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I )ÍMKnostics of Traditional Chínese Medicine ( ompiler-in-Chief Wang Lufen

Translator-in-Chief Li Zhaoguo

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( 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.

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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 ñames)

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)

M

S. Khan (Ireland)

Raymond K. Carroll (Australia) David Molony (America)

Alessandra Gulí (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

(Listed in the order of the number of strokes in the Chinese ñames) Wan Lisheng

Wang Xu

Wang Lingling Wáng 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

ñames) Xun Jianying

Li Yong’an

Zhang Qingrong

Zhang Dengfeng

Yang Hongying

Huang Guoqi Xie Jinhua Translators

(Listed in the order of the number of strokes in the Chinese ñames)

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

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Office of the Translation Committee Director

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Secretaries

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Chen Li

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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 ñames) 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 ñames) 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 ñames)

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

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Layout Designer

Xu Guomin

Jiang Shuiyin

Xiao Yuanchun

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Foreword

4

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As we are walking into the 21st century,

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'‘health for all” is still an important task for the World Health Organization (W H O) to accomplish in

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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

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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

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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

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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

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effects of chemical drugs have become more and

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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,

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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

o

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 compilei^in-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

• 3 •

I

abroad and enable the whole world to have a

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l»« tter understanding of traditional Chinese med­ icine. Professor Zhu Qingsheng Vice-Minister

of

Health

Ministry

of

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the

People’s 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

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preserve health. Such a practice gave rise to the esl/iblishment of various kinds of traditional medicine

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wilh unique theory and practice," such as traditional

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( hiñese medicine,

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Indian medicine and Arabian

medicine, etc. Among these traditional systems of medicine, traditional Chinese medicine is a most ex-

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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

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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

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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-

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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,

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the new requirements initiated by the new diseases and the achievements and limitations of modern med­

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icine have also created challenges for traditional med­

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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

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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, saífe 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

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coo|>eration of W H O and other countries, trained

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al>oiit ten thousand intemational students from over

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• Koreword II DO countries.

In order to further promote the dissemination of

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traditional Chinese medicine in the world, A Newly ( \mpiled P radical English-Chinese Library o f Traditional Chinese Medicine, compiled by Nanjing

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University of TCM with Professor Zuo Yanfu as the

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H»»ii(*ral compileHn-chief and published by the Pub-

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linlung House of Shanghai University of TCM, aims Al Mystematic, accurate and concise expounding of Irwliiional Chinese medical theory and introducing

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Itocording to modern medical nomenclature of disea-

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■§». Undoubtedly, this series of books will be the

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Mlnical therapeutic methods of traditional medicine

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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 OÍ TCM published A Practical English-Chinese Li-

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brury o f Traditional Chinese Medicine in 1990.

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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 transíate

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lile Library.

Nanjing University of TCM and Shanghai Uni[VírMity of TCM are well-known for their advantages

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in liigher education of traditional Chinese medicine mui compilation of traditional Chinese medical textIxKíks.

The compilation of A Newly Compiled

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Jpradical English-Chinese Library o f Traditional ( límese Medicine has absorbed the rich experience ncc umulated by Nanjing University of Traditional ( límese 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

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il. iuonstrating the academic system of traditional ( hiñese medicine. The whole series of books has nyMtcmatically introduced the basic theory and thera-

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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-

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cology, pediatrics, traumatology and orthopedics,

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ophthalmology and otorhinolaryngology; introducing the basic methods and theory of acupuncture and

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moxibustion, massage (tuina), life cultivation and

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rehabililation, including 70 kinds of diseases suitable

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for acupuncture and moxibustion, 38 kinds of disea­

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ses for massage, examples of life cultivation and

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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

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TCM in education and research in the past 10 years.

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efforts have been made in the compilation to highlight the gist of TCM through accurate theoretical

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exposition and clinical praetice, aiming at introdu­

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cing authentic theory and practice to the world.

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2. Systematic

This Library contains 14 sepa-

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ni ir fascicles, i. e. Basic Theory o f Traditional í hiñese Medicine, i hiñese Medicine,

Diagnostics o f

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Traditional

Science o f Chinese Materia

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Medica, Science o f Prescriptions, Intemal Medi­ cine o f Traditional Chinese Medicine, Surgery o f

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Traditional Chinese Medicine, Gynecology o f Tra­ dicional Chinese Medicine, Pediatrics o f Tradition­ al ( hiñese Medicine, Traumatology and Orthopedics o f Traditional Chinese Medicine, Ophthalmology

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of Traditional Chinese Medicine, Otorhinolaryn-

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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

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Compared with the previous Librar-

y, the Newly Compiled Library has made great im-

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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

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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

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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 $ ÍSlí I'm£ ÍI tfistia kím

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 Gulí, Chairman of “Nanjing Association” in Rome, Italy; Doctor Secondo Scarsella, Chief Ed­ itor of YI DAO ZA ZHI; President Raymond K.

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Carroll from Australian Oriental Touching Therapy College; Ms. Shulan Tang, Academic Executive of ATCM in Britain; Mr.

+'ll'±ííÜíiS

,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-

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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 Región, 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

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TCM, has set a high valué on the books in his fore-

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• 5 •

• 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

Cónsul to Manchester in Britain; Miss Yan Meihua, Cónsul 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 íp 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.

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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

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tematic in itself and, at the same time, keeps a cióse 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 demón­ strate the profound contení 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-

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|x)se, some illustrations and colour pictures are included. We hope that this book will be beneficial to

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.

lx>th the intemational students with certain level of Chinese in learning traditional Chinese medicine and lite readers in China who are studying traditional Chí­ nese medicine or going abroad.

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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 complexión 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

n

&

..................................................................................................................................... i

* - *

................ *........................................................................................ 7

.....................................................................................

8

m±mm.............................................................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

í .........................................................................................................................42

< - ) a s w * - £ .........................................................................................................42

C“ ) i E # S ^ ............................................................................................... 44 ( = ) a § f t ................................................................................................................44 era) a s ^ .............................. ................................................................................. 52

(3D

% ^-f

........................................................................... 58 ¡qfy...................................................................................................... 60

«JÍP# ............................................................‘......................................... 60 ( *) ifl s .............................*................... *............ *........... ............. ............ 61 ( - ) Bf®...................................................................................................... 63 (H ) &Í0C...................................................................................................... 65 (0 )

....................................................................................................... 66

l ^ í f : ........................................................................................ ............. 67 ( - > v& m frZK ...........................................................................................................68

!('x>ntents

• 3 •

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

I’ulse-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])WMÍÉ« .................................................................................... 10< ( * ,) N S iW 0 ® íS ¡ K ........................................................................................... ÍOÍ

(+) fsiz m & t k .................................................................... ios (+-) .................................................................. lll (+ -)

................................................................................. 114

0 , (sjBEífeA.............................................................................................................. 116 (- ) ñ

........................................................................................... 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) J£0 Jft .......................................................................................................... 136 ( 0 ) & JÉ A .......................................................................................................... 137

2

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 reversión 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

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............................

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.................

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2. 2. 3. 5 Qi stagnation and blood stasis syndrome í 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

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0 . # ® # Í» ¥ íE .......................................................................................................... 181

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.............................................................................................................. 18(

(= ) tfcüE .............................................................................................. 18í (0 ) *W

.............................................................................................................. 181

#.=.-£

....................................................................................... 19

—,

.............................................................................................................. 191

(-> ¿AMHE ....................................................................................... 19| <“ ) -iL'PBSffi ...................................................................................................... 19|

(= ) 4>PBíMBfiE .................................................................................... 191 ( 0 ) -ll'JfiLaíE ...................................................................................................... 191

(E ) -OBHdlíE ....................................................................................... id ( añ)

................................................................................................... 19|

(-fc) '(>^C/L®fiE .................................................................................................. 19!

(A ) gSj&t'ÍSfiE .................................................................................... 20j ( A ) mAUt'ú-üE .................................................................................................. 2<¡

..............................................................................................

201

( - ) B K ñ W . ...................................................................................................... 2CH

( - ) ü>H*i¡E ....................................................................................... 20| ( H ) )xl3í^)WiiE .................................................................................................. 2(M (0 ) R M

# I

...................................................................................................20|

(1) ñmmw......................................................... 2« 7*0 ................................................................................................................................................................ 20! (-fc) .................................................................................... 20| (A ) fl,*»JWSE .................................................................................... 21 (

H , W ^D fü E .............................................................................................................. 21 ( - ) m ^ ñ w ..........................................................................................................2ií

(-)

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.................................................................................................. 21 m

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.................................................................................................. 2ii

(E ) »M U $i¡E .................................................................................... 21 (A ) I f f i l S t t .................................................................................... 211 0 , ........................................................................................................................... f F ^ » í 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

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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|

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(A ) ñ fM W v E

............................................................................................................. 21

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................................................................................. 21

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................................................................................................................. 2?

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(5 ) Ü?KjHí E .................................................................................... 21 (A )

...................................................................................................... 21 .............................................................................................. 27

( - ) H^ÜE ....................................................................................... 27 (“ )

(H )

..................................................................................................................... 27

27j

( 0 ) JfiL#iE ..................................................................................................................... 271

S iE ............................................................................................................ 27|

Introduction

%

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I )iagnostics of TCM is a subject concentrating on dihHIiduín 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 é # & 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 ü 'J& M

^ m 95 ÉHj

® 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 ó 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 olíaction, 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, «ylidióme differentiation of qi, blood and body fluid, «yndrome differentiation of viscera, syndrome differentia-

a

,:e n

i t jé . m

i ig h í i n

a

IItii| ol meridians, syndrome differentiation of six meridi•in». 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 orífices 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 orífices, 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

tíf c .A M É w z m

Imdy and vice versa. So by observing the changes of the five aensory organs, shape of the body, complexión 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 íñ í e i í i í >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. [fiífí^ íÜ jE a ^ S ío

Secondly, there is a cióse 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

(Ht’Ml. Ilowever, the dysfunction of the regulating ability ni Ihe human body or sudden violent changes of the na tu­

i

ü lm jjo í ñ í r A f r i fflTÍíj]ñb#i1£

i

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 luí íactors must be taken into consideration in the diagno-

ñj W Si n[íol í M ííi t i rfn a ífe ^

•Ih ni diseases.

i .

¿& M T m n ^ íff 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 cióse 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.

u

Combination of disease differentiation and

2.

ayndrome differentiation I his ineans to decide the ñame of the disease and to illllei entiate the manifestations of the disease. m m m m ,

Disease means a pathological development course

y&fá,

—s ís 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 í í M

íh

# RfrgMfiEISe.

ease has its own occurrence, development and varia tion principies. The disease ñame is the label of the disease in question. suchas dysentery, measles and asthina, etc.

Symptom refers to various abnormal manifestations

ííe .

EP J¡E

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-ü M W , n '¡1 ^ - ín i& M

fur and rapid pulse, etc.

ítfc A ifc % PJ éKj ULf í ^ íw $ í t

Syndrome is a summarization of the development of a disease at a certain stage, including cause, location, na-

nm

ifisn a g * ií -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 invasión of

W W #t J i U M „ ffl ííp “

’ñ 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;

llfí JL

perse. The main symptoms brought about are mild fever,

ikm . ;

anhidrosis, pain of head and body, stuffy nose with clear

& , %j t ,%#

bTíü BUS m ñ & & # 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

wílect the understanding of llir tinturo ol disenso, liowevt't. they emphasize on difíoreni aspeéis. Disease reflects lile

M íá iR, íM't; íí i Wf i ®; iíii i i í'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

ü o vti& Q & '& fá 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 .. 4í «rm ai M #1 N M íjE fS • t¡P “ If1^ N

PHM' is beneficial to the understanding of the nature of a

iiE” o ÍMili:- M *-i yí til- AA T' N ft¡ Jf iÁ iR M W # ® o íi*¡ -fí f ÜT JA ^ ií 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-

üem m* ¥ m & m i t a

U’i iHtics. The differentiation of syndrome emphasizes on lite changes of a disease at a certain stage and the under-

ítWiMMíñ'6i, i|í5JAA M ^ ')%®r&íw

nliinding of the nature of a disease according to the present

í ^ f i M té

i lltiical manifestations to provide evidence for present llrjitment

$

te

^ m uen tñ & • u *s

ffiÍL ^ 4-Iñ. M ÍM/K • í í i# Ü 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 ÍfJiÉo

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# ;í- r #

'n # , J i Íh Si’Eí t

ü

try to collect as detailed as possible the data for comprehensive analysis of the disease. The manifestations of a disease are múltiple 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 á 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-

“ ízy

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

n

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 xí B -# ó<j J» t fn W

i# , The human body is a organic whole. Under morbid

a

m

—

conditions, local pathological changes may affect the Whole body; internal pathological changes can be manifeslr
e t >m h í m í ü ^ & m a * „

lile superficies. With the examination of the symptoms

m iu m a m >m , íeo, w ra i # ,

«lid signs of a disease by means of the four diagnostic methods, one can understand the cause of the disease and

^ í¡ E ,ñ i

niiülyze the pathogenesis of the disease so as to provide pvideuce for deciding treatment based on syndrome differ-

ff iif c í& 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] íkj t i ü % 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|£j^i:;& M B i# £n m\ ¡s

'Mfc r KM* • ¥■ * diagnosis.

jii. n m un % m a i r íw ^ jM .ií- ^ a n E ü

m m .

1.1

Inspection

■*&

Inspection means that the doctor use his or her eyes

m

. íi?

i TÉ,

to examine the vitality, colour, shape and posture of the patient’s whole body or local región as well as inspect the colour, quantity and texture of the excreta for the purpose of understanding pathological conditions.

VÁ

7 í/ p iliíft— f+ iM lirí& o

Inspection is a convenient and important method for diagnosing disease. It not only enables the doctor to get

M

i

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 región 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 . í í jé f i i í i n % & m m ñ ü

I Ion of spirit can enable one to understand whether the es-

Í 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 Itilínl expressions, complexión, eye expressions, speech,

fe J H

, in W ^

lircath, physical conditions and response to the external

pS ' ® $ $ ¡

É

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 orífice related to lili' liver, governed by the heart and housing the spirit the

Ü # ■ +*'¿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 ííj 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 complexión,

i. m n

flexible eyes with brightness and vitality, accurate verbal

a & . l A í f e $ íl'fJ • M R

i

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®?ü| , 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, palé complexión, 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, palé complex­ ión, 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-

fá S .iW J n A ' 8.; J5 '# ü zH ?[

x j ñ j§ #|

cal pathological conditions with unfavourable prognosis.

1 .1 .1 .1 .4

False spirit

4. ÍPI#

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 palé complexión suddenly

(IV%'

(HIHH * líilfMlíiíHí'í,^^

ilmuges into reddish cheeks; or extreme dispiritedness, mental derangement and retard response suddenly change

M

íí M

« , 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 íifc a

í t , 04 ®TSí ^

^ ^

I líese phenomena indícate declination of essence and flonting of yang due to failure of yin to control yang. This

M - fít

condition is clinically known as “ the last radiance of the Miílting sun” and “ sudden spurt of vitality before death” ,

m iI

lile premonitory signs of death.

S * ± M í^

“ íh]

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

m

« * ffi n . M is m m

Improvement of spirit depletion takes place in the course ni

the improvement of the whole pathological conditions.

HWífít.iJn 1 .1 .1 .1 .5

Mental derangement

This condition is usually seen in the case of mania.

5. m i E P fé ttjS iR m .tÜ 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

,ÍT A S # f ,

lieurt by phlegmatic fire; the manifestations like sudden n n ig £ £ f;,W

inina, drooling, staring upwards, convulsión of limbs and gl'iwining like pig and goat usually indicate epilepsy due to

S ± íl, E J & M . □

eiiilngenous liver wind and phlegm confusing the mind Which can heal automatically. tóm 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 Í 3 S®

0^

entiation of these manifestations is different from serious dysfunction of viscera at the advanced stage of serious dis­

D? üE M Si. 5 £ M & 'M fs )$ B

ease and spirit depletion due to exhaustion of essence.

1.1.1.2

Inspection of complexión

(z ) u s e

Inspection of complexión 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 complexión 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 í ü o 1 .1 .1 .2 .1

Normal complexión

i.

The normal and healthy complexión 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 complexión is further divided into

JV;ffli il t .

ili l I * Mi

Iimtlimnt complexión and varied complexión.

Dominant complexión refers to the colour of the skin mil

luce lliat never changes due to racial and constitution-

JEft, ± ü

ll fuctors.

Vmied complexión 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 complexión 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 complexión is temporary

tlm'lush mil

nuclear. 5HHM. Ilesides, drinking liquor, excitement and sports ac-

ilt

, ik ffl, -t 'íf $J ffl, is

Ivllv may also lead to the changes of complexión. But llene changes are not morbid.

1 .1 .1 .2 .2

Morbid complexión

'-m

2.

Facial colour during the course of diseasé is called IMM'bid complexión marked by dry and dull colour, or obulnim bright colour, or a single colour alone. s ¡ s — fe, ¡l^ iía fe + fP h The key point in inspecting morbid complexión is to lllfpi'entiate favourable and unfavourable manifestations of lie Uve kinds of colour and the diseases manifested by líese 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 leí

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

lü íé .M ií] F ;J W tfé

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,

M

E f: E

M

iü

the five kinds of colour correspond to disorders of the five zang organs, i. e. blue colour-corresponding to the liver,

JS'Cí. a n j e a n MU 51

red colour to the heart, white colour to the lung, yellow

'ífo

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 complexión related to them. While the five kinds of colour also demónstrate different nature of diseases. The following is the detailed description: Red colour; Red colour indica tes heat syndrome, also

0

± íftÍjE ,^ñJ;

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 plexión appears red. Flushed face is a sign of sthenic heat syndrome due to hyperactivity of visceral yang heat resulting from exoge-

íif f i a £L,

ÍÉ &

MU® Ü!,

nous fever. Flushed and delicate cheeks indicates asthenia heat syndrome due to endogenous heat resulting from yin asthenia. Palé complexión 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. Palé

fi % % IÍII. 4' -fc 7> M o I

complexión is caused by insufficiency of qi and blood in the

''CJ# ft:. Á jJ jié IÍII I . 'Jfg i 1 lü

face due to failure of insufficient yangqi to transport blood

*í*ll(ll

•/

)#.

Tíll:

fct i l

lílLlH

lo nourish the face, or due to failure of the asthenia of qi íind hlood to fill the vessels, or due to coagulation of coid lli llit* meridians and vessels which prevent qi and blood to i irruíate freely. Ploating whitish complexión and facial dropsy are uminlly due to insufficiency of yangqi. Light whitish com­ plexión and emaciation are often caused by consumption of i|l und blood. Palé complexión is often seen in sthenic coid «yndrome, such as interior coid syndrome with sharp ab­ dominal pain. Sudden palé complexión with profuse coid nweating, coid limbs and indistinct pulse is a sign of sudiltíll loss of yangqi. Yellow colour; Indicating asthenia syndrome and

© M ñ : i^ Ü E J S Í E o

tlmnpness syndrome. Yellow colour indicates asthenia of the spleen and aci ilfnulation of dampness. CRUSed

Yellow complexión may be

fif- J É ^

35 ,

É- '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 complexión is called willow complexión due to gastrosplenic qi asthenia and iniiiliií 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 complexión, 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 complexión like being fumigated is called yin jaundice, usually caused by stagnation of coid and dampness or prolonged stagnation of the liver and gallbladder. Bluish complexión: Indicating coid syndrome, pain syndrome, blood stasis syndrome and convulsive syn­

® U f e : ± » Ü F .,* Í j É . ^ íjEí O'I'IííxI o

drome. Bluish colour is a sign of inhibited flow of qi and blood and stagnation of vessels and meridians. The invasión of

W fe Je K Ja is 'ñ ^ % > B m m im o

mm

coid factors causes contraction and stagnation, leading to spasm of meridians and vessels and stagnation of qi and

tía

blood. It may be caused either by deficiency of yangqi

ü é l b , iíl '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/ícai'iw.üjBXgtffifesw-o

sels, or by exuberance of pathogenic heat which stagnates blood vessels. Besides, the stagnation of qi and blood in

-f ü 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. Palé and bluish complexión, or accompanied by chest pain and abdominal pain, is often due to invasión of coid or

ra jé

yang asthenia and coid exuberance. Bluish and greyish

M I . f f i f e t l . P üj

complexión with purplish black lips and chest pain is usual­ ly caused by inaction of heart yang and stagnation of heart

ffife P

blood. Cyanotic complexión 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 complexión mingled with bluish colour is

M 'g 'iT ñ m m w .w ik

called dull jaundice, usually seen in subjugation of the

/h J L ^ íR 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 convulsión, usually due to exuberance of

¡a

(«dltoRenic heat. Blackish complexión: Indicating kidney asthenia synilinliit', coid syndrome, blood stasis syndrome and fluid

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IfUMition syndrome. hlackish complexión is the sign of kidney asthenia, yin prtdomination and exuberance of water or stagnation of qi

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•ilid blood. The kidney is the organ associating closely Wllli water and fire and is the source of yangqi. Asthenia

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i*t kidney yang and retention of fluid will lead to intemal

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iHUlxirance of water coid, loss of warmth in blood, spasm nf Vi'ssels and meridians and inhibíted flow of qi and IiIikmI. Blackish complexión may also be caused by con-

mimption of yin by asthenic fire and failure of essence to

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llimrish the face, or by prolonged stagnation of blood in llir Ixidy. Light blackish complexión is often caused by asthenia ul kidney yang. Dry blackish complexión is usually due to (irolonged consumption of kidney essence and asthenic fire «Onsuming yin. Blackish complexión with squamous and ill v skin often results from internal retention.of blood sta-

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RlN, Blackish colour of the area around the eye socket indi-

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i ules retention of fluid due to kidney asthenia and fluid ex-

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U'Hvasation or leukorrhagia due to downward migration of inlil dampness. 1 .1 .1 .3

Inspection o f body

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Inspection of body means to diagnose the patient by

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nmmiining the physical conditions of the patient.

$ 1 # « , V Á 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

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cji, blood, yin and yang as well as the conflict between healthy qi and pathogenic íactors which may suggest the possibility of contracting certain disease. 1 .1 .1 .3 .1

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Physical strength and weakness

Inspection of physical strength and weakness may enable one to know the functions of the viscera and the con­

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ditions of qi and blood. Generally speaking. the conditions

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of the body correspond to the conditions of visceral func­ tions and the states of qi and blood. That means internal

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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 indícate sufficiency of qi, powerful functions of the viscera, exuberance of qi and blood and healthy body. Strong body means strong resistance against pathogenic invasión, no liability to con-

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tract disease, quick recovery from illness and favourable prognosis. (2)

Weakness; Weakness refers to decline of body

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strength, the manifestations of which are dry skin, lean muscles, thin chest and bones which indícate 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 invasión, easiness to catch disease, difficulty in healing and unfavourable prog­ nosis. 1 .1 .1 .3 .2

2.

Physical obesity and em aciation

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Inspection of physical obesity and emaciation may suggest the possibility to contract certain diseases.

