ^ m ,m % v E , m n \ :
MNU iind gallbladder fire to disturb the upper orfices;

M y rttvl gradual tinnitus like chirping of a cicada,
4'. illlW'S.M:
which can be reduced or stop by pressure, is of asthe

nia syndrome due to asthenia of liver and kidney yin
and hyperactivity of liver yang, or deficiency of kid
ney essence and insufficiency of brain which fails to
nourish the ears.
1 .3 .3 .7 .3
3.
Deafness and diplacusis
Deafness means hypoacusis or even anakusis.

The condition of hypoacusis, unclear hearing and
hearing of repeated voice is called diplacusis. Sudden
deafness and diplacusis are of sthenia syndrome due to
accumulation of adverse rise of fire from the liver and
gallbladder in the ears, or due to phlegmatic turbidity
and pathogenic wind obstructing the ears; deafness
and diplacusis in prolonged disease are usually of as
thenia syndrome due to failure of essence to replenish
^ j i j e , ^ W f i''u iR
1
the upper orfices resulting from asthenia.

1 .3 .3 .7 .4
Dizziness
mt
4.
Dizziness means swirling of things like sailing on

a boat or flying of flies before the eyes. Dizziness and
vrtigo
usually
appear
simultaneously.
Dizziness
caused by pathogenic wind and fire attacking the up

per orfices or phlegmatic dampness confusing the up
!
w m
m *
?M #
PJf . M 1/41
per orfices is of sthenia syndrome; dizziness due to

u
prolapse of gastrosplenic qi and failure of lucid yang to

rise, or due to insufficiency of the kidney and liver,
J' -re. V !:;i
iv Vt-i .fc ;i.
deficiency of essence and blood as well as malnutrition

of eyes, is of asthenia syndrome.
1 .3 .3 .7 .5
5. g f
Ocular itching
Ocular itching means itching sensatin in the eyeld,

canthus or pupil of the eyes. Ocular itching can be eased
w . >* t f
by light rubbing in mild case. However, it is unbearable in
severe case which is usually of sthenia syndrome. Ocular
ffio
; i: f l
I it- ,t- x . |
M
itching like insects creeping with photophobia, tearing and

scorching pain is caused by wind fire in the liver meridian
(Hmurbing the upper part. Mild iiching and dryness of

Oyes is otten due to malnutrition ofthe eyes caused by inBlUllii iciicy of liver blood or asthenia of liver and kidney
i yin.
1 3 - 3 7 .6
Ocular pain
6.
()cular pain refers to pain of one or double eyes
lf
@ !<; M @ ! Mo
A rliicli is usually of sthenia syndrome. Unbearable ocB l u r pain, accompanied by red eyes, bitter taste in
lile mouth, irritability and susceptibility to anger is uBlUiilly caused by up-tlaming of liver fire.
Red and
^ P 'fllin g pain of eyes with photophobia and ocular ex| ffrla is a sign of wind heat disturbing the upper, usuH lly seen in fulminant conjunctivitis or epidemic con|lilx tivitis.
1.3 .3 .7 .7
llplopia
Blurred visin, night blindness and
7- @ ff >]i\j<l
I hese three morbid conditions of eyes are of the

^lis of hypoacusis. Though characteristically differ-
vff
@ Pf0 [j H t IE
they share the same cause and pathogenesis, uHmIIv caused by asthenia of the liver and kidney, in flrien cy of essence and blood and malnutrition of
hS
Wty} ( f ^ ? f 0 @
Jiyt'K. olten seen in the patients with chronic disease
BC the aged and weak people.
mm w m $ , # w #
h
I 1.3.3.7.8
*
Pain and numbness of the tongue
8. S l S . f f iS
*>;im o the tongue is usually due to exuberance of
llt* in llie liver. heart and stomach that affects the

Numbness of the tongue is caused either by
HkNl -istlienia, yin asthenia and malnutrition of the
or by stagnation of phlegm in the tongue col(tlutnls.
#i * * isi, ^ a
#UB,jfcTSJ0rSfe. 3-JftnJ
FJtr n .
106
Besides, headache is also a commonly encountered

symptom involving the head and face which is discussed in
the part of inquiry of pain.
1.3.3.8
Inquiry of chest and abdomen
(A ) H M & f t
The chest and abdomen are the regions where viscera

are located. The disorder of the viscera may bring about
various symptoms over the chest and abdomen. The fol-
m sp w se
lowing is a brief discussion.
SnT.
1 .3 .3 .8 .1
Chest oppression
a # i? ^ #i
1. J&H
Chest oppression is a subjective sensatin of dis

comfort and fullness in the chest, usually due to inhibited circulation of qi in the heart, lung and liver.
Chest oppresioon with cough and profuse sputum is
caused by internal retention of phlegmatic dampness
* J& -JW
and obstruction of pulmonary qi; chest oppression

with palpitation and shortness of breath is usually
caused by asthenia of heart and pulmonary qi and inaction of chest yang; chest oppression with frequent
sighing is often due to emotional upsets and stagnation
of liver qi.
1 .3 .3 .8 .2
Palpitation
2.
Palpitation refers to subjective feeling of quick heart

beating and throbbing, usually a sign of the disorder of the
heart or the heart spirit. If palpitation is caused by fright
or palpitation accompanied by anxiety, it is called fright
palpitation. indicating mild pathological condition. If the
B 'iMf- % irK,
'F
heart is beating rapidly from the chest to the navel with

longer duration, it is called severe palpitation, indicating
serious pathological condition and the further development
of palpitation and fright palpitation. Fright disturbs qi,
that is why the heart spirit is in disharmony; asthenia of
blood leads to the malnutrition of the heart; yin asthenia
leads to exuberance of fire which disturbs the heart spirit;
asthenia of the heart qi and yang deprives the heart of
'll'
^ ; t iftL
l- * '' M I
N inilli and nutrition; asthenia of spleen and kidney yang
\
W? P fi.
ufciilts in hydraulic qi invading the heart; obstruction of
III. f
, )
llr heart vessels prevens blood from free circulation.
, fiE
tt'o
Ilim- conditions all may cause palpitation. fright palpitallun and severe palpitation, which should be analyzed acluriling to the characteristics of palpitation and the accomL (iiicil symptoms.
1 .3 .3 .8 .3
Hypochondriac distensin
3.
llypochondriac distensin refers to distensin and
fra i
(llH'omfort over one side or both sides of hypochondrir |ni. usually seen in disorders of the liver and gallbladtfri
llypochondriac distensin with susceptibility to
llIKn is usually due to emotional upsets and stagnallun
of liver qi; hypochondriac distensin with bitter
j Idulf in the mouth and yellowish greasy tongue fur is

H iiillly caused by damp heat in the liver and gallbladilttf.
I 1 .3 .3 .8 .4
Epigastrio distress
lpigastric mass refers to subjective feeling of opftUiNion and discomfort in the epigastrium, usually
IflfrMt in disorders of the spleen and stomach. EpigasnP* nmss with acid regurgitation is often due to retenB | n l l(x)d in the stomach; epigastrio oppression with
m l i i m l appetite and loose stool is usually caused by
^ M k n rs s of the spleen and stomach.
1 3 .3 .8 .5
Abdominal distensin
5. fltJK
i Abdominal distensin refers to subjective sensation of

H||Uimoii and discomfort in the abdomen, usually due to
ia y i3 w . m n n , # r b
MMIuicms o the spleen and stomach. internal retention of

M e iil' heat. mingling of qi, blood and fluid. Palpable abImhhiihI
distensin is of asthenia syndrome due to weak-
M ft, H
P J
T ft
H fc u l llie spleen and stomach which fail to perform the

(Itiimi Iiiiu tions of transportation and transformation;
IMt|Wl|>nblc abdominal distensin is of slhenia syndrome
IR
1 M i, Jd$ ft |Aj
H tJl 'H
N[
ifk )IK0 K ,41fltt
due to retention of food in the stomach and intestines or

intemal retention of sthenic heat which obstructs the circulation of qi. Tympanites with abdominal distensin ac
companied by bulgy veins on the abdominal wall may be
caused by various factors. such as qi stagnation, retention
of dampness and blood stasis in the abdomen.
1 .3 .3 .8 .6
Borborygm us
6. JPJ
04
Borborygmus may be caused by asthenia of splen

ic qi, asthenia of splenic yang, internal exuberance of
cold dampness, disharmony of the liver and spleen,
I H If- H .,
f i >M
W-, M
, JFF I f
>*
CVL* fu Wt a o1
internal retention of fluid and disharmony of qi activity in the intestines. Borborygmus with diarrhea, continuous abdominal pain and preference for warmth and
pressure is caused by asthenia of splenic yang; borbo
rygmus with abdominal prolpase sensation is caused
by prolapse of gastrosplenic qi; borborygmus with
f'jA k'tnitM jB .
thunderous noise, accompanied by abdominal cold

pain, preference for warmth, cold body and limbs, is
usually caused by invasin of exogenous cold and
dampness; borborygmus with gurgling noise is caused
by retention of fluid in the intestines.
Chest pain, hypochondriac pain, epigastric pain and
Pj S nUfrffi.
ii
.)
abdominal pain are the commonly encountered symptoms

over the chest and abdomen, which is discussed in detail
in the part of inquiry of pain. Besides. attention should be
paid to the inquiry of other subjective symptoms. such as
f l^ io
AW
M tt, tfetzaBiMo
nausea, heartburn and dysphoria. etc.
1 .3 .3 .9
Jpquiry of the symptoms over the
( A ) f M Q & fl tt
loins. back and four limbs

Symptoms over the loins, back and four limbs can be
seen in the regional disorders o the loins, back and four
limbs, but also seen in the disorders of the viscera. The
inquiry of such symptoms should be done together with the
inquiry of other symptoms.
r p r r a jfc W f tt.M
1 .3 .3 .9 .1
Coid sensation in the back
1. m
i This condition is often caused by exogenous wind

ind rold or predomination of yin due to yang asthenia
0 M R , i P 0 1 | 5 f J , s ! t
(hiemal retention of phlegm and fluid,

i 1 .3 .3 .9 .2
Aching loins
2.
mm
Aching loins refers to continuous discomfort and

M'IiIiik sensation in the waist, usually caused by kid||y ntthenia, or by obstruction of wind and dampty. or by sprain due to overstrain.
, 1 .3 .3 .9 .3
3.
Heaviness o f the body
l Heaviness of the body refers to the heavy, aching

Mtd Iclhargic sensation of the body, usually accompaB p l hy dropsy, often caused by failure of the lung to
tH*t||rrse and descend, failure of the triple energizer to
is , d c 'f ^ 7 jc ,7 X j2 m K 0 f
ti W i f1!1
water passage, or failure of the spleen to

IfNIllport and transform, or failure o the kidney to
Veril water, giving rise to retention of fluid in the
Hleles. Heaviness of the body with spiritual lassiiHd# lind dyspnea is usually caused by failure of the
|iiM<n to transform due to asthenia, encumbrance of
l ipleen by dampness and obstruction of yangqi.
1 .3 .3 .9 .4
Numbness o f the four lim bs
4. H J g f i* *
I Numbness of the four limbs refers to hypoesthe;(p til1 disappearance of the sense of muscles on the
l f i .
fotlf limbs, usually caused by asthenia of qi and blood.
'% l ^ j bJc H f MI \H Jj. a M
S iz .
M llV Internal disturbance of liver wind, or by damp

H p u m and obstruction of the meridians and vessels
||f I i Iih m I
stagnation.
I 1.3.10
*
(+ )
Inquiry of symptoms in andropathy
Sv1111>toins in andropathy are also related to the disea-
B| ni tile whole body. The following are some examples.

1.3.3.10.1
mm*%L . m m m m iffl k..
Impotence
. ph
Impolence refers to inability to erect penis or

Wt>nl< i'ict tion of penis, usually due lo insufficiency of
ii
W P fP II f M.'PfW
kidney yang, deficiency of kidney essence, asthenia

of both the heart and the spleen, spreading of damp
heat as well as liver depression and qi stagnation. Impotence, accompanied by aching weakness of the loins
and knees, aversin to coid and coid limbs, is frequently caused by asthenia of kidney yang; impotence, accompanied by dizziness, tinnitus, amnesia
and aching loins, is often caused by deficiency of kid
ney essence; impotence, accompanied by palpitation,
shortness of breath, spontaneous sweating, spiritual
lassitude and abdominal distensin with reduced appetite, is usually due to asthenia of both the heart and
the spleen; impotence, accompanied by dampness or
itching and pain of the scrotum, is usually due to
downward migration of damp heat; impotence, ac
companied by restlessness, susceptibility to anger and
depression, is often caused by depression of liver qi.
1 .3 .3 .1 0 .2
2. aTS
Seminal emission
Seminal emission refers to frequent loss of sperm not

caused by coitus. Seminal emission in dreams is called
il.
nocturnal emission; seminal emission without dream or even in conscious state is called spontaneous emission. Se
minal emission is usually caused by yin asthenia and exuberant fire, hyperactivity of the kidney fire. or by weak
ness of kidney qi. or by invasin of damp heat, etc. Semi
nal emission, accompanied by easiness to erect, hectic fever and night sweating as well as aching weakness of the
loins and knees,.is usually caused by deficiency of kidney
yin and hyperactivity of kidney fire; seminal emission, ac
companied by aversin to coid, coid limbs and aching coid
of loins and knees, is usually caused by decline of kidney
yang and weakness of kidney qi; seminal emission, ac
companied by dripping and painful urination and pudendal
itching, is frequently due to invasin of damp heat.
^ .JR
1 .3 .3 .1 0 .3
ll
Immature ejaculation
3. p ffi
is usually caused by deficiency of kidney yang,
Ifcwkiicss of kidneyqi, or abundancy of fire due to yin
iHIrieney or stagnancy of liver qi. If it is complicated
gm nm & sfi,
versin to coid, coid and aching sensation in the

ItalNl and knees, it frequently results from deficiency
ti Mdney yang. If complicated by liability to erection,
(Mi. fever, night sweating, ache and weakness of
waist and knees, it is usually caused by kidney yin
flciency and abnormal activity of xianghuo. If coml'll' Hled by dribbing and painful urination and puden| pruritus, it is often caused by spreading of damp|ll
1 1.3.3.11
Inquiry of symptoms in gynecology
(+ - ) ta m m u
l'hysiologically, women are characterized by menIttuilon. leukorrhea, pregnancy and delivery of baby.
honn.il conditions of menstruation and leukorrhea are
A ) l'immionly encountered diseases in women. which are
m ,a a
# m$ $
f |)kit tile signs of diseases of the whole body. Therefore,

\Mentloti should be paid to menstruation, leukorrhea.
^flmncy and delivery of baby in diagnosing diseases in
piulen.
3
1*. St Jef]
I he following is a brief introduction to the in-
H lf y o menstruation and leukorrhea.

1.3.3.11.1
Inquiry of menstruation
1.
ft % L
M. nstruation refers to regular uterine bleeding

H
Women of childbearing age. Menstruation normally
n ' t l i u once a month.
Inquiry of menstruation in-
|pltm llie cycle, duration, quantity, colour. nature
D I eompanied symptoms of menstruation. If necesInquiry of menstruation should also include the

ible "I llii- last menstruation. menarche or age of
s i s a m , ; j$ i & f H * .
B|lto|iaus('.
Altnormal menstrual cycle; Normally menstruation
HUm once overy 28 days and lasts for 3 - 5 days. If
( i) m X - t:
n 28
menstrua tion occurs 8-9 days in advance, it is called advanced menstrua tion, usually due to qi asthenia and weakness of the thoroughfare and conception vessels, or due to
yang exuberance and blood heat, liver depression and

blood heat as well as yin asthenia and exuberant fire which
i , va
mi l
disturb the thoroughfare and conception vessels and ute-
jfg jl
rus. Menstruation occurs 8 - 9 days later than usual is

called delayed menstruation, usually caused by asthenia of
blood, or by decline of yangqi and lack of warmth and
A', Al
Vu
.j$U
n A;l A 'J;!il^
nourishment which deprive the uterus of having regular
fiEScH'rS^; i a n f f l j t *
sufficient blood. or by qi stagnation and blood stasis which

prevent blood and qi from free circulation in the thorough
f: A l>l L IM lili A !t)|n 'li o
fare and conception vessels, or by coagulation of coid and

blood stasis which obstruct the thoroughfare and concep
tion vessels.
Abnormal amount o f menstrual blood; The men
(2) H N M h
strual blood discharged in healthy women is 50 - 100 mi,
^)Wffliii<jiii.srt.
which may vary due to constitutional and age factors. Evi-
loo mi.di j N l A A l i A ^ J f l
sol
dent increase of menstrual blood with normal menstrual

cycle is called polymenorrhea, usually caused by bleeding
vm w
due to blood heat and damage of the thoroughfare and con
Ht , f; 'f-j f I t i H % o ^ 0 jl ff\
ception vessels, or by qi asthenia, weakness of the thor
j - >!' il v iA A ' '? I'l'fl
oughfare and conception vessels to control blood. or by

blood stagnation in the uterus collateral and bleeding due
to collateral impairment. Normal menstrual cycle with ev-
V A i K v A A M : !']
ident reduction of menstrual blood or even scanty men

struation is called oligomenorrhea. usually caused by defi
ciency of blood and insufficient blood in the uterus, or by
I''I v; la
ii A
il rS A
uti,
r v i - f i'iiil
asthenia of kidney qi, insufficiency of essence and blood and

insufficient blood in the uterus, or by coid coagulation. blood
0rS .
stasis or obstruction of phlegmatic dampness.

Abnormal colour and te x tu re o f menstrual blood;
The normal colour of menstrual blood is marked by red
colour, proper in density and mixture of blood clot. Pal
(3 )
il
AlfilIEA.
< A I1: iii i '1
'A A A
W) I
i m \ .h h m >
lliil Itiin menstrual blood is a sign of deficiency of blood.

fownisli and thick menstrual blood indicates exuberant
liiinl in blood. Purplish menstrual blood with blood clot aciBlupaiiied by lower abdominal pain is caused by coid coag-
iaSJo
Ulitlion and blood stasis.

(4 ) M m ,
Profuse and sudden u te rin e b le e d in g : This morbid
Mllliiltion refers to irregular uterine bleeding, not in men-
iB j^ a F U K b J iiL .^
ruation. or continuous uterine bleeding. Sudden and
T jd. , #
J h # , ffc % $ iS..
fmfiise uterine bleeding is called uterine burst of bleedP lli gradual uterine bleeding with modera te amount of
Ii|h m I
is called uterine leakage. Though different in occur-
STo
|lice. uterine burst and uterine leakage of blood usually

|)p|x-ar simultaneously, usually caused by heat impairing
mM
l|ir llioroughfare and conception vessels and driving blood

MU extravasa te, or by asthenia of the spleen and kidney qi,
nikness of the thoroughfare and conception vessels
M lifh fail to control menstrual blood, or by blood stagnallun in the thoroughfare and conception vessels and ex-
fcflivasation of blood.
Am enorrhea: Amenorrhea refers to stoppage of
(5)
Miriistruation for over three months without pregnancy at

llu age of menstruation or not during lactation in women.
11 m usually caused by qi asthenia and blood deficiency and
MWi'uity of the thoroughfare vessel, or by asthenia of liver
illiil kidney yin, failure of essence to transform blood and
Wliiulrition of the thoroughfare and conception vessels,

ni by qi stagnation and blood stasis, or by coid coagulation
iM Ifco
I lid retention of phlegm as well as obstruction of the uterllut vessels.

Dysm enorrhea: Dysmenorrhea refers to regular
In w e r
(6)
ii:
abdominal pain. during menstruation or before and
illln menstruation, or pain involving the waist and satlliim, or even unbearable pain. Regular lower abdominal
illwlending pain or sharp pain during or before menstruation
mm*
p m insto
is usually caused by qi stagnation and blood stasis; lower
. 'Hw
abdominal pain alleviated with warmth is often due to cold

coagulation or yang asthenia; lower abdominal dull pain
tSsjcra . o
-during or after menstruation is frequently brought about

by asthenia of both qi and blood and malnutrition of the
m m .
uterus.
1 .3 .3 .1 1 .2
2. f f T
Inqui ry of leukorrhea
Leukorrhea is a kind of milky, odorless and

scanty vaginal excreta which can lubrcate vagina. In
quiry of leukorrhea includes the quantity, colour,
w -m rnm m m M ftm , m
texture and odor of leukorrhea. If leukorrhea is pro

fuse and dripping, or coloured and varying in texture,
or foul in smell, it is a disease of leukorrhagia; whit
ish, thin and dripping leukorrhea is usually due to as
thenia of spleen and kidney yang and downward m i
gration of cold dampness; yellowish, sticky and foul
leukorrhea is known as yellow leukorrhea due to
downward migration of damp heat; whitish leukorrhea

mingled with blood is called bloody and whitish leu
korrhea, often causedy by stagnation of heat in the
liver meridian, or by downward migration of damp
iS T S M .
heat.
1 .3 .3 .1 2
Inquiry of symptoms in pediatrics
The infantile viscera are delicate, vigorous and fast

in development. Under pathological conditions, they are
characterized by quick onset, variability and susceptibility
to both asthenia and sthenia. So, apart from the usual as
pects included in inquiry, the inquiry of symptoms in pedi
atrics should be done according to the infantile physiological features.
Since diseases in the newborn (from the date of birth
to one month after birth) are usually due to congenital
factors or delivery conditions, inquiry should be emphasized on such aspects like the health condition of the mother
(+ z) quiafitt
tluiiiiK pregnancy and delivery periods, the contraction of

jllunmcs, the drugs taken, whether there was dystocia
ill.1 immature delivery.
Boca use infants (one month to 3 years od) develop
jJ L ( 1 ' M M 3 J 3#)
Iw il physically and need much more nutrition than adults,

Wlilli the functions of the infantile spleen and stomach are
tfrwl'- improper feeding tends to lead to malnutrition, di(i i lnii five kinds of flaccidity and five kinds of
HMltiiilion. So the inquiry in pedia tries should emphasize
JS fi
rnling, sitting, crawling, standing, walking, erup]) o! tooth and learning to speak so as to understand the
M 7 m 'b JLIs a
H R iiiiUi I nutrition and development of infants.
/h JL 6 t f l I 5
| At (> rnonths to 5 years of age, infantile immunity obIftlmtd from the mothers body gradually disappears while
pOHtnatal immunity has not fully developed. During
|Bl
i s s a , M i a fru %-s is
|||| [H'riod, infants are susceptible to varicella and mea-
, Jc % B
lreventive inoculation can help infants reinforce

llisistence against diseases and reduce contraction of
nos. The contraction of some epidemic diseases, such
UlPiwles, can develop immunity all life. Cise contact
lllli pBtients suffering from epidemic diseases, such as
Hp>lli. erysipelas and liver disease, may result in in-
m m t
ht Ihm ind contraction of the disease in infants. There i llie aspects of inquiry mentioned above can be used
|| ltn|>oi tant evidences in making diagnosis.
f
Hlnce Ihe infantile viscera are delicate and weak in
Mitin.: against diseases and regulating functions, they

B v p ry casy to be affected by changes of weather and enBHinicni and are likely to be attacked by six exogenous
tktKi'iiic factors, thus developing such symptoms like
PH>| i versin to coid, cough and sore-throat, etc. The
tyllllc spleen and stomach are weak in digestin and are
|| In dyspepsia, leading to such symptoms like vomiB | mikI diarrhea. Since the infantile primordial spirit is
'hJLK
an
not sufficiently developed, infants are very easy to be

frighted, causing crying and frightened shouting.
Pediatrics was called dumb department in the ancient
times. Direct inquiry of the infants is not only difficult.
but also inaccurate. So the inquiry in the pediatrics should
be done with the parents, or by inspection, olfaction and
listening. The following is a brief introduction to the main
points.
raTo
In fa n tile c ry in g : Infantile crying refers to incessant
l.
crying in the daytime and night, or sudden crying with

fright, even with changes of the facial expression, usually
24HM gNit3e,!l!lBH
caused by asthenic cold in the spleen meridian, accumula

tion of heat in the heart meridian, weakness of the heart
function and retention of food, etc.
F ir i.
Five kinds o f in fa n tile stiffness-, Infantile stiff
2. /J\JL 5E I
ness refers to stiffness of the head and neck, hands, feet,

chest and waist as well as muscles, usually due to congen
ital defects, coagulation of cold and wind as well as pre-
W.
dominant liver subjugating the spleen.
m H - m m m p m .
Five kinds o f in fa n tile re ta rd a tio n : Five kinds of

infantile retardation refer to retardation in standing.
3. /JxJLEig
TE
walking, growth of hair, eruption of teeth and speech, usually caused by congenital defects, asthenia of kidney es
m w m t.
sence, or postnatal malnutrition and weakness of the

spleen and stomach, etc.
Five kinds o f in fa n tile fla c c id ity : Five kinds of
Wtflfrt
4. /JnJL S:
infantile flaccidity refers to the flaccidity of- head and

neck, mouth. hands, feet and muscles, often resulting
from congenita! defects or postnatal malnutrition, or im
proper feeding after illness and asthenia of qi and blood.
1. 3. 4
Inquiry of anamnesis
Anamnesis, also known as history of past illness,
ra, s ia i
Mlllv Inducios the constitution of the patient and previl* tiiiitiaclion of diseases.
1, 3. 4 . 1
Inquiry of past physique
( - ) lqlEEi$M)yj/52
past physique of the patient may be relevant to
IV
P |mcw'i11 illness. For example, if the physique is usualI I m i i k . the disease is often sthenic; if the physique is
B )y weak. the disease is often asthenic; if yin is often

|(M l!li'liia .
the disease is usually of heat syndrome due to
p UUceptibility to the invasin of pathogenic febrile and

F> InBtors; if yang is often in asthenia, the disease is uftllv O od syndrome due to susceptibility to the invaP ol i'old and dampness.
i;{i3 4 .2
Inquiry of previous illness
(Z )
lliqmry of previous illness includes the category, re i present treatment, present manifestations and re-
M l'"J H
S "j f t % tfe
l wilh Ihe present illness.

?
. i'A fh ; t i I ^
^ M .
\Hrsides, inquiry of previous illness should also

contraction of dysentery, malaria, diphtheria and
Mli inoculation, allergy and operation.
t fnf t 1 ' A
p T ^
> S P j)[l lit
ffi]]o
Inquiry of family history
PlW|iiiry of family history includes the health of the

M i lirothers and sisters, spouse and children who
IIIVIiih logether with the patient. If necessary, inquiry
Rflillv history should also include the cause of the death
Hli i(l ly related family members. Because some he-
^ s a ffi ifij |pj a % % m w vt
Rt Vdiseases are closely related to ties of blood; some
tuses.
m tsem w
tile diseases, such as pulmonary tuberculosis are

m i iiv contact in daily life.
. *j 'i
1.4
ra ^5-
Pulse-taking and palpation
im
pulse-taking means that the doctor use his or her

hand to palpa te, feel and press certain part of the patients
tt
body to diagnose disease, including taking pulse and palpa
tM - M
o
tion.
1. 4.1
Puise-taking
% f t k i#
Pulse-taking means that the doctor uses his or her

hand to press certain part of the patients pulse to examine
jt #
^ \
tLw ffikja;, m #
the conditions of the pulse and diagnose disease.

Ki
The pulse conditions are closely related to the viscera

and qi and blood. The heart is connected with the vessels;
the heart qi propels blood to circuate in the vessels all
through the body, that is, from viscera to all the limbs
ifii I t i l MIff fln
is
%i
and joints of the body. Such an incessant circulation leads

to the pulsation of the vessels. Besides, the heart exerts
certain effect on the production of blood. The lung govems qi and connects with all vessels. The distribution
of pulmonary qi helps the heart propel blood. The spleen
and the stomach are the source of qi and blood ; the
spleen direct blood to circuate in the vessels. The liver
n % U\Sk*LkZm; m
govems conveyance and coursing, regulating the activity
tfcJL, ifiLi t E JKcH rt M-Vi1
of qi through th body and promoting blood circulation;

the liver also stores blood and regulates the flow of blood.
The kidney stores essence; the kidney essence, qi, yin
and yang constitute the source of yin and yang in the other
viscera. Since essence can transform into blood, the exu
berance of kidney essence ensures sufficiency of blood in
"W HLME M
IfiS c ffi- i
llic Ixnly.
VXWY
lili -
,W
'J
The vessels are the organs to hold blood and the

(Mliways for qi and blood to circuate. The conditions and
tiLZJf festn. i&UH Jiiito
^C ii
is fr
llll'illation of qi and blood as well as the tensin, elasticity

Iflil thickness of the vessels directly influence the states of
(RiInc.
licsides, the functional activities of all viscera as well
l l * the conditions and circulation of qi. blood and body fluid
j lli tlii'iri all can directly or indirectly affect the states o
in.,
W-
ii
f W U . f [5j vi 1;
M ti i s
Ib]g M
|mi|'. When pathogenic factors invade the body and cause

fu nctio no f the viscera, qi. blood and body fluid, the
illditions of pulse will change accordingly. Therefore.
Bynuination of pulse can help diagnosis of diseases.
I . 4 . 1 .1
Regions and methods for taking pulse
I 1 .4 . 1 . 1.1
()
Regions for taking pulse
i- i m
m a
I Cunkou is the usual regin selected to take pulse.

Mlkou. also known as qikou (opening of qi) or
*H#lkou (opening of pulse), refers to pulsation of
n.
-'] p
f
^ P bT B p , BP
J| fe --J i'K # J] 'ibo
llu l artery on the wrist.

J Cunkou is located on the pulsation of the lung
- tn
where qi and blood in the lung meridian flows

H
Hcsides, qi and blood from all viscera circulates

l,ie lung and converges over cunkou. The lung
HHhlian starts from the middle energizer and converges

|llli the spleen meridian. Since the spleen and the stomM i me the sources of qi and blood and function as postnaP Ihi-w of life, cunkou can reflect the conditions of the
p ;
n k m m m m ,m
4 M f^
i f j'i
!k tk ik Z M ,fs3 z2 .*,tS iT t
P T W S B ts n w a fl.
P lllli <|i. On the other hand, the lung meridian is the

rlriliin from where all the other meridians begin and end
Hit ii < k
-f-
L i
-T m g
ulation, because the circulation of qi and blood in
||| llie Iwclve meridians starts from and ends at the lung
Hfrililimi. linally converging over cunkou. That is why
R . Jjj M I'Ja 5)sj. ffls Mj vx
cunkou can reflect the conditions of all viscera, qi, blood

and meridians in the body.
Pulse over cunkou is divided into three parts: cun,
guan and chi. The part slightly below the styloid process
of radius is guan pulse, the part anterior the guan pulse is
the cun pulse, and the part posterior the guan pulse is the
^ ,
chi pulse (see Fig. 3). Both hands have three divisions of
J s ( M ) * K ( M
pulse, i. e. cun pulse, guan pulse and chi pulse. So alto-
Ir. i W f~
gether there are six divisions of pulse.
tt AnPft o
l' ig. 3
) *
-* 1*1
3)1
Tj" >& . R
Divisions of pulse over cunkou
Clinically the correspondence of cunkou pulse and the

viscera is decided according to the description in Neijing
(Canon of Medicine), that is the upper pulse (cun pulse)
m r t h \ " K & F MI
corresponds to the upper part of the body and the lower
p j . B P ( m # i ( #1
pulse ( chi pulse) corresponds to the lower part of the
) , F (K )W fc " F (jJ
body:
T o P ) ,^ r ^ r t 0 " F :
The left cun pulse and the corresponding viscera: the
/t/'J'M:
heart and tanzhong (the part between the breasts).

The right cun pulse and the corresponding viscera:
the lung and the thorax.
' f f i : JU M H **.
The left gua pulse and the corresponding viscera:

the liver and the gallbladder.
The right guan pulse and the corresponding viscera:
the spleen and the stomach.
The chi pulse and the corresponding viscera: the kid
ney and the lower abdomen.
^ i:
The right chi pulse and the corresponding viscera:
.- R :
llir kidney and the lower abdomen.

Such a theory about the relationship between the
IKIhkou pulse and the corresponding viscera is significant
||i clinical diagnosis. However, the application should be
llpxlhlc
and based on the synthetic analysis of the data ob-
Itiiiird from the four diagnostic methods.

M o
1 .4 .1 .1 .2
The methods fo r taking pulse
2.
Tlie following points should be borne in mind in

lnMiig pulse.
VA JL * o
Time Early morning is the ideal time for taking
(1) B+)b]:
(Ni*' I cause the conditions of the pulse are not affected

llV Itmid and other activities. However, this requirement is
.........
to fill in clinical practice. To ensure accurate
puhir taking, the patient should rest for a while to tranIhe heart and breath before the taking of pulse,
pulse should be taken at least for one minute each
lS ilW llo
Ihiic In order to correctly examine the conditions of the
B la] M 'P t 1
CMl*1,
Normal and calm breath: Normal and calm breath

li| that the doctor keeps his or her own breath quiet to
ft
VA , VAm
(2) + 4 :
m ]i
lininc Ihe pulse of the patient and calclate the beat of

B |Mihr ;iccording to his or her own cycle of exhalation
I lithiilation. Healthy people breathe 16 - 18 times one
Hile under normal conditions. And the pulse beats 4-5
f+ 1 6 ~ 1 8 ? ^ , ^ n f P c ^ j 4
m in a cycle of exhalation and inhalation. about 60 - 90
)k l'n]
|Nai minute.
5 f t .B P - J l.ia E M .
n 60-90
f*oKture: The patient sits erect or lies in supina tion
(3)
M lile I. nvarms stretches out naturally to the level of the
ghm ff
a ^ IE ^ i'S c W
|f| The wrist is put straight. the palm turns over and
li l I H r r s
are relaxed to extend the cunkou regin and
* 't P pP f t
% lin
M lili1qi and blood to flow freely.

Afrnngement of fingers: l'he three fingers of the
(4 )
ffi f
doctor are put at the same level and slightly arched to

press the pulse with the belly of the fingers. The middle
finger presses on the guan pulse, the index finger presses
on the regin anterior the guan pulse ( distal to the heart
regin) , the ring finger on the chi pulse posterior to the
'i!
guan pulse (proximal to the heart regin). The arrangement of the fingers is made according to the conditions of
p.
the patients arm. In diagnosing diseases in children, one

finger is used to press just the guan pulse . It is unnecessary to divide the pulse into three parts in this case.
General pressure and single pressure: General
(5 )
pressure means to press the pulse with three fingers to

distinguish the conditions of cun, guan and chi pulses on
both hands. Single pressure means to examine the pulse
on one hand with just one finger to differentiate the states

of cun, guan and chi pulses. Clinically these two methods
n a ^ i'[
are used according to the pathological conditions in question.

L iftin g , pressing and searching; Lifting. pressing
(6)
e ^ I II'I
and searching refer to flexible pressure of pulse in order to

distinguish the conditions of pulse. Light pressure means
lifting ; heavy pressure means pressing ; and mobile
modera te pressure means searching which is used to
look for the most obvious regin of the pulse. In the procedure of diagnosis, doctors should pay attention to the
Mi
use of these three methods to distinguish the variations of

pulse.
Examining the conditions o f pulse: The conditions
(7)
tfc ,
of the pulse refers to the sensation of pulse felt by the fin

gers. The examination of pulse conditions means to distin
guish the features of pulse according to the position of
pulse, the rhythm of pulse, the shape of pulse and the
f fc M S S ;fn g ) ,M < lM
Vln
llrength of pulse.
i*
im 'n E .
1 .4 .1 .2
Norm al pulse
(Z )
Normal pulse refers to the pulse conditions of the

hoalthy people.
1. 4 . 1 . 2 . 1
The shape of the normal pulse
1. i z m m m
The normal pulse is neither f loa ting or sunken,

mrlther fast or slow, sensible with modera te preswire, usually beating 4 - 5 times in a cycle of breath
m ra s M (6 o ~
9Q & / # # ) ,
Ifebout 60 - 90 beats per m inute) , gentle in sensa

tion, powerful in rebounding, modera te in size. regu-
c jh . t f i t a f s h m v w
Im in beating and varying with physical activities and

invironmental changes.
1 . 4 . 1 . 2. 2
The characteristics of the normal
2.
pulse
The normal pulse is marked by gastric qi, spirit
|Wl root. Gastric qi means that the pulse is located at
lite middle, neither floating or sunken, regular in
Iting, moderate in size, gentle in sensation and
Honting. Spirit means that the pulse is soft, powerful
mui rhythmic. Root means that the chi pulse is pow01lu and constantly beating under heavy pressure.
S fJ o
(astric qi, spirit and root are three basic features of

lile normal pulse which complement each other and cannot
r.
1*1 eparated. Simultaneous appearance of the three reflwi-t strong functions of the viscera and sufficiency of qi
lllri blood.
% Jfil
fs irS M
1.
4 .1 . 2. 3
Main factors to affect the normal
pulse
The normal pulse may vary with physiological and
psychological factors in the human body and the environ-
% t
UfT # E nTVAiti M -
mental factors outside.
(1)
Age. sex and building of the body: The pulse is
in J L M / M S t .W 'l '
usually small and fast in children. smooth and slippery in

young people, taut and hard in od people. modera te and
powerful in men, soft and thin in women, slippery and
fast in gravida, sunken and thin or soft and thin in obese
people, floating and large in lean people, long in tall peo
ple and short in small people.
(2 )
Daily life and psychological fa c to rs : The pulse

appears slippery, fast and powerful after movement. eat-
-ir H i r : to is h - IS I f -M I
ing and drinking of wine, weak with hunger, taut in anger

and irregular in fright.
Seasonal. alte rn atio n o f day and night and geo-
jsj;
B t , 1$ nt
(3 )
< :$ .,
graphical fa c to rs : The pulse appears slightly taut in
@t :
spring, slightly full in summer. slightly floating in autumn
t J ( Wi)
m i
and slightly sunken in winter; slightly floating and power

ful in the daytime and slightly sunken, thin and slow in
g 0 m s /?m a h ,
night; sunken and energetic among the people in the north
YXIfrj m
m Mi
and soft among the people in the south.

Besides, the changes of the anatomic position of the
fP
-t P T v R L E t j i
radial artery may shit the pulse normally at the cunkou

regin to the dorsum of the hand from the chi regin,
known as oblique flying pulse. The pulse, shifted to the
back of the cunkou regin, is called ectopic radial pulse.
p w i r i 'i -
All the factors above mentioned may affect the condi

tions of the pulse. However, if the pulse still keeps gas-
W L B M L itin w k M ik i
trie qi. spirit and root, it is still the normal pulse.
H Pf t >
fi
S Ht)
1.4.1.3
Morbid pulse
(= ) m
The pulse in a morbid condition is called morbid

btilse, in which the manifestations of pulse conditions are
dlllter the changes of the position of the pulse, or the
rn m b
mum* b f
41,
MI lie rerice in rhythm, or varia tion in morphology, or

lli.inges in strength. Sometimes morbid pulse may show
I*]. M
# #, sJc H-
(lilference in various aspects, such as the position. rhythm

tul strength of the pulse. The following is a specific dis-
* ffl |5]N-
iRission;
1 .4 .1 .3 .1
Floating pulse
i-
Features: Sensible under light pressure. weak and

iislant beating under heavy pressure. Floating pulse is
m.irked by superficial beating.
Clinical
significance:
Floating pulse
Indicates
ternal syndrome. floating and powerful pulse signifying

(ternal sthenia syndrome while floating and weak pulse
f f [/i
it
lllinifesting external asthenia syndrome. Floating pulse

lili also be seen in internal asthenia syndrome due to conpimption of essence and blood in chronic disease and exrnal floating of asthenic yang.
1 .4 .1 .3 .2
Scattered pulse
2. m m
features: Rootless, arrhythmic and disappearing un

i d pressure.
m m m
u m jk % . m m ay % , m %
Clinical significance; Indicating depletion of primorHlftl (|t. visceral essence at the verge to exhaust and exterllMl floating of asthenic yang.
1 .4 .1 .3 .3
H o llo w pulse
Features: Floating. large and hollow like the leaf of

mtlllioii.
3. t lf t
B m m - . u '\ 'V 'H u
S i l .
t t B U B m f 'B M
k iiiW -
MW
Clinical significance: Indicating loss of blood and im

pairment of yin.
1 .4 .1 .3 .4
Sunken pulse
4.
Features: Sensible only under heavy pressure.
Bm m -. &
M iiE o S tw
Clinical significance: Indicating internal syndrome.

Sunken and powerful pulse signifies sthenia internal syn
drome, while sunken and weak pulse shows asthenic in
'HI
M
ternal syndrome.
1 .4 .1 .3 .5
5. ififlfc
Slow pulse
Fea tures: No more than 4 beats in a cycle of breath

(< 6 0 /m in ).
<i,f$
ffcMX-.
Clinical significance; Indicating coid syndrome. Slow

and powerful pulse signifies sthenia coid syndrome, while
T 5L E3 M ( < 60 ( X a
jSill
t 1} % % M M i t i i % tic
slow and weak pulse shows asthenic coid syndrome. Such

a pulse condition is also seen in internal sthenia heat syn
drome due to internal accumulation of pathogenic heat.
t % # l s
m jv.
Athletes with slow pulse are in a normal condition.

