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TCM Diagnostics

The art of diagnosis is a lifetime voyage in the interpretation of the presenting signs and
symptoms of the syndrome complexes. A viable diagnosis is totally dependent on
competent knowledge of TCM theory. This cannot be stressed enough. What separates
a good acupuncturist from an excellent one is his understanding of TCM theory and how
to apply this knowledge. On the other hand, a competent TCM theorist means nothing
if they cannot interpret the data correctly.
In TCM, diagnosis of disease is the process of discriminating patterns of disharmony, or
the syndrome complexes. This can be divided into two parts. The first part is to
thoroughly examine the patient, like a crime scene investigator as I mentioned before.
The second part of diagnosis is logically interpreting the information gathered in the
examinations, or to discriminate patterns of imbalance.
Traditionally, TCM examination is divided into four parts, commonly referred to as the
Four Pillars of Diagnosis. These are questioning the patient, observing the patient,
palpating the patient, and auscultation / olfaction. Lets look at these in more detail.

Inquiring Questioning the Patient

It is said that if you listen to the patient, the diagnosis is rendered. This is general idea
in the patient interview. When the practitioner questions the patient in TCM, I believe
80% of the time the diagnosis is correct. It is like throwing apples in a bag. The ones
with the most apples is the primary diseased organ / pathway. It is there for vital to
understand the presenting sign and symptoms to categorize dysfunction. In TCM this is
called pattern discrimination. This is the main form of diagnosis and treatment. It is
symptom based. Much of the questions reflect the five element correspondences and
the primary functions of the organs. Therefore proper understanding of the functions of
the internal organs and the Five Element characteristics is crucial to diagnosis.
In TCM, there are ten basic questions that lead to one hundred questions. Here are the
main classic questions in TCM diagnostics:

Energy Level
Low energy Indicates deficiency of Qi. If energy is lower in the end of the day Yin
deficiency. If patient is more deficient in the morning Yang deficiency. If the patient is
constantly tired throughout the day, indicates overall Qi deficiency.
Excess or hyperactivity can be possible excess yang heat, excess interior heat, or
excess yang qi rising.

Chills & Fever

Chills indicate invasion of pathogenic cold.
Fever indicate invasion of pathogenic heat.
Chills with fever indicates exterior syndromes of wind/cold or wind/heat. Wind/Cold
symptoms include severe chills with mild fever, no sweating, general body aches,
headache, pulse will feel floating and slow. Wind/Heat symptoms include mild chills
with severe fever, sweats, excess thirst, and a floating and rapid pulse.
Fever without chills with aversion to heat is do to excess heat in the interior. Symptoms
include profuse sweating, severe thirst, and a surging pulse. Fever at night is mainly do
to Yin deficiency.
Chills without fever indicates interior cold syndromes. Symptoms include chilled
appearance, cold extremities, and a deep, slow, and weak pulse.
Alternating chills and fever indicate intermediate syndrome. Other symptoms might
include bitter taste in mouth, thirst, and fullness in chest.

Absence of perspiration in exterior syndromes indicate invasion of pathogenic cold.
Presence of perspiration in exterior syndromes indicate invasion of wind or heat or
both wind/heat.
Perspiration at night (night sweats), which stops upon awakening, indicates Yin
deficiency with hyperactivity of Yang heat.
Frequent Perspiration that worsens with activity deficient Qi and deficient Yang Qi.
Profuse perspiration that is accompanied with high fever, mental restlessness\, thirst,
preference to cold drinks, and a surging pulse indicates excess heat from excess Yang
heat being expelled out by perspiring.

Poor appetite is a weakness in Spleen and Stomach Qi. Possible symptoms include
prolonged illness and poor appetite, loose stools, lassitude, pale tongue, white thin
coating on the tongue.
Poor appetite with chest fullness, abdominal fullness, thick and sticky coated tongue
indicates stagnation of Qi of the Spleen and Stomach caused by food retention or
stagnation of dampness.
Increased or excess appetite is typical with excess Stomach heat or Stomach fire.
Increased appetite without a desire to eat is typical of Yin deficiency causing internal

Heat will produce a bitter taste in the Liver or the Heart. In Liver fire,
the bitter taste isnt constant. Heart fire produces a bitter taste in the
morning after a sleepless night and Heart fire is always accompanied
with insomnia.
Sweet tastes indicates Spleen Qi deficiency and / or damp / heat.
Sour tastes indicates food retention in the Stomach or lack of harmony between the
Liver and Stomach.
Salty tastes are caused by Kidney Yin deficiency.
Lack of taste sensation is caused by Spleen Qi deficiency.
Pungent tastes are caused by in-balances in the Lung, usually Lung heat.

Vomiting is usually caused by a form of heat.

Sour vomiting is a result of Liver insulting the Stomach..

Bitter vomiting is a result of Liver and Gall Bladder heat.
Vomiting that occurs after eating is usually a result of heat pathogenic factor.

Cold syndromes, or any syndrome in which heat is not noticed causes lack of thirst. In
this case the body fluids are not being consumed because of the cold.
The presence of thirst in a patient indicates heat or retention of damp phlegm in the
interior preventing the body fluids from ascending.

Constipation is usually due to excess heat or excess usage of body fluids.
Loose stools indicate mainly deficiency of Spleen or dampness invading the Spleen
Watery stools with undigested foods usually means a deficiency of Yang of the
Spleen and the Kidney.
Bloody stools with mucous is usually a result of damp heat in the
Intestines and stagnation of Qi in the Intestines.

Dark color urine usually indicates heat syndromes.
Clear and abundant amounts of urine usually indicates cold or an absence of heat.
Turbid / Cloudy urine indicates damp heat.
Red urine usually indicates damage of a vessel due to heat.
Clear increased amounts of urine indicates weak Kidney Qi and Bladder controlling the
Little volume and yellow urine with accompanied urgency and painful urination usually
indicated damp heat in the Bladder.
Dribbling and felling of retention of urine usually indicates Kidney Qi deficiency, possible
damp heat, and stagnation of blood or stones.

Insomnia accompanied with dizziness and palpitations is usually caused by the inability
of the blood to nourish the Heart and the Spleen.
Insomnia with restlessness in the mind and a dream disturbed sleep usually
indicates Heart heat or fire.