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Obesity: Obesity is characterized by round head, short and thick neck. wide and fíat shoulders, wide-short-

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round chest, big belly, smaller body. flabby muscles,

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dispiritedness and lassitude which are the signs of predo-

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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 vértigo, apoplexy and ilhltructive syndrome of the chest. That is why it is said lililí "ótese people are predominant in dampness” and " oIh'sc people are susceptible to wind stroke”. Emaciatiori: Emaciation is characterized by long

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IunkI. thin and long neck, narrow shoulders, narrow and lint chest, small belly, higher body, thin muscles and dry-

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urss of skin which suggest asthenia of blood and internal

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i'Xiik'rance of asthenic fire usually seen in patients with

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pulmonary tuberculosis and internal impairment by asllu'iiic overstrain. That is why it is said that “ thin people iiiv

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predominant in fire” and “ thin people are susceptible

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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

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nf visceral essence as well as unfavourable prognosis. 1 .1 .1 .3 .3

Deformity

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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-

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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 patient’s | k in I

tires in tranquility and action as well as abnormal ac-

llvilies. The postures of the patient in tranquility and action is

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closely related to the conditions of yin and yang of the

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body as well as natures of the illness as being coid or heat or asthenia or sthenia. The movement of the limbs is un-

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der the control of the heart spirit and in cióse relation with

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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

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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

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and action Yang governs action and yin tranquility. The sitting,

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lying and walking postures of the patient may be summarized like this: movement, supination and extensión indicate that the disease of yang na ture, usually manifesting as extemal syndrome, heat syndrome and sthenia syn­ drome; quietness, pronation and bending indícate the dis­

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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 tensión and retention of fluid in the chest and abdomen. Lying: Lying on bed facing the outward with the

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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

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sydrome; lying on a supine position with the extensión of

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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

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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.

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In lilis case, diagnosis should be made with the aid of othrr ways of examination. 1 .1 .1 .4 .2

Inspection of abnormal movements

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Abnormal movements of the patient’s limbs usually Indícate the signs of certain diseases. For eXample, spasm of the limbs, stiff necks and opisthotonus indícate 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,

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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

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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

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cal conditions in question.

sm . The pathological changes of the tissues and organs in the human body are mainly reflected by external manifes­

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tations (such as luster. color and postures), functions and sensation. These external manifestations indica te either

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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

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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

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The head is the región 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

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brains (cerebral marrow) and marrow. which is governed by the kidney. The kidney also governs bones. The devel-

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npment of the skull and brains all depend on kidney es-

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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-

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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,

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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

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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 fíat top of head in children often re­

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uní 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.

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Fontanel: Inspection of fontanel must be done in ex-

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umining the infants under the age of 1 year and a half.

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Sunken fontanel indicates asthenia syndrome, usually ciiused by excessive vomiting which impairs body fluid, or l»V

weakness of the spleen and stomach and prolapse of the

«nstrosplenic qi, or by congenital insufficiency and malnu-

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li ilion of the brains. Protrusion of fontanel indicates stheina syndrome, usually caused by virulent heat in exoge-

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lions febrile disease attacking the upper part of the body,

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oí by fluid retention and blood stasis in the skull. Retard closure of fontanel and non-closure of the bone fissure is

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frequently caused by congenital insuíficiency of kidney es­ sence, or by chronic disease and malnutrition after birth. Shak¡ng: Involuntary shaking or tremor in both chil-

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dren and adults means intemal disturbance of liver wind. ¡A filio 1 .1 .2 .1 .2

Inspection o f hair

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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

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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

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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

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Mlthenia and wind attack, or caused by anxiety and ner-

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vousness which Iead to qi stagnation and fire depression as well as blood heat generating wind.

1.1.2.2

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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.

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I'llii h organ itself is directly or indirectly related to several vlNcera and its functions are also associated with the heart

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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 pathologii’dl changes of the viscera. The inspection of tongue is dis-

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i ussed in another section. The following is the discussion

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nf the inspection of the eyes, ears, nose, mouth, lips, Miitns and throat. 1.1.2.2.1

Inspection of the eyes

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The eyes are the orífices related to the liver. HowPVer. all the visceral essence flows upward into the eyes.

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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

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llver known as wind wheel and the pupil pertaining to the lildney known as water wheel. According to the theory of

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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,

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redness of the white part indicates pulmonary fire, red-

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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 palé canthus and eyelids shows insufficien­ cy of blood. Shape o f the eyes: Sunken orbit is often due to loss

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of body fluid resulting from excessive vomiting and diarrhea, or due to decline of visceral essence resulting from

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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

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and obliquely during the course of a disease mostly indicates internal disturbance of liver wind. Immobile straight

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staring is a severe condition of the declination of visceral essence. Slight fixation of the visión is usually due to in­

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ternal retention of phlegmatic heat. Open eyes during sleep is often caused by weak functions of the spleen and

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stomach. Platycoria and no reaction to light are critical signs of kidney essence exhaustion, also seen in poison-

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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

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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

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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 concéntrate on the colOUi

. shape and inner part of the ears. Colour and shape of the ears: Ears of healthy peo-

ple

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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

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rold syndrome; bluish and blackish colour of the ears is u-

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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

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l'hanges in the ears are mainly otorrhea of pus. Otorrhea

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oí 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

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The nose is the orífice related to the lung, corre-

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»|Xmding to the spleen meridian and connecting with the «lomach meridian. So inspection of the changes of the lióse

is helpful for understanding changes of the lung,

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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 típ

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with thickened skin. bulging surface like acné or wart is

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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

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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.

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Nasal excreta; See the section of inspecting excre­ ta.

(2)

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Inspection of mouth and lips

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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

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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)

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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-

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thenia and exuberant fire; lips as red as cherry usually in­ dicates poisoning by coal gas; palé lips is caused by asthe­

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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-

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(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;

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(llfficulty in opening mouth is lockjaw seen in convulsión in Mil

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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. Palé gums

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Indicates blood asthenia; reddish swelling and painful gums indícate exuberance of gastric fire; slight swelling gums without pain indícate up-flaming of asthenic fire;

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bleeding and reddish swelling gums indícate impairment of

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the collaterals by gastric fire; bleeding gums without red­

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dish swelling suggest impairment of the collaterals by asthenic fire. 1 .1 .2 .2 .6

Inspection of throat

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The throat is the door to the lung and stomach. the palliway for breathing and eating and the región 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

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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

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called tonsillitis due to exuberant virulent heat as well as

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heat fumigation and muscle decaying; false whitish mem-

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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

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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

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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-

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centrates on the shape and movement of the neck. 1 .1 .2 .3 .1

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Changes of the shape

The commonly seen changes are: m -. G o ite r: Goiter refers to unilateral or bilateral lumps

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like tumor below the laryngeal protuberance which is either

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small or large and movable with swallowing, usually caused

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by stagnation of liver qi and retention of phlegm, sometimes

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due to local climate and environment.

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Scrofula: Scrofula refers to cervical clustered nod-

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ules, usually caused by asthenic fire scorching phlegm into nodules due to asthenia of lung and kidney yin, or by accu­

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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

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Indude the following aspects: F laccidity o f the neck: Weakness of the neck úna­

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nle lo support the head is called flaccidity of the neck. Flaccidity of the neck in the babies over 4 months oíd is

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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
m

(2)

m ttssifrajiÑ

m

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.

BÉ8R

m . as-

b

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

mmwío

back with posterior bending of the head, stretching of the

w,

m

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. "ÍÍ5 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 complexión 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

íiu fr Inspection of colour

1. M f e j f

The diagnostic significance of inspection of skin is similar to that of inspection of complexión.

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

'iílM

; & K T íM

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.

,

í

J U lte ¥ fg ,^ E im iÉ M ,l te £ # 0 r íL

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 ü , 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 íiM 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 ío

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 HÍze, unfixed location, occasional appearance and disapIH'arance, palé tongue and weak pulse are yin macules, u-

M , SS 5í Ó ^ í 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 petáis that can be felt by hands and

M

S ifo. • É. S¿ Jfóc ^

. (2)

« ^ s á 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.

o

0 ñ í! J lT g f t 'f á iiE ,Í 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-

¡ü fñ .

vn and desquamation after eruption is favourable, sug-

% M tí}

m

«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 í(5íp, M fr* •

breath is unfavourable, suggesting that pathogenic factors domínate 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 invasión 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

É

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)

ó-féJft&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

M

í

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 domínate 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 domínate over path-

m* ti,

ogenic factors and unfavourable prognosis. Carbuncle, phlegmon. boíl and furuncle: Carbun-

(4 )

H\ÍR,

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

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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 & ñ ‘X % l*l H . % JÉ.

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

ÍÉL:

without tip, changes of skin, fever and pain. It is of yin

S $ -~S ñ '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? ñ , ^ 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.

lúií^ífifnjíio

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.

ífnfiKo

1.1.2.5

Inspection of infantile Índex finger

(E)

veins Inspection of infantile Índex finger veins means to

ffl/J'JLÍtffilIJcíft.tófc#

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

ttífr & ífe 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 iɮfo

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

m

•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 - í l M É f i

Methods for inspecting infantile index finger vein. The parent carries the infant to the place with full

J j) í

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 JLlstÍH $ Sí 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 é J f t & f ó

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-

ñ ñ :

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 convulsión; 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

nú-.

the case of internal invasión 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; múltiple

üE,#ViiEo i

and curled vein indicates serious disease; gradual exten­

g

sión of vein indicates progression of disease; gradual

Í&B

; ^

^

i l , ^

s

.

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.

WWlVníKj &

. i: g fe té m,

saliva, uriñe, 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, uriñe, 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 í M t á t i . si]

states of the viscera.

vat

Inspection of excreta mainly includes examination of

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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, uriñe, 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

í& fi& ífc # 0 ía ,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 expectórate, 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^ü'tíWííío

’>

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 í& £ S U £ 0 jÉ

mingled with fresh blood, it means that the pulmonary collaterals are impaired due to invasión 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 spittlí 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 cióse 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 insüficiency 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. I’ersistent 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. MPÍR±!$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 oí 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 unpres»¡ible abdominal distensión and pain is caused by retention OÍ food due to intemperance of food and indigestión. 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 dysíunction 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

ífP ÍE 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

ÍOÜTñ 5

Jfil

^ fu )S f í

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 íí

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

ür 4=, # # ür

, ür ffiü, 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, triáis should be made to exelude various false manifestations, such as “dyed tongue fur” due to light, diet and drugs.

ÉKJSi ufó, tfc # & M ah

W

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 áiift.

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 í 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 ín

should be comprehensive and based on the changes of

Ihe tongue body and tongue fur. Fork groove

. / , L

X

K id n ey '|f M édium 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

ñor 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 cióse 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&ár-É-:

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moist and lustrous. Such a condition of the tongue is

I I ifiííS # ,

usually seen among healthy people. suggesting sufficiency

J E ^ A ^ ^ u íii^ M ^ fíí

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 ñ 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. IÚL% i® , ^ k 5Ü#; 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 íf f f íi'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)

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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 ñ M M

lOlour Fig. 4). Red and deep-red tongue both indicates lirnt syndrome. The redder the tongue, the severer the

4 )o

Irnl.

Ñ M tiE /K ñ W ñ fe o Red or deep-red tongue is caused by superabundance

uf blood in the vessels of the tongue due to hyperactivity

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WJ m I S

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±

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-

o

ífOme 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 íft 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 í & 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

líiE H if í á H f P H I É 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

!íll '£ t$ % íJc % Bü M

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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#:

i

(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

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. 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 oí 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) flt«L-é-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

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pmhogenic factors with alcoholic toxin attacking on the

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or by intoxication which leads to stagnation of qi

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blood in the tongue collaterals. Deep-red and swollen

lifclgue is due to superabundant heat in the heart and

- fH íS

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

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mui blood or consumption of yin fluid.

mm 7).

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Thin tongue is usually due to asthenia of qi and IiIinkI. or consumption of yin fluid and insufficient mois-

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liiir and nutrition of the tongue. Light-coloured and thin

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iíii

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

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tongue fur. Prickly tongue; The tongue is covered with reddish

(6) £#']-£■:

prickles (see colour Fig. 9), suggesting superabundance of pathogenic heat.

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Prickly tongue is due to superabundance of heat in the viscera, invasión of heat into blood and accumulation of heat in the tongue collaterals. The location of prickles

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may indícate the location of pathogenic heat. Prickles on Ihe tongue tip indícate hyperactivity of heart fire; prickles

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on the tongue center indícate superabundance of heat in the stomach and infestines; prickles on the margins indí­

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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

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(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 simultaneug»ly. 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

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f, <4- 4}W

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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

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nVivcment of the tongue.

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Stiff tongue: The tongue is not soft; it is inflexible

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,

ni Itiff and immobile. Such a change of the tongue is usunlly seen in exogenous diseases due to exuberant heat con-

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Miming body fluid, or due to invasión of heat into the peri-

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inidium, or due to phlegm and turbid substance confusing

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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 invasión of heat into the |H’i 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 invasión 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-

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oring, indicating endogenous liver wind.

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Shivering tongue is caused either by consumption of blood or body fluid which fails to nourish the tendons and

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vessels; or by extreme heat generating wind due to exu­ berant heat scorching the liver meridian; or by liver yang

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transforming into wind.

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Light-whitish and shivering

tongue is due to asthenia of qi and blood and endogenous asthenia-wind. usually seen in internal impairment, chro­

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nic diseases and severe diseases; reddish shivering tongue

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with scanty dry fur is due to consumption of yin fluid,

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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

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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

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monitory sign of wind stroke due to liver wind complicated

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by phlegm or liver wind complicated by stagnation in the Collaterals of the tongue.

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Flaccid tongue: The tongue is too weak to protrude

(4)

#nd withdraw. suggesting extreme consumption of fluid or

« i

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

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Tffi

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Intemal impairment is due to extreme predominance of fire resulting from yin asthenia; light-whitish and flaccid

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tongue is due to decline of qi and blood. Reddish dry and

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fina :id tongue at the advanced stage in exogenous febrile

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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 indicatínn critical condi tion. Such a syndrome is either of coid or OÍ heat nature.

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Shrunk tongue is caused either by invasión 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 ® ñ ® M

consuming fluid and causing spasm of the musculature and vessels; or by stagnation of liver wind with phlegm in the

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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

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.

protrudes out but is unable to retreat is called protruding tongue; the tongue that frequently protrudes out but im-

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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 invasión of pestilence into the heart or

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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-

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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

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“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.

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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

Jfcüfc,

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

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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 invasión 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 )

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moist tongue fur. The tongue fur with excessive dampness tnd slipperiness is called slippery tongue fur. The tongue

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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 invasión 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

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rougher the tongue fur. the severer the consumption of

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t»dy fluid. Such a condition is usually seen at the médium 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

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fl'l >PJ M /S $ P i$r

iI.i£ W 8 É £ .

of pathogenic heat and gradual restoration of body fluid. Greasy and p utrid tongue fu r : Tongue fur compact

(3) « M í:

and difficult to exfolíate which is thick on the center and thin on the margins is called greasy tongue fur (see colour

m z s u M íM 'f á Z iM & a a

Fig. 12). While the tongue fur loose, sparse and easy to

mm i2) ;M M © * M

exfolíate 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. médium 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.

ñ m & c & m m i3). ^ m • f¡ rAí )t

ftn £ ,

M lS íío 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

í/a-.

prognosis of a disease will be. Exfoliated tongue fur and diH-'p-red tongue indícate consumption of yin by exuberant htfnl; exfoliated tongue fur and light-coloured tongue indiultc consumption oí both qi and yin; mirror-like tongue lUKKcsts severe consumption of gastric qi and is a sign of lite

ím »

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

oí the tongue and is not easy to exfolíate. It is also

|Nllr
leal tongue fur. The tongue fur without root means

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Ihe tongue fur appears floating or painted on the

HtliKiic and is easy to exfolíate. 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 continué on the tongue. Inspecting Whi’lhei 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 médium 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 ííífjg iiiS ü 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,

J

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/É3Íío

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

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^ %J M I* ^ ül: rlt

al

external syndrome; tongue with reddish margins and tip km well

m í.

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 llüit does not feel dry is called powder tongue fur, fre-

m m M

quently caused by mixture of exogenous fetid pathogenic

w. rtóMí-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 ñ 'f o ^ ± S üH ^ üHo

During the course of a disease, the change of tongue luí 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 ípep 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 invasión 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 mitió! 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

íjE W

S üE,

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

o

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 í S S S M É 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

, ífi'e ín 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

Mñ % ,

JÚl fój $ 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 $ í t ñ — Sí M

illdications. For example,

|W !,±^-SCo ííp¡ £ M ¿ i ¡

the tongue is red and the

M #L +11

Jungue fur is yellow and dry in sthenia-heat syndrome; the lítligue 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 JÉ; ^ 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

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líti X íi

Mlggests internal accumulation of damp-heat. ComprehenpVtf nnalysis shows that such changes of the tongue and

M„

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Un longue fur suggests asthenia-sthenia complex syn-

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dfimik* due to deficiency of qi and blood complicated by ex-

MiLo

1k ÍR

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-

BÍ.,XieM, í&tfcírfRfllL

MIh nnd fire superabundance, while white and greasy

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(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

SCHÍ, # & m #

l-J m # va ± w m í'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

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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 »

a

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of the viscera.

1. 2. J

Listening to sounds

Voice is produced by vibration of air in the cavity and

r* tí it; É

1*1 ftfl H ’Mt Ü

tube organs. The voice made in the mouth is in cióse rela-

fililí

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 , m1¡i«

. w i- n 'rc .fó tí

A f f f M í 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 üj '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-

,

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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-

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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, iÜHIdren’s voice is sharp and melodious, and voice of the

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Igwl is low and deep. Generally speaking, high and sono-

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h»o» voice in healthy people is a manifestation of sufficien-

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l'V itl primordial qi and pulmonary qi. » There is cióse 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
1.2.1.1.1

Voice

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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-

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fltnl voice with restlessness and polylogia indicates sthenia

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iVliiliome and heat syndrome; low. weak and disjointed

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Vitli r willi quietness and oligologia indicates asthenia synÉoine and coid syndrome. Doop and heavy v o ic e : Deep and heavy voice is u-

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Miitllv caused by failure of pulmonary qi to disperse and ob»liliclion 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)

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Hoarseness is similar to aphonia in pathogenesis.

If

hoarseness is very serious, it will develop into aphonia.

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Hoarseness or aphonia in new disease pertains to sthenia

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syndrome due to exogenous pathogenic factors attacking on the lung or due to failure of the pulmonary qi to dis­

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perse resulting from stagnation of phlegm. Such a patho­

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logical condition is known as "a solid bell cannot ring

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(dysphonia or hoarseness due to sthenia syndrome of the lung)” . Hoarseness or aphonia in a chronic disease per­

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tains to asthenia syndrome due to exhaustion of fluid and impairment of the lung caused by asthenia of lung and kid-

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ney yin and asthenia-fire scorching metal (lung). Such a pathological condition is known as “a broken bell cannot

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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-

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rous voice in coma. Such a morbid condition pertains to sthenia syndrome due to heat disturbing the mind seen in

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invasión of pathogenic factors into the pericardium in seasonai febrile disease or sthenia syndrome of yangming fu-organ. Fading murmur¡ng; Fading murmuring is marked by

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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. Sol¡loquy: Soliloquy is marked by mental depres-

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talking to oneself,

murmuring and incoherent

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Ipocrli, usually caused by coagulation of phlegm confusing lile mind or by severe impairment of heart qi. Such a mor-

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lllil condition is usually seen in epilepsy. Rav¡ng: Raving is marked by manic movement,

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■ouling and sonorous voice usually due to phlegm fire atIflt'king the heart.

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(5)

Paraphasia: Paraphasia means that the patient

»|x','il<s nonsense in consciousness and is aware of it after-

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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

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ni «equela of wind stroke. It is due to obstruction of

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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

o

pIRil malnutrition of the tongue. 1 .2 .1 .2

R espiration

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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-

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tlhiuir and sthenia syndrome; the disease with long durallmi. weak breath and shortness of breath in movement |««i Imíiis

lo asthenia syndrome and coid syndrome.

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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 fíat. 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 ñu*,

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

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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.

t

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

o

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

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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

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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-

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&

lltMtt of other viscera. Cough is usually related to sputum. I» In diagnosis, cares should be taken to analyze the char-

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*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-

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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-

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|H»Nn 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

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MI expectórate accompanied by dry pain of throat and hot

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•PMNitu>n in the nose in breathing is due to invasión of |*tlioKon¡e heat into the lung which consumes pulmonary

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fluid and inhibits flow of pulmonary qi. Dry cough without sputum or with scanty and sticky sputum and dry throat is due to invasión of pathogenic dryness into the lung or due to deficiency of pulmonary yin, consumption of pulmonary fluid and failure of the lung to depúrate 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

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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

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Hiccup and belching are all caused by upward adverse flow of gastric qi. 1 .2 .1 .4 .1

Hiccup

1. Ü i í

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

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Qonditions.

1 .2 .1 .4 .2

Belching

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Belching refers to deep, long and slow noise (linde in the throat due to upward rise of qi from the

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■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-

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llnn oí food in the stomach. Repeated sonorous belching HttNnpanied hypochondriac and epigastrio pain and taut

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jWluo to be alleviated after belching is due to emotional up-

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plH caused by invasión 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 IM»‘iil is usually due to overeating and is not morbid.

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ülfaction

Normally there is no abnormal odor in the healthy

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Mtiplo whose visceral functions are normal and circulation Hl

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and qi is smooth. Under pathological conditions,

Vlmcral functions are affected, qi. blood and body flu -

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lil ill r oncumbered and fumigated by pathogenic factors. M l|it< li.msportation and transformation of food and water

Ktco s j k .

l»i Kilni' ¡ibnotmal, giving rise to the production of strange mliii

So smelling the patient’s 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

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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

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and sore. I t l í W

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.

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

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caries. Foul breath is usually due to stomach heat. Sour odor from the mouth indicates retention of food;

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putrid odor from the mouth suggests internal abscess.

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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 uriñe

Clear uriñe without stinking odor indicates asthe­

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nia and coid syndrome, also seen among healthy people. Scanty reddish and stinking uriñe indicates

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tlowiiward migration of damp-heat. Loose and stin-

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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 indigestión. 1 .2 .2 .1 .5

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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 lililí >-heat.

In dealing with leukorrhea with stifling foul

HoTi cares should be taken to exelude the possibility of

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WllK'cr. 1 .2 .2 .2

O dor in the room

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Putrid and foul odor or corpse odor in the |iMlrnt’s room suggests deterioration of the viscera

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tilld critical pathological conditions; blood smell in the

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l'ltllnit’s room suggests hemorrhage. Besides, strong lllifII of uriñe in the patient’s room is usually seen at lllr lidvanced stage of edema; bad apple smell is usual­

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ly imvii in severe diabetes, indicating critical patho|i)Wh ni conditions.

1.3

Inquiry

Iii(|uiry means investigating into the occurrence,

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lpvt*lo|>uicnt and treatment of the disease as well as the

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|>Mw'iil nianifestations and other related problems by Bptlim of inquiring the patient or other people accompanVlnií llic patient.

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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

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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

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in doing inquiry. The doctor should use simple language to talk with the patient, avoiding using medical terms. 'f- A i %ü M . i® i Bb tjñ fn

4

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Inquiry includes general iníormation, chief com­ plaint, present disease history, present symptoms, past

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J

medical history and family history.

1.3.1

General information

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General information includes ñame, sex, age, mari­ tal status, nationality, profession, one’s place of origin. present address and date of first visit.

The information mentioned above is helpful for doc-

T < f f ± í É f lí 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

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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

ám

ftllil

UKi'd are easy to have cáncer, 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 epi•i. mu diseases are commonly encountered. Ik'sides, the information mentioned above is also imftltlmi! for writing medical record, recording and survey■yi 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

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Mullí nspeets included in inquiry and are important for di-

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H ^ nís. treatment and syndrome differentiation. ix .

1.3.2.1

( - ) íq 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

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the patient comes to the doctor and the chief sympB R til the illness.

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Accurate chief complaint is key to further underHfKlllig of the pathological conditions of the patient. So complaint is helpful for primary classification and di-

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of the disease. And it is also an important eviPli> •’ for mvestigation, cognition, analysis and treatment

t .

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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 á M É B L ig f iM t tf ó

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 ié g a i.