1 .4 .1 .3 .6
6.
Moderate pulse
mm
Features: The pulse is moderate and powerful, beat
ing 4 times in a cycle of breath; or moderate and sluggish,
J j.
beating 4 times in a cycle of breath (60 - 70/min).
S I N . .(6 0 - 7 0 f c / f r # ) .
Clinical significance: Indicating damp disease and

weakness of the stomach and spleen.
1 .4 .1 .3 .7
Fast pulse
Fea tures: The pulse beats over 5-6 times in a cycle

of breath (90 - liO/m in).
7.
im w m - .
and powerful pulse signifies sthenia heat syndrome, while
pulse condition is also seen in the syndrome due to exter

nal floating of asthenic yang.
. 1
B 3 l A M ( 9 0 110 I k / f t v M
Clinical significance: Indicating heat syndrome. Fast
fast and weak pulse shows asthenic heat syndrome. Such a
T-mm m s e .
1 .4 .1 .3 .8
Swift pulse
s. mi&
Features; The pulse beats over 7 times in a cycle of

liifuth (S? 140/min).
I,t s ( > 1 4 0 fc / ^ ) .
Clinical significance; Indicating loss of control of hyIpriictive yang. declina tion of kidney yin and near depleAlou of primordial qi.
1 .4 .1 .3 .9
9. JJ&
Weak pulse
Features; Weak pulse is marked by weak beating of

Hit' pulse at all the cun, guan and chi regions.
Bmm-.
j
%h
W jG3l
r t - A 'M im m m m 'H , .
Clinical significance; Indicating asthenia syndrome,
niiilly seen in asthenia of both qi and blood, especially in
flW ft,
M sthenia.
1 .4 .1 .3 .1 0
Powerful pulse
H ).
Features; Powerful pulse is marked by powerful sen-
mm m-.
iHlinn of pulse beating at cun, guan and chi regions under

|ll|N!rficial, moderate and heavy pressure.
lkf^ffi. M tJj
iJE
m m
iffcJiC: l-tEo
1.4.1.3.11
SIippery pulse
Features; The pulse is beating freely and smoothly
11. T i
M 3^. t flh : fte
lllir the movement of beads of an abacus.
M t J , 'V.
MBUB
/^znt
Clinical significance: Indicating retention of phlegm
tiltl fluid, dyspepsia and sthenia heat. Such a pulse condiIIiiii
is also seen among young and strong people and gravi
XtM.
to
1 .4 .1 .3 .1 2
Astringent pulse
Features: The pulse is beating in an inhibited way

llltr scraping a piece of bamboo.
12. M
B M W :
M m y JtW r
W ttm i/f: i)
Clinical significance: Astringent and powerful pulse

indicates qi stagnation and blood stasis; astringent and
weak pulse signifies lack of essence and insufficiency of
J.'!?.
blood.
1 .4 .1 .3 .1 3
13.
Full pulse
Features; Full pulse is marked by wide size and full

content, beating like roaring waves and sensibility under
light pressure and surges as well as sudden flowing and
t , 'M'MWb
l . f l .
WMVU-M
ebbing.
f* ,
Clinical significance: Indica ting exuberant internal
heat.
1 .4 .1 .3 .1 4
14. M
Thin pulse
Features: The pulse is as thin as a thread, weak and

quite sensible under pressure.
Clinical significance: Indica ting asthenia of both qi

and blood, various overstrain and diseases due to patho
genic dampness.
1 .4 .1 .3 .1 5
15. jf lf t
Soft pulse
Features; Soft pulse is superficial and thin as well as
rm m , i
sensible and weak under light pressure.
Clinical significance; Indicating insufficiency of qi

and blood, and dampness syndrome.
1 .4 .1 .3 .1 6
ffiilEo
16.
Feeble pulse
Features; Feeble pulse is deep and thin as well as

sensible and weak under heavy pressure.
wm m -.
n j a c w f i[ ii, a c & n
M
Clinical significance: Indicating declina tion of both qi

and blood.
1 .4 .1 .3 .1 7
Indistinct pulse
17. $
Features; Indistinct pulse is very thin and soft,

llimml insensible under pressure.
Clinical significance: Indicating extreme deficiency of

(|| mui bkxxl as well as declination of yangqi.
1 .4 .1 .3 .1 8
Taut pulse
18.
Features: Taut pulse appears straight, energetic and

til like
r a n s i* .
the feeling of pressing the string of a violin.
m m m - . a & .*
m vaT , in fie l .
& m it.
% & a i
si *
M .
Clinical significance; Indicating disorders of the liver
gallbladder, pain syndrome and retention of phlegm
iKflciKX:
itF.. fAtk
|fluid.
1.4 .1 .3 .1 9
Tense pulse
Features: Tense pulse appears like the pulling of a
19. m m
B m m - . i * * ,
JH' and flicks the finger when pressed.
t s m '}]'%%% t %
Clinical significance: Indicating coid syndrome, pain
virme and retention of food.
1 .4 .1 .3 .2 0
Rapid and intermittent pulse
20.
Features; Rapid and intermittent pulse beats fast

I ((ocasional and irregular intermittence.
Clinical significance:
u m m
Fast and powerful pulse
lli.li' ules hyperactivity of yang heat, qi stagnation, blood
rL ^
, in #5. ^
KmI and retention of phlegm and food; fast and weak

pllloo
Hignifies weakness of visceral qi and insufficiency of
1.4.1.3.21
Slow and intermittent pulse
Features: The pulse beats slow with occasional and
lM 'P
21. ]}*
E t t H :
irregular intermittence.
W 'ti h . j h s j i K . m m i m
Clinical significance; Slow, intermittent and power-
iKSflcj&X.:
ij'll
ful pulse indicates predominance of yin. qi stagnation, retention of phlegm and blood stasis; while slow, intermit
i^J L to
tent and weak pulse signifies declination of qi and blood.

1 .4 .1 .3 .2 2
Slow-intermittent-regular pulse
22.
Features: The pulse beats slowly with regular and
m m m -.
longer intermittence.
Clinical significance; Indica ting declination of visceral

qi and asthenia of primordial qi.
1 .4 .1 .3 .2 3
Long pulse
23. fcfl*
Features; The pulse surpasses the range of cun. guan

and chi regions.
Bm m -.
fffljg i 'i .
:M o
Clinical significance: Indica ting yang syndrome. heat

syndrome and sthenia syndrome.
1 .4 .1 .3 .2 4
3jE
24.
Short pulse
Features: The pulse appears shorter than the normal
BM -W at: E M . j & J f i
content of cun, guan and chi regions.
Clinical significance: Indica ting qi disorders. Short

and powerful pulse indicates qi stagnation; while short and
i r t
'x
m [fn x n m
weak pulse signifies qi asthenia.

The development of diseases is complicated and may
be caused by various pathogenic factors, leading to the
vnriations of the functions of yin and yang, qi and blood
and viscera as well as the states of the conflict between
, fPiE w
the healthy qi and pathogenic factors. Therefore, the

pulse conditions mentioned above do not exist m a single
form in the clinical practice. Usually two or more pulse
f l'T 'li/f'Yt: ii
HMHtions appear at the same time. Such a pulse condition

fllllnl comhined pulse. The conditions of pulse may appear
Hl! the* same time, unless they are contrary in nature, so
mB.
k) In comprehensively reflect the pathological changes in

Ix<Iy(ienerally speaking, the disease indicated by the
(ttinbined pulse is the synthesis of the diseases indicated
py Ihe pulse conditions appearing simultaneously in a
P:
B | , For example, floating pulse indicates external syndriiitif and fast pulse signifies heat syndrome, so floating
f|ll fiist pulse shows external heat syndrome; floating
|hilrM* indicates external syndrome and tense pulse signifies
IMilil syndrome, so floating and tense pulse manifests extpni.il coid syndrome; taut pulse indicates disorder of the
llvi'i lid gallbladder and fast pulse signifies heat synIhiiiit', so taut and fast pulse manifests liver depression
PNMWforming into fire or damp heat in the liver and galll||(|ili*i, etc.
| On Ihe whole, all related factors should be taken into
dHiltli lera Iion in differentiating pulse for making correct
lili' .ti diagnosis.
I I 2
P alpation
-Jf ffi $ i t ,
itMft%\\!hmmMWvE
f i#
l'nlpation means to use fingers or palms to feel or

pitti certain regions of the patients body to understand
HUMhci Ihe local regions are coid or warm, dry or moist
ll Mili 01 hard as well as whether there are tenderness,
lt|i ni (ilher abnormal changes. Palpation can not only
M|t iindci sland the location, nature and severity of disPW>, bul also help make manifestations of some diseases
Uve. lurther complementing the data obtained from
MA|m><lion, olfaction and listening and inquiry as well as
& N N B ftif..
providing necessary evidence for analyzing pathological

conditions and judging the nature of diseases.
1 .4 .2 .1
Methods for palpation
1 .4 .2 .1 .1
m t t m m .n m & m m m
(- )
Postures
1. m m m t
The postures for palpation is selected according

to the aim and regions for palpation. The usual pos
gM
M * PTin
o
ture used is sitting or supina tion.
* mM
- B & # m 4* t w
B K .
When the patient is seated, the doctor stands or sits
in front of the patient, holding the patient with the left
hand and palpating local regions of the patient with the
# JH
right hand. The usual techniques for palpation is to pal

pa te skin, hands and feet as well as acupoints. If the pa
tient is asked to lie in supination with the relaxation of the
whole body and natural stretching or bending the legs, the
doctor stands at the right side of the patient and palpates
the patient with the right hand or both hands. Such a way
of palpation is often used to press chest and abdomen.
1 .4 .2 .1 .2
Techniques for palpation
The usual techniques used are palpation, feeling,
2.
-HSirJMuBS,,JBE,pp
pressing and tapping, etc.

Palpation; To use fingers or palm to feel the fore-
M:
head, four limbs, chest and abdomen skin to understand

whether the local skin is cold or feverish and moist or dry.
Feeling: To use fingers or palm to feel the chest,
m-.
abdomen and four limbs of the patient to see if there are

superficial pain and lumps as well as the shape and size of
the lumps.
Slight pressure: To use hand slightly press the chest,
abdomen, four limbs and lumps to know the boundary,
texture and movement of the lumps as well as the degree
and nature of local swelling.
iw .
Heavy pressure; To press heavily the morbid regin
E: VAf-
to detect whether there is pain in the deep layer and

whether there is suppuration, etc.
Tapping: To use hand to tap certain regions of the
BP;
piilient to produce tapping sound and waving sensation or

Vibration to decide the nature and degree of pathological
J|
l'hanges. Tapping is either direct or indirect. Direct tap

ping means that the doctor uses his or her hand to directly
t i& u f e o
tltp the superficial regions of the patient; indirect tapping

ineans that the doctor puts his or her left palm over the
Kmlace of the patients body and uses his or her right fist
In tap the left hand dorsum. While tapping, the doctor
miks the patient about the sensation to decide the location
luid degree of disease.
va
m a
$ su & ft,
m&o
The methods mentioned above emphasize on different
rfis s . rm
Mpects in performing palpation. However, they are used

lll rombination. The usual order is palpating and feeling
Hrnt. then pressing and finally tapping, which are perliirined from light degree to the heavy. from the superfi-
5feisTit!!
m n*m .
l lu to the deep layer, from distal regin to the proximal

mid from the upper part to the lower.
1 .4 .2 .2
Pressing the chest and abdomen
1 .4 .2 .2 .1
Pressing the chest
IVessing the chest is helpful for detecting the
(Z ) & M
i.
c W W r w T iii^ iin
pKlhological changes of the heart, the lung and the

IffH'ordium.
Ikilgy chest with clear noise when tapped is seen in
fr BUs e . sp: & m ifi
jWlt'iiinatothorax. Pain of the chest under pressure and

tyllh dull noise when tapped is often seen in retention of
lliilil in the chest and diaphragm or accumulation of phleg(Unllc heat in the lung.
Irecordium, located between the fourth and fifth
J.f'l'.'/: f
/i ii/j
ribs.below the nipple and slightly medial to the nipple. is

the pulsation point of the apex of the heart where all the
vessels converge. Pressing the precordium is helpful for
rssfc
detecting whether the thoracic qi is strong or weak,
fifiB S D
ftJE f !
whether the disease is asthenic or sthenic and whether the

prognosis is favourable or unfavourable. The pressing of
is
precordium is especially useful when cunkou pulse is difficult to take in critical cases. Normally, the pulsation over
^ rfrTT'Ig,
ffii T & .1
* y i
L 'K lE i ti 7J\
i'r
the precordium is sensible and beating smoothly, moderately and rhythmically. indicating exuberance of heart qi.
accumulation of thoracic qi in the chest and no signs of
pathological changes. Weak and indistinct pulsation over
the precordium suggests asthenia of the thoracic qi. Pow
erful pulsation over the precordium vibrating the clothes is
hyperactivity of precordial beating. a sign of outburst of
the thoracic qi.
1 .4 .2 .2 .2
Pressing the hypochondrium
Pressing hypochondrium is helpful for detecting

diseases related to the liver and gallbladder.
2.
mm "i
va t
M tm
Distending pain of hypochondrium with sensible

lumps below the sternum and evident tenderness is usually
due to stagnation of liver qi and gallbladder qi or due to
damp heat in the liver and gallbladder. Hypochondriac
lumps with stabbing and unpalpable pain is often caused by
ffj tfF fc J H r F W fc M ,
depression of liver qi and blood stasis. Right hypochondri
ac lumps which is hard and uneven are due to accumulation

o mass resulting from prolonged stagnation of qi or blood
stasis, and cares should be taken to exelude liver cncer.
Repeated relapse of malaria with hard and palpable lumps
is called malaria with abdominal mass.

1 .4 .2 .2 .3
Pressing epigastrium and abdomen
3. m m m
Pressing epigastrium and abdomen is helpful for

detecting the disorders of the stomach, spleen, small
intestine, large intestine, bladder and uterus, etc.
w ^$ o
Generally speaking, cold sensation of the skin when

prrssed with preference for warmth is usually of cold syn
drome: feverish sensation of the skin when pressed with
preference for cold is of heat syndrome; epigastric and ab
dominal pain with preference for pressure is of asthenia
(yndrome; and epigastric and abdominal pain with averllon to pressure is of sthenia syndrome.
Epigastric fullness with soft sensation and no pain
When pressed is caused by weakness of the stomach; epiutric fullness with hard and painful sensation when
pressed usually results from accumulation of sthenic pathUK<nic factors in the epigastrium. Distending epigastric
|>Mii with hard sensation and gurgling noise when pressed
1*1due to retention of fluid in the stomach resulting from
HKhenia of the middle energizer qi and stagnation of qi.
Full sensation of the abdomen under pressure with
Mflderness is known as sthenic fullness due to qi stagna-
liou. blood stasis or retention of fluid; soft sensation of
, Je /Je tk
fi-j, %
lili' abdomen under pressure and without tenderness is

Mlown as asthenic fullness due to asthenia of yangqi or
^ s pn
H & s r u A S i & m m .
lilluie of transportation caused by qi asthenia.

Drum-like swelling of the abdomen with dull yellow-
, te fe s
Mli skin, visible veins over the abdominal wall and emaciallitll
of the four limbs is called tympanites. Tympanites
Wllli fluid sensation when pressed and dull sound when

ll|p|K'll is called hydraulic tympanites; while tympanites
Wllli empty sensation when tapped is known as pneumo-
%Wi.
tolllpanites.
Inimobile abdominal
lumps
with
ixed
pain
is
iiliniovable mass due to blood stasis; mobile abdominal

lilinps with migratory pain is known as movable mass due
Itl i|i slagnation.
Ilnpaipable pain in right lower abdomen, with mass
wImii
pressing. is often seen in the intestinal abscess and
if,
ifn lifc.f.i'i
'ifef'Vl T~, Vi'/ W, J
)Va #11 tyj
1 .4 .2 . 3
CE)
Palpation of the four lim bs
1 .4 .2 .3 .1
i.
Detection of coid and heat
; I i M. ^ M # ^
Feeling of coid and heat of the hands and feet is

helpful for judging the states of diseases. such as coid
w n a .t i
and heat, asthenia and sthenia, internal and external
i i w
aspeets as well as favourable and unfavourable prognosis.
mm.
^ $
f n mmm #I
s
i ,
ni
Generally speaking, coid sensatin of hands and feet

rnm * & . m m
is usually of coid syndrome due to asthenia of yang and ex

uberance of coid; feverish sensatin of hands and feet is
often of heat syndrome due to predomination of yang and
liEo
exuberance of heat. However, sometimes pathogenic heat

deepens into the body and prevents yang from moving out
ward. leading to internal heat syndrome known as deep
heat and deep syncope' . a critical sign of disease.
If the palms and soles are more feverish than the
dorsa of hands and feet, it suggests fever due to internal
impairment. If the forehead is more feverish than the
palms, it is superficial fever. If the palms are more fever
ish than the forehead, it suggests internal heat.
1 .4 .2 .3 .2
2.
Palpating the skin from inner side of
the elbow to the transverse lines on the wrist

It is helpful for judging the nature of disease according to its conditions of being tense or loose, slippery or
astringent and coid or feverish.
If the skin is very feverish and the pulse is full, slip
pery, fast and powerful, it usually suggests fever in exogenous febrile disease; if the skin is coid and the pulse is
thin and small, it indicates diarrhea and insufficiency of qi
g. M 5$ f i & W tik n
due to asthenia of yangqi and predomination of internal

coid; if the skin is lubricant, it shows sufficiency of qi and
blood; if the skin is as rough as scales of dry fish. it
% w 't i
HUKWsIs insufficiency of essence and blood or phlegm and

(luid disorder due to failure of the spleen to transform flu
id
resulting from decline of splenic yang.

1 .4 .2 .3 .3
Palpation of swelling and distensin
3. m m
Heavy pressure on swollen and distending skin

BVllli hands is helpful for differentiating edema and
(lutulcnce. If the fingers sink into the skin when the
M i e s f , 3 ^ * 1 6 Hpew,
M i l i is pressed and the depression on the skin fails to
bound when the fingers are lifted, it is edema; if

lili' depression on the skin produced by pressure relinds when the fingers are lifted, it is flatulence.
1 .4 . 2 .4
Palpation of acupoints
(0 ) S ft
Acupoints. the places where meridian cji converges

Hln! transmits, are the points that reflect visceral disor ri on the surface of the lx>dy.
Pressing certain
f-
ftfclpoints. according to the changes and reaction of these
be ^
/V L , fll $ >t
Kl$ i t
Ufloints, is helpful for diagnosing the disorders of cerhtln viscera.
îiHo
i In pressing acupoints. cares should be taken to see if
ni) / t
HHre are tenderness, nodules and sensitive response. For

Hiliple, nodules over Feishu (BL 13) and tenderness o-
Im? M y t f
m .m t 'V A R t
S f it . i :
>( Zhongfu (LU 1) usually indcate lung disease; tendernwover Ganshu (BL 18) and QimenCLR 14) shows liver
yx s
n /X r n
^ ^ if-
fhkc; tenderness over Weishu (BL 21) and Zusanli (ST

I ) miggests stomach disease; tenderness over Shangjuxu
(II M7) is usually a sign of intestinal abscess.
S ^ ; E / C ^ il
i .
2 Differentiation of
syndrome
Differentiation of syndrome means to analyzing and
judging the data obtained from the four diagnostic methods
so as to differentiate the nature of the disease and make
clear the naming of the syndrome.
There are various methods for differentiating syn
drome. This chapter mainly introduces syndrome differ
entiation with eight principies, syndrome differentiation
of qi, blood and body fluid, syndrome differentiation of
g + .A M E
viscera and syndrome differentiation of six meridians as

well as syndrome differentiation of wei, qi, ying and
e,
blood, among which the syndrome differentiation with

eight principies is the leading one. Syndrome differentia
tfiurniK
tion of qi, blood and body fluid as well as syndrome differ
8HE.
entiation of viscera are mainly used to differentiate syn-
& ^ |0]
dromes in miscellaneous diseases due to internal impair

ment, while syndrome differentiation of six meridians and
syndrome differentiation of wei, qi, ying and blood are
mainly used to differentiate syndromes in exogenous dis
eases. These methods for differentiating syndromes,
though different characteristics and application. are interrelated and should be used syntheticallv in clinical practice.
2.1
Syndrome differentiation
with eight principies
Syndrome differentiation with eight principies means
s ffl,
differentiating syndromes according to the principies of

yin and yang, internal and external aspects, cold and heat
u>| well as asthenia and sthenia.
The clinical manifestations of diseases, though com
pilen tcd. can be analyzed with the eight principies accordlliH lo the category, location and nature of disease as well
M hK
# W 3*J fn t , M
N the conflict between the healthy qi and pathogenic fc

il ii h. For this reason, the eight principies are the most
I4*ic ones to differentiate syndromes. Syndrome difieren-
i m f r m w m m , A m m jhm
n il n with eight principies is a method used to differenti-
w m m -m .w
He the common factors of diseases and is the leading one
e m m
Mfiong all the methods for differentiating syndromes. It is

therefore the essential one for differentiating syndromes
Itld applicable for all clinical specialties for differentiating
DfiEo
fcfiidromes.
The eight principies concntrate on specific syntulties respectively. However, they are inseparable and
A m frt
fi't: ff i m * l ) J
t itatic. Among the eight principies, yin and yang are

general principies which can be used to generalize the
Hllin six principies, i. e. external, heat and sthenia are of
while internal, cold and asthenia are of yin. The
o t
/l
WJIidiornes of the eight principies are often complicated,

|tilHfonnable and intermingled.
Sometimes there are
Hftr manifestations. Therefore, clinical differentiation of

Mflidi ornes should concntrate both on the difference of
Kxtornal and internal are two principies used to difHpliliJite the location of diseases and the tendency of
llloloîcal changes.
t i i ; / Vffl # ffi g W
mm*
. t m lEfeM ^ m & ik
iPM m *
External and internal differentiation of

syndromes
a itt,
e i,x s & m fn
ItVi1cognition of the disease.
I I, I
t .
ni
M f NVIIIIromes related to the eight principies respectively

(lid ol their cise relationship so as to have a comprehen-
- s
External and internal are two relative concepts. On

tm i
the human body, the skin, hair, muscular interstices and

shallow meridians and collaterals are external;
while
viscera, qi, blood and bone marrow are internal.

External and internal differentiation of syndromes is
important to syndrome differentiation in exogenous disea-
r i M x .
a lia r a
ses. This is because the disorder due to internal impairment starts from the interior and does not show the course
A MM
of developing from the external to the internal. In this
JS f1h 53 m?S?$!
'h Si
P i' ^ A
case there is no need to differentiate the external and in

ternal. In exogenous disease, when the pathogenic factors
j , JB tc U ffi o Bfi M
t#r
often invade the human body, they first attack the super
ficies. In this case, the healthy qi fights against the patho
genic factors, giving rise to the formation of external syn
drome. With the development of the pathological condi
iW4
^ M iA iAO i l 3
iiW
S I K i'S
tions, pathogenic factors transmit from the exterior into

the interior and from the shallow layer into the deep layer
to form internal syndrome. Therefore, external and in
ternal syndrome differentiation is the most basic cognition
of the developing stages of exogenous diseases. The ex
ternal and internal syndrome differentiation enables doc
tors to understand conditions of pathogenic factors and the
states and development of pathological changes so as to
take proper and timely treatment.
2.1.1.1
( - ) mu e
E xtern al syndrom e
IE J b 7nl- l
External syndrome refers to the symptoms appearing

at the primary stage of exogenous diseases caused by inva
= 6 , 0 # # A ^ .
sin of six pathogenic factors into the body through skin,

mouth and nose. marked by sudden onset, short duration
M ffl 9 1 Pif S
@t
S o ^ jE M: t i M & i
and shallow location.

ln
Clinical manifestations: The clinical manifestations
li M :
/?.!
are fever, aversin to coid (or aversin to wind), thin

and white fur and floating pulse, accompanied by stuffy
and running nose, sore-throat and cough.
n "fe..
,# S
t-"W
Analysis of the symptoms Attack of pathogenic fac-
41' W $ h . W
Ihii agamst the superficies and confliction between health-iE ttl ^ , bk

b i|l and pathogenic factors lead to fever and aversin to
I Wlml and coid; stagnation of pathogenic factors in meridi-
, * jxt Xk .
fu;
i ik
I$ j ; , # % M ^ , H[Ajtlf '}]
Mlln prevens meridian qi from free flowing and resulls in

|*liii Ihe lung governs skin and hair, the nose opens into
# M M B , nft Hit\.
Uh' lung and the throat is Ihe door of he lung, so altack of
f r a , -
l'flhogcnic laclors against the surface of ihe body leads lo

)ftunclion of Ihe lung and causes stuffy and running
. sore-throat and cough; the pathogenic factors retain
ti' superficies and have not damaged the interior, so
lile
tongue ur is still thin and white without change;
btdiiiK pulse is the sign of external confliction between

^ W lra lth y qi and pathogenic factors.
fei 2 . 1
1.2
Interna! syndrom e
( Z ) M E
Internal syndrome refers to the symptoms in disorB>l" w'*h deep location (such as disorders of viscera, qi
mui bl(K)d and bone marrow), usually seen at the middle
lu
ndvanced stages of exogenous disease and the whole
y * 11*"'
diseases due to internal impairment. Three con-
H jE M o SI F n - M M
Is M fu \H ' h
iTj i a g ,
,
M
iiEKiM$ . i l W H # ' | f
jll'His liave contributed to the formation of internal syn|uiiir: further development of exogenous disease due to
^ÎIk ii transmission of pathogenic factors from the exte-
S ;
'. al- ,
Jfl5M &{!ffiK ifrf
I p i lind invasin of the viscera by the pathogenic factors;

hi!t attack of the viscera by pathogenic factors; dyshlHi til I M S of the viscera and the imbalance between qi and
1PhI due to impairment of the viscera caused by emotionH
III'ncIs.
i
f ffitSf Vi fg ijj, % i(a ^ Tpnifij
'fc'Ro
improper diet and improper daily lite.
l Imical manifestations; The clinical manifestations

W ItiliTiial syndrome are different due to different causes
M
loi 11in. Since syndrome is either coid or heat and as-
11"
s,lienia and since disease is due to the disorders
n w iis *
mm ; x
i
s ffi
t n
! g Z h f M 'i lili, i |f /A Z
I f l l l i r i qi or blood or body fluid, clinical manifestations

Mi
llllcmal syndrome are various. However, the basic
# ^
i ia fui; i f jJj ff'k mi
clinical manifestation is dysfunction of the viscera which

will be discussed in the following sections. Here sthenic
internal heat syndrome in exogenous disease is taken as an
example to Ilstrate the clinical manifestations of internal
syndrome. The basic manifestations are high fever. aver
sin to heat, restlessness, even coma with delirium,
thirst with profuse drinking of water, scanty and brownish
urie, retention of feces, reddish tongue with yellowish
fur and fast and powerful pulse.
iff;
Analysis of symptoms: Exuberance of internal heat

leads to high fever and aversin to heat; heat disturbing
the heart spirit causes restlessness or even coma with deliri
um; consumption of Ixxly fluid by exuberant heat leads to
M P 'i rj I tfc |
S-r.|
thirst with profuse drinking of water, scanty brownish urie

and retention of feces; reddish tongue with yellow fur and
fast powerful pulse is the sign of exuberance of intemal heat
and confliction between healthy qi and pathogenic factors.
A ppendix:
H alf e x te rn a l and half internal
Pf:
ME
syndrom e
Half external and half internal syndrome refers to
the symptoms appearing in exogenous disease at the stage
I', ffp JE ffi # ;T m S. Z l's] 4 l
marked by confliction of healthy qi and pathogenic factors
M W ffiB o
between the exterior and interior phases, and is usually

caused by transmission of pathogenic factors from the ex
m m a.
terior to the interior but still lingering between the exteri

or and interior phases. The manifestations are alternation
P -I?- BS f - i * |i
of coid and fever, oppression and distress over the chest

and hypochondrium. dysphoria. susceptibility to belching,
lsiiE) o
silence, anorexia, bitter taste in the mouth. dry throat,

dizziness and taut pulse, etc. (see shaoyang syndrome in
syndrome differentiation of six meridians).
2.1. 2
Syndrome differentiation of eold and heat
Coid and heat are two principies used to differentiate
m m m ie
Mi
lili' nature of diseases.
|M)
Coid and heat nature of diseases are the reflection of

llie conditions of yin and yang in the body. Yin predominalon or yang asthenia leads to coid syndrome; while yang
|)Kdomination or yin asthenia leads to heat syndrome.
Syndrome differentiation of coid and heat is helpful for untlcrstanding the nature of disease and providing evidence
[or selecting warming therapy or clearing therapy.
2.1.2.1
t f M f l Mi m * it* ),t
mi
if
i;in:iiM vi ii i m wi, iwm Hi/ iin

/tM, a fe, h h m i l nini
-i - a
.li. i n
filil:, ni il i
,i,ii
Wi l i itifr i iiiii .f 11r t i ni
Vii.j,];Udw.
Coid syndrom e
( - ) SE
Coid syndrome refers to symptoms caused by yang
11# 4
sthenia or yin predomination due to invasin of coid pathIgenic factors or various other factors. This syndrome is
|Usua11y caused by internal exuberance of coid due to inva|on of coid pathogenic factors or excessive intake of coid
4' '/"v M fe C K ^
4 At i
(d i rit
xl. or by consumption of yangqi dufc to internal impairnt and chronic disease. Coid syndrome may be further
Ivided into external coid syndrome. internal coid synfome asthenic coid syndrome and sthenic coid syndrome
Ccording to the causes and location of pathological changes.
Clinical manifestations; The clinical manifestations
Hnry with different types of coid syndromes. The usual
lies are aversin to coid or aversin to coid with prefer
ti-.
a1for warmth, coid limbs and huddling up in sleeping.

lio or light colored complexin, moist mouth without
liist. thin sputuin, saliva and snivel. clear and profuse
ine, loose stool. light colored tongue with whitish moist
lid slippery fur, slow or tense pulse.
Analysis of symptoms: Attack by pathogenic coid and
i m m f:
liiîiation of yangqi or insufficiency of yangqi to warm the

mly lead to aversin to coid or aversin to coid with pref
inir for warmth. coid limbs. huddling up in sleeping,
colored or pal complexin; exuberant internal coid
lu non-consumption of body fluid account for moist
iiulli without thirst; failure of asthenic yang to warm and
M M i* i
;m
W-i
I S . wy n
i'ej
m u it * . i'x
1W J Vf iif
m
transform fluid leads to clear sputum, snivel, saliva and
urie; encumbrance of the spleen by pathogenic coid or
asthenia of splenic yang causes loose stool. Light colored
tongue with whitish slippery and moist fur and slow or
tense pulse are the signs of yang asthenia and internal prcdominance of yin coid.
2.1.2.2
( Z ) &tvE
Heat syndrom e
fe ffi, f J g P B fe l((
Heat syndrome refers to symptoms due to attack by

yang heat or various other factors or yin asthenia. This
syndrome is usually caused by invasin of exogenous yang
i M fe w & * A )
heat, or by interior transmission of heat transforming
ffi H
from pathogenic coid. or by transformation of fire from e-
t fe A f i -t 'i# a
motional upsets, or by transformation of heat from m-
it
k
proper diet. or by internal genera tion of asthenic fire re
a k fijV A l 5? ' rt f
; a S c t
.e i"
sulting from excessive coitus, internal impairment due to

overstrain. exhaustion of yin essence as well as yin asthe
ge.
nia and yang sthenia. Heat syndrome may be further di-
S |] , fe
vided into external heat syndrome. internal heat syn
fe , ? fe ^ fe ^ f
til-. X " i
f'i *
drome . asthenic heat syndrome and sthenic heat syndrome

according to the cause and location of diseases.
l|(il
Clinical manifestations: The manifestations vary with
jfe fftl:
different types of syndromes. The usual symptoms are fe

ver, aversin to heat with preference for coid, flushed
complexin or flushed cheeks, thirst with preference for
f e
' t i i ^
coid drinks, restlessness and insomnia. yellowish and
n p , B jfiL jfffl. If il, ' \ ' f l i
P4 fi & tfc M S
'k K
MM |
sticky sputum and snivel. vomiting blood and epistaxis,

scanty brownish urie, dry feces, reddish tongue with
scanty moist and fast pulse, etc.
. .
Analysis f symptoms: Predomina tion of yang heat
l!0 fe ISi &*l
or yin asthenia and yang sthenia leads to internal exuberance of asthenic heat and causes fever and aversin to heat
with preference for coid; fire tends to fame up drives qi
H PPJ 5 L i & WL M i I
and blood to flow upwards, leading to flushed complexin

or flushed cheeks; consumption of body fluid by exuberant
te M fe t t
liciil or deliciency of yin fluid gives rise to thirst with

luflcicnce for coid drinks and scanty and brownish urie;
hrnl disturbing the heart spirit results in restlessness and
BflNoninia; body fluid scorched by heat causes yellowish
S i ^
B K ; W- M
JUi l f i ;
J )(
lili % . al! lili
t f fllj BIIIffl ltl; #1 jjj f |t,
M M fi-J,
W1
Nlld llnck sputum and snivel; heat impairing blood vessels
i IHil driving blood to extravasate brings about hematemesis

Nlld epistaxis; consumption of body fluid by exuberant heat
I in (k'liciency of yin fluid deprives the intestines of lubricaHoii and proper transmission and leads to dry feces; red
im tongue with scanty fluid and fast pulse are signs of

Ûljerant heat impairing body fluid.
1 I. 3
Syndrome differentiation of asthenia

and sthenia
Asthenia and sthenia are two principies to differentiI" ^lc> conditions ot healthy qi and pathogenic factors.
Asthenia refers to insufficiency of healthy qi, while
I tirina refers to exuberance of pathogenic factors. Synroiiic differentiation of asthenia and sthenia is helpful for
IMHcistanding whether pathogenic factors are in predomi-
js * . ia ja ^ j iiE , r iu T
w * m$ * ,
s *
ffl h i i t t IF. rn P fe
ffl M ffi
P * 1111' ()l decline so as to decide to select therapy for comidriiiciiting asthenia and strengthening healthy qi or therajW lu purging sthenia and eliminating pathogenic factors.
2.1.3.1
Asthenia syndrome
Asthenia syndrome refers to symptoms marked by

mihniia of healthy qi and non-predomina tion of pathogenic
l^ liii s. I he cause of asthenia syndrome is either congeni
( - ) iiE
t E
jjsj
ift 8?%f ^ is pjf m m m ffi m
l&iEfiM
al ni postnatal, especially the postnatal one. The postna-
l'Ali k
ffcl muse includes insufficiency of qi and blood production

din lo improper diet, impairment of visceral qi and blood
din t<>emotional factors and overstrain, exhaustion of reIWl essence due to excessive coitus, or impairment of
fclMillliv <|i due to chronic disease, etc.
Clinical manifestations: Healthy qi in the human
; bJc X
4' jgr. Hl {li
TF.^Cîjiif
llfiil/f; A; J:!t: |l| I
,
|| '
uE
body mainly includes yangqi, yin fluid, essence, blood and
body fluid, all of which are closely related to the viscera.
m m -
Therefore, asthenia syndrome is mainly marked by insuf

ficiency of yangqi, yin fluid, essence, blood and body fluid
as well as the decline of visceral functions. The clinical
manifestations of asthenia syndrome vary with different
# ) iiEM i| 1* ^ M S S <
types which will be explained in the following parts. Here

the common symptoms are taken as example to analyze
the clinical manifestations of asthenia syndrome. The
tfi f I t l i >'n, M ftfcW i H i
common symptoms include fatigue, shortness of breath.

no desire to speak, aversin to coid and coid limbs, spon
f f i ; Jf
f - 31 L- M
taneous sweating, clear and profuse urie, loose stool, emaciation.
feverish sensation over the five centers
(palms, soles and chest). tidal fever, flushed cheeks,

night sweating, pal or sallow complexin, dizziness, pal
pitation and insomnia, dry mouth and throat, thirst with
t t M , /J' f f ki 'P . A %:
im
m &
desire to drink, dry skin. scanty urie and dry feces, ten
der tongue with thin fur or little fur and weak pulse, etc.
Analysis of symptoms: Fatigue, shortness of breath
i'CvJi.*
and no desire to speak are due to failure of asthenic yangqi
w m m zxM
to propel and nourish the body, leading to hypofunction of

viscera and tissues; spontaneous sweating is caused by
failure of deficiency of yangqi and failure of defensive qi to
guard the superficies; clear and profuse urie and loose
stool are due to failure of deficient yang to astringe, warm
and transport; emaciation is due to failure of deficient yin
mm.
to nourish the body; feverish sensation over the five cen

ters, tidal fever-and flushed cheeks are due to predominance of yang heat. internal genera tion of asthenic heat
r ;j & B
and yin asthenia failing to control yang; night sweating is

due to asthenic heat driving body fluid to be excreted;
F ffi, PJ ffi fe ffi % ^ m
pal or sallow complexin is due to blood asthenia failing

to nourish the face; dizziness is due to blood asthenia fail
ing to nourish the head and eyes; palpitation is due to
il
ii t: r .
Rwrinulrition of the heart; nsomnia is due to blood asthe-
HK. w m
tim lailing to nourish heart spirit; dry mouth, desire to
i-iWAK. M
di'nk and dry skin are due to failure of deficient fluid to
/ K - i S t e f i-i M
HOiirish and moisten the tissues and organs; scanty urie
^ 'P, itM ^ i, Pl'J']' f
I*
di ic lo deficiency of body fluid and insufficiency of body
. fft
p ; x m ik p m < m k ' t i \
fluid production; dry feces is due to loss of lubrica tion in

Hit large intestine; tender tongue, thin fur or little fur
miri weak pulse are signs of deficiency of healthy qi.
2 .1 .3 .2
( Z ) IEE
Sth en ia syndrom e
Sthenia syndrome refers to symptoms of predomi
f f i M U B (iiiE
nan! pathogenic factors and non-asthenic healthy qi. The

Muse of sthenia syndrome includes two factors: one is in-
ffi (HjjcH si VAffi fS M4" }j
MNon of exogenous pathogenic factors into the body; the
ffi: - m f A A f t ; - *
nllii-r is dysfunction of the viscera, leading to the accumu-
v m m k ,* .
InIiuii of phlegm, fluid, dampness and blood stasis in the
m.
r t*
|ly.
Clinical manifestations: The clinical manifestations
l'V with different types of sthenia syndrome due to the
(lillei' nce of pathogenic factors and the invading and accu-
1v. Hj 4' |]. # # t- ffi W Idi
UtUliding regions. For example, internal predominance of
J lf F
thogenic coid manifests coid syndrome, while exuberllti c <>l pathogenic heat manifests sthenic heat syndrome.
-(.
E m an m % m % %
* ffi; i t t!i ll
K, ?KS , ti*
lile mi ernal sthenic syndromes due to internal exuberance

n |ll11<gm, fluid, dampness. blood stasis and retention of
f f i, K iis * ^ a itii# w w
mil also vary in clinical manifestations which will be disMmu'd in the following sections. Here the common symp M iin
are taken as examples to show the characteristics of
lllieiu.i syndrome. The common symptoms include fever,

nllrssness, even coma with delirium, chest oppression,
KfS E & A f M
WU mc breath, exuberance of phlegm and drool. unpalpallli p.iin of abdomen, retention of dry feces, or dysentery
fllh hlood and pus, tenesmus, inhibited urination, or
(Mlliliil stringuria. tough tongue, thick or greasy fur and
I I I ii 'Ii k
pulse, etc.
m m m m .
; 2% h #'J
Analysis of symptoms: Fever is due to exuberant
jHg^>#f:
ifil
pathogenic factors, confliction between healthy qi and

pathogenic factors and predomination of yang heat; rest
lessness is due to pathogenic heat disturbing the heart;
!?$('[> t PJ f f
coma with delirium is due to exuberant heat disturbing

heart spirit or sthenic pathogenic factors confusing heart
spirit; chest oppression, hoarse breath and profuse spu
R T fu & .ii
tum with rale are due to retention of pathogenic factors in

the lung which prevents the lung from dispersing and descending; retention of feces and unpalpable abdominal pain
T ET fJJK J L,'
are due to accumulation of sthenic pathogenic factors in

the stomach and intestines which prevents free flow of in
testinal qi; dysentery with blood and pus and tenesmus are
due to accumulation of damp heat in the large intestine
l'fi t , frJ/ sK W. J
which hinders the transportation of the large intestine; in

hibited urination is due to retention of fluid and dampness
and inhibited transformation of qi; painful stranguria is
due to accumulation of damp heat in the bladder and inhib
ited transforma tion of qi in the bladder; tough tongue with
thick or greasy fur and sthenic pulse are the signs of inter
nal retention of pathogenic factors and confliction between
healthy qi and pathogenic factors.
2. I. 4
Syndrome differentiation of yin and
IEPBDE
yann
Yin and yang are the principies for categorizing dis
AHflKl
eases and also the leading ones in the eight principies.

Syndrome differentiation of yin and yang are used in two
aspects: differentiating yin syndrome and yang syndrome;
differentiating yin asthenia and yang asthenia as well as
yin depletion and yang depletion.
2 .1 .4 .1
Yin syndrome and yang syndrome
Syndrome differentiation of yin and yang, based on

the application of the conception that all things can be
KtitrPHo
( - ) R9EWBBE
(llvided into lwo aspects known as yin and yang, genera li-
f e t i l i M M M *j|SJ|il w m iii
|t'N diseases into two categories, i. e. yin syndrome and
* ^ - , i|j
ii:isii.
yung syndrome. External, heat and sthenia syndromes are
JWW.RI1NI
of yang category; while internal, cold and asthenia syn-
\. "I W
dlPomes are of yin category. Therefore. yin and yang are
^ctSM
lile leading ones in the eight principies and include the

lili irr six ones.
2 .1 .4 .1 .1
Yin syndrome
1. RîiE
Syndromes that correspond to the nature of yin are

riillcd yin syndromes. Internal syndrome, cold syndrome
Hinl asthenia syndrome are of yin category. However, yin
Hyiidrome usually refers to asthenia cold syndrome.
Clinical manifestations; Yin syndrome varies with
filil i' nt diseases. The usual symptoms are dull complex-
MMWlWl E
-m
lnii, dispiritedness, fatigue, cold limbs, low voice. shortii>hn of
breath, bland taste in the mouth without thirst,
m .
z t i , m b .n , a p
l'li'in and profuse urie, loose stool, pal and tender

IiHikiic. sunken and thin pulse, or sunken, slow and weak
ptllik'. etc.
Analysis of symptoms: Yin signifies quietness and
M il
\ m m f: m # , 3 * .
Dispiritedness, fatigue, low voice and shortness of
IfPlilh are signs of hypofunction of viscera; dull complex
f , % m , m % m m mf m m tu
in i cold limbs. bland taste in the mouth without thirst.

rkiii and profuse urie and loose stool are signs of insuffi-
& , f ^ M , ' ! ?# -feX fi
llriicy of yangqi and internal exuberance of yin cold; pal

Midi tender tongue. sunken and thin pulse or sunken, slow
n.
Mltil weak pulse are signs of asthenic cold syndrome.
t ,
% mmui-wi
fiEfc.
2 .1 .4 .1 .2
Yang syndrome
2. P0E
I he syndromes that correspond to the nature of

"V
iiiik
are of yang category. External syndrome, heat
i iil . W
Midime and sthenia syndrome are of yang category.

MhWcver, usually yang syndrome refers to sthenic heat
Mullme.
< a ^ is P 0 iH # g ^ a ftii
Clinical manifestations: Yang syndromes in diseases

vary in manifestations. The usual symptoms are flushed
complexin, fever with preference for coid, restlessness,
high voice, hoarse breath, dyspnea with sputum rale, dry
mouth with thirst and desire to drink, scanty brownish urine, retention of dry feces, deep reddish tongue with
yellow and dry fur. powerful or full 01 slippery pulse,
etc.
Anal ysis of symptoms: Yang governs movement and
heat. Flushed complexin, fever with preference for coid,
\{&/7Wx:
L I/fc, # f e l M II1
restlessness and high voice are signs of hypeifunction of

the viscera; hoarse breath, dyspnea with sputum rale are
;n k f i .
the signs of retention of phlegm in the lung and failure of

the lung to disperse and descend; dry mouth with thirst
M ;p A
A'
te # X
and desire to drink, scanty and brownish urie and reten

tion of dry feces are signs of exuberant heat impairing
body fluid; deep reddish tongue with yellow and dry fur
f . s i X
i t ' & %% fe ni
and powerful or full or slippery pulse are signs of sthenic

heat syndrome.
2.1.
4. 2
Yin asthenia syndrome and yang
( Z ) REjgEW M E
asthenia syndrome
2 .1. 4.2. 1
Yin asthenia syndrome
Yin asthenia syndrome refers to asthenic heat symptoms due to failure of yin to control yang resulting from
deficiency of yin fluid.
Clinical manifestations; Emaciation. dry mouth and
throat, dizziness, palpitation, insomnia, scanty tongue
fur, thin pulse, or even feverish sensation over the five
centers ( palms, soles and chest), tidal fever, flushed
cheeks, night sweating, deep reddish tongue with scanty
fur and thin and fast pulse.
Analysis of symptoms: Emaciation, dry mouth and
throat, dizziness, palpitation. insomnia, scanty tongue
fur and thin pulse are due to malnutrition of the body,
1. M
il
I Viscera and tissues; feverish sensatin over the five cen-
$ 'p , M *|ij, |JJ iM 1,

Ibffl m , J.M$ |Aj >\L, ijjij ;|| jin
,^ lK ,
L ln s , tidal tever. flushed cheeks, night sweating, reddish

I tongue with scanty fur as well as thin and fast pulse are
, iS
, ii ki:. & /!.
i (lile lo interior generation of asthenic heat resulting from

I
(h Iu iv
of asthenic yin to control yang.
2 .1 .4 . 2.2
Yang asthenia syndrome
2. PBjE
Yang asthenia syndrome refers to asthenic coid sympImns due to failure of insufficient yangqi to control yin.
[ti
m m wa m * m mm m m m
Clinical manifestations: Pal complexin, dispiritedlim . fatigue, shortness of breath. no desire to speak. aV p i s i o h to coid with coid limbs. spontaneous sweating.
mouth without thirst, or thirst with preference for
, g fF . p
, K
MM- t i . 4' f r f j x , Je M #
L||iit drinks, clear and profuse urie, loose stool, or scanty

pllir with edema, pal, bulgy and tender tongue, whitish
fit.lc f E ig ^ c * .
BUl'lx i y fur as well as slow, sunken and weak pulse, etc.

