TCM Diagnosis by Looking (Observation) One of the 4 Pillars

What is observed by the Practioner.

Shen (Spirit)
Observing and tuning in to a patient's Shen (spirit) is particularly important to help determine the
overal state and prognosis of an imbalance. The Shen gives vital imformation about vitality, and
mental, emotional, and spiritual well being. The Shen shows in the eyes, complexion, and state
of mind.

Body (appearance)
The Five Elements can be associated with body shapes and constitutions

Wood Type
Slender and tall body shape
Fire Type
Pointed head and chin, small hands, with curly or a small amount of hair
Metal Type
Square and broad shoulders, strong body type, and a triangle shaped face
Earth Type
Large head, larger body and belly, strong legs, and a wide jaw
Water Type
Round face and body with a longer than normal torso

Long Term Body Changes

Emaciated, body, esp. with dry skin

Deficient Blood or Yin
Very large thighs
Spleen Deficiency
Great weight loss over course of long illness
Essential Qi exhausted
Overweight
Deficient Spleen Qi with tendency to Dampness or Phlegm (often with Stagnation of Qi)
Hair loss
Kidney Jing Deficiency or Blood Deficiency
Musculoskeletal pain, soreness, numbness or heaviness with swelling and restricted
movement
Bi Syndrome (Painful Obstruction syndrome)

Gradual onset of weakness, motor impairment, and muscular atrophy of the limbs:
Wei Syndromes (flaccidity syndrome)

Short term bodily changes

Change in Muscles (e.g. flaccid, wasting)

Spleen disharmony
Change in Tendons (e.g. stiffness, weakness)
Liver disharmony
Change in Blood Vessels (hardening, producing hard pulse)
Heart disharmony
Change in skin (e.g. tone, dryness
Lung disharmony
Change in bones (e.g. brittle)
Kidney disharmony

Appearance and Demeanor

Includes posture and movement of body as a whole and of individual parts, e.g. eyes, face,
mouth, limbs, fingers.
Symptom(s)

Cause or Pattern

Overweight with Mental Depression

Qi Xu and Excess Damp Phlegm

Loss of Weight in Long Term Illness

Exhaustion of Essential Qi

Thin with Dry Skin

Blood Xu

Extended Neck

Excess Lung Syndrome with Excess Phlegm

Facing Downward

Qi Xu with Shortness of Breath, Dislike of

Speaking

Violent Movement of Limbs

Wind Diseases, Infantile Convulsions

Weakness, Motor Impairment, and Muscular

Atrophy of Limbs

Wei Syndromes

Pain, Soreness, Heaviness and Numbness in

Tendons, Bones and Muscles, with Swelling
and Restricted Movement of Joints

Bi Syndromes

Numbness or Impaired Movement of Limbs on Hemiplegia or Wind Stroke

One Side of the Body
Active patient with excessive/jerky movement: Yang, Excess or Heat patterns

Passive manner or lack of movement/slow

movement:

Yin, deficient, Cold

Continuous fidgeting, especially of legs:

Deficient Kidney Yin

Tremors, convulsions (of whole body or

localized):

Interior Liver Wind

Head and Face

Hair

Hair relates to Blood or Kidney Jing.

Hair loss and premature graying of the hair may be due to Blood Deficiency or Kidney
Jing Deficiency.
Dandruff usually relates to Liver Blood or Yin Deficiency

Face

Two light and shallow lines between the eyebrows indicates a healthy Liver.
Two deep lines or three line between the eyebrows can indicate a Liver problem, such as
frequent anger
A single line can indicate a more serious Liver problem. This can occur after
considerable hardship.

Face Color

Represents the strength of the Qi and Blood of the Zang Fu organs, and especially the
Heart.
The complexion should be moist and lustrous.

Red (Excess or Xu Heat)

Whole Face

Heat from External Evil or Hyperactivity of

Zang Fu (Excess)

Cheeks, Tidal Fever, Night Sweats

Internal Heat (Xu)

Pale (Cold or Loss of Blood)

Pale White

Yin Excess or Yang Xu

Bright White with Puffy and Bloated

Appearance

Yang Qi Xu

Withered White

Blood Xu

Yellow (Damp or Xu)

Body, Face, Eyes, and Skin

Jaundice

Bright Orange

Yang Jaundice (Damp Heat)

Smoky Dark

Yin Jaundice (Cold Damp or Long Term

Stagnation)

Pale Yellow (Not Bright)

Blood and Qi Xu

Blue (Cold, Pain, Blood Stagnation, Convulsions)

Pale with Blue Tinge and Severe Pain in the
Epigastrium and Abdomen

Excess Yin and Cold

Bluish Purple Face and Lips with Intermittent

Pain Behind the Sternum or Precordial Region

Stagnation of Heart Blood

Bluish Purple Face and Lips with High Fever

and Violent Movement of Limbs in Children

Infantile Convulsion

Dark Gray (Blood Stagnation and Kidney Xu)

Pale and Dark with Lumbar Soreness and Cold
Feet

Kidney Yang Xu

Dark without Brightness with Scaly Skin

Prolonged Blood Stagnation

Observation of Sense Organs

Eyes
The eyes reflect the state of the Shen and Jing. It is said, "The Jing of the five Yin and six Yang
organs ascends to the eyes." We observe the "expression" of the eyes to see the spirit.
The Liver opens to the eyes (sense organ associated with Wood element)
Eyesight changes tend to relate to the Liver
Symptom(s)

Cause or Pattern

Shining and are Clear

Good vitality of Shen & Jing

Redness and Swelling

Wind Heat or Liver Fire

Yellow Sclera

Jaundice

Ulceration or Canthus

Damp Heat

Upward, Straight Forward, or Sideways Staring Liver Wind

Dull or Clouded eyes

Disturbed Shen, weakened Jing. Commonly

seen in drug users and long term emotional
problems

Nystagmus

Disturbance of Liver Wind

Spots in visual field:

Deficiency of Liver Blood or Kidney Yin or

Jing

Swelling or dark rings under eyes:

Deficiency of Kidney

Nose
Symptom(s)

Cause or Pattern

Tip of the Nose

Relates to Spleen and Stomach

Flapping of Ala Nasi

Heat in the Lungs or Qi Xu of both Lung and

Kidney

Clear Discharge

Wind Cold

Turbid Discharge

Wind Heat

Prolonged Turbid Discharge, with Stinking

Discharge

Rhinitis or Chronic Sinusitis

Mouth and Lips

Color, moisture and appearance. Normal color is pale red, moist and shiny
Symptom(s)

Cause or Pattern

Pale Lips

Blood Xu

Bluish Purple Lips

Retention of Cold or Blood Stagnation

Red and Dry Lips

Excess Heat

Breathing through mouth

Lung Qi Deficiency

Mouth always slightly open

Deficiency

Sudden Collapse with Open Mouth

Xu

Sudden Collapse with Lockjaw

Excess

Greenish around mouth

Liver Blood Stasis or Liver invading Spleen

Teeth and Gums

Teeth are considered an extension of bone and are influenced by Kidneys. Gums are influenced
by the Stomach.
Symptom(s)

Cause or Pattern

Moist teeth

Good Fluids, and healthy Kidneys

Pale Gums

Blood Xu

Redness and Swelling of Gums

Stomach Fire

Redness and Swelling of gums with Bleeding

Injury of Vessels by Stomach Fire

Throat
Symptom(s)

Cause or Pattern

Redness, Swelling, and Soreness

Lung and Stomach Heat

Redness and Swelling with Yellow or White

Ulcer Spots

Toxic Heat in Lung and Stomach

Slightly sore, dry, red, not swollen, chronic

condition

Deficient Kidney Yin

Bright Red with Mild Soreness

Yin Xu with Hyperactive Fire

False Gray and White Membrane over Throat

that is Hard to Remove, and Bleeds Following
Removal

Diphtheria from Heat in the Lung Consuming

Yin.

Ears
Observe color, discharge, skin tone, any spots or discoloration.
Symptom(s)

Cause or Pattern

Burnt Black and Dry and Withered Auricles in

Severe Illness

Consumption of Kidney essence

Purulent Discharge

Damp Heat of Liver and Gall Bladder

Limbs

Flesh around wrists and ankles should be a good color and firm: indicates a good condition of the
fluids.
Symptom(s)

Cause or Pattern

Dry, dull skin on wrists/ankles with withered

flesh

Exhausted Fluids

Thenar eminence

State of Stomach

Bluish color of venules on thenar eminence

Cold in Stomach

Red venules

Heat in Stomach

Nails
Symptom(s)

Cause or Pattern

Pale

Blood Deficiency

Bluish

Liver or Heart Blood Stasis

Split

Liver Blood Deficiency

Digital Venule Examination in Children

Examine the venules on the index finger in children under 2.
Use left index finger in boys and right in girls.
Creases in joints of index fingers are called "gates".

Wind Gate
First, crease at mcp articulation
Qi Gate
Second (1st interphalangeal)
Life Gate
Third (distal interphalangeal)

Method: rub finger towards body. Venules may appear.

If venules are only present beyond the Gate of Wind, this indicates mild disease (invasion by
exterior pathogen). If venules extend beyond Gate of Qi: interior, more severe condition. If
venules extend beyond Gate of Life: serious, life-threatening condition. Bluish venules indicate a
Cold pattern whereas red venules indicate aHeat pattern

Skin

Skin relates to the Lungs in Five Element Theory.

Skin also indicates the condition of the Blood (and therefore the Liver, which stores
Blood).
Many skin conditions relate to Heat in the Blood or stasis of Blood and may relate to
Liver.
Skin disease can also relate to Heat in the Stomach which can cause Blood Heat.

Indications

Dry skin
Often indicates Deficient Blood
Itchy skin
Wind
Pitting edema
Kidney Yang Deficiency

Venules (spider veins) on the skin are exterior manifestation of the superficial channels. They are
often seen behind the knees or around ankles in older people.
Venule Color

Cause or Pattern

Red

Heat

Bluish

Cold

Greenish

Pain

Purple

Blood Stasis

TCM Diagnosis by Listening (and Smelling) One of the 4 Pillars

1. Listening
The Sound of the Voice

A loud and course voice indicated an Excess pattern

A weak and low voice indicates a Deficient pattern
A lack of desire to speak indicates a Deficient Cold pattern
Incessant talking indicates a Heat pattern

Hoarse Voice or Loss of Voice

Acute onset of a hoarse voice is usually indicative of Exterior Pathogenic Wind,

especially if the throat is red and sore.
A chronic or recurrent hoarse voice usually indicates an interior disease such as
Deficient Lung Qi or Lung Yin
A gradual loss of voice also usually indicates Deficient Lung Qi or Yin

Loud Voice with Incoherent Speech

This is usually accompanied by impaired mental function and indicates Heat is

disturbing the Shen (Spirit/Mind)

5 Element Associations in the Voice

Shouting is a Liver imbalance

Constant Laughing is a Heart imbalance
Chronic weeping, whimpering, sadness is an Spleen imbalance
Groaning is a Kidney imbalance

Cough
Coughing is usually related to Lung's ability to properly disperse and descend Lung Qi, leading
to rebellious Lung Qi

Wheezing or rattling from the Lung is usually mucus or Phlegm in the Lung
Explosive or very loud coughing indicates an excess pattern
A weak cough indicates a Deficient pattern
A dry hacking cough is usually indicative of Heat and Dryness in the Lung
An unproductive cough with small amounts of sticky sputum indicates Heat
scorching the fluids

Breathing

Loud and coarse breathing indicates an Excess pattern

Shortness of breath, weak and/or difficult breathing may indicate the Kidney is
too weak to grasp the Qi. This would include a Deficient type asthma.
Loud and coarse breathing with a preference for exhaling indicates pathogens
retained in the Lung. This would include Excess type asthma.

