diagnosis

methods of making a diagnosis

there are many ways to make a diagnosis in chinese medicine. although zang fu diagnosis is the predominant method practiced in school, all theories below are valid and acceptable forms of TCM diagnosis. each method has its own rules and advantages. how you know which one to select depends upon that patient in front of you or the answer choices if taking an exam. try to learn each diagnostic method in and of itself. sometimes the symptoms in one system will directly relate to symptoms in another system, but not always. incorrectly imposing one system upon another will frequently lead to frustration, wrong diagnosis, and of course wrong answers on exams.

first figure out if there is excess or deficiency, the condition heat or cold (eight pillars), second decide which substance is out of balance (qi, blood, or fluids) and third decide the organ. start from the big generalizations then work your way to more specific systems and organs. you may think you are doing this when deciding an organ first, but there is greater chance of trying to fit the symptoms to your diagnosis, instead of the diagnosis to the symptoms, if you limit your thinking. plus on an exam it might not be a zang fu question, in which you need to know the other systems.

  • exterior/interior, heat/cold, excess/deficiency, yang/yin

  • whether substances are deficient or excess, which substance is injured

  • conditions involving the yin and yang organs

  • taiyang, shaoyang, yangming, taiyin, shaoyin, jueyin

  • wei, qi, ying, xue

  • upper jiao, middle jiao, lower jiao

  • wood, fire, earth, metal, water

  • cutaneous, sinew, luo, primary, divergent, 8 extra vessels (used for acupuncture only)

yang vs yin.png

the eight pillars

  • exterior

    1. simultaneous chills/fever, superficial pulse, thin tongue coat

    2. chills and fever are subjective sensations experienced by the patient, does not require an actual fever

    3. in some cases acute skin conditions are considered exterior since physical location is on the body's surface

    4. affects: skin, muscles, channels

    5. exterior syndromes are pathological conditions resulting from invasion of the superficial layers of the body. sudden onset. the skin, hair, and muscles belong to the superficial portions of the meridians and collaterals.

    6. symptoms: intolerance of cold, fever with aversion to cold - exterior condition. other manifestations: severe chills, mild fever, no sweating, absence of thirst, headache, general aching, nasal obstruction & cough. thin white tongue coating and superficial pulse.

    intermediate

    1. exogenous syndromes, which have failed to fully transmit to the interior. anti-pathogenic qi is not strong enough to expel the pathogen. (shaoyang)

    2. symptoms: alternating chills and fever, discomfort and fullness in the chest and hypochondrium, vomiting, anorexia, bitter taste in the mouth, dry throat, blurred vision and string-taut pulse

    interior

    1. fever no chills, or chills no fever, deep pulse, thicker tongue coat

    2. if there is not simultaneous chills and fever the condition is interior

    3. affects: internal organs, bones, qi, blood

    4. affects 5 zang and 6 fu organs. interior syndromes are pathological conditions coming from transmission of exogenous pathogenic factors to the interior of the body. there are three ways they can be transmitted: 1) exterior to interior invading zang-fu 2) direct attack on zang-fu from exogenous pathogenic factors. 3) drastic emotional changes, improper diet, overstrain and stress. changes in the tongue or pulse reflect interior or exterior problems.

    5. symptoms: fever with no aversion to cold or aversion to cold with no fever - interior condition. mild chills, severe fever, no sweating or sweating, thirst. thin yellow tongue coating, superficial and rapid pulse.

  • heat

    1. thirst, fever, aversion to heat, sweating, yellow body fluids, possible constipation, red tongue, yellow or no coat, rapid pulse

    2. exterior heat - fever and chills, more fever than chills, headache, body aches, thirst, sore throat, yellow nasal discharge, thin white or thin yellow coat, possible red tip of tongue, superficial, rapid pulse

    3. treatment principle: promote sweat, clear heat, release exterior

    4. interior heat - aversion to heat, no chills, sweating, red face, yellow sputum, dark yellow urine, constipation, red tongue yellow or no coat, rapid pulse, can also be slippery

    5. treatment principle: clear heat, nourish yin

    6. interior heat can be excess or deficient

    7. excess heat: high fever, entire face is red, thirst for cold fluids, sweating all over body, red tongue, yellow coat, slippery, rapid pulse

    8. deficient heat: low-grade fever in the evening, red cheeks (malar flush), thirst for small sips or thirst for warm water, night sweats, red tongue little or no coat, thready, rapid pulse

    9. true heat, false cold: patient has cold hands and feet, but body is warm, prefers cold drinks, irritability, dry throat, foul breath, yellow urine, red tongue, deep forceful pulse, often seen with liver qi stagnation preventing. yang qi from getting to extremities

    10. may arise from invasion of exogenous pathogenic heat or deficiency of yin in the interior of the body

    11. symptoms: fever, preference for coolness, thirst with preference for cold drinks, redness of the face and eyes, irritability, constipation, deep-yellow and scanty urine; red tongue with yellow, dry coating; rapid pulse

    cold

    1. no thirst, chills, clear body fluids, normal or pale tongue, moderate or deep, slow pulse

    2. exterior cold - chills and fever, more chills than fever, headache, body aches, itchy throat, clear nasal discharge, normal thin white coat on tongue, superficial, moderate or superficial, tight pulse

    3. treatment principle: expel wind, release exterior

    4. interior cold - chills, no fever sensation of cold, pale face, frequent clear urine, loose stools, pale tongue, white coat, deep, slow pulse

    5. interior cold can be excess or deficient:

    6. excess cold: sudden, excruciating severe pain, dislike being touched, thick white tongue coat, tight pulse

    7. treatment principle: expel excess cold

    8. deficient cold: dull pain, likes pressure, likes warmth, pale tongue, white coat, deep, slow pulse

    9. treatment principle: warm interior, supplement yang

    10. true cold, false heat: patient has feverishness, flushed face, and thirst, but wants to be covered up, desires warm drink, clear urine, loose stools, pale tongue, white coat, superficial weak pulse

    11. heat above, cold below: heat sensation in chest, thirst, irritability, suffocation, desire to vomit, with loose stools and abdominal pain relieved by warmth

    12. may arise from exterior exposure or from deficiency of yang in the interior of the body

    13. symptoms: aversion to cold, preference for warmth, tastelessness in the mouth, absence of thirst, pallor, cold limbs, lying curled up, loose stools, abundant urine, hot drinks; pale tongue, white moist coat; slow, tense pulse.

  • excess

    1. acute, sudden, vivid, dramatic, solid, full high fever, big thirst, quick changes sharp pain, pain worse with pressure pain eases with movement/sitting food worsens stomach pain sweating, vomiting, bowel mvmt help often overactive shen, agitation thick, sticky tongue coat excess, flooding, full pulse more often affects yang organs

    2. treatment principle: expel or drain excess

    deficient

    1. chronic, dull, empty, worse over time low grade fever, minor thirst (if any) mild, achy pain, pain better with pressure, pain better with rest, worse with movement, food helps stomach pain, worse with sweating, vomiting, bowel movement, depleted shen, depression, pale tongue (if qi or blood deficient), weak pulse, usually affects yin organs

    2. treatment principle: nourish deficiency

  • empty (deficiency) yin

    1. white face with red cheeks

    2. low-grade fever in the afternoon, 5 palm heat

    3. night sweats

    4. dry stools

    5. yellow urine

    6. dry throat & mouth

    7. emaciation

    8. red, peeled, dry tongue

    9. floating-empty pulse

    10. most affected organs are kidneys, lung, heart, liver and stomach

    empty (deficiency) qi

    1. pale face

    2. weak voice

    3. slight sweating in daytime

    4. bland taste

    5. weak voice, slight breathlessness, tiredness, lack of appetite

    6. empty pulse

    7. most affected organs are spleen and lung

    empty (deficiency) yang

    1. all qi symptoms + bright palm face

    2. chilliness, cold limbs

    3. spontaneous sweating

    4. loose stools

    5. frequent pale or clear urine

    6. no thirst, or a desire for hot drinks

    7. lassitude, listlessness

    8. pale, wet tongue

    9. weak pulse

    10. most affected organs are spleen kidneys, lung, heart and stomach

    empty (deficiency) blood

    1. dull face, pale lips

    2. insomnia, depression, poor memory, numbness, blurred vision, dry hair

    3. pale, thin tongue

    4. fine or choppy pulse

    5. most affected organs are heart and spleen. if liver involved: blurred vision, depression, numbness, and scanty periods. if heart involved: insomnia and pale face, lips, tongue

  • face

    1. bright-white - full cold (excess yin)

    2. sallow-white - empty-cold (deficiency)

    pain

    1. sharp pain, worse on pressure - full cold (excess yin)

    2. dull ache, better on pressure - empty-cold (deficiency)

    bowels

    1. better after bowel movement - full cold (excess yin)

    2. worse after bowel movement - empty-cold (deficiency)

    thirst

    1. desire to drink warm liquids - full cold (excess yin)

    2. desire to drink warm liquids - full cold (excess yin)

    urine

    1. clear abundant urination - full cold (excess yin)

    2. clear abundant urination - empty-cold (deficiency)

    pulse

    1. full, tight and deep - full cold (excess yin)

    2. weak, slow and deep - empty-cold (deficiency)

    tongue

    1. thick white coating - full cold (excess yin)

    2. thin white coating - empty-cold (deficiency)

  • face

    1. whole face red - full heat (excess yang)

    2. malar flush, dry throat - empty-heat (deficient yin)

    eyelid

    1. red all over the inside of the eyelid - full heat (excess yang)

    2. thin red line along inside edge of eyelid- empty-heat (deficient yin)

    bowels

    1. constipation, abdominal pain - full heat (excess yang)

    2. dry stool, no abdominal pain - empty-heat (deficient yin)

    thirst

    1. desire to drink cold water - full heat (excess yang)

    2. desire to drink warm water, or cold water in sips - empty-heat (deficient yin)

    urine

    1. deep-yellow, scanty urine - full heat (excess yang)

    2. yellow urine - empty-heat (deficient yin)

    pulse

    1. full-rapid, overflowing - full heat (excess yang)