Analysis of symptoms: Failure of insufficiency of
m m v f: p b ^ j ,#
to propeI and nourish leads to hypofunction of vistVin and tissues, giving rise to such symptoms like pal
. W ifif fe t\jt , $j
IMhplexion, dispiritedness, fatigue, shortness of breath

li<| lio desire to speak: deficiency of yangqi weakens the
tfrusive qi. Ieading to spontaneous sweating; failure of
Uvlli iciil yangqi to control yin results in internal exuberHIM' ol yin coid, bringing about aversin to coid, coid
llinlm, hland taste in the mouth without thirst or thirst
m5 , PHI >\'fg '/h X ' X W @;
B|Mi P'clerence for hot drinks; failure of asthenic yang to

l| t l i i i i V . c
'if ph , an % fx, 7k
and warm causes clear profuse urie and loose
# . g &mi j& , qi m df w ate,
I M i scanty urie, swelling and distensin are usually

Htiird liy failure of asthenic spleen and kidney yang to
tMiin and transport which leads to internal retention of
P l'l Ml|d edema; pal, bulgy and tender tongue with whitili lid slippery fur as well as sunken, slow and weak
fUlw iic signs of internal exuberance of yin coid due to
IfNIlK iiNlhenia.
m,
ti
S fff, B 1 K E ) l
2 .1 .4 .3
Yin depletion syndrome and yang
(= ) t l tin tB f iE
depletion syndrome
2. 1. 4. 3. 1
Yin depletion syndrome
Yin depletion syndrome refers to the critical condi
i.
rrR E E
t [55ilE
Fh ^
tions of severe exhaustion of yin Huid. This syndrome is
S *7tw ffr 8JCi f fiff 31 fll M
M1
usually caused by continuous high fever. profuse sweating
iiF.Mo ^ 0 ^ l l l f e ^ t t f e
and excessive vomiting and diarrhea in exogenous febrile
i l . A ' f , J i?! nt
; bX j
diseases. or by massive bleeding, or by chronic disease in

which profuse yin fluid is lost due to gradual consumption.
Tt .$!>)$
m i^ m ii
Clinical manifestations: Apart from the serious

symptoms seen in the primary disease. there appear some
S J t t lU 'h $ I RLFFfefcrt
un
other symptoms, including pyretic. salty and sticky swea

ting. fever over the body, warm limbs with aversin to
'ic K - SM ft .'M
heat, dry skin. flushed complexin, thirst with prefer

ence for coid drinks, restlessness, or even coma, scanty
'p . f f i n fi
urie, reddish and dry tongue as well as thin. fast. swift

and weak pulse, etc.
Analysis of the symptoms: Failure of exhausting yin
fluid to control yang gives rise to internal exuberance of
ilF.flx'/H/ : l!il M
j 4' libfi'l l>lI Jfe iMK. i&1
asthenic heat and drives fluid to be excreted, leading to

feverish. salty and sticky sweating. feverish body and
warm limbs with aversin to heat as well as flushed com
,:j )S A -J1f
MIIJ LK T j
plexin: deficiency of yin fluid and loss ol moisture lead to

dry skin.
thirst. preference for coid drinks and dry

M; M &
tongue; exhaustion of fluid causes scanty urie; heat dis-
S A
turbing heart spirit results in restlessness or even coma:

reddish dry tongue as well as fast, swift and weak pulse
are the signs of internal heat due to yin asthenia.

2.1.4.3.2
Yang depletion syndrome
2.
Yang depletion syndrome refers to critical symptoms

due to declina tion of yangqi. This syndrome is usually
caused by massive bleeding. profuse sweating. violent
vomiting and diarrhea which lead to exhaustion of blood
and loss of yang together with yin. or by sudden loss of
rrP B iiE
P B iE f lH i
t ffi
@fUSI M MiiH
u A T ii J
ri.ScWjfii'ffit.WKlPiDIfti
j!HllK<|i <lue lo extreme exuberanl coid attacking the body,
R ti flt i. l r c r t t
Ul ly clironic disease which gradually exhausts yangqi. or

!(V retention of phlegm that obstruets the heart vessels,
;m
m m n i.-i>
^ m
B hZ,
u
l linical manifestations: Apart from severe symptoms
B prunary disease, there are still some other manifestaHw,. such as profuse coid sweating. pal complexin.
||Nl<l skin. coid limbs, bland taste in the mouth without
IU ^ H
j J/i^ f |;
,l
i
l
i &l'f. )
U
lte
8
, H
U
i#-, 11 jf yp
fe ^C, wf
tttlrwl o- with thirst and preference for hot drinks, weak

lilililli. dispiritedness, or even unconsciousness, coma,
I t and moist tongue as well as indistinct pulse.
. if
. ir
M y||, B ' i
Gkio
Analysis of symptoms: Profuse coid sweating is due
i m f r t f: r a n M ,
|l tlcplolion of yangqi that fails to astringe; pal complex-
w-i m . wj n f m
iNti lid pal tongue are due to decline of yangqi that fails
r a tl'iuisport blood upwards; coid skin and limbs is due to
B l l u c of yangqi that fails to warim bland taste in the
jfllittilli without thirst or with thirst and preference for hot
ra % ^ . m % iî j g , jna m
HIk is due to internal exuberance of yin coid resulting
' f M M M % fe i k ; W % ^ ffl,
iMtl declina tion of yangqi; weak breath is due to loss of
'U f J l^ .W J u f - t R i ^ ;
B rkmi and asthenia ot qi; dispiritedness and even uncon-
a # A
Bf #
. w f t #
m*
t|ni'tli<'ss and coma are due to declination of yangqi and

M I ni nulrition for spirit; indistinct pulse is due to deple-
Jt A
Jpii ni yangqi that fails to warm and transport blood.
kio
Jj
f i 35 ifil |0c, Fi| i c t
Molli yin depletion syndrome and yang depletion synIpiHiii1inav appear at the critical stage of diseases. InaccuH p (III lerentia tion of syndrome or delayed treatment will
M . S tfc n
,It
WS PJI
p l lo separa tion of yin from yang and result in death.

p ite yin and yang in the human body depend on each oth-
In ixisl. depletion of yin may lead to depletion of yang,
llu
M , ffi U t: lJJ
IHWBtt: ffl
Vico versa. In clinical practice, it is necessary to

i
:MM.
le. i i whether yin depletion or yang depletion is pri-
fy loi the benefit of timely treatment.
t PH til "
R itt t o
2. 1. 5
Relationship among the eight principal
A ff l E f tS J W
syndromes
In syndrome differentiation of eight principies, com
plicated diseases are generalized into four pairs of princi
pal syndromes, i. e. external and internal syndromes,
ij Im-
h ;
;j
;.! . *!!: ,A
cold and heat syndromes, asthenia and sthenia syndromes
iii: j.fr;iiH 'i ');iHj ;iji E j m i l
and yin and yang syndromes. These four pairs of principal
ir ii. il
syndromes, however, are not solitary. absolute and stat-
l4 <\M(]::;!; iil: fix; )-
ic. In fact, they are correlated and inseparable. In clinical
t </ -m
differentiation of syndromes, triis are not only made to
Z M f i M m f r . ^J' ^ i j . i
distinguish the principal syndromes. but also their correla-
lO T ilW - f K'i-iHSiJA J
tion. Only a comprehensive analysis of the eight principal

syndromes ensures correct diagnosis.
2.1.
5.1
R elatio n sh ip betw een tw o p rin ci
(- )
pies in a pair
The relationship between two principies in a pair
manifests as combina tion or mixture of the syndromes.
transforma tion of syndromes and false manifestations in
- / ^ m 'I i b i m J
-V *
- 'H W t 'l
-'iV.iii-n'JHtfii V.îil-KHTB
certain syndromes.
2. 1. 5. 1. 1
Relationship between external and
1. 3 l E M E l t t * :l
internal syndromes
During the course of disease and under certain condi
tions, there may appear simultaneous internal and exter
W ^ T . T tia ^ M l^ l
nal disorder, transmission of pathogenic factors from the

exterior into the interior and from the interior to the exte
rior.
Simultaneous external and internal disorder; At
(1)
the same stage, there appear both external syndrome and
0'W].
internal syndrome. The causes of such a morbid condition

are various. It may be caused by invasin of pathogenic
^ llll
)fd |
M i l i t JSH fM T JL ttl
JiUtors into both the external and internal phases marked

llV ii|>pearance o both external syndrome and internal synlltlimc at the early stage. or by transmission of pathogenic
Inrloi s into the interior when the external syndrome is not
hlK'ri yet. or by contraction of new disease when od one
P tlot cured yet, such as internal impairment followed by
Miliaction of exogenous disease or contraction of exogeHDIim disease followed by improper diet, etc.
Simultaneous appearance of both external and interH l Kyndromes often appears together with coid and heat
Well as asthenia and sthenia. usually manifesting as extiiil heat and internal coid. external coid and internal
B i t as well as external sthenia and interna! asthenia. etc.
Mlli'h will be discussed in the following sections.
External and internal transm ission: During the
(2)
ItJ IB
BUcnc of disease and under certain conditions, external

M in m e factors fail to be relieved and transmit into the
IfHilHor. bringing about interna! syndrome; in some interIjfcl nyndromes, pathogenic factors transmit from the inteM1lo the exterior and produce some external symptoms.
S illf t .
i Transmission of exterior pathogenic factors into the

H^rini : Infernal syndrome appears after external syn-
A ili:, fs
m a E, jfff A E Pif!
p m ic and external syndrome disappears with the appear^p ol llie internal syndrome. Such a morbid condition is
a i.
^
fL
-3% lE
m><\
% Sei'1
HtyN'ri hy hyperactivity of pathogenic factors. or by frenptil deliciency of healthy qi, or by improper nursing, or
tli'lnved or erroneous treatment that reduces resistance
0 lile body and leads to transmission of pathogenic factors
fffiWWLo
& f i I 1O #] bu : w.
PPHIii Ihe external to the internal. This morbid condition is

pHflIlv seen in the course of exogenous diseases. For extlii|ili . external syndrome manifests such symptoms like
fttiIMnh lo coid, fever, headache and body pain, whitish
k ii h k
Htln lu .ind floating pulse, etc. Transmission of exterior

me factors into the interior and external syndrome
y-j'Ntf,
transforming into intemal syndrome can be distinguished by

such changes like disappearance of aversin to cold and aver
sin to heat together with high fever, thirst with desire to
drink, reddish tongue with yellowish fur and fast pulse, etc.
Transmission of pathogenic factors from the interior
h u i1
,* : * # a a ,| i
to the exterior; Under certain conditions in some internal
- f f j& f r .iW A M i i
syndromes, pathogenic factors transmit from the interior

to the exterior, leading to the appearance of some exter
M E H i lW & .f c f t M J M
nal symptoms and alleviation of the internal syndrome.
U , ]|I| f vf fr , ^ f'S|
This is the result of proper treatment and nursing that
m m m
have strengthened the resistance of the body and driven
h t iM s * . mn:
pathogenic factors out of the body. For example, high fe
m m .m w , & # m m , m n l i
ver. restlessness, chest oppression. cough and dyspnea in

primary disease followed by disappearance of fever after
sweating, or eruption of measles and milliaria alba as well
. j* M | l|
as alleviation of restlessness, chest oppression, cough and

dyspnea is the sign of pathogenic factors transmitting from
the internal to the external.
Transmission of pathogenic factors from the exterior
to the interior is a sign of aggravation of pathological
changes, while transmission of pathogenic factors from
t i S ' S l i t i A W f l j
the interior to the exterior signifies the decline of disease.

Cognition of such changes is significant for judging the de
I S M
velopment and changes of diseases.

2.
1. 5. 1. 2
Relationship between cold syn
2.
drome and heat syndrome

Cold syndrome and heat syndrome, though different
^ jE li^ U iH M W ^ ) ( |
in nature, are correlated. They may simultaneously ap

pear in one patient and manifest as mixture of cold and
" VA Ir]^ A # I] H'f(
heat. Under certain conditions, they may transform into

each other. During the development of diseases. especially al severe stage, there may appear such phenomena like
false cold and false heat.
m t.m m ^ m \ m tM
t "fy'M iil'-i /l;(
Mixture of cold and heat: Cold syndrome and heat

lyildiome appear at the same time in one patient. It may
In) one stage at the development o a disease or signiy two
(1)
b se, be ib m iiK. y. i'ii m

* |j[;, fj; % $ A% % M 4,'V
IVtidromes in one patient, i. e. a cold syndrome and a heat

Ujndrome. The commonly encountered ones are upper
-h'r.
IhiiI and lower cold, upper cold and lower heat, external
jt'C
p lil and internal heat as well as external heat and internal
-t' tjM
Mlil.
4 j: ft KM , j :
ft, # !*LM
.k
o
IJA KJ iiE: !& # >j]ll' h
Upper heat and lower cold syndrome: For example,

llU'i'e are heat symptoms like feverish sensation in the
llM l. halitosis and swelling pain of gums in the upper
'm'A'fy, i'W-kmtMi?'!
iii-:m , >j h f # Ho m #n:
of the body accompanied by cold symptoms like abtminal pain and preference for warmth and loose stool in
lile lower part of the body.
m ,a i m m $ t * m s
, i l t 1 . A KîiHo
Upper cold and lower heat syndrome: For example,
libre are cold symptoms like cold stomachache, reduced
m m w m .
fliHito and vomiting clear drool in the upper part of the
Hf,
n l y accompanied by heat syndromes like scanty brownish

Itflllt. frequent micturition and painful urination in the
tyri energizer due to cold in the stomach and heat in the
KW iiHo îJSU:
& # m !& n m n ffi
m.
pt nmz iit. x. ;ti3 /j'f'ii to

* , mm
t m w
N lllle i .
FA til:.
Kxlernal heat and internal cold syndrome; This syn-
,#|nlHH
Wnilic is usually caused by frequent existence of internal

plil complicated by invasin of pathogenic heat; or by im-
feo
pHiihrnl of yangqi in the spleen and stomach in external
mzfp;skm&vE0 a m m
M il wndrome due to excessive taking of cold drugs. For

Hk... pie. in patients with asthenia of spleen and kidney
ma-,
MliK complicated by invasin of exogenous pathogenic
zffi<
Ipiil. lltere appear borborygmus, abdominal pain and diar-
#'J t, x.
, i-
2. 1. 5
Relationship among the eight principal
i .
^ b] *
pal syndromes, i. e. external and internal syndromes,
! l r'ft
U ffi - M ffi . # i11 1J
coid and heat syndromes, asthenia and sthenia syndromes
f f i j i i i f : ba ^ f f i . K f f i 'jI-iii
syndromes
In syndrome differentiation of eight principies, com
plicated diseases are generalized into four pairs of princi
and yin and yang syndromes. These four pairs of principal

syndromes, however, are not solitary, absolute and stat-
1W ^ t t f f i M #
OH))
ic. In fact, they are correlated and inseparable. In clinical

differentiation of syndromes. triis are not only made to
z i'V im m -
distinguish the principal syndromes. but also their crrela -
( W ffiE ff. F ^ U '< i l
A %
tion. Only a comprehensive analysis of the eight principal

syndromes ensures correct diagnosis.
fi .
2.1.5.1
R elatio n sh ip b etw een tw o p rin c i
ll'
i.lfj11 j i iifJ i
( - )
pies in a p air
The relationship between two principies in a pair
|h]
manifests as combina tion or mixture of the syndromes,

transformation of syndromes and false manifestations in
iiH flN M
- - fcflM ffifffl f'iJ'

\H,
iiF fix " I
certain syndromes.
2.1.5.1.1
I.
Relationship between external and
internal syndromes
During the course of disease and under certain condi
^ $.
tions, there may appear simultaneous internal and exter

nal disorder, transmission of pathogenic factors from the
u.
exterior into the interior and from the interior to the exte
rior.
Simultaneous external and internal disorder; At
(1)
| L l]# h
the same stage, there appear both external syndrome and
- 0 $ , g U M f f i . x;l|
internal syndrome. The causes of such a morbid condition
are various. It may be caused by invasin of pathogenic
M | W J# fW H rW T iL ^, i
b h \
prlors into both the external and internal phases marked

hv tippearanee of both external syndrome and internal synrfiMiMc at the early stage. or by transmission of pathogenic
H'loi s into the interior when the external syndrome is not
ftMl yet. or by contraction of new disease when od one
Bftol cured yet, such as interna! impairment followed by
pMitini'tion of exogenous disease or contraction of exogeM disease followed by improper diet, etc.
k Simultaneous appearance of both external and interH lyudromes often appears together with cold and heat
Ktydl as asthenia and sthenia, usually manifesting as exIp m i . i I
heat and internal cold, external cold and internal
lwi lis well as external sthenia and internal asthenia, etc.

fllli'li will be discussed in the following sections.
I External and internal transmission; During the
(2 )
E S ti
Hui'm! of disease and under certain conditions, external

HhoKcmc factors fail to be relieved and transmit into the
B irior, bringing about internal syndrome; in some interH lyndromes, pathogenic factors transmit from the inteHl lo the exterior and produce some external symptoms.
Transmission of exterior pathogenic factors into the
A f P A M : J tf ft/U S
B iflo r; Internal syndrome appears after external syn-
M v E f s t} SE M E, ffl A E I?
(l|oiini and external syndrome disappears with the appear-
z r ' k ' f m PAMo 0
p l* df the internal syndrome. Such a morbid condition is

B fr'il by hyperactivity of pathogenic factors. or by frefet'iit deficiency of healthy qi, or by improper nursing, or
Ih 'Idayed or erroneous treatment that reduces resistance
h e body and leads to transmission of pathogenic factors
in the external to the internal. This morbid condition is
M ia
. Jg Â
f f i . t u a as
Nllly seen in the course of exogenous diseases. For exM))li i external syndrome manifests such symptoms like
i" iHion to cold, fever, headache and body pain, whitish
n H 3 lt
B | fur and floating pulse, etc. Transmission of exterior
^ , B P * / A P . , k iil
Hkt>j|cnic factors into the interior and external syndrome
transforming into intemal syndrome can be distinguished by

such changes like disappearance of aversin to coid and aver
sin to heat together with high fever. thirst with desire to
drink, reddish tongue with yellowish fur and fast pulse, etc.
M P B : K-SMiiE. fUj
Transmission of pathogenic factors from the interior

to the exterior; Under certain conditions in some internal
W& W T
? RAM it J
syndromes, pathogenic factors transmit from the interior

to the exterior, leading to the appearance of some exter
f ?p f f , W M M
nal symptoms and alleviation of the internal syndrome.

This is the result of proper treatment and nursing that
have strengthened the resistance of the body and driven
Mis-.
pathogenic factors out of the body. For example, high fe
. m n , t m , m nt1
ver. restlessness. chest oppression, cough and dyspnea in

primary disease followed by disappearance of fever after
sweating, or eruption of measles and milliaria alba as well
15, jS H 'M 3? S til M |
as alleviation of restlessness, chest oppression, cough and
l'E3^
-'ira
E Pifl3
ta.
dyspnea is the sign of pathogenic factors transmitting from

the internal to the external.
Transmission of pathogenic factors from the exterior
to the interior is a sign of aggravation of pathological
changes, while transmission of pathogenic factors from

f H. T
the interior to the exterior signifies the decline of disease.

Cognition o such changes is significant for judging the de
Hj
fe f t W
Wl^ M S L o
velopment and changes of diseases.

2. 1. 5. 1. 2
2.
Relatonship between coid syn
drome and heat syndrom e

ffi fu
Coid syndrome and heat syndrome, though different
ffi fi f A Jflj
in nature, are-correlated. They may simultaneously appear in one patient and manifest as mixture of coid and
M\
heat. Under certain conditions. they may transform into

each other. During the development o diseases, especially at severe stage, there may appear such phenomena like
false coid and false heat.
ffi, sjc
ffi
t % % ffi!
fjll.
Mix ture of coid and heat Coid syndrome and heat
^1 idl ome appear at the same time in one patient. It may
|H' ni ir stage at the development of a disease or signify two
fc/fldiomes in one patient, i. e. a coid syndrome and a heat
fylldmme. The commonly encountered ones are upper
L ^ 'Ml ;,,|d lower coid. upper coid and lower heat. external
^lil and intemal heat as well as external heat and internal
( i ) & * & = AUtfftiid
X/ HKi
A ffi, m % %
Ih tn o % ft 4/V
? j VJ, ^
^ ^
jj; |i,!
t'W 'Mfr &,-&(/tB Ji .flr

B ^ |hJ0't B W W # ^ i l . J1-111
# *
,# %
, 3? !aLfj
(nld.
w.
Upper heat and lower coid syndrome; For example,
[JA K Jiiih: Ii#|W|Bt I:
llitirr are heat symptoms like feverish sensatin in the

llelNl, halitosis and swelling pain of gums in the upper
ffifee, % h t t F ^ i i E
All'l o! the body accompanied by coid symptoms like ab-
B # SE 5A
I Awmii:d pain and preference for warmth and loose stool in

H j lower part of the body.
- . ^ w ^ e , x a im
f f i# m , ffi # t * hj &
itfcjk F.
Upper coid and lower heat syndrome: For example,

M'r are coid symptoms like coid stomachache, reduced
U ^ lr and vomiting clear drool in the upper part of the
MiWi
M t t , p ^ , if
E 0
tM F ^ ffi:
m iM
m , T M M * tt M
ffi S 'fy L m F ii #J bn:
Nv mrompanied by heat syndromes like scanty brownish
B # M B. i Be W ffi x# 'P , BR
m ir > Irequent micturition and painful urination in the
0 ? t 8 ;t ^ ff i. X /M fe
B * ''1 rnergizer due to coid in the stomach and heat in the
F M i(J
kldri
ft 'I_h ^ h
.je 0
l'.xlernal heat and internal coid syndrome: This synftmir is usually caused by frequent existence of internal
m* *
NI complicated by invasin of pathogenic heat; or by im-
fs
llliirnl ol yangqi in the spleen and stomach in external
3&ZB-, s S c ^ ttffi 0
t NViidmme due to excessive taking of coid drugs. For

m n p lc . in patients with asthenia of spleen and kidney
HlM complica led by invasin of exogenous pathogenic
flN i Hiere appear Ixirborygmus, abdominal pain and diar-
i? t /
m m m
a IM mZ>(
n ph *%m m i&..
m a-.
z w . K m m t i M j m M , if 1Jfm f . X l
%
l$
: mi
rlu-a with indigested food complicated by fever, slight avorsion to wind and coid. headache and swelling soreIhroat, etc.
HSMfeijE: I f P I
External coid and internal heat syndrome: This syn
fe
drome may be caused in two ways. One is requent exist-
- -.14
ence of internal heat complicated by invasin of wind and

I*] fe <X
cold. For example. manifestations of hyperactivity of liv
M ; . '
or fire like susceptibility to irrita tion, flushed complexin,

red eyes, dizziness, distending headache. bitter taste and
W tf j.u tfn P W A
dryness in the mouth are complicated by external cold
i<J
m X E
gp
symptoms like aversin to cold, fever, anhidrosis and

cough. The other is cold pathogenic factors transmitting
t 1
'km
M fe ffio
into the internal and transforming into heat prior to the

relief of external cold. For example. symptoms of exter
nal cold syndrome like severe aversin to cold and slight
I i f 4 % % ffi t & t t M d i
fever. pain of head and body. anhidrosis and floating pulse

, X t t P i ^ J
followed by internal transmission of pathogenic cold and
ii
continuous existence of external cold with the symptoms
M I^ S fe iE M
of internal heat syndrome like aggravation of fever,
MfeEo
*1
thirst, restlessness and reddish tongue.

In dealing with simultaneous appearance of cold syn
ffi-^fejE|S]Bt#JAL!lli
drome and heat syndrome, triis should be made to distinguish the upper and the lower as well as the external and
H % t * fe I & &
o W1
the internal. The differentiation of whether the cold is

principal or secondary or whether heat is principal or sec-
m . f ff
ffl m w $ m <1
ondary is also essential for establishing therapeutic princi

pies and deciding treatment.
Inter-transform ation o f cold and heat: Cold syn
(2>
A fl
drome or heat syndrome of diseases signifies the condi-
* * it E ^ f e iiE . JifltftGH m i
tions of yin and yang in the body. Under cerlain condi
tfiS R o
II
tions, the states of yin and yang in the body vary. The
cold or heat nature of the syndrome changes accordingly.
jjijj iiE M f * fe M t t
fll i
m ito
Transformation of cold syndrome into heat syndrome:
fc^/feilE:
!&$M
I ii<
palienl shows cold syndrome first, and then heat syn
drome.
I he cold syndrome disappears after the appear-
HM is , * M f |!j{i Z r*j k . l!|i
lluv ol the heat syndrome. For example, the patient is
lKo Midi: Atl
I lltiicked by pathogenic cold and shows symptoms of exterflitl coid syndrome, such as aversin to cold, fever, head-
M M , fcb M m
* i# m
w lie and body pain, no sweating, white fur and floating-
t ^
fe -
m n w
m m a , m w a - $
L tense pulse. As the pathological conditions further devel|pt> Ihe cold pathogenic factors transmit into the interior
L l lid
e M ,
M , f
transform into heat, bringing about symptoms of in-
lnn.il heat syndrome, such as disappearance of aversin

Cold, high fever, dysphoria, thirst, yellow fur and fast
pulm'. etc.
I ransformation of heat syndrome into cold syntlionic: The patient shows heat syndrome first, and then
m fe ie . m tu m m e , m a
od syndrome. When cold syndrome appears, heat syn-
H I/S ,fe ffi{ li ^ ^ ,U | i
Hfntnc disappears. Such a transformation may be either
A fe E ^ ft %M Eo g f + f t
W lden or gradual. For example, chronic heat dysentery
i nfe# 0 A , P0
tHiiiNiimes yangqi and gradually transforms into asthenic

Mil dysentery. This transformation is slow. In patients
S
iiff tW ig .
to ^ fe l?
Bftllli high fever, yang leakage with profuse sweating or

(fhiin exhaustion with excessive vomiting and diarrhea will
t t t f i f f i, K
Iftxl lo symptoms of asthenic cold syndrome (depletion of
m m
(talIK). such as sudden decrease of body temperature, cold
.W 'fc @C*6 M i m ffi ( t
i m
m , m jk m
iptliN. pal complexin and indistinct pulse. This trans|ht iHUi Iion is sudden.
I lie transformation between cold syndrome and heat
pifliiltoiiu' lies in the confliction between pathogenic facP
1111,1 healthy qi. Transformation of cold syndrome into
^ E i t %fe E, M A [ jK (
VMl 'ivndrome indicates that the healthy qi is strong, yan I In exuk'rant and pathogenic factors transforms into
pinl with yang. Such a morbid condition. though indicaHhu Imtlier development of the pathological conditions,
P*K<'ls....-mal strength of the healthy qi that is capable
K hiiikIi ol
resisting invasin of pathogenic factors.
f e ,S M j , tiM W
M ffi
t i
^SEiiF., H #1
ifCffl;
f e
til: $$
iH
it
JE % J H , |||
Jl \i ffl I<J . l
i E j . ii; f iri W . Mi ti'i
Transformation of heat syndrome into cold syndrome indicates decline of the healthy qi. consumption of yangqi and
no strength to resist pathogenic factors, suggesting predominance of pathogenic factors and asthenia of healthy
qi. failure of the healthy qi to dominate over pathogenic
factors and worsening of the pathological conditions.
False and true m anifestations o f cold and h e a t;
In the development of certain diseases, especially at the
critical stage of some severe diseases, cold syndrome or
fm mz m a js&e irsm
heat syndrome may show some manifestations contrary to
ttS M
l Kl-
the nature of the disease, therefore bringing about true

cold and false heat syndrome or true heat and false cold
JC & ffigkF ..
syndrome. False manifestations usually cover up the na
M $ i 0 \'J * , f EVi
ture of disease. In clinical treatment, cares should be

taken to distinguish true manifestations from the false
ones to avoid erroneous diagnosis.
True cold and false heat syndrome: Cold syndrome
shows false heat symptoms. For example, in some pa
tients with severe yang asthenia and internal cold syn
f;j e m o
drome, there appear such symptoms like cold limbs,
/i
dispiritedness, indigested diarrhea, clear and profuse u-
m to Jti- f -a
* ill: Al #
.f# f'i1 ifr. FfiJri'tM M 11
rine and pal tongue with white fur together with the
symptoms like heat syndrome, such as flushed complex
i ti
p M,
in, feverish body, thirst and large pulse. However,

flushed complexin only occasionally appears on the
a f f i i r , -fj ik i t 5 & & w w
cheeks with pal complexin; the body is feverish, but the
5]{XM^lIIP#C,0f|
patient still wants more clothes and quilt; though thirsty,

the patient prefers hot water and does not drink much;
M p $S p # * t:. fitft
though large, the pulse is weak when pressed. Such a

morbid condition is caused by interna! exuberance of cold
which drives declining yang outward known as predominant yin rejecting yang.
True heat and false cold syndrome: Heat syndrome
shows false cold manifestations. For example, in some
I M I B .
u m m t:
1" '
palienls with severe internal heat syndrome, there appear
rtjiiiiMo
Nymptoms of fever, thirst with preference for cold drinks,
& f f i M > ;li jWj|1:A. i I (H
\* a !ii
iivm ni
l'csllessness, scanty brownish urie, retention of dry fe
'i:>'h'i ki.4 , A
ces and reddish tongue with yellow fur together with
[ f W * r Vt .|n|iM
xymptoms like cold syndrome. such as cold limbs and

Nimben pulse, etc. However, the patient feels cold in
jWi<Mo MH<M
.Y
\
ii. )li
limbs. but scorching feverish over the chest and abdomen

willi aversin to heat: though sunken. the pulse is fast
ifcfL-ilJîfW h
a M ili JJ |J|.
und powerful. This is due to internal exuberant heat staglUites yangqi and prevents it to reach the limbs. Such a
J-^K Hjifc./j);
Uioibid condition is caused by internal exuberant yang

llliving yin outward, known as exuberant yang rejecting
mil"- IJnder such a condition, the severer the internal
t , BPJTriW
hrat. the colder the limbs. which is known as severer

lli'.it and severer cold .
Key points for differentiating false and true cold and
syndromes;
Firstly, false manifestations usually appear over the
Diiiplcxion, limbs and superficies. However, the changes
ni viscera, qi, blood and body fluid are essential. So the
;' . iy
jf j ,' JU? $ " 1 ffi KJ1' t
ilMiuIcstations of internal syndrome should be taken as the

vid. tice for diagnosis, such as whether there are thirst.
U-'j-' )]ffi, ffi )||l:
fe, l,LlIIi ,
I<J^
l'f M & VA f
i ffi f)
k .r k im i'- ) m \ A w i\ n 'i
JUlnvnce and aversin and how the tongue conditions

lliil pulse states are.
Sccondly, pay attention to the difference between
llilfcc manifestations and true ones. For example. in false
Ih ii! syndrome, flushed complexin only appears 011 the
k %o min<* ffi fmkiu

iJ t
> Mfe $5 i \ ffi
(urdir:id and cheeks, and the colour is light, tender.

........ ik and occasional; while flushed complexin in the
a i f f i i j f i f f i il i:.
|lnr liral syndrome involves the whole face. Take false
B $ S f f iS J E J & * M f i
1I11 syndrome for example. though the limbs are cold,

|l p Hu n does not want more clothes and quilt and the
and abdomen feel scorching feverish; in true cold
yntliHiiic. cold limbs apiK'.ars logclher with huddled pos
y.
i'U 4( ill
j&
N iJ' ',v; J- 'al ' ' i tg i'h, {ik

'V..
ture in sleep and need more clothes and quilt.

2.1.5.1.3
3.
Relationship between asthenia syn
drome and sthenia syndrome

In the development of diseases. asthenia of healthy qi
and sthenia of pathogenic factors oppose each other and
are also related to each other. Therefore, asthenia syn
drome and sthenia syndrome may appear simultaneously or
Itfc, J E -^T VI m . 4
.tiM X j VI F*
transform into each other and appear in sequence. At the

critical stage of diseases, there may appear false sthenia
and false asthenia manifestations.
M ix tu re of asthenia and sth en ia : Asthenia of
(i)
f - k
healthy qi and sthenia of pathogenic factors exist simulta

neously at the same stage in a patient. This morbid condi
tions is usually caused by pathogenic factors in a sthenia
^ t^ F .o % H M % % E .3
syndrome impairing healthy qi, or by invasin of new
ffi f E n .IE ^ E f f fiJ P !S |
pathogenic factors in an asthenia syndrome with deficiency
4 ;
W
L % i iE. IE
^ &.
of healthy qi, or by accumulation of pathological substances in the body due to deficiency of healthy qi and dysfunction of viscera in an asthenia syndrome. Mixture of
asthenia and sthenia may be a stage in the development of
a disease or may appear as two syndromes at the same
time in a patient in which one is asthenia and the other
iB
le] B B fi W#
ME |
sthenia. This morbid condition may be further divided into

asthenia syndrome complicated by sthenia, sthenia syn
drome complicated by asthenia and equality of asthenia and
sthenia according to the levels of asthenia and sthenia.
i.
Sthenia syndrome complicated by asthenia: This

syndrome is marked by predominance of pathogenic
factors complicated by asthenia of healthy qi. For exam
ple. in an internal sthenic heat syndrome with the mani
festations of high fever, flushed complexin, dysphoria,
sweating, reddish tongue and full and large pulse, there
appear at the same time such symptoms like thirst, scanty
brownish urie and retention of dry feces. Such a morbid
M M M t j E , n-t X t i
t'imdilion is due to consumption o l)ody fluid by predomitliinl lieal and exuberance of pathogenic heat.
Asthenia syndrome complicated by sthenia: This
: JTrt l'i ll / t V
lyndmme is marked by deficiency of healthy qi complicat-
% , M M ffl\'-H 'h k i:,Ai
9<l hy retention of sthenic pathogenic factors. For exam-
M ^ iiE M o fiJ iM fe ),, IUJ
|llr. at the advanced stage of seasonal febrile disease,
u I-,
appear such symptoms like low fever. dispirited-
i i ! . Jjt
f J
nn. dry mouth, poor appetite, furless tongue and thin
l!/i W 1fj fti .
(Hllue. etc. Such a morbid condition is typical of asthenia
ndi'ome complicated by sthenia marked by deficiency of
feffio
i l i % W % 'k
lifnllhy qi due to impairment of qi and yin by remaining

Nil.
Fquality of asthenia and sthenia: This syndrome is
HIMt'lu'd by equal degree of the deficiency of healthy qi and
lcnia of pathogenic factors. For example, tympanites
FJfMffltfl
- D I 'n liM
fiibW-
lIlH' lo failure of asthenic spleen and kidney yang to transIIin qi and transport fluid is marked by manifestations of
lili.liia syndrome like drum-like abdomen and scanty urie
I Well as by symptoms of asthenia syndrome like aversin
(luid, cold limbs, pal complexin, aching weakness of
a-
.JNiin and knees and deep-thin pulse, etc. In such a morbid

jlMiililiori, the degree of the deficiency of healthy qi and
k . kk % $ # S Kj j# %
degree of the sthenia of pathogenic factors are practiMlly equal.

Transformation of asthenia and sthe nia: In the
(2 )
Vi'lopinent of a disease, the confliction of pathogenic fac-
ff4flIE4 fc S ffi % iil. M
l luid healthy qi is usually signified by transformation of
M J $ $ I t o ilffi
# 5L M i\
|felllii11a and sthenia. Such a transformation usually appNii'i as transformation of sthenia into asthenia and devel..... ni o asthenia into sthenia in clinical practice.
liansformation of sthenia syndrome into asthenia:
Milu liansormation is marked by sthenia syndrome
SSI^jE , fs i M i t iil ifii '*)
plnwrd hy asthenia syndrome in the course of a disease.
iiE ^M B i^n '^.l i 'k 'i: iil -H
Kh Ii a transformation of syndrome is usually due to
1 t l l iiF. o W 'I|'-I W / l M "It
liyix'ractivity of pathogenic factors, or retention of patho

genic factors in the body and impairment of healthy qi due
lo erroneous treatment and delayed treatment. For exam
ple, at the primary stage of exogenous disease, there ap
pear such symptoms like high fever, flushed complexin,
M E ,,
i l j g j l
restlessness, or even coma and delirium, reddish tongue

with yellow fur as well as full and large pulse which are
the manifestations of sthenic heat syndrome. At the ad-
p b h t
. i
vanced stage, there appear such symptoms like dispirited

ness, emaciation, dry throat and mouth, tremor of hands
and feet, reddish and dry tongue, furless tongue as well
(iiEo
as thin and fast pulse which signify the transformation of

sthenia syndrome into asthenia syndrome due to prolonged
retention of pathogenic heat exhausting liver and kidney
yin in spite of the fact that pathogenic heat has already
been eliminated.
Development of asthenia into sthenia: Such a
T s ^ iitii
development is marked by appearance of symptoms of
T E n * * J iM f r
sthenia syndrome in an asthenia syndrome due to deficien

cy of healthy qi, hypofunction of viscera and retention of
such substances like phlegm, food, dampness, fluid and
tt.H P *0 d s a . m a
blood stasis in the body. For example, in the aged there
(*3w C ?:P H nrl6 .f r M
usually appear such symptoms like palpitation and short

ness of breath ( which is worsened after movement and
difficult to heal) followed by occasional chest oppression
and stabbing pain, purplish tongue and thin and astringent
pulse, etc. Such pathological changes are due to gradual
3 c jjM M L ft,W i L fT &
asthenia of yangqi in the heart in the aged. The prolonged

asthenia of yangqi n the heart is unable to transport
blood, leading to slow circulation of blood and obstruction
of the heart vessels. Though there appear chest oppres
sion and stabbing pain, purplish colora tion of the tongue
and retention of blood stasis, asthenia of yangqi in the
heart still exists. That is why the nature of the syndrome
IR mixture of asthenia and sthenia.

(3)
False and true m anifestations o f asthenia and

[ |th e n ia : During the development of a disease, some as-
t*
i f Eftl til-: ,T , i t 1
]
llienia syndromes and sthenia syndromes may show some

iiIhc manifestations contrary to the nature of the disease
^ fu M $ flx iiH M
Ityown as true asthenia and false sthenia syndrome and
m E H't K a M hk g 4k fi l;. k-
(fue slhenia and false asthenia syndrome. In the difierenlint ion of syndromes, triis should be made to distinguish
llir .1Ise from the true in the complicated manifestations
Mi i i s
lo
differentiate the nature of disease.
True sthenia and false asthenia syndrome; The disHw is essentially sthenic with the manifestations of some
JUllirmc symptoms. Such a syndrome is usually caused by re-
iiE^TSL
liillion of sthenic pathogenic factors preventing yangqi or
r a n c ia
l|! Nlid blood from warming and nourishing the body. For
B miiiIiIc . in the sthenic heat syndrome due to retention of
fM S M ' W uH. ) M J '<&,
Wtl in the intestines and stomach, the appearance of cold
' F ib K .M 'iJif
(Imlm. loose stool and deep and slow pulse are like the
\m m M o
fig , I f S
pliilcstations of asthenic cold syndrome. However, the
K#7K,
|kill< il eels cold in limbs but scorching feverish over the

plitNt and abdomen; the stool is loose, but foul in smell
, ijft z Jio n i ;
|Htl yellow in colour, and the abdomen is painful and un-
Mm iiE BP i r A ffi i'ri k 1 m
|Ml|Mhlr; the pulse is deep and slow, but appears powerful
t 'i;
1-j
tE
tyliru pressed. True sthenia and false asthenia syndrome

Bjuxl wliat was known as asthenic manifestations in setah sllienia condition in the past. Clinically attention
Mliild lie paid to the differentiation of mixture of asthenia
|fyl llicnia syndrome due to consumption of healthy qi by
pathogenic factors.
Tiiic asthenia and false sthenia syndrome;
The
E l * E : M i m il f
ki'imc is essentially asthenic with the manifestations of
m jgftE. p m m % in t-
|lln iii.i like symptoms. Such a syndrome is usually caused

pf ilt'ln icncy of yangqi due to prolonged disease fails to
Rulin .un transport, leading to hypofunction of the viscera.
M PH
J > M Jl ) j . l'X
4. r,,;
I lowever, sthenic pathogenic factors have not been developed yet. For example, insufficiency of gastrosplenic qi
and dysfunction of the spleen bring about some sthenia-
yi
like symptoms, such as abdominal distensin and fullness

or pain. Though there is abdominal distensin and full
ness, it is alleviated occasionally, unlike that of sthenia
syndrome which never attenuates; though there is abdom
f f i ,
inal pain, but it is palpable, unlike that of sthenia syn
s i t i i " .
drome which is unpalpable. True asthenia and false sthe
^ 0 iM ge % W )& % * & H I
JtJg
m A 0f l'i
f f i BP
n s M a J
nia syndrome was known as sthenia manifestations in se

vere asthenia syndrome in the past. Clinically attention
should be paid to the differentiation of mixture of asthenia
and sthenia syndrome due to development of asthenia into
sthenia syndrome.
Key points for differentiate true and false asthenia
and sthenia:
411 F :
CD ir\
Tongue states: Tough tongue with thin fur is usually

of sthenia syndrome; bulgy and tender tongue with thin
J'r \ ' M
r h>l t
ill'-; i1? 'jH !J
>A
fur is usually of asthenia syndrome.

Pulse conditions: Powerful pulse with spirit is of
sthenia syndrome; weak pulse without spirit is of asthenia
u m itiW f
V - i:: .! : Je
syndrome. Attention should be taken to differentiate
>jrfgiiKo
whether the sunken pulse is weak or strong.
Jj
:L
Il
P * , *
;i
t Jj o
Voice: Sonorous voice is of sthenia syndrome; low
i-V/j :
and timid voice is of asthenia syndrome.

^Mffio
History of disease: This includes the constitution of
the patient, causes of illness, duration of illness and
m & m ,m
mm m,
treatment. Generally speaking, patients with strong con

stitution usually suffer from sthenia syndrome, while pa
tients with weak constitution usually suffer from asthenia
syndrome; diseases caused by six exogenous pathogenic
A if: & S % ill:,
factors are of sthenia, while diseases due to overstrain

and chronic diseases are often of asthenia; new disease is
J f f i; ^ #
Ij-l \')l,
-mm z i M
Hwully sthenic, while chronic disease is often asthenic.