Frequent Sighing

Usually related to Liver Qi Stagnation

Usually related to Rebellious Stomach Qi

Hiccups

BorBorygmus

Usually related to Deficient Spleen Qi or Deficient Spleen Yang, especially if

there is loose stools and bloating.
This can also be due to Liver Qi Stagnation invading the Intestines

2. Smelling
In general, secretions and excretions related to Excess Heat type patterns have a foul odor. Less
odorous secretions and excretions usually relate to Cold and Deficiency type patterns.
Odors

Urgent diarrhea with foul stools indicates Damp-Heat in the Large Intestine.
Belching with a foul or sour odor indicates retention of food.
Leucorrhoea with a strong or foul odor indicates Damp-Heat in the Lower Jiao
affecting the Uterus.
Chronic Halitosis (Bad breath) indicates Stomach Heat

5 Element Associations of Smell

Rancid "goatish" odors are related to the Liver

Scorched or burned odors are related to the Heart
Fragrant, sweet, or cloying odors are related to the Spleen
Rank or Rotten odors are related to the Lung
Putrid odors are related to the Kidney

TCM Diagnosis by Asking - One of the 4

Pillars
Questioning or interviewing a patient during intake covers many topics, including:

Past medical history

Origin of the current problem
Living and environmental conditions
Current and past emotional issues, including family relationships, partner relationships,
work issues etc.
Eating patterns and Diet
Specific questions relating to bodily systems

Identification of TCM patterns is done by using paradigms such as the 8 Principles (Ba Gong),
Zang Fu organ diagnosis, Channel diagnosis, as well as other paradigms. Patterns can be
identified generally as in the 8 Principles, or more specifically as in Zang Fu diagnosis.
Absence of a sign or symptom may, in some cases, be vital to a correct TCM diagnosis, and
absence of symptoms are generally not reported by a patient. For example, absence of thirst may
indicate a cold condition. Keep in mind that all relevant information is not usually provided by
the patient.
Traditionally, there are ten areas of questioning
Common areas of Questioning today:

Chills and Fever

Sweating
Head and Body
Thorax and Abdomen
Food and Taste
Stools and Urine
Sleep
Ears and Eyes
Thirst and Drink
Pain
Gynecological Conditions
Pregnancy and Childbirth (where appropriate)

Questions should be relevant to the patients condition, as not all questions are useful in every
situation. Additional questions should be asked based on information provided by the patient as
well as what is observed by the practitioner.
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Chills and Fever

Chills and Fever in Exterior Patterns
Chills and fever in an Exterior Pattern (unless they are alternating), an invasion or attack by
exogenous pathogenic factors. It is important to distinguish the presence of chills or fever or
both. Chills is not only the feeling of Cold, but also having an aversion to Cold. The patient does
not want to go outside into the Cold, does not like drafts, and the chills are not alleviated by
covering up with blankets. Fever, in this context, is a subjective sensation of heat rather than
actual body temperature.
The initial stages of an Exterior diseases is an acute condition, like the flu or common cold.
When a patient has an aversion to cold and chills, it usually indicates an invasion of exogenous
Wind Cold or exogenous Wind Heat. The patient feels cold because the pathogenic factor blocks
circulation of the body's Defensive Qi (Wei Qi), which is impaired from circulating and warming
the body. The chills and fever occur simultaneously at the beginning stages of an acute disease
because the body is trying to expel the pathogen. This is the pathogenic/evil Qi struggling with
the antipathogenic/protective Qi.
Wind Cold
Symptoms: chills, aversion to cold, possible fever (especially low grade), usually with body
aches, absence of sweating, headache.
Pulse: superficial/floating and tight.
Wind Heat
Symptoms: Predominantly fever, with only slight aversion to cold or mild chills. Also thirst,
slight or profuse sweating.
Pulse: superficial/floating and rapid.
Alternating Fever and Chills
This is a half external and half internal condition where there is exterior invasion of Wind-Cold
or Wind-Heat, but the pathogen has penetrated to a deeper level (Shaoyang) of the body .
Exterior diseases are generally diagnosed according to two paradigms:

The Six Stages (Taiyang, Shaoyang, etc.)

The Four Levels (Wei, Qi, Ying, Blood).

Chills and Fever in Interior Patterns

Interior Excess Heat patterns usually present with a persistent high fever and aversion to heat,
but no chills. Other symptoms may include profuse sweating, thirst, and a flooding pulse.
Interior Deficient Heat patterns usually present with tidal fever (fever that comes in 'tides', at
specific hours of the day, usually in the evening or night). Other symptoms may include night
sweats, 5 palm heat (heat or sweating in the palms of the hands, soles of the feet, and the chest),
and a red tongue body.

Chills without fever usually indicates interior Cold from Deficiency of Yang
If chills are alleviated by covering up with blankets, there will be other symptoms
such as cold limbs, and a deep, slow and weak pulse.
A constant low-grade temperature usually indicates Damp Heat
Fever in the middle of the night
With an adult: This usually indicates Yin Deficiency, especially if accompanied
by Night Sweats
With a child: Retention of Food
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Sweating
It is usually beneficial to ask a patient about sweating, even if they don't initially volunteer the
information.
Example Questions:

Do they sweat easily or excessively, and at what times?

Do they have spontaneous sweating without exertion?

In Exterior Patterns sweating can indicate:

Wei Qi (Defensive Qi) is weaker than the pathogenic Qi and can not expel the pathogen.
When other heat signs are present, it may indicate Exterior Wind Heat. If perspiration
breaks the fever, the pathogen has been expelled.
No sweating is usually an Excess Cold pattern, where cold blocks the pores.

In Interior Patterns sweating is differentiated by:

Time of day

Area of body

Day time spontaneous perspiration (without exertion) indicates Yang or Qi

Deficiency. Wei Qi can not regulate the pores.
Night time sweats are usually Yin Deficiency. Relative excess of Heat causes
pores to open during the Yin most times.

Sweating on the head is usually Stomach Heat or Damp-Heat

Oily sweat on forehead may indicate Collapse of Yang
Sweating only on the arms and/or legs is Stomach and Spleen Deficiency
Sweating only on hands indicates Lung Qi Deficiency or mental anxiety.
Sweating over the whole body indicates Lung Qi Deficiency
Five palm heat (palms of the hands ,soles of the feet, and the chest indicates Yin
Deficiency

Condition of illness

Profuse cold sweat during severe illness indicates Yang Collapse

Oily sweat on forehead that are not flowing and looks like pearls may indicate
imminent death from Yang Collapse

Quality of Sweat

Oily sweat indicates severe Yang Deficiency

Yellow sweat indicates Damp Heat
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Head and Body

The Head is where all six Yang channels meet. The three Yang channels of the upper limbs end
on the face and the three Yang of the lower limbs begin on face. Yang channels bring the clear
Yang to the head and orifices, enabling clear vision, hearing, taste, and smell.

Headache
Headache is distinguished according to the onset, time, location, nature of the pain, condition.
Onset

Sudden onset and of short duration indicates exterior attack of Wind cold
disturbing the Yang or Qi in the head.
Chronic headaches are often attributed to an interior condition.

Time of Day

Daytime headache indicates Qi or Yang Deficiency

Evening headache indicates Blood or Yin Deficiency

Occipital headache indicates Taiyang channels (BL, SI). Usually caused by

Exterior Wind-Cold or Kidney Deficiency

Location

Frontal headache indicates Yangming channels (LI, ST). Often caused by

Stomach Heat or Blood Deficiency, but can also be caused by exogenous Wind.
Temporal or parietal headache indicates Shaoyang channels (GB, SJ). Usually
caused by exterior Wind-Cold or Wind-Heat in Shaoyang, or Rising Liver Fire
affecting Gall Bladder channel.
Vertex headache indicates Jueyin channels (LIV). Usually caused by Deficient
Liver Blood
Whole head headache usually indicates severe Exterior Wind-Cold, or may
indicate mild Deficiency of Blood and Qi.

Nature of Pain

A heavy sensation is usually due to Dampness or Phlegm

'Pain inside the brain' is usually due to Kidney Deficiency
Distending, throbbing, or bursting pain is usually associated with Ascending Liver
Yang
Fixed pain in one area with a boring sensation into the head is usually due to
Blood Stagnation

Condition

Headache with aversion to wind or cold usually indicates Exterior invasion of

pathogenic factors
Headache that is worse with Cold indicates a Cold Pattern
Headache that is worse with Heat indicates Heat Pattern
Headache that is worse when fatigued, better when at rest usually indicates Qi
Deficiency

Dizziness
Dizziness can be due to Internal Wind, Fire, Phlegm, or Deficiency of Qi and Blood
Internal Wind from Ascending Liver Fire

Dizziness with loss of balance, often with such signs as tinnitus, headache,
nausea, red eyes, wiry pulse, irritability, and other characteristic signs of
Ascending Liver Yang

Mild to severe dizziness with heavy and "foggy" feeling in the head plus other
signs e.g. nausea, excessive sputum, slippery pulse. Phlegm obstructs the head, so
that the clear Yang cannot ascend.

Phlegm

Qi and Blood Deficiency

Slight dizziness, worse when fatigued, accompanied by such signs as fatigue,

perhaps palpitations and difficulty falling asleep, pale tongue and weak pulse.

Acute Onset of Dizziness

Indicates an Excess pattern

Gradual Onset or Chronic Dizziness

Indicates a Deficiency pattern

Pain All Over the Body

Pain that has sudden onset and is accompanied by chills and fever is due to an invasion of
exterior Wind, usually Wind-Cold.
Pain all over the body with fatigue is usually deficiency of Qi and Blood
Postpartum women with dull pain usually indicates Deficient Blood
Postpartum women with severe, fixed or stabbing pain usually indicates Blood Stasis
Muscle pain with hot sensation is usually due to Stomach Heat
Pain with a feeling of heaviness is usually due to Dampness obstructing the muscles

Pain in the Joints, Painful Obstruction Syndrome (Bi Syndrome)

Wandering Bi Pain is usually from wind.

Fixed and very painful joints that are worse in cold weather and improved with heat
indicates Cold Bi.
Fixed pain with numbness and heaviness that is worse when Damp outside indicates
Damp Bi.
Joint pain with swelling and heat in joints may indicate Wind Cold and Damp have
turned to heat.

Lumbar Pain

Continuous dull pain that is better with rest indicates Kidney Deficiency
Severe pain and stiffness with recent onset indicates lumbar sprain caused by Blood
Stasis
Severe pain that is worse in cold and damp but improved by heat indicates an invasion of
exogenous Cold and Damp into the channels of the back.
Fixed and boring pain and an inability to turn at the waist indicates Blood Stasis
Pain that extends up to the shoulders, with other exterior symptoms such as headache,
stiff neck, nasal congestion, etc. indicates exterior Wind attack.

Numbness

Bilateral numbness of the hands and feet, or arms and legs, usually indicates Blood
deficiency
Numbness of fingers (especially the 1st 3 digits), numbness of the elbow and arm on one
side is usually internal Wind and Phlegm (impending Wind-stroke).

Thorax and Abdomen

Areas of the thorax and abdomen can be generally associated with the internal organs
Thorax: Heart and Lungs, Upper Jiao
Flanks and Ribcage: Liver and Gallbladder
Abdomen: Liver, Intestines, Spleen, Kidney, Bladder
Epigastric area: Spleen and Stomach
Umbilical area: Kidney

Chest Pain

Chest Pain is often Blood Stasis in the Heart from Deficient Yang.
Chest Pain with Cough and copious Yellow Phlegm indicates Phlegm-Heat in Lung.

Hypochondriac Pain

Distention or Discomfort in the hypochondriac region is usually Liver Qi Stagnation.

Severe hypochondriac pain is usually indicative of Liver Blood Stasis.

Epigastric Pain

Can be due to Liver Qi Stagnation or Stomach Heat.

If the pain is dull, it may indicate retention of food in the stomach.
If the pain is better after eating or applying heat it may indicate Deficient Cold in
Stomach.
If the pain is worse after eating it may indicate a Deficient pattern.
If there is also fullness in the epigastrium, this indicates an Excess pattern

Lower Abdominal Pain

Causes

If relieved by defecation, this indicates Excess

If worse on defecation, this indicates Deficiency

Internal Cold
Stagnation of Liver Qi
Stagnation of Liver Blood
Retention of food in Intestines
Blood Stasis in the Intestines
Blood Stasis in the Uterus
Damp Heat in Intestines

Hypogastric Pain

Can be caused by Damp-Heat in the Bladder.