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includes three aspects: occurrence, pathological changes and course of diagnosis and treatment. 1 .3 .2 .2 .1

1- ísíwtHyi

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.

iré& vt

ment Inquiry of the procedure of diagnosis and treat­

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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

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mi

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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 Ín

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

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m ,w

■ ll .IIINC. fr I The present symptoms are the reflections of the

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■MU-nt pathological changes and are the important evifpiHCH for the diagnosis and syndrome differentiation. In•lUlrv of the present symptoms (including the location. na-

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degree, occurrence and dura tion as well as the conHIII m

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for aggravation or alleviation) is helpful for under-

llftllilllig the cause, location and nature of disease as well

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M II»' Hlate of healthy qi and pathogenic factors.

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ñ

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WSWfTITL K.i, I, disease has its specific main symptoms and secHltilHiv symptoms. So inquiry of the present symptoms ptlilil concéntrate on both the systemic content of inquiry ^|fl lile basis of chief complaint and the main symptoms.

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f í tf'l % Í M I , X W

S MÜ

, 4i 0 ó'j, T íi: * itkiU fe] o 1

Inquiry of the present symptoms includes inquiry of

PVim Alid coid. sweating, pain, sleep. diet and appetite,

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■ bullón and uriñe and symptoms over the head and face

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Mtypll ns back and limbs. It also covers the symptoms in

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B Mluli i.ili y. gynecology and pediatrics.

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I 1.3.1

Inquiry of fever and coid

lliquíry of fever and coid means asking the patient

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£e

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l'o]#314

f>’l

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fñ J M & B iJ M fí í¡ h.

whether he or she has the sensation of fever and aversión 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. Aversión 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 undérstanding 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 bí m fq j f

Well as other complications. Clinically the types of coid and fever include aversión

i|£ M & W M

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|n cold and fever, coid sensation without fever, fever Without cold sensation, and alternate cold and fever. 1 .3 .3 .1 .1

Aversión to cold and fever

i.

Aversión to cold and fever means that the patient fllulikes cold and the body temperature increases, usu-

ís]0íí^?a-J+ifi5ifn £ & .£ 5¡L 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 invasión of pathogenic factors ll| the skin which affects the function of defensive

ymiK to warm the muscles; fever is caused by patho■Pliic factors encumbering the superficies and resist-

|f|
SiJo

lile pathogenic factors are in the superficies, there is llllln ence in aversión to cold and fever due to the llllln ence of pathogenic factors in nature. Generally

lIliTe are three types of aversión to cold and fever acBlllding to their degree.

Serious aversión to cold and mild fever ¡ Serious

( 1)

£

ItorMon to cold and mild fever indícate 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 Wmitullí, leading to serious aversión 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 aversión to c o ld : Serious InviM and mild aversión to cold indícate external syndrome

(lm< lo wind-heat. Wind-heat is a pathogenic factor of yang UMIui<*. When pathogenic factor of yang nature causes

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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 aversión to cold is mild. M ild fever and aversión to w in d : Mild fever and

(3)

aversión to wind indícate external syndrome due to wind attack. Aversión 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

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open, muscular interstices become loose when attacked by wind. That is why there are mild fever and aversión to wind. The degree of aversión 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, aversión to cold and fever are all serious, signifying drastic struggle

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between healthy qi and pathogenic factors. When both pathogenic factors and healthy qi are deficient, aversión to cold and fever are all mild, indicating slight struggle be­

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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. Í 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 vasión of pathogenic cold into the interior which stagnates yangqi and prevents it from moving oútwards; or by decline of yangqi and lack of warmth of the body. According to the onset, dura tion, cause and pathogenesis,

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cold without fever can be further divided into aversión to cold in new disease and fear of cold in chronic disease.

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M M M SI

Aversión to coid in new disease: Aversión to coid

(1)

In new disease is caused by serious invasión of coid ilinvtly into the viscera which stagnates yangqi and de-

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(n'lvt's the body of warmth. Sudden aversión 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)

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•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, (lililí íever 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 aversión to heat instead of to coid. It is usu-

i .

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Ntlv caused by wind-cold invading into the interior and ■ftliufoi ming into heat, or by transmission of wind-heat

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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 m’companied 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)

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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 o’clock 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 invasión of path­ ogenic heat into yangming, retention of dry-heat in stom­ ach and intestiñes 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 invasión of heat into nutrient phase

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mui consumption of nutrient yin in febrile disease.

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M ild fe v e r: Mild fever, also known as low fever, hum us

(3) «

:

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that the fever is slight or indistinct or subjective

iBlisation of fever with normal temperature. Mild fever is

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RWrked by longer duration. The cause and disease in-

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volved are complicated. For example, internal heat due to

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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;

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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 í*

Alternate coid and fever means that aversión to (Ktltl and fever occur alternately due to struggle beIWi'en healthy qi and pathogenic factors, signifying n ía

llvelopment and abatement of coid and fever. Irregul.ii li ltórnate coid and fever is seen in shaoyang disease

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(KMtaining to semi-internal and semi-external syn-

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llluine due to struggle between healthy qi and patho-

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tH'iix factors. The predomination of pathogenic faclui* leads to aversión 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 ñ A A f r 'V t m T m & Z

il»V m once two and three days, accompanied by se[|>ie headache, thirst and profuse sweating, pertains lll miliaria.

When pathogenic factors invades the

l«lv . 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

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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 regúlate yingqi and weiqi and moisten the skin. Under pathological conditions, sweating becomes abnormal due to the invasión of pathogenic factors and imbalance between yin and yang inside the body. Inquiry of

iíJ 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, región and quantity of swea­ ting.

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1 .3 .3 .2 .1

Anhidrosis

Anhidrosis when there should be sweating is usu­

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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 í 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

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symptoms are serious aversión to cold, mild fever and floating and tense pulse, etc. Anhidrosis in internal syndrome¡ This condition is

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usually seen in blood asthenia syndrome and yang asthenia

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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 palé complexión and lips, whitish palé toilgue, it is usually caused by insufficiency of yin blood and exhaustion of sweat source; if it is accompanied by aversión to cold and cold limbs. it is usually caused by insufficiency of yangqi and hypofunction to transform qi.

m

i

I 1 .3 .3 .2 .2

Hidrosis

2. W í f

Sweating can be caused by exogenous coid atliít'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

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Wi'lfM is weak and the muscular interstices are loose. If

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«ícompanied by fever, aversión to wind and floating and «low pulse, it is external asthenia syndrome? if accompalllt d by high fever, light aversión to coid, sore-throat and iRNIting and rapid pulse, it is external heat syndrome. Hidrosis in internal syndrome; This condition is üminlly seen in exuberance of endogenous heat syndrome,

(2)

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-fMRíiiiE

ftlilogenous heat syndrome due to yin asthenia, weakness M weiqi due to qi asthenia and sudden loss of yangqi. Spontaneous sweating: Spontaneous sweating refers líl t'onstant sweating, especially after physical movement,

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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

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lljltre serious. Night sweating: Night sweating refers to sweating iMitniing when the patient falls asleep but stopping after

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the patient wakes up. It is usually seen in endogenous heat syndrome due to yin asthenia, or asthenia syndrome

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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.

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Profuse sweating: Profuse sweating is either asthenic or sthenic. Profuse sweating with high fever, flushed complexión, 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

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crete. If profuse sweat occurs in patients with prolonged

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illness accompanied by symptoms like palé complexión, 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

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shivering is usually seen during the course of exogenous febrile disease, marking the turning point of conflict be­

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.

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

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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

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h|)|kmi s

over the head. The causes of head sweating are

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including exuberant heat in the upper energizer

wln* li drives body fluid to excrete in the upper, often acl'ompanied by reddish complexión 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 tullí íess, 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 palé complexión 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 KVi’r half of the body, either the upper or the lower, the l|ít side or the right side. The location of disease is on the

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IHrl of the body without sweat. This problem is usually

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■toen in apoplexy. flaccidity and hemiplegia, often caused

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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 uriñe, 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.

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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

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in clinical treatment. Pain may appear at any part of the body. It may be caused by sthenia, such as invasión 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

ít

%. “T'iá ¡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 aversión 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.

i

Headache; The three yang meridians of both the

(1)

ik t á :

I hitnd and íoot 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-

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I (ion of pain over the head can enable one to decide which

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\meridian and which viscus are involved. For example, if l fleck is involved in headache, it is a problem related to the

i

M t i % ffi, m 'p ra «§, ^ jü ín

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 ^ífitP iiííiíü X

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liendache are various. Headache of sthenia syndrome is ummlly caused by such factors like attack by exogenous

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Wllid. coid, summer-heat, dampness, pathogenic fire as

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' Well as obstruction or disturbance of the upper orífices by l'hli ■gm and blood stasis. Headache of asthenia syndrome |« usually due to insufficiency of qi and blóod 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¡&Itá:

■frcordial pain or pain involving the inner side of the arm

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Indícalos that the location of the pain is in the heart due to

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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

ítm

a l is usually due to blood stasis in the heart vessels. Pain

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nP

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Itvn tlic chest means that the location of pain is in the liillK cluo to exogenous pathogenic factors invading the lung

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in1rolenlion of phlegm and fluid in the lung which prevent

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qi from smooth flowing; chest pain with expectora tion of

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foul sputum mingled with pus and blood indicates lung ab-

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l í .

' (

lili

S

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I

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 circuíate to the sides. Therefore, hypochondri­

(3 ) M

;

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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

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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 íjE.

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into large abdomen, small abdomen and lower abdomen. The part between the epigastrium and the navel is large

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abdomen; the part between the navel and the margin of pubic región is the small abdomen where the kidney, blad-

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der, intestines and uterus are located; the two sides of

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the small abdomen are lateral part of small abdomen

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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

ÍE ;n ® > IÚ L

caused by cold stagnation, heat retention, qi obstruction.

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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 ló­ cate the región 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 )

ífM :

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

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oí 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-

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%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 oí 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 tíi 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 invasión 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

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ol Ihe stomach and the spleen which fail to transport cere-

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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

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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)

%

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disease is of asthenia syndrome due to deficiency of qi and r íL

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 & ü W &

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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

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pathogenic factors, it is of asthenia syndrome. D isten din g p a in : Pain accompanied by distensión is

caused by qi stagnation. If distending pain appears now


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 pa¡n: Stabbing pain is a sign of blood sta­

sis, usually appearing over the chest, hypochondrium, ep­ igastrium and abdomen due to blood stasis.

M

-o (3) A 'Í J í ) : í 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

W

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P )K K Í¡| S |

pochondrium , epigastrium and abdomen is often caused by qi stagnation. Fixed p a in : Fixed pain over the chest,, hypochondri­

(4) Ü1

um, epigastrium and abdomen is often caused by blood júl^ o k í *

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'ñíVffiHl

ureompanied by coid sensation and

preference

for

ttamith, aggravated by coid and alleviated by warmth.

m iir ií# 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 pa¡n: Scorching pain refers to pain with

(6>

Imi'iung sensation, preference for coid and aversión to INI. Serious and unpalpable scorching pain is of sthenic l|tml Nyndrome, usually caused by invasión of pathogenic Un) into the meridians; mild scorching pain with preferMliv for palpation is of asthenic heat syndrome, often H'Wtt’d 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 ob•li 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 OÍ pathogenic coid into the stomach and intestines. f Dull pa¡n: Dull pain means that the pain is not sharp íll'l lnlcrable, but constant. Dull pain often appears over

(8) ñ ñ : m ñ -fó ni e w -i m % * w .

Iiiíiid. chest, hypochondrium, epigastrium and abdo■tyl din' lo consumption of essence and blood. or msuffi■pH v oí yangqi and endogenous exuberance of yin coid

a¿ ,

■Mili (li’pi ¡ves the body of warmth.

I I M

Hn/ivy pain: heavy pain usually appears over the

¥ rt íis. tr,

£ í(J

#

.

o ) ím -. 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. Dr»lJfling pain: Dragging pain usually involves other

0 fFP E I± /l,H . J ú i±

(10)

ftr ñ .

„

parts of the body due to malnutrition of the meridians or

iitMM , &— M

R íifc

J

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)

ír]fillS

Sleep is in cióse 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 íiih ^ 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 ^ ñ M W \ ñ ;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, palé 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 alItliiüt 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, diagIKimís 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
£ t& m .

• 3P.

#

i#

ví

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 invasión of heat into

ZM

. :

A

¿ ti B E H

B

f f i

tí

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,

í'j] „ JíZ

Ü: $J N f í t P 'ñ -ít

quantity of drinking of water, preference for coid or hot

'!•: £ 'P , h n % & . (i A. fí %

drinks, appetite. quantity of the intake of food, partiality

ftlttlM

11

¡di

and aversión 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 iíg P T íS 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 í S ^ S t f c » P 'F í f

w¡m

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.

p

váríx? 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, «íc%

M

íft fój fá 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; íft 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 complexión, sweallliK and surging and rapid pulse is usually caused by exula»i‘Hilce 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

p^i 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 ^■Itlyi 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 invasión 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

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, *

-fi ffi i r

Ü E , gl

M

A

M ifií ÍX /K S g 8k í 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 ü 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 indigestión which are similar to each other but are not totally the same. Re­

f líw .í0 x * íf é 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 complexión, palé tongue and weak pulse is usually caused by weakness of the stomach and spleen to transport and transform. Reduced appetite and indigestión 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 aversión 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 indigestión 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 indigestión 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 ís l . u r m z t o ñ 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 digestión. 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*

»ÉDmach and weak function of the spleen. Strong function h| Ihe stomach causes fast digestión 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 (hiIh•ni feels hungry, but has no desire to eat or just eats a

(5)

a

ti m

lllllr lood. It is usually due to insufficiency of gastric yin llld internal disturbance of asthenic fire. Internal disturb-

i*Jtt0í§£ o Ñ.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 ,

o

■ 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 fifí W, -J i W-i1/ jJj

lililí II ie functions of the stomach and the spleen gradually U>i orne weak, suggesting aggravation of disease. Sudden

in £ o X f á íí!¿>T(í(Áj Ü\ . )i¡i 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 é p tW ü í® .

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

áJ % j» B % ¡ *iIE,í&JüLT#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 gftn«t«l 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

ñ9zMJ¡JxWio

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 É

^ W K í 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 ^ ÍÍ g ®

tMlguc. usually caused by dryness and heat consuming

|íJ]0íih91o

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

Éfpnsy 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

^ jfnftü, Ü'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

)

Íp I ^

®

Defecation, though directly governed by the large in(pnlliir. is closely related to the functions of the spleen

M i FJr fí] • ÍR

^ ^ jfij Sil

«til the stomach to digest, transport and transform, the

í t J f W¡es,ítii;, ^ 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 tfé

F/r

Hl llir lung to cleanse and descend. Urination, though di■lllv governed by the bladder, is in cióse relation with

íM fü, 8$ iW%

fq

||

i l Ü¡]

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

í&)itfe. &

Hlllillons of the triple energizer to regúlate water pasftyü* 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

ííc«o

^ ii

'|fr

, /jl'

Inquiry of urination and defecation includes the na­

l'ñ]—.ÍÍÍͿͱÍÍÍÍJI'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, yfí-

frequency and quantity of uriñe 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 fé-

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 ifé 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

íS .

due to heat retention in the intestines which prevents qi in

Í S , * P 0 I Í ^ Í 5 , l ^ » F » íJ

*%^

ifi;

® •

HMí

*

the fu organ to flow; constipation, accompanied by cold pain in the abdomen, cold extremities, palé 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, palé tongue and weak pulse, is usually due to qi asthenia; con­ stipation,

accompanied by palé complexión,

lips and

tongue, dizziness and palpitation, is usually due to blood asthenia; constipation, accompanied by dry mouth. red

S

t i , § Wi®}cñ

,

£ M % jé

»

,1 , 1 , frM S , £ * jfillÍ ;« ,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 ÉOWtiward 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 inteslllii’S; clear loose stool mingled with water and feces, acIpinpanied by abdominal pain, borborygmus and whitish (jpfrasy tongue fur, is caused by internal invasión of coid pmpncss which encumbers the spleen yang to separate lilcídity 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 distensión after iihmI and

lassitude, is often caused by asthenia of splenic

|| nnd failure of the spleen to transport and transform; diIfrliea íollowing 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 fá ñ 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 ñ fto

>ften due to weakness of the spleen and the stomach;

é. $¡

, f-F % ffc Él Í 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

élJ’J t Wlo X í® ¡ti lírt.

neridians and coagulates qi and blood into pus blood;

ifiL-ífeíM/p

blood in stool is known as hematochezia which is divided

jffi JÚL; 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 invasión 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, distensión and frequent flatus is caused by liver qi attac­ king the spleen and obstruction of intestinal qi; incontinence

ülij

ítiifii

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

ía ir

Bwilimcous defecation with coma is also due to failure of muís to control, but is not necessarily caused by weak-

ífe & & rfff A H S í f U í ü ,

■kN oí 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 uriñe are af-

o~ 200 -

2000 mi0® j^ ín ^ M ^ :t í:7 Í c ,

fcklrd by such factors like drinking of water, body Ppf!i|irrature, sweating and age.

IPfóo

[ Uriñe is transformed from body fluid. The inquiry of

'h m jm m f t ík '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 uriñe: Clear and profuse uriñe

(1)

/hfiíiHsc

piiminlly due to asthenic coid syndrome. Profuse uriñe is un important evidence in diagnosing other diseases, Hpli lih |K)lyuria in diabetes marked by emaciation, polyBmIh and polyphagia. Reduced uriñe is often caused by ■Ulieinit heat consuming body fluid, or sweating, vomi•WtK «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 uriñe 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 tíi

control. Obstructive urination with dripping discharge is

■

a s t r a l

known as retention of uriñe; blockage of uriñe is called obstruction in urination; the conditions of both are collectively called retention of uriñe. The retention of uriñe due to downward migration of damp heat or blood stasis and

E.

obstruction by calculus is of sthenia syndrome; while re­ tention of uriñe 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 / ¿ íM o

/hféJSd

tion is usually due to asthenia of kidney qi and failure of the kidney to manage elosure and opening, often seen in oíd and weak patients with prolonged illness. Inability to control uriñe and spontaneous discharge of uriñe is called incontinence of uriñe, usually due to insufficiency of kid­ ney qi and weakness of kidney function. If coma i§ accom­ panied by incontinence of uriñe, 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 uriñe.

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

Vértigo

i.

ík m

Vértigo means that the patient subjectively feels llml liis or her body or the things in sight are swirHliH Vértigo may be caused by up-flaming of liver

ffFA±i£JT|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 É IS # .» ® ® ,

ftr tig » , accompanied by distensión, 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; vértigo, accompanied by

í5 ti,

, ilí ^ H S , 0

B tru d in g pain, tinnitus and aching flaccidity of loins m

, ffi ÉJ

knees, is usually caused by hyperactivity of liver

(iitilKi vértigo, accompanied by head heaviness like

,§

H ^ F r r fn íiiJ 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, palé complexión, light col§lll nf tongue and aggravation after overstrain, is due ||lnI iislhenia and blood deficiency which fail to nourMii lile upper part; vértigo, 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 ifé é M p W É 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 í i ® , sS ba

p , tk

z ^ p ^ m ,m % v E ,£ m n \ :

MNU iind gallbladder fire to disturb the upper orífices; M y rttvl gradual tinnitus like chirping of a cicada,

4'. íilllW'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 é ü e , ^ W f i'í'u iR 1

the upper orífices 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 vértigo

usually

appear

simultaneously.

Dizziness

caused by pathogenic wind and fire attacking the up­ per orífices or phlegmatic dampness confusing the up­

!é w m

m *

ñ ?M± í #

PJf ñ . M • 1/41

per orífices 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 í

Ocular itching

Ocular itching means itching sensatión in the eyelíd, canthus or pupil of the eyes. Ocular itching can be eased

w ü . >•* ñ t í f í

by light rubbing in mild case. However, it is unbearable in

« g

severe case which is usually of sthenia syndrome. Ocular

ffio

,

; ■ i: f l

I ¡ it- ,tí- x . £ « | M

itching like insects creeping with photophobia, tearing and scorching pain is caused by wind fire in the liver meridian

1

(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

ílíf

@ «!<; M @ •!£ íMo

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 visión, night blindness and

7- @ ff >íí]i\í£íj
I hese three morbid conditions of eyes are of the ^■lis of hypoacusis. Though characteristically differ-

vff •

@ íPf0 [éj H í® 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

ÍhÍS —

Wty} ( f íí^ ? f 0 @

Jiyt'K. olten seen in the patients with chronic disease

BC the aged and weak people.

mm w m $ , # w # h

¿A

I 1.3.3.7.8 *

Pain and numbness of the tongue

¥?

o

8. S íl S . f f iS

*>;im oí 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 sensatión 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£ É ■

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'íí

^ ; í t iftL

lí- * '£»' ‘M I

■ N inilli and nutrition; asthenia of spleen and kidney yang

\ Wí?í P fi.

ufciilts in hydraulic qi invading the heart; obstruction of

IÍII. f í

A

, ±í)

llr heart vessels prevenís blood from free circulation.

W

, 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 distensión

3.

llypochondriac distensión refers to distensión and

fría i

—

(llH'omfort over one side or both sides of hypochondrir |ni. usually seen in disorders of the liver and gallbladtfri

llypochondriac distensión with susceptibility to

llIKn is usually due to emotional upsets and stagnallun

of liver qi; hypochondriac distensión 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

lípigastric mass refers to subjective feeling of op■ftUiNion 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 distensión

5. fltJK

i Abdominal distensión refers to subjective sensation of H||U’im¡oii and discomfort in the abdomen, usually due to

ia y i3 íw . m n ñ n , # í r b

MMIuicms oí the spleen and stomach. internal retention of M e iil' heat. mingling of qi, blood and fluid. Palpable abImhhiihI

distensión is of asthenia syndrome due to weak-

M íft, £ H

P¡ JÉ

T ftí

H fc u l llie spleen and stomach which fail to perform the ■(Itiimi Iiiiu tions of transportation and transformation; IMt|Wl|>nblc abdominal distensión is of slhenia syndrome

#

IR

1 M i, JdÜ$ Íft |Aj

H tJl 'Hñ

,

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 distensión 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. JüPíJ

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 .,

í 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 ík'tniítíM jB .

thunderous noise, accompanied by abdominal cold pain, preference for warmth, cold body and limbs, is usually caused by invasión 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 ÍS nUífríffi.

Íiíi■ .)

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^ ííi”o AW Í íM tt, tfetízaíBiíüMo

nausea, heartburn and dysphoria. etc.

1 .3 .3 .9

Jpquiry of the symptoms over the

( A ) fó M Q & íflÉ tt

loins. back and four limbs Symptoms over the loins, back and four limbs can be seen in the regional disorders oí 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 fé tt.M

1 .3 .3 .9 .1

Coid sensation in the back

1. í 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 É | 5 f J í£ , 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 damp■ty». 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 'íf ^ Í 7 jc ,7 X j2 m K 0 f Ü ti W í i • f1!1

water passage, or failure of the spleen to IfNIllport and transform, or failure oí the kidney to ■Veril water, giving rise to retention of fluid in the Híleles. Heaviness of the body with spiritual lassiiHd# lind dyspnea is usually caused by failure of the •|ii«M
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 í f i í .

fotlf limbs, usually caused by asthenia of qi and blood.

'% é l ^ jé • bJc H f MI \H ¿Jj. aü M

»

S iz .

£ 0

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*í%L . m m m ñ m iffl k..

Impotence

i

. ph®

Impolence refers to inability to erect penis or Wt>nl< i'ict tion of penis, usually due lo insufficiency of

iíií

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, aversión 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 distensión 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. íaTS

Seminal emission

Seminal emission refers to frequent loss of sperm not caused by coitus. Seminal emission in dreams is called

M

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 invasión 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 aversión 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 invasión of damp heat.