2. 1. 5. 2
R elatio n sh ip b etw een d iffe re n t
(Z )
imlrs of p rin cip ies

In the eight principies, external and internal, cold
muI heat as well as asthenia and sthenia generalize the na-
lli'rlS
lllii* of diseases from the aspects of the location and nature

if diseases as well as the conditions of the healthy qi and
lllhogenic factors. However, different aspects of the naIiih of diseases are inter-related. For example, cold and
j|n*n! nature of diseases as well as the predominant and de(li ''iit states of healthy qi and pathogenic factors cannot
rt w n nr n . f g m to l # & w s t i
HInI independent of the external or internal location of

UlMinses; accordingly, external syndrome or internal synNime cannot exist independent of cold and heat as well as
E,$tf>jU T:
'iiia and sthenia nature of diseases. The inter-relation

wlWivn the internal and external, cold and heat as well
l | imthenia and sthenia may bring about various synpimies. The following is a brief discussion of the major
mu
2 .1 .5 .2 .1
External cold syndrome
i.
Kxtemal cold syndrome refers to the symptoms of

|^>K<tious disease at the primary stage caused by pathoH llilr wind and cold attacking the surface of the body.
r a
Clinical manifestations: Severe aversin to cold, light

Mv#r> pain of head and body, stuffy and running nose, no
IHNttling. whitish thin and moist tongue fur, floating and
n iM ' pulse.
Analysis of symptoms: Aversin to cold is due to
HhiWiiic cold attacking the superficies and stagnating
[jfNHK in Ihe superficies; fever is due to healthy qi fighting
;n m
iflgtiliitl pathogenic factors; pain of head and body is due to

llW n ic cold stagnating the meridians and preventing
(RtM'lillmi <|i from free flowing; stuffy and running nose is
pi> In lailure of the lung to disperse; no sweating is due
ftT#
H 'J - S ff
'PtM r i
i f i 'M . B
if
to obstruction of the muscular interstices by cold which

tends to contract; whitish thin and moist tongue fur as
well as floating and tense pulse are signs of pathogenic
cold encumbering the surface of the body.
2 .1 .5 .2 .2
2. 3 t & i l
External heat syndrome
External heat syndrome refers to symptoms of exoge

nous febrile disease at the primary stage caused by wind
and heat attacking the surface of the body.
Clinical manifestations; Fever, slight aversin to
wind and cold, headache, or sweating, slight thirst,
SE
f i , l t i fF P T
flfl
swelling sore-throat, red margin and tip of tongue, whit

ish thin tongue fur or yellowish thin and dry tongue fur,
floating and fast pulse.
Analysis of symptoms: Slight aversin to cold and fe
ilHfec-
: W -& & t f l
ver are due to wind and heat attacking the surface of the
body and the fact that heat is a pathogenic factor of yang
nature; headache and swelling sore-throat are due to up
per disturbance by pathogenic heat; sweating is due to up
per floating of pathogenic heat that loosens the muscular
interstices; slight thirst is due to mild impairment of body
fluid by pathogenic heat; red margin and tip of tongue as
well as floating and fast pulse are signs of wind and heat
attacking the surface of the body.
2 .1 .5 .2 .3
External sthenic syndrom e
3.
External sthenic syndrome refers to symptoms of ex

ogenous disease at the primary stage caused by pathogenic
fgo vammirt
cold attacking the surface of the body. This syndrome is

marked by severe aversin to cold, no sweating and float
ing and tense plse, also known as external sthenic syn
drome of cold attack which is discussed in the section of
m .
external cold syndrome.

2 .1 .5 .2 .4
External asthenia syndrome
External asthenia syndrome usually refers to two

kinds of syndromes. One is the external syndrome caused
4. ^J iiE
n m im % i9 M
I liv exogenous wind attack and marked by aversin to

i Wind.
spontaneous sweating and floating and moderate
M M I*
i (mise. This syndrome is called exogenous external asthe-
I flln syndrome as compared with external sthenia syndrome
^ f S a j# ni - %
I ni cold attack marked by severe aversin to cold. no

B|Wealing and floating-tense pulse. The other is external
E iHtlienia syndrome of internal impairment caused by loose-
m ik m w
I Hims of weiqi resulting from asthenia of pulmonary and
f&vEo
m H & k
(picnic qi.
Clinical manifestations; Light fever, aversin to
Bullid, headache. sweating, whitish thin tongue fur, float-
J&ff
nnd moderate pulse, or frequent spontaneous swea-
iT li.g M .
lliiy,. susceptibility to common cold, accompanied by pal

f flHiiplexion. lassitude, shortness of breath. asthma right
Hlli'l'
movement, poor appetite. loose stool, pal tongue
P th white fur and thin and weak pulse.

| Analysis of symptoms: Fever, sweating and aversin
til cold seen in exogenous external asthenia syndrome are
?(|Uc
lo disharmony between weiqi and yingqi and looseness
m t - n w f n . i a i f e . a
til1muscular interstices resulting from pathogenic invasin
,4j M S M ;
Ule surface of the body by wind which tends to open and

lll iu r s l :
headache is due to wind attacking the superfices
rkifM % H
KjE
til Inhibited flow of meridian qi; whitish thin tongue fur

h il loaling and moderate pulse are signs of pathogenic
Mil id lingering in the surperficies. In external asthenia
M u ll m e
of internal impairment, frequent spontaneous
BMItug and susceptibility to common cold are due to

W M iess
Mil yingqi due to qi asthenia in the lung (which governs

Mli nnd hair) and the spleen (which governs muscles).
|h. Iinig governs qi and manages respiration; while the
Icen governs transformation and transportation; both of
%llli
li are
i .
^ ?JRf tR ; W- I-i'
of muscular interstices and weakness of weiqi
Ihe
production source of qi and blood. Asthenia
H |Hllin<Mi.'iry and splenic qi and hypofunction of the lung
s #j ib s >fic rl mf i .
M5. f ^%M. $ W'JHI'i.f
and the spleen lead to such symptoms like pal complex

in, lassitude, shortness of breath, asthma right after
movement, poor appetite. loose of stool, pal tongue with
white fur as well as thin and weak pulse, etc.
2 .1 .5 .2 .5
Interna! sthenic cold syndrome
Internal sthenic cold syndrome refers to symptoms of

internal exuberance of yin cold frequently caused by inva
sin of pathogenic yin cold into the viscera, or excessive
intake of uncooked and cold food which stagnate yangqi.
Clinical manifestations: Clinical manifestations are
various due to difference in causes. The usual ones are
cold limbs, pal complexin, moist mouth without thirst,
# H l(i
W:
ffi l, P7l'<M<
or thirst with preference for hot drinks, unpalpable pain of

abdomen, clear and profuse urie, loose stool, whitish
moist tongue fur as well as deep and slow pulse or deep
and tense pulse.
Analysis of symptoms: Cold limbs and pal complex
in are due to invasin of pathogenic cold into the viscera

which stagnates yangqi and deprives the body of warmth;
&3 J&n , ffi ; M rt >M
a i i ^ iS .d
moist mouth without thirst, or thirst with preference for

hot drinks and profuse clear urie are due to internal exu
berance of yin cold and non-impairment of body fluid; un
palpable pain of abdomen is due to stagnation of yin cold
and inhibited movement of qi; loose stool is due to patho
6 JE. M
genic cold stagnating gastrosplenic yang and failure of the

spleen to transport and transform; whitish moist tongue
fur and deep and slow pulse or deep and tense pulse are
signs of internal cold.
2 .1 .5 .2 .6
. .
Internal asthenia cold syndrome
6. HJSiE
Internal asthenia cold syndrome refers to symptoms

of deficiency of yangqi which is discussed in the section of
yang asthenia syndrome.
2 .1 .5 .2 .7
Internal sthenic heat syndrome
Infernal sthenic heat syndrome refers to symptoms of
WLPHffio
7. M^SVE
&
llllc'i iial exuberance ol pathogenic yang heat usually caused
\H&J
iti: M:
fclll I
hy internal invasin of pathogenic yang heat, or by pathoLpt'iiu cold transforming into heat and invading the inter
fer or by emotional impairment and emotional transfor
m ion of fire, or by improper diet which accumulates into
Ir u t .
Clinical manifestations; The clinical manifestations
l|
: S F IjScJtri
Alt* Vii ious due to difference in causes. The usual ones are
lllitlied
complexin and somatic fever, aversin to heat
[||mI preference for cold, thirst with preference for cold
mx
P
i ^
i ffl , jJA L: 0 i :
a , MWM & , p f #
.#i
Hlilis. restlessness, or even coma with delirium, yellowjli tliick sputum and snivel, vomiting blood and epistaxis,
W , n iil t t i l . B. J3f S I % II i
Disipable pain of abdomen, scanty brownish urie, reim iH o ii
of dry feces, reddish and dry tongue, yellowish
rftT-,
, m m . Jc
NUe Iur, full pulse, or slippery pulse, or fast and

rite pulse.
Analysis of symptoms; Flushed complexin and so
ltu fever as well as aversin to heat and preference for
|ltl re due to exuberant internal heat fumigating the exPl ion thirst with preference for cold drinks, dry tongue
T~, /]'{< M A '; ftft 'll'# , H
yellowish urie are due to heat consuming body fluid;

Itt disturbing heart spirit may lead to restlessness in
ld rase and coma with delirium in severe case; yellow-
Ltfa, it lli
T A irtlfiL
m IIL;
|)l lliick sputum and snivel is due to heat scorching body

Wdi Ilematemesis and epistaxis are due to heat impairing
piMl collaterals and driving blood to extravasate; unpalnlili abdominal pain and retention of dry feces are due to
ffiflo
M ltiition of heat in the intestines and stagnation of intesHti"l <|ii reddish tongue with yellow fur and full, slippery,
l l mid sthenic pulse conditions are signs of internal heat.
?. 1. 5. 2. 8
Infernal asthenia heat syndrome
8. M J M
Internal asthenia heat syndrome refers to symptoms
M j M , J f J ^Ni^j
I i mr.iimplion of body fluid which is discussed in the sec-
Wi ^ J Z Jf k M tfl 'ni: fe .. u
Nnn ol vm asthenia syndrome.
^ l jTff !All!J])f itl:.
2 .2
Syndrome differentiation
of qi, blood and body fluid

Syndrome differentiation of qi, blood and body fluid
is a method used to analyze the pathological changes of qi,
blood and body fluid during the course of a disease and dif
ferentiate the symptoms according to the theory of TCM
H. lam
'fe^ a
@+a
M it.I
>jl ,, e
t W
A &ffi li A
about qi, blood and body fluid.

The pathological changes of qi, blood and body fluid
can be generalized into two major aspects. One is the as
thenia of qi, blood and body fluid, which pertains to asthe
ffi ' .. in., W

-:m M v ill
nia syndrome in syndrome differentiation of eight princi
H T A*M i#ffi ct' /#ffi #j ifidi
pies; the other is the disturbance of the transporta tion and
i & H . . lin., t$-W. M i s t , R l i
metabolism of qi, blood and body fluid with the manifesta

tions of stagnation and adverse flow of qi, blood stasis and
retention of fluid, which pertains to sthenia syndrome in
f f i ^ ^ f f i^ J S ^ o
syndrome differentiation of eight principies.

Qi, blood and body fluid are the material basis for the
hti,ifiiji
functional activities of the viscera. The production, trans
H ft
porta tion and distribution of qi, blood and body fluid are
ii ^ t c R m ' M tp x
rfi /ji<j
dependent on the functional activities of the viscera. So,

visceral disorders may affect the changes of qi. blood and
i 4 - , nj va ve p m J
body fluid. On the other hand, the disorders of qi, blood
in .
and body fluid also affect the functions of the viscera.
mw
frd^ffc: n f n . il>
$ , ni # m
pfi 3\wi
Therefore, the disorders of qi, blood and body fluid are

closely related to the conditions of the viscera. Clinically.
m $
the differentiation of syndromes of qi, blood and body fluid
iis j* t , n liu. &
m h
m. m
ffi * m |
m ffi t '- jii
is made in combination with the differentiation of syn

dromes of the viscera.
2. 2. 1
Syndrome differentiation of qi disorders
The disorders of qi are various and clinically divided
t WS ' i-Mii J * t |
Hilo four categories, i.e. qi asthenia, qi sinking, qi stagDM Iio ii
and qi reversin. Qi asthenia and qi sinking syn-
ilinmcs are asthenic in nature, while qi stagnation and qi
J ffi -% \
'4'\iiE
if / ( l lili' j
Versin syndromes are sthenic in nature.
2.2. 1.1
(- ) I I I
Qi asthenia syndrome
Qi asthenia syndrome refers to insufficiency of

(Mflinonlial qi and asthenia symptoms of hypofunction of
n i hypofunction of the viscera and tissues resulting from
t f f s
lu/u'(
fflllty.
ff^SC o
H|f viscera and tissues. This syndrome is usually caused

excessive consumption of primordial qi due to chronic
Hlriisr. severe disease or overstrain, or by deficiency of
|f|iuordial qi due to congenital defects and postnatal imjttiijier diet, or by decline of primordial qi due to weakness
f'1
Clinical manifestations: Lack of qi, no desire to

Mfnk, low voice, shortness of breath, dispiritedness,
Mullude, dizziness, spontaneous sweating, aggravation
idl the symptoms after movement, pal and tender
/s il e fin :,
ft, B A f f i o
tamiic. as well as weak pulse.

Analysis of symptoms; Lack of qi, no desire to
v E M 'fr tif: j
. fifi
Htydu low voice, shortness of breath, dispiritedness and

Hpilludc are due to insufficiency of primordial qi and hyHllliclion of the viscera; dizziness is due to failure of asllti me qi to nourish the head; spontaneous sweating is due
(llllurc of weakened weiqi to protect the superficies of
> Ih><Iy; all the symptoms are aggravated after move-
$ r M l s i& : J ju S o
r ^ J l/ f ;
fplHIl Ixrause overstrain consumes qi ; pal and tender
% t i , H, iil
ItldUiic and weak pulse are signs of qi asthenia and insuffiHt'hi v ol qi and blood.
Key points for syndrome differentiation: The essen-
m v E g & : * F .W '> H .
I nymptoms for diagnosis are lack of qi. lassitude,

dl|ili iledness, spontaneous sweating and weak pulse.
II. 2 . 1 . 2
Qi sinking syndrome
Qi sinking syndrome refers to symptoms of asthenia
lcffio
(z> npBi
/ c f i i i : i Ao.i a,
marked by prolapse of the viscera due to inability of qi to

lift and sinking of lucid yang. Qi sinking syndrome is usu
ally due to splenic asthenia. That is why this syndrome is
mwm.
also called syndrome of sinking of gastrosplenic qi or qi
sinking due to splenic asthenia. This syndrome is usually
il S M n f ffio
m i
,& x m
M t M lj
astil
the further development of qi asthenia or caused by overstrain.

Clinical manifestations: Prolapsing distensin of epi
\\m-M:
fflg&Afcit
gastrium and abdomen, or prolapse of rectum due to chro

nic diarrhea, prolapse of uterus, dizziness, lassitude. pal
tongue with whitish thin fur and weak pulse, etc.
t iltil,
m m .
Analysis of symptoms; Prolapsing distensin of epi

gastrium and abdomen, or prolapse of rectum and uterus
are due to inability of asthenic qi to lift and maintain the
F U . U Vf F S R i J / f R i & f l
viscera in the normal position; dizziness. chronic diarrhea
' k' t; . r
and lassitude are due to inability of asthenic qi to lift and
^ Jl Jj , rf I
F
' i 4< )\ifiil'
lucid yang to rise; pal tongue, whitish thin fur and weak
pulse are signs of the decline of the functions of the body
due to qi asthenia.
j.fi - 'Ai'iiMtUf i i'J f f ilt B
Key points for syndrome differentiation: Prolapse of

the viscera, dizziness, lack of qi and lassitude.
2.2.1.3
Qi stag n atio n syndrom e
( = ) niw E
Qi stagnation syndrome refers to symptoms caused by

qi stagnation in a certain regin or a certain viscera in the
.j j
human body. The causes of qi stagnation syndrome are

various, such as emotional upsets, improper diet, attack
by exogenous pathogenic factors, asthenia of yangqi, or
trauma, failing, contusion and sprain which all may lead
to dysfunction and disturbance of qi and bring about qi
stagnation.
Clinical manifestations: Distending oppression, pain
(distensin is more serious than pain) or migratory pain
M. 4 1
Dllil Hllacking pain are felt over the chest, hypochondrium - epigastrium and abdomen. The location of pain and
lllhl elisin is usually unfixed. The distensin cannot be felt
ifcy |miIpntion but is alleviated after sighing. borborygmus
|(Ul breaking wind. It may be attenuated or worsened with
ptr changes of emotions.
Analysis of symptoms: Normally qi should be free and
plHNilh in flowing, stagnation will lead to distending op-
v E m ft# ?: h i l i m m t j
m ,- t m
, g ro m & .
ph'wiou in mild case and pain in severe case; qi some-
a m ns
k s m utic.&.&
Ulncs gathers up and sometimes disperses, so the location
nP ' f aE >Ht fe 0>f , fe 2.
0 |luin is not fixed, pain is now serious and then light and
iNiiiiof be felt by palpation; sighing, borborygmus and
iwlung wind smooth the flow of qi, that is why disten-
m x m i, - f i & w . j f f w
Mi and pain are alleviated; hyponchondriac distensin

Mkl pain are due to emotional upsets and stagnation of liv i|l which prevent free dispersin and inhibit flow of meqi; distending oppression of chest is due to stagnaMtin of pulmonary qi; epigastric and abdominal distending
roR'W $!&f&li.
|Mlil is due to stagnation of gastric and intestinal qi; opMMion and pain over the chest is due to obstruction of
Bfiri qi and inhibited flow of blood in vessels.
I Key points for syndrome differentiation: Local dishrilng oppression and pain. The symptoms are usually
rluiiH due to different causes of qi stagnation and patho-
* m,
nl changes of different viscera. So cares should be

ten l<>differentiate the location of distending oppression
* 1 (niii as
1.2 . 1. 4
w # * , $ & frm m n
ffi
well as the accompanied symptoms.
Qi reversin syndrome
(ES) n i$ E
Qi reversin syndrome refers to symptoms of

klldi r of qi to ascend and descend, or excessive ascent.
lili yndrome is usually caused by exogenous pathogenic
J^ f-S P W ijE fe o
4m i I
M u s , or phlegm, retention of food, retention of cold

piil. o emotional upsets which lead to upward reversin
0 pulliHHiary and gastric qi as well as excessive ascent of
MtikF*3# .
Jlf M * i . Sfcflril,
liver qi.
Clinical manifestations: Cough and asthmatic breath
in upward reversin of pulmonary qi: hiccup. belching,
QlL
3 % I J! Wl) I
nausea and vomiting in upward reversin of gastric qi;
kmymm. m
headache, dizziness, even coma and hematemesis in up
n h lir c
ward reversin of liver qi.
[l,V -M: S-. 'YM .NElto
Analysis of symptoms: Cough and asthmatic breath

are due to invasin of exogenous pathogenic factors, or
accumulation of phlegm which drive the pulmonary qi to
ifn
vomiting are due to invasin of exogenous pathogenic fac
J
gt I % T fo ffi $ >JWm
i
tors, or retention of food and retention of phlegm and flu
id in the stomach which prevents the gastric qi from de-
i j M i i s & f i i r . a 't
flow adversely upwards; hiccup, belching. nausea and
jf p .i''t U ^ t ^ I R T i - l
fe#
scending and drives it to flow adversely upwards; headache. dizziness and even coma are due to emotional upsets
k m $. I : ; - i f t A I I - M K
and impairment of the liver by rage which prevent the liv
er qi from free dispersing and drives it to ascend exces-
Iff] h ?!,150 % { PJ O. _t M .|A
sively, making stagnant qi transform into fire which
oKlfito
i1-1
.: v V K : iii ^ J
moves up to disturb the head and eyes along the meridians; hematemesis is due to upward flow of blood with ad
verse running of qi and impairment of yang collaterals.
Key points for syndrome differentiation: Upward ad
verse flow of lung. stomach and liver qi.
2. 2. 2
Syndrome differentiation of blood disease

!ii[M;-r'-
Blood disease is either of asthenia syndrome due to
-a
i M-idiI
inability of blood asthenia to nourish the body. or of sthe
j iM ' it; lr # M !l-, !/4 HH
nia syndrome due to blood stasis, blood heat and blood
:! ;
coid resulting from disturbance of blood circulation.
f' - Ifu
2.2.2.1
Bood a s th e rra syndrom e
Blood asthenia syndrome refers to asthenia syndrome

caused by failure of insufficient blood to nourish viscera.
'))
h n'ii I,; !!1 ,'ft > >1 I I
%J !!L#k .
Jlt-W , l i l i l
( ) ito iS E
if iij i- jM iM
^ '.i
meridians and tissues. Ibis syndrome is usually caused by
4m
Vmiotis chronic and acute bleeding. or by excessive con-
; i if ii;
iIi
tt
ig * ^ &
Iilinplation and anxiety which have consumed blood. or by
- Sf K JI; WL
K Mi
Mlhrnia of the spleen and stomach which affect blood pro-
fffi ^L; c W- f
llUi lion, etc.
'I
Ifil
Clinical manifestations; Pal or sallow complexin,

imlr eyelids, lips and nails, dizziness. palpitation, insomIiIm. numbness of hands and feet, scanty, pal and delayed
Itriistruation, or even amenorrhea, pal tongue, and thin
J S s K tfc ,
lid weak pulse.
Analysis of symptoms: Pal or sallow complexin as
v E m m f:
rill as pal eyelids, lips and tongue are due to failure of

tlicnic blood to nourish the face; dizziness is due to as-
Kll? J F l : IlLJ^r [1 lk
llriiic blood to nourish the head; palpitation and insomnia

ii' due to failure of asthenic blood to nourish heart spirit;
tf:, 7 ftbm &
# , M ifrt f k
mlmess of hands and feet as well as pal nails are due to

Hlinv of asthenic liver blood to nourish tendons; scanty,
5L
, /IV tp fe
: tfj] M
|Mli' and delayed menstruation or even amenorrhea is due

insulticiency of blood in uterus and thoroughfare and
itvplion vessels; thin and weak pulses are signs of inWlii'icncy of blood in the vessels due to blood asthenia.
BM
Je f j , It il iM Jcl'fci T B M
m
Key points for syndrome differentiation: Lack of
HffiW A :
tiEVA
llx'i nutrition of the body with the manifestations of

If complexin, eyelids, lips, tongue and nails as well as
poliiiic tion of the organs with the symptoms of dizziness
T i f # , VA
# 4 Bb M K % 3% Wr
W
:<l palpitation, etc.
2 2 . 2.2
Biood stasis syndrome
' Hlood stasis syndrome refers to syndrome caused by
(z) m e
M
iiE Jit g ^ jfn
Nftilion of blood stasis in the body. Blood stasis refers to
ii m
m n m ..
Ilrnvasalion of blood that is not excreted or dispersed in

i mui retained in the body; or refers to stagnation of
imd ni Ihe meridians, vessels or organs and tissues due
llilnliiled circulation of blood. This syndrome is usually
{ I1 :
n r-% .BM T
III A j f
M Vi 'di
il fc
caused by extravasation and stasis of blood due to trauma

or qi asthenia; or by qi stagnation inhibiting blood circula
tion; or by failure of asthenic qi to propel blood to flow;
or by stagnancy of blood due to retention of pathogenic
cold in the vessels; or by confliction between heat and
M M U A J L # , JfiLftJW
blood due to invasin of pathogenic heat into blood phase.

Clinical manifestations; Stabbing and cutting pain
with fixed location which is unpalpable and worsened at
J M T J f f l.S P f t S S g .f B c . f )
night; local lumps which appear cyanotic in the superficies

and hard and unmovable in the abdomen; repeated bleed
ing with purplish colour or with clot or with asphalt-like
stool; amenorrhea or metrorrhagia in women; blackish
complexin, cyanotic lips and nails. subcutaneous purplish
petechiae, or squamous skin. or visible abdominal veins.
or silk-like red stripes on the skin; cyanotic tongue or
with cyanotic petechiae and points, thin and astringent
pulse.
M IS . & J fti & M ttli
B&mm.
Analysis of symptoms: Stabbing pain with fixed posi
tion is due to obstruction by blood stasis; severe and un
M1J f i , Wln fs p t M
\7J wi
palpable pain is due to aggravation of inhibited qi move

ment under pressure; severe pain at night is due to the
ftliM
f f i fe & m Pil 1
fact that yinqi is active in the night and blood stagnation

becomes more serious; purplish lumps on the superficies
iil W IR
and hard, unmovable and unpalpable lumps in the abdomen

are due to local retention of blood stasis; repeated bleed
ing with purplish colour, clot, or asphalt-like stool, or
metrorrhagia ar due to obstruction of vessels resulting
from blood stasis and extravasation of blood; cyanotic
lips, tongue and nails, or subcutaneous petechiae, or silklike red stripes, or local visible veins are due to retention
of blood stasis and inhibited flow of qi and blood; blackish
complexin and squamous skin are due to prolonged
i l .
fl
179
I ) fferciitiat on o f nyntlrotnc
rrlciilion of turbid substance and malnutrition of skin and

mu i idians;
amenorrhea is due to stagnation of blood stasis
nlid obstruction of thoroughfare and conception vessels;
. a n K X f f .n a K
s m s m
m' 'k # MU n[ ALlili fe %.j .
iiltriugent pulse is a sign of retention of blood stasis in the

Vrssels and inhibited flow of blood.
.H d & m .
Rey points for syndrome differentiation: Stabbing

[pniti with fixed position. lumps, bleeding with purplish
W ife , J f l J l L t f W.
D Iih ii . cyanotic lips. tongue and nails.
| 2.2.2.3
Blood cold syndrom e
(.= .) tnSE
lilood cold syndrome refers to syndrome caused by

ftild retention and qi stagnation in local meridians and vesH'k
This syndrome is usually caused by retention of
fe
pthojenic cold in the vessels and stagnaney of qi; or by

lilbited flow of blood due to cold produced by yang asthe-
t&ilJLft};
lliu which deprives blood of warmth and proper circula-
lliin.
Clinical manifestations: Local cold pain which alleviDlt'N with warmth and aggravates with cold, cyanotic and
, Hll'l skin over the affected part. delayed menstruation,
f is?, >
k iJ
' M >2
(iurplish menorrhea with clot. dysmenorrhea, purplish

I Iihikiic with white fur, and sunken, slow and astringent
il*'
Analysis of symptoms: Local cold, preference for
Efe^-tff: B M M M \
[Hfiii inlli and purplish and cold skin are due to stagnation of
n mui blood resulting from pathogenic cold. or due to inM
lill r il
blood circulation resulting from failure of asthenic
n iiK lo warm vessels and transport blood; delayed mentlniiilion, purplish menorrhea with clot, dysmenorrhea or
BVili imenorrhea are due to retention of cold in the uteh i i, disorder of thoroughfare and conception vessels and
iHllli.iiK'y of blood in circulation; purplish tongue with
filil
lu . sunken, slow and astringent pulses are signs of
l E , ^ Jii i
t l .
retention of pathogenic cold in the vessels and inhibited

flow of blood.
mu
Key points for syndrome differentiation: The syn

drome is marked by stagnant blood circulation due to excessive interior cold with local cold pain alleviated with
warmth and cyanotic skin.
2.2.2.4
Blood heat syndrome
(E S ) JfllSViiE
Blood heat syndrome refers to syndrome caused by

exuberance of fire and heat in the viscera that invades
g .a & j L a -ftx a ftm il
blood phase. This syndrome is usually caused by extreme

emotional disorder which transforms into fire; or by excessive drinking of alcohol which transforms into heat and
invades blood phase. Blood heat syndrome can be seen in
miscellaneous disease due to internal impairment and ex
t ffc fc J S lr
ogenous febrile disease which are discussed in the section

of syndrome differentiation of wei, qi, ying and blood.
Clinical manifestations: Hemoptysis, or hemateme
fS S tJ l: [^JL,^cnJL,
sis, bleeding, hematuria, hematochezia, advanced pro

fuse menstruation, even metrorrhagia, dysphoria, thirst,
deep reddish tongue and fast pulse.
Analysis of symptoms; Internal exuberance of fire
vEmMfr-.
and heat impairs collaterals and causes various bleeding

marked by sudden onset, profuse quantity and deep red
JM, S.M W % # & U ftJ J1
colour; fire and heat may lead to different blood syn

dromes when they have impaired different viscera: im
pairment of lung collateral causes hemoptysis, impairment
MJhjfiLffif: M sW & . iJ
of stomach collaterals causes hematemesis, impairment of

the kidney or bladder causes hematuria, impairment of the
large intestine causes hematochezia and impairment of the
thoroughfare and conception vessels causes advanced and
profuse menstruation or even metrorrhagia; internal exu
1.
berance of fire and heat consumes fluid and causes thirst;

heat disturbs heart spirit and causes dysphoria; exuberant
-i> M
heat promotes blood flow and drives blood to the vessels of
S - P iU J L 'S 't E ^ ;
f f i J a S i
>
f t j i i i r J
l l
longue and makes the tongue appear deep red; heat proprls blood and leads to fast pulse.
Key points for syndrome differentiation: This synW*ome is marked by various bleeding accompanied by
K E 5 /S :
ifilS tf 0f
BJttL, m )k
fiymptoms of internal exuberant fire and heat, such as

tlysphoria, thirst, deep red tongue and fast pulse, etc.
2. 2. 3
Syndrome differentiation of simultane-
=-s
H LW \m m v E
ous disorder of qi and blood

Qi and blood depend on each other to exist and profcote each other to develop. Pathologically, qi and blood
Ifeet each other, blood disorder may involve qi and vice
n|nj.
-til e +
fersa. If qi disorder and blood disorder appear at the same

Bmc, it is known as simultaneous disorder of qi and blood.
jm .
x & ju i .
fclinically, simultaneous disorder of qi and blood is divided

lulo two major categories: asthenia of both qi and blood,
% JI IrI^ E ^ , JilE M % jl ij
k s of blood due to qi asthenia, qi depletion with blood in

pitlienia syndrome; qi stagnation and blood stasis in stheluu syndrome, and qi asthenia and bjood stasis in synIfome of principal asthenia and secondary sthenia.
2 .2 .3 .1
Asthenia of both qi and blood
( - ) n im s i^ u E
Asthenia of both qi and blood refers to syndrome

rtJmised by simultaneous existence of qi asthenia and blood
Hh( henia.
k & m t f & m m t t jm 'ji.,
This syndrome is usually caused by asthenia of
I ;ind blood in chronic disease; or by asthenia of the

pirn and stomach that affeets the production of qi and
llood; or by qi loss of blood followed by depletion of qi; or
ky <|i asthenia followed by blood asthenia.
Clinical manifestations: Lack of qi, no desire to
||xmI<, dispiritedness, fatigue, or spontaneous sweating,
Ixziness, palpitation, pal or sallow complexin, pal lips
HiKI nails, pal and tender tongue, thin and weak pulse.
182
Analysis of symptoms: Lack of qi, no desire to
iB m t r : l i l i l !
speak, dispiritedness, fatigue or spontaneous sweating are

due to hypofunetion of viscera due to qi asthenia? pal or
sallow complexin as well as pal lips and nails are due to
inability of qi and blood asthenia to nourish the body; diz
ziness, palpitation and insomnia are due to the inability of
qi and blood asthenia to nourish the head and heart spirit;
I Ro
pal and tender tongue as well as thin and weak pulse are
signs of qi and blood asthenia.
f fiiu
Key points for syndrome differentiation: Hypofunction of the viscera due to qi asthenia and inability to nour
S 1S
S &
i fu j4lJ 4?!
ish viscera and body due to blood asthenia.
2.2 .3 .2
Qi asthenia and hemorrhagia syn
(z)
drome
Qi asthenia and hemorrhagia syndrome refers to syn
^ C ft^ J liiE jif T l
drome caused by failure of asthenic qi to control blood.
MIU (ti j f t J
This syndrome is mainly caused by spleen asthenia due to
Efe. * v E A
chronic disease, or by inability of asthenic qi to control

blood resulting from overstrain.
H.S.
Clinical manifestations: Hematemesis, hematochezia, or muscular bleeding, or epistaxis, or profuse men
MM. >c W iffl # M >sStfl t
struation, metrorrhagia, accompanied by lack of qi, no

desire to speak, lassitude, pal complexin, pal tongue
and weak pulse.
Analysis of symptoms: Failure of asthenic qi to con
trol blood and extravasation of blood lead to hematemesis,
hematochezia, bleeding and metrorrhagia? lack oqi, no
desire to speak ahd lassitude appearing at the same time or
in advance of bleeding are due to hypofunction of the vis
,i * t iJ ilW | s | W ,^ l
cera resulting from qi asthenia? pal complexin and
k & W J t K m S M . Z
tongue as well as weak pulse are signs of asthenia of both

qi and blood due to bleeding.
Key points for syndrome differentiation: Hypofunction
f e & i,S .l8 3 3 .
ni the viscera and bleeding.

2.2.3.3
Depletion of qi w ith bleeding syn
It * ^ ?S ^ ifim i ] JlV M
( = ) nien Q fE
drome
Depletion of qi with bleeding refers to syndrome in
n B tJ fo J H jE J tf :* :*
Which qi depletes due to massive bleeding. This syndrome

I* usually caused by trauma, or by damage of the viscera,
in by massive bleeding from uterus or in delivery of child.
Clinical manifestations: Massive bleeding accompaflied by pal complexin, profuse sweating, coid limbs,
LMPI&t,#LBfe:8 I.*
Weak breath, extreme dispiritedness, even coma, pal

tongue, indistinct pulse, or hollow pulse, or scattered
toulse.
Analysis of symptoms: Blood is the mother of qi, so
loss of blood will lead to loss of qi at the same time; pal
a.m \3ttm , K m 2 .t:
Complexin and coid limbs are due to loss of qi and yang to

Warm the body; profuse sweating is due to sudden loss of
yangqi which weakens the superficies and gives rise to
leakage of fluid; weak breath, extreme dispiritedness and
h*,WJJL?TM;L&
even coma are due to loss of proper nutrition of the spirit

resulting from depletion of qi and blood; indistinct pulse
1(11
Or hollow pulse or scattered pulse are due to loss of qi and
, 7 t H 9 i f e , J0c % % &
blood that disperses primordial qi and fails to enrich the

Vessels; pal tongue is the sign of consumption of qi and
tu .
blood which fail to nourish the head.
6MEft.
c.*
Key points for syndrome differentiation: Massive

bleeding and simultaneous loss of qi and blood.
2 .2 .3 .4
Qi asthenia and blood stasis syndrome
(BS) n ^ fln K E
drome caused by blood stagnation resulting from qi asthe-
mtLMEJ6f'Hl*:B
l* * , # a ln &wm&m
liia to transport blood. This syndrome is usually caused by
W E f .
Qi asthenia and blood stasis syndrome refers to syn
qi asthenia to propel blood in chronic disease and gradual
% t i , ffiW
forma tion of blood stasis due to inhibited flow of blood.
BOL o
Br
Clinical manifestations: Dispiritedness, lackofqi, no

desire to speak, or spontaneous sweating, fixed, unpalpa
ble and stabbing pain over the chest, hypochondrium and
other local regions, pal complexin, light purplish tongue
or with petechiae, sunken, astringent and weak pulse.
Analysis of symptoms: Dispiritedness, lack of qi, no
desire to speak, spontaneous sweating and pal complex
k m
iJ j is f
M *
m tm
3: t i*
in are due to hypofunction of the viscera and tissues;

fixed, unpalpable and stabbing pain is due to inhibited flow
of blood; light purplish tongue or with petechiae, sunken,
astringent and weak pulse conditions are signs of qi asthe
nia and blood stasis.
drome is marked by the manifestations of both qi deficien
cy and stagnant blood circulation.
2. 2. 3. 5
Qi stagnation and blood stasis
( E ) ngM UKfiE
syndrome
Qi stagnation and blood stasis syndrome refers to
syndrome caused by stagnation of qi and stasis of blood.
This syndrome is usually caused by emotional upsets, or
by invasin of pathogenic cold and stagnation of qi and
"^T
blood. Qi can promote blood circulation and blood can car-
l, j M c % ^ J f [ L :F A {fc rt
ry qi. Since qi and blood circuate continuously inside the

body, qi stagnation and blood stasis frequently affect each
other and often appear at the same time.
Clinical manifestations: Depression or restlssness,
whmmm: t t i i
distending pain or migratory pain over chest and hypo

chondrium, or accompanied by mass formtion, unpalpa
ble stabbing pain, purplish tongue or with purplish pete
chiae, taut and astringent pulse, distending pain of breast
before or after menstruation,
dysmenorrhea, purplish
menstruation with blood clot, or amenorrhea, etc.
mm o
Analysis of symptoms: The symptoms in this syn
s "H'W i M i* |(||
drome vary due to the location of qi stagnation and blood

stasis in different viscera and meridians. Clinically the
common manifestations are qi stagnation and blood stasis
due to stagnancy of qi activity and failure of liver to dis
perse and convey because the liver governs dispersin and
conveyance and stores blood. Depression or restlessness,
distending fullness of the chest and hypochondrium, mi-
1f W1? ^ M M , W
gratory pain and distending pain of the breast are due to
I LS Kf l ;
Jjfc
,t
11 ^
stagnation of liver qi and failure of the liver to disperse

and convey? hypochondriac lumps and unpalpable stabbing
pain are due to internal retention of blood stasis resulting
from prolonged stagnation of qi and inhibited flow of
blood; dysmenorrhea, purplish menorrhea with blood clot

and even amenorrhea are due to qi stagnation and blood
stasis; purplish tongue or with purplish petechiae as well
as taut and astringent pulse are signs of qi stagnation and
blood stasis.
Key points for syndrome differentiation: Stagnancy of
qi activity, inhibited blood circulation and blood stasis.
2. 2. 4
f P
L t
IS . ^
fe ) ^
)) j (
Syndrome differentiation of fluid disorder
The disorders of body fluid mainly include deficiency
K]
of body fluid as well as retention of phlegm and fluid and
ni
A W E l i ; % - j, u
edema. The former is caused by insufficiency of the production of body fluid or excessive loss of body fluid, the
latter is caused by dysfunction of the viscera and disturbftnce of the distribution and excretion of body fluid which
leads to the retention and accumulation of fluid.
2 . 2 .4 .1
Insufficiency of body fluid
Insufficiency of body fluid refers to syndrome due to

deficiency of body fluid which fails to nourish and moisten
viscera, tissues and organs. This syndrome is mainly
lj jji. ||
(- )
lused by excessive consumption of body fluid due to high

ver, profuse sweating, excessive vomiting, excessive
arrhea and profuse urie or consumption of fluid by dry.ss and heat; or by insufficiency of body fluid due to
:anty drinking of water and decline of visceral qi.
Clinical manifestations: Dry mouth and throat, dry or
ssured lips, sunken orbit, dry skin, thirst with desire
>r water, scanty urie, retention of dry feces, dry
mgue with scanty saliva and thin and astringent pulse.
Analysis of symptoms: Dry mouth, lips, tongue,

iroat and skin as well as sunken orbit and thirst with de
mmmmm
n ,
re for water are due to failure of deficient body fluid to

ourish and moisten the viscera and body; scanty urie is
je to deficiency of body fluid to transform urie; retention
dry feces is due to scanty body fluid to lubricate the
irge intestine; scanty saliva is due to deficiency of body
fif;
. SfeSttS *JW
uid to moisten the tongue; thin and fast pulse is due to

sufficiency of qi and blood.
Key points for syndrome differentiation: Dry mouth,
HES/S: *fiEKJin JB,
ps, tongue, throat and skin as well as scanty urie and

ry stool.
2.2.4.2
Phlegm syndrome
( Z ) &E
Phlegm syndrome refers to syndrome due to local

i'tention of phlegm or migra tion of phlegm. Phlegm is
roduced by such factors like six exogenous pathogenic fac-
U d S fl. f W A S ,
)rs, emotional impairment, improper food, overstrain

ud lack of necessary physical activities which affect the
ransforming functions ol the lung, spleen and kidney,
ading to stoppage of fluid distribution and production of
hlegm. The retention of phlegm in viscera, meridians
nd tissues results in phlegm syndrome.
^vEo
Clinical manifestations: Cough with sticky sputum,
chest oppression, or dizziness, or epigastric mass, ano
, g <0
rexia, nausea, vomiting, or coma with sputum rale, or
i i t
mental derangement with mania, dementia and epilepsy,

or numbness of limbs, hemiplegia, or scrofula, goiter,
breast nodules, phlegm nodules, greasy fur and slippery
pulse.
Analysis of symptoms: Phlegm is marked by variability in causing disease. So there is a saying that all disea
$ ^
, wl t w
ses are caused by phlegm . Chest oppression and cough

with sticky sputum are due to retention of phlegm in the
lung which affects the lung to disperse and descend; dizzi
?fe. i PR'FJK W
Jtr @
ness is due to phlegm invading the head and preventing lu
s fS S * a ,] & I : 5 ,f
cid yang from rising; epigastric mass, anorexia, vomiting

l and nausea are due to retention of phlegm in the middle
energizer that prevents the spleen from transforming and
the stomach from descending; coma with sputum rale or
mental derangement with mania, dementia and epilepsy
i are due to phlegm confusing the mind; numbness of limbs,
or hemiplegia is due to retention of phlegm in the meridi
ans and inhibited flow of qi and blood; scrofula, goiter,
breast nodules and phlegm nodules are due to retention of
phlegm in the skin and muscles; greasy fur and slippery
pulse are signs of intemal exuberance of phlegmatic damp
ness.
Key points for syndrome differentiation: This syn
drome is marked by vomiting of sputum or dizziness, vom
iting, or coma with sputum rale, or numbness of limbs, or
phlegm nodules, greasy fur and slippery pulse. Phlegm
syndrome may be divided into cold phlegm, heat syn
drome, damp phlegm, dry phlegm and stagnant phlegm
according to the nature of phlegm and the complication
which should be carefully differentiated.
caused by excessive consumption of body fluid due to high

fever, profuse sweating, excessive vomiting, excessive
diarrhea and profuse urie or consumption of fluid by dry
ness and heat; or by insufficiency of body fluid due to
scanty drinking of water and decline of visceral qi.
Clinical manifestations: Dry mouth and throat, dry or
fissured lips, sunken orbit, dry skin, thirst with desire
for water, scanty urie, retention of dry feces, dry
* . /hu M
te-fe. SS
tongue with scanty saliva and thin and astringent pulse.
le
ms .
Analysis of symptoms: Dry mouth, lips, tongue,
f:
throat and skin as well as sunken orbit and thirst with de

sire for water are due to failure of deficient body fluid to
/ B ,f
nourish and moisten the viscera and body; scanty urie is

due to deficiency of body fluid to transform urie; retention
of dry feces is due to scanty body fluid to lubrcate the
large intestine; scanty saliva is due to deficiency of body
PJMe
fluid to moisten the tongue; thin and fast pulse is due to

insufficiency of qi and blood.
EWn JS,
Key points for syndrome differentiation: Dry mouth,

lips, tongue, throat and skin as well as scanty urie and
dry stool.
2.2.4.2
Phlegm syndrome
( Z ) &E
Phlegm syndrome refers to syndrome due to local

retention of phlegm or migration of phlegm. Phlegm is
produced by such factors like six exogenous pathogenic fac
t B - ^ T l- S A S .
tors, emotional impairment, improper food, overstrain

and lack of necessary physical activities which affect the
transforming functions of the lung, spleen and kidney,
leading to stoppage of fluid distribution and production of
phlegm. The retention of phlegm in viscera, meridians
g T *
and tissues results in phlegm syndrome.