Can be caused by Liver Fire coursing down into the Bladder.
[ Top of Page ]

Food and Taste

This gives us information regarding the state of Spleen & Stomach (also the flavors desired give
clues to other Organs according to the five element correspondences).

Appetite and Eating

Condition relieved by eating indicates a Deficiency pattern

Condition aggravated by eating indicates an Excess pattern
Lack of appetite indicates Deficient Spleen Qi
Always hungry even after eating indicates Stomach Heat
Fullness/distention after eating indicates Retention of Food
Prefers warm food indicates a Cold Pattern
Prefers cold food indicates a Heat Pattern

Taste in Mouth

Bitter taste is usually due to an Excess Heat pattern (Liver or Heart)

A constant bitter taste in the mouth is usually due to Liver Fire
A bitter taste in the morning after no sleep is usually due to Heart Fire
A sweet taste may indicate Spleen Deficiency or Damp Heat
A sour taste is usually due to retention of food in Stomach or the Liver invading the
Stomach
A salty taste is usually due to Kidney Yin Deficiency
A pungent taste is usually due to Lung Heat

Vomit

Sour vomiting may indicate Liver Invading Stomach

Clear/Watery vomiting may indicate Cold in Stomach with Fluid retention

Vomiting after eating may indicate a Heat Pattern

Sudden & Loud vomiting may indicate Excess pattern
Slow & Weak vomiting may indicate Deficiency pattern
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Stools and Urine

A condition alleviated after bowel movement indicates an Excess condition, while a condition
worsening after bowel movement indicate a Deficiency condition.

Constipation

Acute constipation with infrequent dry stools, accompanied by thirst, and a dry yellow
tongue coating indicates heat in stomach and intestines
Constipation in elderly, or women postpartum indicates Deficient Blood and Fluids
Constipation with small, bitty stools indicates Liver Qi Stagnation and Heat in Intestines
Difficult bowel movements with stools that are not dry indicates Liver Qi Stagnation
Constipation with abdominal pain indicates Internal Cold and Yang Deficiency or Liver
Qi Stagnation
Constipation with dry stools and no thirst indicates Kidney or Stomach Yin Deficiency
Alternating constipation and diarrhea indicates Liver Qi invading the Spleen

Diarrhea

With pain indicates Stagnation of Liver Qi, or Liver Heat, or interior Heat or Cold in the
Intestines
Foul odor, especially if urgent indicates Heat
Urgent diarrhea or loose stools with burning sensation in the anus indicates Heat
Absence of odor indicates Cold
Chronic diarrhea indicates Deficient Kidney or Spleen Yang failing to transform food and
fluid
Chronic, daily, and early morning (cocks crow diarrhea) indicates Kidney Yang
Deficiency
With mucous indicates Dampness in the Intestines
Frequent watery or unformed stools indicates Deficient Yang, Deficient Qi, or Dampness
Loose stools with undigested food indicates Deficient Spleen Qi or Deficient spleen Yang
Frequent or urgent stools that are not loose or only slightly loose indicates Sinking of
Spleen Qi or Spleen and Stomach Qi Deficiency
Black or very dark stools indicates Blood Stagnation
With Blood indicates a Heat condition (A patient with Blood in the stool should always
be referred to a western physician to rule out Cancer)

Borborygmus (gurgling in the abdomen)

With loose stools indicates Spleen deficiency

With abdominal distention but no loose stool indicates Liver Qi Stagnation

Flatulence

Stagnation of Liver Qi is often involved

With foul odor indicates Damp-Heat in Spleen, Stomach Heat, or Stagnant Qi in the
Small Intestine
Without odor indicates Deficient Spleen Yang producing interior Cold

Urinary Function

Enuresis/incontinence indicates Kidney Yang Deficiency

Retention of urine indicates Damp Heat in Bladder
Difficult urination, especially with painful and dark urine, indicates Damp-Heat in
Bladder
Inability to complete urination, dribbling, or lack of force in urination indicates Kidney
Qi Deficiency, Dampness, or Cold
Frequent and copious urination, especially at night, indicates Kidney Yang Deficiency
Frequent and scanty urination indicates Kidney Qi deficiency
Frequent, scanty, and dark urination indicates Damp-Heat in Bladder

Pain associated with urination

Before urination indicates Stagnation of Qi in the Lower Jiao

During urination indicates Heat in Bladder
After urination indicates Deficiency of Qi

Urine Color

Pale indicates Cold of the Bladder and Kidney, usually from deficient Kidney
Yang
Dark, yellow, or reddish indicates Heat
Turbid or Cloudy indicates Dampness in bladder

Urine Amount

Large amounts indicates Kidney Yang Deficiency

Scanty amount indicates Heat or Dampness obstructing Bladder, Deficient Fluids,
or Kidney Yin Deficiency producing Empty Heat
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Sleep

The Heart is the residence of the Shen, and the Blood and Yin nourish the Shen. When Blood
and/or Yin is Deficient, the Shen has no residence and can not rest.

Unable to fall asleep but sleeps well once asleep is usually due to Deficient Heart Blood
Waking often during night is usually Heat disturbing the Shen
This can be due to Kidney Yin failing to nourish Heart Yin, Stomach Heat from retention
of food, etc.
Waking early or unable to fall asleep again indicates Gallbladder Deficiency. This is
common in the elderly as Qi and Blood are weaker.
Dream-disturbed sleep usually indicates Liver Fire and/or Heart Fire
Liver Fire and Heart Fire can be due to Kidney Yin Deficiency
[ Top of Page ]

Ears and Eyes

The Kidney opens to the ears, but not all ear disorders are related to the Kidney. The Shaoyang
channels (GB, SJ) travel to the ears, and some Exterior Heat conditions that affect the Shaoyang
can cause ear problems. Dampness and Phlegm can also obstruct rising of Yang to upper orifices
which can affect the ears.

Tinnitus (Ringing in the Ears)

Sudden onset indicates Excess condition, usually of Liver Fire or Liver Wind
Gradual onset indicates Kidney Deficiency
Aggravated by pressing on ears indicates Excess
Alleviated by pressing on ears indicates Deficiency
Loud, high pitched noise like whistle indicates Rising Liver Yang, Liver Fire, or Liver
Wind
Low pitched noise like rushing water indicates Kidney Deficiency

Deafness

Sudden onset indicates Excess condition, usually Liver Fire or Liver Wind
Gradual onset and chronic deafness indicates Deficiency, usually of the Kidney, or of
Heart Blood Deficiency, or Yang Deficiency

Eyes

Pain, swelling, and redness indicates Invasion by Exogenous Wind-Heat or internal Liver
Fire
Blurry vision and floaters indicates Liver Blood Deficiency
Photophobia indicates Liver Blood Deficiency
Pressure in eyes indicates Kidney Yin Deficiency and/or Liver Fire
Dryness of eyes indicates Liver/Kidney Yin Deficiency

[ Top of Page ]

Thirst ad Drink

For cold liquids indicates Heat

For warm liquids indicates Cold
Thirst for large amounts of Cold Water indicates an Excess Heat Pattern
No Thirst indicates Cold pattern, usually of the Stomach or Spleen
Thirst with no desire to drink indicates Damp-Heat
Thirst with desire to sip liquids slowly, or sip warm liquids indicates Yin Deficiency (of
Stomach or Kidney)
[ Top of Page ]

Pain
Excess conditions causing pain are usually due to Qi circulation in the Channels being obstructed
due to stagnation, cold, or heat. Deficient condition that cause pain are usually due to the
channels not being nourished by Yin and Blood. An Excess condition causes more severe pain,
while a deficient one causes more dull pain.

Excess Conditions

Invasion of exogenous pathogens

Interior Cold or Heat
Stagnation of Qi (causes distention more than pain, or vague distending sensation without
location)
Stasis of Blood, usually causes severe, localized, fixed, or boring pain
Obstruction by Phlegm
Retention of Food

Deficient Conditions

Deficient Qi and Blood

Deficient Yin with consumption of Body Fluids

[ Top of Page ]

Gynecological Conditions
Ask about Menstruation, Vaginal Discharge, Pregnancy, and Childbirth. A Woman's menses
give a clear idea of the condition of her Qi and Blood.

Important questions

Length
Duration
Amount of bleeding
Color
Quality of flow
Pain or other symptoms, before, during and after flow

Cycle

Early arrival of period indicates Heat in the Blood (red tongue) or Qi Deficiency (pale
tongue)
Late period indicates Blood Deficiency, Blood Stagnation, or Cold
Irregular period indicates Stagnation of Liver Qi or Deficient Spleen Qi

Amount

Heavy blood loss that is bright red indicates Heat in Blood, while pale and more scanty
blood indicates Spleen Qi Deficiency
Abnormal Uterine Bleeding indicates Heat in Blood, Deficient Spleen Qi, Stagnant Qi or
congealed Blood, or Deficient Liver/Kidney Yin
Scanty periods indicates Blood Deficiency or Stagnation of Blood or Cold Obstructing
Amenorrhea indicates Deficient Blood and Qi, Stagnant Qi/Blood Stasis, Deficient
Kidney/Liver Yin, Mucus dampness Obstructing Menses

Color

Normal color is a dull to medium red

Very dark red or bright red Indicates Heat in the Blood
Pale blood Indicates Deficiency of Blood
Purple/blackish blood Indicates Stasis of Blood or Cold

Quality

Congealed blood with clots Indicates Blood stasis or Cold

Watery blood Indicates Blood or Yin Deficiency
Turbid blood Indicates Blood Heat or Stagnation of Cold

Pain

Before periods indicates Stagnation of Qi or Blood, Cold/Cold Damp Obstructing

During periods indicates Stagnation of Qi or Blood, Stagnation of Cold, or Deficient
Blood and Qi
After periods indicates Qi and Blood Deficiency

Leucorrhoea
Color

White, thin, clear indicates Cold from Spleen or Kidney Yang Deficiency,
Exogenous Cold Damp, or Stagnation of Liver Qi
Yellow, especially if thick and accompanied by vaginal itching or soreness
indicates Damp-Heat in the Lower Jiao
Red and white discharge indicates Damp Heat
Yellow, with pus and blood after menopause indicates Toxic Damp-Heat in the
Uterus (the patient should be referred to a western physician for a complete
gynecological exam)

Consistency

Watery indicates Cold Damp

Thick indicates Damp Heat

Little or no odor indicates Cold

Strong odor indicates heat

Odor

[ Top of Page ]

Pregnancy and Childbirth

Pregnancy

Infertility due to Deficiency is usually because of Deficient Blood, Deficient Kidney Jing,
or Cold
Infertility due to Excess is usually because of Damp Heat in Lower Burner or Stasis of
Blood in Uterus
Vomiting during pregnancy indicates Stomach Heat, or Deficiency of Stomach and
Chong Mai
Miscarriage before three months may indicate Deficiency of Blood or Essence (Kidney)
Miscarriage after three months may indicate Stasis of Liver Blood or Sinking of Spleen
Qi

Childbirth

Nausea and heavy bleeding after delivery indicates Exhaustion of Chong Mai
Sweating and fever after delivery indicates Exhaustion of Qi and Blood
Postnatal depression may indicate Blood Deficiency has lead to Heart Blood Deficiency

TCM Diagnosis by Palpation (Pulse

Diagnosis) - One of the 4 Pillars

Divisions of the Pulse

Location of the Radial Pulses
The Method of Pulse Diagnosis
Factors Influencing Pulse

In Western medicine, the pulse is only a minor diagnostic tool, it is, however, very important in
TCM. Pulse diagnosis gives information on
1. The state of balance of the body as a whole, i.e. the state of the Qi, Blood, Yin and Yang,
and even the constitution.
2. The state of individual Organs (esp. Yin Organs).
TCM practitioners feel the pulse and note the rate. They discern width or amplitude, length, how
close it is to the surface, how deep and close to the bone, the strength, and other qualities.