Dizziness is usually a symptom of deficiency of Qi , blood deficiency, fire, wind or


The head is the meeting place of all the Yang pathways. The Qi of all the Zang and Fu
flow to the head. If any of the external pathogenic evils attack the head or neck and
damages the yang pathways, or if Qi and blood stagnates as a result of internal
diseases, the head and brain lack nourishment and a headache is sure to follow.
Recent onset and short duration is usually a result of wind cold.
Gradual onset are usually of interior etiology.
Day-time headaches are usually a result of Qi deficiency or Yang deficiency.
Evening headaches are usually caused by blood deficiency or Yin deficiency.
Cervical spine headaches, especially at the nape of the neck (Greater Yang Channels)
are usually caused by Kidney Qi deficiency or invasion of wind / cold.
Forehead headache Bright Yang Channels) are usually caused by Blood deficiency or
Stomach heat.

Temporal headaches ( Lesser Yang Channels) are usually a result of invasion of wind /
heat, wind / cold, or from interior Liver and Gall Bladder Fire rising.
Top of the head headache (Terminal Yin Channels) are usually a result of Liver blood
Whole head headache is usually a result of invasion of wind / cold.
Heavy feeling headache is a result of either phlegm or dampness.
Headache that is inside the head is usually a result of Kidney Qi deficiency.
Throbbing headache is usually a result of Liver Yang rising.
A dull, boring headache is usually a result of blood stagnation.
Back pain

Continuous and dull pain in the back is usually a result of Kidney Qi deficiency.
Recent, severe, and stiff back pain is usually a result of Blood stagnation.
Severe pain that is aggravated by cold and damp weather and is comforted by heat is
usually a result of pathogenic cold and dampness invading the back.
Boring pain is usually a result of Blood stagnation.
Pain in the shoulders and upper back is usually a result of exterior conditions wind /
cold, wind / heat, etc.
Pain in the Joints

Pain in the joints that moves from joint to joint is usually a result of Wind.
Fixed joint pain that is very painful is usually a result of invasion of Cold.
Fixed joint pain that is associated with swelling and numbness is usually a result of
invasion of dampness

Bilateral arm and leg numbness, or hand and feet numbness is usually a result of blood
Unilateral numbness of fingers, elbows, and arm (especially the first three digits) is
usually a result of Wind and Phlegm.
Pain in the entire body

A rapid, sudden onset that is associated with chills and fever is usually a result of Wind /
Pain that I felt all over with associated tiredness is usually a result of Blood deficiency.
Pain that is in al the muscles and has an associated hot sensation is usually a result of
Stomach Heat.
Pain all over that is associated with a feeling of heaviness is usually a result of Invasion
of dampness in the muscles.

Thorax and Abdomen

The thorax is under the direct influence of the Lung and Heart Zang.
The sides of the body are mainly influenced by the Liver Zang and the Gall Bladder Fu.
The abdomen is influenced by the Liver, Spleen, Intestines, Kidney, and Bladder.
Pain in the chest is usually a result of Blood stagnation in the Heart that is usually
caused by Yang deficiency.
Chest pain that is associated with a productive yellow cough is usually a result of Lung
Abdominal distension and fullness is usually a result of Liver Qi stagnation.
Epigastria pain is usually a result of either Food retention in the Stomach or Stomach
Epigastria pain that is very dull and not severe in nature is usually a result of Stomach
cold deficiency.

Most all ear conditions are due to Kidneys because the Kidneys open to the ear. All the
Lesser Yang pathways flow to the ear and therefore external pathogenesis of these
pathways such as Heat, Dampness, and Phlegm can affect the ear.
Tinnitus A sudden onset is usually a condition of Liver-Fire or Liver-Wind. A gradual
onset is usually a condition of Deficiency of Kidneys.
A loud high pitch noise is usually a condition of Liver Yang rising, Liver Fire, or Liver
A low pitch noise is usually a condition of Kidney Qi deficiency
Deafness that is chronic in nature is usually a condition of Kidney Qi deficiency. Blood
and Heart deficiency, deficiency of Qi, and Yang Qi deficiency
Pain in the eyes is usually a condition of Liver because of the relationship to the opening
of that viscera.
This is the process in which the practitioner gathers information by the observation of
changes in the patients body. The most common parts that are inspected are the
tongue and the face. Changes in the appearance of the body can give the practitioner
clues in the nature of disease and pathology.
Observation of the Face
One part of the observation examination is face diagnosis. This was written in the
Huang Nei Jing. In TCM the face is another landmark, like tongue, or the vital organs.
Impairment of the organs can therefore reflect in the face. This can manifest in facial
complexion, texture, or moisture in the corresponding area.

Observation of the Eyes

It was already established that the Liver opens and controls the eyes. It is said that all
the organs reflect in the eyes. Different appearances of redness, moisture, and textures
in parts of the eye can reflect in impairment in the corresponding areas of the eye.
Observation of the Tongue
Along with pulse diagnosis, this is can be the deciding factor in determining patterns of
disease. This diagnostic procedure is much easier to master that pulse diagnosis. The
tongue is a map of the internal organs.
The tongue can be divided into three sections Upper Burner, Middle Burner, and Lower
Burner. The Upper Burner consists of the Heart and Lung. The Middle Burner consists
of the Liver, Spleen, Gall Bladder, and Stomach. The Lower Burner consists of the
Kidneys, Bladder, and Intestines. One can simply note changes in geography of the
tongue and link them to a organ. For example, a red tip indicates Heart dysfunction,
specifically heat in the Heart. If there is white coating present only in the back of the
tongue indicates dysfunction in the Kidneys, specifically Qi deficiency of the Kidneys.
The practitioner simply has to memorize key patterns of disease and the location of the
organs in the tongue to be a successful tongue diagnostician.
Close attention is paid to the tongue to determine pathology. The TCM practitioner
evaluates the patients tongue color, shape, and coating. Lets look at the specific
conditions that are encountered in tongue pathology.
Tongue Proper
Pale Tongue: Indicates xu (Deficient) and cold syndromes or symptoms due to yang Qi
deficiency and insufficiency of Qi and blood.
Red Tongue: Indicates heat syndromes, mostly shi types (Excess) of disease caused by
interior heat, or symptoms of fire preponderance due to yin deficiency.
Deep Red Tongue: Denotes the excessive heat seen in febrile disease due to invasion
of exogenous pathogenic heat which as been transmitted from the exterior to the interior
of the body. It also can be seen in miscellaneous diseases due to a preponderance of
fire caused by yin deficiency, or seen in diseases of accumulated fire in the liver
Purplish Tongue: Shows the syndrome of blood stagnation. A tongue with purplish spots
or petechiae also indicates blood stagnation.
Tongue Appearance