    2. floating-empty or thin - empty-heat (deficient yin)

    tongue

    1. red with yellow coating - full heat (excess yang)

    2. red & peeled, or thin - empty-heat (deficient yin)

    taste

    1. bitter taste - full heat (excess yang)

    2. no bitter taste - empty-heat (deficient yin)

    feeling of heat

    1. all day - full heat (excess yang)

    2. in the afternoon or evening - empty-heat (deficient yin)

    fever

    1. high fever - full heat (excess yang)

    2. low-grade fever in the afternoon - empty-heat (deficient yin)

    mind

    1. very restless & agitated - full heat (excess yang)

    2. vague anxiety, fidgeting - empty-heat (deficient yin)

    sleep

    1. dream-disturbed, very restless - full heat (excess yang)

    2. waking up frequently during the night - empty-heat (deficient yin)

    skin

    1. red-hot painful skin eruptions - full heat (excess yang)

    2. scarlet-red, flat, painless skin eruptions - empty-heat (deficient yin)

    treatment method

    1. clear heat - full heat (excess yang)

    2. nourish yin, clear empty-heat - empty-heat (deficient yin)

    bleeding

    1. profuse - full heat (excess yang)

    2. slight - empty-heat (deficient yin)

  • complicated syndromes of heat and cold (heat above & cold below)

    1. symptoms: thirst, irritability, sour regurgitation, bitter taste

    2. heat above: heat sensation in the chest, frequent desire to vomit, mouth ulcers

    3. cold below: abdominal pain alleviated by warmth, loose stools, borborygmus, and profuse-pale urine

    transformation of cold and heat syndromes

    1. cold in exterior transforming to heat in interior.

    2. exterior cold: fever with aversion to cold, no sweating, headache, stiff neck, aches throughout body. as it goes deeper into interior of body and turns into heat, cold signs subside, fever persists and other heat signs are present: irritability, thirst, and a yellow tongue coat.

    3. heat transforming into cold: abrupt appearance of cold limbs, pallor, deep slow with pulse with high fever, thirst, irritability and a surging rapid pulse

    true and false phenomena in cold and heat syndromes

    1. treat heat, false cold - heat in the interior, false cold on the exterior: cold limbs, thirst with a desire for cold drinks, burning sensation in the chest and abdomen, no aversion to cold, but aversion to heat, irritability, dry throat, foul breath, deep-yeelow and scanty urine; and a deep, forceful pulse.

    2. true cold, false heat - cold in interior, false heat on the exterior: feverishness of the body, flushed face, thirst, wants to cover the body, drinks warm liquids to relieve the thirst, clear urine, loose stools; pale tongue with white coat; superficial pulse

  • yang

    1. any two or three of exterior, heat, excess

    2. profuse perspiration with oily sweat

    3. chilliness

    4. cold limbs

    5. no thirst

    6. frequent profuse urine, or incontinence

    7. loose stools or incontinence

    8. weak breathing

    9. minute, deep pulse

    10. pale, wet, swollen and short tongue

    yin

    1. any two or three of interior, cold, deficient

    2. notes:

      1. when determining yang vs yin, remember it is the disease that is yang or yin, not a reflection of the patient's state of qi or yang/yin substances.

      2. thus a "yang disease" is exterior, acute, sudden, excess, and hot.

      3. a "yin disease" is interior, chronic, deficient and cold

    3. collapse of yin:

      1. abundant sticky perspiration

      2. skin hot to the touch, warm hands and feet

      3. hot limbs

      4. dry mouth with desire to drink cold liquids in small sips

      5. retention of urine

      6. constipation

      7. shortness of breath, restlessness

      8. floating-empty & rapid pulse

      9. red, peeled, short and dry tongue

zang fu diagnosis

  • DEFICIENCY

    heart qi deficiency:

    • palpitations with qi deficiency signs: SOB, pale face, spontaneous sweating, fatigue, mild depression

    • tongue: pale

    • pulse: weak, thready

    heart yang deficiency:

    • heart qi deficiency signs + feeling of cold, cold hands, discomfort in heart region

    • tongue: pale, swollen

    • pulse: deep, weak

    yang collapse:

    • heart yang xu signs + cyanosis of lips, if severe may have coma, profuse sweat, feeble breathing

    • tongue: pale, bluish

    • pulse: hidden, minute, knotted

    heart blood deficiency:

    • palpitations, insomnia, poor memory, dream disturbed sleep, anxiety, easily startled, pale lips and complexion

    • tongue: pale and thin

    • pulse: hesitant or thready

    heart yin deficiency:

    • like heart blood deficiency, except more restlessness, dry mouth and thirst, night sweats, malar flush, feeling of heat

    • tongue: red, little coat

    • pulse: thready, rapid

    EXCESS

    heart fire blazing:

    • palpitations, agitation, thirst, tongue ulcers, feeling of heat, insomnia, dream disturbed sleep, red face, dark urine, bitter taste in morning

    • tongue: red, redder tip, swollen yellow coat

    • pulse: surging, rapid

    phlegm misting the mind:

    • mental confusion, incoherent speech, rattling in throat, muttering to self quietly, lethargy, depression, aphasia, dull eyes, like the depressive phase of manic-depression

    • tongue: swollen, white sticky coat

    • pulse: rolling, string taut

    phlegm fire harassing:

    • mental confusion, palpitations, thirst, bitter taste, rash behavior, chest oppression, rattling in throat, expectoration of phlegm, tendency to hit or scold, restlessness, uncontrolled laughter or crying, shouting, manic behavior

    • tongue: red, redder tip, yellow sticky coat, heart crack

    • pulse: rolling, rapid, forceful

    heart qi stagnation:

    • palpitations with qi stagnation signs: chest oppression, slight SOB, depression, sighing, feeling of lump in throat, poor appetite, weak limbs, slightly purple lips, pale complexion

    • tongue: pale-purple

    • pulse: weak

    heart vessel obstructed:

    • palpitations, SOB, inability to lie down, stabbing prickling pain in chest that comes and goes, may radiate shoulder/upper back, depression, restlessness, chest oppression, aggravated by cold, cold hands, purple lips

    • tongue: swollen with sticky coat, purplish spots

    • pulse: hesitant, string-taut or knotted

  • deficiency cold:

    • dull abdominal pain alleviated by pressure, desire for hot drinks, borborygmus, diarrhea, pale abundant urine, cold limbs

    • tongue: pale, white coat

    • pulse: deep, weak, slow

    full heat:

    • restlessness, insomnia, heat in chest, tongue/mouth ulcers, dark scanty urine, burning upon urination, blood in urine, deafness

    • tongue: red, redder tip, yellow coat

    • pulse: surging, rapid

    small intestine qi pain:

    • lower abdominal twisting pain, may extend to back, dislike pressure, borborygmus, flatulence, pain relieved by passing gas, pain in testes

    • tongue: white coat

    • pulse: surging, rapid

    small intestine qi tied:

    • severe, sudden abdominal pain, dislike pressure, abdominal distention, constipation, vomiting, borborygmus, flatulence, similar to appendicitis

    • tongue: thick white coat

    • pulse: deep, string-taut

    worms:

    • roundworms: abdominal pain, vomiting, cold limbs

    • hookworms: desire to eat strange objects

    • pinworms: itchy anus at night

    • tapeworm: constant hunger

  • DEFICIENCY & EXTERIOR PATTERNS

    lung qi deficiency:

    • cough, SOB, weak voice, dislike speaking. spontaneous sweating, easy to catch colds, fatigue

    • tongue: pale

    • pulse: weak

    lung dryness:

    • dry cough, dry skin or throat, hoarse voice, thirst

    • tongue: dry

    • pulse: weak

    lung yin deficiency:

    • dry cough, weak hoarse voice, dry mouth/throat, possible blood streaked sputum, night sweats, dislike speaking, tiredness

    • tongue: red, little or no coat

    • pulse: thready, rapid

    exterior wind cold

    • chills, fever, aversion to cold, itchy throat, clear watery discharge, sneezing, body aches, occipital HA, slight SOB

    • tongue: normal

    • pulse: superficial, tense

    exterior wind heat

    • chills, fever, sore throat, thirst, yellow discharge, body aches, HA, slight sweat

    • tongue: normal, possible red sides

    • pulse: superficial, rapid

    invasion wind water:

    • sudden swelling eyes/face, spread to body, shiny complexion, pale scanty urine, SOB, aversion to wind, fever, cough

    • tongue: sticky white coat

    • pulse: superficial, rolling

    EXCESS PATTERNS

    lung heat:

    • cough, slight sob, flaring nostrils, red face, thirst, feeling of heat

    • tongue: red, yellow coat

    • pulse: surging, rapid

    damp phlegm:

    • chronic cough, SOB, white sticky phlegm easy to expectorate in morning, dislike lying down, nausea, wheezing, heaviness, muzziness, dizziness

    • tongue: swollen, sticky white coat

    • pulse: rolling, slow

    heat phlegm

    • barking cough, SOB, yellow or green sputum, wheezing, chest oppression, feeling of heat, thirst, insomnia, agitation, heaviness, dizziness

    • tongue: red, swollen, sticky yellow coat

    • pulse: rolling, rapid

    dry phlegm

    • dry cough, scanty difficult to expectorate sputum, SOB, chest oppression, heaviness, muzziness, dizziness, dry throat, wheezing

    • tongue: swollen, dry, sticky coat

    • pulse: rolling, thready

    phlegm fluids

    • cough with white watery frothy sputum, SOB, splashing sound in chest, vomiting, chest oppression, heaviness, muzziness, dizziness

    • tongue: pale, sticky white coat

    • pulse: rolling, soft, or string taut

  • DEFICIENCY PATTERNY

    large intestine dryness:

    • dry stools, difficult to pass, dry mouth and throat, foul breath, dizziness

    • tongue: dry, pale or red

    • pulse: thready

    large intestine deficiency cold:

    • loose stools like duck droppings, dull abdominal pain, pale urine, borborygmus, cold limbs