Divisions of the Pulse

Three area of the Pulse:

Inch or Cun: Distal or Front (at wrist crease)
Bar or Guan: Middle (just medial to radial styloid process)
Cubit or Chi: Proximal or Rear

Three Levels of the Pulse:

Superficial: state of Qi and Yang Organs in general
Middle: state of Blood
Deep: state of Yin and Yin Organs
OR
Superficial: the condition of the Exterior or of the Upper Burner
Middle: Stomach and Spleen diseases
Deep: Interior diseases, esp. Liver and Kidneys

Location of the Radial Pulses

Three positions at each wrist, along the radial artery.

The pulses are palpated at three positions, superficial, middle and deep.
Most texts agree on the following:

The pulse essentially reflects the state of Qi in the different burners of the San Jiao (triple
burner).
Distal:

Upper Burner

Middle:

Middle Burner

Proximal:

Lower Burner

The pulse positions mainly give information regarding the Yin Organs. It is more difficult
to assess the Yang Organs at individual positions (we tend to assess the Intestines in the
Lower Burner position)

In pulse diagnosis, most important thing is to assess

Health of the Qi in general

Relationship of Yin and Yang on the pulse
Relative states of Deficiency and Excess
Whether an exterior pathogen is present

Each pulse position can reflect different phenomena in different situations. For example: The
Lung pulse full can occur as a result of emotional problem (grief) affecting Lungs or from
Phlegm in Lungs or from an Excess in Large Intestine channel, such as a tooth abscess.

The Method of Pulse Diagnosis

Feel pulses with the pads of the fingers (most sensitive part)
Hand must be relaxed - neither tense nor flaccid, but flexible and maintained in the pulse-taking
position with the minimum of effort.
Exercise: Tense the hand as much as possible. Then relax and let the hand droop. Then
gradually, with as much attention as possible, put just enough energy into your hand to lift the
fingers. Imagine your fingers are like the leaves of a tree; if you waved your arm your hand and
fingers would float gently after your arm. This is the optimum condition of the hand for pulse
taking, relaxed, flexible but responsive.
Place the third (middle) finger pad on the radial artery just medial to the styloid process. The
index finger is then placed in the distal position at the wrist crease and the ring finger in the
proximal position.

NOTE: on a small person, the fingers will have to be squeezed close together but on a large
person they may need to be spread out.
Try to feel the radial artery pulse with all three fingers. Use equal pressure on all three fingers
and then release the pressure on the middle finger slightly to compensate for the styloid process.
(The pressure of the radial artery on the styloid can produce an artificial pulse reading if the
same amount of pressure is exerted there. The pulse would then appear to be excessive in the
middle position.)
When you can just feel the radial artery, and have adjusted the pressure of your finger tips,
release the pressure equally until you can JUST feel the pulse. This is the superficial position.
Then press as deeply as possible (maintaining the relative pressure levels as before) until you cut
off the pulse altogether. Release the pressure until the pulse just returns. This is the deep
position.

Timing: Optimum time is early morning, when Yin is calm and Yang has not yet arisen.
Position: Patient's arm should be horizontal and not higher than level of heart. Most
practitioners use a table and place patient's wrists on a small cushion.
Finger Placement: Best to keep all fingers in place as described above, and only lift
fingers slightly to feel different levels.
Breathing: Practitioner must regulate his/her breathing in order to be more receptive.

Patient's pulse is traditionally correlated with the Practitioner's Breathing Cycle in order to
determine if patient's pulse is slow or rapid. (This was misinterpreted for a long time in the
West).
Normal pulse:

4-5 beats per practitioner's breath.

Three beats or less:

Slow Pulse

More than five beats: Rapid Pulse

Also pulse can be counted using a watch according to following table:
Age

Rate

1-4

90 or above

4-10

84

10-16

78/80

16-35

76

35-50

72/70

50+

68

Factors that Influence a Pulse Reading

The 4 Seasons: Pulse is deeper in Winter, more superficial in summer.

Gender: Men's pulses are naturally a little stronger. In men, the LEFT pulse is slightly
stronger and in women the RIGHT pulse is slightly stronger.
Occupation: those doing heavy physical work should have stronger pulse.
Patient should not have just eaten a large meal (1 hr. before OK). Otherwise, Stomach
pulse will read very high and other Organ readings may be depleted.
Allow the patient to rest after arrival at office.
Allow 15 minutes after urination, defecation or ingestion of liquids.
Pulse diagnosis should take place in a calm, restful environment.
Silence should be maintained during procedure.
Western medications can interfere with reading, as can hypertension, and structural
anomalies.

The 29 Pulses in Chinese Medicine (TCM)

Pulse Diagnosis
The Normal Pulse: reflects good Heart Qi and Blood. It should be calm, smooth, soft, but not too
soft, and not slow, rapid, rough or hard. It should be regular. Its quality should not change very
often or easily. Deep level and rear position should be felt clearly, indicating that the Kidneys are
healthy.
Note: Different sources vary on both their naming conventions and on the total number of
standard pulse images. We have tried to organize this information to include 29 pulse images and
their various names.

The Main Pulse Images

Fu Mai (Floating, Superficial)

Hong Mai (Surging, Flooding)
Ge Mai (Leathery, Drumskin, Tympanic, Hard)
Kou Mai (Hollow or Scallion Stalk, Green Onion)
Ru Mai (Soft or Soggy)
San Mai (Scattered)
Xu Mai (Forceless, Empty, Deficient)
Chen Mai (Deep)
Fu Mai (Hidden)
Lao Mai (Firm, Confined)
Ruo Mai (Weak)
Chi Mai (Slow)
Huan Mai (Slowed down, Moderate, or Relaxed)
Se Mai (Choppy, Hesitant)
Jie Mai (Knotted, Bound)
Shi Mai (Excess, Full, Replete, Forceful)
Hua Mai (Slippery, Rolling)
Jin Mai (Tight, Tense)
Chang Mai (Long)
Xuan Mai (Wiry, Taut)
Wei Mai (Minute, Faint, Indistinct)
Xi Mai (Thready, Thin)
Duan Mai (Short)
Dai Mai (Regularly Intermittent)
Shuo Mai (Rapid)
Ji Mai (Racing, Swift, Hurried)
Cu Mai (Rapid-Irregular, Skipping, Abrupt)
Dong Mai (Moving, Throbbing, Stirring)
Da Mai (Large, Big)

Fu Mai (Floating, Superficial)

Description:

Located in the exterior. With the finger raised, it has a surplus, when pressing
down it is insufficient, weak, or disappears. When pressure is released, it regains
full strength.

Indications:

External invasion, Yin Xu with Yang floating upwards, Qi or Yang Xu

Etiology:

Mainly an exterior condition, syndromes due to Xu, or Yang Qi loosing its root in
the lower part of the body and floating to the upper regions.

Hong Mai (Surging, Flooding)

Description:

Floating, large (i.e. wide) comes on exuberant, departs debilitated. "Coming onto
the shore with force and retreating without force"

Indications:

Extreme heat; if with thirst, high fever it can be Yangming heat or internal heat. If
surging and forceless, this is Xu surging.

Etiology:

This pulse has been said to arrive strong at the chi position and depart at the cun
position, thus its wave like character. The Yang is floating excess and upward,
this is a manifestation of fire floating upward and water drYing internally(i.e. loss
of blood, diarrhea)

Ge Mai (Leathery, Drumskin, Tympanic, Hard)

Description:

Bowstring and large (wide) with an empty center; feels like the head of a drum.
Felt with light pressure. Floating, large, and hard and resistant to pressure.

Indications:

Hemorrhage, Spermatorrhea, Abortion, Excessive Menstrual Flow, Xu Cold

Etiology:

The Qi becomes detached and floats to the exterior, the healthy Qi is failing to
store sperm and blood.

Kou Mai (Hollow or Scallion Stalk, Green Onion)

Description:

Floating, soft, large body, but empty in the center. Forceless--large and weak.

Indications:

Hemorrhage, Damage of Yin, Great Blood Loss (severe diarrhea/hemorrhage)

Etiology:

There is failure to fill the vessels by insufficient Ying and Blood causing Yang Qi
to detach and float to the surface.

Sources disagree on the description of this pulse, some say that the beats around
the middle level are palpable(i.e. light or heavy pressure) and the beats at the
middle level are impalpable. Bob Flaws says that "a pulse which is empty in the
center is an extreme floating pulse which not only gets weaker when one presses
down but disappears altogether. It only reappears again when pressure is released
to the superficial level."

Ru Mai (Soft or Soggy)

Description:

Floating, fine, soft and flexible. Can be felt with light pressure but cannot be
obtained by heavy pressure. "Floating, thready, and soft" "Like a silk thread in
water"

Indications:

Primarily means Dampness, can be Yin Xu, Blood Xu, Spleen Xu

Etiology:

The dampness is obstructing the vessels or the Qi and Blood are unable to fill the
vessels giving it its soft quality. This is distinguished from other floating pulses,
which tend to be large(i.e. wide)

San Mai (Scattered)

Description:

Floating, large (ie.wide) and without root; with light pressure it is easily irregular,
becoming scattered and chaotic; with heavy pressure it is impalpable.

Indications:

Dispersion of Yuan Qi, Kidney Yuan Qi Xu, severe deficiency and exhaustion of
internal organ Qi

Etiology:

This pulse is without root, without definite edges and boundaries, not
characterized as an irregular beat pulse, although it feels chaotic. It is a further
progression from the Kou Mai (Hollow), being even weaker than the Kou Mai.
"Like wind blowing hair or scattered leaves"

Xu Mai (Forceless, Empty, Deficient)

Description:

Generalized term for various types of forceless pulses or is described as a floating,

large, slow, empty. deficient, soft, forceless pulse image.

Indications:

Qi and Blood Xu Can be damage by summerheat.

Etiology:

Chen Mai (Deep)

Description:

Located near the bone. Cannot be detected with light or moderate pressure but can
be felt with heavy pressure. (Not to say it is impalpable at lighter pressure)

Indications:

Interior patterns. If deep and rapid=Interior heat. If deep and slow=interior cold. If
deep and forceless=Qi and Yang Xu If deep and forceful=excess of internal
disease.

Etiology:

Pathogens in the interior are obstruction healthy flow of Qi and Blood.

Fu Mai (Hidden)
Description:

Difficult to feel, under the sinews, not obvious, requires heavy pressure to obtain.
Almost to the bone. Deeper than the deep pulse.

Indications:

Severe pain, extreme stagnation,(of food or of pathogens), syncope, last stage of

an illness, coma, and lack of circulation.

Etiology:

Lao Mai (Firm, Confined)

Description:

Pressed superficially or moderately, it does not respond, but can be obtained by

heavy pressure. Hard, firm, not changeable, replete, large, bowstring, and long.

Indications:

Internal cold, perhaps hernia, abdominal masses. Can also indicate wind epilepsy,
inflexibility, and cramping, hard accumulations hidden in the interior, running
piglet and sudden violent counterflow.

Etiology:

The pathogenic factors are steady, there is interior cold and decline of Yang Qi

Ruo Mai (Weak)

Description:

Deep, fine, soft like a thread.

Indications:

Simultaneous Qi and Blood Xu

Etiology:

Blood Xu results in failure to fill the vessels and Qi Xu results in its forcelessness.

Chi Mai (Slow)

Description:

Below 60 BPM or less than 4 beats per practitioners breath.

Indications:

Etiology:

Cold syndromes. Forceful and slow=accumulation of cold; Forceless and

slow=cold from Xu Slow and floating=external cold. Slow and deep=interior
cold. Slow and choppy=blood disease. Slow and slippery=Qi disease.
There is stagnation of Qi due to cold. There may be other factors as well, such as
obstruction of blood due to accumulation of heat, this pulse must be forceful and
excessive when palpated (i.e. Yangming)

Huan Mai (Slowed down, Moderate, or Relaxed)

Description:

As a ping mai, or normal pulse it is level and harmonious, relaxed and forceful.
As a bing mai or abnormal pulse it is relaxed, loose, slack, on the verge of slow.
About 60 BPM. The beats come and go slowly, feels viscous, the rate is like
normal but the slowness shows up at the end of a beat, before a slow pulse.