Flabby Tongue: A flabby tongue body with teeth marks on the margin and pale in color
indicates a yang deficiency of the spleen and kidney leading to accumulation and
obstruction of phlegm-dampness. A flabby tongue with a deep red color indicates
excessive pathogenic heat attacking the heart and spleen.
Thin and Small Tongue: This indicates consumption and deficiency of blood and yin. A
thin and small tongue with a pale color denotes deficiency of both qi and blood. A thin
dry tongue with a deep red color is mainly due to a preponderance of fire and great
exhaustion of body fluids.
Rigid Tongue: Seen in febrile diseases due to the invasion of exogenous pathogenic
heat transmitted into the pericardium or due to an obstruction of pathogenic phlegm. It
may also be seen in high fever leading to consumption of body fluids and
preponderance of pathogenic heat. It is a prodrome of wind-stroke (cerebral stroke).
Deviated Tongue: This is a prodrome of wind-stroke.
Cracked Tongue: Cracks on the tongue with deep red color indicate excessive heat. A
cracked pale tongue indicates insufficiency of yin and blood. However, a cracked tongue
of long term duration without any other symptoms can be considered normal.
Tongue Coating
Thinness and Thickness: Generally, if substantial pathogenic factors such as damp,
phlegm or food accumulation occur and cause obstruction, they further affect the spleen
and stomach leading to the ascent of turbid qi and forming of a thick tongue coating. A
white thin tongue coating is formed if non substantial pathogenic factors such as wind,
heat, dryness, or cold attack the body; or if the pathogenic factors stay on the body
surface; or if body resistance is weak during the disease development.
Moistness and Dryness: The normal tongue coating is moist, which indicates that plenty
of body fluid is flowing upward. If the tongue coating is dry, it is due to body fluids failing
to moisten the tongue. A dry tongue coating may also be present in some febrile
diseases where pathogenic heat consumes the body fluid. A slippery tongue coating
may be due to pathogenic damp-humor floating over the tongue surface.
Sticky and Curdled Tongue Coating: A sticky coating is due to hyperactivity of
endogenous pathogenic phlegm and damp rising tot he tongue, and is mostly seen in
diseases caused by pathogenic damp-heat or phlegm-humor. A curdled tongue coating
is the outcome of food accumulation in the stomach leading to the ascent of turbid qi to
the tongue surface. It is also seen in disease caused by phlegm-damp.
Peeled Tongue Coating: Mostly due to deficiency of qi and yin. If peeled tongue is
accompanied by a sticky coating, it indicates a complicated disease condition to which
the body resistance is weakened.
No Tongue Coating: Changes in the tongue coating indicate fluctuation in the disease
condition. For example, if a qi deficiency of the stomach is manifested by a lack of
tongue coating at an early stage, the tongue coating will reappear after the stomach qi is
recovered. If a disease has no tongue coating, then suddenly appears, this indicates a
perverse flow of stomach qi, or excessive pathogenic heat. If a disease has a tongue
coating at the beginning, which disappears abruptly, this indicates stomach yin fluid has
decreased. If a thick coating gradually turns into a thin white coating, this indicates that
pathogenic qi is being gradually weakened, and the disease condition is becoming
Generally, an observation of the thinness and thickness of the tongue coating will
indicate the depth of pathogenic qi. The tongue's moistness or dryness shows the body

fluid condition. The degree of stickiness of the tongue coating indicates the dampness of
the stomach and spleen. The appearance or disappearance of tongue coating signified
the cure or worsening of the disease condition.
Color of Tongue Coating
White Coating: Indicates exterior-cold syndromes. A white and thin coating is seen
mostly in exterior syndromes, while a white and thick coating appears in interior-cold
syndromes. If there is a powder-like whitish coating covering the tongue surface, it is
caused by the internal accumulation of summer-humid heat and is usually seen at the
onset of pestilential diseases.
Yellow Coating: Indicates interior and heat syndromes. A light yellow tongue coating is
seen in cases of slight fever. A deep yellow color indicates high fever. Brownish tongue
coatings represent an accumulation of pathogenic heat.
Grayish Coating: Denotes interior-heat syndrome or interior-cold syndrome. A grayish
black and slippery coating on the tongue usually indicates symptom-complex due to
cold-damp in the interior. A greyish, yellow, and sticky tongue coating usually indicates
the accumulation of damp-heat. Greyish and dry tongue coatings are usually due to the
consumption of body fluid by excessive heat.
Black Coating: This is often seen at the serious and dangerous stage of disease, and
indicates extreme heat or cold. A black, yellow, and dry coating with thorns on the
tongue surface usually denotes consumption of body fluid by extreme heat. A black and
slippery tongue coating shows excessive cold due to yang deficiency.

The pulse is an invaluable diagnostic procedure. If done properly, it can provide the
doctor with instructions in their course of treatment. Pulse diagnosis is crucial for all
aspects in acupuncture. The pulses can determine which organ and pathway is
imbalanced, where the disease is located in the body, how far to insert the needles, how
to manipulate the needles, how long a session should last, and the patients prognosis.
Ultimately, with tongue diagnosis, pulse palpation can be the major determining factor
and basis of treatment
The Heart is obviously noted as regulating the pulses. However, it is much more
complex, or integrated than this. In TCM, the pulses are associated with the internal
organs, Qi, and blood. For example, blood circulation is a cooperative effort brought on
by the Heart, Lung, Liver, and Spleen Zang. The Heart controls the circulation of blood,
the Spleen controls the containment of the blood in the blood vessels, the Liver stores
the blood, and the Lung and Spleen contribute to the pushing of blood though out the
vessels and body. The Qi and blood has almost a symbiotic relationship. It is said that
the blood is the mother of Qi, and the Qi is the ruler of blood. This explains how the
blood nourishes the Qi and Qi regulates, or pushes the blood in the blood vessels.
Without nourishment Qi cannot function and without the Yang function of movement that
the Qi provides, of blood cannot function. You can therefore see how the state of Qi and
blood can influence the pulses.
There is nothing easy about mastering pulse palpation. It takes years to fully appreciate
the art of feeling the Qi in the radial artery. However, with in a few years of palpating