    • tongue: pale

    • pulse: deep, weak

    large intestine collapse

    • chronic diarrhea, prolapsed anus, hemorrhoids, tired after bm, cold limbs, desire for warm, desire for abdominal massage

    • tongue: pale

    • pulse: deep, weak, thready

    LARGE INTESTINE EXCESS PATTERNS:

    large intestine damp heat:

    • abdominal pain not relieved by bm, abdominal fullness, diarrhea, mucus and blood in stools, offensive odor, burning anus, dark urine, thirst no desire to drink, sweating does not reduce fever, heaviness body/limbs

    • tongue: red, sticky yellow coat

    • pulse: rolling, rapid

    large intestine heat

    • constipation with dry stools, scanty dark urine, burning in anus, thirst, dry tongue, burning, sensation in mouth

    • tongue: thick dry yellow coat

    • pulse: excess, rapid

    heat obstructing:

    • constipation, burning in anus, abdominal distention worse with pressure, high fever, tidal fever, sweating on limbs, vomiting, thirst, delirium

    • tongue: red, thick dry yellow coat

    • pulse: deep, excess

    excess cold invading

    • sudden cramping abdominal pain, diarrhea with pain, feeling of cold, cold abdomen

    • tongue: thick white coat

    • pulse: deep, tense

    large intestine qi stagnation:

    • constipation with bitty stool, irritability, abdominal distention and pain, condition aggravated according to mood

    • tongue: normal

    • pulse: string-taut

  • DEFICIENCY AND MIXED PATTERNS:

    liver yin deficiency:

    • dizziness, numbness, tingling, blurry vision, ‘floaters’, dry eyes, poor night vision, scanty menses, amenorrhea, dull pale complexion, muscle weakness, cramps, withered nails, dry hair and skin, depression, yin deficiency: red cheekbones

    • tongue: red, without coat

    • pulse: thready, rapid

    liver blood deficiency:

    • dizziness, numbness, tingling, blurry vision, ‘floaters’, dry eyes, poor night vision, scanty menses, amenorrhea, dull pale complexion, muscle weakness, cramps, withered nails, dry hair and skin, depression, yin deficiency: red cheekbones

    • tongue: pale, thin

    • pulse: thready

    liver yang rising:

    • dizziness, tinnitus, HA, deafness, blurry vision, dry mouth/throat, insomnia, hypertension, irritability

    • tongue: red

    • pulse: string-taut

    liver yang rising generating wind:

    • tremor, severe dizziness, tinnitus, HA, hypertension, dry eyes, blurry vision, numbness

    • tongue: red

    • pulse: string-taut

    liver blood deficiency generating wind:

    • fine tremor, blurry vision, dizziness, numbness, scanty menses, insomnia, poor memory

    • tongue: pale, thin

    • pulse: string-taut, thready

    extreme heat generating wind:

    • high fever, convulsions, stiff neck, opisthotonos, coma if severe

    • tongue: deep red, dry yellow coat

    • pulse: string-taut, rapid

    EXCESS PATTERNS:

    liver qi stagnation:

    • irritability, hypochondria fullness, pain, moodiness, sighing, depression, plum pit, irregular menses, PMS, breast distension

    • tongue: normal or dusky purple

    • puse: string-taut

    rebellious liver qi

    • liver overact on stomach, nausea, vomiting, belching, hiccup, distention, irritability, breast distention

    • tongue: normal red sides

    • pulse: string-taut

    liver fire

    • temporal headache, red face/eyes/nose bridge, thirst, bitter taste, easily angered, dream disturbed sleep, constipation, dark urine, epistaxis, hemoptysis

    • tongue: red, redder sides, dry yellow coat

    • pulse: string-taut, rapid

    damp heat in liver

    • hypochondriac fullness, bitter sticky taste, poor appetite, nausea, feeling of heaviness, vaginal discharge, genital redness/itching, burning dark urination

    • tongue: red, redder sides, sticky yellow coat

    • pulse: rolling, string taut, rapid

    liver blood stasis

    • hypochondria pain, abdominal masses, painful menses with clots, hemoptysis, epistaxis, purple nails

    • tongue: purple, possible with spots on sides

    • pulse: string taut

    cold in liver channel:

    • hypochondria pain refer to scrotum, better with warmth, vertex HA, cold hands/feet, vomit, clear fluids

    • tongue: pale, wet white coat

    • pulse: deep, slow, string taut

  • gb deficiency:

    • dizziness, blurry vision, indecision, timidity, easily startled, lack of courage and initiative, wake up too early in the morning

    • tongue: pale

    • pulse: weak

    damp in the gall bladder:

    • hypochondriac pain, fullness, jaundice, yellow sclera, feeling of heaviness, nausea, vomiting, dull headache, no thirst, sticky taste, turbid urination, inability to digest fats

    • tongue: sticky white coat bilateral two strips or one unilateral strip

    • pulse: rolling, string-taut

    damp heat in gall bladder

    • hypochondriac pain, fullness, jaundice, yellow sclera, feeling of heaviness, nausea, vomiting, thirst no desire to drink, bitter taste, dizziness, irritability, swelling of feet, loose stool or constipation, dark urination, alternate hot and cold, feeling of heat, inability to digest fats

    • tongue: sticky yellow coat bilateral two strips or one unilateral strip

    • pulse: rolling, string-taut, rapid

  • DEFICIENCY PATTERNS

    spleen qi deficiency:

    • poor appetite, abdominal distention, low energy, tired after eating, weak limbs, loose stools, pale face

    • tongue: pale

    • pulse: weak

    spleen qi sinking:

    • spleen qi deficiency + bearing down sensation in abdominal, organ prolapse, frequent urination, chronic diarrhea, menorrhagia

    • tongue: pale

    • pulse: weak

    spleen yang deficiency:

    • spleen qi deficiency + easy bruising, bleeding under skin, blood in urine or stools, excess uterine bleeding

    • tongue: pale

    • pulse: thready, weak

    spleen blood deficiency

    • spleen qi deficiency signs; deficiency causes poor production of blood, scanty menses, insomnia, sallow complex

    • tongue: pale, thin

    • pulse: hesitant, thready

    EXCESS PATTERNS

    cold damp invading spleen:

    • poor appetite, fullness, heaviness, cold in abdominal, sweetish or lack of taste, loose stool, lassitude, tiredness, nausea, edema, excess white vaginal discharge, greenish color around mouth

    • tongue: pale, sticky white coat

    • pulse: rolling, slow or soft

    damp heat invading spleen

    • poor appetite, fullness, heaviness, thirst no desire to drink, nausea, vomiting, loose stool with offensive odor, feeling of heat, dark urine, low-grade fever, sweating that does not lower fever, headache with feeling heaviness, skin eruptions

    • tongue: red, yellow sticky tongue coat

    • pulse: rolling, rapid or soft, rapid

  • DEFICIENCY PATTERNS

    stomach qi deficiency:

    • uncomfortable feeling in epigastrium, no appetite, no taste, loose stools, weak limbs, tired especially in the morning

    • tongue: pale

    • pulse: weak right middle position

    stomach yin deficiency:

    • hunger no desire to eat, dull burning pain epigastrium, constipation, dry mouth/throat, desire for small sips

    • tongue: red, geographic or no coat in center

    • pulse: thready, rapid

    stomach deficiency cold:

    • dull pain in epigastrium better with eating or pressure, prefer warm food and drink, no appetite, vomit clear fluids, cold limbs, tired, pale face

    • tongue: pale, moist

    • pulse: slow

    EXCESS PATTERNS

    stomach qi stagnation:

    • epigastric pain, distention, nausea, vomiting, belching, hiccupping, irritability

    • tongue: normal

    • pulse: string taut right middle position

    stomach fire:

    • burning epigastric pain, thirst for cold liquids, restlessness, bleeding gums, dry mouth, mouth ulcers, excess hunger, sour regurgitation, foul breath, feeling of heat, dry stool

    • tongue: red, dry yellow, possibly black coat

    • pulse: rapid

    stomach phlegm fire:

    • stomach fire + oppression in chest, mucus in stools, expectoration of phlegm, mental derangement

    • tongue: red, sticky yellow coat

    • pulse: rolling, rapid

    cold invading stomach

    • sudden severe pain in epigastrium, cold limbs, prefer warm, vomiting clear fluids, vomit after drinking

    • tongue: thick white coat

    • pulse: deep, tense, slow

    stomach qi rebellion:

    • nausea, vomiting, belching, hiccupping, difficulty swallowing

    • tongue: normal

    • pulse: string-taut or tense right middle

    damp heat in stomach

    • epigastric fullness, pain, heaviness, nausea, thirst no desire to drink, sticky taste, feeling of heat, thick nasal discharge

    • tongue: red, sticky yellow coat

    • pulse: rolling, rapid

    food stagnation:

    • epigastric fullness, pain, distention, better with vomiting, nausea, sour regurgitation, belching, aversion to food, loose stool or constipation, excess dreaming

    • tongue: thick, sticky

    • pulse: rolling

    blood stasis in stomach:

    • severe, stabbing epigastric pain, worse at night, dislike pressure, nausea, possible vomiting blood

    • tongue: purple

    • pulse: string-taut

  • DEFICIENCY PATTERNS

    kidney yin deficiency:

    • dizziness, tinnitus, vertigo, poor hearing, poor memory, night sweats, dry mouth and throat, afternoon or evening fever, low backache, dark scanty urination, constipation, infertility, premature ejaculation, anxiety

    • tongue: red, little or no coat

    • pulse: thready, rapid

    kidney yang deficiency:

    • low back pain, cold in lumbar and knees, feeling of cold, weak legs, abundant clear urination, urination at night, edema lower legs, loose stools, impotence, infertility, decreased libido, low sperm count, lassitude

    • tongue: pale, white coat

    • pulse: deep, weak, slow

    kidney qi not firm:

    • sore low back, weak knees, frequency copious urine, dribbling after urination, incontinence, enuresis, nocturnal emission without dreams, premature ejaculation, spermatorrhea, vaginal discharge, bearing down sensation, recurring miscarriage