Indications:

Syndromes of Damp, SP/ST Xu Not enough Qi and Blood to fill the vessels.

Etiology:

May also be due to wind if floating and relaxed. If it is deep and relaxed is is
damp syndrome. If large and relaxed=liver wind internally, if relaxed and weak it
may signify heart Qi Xu

Se Mai (Choppy, Hesitant)

Description:

Slow, relaxed, stagnant, difficult, fine, may stop and loose a beat but then
recovers. It is not smoothly flowing. It feels like a knife scraping bamboo.

Indications:

Consumption of essence, Blood Xu, Stagnation of Qi, Blood Stagnation, Phlegm

or food stagnation. It can also be due to heart palpitations.

Etiology:

Blood and essence failing to nourish the meridians. Blood is not flowing
smoothly.

Jie Mai (Knotted, Bound)

Description:

Slow, relaxed, stops at irregular intervals.

Indications:

Stagnation of Qi due to excess Yin, Blood Stasis due to cold phlegm, Blood
Stagnation. Sometimes abdominal masses, also indicates Heart palpitations.

Etiology:

Yin and Yang out of balance due to excess Yin. (This represents an irregular beat
or palpitation stemming from the ventricle of the Heart)

Shi Mai (Excess, Full, Replete, Forceful)

Description:

Bowstring, large, hard and replete pulse which has a surplus at all 3 levels of
cunkou.

Indications:

Excess condition where both pathogenic and anitpathogenic factors are strong.

Etiology:

Blood vessels are full with both Qi and Blood

Hua Mai (Slippery, Rolling)

Description:

Comes smoothly flowing and uninhibited; feels smooth like pearls rolling in a
dish. Beats come and go fluently and smoothly, feeling slick to the fingers.

Indications:

Phlegm retention, indigestion, excess heat. May also indicate dampness. The Hua
Mai is considered normal (ping mai) for women during pregnancy or
menstruation.

Etiology:

The smooth and slick pulsation is caused by the accumulation of pathogens in the
interior with sufficiency of Qi and Blood.

Jin Mai (Tight, Tense)

Description:

Tight, has strength, feels like a taut rope. Feels like a stretched and twisted rope.

Indications:

Cold or Pain. Undigested food

Etiology:

Caused by the contraction of tense vessels resulting from the conflict between
cold and healthy Qi and the obstruction of Yang Qi

Chang Mai (Long)

Description:

Long and can be felt beyond its location. Felt past the cun position.

Indications:

Excess liver Yang, Yang and Heat Excess in the Interior, Strong Pathogenic
factors

Etiology:

A long and smooth pulse can be normal (ping mai) for some people, the long
characteristic is usually present with wiry.

Xuan Mai (Wiry, Taut)

Description:

Feels straight, long and tense, like the feeling of pressing a tight string of a
musical instrument. Crisp and distinct edges, tends to reveal itself when one
slightly lets up on the pressure.

Indications:

Liver and Gall Bladder disease, various painful disorders, phlegm retention,
malaria, abnormal circulation of Qi

Etiology:

Tense vascular Qi due to the liver not gently performing its function, can also be
due to the retention of a pathogen in the liver. If wiry, Thready and forceful-like
feeling the edge of a knife is indicative of Stomach Qi exhaustion.

Wei Mai (Minute, Faint, Indistinct)

Description:

Insufficient, extremely fine, soft, barely palpable. It may be felt and then
sometimes it is lost. "Extremely Thready and soft"

Indications:

Decline of Yang Qi. Yin, Yang, Qi, and Blood Deficiency.

Etiology:

The Yang Qi cannot push the blood in the vessels or the Yin/blood cannot fill the
vessels.

Xi Mai (Thready, Thin)

Description:

Soft, feels like a silken thread, weak, without strength but not scattered by
pressure.

Indications:

Qi and Blood Xu, various deficiency syndromes, disorders due to Damp. Does not
indicate weakness.

Etiology:

Impairment of Ying Blood fails to make the vessels plentiful. Qi is too deficient to
move the blood. May also occur due to compression of vessels by dampness.

Duan Mai (Short)

Description:

Does not reach(i.e. fill longitudinally) its location or range. Can be felt most
clearly at the Guan position, more indistinct at the Cun and the Chi.

Indications:

Short and forceful indicates Qi Stagnation, Short and weak indicates Qi Xu

Etiology:

Qi is failing to move the Blood.

Dai Mai (Regularly Intermittent)

Description:

Comparatively relaxed and weak, stops at regular intermittent intervals. These

intervals may be strikingly long.

Indications:

Decline of Zang Fu (organ) Qi, Wind Syndromes, Pain, Terror, Fear, Trauma.

Etiology:

Flaws: "Patients with this pulse have advanced heart disease according to western
medicine and should be immediately referred to a western doctor"

Shuo Mai (Rapid)

Description:

Above 90 BIM, or more than 5 beats per breath.

Indications:

Heat Syndromes. Forceful and rapid = excess heat. Weak and rapid = Deficiency
Heat.

Etiology:

Hyperactivity of heat accelerating Qi and Blood. Rapid pulse may be weak when
it's Yin Xu due to a chronic disease resulting from interior deficient heat. Rapid
pulse, when seen in cases of floating of Yang Xu, must be large and weak with a
sense of emptiness.

Ji Mai (Racing, Swift, Hurried)

Description:

Very rapid, over 120 BIM, or 7-8 beats per breath.

Indications:

Excess of Yang and exhaustion of Yin, impending exhaustion of primary Qi Can

also be due to Heart Palpitations.

Etiology:

Exhaustion of Yin in the lower body and excess of Yang in the upper parts. Often
accompanies high temperatures. Swift and wiry=not enough true Yin,
overabundance of Yang. Swift and forceful=Primary Yang will be exhausted.
Note: This can be normal for infants.

Cu Mai (Rapid-Irregular, Skipping, Abrupt)

Description:

Rapid and irregularly interrupted.

Indications:

Excess Heat, Domination of Yang, Qi, Blood, Phlegm and Food Stagnation. This
can be from an Atrial Fibrillation.

Etiology:

This is clinically very severe, Yin and Yang are not in communication.

Dong Mai (Moving, Throbbing, Stirring)

Description:

Slippery, rapid, forceful, feels like a bean--strong and throbbing abruptly.

"Without head or tail" This is most distinguished at the Guan position, and is a
subcategory of the short pulse.

Indications:

Pain, Fright, Shock

Etiology:

Conflict between Yin and Yang, disturbance of ascending and descending, leading
to faster circulation of Qi and Blood which makes it appear smooth, rapid, and
forceful yet palpable over a narrow region.

Da Mai (Large, Big)

Description:

Large, fills up the fingertip, forceful. Similar to the Hong Mai, but does not have
the wave-like shape

Indications:

Advance of a disease due to domination of pathogenic factors and also Deficiency

Syndrome.

Etiology:

It is possible to differentiate exuberance or decline of pathogenic factors and the

health of the Qi according to whether Large pulse is forceful or weak.

Tongue Diagnosis in Chinese Medicine

Introduction
The tongue has many relationships and connections in the body, both to the meridians and the
internal organs. It is therefore very useful and important during inspection for confirming TCM
diagnosis. It can present strong visual indicators of a person's overall harmony or disharmony.
The tongue has a special relationship with the Heart, in that the Heart opens to the tongue. The
tongue is said to be an "offshoot" of the Heart, or "flowers" into the Heart.
The normal tongue in Traditional Chinese Medicine has a light red or pinkish body with a thin
white coating.

Connections
Channels/Meridians Reaching the Tongue

Heart Channel (Hand Shaoyin)

- The Luo connecting channel connects to the root of the tongue.
Spleen Channel (Foot Taiyin)
- An internal branch of the primary channel spreads over the lover surface of the tongue.
- The tongue is penetrated by the Spleen Divergent channel
Kidney Channel (Foot Shaoyin)
- An internal branch of the primary channel terminates at the base of the tongue.
Bladder Channel (Foot Taiyang)
- A branch of the muscle/sinew channel binds to the root of the tongue.
San Jiao Channel (Hand Shaoyang)
- A branch of the San Jiao muscle channel links with the root of the tongue.

Tongue areas as they correspond to internal organs in Chinese Medicine

Tongue Diagnosis Method and Cautions

Lighting
Sunlight will give the most accurate color of the tongue body and coat. If sunlight is not
available, use a second light source such as a small flashlight to compare the tongue color
to the original light source.
Position
The tongue should be extended in a relaxed manner, and should not be held out for an
extended duration.

Food and Drink

Food and drink, such as coffee, green tea, and candy may alter the color of the tongue
coating.
Brushed Tongue
Some patients may brush their tongue to help freshen their breath or as an Ayurvedic
practice. Ask the patient not to brush their tongue, at least the day of their TCM tongue
diagnosis.
Seasons of the Year
In Summer, there may be more Dampness present in the tongue coating, leaving it
slightly thicker and light yellow.
In Fall or Autumn, the tongue may be thinner with a coating that is more dry.
In Winter, there may also be more moist or damp presenting in the tongue.
In Spring, the tongue should be normal.
Time of Day
The coating of the tongue usually becomes thinner as the day progresses, while the color
of the tongue body becomes more red and shiny.
Patient's Age
In the elderly, Qi and Blood Deficiency is more common, so the tongue may present with
dryness and cracks.
Infants tend to have white thick coating that is easily removed, peeled tongues are also
common.
Overweight patients usually have more Damp and/or Phlegm and therefore their tongues
may be larger and lighter in color.
Thin patients tend towards redder tongues.
[ Top of Page ]

Tongue Feature Indications

Tongue Body Color

Tongue Body Shape
Tongue Body Features
Tongue Body Moisture
Tongue Coating
Tongue Coat Thickness
Tongue Body Cracks
Tongue Coat Root
[ Top of Page ]

Tongue Body Color

Indicates the state of Blood, Yin organs, and Ying (Nutritive) Qi.
Normal Tongue Body

Pink or light red in color

Bluish Purple or Reddish Purple Tongue Body

Purple can indicate both Heat and Cold conditions.

A reddish purple tongue indicates Heat and Blood Stagnation.
A dark reddish purple tongue that is dry usually indicates depleted fluids due to
Excess Heat
A light purple, bluish purple, or greenish purple tongue body color can indicate
Cold and Blood Stagnation.

Red Tongue Body

A red tongue body is darker than the normal red, which is pinkish in color. It
indicates either Deficient or Excess Heat.
A red tongue body with a thick yellow coat or swollen buds indicates Excess Heat
A red tongue body with a bright shiny coat, little coat, or no coating indicates
Deficient Heat.

Red Tip

Heat in the Heart Zang

Scarlet Tongue Body

A scarlet tongue that is also peeled or shiny indicates Yin Deficiency, usually of
the Heart and/or Lung depending on the area of swelling.

Dark Red Tongue Body

The red is darker and more crimson in color. This tongue body can indicate
internal injury such as trauma (De Da), invasion of external evil in the Ying
(Nutritive) and Xue (blood) levels, or it can indicate Blood Stagnation.
If there are red spots with a thin coat, this usually indicates damage to the Ying or
Xue level.
If the tongue body also has cracks and there is little or no tongue coat, this usually
indicates Deficient Heat due to internal injury.

Pale Tongue Body

Indicates the quality of Blood, reflecting Blood and/or Qi Deficiency or Cold.

If the tongue body is also moist, tender, and swollen, this can indicate Yang Cold.
A pale thin tongue body usually indicates Qi and Blood Deficiency.

Green Tongue Body

A green tongue body usually indicates Excess Yin Cold or the presence of a
strong Excess evil with weak Zheng Qi. The Yang is not properly moving Blood
and Fluids and there is Stagnation in the body.
Internal Wind may also present with a green tongue body.
[ Top of Page ]

Tongue Body Shape

The body shape reflects the state of Blood and Ying (Nutritive) Qi, and indicates Excess or
Deficiency. Constitution can also affect the shape of the tongue body.
Stiff

A stiff or rigid tongue is difficult to move (protrude, retract, side to side). This
may cause speech abnormalities such as slurring or mumbled speech. A stiff
tongue is an indication of Excess, and often one of Internal Wind.
If a stiff tongue is accompanied by a bluish purple tongue body, this usually
indicates potential or impending Wind-Stroke.
If a stiff tongue is accompanied by a bright red tongue body, this usually indicates
heat in the Heart and Pericardium disturbing the Shen (Spirit).
If a stiff tongue is accompanied by a thick sticky tongue coating, this usually
indicates "Phlegm Misting the Heart".