pulses, your fine touch and pulse perceptions become easier and the images will
become much more clear. Initially it is encouraged to spend more time in pulse
palpation. In China it is not uncommon to spend twenty to twenty-five five minutes in
evaluating the pulses. Obviously, this is not time effective in a busy clinic. Five to ten
minutes is sufficient enough time when learning pulse diagnosis.
When taking the pulse, clear your thoughts and focus entirely on the patients Qi. Try to
zone in on the radial pulse and start to decipher the images. It is said in ancient texts
that the doctor doesnt palpate the pulse, but rather listens to the pulses. This reflects
the importance of concentration and focus.
Taking the Pulse
In classic Chinese texts, the pulses should be taken under optimal conditions. Providing
the proper setting assures the doctor of true and clear findings.
Patient Position
The pulses should always be taken in the recumbent, or sitting position. The wrist
should be at the same level as the heart. Make sure the patient is comfortable. If the
patient cannot sit, take the pulses standing with the elbow bent and relaxed and the wrist
at the heart level.
Doctor Position
It is important to note that the doctor must be comfortable when taking the pulse. If the
doctor is uncomfortable, their concentration isnt optimal and the pulse palpation is
hurried and sloppy. Traditionally, the doctor takes the pulses sitting on a desk or table.
The doctors arm is rested on the desk or table with their arms at 90 degrees to the
patients. The doctors right hand interprets the patients left radial artery, and the
doctors left hand interprets the patients right radial artery. There should be no
switching of positions. After a while of taking pulses, your index finger, middle finger,
and ring finger will become very sensitive and comfortable in their respected positions.
The Pulse Positions
There are many different opinions on the six pulse positions. The most popular comes
from Li Shi-Zhen described in his text, Pulse Diagnosis written in 1564. The three
pulse positions are cun front/distal position, guan middle position, and the chi
last/proximal position.

Right Arm
Spleen/StomachKidney Yin


Left Arm

Kidney Yang

These positions are located at the radial artery at the styloid process of the radius on
both wrists. It is believed that the patients Qi and blood in the pathways and its

associated organ are felt at these positions. Therefore, the status of a patients health is
reflected in the pulses.
Feeling the Pulses
When examining the pulse, the doctor should always use his index finger for reading the
cun position, middle finger to read the guan position, and ring finger to read the chi
position. This was discussed earlier in the doctor positioning. It is mentioned again
because of its significance.
The Three Depths
When taking the pulses. The doctor must Asses the qi and blood in all positions as well
as all three depths. The pulses can be interpreted in three depths, superficially, slightly
deeper, and deep. In classic texts, these are referred to a heaven, man, and earth. The
depths describe where the Qi and blood are located at, where the disease is located at,
and what part of the body is affected.
Pulse Depths
Upper Body - External
Middle Body - Pathway level
Lower Body - Organ level
If the pulse is predominant in the cun position, it is said that the Qi and blood is
superficial, just underneath the epidermis. This is usually indicative of external evils like
wind and heat or Yang excess. The cun position can diagnose disease from the
diaphragm to the head.
If the pulse is located in the guan position, the Qi and blood is located in the pathways
where it is supposed to be. This is located between the epidermis and the muscles.
The guan position diagnoses disease from the umbilicus to the lower diaphragm.
If the pulse is felt in the chi position, the Qi and blood is at the visceral level. This means
that the Qi is very weak and the organ is either involved or is diseased itself. The chi
position diagnoses disease from the below the umbilicus.
The level in which the Qi and blood are manifesting determines needling depths. If the
pulses are very superficial, the Qi is flowing superficially and therefore needling should
be shallow. If the pulses are located in the middle position, the Qi and blood are flowing
in their respected pathways and needling is deeper. If the pulses are deep, to the bone,
the Qi and blood is located in the organs and needling is deep. When you look at
references in acupuncture texts on needling depths, the determining factor is where the
Qi and blood is located. This is rarely discussed. For example, when reviewing
needling depths of Hegu (LI-4) the range is from 0.3 cun to 1.0 cun. A superficial pulse
will be needled at 0.3 cun , the middle pulse is needled 0.5 cun, and the deep pulse is
needled at 1.0 cun.
Normal Pulses
To determine pathological pulses, one must establish normal images (Ping Mai). The
following characteristics of a normal, healthy pulse are as follows:

1. Spirited (You Shen): This means if the pulse is strong and patterns of its beat
is distinct. If the can be felt coming and going with good force, it has spirit. If it is
faint, irregular, choppy, or once and a while ceases, it is said that the pulse is
without spirit.
2. Rooted (You Gen): If the pulses at the last, Chi position and it is felt all the way
to the radial bone, it is said to be strongly rooted. In classics it states that if the
pulses are rooted, the patients health is good. Just as the roots of a tree that
deeply plants and anchors deep in the ground, the patients health is deeply
3. It has Stomach (You Wei): The pulses should posses some slippery quality.
When one feels comfortable in feeling all the pulse images, identifying this slightly
slippery quality will be appreciated. If the pulses feel tense or large and not
slightly slippery, it looses its harmony, and is said to lack Stomach Qi.
Harmonious pulses of the Seasons
A persons pulses are subject to the ever changing environment. To maintain the
balance between the interior and the exterior, the body changes and is reflected in the
normal pulse. During the springtime the Yang Qi becomes more prominent. The pulse
will be increasingly stronger and slightly wiry. During the summertime the heat will
cause the pulses to be overflowing. During the autumn the Yang Qi slowly weakens and
the pulses will become empty, floating, and fine. During the winter the pulses sink deep
because of the cold climate and they become deep and strong.
Pathological Pulses
When imbalances of body, mind, and spirit inflict the body, physical changes
immediately follow. A person can suffer with pain, fatigue, and organic dysfunction.
Fortunately, physical changes are also present in the pulse images. In TCM, they label
these pathological changes as Bing Mai and categorize them into twenty-nine pulse
images. The twenty-nine images are classified into four easily felt categories. In
the Bing Hu Mai Xue, it states that there are four principles, or essential images that
nearly all pulses poses. They are fast, slow, floating / superficial, and deep.
When a beginning student of TCM starts to tackle these pulse categories, it seems
overwhelming and even impossible to feel all twenty-nine images. If one sticks to the
four categories of pulses, pulse diagnosis can be less of a headache and more of a
wonderful tool of ancient wisdom.
Lets look in more detail on some of the pathological pulses. Remember that feeling the
pulses takes time. Dont get discouraged in the beginning. Pulse palpation is an art as
well as a science. With that in mind, be diligent, patient, and determined and success is
sure to follow.

Bing Mai, Pathological Pulse Images

1. Floating / Superficial Pulse (Fu Mai) :

Pulse Image: Pulse has most strength at upper-most level, and can be only be felt on a
slight touch. Li Shi Zhen describes this as feeling like a piece of wood floating on water.
It is very strong at the surface and disappears on deeper palpation, like when the piece
of wood is pushed under water and then reappears when light pressure is applied.

Pathology: External pathogen or

External Pathogen
A floating pulse appears when Yang Qi is excess. This image is mostly seen in cases of
Wind. This can be Wind, Wind/Cold, or Wind/Heat.
Wind/Cold If the image is floating and tight.
Wind/Heat If the image is floating and rapid.