í^ .JR

1 .3 .3 .1 0 .3 ll

Immature ejaculation

3. íp ffi

is usually caused by deficiency of kidney yang,

Ifcwkiicss of kidneyqi, or abundancy of fire due to yin

íü

,

♦iHIrieney or stagnancy of liver qi. If it is complicated

gm nm & sfi,

■ «versión 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|l«l 1 1.3.3.11

Inquiry of symptoms in gynecology

(+ - ) ñ 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

a

m ,a a ü é

# 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*«. S£t Jefñ] ü

I he following is a brief introduction to the in-

H lf y oí menstruation and leukorrhea. 1.3.3.11.1

Inquiry of menstruation

1.

ftñ % 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 , í ; j$ ií & f H * .

B|lto|iaus('. Altnormal menstrual cycle; Normally menstruation HUm •» once overy 28 days and lasts for 3 - 5 days. If

( i) m ñ 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

m

o

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 Víu «•

£.j$U n A;l A Í'J;!íil¡^«

nourishment which deprive the uterus of having regular

fiEScH'írS^; á í i a n f f l í j t *

sufficient blood. or by qi stagnation and blood stasis which prevent blood and qi from free circulation in the thorough­

í f: A l>l L• IM lili A !t)|ín '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) á H N M h

strual blood discharged in healthy women is 50 - 100 mi,

^)Wfflíiiíi<jiíii.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 , fí; 'f-j f I t i H % o ^ 0 júl ff\

ception vessels, or by qi asthenia, weakness of the thor­

£ í 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; lía

ii A

• iúl rS A

ñuti,

r í v i - f i'iiíil

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. Palé

(3 )

il ¡

AlfilÉIEA. < A I1: iíii i '1

'A A A

W) •I

iáñ 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-

iíaSJo

Ulitlion and blood stasis. (4 ) M m ,

Profuse and sudden u te rin e b le e d in g : This morbid

I

Mllliilítion refers to irregular uterine bleeding, not in men-

iB j^ a F U K ü íb J iiL .^ »

«Éruation. or continuous uterine bleeding. Sudden and

T jíd. , í#

J h # , ffc % $ üiS..

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

íiM 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)

ñ 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

tSsjcrañ . 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 ó íf íT

Inqui ry of leukorrhea

1

Leukorrhea is a kind of milky, odorless and scanty vaginal excreta which can lubrícate 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

I

T

S

.

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 oíd) develop

® ¿ íjJ L ( 1 ' M M 3 J í§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 ln’ii • five kinds of flaccidity and five kinds of HMltiiilion. So the inquiry in pedia tries should emphasize

JS fi

írnling, 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 mother’s body gradually disappears while pOHtnatal immunity has not fully developed. During

|Bl í i s í s a , M iñ a fru %-s íü is

||||» [H'riod, infants are susceptible to varicella and mea-

, íJc % B

l’reventive 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. Cióse contact lllli pBtients suffering from epidemic diseases, such as Hp>ll¡i. erysipelas and liver disease, may result in in-

m m té

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 «versión to coid, cough and sore-throat, etc. The ■tyllllc spleen and stomach are weak in digestión 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. íraTo 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

2££4HM 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 íH - 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

Wtñfál’frít» 4. /JnJLí í 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, ís ia iííÉ

Mlllv Inducios the constitution of the patient and previl* tiiiitiaclion of diseases.

1, 3. 4 . 1

Inquiry of past physique

( - ) lqlEEÍií$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 invasión of pathogenic febrile and F> InBtors; if yang is often in asthenia, the disease is uftllv OÍ «oíd 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 í"j f t % ítfe

■ l wilh Ihe present illness. ?£

. i'A fh ü ; t i Í»I ^

^ M .

\Hrsides, inquiry of previous illness should also contraction of dysentery, malaria, diphtheria and ■Mli inoculation, allergy and operation.

¿ t fnf í t 1 í ' A

íp ÍT ^

> S P ® j)[l lit

ffi]Í”]o

■I

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 í a ffi ifij |pj a % % m w vt

ÜRt Vdiseases are closely related to ties of blood; some

tuses.

m étsem w

■tile diseases, such as pulmonary tuberculosis are m i iiv contact in daily life.

«

m

. *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 patient’s

ítt

body to diagnose disease, including taking pulse and palpa­

tM - íM 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 patient’s 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 circuíate in the vessels all through the body, that is, from viscera to all the limbs

ifii I t i l Ü 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 circuíate in the vessels. The liver

n % UÉ\Sk*ÍLÍkZm”; m

govems conveyance and coursing, regulating the activity

tfcJÉL, ifiL’i t ÍE JKcH rt M-Vi1

of qi through thé 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 HÍLME M

o

IfiS c ffi- i

llic Ixnly.

H

VXWY

lili -

,W 'J

The vessels are the organs to hold blood and the (Mliways for qi and blood to circuíate. The conditions and

tíiLZJfí’ festín. i&UíH Jiiito

^C iúi

is fr

llll'illation of qi and blood as well as the tensión, 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 oí

iín.,

W-

óii ®

f í W U . f [5ñj vi 1;

M íti i s I’b]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 región 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| í fe -’-J¡ ’i'K í# ¿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 ;

± m

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 ñ 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 < ík

-f-

ÉL í i

-T m ág

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

3

R . Jjj M ÍI'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. í i W f~

gether there are six divisions of pulse.

ítt AÑnPft o

l' ig. 3

( «

) *

“ -* 1*1 3)1

í í Tj" >& . R —

Divisions of pulse over cunkou

®3

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 í í 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 § Í 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 guañ 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.

íí^ íi:

The right chi pulse and the corresponding viscera:

Í.- R ÍÍ:

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 ío 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

ílS ilW lílo

Ihiic In order to correctly examine the conditions of the

Bí la] M 'P tí 1

CMl*1,

i

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 calcúlate 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 Ü 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 íff

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 región and

*íé '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 región anterior the guan pulse ( distal to the heart región) , the ring finger on the chi pulse posterior to the

'i!

guan pulse (proximal to the heart región). The arrangement of the fingers is made according to the conditions of

p.

the patient’s 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

Tí

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)

í Ü eí ^ I íí 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 región 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 Í S ;fn £ íg ) ,M » < lM ÍVÍln

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 ñor sunken, mrlther fast ñor 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 ñor 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 pow01luí 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

ÍÜ fís irS M ■

o

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-

% tó

UfóT • # E nTVAiti M -

mental factors outside.

(1)

Age. sex and building of the body: The pulse is

in J L M á í / M S t .W 'l '

usually small and fast in children. smooth and slippery in young people, taut and hard in oíd 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 : íto 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-

íjsj;

B t é , 1$ nt (3 )

< § :$ .,

graphical fa c to rs : The pulse appears slightly taut in

@t :

spring, slightly full in summer. slightly floating in autumn

í t í¿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 ís ■/?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

l

i

t

^

h

fPÍ

-t P T v R L E t j i

radial artery may shiít the pulse normally at the cunkou región to the dorsum of the hand from the chi región, known as oblique flying pulse. The pulse, shifted to the back of the cunkou región, 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 ú

trie qi. spirit and root, it is still the normal pulse.

H í í Pf •íí t í >

ífi »

S Ht)í

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 fó

41,

MI lie rerice in rhythm, or varia tion in morphology, or líli.inges in strength. Sometimes morbid pulse may show

I*]. M

M

# #■, sJc H-

(lilference in various aspects, such as the position. rhythm ■tul strength of the pulse. The following is a specific dis-

1

J

®

* ffl |5]N-

iRission;

1 .4 .1 .3 .1

Floating pulse

i-

Features: Sensible under light pressure. weak and ■üiislant 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 ex■rnal 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 ñ u m jkí % . 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. ít lf t B m m - . u ± '\ 'V 'H u S i l .

t t B U B m f 'B M

k iíiiW -

MWá „

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 Mí® „

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 ).


fáfcMX-.

Clinical significance; Indicating coid syndrome. Slow and powerful pulse signifies sthenia coid syndrome, while

T 5L E3 M ( < 60 ( X a

jSiíll

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.

ñ t í % # lü s

í

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

m

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 í 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. JÉJ&

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, Éniiilly seen in asthenia of both qi and blood, especially in

T

íflW íft,

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.

lkfé^ffi. M tíJj

iJE m m

.

ifóífcÉJiC: ±l-ÍtEo 1.4.1.3.11

SIippery pulse

Features; The pulse is beating freely and smoothly

11. T i » M 3^. t í •flh : fte

lllir the movement of beads of an abacus.

’M t Í J , Í'V.

MBUB

/^zntí 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

XítíM.

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

JÉ.'!?.

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'MWííb l . í f ó l .

WMVÁU-M

ebbing. ííf* , 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[ « iíi, ® a c í& 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.

b

% & a i

si *

ÍM . Clinical significance; Indicating disorders of the liver gallbladder, pain syndrome and retention of phlegm

iKÜflciKX: 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.

m

u

t s m '£}]'%•%% t¡ % Clinical significance: Indicating coid syndrome, pain viróme 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 ^

, iín #5. ^

Km«I» 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

é lM 'P

o

21. £]}* E t ííít H :

^

irregular intermittence.

W 't’i h . j h s j É 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^JÉ L ÍÉ Íto

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

J

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 -. féffljg iá 'i .

:M o

Clinical significance: Indica ting yang syndrome. heat syndrome and sthenia syndrome. 1 .4 .1 .3 .2 4

3£íjE„ 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

m

m

w

, ífPiE 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 lú'T’ í'li/f'Yt: • iíií

W

HMHÜtions 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»
o

¿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

ÜÜ-Jf ffi $ i t ,

it®Mft%\\!hmmMWvE

fé i#

l'nlpation means to use fingers or palms to feel or ■pitti certain regions of the patient’s 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>
$

& N N B ftíifíí..

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 * PTiín« o

ture used is sitting or supina tion.

* mM

- B & # m 4* í t í£ w

B K í. 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. -HÍSiírJMuBS,®,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 región

£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

ía

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 patient’s 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 .ñ 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-

5fe±isTit!! m n*m .

l luí to the deep layer, from distal región 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 ñ r w T iii^ iiín

pKlhological changes of the heart, the lung and the IffH'ordium. Ikilgy chest with clear noise when tapped is seen in

fr BUs e . spá: & m ñ 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. I’recordium, located between the fourth and fifth

J.fé'l'.í'/: 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

ñrssfc

detecting whether the thoracic qi is strong or weak,

fifiB S D

ftJÍÍE fé !

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 ñtm ü

o

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

« ffjü tfF ífc J H r F W ífc M ,

depression of liver qi and blood stasis. Right hypochondri­

3

ac lumps which is hard and uneven are due to accumulation oí mass resulting from prolonged stagnation of qi or blood stasis, and cares should be taken to exelude liver cáncer. Repeated relapse of malaria with hard and palpable lumps

o

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; epi■utric fullness with hard and painful sensation when pressed usually results from accumulation of sthenic pathUK<•nic factors in the epigastrium. Distending epigastric |>MÍii 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-

y

liou. blood stasis or retention of fluid; soft sensation of

ñ , “Je /Je tk

ÉL

fi-j, %ñ

lili' abdomen under pressure and without tenderness is Mlown as asthenic fullness due to asthenia of yangqi or

^ s pn

H & ñ •s r u A S i & m m .

lilluie of transportation caused by qi asthenia. Drum-like swelling of the abdomen with dull yellow-

ü

m

a

m

, 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

íixed

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 wIm’ii

pressing. is often seen in the intestinal abscess and

if,

ifn ílifíc.fé.i'íi 'Éiífef'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 iá 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 í w

aspeets as well as favourable and unfavourable prognosis.

mm.

^ $

f n mmm® #I s

s

i ,

ñ ni

Generally speaking, coid sensatión of hands and feet rnm ñ * & . m m

is usually of coid syndrome due to asthenia of yang and ex­ uberance of coid; feverish sensatión 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

m

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 distensión

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 é , 3 ^ * 1 6 Hp¡ew,

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 re■linds when the fingers are lifted, it is flatulence.

1 .4 . 2 .4

Palpation of acupoints

(0 ) S ü 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 ÍÍL , fll $¡ >t ÍÉ

ÉKl$ i t

■Ufloints, is helpful for diagnosing the disorders of cerhtln viscera.

^iiHo

i In pressing acupoints. cares should be taken to see if

® ni) / t

HHre are tenderness, nodules and sensitive response. For H«iliple, nodules over Feishu (BL 13) and tenderness o-

Im?± M y t fá

^

m .m t í'V A R ít S f it . iü :

»•>( Zhongfu (LU 1) usually indícate lung disease; tendernwover Ganshu (BL 18) and QimenCLR 14) shows liver

yx s í

n /X ír 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 ñ / 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 íE

viscera and syndrome differentiation of six meridians as well as syndrome differentiation of wei, qi, ying and

üe,

blood, among which the syndrome differentiation with eight principies is the leading one. Syndrome differentia­

tfiíurniK

tion of qi, blood and body fluid as well as syndrome differ­

8H¡E.

entiation of viscera are mainly used to differentiate syn-

& ^ |0]

ÍI

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

#í W £ 3*J fn ñ í t , M

ÍN the conflict between the healthy qi and pathogenic fác­ 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 íjhm

n iló 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

m

ííe 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

DfiíEo

fcfiidromes. The eight principies concéntrate on specific synítulties respectively. However, they are inseparable and

A m frtí ífi't: ff i ¿ m * l « á é í ) 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

ío t

/l

WJIidiornes of the eight principies are often complicated, |t«ilHfonnable and intermingled.

Sometimes there are

Hftr manifestations. Therefore, clinical differentiation of Mflidi ornes should concéntrate both on the difference of

S

Kxtornal and internal are two principies used to difHpliliJite the location of diseases and the tendency of ■lllolo^ical changes.

t i i ; / Vffl # ñ ffi íg W

mm*

. t m lEífeM ^ m í& 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 olí their cióse relationship so as to have a comprehen-

ü

- s

External and internal are two relative concepts. On ñ 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-

‘■ í 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

M

o

JíSÜ f1h• 53 m?S?$!■

í'h íSi

ÍP i'Á ^ A

case there is no need to differentiate the external and in­ ternal. In exogenous disease, when the pathogenic factors

j ü , JB tíc 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

iWÍ4¿

^ M iA iAO Ü i l 3

iiW

S I K i'íS

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 JÉ Í b 7nÍlí- á l

External syndrome refers to the symptoms appearing at the primary stage of exogenous diseases caused by inva­

= 6 , 0 # # ÍÜ A Í^ .

sión of six pathogenic factors into the body through skin, mouth and nose. marked by sudden onset, short duration

ÍÉ

M ffl 9 1 Pif S

@t í¿

I

ÍS o ^ íjE M: t i ® ’M & i ¡

and shallow location. l¡n

Clinical manifestations: The clinical manifestations

li M : »■/?.!

are fever, aversión to coid (or aversión to wind), thin and white fur and floating pulse, accompanied by stuffy

#

and running nose, sore-throat and cough.

ní "fe..

,# S

^

t-"W

Analysis of the symptoms¡ Attack of pathogenic fac-

Í

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 aversión to I Wlml and coid; stagnation of pathogenic factors in meridi-

, * jxt Xk .

fu;

¿i ik

•

I$ ± j£í í ; , # % M ^ , H[Ajtlfó '}■]

Mlln prevenís meridian qi from free flowing and resulls in |*liii Ihe lung governs skin and hair, the nose opens into

M•

# M M B , nft ü í «Hit\¡.

■Uh' lung and the throat is Ihe door of íhe lung, so altack of

fá r a ,® -§

l'flhogcnic laclors against the surface of ihe body leads lo ■)f»tunclion 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 íur 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 ) Mü 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 «luí

ndvanced stages of exogenous disease and the whole

y * 11*"'

diseases due to internal impairment. Three con-

H íjE M o £ SI F n - M M Is M fu \H í ' h

iTj i a g ,

, M

iiEíKiM$ . i l W H # ' | f

:

■jll'His liave contributed to the formation of internal syn|Éuiiir: further development of exogenous disease due to ^^IIk ii transmission of pathogenic factors from the exte-

S ;

'. al- ,

Jfl5M &{■!■ffiK ifrñf

I p i lind invasión of the viscera by the pathogenic factors; ■h»i!t attack of the viscera by pathogenic factors; dyshlHi til I M S of the viscera and the imbalance between qi and 1P«hI due to impairment of the viscera caused by emotionH

III'ncIs.

i f í ffitSíf Vi fg £ ijíj, % i(a ^ Tpnifij 'fc'ÍRo

improper diet and improper daily lite.

l Imical manifestations; The clinical manifestations W ItiliTiial syndrome are different due to different causes M

loi 11i«»n. Since syndrome is either coid or heat and as-

P

11"

s,lienia and since disease is due to the disorders

^

,

n w iis *

j

k

mm ; x

i s ffi

*

tí n ñ

!É g Z á h f Ñ 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 ffá'k ími

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 ¡Ilústrate the clinical manifestations of internal syndrome. The basic manifestations are high fever. aver­ sión to heat, restlessness, even coma with delirium, thirst with profuse drinking of water, scanty and brownish uriñe, 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 aversión 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 í |

@

S-£r.|

thirst with profuse drinking of water, scanty brownish uriñe 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

Pfí:

MÍE

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,

ílsiiE) 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

W

I

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 predominalíon or yang asthenia leads to coid syndrome; while yang |)K‘domination 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 í M f l Mi m * it* ),t

mi

if

i;in:iiM vi ii i m wi, iwím Hi/ iin /tM, a fe, ‘ h í h m i l nini -ií - a .li. i n fililí:, ni il i ,i,ii Wi • l i itifr i iiiii .f 11r t « i ni ¡Vii.j,];¿ííUídw.

Coid syndrom e

( - ) SüE

Coid syndrome refers to symptoms caused by yang

11# 4

«sthenia or yin predomination due to invasión 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

f

f

i

4' '/"v M fe • ÜC K ^

4 At i (d i rit

xl. or by consumption of yangqi dufc to internal impair■nt 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 aversión to coid or aversión to coid with prefer­

ti-.

ía1for warmth, coid limbs and huddling up in sleeping. lio or light colored complexión, 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:

lii^iiation of yangqi or insufficiency of yangqi to warm the mly lead to aversión to coid or aversión to coid with pref­ iniré for warmth. coid limbs. huddling up in sleeping, colored or palé complexión; exuberant internal coid luí non-consumption of body fluid account for moist iiulli without thirst; failure of asthenic yang to warm and

M M i* i

í® ,

;m

W-i ®

I S . wy n

íi'ej

m u it * ® . i'x 1W’ J Vf iif

m transform fluid leads to clear sputum, snivel, saliva and uriñe; 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,£ fé 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 invasión of exogenous yang

í 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-

í t fe A f i ¡ á -t 'i# a

motional upsets, or by transformation of heat from ím-

it ‘ k

proper diet. or by internal genera tion of asthenic fire re­

a k fijV A l í • 5? í'é rt fñ ’

; a S c ít

#

.e i"

V•

H

;

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 |ü] , fe

vided into external heat syndrome. internal heat syn­

fe ,á ? fe ^ fe ^ f°

til-. X " i

ñ 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

íjfe fftl:

different types of syndromes. The usual symptoms are fe­ ver, aversión to heat with preference for coid, flushed

E

complexión or flushed cheeks, thirst with preference for

P

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 íS

®i

'k K •

MM |

sticky sputum and snivel. vomiting blood and epistaxis, scanty brownish uriñe, dry feces, reddish tongue with scanty moist and fast pulse, etc.

. .

Analysis óf symptoms: Predomina tion of yang heat

l!0 fe ISi íí&*l

or yin asthenia and yang sthenia leads to internal exuberance of asthenic heat and causes fever and aversión to heat with preference for coid; fire tends to fíame up drives qi

H • PPJ 5 L ü ® iü & WL Ü M i I

and blood to flow upwards, leading to flushed complexión or flushed cheeks; consumption of body fluid by exuberant

í€ te M ••fe t t

J

liciil or deliciency of yin fluid gives rise to thirst with luflcicnce for coid drinks and scanty and brownish uriñe; hrnl disturbing the heart spirit results in restlessness and BflNoninia; body fluid scorched by heat causes yellowish

M

S i ^

B K ; W- M

JÜUi í l f i ;

M

.

J )í(

lili % . al! lili

£ t f • fllj B±IÉIIffl lítl; #1 ® jjj f |t, ®

ñ • M¡ £ M ífi-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

imí tongue with scanty fluid and fast pulse are signs of ^■Uljerant heat impairing body fluid.

1 I. 3

Syndrome differentiation of asthenia and sthenia

Asthenia and sthenia are two principies to differenti•I" ^lc> conditions ot healthy qi and pathogenic factors. Asthenia refers to insufficiency of healthy qi, while I «tirina refers to exuberance of pathogenic factors. Syníroiiic differentiation of asthenia and sthenia is helpful for IMHÍcistanding whether pathogenic factors are in predomi-

js * . ia ja ^ j» iiE ,ñ r iu T w * m$ * ,

s *

ffl Í h i i t t IF. rn Pé £ fe

ffl M ffi

P * 1111' ()l decline so as to decide to select therapy for comidriiiciiting asthenia and strengthening healthy qi or therajW luí 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

( - ) ¡É iiE íít ÜE

jjsj

iftí ¡8?■%¿¡f ^ is pjf m m m ffi m „

l&iEífiM

a

al ni postnatal, especially the postnatal one. The postna-

l'Alíi 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.^C^iíjiif llfiil/f; A; J:!tí: |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 -

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

# )É 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

ítfi fá I t ¿ l i >'n, M ftfcW i H i

common symptoms include fatigue, shortness of breath. no desire to speak, aversión to coid and coid limbs, spon­

f f i ; Jfí

fñ Üí - 31 ‘L- M

•Í |

taneous sweating, clear and profuse uriñe, loose stool, emaciation.

feverish sensation over the five centers

(palms, soles and chest). tidal fever, flushed cheeks, night sweating, palé or sallow complexión, dizziness, pal­ pitation and insomnia, dry mouth and throat, thirst with

t t M , /J' f f ki 'P . A í%: im »

’ím & í

desire to drink, dry skin. scanty uriñe and dry feces, ten­ der tongue with thin fur or little fur and weak pulse, etc. Analysis of symptoms: Fatigue, shortness of breath

ñi'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 uriñe and loose stool are due to failure of deficient yang to astringe, warm and transport; emaciation is due to failure of deficient yin

mm.

4

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 ;jé & ü 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 Ó % ^ m

palé or sallow complexión 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

iúl

’k

iíií 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'ínk and dry skin are due to failure of deficient fluid to

/ K - i S t e f ü i-i M

HOiirish and moisten the tissues and organs; scanty uriñe

® ^ 'P, itM ^ ié, Pl'J']' fí

I*

di ic lo deficiency of body fluid and insufficiency of body

. fft

p ; x m ik p ñ m < m k í ' 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 ) IEÜE

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 (HjjácH si VAffi fS M4" }j

MNÍon of exogenous pathogenic factors into the body; the

ffi: - ñ í m í 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.

ír tí*

|»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. ÍHj 4' |íí]. # # t- ffi W Idi

UtUliding regions. For example, internal predominance of

J lf ó F

■thogenic coid manifests coid syndrome, while exuberllti c <>l pathogenic heat manifests sthenic heat syndrome.