    • tongue: pale, white coat

    • pulse: thready, weak

    kidney failing to receive qi

    • SOB with exertion, rapid weak breathing, chronic cough, asthma, spontaneous sweating, low backache

    • tongue: pale

    • pulse: deep, weak, tense

    kidney jing deficiency

    • in children: poor development, growth/mental retardation, fontanelles not closed

    • in adults: premature aging, early loss teeth/hair, infertility, soft bones, memory loss

    • tongue: like yin or yang deficiency, whichever is more evident

    • pulse: thready, rapid, or deep, weak

    COMBINED PATTERNS

    kidney yin deficiency with empty heat blazing:

    • malar flush, night sweats, insomnia, afternoon/evening fever, 5-palm heat, dry throat, thirst for small sips, dizziness, tinnitus, low back pain, nocturnal emission with dreams, excess sexual desire, dark urine

    • tongue: red, cracked with red tip, no coat

    • pulse: thready, rapid

    kidney yang deficiency with water overflowing:

    • edema lower legs, feeling of cold in low back, abdominal distention/fullness, clear scanty urination, possible palpitations, SOB, frothy sputum, cold hands, cough, asthma

    • tongue: pale, swollen, moist white coat

    • pulse: deep, weak, slow

  • bladder deficient cold:

    • frequent pale abundant urination, incontinence, enuresis, cold low back, feeling of cold

    • tongue: pale, moist

    • pulse: deep, weak

    damp heat in urinary bladder:

    • frequent, urgent, difficult urination with burning sensation, dark in color, possibly blood in urine, thirst no desire to drink, feeling of heat

    • tongue: thick, sticky yellow coat at root

    • pulse: rolling, rapid

    cold damp in urinary bladder:

    • frequent, urgent, difficult urination, often stopping midstream, feeling of heaviness in hypogastrium and urethra, pale and turbid in color

    • tongue: white sticky coat at root

    • pulse: rolling, slow

  • DEFICIENCY PATTERN

    blood deficiency:

    • heart blood deficiency symptoms plus chest discomfort, tightness, dull ache and slight SOB

    • tongue: pale, thin, slightly dry

    • pulse: hesitant, thready

    EXCESS PATTERNS

    heat in pericardium by an external pathogen:

    • mental confusion, delirium, incoherent speech, fever at night, obvious macules, like ying or blood level heat

    • tongue: red, dry, no coat

    • pulse: thready, rapid

    pericardium fire:

    • like heart fire plus tightness, heat and slight ache in the chest, rapid breathing

    • tongue: red, redder on tip, swollen with red points, yellow coat, possibly midline crack to the tip

    • pulse: excess, rapid or abrupt

    phlegm fire harassing pericardium:

    • phlegm fire harassing heart with heat sensation in chest, chest oppression, rapid breathing

    • tongue: red, redder on tip, swollen with red points, yellow dry sticky coat, deep midline crack

    • pulse: excess, rapid, rolling or excess, rapid, string-taut

    qi or blood stagnation in pericardium:

    • same as heart qi or blood stagnation

six-stages/shang han lun

    • first described by dr. zhang zhong-jing around 200 ad in the text shang han za bing lun;

    • it was later edited into the shang han lun and jin kui yao lue (golden cabinets).

    • the focus is diseased, started by cold pathogens.

    • chills and fever, aversion to cold, head/neck stiffness and pain, superficial pulse

    • taiyang channel excess: more cold, no sweating, pulse also tense -

      • ma huang tang, ge gen tang

    • taiyang channel deficiency: more wind, patient has sweating, pulse also moderate -

      • gui zhi tang

    • taiyang fu water accumulation: aversion to cold, urinary retention, vomiting immediately after drinking -

      • wu ling san

    • taiyang fu blood accumulation: lower jiao distention, fullness, urgency, blood in urine, restlessness -

      • tao he cheng qi tang

    • fever, sweating, aversion to heat

    • yangming jing: high fever, profuse sweat over entire body, thirst for cold water, big pulse, (4 bigs), red tongue, white or yellow dry coat

      • bai hu tang

    • yangming fu: tidal fever, sweating on hands and feet, constipation, fullness, red tongue, dry yellow coat, rolling, rapid pulse

      • da cheng qi tang

      • xiao cheng qi tang

      • tiao wei cheng qi tang

    • bitter taste in mouth, dry throat, dizziness, blurry vision, alternating chills and fever, fullness in chest and hypochondrium, low appetite, normal tongue, string-taut pulse

      • xiao chai hu tang

    • interior deficient cold, abdominal fullness, sometimes pain, reduced appetite, no thirst, loose stool, diarrhea, fatigue, edema, pale tongue with white coat, deep, weak pulse

    • though taiyin includes lu/sp, taiyin channel symptoms related to mostly spleen

      • li zhong wan

    • heart and kidney, affecting shen

    • shaoyin cold: aversion to cold, listlessness, desire to sleep, lying with body curled up, diarrhea, frequent pale urination, pale tongue, white coat, deep weak pulse

      • si ni tang

      • zhen wu tang

    • shaoyin heat: irritability, insomnia, dry mouth, dry throat, night sweats, dark urine, red tongue little coat, thready, rapid pulse

      • huang lian e jiao tang

    • mix heat and cold, heat above and cold below, heat and irritability in chest, energy rising in chest, thirst, diarrhea, vomiting, cold limbs, possible roundworms, pale tongue, white coat, deep, slow pulse

      • wu zhu yu tang

      • si ni san

      • wu mei wan

four-levels/wen bing

    • first described in the 1600’s in response to acute exogenous febrile diseases

    • i.e. epidemic diseases. the illness is characterized by high fever damaging yin, quick progression, easy to cause movement of blood

    • fever, slight chills, headache, cough, thirst, dry mouth, yellow nasal discharge, normal tongue or red tip, superficial, rapid pulse

    • exterior heat

    • high fever, aversion to heat, sweating, thirst, dry mouth, irritability, cough with yellow sputum, scanty urine, constipation, red tongue, dry yellow coat, surging, rapid pulse

    • organ level heat

    • fever worse at night, thirst no desire to drink, dry mouth, irritability, insomnia, delirium, restlessness, skin rashes, very red tongue, little or no coat, rapid thready or choppy pulse

    • nutritive level heat

    • like ying level heat, but more severe, fever worse at night, thirst no desire to drink, dry mouth, irritability, insomnia, delirium, convulsions, loss of consciousness, obvious bleeding, red tongue, little coat, thready rapid pulse

    • blood level heat

san jiao differentiation

    • created in response to heat patterns around 1800

    • focuses on the region of the body and the organs attacked

    • lung: fever aversion to wind and cold, thirst, sore throat, cough, chest pain or oppression, red tongue, yellow coat

    • like wen bing wei or qi level

    • stomach or intestines: dry heat causing red face, red eyes, high fever, thirst, dry throat, nausea, vomiting, constipation, red tongue, dry coat, thready rapid pulse

      • similar to yangming jing, yangming fu, or wen bing qi level

    • spleen: damp heat in spleen causing fullness in epigastrium, no appetite, heavy limbs, diarrhea, greasy tongue coat, rolling rapid pulse

      • similar to wen bing qi level

    • kidney: low-grade fever in afternoon or evening, five center heat, dry mouth and throat, night sweats, deafness, insomnia, lassitude, deep red tongue, no coat, thready rapid pulse

      • like shaoyin heat

    • liver: fever, coma, convulsions, tremors, dizziness, dream disturbed sleep, deep red tongue, no coat, thready, rapid or thready, rapid, wiry pulse

    • similar to wen bing blood level

    • fever, thirst, desire for cold water, burning and pain in whole body, irritability, dark scanty urine, constipation, red tongue, yellow coat, rolling rapid pulse

five element relationships

    • wood nourishes fire

    • fire nourishes earth

    • earth nourishes metal

    • metal nourishes water

    • water nourishes wood

  • normal mechanism for organs to keep each other in balance

    • wood controls earth

    • earth controls water

    • water controls fire

    • fire controls metal

    • metal controls wood

  • same relationship between organs as control cycle, now signifying a pathological condition

  • same organ relationship as control cycle, but opposite direction; also pathological

  • wood not nourishing fire: liver blood not nourishing heart blood (insomnia, palpitations, timidity)

    fire not nourishing earth: heart shen is needed for spleen yi concentration (distracted thinking)

    earth not nourishing metal: spleen not transforming (phlegm in the lung)

    metal not nourishing water: lung qi not sending qi and fluids down (breathlessness, asthma, dryness)

    water not nourishing wood: kidney not supplying yin to liver (liver yin a/o blood xu, tinnitus, dizziness, headache, irritability)

  • wood being drained by fire: heart blood xu causing general blood xu (scanty menses, amenorrhea)

    fire being drained by earth: spleen not making enough blood (palpitations, insomnia, poor memory, depression)

    earth being drained by metal: xu lung qi (general qi xu, fatigue, loose stools, no appetite)

    metal being drained by water: deficient kidney not grasping qi (breathlessness)

    water being drained by wood: long term liver blood xu (kidney essence xu, night sweats, dizziness, tinnitus

  • wood overacting earth: wood creating rebellious qi (hypochondriac pain, irritability, nausea, diarrhea)

    fire overacting metal: fire dries up lung fluids (cough, yellow sputum)

    earth overacting water: spleen damp (disturbance in fluid excretion, edema)

    metal overacting wood: lung qi obstruct (fatigue, irritability, liver qi stagnation)

    water overacting fire: kidney yin xu (xu heat in heart - some texts say kidney can’t overact)

  • wood insulting metal: obstructed qi (breathlessness, paroxysmal cough)

    fire insulting water: heat drying fluids (kidney yin xu, night sweats, malar flush, insomnia)

    earth insulting wood: spleen damp impedes liver qi (hypochondriac distention, jaundice

    metal insulting fire: phlegm in lung impairs heart blood circulation (palpitations, insomnia)

    water insulting earth: kidney not transforming fluid (spleen damp, loose stools, edema, fatigue)

  • wood:

    • green complexion

    • small head

    • straight back

    • tall, slender

    • strong bones

    • small hands/feet

    fire:

    • red complexion

    • small pointed head

    • curly hair

    • small hands

    • walks fast

    earth:

    • yellow complexion

    • round face

    • large head

    • large abdomen

    • strong thighs

    metal:

    • white complexion

    • square face

    • flat abdomen

    • strong body

    • strong voice

    • walks slow

    water:

    • dark complexion

    • broad face

    • large head

    • large abdomen

    • long spine

5 element cycles.png

inspection of the body

    1. falling out: blood deficiency

    2. prematurely gray: decline of kidney essence

    3. state of the hair: blood or kidney essence

    4. thickness and luster of the hair: dependant on the liver

    5. dull hair with a tendency to split: deficiency of liver blood

    1. lustrous & moist complexion

    2. disease is mild, qi and blood are not deficient, prognosis is good.