If the floating pulse is also forceless and empty in deep position it is indicative of
Positions Felt:
Cun Position: This is mainly felt in the cun (front) position. This is in the upper jiao. The
Lung and Heart Zang occupy these positions. The Lung is the most vulnerable organ to
the exterior. It is therefore subjective to wind, heat, and cold. If the Lung is weak, these
pathogens invade the body and can yield a floating pulse. As we mentioned earlier,
Lung controls the Wei Qi, or the immune system. A floating pulse in the right cun
position almost always means a flu / cold is present, in progression, or ending.
Guan Position: When the Spleen is deficient and it affect the entire middle jiao, a
floating pulse will appear in this position on the right arm. If the Liver Qi is overabundant a floating pulse in the left guan position will be present.

Chi Position: A floating pulse isnt felt

much in the Chi position. When it is
present, it reflects lower jiao
dysfunction and can lead to urination
and stool problems.
1. 2.

Deep / Sinking Pulse (Chen Mai) :

Pulse Image: Pulse has most strength at lowest level and requires deep pressure to
feel. It is said to feel like a cotton ball on sand in the superficial position and very strong
and rigid in the deep position.

Pathology: Internal organ deficiency

If the pulse is weak and deep it indicates deficiency of Qi. If the pulse is full and deep it
indicates interior cold or heat.
Positions Felt:
This can be felt in all the positions.

Cun Position: When a deep pulse id

felt in the front position it means there
is some water retention or phlegm
stuck in the upper jiao especially the
Guan Position: A deep pulse in the guan position is indicative of cold stagnation in the
middle jiao Stomach / Spleen.
Chi Position: A deep pulse in the chi position is very common. This translates to
weakness in Kidney Qi and Kidney Yuan Qi.
1. 3.

Slow (Chi Mai) :

Pulse Image: Pulse is less than 60 beats per minute or if the pulse beats three times in
a respiration.

Pathology: Cold in the interior, or severe qi deficiency.

If the pulse is slow it indicates invasion of cold. If the pulse is slow and floating it is due
to invasion of wind / cold. If the pulse is slow and empty it indicates deficiency of Yang.
Positions Felt:
This can be felt in all the positions.

Cun Position: When a slow pulse is

felt in the front left position it indicates
cold accumulation in Heart and chest
area. If felt in the front right position it
is indicative invasion of wind cold or
Guan Position: A slow pulse in the guan position is indicative of cold stagnation in the
middle jiao Stomach / Spleen and Liver which can lead to painful spasms in the
muscles and tendons.
Chi Position: A slow pulse in the chi position translates to weakness due to cold
retention in Kidneys.
1. 4.

Rapid (Shu Mai) :

Pulse Image: Pulse is greater than 80 beats per minute.

Pathology: Heat, either excess or deficient
This pulse image occurs when there is excess Yang Qi. If the pulse is rapid and floating
it is indicative of superficial heat. If the pulse is rapid and deep it is indicative of internal
heat. If the pulse is rapid and strong it indicates excess heat. If the pulse is rapid and
lacks strength it indicates deficient heat, or Yin deficiency.
Positions Felt:
This can be felt in all the positions.
Cun Position: When a rapid pulse is felt in the front left position it indicates Heart heat
blazing upward. If felt in the front right position it is indicative of Lung dryness.

Guan Position: A rapid pulse in the left

guan position is indicative of Liver fire
blazing upward. If the right guan
position is rapid it usually is due to
Stomach fire.
Chi Position: A rapid pulse in the chi position translates fire blazing upward due to
Kidney Yin deficiency.
5. Empty Pulse:
Pulse Image: This pulse describes the strength of pulse. Under firm pressure, the
empty pulse feels soft and weak. However, an empty pulse is felt with light or heavy
pressure, but feels forceless to the fingers.

Pathology: Deficient Qi and blood

An empty pulse reflects a weakness of the body and leads to a lowered state of
resistant. Whether the pulse is rapid or slow, an empty pulse is always due to
deficiencies. This pulse image reflects a state of deficient Qi and blood.
Positions Felt:
Cun Position: This is mainly felt in the cun (front) position. This is in the upper jiao. The
Lung and Heart Zang occupy these positions. If the Heart blood is deficient leading to
mal-nourishment of the Heart, this position on the left becomes empty.
Guan Position: When food stagnates and the Stomach swells because of deficiencies,
the process of transformation and transportation function of the Spleen is lost. A empty
pulse is then felt in this position.

Chi Position: When the Jing and blood

is damages causing low back pain and
numbness, the pulse in this position
becomes empty.
6. Full Pulse:
Pulse Image: This pulse describes the strength of pulse. It is present upon deep and
superficial pressure. It is felt as a full throbbing pulse. Pulse can be felt strongly on all
three levels at the same time.

Pathology: Heat, excess or both.

A full pulse reflects states of excess. This pulse image reflects the struggle of the
bodys excess Qi and blood and a normal energy level.
Positions Felt:
Cun Position: A full pulse at this position reflects excess heat and wind in the upper jiao.
This can lead to symptoms such as headache, fever, soar throat, and stuffiness in the
Guan Position: Accumulated heat in the middle jiao Spleen/Stomach causes a full
pulse at this position. Symptoms such as stuffiness and abdominal distension.

Chi Position: Excess heat in the lower

jiao leads yields a full pulse and can
lead to lumbar pain, abdominal
distension, and constipation.
1. 7.

Slippery Pulse:

Pulse Image: Pulse feels like pearls coursing through the pulse, with a definitive rolling
quality. The pulse quickly hits each individual finger and just as quickly rolls away. It
feels like slippery little balls that remain even. A slippery pulse usually occurs with a
rapid pulse.
Pathology: Dampness of any variety, phlegm, pregnancy, heat.
A slippery pulse indicates a mild illness. It is a result of an abundance of Yang Qi in the
body. It also can be caused by heat from the Liver or the Kidney fire that cause the
blood to heat up. It is seen very often in pathologies with increased dampness and
phlegm. Pregnant females very often have a slippery pulse reflecting abundant Qi and
blood in the body. Healthy people that have abundant Qi and blood can also present
with a slight slippery pulse.
Positions Felt:
Cun Position: A slippery pulse at this position reflects when the Qi accumulates in the
chest and diaphragm, interfering with the descending function. This leads to symptoms
of acid reflux, vomiting, stiff tongue, and coughing.
Guan Position: A slippery pulse at this position reflects Liver heat t and Spleen
dampness. This is very common in this position on both the right and left arms.