^ E .
Clinical manifestations: Cough with sticky sputum,
Different Inl ion o nynclrome
chest oppression, or dizziness, or epigastric mass, ano

rexia, nausea, vomiting, or coma with sputum rale, or
mental derangement with mania, dementia and epilepsy,
iil n,
a ro * , a
or numbness of limbs, hemiplegia, or scrofula, goiter,

breast nodules, phlegm nodules, greasy fur and slippery
pulse.
Analysis of symptoms: Phlegm is marked by variability in causing disease. So there is a saying that all disea
ses are caused by phlegm . Chest oppression and cough
with sticky sputum are due to retention of phlegm in the
lung which affeets the lung to disperse and descend; dizzi
H& 4EI
ness is due to phlegm invading the head and preventing lu

cid yang from rising; epigastric mass, anorexia, vomiting
and nausea are due to retention of phlegm in the middle
energizer that prevents the spleen from transforming and
the stomach from descending; coma with sputum rale or
mental derangement with mania, dementia and epilepsy
are due to phlegm confusing the mind; numbness of limbs,
or hemiplegia is due to retention of phlegm in the meridi
ans and inhibited flow of qi and blood; scrofula, goiter,
im
breast nodules and phlegm nodules are due to retention of

phlegm in the skin and muscles; greasy fur and slippery
pulse are signs of internal exuberance of phlegmatic damp
ness.
drome is marked by vomiting of sputum or dizziness, vom
iting, or coma with sputum rale, or numbness of limbs, or
phlegm nodules, greasy fur and slippery pulse. Phlegm
su
syndrome may be divided into cold phlegm, heat syn
M & R n m a L v E im *
drome, damp phlegm, dry phlegm and stagnant phlegm

according to the nature of phlegm and the complication
which should be carefully differentiated.
R m & m m m ,
2.2.4.3
( .= ) tM E
Fluid-retention syndrome
Fluid-retention syndrome refers to syndrome caused

by retention of fluid in the viscera and tissues, usually
caused by stoppage of fluid and retention of fluid resulting
from six exogenous pathogenic factors, or overstrain and
I( St 7jt & ;fj, f f S
weakness.
Clinical manifestations: Epigastric and abdominal
fullness and distensin, borborygmus, vomiting of clear
t $S.
t t 7jc,
tt* C
fluid; or cough and asthma, profuse thin sputum, chest

oppression and palpitation, even inability to lie fat on
bed; or thoracic and hypochondriac fullness, distending
pain, aggravation of pain after cough, spitting or rota ting
the body; or dizziness, dysuria, dropsy and aching heavi
ness of the limbs; whitish slippery fur and taut pulse.
Analysis of symptoms: The symptoms are various due
to different location of fluid-retention. In his Synopsis of
Golden Chamber, Zhang Zhongjing divided fluid-retention
syndrome into phlegmatic fluid-retention ( in a narrow
sense), suspended fluid-retention, sustained fluid-reten
tion and extravasating fluid-retention. Phlegmatic fluid-
m .
retention is marked by epigastric and abdominal disten
sin, borborygmus and vomiting of clear fluid due to re
pb*
w.yMLl
fuirfl/K -if
tention of fluid in the stomach and intestines, inactiva tion

of gastrosplenic yang and dysfunction of transportation and
transformation; suspended fluid-retention is marked by
chest and hypochondrium fullness, distending pain, aggra
vation of pain after cough, spitting or rota ting the body
due to retention of fluid in the chest and hypochondrium;
sustained fluid-retention is marked by cough and asthma,
profuse thin sputum, chest oppression and palpitation, e-
g S t T r a t e m K .M t e f r f .
uw .
ven inability to lie fat on bed due to retention of fluid in

the lung and fluid-retention invading the heart; extravasa
ting fluid-retention is marked by dizziness, dysuria, drop
sy and aching heaviness of the limbs due to retention of
E#U
fluid in the muscles of the four limbs; whitish slippery

tongue and taut pulse are signs of fluid-retention.
Key points for syndrome differentiation: Phlegmatic
fluid-retention is marked by epigastric and abdominal full
ness and distensin as well as borborygmus; suspended
fluid-retention is marked by thoracic and hypochondriac
I $ 3
tillness, distending pain, aggravation of pain due to spitting, cough or rotation of the body; sustained fluid-reten
tion is marked by cough and asthma, profuse and thin spu
m w m m m .
tum, chest oppression and palpitation; extravasa ting fluid-
T0$itciS.
Ictention is marked by dropsy of limbs and dysuria.
2.2.4.4
Edema
(ES) 2 k
Edema refers to dropsy of eyelid, face, four limbs,

hest and abdomen or even the whole body due to
iceumulation of fluid in the muscles resulting from
(listurbance of the lung, spleen and kidney in distribu ting
Rlid excreting fluid. Clinically, edema is divided into yang
M im w m E .
Wcma and yin edema.

2 .2 .4 .4 .1
Yang edema
1. P07Je
Yang edema, of sthenia in nature, is marked by

IWelling above the waist and short dura tion due to exoge-
5 I E . 5 l i t 'S , ^ S a .
lious pathogenic wind or spreading of fluid and dampness.
J U T ^ I M tR W .
mm.
*
Clinical manifestations: Dropsy of face and eyelids,
BvcMitually involving the whole body with rapid developHHfit. smooth and bright skin, scanty urie, accompanied
Hty Irver, aversin to wind and cold, aching pain of limbs,
mi i'-lliroat, thin fur and floating pulse; or dropsy of the
Wholr body with slow development, depression under
Hfi'NNiirC' heaviness of the limbs, epigastric and abdominal
Iflllliu'ss and oppression, poor appetite, nausea and regurg itiftlo n ,
whitish greasy tongue fur as well as soft and
llnw pulse.
Analysis of symptoms: Dysuria and sudden dropsy are

due to disorder of fluid distribution and spreading of fluid
in the muscles resulting from dysfunction of the lung to
disperse and reglate caused by wind attack; dropsy of
head and eyelids with the involvement of the whole body
due to the fact that wind tends to float upwards and
change and that wind comes into combination with fluid;
fever, aversin to wind and cold, aching pain of limbs,
sore-throat, thin fur and floating pulse are due to patho
W, # te W BS s i . 1
.S .
genic wind invading the lung and failure of the lung to dis
perse; general edema and heaviness of limbs are due to
encumbrance of the spleen by fluid and dampness which
te n a te ,
leads to failure of yangqi to rise, dysfunction of transfor

mation and extravasa tion of fluid; dysuria or scanty urie
is due to internal accumulation of fluid and dampness, dys
function of the triple energizer to control fluid and dis
turbance of the bladder to transform qi; epigastric and
* , $ n 0 H U K .i^
abdominal fullness and oppression, poor appetite, regurgi-
i,
tation and nausea are due to encumbrance of the spleen

and stomach by dampness which affects ascent and de
scent.
drome is marked by rapid onset and development of edema
primarily involving the eyelids, face and head as well as
severe edema of the upper part of the body.
2 .2 .4 .4 .2
Yin edema
2. K7K
Yin edema is marked by asthenia of spleen and kidney

qi, severe edema of the part below the waist and long duration, usually cased by asthenia of the healthy qi due to
w . g m m iK iE ,
prolonged illness, internal impairment due to overstrain

and consumption of spleen and kidney yang.
Clinical manifestations: Repeated relapse of edema,
severity below the waist, depression under pressure, epi
gastric and abdominal distensin and oppression, poor
7 m s .n l
nppetite and loose stool, dispiritedness, fatigue of limbs,

cold body and limbs, preference for warmth, or aching
K & 7h M 'P , E fe afl nJi.
cold sensation of loins and knees, scanty urie, dull or

pille complexin, pal and bulgy tongue with white and
ulippery fur as well as sunken, slow and weak pulse.
Analysis of symptoms: Edema and scanty urie are
E fe fttlf: M i U i s A ,
due to spreading of fluid and dampness resulting from fail

ure of the asthenic spleen yang to warm and transport and
*|J .7K S?ffi. iJ 7jCj, /h- i
failure of asthenic kidney yang to transform qi; repeated

relapse of edema, severity below the waist and depression
under pressure are due to asthenia of spleen and kidney
yang, accumulation of fluid and dampness, downward migration of dampness as well as heavy and sticky nature of
dampness; cold body and limbs, aching cold sensation of
# ) f t $ .8 J B ! $ ,f f if e S i
[loins and knees, dull or pal complexin, dispiritedness

and fatigue of limbs are due to asthenia of spleen and kid-
>7|C
, J|JK MI
Hey yang and decline of mingmen fire to warm and nourish

the body;
epigastric and abdominal
distensin and
g l I lM J f tM jS X ij.J iP B I!
Oppression, poor appetite and loose stool are due to

[isthenia of spleen yang and inability to transport and
transform; pal and bulgy tongue, white and slippery fur
ns well as sunken, slow and weak pulse are signs of yang
listhenia and internal exuberance of dampness.

Key points for syndrome differentiation: Repeated
g ? E f ? : ^ v E W m i i
welapse of edema, long dura tion, severity below the

Waist, accompanied by asthenia of spleen and kidney
nng.
2 .3
Syndrome differentiation of
viscera
Syndrome differentiation of viscera means to

differentiate syndromes according to the physiological
functions and pathological changes of the viscera.
w # .* js lw p
Syndrome differentiation of viscera is the base for

syndrome differentiation in the clinical specialties of TCM
i m m & , s * m m ie* $ >h I
and is an important part in the syndrome differentiation
iiie I
system in TCM. Syndrome differentiation of viscera, a

further progress of syndrome differentiation of eight prin
cipies as well as qi, blood and body fluid, is helpful for dif
ferentiation of the location, cause and nature of disease,
the conditions of healthy qi and pathogenic factors as well
as the pathological states of the viscera, making it more
specific for treatment.
2.3.1
Syndrome differentiation of heart disease
Pathological changes of the heart refer to the dysfunction of the heart and its functions to govern the mind
and blood vessels, clinically marked by palpitation, heart
ES, ilS#; IX *i>tf I
pain, dysphoria, insomnia, dreaminess, amnesia, de

rangement, knotted pulse, slow regular intermittent pulse
or rapid irregular intermittent pulse. Since the heart
opens to the tongue, so some of the tongue disorders,
such as tongue pain and tongue sore, are also related to
the heart.
T *>7F ? T-Sr. 0
. iP f * , g - f f - .
|J3M T'Ci'
The heart disease is either asthenic or sthenic. As

thenic heart disease is usually due to excessive anxiety, con
i'J W
genital defects. asthenia of visceral qi in senility or im
3 5 JE, gSc^ i5Bt % t Si I
pairment of the heart by prolonged illness which leads to
tK in as
# a * % , -i>H
asthenia of heart qi, asthenia of heart blood, asthenia of

heart yin and sudden loss of heart yang. Sthenic heart dis
ease is due to phlegm retention, fire disturbance, cold coagulation, qi stagnation and blood stasis which lead to ob
struction of heart vessels, hyperactivity of heart fire,
J U f c f c lt f r * .
confusion of heart by phlegm and phlegmatic fire distur

bing the heart, etc.
2.3.1.1
A sth en ia of heart qi
Asthenia of heart qi refers to asthenia symptoms of
( - ) /isnffi
-L' 'n, i$ . iF t rti f
l.ilpitation and shortness of breath resulting from insuffi-
f lJ g a iK '
< lency of heart qi and failure of heart qi to propel. This

fjldrome is due to frequent weakness, or malnutrition
T%
Si
, sK
with prolonged disease, or deficiency of visceral qi caused

ItV senility, which leads to asthenia of heart qi, weakness
In propelling and malnutrition of the heart.
Clinical manifestations: Palpitation, shortness of
liitMth, spiritual lassitude, aggravation after movement,
t S
zhla
i n
f e lf c
|mIi* complexin, or spontaneous sweating, pal tongue

N|||(l weak pulse, seen in cardiac insufficiency ( compensalo ry
jRL
-f M
$5
14 'L' K
period) due to coronary atherosclerotic cardiopathy,
viral myocarditis, chronic rheumatic heart disease, hypom sio n,
primary myocardiopathy,
1 4 - B. l i Ha J1 ,
It
chronic pulmonary
Bnrt disease, and mitral valve prolapse syndrome as well
& m m % - -ffi^ &f a m
p patients with cardiac neurosis.
I Analysis of symptoms: Insufficiency of heart qi, lack

proper moisture and nourishment of the heart and irbillar beating of the heart lead to palpitation; shortness
breath and spiritual lassitude are due- to functional de
dillo resulting from qi asthenia; spontaneous sweating is
,tt & sK & 31
^ @
f f ; $1PJ H ffi >St 5J J i
l to qi asthenia and weakness of weiqi to protect the sulflicies; aggravation after movement is due to consumpIIimi of qi after movement; pal complexin, pal tongue
N IH l
weak pulse are due to failure of asthenic qi to propel
|li<l insufficiency of qi and blood.

L Key points for syndrome differentiation; Palpitation,
hIimi tness
of breath, spiritual lassitude, aggravation after
*EI
, n # m m >ffi %} s jjn t
Mvement and decline of functional activities due to qi aspniln.

k 5^,3.1.2
Heart yang asthenia syndrome
( Z ) ifo B M il
lieart yang asthenia syndrome refers to asthenia coid

Midime marked by palpitation, aversin to cold and cold
llttiliN din* to asthenia of heart yang to warm and propel.
< ifij i i S i
This syndrome is the further development of heart qi as

thenia in which asthenia of qi impairs yang and leads to as
thenia of heart yang and lack of proper warming and nourishment of the heart as well as inhibited circulation of
blood.
Clinical manifestations: Palpitation chest oppression
ilSSiSS!: -frtP
or pain, shortness of breath, spontaneous sweating, aver

sin to cold and cold limbs, pal complexin 01* cyanotic
complexin and lips, pal and bulgy tongue or purplish
tongue, whitish slippery tongue fur, weak pulse, or knot-
T J A L T g ttiti) *
ted pulse, or slow regular intermittent pulse. This syn

drome is usually seen in coronary atherosclerotic cardiopathy, infectious endocarditis, viral myocarditis, chronic
rheumatic heart disease, hypotension, primary myocardiopathy, chronic pulmonary heart disease, mitral valve
prolapse syndrome and cardiac insufficiency (compensa tory period) due to cardiac neurosis.
Analysis of symptoms; Palpitation is due to asthenia
of heart yang, weakness to propel and irregular heart
>'C.' 5)
f >
beating; chest oppression or pain and shortness of breath

are due to inactiva tion of thoracic yang; aversin to cold
jA*EPBS!filfeJUJcjl
and cold limbs are due to yang asthenia and lack of proper
warming; spontaneous sweating is due to weakness of
-i>PBi S is 5t t , Jfilt
weiqi to protect the superficies; pal complexin or cya
S iL ffife f d B ffeW *.,
notic complexin and lips as well as knotted pulse, slow
a .
regular intermittent pulse or weak pulse are due to asthe
S ! ,
nia of heart yang to warm and propel and inhibited circula

tion of blood; pal and bulgy tongue or purplish tongue as
well as white and slippery fur are signs of yang asthenia
and exuberant cold.
Key points for syndrome differentiation: Palpitation,
chest oppression or pain, weak pulse or knotted pulse and
slow regular intermittent pulse as well as aversin to cold
and cold limbs.
ni
2. 3 . 1 . 3
(E ) IOBBRBE
Sudden loss of heart yang syn
drome
Sudden loss of heart yang is a critical condition due to
'L'PH&KESS't'W*
extreme exhaustion of heart yang and sudden loss of yanK<|i. This syndrome is the further development of heart
fg. * i E r a n e t a
yang asthenia. It may be caused by severe impairment of

heart yang by pathogenic cold or obstruction of the heart
fti
hy phlegm.
S t# o
Clinical manifestations: Apart from the symptoms of
PBs fE
ffi. M 'll' ? Wi
teflcSS: E'OPBJiiEk
heart yang asthenia, there appear some other symptoms,

uuch as sudden profuse cold sweating, cold limbs, weak
.n m
w m
. ar a
breath, pal complexin, or sharp heart pain, cyanotic

lips, indistinct pulse, even or unconsciousness and coma,
mmse s
- s s t t M
s. vv
' n . S t r , 7F- S JR
itC W
UMually seen in cardiogenic shock due to various diseases.
Analysis of symptoms: Profuse cold sweating is due

lo leakage of body fluid with sudden loss of yangqi; cold
|limbs is due to decline of yangqi to warm the limbs; weak
breath is due to asthenia of yangqi and leakage of thoracic
(|i to help the lung perform respiration; pal complexin is
Hue to sudden loss of yangqi, weakness in warming the
InKly, inhibted circulation of blood and vacuity of the ves-
f f i , i f t f e b J 4 l
ir Is; sharp heart pain and cyanotic lips are due to inhibited
nrculation of blood and stagnation of blood in the heart
8* . J8l ' >
* iJ
a .D I fl.
tensis; unconsciousness or coma are due to declination of

Vibgqi, lack of necessary warmth and nourishment of the
flirt and dispersin of the spirit; indistinct pulse is a sign
^.*PBnfWiMEL
Ihe declination of yangqi.

Key points for syndrome differentiation: Asthenia of
Mltfqi' sudden profuse cold sweating, cold limbs, weak
breath, pal complexin, cyanotic lips and indistinct
I iii I n c .
PEWiC: EK-L'Wtf!
2.3.1.4
Heart blood asthenia syndrome
ffi
(B3) /MUfiiSE
'h ifiL J: i ^ a i i 'Li'
Heart blood asthenia syndrome is caused by asthenia
^ W*M
of heart blood and lack of proper moisture and nourishment of the heart. This syndrome is caused by weakness
vEfco
of the spleen in producing blood, or by excessive loss of

blood, or by lack of proper nursing in chronic disease, or
by consumption of heart blood.
Clinical manifestations: Palpitation, dizziness, in
somnia, dreaminess, amnesia, pal complexin or sallow
TiAl
complexin, pal lips and tongue as well as thin and weak

pulse, seen in various hemorrhagia, disturbance of blood
production and anemia due to various chronic and con-
=f &
& jfiL*
JfiLtJ fB *1 *
& It JI4
3UC
sumptive diseases.
Analysis of symptoms: Palpitation is due to insuffi
f & # *tkS L fc# i
ciency of heart blood, lack of proper nourishment of the

heart, and irregular heart beating; insomnia and dreami
jfiL> 5 #
* 'fr t t ^ 3cM ^ jlU<
ness are due to failure of blood to nourish the heart and

anxiety; dizziness, amnesia, pal or sallow complexin as
well as light whitish lips and tongue are due to failure of
a j t . j R S R jiiL '!? !
asthenic blood to nourish the head and face; thin and weak
pulse is due to insufficiency of blood in the vessels.
IjE
drome is marked by palpitation, insomnia, dizziness, pal

or sallow complexin, light whitish lips and tongue due to
failure of deficient blood to nourish the body.
Cifo
2.3.1.5
Heart yin asthenia syndrome
Heart yin asthenia syndrome refers to tHe syndrome
( E ) M M tiE
'C?
l ^ '^ 1
caused by depletion of heart yin and internal disturbance

of asthenic heat. This syndrome is usually caused by ex
o * fiE H IlJ S $ r # ;*
cessive contempla tion which consumes heart yin? or by
H tftifrM 3 R B & # fJn W
consumption of yin fluid at the advanced stage of febrile

disease; or by deficiency of liver and kidney yin involving
the heart.
= f^ m to
Clinical manifestations: Dysphoria, palpitation, in-
l|il
-11'fes |l'
, 'k
lomnia, dreaminess, afternoon tidal fever, feverish sen-
I la tion over five centers (palms, soles and chest), flushed

I fcheeks, night sweating, reddish tongue with scanty sali-
j fevM
VM, thin and fast pulse, usually seen in viral myocarditis,
iS Ifc t t
|A|||(!
I fchronic rheumatic heart disease, mitral valve prolapse

I nyndrome, pericarditis, arrhythmia, cardiac neurosis and
fchabilitative stage of various infectious diseases.
g .
Analysis of symptoms: Palpitation is due to insuffifclt'iicy of heart yin, lack of proper nutrition of the heart
Iln d irregular heart beating; dysphoria, insomnia and
Bfc'aminess are due to lack of proper nutrition of the
sf # ><i>sti
',
m *i>1$ i
-il' ^ W # , ii. l ft He
' T ' S , JTOJ ' l l ' M ,
BK,
, 'C,' f t
0 & , )
fteart, asthenic heat disturbing the heart and anxiety; feVimish sensatin over the five centers, afternoon tidal fe m-, flushed cheeks and night sweating are due to failure
yin to control yang and internal generation of asthenic
W S S I.
lint; reddish tongue with scanty saliva and thin and fast
ifalne are signs of yin asthenia and internal heat.
Key points for syndrome differentiation.. Palpitation,
K E S j t,
ip h o ria, insomnia, dreaminess, feverish sensatin over

til* five centers, afternoon tidal fever and flushed cheeks.
2. 3. 1. 6
tltome
Heart vessels obstruction syn-
( 7 \)
Heart vessels obstruction syndrome refers to symp-
-6 c
H ffi H ta T
litiH of palpitation, chest oppression and heart pain due to

^P tfuction of the heart vessels by blood stasis, phlegm,
H t b E W * fp-KE tf>,
J ll coid and qi stagnation. This syndrome is caused by

fclnuiiy asthenia of healthy qi, inactivation of heart yang
lili obstruction of the heart vessels by substantial pathoF nl' factors. According to different causes, this synF
K'
he divided into different types, such as ob-
tion of heart vessels by stagnation. obstruction of
'C ,'E ,
* gg: ,3? g ,|>
heart vessels by phlegm, obstruction of heart vessels by

cold coagulation and stagnation of qi in heart vessels, etc.
Clinical manifestations: Palpitation, chest oppression
and pain, pain involving the shoulder, back and inner part
of arm and occasional occurrence; or stabbing chest pain,
dull tongue or tongue with purplish petechiae, thin and astringent pulse or knotted pulse and slow regular intermit
tent pulse; or chest oppression and pain, obesity and pro
fuse sputum, heaviness of body and lassitude, whitish
greasy tongue fur, sunken and slippery pulse or sunken
and astringent pulse; or aggravation of pain with cold, al
leviation with warmth, cold body and limbs, pal tongue
sTJE
with white fur, sunken and slow pulse or sunken and tense
pulse; or pain and distensin, hypochondriac distensin,
sighing, light reddish tongue and taut pulse. Such symp
toms are usually seen in coronary atherosclerotic cardiopathy, angina pectoris, myocardiac infarction and primary
cardiac myopathy, etc.
Analysis of symptoms: Palpitation is due to inactiva tion of heart yang, lack of warmth and irregular heart
E frflr: -il'PB*;
ft
T S # , K J S U 'li
beating; chest oppression and pain are due to failure of

yangqi to disperse, weak flow of blood and obstruction of
heart vessels; pain involving the shoulder, back and inner
side of the arm is due to the fact that the heart meridian
W f.
distribu tes directly to the lung, comes out from the armpit
.#I
and moves along the inner side of the arm. Stasis in the
heart vessels is marked by dull pain, usually accompanied
by dull or purplish tongue with petechiae, thin and astrin
gent pulse or knotted pulse and slow regular intermittent
pulse;obstruction of heart vessels by phlegm is marked by
dull pain,
usually accompanied by obesity,
profuse
phlegm, heaviness and lassitude of the body, whitish

greasy fur, sunken and slippery pulse or sunken and
astringent pulse that indicate internal exuberance of
phlegm; obstruction of heart vessels by cold coagulation is

marked by sharp pain, sudden onset, alleviation with
warmth, accompanied by aversin to cold and preference
for warmth, cold limbs, pal tongue with white fur, sunk-
en and slow pulse or sunken and tense pulse that indica te

Internal exuberance of cold; obstruction of heart vessels
by qi stagnation is marked by distending pain and cise re
ation of occurrence with psychological factors, often ac
companied by hypochondriac distensin, susceptibility to
ighing and taut pulse that indicate stagnation of qi.
Key points for syndrome differentiation: The key
D ? f f i ^ : ;ffil^C.'1$fo
points are palpitation, chest oppression and pain. Since
1*1
ffi A i# Wr ffc
lobstruc tion of heart vessels is caused by various factors,

uch as blood stasis, phlegmatic turbidity, cold coagula
ron and qi stagnation, so triis must be made in differentiating pain and complications to specify the causes of dis
Jf

f i i D
j c I S
puse.
2.3.1.7
Exuberance of heart fire syndrome
Exuberance of heart fire syndrome refers to sthenic

heat syndrome due to internal exuberance of heart fire.
( t ) t W K iS E
-i>k % ffi ffi * t T 'll'
k rt M S S a M ft ffi f-
This syndrome is caused by mental depression, transforftmtion of fire from qi stagnation, or internal invasin of
pathogenic heat and fire, or excessive intake of acrid, hot
Niid tonic food, transformation of fire from prolonged acirnulation in the heart.
Clinical
manifestations:
Dysphoria,
insomnia,
-frS&BR, ||
llikhed complexin, thirst, fever, constipation, yellow u-
ife n 58 <#
I lile * deep reddish tongue tip, yellow fur and fast pulse;
Z L & '& ft'B W i.. s a a - s
>tH l J t <"S
W ulceration and pain of tongue, or hematemesis, hemorHjpgia, or even mania, delirium and unconsciousness, uftlly seen in hypertension, thyroidism, endocarditis, pe-
jA L T S JlE ^,P /]fl6 /L
ii'Mlontitis, infection of urinary system and craniocerebral

Inlrclion, etc.
Analysis of symptoms5 Dysphoria and insomnia are
W:
*rt tr i X
rt W tft
due to internal exuberance of fire heat and disturbance of

heart spirit; thirst, constipation and yellow urie are due
to consumption of fluid by pathogenic fire; flushed com
plexin and deep reddish tip of tongue are due to up-flam
ing of fire and heat; fast pulse is due to exuberant heat
promoting blood circulation; sores, ulceration and pain of
mouth and tongue are due to heart fire affecting the
D j f l L ; igfu& 'jsR , m nt
tongue through meridians; hematemesis and hemorrhagia

are due to heart fire driving blood to extravasa te; fever,
mania, delirium and unconsciousness are due to exuber
ance of pathogenic heat that disturbs heart spirit.
Key points for syndrome differentiation: Dysphoria
and insomnia as well as manifestations of exuberant fire
and heat on the tongue and pulse.
2.3.1.8
( A ) S5j*/ISS3iE
Mind confusion by phlegm
Mind confusion by phlegm refers to symptoms of un

consciousness due to phlegm confusing heart spirit. This
syndrome is usually caused by damp turbid substance that
hinders qi movement; or by emotional upsets, stagnation
of qi, failure of qi to promote fluid flow and accumulation
of fluid into phlegm; or by intemal disturbance of phleg
matic turbid substance combined with liver wind, leading
?r& ,
to confusion of heart spirit by phlegmatic turbid sub
stance.
BtWCc
c u a t i s ff
fc. Wl M & W. ' fc tt
Clinical manifestations: Mental confusion, even un

consciousness, or mental depression, dull facial expressions, dementia, murmuring, abnormal behaviour; or
sudden coma, unconsciousness, drooling, sputum rale in
the throat; dull complexin, chest oppression, nausea,
A * , o n g j* ,itr ^ ^ .
whitish greasy fur, slippery pulse. Such symptoms are usually seen in craniocerebral infection and depressive
schizophrenia, etc.
Analysis of symptoms: Mental confusion and coma
are due to phlegmatic turbid substance confusing mind and
T J & T S IM
disorder of spirit; dementia, mental depression, dull fa

cial expressions, murmuring and abnormal behaviour are
due to qi stagnation and phlegm coagulation, mixture of
* > fif tt W f p, l i m
. Mim
phlegm and qi and confusion of spirit; sudden syncope,

unconsciousness, drooling and sputum rale in the throat
a m.
un
f t . -t;
are due to mixture of phlegm with liver wind to hinder

heart spirit; dull complexin is due to internal retention of
phlegmatic turbid substance, failure of lucid yang to rise
and upper movement of turbid qi; chest oppression and
^ . 3 , i l r a # n E . S t T i
vomiting are due to failure of the stomach to descend and
K,
i* r t f t
adverse flow of gastric qi; whitish greasy tongue fur and

slippery pulse are signs of internal exuberance of phleg
matic turbid substance.
Key points for syndrome differentiation: Mental con
fusion or dementia, sputum rale in the throat and whitish
greasy tongue fur that indicate internal exuberance of
phlegmatic turbid substance.
2.3.1.9
D isturbance o f the heart by p h leg
m atic fire
Disturbance of the heart by phlegmatic fire refers to
the syndrome of mental derangement due to fire, heat and
phlegmatic turbid substance disturbing the heart spirit.
& 1 f.t
This syndrome is usually caused by emotional stimulation,

transformation of fire from qi stagnation scorching fluid
into phlegm; or by exogenous damp heat that accumulates
into fire; or by exogenous pathogenic heat that scorches
fluid into phlegm and leads to internal disturbance of
phlegmatic fire.
Clinical manifestations: Fever, restlessness, or coma
with delirium, flushed complexin, thirst, hoarse breath,
, ^ P - S / C lll'W
constipation, yellow urie, or sputum rale in the throat,
? r. M I'bJ^ S. )WW *
chest oppression, dysphoria, insomnia, or even mania,

iKhting against people, breaking objects, ravings, emotional disorder, reddish tonque, yellow and greasy fur as
sairs u s .
r .w a M . .
--i 'al
well as slippery and fast pulse, usually seen in craniocereE^F o
bral infection and manic schizophrenia, etc.

Analysis of symptoms: Disturbance of the heart by
phlegmatic fire is due to either exogenous pathogenic fac
tors or internal impairment. Fever, restlessness, or even
coma with delirium and mania are due to phlegmatic fire
* .
disturbing heart spirit in exogenous febrile disease;
E;M
ja l i f s m > i s t a I
flushed complexin, red eyes and hoarse breath are due to

fumiga tion of internal heat; yellow urie and constipation
are due to heat scorching fluid; yellowish thick sputum,
P J n ^ W ,S ; i l'B ] ^ .W
or sputum rale in the throat and chest oppression are due

to internal exuberance of phlegmatic fire and stagnation of
ffl t t * # . g PJ <0M & I R . a
qi; in miscellaneous diseases due to internal impairment,

internal exuberance of phlegmatic fire and disturbance of
f f i I S M T A S t lo
heart spirit lead to dysphoria and insomnia in mild case

and mania, ravings, emotional disorder, fighting against
people and breaking objects in severe case.
ssw sa.
Reddish
tongue, yellowish greasy fur and slippery and fast pulse

are signs of internal exuberance of phlegmatic fire.
Key points for syndrome differentiation: High fever,
restlessness or coma with delirium and sputum rale in the
throat in exogenous febrile diseases; mania and internal
exuberance of phlegmatic fire in miscellaneous diseases
with internal impairment.
2. 3. 2
Syndrome differentiation of lung disease
Lung disease mainly reflects dysfunctions of the lung

and its functions in goveming qi and breath as well as in
regulating water passage. The usual clinical symptoms include cough,
asthmatic breath,
expectoration,
stuffy
nose, nasal discharge and edema.

Lung disease is either asthenic or sthenic. Asthenic
. N
lung disease is usually caused by prolonged disease with

cough, or insufficiency of qi and yin production, or conlumption of qi and yin in febrile disease that leads to as
thenia of pulmonary qi and asthenia of pulmonary yin.
Sthenic lung disease is usually due to invasin of pathogenic wind, cold, dryness and heat, or internal exuberance of
phlegmatic dampness that leads to failure of pulmonary qi
to disperse and descend, resulting in such syndromes like
invasin of the lung by wind cold, invasin of the lung by
dryness, invasin of the lung by wind heat, exuberance of
pulmonary heat, accumulation of phlegmatic heat in the
lung, retention of phlegm and fluid in the lung and mix
ture of wind and fluid.
2.3.2.1
Pulmonary qi asthenia syndrome
Pulmonary qi asthenia syndrome refers to asthenia
(- ) l i n a s
J-^1fS iiE l: T J Al
syndrome due to insufficiency of pulmonary qi and

hypofunction of the lung in goveming qi and weakness of
weiqi to protect the superficies. This syndrome is caused
M r n ir tH
by chronic disease with cough and consumption of pulmo

nary qi; or by insufficiency of essence and tonifica tion of
the lung due to spleen asthenia that fails to transform
food.
Clinical manifestations: Weak cough, shortness of
breath with aggravation after movement, cough with thin
sputum, low and timid voice, spiritual lassitude, pal
complexin, spontaneous sweating, aversin to wind,
susceptibility to invasin of exogenous pathogenic factors
and weak pulse. These symptoms are usually seen in
chronic bronchitis, chronic obstructive pulmonary emphysema, insufficiency of lung ( compensatory stage) due to
chronic and pulmogenic heart disease, remission stage of
bronchial asthma, rehabilitative stage of pneumonia and
influenza and various diseases due to hypofunction of immunity.
yzm m .
Analysis of symptoms: Weak cough and asthma are

due to asthenia of pulmonary qi, upper adverse flow of qi
and failure of dispersin and descent; aggravation of cough
and asthma after movement is due to consumption of qi;
expectora tion of thin and clear sputum is due to failure of
the lung to distribute fluid due to asthenia and accumulate
fluid into phlegm which is brought upwards with the ad
verse flow of qi; shortness of breath, low and timid voice
are due to insufficiency of thoracic qi due to lung asthenia;
spontaneous sweating, aversin to wind and susceptibility
to invasin of exogenous pathogenic factors are due to as
thenia of pulmonary qi and weakness of weiqi to protect
the superficies; dispiritedness and lassitude, pal com
plexin, light-colored tongue with whitish fur and weak
pulse are signs of functional decline due to qi asthenia.
Key points for syndrome differentiation: Weak
cough, expectora tion with thin and clear sputum and func
ti>
tional decline due to qi asthenia.
D l'fi M m tk M o
2.3.2.2
( Z ) HRBffiuE
Lung yin asthenia syndrome
Lung yin asthenia syndrome refers to syndrome of as
f lK & E J iB S T M f W
thenic internal heat due to insufficiency of lung yin and

failure of depuration. If intemal disturbance of asthenic
heat is not evident, it is called fluid consumption and lung
dryness syndrome. This syndrome is mainly caused by
iiE s m i , s ^ a
consumption of lung yin due to dry heat impairing the lung

or consumptive disease damaging the lung; or by con
sumption of fluid due to sweating; or by asthenia of lung
yin due to chronic cough impairing lung yin.
Clinical mifestations: Dry cough with scanty spu

tum, or scanty and sticky sputum difficult to expectrate,
or sputum mixed with blood, hoarseness, dry mouth and
throat, emaciation, feverish sensatin over five centers
(palms, soles and chest), afternoon tidal fever, flushed
cheeks and night sweating, reddish tongue with scanty
m a m ?,
, mm .
fluid as well as thin and fast pulse. These symptoms are

H<*t*n in the rehabilitative stage of various infective diseaik8 (such as pneumonia, bronchitis and whooping cough)
h s
well as pulmonary tuberculosis, endobronchial tubercu
losis, bronchiectasis and lung cncer, etc.

Analysis of symptoms: Dry cough with scanty sputum
or with scanty and sticky sputum difficult to expectrate is
ft
fTf jf^; . Ak
due to insufficiency of lung yin and internal genera tion of

nsthenic heat which deprive the lung of moisture and lead
it j;
to adverse flow of qi; sputum mingled with blood is due to
. PJ
05 S
&
W JfiLs S
f)> lili
& IW
bleeding resulting from asthenic fire scorching the lung

collaterals; hoarseness is due to insufficiency of lung yin,
loss of proper moisture of the throat and fumigation of as
# ,P J
thenic fire; dry mouth and throat and emaciation are due
to insufficiency of lung yin and lack of nutrition; aftemoon
lfl l#
tidal fever, feverish sensation over the five centers,

flushed cheeks, night sweating, reddish tongue with
icanty saliva and thin and fast pulse are signs of internal
heat due to yin asthenia.
Key points for syndrome differentiation: Dry cough,
scanty and sticky sputum and internal heat with yin asthe
nia.
2. 3 . 2 . 3
Syndrome of wind cold encumbe-
( - ) JxlS^ffifiE
ring lung
Syndrome of wind cold encumbering lung refers to
the syndrome of failure of pulmonary qi to disperse due to
wind cold attacking the lung. This syndrome is usually
j i
*w m , * # * *
caused by failure of pulmonary qi to disperse due to exoge
iii
nous wind cold.

Clinical manifestations: Cough, thin expectora tion,
6 S 1 :
stuffy nose with clear snivel and throat itching, accompa

nied by aversin to cold and fever, or body pain without
sweating, whitish thin tongue fur as well as floating and
tense pulse, usually seen at the primary stage of upper
i .J J c ? !K . r L hii'P
respiratory tract infection, bronchitis, pneumonia and va

rious infectious diseases.
Analysis of symptoms: Cough with clear and thin spu
vE m frffi:
tum, stuffy nose with clear snivel and throat itching are
due to failure of pulmonary qi to disperse resulting from
wind cold encumbering the lung; aversin to cold, fever,
body pain, no sweating, whitish thin tongue fur and float
ing and tense pulse are due to wind cold attacking the su
, J
perficies, stagnation of weiqi, lack of warmth of the surface of the body and obstruction of the muscular inter
stices.
Key points for syndrome differentiation: Cough, thin
and clear sputum, aversin to cold, fever, pain of head
and body as well as no sweating.
2.3.2.4
W ind heat invading lung syndrom e
(0) H t t S I K E
Wind heat invading lung syndrome refers to the syn

drome of the lung failing to disperse resulting from wind
heat attacking the lung. This syndrome pertains to weifen
m Eo
syndrome in syndrome differentiation of wei, qi, ying and
v E ^ m iL frv E o g m t m i i
lhh
blood. It is often caused by invasin of wind heat into the

lung.
Clinical manifestations; Cough, yellowish thick spu
tum, stuffy nose with turbid snivel, fever, slight aversin
to wind and cold, slight thirst, or sore-throat, reddish
tongue tip, thin and yellowish tongue fur, floating and
a , # * , # .
TJL^
fast pulse, usually seen at the primary stage of various in

fectious diseases, such as upper respiratory. tract infec
tion, pneumonia;'bronchitis, lung abscess, mumps, epidemic hemorrhagic fever, scarlet fever and measles, etc.
Analysis of symptoms: Cough, yellowish thick spu
tum and stuffy nose with turbid snivel are due to wind heat
attacking the lung, loss of depura tion of the lung and ad
verse flow of pulmonary qi; sore-throat is due to wind
tst.
heat disturbing the upper; slight aversin to wind and

cold, slight thirst, reddish tongue tip, yellowish thin
tongue fur and floating and fast pulse are due to wind heat
attacking the superficies, stagnation of weiqi and con
sumption of body fluid by heat.
miE * j :
Key points for syndrome differentiation: Cough, yel

lowish thick sputum, fever, slight aversin to wind and
m m
cold, slight thirst and reddish tongue tip.
2. 3. 2. 5
e#
( 5 ) i3B3BSiBfiE
Syndrome of dryness attacking
lung
Syndrome of dryness attacking the lung refers to the
syndrome of consumption of fluid in the lung system due
to invasin of pathogenic dryness into the lung. This syn
w e
drome is divided into febrile dryness syndrome and cool
g g fi
dryness syndrome according to its heat or cold nature.
U .W M Z ft,
, x K Jtfsi c ^ n s i) W-:..
This syndrome is caused by dryness in autumn consuming

pulmonary fluid and disturbing weiqi; or by dryness trans
forming from pathogenic wind and febrile factors consu
ming body fluid. Dryness in early autumn is febrile and
i .g m &
,
the disease caused is febrile dryness; while dryness in late
i S
I .
autumn is cold and the disease caused is cool dryness.

Clinical manifestations: Dry cough with scanty spu
tum, or sticky sputum difficult to expectrate, even chest
pain, sputum mingled with blood, or epistaxis, he-
L 'i& m & a .u& ., O . f d .
matemesis, dryness of mouth, lips, nose and throat, dry

feces with scanty urie, thin and dry tongue with scanty
. I f f S
I .
'S T 'a T B t j t ^ * J i | (
saliva, or accompanied by fever, slight aversin to wind

cold, no sweating or scanty sweating, floating and fast
pulse or floating and tense pulse. These manifestations
nre usually seen at the primary stage of various infectious
diseases, such as upper respiratory tract infection, pneu
mona, bronchitis and pharyngitis.
Analysis of symptoms: Dry cough without sputum or
with scanty and sticky sputum difficult to expectrate is

due to pathogenic dryness invading the lung, consuming
pulmonary fluid and depriving the lung of moisture and
depura tion; chest pain, sputum mingled with blood, or
epistaxis and hematemesis are due to impairment of the
pulmonary collaterals due to dryness; dryness of mouth,
lips, nose, throat and feces as well as scanty urie and
thin tongue fur with scanty saliva are due to pathogenic
dryness consuming body fluid; fever and slight aversin to
wind cold are due to disorder of weiqi resulting from path
ogenic dryness invading the superficies; no sweating and
floating and tense pulse are due to mixture of pathogenic
dryness with cold which blocks the muscular interstices;
scanty sweating and floating and fast pulse are due to mix
ture of dryness with heat which opens the muscular inter
stices.
Key points for syndrome differentiation: Dry cough,
scanty and sticky sputum difficult to expectrate, dryness
of mouth, lips, nose and throat with scanty saliva.
2. 3. 2. 6
Syndrome of accumulation of pa
( 7 \ ) S t 3 BtlffiE
thogenic heat in lung

Syndrome of accumulation of pathogenic heat in lung
refers to the syndrome due to loss of depura tion of the
lung resulting from exuberant pathogenic heat in the lung.
This syndrome pertains to qifen syndrome in syndrome
JMCE.
differentiation of wei, qi, ying and blood. This syndrome

is usually caused by internal development of exogenous
wind heat or accumulation of heat in the lung transforming
from internal development of pathogenic wind cold.
Clinical manifestations: Fever, cogh, asthmatic
breath, even flapping nose with hot breath, red swelling
lis ia s >
ja ,S ! a y # 4 n * S r . f l: ilf
and pain of throat, chest pain, yellowish sticky sputum,
& M
or rusty sputum, or foul sputum mingled with blood,
t &
thirst, scanty urie, constipation, red tongue with yellow
L P M . /h M M # . A f MI
fe .
B tfn Iffl * 1
fur and fast pulse. These manifestations are usually seen
"J 'aL 1
Iti various respiratory tract infectious diseases (such as

pneumonia, infectious common cold, acute bronchitis,
lung abscess and bronchial asthma, etc.) as well as meaules and scarlet fever, etc.
Analysis of symptoms: Fever is due to fumiga tion of
im f r t f : m m m m ii
Internal heat; cough and asthma are due to invasin of

pthogenic heat in the lung, loss of depuration of the lung
ftlid upper adverse flow of qi; flapping nose with hot
Q
l *
&
K 'tfl; )|i|
breath is due to pathogenic heat invading the lung and

nUgnation of pulmonary qi; red swelling and pain throat is
due to fumigation of pulmonary heat and stagnation of qi
lid
blood; chest pain is due to pathogenic heat scorching
PJM
* 5JBfc W * m f M
It
$, $
* IT ffi Wi
Ihe pulmonary collaterals; yellow and sticky sputum is due

lo pathogenic heat scorching fluid into sputum which miBdn up with heat and moves adversely upward with pulmoifliiry qi; rusty sputum is due to pathogenic heat impairing
llie pulmonary collaterals; foul sputum mingled with blood
H| due to phlegmatic heat accumulation in the lung, qi
HAKnation and blood coagula tion as well as putrid muscles

Mild
blood; thirst, constipation and scanty urie are due to
WUl)erant heat consuming fluid; reddish tongue with

Hfullow fur and fast pulse are signs of exuberance of interiml lieat.
Key points for syndrome differentiation: Fever,
m v E W ti:
lUKh' asthmatic breath, chest pain and yellowish sticky

l'Utum.
2 .3 . 2 . 7
\ m m ko
Syndrome of phlegmatic dampness
( t ) SlSKflSfiE
HMention in lung
Syndrome of phlegmatic dampness retention in lung
M'frrs to the syndrome due to failure of the lung to dis|hm c
;ind descend resulting from retention of phlegmatic
ptTipness in the lung. This syndrome is caused by retenlldli of phlegm coagulating from fluid in the lung due to
E t J ir ^ i t E
asthenia of splenic qi and failure of transformation and

transporta tion; or by prolonged cough impairing the lung,
weakened function of the lung to transport fluid which
leads to accumulation of dampness into phlegm and reten
tion of phlegm in the lung system; or by invasin of exog
enous cold and dampness into the lung which prevents the
lung from dispersing and descending, leading to failure of
the lung to transport fluid, accumulation of fluid into
phlegm and retention of phlegm in the lung.
Clinical manifestations: Cough with profuse whitish
sputum easy to expectrate or with clear, thin and frothy
sputum, even asthmatic breath with sputum rale, pal
tongue with whitish greasy fur and slippery pulse, usually
S !* . .
seen in chronic bronchitis, bronchial asthma, chronic ob

structive pulmonary emphysema, chronic pulmonogenic
heart disease and lung cncer, etc.
Analysis of symptoms: Cough and profuse sputum are
I l J f l I o
iE0s#0f: m m
due to retention of phlegmatic dampness in the lung and

upper adverse flow of pulmonary qi (whitish, sticky and
easy to expectrate sputum is due to retention of phleg
matic dampness in the lung; while clear, thin and frothy
sputum is due to retention of fluid in the lung); chest op
pression, even asthmatic breath with sputum rale are due
to retention of phlegm and fluid in the respiratory tract
and inhibited flow of pulmonary qi; pal tongue with whit
ffifeo
ish greasy or whitish slippery fur , slippery pulse or soft

and slow pulse are signs of exuberance of internal phleg
matic dampness.
Key points for syndrome differentiation: Cough,
asthmatic breath, profuse whitish sputum which is either
sticky and slippery or thin and clear.
2. 3. 2. 8
Syndrome of confliction of wind
and fluid in lung

Syndrome of confliction of wind and fluid in lung
u\) r*m n e
fttfers to the syndrome due to invasin of pathogenic wind

Which prevents the lung from dispersing, descending and
rrgulating water passage as well as causes extravasation of
*EEJ T P07jc m
(luid and dampness in the skin. This syndrome pertains to

JfttliK edema, usually caused by exogenous pathogenic wind
isgfeiR,
Ultacking the lung and failure of the lung to disperse, de(MtMid and reglate water passage which give rise to stagimtion of wind, retention of fluid, confliction between
blnd and fluid as well as extravasation of fluid in the skin.
, Clinical manifestations: Primary dropsy of the eyelids
HfiJ
mi|d face, eventual edema of the whole body with rapid de-
i.
Hkpment, thin and bright skin, scanty urie, accompaiiumI by aversin to cold, fever, no sweating, whitish thin
J S L *# & .
S # * l *
Migue fur, floating and tense pulse; or accompanied by
# S ; K t iL n H i W * ,- S *
vvHling and pain of throat, reddish tongue as well as
X . B * # # o b J J a L M iI '#
ll'Niling and fast pulse. These manifestations are usually

h r u in acute nephritis, pyelonephritis and acute onset of
pronic nephritis, etc.