£

-Ü(. E • m an« m % m % %

* ffi; i t ít!i íll ñ ’ íK’, ?KS , ti*

lile mi ernal sthenic syndromes due to internal exuberance n |ll11<■gm, fluid, dampness. blood stasis and retention of

í f f i, K iiís * ^ 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 ÍE & • 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

ÍjHíg^>#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;

íí

!?$('[> í t • PJ f 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

ñT ET fJJK JÚ 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

o

l'fi í 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

IEPBDÍüE

yann Yin and yang are the principies for categorizing dis­

AíHííflKl

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

KítitrPHo

( - ) R9ÜEWBBÜE

(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

« * ^ - , ií|j

¡ii:«isii.

yung syndrome. External, heat and sthenia syndromes are

JWW.RI1NI

of yang category; while internal, cold and asthenia syn-

• ‘\í. "I W

dlPomes are of yin category. Therefore. yin and yang are

^ctSM í

lile leading ones in the eight principies and include the lili irr six ones. 2 .1 .4 .1 .1

Yin syndrome

1. R^iiE

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 fililí i' ■nt diseases. The usual symptoms are dull complex-

MMWlWl üE

-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 uriñe, loose stool, palé 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 é , % m , m % m m mf m m tu

ión i cold limbs. bland taste in the mouth without thirst. rkiii and profuse uriñe and loose stool are signs of insuffi-

& , □ fá ^ M , á ' ■§! ?# -fe»X fíi

llriicy of yangqi and internal exuberance of yin cold; palé 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. P0ÜE

I he syndromes that correspond to the nature of "V

iiiik

”

are of yang category. External syndrome, heat

¿i iil . W

Midióme and sthenia syndrome are of yang category. MhWcver, usually yang syndrome refers to sthenic heat ■Mullóme.

< a ^ is ± P 0 i¡H # íg ^ a ft¡ii

Clinical manifestations: Yang syndromes in diseases vary in manifestations. The usual symptoms are flushed complexión, 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 complexión, fever with preference for coid,

\í{&/7Í’Wx:

® ÍLÉ I/fc, # f e l í 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

í£ ■A'

te # ’ X «

and desire to drink, scanty and brownish uriñe 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 ) REjgüEW M üE

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 sensatión over the five cen-

$ 'p , M *|ij, |¡JJ iM 1, Ibffl m , J.M$ |Aj >\L, ijjij ;|| jin ,^ ílK ,

L ln s , tidal tever. flushed cheeks, night sweating, reddish I tongue with scanty fur as well as thin and fast pulse are

M ‘

, iS

, iíi ki:. & ■/!.

i (lile lo interior generation of asthenic heat resulting from I

(h íIu iv

of asthenic yin to control yang.

2 .1 .4 . 2.2

Yang asthenia syndrome

2. PBjéíE

Yang asthenia syndrome refers to asthenic coid sympImns due to failure of insufficient yangqi to control yin.

m

[ti

v

m m wa m * m mm m m m

Clinical manifestations: Palé complexión, dispiritedlim . fatigue, shortness of breath. no desire to speak. a■V p i s i o h to coid with coid limbs. spontaneous sweating. mouth without thirst, or thirst with preference for

, g fF . p , üK MM- t i . 4' fü r f j x , Je M #

L||iit drinks, clear and profuse uriñe, loose stool, or scanty ■pllir with edema, palé, bulgy and tender tongue, whitish

fiít.líc íf 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£ ,# é

to propeI and nourish leads to hypofunction of vistVin and tissues, giving rise to such symptoms like palé

ü . Wü ifif fe t\jt £ , $j

ÜIMhplexion, 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 aversión to coid, coid

llinlm, hland taste in the mouth without thirst or thirst

ÜmÍ5 , PHI >\'fg '/h ¡X ' X § í W í@;

B|Mi P'clerence for hot drinks; failure of asthenic yang to l| t l i i i i V . c

'if phñ , anü % fx, 7k ®

and warm causes clear profuse uriñe and loose

# . g &¿mi j& , üqi m df w ate,

I M i scanty uriñe, swelling and distensión 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; palé, bulgy and tender tongue with whiti»li «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 lü 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 üE

t [5Í5ilE

Fh ^

tions of severe exhaustion of yin Huid. This syndrome is

S *7tw ffrí 8JCi f fiff 31 ífll 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 ' í f , ©J i?!í 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 Í t t lU Í 'h $ «I RLFFfeífcrt

un

other symptoms, including pyretic. salty and sticky swea­ ting. fever over the body, warm limbs with aversión to 'ic • K - SM ftÜ .'M

heat, dry skin. flushed complexión, thirst with prefer­ ence for coid drinks, restlessness, or even coma, scanty

'p . f f i n fií

uriñe, 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/í : l!il M í jé 4' libífi'l l>lI ■JÉfe iMÍK. i&1

asthenic heat and drives fluid to be excreted, leading to feverish. salty and sticky sweating. feverish body and warm limbs with aversión to heat as well as flushed com­

,:j )S • A -J1f§

• MIIJ LK T j

plexión: 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 uriñe; heat dis-

S A

turbing heart spirit results in restlessness or even coma: reddish dry tongue as well as fast, swift and weak pulse

o

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 i¡E £ fé É íl¡H i

ít ffi

@fUSI M MiiH É u A í T í ii J

íri.ScWjfii'ffit.WKlPiDIfti

j!HllK<|i
«R tié flító i. lí r c r t t

Ul l»y 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. palé complexión. ||Nl
IU ^ H ¡ñ

j J/¿i^ f |;

,l i l iñ &l'f. ) U lte 8 ¡í, H U Í

i’#-, 11 jfó yp

fe í^C, wf

tttlrwl oí- 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|í|, B í'ñ i

Gkiño

Analysis of symptoms: Profuse coid sweating is due

i m f r t í f: r a n M , ®

»|l tlcplolion of yangqi that fails to astringe; palé complex-

w-iñ ñ m . wj n f í m

iNti «lid palé 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 % ^ ñ . m % i^i j g , jna □ m

ÉHIk» 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 é J l^ .W J u f - t R i ® ^ ;

B rkmi and asthenia ot qi; dispiritedness and even uncon-

ñ

a •# A

Bf #

. wü 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-

Jtó • A

Jpii ni yangqi that fails to warm and transport blood.

ükiño

Jj

f i 35 ifil |0c, F¡i| i c í 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 Í tfc ín

® ,Ité

WSí 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-

m

■ In i’xisl. depletion of yin may lead to depletion of yang,

ní

■ ■llu

M , ffi U t: l¡JJ

IHWBtt: ffl • ®

Vico versa. In clinical practice, it is necessary to i

VÁ

é :MM.

le. i i whether yin depletion or yang depletion is pri-

■fy loi the benefit of timely treatment.

t PH til " í

R ittñ té o

2. 1. 5

Relationship among the eight principal

A ff lü E f tíS 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 ;í¡

;j

;.! . *Í!!: ,íA

cold and heat syndromes, asthenia and sthenia syndromes

iii: j.fr;iiH 'i '■);¡iHj ;ijíi E íj m i l

and yin and yang syndromes. These four pairs of principal

ir ii. il

syndromes, however, are not solitary. absolute and stat-

l’4 <\M(]::;Í!Ü; iil: fix; )í-

ic. In fact, they are correlated and inseparable. In clinical

t í
differentiation of syndromes, triáis 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'iü-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

- / ^ m í 'íüíIí í í i b i m J

¡ -V *

m

-• 'H W t 'íl

-'iV.iii-ín'JHtfii V.^iil-KHTB

certain syndromes. 2. 1. 5. 1. 1

Relationship between external and

1. 3 l ü E M Ü 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 .ñ T ítia ^ 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'íW].

internal syndrome. The causes of such a morbid condition are various. It may be caused by invasión of pathogenic

^ llll )fíd |

M i l i t ó JSíH fíM T JL ttl

JiU’tors into both the external and internal phases marked llV ii|>pearance oí 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 oíd 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 ex■tiiíil 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 IíB

BUcnc of disease and under certain conditions, external M in ó 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 inte■M1lo the exterior and produce some external symptoms.

S íiíllf t .

i Transmission of exterior pathogenic factors into the H^rini : Infernal syndrome appears after external syn-

A ili:, fs

m a ÜE, jfff A ÜE 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><\

% ñ • “Seíi'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

féffiWWLo & f i I 1O #¡] bu : w.

k

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 ífttiIMnh lo coid, fever, headache and body pain, whitish

k ¡ii h ík

Htln luí .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 aversión to cold and aver­ sión 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 í ¡i1 ,* : * # a a ,| i

to the exterior; Under certain conditions in some internal

- fé f ó j& íf r .íiW A M iá i

syndromes, pathogenic factors transmit from the interior to the exterior, leading to the appearance of some exter­

M íE H iá lW & .íf c f t M J M

nal symptoms and alleviation of the internal syndrome.

U , ]¿Í¿|I| f vfí 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 ít iM ís * . mnü:

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

ü ííí. j* Í¿ 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

í t i S 'í í S l i t i A W Í 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

^ Í jE íli^ U iH M W ^ ) í( |

in nature, are correlated. They may simultaneously ap­ pear in one patient and manifest as mixture of cold and

"í 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 ít.m m ^ m \ m ítM í 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 oí a disease or signiíy two

(1)

—bí se, be ib m iiK. y. i'ii m * |j[;, fj; % $ ÍA% % „ ‘M 4,'V

IVtidromes in one patient, i. e. a cold syndrome and a heat Ujndrome. The commonly encountered ones are upper

-h'r.

IhíiiI and lower cold, upper cold and lower heat, external

jt'C

p lil and internal heat as well as external heat and internal

-ít' tjM

Mlil.

4 í j: íft KM , j :

íft, # !*LM

.k

ñ o IJA KJíí iiE: !& # í>j]ll'í 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

¡'mí'A'fyñ, i'W-kmtMi?'! iii-:m , >j h ñ f # úHo m #n:

of the body accompanied by cold symptoms like ab■tminal pain and preference for warmth and loose stool in lile lower part of the body.

ím

m ,a í i m m $ t * m s , i l t 1 . Í A K^iiHo

Upper cold and lower heat syndrome: For example,

m

M

libre are cold symptoms like cold stomachache, reduced

m m w m .

«fliHito and vomiting clear drool in the upper part of the

üHfó,

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

;

h

KW iiHo ^iJSU:

& # m !& n m n ffi

m.

pt ínmz iit. x. ;ti3® /j'f'ii to * , mm

t m w

■ N lllle i .

FÍA til:. Kxlernal heat and internal cold syndrome; This syn-

,Ü#|nlHííH

Wnilic is usually caused by frequent existence of internal plil complicated by invasión of pathogenic heat; or by im-

feo

pHiihrnl of yangqi in the spleen and stomach in external

mz¡fp;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 invasión of exogenous pathogenic

ñzffi<

Ipiil. lltere appear borborygmus, abdominal pain and diar-

#'J tí, x.

, i-

2. 1. 5

Relationship among the eight principal

i .

A

^ Ü

^ Í b] *

pal syndromes, i. e. external and internal syndromes,

!¡ l r'ft

U ffi -í M ffi . # i11 1JÜ

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-

1’W ^ t t f f i M #

OH))

ic. In fact, they are correlated and inseparable. In clinical differentiation of syndromes. triáis are not only made to

z i'V im m -

4

distinguish the principal syndromes. but also their córrela -

( Í W ffiE ff. F Í ^ ¡ U '< i ¡ l

A %

tion. Only a comprehensive analysis of the eight principal syndromes ensures correct diagnosis.

ífií .

2.1.5.1

R elatio n sh ip b etw een tw o p rin c i­

ll'

íi.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 flíN M

«- - fcflM ffifóffl fí'iJ'í ’\H,

ít

^

iiF fix " í 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

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internal syndrome. The causes of such a morbid condition

s

are various. It may be caused by invasión of pathogenic

M | W J# fW ® H írW 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 oíd one Bftol cured yet, such as interna! impairment followed by pMitini'tion of exogenous disease or contraction of exoge■M 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

l»wi 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 )

ÍE S íti

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 inteH»l lo the exterior and produce some external symptoms. ■

Transmission of exterior pathogenic factors into the

A f P A M : J tfé ft/U S Í

B iflo r; Internal syndrome appears after external syn-

M v E ’ f s tí} SE M ÜE, ffl A üE I?®

(l|oiini and external syndrome disappears with the appear-

z r ñ ' k ' f á ñ 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 ^A 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

ít

transforming into intemal syndrome can be distinguished by such changes like disappearance of aversión to coid and aver­ sión to heat together with high fever. thirst with desire to drink, reddish tongue with yellowish fur and fast pulse, etc. M ÍP íB ÍÍ: K-SMiiE. fUj

Transmission of pathogenic factors from the interior to the exterior; Under certain conditions in some internal

—

W& W T •

? R¿AM iát 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 , ® üt ® m , m ¡ínt1

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? É 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

M

changes, while transmission of pathogenic factors from f Hí. ®T

the interior to the exterior signifies the decline of disease. Cognition oí such changes is significant for judging the de­

ÍHj

fe f t W

Wl^ M S L o

velopment and changes of diseases. 2. 1. 5. 1. 2

2.

Relatíonship between coid syn­

drome and heat syndrom e ü ffi fu

Coid syndrome and heat syndrome, though different

ffi ífi f í A Jflj

in nature, are-correlated. They may simultaneously appear in one patient and manifest as mixture of coid and

ñj

±M\

heat. Under certain conditions. they may transform into each other. During the development oí diseases, especially at severe stage, there may appear such phenomena like false coid and false heat.

ffi, sjc

ffi

í t % % ffi!

ífíjll. 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

íA ffi, m % %

Ih tn o % íft 4/V

?£ ñ j VJ, ^

^ ^

jj; |i,!

‘t'W — 'Mfr &,-&(•/tB Ji .flr B ^ |hJ0't B W W # ^ i l . J1-111 —# *

,—# %

, 3? !aLfíj

(nld. w. Upper heat and lower coid syndrome; For example,

[JA K Jíiiih: Ii#|W|Bt I:

llitirr are heat symptoms like feverish sensatión 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 í lower part of the body.

í - . ^ w ^ í e , x a im f f i# m ,± ® ffi ® # t * íhj & • itfcjk¡ F.

Upper coid and lower heat syndrome: For example, ■M'r are coid symptoms like coid stomachache, reduced U ^ ü lr and vomiting clear drool in the upper part of the

MiWi

M t t , p ^ , if

h

E 0

tM F ^ ffi:

m ¿iM

h

m , T ® M M * tt M

ffi ÍS • 'fy L m F ñ iiü „ #¡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 í;t ^ ff i. X £Üí® /M £ fe

B * ''1 rnergizer due to coid in the stomach and heat in the

F M íi(J

■kldri íft Ó'ÍI_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 invasión 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 invasión of exogenous pathogenic flN i Hiere appear Ixirborygmus, abdominal pain and diar-

i? t /

m

m

m m m

a IM mZ>¡(

n ph *%m m i&..

m a-. ñ z w . K m m t i M j m M , if 1Jfmí f . X l

% ¡l$

a

:¡í mi

,

rlu-a with indigested food complicated by fever, slight avorsion to wind and coid. headache and swelling soreIhroat, etc. HÜSMfeijE: I f P I

External coid and internal heat syndrome: This syn­

fe £

drome may be caused in two ways. One is írequent exist-

- -.14

ence of internal heat complicated by invasión of wind and I*] fe <X

cold. For example. manifestations of hyperactivity of liv­

W

M ; . 'í

or fire like susceptibility to irrita tion, flushed complexión, 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

íi<J

m •X E gp

symptoms like aversión 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 aversión to cold and slight

I» i f 4 % % ffi tó & t t M d i

fever. pain of head and body. anhidrosis and floating pulse , X íü t t P í i ^ ü 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,

MfeñEo

*1

thirst, restlessness and reddish tongue. In dealing with simultaneous appearance of cold syn­

Üffi-^feÍjE|S]Bt#JAL!lli

drome and heat syndrome, triáis should be made to distinguish the upper and the lower as well as the external and

H % í t * fe I & £ &

ío W1

the internal. The differentiation of whether the cold is principal or secondary or whether heat is principal or sec-

m .ñ fá 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 ié

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 fó * fe M t t

fll i

m ito Transformation of cold syndrome into heat syndrome:

ífc^/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‘ü |!j{i Z rí*j ‘k . l!|i

lluv ol the heat syndrome. For example, the patient is

ÍlKo Midi: Atl

I lltiicked by pathogenic cold and shows symptoms of exterflitl coid syndrome, such as aversión to cold, fever, head-

M M , fcb M ® m * «i# m

w lie and body pain, no sweating, white fur and floating-

ít ^

fe -

ó 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

í e M ,

P

M , fí

transform into heat, bringing about symptoms of in-

lnn.il heat syndrome, such as disappearance of aversión 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

íü m fe íie . m tu m m íe , m a

■oíd syndrome. When cold syndrome appears, heat syn-

H í± I/S ,fe ffi{ ® liÜ ¿ ^ ^ ,U | i

Hfntnc disappears. Such a transformation may be either

A fe ü E ^ ft %M üEo 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 é iiíff tW iíg .

to ^ fe l?

Bftllli high fever, yang leakage with profuse sweating or (fhiin exhaustion with excessive vomiting and diarrhea will

á t t t í f iá f f i, K

Iftxl lo symptoms of asthenic cold syndrome (depletion of

m m

(talIK). such as sudden decrease of body temperature, cold

Ü .W 'üfc @C*6 M ié m ffi ( t

iü m

m , m jk m

m ñ «

iptliN. palé complexión 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

^ ÜEí i t %fe üE, 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 invasión of pathogenic factors.

f e ,S M j£ ,íñ tiM W

M ffi »

t i

^SEiiF., H #1

ifCffl;

f e

til: $$■

iH

it

JE % JÉ H , |¡||

Jl \¡i ffl ÍI<J Ü Ü . íl¿ ® i E jé . 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&üe irsím

heat syndrome may show some manifestations contrary to

ttS M

l í ÉKl-

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

ít é

M $ i 0§ Í\'J * ® , fé ÜEVi

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 üe 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'ítM M ‘11

rine and palé tongue with white fur together with the symptoms like heat syndrome, such as flushed complex­

iü í® tíií£

£

p M,

ión, feverish body, thirst and large pulse. However, flushed complexión only occasionally appears on the

a f f i i r , -ífj ik i t ¡5 ñ & & w w

cheeks with palé complexión; the body is feverish, but the

5Ü]±{X®M^ÍlÉIIíP#C,0«f|

patient still wants more clothes and quilt; though thirsty, the patient prefers hot water and does not drink much;

M p $S ■íp # * tí:. 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 «

“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:ÍA. i I (H

\* a !íii

w

iivm ni

l'csllessness, scanty brownish uriñe, retention of dry fe­

'i:>'hí'ií ki.4 , A

ces and reddish tongue with yellow fur together with

í ¿ [ f W * r í Vt .|n|iM

xymptoms like cold syndrome. such as cold limbs and Nimben pulse, etc. However, the patient feels cold in

íjÍWi<Mo ÍMH<¡M .Y \ íii. )li

limbs. but scorching feverish over the chest and abdomen willi aversión to heat: though sunken. the pulse is fast

ifcüfL-ilJ^ifííW 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

ñ ;'ü . íiy

jf j ,' í JÉU?£ $ "í ¡1 ffi ÉKJ1' ít

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 , ÍI<J^

l'fí ■M & VA f

i ffi fó)

k .r k im íi'- ) m \ A w i\ n 'i

ÉJUlnvnce and aversión 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 complexión only appears 011 the

k %o min§<* ffi fámkiu ¿iJÉí t >ü Mfe $5 i \ ffi

(urdir:id and cheeks, and the colour is light, tender. ........ ik and occasional; while flushed complexión in the

í a i í f f i é i j é f i f f i il ¿ i:.

|lnr liral syndrome involves the whole face. Take false

Í B $ S f f iS J E J & * M f i£

1I11 syndrome for example. though the limbs are cold, |l» p Hu ní 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'í ',v; Jí- '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

H

Itfc, JÉ üE -^£«ñT VI m í. 4 ¡ .tiM • X ñ j VIÉ 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)

fó - 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^ü F .o % H M % % ÜE .3

syndrome impairing healthy qi, or by invasión of new

ffi f ó íE n .IE ^ E fó f fiJ P !S ® |

pathogenic factors in an asthenia syndrome with deficiency

4 ;

W L %ñ 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

íiB

le] Bí B fi W#

MíE |

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 complexión, dysphoria, sweating, reddish tongue and full and large pulse, there appear at the same time such symptoms like thirst, scanty brownish uriñe and retention of dry feces. Such a morbid

M M M t j E , ñ n-t X Í t iÍ »

t'imdilion is due to consumption oí l)ody fluid by predomitliinl lieal and exuberance of pathogenic heat. Asthenia syndrome complicated by sthenia: This

: J¿Trt l'i ll / t V

lyndmme is marked by deficiency of healthy qi complicat-

ñ % ± , M M £ ffl\'¡-ÍH í'h k i:,Ai

9
M — í^ iiE M o fiJ íü 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 ñ .

(Hllue. etc. Such a morbid condition is typical of asthenia

l

■ndi'ome complicated by sthenia marked by deficiency of

ífeffio

i l i ñ % ± W ñ % '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 lÉcnia of pathogenic factors. For example, tympanites

FJfMffltfl

- D I 'n liM

o

fiibüíW-

lIlH' lo failure of asthenic spleen and kidney yang to trans■IIin qi and transport fluid is marked by manifestations of lili.íliia syndrome like drum-like abdomen and scanty uriñe ■I Well as by symptoms of asthenia syndrome like aversión ■ (luid, cold limbs, palé complexión, 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 % ñ $ # S éKj 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-

ff4■íflIE4 ■ ífc í£ S íffi % iil. M

■ l luid healthy qi is usually signified by transformation of

M JÉ $ $ I t o ilffi

# 5L M i\

|fellli‘i11a and sthenia. Such a transformation usually appNii'i as transformation of sthenia into asthenia and devel..... ni oí asthenia into sthenia in clinical practice. liansformation of sthenia syndrome into asthenia: Milu liansíormation is marked by sthenia syndrome

ÜíSSI^íjE , fs Üi M i t iilí • ifii '*)■

plnwrd hy asthenia syndrome in the course of a disease.

iiE ^íM B íi^n 'í^.lü 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 complexión,

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

(ÉiiEo

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

é T íE n * £ * J iíM 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

(*3§w C ?á:P H n»ríl6 .‘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 É L ft,W iÉ L fT &

asthenia of yangqi in the heart in the aged. The prolonged asthenia of yangqi ín 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

m

m

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-

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i f ÜEftl £ til-: £,T , i t 1■ ]

llienia syndromes and sthenia syndromes may show some ÜiiIhc manifestations contrary to the nature of the disease

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Ityown as true asthenia and false sthenia syndrome and

m üE H't ÍK a M hk g 4k ífi ül;. k-

(fue slhenia and false asthenia syndrome. In the difierenlint ion of syndromes, triáis 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 disÉHw is essentially sthenic with the manifestations of some JUllirmc symptoms. Such a syndrome is usually caused by re-

iiE^éTSL

li’illion 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

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Wtl in the intestines and stomach, the appearance of cold

í'ñ F ib K .M 'iJíifí

(Imlm. loose stool and deep and slow pulse are like the

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fig , I f S

■pliilcstations of asthenic cold syndrome. However, the

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K#7K,

|kill<• il íeels cold in limbs but scorching feverish over the plitNt and abdomen; the stool is loose, but foul in smell

, ¿ijft¿ z íí Jio n i ;

|Htl yellow in colour, and the abdomen is painful and un-

ÍÍMm iiE BP i r A ffi i'ri “ k £ Í 1 m

|Ml|Mhlr; the pulse is deep and slow, but appears powerful

”o

tíí í'i;

1-j

M

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 * » Ü E : M i m il f

■ki'imc is essentially asthenic with the manifestations of

m jgftüE. ¿p íü 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 .uní transport, leading to hypofunction of the viscera.

M PH

J É > M ® Jl ) j . l'X í ’íí

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 distensión and fullness or pain. Though there is abdominal distensión 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 )& % * & ÍH« I

JtJÉÉíg

^

mí 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 ¥\ í' M

rí h>l tí

W

ill'-; i1? 'jH !Jí

>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.

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:L

Il

í

P * , *

;i

t Jj o

Voice: Sonorous voice is of sthenia syndrome; low

© ií-V/j :

and timid voice is of asthenia syndrome. ^íMffio 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

i

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

l

l

r

f

á í J É f f i; ^ # Ü Ij-l \')l,

-mm z i M

I

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 naIiihí 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 ñ . f á g m to íl # & w ¿s t i

■HInI independent of the external or internal location of UlMinses; accordingly, external syndrome or internal syn■Nime cannot exist independent of cold and heat as well as

ÜEÍ£,$tf>j££U 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

s

i «

.