Chi Position: Excess damp heat in the

Kidney and Bladder leads to a slippery

pulse and can lead to lumbar pain,

abdominal distension, dysentery,
dysuria, and constipation.
8. Choppy Pulse:
Pulse Image: Pulse is uneven and rough. Classically defined as a knife scraping
bamboo . It is fine, short, and slow. It also moves at irregular depths, like a silkworm
eating at a leaf. The will not stop periodically like that of a intermittent pulse. The
choppy pulse is felt in the superficial middle, and deep pulses unlike the minute pulses.
Pathology: Blood deficiency or Qi and blood stagnation.
A choppy pulse usually is indicative of deficiency of Yin blood. It can also be felt when
there is invasion of cold damp that penetrates the organs and causes stagnation of
blood circulation. In pregnant women, a choppy pulse reflects insufficient blood and
nourishment of the fetus.
Positions Felt:
Cun Position: A choppy pulse at this position reflects damaged Heart blood that can lead
to chest pain.
Guan Position: A choppy pulse at this position reflects weakness and deficiency of the
Stomach / Spleen causing fullness and swelling.

Chi Position: A choppy pulse at this

position reflects damaged jing and
blood in the Lower Jiao resulting in
constipation, and dribbling of urine.

1. 9.

Long Pulse:

Pulse Image: This pulse feels long in its beat rate. If it is long , soft, and calm it
indicates health. If it is long tight, like a string it indicates disease.
Pathology: This pulse image can reflect the strong health of an individual. In diseased
patients, this pulse reflects excess Yang heat in the blood, wind phlegm, or internal heat
in the Stomach or Large Intestines.
1. 10. Short Pulse:

Pulse Image: This pulse image feels short and its beats are strong, but it rises and falls
Pathology: Qi and blood deficiencies
This pulse is felt when Qi becomes weak and is not able to circulate evenly.
1. 11. Wiry Pulse:
Pulse Image: This pulse image feels taught, long, and strong in nature. It can be felt in
light or heavy palpation. It is said to feel like a bow string, very firm and fixed. It can
also be compared to a sting instrument, very springy and elastic in nature. It feels like a
thin musical string that bounds up against the fingers evenly but with force. This is very
commonly felt, especially in the Liver (Guan) position.
Pathology: Qi stagnation, especially in Liver, can also be phlegm
This is commonly found in cases of liver Qi stagnation. It can also be present if there is
excess heat (fast pace) and cold (slow pace). Patients that have spasms, stiffness, and
pain in the body will also yield a wiry pulse. Excess phlegm can lead to a wiry pulse. In
general, if the disease is mild, the pulse is wiry and soft. If the disease is sever, the
pulse is wiry and hard.
Positions Felt:
Cun Position: A wiry pulse at this position reflects accumulated phlegm in the chest and
Guan Position: A wiry pulse at this position reflects Liver and Gall Bladder disease,
primarily Qi stagnation. Excess cold in the Stomach can also yield a wiry pulse in this

Chi Position: A wiry pulse at this

position reflects deficiency and cold of
the Kidneys.
1. 12. Thin Pulse:
Pulse Image: Exactly what it says. Pulse simply feels thinner than it should. It feels like
a thin string of thread. It s felt as weak, soft, and without strength.
Pathology: Blood or qi deficiency.
This is seen in cases of deficiencies and failure of Qi and blood. It can also be seen in
disharmonies of the even emotions, weakness in Yang Qi, internal damage to jing, and
penetration of dampness.
Positions Felt:
Cun Position: A thin pulse at this position reflects severe deficiency if Qi.

Guan Position: A thin pulse at this position reflects Spleen / Stomach deficiency.

Chi Position: A thin pulse at this

position reflects deficiency and cold of
the Kidneys.
1. 13. Tight Pulse:
Pulse Image: Pulse feels taught like a rope, thicker than wiry, feels as if the pulse
evenly hits the fingers in different places with every beat.
Pathology: Cold, usually causing stagnation.
Cold of any nature will produce a tight pulse. Cold can attack the Liver, Lungs,
Spleen/Stomach, and Kidneys.
Positions Felt:
Cun Position: A tight pulse at this position reflects cold damage. In the left position it
reflects external cold. In the right position it reflects internal cold.
Guan Position: A tight pulse at this position reflects Spleen / Stomach cold damage.
Chi Position: A tight pulse at this position reflects deficiency and cold of the Kidneys.
1. 14. Weak:
Pulse Image: Strength of the pulse is minimal, and with more pressure cannot be felt at
Pathology: Qi deficiency
Positions Felt:
Cun Position: A weak pulse at this position reflects weakness in the Heart and Lungs
Guan Position: A weak pulse at this position reflects Spleen / Stomach weakness.
Chi Position: A weak pulse at this position reflects deficiency of the Kidneys.

1. 15. Intermittent Pulse:

Pulse Image: Regularly is irregular for this pulse image. Pulse seems to miss a beat and
then pauses.
Pathology: Heart organ disharmony or exhaustion of the organs
It can also be felt after three months of pregnancy. Indicating deficient Qi.

Auscultation & Olfaction

Some information can be gathered from listening to the speech and respiration. If the
speech is loud and robust, it indicates excess. If the voice is weak and timid, it indicates
weakness and deficiencies. Weak breathing is indicative of deficient Qi. Forceful
breathing indicates presence of excess heat.

Any foul odor usually indicated the presence of heat. This can be seen in the case of
body odor. A foul and sour odor can be caused by food retention. Metal smells are
commonly seen in Lung impairment.

Causes of Illness - 6 Evils

The Six Evils or Six Pernicious Influences in Chinese
The evils are external in origin, but can penetrate deeply into the body.
The Six Evils are:





Summer Heat


(Associated with Liver, Wood, Spring, Yang evil)
Wind is involved with movement and activity, and brings other evil Qi in with it. It is the most
important evil as it is the cause of the "100 diseases".
Disperses Qi upward and outward

Yang energy wants to rise and expand

Illnesses manifest in upper and outer parts of the body in early stage: head, sense organs and

Rashes Common: itchy, come and go quickly, spread quickly

Sweating common: causes opening of pores (Qi and fluids lost)

Rapid onset and rapid changes

Acute illnesses with rapid progression such as fever, infectious diseases

Creates abnormal or sudden movement

spasms, convulsions, twitches

Creates abnormal positions


Stiff neck with flu

Most common in spring

Wind Syndromes - External Wind

1.) Wind-Cold

chills more than fever

aversion to cold

occipital headache

stiff neck


mucous will be clear and copious

runny nose

body aches that move around

tongue: slightly pale, thin white coat

Excess Type External Wind

Little or no sweating

pulse: floating, slow, tight

Wei Qi is strong so pores are held closed

warm relieve surface treatment is used to sweat

out evil and excess Wind and Cold

Ma Huang Tang
Xu Type External Wind


Pulse: floating, slow, Xu

Wei Qi is weak. There is sweating but it does not release the Exterior

Harmonize Ying and Wei Qi. Ying nourishes Wei to gently strengthen it, without tonifying Evil Qi