Flaccid

The flaccid tongue is the opposite of the stiff tongue. It is weak and lacks
strength. It usually indicates Deficiency. When heat has consumed and damaged
body fluids, they can not rise to nourish the tongue. This can indicate Yin
Deficiency, Qi Deficiency and/or Blood Deficiency.
A flaccid tongue that is also pale usually indicates Qi and Blood Deficiency.
A flaccid tongue that is also dark red, dry, and has cracks usually indicates
extreme heat injuring fluids.
A flaccid tongue body with a scarlet tongue body usually indicates Exhaustion of
Yin.

Swollen

This is a very large tongue body and can indicate both Excess and Deficiency.
A swollen tongue that is also pale can indicate Qi Deficiency
A swollen tongue that is also bright red and painful can indicate Heart and Spleen
Heat. This could also be due to excess alcohol consumption.

Big or Enlarged Tongue

An enlarged tongue can indicate Phlegm, Damp, or Water Stagnation.

An enlarged tongue with a pale body and a moist coat may indicate Spleen and
Kidney Yang Deficiency
An enlarged tongue with a red body and a greasy yellow coat may indicate Spleen
and Stomach Damp-Heat.

Half the Tongue Is Swollen

A half swollen tongue may indicate general weakness of the Channels.

Hammer Shaped

This is where the front half or third of the tongue is enlarged at the sides.
A hammer shaped tongue usually indicates Spleen, Stomach, and Kidney
Deficiency
This tongue is almost always indicative of a serious condition, and may indicate
mental illness.

Local Swelling on One Side

Localized swelling of tongue with a normal tongue body color indicates Qi

Deficiency
Localized swelling of tongue with a red tongue body color indicates Qi and/or
Blood Stagnation

Swollen Sides

A tongue with swelling in Liver and Gallbladder area usually indicates Rising
Liver Yang or Liver Fire.

Swollen Between the Tip and the Central Surface

This area corresponds to the Lung area and usually presents with a normal or pale
tongue body.
This tongue is usually found in patients with chronic Lung and Spleen Deficiency,
which tends toward Damp and Phlegm accumulation.

Swollen Edges

This tongue may indicate Spleen Qi or yang Deficiency.

If Spleen Yang is Deficient, the edges will also be wet.

Swollen Tip

When the very tip of the tongue is swollen, it usually indicates Heart problems.
If the tongue is also deep red, this may indicate Heart Fire.
If the tongue is normal in color or pale, this may indicate Heart Qi Deficiency.

Short and Contracted

When the patient can not show the entire tongue, it usually indicates a more
severe disease.
If the tongue is also moist and pale, this indicates stagnation of Cold
(bluish/purple) in the meridians or Spleen Yang Deficiency.
If a contracted tongue also has a sticky tongue coating, this may indicate TurbidPhlegm blocking the channels.
If the tongue is also deep red and dry, excessive heat has consumed Body Fluids
and stirred up internal Wind.
A short, swollen, tender, and pale tongue usually indicates Qi and Blood
Deficiency.
A short or small frenum may be inherited and is normal.

There is difficulty in retracting the tongue.

This indicates interior Excess Heat, Heart Fire, or Phlegm-Fire Misting the Heart.
There may be numbness which is associated with

Long

Front Swollen

Swelling towards the front one-third of the tongue may indicate Phlegm retention
in the Lungs.

This can indicate that Qi and Blood are deficient and not able to properly nourish
and moisturize the tongue. The tongue body will also usually be pale in color with
Qi and Blood Deficiency.
A thin tongue that is also dark red and dry may indicate Yin Deficient Fire.

Thin

[ Top of Page ]

Tongue Body Features

Rough or Tender Texture

A tender tongue that appears smooth, delicate, and is possibly swollen indicates
deficiency.
A rough tongue that appears wrinkled and rough indicates Excess.

Red Spots

Red spots may indicate Heat Toxins in the Blood or Heat Toxins attacking the
Heart.

Red spots can indicate the presence of Damp-Heat in the Xue Level, where the
internal organs are accumulating toxins.
Red spots on the Tip (Lung/Heart area) is usually not severe and may present in
the beginning stages of illness.
Red spots on the entire tongue may indicate a more severe illness.
Red spots on the sides of the tongue (Liver/Gallbladder area) may also indicate a
more severe illness.
Red spots on the back of the tongue (Kidney area) may indicate the advanced
stage or chronic nature of an illness.

White Spots

White spots are usually due to Spleen and Stomach Qi Deficiency together with
excess heat accumulating in the body. In this case, the tongue may also have sores
and pus.

Black Spots

Black spots usually indicate Qi and Blood Stagnation or heat in the Blood.

Ulcerated Tongue Body

in progress...

Numb Tongue Body

in progress...

Loose Tongue Body

in progress...

Deviated Tongue Body

This is where the tongue tends toward one side of the mouth
This is due to Wind, either from exterior Pathogenic Wind or internal WindDamp patterns.

Moving, Lolling, Wagging, Playful Tongue Body

This usually indicates heat in the Heart and Spleen channels stirring up internal
Wind.
In children, this may indicate developmental problems.

Rolled Tongue Body

in progress...

Teeth Marks on Tongue Body (Scalloped)

If the tongue body has normal color, this usually indicates Spleen Qi Deficiency
If there are teeth marks together with a swollen tongue, this may indicate Spleen
Yang and/or Qi Deficiency.
If the tongue is also pale and moist, it is more likely Spleen Yang Deficiency or a
Cold-Damp pattern.

Quivering or Trembling Tongue Body

Trembling of the tongue that can not be controlled may be due to external febrile
disease or excess heat consuming Yin. The excess heat stirs up Internal Wind.
The tongue body will be a deep red color and the pulse will be rapid.
If the tongue body is pale and trembling, this usually indicates a chronic condition
of Qi and Blood Deficiency, where the tongue is not being nourished.
Side effects of some western medications (pharmaceuticals) may cause trembling
of the tongue.

Sore Covered Tongue Body

in progress...
[ Top of Page ]

Tongue Body Moisture

Reveals the state of Yin and Fluids in the body.
Dry Tongue Body

in progress...

Slightly Dry Tongue Body

in progress...

Wet Tongue Body

in progress...

General Deficiency and Excess of Yin and

Yang
Quality of:

Excess Yang Acute

(Excess Heat
Condition)

Yin Xu - Chronic Excess Yin (Deficient Heat

Acute
Condition)
(Excess
Cold/Dampness
Condition)

Yang Xu Chronic
(Deficient Cold
Condition)

Pulse
Normal:
Moderate

Rapid, Strong.

Rapid, Weak.

Slow.

Slow, Weak.

Tongue
Normal:
Pink/Light
Red

Red Body, Yellow

Coat

Red Body,
Thin/No Coat

Pale/Pink Or
Purplish/Bluish
Body.

Notes:
Yellow Due To
Heat Burning Body
Fluids.

Notes:
Light Mild
Heat/Slow Boiling
Heat.
Map Coating
(Partial Peel: Only
Part Of Tongue
Has Coat).

Pale Body,
Thin/White
Coat (Normal),
Flaccid.

Face

- Could Be
Thinner

- Poss. Thick Coat

- Poss. Swollen

- Poss. Teeth
Marks Over
Months Or
Years

Notes:
Thickness Due To
Excess Body
Fluids.
Notes:
Not Excess Or
Additive Cold,
More Of A Xu
Cold.
Has Nothing To
Do W/Yin
Fluids.
Water
Metabolism
Slows, Causing
Chronic Water
Retention
Problem.

Red.

Only Cheeks Red. Pale.

- Poss. Dryness

- Poss. Dryness

- Poss. Swollen

Pale.

Eyes

Skin

Red.

Red, Dry.

Notes:
If Inflammation Is
Involved There Will
Be Burning
Sensation.
Any Burning
Sensation Is Usually
Associated W/Heat.

Notes:
Dryness Due To
Fluid Xu, And
Heat Excess.

Red, Inflamed.

Dry Skin.

- Poss. Skin Rashes

- Poss. Rash, But

No Puss Or
Wounds

Notes:
If Patient Sweats, It
Will Be A Profuse
Sweat.

Strong/Loud Cough
W/Phlegm.
- Poss. Yellow,
Green, Or Brown
Phlegm. Indicates
Infectious Disease

Dark Circles.
Notes:
Dark Circles
Due To
Slow/Poor
Circulation.
Kidney
Involved:
Kidney Qi Xu,
Or Kidney
Yang Xu.

Oily Skin, Body

Odor, Pale.

Spontaneous
Sweat W/Wo
Exertion.

- Poss. Rashes
W/Puss If There Is Notes: Door Is
Dampness
Open,
Functional
Yang Energy
- Poss. Sweat, But
Xu, So Sweat
Only In Late
- Poss. Cysts,
Afternoon, Or At Masts, Edema Due Leaks Out.
Night
To Fatty Tissue
Stagnation
- Poss. Five Palm
Heat

Lungs

Edema Around
Eyes.

Notes:
If There Is Sweat,
It Will Be Greasy
And Oily.
Dampness Tries
To Protect The
Evil By Pulling It
Down, Inhibiting
Sweat From
Benefiting Fever
Condition.

Weak/Dry Cough. Profuse Thick

White/Clear
- Poss. Aftermath Phlegm.
Of Illness
Notes:
Smokers Cough.

Shortness Of
Breath,
Difficulty
Breathing, Or
Weak Shallow
Breathing.
Notes:

Heart

- Poss. Blood

Asthma Has
Both Lung And
Kidney Xu.

Very Rapid/Strong
Beat.

Weak Heart
And Low
Functional
Energy, Lots Of
Heart Problems.

Rapid/Weak Beat. Very Poor Blood

Circulation.
- Poss.
Notes:
Discomfort/Pain
- Poss. Heart Pain
Stimulants Such As Around The Heart
Coffee & Cigarettes
- Congestion:
Are Excess Yang
Blood Clots Due
Additives Into The
To Blood
System.
Stagnation
Notes:
Heart Failure
Prevalent.

- Poss. Skipping
Heart Rates
- Poss. Cardiac
Pain, And
Cardiac Failure

When There Is
Stagnation There
Is Pain, No
Stagnation, No
Pain.
Angina.
Appetite

High.

Hungry, But Can

Not Eat.

Very Low
Appetite.

Notes:
Notes:
Patient May Eat A
Lot, But Do Not
Gain Weight

- Poss. Gas,
Bloating,
Abdominal Pain,
Nausea,
Vomiting,
Diarrhea
Notes:
Deficient Fluids
(Insufficient To
Digest Food).

Thirst

High Thirst, Likes

High Quantity Of
Cold Drinks.

Very Low
Appetite, No
Energy To
Eat/Digest.

Crave Foods That - Poss.

Create Dampness, Undigested
Food In Stool
Such As Raw Or
Greasy Foods,
Makes Patient Feel
Comfortable.
Could Be Cause
Of Illness.

Thirsty, Sips Cool Might/Might Not

Drinks, But Can
Have Low Thirst.
Not Drink Very
Much.

Low Thirst,
Likes Warm
Water.

Digestion

Bloating, Stool Will

Be Dry, W/Difficult
Bowel Movement,
Extending Pain,
Sharp Pain, Does
Not Like Pressure,
Does Not Like Heat.

Dry Hard Stool

(Chronic). Dull,
Achy Abdominal
Pain, W/A Little
Burning
Sensation. Likes
Pressure, Does
Not Like Heat.

- Poss. Burning
Diarrhea Associated
W/Damp Heat Or
From Extreme Heat
Stagnation. Truly A
Constipation
Condition Where
Only Fluids Can Be
Passed (Appears To
Be Diarrhea), But
Solids Are Not
Passed

Sticky Stool
W/Mucus, Poorly
Formed.
Abdominal Pain.
Does Not Like
Pressure. Likes
Heat.