Clinical manifestations: Severe aversión 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: Aversión 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

iflgtilii’tl 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 í '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 aversión to wind and cold, headache, or sweating, slight thirst,

SE»

f i , í l t i fF • P T

íflfl

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 aversión to cold and fe­

ilHfec-

: W Í-& & 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 aversión to cold, no sweating and float­ ing and tense púlse, also known as external sthenic syn­ drome of cold attack which is discussed in the section of

m í.

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. ^JÜ iiE n ± m im % i9 íM

I liv exogenous wind attack and marked by aversión 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 aversión 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

ü

e

m íH & k

■(picnic qi. Clinical manifestations; Light fever, aversión to Bullid, headache. sweating, whitish thin tongue fur, float-

J&ff

nnd moderate pulse, or frequent spontaneous swea-

iT íli.g M » .

lliiy,. susceptibility to common cold, accompanied by palé ¡f flHiiplexion. lassitude, shortness of breath. asthma right Hlli'l'

movement, poor appetite. loose stool, palé tongue

P th white fur and thin and weak pulse. | Analysis of symptoms: Fever, sweating and aversión •til cold seen in exogenous external asthenia syndrome are ?(|Uc

lo disharmony between weiqi and yingqi and looseness

m •í t - n w f n . i a i f e . a

til1muscular interstices resulting from pathogenic invasión

,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

ñrkifM • % H

éKjíE £ „

■til Inhibited flow of meridian qi; whitish thin tongue fur h il íloaling and moderate pulse are signs of pathogenic Mil id lingering in the surperficies. In external asthenia M u lló m e

of internal impairment, frequent spontaneous

BíMItug 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 .

± ^ • í?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

ás ■#j ib s ü >éfic rl mñfóí i .

ñ M5. f¡ ^%M. $ W'JHI'ííi.fñ

and the spleen lead to such symptoms like palé complex­ ión, lassitude, shortness of breath, asthma right after movement, poor appetite. loose of stool, palé 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 sión 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, palé complexión, moist mouth without thirst,

# H l(i W:

ffi Él, P7l'<M<

or thirst with preference for hot drinks, unpalpable pain of abdomen, clear and profuse uriñe, loose stool, whitish moist tongue fur as well as deep and slow pulse or deep and tense pulse. Analysis of symptoms: Cold limbs and palé complex­

M

M

:

ión are due to invasión of pathogenic cold into the viscera which stagnates yangqi and deprives the body of warmth;

¡&3 » J&n , ffi Ó ; M » rt >M

a i íi ^ iS .d

moist mouth without thirst, or thirst with preference for hot drinks and profuse clear uriñe 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. HJÉÍSiíE

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

WÜLPHÉffio 7. M^SVÜE

&

l

llllc'i iial exuberance ol pathogenic yang heat usually caused

\H&J¡

iti: M:

fclll I

hy internal invasión of pathogenic yang heat, or by pathoLpt'iiu cold transforming into heat and invading the inter­ ferí • or by emotional impairment and emotional transfor­ mé ion of fire, or by improper diet which accumulates into Ir u t .

Clinical manifestations; The clinical manifestations

l|£

í® : S F ® IjScJütri

Alt* Víii ious due to difference in causes. The usual ones are lllitlied

complexión and somatic fever, aversión to heat

[||mI preference for cold, thirst with preference for cold

mx P

i ^

i ffl , ñ jJA L: 0 é i :

a , MWM & , p í f # ®

.#i

Hlilis. restlessness, or even coma with delirium, yellowjli tliick sputum and snivel, vomiting blood and epistaxis,

W , n± iíil t t iú l . B. J3fé S I % II i

Disipable pain of abdomen, scanty brownish uriñe, reim iH o ii

of dry feces, reddish and dry tongue, yellowish

rftíT-,

m

, m m . üJc

N«Ue Iur, full pulse, or slippery pulse, or fast and ■ritíe pulse. Analysis of symptoms; Flushed complexión and so­ lítu fever as well as aversión to heat and preference for |ltl «re due to exuberant internal heat fumigating the exPl ion thirst with preference for cold drinks, dry tongue

ñ T~, /]'{<£ M A '; íftíft 'll'# , H

yellowish uriñe are due to heat consuming body fluid; Itt disturbing heart spirit may lead to restlessness in Üld rase and coma with delirium in severe case; yellow-

ÉLtfa, i£t líli

£ Í T ■A irtlfiL

m IÍIL;

|)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 lt’iition 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 Í M

Internal asthenia heat syndrome refers to symptoms

M j É M , J § f é É J Í^Ni^j

«I i mr.iimplion of body fluid which is discussed in the sec-

Wi ® ^ JÉ Z Jf k M ítfl '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

A

H. líam ®

'fe^ a

íá M

íl

W

@+a

M it.I >júl ,, e

ít •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 ■ ■¡¿' í.. iín., W -:m M v ill

nia syndrome in syndrome differentiation of eight princi­

H T A*M i#ffi ct' /#ffi #j iféidi

pies; the other is the disturbance of the transporta tion and

i & H . . lin., t$-W. M i s í 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 íS ^ o

syndrome differentiation of eight principies. Qi, blood and body fluid are the material basis for the

htíüi,ifiiíji

functional activities of the viscera. The production, trans­

H íft

porta tion and distribution of qi, blood and body fluid are

íiiñ ^ t ó c R m ' ñ M tp x

rfi ¿í/jíi<j

®

dependent on the functional activities of the viscera. So, visceral disorders may affect the changes of qi. blood and

i í £ 4 - « , nj va ve pñ 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

ííí frd^ffc: n f n . iúl>■

$ , 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 tó '- 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

— s

I

t WS ' íííi-ÍMÍii J * t |

Hilo four categories, i.e. qi asthenia, qi sinking, qi stagDM Iio ii

and qi reversión. Qi asthenia and qi sinking syn-

ilinmcs are asthenic in nature, while qi stagnation and qi

JÉ ffi -Ü% \ '4'\iiE

ifé / ( ¡‘¡lí lili' j

■Versión 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

m

m

m

n i hypofunction of the viscera and tissues resulting from

í t f í f é s ü

líu/u'(

■fflllíty.

ñff^SÍC o

m

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, palé and tender

/s ilí íe fin ®:,

íft, 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 í

. 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>
$ r M l s i& É : J ju S o

ü r ^ ü íJ l/ f ;

fplHIl Ixrause “ overstrain consumes qi” ; palé and tender

jé

% t i , H, iíil

ñ

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 & : * Ü 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

lÜcffio

(z> npBíi / c f é i i i : i ¿ í ñ Ao.iÉ a,

n

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

m

sinking due to splenic asthenia. This syndrome is usually

ilü S M n fé ffio

m

m i ,& x m

%

y

m

M t M lj

astil

the further development of qi asthenia or caused by overstrain. Clinical manifestations: Prolapsing distensión of epi­

\\m-M:

fóflg&Afcit

gastrium and abdomen, or prolapse of rectum due to chro­ nic diarrhea, prolapse of uterus, dizziness, lassitude. palé tongue with whitish thin fur and weak pulse, etc.

t iltil, ¡m m .

Analysis of symptoms; Prolapsing distensión 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 . Íí U Vf F S R i J / f ó R i & f l

viscera in the normal position; dizziness. chronic diarrhea

•' k' tóü; . r

and lassitude are due to inability of asthenic qi to lift and

^ Jl Jj , írf ñ I

F ' i 4< )\ifiil'

lucid yang to rise; palé tongue, whitish thin fur and weak pulse are signs of the decline of the functions of the body due to qi asthenia.

j.fií - 'Ai'iiMtíUfé « iü íi'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 üE

Qi stagnation syndrome refers to symptoms caused by qi stagnation in a certain región 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 (distensión is more serious than pain) or migratory pain

Mí. 4 1

Dllil Hllacking pain are felt over the chest, hypochondrium - epigastrium and abdomen. The location of pain and lllhl elisión is usually unfixed. The distensión 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 í i l i m m t j

m ,- é í t m ®

, g roí m & .

ph'wiou in mild case and pain in severe case; qi some-

a m £ ns■ k sí m utic.&.&

Ulncs gathers up and sometimes disperses, so the location

ÍÍ nPÍÍ ' f aE >H‘t fe 0>f £ , fíe 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 distensión Mkl pain are due to emotional upsets and stagnation of liv■ i|l which prevent free dispersión and inhibit flow of meqi; distending oppression of chest is due to stagnaMtin of pulmonary qi; epigastric and abdominal distending

roR'W $!&fóí&liÍí.

|Mlil is due to stagnation of gastric and intestinal qi; op■MMion 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 dis■hrilng oppression and pain. The symptoms are usually ■rluiiH due to different causes of qi stagnation and patho-

* m,

®

w«

’nl changes of different viscera. So cares should be ■ten l<>differentiate the location of distending oppression * 1 (niíii as

1.2 . 1. 4

w # * , $ & frm m n

ffi

well as the accompanied symptoms.

Qi reversión syndrome

(ES) n i$ íE

Qi reversión 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 íP íW ijE fe o

4m i I

M u ís , or phlegm, retention of food, retention of cold piil. oí emotional upsets which lead to upward reversión 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 reversión of pulmonary qi: hiccup. belching,

QlL

3 % I JÍ! Wl) I

nausea and vomiting in upward reversión of gastric qi;

kmymm. m

headache, dizziness, even coma and hematemesis in up­

n h lir c

ward reversión of liver qi.

[l£,V -M: S-. 'YM .NElúto

Analysis of symptoms: Cough and asthmatic breath are due to invasión of exogenous pathogenic factors, or accumulation of phlegm which drive the pulmonary qi to

ifn

vomiting are due to invasión of exogenous pathogenic fac­

J gt I %£ T fo ffi± $ >JWm i

tors, or retention of food and retention of phlegm and flu­

íé

id in the stomach which prevents the gastric qi from de-

i j M i i s & f ó i i r . a í 't ü

flow adversely upwards; hiccup, belching. nausea and

jf p .i'íí't ííU ^ ít ^ 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 : ; - íi’ f t A I I - M K

and impairment of the liver by rage which prevent the liv­

M

er qi from free dispersing and drives it to ascend exces-

Iff] h ?!,150 % {ñ PJ ¿O. _t M .|A

sively, making stagnant qi transform into fire which

oKlfito

• i1-1 .: v íV K : iíiiÜ ^ 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 !íii[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■ í' íit; ílr # M !l-, !/4 HH

nia syndrome due to blood stasis, blood heat and blood

¡:! ;

coid resulting from disturbance of blood circulation.

fí'í - Ifu

2.2.2.1

Bíood 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,; !Í!1 ,'ft >á >1 I I

%J !Í!L#ík .

Jílt-W , l i l i l í ■

( — ) ito iS ü E

if iijÉ ií- jM ííiM

^ '.i

meridians and tissues. Ibis syndrome is usually caused by

4m

Vmiotis chronic and acute bleeding. or by excessive con-

;í i if ii;

i

I

£

iIi

tt

ig * ^ &

Iilinplation and anxiety which have consumed blood. or by

® - SfíÉ K JÜI; WL

K Mi •

Mlhrnia of the spleen and stomach which affect blood pro-

féffi ^ÉL; ác W- “ f

.

llUi lion, etc.

'I

Ifil

Clinical manifestations; Palé or sallow complexión, imlr eyelids, lips and nails, dizziness. palpitation, insomIiIm. numbness of hands and feet, scanty, palé and delayed Itíriistruation, or even amenorrhea, palé tongue, and thin

J S s í K ñ tfc ,

«lid weak pulse.

Analysis of symptoms: Palé or sallow complexión as

v E m m f:

•ri’ll as palé eyelids, lips and tongue are due to failure of ■tlicnic blood to nourish the face; dizziness is due to as-

Kllí? J F ¥ É l : IlÍLJÉ^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 palé 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’ íiíl iM Jcl'Áfciá T B M ím „

Key points for syndrome differentiation: Lack of

HffiW A :

tiEVA

,

llx'i nutrition of the body with the manifestations of If complexión, eyelids, lips, tongue and nails as well as poliiiic tion of the organs with the symptoms of dizziness

T ’i f # , VA # 4 íü Bbñ M K % 3®% Wr W

k

:
2 2 . 2.2

Biood stasis syndrome

' Hlood stasis syndrome refers to syndrome caused by

(z) m é e M

iiE Jit g É ^ jfn

Nftilion of blood stasis in the body. Blood stasis refers to

i¿i m

m n m é ..

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

Ü T

{ £ IÁ1 :

n r-% .BM T

IÍII ¡A j f í

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

Í M M U A J Í Í L # , JfiLftJW

blood due to invasión 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 é B c .í 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 complexión, 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 .á & J ftiÜ & 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 íp ít M \7J wi

palpable pain is due to aggravation of inhibited qi move­ ment under pressure; severe pain at night is due to the

ftíliM

f f i í ñ fíe« & m Pil 1

fact that yinqi is active in the night and blood stagnation becomes more serious; purplish lumps on the superficies

iíil 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 aré 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 complexión 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 íím s m

¡m'á 'k # • MU n[ ÍALlili fe %.j» .

iiltriugent pulse is a sign of retention of blood stasis in the Vrssels and inhibited flow of blood.

ü .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

(.= .) tínSüE

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»

pthojíenic cold in the vessels and stagnaney of qi; or by ■lilbited flow of blood due to cold produced by yang asthe-

t&üilJúLft}; ■

o

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,

fñí is?, >

k iJ

í'ñ 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

üEfe^-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 BVi‘li ¡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 ■ fililí

luí . sunken, slow and astringent pulses are signs of

é l E , ^ Júii i

ñ

í t lü .

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 & jÉ 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 ífc 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: [^JÉL,^cn±JÉL,

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 % # & ÉU ftJ JÍ1 ■

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

MJhjfiLffifé: íM síW & . íüiJ

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 Á L 'S 't E ^ ;

¡ $

f f i J ía S i

>

4

í f t j i i í i í r J

l l

á

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

ÍK 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 ÉLW \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.

-ítil 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 í & jíu iíí .

fclinically, simultaneous disorder of qi and blood is divided lulo two major categories: asthenia of both qi and blood,

% JÚI IrI^ü E Í^ , JÉilE M % jél i«j

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 é & m íím t t jm 'ji.,

This syndrome is usually caused by asthenia of

■I ;ind blood in chronic disease; or by asthenia of the ■pirón 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, palé or sallow complexión, palé lips HiKI nails, palé and tender tongue, thin and weak pulse.

o

182 Analysis of symptoms: Lack of qi, no desire to

iB m t í r : l i l i l í !

speak, dispiritedness, fatigue or spontaneous sweating are due to hypofunetion of viscera due to qi asthenia? palé or sallow complexión as well as palé 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;

*

0

I Ro

palé 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

Sí 1®íS

ÍS §&

í i fu j4lJÉ 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 íft^ J Í liiE jifííÉ 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.ÉS.•

¡M í

.

Clinical manifestations: Hematemesis, hematochezia, or muscular bleeding, or epistaxis, or profuse men­

MM. >ác W iffl ■ # M >sStífl ít

struation, metrorrhagia, accompanied by lack of qi, no desire to speak, lassitude, palé complexión, palé 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 o¿qi, no desire to speak ahd lassitude appearing at the same time or in advance of bleeding are due to hypofunction of the vis­

ü ,i» * ít iJ ¡ ilW | s | W ,^ É l

cera resulting from qi asthenia? palé complexión and

‘k & W J t K m S M É . Z ü é

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 & É i,S « .l8 í3 3 .

ni the viscera and bleeding. 2.2.3.3

Depletion of qi w ith bleeding syn­

It * ^ ?S ^ « ifim i ] ÉJlV M ( = ) nien Q fóüE

drome Depletion of qi with bleeding refers to syndrome in

n B tJ fo J H jE J tfé É :* :*

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 palé complexión, profuse sweating, coid limbs,

ÉLMPI&t,#í¡LBífe:8É I.*

Weak breath, extreme dispiritedness, even coma, palé 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; palé

É a.m íÉ\3tt¡m , K Éím 2 .t:

Complexión 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*,WJJ¡¡L?£íTM;ÉL&

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; palé tongue is the sign of consumption of qi and

tu .

blood which fail to nourish the head.

Í6±£MÍEft.

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 ü E

drome caused by blood stagnation resulting from qi asthe-

mtÉLMEJ6fé'Hl*:B él* * , # a éln &wm&m

liia to transport blood. This syndrome is usually caused by

W íE fé .

Qi asthenia and blood stasis syndrome refers to syn­

qi asthenia to propel blood in chronic disease and gradual

% t i , ffiWí

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, palé complexión, 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 palé complex­

k m

iJ j i¡s féí

Mü *

m tm 3: t i*

ión 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. Key points for syndrome differentiation: The syn­ 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 invasión of pathogenic cold and stagnation of qi and

"^ÍÉÍT

blood. Qi can promote blood circulation and blood can car-

Í l, j M £ § c % ^ J f [ L :F A {fc rt

ry qi. Since qi and blood circuíate continuously inside the body, qi stagnation and blood stasis frequently affect each other and often appear at the same time. Clinical manifestations: Depression or restléssness,

wíhmmm: t t i i

distending pain or migratory pain over chest and hypo­ chondrium, or accompanied by mass formátion, 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 dispersión 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 í ;

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

s

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

É L t

í

S

IS . ^

^

fe ) ^

))¡ j (

Syndrome differentiation of fluid disorder

The disorders of body fluid mainly include deficiency

ÍK]

of body fluid as well as retention of phlegm and fluid and

ni A W í 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

ílj jji. ||

(- )

lused by excessive consumption of body fluid due to high ¡ver, profuse sweating, excessive vomiting, excessive arrhea and profuse uriñe 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 uriñe, 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 uriñe is je to deficiency of body fluid to transform uriñe; retention í dry feces is due to scanty body fluid to lubricate the irge intestine; scanty saliva is due to deficiency of body

fifí;

. SífeSttS *JW

uid to moisten the tongue; thin and fast pulse is due to ísufficiency of qi and blood. Key points for syndrome differentiation: Dry mouth,

HÍÍES/S: *fiEKJin JB,

ps, tongue, throat and skin as well as scanty uriñe and ry stool.

2.2.4.2

Phlegm syndrome

( Z ) &ÜE

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 flí.íÉ f ÍW 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

, íg <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 í 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

?ífe±Ü. íi PR'FJK W Játrí @

ness is due to phlegm invading the head and preventing lu­

¡ £ s fS S * a ,] » & IÉ :Í 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 uriñe 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 uriñe, retention of dry feces, dry

* . /hu M

te-fe. SS

tongue with scanty saliva and thin and astringent pulse.

líe

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 ,íf

nourish and moisten the viscera and body; scanty uriñe is due to deficiency of body fluid to transform uriñe; retention of dry feces is due to scanty body fluid to lubrícate 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 uriñe and dry stool.

2.2.4.2

Phlegm syndrome

( Z ) &ÜE

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

ñ tÑ B ñ - ^ É T íl- 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 í *

and tissues results in phlegm syndrome. ^Ü E . Clinical manifestations: Cough with sticky sputum,

1

•2

Different Inl ion oí 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,

iíil 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. 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

su

syndrome may be divided into cold phlegm, heat syn­

ñ M ñ & 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 ® & ;f¡j, f f S

weakness. Clinical manifestations: Epigastric and abdominal fullness and distensión, borborygmus, vomiting of clear

P

í t $S. £

í t í t 7jc,

ütt* C

fluid; or cough and asthma, profuse thin sputum, chest oppression and palpitation, even inability to lie fíat 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-

ím ® .

retention is marked by epigastric and abdominal disten­

ís

sión, borborygmus and vomiting of clear fluid due to re­

pb*

w.«yMLlí féuirfl/K -iíf

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 íf . uw .

ven inability to lie fíat 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

Í¡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 distensión as well as borborygmus; suspended

«o

fluid-retention is marked by thoracic and hypochondriac

«I $ 3

ítillness, 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$itóciS.

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 íE .

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 lí i± » t 'S , ^ S a » .

lious pathogenic wind or spreading of fluid and dampness.

J U T ^ íI M tR W .

mm. *

Clinical manifestations: Dropsy of face and eyelids,

BvcMitually involving the whole body with rapid developHH’fit. smooth and bright skin, scanty uriñe, accompanied Hty Irver, aversión 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 regúlate 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, aversión 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 Ü .

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 uriñe is due to internal accumulation of fluid and dampness, dys­ function of the triple energizer to control fluid and dis­

n

turbance of the bladder to transform qi; epigastric and

* , £ « $ n ± 0 H É U K .i^

abdominal fullness and oppression, poor appetite, regurgi-

íi,

tation and nausea are due to encumbrance of the spleen and stomach by dampness which affects ascent and de­ scent. Key points for syndrome differentiation: This syn­ 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 caüsed by asthenia of the healthy qi due to

w . g m m iK iE ñ ,

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 distensión 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 a®¡flí nJi.

cold sensation of loins and knees, scanty uriñe, dull or pille complexión, palé and bulgy tongue with white and ulippery fur as well as sunken, slow and weak pulse. Analysis of symptoms: Edema and scanty uriñe are

ü E fe fttlf: M i É 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- íiü

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 !Ü $ ,f f if e « S i»

[loins and knees, dull or palé complexión, 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

distensión and

g lÉ IÍ lM J f tM jS X ij.J iP B Í I!

Oppression, poor appetite and loose stool are due to [isthenia of spleen yang and inability to transport and transform; palé 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 ? íE 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 íieí* $ >h I

and is an important part in the syndrome differentiation

iíiíiíüe 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, ilíS#; IÍX *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 í? T-Sr. 0 í «

. íiP í f * , g - f é í f - ü . |J3M T'Ci'

The heart disease is either asthenic or sthenic. As­ thenic heart disease is usually due to excessive anxiety, con­

ÉS

• i'J íW

genital defects. asthenia of visceral qi in senility or im­

3 5 JE, gSc^ ¡i5Bt % í t Si •I

pairment of the heart by prolonged illness which leads to

tK in as

• # a * % ñ , -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

( - ) /is»n®ffi -L' 'n, i$ . iíF ñ té rti f

■

l».ilpitation and shortness of breath resulting from insuffi-

f líJ á g a iK '

< lency of heart qi and failure of heart qi to propel. This ■fjldrome is due to frequent weakness, or malnutrition

É 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,

ñ.