Gui Zhi Tang

2.) Wind-Heat

fever more than chills

sore throat

cough with thick, yellow mucous

thirst for cold drinks

frontal headache; can be stronger, pounding (Yang Ming)

redness or inflammation of eyes



red face

Pulse: Floating, rapid

Tongue: slightly red in early stage, yellow coat, thorns on lung area
3.) Wind-Damp

sensitivity to wind

fever and chills with fever more pronounced in the afternoon

strong body aches

body and head feel heavy

copious phlegm - runny nose, congestion, stuffiness, sinusitis

sinus headache

foggy headed, difficult thinking

Pulse: slippery

Tongue: swollen, likely to be a thick coat, could be greasy

4.) Wind-Damp Bi Pain

Arthritis, nerve pain, and numbness that is worse with cold and damp


Pulse: slippery

Tongue: swollen, thick coat

Treat by opening channels and mildly relieving surface

5.) Wind-Water

disruption of Jin-Ye

anything with sudden Oedema

acute onset

frequently occurs in the face

Treat by relieving surface, eliminating water

causes include allergic reaction, rash, acute nephritis

Pulse: slippery

Tongue: swollen, greasy coat

6) Wind-Rash

acute onset

moves around to different parts of body

will appear and disappear

Pulse: floating, rapid

Tongue: red with yellow coat

Wind Syndromes - Internal Wind

Associated with the Liver, and causes diseases of shaking and abnormal body positions.

It is usually chronic, where external wind is usually acute.

It combines easily with phlegm, as in Deviation (Wind blows it out of position and the phlegm
makes it stick in an abnormal position).
Symptoms of Internal Wind

spasms and abnormal muscle contractions



post-stroke squeal


shaking from anger

migraine (Wind blowing in head)

Pulse: wiry usually rapid

Tongue: shaking or deviated

Causes of Liver Wind
Excess fire affecting the Liver

Fire creates Wind

enters the Blood level

high fever (diseases such as meningitis)

poisons, toxins, radiation, drugs, alcohol

constitutional Liver Fire

Pulse: rapid, wiry, excess

Tongue: red, yellow coat; shaking or stiff

Liver Yin Xu, Yang Kan - Long-standing Yin deficiency with Heat

long term use of drugs, alcohol

chronic Yin Xu fevers

Pulse: Wiry, rapid, thin

Tongue: red, no coat, shaking

Liver Blood Deficiency
1) Blood Xu makes Heat
2) Blood not nourishing the "General"

Numbness of limbs common

Pulse: thready or hollow

Tongue: pale with white or yellow coat

Liver wind mixing with Phlegm
Wind blows it into an abnormal position and phlegm makes it stick. It affects Liver (Wind) and
Heart (Phlegm misting). There is rigidity especially of limbs, neck, tongue, and stiffness in tongue
(May affect the Speech)
Neurological conditions

brain disorders

Alzheimer's, senility


brain tumours
Fire and Phlegm occurring together

more sweating than with internal wind alone

rapidly changing emotions

commonly occurs with long term alcohol and drug use

red face

Pulse: Rapid, slippery, full

Tongue: red, particularly at tip, may be skewed to one side

(Associated with Kidney, Winter, Water element, Yin evil)

Damages the Yang

Impairs ability to maintain body temp

Weakens and slows life activities

Feeling of cold

Symptoms better with warmth

causes Qi and Blood to contract and congeal which creates stagnation, pain, stiffness

Easily effects the low back and knees, joints

Easily effects the Stomach, Intestines, Liver

Thin, watery, pale, cold discharges urine, stools, blood etc.

Syndromes of Cold
Wind Cold

chills more than fever

aversion to cold

occipital headache

stiff neck

clear copious phlegm

runny nose


mild body aches

Excess type

little or no sweating

Pulse: Floating, slow, tight

Tongue: slightly pale, thin white coat

Deficiency type


Pulse: Floating, slow, Xu

Tongue: slightly pale, thin white coat

Cold attacking the Spleen and Stomach

Looks like spleen Qi Cut but the cause is external (Examples are living by the ocean or eating
cold foods). Phlegm and Dampness can also collect and cause dizziness.


loose stools

watery stools


poor digestion



stomach or abdominal pain that is worse with cold

loss of appetite


Pulse: slow

Tongue: pale
Cold evil damaging both spleen and Kidney Yang
Can be acute, as in hypothermia, or chronic, as in a cold climate damaging spleen and kidneys.
Symptoms as in previous syndrome with:

watery stools

undigested food in stools

bird stools

aversion to cold

feeling of cold in entire body

profuse urination or oedema

strong fatigue

pale face

possibly green or purple lips

Purple or black under eyes if the Kidney Yang is damaged

Pulse: slow, weak

Tongue: pale, white coat, tooth marks

Cold contracting the Qi and Blood
Cold slows circulation, contracts, congeals, stagnates
Liver Qi Stagnation

abdominal bloating

depression, irritability

Pulse: wiry

Tongue: light purple

Blood stagnation

pain that is sharp, stabbing, needle-like, constant

purple lips, complexion etc.

Pulse: choppy

Tongue: deep purple, possibly purple spots

Wind cold damp Bi pain

arthritis (more commonly Osteoarthritis) with cold, stiff, contracted joints

sensitivity to cold is strongest symptom

can be nerve or muscle involvement

symptoms better with warm weather, heat therapy, saunas

Cold contracting the liver meridian

pain on inside of legs, genital area along liver meridian

severe menstrual pain



muscular problems i.e. groin pull

testicular problems

sperm production

may be infertility

will exhibit signs of liver blood stagnation

Pulse: choppy

Tongue: pale and purple

(Associated with spleen, late summer, Earth element, Yin evil)
Dampness is heavy, tenacious, difficult to treat, and lasts a long time. It tends to move
downwards in the body.
Sticky, greasy, oily, dirty, bad smell