Weak/Slow
Digestion. Mild,
Dull, Achy
Abdominal
Pain. Likes
Heat, Likes
Pressure.

- Poss. Diarrhea

- Poss. Early
Morning
Diarrhea.
Lowest
Environmental
Yang.

Notes:
Do Not Give
Patients Warm
Water Or Spicy
Foods.
Kidney /
Bladder
(Water
Metabolism)

Dark, Scant, Yellow Scant, Light

Urine, Strong
Yellow Urine,
Urinary Track
Low Grade UTI.
Inflammation (UTI).
- Poss. Chronic
- Poss.
Extending/Sharp
Pain
Notes:
UTI Symptoms:
Urgency,
Frequency, And
Burning Sensation.

Copious Urination, Copious, Clear,

Light/Whitish
Frequent,
Colored.
Usually Night
Urination.
- Poss. Cloudy Or
W/Puss Due To
- Poss. Feeling
Dampness
Of Not Being
Finished, Due
To Lack Of
Functional
Energy
Notes:
Kidney Yang
Deficiency
Problem.

Reproduction

Strong/Excess Sex
Drive

Slightly Higher
Prone To STD's,
Sex Drive, But
Yeast, Infections,
Tires Easily (Hard Warts, Cysts.
- Poss. High Chance Time Performing).
Of Contracting
Illness (Fatigue,
- Poss. Vaginal
PID's, STD's,
Dryness
Prostatitis)
- Poss. Hormone
Imbalance

Menses
Normal:
Regular, No
PMS, No
Cramps, No
Clots, No
Spotting

Very Red Color,

Short Cycle.

Brown Or Dark
Red, Scanty.

- Poss. Early
Menstruation (5 To
7 Days)
Notes:

Low Sex Drive,

Can't Perform.
- Poss.
Infertility,
Premature
Ejaculation,
Nocturnal
Emissions, Low
Sperm Count

Dark Purplish,
Long Period Or
No Period Due To
Excess Fluids Or
Cold Respectively

Long Cycle,
Thin, Or Light
Colored,
Delayed
Menstruation.

- Poss. Blood
Clots

- Poss. Skipping
Cycle (No
Cycle)

Wants To Sleep,
Groggy After
Sleep.

Wants To Sleep
A Lot, Likes To
Take Naps, And
Always Feels
Better After
Sleep.

Blood Is Either
Dried Up In A Short
Cycle, Or Heavy
Due To Pushing
Force Of Heat.
Sleep

Does Not Like To

Sleep, Toss And
Turn, Restless.

Trouble Falling
Asleep,
Symptoms Worse
At Night.

Notes:
Coffee Is A Good
Example Of Excess
Functional Energy
Added To The
System.

Notes:
- Poss. Day Time
Naps, Easier To
Fall Asleep

Clear Yang Gets

Pulled Down By
Dampness.

Notes:
Blood Deficiency.

Energy

High Level Of
Energy, Restless.

Restless, But
Often Feel Tired,
Exhausted. Tired, Lethargic w/no
But Cannot Sleep. Motivation.

Weak, Due To
No Functional
Energy, True
Weakness.

Emotions

Angry, Anxious,
Agitated, Restless

Angry And
Clinical, Mental,
Anxious, But Less Or Neurological

Sad, Depressed,
No Motivation,

All The Time.

Energy Behind
The Emotion.

Disorders.

Cannot Interact,
Afraid, Low
Self Esteem.

Notes:
Two Types Of
Mental Illness.
Phlegm Misting
The Heart: Not
Social, Hide In A
Corner. Phlegm
Heat
Attacks/Invades
The Heart.
Speech

Loud, Rapid, Talks

A Lot.

Speaks Quickly,
But Not Loud Or
Strong.

Slow Speech,
Heavy Or
Phlegmy Voice,
Speech Disorders,
Esp. W/Tongue
Swelling.

Slow And
Weak. Mainly
Yes Or No
Answers.

Body
Temperature

Hot, High Fever,

Sensitive To Heat.

Low Grade Fever, Cold, Sensitive To Very Cold,

5 Palm Heat (Also Cold.
Sensitive To
called 5 Center
Cold.
Heat).

Ba Gang Diagnosis
Identification of Patterns According to the Eight Principles/Patterns

Interior/Exterior
Hot/Cold
Full/Empty
Yin/Yang

The Eight Principles is an important basic paradigm in TCM, as it shows the Location and
Nature of the imbalance. Using Eight Principles we learn the basic characteristics of the
presenting imbalance.

Interior/Exterior
Interior/Exterior indicates the location of the disharmony, not the cause. For example: Diseases
caused by an exterior pathogen may begin in the exterior, but in time they may affect the interior
(such as the internal organs).

Interior
Internal Organs are affected, and is usually due to an internal (emotional) or miscellaneous
cause. It is occasionally caused by exterior pathogens that have penetrated into the Interior.
It is important to note that once a disease is in the Interior, it is classified and treated as Interior
regardless of its etiology. For example: Exterior Wind Cold may penetrate into the Lung Organ
and causes cough with Phlegm, which is an Interior condition.
Symptoms and signs extremely varied according to Organ affected and Hot/Cold and Full/Empty
nature.

Exterior
Exogenous Pathogens produce Exterior conditions that can affect the skin, muscles and channels.
The Two types of exterior conditions are:
1. Those disorders affecting skin & muscles, caused by exogenous pathogen, that have acute
onset.
Example: Invasion of Wind-Cold or Wind-Heat into Exterior
Wind Cold:

Wind Heat:

Chills with low grade

fever or no fever
no sweating
aching
headache
stiff neck
stuffy nose
fear of cold
scratchy throat
cough

fever
milder chills
sweating
milder aching
headache
less painful stiff neck
stuffy nose
fear of wind
sore throat
cough

2. Those affecting the channels (can be acute or chronic)

Example: Bi Syndrome (Painful Obstruction Syndrome) which is where exogenous pathogens
(Wind, Damp, Cold) penetrate channels and obstruct the circulation of Qi causing pain.
[ Top of Page ]

Hot/Cold
Describes the basic nature of the imbalance. The Clinical manifestations depends on whether the
condition is Full or Empty.

Full Heat - Excess Heat in the Interior

Main Signs: Fever (sometimes), thirst, red face, red eyes, constipation. Urine is scanty and dark.
Pulse: Rapid and Full
Tongue: Red with yellow coating
Following are some very general signs of Full Heat that may also be present. Exact symptoms
depend on Organ(s) affected.

Raised, red skin eruption that feels hot e.g. acute urticaria
Any burning painful sensation e.g. urine or stomach pain
Loss of blood with large quantities of bright red blood indicates Heat in the Blood
Extreme mental restlessness/manic behavior (Heat in the Heart)
Thick, yellow, sticky, malodorous secretions/excretions

Full Heat is caused by Excess of Yang energy in body.

Common causes of Full Heat are:

Too much hot-energy food (influences LIV or ST)

Long term emotional distress (stagnation of Qi causes Liver or Heart Heat)
Exogenous pathogen invades body and transforms into Heat once inside body. For Example;
Exterior Cold or Heat turns into Heat and settles in Stomach, Lung or Intestines: symptoms may
include high fever, sweating and thirst.

Empty Heat - Deficient Yin in the Interior

Main Signs: Afternoon fever or feeling of heat in afternoon, dry mouth, dry throat at night, night
sweats, fever in 5 hearts, dry stools, scanty-dark urine, mental restlessness and fidgeting, vague
anxiety.
More specific signs depend on Organ involved.
Pulse: Floating-Empty and Rapid or Thin and Rapid
Tongue: Red, in severe cases peeled. No Coating.
Common cause of Empty Heat is Kidney Yin Deficiency, as the Kidneys are the foundation of
all Yin energies of body.
Kidney Yin Deficiency can lead to:

Deficiency of Lung Yin - Malar flush, dry cough

Deficiency of Liver Yin - Headaches, dry eyes, irritability
Deficient Heart Yin - palpitations, insomnia and feelings of restlessness.

Kidney Yin Deficiency can be caused by many factors, stress being a major one. Excessive
sexual indulgence, overwork, smoking, alcohol and drug abuse, all deplete Kidney Yin. Longstanding emotional distress can cause Liver Qi Stagnation and Heat or deplete the Kidney Yin
directly.

Full Cold - Excess Cold in the Interior

Main Signs: Chilliness, cold limbs, no thirst, pale face, abdominal pain worse on pressure but
improved by heat, desire for warm drinks, loose stools, profuse clear urine.
Pulse: Deep, Full, and Tight
Tongue: Pale with a thick white coating
Other signs of Full Cold:

Cold causes Pain by contracting and blocking Qi flow.

Excess Cold often produces pain, especially abdominal pain.
Pain is relieved by heat/exacerbated by pressure.

Anything white, bluish-purple or concave (vs. raised) may be due to Cold.

Example: pale tongue, pale face, white tongue coating, concave v. pale spots on tongue, bluishpurple tongue bluish lips or extremities. Secretions/excretions are thin, clear and watery in Cold
conditions.
Excess Cold arises from Excess of Yin.
Common causes of Excess Cold are: Invasion of exterior Cold into Interior

Stomach: vomiting & epigastric pain

Intestines: diarrhea/abdominal pain
Uterus: dysmenorrhea
Liver channel: swelling/pain in scrotum

All of the above have acute onset

Empty Cold - (Deficiency of Yang)

Main Signs: Chilliness, cold limbs, dull-pale face, no thirst, listlessness, spontaneous sweating,
loose stools, profuse clear urination.
Pulse: Deep, Slow, and Weak
Tongue: Pale with thin white coating. May be wet and swollen
Empty (Deficiency) Cold is caused by Deficiency of Yang. This is due to Yang Qi being too
weak to warm the body. This is usually related to Deficiency of Yang of Kidney, Spleen, Heart
or Deficiency of Lung Qi.
For Example: In Spleen Yang Deficiency, Spleen Yang fails to warm muscles, hence chilliness.
Spleen Yang does not transform food, hence diarrhea.
Hot and Cold can exist simultaneously in the body.
For Example: There can be Cold in the Spleen (Deficient Spleen Yang) with Damp Heat in the
Bladder (Excess Heat). This pattern may occur because Spleen Yang is insufficient to transform
Fluids, which then accumulate, forming Dampness. The Dampness then pervades downward to
affect the Lower Burner.
[ Top of Page ]

Full/Empty (Excess/Deficiency)
This is a very important, and distingiushed by:

1. Is a Pathogen Present
2. The Strength of the body's Qi

Full (Excess) Condition:

Pathogen is Present - Interior or Exterior, or stagnation of Qi, Blood or Food.
The Body's Qi is relatively intact.

Empty (Deficient) Condition:

No pathogen is present.
Body's Qi is weak or it is Yin, Yang, or Blood Deficient

Mixed (Deficiency and Excess)

Pathogen is present and body's qi is weak or blood, etc.

Distinguishing Full from Empty:

Full condition produces signs like:
Loud voice, acute disease, restlessness, irritability, severe pain, coarse breathing, pain worse on
pressure, high pitch tinnitus, profuse sweating, scanty urination, constipation, whole face red,
throwing off bedclothes, Full-type pulse, thick tongue coating
Empty condition produces signs like:
Weak voice, chronic disease, listlessness, lying curled up weak respiration, dull, lingering pain,
pain alleviated by pressure, slight sweating, frequent urination, loose stools, low pitched tinnitus,
Empty-type pulse, thin tongue coating
NOTE: These signs are too general to be of much use clinically.
Beware of making the distinction of Full/Empty on only one sign. Some signs can be categorized
as either Full or Empty depending on their etiology.
Examples
Constipation:

Full: Due to Heat or Stagnation

Empty: Due to Deficient Blood or Yin

Loose stools:

Empty: Due to Spleen Qi deficiency (not accompanied by heat)

Full: Urgent/foul with burning

Etiology of Full Conditions

By definition, Full conditions Involve Pathogens

Exterior Condition: Invasion of pathogenic exterior Cold, Wind, Damp or Heat

Interior Condition: Cold, Heat, Dampness, Wind Fire or Phlegm
Interior Pathogen: Also Blood Stasis and Qi Stagnation

Interior pathogens usually arise in the interior, due to malfunction of the internal Organ(s). They
can, however, occasionally arise when an exterior pathogen makes its way into the Interior, or
when an exterior pathogen weakens the body's Qi so that internal Organs begin to malfunction.