#

■ t S

zhla

i n

J

r

,

f e líf c

|mIi* complexión, or spontaneous sweating, palé tongue N|||(l weak pulse, seen in cardiac insufficiency ( compensalo ry

ñjRL -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 - ÜB. l i Ha J1 ,

£ It

chronic pulmonary

Bnrt disease, and mitral valve prolapse syndrome as well

& m ñ m % -é -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

^ @

0

f f ; $1PJ H ffi >St ® 5ÍJ J§ i® í

■ l to qi asthenia and weakness of weiqi to protect the suÉlflicies; aggravation after movement is due to consumpIIimi of qi after movement; palé complexión, palé tongue N IH l

weak pulse are due to failure of asthenic qi to propel

|li
of breath, spiritual lassitude, aggravation after

*ÜEI , 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 ■Midióme marked by palpitation, aversión 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

ilSíSiSíS!: -frtP

or pain, shortness of breath, spontaneous sweating, aver­ sión to cold and cold limbs, palé complexión 01* cyanotic complexión and lips, palé and bulgy tongue or purplish tongue, whitish slippery tongue fur, weak pulse, or knot-

ñ 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.' 5Í)

íf >

beating; chest oppression or pain and shortness of breath are due to inactiva tion of thoracic yang; aversión to cold

j£A*E»PB£S!filífeJÍUÍJcjl

and cold limbs are due to yang asthenia and lack of proper warming; spontaneous sweating is due to weakness of

-i>PBiÉ S is 5t t ¡ , JfilÍt

weiqi to protect the superficies; palé complexión or cya­

S Ü iL ffife fó Ó d íB ffeW *.,

notic complexión and lips as well as knotted pulse, slow

« « a » .

regular intermittent pulse or weak pulse are due to asthe­

S É !» ,

nia of heart yang to warm and propel and inhibited circula­ tion of blood; palé 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 aversión to cold and cold limbs.

ni

2. 3 . 1 . 3

(E ) IOBBRBÍÜE

Sudden loss of heart yang syn­

drome Sudden loss of heart yang is a critical condition due to

'L'PH&KíESÍS'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

PBsí fíE

ffi. M 'll' í? Wi

teflcSS: ÍE'OPBJÉiiEk

heart yang asthenia, there appear some other symptoms, uuch as sudden profuse cold sweating, cold limbs, weak

.n m

w m

. ar a

breath, palé complexión, 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- É É S í ® JR

itíC 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; palé complexión is Hue to sudden loss of yangqi, weakness in warming the InKly, inhibíted circulation of blood and vacuity of the ves-

f f i , i f t ® f e £ É 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* . J¡8l ' í >

* iJ

a .D I fl.

tenséis; unconsciousness or coma are due to declination of Vibgqi, lack of necessary warmth and nourishment of the ■flirt and dispersión of the spirit; indistinct pulse is a sign

^.*PBn»fWiMEÍL

»»í Ihe declination of yangqi. Key points for syndrome differentiation: Asthenia of Mltfqi' sudden profuse cold sweating, cold limbs, weak breath, palé complexión, cyanotic lips and indistinct I iii I n c .

PüEWiC: «EK-L'Wtf!

f

2.3.1.4

Heart blood asthenia syndrome

t

i

ffi

(B3) /MUfiiSE 'h ifiL JÉ: i í ^ ía ¿ i i 'Li'

Heart blood asthenia syndrome is caused by asthenia

^ íW*M

of heart blood and lack of proper moisture and nourishment of the heart. This syndrome is caused by weakness

$

vEífco

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, palé complexión or sallow óTiAl

complexión, palé 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*

JfiLítJ fB ñ *1 *

& É 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 ^ 3c»M ^ jlU<

ness are due to failure of blood to nourish the heart and anxiety; dizziness, amnesia, palé or sallow complexión as well as light whitish lips and tongue are due to failure of

a j t . j R S R ñ í jiiL '!? »»!

asthenic blood to nourish the head and face; thin and weak pulse is due to insufficiency of blood in the vessels. Key points for syndrome differentiation: The syn­

IÍíjE

drome is marked by palpitation, insomnia, dizziness, palé or sallow complexión, light whitish lips and tongue due to failure of deficient blood to nourish the body. «Ciféo

2.3.1.5

Heart yin asthenia syndrome

Heart yin asthenia syndrome refers to tHe syndrome

( E ) M M tiE

'C?

Él ^ '^ 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 # ;* Í

cessive contempla tion which consumes heart yin? or by

H tftifrM í 3 R B & # fJn íW

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-

I

l|¡il

-11'fes í|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-

I

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. í» 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 # >sti

'«■,

m *i>1$ i

-il' ^ W ¡ # , ii. á l íft He ' T ' í S , JTOJ ' l l ' M , £

BK,

, 'C,' f t 0 & , ¡í)¡

fteart, asthenic heat disturbing the heart and anxiety; feVimish sensatión 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,

ÍK E S já t,

«ip h o ria, insomnia, dreaminess, feverish sensatión 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 É T

liétiH of palpitation, chest oppression and heart pain due to ^P tfuction of the heart vessels by blood stasis, phlegm,

H t b íE 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, palé tongue

sTJE

with white fur, sunken and slow pulse or sunken and tense pulse; or pain and distensión, hypochondriac distensión, sighing, light reddish tongue and taut pulse. Such symp­

i

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

ü E Ü 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 aversión to cold and preference for warmth, cold limbs, palé 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 cióse re­ íation of occurrence with psychological factors, often ac­ companied by hypochondriac distensión, 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 triáis must be made in differentiating pain and complications to specify the causes of dis­

Jfí Í É

W

í f í 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 ) tó W K iS ü E -i>k % ffi ffi * í t É T 'll' ■k rt M Sí S a M £ íft ffi f«-

•This syndrome is caused by mental depression, transforftmtion of fire from qi stagnation, or internal invasión of pathogenic heat and fire, or excessive intake of acrid, hot Niid tonic food, transformation of fire from prolonged ac■irnulation in the heart. Clinical

manifestations:

Dysphoria,

insomnia,

-frS&BR, |Í|

llikhed complexión, 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 líí Jü í t <"S

W ulceration and pain of tongue, or hematemesis, hemorHjpgia, or even mania, delirium and unconsciousness, u■ftlly seen in hypertension, thyroidism, endocarditis, pe-

jA L T S JÍl£E ^,íP «Ü í/]fl6 /L

ii'Mlontitis, infection of urinary system and craniocerebral Inlrclion, etc. Analysis of symptoms5 Dysphoria and insomnia are

W:

*rt tír i ‘X

rt ¡W• tft

due to internal exuberance of fire heat and disturbance of heart spirit; thirst, constipation and yellow uriñe are due to consumption of fluid by pathogenic fire; flushed com­ plexión 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*/IS»S3iE

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

R

stance.

BtWCc

c u a t i s ff

ífc. Wl M & W. Ü' 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 complexión, chest oppression, nausea,

A * , o n ± g íj* ,itír ^ ^ .

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

ñ 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, ü 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 complexión is due to internal retention of phlegmatic turbid substance, failure of lucid yang to rise and upper movement of turbid qi; chest oppression and

^ . ± 3É , 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 complexión, thirst, hoarse breath,

© ,® ^ P - S Í / C lll'W

constipation, yellow uriñe, or sputum rale in the throat,

® Ü?ü r. M »£ I'bJ^ «S. )WW •*

chest oppression, dysphoria, insomnia, or even mania, íiKhting against people, breaking objects, ravings, emotional disorder, reddish tonque, yellow and greasy fur as

sairs u s . ¿ í « É r .w a íM .» » « .

--i 'al

well as slippery and fast pulse, usually seen in craniocereÍE^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 ü m > i s í t a I

flushed complexión, red eyes and hoarse breath are due to fumiga tion of internal heat; yellow uriñe and constipation are due to heat scorching fluid; yellowish thick sputum,

P J n ± ^ í íW ,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 iÜ É Í 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 invasión 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 invasión of the lung by wind cold, invasión of the lung by dryness, invasión 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:í § É 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, palé complexión, spontaneous sweating, aversión to wind, susceptibility to invasión 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 dispersión 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, aversión to wind and susceptibility to invasión of exogenous pathogenic factors are due to as­ thenia of pulmonary qi and weakness of weiqi to protect the superficies; dispiritedness and lassitude, palé com­ plexión, 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'fiÉ M m tk M o

2.3.2.2

( Z ) HÍRBffiuE

Lung yin asthenia syndrome

Lung yin asthenia syndrome refers to syndrome of as­

f líK & íE J iíB 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 ñ ñ i í , 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 máñifestations: Dry cough with scanty spu­ tum, or scanty and sticky sputum difficult to expectórate, or sputum mixed with blood, hoarseness, dry mouth and throat, emaciation, feverish sensatión 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 diseaik‘8 (such as pneumonia, bronchitis and whooping cough) h s

well as pulmonary tuberculosis, endobronchial tubercu­

losis, bronchiectasis and lung cáncer, etc. Analysis of symptoms: Dry cough with scanty sputum

or with scanty and sticky sputum difficult to expectórate is

íft

^

fTf jfñ^; ® . 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

ñ

A

+

05 S í

%

&

W JfiLs S í

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

*

l¡fl 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^ffifiíE

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

,

*üw üm , * « # * * «

caused by failure of pulmonary qi to disperse due to exoge­

iíii

nous wind cold. Clinical manifestations: Cough, thin expectora tion,

6 ÍS 1 :

stuffy nose with clear snivel and throat itching, accompa­ nied by aversión 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» É .J J c ? ¥ !K . ñ rü L í 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; aversión 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

•

ó , 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, aversión 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 Eño

syndrome in syndrome differentiation of wei, qi, ying and

v E ^ m iL frv E o g m t m i i

élhh

blood. It is often caused by invasión of wind heat into the lung. Clinical manifestations; Cough, yellowish thick spu­ tum, stuffy nose with turbid snivel, fever, slight aversión to wind and cold, slight thirst, or sore-throat, reddish tongue tip, thin and yellowish tongue fur, floating and

a , » # * , » # » .

«TJÁL^

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 aversión 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 aversión to wind and

m m ñ

cold, slight thirst and reddish tongue tip.

2. 3. 2. 5

e#«

( 5 ) íi3B3BSiBfiE

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 invasión of pathogenic dryness into the lung. This syn­

w ü e íí

drome is divided into febrile dryness syndrome and cool

íg g fi

dryness syndrome according to its heat or cold nature.

U ñ .W M Z ft,

, x ü 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 & ñ ■ ,

the disease caused is febrile dryness; while dryness in late

U

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 expectórate, even chest pain, sputum mingled with blood, or epistaxis, he-

É L 'i& m & a .u& É ., O . f d .

matemesis, dryness of mouth, lips, nose and throat, dry feces with scanty uriñe, thin and dry tongue with scanty

W

S

. I f f S

M

W

I .

'S T 'a T ± B í t j t ^ * J i | (

saliva, or accompanied by fever, slight aversión 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 monía, bronchitis and pharyngitis. Analysis of symptoms: Dry cough without sputum or

with scanty and sticky sputum difficult to expectórate 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 uriñe and thin tongue fur with scanty saliva are due to pathogenic dryness consuming body fluid; fever and slight aversión 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 expectórate, dryness of mouth, lips, nose and throat with scanty saliva.

2. 3. 2. 6

Syndrome of accumulation of pa­

( 7 \ ) S t 3 B§tlffiüE

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

JÜMCÜE.

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, coúgh, asthmatic breath, even flapping nose with hot breath, red swelling

lis ia s > ja ,S ! a y # 4 É 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,

ít &

thirst, scanty uriñe, constipation, red tongue with yellow

§L» P M . /h ÍM M # . A f í MI

fe ñ .

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 íf : m m m m ii»

Internal heat; cough and asthma are due to invasión of püthogenic heat in the lung, loss of depuration of the lung ftlid upper adverse flow of qi; flapping nose with hot

Q lí *

& K 'tfl; )|i|í

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 * 5JBífc 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

e

*

.

HAKnation and blood coagula tion as well as putrid muscles Mild

blood; thirst, constipation and scanty uriñe 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 ) SlSKflíSfiE

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 tÉ J ir ^ iÉ tá 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 invasión 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 expectórate or with clear, thin and frothy sputum, even asthmatic breath with sputum rale, palé tongue with whitish greasy fur and slippery pulse, usually

« S É !* .» » .

seen in chronic bronchitis, bronchial asthma, chronic ob­ structive pulmonary emphysema, chronic pulmonogenic heart disease and lung cáncer, 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 expectórate 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; palé tongue with whit­

ffiáfeo

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 invasión of pathogenic wind Which prevents the lung from dispersing, descending and rrgulating water passage as well as causes extravasation of

*EEJ» T P07jc m

w

(luid and dampness in the skin. This syndrome pertains to JfttliK edema, usually caused by exogenous pathogenic wind

isgífeiR,

Ultacking the lung and failure of the lung to disperse, de(MtMid and regúlate 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 uriñe, accompaiiumI by aversión to cold, fever, no sweating, whitish thin

J S L *# £ & .

S # *É l *

Migue fur, floating and tense pulse; or accompanied by

» # S ;á K Ítü iL n H i« W * ,- S *

•vvHling and pain of throat, reddish tongue as well as

á X . B * # # o b J J a L íM iIé '#

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 invasión 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 íl/ h f iW

lin vasa tion of fluid; scanty uriñe is due to failure of the

X ff.

HpP' T energizer to disperse and loss of qi transformation. K | l’Companied by aversión 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 uriñe, accompanied by aversión to cold and fever, etc. 2 . 3.3

Syndrome differentiation of spleen disease

m s

IJÍ ÍIE

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 í E i l

JÜLW?6IBífe#aif m«

VÁ

*fig

sión or pain, loose stool, dropsy, heaviness of limbs, pro­ lapse of the viscera and bleeding, etc.

m tB i ó i y? ^ íal 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

lío.; % üe ^ a tfc #

i?

m

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 vasión 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 distensión, especially after meal, loose stool, or dry feces followed by loose stool, lack of qi, no desire to speak, lassitude of limbs, sallow complexión, emaciation, or dropsy, palé tongue with whitish fur, slow and weak pulse, usually seen in chronic gastritis, digestive ulceration,

vi »*

W *K

W

. lin ft

ffi & , jfcft jj+, ,'i m

» e ,jm m 0

chronic enteritis and malabsorption syndrome, etc.

ift^ g J g 'á 'íiE ^ o

Analysis of symptoms: Poor appetite and abdominal

iEmfttfr-. W ^ í l í ^ . á B

distensión 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 distensión 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 complexión 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 distensión, loose stool. lackofqi, no ■esire to speak and lassitude of limbs.

2.

3.3. 2

K

Syndrome of asthenia of splenic

f i É . -3? "n, Mi

ÉÉ tü, ü 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 ia‘ranee of yin cold. This syndrome is caused by further ilüvelopment 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, aversión to cold. cold sensation of

W P B d lü E Jiíl

n m M vEm , +

four limbs, light whitish complexión, 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, palé, 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, Crohn’s disease, irritable intestinal syndrome and chronic nephritis and IgA nephropathy. Analysis of symptoms: Poor appetite and abdominal distensión 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 complexión 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; palé, 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 distensión, lingering abdominal cold pain and loose stool.

a i#

ma 9i' «

I

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

WiiEÍÜo

mMil of asthenia of splenic qi; or by chronic diarrhea or ■rntery, or overstrain; or by múltiple 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 uriñe, accompanied by li of qi, fatigue, lassitude of limbs, low voice or no dé­ lo speak, dizziness, palé tongue with whitish fur and

m sé

M c ü ., ñ i j a T i i ' i É f

|k pulse. Such manifestations are usually seen in chrognstritis, digestive ulceration, chronic enteritis, mal>fption syndrome, Crohn’s disease, irritable intestinal iilrome, gastroptosis, hepatoptosis, nephroptosis and

T S . f T S > f f T í 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

Jtoü 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 insufírfti'y of splenic qi and failure of the viscera to remain in l|r normal position; turbid uriñe 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;

|m»li ol (|i, fatigue, lassitude of limbs, low voice, no deiln lo s|>eak, dizziness, palé tongue with white fur and pulse are signs of insufficiency of gastrosplenic qi,

0 í§ m

T f l,$ !'J J & P Í T S .J I f t

failure of lucid yang to rise and hypofunction of viscera and tissues. Key points for syndrome differentiation: Prolapsing

* íe im m

sensation and distensión 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

sSciíc.tfD. .sSEflJLiWl.

• "VI

or hypermenorrhea and profuse uterine bleeding, accom­ panied by poor appetite, abdominal distensión, loose stool, sallow complexión or lusterless complexión, dispir­ itedness, lassitude, lack of qi, no desire to speak, palé tongue, thin and weak pulse. Such symptoms are usually

STETS-í-bit ífci(iUJúl M ,|

seen in various hemorrhagic diseases, such as upper di-

ü >Jfo. ® # ! > í t l Ít6 %

f

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

tíjjflit É L m w m m É ití'i

stomach and intestines leads to hematemesis and hema­

J Í 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 , JÜL í a #

3?

S í # 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 ñ g Ñ i & * .< ■

bleeding; asthenia of splenic qi and failure of the spleen to

# * * ; £ * . It.

V .lJ

I

pMlisport and transform lead to poor appetite, abdominal iliB U S io n

ií< j

and loose stool; asthenia of splenic qi and insuf-

tlnmt production of qi and blood lead to sallow or lusterMN complexión, lack of qi and no desire to speak; palé h i( u c , thin and weak pulse are signs of asthenia of both blood.

<|ií l i t u l

Key points for syndrome differentiation: Various lilftoding, poor appetite, abdominal distensión 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 ü E lr fé É T »

■Ircn refers to the syndrome due to internal exuberance

s r t . s . + r o s i i i ’i í s n w i É

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 í# @

Wf limbs, scanty uriñe, 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 cáncer and liver piirer, etc. | Analysis of the symptoms: Abdominal fullness and

vEiñfttir: SiSrtí®.'!1

ppiBHsion, poor appetite, nausea and vomiting, abdomiH«l pain and loose stool are caused by exuberance of interp l Cold and dampness which leads to encumbrance of

, MISHSLlSñ . S *l^. S-fr P R n ± ,« « íf¡f

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 sensatión of the head and body, or dropsy of the limbs and scanty uriñe 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 sensatión 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 ) ü ^ a iS ü 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 fá ' * 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. JÜfSc.

■rnnty and yellow uriñe, 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 »|nít 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 cáncer 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, loóse 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 uriñe 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 mIiíiis 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.

4

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 átt.

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

jÉ ü E ^ ®

, IíJct: I)

of liver yin and liver blood due to malnutrition after pro­ longed duration of disease, or involvement in the disorder

mi^ £ ;

% ilE 0 É 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 invasión 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 líE JiS É T tl

caused by malnutrition of the liver and the related tissues and organs due to insufficiency of liver blood. Tíiis syn­

ítffT ^M tfJvE ÍÑ o & v E & l

drome is usually caused by insufficiency of blood production due to asthenia of the spleen and stomach, or by con­

É . & m M & ’gÉLBí&o

sumption of blood due to hemorrhage and chronic disease. Clinical manifestations: Vértigo, dizziness, palé complexión, dry and irritating sensatión in the eyes, blurred visión 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-

áfflo 1 0 L T # # ffljlíU iíU lL S j

Oirhage, dysfunction of blood production and chronic conminiptive disease.

#ScMáW0Lo

Analysis of the symptoms: Dizziness, palé complex­ ión and whitish tongue are caused by insufficiency of blood |i| nourish the head and face; vértigo, dry and irritating ■llisalion in the eyes. blurred visión 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 ñ

'> 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||)Néts, transformation of fire from qi stagnation and fire \ ¡ É 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 cáncer, gall­ bladder cáncer and pancreas cáncer 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 sensatión 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 sensatión 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 sensatión of the cheeks, tidal fever, night sweating, feverish sensatión over the five centers (palms, soles and chest) and dry mouth and throat.

2.3.4.3

v

Syndrome of liver qi stagnation

< = ) S fn S B ^ ü 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

ño

norm ally due to retention of pathogenic factors in the liver

t IM

o

IVessels. Clinical manifestations: Emotional depression, miMWtory pain in the chest, hypochondria or lower abdo­ men, chest oppression, frequent sigh, thin and white

Ó » ® :® . 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 á k rTíaL^L )M

liy|K)chondria; distending pain of breast, dysmenorrhea, ■regular menstruation and even amenorrhea in woman.

m0 ñ r j a T t t á s * * , » »

B uí'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 stagnátion of liver qi and dysfunction of

Hvcm * dispersión;

migratory distending pain in the chest,

XM ,

, tt

B^pochondria, breast and lower abdomen is caused by liv■f depression, qi stagnation and inhibited flow of meridian *I»1 sensation of foreign body in the throat, or goiter, B^ofula 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 :

Í*|>iession, migra tory distending pain in the chest, hypo■inndria, 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 Üi& iE

jft& m nt

upward adverse rising of fire. This syndrome is mainly

MtiEM. I

caused by emotional upsets and transformation of fire from

í'If

-f í 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 - ñ M B fá r M íp M í g ,

and deafness, insomnia or nightmare, or scorching pain in the hypochondria, or hematemesis and epistaxis, constipation, scanty and yellow uriñe, red tongue, yellow fur

t í , » & ü f » «I & T i* ÉL ¿SI

and taut and rapid pulse. These symptoms are usually

#f

seen in hypertension, hyperthyroidism, neurasthenia ■

S W¡, Si í í ffl1fiPffi, ta 3fc íñ ^

manic depression, migraine, cerebral arteriosclerosis and

¿J) J¡* W. i t & , M ¥ $ I* - f l

climacteric syndrome.

:

Analysis of the symptoms: Dizziness, distending

vEÍ'ñj^Vf:

headache, flushed face and red eyes. bitter taste and dry-

Dí,

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

í i ;O í Í P ü f f t l ^

due to internal disturbance of heat and fire; irritability

Z M Í, PJ

and susceptibility to rage are caused by liver depression;

fff M -M®J-ftll W í i ; *

scorching pain in the hypochondria is caused by stagnation

Ü lfilS ÍT >iJ ít lf in f iíH , i f o f l

of qi and fire in the liver meridian; hematemesis and epi-

M U ; X #3í í f i i , M

staxis with fresh blood are caused by extravasation of

/ M I M ffi. Üf ffi & * W M > ■

blood due to upward adverse rise of qi and fire; constipa-

^ ü

W ^ j & '/ ’X X I I j H ± Ü fl

ffi.

tion, scanty yellowish uriñe, 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 Ü .: 1ñ, ^ U ffi Ü # 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 É S ÍIÍiS P

W ■

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 Í E ; J ií S É 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-

iñ 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, dizzi■ness, tinnitus, flushed cheeks and red eyes, irritabílity 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

U

\ t

I nnd thin pulse. Such symptoms are usually seen in hyperI tensión, cerebral arteriosclerosis, Parkinson’s disease, hyperthyroidism, neurasthenia, manic depression, mifraine and climacteric syndrome, etc. Analysis of the symptoms: Distending headache, diz■iness, tinnitus, flushed cheeks and red eyes, irritability

M

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 & át a aa» , * i f » kij

m ñ /c m m 0

Key points for syndrome differentiation: Dizziness,

m\e ü 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, convulsión 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 Ífc JR U íE ftí& íilT 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 % íM ffií it M . M iflfj

hyperactivity of liver yang which transforms into wind, Iherefore leading to the wind syndrome marked by root

M¿.üEc

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

s

A

•

*

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, Parkinson’s disease, epilepsy and injury of spinal cord.

J fiu iilíil'f S *hJpitü£,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

í h. át í f . í t üS ¡ tfF M rt ¡Ib • íffii

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/LÉHlffiíio

liver and kidney yin; red tongue with white or greasy fur

JfiUÉSL.IFM

*

and powerful pulse are the signs of consumption of yin and

B

U

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. Key points for syndrome differentiation: This syn­

ÍWE5.ÉU

B|i

drome is marked by frequent dizziness and hyperactivity of liver yang as well as sudden severe vértigo, 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 K£J5UE

tlng wind vSyndrome of extreme heat genera ting wind refers to

a a ífc W iE J i- lfÉ 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 í^ a tÍ T tt§ S # f¡ lK

abscess, tuberculous encephalitis, epidemic hemorrhagic fever, scarlet fever and puerperal infection.

í í -14tb it a j i a ñ , 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 ñM'M•

are caused by invasión 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. Key points for syndrome differentiation: This syn­ drome is marked by high fever and restlessness accompa­

ffiá u 8 t Í¡ E S £ : ^ iiE K f f it t . m k T 'í o fe ja ra sí

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 íÍ^ M ,iE J ií§ É 1 ia j

fers to the syndrome due to consumption of yin fluid and malnutrition of tendons and vessels. This syndrome is u-

JxlüEÍÉ.

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

üft • w á . j® .