[ Analysis of symptoms: Primary dropsy of eyelids and
k t
eventual edema of the whole body with rapid devel-
.tyNiicnl as well as thin and bright skin are due to invasin

Hl pathogenic wind into the lung which prevents the lung
Itniu dispersing, descending and regula ting water passage
I well as causes confliction between wind and fluid and
M l/ h f iW
lin vasa tion of fluid; scanty urie is due to failure of the
X ff.
HpP' T energizer to disperse and loss of qi transformation.

K | lCompanied by aversin to cold, fever, no sweating,
fi
*|iI||nIi thin fur as well as floating and tense pulse, it is

p
nyudrome marked by confliction between wind and flu-
H with superficial cold; if accompanied by swelling and

lili of throat, reddish tongue and floating and fast pulse,
P Id Ihe* syndrome marked by confliction between wind and
(tlilil willi superficial heat.
K<*y points for syndrome differentiation: Sudden
ZuEo
onset of edema of the eyelids and face first with quick involvement of the whole body, scanty urie, accompanied
by aversin to cold and fever, etc.
2 . 3.3
Syndrome differentiation of spleen disease
m s
IJ IE
Spleen disease is mainly marked by dysfunction of the
r $
lung to transport, transform and govem blood. The clini

cal symptoms are usually poor appetite, abdominal disten
3f f i f e E i l
JLW?6IBfe#aif
m
*fig
sin or pain, loose stool, dropsy, heaviness of limbs, pro

lapse of the viscera and bleeding, etc.
m tB i i y? ^ al in-^ o
Spleen disease is either asthenic or sthenic. Asthenic

spleen disease is mainly caused by improper diet, irregu
& /h 1
lar daily life, excessive vomiting and diarrhea as well as

other acute or chronic diseases which impair the spleen
and lead to such problems like asthenia of splenic qi, as
thenia of splenic yang, sinking of qi due to splenic asthe
lo.; % e ^ a tfc #
i?
nia and failure of the spleen to govern blood; sthenic

spleen disease is caused by improper diet or intake of contaminated food or exogenous cold dampness or internal in
vasin of damp heat which leads to cold dampness encum
bering the spleen and accumulation of damp heat in the
spleen, etc.
2.3.3.1
Syndrome of asthenia of splenic qi
(- )
Syndrome of asthenia of splenic qi refers to the syn

drome due to asthenia of splenic qi and failure of transpor
tation and transformation, usually caused by improper di
et, overstrain and impairment of splenic qi by chronic and
acute diseases.
SfSc o
Clinical manifestations: Poor appetite, abdominal

distensin, especially after meal, loose stool, or dry feces
followed by loose stool, lack of qi, no desire to speak,
lassitude of limbs, sallow complexin, emaciation, or
dropsy, pal tongue with whitish fur, slow and weak
pulse, usually seen in chronic gastritis, digestive ulceration,
vi
*
W *K
. lin ft
ffi & , jfcft jj+, ,'i m
e ,jm m 0
chronic enteritis and malabsorption syndrome, etc.
ift^ g J g ' 'iE ^ o
Analysis of symptoms: Poor appetite and abdominal
iEmfttfr-. W ^ l ^ . B
distensin are due to asthenia of splenic qi, failure of

transportation and transformation, weakness to digest,
irc
ifibsorb and transport cereal nu trien i; aggravation of ab

dominal distensin after meal is due to aggravation of
istagnancy of splenic qi after meal; loose stool or dry feces
followed by loose stool are due to downward migration of
dampness into the large intestine resulting from failure of
klie spleen to transform dampness? lack of qi and no desire
(to speak are due to failure of transportation and transformation resulting from asthenia as well as insufficiency of
Igastrosplenic qi; lassitude. sallow complexin and gradual
lemaciation are due to insufficiency of splenic qi, insuffifcient production of qi and blood which fail to nourish the
|body and skin; dropsy of limbs is due to failure of asthenic
pleen to transport, intemal genera tion of dampness and
xtravasation of fluid in the muscles.
Key points for syndrome differentiation:
Poor
[tppetite, abdominal distensin, loose stool. lackofqi, no

esire to speak and lassitude of limbs.
2.
3.3. 2
Syndrome of asthenia of splenic
f i . -3? "n, Mi
t, W
(Z ) M ltS E
yang
Syndrome of asthenia of splenic yang refers to the
Hyndrome due to asthenia of splenic yang and intemal exil
iaranee of yin cold. This syndrome is caused by further
ilvelopment of the asthenia of splenic qi; or by excessive
Intake of uncooked or cold food; or by asthenia of splenic
V.mg and failure of fire (heart) to generate (promote)
(nirth (spleen).
Clinical manifestations: Poor appetite. abdominal
llmlension, lingering abdominal cold pain, preference for
wiiimth and palpation, aversin to cold. cold sensation of
W P B d l E Jil
n m M vEm , +
four limbs, light whitish complexin, bland taste in the

mouth without thirst, loose stool, or stool with indigested
food, heaviness of limbs, or dropsy of limbs, dysuria,
profuse and thin leukorrhagia, pal, bulgy and tender
tongue, or tongue with tooth prints, whitish slippery fur,
sunken, slow and weak pulse. Such manifestations are usually seen in chronic gastritis, digestive ulceration, chro
nic enteritis, malabsorption syndrome, Crohns disease,
irritable intestinal syndrome and chronic nephritis and IgA
nephropathy.
Analysis of symptoms: Poor appetite and abdominal
distensin are due to asthenia of splenic yang and failure of
transportation and transformation; lingering abdominal
cold pain, preference for warmth and palpation are due to
asthenia of yang and exuberance of yin, internal generation of cold as well as cold coagulation and qi stagnation;
bland taste in the mouth without thirst and loose stool, or
even stool with indigested food are due to failure of splenic
yang to warm and transport food because of asthenia; aversion to cold, cold sensation of limbs and light whitish
complexin are due to failure of yang to warm because of
asthenia; heaviness of limbs, even general edema and
dysuria are due to inactiva tion of gastrosplenic yang,
internal retention of dampness and extravasation of damp
ness; profuse and thin leukorrhagia is due to asthenia of
splenic yang, weakness of belt vessel and downward mi
gra tion of dampness; pal, bulgy and tender tongue, or
tongue with tooth prints, whitish slippery pulse; as well
as sunken, slow and weak pulse are signs of yang asthenia
and internal exuberance of yin cold.
Key points for syndrome differentiation:
Poor
appetite, abdominal distensin, lingering abdominal cold

pain and loose stool.
a i#
ma 9i'
2.3.3.3
Syndrome of sinking of splenic qi
( = ) W n T P 8 iI
I Syndrome of sinking of splenic qi refers to the synJonii* due to asthenia of splenic qi and failure of splenic qi
i im*. This syndrome is mainly caused by further devel-
&,
ms t mmmm
WiiEo
mMil of asthenia of splenic qi; or by chronic diarrhea or

rntery, or overstrain; or by mltiple delivery and im])|H*r nursing after labor which over consume splenic qi.
Clinical manifestations: Prolapsing sensation and dis

pon of epigastrium and abdomen, especially after
Jll, frequent desire for defecation, prolapsing sensation
Milus, or chronic diarrhea, or even prolapse of rectum,
'prolapse of uterus. or turbid urie, accompanied by
li of qi, fatigue, lassitude of limbs, low voice or no d
lo speak, dizziness, pal tongue with whitish fur and
m s
M c ., i j a T i i ' i f
|k pulse. Such manifestations are usually seen in chrognstritis, digestive ulceration, chronic enteritis, mal>fption syndrome, Crohns disease, irritable intestinal
iilrome, gastroptosis, hepatoptosis, nephroptosis and
T S . f T S > f f T f .
Mleroptosis, etc.
Analysis of symptoms: Prolapsing sensation and dis-
vEmfrtir-.
Jlion of epigastrium and abdomen, especially after

imI
frequent desire to defeca te, prolapsing sensation of
Jto nnd chronic diarrhea are due to insufficiency of spleni|i, failure of transformation and transportation, sinking
Mlllenic qi resulting from weakness to rise; gastroptoi prolapse of rectum and hysteroptosis are due to insufrfti'y of splenic qi and failure of the viscera to remain in
l|r normal position; turbid urie is due to failure of the
Itltiii}'. splenic qi to transport cereal nutrient, separa te
w
luridity from turbidity and transmit it to the bladder;
|mli ol (|i, fatigue, lassitude of limbs, low voice, no deiln lo s|>eak, dizziness, pal tongue with white fur and
pulse are signs of insufficiency of gastrosplenic qi,
0 m
T f l,$ !'J J & P T S .J I f t
failure of lucid yang to rise and hypofunction of viscera

and tissues.
Key points for syndrome differentiation: Prolapsing
* e im m
sensation and distensin of epigastrium and abdomen,

chronic diarrhea. prolapse of anus and dizziness, etc.
f im m m .
2.3.3.4
Syndrome of failure of the spleen to
(B 3 ) R E S U M E
govern blood
Syndrome of failure of the spleen to govern blood re
fers to the syndrome of bleeding due to failure of the
spleen to control blood caused by asthenia of the spleen.
This syndrome is usually caused by spleen asthenia due to
chronic disease, or by overstrain and impairment of the
spleen which lead to asthenia of the splenic qi.
Clinical manifestations*. Hematemesis, or hema
tochezia, or hematuria, or hematohidrosis, or epistaxis,
lis i m M : B E j t . S f r f l i
sScic.tfD. .sSEflJLiWl.
"VI
or hypermenorrhea and profuse uterine bleeding, accom

panied by poor appetite, abdominal distensin, loose
stool, sallow complexin or lusterless complexin, dispir
itedness, lassitude, lack of qi, no desire to speak, pal
tongue, thin and weak pulse. Such symptoms are usually
STETS--bit fci(iUJl M ,|
seen in various hemorrhagic diseases, such as upper di-
>Jfo. # ! > t l t6 %
gestive tract bleeding, hematuria, purpura, hematopathy

and dysfunctional uterine bleeding.
Analysis of symptoms: Asthenia of splenic qi, failure
of the spleen to govern blood and extravasation of blood
lead to various bleeding; extravasation of blood in the
tjjflit L m w m m it'i
stomach and intestines leads to hematemesis and hema
J lS J lfE M K J f o .M J illl
tochezia ; extravasation of blood in the bladder leads to he
f i f i , JL a #
3?
S # M . f|*
maturia ; extravasation of blood in the muscles leads to hematohidrosis; extravasation of blood in the nose leads to
epistaxis; weakness of the thoroughfare and conception
vessels leads to hypermenorrhea and profuse uterine
i t z m j W M g i & * .<
bleeding; asthenia of splenic qi and failure of the spleen to
# * * ; * . It.
V .lJ
pMlisport and transform lead to poor appetite, abdominal

iliB U S io n
i<
j
and loose stool; asthenia of splenic qi and insuf-
tlnmt production of qi and blood lead to sallow or lusterMN complexin, lack of qi and no desire to speak; pal
h i( u c , thin and weak pulse are signs of asthenia of both
blood.
<|i l i t u l
Key points for syndrome differentiation: Various

lilftoding, poor appetite, abdominal distensin and loose
*lpol-
2.3.3.5
Syndrome of cold and dampness
( E ) S a B M t iE
incumbering the spleen

\ Syndrome of cold and dampness encumbering the
S S H W E lr f T
Ircn refers to the syndrome due to internal exuberance
s r t . s . + r o s i i i i s n w i
iiftpold
and dampness and stagnancy of gastrosplenic yang.
lln i syndrome is usually caused by improper diet, exces-
^ . # f f i# 7 jc ,A J g S f c , l t
m v intake of cold and uncooked food, walking in rain or

water, prolonged living in damp area and frequent in
fe rn a l
exuberance of dampness.
I Clinical manifestations: Abdominal fullness and op-
te * * ? :
ision, poor appetite, nausea and vomiting, abdominal

In and loose stool, bland taste in the mouth and no
llili lt, heavy sensation of the head and body, or dropsy of
s # @
Wf limbs, scanty urie, or yellow and dull coloration of the

Ifellv
and eyes, or leukorrhagia, bulgy tongue, whitish
ppnHy or whitish slippery fur, slow and weak or sunken

llul thin pulse. Such symptoms are usually seen in acute
Ir itis , chronic gastritis, digestive ulceration, chronic
Mtorilis, disturbance of gastrointestinal functions, chron% Impatitis, cirrhosis of liver, stomach cncer and liver
piirer, etc.
| Analysis of the symptoms: Abdominal fullness and
vEifttir: SiSrt.'!1
ppiBHsion, poor appetite, nausea and vomiting, abdomiHl pain and loose stool are caused by exuberance of interp l Cold and dampness which leads to encumbrance of
, MISHSLlS . S *l^. S-fr

P R n , ff
gastrosplenic yang, dysfunction of the spleen and stomach

as well as disturbance of descent and ascent; bland taste
in the mouth and no thirst are due to intemal exuberance
of coid and dampness and non-consumption of body fluid;
heavy sensatin of the head and body, or dropsy of the
limbs and scanty urie are due to stagnation of qi and lucid
yang by dampness which spreads in the skin and muscles;
yellow and dull coloration of the body and eyes is due to
extravasa tion of the bile caused by encumbrance of damp
ness and coid which affects the functions of the liver; leukorrhagia is caused by downward migra tion of coid and
dampness which impairs the belt vessel; bulgy tongue,
whitish greasy or whitish slippery fur, slow and weak or
sunken and thin pulse are the signs of intemal exuberance
of coid and dampness.
Key points for syndrome differentiation: Symptoms
due to dysfunction of the stomach and spleen, such as ab
dominal fullness and oppression. poor appetite, nausea
and vomiting, abdominal pain and loose stool; symptoms
of internal exuberant coid and dampness, such as heavy
sensatin of the head and body, or dropsy of the limbs,
yellow and dull coloration of the body and eyes, etc.
2.3.3.6
Syndrome of damp heat encumbe-
( A ) ^ a iS E
ring the spleen

Syndrome of damp heat encumbering the spleen re
fers to the syndrome caused by dysfunction of the spleen
and stomach due to retention of damp heat in the middle
w m m m ttiv E f ' * a i l
energizer. This syndrome usually results from attack of

damp heat or endogenous production of heat due to excessive intake of pungent and greasy food as well as alcohol
and cheese.
Clinical manifestations: Fullness and oppression in
the epigastrium and abdomen, anorexia, vomiting, nausea,
thirst with oligodipsia, loose stool, unsmooth defecation,
HE t r , S S , 16 S >V.
JfSc.
rnnty and yellow urie, heaviness of limbs, dull fever,

Indure to relieve fever after sweating, or yellow coloradon of the skin and eyes, or pruritus of the skin, reddish
InhKue, yellowish and greasy tongue coating as well as
|nt pulse. vSuch manifestations are usually seen in acute
piltritis, chronic gastritis, acute enteritis, chronic enterHIh. indigestive ulcera tion, viral hepatitis, chronic hepati
tis cirrhosis of liver, gastrocarcinoma and liver cncer as
well as some infectious diseases, such as typhoid fever and
[ptiratyphoid fever.
Analysis of the symptoms: Fullness and oppression in
he epigastrium and abdomen, anorexia, vomiting, nauseN, lose stool and unsmooth defecation are caused by dysfifection of the spleen and stomach as well as abnormal
Muiilges in ascending and descending due to retention of
.limp heat in the middle energizer? heaviness of the limbs
l caused by stagnancy of qi activity due to encumbrance of
llmpness; dull fever, failure to relieve fever after swealintf, thirst with oligodipsia and scanty-yellowish urie are
Clused
llon
by internal retention of dampness; yellow colora -
of the skin and eyes are caused by extravasation of
lillr due to retention of damp heat in the spleen and

ftlpmach that steams the liver and gallbladder? reddish
I tongue, yellowish greasy tongue fur and soft pulse are the
mIiiis of internal retention of damp heat.
Key points for syndrome differentiation: The diagiiostic evidences for this syndrome are fullness and
Oppression in the epigastrium and abdomen, anorexia,
VOmiting, nausea, loose stool, unsmooth defeca tion, dull
Ifver, failure to relieve fever after sweating or yellow
colora tion of the skin and eyes.
2.
Syndrome Differentiation of liver disease
Liver disease mainly manifests in the liver proper and
its abnormal changes in dispersing as well as in storing

blood. The clinical manifestations are depression, or irritability, susceptibility to rage, distending pain in chest,
hypochondrium and lower abdomen, dizziness, tremor of
limbs, spasm of hands and feet, bitter taste in the mouth
and jaundice. Besides, eye disorders and irregular men
JS L tt.
jlW K iS T J ffff
struation are usually believed to be caused by disorder of

the liver because the liver opens into the eyes and the liv
er is the essential organ in woman.
^JF o
The liver disease is either asthenia or sthenia. The

asthenia syndrome of liver is often caused by insufficiency
j E ^
, IJct: I)
of liver yin and liver blood due to malnutrition after pro

longed duration of disease, or involvement in the disorder
mi^ ;
% ilE 0 I f M fff ffi
of other organs, or bleeding; sthenia syndrome of liver is

usually caused by liver depression and qi stagnation, exu
berance of liver fire, hyperactivity of liver yang, damp
heat in the liver and gallbladder and retention of coid in
the liver vessel due to emotional impairment, transforma tion of fire from qi stagnation, upward adverse flow of qi
and fire, or internal invasin of pathogenic coid, fire and
damp heat. If pathogenic fire scorches liver yin and yin
asthenia fails to control yang, yang will become hyperactive and transform into wind, therefore leading to endogenous of liver wind.
2.3.4.1
A sthenia syndrom e of liv e r blood
Asthenia syndrome of liver blood is the syndrome
( - ) ffFKtldEfiE
JfF ilild lE JiS T tl
caused by malnutrition of the liver and the related tissues

and organs due to insufficiency of liver blood. Tiis syn
tffT ^M tfJvE o & v E & l
drome is usually caused by insufficiency of blood production due to asthenia of the spleen and stomach, or by con
. & m M & gLB&o
sumption of blood due to hemorrhage and chronic disease.

Clinical manifestations: Vrtigo, dizziness, pal
complexin, dry and irritating sensatin in the eyes,
blurred visin or night blindness, dry and lusterless nails,
& ^ , iS T S , a r f lt f
m numbness of limbs, inflexibility of joints, tremor of

I m i k Is
and feet, or scanty and light-coloured menstrua -
Iton, or even amenorrhea, whitish tongue and thin pulse,

pucli symptoms are seen in anemia caused by various hem-
fflo 1 0 L T # # ffljlU iU lL S j
Oirhage, dysfunction of blood production and chronic conminiptive disease.
#ScMW0Lo
Analysis of the symptoms: Dizziness, pal complex

in and whitish tongue are caused by insufficiency of blood
|i| nourish the head and face; vrtigo, dry and irritating
llisalion in the eyes. blurred visin or night blindness are
lused by insufficiency of liver blood to nourish the eyes;
ilry and
lusterless nails, numbness of limbs, inflexibility
of joints and tremor of hands and feet are caused by malputrition of the nails and tendons and vessels due to blood
pHhenia; scanty and light-coloured menstruation or even
it
. t t n -k
'> fe
ttfcnorrhea are caused by deficiency of thoroughfare ves||| and insufficiency of blood source due to insufficiency of
hvcr blood.
Key points for syndrome differentiation: Malnutrition
nf head, eyes, nails, tendons and vessels as well as geni'i.il malnutrition due to blood asthenia.
) 2.3.4.2
Syndrom e o f liv e r yin asthenia
cz)
Syndrome of liver yin asthenia is the syndrome resul[Ihu; from failure of yin to control yang due to consumption
ol
liver
yin. This syndrome is usually caused by emotional
vEUo | l i
i||)Nts, transformation of fire from qi stagnation and fire

\
O r c h i n g liver yin; or by consumption of liver yin in the
luid stage of febrile disease; or by insufficiency of liver
yin due to insufficiency of kidney yin and failure of water
lo ilrengthen wood.
Clinical manifestations: Dull scorching pain in the hy(Knhondria, dizziness, dry and irrita ting sensation in the
rv-s. hypopsia, feverish sensation over the cheeks, tidal
IpvtM and night sweating, feverish sensation over the five
III
centers (palms, soles and chest), reddish cheeks in the

afternoon, dry mouth and throat, or tremor of the hands
and feet, reddish tongue with scanty fluid as well as taut,
thin and rapid pulse. Such symptoms are usually seen in
chronic hepatitis, cirrhosis of liver, liver cncer, gall
bladder cncer and pancreas cncer as well as various infectious diseases at the late stage.
Analysis of the symptoms: Dull pain in the hypochondria is caused by malnutrition of the liver due to consump
tion of liver yin; dizziness, dry and irritating sensatin in
the eyes and hypopsia are caused by failure of insufficiency
of liver yin to nourish the head and eyes; feverish sensation of the cheeks and tidal fever in the afternoon, reddish
cheeks, night sweating, feverish sensatin over the five
centers (palms, soles and chest) as well as dry mouth and
throat are caused by asthenic fire disturbing inside due to
yin asthenia and yang hyperactivity; tremor of hands and
feet is caused by malnutrition of tendons and vessels due
to asthenia of liver yin; reddish tongue with scanty fluid
and taut, thin and rapid pulse are the signs of endogenous
heat due to yin asthenia.
Key points for syndrome differentiation: The diag
nostic evidences for this syndrome are dull scorching pain
in the hypochondria, dizziness, dry and irrita ting sensation in the eyes, hypopsia, feverish sensatin of the
cheeks, tidal fever, night sweating, feverish sensatin
over the five centers (palms, soles and chest) and dry
mouth and throat.
2.3.4.3
Syndrome of liver qi stagnation
< = ) S fn S B ^ E
Syndrome of liver qi stagnation refers to the syn
ill
drome due to failure of the liver to disperse and stagnation

of qi. This syndrome is usually caused by emotional upsets, impairment of the liver due to depression and rage;
or by failure of liver qi to act freely and to disperse
norm ally due to retention of pathogenic factors in the liver
t IM
IVessels.
Clinical manifestations: Emotional depression, miMWtory pain in the chest, hypochondria or lower abdo
men, chest oppression, frequent sigh, thin and white
: . jjJc'aL
lonKue fur as well as taut pulse; or sensation of foreign

Uxly in the throat, or goiter and scrofula, or lump in the
SJaLI^T
; f k rTaL^L )M
liy|K)chondria; distending pain of breast, dysmenorrhea,

regular menstruation and even amenorrhea in woman.
m0 r j a T t t s * * ,
B u'Ii symptoms are usually seen in neurasthenia, depresllon, throat-esophagus neurosis, hyperthyroidism, simple
Iliyroid enlargement, chronic hepatitis and climacteric
nyndrome, etc.
Analysis of the symptoms: Depression and frequent
|lt(li
are due to stagntion of liver qi and dysfunction of
Hvcm * dispersin;
migratory distending pain in the chest,
XM ,
, tt
B^pochondria, breast and lower abdomen is caused by livf depression, qi stagnation and inhibited flow of meridian
*I1 sensation of foreign body in the throat, or goiter,
Bôfula and hypochondriac lump are caused by retention
tl|phlegm transformed from qi stagnation in the throat,
Mti< and hypochondria; irregular menstruation, dysmenortlrn* or even amenorrhea are caused by liver depression,
i ( Mlagnation and inhibited circulation of blood because the
Ver is fundamental in woman; thin and whitish tongue
fiE * .
If nnd taut pulse are the signs of the liver that fails to act
fcely and disperse normally.
Key points for syndrome differentiation: Emotional
m ue h /S :
*|>iession, migra tory distending pain in the chest, hypoinndria, breast and lower abdomen as well as irregular
m , ft- kR
piMiMtruation.
2.3.4.4
Syndrome of liver fire hyperactivlty
vSyndrome of liver fire hyperactivity refers to the

fulmine due to exuberant fire in the liver meridian and
(BU) BW i& iE
jft& m nt
upward adverse rising of fire. This syndrome is mainly
MtiEM. I
caused by emotional upsets and transformation of fire from
'If
-f t U t
liver depression; or by exogenous pathogenic heat and

fire;
o r
b y
b flffl
exuberant fire in the other organs that involves
the liver.
Clinical manifestations: Dizziness, distending headache,
f lu s h e d
face and red eyes, bitter taste and dryness
of mouth, irritability and susceptibility to rage, tinnitus
11
1
& B # , S O T - M B f r M
p M g ,
and deafness, insomnia or nightmare, or scorching pain in

the hypochondria, or hematemesis and epistaxis, constipation, scanty and yellow urie, red tongue, yellow fur
t , & f I & T i* L SI
and taut and rapid pulse. These symptoms are usually
#f
seen in hypertension, hyperthyroidism, neurasthenia
S W, Si ffl1fiPffi, ta 3fc ^
manic depression, migraine, cerebral arteriosclerosis and
J) J* W. i t & , M $ I* - f l
climacteric syndrome.
Analysis of the symptoms: Dizziness, distending
vE'j^Vf:
headache, flushed face and red eyes. bitter taste and dry-
D,
i 'i
ness of mouth are caused by pathogenic heat and fire dis-
@# H B O "Pf X
turbing the upper part of the body along the liver meridian; insomnia or nightmare is caused by mental distraction
i ;O P f f t l ^
due to internal disturbance of heat and fire; irritability
Z M , PJ
and susceptibility to rage are caused by liver depression;
fff M -MJ-ftll W i ; *
scorching pain in the hypochondria is caused by stagnation
lfilS T >iJ t lf in f iH , i f o f l
of qi and fire in the liver meridian; hematemesis and epi-
M U ; X #3 f i i , M
staxis with fresh blood are caused by extravasation of
/ M I M ffi. f ffi & * W M >
blood due to upward adverse rise of qi and fire; constipa-
W ^ j & '/ X X I I j H
fl
ffi.
tion, scanty yellowish urie, reddish tongue with yellow

ish fur and taut and rapid pulse are caused by fire scorching body fluid.
Key points for syndrome differentiation-. The diagnostic evidences of this syndrome are irritability and sus-
S fiE S .:
1, ^ U ffi # tfr & >M
ceptibility to rage, insomnia or nightmare, dizziness, dis-
tending headache, flushed cheeks and red eyes, bitter

taste and dryness of the mouth and scorching pain in the
,i
S IiS P
liypochondria and sides.
2.3.4.5
a g u i s o
Syndrome of liver yang hyperactivity
(E )
Syndrome of liver yang hyperactivity refers to the
ff F R B / L E ; J i S j )i
syndrome marked by upper sthenia and lower asthenia due

I to consumption of liver and kidney yin, failure of yin to
I control yang and hyperactivity of liver yang. This syn-
i o
l&FJrt t . A
I drome is usually caused by impairment due to excessive

I rage, transformation ot fire from qi stagnation and conI sumption of liver and kidney yin by fire and heat; or by
I excessive sexual intercourse that exhausts kidney yin; or
I by consumption of kidney yin due to senility and failure of
I water to nourish wood which lead to failure of yin to conI trol yang and hyperactivity of liver yang.
Clinical manifestations: Distending headache, dizziness, tinnitus, flushed cheeks and red eyes, irritablity
I nnd susceptibility to rage,
insomnia and dreaminess,
laching pain and weakness of loins and knees, top-heaviIness, reddish tongue with scanty fluid, taut pulse or taut
oj }j T i#j ifil idE^ J a
\
t
I nnd thin pulse. Such symptoms are usually seen in hyperI tensin, cerebral arteriosclerosis, Parkinsons disease,
hyperthyroidism, neurasthenia, manic depression, mifraine and climacteric syndrome, etc.
Analysis of the symptoms: Distending headache, diziness, tinnitus, flushed cheeks and red eyes, irritability
fff P0, Jjf PB/ l
nd susceptibility to rage, insomnia and dreaminess are
f[ 1$ i
ii^,
ifu
niused by failure of liver and kidney yin to control liver

yung and hyperactivity of liver yang due to consumption of
IJver and kidney yin; aching and weakness of loins and
knees are caused by malnutrition of tendons and bones due
l< asthenia of liver and kidney yin; top-heaviness is caused
by hyperactivity of liver yang and consumption of liver and
kidney yin; reddish tongue with scanty fluid, taut pulse or
taut and thin pulse are the signs of asthenia of liver and
kidney yin and hyperactivity of liver yang.
& . b & t a aa , * i f kij
m /c m m 0
Key points for syndrome differentiation: Dizziness,
m\e j S :
distending headache, tinnitus, flushed cheeks and red

eyes as well as top-heaviness and aching and weakness of
loins and knees.
2.3.4.6
(A ) BmrtSjfiE
Syndrome of endogenous liver wind
Syndrome of endogenous liver wind is the syndrome

marked by dizziness, convulsin and tremor. According to
the causes, this syndrome is clinically further divided into
l- i
syndrome of liver yang transforming into wind, syndrome

of extreme heat generating wind, syndrome of yin asthe
nia disturbing wind and syndrome of blood asthenia gener
ating wind.
2.
MvEm
3. 4. 6 .1
1. IffffltfcJxlffi
Syndrome of liver yang transfor
ming into wind
jffP B fc JR U E ft& ilT tf
Syndrome of liver yang transforming into wind refers

to wind syndrome due to consumption of liver and kidney
yin and hyperactivity of liver yang. This syndrome is usu
ally caused by emotional upsets and qi stagnation transfor
ming into fire and consuming yin; or by constant asthenia
of liver and kidney yin, failure of yin to control yang and
/C . PH/ l % M ffi it M . M iflfj
hyperactivity of liver yang which transforms into wind,

Iherefore leading to the wind syndrome marked by root
M.Ec
asthenia and branch sthenia as well as exuberance in the

upper and deficiency in the lower.
Clinical manifestations: Dizziness, shaking head,
te * * } :
headache, neck stiffness, tremor of limbs, stuttering,

numbness of hands-^nd feet, abnormal gait, red tongue
with white or greasy fur, powerful pulse, ,even sudden co

ma, facial distortion, hemiplegia, aphasia and sputum rale
A *.H
in the throat. Such symptoms are usually seen in hypertension, cerebral arteriosclerosis, cerebral infarction,
cerebral hemorrhage, cerebrovascular accident sequela,
Parkinsons disease, epilepsy and injury of spinal cord.
J fiu iilil'f S *hJpit,Wl f l
etc.
Analysis of the symptoms: Dizziness, shaking head
and headache are caused by hyperactive liver yang trans
forming into wind and disturbing the upper part of the
h. t f . t S tfF M rt Ib ffii
body; neck stiffness and tremor of limbs are caused by en

dogenous liver wind and spasm of tendons and vessels;
stuttering is caused by wind and yang rising up to disturb
the tongue collaterals; numbness of hands and feet is
caused by malnutrition of the tendons and vessels due to
consumption of liver and kidney yin; abnormal gait is
i? . S U , I
caused by hyperactivity of liver yang and consumption of
PH/LHlffiio
liver and kidney yin; red tongue with white or greasy fur
JfiUSL.IFM
and powerful pulse are the signs of consumption of yin and
i?
A * ,
hyperactivity of yang; sudden coma, and sputum rale in

the throat are caused by abrupt rise of liver wind and
yang, disturbance of qi and blood as well as blockage of
the upper orifices by liver wind mingled with phlegm; fa
cial distortion, hemiplegia, stiff tongue and aphasia are
caused by wandering of liver wind and phlegm in the me
ridians.
WE5.U
B|i
drome is marked by frequent dizziness and hyperactivity of

liver yang as well as sudden severe vrtigo, headache,
Itiff neck, tremor of limbs, stuttering, numbness of
hands and feet, even sudden coma and hemiplegia.
2.3.4.6.2
Syndrome of extreme heat genera-
2. *M KJ5UE
tlng wind
vSyndrome of extreme heat genera ting wind refers to
a a fc W iE J i- lf T W
thi* syndrome due to exuberant pathogenic heat scorching

tendons and vessels. This syndrome is usually seen in ex-
)xl
OKnious febrile disease in which exuberant pathogenic

lujHt scorching the heart and liver meridians, leading to
upasm of tendons and vessels and resulting in endogenous
m m m a . M aarw ,
liver wind.
Clinical manifestations: Continuous high fever, rest
lessness, spasm of hands and feet, stiff necks, upward
staring of eyes, even episthotonos, lackjaw, unconscious
ness, deep reddish tongue, yellowish dry fur and taut and
rapid pulse. Such symptoms are usually seen in epidemic
encephalitis B, epidemic cerebrospinal meningitis, brain
S O a ^ a t T tt S # f lK
abscess, tuberculous encephalitis, epidemic hemorrhagic

fever, scarlet fever and puerperal infection.
-14tb it a j i a , j* m in
Analysis of the symptoms: Stiff necks, upward star

ing of eyes or even episthotonos are caused by exuberant
pathogenic heat scorching tendons and vessels and causing
liver wind; high fever, restlessness and unconsciousness
BJ W
.i t , PJ ffi M'M
are caused by invasin of heat into the pericardium and

disturbance of the brain; deep reddish tongue, yellowish
dry fur and taut and rapid pulse are the signs of exuberant
heat consuming body fluid.
drome is marked by high fever and restlessness accompa
ffi u
8 t E S : ^ iiE K f f it t .
m k T ' o fe ja ra s
nied by spasm of the limbs, stiff neck and episthotonos
. /fj ^
which signify internal stirring of liver wind.

2.3.4.6.3
Syndrome of endogenous wind due
3.
M il
to yin asthenia
Syndrome of endogenous wind due to yin asthenia re
W ^ M ,iE J i 1 ia j
fers to the syndrome due to consumption of yin fluid and

malnutrition of tendons and vessels. This syndrome is u-
JxlE.
sually caused by consumption of yin fluid at the advanced

stage of exogenous' febrile disease; or by consumption of
yin fluid due to internal impairment and chronic disease
which lead to malnutrition of tendons and vessels and en
dogenous asthenia wind.
Clinical manifestations: Tremor or flaccidity of hands
and feet, dizziness and tinnitus, tidal fever in the afternoon
ft w . j .
or in the evening, feverish sensation over the five centers

Ipalms, soles and chest) or bone-steaming fever, flushed
fcheeks, emaciation, dry mouth and throat, red tongue
with scanty fluid and thin and rapid pulse. Such symptoms
fire usually seen at the advanced stage of some infectious
Siseases, such as epidemic encephalitis B, epidemic cerebrospinal meningitis and scarlet fever as well as at the ad
vanced stage of some chronic and consumptive diseases,
llich as hematopathy and malignant tumor.
Analysis of the symptoms: Tremor or flaccidity of
hands and feet is caused by malnutrition of tendons and
vEMfrtfr: HfWMm-'j
# , j M f t b . i J it.
kessels and endogenous asthenia wind due to consumption

ol liver and kidney yin fluid; dizziness and tinnitus are
U'nused by malnutrition of ears and eyes due to asthenia of
Jllver and kidney yin; emaciation, dry mouth and throat
re caused by failure of asthenic yin fluid to nourish the
fcody; tidal fever in the afternoon or in the evening, feworish sensation over the five centers (palms, soles and
B e s t)
or bone-steaming fever,
flushed cheeks, red
t Migue with scanty fluid and thin and rapid pulse are
niused by yin asthenia, yang hyperactivity and upward
lliiming of asthenic fire.
Key points for syndrome differentiation: This syniliDme is marked by tremor of hands and feet accompanied
fssO, A
bv lidal fever in the afternoon or in the evening, feverish

mensation over the five centers or bone-steaming fever.
2.3.4.6.4
Syndrome of blood asthenia genera-
4. jflLjtME
tlng wind
Syndrome of blood asthenia generating wind refers to
jfiLJxlffiJf I iln
Ihr syndrome due to consumption of blood and malnutriIion of tendons and vessels. This syndrome is usually
H vEM ,
imiMcd by blood asthenia due to chronic disease, acute or
j i , g K t . , f i t t ^ j i , a t f 'f i i i i
rlircAiic hemorrhage which leads to asthenia of blood, mal-
nutrition of tendons and vessels as well as endogenous

wind.
Clinical manifestations: Tremor of hands and feet,
W m k M :
fascicular twitching, numbness of limbs, dizziness. tinnitus, pal complexin, light coloured nails, whitish tongue
and thin and weak pulse.
Analysis of the symptoms: Tremor of hands and feet,
fascicular twitching and numbness of limbs are caused by
consumption of blood, malnutrition of tendons and vessels
and endogenous asthenia wind; dizziness and tinnitus are
caused by failure of blood asthenia to nourish the head;
pal complexin, light coloured nails, whitish tongue and
thin and weak pulse are caused by failure of blood asthenia
s s i f t \ftikmwio
to nourish the body.

drome is marked by tremor of hands and feet, fascicular
twitching, numbness of limbs and accompanied manifesta
tions of blood asthenia.
2.3.4.7
Syndrome of coid stagnation in the
( t ? ) SffFBSiiE
liver meridian
Syndrome of coid stagnation in the liver meridian re
fers to the syndrome due to coid pain in the distributing
regin of liver meridian caused by stagnation of pathogenic
coid in the liver vessels. This syndrome is usually caused
by pathogenic coid attack, stagnation of qi and blood in the
liver meridian, inhibted circulation of qi and blood as well
spaw a.
as spasm of meridians and vessels.

Clinical manifestations: Lower abdominal coid pain,
sagging distensin and pain of the pudendum, or contraction and pain of scrotum, aggravation with coid and allevi
ation with warmth, or coid pain in the vertex, coid limbs
and body, light coloured tongue with whitish and moist
fur, sinking and tense pulse or taut and tense pulse. Such
symptoms are usually seen in hernia, orchitis, varicocele
*rl
nnd migraine, etc.