Mixed Full-Empty Conditions

The Full part indicates the presence of a pathogen
The Empty part indicates that the body's Qi is weak and not reacting appropriately to the
pathogen.
Examples of Empty conditions complicated with Fullness:

Kidney Yin Deficiency with Liver Yang Rising

Kidney Yin Deficiency with Flaring of Deficient Heart Fire
Spleen Qi Deficiency with retention of Dampness
Deficiency of Qi with Stasis of Blood

Empty (Deficient) Conditions:

There are four kinds...

Deficient Qi
Deficient Yang
Deficient Blood
Deficient Yin

Empty (Deficient) Qi: - This is the least severe deficiency.

Signs and Symptoms: Pallor, weak voice, slight daytime sweating, slight dyspnea, fatigue, lack
of appetite, weak pulse.
These are primarily signs of weakness of Lung and Spleen Qi. Other signs & symptoms may be
present, depending on which other Organs may be involved, esp. Heart or Kidneys

Case History

Fatigue, Lack of appetite, abdominal bloating, borborygmus and loose stools over a long period
of time.
Pulse: empty
Tongue: pale and slightly swollen.
Signs are of Spleen Qi Deficiency (not transforming the digestate)

Empty (Deficient) Yang - This is the next stage on from Deficient Qi.
Qi is an aspect of Yang, so Yang Deficiency is similar to Qi Deficiency. However, in Qi
deficiency, the function of Qi in transformation has broken down. Yang has the additional
function of warming and protecting, so when Yang becomes Deficient, more Cold signs are
produced.
Signs: As above for Deficient Qi, plus chilliness, bright pale face, cold limbs, no thirst, desire for
warm drinks, loose stools, frequent pale and copious urination, weak pulse, pale and wet tongue.
Organs most often suffering from Yang Deficiency are: Spleen, Kidneys, Lung, Heart, and the
Stomach.
Case History

Women of 30 suffering from tiredness, chilliness, chronic weakness and pain in the lower back,
frequent and pale urination, loose stools.
Pulse: Weak Especially on Right Rear Deep Position
Tongue: Pale, Wet and Slightly Swollen.
Signs are of Deficient Yang of the Spleen and Kidneys

Empty (Deficient) Blood

This can occur when Qi (especially Spleen Qi) is Deficient for a period of time and Qi does not
then produce Blood. It can also occur after childbirth, after hemorrhage, or after an illness that
weakens Qi or Yin.
Signs: Dull pale face, pale lips, blurry vision, dry hair or skin, depression, fatigue, poor memory,
numbness, insomnia, scanty periods or amenorrhea.
Pulse: Fine or Choppy
Tongue: Pale

These signs point to dysfunction of several Organs. When Blood is Deficient, the Organs most
often directly affected are the Heart (which moves and governs the Blood) the Liver (which
stores the Blood) and the Spleen (which produces Qi and Blood and keeps the Blood in the
vessels)

Deficient Liver Blood: Blurry vision, depression, fatigue, numbness scanty periods
Deficient Heart Blood: Insomnia, pale face, pale lips, pale tongue

Case History

Woman of 27 suffered from fatigue, poor memory, scanty menstruation, constipation and
insomnia.
Pulse: Choppy and Fine
Tongue: Pale and Thin
Signs indicate Deficiency of Blood of Liver (scanty menstruation, fatigue, constipation) and of
the Heart (poor memory, insomnia)

Empty (Deficient) Yin

This can begin when Blood is Deficient for a long time, since Blood is part of Yin and has the
same source. Deficient Yin can also be caused when an Excess Heat condition damages the Yin
of the body, by overworking, by excessive indulgence in stimulants, or sexual excess.
Yin has the function of cooling, therefore when Yin is Deficient there are Heat signs. However,
these are Empty Heat (since the condition is one of Deficiency of Yin rather than Excess of
Yang). Yin also moistens, hence there are signs of dryness when Yin is Deficient.
Signs: Low grade fever or feeling of heat in the afternoon, "five palm heat", dry throat at night,
agitated feeling in the afternoon or evening, night sweats, emaciation, malar flush, floating and
empty, rapid pulse, and a red peeled and dry tongue
Other signs depend on which Organ(s) are involved. Organs that are most prone to Yin
Deficiency are the Kidneys, Heart, Liver, Lung, and Stomach.
Case History

A woman of 45 suffered from dizziness, night sweating, soreness of the lower back and slight
tinnitus.
Pulse: Fine, and Slightly Rapid
Tongue: Normal with a Rootless Coating

Signs are of Deficiency of Kidney Yin and Stomach Yin

(rootless tongue coating indicates Deficiency of Stomach Yin)
[ Top of Page ]

Yin/Yang
Two meanings:
1. Summary of the other six categories
Interior, Empty, Cold is Yin
Exterior, Full, Heat is Yang
2. Special Use
Can define two kinds of Emptiness (Deficiency)
Deficient Yin (see above)
Deficient Yang (see above)
Can define two kinds of Collapse
Collapse of Yin
Collapse of Yang

These are very severe Deficient conditions, implying a complete separation of Yin and Yang.
Usually followed by death: rarely to be found in clinic.

Qi, Blood, and Fluid Pattern Differentiation

Qi Patterns

Deficient Qi
Sinking Qi or Collapse
Stagnation of Qi
Rebellious Qi

Blood Patterns

Blood Deficiency
Blood Stagnation

Jin Ye (Fluid) Patterns

Fluid Deficiency

Combined Patterns

Qi and Blood Deficiency and Stagnation

Qi Patterns
1. Deficient Qi
Deficient Qi indicates that there is not enough Qi to perform a required function in the body.
Each organ can have a deficiency and the signs and symptoms will vary with each. The Lungs
and the Spleen are easily and often affected in Qi Deficiency because of their important role in
Qi production, but any organ can be affected.
Causes

Mal-Nourishment
Illness
Old Age
Weak Constitution

Some Examples...
Lung Qi Deficiency Symptoms

Breathlessness
Weak Voice
Spontaneous Sweating

Spleen Qi Deficiency Symptoms

Loss of Appetite
Loose Stools
Fatigue
Normal or Pale and Swollen Tongue

Heart Qi Deficiency Symptoms

Palpitations

Kidney Qi Deficiency Symptoms

Frequent Urination
Possible Lower Back Pain and Weak Knees
Possible Poor Memory

2. Sinking Qi or Collapse
This is where the Spleen Qi can no longer hold substances or certain internal organs in place.
This is usually seen as prolapse of the rectum and prolapse of the Uterus. Sinking Qi usually
results from Spleen Qi Deficiency, and is more severe.
Causes

Spleen Qi Deficiency

Common Symptoms

A sensation of "dragging" or bearing down

Fatigue
Lethargy
Mental Depression
Prolapse of Organs (Stomach, Uterus, Intestines, Vagina, Bladder, Anus)
Empty Pulse

3. Stagnation of Qi
This is where the normal movement or flow of Qi is impaired. When Qi stagnates in a particular
Organ, there may be pain and/or impairment of that Organ's function. Compared to Blood
Stagnation, Qi Stagnation is a moving pain, whereas the pain from Blood Stagnation is fixed in
nature.
Causes

Qi stagnation can be due to traumatic injury or internal causes.

Common Symptoms

Pain in the Area of Stagnation

A Feeling of Oppression
Distention and Bloating
Depression, Irritability, and Other Emotional Disturbances
Wiry Pulse
Possible Purple Tongue

4. Rebellious Qi
All of the organs in the body have a normal direction of Qi flow. Rebellious Qi is when the flow
of Qi is moving in a direction other than the intended direction.

The Normal Direction of Qi Flow

Organ

Stomach
Liver

Normal
Flow

Rebellious Flow

Symptoms

Downwards

Upwards

Belching, Hiccup, Vomiting, Nausea

Upwards

Excessive upwards
(Yang or Fire
Rising)

Headache, Dizziness, Irritability

To Stomach
(Attacks or
Invades)

Nausea, Belching, Vomiting

To Spleen
(Attacks or
Invades)

Diarrhea

To Intestines

Dry Stools, Alternating Constipation and

Diarrhea

Downwards

Burning Urination

Lungs

Downwards

Upwards

Cough, Asthma

Kidneys

Downwards

Upwards

Asthma

Heart

Downwards

Upwards

Agitation, Insomnia, Mental Restlessness

Blood Patterns
Blood Deficiency
Usually caused by Spleen Qi deficiency (SP provides raw materials). When Blood becomes
deficient, the Heart and Liver are especially affected. (Ht governs Blood, Liver stores Blood)
Main Symptoms of Heart Blood Deficiency

Pulse

Sallow or "dull white" complexion

Poor memory
Insomnia (problems falling asleep)
Dizziness and Numbness
Blurred vision
Pale Lips

Fine or Choppy Pulse

Tongue

Pale and possibly slightly dry. The tongue will be thin in severe chronic cases.

Additional Symptoms
Gynecological

Amenorrhea and scanty periods

Mental and Emotional

Depression, anxiety, apathy, lack of spirit

Chronic Symptoms

Dry tongue, dry skin, and dry hair

Severe Symptoms

Dryness of Blood can engender interior Liver Wind which can lead to skin
problems such as dry and itching skin, eventually leading to muscle tics and
tremors.

Blood Stagnation (Stasis)

Blood Stagnation is where the normal flow of Blood has become obstructed. Stagnant Blood can
occur in the channels (usually due to trauma), or in the internal Zang Fu (Yin Yang) Organs,
mainly in the Liver, Heart, Uterus, Intestines and Stomach. Heat in the Blood also eventually
causes blood to stagnate/congeal, as does Internal Cold.

General Symptoms of Blood Stagnation

Stabbing fixed pain

Dark complexion
Purple lips and nails
Dark blood and clots if there is bleeding

Tongue

Red purple if there is Heat

Blue purple if there is Cold
Possible purple or red spots

Pulse

Wiry or choppy pulse

Jin Ye Patterns
Imbalances Involving Body Fluids

Fluid Deficiency
Deficient fluids can result from Heat or dry atmospheres, also from Deficient Blood. Symptoms
are of dryness.
Stagnation of fluids occurs when Yang fails to transform and transport fluids. Fluids then
accumulate to form Dampness.
Symptoms depend on which Organ has Qi or Yang Deficiency and where the Fluids have
accumulated. Spleen is often affected or underlying cause.
Dampness distressing the Spleen produces such signs as: fatigue, cloudy and heavy head, nausea,
copious sputum, heavy limbs.
Edema can be caused by:

Lung Qi Deficiency
This affects the Upper Body
Spleen Qi Deficiency
This affects the abdomen and 4 limbs
Kidney Yang Deficiency
Pitting Edema in the lower body

Dampness may congeal into Phlegm (Mucus)

There are two kinds of Phlegm:

Substantial Phlegm
Such as mucus in the Lungs
Insubstantial Phlegm
Such as swellings, nodules, goiter, and Kidney, Bladder, and GB stones

Qi and Blood Deficiency and Stagnation

Qi Stagnation over a long period of time can lead to a situation where the Qi can not move the
Blood, this causes the Blood to stagnate or congeal. This is commonly caused by patterns such as
Liver Qi Stagnation, due to emotional issues.

If Blood becomes deficient, it eventually also causes Qi to become deficient. If the deficient or
injured Qi fails to move the Blood, stagnation of Blood will occur. This pattern is common after
childbirth, hemorrhage due to trauma, or excessive menstrual bleeding.
In the case of trauma, Blood and Qi often stagnate in the location of the physical trauma.
Stagnation can occur in both the channels and the internal organs depending on the severity of
the injury.