    3. dark & haggard complexion

    4. disease is severe, essential qi is already injured, prognosis poor

    5. clear and rather moist

    6. stomach qi good. dry and rather lifeless - stomach qi is exhausted

    7. green color

    8. interior cold, pain, or interior wind (liver pattern)

    9. deep color

    10. interior. floating color - exterior

    11. clear color

    12. yang condition.

    13. dull color - yin condition

    14. thin color

    15. qi deficiency

    16. thick color - full condition

    17. scattered color

    18. new disease

    19. concentrated color - old disease

    20. red

      1. entire face - excess heat syndrome from exogenous pathogen, or hyperactive yang

      2. malar flush with tidal fever and night sweating - interior heat d/t yin def.

    21. pale

      1. cold syndromes of deficiency type, and loss of blood

      2. pale complexion is often due to yin excess or yang deficiency

      3. bright white face with puffy, bloated appearance - sign of deficiency of yang qi

      4. pale, withered face - blood deficiency

    22. yellow

      1. deficiency and damp ype syndormes

      2. entire body is yellow - jaundice

      3. tends toward bright orange - yang jaundice from damp heat

      4. hazy and smoky yellow - yang jaundice with more damp than heat

      5. withered, dried up yellow - heat in stomach and spleen

      6. sallow yellow - deficiency of stomach and spleen

      7. dull pale yellow - cold damp in stomach and spleen

      8. pale yellow without brightness - deficiency of both qi and blood

      9. pale with red spots - spleen deficiency, and stasis of liver blood

      10. clear & moist between eyebrows - stomach qi is recovering after a long illness

      11. smoky, dark yellow - yin jaundice from cold-damp or long-standing blood stagnation

    23. blue

      1. cold, pain, blood stagnation, and/or convulsions.

      2. pale and blue - excess yin and cold, with severe pain in epigastrium and abdomen

      3. bluish-purple face and lips:

        1. with intermittent pain in precordial region or behind the sternum - stagnation of heart blood

        2. with high fever, violent movement of limbs in children - signs of infantile convulsions

      4. dark-bluish complexion - cold or chronic pain

      5. dull-blue complexion - severe yang deficiency with blood stasis or chronic pain

      6. bluish complexion in children - liver wind

    24. green

      1. pale green under the eyes - liver qi stagnation

      2. green complexion on cheeks - liver qi stagnation, liver blood stasis, cold in liver, liver wind

      3. green with a red tinge - lesser yang pattern

      4. green color with red eyes - liver fire

      5. yellowish green cheeks - phlegm with liver yang rising

      6. green color on nose - stagnation of qi with abdominal pain

      7. dark reddish green - stagnant liver qi turning into heat

      8. pale green under the eyes - liver blood deficiency

    25. dark gray

      1. kidney deficiency and blood stagnation

      2. pale and dark complexion, with lumbar soreness and cold feet - insufficient kidney yang

      3. dark color complexion without brightness, but with scaly skin - prolonged blood stagnation

    26. white

      1. deficiency or cold - blood deficiency or yang deficiency

    27. black

      1. cold, pain, or kidney disease - kidney yin deficiency

      2. black and moist looking - cold

      3. dried up and burnt - heat from kidney yin deficiency

    1. red tip of nose - spleen deficiency

    2. bluish color in the center of the forehead - heart has suffered shock

    3. short chin - kidney deficiency

    1. red color in corner of eye - heart fire

    2. red color in sclera - lung heat

    3. green, blue, purple, or red spots appearing at the end of red veins, with purple blood spots on them - lesions in back or chest. if spots are not connected to veins, they have no diagnositc significance.

    4. gray and scattered spots, like clouds - injury of qi

    5. deep black spots, like sesame seeds - injury of blood

    6. black spots surrounded by a gray cloud-like halo - injury of qi & blood

    7. red veins visible and spiral shaped - pain

    8. upward, straight forward or sideways staring of eye - disturbance of liver wind

    9. yellow color in the sclera - damp heat jaundice

    10. dull white color in the corners of the eye - heat

    1. slightly moist and shiny - disease not serious

    2. dry - heat in stomach in li

    3. dry and black - presence of fire poison

    4. flapping of the ala nasi sometimes in asthmatic breathing - d/t lung heat, lung & kidney qi deficiency deficiency

    5. clear nasal discharge - exposure to cold

    6. turbid discharge - exposure to wind-heat

    7. prolonged turbid nasal discharge with stinky smell - chronic rhinitis, or chronic sinusitis

    8. tip of the nose is green or blue - abdominal pain

    9. tip of the nose is yellow - damp heat

    10. white color - blood deficiency

    11. red color - heat in the lungs and spleen

    12. gray - impairment of water movement

    1. dry & withered auricles, burnt-black in color - prolonged or severe illness, due to consumption of kidney essence, or due to kidney qi deficiency

    2. lobes are dry, withered and black - extreme exhaustion of kidney qi

    3. purulent discharge "tin ear" (infection) - damp heat of the liver & gall bladder

    4. white color - cold pattern

    5. bluish or black color - pain

    6. long and full lobe - strong kidneys and good constitution

    7. thin and small lobe - poor constitution

    8. swelling and pain of ear or middle ear - fire in the shao yang channels

    9. thin ear - deficiency of qi and blood

    1. teeth are an extension of the bones, influenced by the kidneys

    2. teeth are bright and dry, like a stone - heat in yang ming in context of exterior diseases

    3. teeth are dry and grayish - kidney yin deficiency

    4. gums are under the influence of the stomach

    5. pale gums - blood deficiency

    6. redness and swelling of gums & teeth - flaring of stomach fire, if no pain - empty heat

    7. redness and swelling with bleeding - injury of the vessels by stomach fire

  • blood deficiency, very pale lips - blood or yang deficiency

    1. bluish-purple lips - retention of cold or stagnation of blood

    2. dry lips, deep red in color - excessive ehat, heat in the spleen & stomach

    3. mouth always slightly open - deficiency

    4. only breathes through mouth - lung qi deficiency

    5. sudden collapse with open mouth - deficiency.

    6. sudden collapse with locked jaw - excess

    7. greenish color around the mouth - liver blood stasis & invasion of the spleen by liver qi

    1. red and swollen with yellow or white ulcer spots - excess toxic-heat in the lung and stomach

    2. bright red with mild soreness - yin deficiency leading to hyperactivity of fire

    3. false membrane over throat, grayish white, hard to remove, bleeding after forceful rubbing, returns immediate - diphtheria from heat in lung consuming yin.

    1. swollen tonsils normal color - retention of dampness or phlegm from qi deficiency most often seen in children recovering from pathogenic factors and chronic upper respiratory infections.

    2. chronic redness & swelling that comes and goes - chronic heat in st, li and more common children

    3. red and swollen tonsils with exudate - wind heat and or toxic heat in st, li

    4. greyish tonsils - acute glandular fever (mononucleosis)

    1. healthy color & firmness of the flesh around ankles & wrists - good state of body fluids

    2. skin lacks luster & is dry, the flesh is shriveled - exhaustion of body fluids

    3. pale nails - blood deficiency

    4. bluish nails - liver blood stasis

    5. bluish color venules on the thenar eminence of the thumb - cold in the stomach

    6. bluish and short venules - deficiency pattern

    7. red venules - heat in the stomach

    8. rigid - liver yang rising or liver wind in elderly, bi syndrome with dampness

    9. empty conditions - liver deficiency & kidney yin, spleen or kidney yang (more common elderly)

    10. limb paralysis - usually d/t spleen & stomach deficiency, or qi and blood deficiency, yin deficiency of liver and kidneys

    11. full conditions - retention of dampness in muscles and blood stasis

    12. contraction of limbs - acute - wind empty - liver blood or liver yin deficiency

    13. limb tremors - wind, & or liver wind, phlegm, liver yang rising, liver blood deficiency, liver and kidney yin deficiency

    1. index fingers of children under two are used for diagnosis

    2. left finger in boys and right finger in girls

    3. the creases on the fingers are called "gates", if venules appear beyond the gate

    4. first gate, gate of wind (base of finger/mcp) - exterior pathogen/mild disease

    5. second gate, gate of qi (pip) - interior/more severe disease

    6. third gate, gate of life (dip) - serious/life threatening disease

    7. blue venules - cold

    8. red venules - heat

    1. thin person with dry skin - insufficiency of blood

    2. thin and emaciated person - long-term deficiency of blood and yin

    3. overweight with mental depression - deficiency of qi and excess phlegm damp

    4. great loss of weight in the course of a long illness -exhaustion of essential qi

    5. sit facing downward and dislikes speaking - may indicate qi deficiency with sob

    6. violent movement of the four limbs - wind diseases (tetanus, infantile convulsions)

    7. wei syndrome - weakness, motor impairment, muscular atrophy of the limbs

    8. bi syndrome - numbness, pain, heaviness in the tendons, bones and muscles accompanied by swelling and restricted movements of the joints

    9. numbness & impaired movements of limbs on one side of body - hemiplegia or wind stroke

    10. wood types - a tall, slender body

    11. metal type - broad, square shoulders, strongly built body, triangular face; moves slowly and deliberately. if they move quickly, there is a problem.