Analysis of the symptoms: Lower abdominal cold
|lin, sagging distensin and pain of the pudendum, or
bold pain in the vertex, or contraction and pain of scro-
tum, aggravation with cold and alleviation with warmth

fe caused by contraction and stagnancy of cold, cold atliu k on the liver meridian, spasm of meridians and vessels
||N well as stagnation of qi and blood; cold limbs and body
,r.
Hl! caused by pathogenic cold attack on the body and stagktttion of yangqi from developing outwards; light coloured
liMigue with whitish and moist fur, sinking and tense pulse
of taut and tense pulse are the signs of internal exuberwilce of yin cold.
drome is marked by cold pain in the lower abdomen, puilWidum and vertex as well as cold limbs and body.
J,3.5
Syndrome differentiation of kidney disease
Kidney disease mainly reflects morbid changes in the

pllysiological functions of the kidney proper and its funcMons, such as storing essence, management of growth and
W , 7 J c > # I M ; iik I.
miproduction, governing water and bones, producing mar

row and blood, controlling the reception of qi as well as
jfloiirishing and warming viscera. Clinically kidney disease
Nt marked by aching and weakness or pain in the loins and
!' iJ(H*s, tinnitus and deafness, loss of hair and shaking of
ith, impotence and seminal emission, oligospermia and
i>. /1 ^
ulmlity, oligomenorrhea in woman> clear and profuse u-
ti*
fllici enuresis, incontinence of urie or oliguria and edeIIin. early morning diarrhea, dyspnea and more exhalation
tinrl less inhalation.
Kidney disease is usually of asthenia na ture and freHiiriitly caused by constitutional asthenia, or insufficiency
ol r isence during childhood, or consumption of essence in
the aged, or intemperance of sexual life, or involvement

of the kidney in the disorders of other viscera, which lead
to asthenia or deficiency of yin, yang, essence and qi.
2.3.5.1
Syndrome of kidney yang asthenia
Syndrome of kidney yang asthenia refers to the as
( - ) MBBuE
' f r o U E f T f f l j l
thenia cold symptoms due to failure of qi to transform re

sulting from decline of kidney yang and its failure in nour-
ilEM .
ishing the body. This syndrome is usually caused by constitutional asthenia of yang, or decline of Mingmen fire in
the aged, or impairment of kidney yang due to chronic
disease, or involvement of the kidney in the disorders of
the other visceral yang, or intemperance of sexual life and
consumption of kidney yang.
Clinical manifestations: Aching and cold sensation in
ilSiSSL:
the loins and knees, cold limbs and body, dispiritedness

and lassitude,
impotence,
immature ejaculation,
cold
sperm, infertility due to cold in the uterus, sexual hypoesthesia, or loose stool, early morning diarrhea, or fre
quent micturition, clear and profuse urie, profuse noctural urie, bright whitish or blackish complexin and
light coloured tongue with white fur as well as sinking,
deep and weak (especially over chi regin) pulse. These
. i is i
symptoms are usually seen in hypothyroidism, hypoadrenocorticism, hypogonadism and chronic nephritis, etc.
Analysis of the symptoms: Aching and cold sensation
in the loins and knees, cold limbs and body, dispiritedness
and lassitude are caused by asthenia of kidney yang and its
failure in nourishing the body; bright whitish or blackish
complexin is caused by asthenia and weakness of the kid
ney to warm and transport qi and blood, leading to inter
P n te n
nal exuberance of yin cold; impotence, immature ejacula

tion, cold sperm, infertility due to cold in the uterus,
sexual hypoesthesia are caused by asthenia of kidney yang
and Mingmen fire as well as decline in reproduction;
sfrf ] ik H '
Inquent micturition. clear and profuse urie and profuse

floctural urie are caused by insufficiency of kidney yang
nnd its failure in warming and transporting qi; loose stool
lid early morning diarrhea are caused by decline of Mingliion fire and failure of fire to warm earth; light coloured
fatigue with white fur as well as sinking, deep and weak
rbpecially over chi regin) pulse are the signs of insuffii'l5ncy of kidney yang.
Key points for syndrome differentiation: This synilime is marked by decline in reproduction accompanied
hy cold limbs and body as well as aching and cold in the
[loins and knees.
L 2.3.5.2
Syndrome of edema due to kidney
( Z ) f7j<j$i
Itthenia
Syndrome of edema due to kidney asthenia refers to
iiE J& i T 'ff
tiir symptoms of edema due to kidney yang asthenia and

l | failure in transforming qi. This syndrome is usually
hilised by dysfunction due to chronic disease and consump|on of kidney yang, or by constitutional asthenia and dei line of kidney yang which lead to retention of fluid and
tfutaneous edema.
Clinical manifestations: Anasarca (especially the rei'ion below the waist) rebounding after pressure with finfcrs, oliguria. aching cold in the loins and knees,
Ivirsion to cold and cold limbs. abdominal distensin and
fullness, or palpitation and shortness of breath, or cough.
yNpnea and sputum rale,
light-coloured and bulgy
E J lJo
W S T W m.
hinque, whitish slippery tongue fur, sinking, slow and

ittik pulse. Such symptoms are seen in chronic nephritis,
JgA ncphropathy, diabetic nephropathy and lupus nephritis
i t well as various acute and chronic failure of kidney.
Analysis of the symptoms: Anasarca (especially the
E # # r :
Ir ion l)elow the waist) rebounding after pressure with

liiKers and oliguria are caused by insufficiency of kidney
s rt
js j / h
' j - ' .
ff-
yang and its failure in transforming qi which lead to reten

tion of fluid and edema; abdominal distensin and fullness
are caused by retention of fluid due to yang asthenia and
inhibited activity? palpitation and shortness of breath are
caused by fluid attacking the heart and stagnating heart
yang; dyspnea and sputum rale are caused by retention of
fluid attacking the lung and failure of the pulmonary qi to
disperse and descend; aching cold in the loins and knees,
aversin to cold and cold limbs are caused by asthenia of
kidney yang and its failure in warming the body as well as
internal exuberance of yin cold; light-coloured and bulgy
tongue, whitish slippery tongue fur, sinking, slow and
weak pulse are the signs of consumption of kidney yang
and intemal retention of fluid.
drome is marked by edema (especially over the regin below the waist), oliguria, aching and cold sensation in the
loins and knees as well as cold limbs and body.
2.3.5.3
Syndrome of kidney yin asthenia
Syndrome of kidney yin asthenia refers to the
( = ) SfiBf E
B H E ftf T W H
symptoms of endogenous asthenic heat due to consumption

of kidney yin and insufficiency of nourishment. This syn
m m i i f . * w g :f m
drome is usually caused by consumption of kidney yin due

to asthenic overstrain and chronic disease; or by consump
tion of kidney yin at the advanced stage of seasonal febrile
disease; or by intemperance of sexual life and hypersexuality which exhausts yin.
Clinical manifestations: Aching and weakness of the
loins and knees, dizziness and tinnitus, insomnia and am
* ^ n S ,f e lR < S .IIa * .
nesia, seminal emission, scanty menstruation or amenorrhea, or metrorrhagia and metrostaxis, flushed cheeks in
the afternoon, bone-steaming tidal fever, night sweating,
dry mouth and throat, emaciation, yellowish and scanty
urie, reddish tongue with scanty fur and thin and rapid
n ru L fl
PmIh<. Such symptoms are seen in some consumptive disIm n c s
(such as tuberculosis and tumor), sexual disorder
Mild at the rehabilitative stage of some infectious diseases.

Analysis of the symptoms: Aching and pain in the
vE & frV it
lulns and knees, dizziness and tinnitus as well as amnesia

i caused by consumption of kidney yin and malnutrition
niCerebral marrow, orifices and bones? seminal emission
Hcaused by yin asthenia.and fire exuberance, asthenic
lire disturbing sperm house;
scanty menstruation and
Amenorrhea are caused by consumption of blood and insuf-
JR?T JJ H M ; A D c 'll'
Ciency of blood in the thoroughfare and conception vesrls; metrorrhagia and metrostaxis are caused by extra vation of blood due to asthenic fire; restlessness, fever
iltd insomnia are caused by asthenic fire disturbing mind;
pnaciation, bone-steaming tidal fever, flushed cheeks and
higlit sweating, dry mouth and throat as well as yellow
# .
nd scanty urie are caused by insufficiency of kidney yin,

pck of moistening and nourishment as well as fumigation
ni asthenic fire; reddish tongue with scanty fur or without
1fur and thin and rapid pulse are the signs of yin asthenia
lid endogenous heat.
Key points for syndrome differentiation: This synIjrome is marked by aching and pain of the loins and
Btiiees, dizziness and tinnitus, seminal emission and irreg
ular menstruation accompanied by yin asthenia and endogkiious heat.
2.3.5.4
Syndrome of kidney essence insuf
(ES) W R T S E
ficiency
Syndrome of kidney essence insufficiency refers to
the symptoms of retard growth, decline in reproduction
And senilism due to consumption of kidney essence. This
pyndrome is mainly caused by congenital defect, postnatal
malnutrition and insufficiency of primordial qi; or by im
pairment due to chronic disease, intemperance of sexual
M ffilsS . ^ J E ^ eiT
life and consumption of kidney essence.

Clinical manifestations:
f w m m c.
Infantile retardation of
growth and elosure of fontanel, flaccidity of skeleton, re
, a n s a .
tardation of body growth, slowness in action and feeble-
Ki
mindedness; senilism in adults, aching and weakness of

loins and knees, dizziness, tinnitus and deafness, loss of
hair and looseness of teeth, flaccidity of feet, amnesia and
dull facial expression; sterility due to oligospermia in
man, infertility due to amenorrhea in woman and sexual
ttlJ
m&To
hypoesthesia. Such symptoms are usually seen in infantile

malnutrition, rickets, retardation of intelligence, senile
dementia, sexual underdevelopment, hypogonadism, ste
rility in man and infertility in woman.
Analysis of the symptoms: Infantile retardation of
growth and elosure of fontanel, flaccidity of skeleton, re
tardation of body growth, slowness in action and feeblemindedness are caused by asthenia of kidney and its failure
a n is a ,# # .# !
in transforming qi and blood as well as malnutrition of the
T o
brain and body; senilism in adults, aching and weakness of

loins and knees, dizziness, tinnitus and deafness, loss of
hair and looseness of teeth, flaccidity of feet, amnesia and
dull facial expression are caused by asthenia of kidney es
sence that fails to control bones and nourish the brain,
teeth, hair and spirit; sterility due to oligospermia in
,-k r m
man, infertility due to amenorrhea in woman and sexual

hypoesthesia are caused by asthenia of kidney essence and
insufficiency of the reproductive source.
Key points for syndrome differentiation * This syn
drome is marked by retardation of body development in in
fants, hypogonadism and senilism in adults.'
2.3.5.5
Syndrome of kidney qi weakness
Syndrome of kidney qi weakness refers to the symp

toms due to asthenia of kidney qi and its failure in storage
and consolidation. This syndrome is usually caused by
(E ) n * @ E
weakness in the aged and asthenia of kidney qi; or by conUrnital defect and insufficiency of kidney qi; or by conUmption of kidney qi due to chronic disease and overptrain.
Clinical manifestations: Aching and weakness of loins
Miid knees, dizziness and tinnitus, frequent clear urie, or
iliipping urination, or enuresis, or frequent noctural uriliition, or incontinence of urie in man, seminal emisHi(>n, immature ejaculation, dripping menstruation, or
thin and profuse leukorrhagia, or excessive movement of
and susceptibility to abortion, light-coloured tongue
M u s
IWith whitish fur and weak pulse. Such symptoms are usu-
B U ? J i^ S ,ttJ i I l
MlHy seen in prostate hyperplasia, hypogonadism, metronilxis due to dysfunction and habitual abortion, etc.
Analysis of the symptoms: Aching and weakness of
loins and knees, dizziness and tinnitus are caused by asIhrnia of kidney qi and insufficient nutrition; frequent
rifar urie, or dripping urination, or enuresis, or fref|tient noctural urination, or incontinence of urie in man
mk caused by asthenia of kidney qi and dysfunction of
li!|ddcr; seminal emission and immature ejaculation are
liHcd by asthenia of kidney qi and its failure in storage,
Hpping menstruation, or thin and profuse leukorrhagia,
i excessive movement of fetus and susceptibility to aborllim. are caused by insufficiency of kidney qi, dysfunction
I the thoroughfare and conception vessels as well as
Mkness of the belt vessel; light-coloured tongue with
hitish fur and weak pulse are the signs of qi asthenia.
' Key points for syndrome differentiation: This synh o iiic
is marked by aching and weakness of the loins and
h r c s , frequent and clear urie or dripping urination, seinln il emission, immature ejaculation, dripping menstruaIihi. thin and profuse leukon'hagia and weakness of the
Itlldder.
t- v E m m tk
&
f
b
J - i t t . V fi i i . k
&m
!\
2.3 .5 .6
(A ) If^flnE
Syndrome of kidney failing to re-
ceive qi
Syndrome of kidney failing to receive qi refers to the
symptoms of dyspnea and shortness of breath due to asthe
nia of the kidney qi and its failure to receive qi and direct
it to its source. This syndrome is usually caused by con
sumption of pulmonary qi and impairment of the kidney
due to cough in chronic disease; or by consumption of kid
ney qi due to overstrain; or by congenital deficiency of
primordial qi and malnutrition of the kidney; or by asthe
nia of kidney qi in the aged.
Clinical manifestations: Dyspnea and shortness of
breath, more exhalation and less inhala tion, aggravation
p j
> i g
of dyspnea after movement, low and weak voice, sponta

neous sweating, lassitude, aching and weakness of loins
t t l .
and knees, light-coloured tongue and weak pulse; or ag

gravation of dyspnea, profuse cold sweating, cold limbs
and cyanotic complexin, floating and large pulse; or
shortness of breath and dyspnea, flushed cheeks and dys
jhhS o
ija T iii *
W * . Uf
phoria, vexation, dry mouth and throat, reddish tongue

with scanty fluid as well as thin and rapid pulse. Such
symptoms are usually seen in chronic obstructive pulmo
nary emphysema, pulmogenic heart disease, bronchial

asthma, lung cncer and failure of respiratory function,
etc.
Analysis of the symptoms: Dyspnea and shortness of
breath, more exhalation and less inhalation and aggrava
%%L.
!B t >l'J
.
H:
tion of dyspnea after movement are caused by asthenia of

kidney qi and its failure in receiving qi and directing qi to
its source; low and weak voice, spontaneous sweating,
2 * *
f e , l til
lassitude, aching and weakness of loins and knees, lightcoloured tongue and weak pulse are caused by asthenia of
g tP B , S . P E im f
lung and kidney qi, declination of thoracic qi and weakness

of defensive qi; aggravation of dyspnea, profuse cold
f f i w , r r t i
iweating, cold limbs and cyanotic complexin, floating

nd large pulse are caused by exhaustion of kidney yang
nd floating of asthenic yang; flushed cheeks and dyspho
ria, vexation, dry mouth and throat, reddish tongue with
Hcanty fluid as well as thin and rapid pulse are caused by
sthenia of kidney qi complicated by consumption of yin
finid and failure of yin to control yang.
drome is marked by asthmatic cough, shortness of breath,
plore exhalation and less inhala tion, aggravation of dysplira after movment and accompanied by asthenia of both
cffio
lung and kidney qi.
2. 3. 6
Syndrome differentiation of stomach

disease
Stomach disease mainly reflects the disorders of the

tomach and the pathological changes of its functions in
kceiving food, digesting food and descending. Clinically
ulomach disease is marked by stomachache, belching, hick p ' nausea and vomiting, etc.
Stomach disease is either asthenic or sthenic. Sthenic

utomach disease is usually caused by exogenous pathogenic
(uptors attacking the stomach and improper diet, leading
lo the forma tion of stomach cold, stomach heat and retenllon of food in the stomach. While asthenic stomach disi'ime is usually caused by improper diet, excessive vomitlliK and diarrhea, impairment of yin by febrile disease,
*|>lecn asthenic involving the stomach and other acute and
rhronic diseases that impair the stomach and lead to asllirnic cold in the stomach and consumption of stomach
yin.
2.3.6.1
Syndrome of stomach cold
Syndrome of stomach cold refers to internal cold
( - ) S5E
* f fip t T * 5 M I
syndrome marked by epigastric and abdominal cold pain

due to pathogenic cold attacking on the stomach, or due to
weakness of the stomach yang and endogenous yin cold.
This syndrome is mainly caused by cold attacking on the
epigastrium and abdomen, or excessive intake of cold and
uncooked food, or overstrain or asthenic cold of the gas
tric qi.
Clinical manifestations: Cold pain in the epigastrium
which is worsened with cold and alleviated with warmth;
or sharp pain which is unpressable or lingering or prefers
pressure; nausea and vomiting, relief of pain after vomi
ting, bland taste in the mouth without thirst, whitish or
bluish complexin; or epigastric and abdominal distending
pain, gurgling of water in the stomach and regurgita tion
of clear fluid; or accompanied by dispiritedness and lassi
tude, cold limbs and preference for warmth and loose
stool; light-coloured tongue with whitish slippery fur,
sinking, tense or slow pulse. Such symptoms are usually
seen in acute gastritis, chronic gastritis, duodenitis, duo
denal bulbar ulcer, gastric ulcer, gastric spasm, pylorochesis, gastrointestinal dysfunction, stomach cncer and
duodenal cncer, etc.
Analysis of the symptoms: Cold, sharp and unpalpa
ble pain in the stomach is caused by retention of pathogen
ic cold in the stomach and stagnation of qi; alleviation of
pain with warmth and aggravation with cold are due to the
fact that cold is a pathogenic factor of yin nature and can
only be resolved by yang; cold, lingeringv palpable or un
palpable pain in the epigastrium is caused by longer duration of disease, repeated occurrence of 'stomach, con
sumption of gastrosplenic yang, or overstrain, asthenic
cold of gastric qi and loss of warmth in the stomach; nau
sea, vomiting and relief of pain after vomiting are due to
stagnation of qi and improper descending of gastric qi;
So J J & T t t S
ta Mi
+ bJP&I
bland taste in the mouth without thirst is due to the fact

th a t
body fluid is not consumed because yin is exuberant
}|nd yang is asthenic; whitish or bluish complexin is due
n ? ? f7 jc 0
h stagnation of yin cold; epigastric and abdominal disten-
ilion and fullness. gurgling of water in the stomach and re

gurgita tion of clear fluid are due to impairment of gastric
tynng by cold and upward adverse rise of fluid retention
with gastric qi; dispiritedness and lassitude, cold limbs
ud preference for warmth and loose stool; light-coloured
tongue with whitish slippery fur. sinking, tense or slow
pulse are the signs of yang asthenia and internal exubernee of yin cold.
Key points for syndrome differentiation: This synBrome is marked by cold pain in the epigastrium, which is
Ulleviated with warmth and aggravated with cold, and inkmial exuberance of yin cold.
i 2.3.6.2
Syndrome of stomach heat
Syndrome of stomach heat refers to symptoms of
(.-) HftfiE
S & i E J l : f l T S 4 *
Bthenic heat due to superabundance of fire and heat in the

tomach and failure of gastric qi to .descend. This synrome is usually caused by excessive intake of pungent,
(warm and dry food which transforms into heat and fire; or
by emotional upsets and stagnation of qi which transform
into fire and attacks the stomach; or by pathogenic heat
Itacking the stomach.
Clinical manifestations.- Scorching pain in the stomMk'h, gastric discomfort with acid regurgita tion, or vomirtng right after eating, or preference for cold drinks, or
polyorexia, or halitosis, or swelling, pain and ulceration
ol gum, dental bleeding, constipation, scanty yellowish urine, reddish tongue with yellow fur and slippery and rap
id pulse. These symptoms are usually seen in acute and
Chronic gastritis, digestive ulcer, esophagus cncer and
llomach cncer as well as periodontitis and diabetes.
?tiL m T & w . m
Analysis of the symptoms: Scorching and unpalpable

pain in the stomach is caused by stagnation of heat in the
stomach and obstruction of the gastric qi; gastric discom
fort with acid regurgita tion or vomiting right after eating
is caused by upward adverse rise of liver and gastric qi and
fire as well as failure of gastric qi to descend; polyorexia
IIP
is caused by exuberance of gastric fire and excessive di

gestin ; halitosis is caused by upward adverse rise of gas
tric heat with turbid qi; preference for cold drinks, con
stipation and scanty yellow urie are due to consumption
of body fluid by pathogenic heat; swelling, pain and ulcer
ation of gum and dental bleeding are caused by fumigation

of gastric fire along the meridian, stagnation of qi and
blood as well as impairment of the collaterals; reddish
tongue with yellow fur and slippery and rapid pulse are the
signs of internal exuberance of fire and heat.
m e h ,6=
drome is marked by scorching pain in the epigastrium,

stomach discomfort with acid regurgita tion, polyorexia
and internal exuberance of fire and heat.
2.3.6.3
Syndrome of food retention in the
(E)
stomach
Syndrome of food retention in the stomach refers to
B J f ilE J ilf *
the symptoms of gastric and abdominal fullness and pain,

vomiting, diarrhea, acid regurgita tion and halitosis due to
m . W M W M l &
retention of food in the stomach. This syndrome is caused

by intemperance of food, or congenital weakness of the
stomach and spleen as well as dysfunetion of th tomach
in receiving and digesting food.
Clinical manifestations: Unpalpable gastric and ab
dominal fullness and pain, eructa tion with fetid odor, ano
rexia, or vomiting of fetid food, alleviation of abdominal
distensin and pain after vomiting, or borborygmus with
abdominal pain, unsmooth defecation,
foul stool like
M U I ! : J f J K M I
ilecayed eggs, thin and greasy tongue fur, slippery pulse
o 15TJS
ir sinking and sthenic pulse. Such symptoms are usually

vil in acute gastritis, acute enteritis, gastric dilatation,
chronic gastritis, malabsorption syndrome and Crohns
lease.
Analysis of the symptoms: Unpalpable gastric and ab
dominal fullness and pain, eructa tion with fetid odor, anokx ia, or vomiting of fetid food, alleviation of abdominal
distensin and pain after vomiting are caused by retention
f food in the stomach, stagnation of qi and upward ad
> n.
iarse rise of gastric qi; borborygmus with abdominal pain,

unsmooth defecation, foul stool like decayed eggs are
jiused by retention of food in the intestines, inhibited
llow of qi and transporta tion; thin and greasy tongue fur,
Jippery pulse or sinking and sthenic pulse are the signs of
Itemal retention of food.
Key points for syndrome differentiation: This synJfome is marked by epigastric and abdominal fullness and
A S
. 1 ( t $S # t ! . l H
ttin, vomiting of fetid food, or unsmooth defecation, foul

lool like decayed eggs and history of disease due to imjoper diet.
2.3.6.4
Syndrome of asthenic stomach yin
Syndrome of asthenic stomach yin refers to the
(BS) RBlE
IK ftE Jlr f lP Jf
Jnnptoms due to insufficiency of gastric yin, loss of proptr moistening and descending of the stomach as well as inlc>i nal disturbance of asthenic heat. This syndrome is usuiillv caused by prolonged stomach di-sease; or by con-
f f i^ M ;
kimption of yin fluid at the advanced stage of seasonal feItlilc disease; or by consumption of body fluid due to exItwsive vomiting and diarrhea; or by excessive intake of
UliKent, fragrant and dry foods; or by excessive taking of
hftrm and dry drugs; or by consumption of gastric fluid
illir to emotional depression and fire transformed from qi
MttKnation.
ffipm >&
ffi
Clinical manifestations: Scorching and dull pain in the

epigastrium, hunger without desire to take food, or epi
gastric fullness and discomfort, or dry vomiting and hiccup, dry mouth and throat, dry feces, scanty urie, red
dish tongue with scanty fluid and thin and rapid pulse.
m il m & T m tf& n
Such symptoms are usually seen in acute and atrophic gas

tritis, malabsorption syndrome, Crohns disease, esophagus cncer, stomach cncer, liver cirrhosis and liver
cncer as well as at the rehabilitative stage of various in
fectious diseases.
Analysis of the symptoms: Scorching and dull pain in
ff: i
the epigastrium, hunger without desire to take food are

caused by insufficiency of gastric fluid, loss of proper
moistening in the stomach, internal disturbance of asthen
ic heat and failure of gastric qi to descend; epigastric full
ness and discomfort or dry vomiting and hiccup are caused
by loss of proper moistening in the stomach and failure of
MU?. Sr4>.J4ffll?TfEj
gastric qi to descend; dry mouth and throat, dry feces and

scanty urie are caused by yin asthenia and consumption of
body fluid; reddish tongue with scanty fluid and thin and
rapid pulse are the signs of yin asthenia and internal heat.
m vE w & :
drome is marked by scorching dull pain in the epigastrium,

hunger without desire to take food. or dry vomiting and
hiccup as well as dry mouth and throat, reddish tongue
with scanty fluid.
mm.
2. 3. 7
- t . m m m idE
Syndrome differentiation of gallbladder

disease
Syndrome differentiation of gallbladder disease re

flects the disorder of the gallbladder proper and the dis
turbance of its functions in storing and secreting bile to
assist digestin and absorption of food as well as in making
strategy. The commonly encountered symptoms in clinical
mm jim & n s.ns ti-ufl
practice are hypochondriac pain,
bitter taste in the
mouth, jaundice, palpitation, timidity and dizziness, etc.

Since the secretion and excretion of bile are closely
related to the dispersing function of the liver, the symp
toms of gallbladder, such as hypochondriac pain, bitter
taste in the mouth and jaundice, usually indica te simultalicous disorder of the liver and gallbladder which will be
described in the part of complicated diseases of the viscerii. The following mainly describes the syndrome of gall
bladder stagnation and phlegm disturbance marked by pal
pitation, timidity and dizziness.
Syndrome of gallbladder stagnation and

phlegm disturbance
Syndrome of gallbladder stagnation and phlegm dislurbance refers to the symptoms of gallbladder failing to
[disperse due to internal disturbance of phlegm-heat. This
f l S f W t t E J i ! i3
B r t/c ,I iS * J 9 * 3 1 lW iE
fio
jiyndrome is mainly caused by emotional depression and inIttirnal disturbance of the gallbladder by a mixture of
r t tM J W J L
pjllegm and heat due to fire transformed from qi stagnaIion which scorches fluid into phlegm.
Clinical manifestations: Timidity and susceptibility to
l i s * * : J f i f ^ 1t,t(
fcight, palpitation and restlessness, insomnia and dreamimws, dysphoria, difficulty in making decisin, thoracic
iX t^ fe , m m n m , # , i .
mui hypochondriac oppressin and distensin, frequent

nitfh, dizziness and vrtigo, bitter taste in the mouth,
Vomiting, reddish tongue, yello-wish and greasy fur as
Wi ll as taut and slippery pulse. Such symptoms are usually
M ni in neurasthenia, cholecystitis, arrhythmia and clifllm teric syndrome.
Analysis of the symptoms: Timidity and susceptibility
lu Iright, palpitation and restlessness as well as difficulty
I making decisin are caused by internal disturbance of
Ihli'gm-heat and disorder of gallbladder qi; insomnia and
piiminess and dysphoria are caused by phlegm-heat dis-
S J tK .ttK J f.
turbing mind; thoracic and hypochondriac oppressin and

distensin as well as frequent sigh are caused by failure of
the gallbladder to disperse and inhibited flow of qi; dizzi
ness and vrtigo are caused by phlegm-heat attacking the
head along the gallbladder meridian; bitter taste in the
mouth and vomiting are caused by heat driving gallbladder
qi to rise and failure of the stomach to descend; reddish
tongue, yellowish and greasy fur as well as taut and slip
pery pulse are the signs of internal exuberance of phlegmheat.
drome is marked by palpitation, insomnia, dizziness, tho
racic and hypochondriac oppression and distensin, bitter
taste in the mouth and yellowish greasy tongue coating.
2.3. 8
Syndrome differentiation of small
i m
intestinal disease
Small intestinal disease reflects the disorder of the
small intestine and the pathological changes of its func
tions in receiving and digesting food as well as in separating lucid substance from turbid substance. Clinically the
symptoms of small intestinal disease are abdominal disten
sin, borborygmus and loose stool.
In the theory of viscera and their manifestations, the
digestive and absorptive functions of the small intestine
are attributed to the spleen. So the disorders of the small
w m n i*i . m w /W& tf
intestine are usually included in the disorders of the

spleen. The following is a brief description of sthenic'heat
A:
syndrome of small intestine due to the heart transferring

heat to the small intestine.
Sthenic heat syndrome of small intestine
im m fto v
Sthenic heat syndrome of small intestine refers to the

symptoms due to exuberance of heat in the small intes
tine. This syndrome is usually caused by the heart trans-
0 il^ T ^ h M iB f S C i
ferring heat to the small intestine.

Clinical manifestations: Dysphoria and thirst, ulcer
in the mouth and on the tongue, scanty and brownish urine, inhibited urination, scorching pain in urination, he
t,
aturia, reddish tongue, yellowish tongue fur and rapid

pulse. These symptoms are usually seen in Behcets dis
ease, infection of urinary tract and sicca syndrome.
Analysis of the symptoms: Dysphoria is caused by in
ternal exuberance of heart fire which disturbs mind; thirst
is caused by heat scorching body fluid; ulcer in the mouth
and on the tongue are caused by hyperactivity of heart
fire; scanty and brownish urie, inhibited urination and
tA filo
scorching pain in urination are caused by exuberant heat in

the small intestine transferred by the heart because the
heart and the small intestine are internally and extemally
related to each other; hematuria is caused by extravasa
flSBifrf il i L S f f t MUtlfiLo
tion of blood due to exuberant heat scorching the yin col

laterals; reddish tongue, yellowish tongue fur and rapid
pulse are the signs of internal exuberance of heat.
drome is marked by vexation, thirst, mouth and tongue
ulcer as well as scanty urie, inhibited urination and
icorching pain in urination.
2. 3. 9
Syndrome differentiation of large intes
A ,
jzM /fW tH E
tinal disease
Large intestinal disorder mainly reflects the dysfunc
tion of the large intestine proper and the pathological
changes in its functions in transporta tion and transforma
tion. The clinical symptoms of large intestinal disorder
me usually constipa tion, diarrhea and purulent and bloody
lysentery.
Large intestinal disorder is either asthenic or sthenii
l'he asthenia syndrome of large intestine is usually
m&.
caused by congenital yin deficiency, or by exuberant heat

consuming body fluid, or by excessive vomiting and diar
rhea, or by impairment of yin due to chronic disease
which lead to consumption of large intestinal fluid; the
sthenia syndrome of large intestine is often caused by at
tack of summer-dampness and heat, or by improper food
that lead to retention of damp heat in the large intestine.
2.3.9.1
Syndrome of large intestinal fluid
(- )
consumption
Syndrome of large intestinal fluid consumption refers
to the symptoms of retention of dry feces and difficulty in
defecation due to consumption of large intestinal fluid and
inhibited transportation. This syndrome is usually caused
by congenital yin deficiency, or by insufficiency of blood
in the aged, or by excessive vomiting and diarrhea, or by
consumption of yin due to chronic disease, or by non-restoration of consumed fluid at the advanced stage of febrile
disease, or by excessive hemorrhage, etc.
Clinical manifestations: Dry feces and difficulty in
defecation, defecation once in several days, dry mouth
ff.n i
and throat, or dizziness and halitosis, reddish tongue with

scanty fluid, yellow and dry tongue fur, as well as thin
&o T E T i a
and unsmooth pulse. Such symptoms are usually seen in

disturbance of intestines, habitual constipation, chronic atrophic gastritis, esophagus cncer, stomach cncer and
intestinal cncer as well as the rehabilitative stage of vari
ous infectious diseases.
Analysis of the symptoms: Dry feces and difficulty in
defecation, defecation once in several days are caused by
consumption of large intestinal fluid, loss of moisture in
the large intestine and its function in transportation; dry
mouth and throat are caused by consumption of fluid and
loss of moisture; dizziness and halitosis are caused by
stagnation of large intestinal qi and disturbance of lucid
jt .it P B t t t f t ,n & * r .i a,
ynng by upward adverse flow of turbid qi; reddish tongue

with scanty fluid, yellow and dry tongue fur, as well as
lliin and unsmooth pulse are the signs of consumption of
yin fluid and endogenous dry-heat.
Key points for syndrome differentiation: This syndrome is marked by retention of dry feces and difficulty in
defecation as well as manifestations of loss of fluid.
2.3.9.2
Syndrome of large intestinal damp-
(~ )
heat
Syndrome of large intestinal damp-heat refers to the
ymptoms of diarrhea and dysentery due to invasin of
rinmp heat into the intestinal tract and failure of the intestlne to transport. This syndrome is mainly caused by invaMion of pathogenic damp-heat in summer and autumn into
m m .m
Rlie intestinal tract, or by improper diet, leading to reten

cin of damp-heat and turbid pathogenic factors in the in-
ffCo
fcrstinal tract.
Clinical manifestations: Abdominal pain, yellowish
te * * :
hnd foul fulminant diarrhea, scorching sensation over the
hnus, or purulent and bloody dysentery, tenesmus, scanty
m m i , s m e s , / j'f iM s t .
lid yellow urie, reddish tongue, yellow and greasy
longue fur as well as slippery and rapid pulse. Such sympionis are usually seen in acute enteritis, dysentery, ulcerHIive colitis, intestinal tuberculosis and tumor in the intestln.'il tract.
Analysis of the symptoms: Abdominal pain, yellowish
[ttld foul fulminant diarrhea are caused by retention of
d,imp-heat in the large intestine, stagnation of qi in the
Intestinal tract and failure of the intestine to transport;
n<orching
sensation over the anus is caused by heat inva
the large intestine; purulent and bloody dysentery is
i mi sed by damp-heat fumiga ting the large intestinal tract

Nuil impairing the collaterals; tenesmus is caused by stagtlnlion of dampness and qi as well as heat fumiga ting the
SSSBo
intestinal tract; scanty and yellow urie, reddish tongue,

yellow and greasy tongue fur as well as slippery and rapid
pulse are the signs of internal stagnation of damp-heat.
drome is marked by abdominal pain, fulminant diarrhea,
or purulent bloody dysentery as well as manifestations of
damp-heat.
2. 3. 10
Syndrome differentiation of bladder
+ s
disease
Bladder disease mainly reflects the disorder of the
bladder proper and the pathological changes of its func
tions in storing and excreting urie. The clinical manifes
tations are frequent urination, urgency in urination, pain
in urination and anuria as well as brownish and turbid urine, hematuria and sandy urie, etc.
Bladder disease is often of sthenic nature due to re
tention of damp heat in the bladder and inhibited transfor
mation of qi in the bladder. The asthenic disease of the
Se.
bladder is usually caused by asthenic cold in the lower enrgizer and unconsolidation of the bladder due to asthenia
?Kfo
of kidney yang.
Syndrome of damp heat in the bladder

Syndrome of damp heat in the bladder refers to symp
toms of morbid changes in urie due to retention of damp
heat in the bladder and inhibited transformation of qi.
This syndrome is frequently caused by invasin of exoge
nous damp heat in the bladder, or by downward'migration
of damp heat transformed from improper diet into the
bladder.
Clinical manifestations: Frequent and urgent urina
tion, lower abdominal distending pain, scorching pain in
M 9 f ,R
urination, scanty and brownish urie, or hematuria, or
StSUfiL,
sandy urie, accompanied by fever, lumbago, reddish
I * , /M i! t4 il
5 , fj
tongue, yellowish greasy tongue fur and slippery and rapid

pulse. Such symptoms are usually seen in acute pyelitis,
cystitis, prostatitis, urethritis and urinary calculus, etc.
Analysis of the symptoms: Frequent and urgent
urination, lower abdominal distending pain, scorching
pain in urethra are caused by retention of damp heat in the
[bladder and inhibited transformation of qi; scanty and
P J 'M a J M ;
rt H W-Wl
brownish urie is caused by retention of damp heat and

lcorching of fluid; hematuria is caused by damp heat im(>;iiring yin collaterals; sandy urie is caused by lingering
damp heat scorching impurity in the urie into stones; fe-
PJRr-S jS & fiP jS & .a fc & ffJff.ilS
Vnr and lumbago are caused by fumigation of damp heat in-
fcolving the kidney; reddish tongue, yellowish greasy

Dngue fur and slippery and rapid pulse are the signs of intnal accumulation of damp heat.
Key points for syndrome differentiation: This syn-
* v v m m %
prome is marked by frequent and urgent urination, burnflliK pain in urethra during urination and yellowish and
fcownish urie.
2,3.11
Syndrome differentiation of accompa-
+ - x
nying diseases of viscera

Accompanying diseases of viscera refer to simultaneiiiis disease
of two or more viscera.

M l o
The viscera are different in functions, but they are

closely related to each other and form an organic whole.
m z m , - e n m
Therefore under pathological conditions, they may affect
h j
Hicli other and resulting in accompanying diseases.
, t n BI ffi 2 S * ffi 4:
i#*S.
The accompanying diseases of viscera are pathologinilly related to each other and affect each other. For exmuple, accompanying diseases usually occur among the
Viniera internally and externally related to each other or
promoting, restraining, over-restraining and reverse re-
#J*L,
straining each other.

The manifestations of accompanying diseases of vis
cera are not simply the addition of the symptoms of the
viscera. Actually the accompanying diseases of viscera
have their specific mechanism which results in the corre-
g , if a g i t i s
sponding symptoms.
SSEo
2. 3 . 1 1 . 1
Asthenia syndrome of heart and
(- ) A H IA IE
lung qi
Asthenia syndrome of heart and lung qi refers to the
symptoms of palpitation, cough and dyspnea due to simul
taneous asthenia of heart and lung qi. This syndrome is usually caused by consumption of pulmonary qi with the involvement of the heart due to cough and dyspnea in chron
.';
ic disease; or by weakness in the aged or by overstrain.
0fSfc.
& . i 3? <
jfl
Clinical manifestations: Palpitation, shortness of

breath, chest oppression, weakness in cough, vomiting of
thin and clear sputum, dizziness and dispiritedness, timid
and low voice, spontaneous sweating and lassitude, aggra
vation after movement, pal complexin, light-coloured
tongue with whitish fur, or light purplish tongue and lips,
Sito IJ&TIlttlfigttHili
sinking and weak or knotted pulse and intermittent pulse.

Such symptoms are usually seen in chronic and obstructive
pulmonary emphysema, chronic and pulmogenic heart dis
ease, congestive heart failure, pericarditis and mitral
valve prolapse syndrome.
Analysis of the symptoms: Palpitation is caused by
asthenia of heart qi which fails to propel and nourish the
heart; shortness of breath and chest oppression are caused
by asthenia of heart and lung qi which lead to insufficient
% >JJ$lf5|>
, W'n.f'Wi
production of thoracic qi and inhibited flow of qi; weak

ness in cough is caused by asthenia of pulmonary qi,
failure of pulmonary qi to deprate and descend as well as
upward adverse flow of qi; vomiting of thin and clear
*n,Jlf?S3If3. JWI&f It
Iputum is caused by asthenia of pulmonary qi which fails to
A ,i-n
S f f E.J j ; d j W
i|
listribute body fluid and leads to accumulation of fluid into

phlegm; dizziness and dispiritedness, timid and low voice,
m i
|x>ntaneous sweating and lassitude are caused by hypoaclvity of the body due to asthenia of qi; aggravation after
movement is due to consumption of qi; pal complexin,
light-coloured tongue with whitish fur, or light purplish
tongue and lips, sinking and weak or knotted pulse and inIrrmittent pulse are the signs of asthenia of heart and lung
()i which is weak in transporting blood.
Key points for syndrome differentitation: The major
fnanifestations are both palpitation, cough, asthma and
lymptoms due to qi deficiency and weakened functional
(ctivity.
2.3.11.2
(z ) i m m f u
pleen
Asthenia syndrome of heart and spleen refers to the
lymptoms of malnutrition of the heart, dysfunction of the
leen and weakness of the spleen in controlling blood.
This syndrome is usually caused by improper regulation in
prolonged disease, or by excessive contempla tion, or by
Intemperance of food and impairment of the spleen and
Itomach, or by acute and chronic hemorrhage leading to
JfiL*
lrficiency of heart and spleen qi and blood.
mm o
V S 'L '
JL ^ J f f i
Clinical manifestations: Sallow complexin, lassiI i k I c1,
palpitation, insomnia and dreaminess, dizziness and
Amnesia, poor appetite, abdominal distensin and loose

Mool, hematemesis, hematochezia, or subcutaneous hem-
$ M Iif[ U ' I L , & T i JL.
rrhage, or scanty and light-coloured menstruation and

flipping menstruation, light-coloured and tender tongue
pJjjiL
well as thin and weak pulse. These symptoms are usuIIv seen in arrhythmia, cardiac neurosis, chronic gastritis,
tliucslive ulcer, hemorrhage from upper digestive tract,
m.il;il)sorption syndrome, iron-deficiency anemia, aplastic
I*.
* 4 fc d lJ lu iR # c * ft *
anemia, purpura, leukopenia and dysfunctional uterine

bleeding.
Analysis of the symptoms: Insomnia and dreaminess
vE frV i: 'frjfiL'T'.S.'C,'
are caused by insufficiency of heart blood, malnutrition of
J8I
the heart and irritability; dizziness and amnesia are caused

by insufficiency of heart blood; poor appetite, abdominal
distensin and loose stool are caused by spleen asthenia,
qi deficiency and dysfunction of transformation;
he
matemesis, hematochezia, or subcutaneous hemorrhage,

or dripping menstruation are caused by failure of the
spleen to control blood due to asthenia; sallow complex
H f e ? S , 'f , f c
je *
in, lassitude, light-coloured and tender tongue as well as

thin and weak pulse are the signs of qi and blood consump
tion.
Key point for syndrome differentiation: This syn
E l i l 'C , '# * 1
drome is marked by palpitation, insomnia, abdominal dis

tensin, loose stool and manifestations of asthenia of both
qi and blood.
2 .3 .1 1.3
( .= )
/CiiSfflMiiE
kidney yang
Asthenia syndrome of heart and kidney yang refers to
the symptoms of blood stagnation and retention of fluid
due to decline of heart and kidney yangqi. This syndrome
is mainly caused by decline of heart yang and prolonged
disease involving the kidney; or by retention of fluid at
tacking on the heart due to deficiency of kidney yang and
failure of qi transformation.
Clinical manifestations; Palpitation, cold body and
limbs, dispiritedness and lassitude, edema of limbs, dysuria, cyanosis of the lips and nails, light-coloured, dull and
purplish tongue, whitish and slippery fur as well as sink
ing, thin and indistinct pulse. Such symptoms are usually
'h * f<J, B
S J 1*1
it.jfciifflmJ i
seen in heart and kidney failure due to hypertension, in

fectious endocarditis, myocarditis, chronic pulmogenic
heart disease, chronic nephritis, systemic lupus erythematosus, diabetes, hypothyroidism and epidemic hemor-
IE
M 'ilV k fj Jfoft 3? % #
rhagic fever.
Analysis of the symptoms: Palpitation is caused by
PBril.'C;
asthenia of heart and kidney yang as well as failure of the

heart to warm, nourish and propel; edema of limbs and
r o ^ f t , K V c K .,
dysuria are caused by asthenia of kidney yang, dysfunction

of qi transformation and internal retention of dampness;
cyanosis of the lips and nails, light-coloured, dull and pur
,ma.%t<sSsL'^%-W\ IH
plish tongue are caused by asthenia of heart and kidney

yang which fails to transport blood; cold body and limbs,
dispiritedness and lassitude, whitish and slippery fur as
well as sinking, thin and indistinct pulse are the signs of
asthenia of heart and kidney yang as well as internal exu
berance of yin cold.
drome is marked by severe palpitation, edema of limbs,
dysuria as well as cold body and limbs, dispiritedness and
lassitude.
2.3.11.4
S yndrom e of disharm ony b etw een
(ES)
the heart and kidney