M

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 ñ

# , j é M f t ñ b . i J ití.

,

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. jflLjÉtíÉMÜE

tlng wind Syndrome of blood asthenia generating wind refers to

jfiL«£JxlffiJ§féÉ 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 ñ i , a t í í 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 ík M :

fascicular twitching, numbness of limbs, dizziness. tinnitus, palé complexión, 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; palé complexión, light coloured nails, whitish tongue and thin and weak pulse are caused by failure of blood asthenia

s s í i f t É \ftikmwio

to nourish the body. Key points for syndrome differentiation: This syn­ 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 ? ) SÜffFBSiiE

liver meridian Syndrome of coid stagnation in the liver meridian re­ fers to the syndrome due to coid pain in the distributing región 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, inhibíted circulation of qi and blood as well

spaw a.

as spasm of meridians and vessels. Clinical manifestations: Lower abdominal coid pain, sagging distensión 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 distensión 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. Key points for syndrome differentiation: This syn­ drome is marked by cold pain in the lower abdomen, puil«Widum 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 ; iíik 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 uriñe 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

( - ) MBBÜuE 'í f r o U í E é f é É 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

ilSiíSíSL:

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 uriñe, profuse noctural uriñe, bright whitish or blackish complexión and light coloured tongue with white fur as well as sinking, deep and weak (especially over chi región) pulse. These

ü é

. ié is i Í

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 complexión is caused by asthenia and weakness of the kid­ ney to warm and transport qi and blood, leading to inter­

P ín 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;

sfírf ] ik H '

Iníquent micturition. clear and profuse uriñe and profuse floctural uriñe 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 región) pulse are the signs of insuffii'l»5ncy of kidney yang. Key points for syndrome differentiation: This synilióme 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 ) üf¡É7j<j$ií

Itthenia Syndrome of edema due to kidney asthenia refers to

iiE J& ííiÉ 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 distensión and fullness, or palpitation and shortness of breath, or cough. ■yNpnea and sputum rale,

light-coloured and bulgy

E Jñ lJo

W S Í T ñ ñ 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

íE £ # # r :

Ir «ion l)elow the waist) rebounding after pressure with íliiKers and oliguria are caused by insufficiency of kidney

s rt js j / h

ñ

S

' j - ' .

í h

+

ff-

yang and its failure in transforming qi which lead to reten­ tion of fluid and edema; abdominal distensión 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, aversión 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. Key points for syndrome differentiation: This syn­ drome is marked by edema (especially over the región 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

( = ) ÜSfiBíf ÜE «■ B H íÉ üE ftféÉ T W H

symptoms of endogenous asthenic heat due to consumption of kidney yin and insufficiency of nourishment. This syn­

m m ¡Ñ i i f é . * w g ú :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 ,íf e lR < ÍS .IIía * .

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 uriñe, 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

f

lulns and knees, dizziness and tinnitus as well as amnesia ■ i caused by consumption of kidney yin and malnutrition ni¡Cerebral 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-

Ü JÉ¿R?T JÍJ ÍH M ; ÉÉA ± D c 'll'

■Ciency of blood in the thoroughfare and conception ves■rls; metrorrhagia and metrostaxis are caused by extra va■tion 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

íí# .»

■nd scanty uriñe 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 Ü 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

ÍÍM ffilsS . ^ íJ E ^ eéiT

life and consumption of kidney essence. Clinical manifestations:

f íw m m c.

Infantile retardation of

growth and elosure of fontanel, flaccidity of skeleton, re­

íb »

, 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

n

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 ) ü n * @ íE

weakness in the aged and asthenia of kidney qi; or by conUrnital defect and insufficiency of kidney qi; or by con■Umption of kidney qi due to chronic disease and overptrain. Clinical manifestations: Aching and weakness of loins Miid knees, dizziness and tinnitus, frequent clear uriñe, or iliipping urination, or enuresis, or frequent noctural uriliíition, or incontinence of uriñe 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 ? Ü J i^ £ S É ,ttJ iÍÍ ÍIÍ É Íl£

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 uriñe, or dripping urination, or enuresis, or fref|tient noctural urination, or incontinence of uriñe 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 Mükness 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 uriñe or dripping urination, seinln il emission, immature ejaculation, dripping menstruaIíihi. thin and profuse leukon'hagia and weakness of the Itlldder.

t- v E m m tk & • •f

b J - í i í t t . V fi i i . k

&m í!\

2.3 .5 .6

(A ) If^íflnüE

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

,

a

p j «

m

> 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 complexión, floating and large pulse; or shortness of breath and dyspnea, flushed cheeks and dys­

jhíéhS o

ñ ija T iiiÉ ® *

‘f

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

0

nary emphysema, pulmogenic heart disease, bronchial asthma, lung cáncer and failure of respiratory function, etc. Analysis of the symptoms: Dyspnea and shortness of breath, more exhalation and less inhalation and aggrava­

%%L.

!B tú >lü'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 , Él til

lassitude, aching and weakness of loins and knees, lightcoloured tongue and weak pulse are caused by asthenia of

¡ g tP B ,® S « .íÍ 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 , í r í r t i

iweating, cold limbs and cyanotic complexión, 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. Key points for syndrome differentiation: This syn­ 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

( - ) S»5E * » f fip tíííÉ 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 complexión; 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 cáncer and duodenal cáncer, 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;

ÜSo ñ J J & T ñ t t S ta Mi

+ — ÍbJP&I

bland taste in the mouth without thirst is due to the fact th a t

B

r

a

,

;

j

c

i

.

body fluid is not consumed because yin is exuberant

}|nd yang is asthenic; whitish or bluish complexión is due

n ? £ ? f7 jc 0

h» stagnation of yin cold; epigastric and abdominal disten-

a

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 Éud 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 exuber■nee 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 : í í 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 syn■rome 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 vomirtíng 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 cáncer and llomach cáncer as well as periodontitis and diabetes.

?¡tiL ñ m T ñ & w ñ . 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 gestión ; halitosis is caused by upward adverse rise of gas­ tric heat with turbid qi; preference for cold drinks, con­ stipation and scanty yellow uriñe are due to consumption of body fluid by pathogenic heat; swelling, pain and ulcer­

«o

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. Key points for syndrome differentiation: This syn­

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

(üE)

stomach Syndrome of food retention in the stomach refers to

« B J f é ilE J iílfÉ Í *

the symptoms of gastric and abdominal fullness and pain, vomiting, diarrhea, acid regurgita tion and halitosis due to

m . W M W M lñ £ £ £ & » ■

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 thé átomach 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 distensión and pain after vomiting, or borborygmus with abdominal pain, unsmooth defecation,

foul stool like

M U I ! : J fé J K M I®

ilecayed eggs, thin and greasy tongue fur, slippery pulse

o 15TJS

i»r sinking and sthenic pulse. Such symptoms are usually ‘«vil in acute gastritis, acute enteritis, gastric dilatation, chronic gastritis, malabsorption syndrome and Crohn’s ■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 distensión 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 í 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) ÜRBlÉüE IK íftíE Jlr fé É ílP 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-

ñ 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 uriñe, red­ dish tongue with scanty fluid and thin and rapid pulse.

m il m & T ñ ñ m tfá& n

Such symptoms are usually seen in acute and atrophic gas­ tritis, malabsorption syndrome, Crohn’s disease, esophagus cáncer, stomach cáncer, liver cirrhosis and liver cáncer 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?. S¿r4>íí.J»4ffll?¡TfEj

gastric qi to descend; dry mouth and throat, dry feces and scanty uriñe 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. Key points for syndrome differentiation: This syn­

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 digestión 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 ü E J i í ! ¡i3 B r tÍ/c ,I§ £ iS * J 9 í* 3 1 lW iíE fio

jiyndrome is mainly caused by emotional depression and inIttirnal disturbance of the gallbladder by a mixture of

r t tM J W J ííL

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 é ^ ‘1t,t¡(

fcight, palpitation and restlessness, insomnia and dreamimws, dysphoria, difficulty in making decisión, thoracic

iX ít^ ífe , m m n m , # ± , i .

mui hypochondriac oppressin and distensión, frequent nitfh, dizziness and vértigo, 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 decisión 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 distensión as well as frequent sigh are caused by failure of the gallbladder to disperse and inhibited flow of qi; dizzi­ ness and vértigo 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. Key points for syndrome differentiation: This syn­ drome is marked by palpitation, insomnia, dizziness, tho­ racic and hypochondriac oppression and distensión, bitter taste in the mouth and yellowish greasy tongue coating.

2.3. 8

Syndrome differentiation of small

i m

m

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 sión, 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 í

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^ ú ñ T ^ h M iB f S C é 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,

ñíaturia, reddish tongue, yellowish tongue fur and rapid pulse. These symptoms are usually seen in Behcet’s 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 uriñe, 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

flSBiáfrf il iÜ 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. Key points for syndrome differentiation: This syn­ drome is marked by vexation, thirst, mouth and tongue ulcer as well as scanty uriñe, inhibited urination and icorching pain in urination.

2. 3. 9

Syndrome differentiation of large intes­

A ,

jzM /fáW 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 ílysentery. 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 É

and unsmooth pulse. Such symptoms are usually seen in disturbance of intestines, habitual constipation, chronic atrophic gastritis, esophagus cáncer, stomach cáncer and intestinal cáncer 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 syn¡drome 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 invasión of rinmp heat into the intestinal tract and failure of the intes¡tlne 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 ción of damp-heat and turbid pathogenic factors in the in-

ffÜCo

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 uriñe, reddish tongue, yellow and greasy

«i

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
dí

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 uriñe, reddish tongue, yellow and greasy tongue fur as well as slippery and rapid pulse are the signs of internal stagnation of damp-heat. Key points for syndrome differentiation: This syn­ 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

I

+ s

disease Bladder disease mainly reflects the disorder of the bladder proper and the pathological changes of its func­ tions in storing and excreting uriñe. 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 uriñe, 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 enérgizer 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 uriñe due to retention of damp heat in the bladder and inhibited transformation of qi. This syndrome is frequently caused by invasión 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 ü

urination, scanty and brownish uriñe, or hematuria, or

üStSUfiL,

sandy uriñe, accompanied by fever, lumbago, reddish

I * , /M i! tú4 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 uriñe is caused by retention of damp heat and ílcorching of fluid; hematuria is caused by damp heat im(>;iiring yin collaterals; sandy uriñe is caused by lingering damp heat scorching impurity in the uriñe into stones; fe-

PJRír®-S íjS & 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 in■tnal accumulation of damp heat. Key points for syndrome differentiation: This syn-

* v ív m m %

prome is marked by frequent and urgent urination, burnflliK pain in urethra during urination and yellowish and fcownish uriñe.

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 lñ o

The viscera are different in functions, but they are closely related to each other and form an organic whole.

m z m ,í ñ - e í n m

Therefore under pathological conditions, they may affect

h jí

Hicli other and resulting in accompanying diseases.

, t n BI« ffi 2 Sí * 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 á 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

í.';

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, palé complexión, 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

% >ÍÜJJ$¡lf5|>

■ , W'n.ífé'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 depúrate and descend as well as upward adverse flow of qi; vomiting of thin and clear

*n,JÉÍÍlfÉ?S3ÍI¡áf3. 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 hypoaclívity of the body due to asthenia of qi; aggravation after movement is due to consumption of qi; palé complexión, 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

Asthenia syndrome of heart and

(z ) i m m f á u í

•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*

ílrficiency of heart and spleen qi and blood.

mm o

VÁ S í 'L '

J»

%

JÚL ^ JÉ f f i

Clinical manifestations: Sallow complexión, lassiI i k I c1,

palpitation, insomnia and dreaminess, dizziness and

Amnesia, poor appetite, abdominal distensión and loose Mool, hematemesis, hematochezia, or subcutaneous hem-

$ M Iif[ U '® IÓ L ,® & T íií JÍÍL.

írrhage, or scanty and light-coloured menstruation and fliípping menstruation, light-coloured and tender tongue

pJjjiL

well as thin and weak pulse. These symptoms are usu«IIv 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 líu iR # c * ft« *

anemia, purpura, leukopenia and dysfunctional uterine bleeding. Analysis of the symptoms: Insomnia and dreaminess

vEÍÑ frV i: 'frjfiL'T'.S.'C,'

are caused by insufficiency of heart blood, malnutrition of

J¡8I

the heart and irritability; dizziness and amnesia are caused by insufficiency of heart blood; poor appetite, abdominal distensión 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 Í ? S í , 'f Í , f c je *

ión, 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 tensión, loose stool and manifestations of asthenia of both qi and blood.

2 .3 .1 1.3

Asthenia syndrome of heart and

( .= )

/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

éiít.jfciiíáfflmJ i

seen in heart and kidney failure due to hypertension, in­ fectious endocarditis, myocarditis, chronic pulmogenic

«i

heart disease, chronic nephritis, systemic lupus erythematosus, diabetes, hypothyroidism and epidemic hemor-

Ü IE

M 'ilV k ífj Jfoíft 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 ^ íf 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

ñ,mía.%t¡<sSsL'á^%-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. Key points for syndrome differentiation: This syn­ 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 í H » . ñj E T M

I

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

Í R * P J S f f i o

I l 'Í>

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

JÉABflftííEílo

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. Key points for syndrome differentiation: This syn­

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,

ifój

poor appetite, abdominal distensión and loose stool, low voice and no desire to speak, lack of energy, palé com­ plexión. 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 distensión 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, palé com­ plexión, 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. Key points for syndrome differentiation: This syn­ 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 ü BBffiíE

yang asthenia Syndrome of spleen and kidney yang asthenic refers

J J T J f P B .f é íE J S f é É 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 , * ÜE ^ É 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 distensión, dysuria, cold pain in the loins and knees or lower abdomen, bright-white complexión, 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 bTJÁLTUÍ

seen in chronic enteritis, malabsorption syndrome, irrita­ ble intestinal syndrome, Crohn’s 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 distensión 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 complexión, 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. Key points for syndrome differentiation: This syn­ 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 ) BTÍf 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

¡Hífc&rtimMvEmo * v f . £

to control yang. This syndrome is marked by consumption

BHíft 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 ít.

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 í'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 ÍK H>.

hepatitis, cirrhosis of liver, liver cáncer, chronic nephri-

I-:

tis, diabe tic nephritis, renal tuberculosis, kidney cáncer, bladder cáncer, 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 É É U ffF íflliÉ ,* 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

j§

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 oí fire disturbing the thoroughfare and conception vessels tlue to yin asthenia; dry mouth and throat, feverish sensa-

P&»HT, 2'£.■>*&, Sí

r

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. Key points for syndrome differentiation: This syn­ 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 ÍE flifr ffiS fé É T Jff

Syndrome of liver fire invading lung refers to the

mm,

symptoms of the lung failing to depúrate and clear due to invasión 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 distensión 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 uriñe, reddish tongue, yellowish thin fur and taut and rapid pulse. Such symptoms are usually seen in bronchiectasis, pulmonary tuberculosis, endobronchial tuberculosis and lung cáncer. Analysis of the symptoms-. Scorching pain in the chest and hypochondria, irritability and Susceptibility to rage, dizziness and distensión 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

m

m

>± 3 b tj» j!íís 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 depúrate; hemoptysis is caused by internal exuberance of fire and heat impairing pulmonary collaterals; dry fe­

ÍR W ÍE & .

ces, yellowish and reddish uriñe 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. Key points for syndrome differentiation: This syn­ 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 distensión and loose stool due to failure of

M , JKJR >®

A

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 JÉMUfl, a m \

sigh, emotional depression, irritability and susceptibility to rage, anorexia and abdominal distensión, loose stool

♦

and retention of feces or loose stool and unsmooth defeca­ tion, borborygmus and breaking wind, or abdominal pain

K

S Ü

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-

ñm 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 distensión, loose stool and retention of feces are caused by invasión 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 Í 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. Key points for syndrome differentiation: This syn­ drome is marked by chest and hypochondriac distensión 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 distensión 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 invasión of liver qi into the stomach. Clinical manifestations; Hypochondriac and epigastric

«

*

3¡í: J f t jÜ 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 a^ute gastritis, chronic gastritis, digestive ulcer, reflux esophagitis, cholecystitis and gallstones. Analysis of the symptoms.* Hypochondriac and epigas­

ii E « 4 M f í: JFF^ciBKtW

tric distending pain or wandering pa*n are caused by fail­ ure of the liver to disperse and corJvey * invasión 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. Key points for syndrome differentiation: This syn­

P Í E B jS : * Ü 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

( + - ) ffiiSíftfiE

and gallbladder Syndrome of damp-heat in liver aifrá gallbladder refers to the symptoms of dysfunction in d is ^ ersi°n and conveyance due to accumulation of damp-he^at 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 whíich 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 a£ss> anorexia and

)IK.

abdominal distensión, bitter taste in the mouth, acid re­ gurgita tion and nausea, disorder of defecation, scanty and reddish uriñe, 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 cáncer, gallbladder cáncer and pancreas cáncer) as well as orchitis, scrotal eczema, pelvic inflammation and vaginitis. Analysis of the symptoms: Hypochondriac scorching

\ m ñW :

distending pain, or hypochondriac mass are caused by ac­

£ ir , ^

■jfiLít

cumulation of damp-heat, dysfunction of the liver and gall­ bladder in dispersión 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 dispersión 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 uriñe, or alterna te chills and fever, anorexia and abdominal distensión 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. Key points for syndrome differentiation: This syn­ drome is marked by distending pain in the hypochondria

« m,

and rib-side, anorexia, abdominal distensión, coloration of the skin and eyes and pudendal pruritus.

mrnrn.

a

n

H

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2 .4

Other syndrome differentiation

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methods 2. 4.1

Introduction to six-meridians syndrome

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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.

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m

2.4.1.1

Taiyang syndrome

se

( - ) *BB£üiiE

Taiyang governs the superficies and Controls both nutrient and defensive qi. When wind and cold attacks the

So

s

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

fbíüg A ju ff.U íbaiA 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 invasión 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 invasión of pathogenic wind into the superficies and disorder of nutrient and defensive qi. Clinical manifestations: Fever, aversión to wind,

( 1) *.F0

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m jím m m m » IfófSiSSÍ:

jí,

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 sión of pathogenic wind into the superficies and struggle between defensive qi and pathogenic factors; sweating and aversión 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 ín 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 invasión of pathogenic cold into the superficies, ob­

(2)

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E JifégfB li*. UPII

struction of defensive qi and stagnation of nutrient qi. Clinical manifestations: Aversión 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: Aversión 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

S7jcüEéíM *P0güEX<ÍW . #

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, aversión to cold,

tó ífc ft S E s

dysuria, lower abdominal distensión and fullness, thirst, vomiting after drinking water and floating pulse. Analysis of the symptoms: Fever, aversión to cold

fiPít.l»». iiE t e ± | S 0 &

k l

f

and floating pulse are caused by failure to relieve taiyang

m ..

meridian syndrome? dysuria and lower abdominal disten­ sión 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 indigestión 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 é 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

íá ,f P « É & r t ft.J f J fiL ff iá g

meridian syndrome which leads to transmission of patho­

i- 'p m . a i >> m é , m , s m m

genic heat into the internal and its mixture with blood in

ffi; s? ñ rt £§. ± dé-li' # -üt ja

the lower abdomen; mania is caused by internal stagnation

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Jfü.ü', ^

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 í5 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 invasión of

( = ) B0§B^üE

«HJIfaiiEjtféJPAIspJ!,

pathogenic factors into yangming meridian, hyperactivity of yang heat and dry-heát 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 .

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g é 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.

iEÍÑo

Clinical manifestations: High fever, no aversión to cold but aversión to heat, profuse sweating, polydipsia, flushed cheeks and dysphoria, reddish tongue with yellow­

¿b, x n 3 1<*. ® ñ

£r ^ M ifc * W

ish dry fur and full and large pulse. Analysis of the symptoms: Fever, flushed cheeks, no aversión to cold but aversión to heat are due to invasión 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

ü jí íR 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

ffijfiLiSJSÍlliSfefco

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 ÍI

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 ü E íio ^ 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: Aversión 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 uriñe, light-coloured tongue with white fur and deep and indis­ tinct pulse. Analysis of the symptoms: Aversión 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 uriñe, 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

n

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 , invasión 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

ÜEm 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 dispersión 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 vasión 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 í a H íe

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 ttü E

Defensive phase syndrome refers to the syndrome due to invasión of pathogenic factors into the lung, disor­ der of defensive qi and dysfunction of the lung. This syn­

s

p

t- ¡ii \

drome is usually seen at the primary stage of epidemic fe­ brile disease. Clinical manifestations: Fever, slight aversión 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 aversión to

vEMM

í :

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, aversión not to cold but to heat, vexation and thirst, sweating, reddish uriñe, 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'ílj n ‘é 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, aversión not to

i

m

i

j

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 ñ , 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, distensión 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,

u

(= )

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 invasión of pathogenic febrile factors into nutri­

S iS ^ f lÜ 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 invasión of pathogenic heat into nutrient phase and disturbing the mind; mild

S tS K ± fc ,íl!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 invasión of patho­

J4 l4 H E Jtfé ia & J»S íS S

genic febrile factors into yin blood and leading to disturb­

A M L ,# I£ ^ J Ó U 3 & J x L fé 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 í JfiL,

and rapid pulse; or convulsión, 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 &í-.

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

JñL$?í, 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; convulsión, 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-

t

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 # , roí m

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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 demónstrate the academic theory and

2000

clinical practice of TCM and to meet the requirements of

2002

X m &}%}*&'

:

compilation, the compilers and transíators have made great efforts to revise and polish the Chinese manuscript and English transía tion so as to make it systematic, accurate, scientific, standard and easy to understand. Shang­ hai University of TCM is in charge of the transíation. Many scholars and universities have participated in the compilation and transía tion of the Library, i. e. Professor Shao Xundao from Xi’an 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 %±íí 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 * í *

4, E Í 5 * # í f * E I £ « r í 5 É 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 transíation.

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 transíation 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,

X

# i§£in 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 sión.

Zuo Yanfu

£ 1 ít

Pingju Village, Nanjing Spring 2002

2002 ípfo)#

E

!olour Fig. formal State; he tongue

lour Fig. 2 kht-whitish ligue

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Colour Fig. 3 Red tongue m m 3

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Colour Fig. 4 Deep-red tongue OT4

Colour Fig. 5 Cyanotic and purplish tongue 35

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Colour Fig. 6 Bulgy tongue m f 16

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Colour Fig. 7 Thin and emaciated tongue

Colour Fig. X Fissured tongu

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Colour Fig. 10 Tooth-marked tongue

Colour Fig. 9 Prickly tongue m@9

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Colpur Fig. 11 Deviated tongue &®11

Colour Fig. 12 Greasy tongue fur % m n

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Colour Fit Patchcd o>

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Colour Fig. 15 Yellow tongue fl

Colour Fig. 16 Grayish tongue fur #@ 16

Note:

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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

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The Multimedia Teaching Software is jointly published h Phonotape & Vidiotape Publishing House of Shanghai Univafl^

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TCM and the Electronic Phonotape & Vidiotape Press of Shl

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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 Chínese medicine, phiiosophy and wisdom. The Multimedia Teaching Software was developed by Profosi

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Zhaofu and Associate Professor G u Yidi from the Diagn) Section of S hanghai University of TCM based on their

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teaching experience and coliection of hundreds of valuablo examination pictures of tongue with photographic and

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144 typical, vivid and distinct tongue diagnosis pictures Excellent human-computer communication system Ideal "electrical teacher" for teaching yourself at home

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Phonotape & Vidiotape Publishing House of Shanghai Unlvi TCM Electronic Phonotape & Vidiotape Press of Shanghai J

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University Address: 530 Lingling Road, Shanghai, China

f t f t f t l f é : 200032

Postcode: 200032

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( 086 ) 2 1 - 5 4 2 3 2 0 7 6

Tel: (086)-21 -54232076

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( 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

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Medicine Science of Chinese Materia Medica Science o f Prescriptions

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Internal Medicine of Traditional Chinese

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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 ( 'hiñese Acupuncture and Moxibustion ( 'hiñese Tuina (Massage) Life Cultivation and Rehabilitation of Traditional Chinese Medicine