    12. earth type - slightly fat body; large head, belly, & thighs; wide jaws

    13. water type - round face and body, with a long spine

    14. fire type - pointed head, small hands, moves quickly. if they move slowly, there is a problem

    15. person moves quickly & throws off the bed covers - may indicate liver or heart problems

    16. small movements & continuous fidgeting, especially of the legs - deficiency heat pattern of the kidneys.

    1. skin is related to liver (through the blood), lungs, and stomach (heat)

    2. dry skin - liver blood deficiency. itching skin - wind

    3. swelling of skin, leaves a fingermark with pressure - true (water) edema d/t kidney yang deficiency

eye diagnosis.png
master roshi facial diagnosis.png

the questions to ask

    • aversion to cold/chilly - external invasion of w/c or w/h (d/t pathogenic factor blocking defensive qi).

    • low grade fever, worse in the afternoon or only in the afternoon - yin deficiency.

    • constant low-grade fever - damp heat.

    • fever in the middle of the night: in adults - yin deficiency; in children - retention of food.

    • alternating chills & fever - symptom of intermediate syndromes

    • area of body

      • only on head - heat in stomach or damp heat

      • only arms and legs - stomach and spleen deficiency

      • only on hands - lung qi deficiency, heart qi deficiency

      • whole body - lung qi deficiency

      • palms, soles, and chest - yin deficiency

      • (oily sweat) on forehead - yang collapse

    • time of day:

      • during the day - yang deficiency

      • during the night - yin deficiency (in some cases, it may be d/t damp heat)

    • condition of illness:

      • profuse, cold sweat during a severe illness - yang collapse

      • oily sweat on forehead, like pearls, not flowing - yang collapse (danger of imminent death)

    • quality of sweat:

      • oily - severe yang deficiency

      • sticky collapse of yin

      • yellow - damp heat

  • headache onset:

    1. recent onset, short duration - external wind cold attack

    2. gradual onset - internal condition

    headache time of day:

    1. daytime - qi or yang deficiency

    2. evening - blood or yin deficiency

    3. nighttime-blood stasis

    headache location:

    1. nape of neck - tai yang channels (exterior wind-cold or kidney deficiency)

    2. forehead - yang ming channels (stomach heat or blood deficiency)

    3. temples or sides - shao yang channels (exterior w-c or w-h, or interior lv & gv fire rising)

    4. vertex jue yin channels (liver blood deficiency)

    5. whole head - exterior wind cold

    headache character of pain:

    1. heavy feeling - dampness or phlegm

    2. pain "inside" the head, "hurting the brain" - kd deficiency

    3. distending, throbbing - lv yang rising

    4. boring, like a nail - blood stasis

    5. feeling of muzziness, heaviness - damp add dizzziness and it becomes phlegm

    6. feeling of muzziness, heaviness, dizziness - phlegm

    7. occipital headache and stiffness - external wind

    headache condition:

    1. occurs with aversion to wind or cold - external invasion

    2. aggravated by cold - cold pattern

    3. aggravated by heat - heat pattern

    4. aggravated by fatigue, improved by rest - qi deficiency

    5. aggravated by emotion tension - liver yang rising

    6. aggravated by sexual anxiety - kidney deficiency

    dizziness:

    1. severe giddiness, everything seems. tosway, person loses balance - internal wind

    2. slight dizziness with heaviness & muzziness of head - phlegm (prevents clear yang rising to head)

    3. slight dizziness aggravated when tired - blood deficiency

    4. sudden onset of dizziness - full pattern, gradual onset of dizziness - empty pattern

    5. dizziness with throbbing headaches - liver yang rising

    nose

    1. chronic profuse runny nose with clear watery discharge - lung qi deficiency or yang deficiency of lung & kidney and du mai

    2. dryness with throbbing headache - liver yang rising

    3. bridge green - liver qi stagnation, bridge grayish or dark - liver blood stasis, red - liver fire

    4. nose slightly moist and shiny - good prognosis

    5. dry nose - heat in stomach or large intestine

    mouth ulcers

    1. very painful, red-rimmed on gums - stomach full heat

    2. pale-rimmed on gums - stomach empty heat

    3. tip of tongue - heart fire or heart deficiency

    4. insides of cheeks - stomach heat

    5. during pregnancy - disharmony of directing vessel

    6. pale rimmed aggravated by overwork - kidney yin deficiency or original qi deficiency

    7. ulcers that come and go - empty condition - or ulcers that are frequent - full conditions

    bleeding gums

    1. poor appetite, bleeding gums, loose stools, tiredness - spleen qi deficiency (not hold blood)

    2. bleeding gums, thirst, heat - stomach full heat

    3. bleeding gums, dry mouth, desire to drink small sips - stomach yin deficiency

    4. bleeding gums, dizziness, tinnitus, night sweating, malar flush - kidney yin deficiency

  • pain in whole body

    1. sudden onset, with chills and fever - external wind-cold

    2. occipital headache with stiffness - external wind

    3. pain all over with tiredness - qi and blood deficiency

    4. in woman after childbirth: dull pain - blood deficiency, severe pain - blood stasis

    5. pain in arms and shoulders only when walking - liver qi stagnation

    6. pain in all muscless with hot sensation in the flesh - stomach heat

    7. pain with feeling of heaviness - dampness obstructing the muscles

    8. distening/bloating more than pain or no fixed location - qi stagnation

    9. chronic headaches with distending, throbbing pain - liver yang rising

    10. severe boring or stabbing with fixed location - blood stasis

    11. intense pain with feeling of fullness (more children) - retention of food

    pain in joints

    1. wandering from joint to joint - wind

    2. fixed and very painful - cold

    3. fixed with swelling and numbness - dampness

    4. fixed with swelling and redness of the joints - damp-heat

    5. severe stabbing pain with rigidity - blood stasis

    6. rheumatoid arthritis - phlegm

    7. pain in joints or epigastrium - external dampness

    backache

    1. continuous, dull - kidney deficiency

    2. recent onset, severe, with stiffness - sprain of back, causing blood stasis

    3. severe pain, aggravated by cold/damp weather, alleviated by heat - external cold & damp to back channels

    4. boring pain with inability to turn the waist - blood stasis

    5. pain in back extending up to shoulders - external attack wind

    numbness

    1. numbness of arms & legs, or only hands & feet on both sides - blood deficiency

    2. numbness of fingers, elbow & arm on one side only (especially first 3 fingers) - interior phlegm & wind (this may indicate the possibility of impending wind stroke)

    cold hands

    1. yang deficiency, (usually), blood deficiency, or qi stagnation

    2. palpitations & dizziness - heart blood deficiency

    weak knees

    1. kidney yang deficiency

    cold feet

    1. kidney yang deficiency (usually), in women liver blood deficiency

  • chest

    1. thorax influenced by - heart, lungs

    2. flanks influenced by - liver, gall bladder

    3. pain in chest - blood stasis in heart, which is usually d/t yang deficiency

    4. pain in chest accompanied by cough with profuse yellow sputum - lung heat

    5. feeling of oppression - phlegm in lungs, severe liver qi stagnation

    hypochondrium

    1. feeling of distension - liver qi stagnation

    2. stabbing pain - liver blood stasis

    3. distention & stuffiness of hypochondrium - liver qi stagnation; with severe pain - liver blood stasis

    epigastrium

    1. dull pain in the epigastrium, not very severe - deficiency of cold in stomach

    2. epigastric pain alleviated by eating - empty pattern

    3. epigastric pain aggravated by eating - full pattern

    4. fullness in epigastrium - spleen deficiency or dampness

    5. feeling of distention - liver qi stagnation

    abdomen

    1. abdomen influenced by - liver, spleen, kidneys, bladder, intestines

    2. lower abdominal pain - interior cold, liver qi or blood stagnation, damp heat, or blood stasis in uterus or intestines

    3. differentiation based on accompanying signs & symptoms

    4. abdomen pain relieved by bowel movements - full pattern

    5. abdomen pain aggravated by bowel movements - empty pattern

    hypogastrium pain

    1. damp heat in urinary bladder or sometimes liver fire infusing downwards to the ub

  • food

    1. relieved by eating - empty pattern; aggravated by eating - full pattern

    2. lack of appetite - spleen qi deficiency, always hungry - stomach heat

    3. hunger with no desire to eat or eating small amounts of food - stomach yin deficiency

    4. fullness and distention after eating - food retention or damp, distention only - qi stagnation

    5. preference for hot foods - cold pattern; preference for cold foods - heat pattern

    6. sharp pain - blood stasis

    taste

    1. bitter taste - liver or heart full heat

    2. constant bitter taste - liver fire

    3. with insomnia & only present in morning after a sleepless night, not after a restful night - heart fire

    4. sweet - spleen deficiency, or damp heat in the spleen

    5. sour - food retention or liver-stomach disharmony

    6. salty - kidney yin deficiency

    7. pungent - lung heat

    8. lack of taste - spleen & stomach deficiency

    vomit

    1. sour vomit - invasion of stomach by liver

    2. bitter vomit - liver and gb heat

    3. clear, watery vomit - cold in stomach with retention of fluids

    4. vomit soon after eating - heat pattern

    5. sudden and loud vomiting - full pattern

    6. slow emission with a weak noise - empty pattern

  • constipation

    1. worse after bowel movement - empty pattern; better after bowel movement - full pattern

    2. acute constipation with thirst & a dry yellow tongue coating - stomach heat, or small intestine heat

    3. constipation in the elderly or in postpartum women - blood deficiency

    4. constipation with small, bitty stools like a goat's - liver qi stagnation and heat in the intestines

    5. constipation with abdominal pain - internal cold and yang deficiency

    6. constipation with dry stools, dry mouth, small sips - yin deficiency (usually of kidney &/or stomach)

    7. stools not dry, but difficult to pass - liver qi stagnation

    8. alternate constipation and diarrhea - liver qi stagnation invading the spleen

    diarrhea

    1. loose stools with undigested food - spleen qi deficiency

    2. patient cannot hold their stools easily - central qi deficiency with sinking of spleen

    3. diarrhea with abdominal pain and fullness, undigested food - interior cold in the intestines

    4. black or very dark stools - stasis of blood

    5. diarrhea with mucus in the stools - dampness in the intestines

    6. diarrhea with mucus and blood in the stools, blood comes first, bright red, splashing in all directions - damp heat in the intestines

    7. blood comes first, is turbid and the anus feels heavy and painful - heat in the blood

    8. stools come first and then watery blood - spleen qi deficiency unable to hold blood

    9. pain accompanying diarrhea - liver involvement or heat

    10. burning sensation in the anus while passing stools or foul smelling stools - heat

    11. borborygmus with loose stools - spleen deficiency

    12. borborygmus with abdominal distension and without loose stools - liver qi stagnation

    13. flatulence with foul smell - damp heat in the spleen or heat in the intestines

    14. flatulence without smell - interior cold from spleen yang deficiency

  • function?