Syndrome of disharmony between the heart and kidney refers to the symptoms of asthenia of heart and kidney
BMH'
yin and hyperactivity of heart and kidney yang due to im-
E # fl
balance between the heart and the kidney. This syndrome

is usually caused by excessive contempla tion; or by de
pression which transforms into fire to consume heart and
kidney yin; or by overstrain, prolonged disease and in
temperance of sexual life.
Clinical manifestations: Restlessness and insomnia,
palpitation and dreaminess, dizziness and tinnitus, amne
sia, aching and weakness of loins and knees, seminal
j a W >3S 'C.' M Si iW
emission, feverish sensation over the five centers (palms,

soles and chest), tidal fever and night sweating, dry
S M f c H . j E T M
mouth and throat, reddish tongue with scanty fur or with

out fur and thin and rapid pulse. Such symptoms are usu
ally seen in neurasthenia, arrhythmia, cardiac neurosis,
hypertension and hyperthyroidism.
Analysis of the symptoms: Restlessness and insomnia, palpitation and dreaminess are caused by asthenia of
heart and kidney yin and relative hyperactivity of yang
which disturbs the mind; dizziness and tinnitus, amnesia,
aching and weakness of loins and knees are caused by con
sumption of kidney yin, insufficiency of bone marrow and
R * P J S f f i o
I l '>
malnutrition of cerebral marrow and loins; seminal emis

sion is caused by internal exuberance of asthenia fire
which disturbs the kidney, feverish sensation over the five
JABflftElo
centers (palms, soles and chest), tidal fever and night

sweating, dry mouth and throat, reddish tongue with
scanty fur or without fur and thin and rapid pulse are the
signs of yin asthenia and hyperactivity of fire.
m iE 5 j :
drome is marked by restlessness, insomnia, dreaminess,

seminal emission, aching and weakness of loins and knees
as well as manifestations of yin asthenia and hyperactivity
of fire.
2.3.11.5
Syndrome of lung and spleen qi
asthenia
Syndrome of lung and spleen qi asthenia refers to the
symptoms of asthenia due to asthenia of lung and spleen
qi, failure of the lung to disperse and descend as well as
* iiE
failure of the lung to transform. This syndrome is usually

caused by cough and consumption of pulmonary qi due to
prolonged disease and disorder of the child-organ involving
the mother-organ; or by improper diet, impairment of the
spleen and stomach involving the lung.
Clinical manifestations: Continuous cough, shortness
of breath and dyspnea, profuse thin and clear sputum,
ifj
poor appetite, abdominal distensin and loose stool, low

voice and no desire to speak, lack of energy, pal com
plexin. or edema of limbs, light-coloured tongue with
whitish and slippery fur as well as thin and weak pulse.
Such symptoms can be seen at the remission stage in chro
nic bronchitis, chronic bronchial asthma and chronic ob
structive pulmonary emphysema as well as in immunological hypofunction due to various factors.
Analysis of the symptoms: Continuous cough, short
ness of breath and dyspnea are caused by asthenia of pul
monary qi, failure of the lung to disperse and descend as
well as upward adverse flow of qi; poor appetite, abdomi
nal distensin and loose stool are caused by asthenia of
spleen qi, failure of transformation and transporta tion;
profuse thin and clear sputum is caused by asthenia of qi
which fails to distribute fluid and leads to attack of fluid
retention on the lung; edema of limbs is caused by failure
of the spleen to transform dampness due to asthenia; low
voice and no desire to speak, lack of energy, pal com
plexin, light-coloured tongue with ^vhitish and slippery
fur as well as thin and weak pulse are the signs of qi as
thenia and hypofunction of the body.
drome is marked by cough, dyspnea, shortness of breath,
poor appetite and loose stool accompanied by qi asthenia
and hypofunction of the body.
2. 3 . 1 1 . 6
Syndrome of spleen and kidney
(A )
B BBffiE
yang asthenia
Syndrome of spleen and kidney yang asthenic refers
J J T J f P B .f E J S f T J I *
to asthenic cold symptoms marked by diarrhea or edema

due to deficiency of spleen and kidney yang as well as fail
ure of kidney yang to warm and transform. This syndrome
is usually caused by consumption of yang due to chronic
disease, or by chronic diarrhea or dysentery, or by retention
i l f e , * E ^ T X Mi fli ' I
of pathogenic dampness, which lead to decline of kidney

yang to warm and nourish spleen yang.
Clinical manifestations: Chronic diarrhea and dysen
tery, morning diarrhea with indigested or thin and cold
stool, dropsy of face and body, abdominal distensin, dysuria, cold pain in the loins and knees or lower abdomen,
bright-white complexin, cold limbs and body, light-col
oured and bulgy tongue with whitish slippery fur as well as
deep, slow and weak pulse. Such symptoms are usually
B U & X tio
bTJLTU
seen in chronic enteritis, malabsorption syndrome, irrita

ble intestinal syndrome, Crohns disease, chronic nephritis, purpuric nephritis and chronic failure of the kidney.
Analysis of the symptoms: Chronic diarrhea and dys
entery, morning diarrhea with indigested or thin and cold
stool are caused by asthenia of spleen and kidney yang,
decline of mingmen fire and failure of fire to warm earth;
dropsy of face and body, abdominal distensin and dysuria
fifis * * ,
are caused by asthenia of spleen and kidney yang leading

to failure to warm and transform fluid and internal reten
tion of fluid; cold pain in the loins and knees or lower ab
domen are caused by decline of spleen and kidney yang to
nourish the body and viscera; bright-white complexin,
cold limbs and body, light-coloured and bulgy tongue with
whitish slippery fur as well as deep, slow and weak pulse
are the signs of internal exuberance of yin cold and inter
nal retention of fluid cold due to yang asthenia.
drome is marked by morning diarrhea with indigested
food, dropsy and cold pain in the loins and abdomen.
2.3.11.7
Syndrome of kidney and liver yin
( t ) BTf BlffifiE
asthenia
Syndrome of kidney and liver yin asthenia refers to
symptoms of interior disturbance of asthenia-heat due to
consumption of liver and kidney yin fluid and failure of yin
Hfc&rtimMvEmo * v f .
to control yang. This syndrome is marked by consumption
BHft v )# r
of fluid due to chronic disease and improper regulation; or

by interior impairment due to emotional disorder and con
sumption of yin due to hyperactivity of yang; or by con
0 X J f 'I f IS S fr S jlW t.
sumption of renal essence due to intemperance of sexual

life; or by exhaustion of liver and kidney yin fluid due to
prolonged duration of febrile disease.
Clinical manifestations: Dizziness, tinnitus and am
nesia , dull pain in the hypochondria, aching and weakness
of the loins and knees, insomnia and dreaminess, seminal
emission, scanty menstruation or amenorrhea, or metror
g S 's E g H ,i* I ,P ) l
rhagia and me trostaxis, dry mouth and throat, feverish

sensation over the five centers (palms, soles and chest),
night sweating and flushed cheeks, reddish tongue with
scanty fur, thin and rapid pulse. Such symptoms are usu
ally seen in various consumptive diseases ( such as chronic
^ IS t t L BE K H>.
hepatitis, cirrhosis of liver, liver cncer, chronic nephri-
I-:
tis, diabe tic nephritis, renal tuberculosis, kidney cncer,

bladder cncer, systemic lupus erythematosus) and at the
rehabilitative stage of various infectious diseases (such as
sicca syndrome and sterility).
Analysis of the symptoms: Dizziness, tinnitus and
amnesia are caused by consumption of liver and kidney
yin; dull pain in the hypochondria, aching and weakness of
Ig ^ w y U ffF flli ,* i
the loins and knees are caused by asthenia of liver and kid
ney yin and lack of proper nourishment; insomnia and
IM& rt
. Dfc3L' fr # . I I & HK
dreaminess are caused by interior heat disturbing mind
due to yin asthenia; seminal emission is caused by asthenia-fire disturbing essence source; scanty menstruation or
amenorrhea is caused by asthenia of liver and kidney yin
to replenish the thoroughfare and conception vessels; meIrorrhagia and metrostaxis are caused by superabundance
o fire disturbing the thoroughfare and conception vessels
tlue to yin asthenia; dry mouth and throat, feverish sensa-
P&HT, 2'.>*&, S
tion over the five centers (palms, soles and chest), night
sweating and flushed cheeks, reddish tongue with scanty fur,
thin and rapid pulse are the signs of lack of moistening due to
yin asthenia and interior exuberance of asthenia fire.
drome is marked by aching and weakness of the loins and
knees, hypochondriac pain, dizziness, tinnitus and semi
nal emission as well as interior heat due to yin asthenia.
2.3 .1 1.8
Syndrome of liver fire invading
mm*
(A ) KFKSffiE
lung
JF F A E flifr ffiS f T Jff
Syndrome of liver fire invading lung refers to the
mm,
symptoms of the lung failing to deprate and clear due to

invasin of adverse movement of fire in the liver meridian
into the lung. According to the theory of five elements, it
is called wood-fire tormenting metal. This syndrome is
usually caused by impairment of liver due to depression
and rage and stagnation of qi transforming into fire; or by
accumulation of pathogenic heat in the liver meridian at
tacking the lung.
Clinical manifestations: Scorching pain in the chest
and hypochondria, irritability and susceptibility to rage,
dizziness and distensin of head, flushed cheeks and red
eyes, restless fever and bitter taste in the mouth, paroxysmal cough, yellowish thick and sticky sputum, or he
moptysis, dry feces, yellowish and reddish urie, reddish
tongue, yellowish thin fur and taut and rapid pulse. Such
symptoms are usually seen in bronchiectasis, pulmonary
tuberculosis, endobronchial tuberculosis and lung cncer.
Analysis of the symptoms-. Scorching pain in the
chest and hypochondria, irritability and Susceptibility to
rage, dizziness and distensin of head, flushed cheeks and
red eyes are caused by internal stagnation of liver meridi
an qi and fire; restless fever and bitter taste in the mouth
are caused by heat steaming gallbladder qi; paroxysmal
> 3 b tj j!s c .
cough, yellowish thick and sticky sputum are caused by

liver fire attacking the lung and failure of the lung to clear
>/h M M jfc o ? { )>h i i
and deprate; hemoptysis is caused by internal exuberance

of fire and heat impairing pulmonary collaterals; dry fe
R W E & .
ces, yellowish and reddish urie are caused by exuberant

heat consuming fluid; reddish tongue, yellowish thin fur
and taut and rapid pulse are the signs of internal exuber
ance of sthenia-fire in the liver meridian.
drome is marked by cough, hemoptysis, scorching pain in
the chest and hypochondria, susceptibility to anger and in
ternal exuberance of sthenia-fire.
2.3 .1 1 .9
S yndrom e of im balance b etw een
(T i)
liver and spleen

Syndrome of imbalance between liver and spleen re
fers the symptoms of chest and hypochondriac distending
pain, abdominal distensin and loose stool due to failure of
M , JKJR >
iil \\>
the liver to disperse and convey as well as dysfunction of

the spleen. This syndrome is mainly caused by emotional
upsets, impairment of the liver due to depression and rage
as well as attack of the liver qi on the spleen due to failure
of the liver to act freely; or by impairment of the spleen
due to improper diet and overstrain as well as the spleen
reversely restraining the liver due to dysfunction of the
spleen.
Clinical manifestations: Distending pain and wander
ing pain in the chest and hypochondria, susceptibility to
m i% m A :
* ,
A , l i JMUfl, a m \
sigh, emotional depression, irritability and susceptibility

to rage, anorexia and abdominal distensin, loose stool
and retention of feces or loose stool and unsmooth defeca

tion, borborygmus and breaking wind, or abdominal pain
with desire of diarrhea, alleviation of pain after diarrhea,

whitish tongue fur, taut pulse or slow and weak pulse.
Such symptoms are usually seen in chronic enteritis, irri-
m m 0
table intestinal syndrome, allergic colitis, malabsorption

syndrome and chronic hepatitis.
Analysis of the symptoms: Distending pain and wandering pain in the chest and hypochondria, susceptibility
to sigh, emotional depression, irritability and susceptibili
ty to rage are caused by failure of the liver to disperse and
convey as well as stagnation of qi; anorexia and abdominal
distensin, loose stool and retention of feces are caused by
invasin of adverse liver qi into the spleen and dysfunction
A n***?
of the spleen; loose stool and unsmooth defecation, borbo

rygmus and breaking wind, or abdominal pain with desire
of diarrhea are caused by stagnation of qi and retention of
M E # ..
dampness; alleviation of pain after diarrhea is due to the

fact that stagnation of qi is relieved after defecation;
whitish tongue fur, taut pulse or slow and weak pulse are
the signs of liver depression and spleen asthenia.
drome is marked by chest and hypochondriac distensin
and fullness, anorexia, abdominal pain and borborygmus
as well as loose stool and diarrhea.
2.3.11.10
Syndrome of incoordination be
tween liver and stomach

Syndrome of incoordination between liver and stom
ach refers to the symptoms of epigastric and hypochondri
ac distensin and pain due to stagnation of liver qi which
invades the stomach and prevents gastric qi from normal
descending. This syndrome is mainly caused by emotional
upsets, stagnation of liver qi and invasin of liver qi into
the stomach.
Clinical manifestations; Hypochondriac and epigastric
3: J f t j N i J f t f l t
distending pain or wandering pain, hiccup, belching, acid

regurgita tion, anorexia, mental depression, irritability
and susceptibility to anger and sigh, whitish thin or yel
lowish thin tongue fur, taut pulse or taut and rapid pulse.
it# #
W 'M W tM Ig '
"i m
Such symptoms are usually seen in aûte gastritis, chronic

gastritis, digestive ulcer, reflux esophagitis, cholecystitis
and gallstones.
Analysis of the symptoms.* Hypochondriac and epigas
ii E 4 M f : JFF^ciBKtW
tric distending pain or wandering pa*n are caused by fail

ure of the liver to disperse and corJvey * invasin of ad
verse flowing liver qi into the stomach and failure of gas
tric qi to descend; hiccup, belching acid regurgitation
and anorexia are caused by stagnation f Qi and fire in the
stomach and adverse flow of gastric^
mental depres
sion, irritability and susceptibility tO anger and sigh are

caused by failure of the liver to act fr ^ ety> stagnation of qi
and transformation of fire from stagr>ated qi; whitish thin
or yellowish thin tongue fur, taut pu ^se or taut and rapid
pulse are the signs of stagnation of liver qi and transfor
mation of fire from stagnated qi.
P E B jS : * E i m
drome is marked by distending pain c?r wandering pain in

the chest, hypochondria and stomach
weH as hiccup and
rfKfilo
retching.
2 . 3 . 1 1 . 11
Syndrome of dc*mP-heat in liver
( + - ) ffiiSftfiE
and gallbladder
Syndrome of damp-heat in liver aifr gallbladder refers
to the symptoms of dysfunction in d is ^ ersin and conveyance due to accumulation of damp-heât in the liver and
gallbladder. This syndrome is usually caused by pathogen
ic damp-heat; or by partiality to greasy and sweet foods
which causes internal generation of dar^np-heat; or by dyslunction of the stomach and spleen which leads to internal
IS fF M to
production of dampness and the spleer*1 reversely restraining the liver, resulting in accumulation of damp-heat in
the liver and gallbladder.
Clinical manifestations: Hypochono driac scorching dislending pain,
or hypochondriac m ass> anorexia and
)IK.
abdominal distensin, bitter taste in the mouth, acid re

gurgita tion and nausea, disorder of defecation, scanty and
reddish urie, or alterna te chills and fever, yellow colora-
K .a w flM E S .a ffT fe it
tion of the skin and eyes, or pudendal pruritus, or foul

and yellowish leukorrhea, reddish tongue with yellowish
and greasy fur, taut and rapid pulse or slippery and rapid
pulse. Such symptoms are usually seen in various digestive system diseases (such as viral hepatitis, cirrhosis of
liver, jaundice, cholecystitis, pancreatitis, liver cncer,
gallbladder cncer and pancreas cncer) as well as orchitis, scrotal eczema, pelvic inflammation and vaginitis.
Analysis of the symptoms: Hypochondriac scorching
\ m W :
distending pain, or hypochondriac mass are caused by ac
ir , ^
jfiLt
cumulation of damp-heat, dysfunction of the liver and gall

bladder in dispersin and conveyance, stagnation of qi and
unsmooth circulation of blood; bitter taste in the mouth is
caused by stagnation and steaming of damp-heat; yellow
coloration of the skin and eyes is caused by dysfunction of
the liver and gallbladder in dispersin and conveyance
which leads to extravasation of the bile in the skin and
muscles; acid regurgita tion and nausea, disorder of defe
cation, scanty and reddish urie, or alterna te chills and
fever, anorexia and abdominal distensin are caused by
stagnation of damp-heat and disorder of the spleen and
stomach in ascending and descending; pudendal pruritus,
or foul and yellowish leukorrhea are caused by downward
migration of damp-heat along the liver meridian; reddish
tongue with yellowish and greasy fur, taut and rapid'pulse
or slippery and rapid pulse are the signs of stagnation of
steaming of damp-heat in the liver and gallbladder.
drome is marked by distending pain in the hypochondria
m,
and rib-side, anorexia, abdominal distensin, coloration

of the skin and eyes and pudendal pruritus.
mrnrn.
2 .4
Other syndrome differentiation
aS-Eg-^r
-JfTttiWE.
methods
2. 4.1
Introduction to six-meridians syndrome
- s
&
# e e*
differentiation
Six-meridians syndrome differentiation, a method developed by Zhang Zhongjing, a celebrated doctor in the
Han Dynasty, is the principie for syndrome differentiation
and treatment in Treatise on Seasonal Febrile Disease and
is the basis of syndrome differentiation for the later gen
era tions.
Six-meridians syndrome differentiation categorizes
the stages of exogenous febrile diseases into six types for
selection of treatment according to the main principie of
W EBS,
yin and yang, namely taiyang disease, yangming disease,

shaoyang disease, taiyin disease, shaoyin disease and ju
eyin disease.
Six-meridians diseases reflect the pathological chan
ges of the meridians and viscera. Among the six types of
diseases, taiyang disease pertains to the external, yang
ming disease to the internal, shaoyang disease to the
S . H PJi
IM f -
Hl..
semi-external and semi-internal; while the three yin types

all pertain to the internal. The three yang types of disease
reflect the pathological changes of the six fu organs, while
the three yin types of diseases reflect the pathological
changes of the five zang organs. So the six-meridians dis
eases include the pathological changes of both the twelve
meridians and viscera. Since the six-meridians syndrome
differentiation focuses on the analysis of the pathological
changes and transmission rule of diseases caused by
exogenous wind-cold, they are not identical with syn
drome differentiation of viscera.
#t-g65io ffiT
-A
HA
2.4.1.1
Taiyang syndrome
se
( - ) *BBiiE
Taiyang governs the superficies and Controls both

nutrient and defensive qi. When wind and cold attacks the
So
human body, it first invades taiyang. Then defensive qi

will take action to resist. The struggle between pathogen
ic factors and healthy qi in the superficies brings about
taiyang meridian disease which reflects the primary stage
fbg A ju ff.U baiA P B
of exogenous febrile disease. If the pathogenic factors are
jS f f io
not relieved and enter the fu organs along the meridians,

it will cause taiyang fu syndrome.
2. 4. 1. 1.1
Taiyang meridian syndrome
l.
Taiyang meridian syndrome, the disease caused by

invasin of pathogenic factors into the superficies, may be
divided into taiyang wind-attack syndrome and taiyang
cold-attack syndrome according to the constitution of the
patients and the nature of pathogenic factors.
Taiyang w in d -a tta ck
syndrome: A syndrome
caused by invasin of pathogenic wind into the superficies

and disorder of nutrient and defensive qi.
Clinical manifestations: Fever, aversin to wind,
( 1) *.F0
JxU.IJt M fP M . S J1&
m jm m m m
IffSiSS:
j,
sweating, stiffness and pain in the neck and head, whitish

thin tongue fur and floating and slow pulse.
AW
ws* a, j
im o
Analysis of the symptoms: Fever is caused by inva

sin of pathogenic wind into the superficies and struggle
between defensive qi and pathogenic factors; sweating and
aversin to wind are caused by looseness of the muscular
interstices and failure of nutrient qi to keep inside because
wind tends to open and disperse; stiffness and pain n the
neck and head are caused by pathogenic wind attack and
disorder of meridian qi because taiyang meridians con
verge over the head and distribute down to the neck from
the head; whitish thin tongue fur is due to the fact that
pathogenic factors are still retained in the skin and have
penetrated inside; floating and slow pulse is the sign of
m m
external asthenia.
Taiyang c o ld -a tta ck syndrome: The disease caused
by invasin of pathogenic cold into the superficies, ob
(2)
Jk
E JifgfB li*. UPII
struction of defensive qi and stagnation of nutrient qi.

Clinical manifestations: Aversin to cold, fever, no
sweating, or dyspnea, stiffness and pain in the neck and
head, body pain, whitish thin tongue fur and floating and
tense pulse.
Analysis of the symptoms: Aversin to cold is caused
by cold attacking the superficies, and stagnation of defen
ro sa.
Jirafa'
sive qi; fever is caused by struggle between defensive qi

and healthy qi; no sweating and dyspnea are caused by ob
struction of the muscular interstices and failure of the lung
to disperse and descend; pain in the head and body is
caused by stagnation of nutrient qi and inhibited flow of
meridian qi; whitish thin tongue fur, floating and tense
pulse are the signs of wind and cold attacking the superfi
cies.
2.4.1.1.2
Taiyang fu syndrome
2 . P 0 1 t i E
Taiyang fu syndrome refers to the syndrome due to

failure to relieve taiyang meridian syndrome and transmis
sion of pathogenic factors into the bladder along the me
ridians. It may be divided into taiyang water-accumulation
syndrome and taiyang blood-accumulation syndrome ac
cording to the pathogenesis.
Taiyang w ater-accum ulation syndrome: A syn
drome caused by hypofunction of the bladder in transfor
( 1)
iJ I
S7jcEM *P0gEX<W . #
ming qi and accumulation and retention of water due to

failure to relieve taiyang meridian syndrome and transmis
sion of pathogenic factors into the bladder.
Clinical m anifestations; Fever, aversin to cold,
t fc ft S E s
dysuria, lower abdominal distensin and fullness, thirst,

vomiting after drinking water and floating pulse.
Analysis of the symptoms: Fever, aversin to cold
fiPt.l.
iiE t e | S 0 &
k l
and floating pulse are caused by failure to relieve taiyang
m ..
meridian syndrome? dysuria and lower abdominal disten

sin and fullness are caused by transmission of pathogenic
heat into the bladder and dysfunction of the bladder in
transforming qi; thirst is due to retention of fluid and fail
ure of qi to distribute fluid; vomiting after drinking is due
to indigestin and adverse flow of gastric qi.
Taiyang blood-accumulation syndrome: This syn
drome is caused by internal transmission of pathogenic
(2)
AK
W d a f f i J i f A ffl
factors and its mixture with blood in the lower energizer

due to failure to relieve taiyang meridian syndrome.
Clinical manifestations; Lower abdominal spasm,
it s * * :
fullness or mass, normal urination, mania, deep and un

smooth pulse or deep and knotted pulse.
Analysis of the symptoms: Lower abdominal spasm or
even hard mass is due to improper treatment of taiyang
,f P & r t ft.J f J fiL ff i g
meridian syndrome which leads to transmission of patho
i- 'p m . a i >> m , m , s m m
genic heat into the internal and its mixture with blood in
ffi; s? rt . d-li' # -t ja
the lower abdomen; mania is caused by internal stagnation
# feffrSLinE;
Jf.', ^
of heat disturbing mind; normal urination is due to the

fact that the disease still remains in blood phase and has
it
E iiS lE 5 ig r ,* fi5 3 ^ B .
not affect the function of the bladder in transforming qi;

deep and unsmooth or deep and knotted pulse is the sign of
obstruction due to stagnation of heat and inhibited flow of
blood.
2.4.1.2
Yangming syndrome
Yangming syndrome, the syndrome due to invasin of
( = ) B0BÊ
HJIfaiiEjtfJPAIspJ!,
pathogenic factors into yangming meridian, hyperactivity

of yang heat and dry-het in the stomach and intestines, is
the critical stage during the course of struggle between
pathogenic factors and healthy qi in exogenous febrile dis
ease. Yangming syndrome is usually caused by delayed or
improper treatment of taiyang disease which leads to path
ogenic factors transmitting inside and transforming into
im .
#! W&
g A ffl
heat; or by exogenous factors attack on people with fre

quent deficiency of body fluid and relative superabundance
of yangqi. Yangming syndrome can be divided into yang
ming meridian syndrome and yangming fu syndrome ac
cording to the location of disease and the characteristics of
syndrome.
2. 4. 1. 2. 1
1. PBflflSiiE
Yangming meridian syndrome
Yangming meridian syndrome refers to the syndrome

with no retention of feces in the intestines due to hyperac
tivity of pathogenic heat.
iEo
Clinical manifestations: High fever, no aversin to

cold but aversin to heat, profuse sweating, polydipsia,
flushed cheeks and dysphoria, reddish tongue with yellow
b, x n 3 1<*.

r ^ M ifc * W
ish dry fur and full and large pulse.

Analysis of the symptoms: Fever, flushed cheeks, no
aversin to cold but aversin to heat are due to invasin of
pathogenic factors into yangming meridian, transforma
tion of heat and dryness, hyperactivity of dryness and heat
all over the body; profuse sweating is caused by intemal
j R S f f f f i.j iiiip a - s it t . . 1;-
accumulation of heat driving fluid out of the body; poly

dipsia and yellowish dry tongue fur are caused by exces
ffijfiLiSJSlliSfefco
sive heat consuming body fluid; dysphoria is due to heat

disturbing mind; full and large pulse is due to superabun
dance of heat and rapid flow of blood.
2.4.1.2.2
Yangming fu syndrome
2.
rnrnvt
Yangming fu syndrome refers to the syndrome with

retention of dry feces in the intestines due to mixture of
superabundance of pathogenic heat with waste materials in
m m m m o
the intestines.
Clinical manifestations: Fever, afternoon tidal fever,
0W I
continuous sweating over hands and feet, abdominal hardness and fullness with unpressable pain, constipation,
restlessness, even delirium, yellowish dry tongue fur or
brownish tongue fur, tongue with prickles, deep and pow-
iB S c ,
I I #
2.
4 . 1 . 5.1
Shaoyin cold-transformation syn
i.
drome
Shaoyin cold-transformation syndrome refers to the
syndrome due to asthenia of heart and kidney yang and
pathogenic factors transforming into coid following the na
S E io ^ iiE ^ @ ^
ture of yin. This syndrome is usually caused by impair

ment of heart and kidney yangqi due to delayed and wrong
treatment; or by frequent asthenia of the heart and kidney
as well as direct attack of pathogenic coid on shaoyin.
Clinical manifestations: Aversin to coid and curled
posture in sleep,
dispiritedness and sleepiness, coid
limbs, diarrhea with indigested food, no thirst or thirst

with preference for hot drinks, clear and profuse urie,
light-coloured tongue with white fur and deep and indis
tinct pulse.
Analysis of the symptoms: Aversin to coid and
curled posture in sleep, dispiritedness and sleepiness as
well as coid limbs are caused by decline of heart and kid
ney yangqi and lack of warmth; diarrhea with indigested
food is caused by decline of kidney yang to warm the
spleen to transform food; no thirst is due to internal exu
berance of yin coid; thirst with preference for hot drinks
is due to failure of kidney to transform qi and produce fluid
resulting from asthenia of kidney yang or due to excessive
diarrhea consuming body fluid; clear and profuse urie,
light-coloured tongue with white fur and deep and indis
tinct pulse are the signs of decline of yang and exuberance
of yin.
2.
4 . 1 . 5. 2.
Shaoyin heat-transformation syn
drome
Shaoyin heat-transformation syndrome refers to the
syndrome of asthenia-heat due to asthenia of heart and
kidney yin, hyperactivity of heart and kidney yang as well
as pathogenic factors transforming into heat from yang.
2.
'M m vcfc
TI lis syndrome is caused by failure to relieve pathogenic

heat and consumption of kidney yin; or by frequent yin as
x m m m ..
thenia , invasin of pathogenic factors into shaoyin, trans

formation of pathogenic factors into heat following the na!ture of yang and consumption of kidney yin scorched by
eat.
Clinical manifestations: Vexation and insomnia, dry
1niouth and throat, reddish tongue tip or deep-red tongue
Mild thin and rapid pulse.
Analysis of the symptoms: Vexation and insomnia are
Em f t V r :
[due to deficiency of kidney yin, disharmony between wa

ter and fire which leads to hyperactivity of heart fire to
idisturb the mind; dry mouth and throat, reddish tongue
I lip or deep-red tongue and thin and rapid pulse are the
[ligns of deficiency of water and superabundance of fire.
2.4.1.6
Jueyin syndrom e
Jueyin syndrome appears in the advanced stage of six[meridians disorders due to cold-attack, marked by complex changes and mixture of cold and heat in pathogenesis.
I Upper-heat and lower-cold syndrome is taken as an exam|pie to show the characteristics of this syndrome. Jueyin
llyndrome is usually evolved from the disease lingering in
Ihe other meridians.
Clinical manifestations: Thirst, qi rushing up into the
heart, pain and feverish sensation in the heart, hunger
without appetite, postcibal vomiting of ascaris, cold exIrnnities and diarrhea.
Analysis of the symptoms: Jueyin meridian pertains
10 the liver and distributes beside the stomach and through
11ir diaphragm. So jueyin disease is marked by dysfunction
of the liver and stomach. Complex of heat and cold is due

lo the fact that jueyin disorder affects dispersin and conVfyance which leads to disorder of qi and imbalance
Ifctween yin and yang; thirst, qi rushing up into the
( A
mmm.
heart, pain and feverish sensation in the heart, hunger

without appetite and postcibal vomiting are caused by in
vasin of adverse flowing liver qi into the stomach as well
as heat in the stomach and adverse flow of qi; diarrhea is
i^ o /J H c
due to spleen asthenia and cold in the intestines; postcibal

vomiting of ascaris is due to upper-heat and lower-cold
which drives ascaris to move upward with the rise of gas
tric qi.
The theory of six-meridians syndrome differentiation
holds that the relation between pathogenic factors and vis
cera, meridians, qi and blood is characterized by trans
mission, combina tion of syndromes, complica tion and di
rect attack. The change of one meridian disorder into another meridian disorder is called meridian transmission;
simultaneous of syndromes involving two or three yang
meridians is called combination of syndromes; onset of another meridian disorder before one meridian disorder is
relieved is called complication; if pathogenic factors at the
primary stage of exogenous febrile disease do not transmit
from the yang meridians but directly attack three yin me
ridians, it is called direct attack.
2. 4. 2
ASM,
Introduction to syndrome differentia
t J a H e
tion of defensive q i, q i, nutrient qi

and blood
Syndrome differentiation of defensive qi, qi, nutrient
qi and blood is a syndrome differentiation method for ex
ogenous epidemic febrile disease developed by Ye Tianshi
in the Qing Dynasty. It summarizes the symptoms of ex
ogenous epidemic febrile disease at different stages into
four types for the benefit of treatment, namely defensive
phase syndrome, qi phase syndrome, nutrient phase syn
drome and blood phase syndrome.
Syndrome differentiation of defensive qi, qi, nutrient
i-JE^
lil
qi and blood was developed on the basis of six-meridians
KM
syndrome differentiation due to cold attack, replenishing

six-meridians syndrome differentiation and enriching the
content of syndrome differentiation for exogenous febrile
disease.
2.4.2.1
Defensive phase syndrome
( - ) E tt E
Defensive phase syndrome refers to the syndrome

due to invasin of pathogenic factors into the lung, disor
der of defensive qi and dysfunction of the lung. This syn
t- ii \
drome is usually seen at the primary stage of epidemic fe

brile disease.
Clinical manifestations: Fever, slight aversin to cold
and wind, reddish tongue tip, whitish thin or slightly
yellow tongue fur, floating and rapid pulse, usually ac
companied by headache, cough, dry mouth, slight thirst
and swelling pain of the throat.
Analysis of the symptoms: Fever and slight aversin to
vEMM
cold and wind are caused by struggle between pathogenic fac

tors and defensive qi in the superficies; headache is due to fe
brile pathogenic factors disturbing the head; cough is due to
febrile pathogenic factors attacking the lung; slight thirst and
dry mouth are due to mild consumption of body fluid at the
primary stage of epidemic febrile disease; swelling and
painful throat are due to febrile pathogenic factors attac
king the lung, scorching the throat and stagnation of qi
m w m .
and blood; reddish tongue tip, whitish thin or slightly

yellow tongue fur, floating and rapid pulse are the signs of
febrile pathogenic factors invading the superficies.
2.4.2.2
Qi phase syndrome
Qi phase syndrome refers to intemal sthenia-heat

syndrome due to febrile pathogenic factors penetrating in
side and attacking the viscera, marked by superabundance
of healthy qi and sthenia of pathogenic factors. The manifestations of this syndrome are different due to different
(Z )
location of pathogenic febrile factors in invading the viscera.

Clinical manifestations: Fever, aversin not to cold
but to heat, vexation and thirst, sweating, reddish urie,
reddish tongue, yellowish tongue fur and rapid pulse, or
accompanied by cough, chest pain, expectoration of yel
lowish thick sputum; or accompanied by vexation, heartburn and restlessness; or high fever, profuse sweating,
polydipsia and preference for cold drinks as well as full and
large pulse; or afternoon tidal fever, unpressable abdominal
liardness and pain, constipation or watery diarrhea, yellowish
dry tongue fur, or even dry blackish tongue fur with prickles,
JKj'lj n t *'L**j$ i ~P
deep and sthenia pulse; or alternate chills and fever like ma

laria, pain in the rib-side and bitter taste in the mouth, vexa
tion and retching as well as taut and rapid pulse.
Analysis of the symptoms: Fever, aversin not to
cold but to heat, vexation, thirst and reddish tongue with

yellowish tongue fur are caused by internal exuberance of
heat and severe struggle between pathogenic factors and
healthy qi; cough, chest pain and expectoration of yellow
# . m & m , m m m m , &
ish thick sputum are caused by accumulation of pathogenic

heat in the lung and dysfunction of the lung in depura tion
and descending; vexation and heartburn are due to dys
phoria resulting from disturbance of diaphragm by heat;
high fever, profuse sweating and serious thirst are due to
superabundance of gastric heat and steaming of internal
heat; hectic fever, abdominal fullness, distensin and
pain as well as constipation are due to retention of heat in
the intestines and stagnation of intestinal qi; alternate
chills and fever like malaria, pain in the rib-side and bitter
taste in the mouth are due to retention of pathogenic fac
tors in the gallbladder.
2.4.2.3
Nutrient phase syndrome
Nutrient phase syndrome refers to the syndrome due

to internal transmission of pathogenic febrile factors,
(= )
mme
consumption of nutrient yin and disturbance of the mind.

This syndrome appears at the serious stage of epidemic fe
brile disease.
Clinical manifestations: vSevere fever in the night,
mild thirst, vexation and insomnia, or even delirium, appearance of macules and eruption, deep-red tongue with
scanty fur and thin and rapid pulse.
Analysis of the symptoms: Severe fever in the night
is due to invasin of pathogenic febrile factors into nutri
S iS ^ f l S A
f M
f t f M
I l t t .
ent phase and scorching nutrient yin; vexation and insom

nia, or even delirium are due to invasin of pathogenic
heat into nutrient phase and disturbing the mind; mild
S tS K fc ,l!ln *a a ii
thirst is due to pathogenic heat steaming nutrient yin to

rise up; appearance of macules and eruption are due to
heat invading blood collaterals; deep-red tongue with
scanty fur and thin and rapid pulse are the signs of heat
scorching yin.
2.4.2.4
Blood phase syndrome
<ea> h u m e
Blood phase syndrome is caused by invasin of patho
J4 l4 H E Jtf ia & JS S S
genic febrile factors into yin blood and leading to disturb
A M L ,# I ^ J U 3 & J x L f K
ance of blood, genera tion of wind and consumption of yin.
* i E *
This syndrome appears at the critical stage of epidemic fe

brile disease.
Clinical manifestations; Worsened fever in the night,
restlessness, or even delirium, mania, appearance of pur
plish or blackish macules and eruptions, or hematemesis,
epistaxis, hematochezia, hematuria, deep-red tongue,
ffl Jfil, f i JfiL,
and rapid pulse; or convulsin, stiffness of neck, episthotonos, upward staring of eyes, lockjaw and taut and
rapid pulse; or continuous low fever, evening fever with
alleviation in the morning, feverish sensation over the
five centers (palms, soles and chest), emaciation and
dispiritedness, deafness and thin pulse; or tremor of
hands and feet and flaccidity.
M flL.
W.iftL, 3 - f e U &-.
Analysis of the symptoms: Worsened fever in the

night is due to exuberant heat in blood phase scorching
blood; restlessness, delirium and mania are due to heat
disturbing the mind; appearance of purplish or blackish
macules and eruptions and various bleeding are caused by
JL$?, MI JiL
heat scorching collaterals and causing extravasation of

blood; deep-red tongue, and rapid pulse are signs of exu
berance of heat in blood phase; convulsin, stiffness of
neck and episthotonos are due to exuberant heat in blood
\ mn.i m i .
phase to scorch vessels and tendons; low fever, evening

fever with alleviation in the moming, feverish sensation
over the five centers (palms, soles and chest) are due to
retention of pathogenic heat consuming liver and kidney
yin and internal disturbance of asthenia-heat due to yin
asthenia; emaciation and dispiritedness and thin pulse are
due to deficiency of yin essence and malnutrition of the
body; dispiritedness is due to malnutrition of spirit; deafness is due to consumption of kidney yin and malnutrition
of ears; tremor of hands and feet and flaccidity are signs
of endogenous asthenia-wind due to consumption of liver
yin and malnutrition of tendons.
Exogenous epidemic febrile disease usually starts
from defensive phase, gradually developing into qi phase,
nutrient phase and blood phase as the pathological condi
tions are gradually getting worsened. Such a progress is
called due transmission. If pathogenic factors enter defen
sive phase and directly penetrates into blood phase without
passing through qi phase, coma and delirium will be
caused. Such a progress is known as adverse transmis-
sion. Besides, there are still some other ways of trans

mission, such as simultaneous involvement of defensive
phase and qi phase , heat in both qi phase and nutrient
phase and heat in both qi phase and blood phase.
T 3 E # , ro m
, m ; &
PostScript
J s
T&
The Compilation of A Newly Compiled English-Chinese Library o f TCM was started in 2000 and published in
2002. In order to demnstrate the academic theory and
2000
clinical practice of TCM and to meet the requirements of
2002
X m &}%}*&'
compilation, the compilers and transators have made

great efforts to revise and polish the Chinese manuscript
and English transa tion so as to make it systematic, accurate, scientific, standard and easy to understand. Shang
hai University of TCM is in charge of the transation.
Many scholars and universities have participated in the
compilation and transa tion of the Library, i. e. Professor
Shao Xundao from Xian Medical University (former Dean
of English Department and Training Center of the Health
Ministry), Professor Ou Ming from Guangzhou University
of TCM ( celebrated translator and chief professor),
if % fum
^ if u
Henan College of TCM, Guangzhou University of TCM,

Nanjing University of TCM, Shaanxi College of TCM, Li-
x m * e mi
aoning College of TCM and Shandong University of TCM.
W * * > E * I f c ,r # l f * K * *
4, E 5 * # f * E I r 5 l f (
The compilation of this Library is also supported by

the State Administrative Bureau and experts from other
universities and colleges of TCM. The experts on the
Compilation Committee and Approval Committee have directed the compilation and transation.
Professor She
Jing, Head of the State Administrative Bureau and Vice

Minister of the Health Ministry, has showed much con
cern for the Library. Professor Zhu Bangxian. head of the
Publishing House of Shanghai University of TCM, Zhou
Dunhua, former head of the Publishing House of Shanghai
University of TCM, and Pan Zhaoxi, former editor-inchief of the Publishing House of Shanghai University of
TCM, have given full support to the compilation and
transation of the Library.
ix t
fiJiSUL
With the coming of the new century, we have presented this Library to the readers all over the world,
# iin B rt f>Y+ E
sincerely hoping to receive suggestions and criticism from

the readers so as to make it perfect in the following revi
sin.
Zuo Yanfu
1 t
Pingju Village, Nanjing

Spring 2002
2002 pfo)#
!olour Fig.
formal State;
he tongue
lour Fig. 2
kht-whitish
ligue
lE t,1
\\m
Colour Fig. 3
Red tongue
m m 3
n:,'r
Colour Fig. 4
Deep-red tongue
OT4
Colour Fig. 5
Cyanotic and
purplish tongue
35
30
Colour Fig. 6
Bulgy tongue
m f 16
ol
s b iib
Atlas
Colour Fig. 7
Thin and emaciated
tongue
Colour Fig. X
Fissured tongu
m m i
mm
Colour Fig. 10
Tooth-marked
tongue
Colour Fig. 9
Prickly tongue
m@9
05110
Colpur Fig. 11
Deviated tongue
&11
Colour Fig. 12
Greasy tongue fur
% m n
m x:
M fv
tf& i1!
Colour Fit
Patchcd o>
i te tongue f U r
S 5I14
Colour Fig. 15
Yellow tongue fl
Colour Fig. 16
Grayish tongue fur
#@ 16
Note:
M g
colour Fig.
6,7,8,9,10
and 11 are extr acted from Muit mui
Teaching Software o f Tongue Diagnosis
( CD - ROM)
j o i n t l y publishod
the Phonotape & V i d i o t a p e P u b l i s h i n g House of Shanghai Un i ve r s i

of TCM and the E l e c t r o n i c Phonotape & Vi di ota pe Press of Shangh
J i aot ong Uni ve rs ity
{' fVltl
.' !!
I I I ' A
i ? fi!j I
V iv id , D is t in c t a n d A u d io v is u a l C D
A n ex cess to th e m y s te r y o f to n g u e d ia g n o s is i n T C M
7 1? * n s - i # tt t m m ?
&
The Multimedia Teaching Software is jointly published h

Phonotape & Vidiotape Publishing House of Shanghai Univafl^
'ii
TCM and the Electronic Phonotape & Vidiotape Press of Shl
m m m j
) . ^ tu
Jiaotong University, the content of which is vivid, distinol

accurate. It enables you to understand tenets of tongue di*|
and leads you to the realm of TCM, providing you with an aoi
Chnese medicine, phiiosophy and wisdom.
The Multimedia Teaching Software was developed by Profosi
& 'H r - ) U ! :ili
tm 'I' UMkTmMYM.
>t
Zhaofu and Associate Professor G u Yidi from the Diagn)

Section of S hanghai University of TCM based on their
k 7-
)m m R i w t i f f t s t f w
iis
teaching experience and coliection of hundreds of valuablo

examination pictures of tongue with photographic and
i ,
4
techniques.
m m x m n m w ,
) f Wj T,
fttMMM
m m x * \ m "& = F m r
144 typical, vivid and distinct tongue diagnosis pictures

Excellent human-computer communication system
Ideal "electrical teacher" for teaching yourself at home
$\s\m
Phonotape & Vidiotape Publishing House of Shanghai Unlvi

TCM
Electronic Phonotape & Vidiotape Press of Shanghai J
t m u i.
'i'i i j
University
Address: 530 Lingling Road, Shanghai, China
f t f t f t l f : 200032
Postcode: 200032
I i , r :
( 086 ) 2 1 - 5 4 2 3 2 0 7 6
Tel: (086)-21 -54232076
? :
( 086 ) 2 1 -6 4 1 8 2 0 3 2
Fax: (086)-21 -64182032
A N e w ly C o m p iled P ra c tic a l English-C hinese L ib ra ry o f

T ra d itio n a l C h in ese M e d ic in e
liasic Theory of Traditional Chinese

Medicine
Diagnostics o f Traditional Chinese
^H #T ^
Medicine
Science of Chinese Materia Medica
Science o f Prescriptions
7 JW \
Internal Medicine of Traditional Chinese
* n i* i m m
Medicine
Surgery o f Traditional Chinese Medicine
Cynecology of Traditional Chinese
Medicine
Pediatrics of Traditional Chinese Medicine
Traumatology and Orthopedics of
't raditional Chinese Medicine
Ophthalmology of Traditional Chinese
Medicine
Otorhinolaryngology of Traditional Chinese
Medicine
( 'hiese Acupuncture and Moxibustion
( 'hiese Tuina (Massage)
Life Cultivation and Rehabilitation of
Traditional Chinese Medicine

Diagnostic o

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( !

impiler-in-Chief WANG Lufen

hanghai Pujiang Education Press

Compiled by Nanjing University of

iHniitl < mpler-in-Chief ZUOYanfu

ilm iuiii.ii Pujiang Education Press

SliMtixhni Pujian# Education Press (Shanghai University of Traditional ('hiese Medicine

I00 C'aiLun Koad Shanghai, 201203, China

I )MKnostics of Traditional Chnese Medicine

( A Nt'wly Compiled Practical English-Chinese Library of TCM General Compiler-in-Chief

n .( D ... 3 s ... 3 ...

(Ifffelfr 1200 q- m & M 201203)

ISBN 978 - 7 - 81010 - 652 - 8/R 618

Compilation Board o f the Library

(Listed in the order of the number of strokes in the Chinese ames)

Raymond K. Carroll (Australia)

Alessandra Gul (Italy)

Shulan Tang (Britain)

Tzu Kuo Shih (America)

Helmut Ziegler (Germany)

(Listed in the order of the number of strokes in the Chinese ames)

Wang Lingling Wng Lufen

He Shuxun (specially invited)

Chen Tinghan (specially invited) Shao J ianmin

Lin Xianzeng (specially invited)

Lin Duanmei (specially invited)

Zhou Ligao (specially invited)

Ling Guizhen (specially invited)

3EJ05Oj^: * * < * * >

Translation Committee o f the Library

(Listed in the order of the number of strokes in the Chinese

Huang Guoqi Xie Jinhua

(Listed in the order of the number of strokes in the Chinese ames)

Office of the Translation Committee

JS*jS JHI &BP $J m WS;

Approval Committee o f the Library

(Listed in the order of the number of strokes in the

Office of the Compilation Board Committee

( Listed in the order of the number of strokes in the Chinese ames)

(& - & & & ,% & )

nxn *xm & n

As we are walking into the 21st century,

'health for all is still an important task for the

the new century. The realization of health for all

efforts to promote its development. Currently the

meets the need to solve such problems. Therefore,

Various aspects of work need to be done to pro

(% - & & .& $ # )

As we are walking into the 21st century,

effects of chemical drugs have become more and

more evident. Furthermore, both the governments

meets the need to solve such problems. Therefore,

series of books known as A Newly Compiled

Professor Zuo Yanfu,

general compilei^in-chief of this Library, is a person

this Library is done with consummate ingenuity

This Library encompasses a systematic summarization of the teaching experience accumulated in

abroad and enable the whole world to have a

l tter understanding of traditional Chinese med

Peoples Republic of China

#, & Mr mtuif g ira it,r

wilh unique theory and practice," such as traditional

Indian medicine and Arabian