    1. enuresis or incontinence - kidney deficiency

    2. retention of urine - damp heat in urinary bladder

    3. difficulty urinating - urinary bladder damp heat or kidney deficiency (especially in the elderly)

    4. very frequent and copious urination - kidney deficiency

    5. frequent and scanty urination - qi deficiency

    pain?

    1. pain before urination - qi stagnation in lower burner

    2. pain during urination - heat in the ub

    3. pain after urination - qi deficiency

    color?

    1. pale - cold pattern (usually ub and kd)

    2. red or yellow or dark - heat

    3. turbid or cloudy - damp in the ub

    4. copious, clear and pale during w-c or w-h attack - pathogenic factor has not penetrated interior

    5. dark urine during exterior invasion of w/c or w/h - pathogenic factor in the interior

    6. dark urination during an exterior attack of w/h or w/c - pathogenic factor in the interior

  • insomnia

    1. not being able to fall asleep, but sleeping well after falling asleep - heart, spleen, liver blood deficiency

    2. waking many times - kidney, heart, liver yin deficiency

    3. insomnia with anxiety, dream - disturbed sleep and qi and blood deficiency - heart and spleen blood deficiency

    4. insomnia with difficulty in falling asleep, dizziness, blurred vision - liver blood deficiency

    5. insomnia, waking up frequently during the night with excessive dreams together with night sweating and palpitations: heart & kidney yin deficiency with empty heat

    6. dream-disturbed sleep - liver fire eor heart fire

    7. restless sleep with dreams - food retention

    8. wake up early in the morning and failing to fall asleep again - gall bladder deficiency

    9. as we grow older, it's normal to wake early, d/t the physiological decline of qi & blood

    lethargy

    1. feeling sleepy after eating - spleen qi deficiency

    2. lethargy and heaviness of the body - dampness

    3. lethargy and dizziness - phlegm

    4. extreme lethargy and lassitude with feeling of cold - kidney yang deficiency

    5. lethargic stupor with exterior heat symptoms - invasion of pc by heat

    6. lethargic stupor with rattling in throat, slippery pulse, sticky tongue coat - phlegm blurring the mind

  • tinnitus

    1. sudden onset - full pattern (liver fire or liver wind)

    2. gradual onset - empty pattern (usually a kidney deficiency)

    3. aggravated by pressing hands over the ears - full pattern

    4. alleviated by pressing hands over the ears - empty pattern

    5. loud, high-pitched noise, like a whistle - liver yang, liver fire, or liver wind rising

    6. low-pitched noise, like rushing water - kidney deficiency

    deafness

    1. sudden onset onset - full pattern (liver fire or liver wind)

    2. gradual onset - empty pattern (usually kidney deficiency)

    3. chronic deafness - kidney deficiency, heart blood deficiency, upper burner qi deficiency, yang qi deficiency

    eye pain

    1. pain like a needle, with redness of eye and headache - fire poison in heart channel

    2. pain, swelling, & redness of eye - invasion of eye channels by exterior w/h or interior liver fire

    3. blurry vision and floaters in the eyes - liver blood deficiency, liver yin or kidney yin deficiency

    4. photophobia - liver blood deficiency, liver yang rising

    5. pressure in the eyes -kidney yin deficiency

    eye dryness

    1. dry eyes - liver and/or kidney yin deficiency

    eye observation

    1. yellow sclera - jaundice

    2. ulceration of the canthus - damp heat

    3. upward, straight forward, or sideways staring of the eye - liver wind

    4. dull white corners of the eyes - heat

    5. pale white corners of the eyes - blood deficiency

    6. swelling under the eyes - kidney deficiency

    1. thirst with desire to drink large amounts of cold water: full heat pattern of any organ’

    2. absence of thirst: cold pattern, usually spleen or stomach

    3. thirst with no desire to drink: damp heat

    4. thirst with desire to sip liquids slowly, or to sip warm liquids: yin deficiency (usually of stomach or kidney)

    5. thirst for cold liquids: heat pattern; thirst for warm liquids - cold pattern

    1. chronic tiredness, loose stools: spleen qi deficiency with cold signs - spleen yang deficiency

    2. chronic tiredness, weak voice, easily catches colds: lung qi deficiency - with cold - lung yang deficiency

    3. chronic tiredness, backache, lassitude, cold, depression, frequent urination: kidney yang deficiency

    4. chronic tiredness, anxiety, tenseness, wiry pulse: liver qi stagnation

    5. short-term tiredness, alternating cold & heat sensation, irritability, unilateral tongue coating: lesser yang

    6. chronic tiredness with slight depression, dizziness and scanty periods: liver blood deficiency

    1. distending pain in the chest, epigastric, hypochondriac, and abdominal regions: moving qi stagnation

    2. prickling pain, boring, sharp and fixed: blood stagnation

    3. weighty pain, heavy sensation: damp blocking qi and blood

    4. colicky pain: abrupt qi obstruction by substantial pathogenic factors

    5. pulling pain, spasmodic, and short: disorders of the liver caused by liver wind

    6. burning pain, desires coolness: invasion of collaterals or lack of warmth in zang fu organs d/t yang qi deficiency

    7. hollow pain: deficiency of blood

  • (don’t differ much from adults;

    questions need to be asked in the presence of the parents)

    consider the following:

    nutritional, emotional, and physical state of mother during pregnancy; traumas at birth; breast-feeding and early weaning; vaccinations; childhood diseases contracted.

    1. disturbed sleep in older children: liver fire, stomach heat, retention of food

    2. weaning too early: can lead to retention of food and some skin diseases

    3. too early weaning or rich food consumed too early: can lead to sore throats and/or runny nose

    4. traumas at birth (such as caesarian or very long birth): affects baby’s lungs

    5. whooping cough during childhood: weakens lungs especially if occurs in severe form

    6. immunization: skin rash, insomnia, change in character - latent heat that could last to adulthood

    7. chronic catarrh, constant runny nose, cough, glue ear: residual wind with a spleen deficiency and phlegm

    8. chronic earache: lingering pathogenic factors usually damp-heat in gall bladder channel

    9. chronic cough/wheezing/respiratory infections: lingering pathogenic factor, lung phlegm heat

  • impotence

    1. young men - more a heart pattern rather than kidney deficiency

    2. older men - kidney yang deficiency or kidney qi deficiency

    3. heaviness of scrotum, urethral discharge, sticky yellow tongue - damp heat in liver

    lack of libido

    1. kidney qi or yang deficiency sometimes spleen, heart, lungs (most common heart)

    premature ejaculation

    1. kidney qi not firm, possible heart qi or heart blood deficiency

    tiredness & dizziness after ejaculation

    1. kidney deficiency

  • sexual

    1. lack of libido - inability for orgasm - kidney and heart deficiency or kidney yang deficiency and minister fire

    2. excessive sexual desire - liver or heart fire or kidney yin deficiency

    3. headache soon after orgasm - rebellious qi of the penetrating vessel or heart fire

    menses

    (this is not significant for women who take contraceptive pills, have an IUD, or are multiparous)

    1. cycle: always early - heat in the blood or qi deficiency

    2. cycle: always late - blood deficiency, stagnation of blood or cold

    3. cycle: irregular sometimes early and sometimes late - stagnation of liver qi, liver blood stasis, spleen qi deficiency, kidney qi deficiency

    4. amount: heavy loss of blood

    5. amount: scanty periods - blood deficiency, stagnation of blood or cold

    6. color: dark-red or bright-red color - heat in blood

    7. color: pale blood - blood deficiency

    8. color: purple or blackish blood - stasis of blood or cold

    9. fresh-red blood - empty-heat from yin deficiency

    10. quality: congealed blood with clots - stasis of blood or cold

    11. quality: watery blood - blood or yin deficiency

    12. quality: turbid blood - blood heat or stagnation of cold

    13. pain: before periods - stagnation of qi and blood

    14. pain: during periods - blood heat or stagnation of cold

    15. pain: after periods - blood deficiency

    leukorrhea

    1. color: white discharge - cold d/t spleen or kidney yang deficiency, external cold-damp, or sometimes liver qi stagnation

    2. color: yellow discharge - heat pattern, usually d/t damp heat in the lower burner

    3. color: greenish discharge - liver channel damp heat

    4. color: red and white discharge - damp heat

    5. color: yellow discharge with pus and blood in postmenopausal women - toxic damp heat in uterus

    6. watery consistency: - cold-damp pattern

    7. thick consistency:- damp heat pattern

    8. fishy smell - cold damp pattern

    9. leathery smell - damp heat pattern

    pregnancy

    1. infertility d/t empty conditions - blood or kidney essence deficiency

    2. infertility d/t full conditions - damp heat in the lower burner or blood stasis in the uterus

    3. vomiting during pregnancy - stomach and penetrating vessel deficiency

    4. miscarriage before three months - blood or essence deficiency associated with kidney deficiency

    5. miscarriage after three months - liver blood stasis or spleen qi sinking

    childbirth

    1. nausea and heavy bleeding post-delivery-exhaustion of penetrating vessel

    2. sweating and fever post-delivery - exhaustion of qi and blood

    3. postnatal depression - blood deficiency, leads to heart blood deficiency

tongue pulse.png

the types of tongues

  • heart
    deep branchy goes to the root of the tongue

    kidney
    terminates at the root of the tongue

    spleen
    transverses the root of the tongue and spreads over its lower surface

    1. conditions of the tongue proper may reflect deficiency or excess of zang-fu organs and relative strength of the essential qi

    2. conditions of tongue coating reflect depth and nature of invading pathogenic factors

    3. observe the tongue in natural light

    4. food or drugs may color the tongue coating

    5. eating or drinking changes the thickness or moisture

    • pale

      deficiency of yang qi

      • deficiency of qi and blood

    • red

      • with coating: interior excess heat

      • no coating: yin deficiency

      • red tip: ht fire, ht yin deficiency

      • red sides: liver fire or gb heat

    • deep red

      • exogenous febrile disease: invasion of ying & xue systems by pathogenic heat.

      • endogenous: yin deficiency with fire

    • purple

      • blue purple: stasis of blood due to hot or cold.

      • deep-blue purplish, also dry and lusterless - heat.

      • pale purplish & moist: cold, stasis of blood

      • purplish spots: stasis of blood

      • reddish purple: heat & stasis of blood

    1. thin

      thin, pale: deficiency of qi & blood.

      thin, dry & deep, red tongue: hyperactivity of fire due to yin deficiency (body fluids consumed).

    2. cracked

      may be present in a normal person

      deep red: excessive heat consuming body fluids.

      pale: deficiency of blood

      short horizontal cracks: stomach yin deficiency

      center crack reaching tip: heart pattern

      short cracks on sides: chronic spleen qi deficiency

    3. swollen

      delicate & pale with toothprints: yang deficiency of spleen and kidney

      deep red, taking up entire space of the mouth: excessive heat in heart & spleen.

      bluish purplish, dark: toxicosis

      red or normal colored: damp heat

      pale & damp: yang deficiency

    4. thorny

      papillary buds swell up and look like thorns.

      thorny & red: accumulation of pathogenic heat in interior.

    5. deviated

      wind stroke or early threatening signs of wind stroke

      interior wind

    6. rigid

      lacks flexibility, difficult to protrude, retract or roll.

      exogenous febrile diseases: invasion of pc.by heat,retention of turbid phlegm, or excessive pathogenic heat consuming body fluids.

      endogenous diseases: wind stroke or early threatening signs of wind stroke

    7. flaccid

      weak in motion.

      extreme deficiency of qi and blood, or consumption of yin fluids.

      pale: deficiency of qi & blood.

      flaccid & deep red: collapse of yin

    8. length

      long: tendency to heat (heart heat).

      short: pale & wet = cold. red & peeled = yin deficiency

    9. spleen qi deficiency

      toothmarked

      quiverin

    1. moist: normal tongue coating is moist an lustrous (normal body fluids). slippery coating/excessive moisture with saliva dribbling when tongue stuck out (severe case) - upward flooding of harmful water & cold damp.

    2. dry: coarse & feels lacking moisture. consumption of body fluid due to excessive heat or consumption of yin fluid not allowing it to nourish upwards.

    3. sticky: covered by a turbid layer of fine greasy substance and hard to scrub - retention of turbid damp & phlegm or retention of food

    4. granular: granules are coarse, loose and thick like a residue of making soy and easily scrubbed - excessive yang heat brings the turbid qi in the stomach upwards, retention of turbid phlegm or retention of food.

    5. peeled: “geographic tongue:” some coating peeled off - consumption of qi and yin in the stomach. “glossy tongue:” entire coating peels off leaving surface mirror smooth - sign of exhaustion of stomach yin and severe damage of the stomach qi.

    6. thin: tongue proper can be seen indistinctly. generally present if superficial portion of body affected, or deficiency of antipathogenic qi. (thinning coating points to gradual elimination of pathogenic factor.)

    7. thick: tongue proper cannot be seen at all. retention of damp, phlegm, or food in the interior, or inward transmission of disease. (thickening coating points to inward transmission of pathogenic factor from exterior.)

    1. white: exterior cold syndromes. thin & white - normal or exterior cold syndromes. thick & white - interior cold syndromes.

    2. yellow: interior syndromes & heat syndromes. deeper yellow - more severe pathogenic heat. light yellow - mild heat. deep yellow - more severe heat. burnt yellow - accumulation of heat

    3. grey: interior heat or cold & damp syndromes. grey, yellowish & dry - consumption of body fluid due to excessive heat. grey, whitish & moist - retention of cold damp, or phlegm & fluid.

    4. black: interior syndromes with extreme heat or excessive cold. severe stage of illness. black, yellowish & dry, with thorns - consumption of body fluids due to extreme heat. pale black & slippery - excessive cold due to yang deficiency

    1. too wet: yang qi not transporting or transforming fluids

    2. dry: full heat or empty heat

    3. sticky or slippery: damp or phlegm

the california pulse list

    • fu mai

    • cen ai

    • chi mai

    • shu mai

    • xu mai

    • shi mai

    • hong mai

    • xi mai

    • hua mai

    • se mai

    • xuan mai

    • jin mai

    • ru mai

    • ruo mai

    • cu mai

    • jie mai

    • dai mai

    • floating

    • sinking/deep

    • slow

    • rapid

    • empty

    • full

    • flooding

    • thin

    • slippery

    • choppy

    • wiry

    • tight

    • soggy

    • frail

    • hurrie

    • knotted

    • intermittent

    • floating

    • submerged

    • slow

    • quick

    • weak

    • strong

    • huge

    • fine

    • slippery

    • rough

    • wiry

    • _

    • _

    • weak

    • short

    • knotted

    • intermitent

    • superficial

    • deep

    • slow

    • rapid

    • xu

    • shi

    • _

    • thready

    • rolling

    • _

    • wiry

    • _

    • _

    • _

    • short

    • knotted

    • intermittent

    • superficial

    • deep

    • slow

    • rapid

    • deficient

    • excess

    • surging

    • thready

    • rolling

    • hesitant

    • string-taut

    • tense

    • soft

    • weak

    • abrupt

    • knotted

    • regularly/intermittent

the types of pulses

    • easily felt with gentle touch

    • exterior conditions

    • superficial, large & weak

      • prolonged endogenous diseases, indicating outward floating of yang qi

    • floating at superficial level but empty at deep level, deficiency of yin

      • rare cases floating in interior conditions (anemia, cancer) due to deficiency of qi “floats to surface.”

    • felt only on heavy pressure

    • interior conditions

    deep & forceful

    • interior excess conditions

    deep & weak

    • interior deficiency type, deficiency of qi and yang

    deep & full

    • stasis of qi and blood in the interior, or interior cold or heat

    • less than 4 beats per breath (60bpm)

    • cold

    slow & forceful

    • interior syndrome of excess type, retention of yin cold

    slow & weak

    • interior syndrome of deficiency due to deficiency of yang qi

    • more than 5 beats per breath (90 bpm)

    • heat

    rapid & forceful

    • excess heat retained in the interior/antipathogenic qi is strong

    rapid & weak

    • deficiency yin in prolonged illness, produces deficiency heat in interior

    rapid, weak, & large (full)

    • outward floating of deficiency yang

    • forceless pulse felt on 3 regions at 3 levels

    • deficiency of qi & blood

    • forceful pulse felt on 3 regions at 3 levels

    excess qi & blood

    • struggle with antipathogenic qi against hyperactive pathogenic factor

    excess & rapid, full, hard, long

    • full heat

    excess & slow

    • full cold

    1. broad, large & forceful like roaring wave, which comes on powerfully and fades away.

    2. excessive heat

    • fine thready, distinct & clear

    • deficiency due to overstrain & stress

    • deficiency of qi & blood & yin

    • internal dampness with severe deficiency of qi

    1. superficial & thready, hits fingers without strength.

    2. damp

    1. deep & thready, hits fingers without strength.

    2. deficiency of qi & blood & yang

    1. smooth and flowing like pearls rolling on a dish.

    2. smooth rounded, slippery to touch, oily.

    3. phlegm, damp, or pregnancy

    4. retained fluid

    5. retention of food

    6. excess heat

    1. feels rough and uneven or jagged.

    2. stagnation of qi & blood

    3. impairment of essence

    4. deficiency of blood

    5. after profuse & prolonged sweating

    1. taut, straight, and long like violin or guitar string

    2. disorders of liver & gb

    3. pain

    4. retention of fluids

    5. phlegm

    1. feels tight and forceful like a stretched rope

    2. cold interior or exterior

    3. pain

    4. retention of food

    5. asthma from cold in lungs

    6. stomach cold

    • hurried & rapid

    • irregular missed beats

    • excessive yang heat =

    • heart fire deficiency of heart qi

    • swelling & pain, stagnation of qi & blood

    • retention of phlegm or food

    • prostration

    • slow

    • irregular missed beats

    • excessive yin

    • accumulation of qi

    • retention of cold phlegm

    • stagnant blood

    • cold & deficiency of heart qi or heart yang

    • slow & weak

    • could be serious heart condition

    • serious internal problems of one or more yin organs

    • regular missed beats

    • declining zang qi

    • wind syndromes

    • pain

    • emotional fear & fright

    • traumatic confusions & sprains

  • heat pattern, extends slightly beyond normal pulse position

  • severe deficiency of qi, or deficiency of stomach qi

  • generally a healthy pulse

  • after hemorrhage. rapid and slightly hollow - forthcoming loss of blood

  • stretched like a drum. hard and tight on the superficial level, but empty at deep level. severe deficiency of kidney essence or yin

  • felth on the deep level, hard and wiry (string-taut). interior stagnation and pain. firm and slow - interior cold

  • only on superficial level. could be damp if in combination with a very empty (deficiency) condition.

  • deficiency of yang

  • severe deficiency of qi and blood, & kidney qi.

  • extreme deficiency of yang

  • trembles under the finger, round like a bean. shock, anxiety, fright or extreme pain. people with deep emotional shock.

  • excess of yang, with fire in the body exhausting the yin.