"looks like water or mud, "looks and smells dirty

greasy hair and face

greasy skin: acne, pus, oozing wound

mucous or discharge anywhere in body

bad body odour, bad breath, smelly perspiration

bad smelling diarrhoea with mucous (if mixed with heat, there can be cloudy urine)

thick or bad smelling vaginal discharge as in STD

copious nasal discharge

oedema or swelling

arthritis with swollen joints

fluid coming out of anywhere

Candida, fungus, yeast

Damages the Yang of body

worse in cold, damp weather

Spleen works to transform Damp; Kidney supports Spleen

Creates stagnation

Stagnate fluids will also stagnate Qi and Blood

Syndromes of Damp
Acute condition, but has the slowest onset of all winds. It is affected by damp and cold weather.
Symptoms can reflect a respiratory infection with copious phlegm or a gastrointestinal flu.

strong generalized body aches

heavy feeling in head and body

foggy headed, unclear thinking, band headache

copious phlegm, can be runny or thick


afternoon fever

nausea, vomiting

diarrhoea, possibly with mucous

Pulse: slippery, slowing down pulse

Tongue: swollen with thick, greasy coat

Wind-Damp Bi pain

swelling of joints


Pulse: slippery

Tongue: swollen with thick, greasy coat

Damp poison in skin

discharge: pus, carbuncles, boils, acne, oozing

infection after wound

warts, fungus, yeast

Damp heat
Infection or inflammation that can affect many places, such as the Liver, Gallbladder, Urinary
Bladder, Intestines, Sinuses, etc.
"itis" Diseases






Pulse: slippery, rapid (which quality is greater?)

Tongue: red, thick yellow coat, swollen (how thick, how swollen, how red?)
Internal dampness arising in the body
Dampness arising from Spleen Xu: Dampness is the main factor, the Xu is secondary. It often
compromises immunity due to congestion of lymphatic system, autoimmune conditions in
particular. If severe, it becomes Phlegm. A long term chronic situation is often due to damp, cold,
raw foods.
Symptoms may be associated with a wide variety of diseases: Chronic Fatigue, Fibromyalgia,
Candida, Lymphoma, Etc.





heaviness of head and body


low appetite

(Associated with the Heart, summertime, Fire element, Yang Evil)
Damages Yin

dries fluids, easily leads to Yin Xu

Heat rises

diseases most common on face, eyes, and nose

Causes redness

the more red, the more heat

Easily produces wind

when heat affects the Liver

Speeds things up

agitation, restlessness

can be bleeding: Blood moves so fast it leaves the vessels

Easily affects the skin

red, itchy, painful rashes

Syndromes of Heat

fever more than chills

sore throat

frontal headache (yang Ming channels)

big thirst

sinus infection

red eyes, conjunctivitis

cough with yellow, green or brown phlegm

Tongue: red and raised dots in lung area (thorns)

Pulse: rapid, floating

Damp Heat

Upper Jiao - Affects face and chest

Middle Jiao - Affects Spleen and Liver

Lower Jiao - Intestines, bladder, genitals, etc.

Excess Fire
Strong heat that reaches deep in to organs. It can have an external or internal origin.

big thirst



symptoms are loud and forceful (cough, diarrhoea etc.)

Syndromes of Fire
Lung fire

can be loud, forceful cough with blood (fire has burnt off protection of mucous membranes so
capillaries have burst)

mucous is yellow, green , brown

red, painful rash

Stomach fire

burning ulcer, heartburn)

Stomach channel problems: toothache (infection), frontal headache strong pain or burning on
Heart fire

strong anxiety



Liver fire


shingles in costal region

burning pain in genital area as from STD's

Large Intestine fire


toothache (channel pain) -> Kidney fire

long term alcohol or drug abuse

bone infection

meningitis (affects Marrow)

Deficient Fire
Yin Xu, Yang Kan, Heat is deep in the body: Ying level. Pattern of mixed Xu and excess.
Treatment must include quelling fire as well as nourishing yin

smouldering heat especially at night

low grade rashes

severe restlessness

slight bleeding

Tongue: scarlet

Pulse: thready, rapid

Summer Heat
(Associated with the Heart, Fire Element, Summer, Yang Evil)

Syndromes of Summer Heat

Summer heat

high fever


thirst with strong desire to drink

can go up and affect the head


blurred vision



scant yellow urine


Yin collapse

profuse sweating

Tongue: dry, red

Pulse: surging (flooding - strong, big waves)

Summer Heat combined with Dampness
A person with a Damp constitution experiencing Summer Heat, or a person who eats Damp
foods in summer (ice cream, cold soda).
Dampness turns into phlegm because of heat



loose stools or diarrhoea

poor appetite and fatigue

phlegm can rise to head


heavy head

foggy thinking

suffocating feeling in chest

tightness in chest

sweating, but not as much as Summer Heat without Dampness

(Associated with the Lung, Autumn, Metal Element, Yang evil)
Exterior in origin (not yin Xu, not internal)
Easily damages body fluids

Dry skin

Dry hair

Dry eyes

Dry lips

Dry throat or low grade sore throat

Dry stools

Scant urine

Easily damages lungs

Could be from dry climate or smoking

Dry cough and dry phlegm (thick, sticky, hard to expel)

Syndromes of Dryness
Warm Dryness




Dry Mouth

Dry Nasal Passages

Dry cough with Dry Phlegm

Tongue: red with thin or no coat

Pulse: rapid

acute: treat as wind-heat

chronic: tonify yin

Cool dryness (Example: Dried out from air conditioning)

Dry phlegm (thick, doesn't move)

Sensitive to cold


Mild fever


Dry cough

Dry mouth

Dry nasal passages with stuffiness

Tongue: thin, white

Pulse: tight, slow


Acute: Treat as wind-cold

Causes of Illness - 7 Emotions

The Seven Emotions in Chinese Medicine
Emotional related diseases factors, which effect the organ associated with the emotion as well as
organs that have a Five Element relationship with that elements emotion.
The Seven Emotions are:
Worry and Pensiveness
Joy (Over-excitement, Manic) - Heart and Fire Element
Slows the Qi - Fear controls Joy (Water controls Fire)
Unclear Thinking
Mania, Disturbed Shen (possibly manic, risk-taking)
Heart Attack
Example: Migraine headache caused by sudden joy from receiving good news.
Anger (Rage, Resentment, Frustration) - Liver and Wood Element
Makes Qi Ascend - Grief controls Anger (Metal controls Wood)
Vertex Headache
Blurry Vision
Blood Pressure is Raised
Internal Wind (trembling from anger or an onset of Wind symptoms such as a seizure)
Pain in the Coastal Region Especially in the Liver

Liver attacks Spleen and Stomach

Spleen Qi Xu
Rebellious Stomach Qi
a. Nosebleeds common because Qi is ascending
b. Vessels Burst Because Spleen is Weak
Liver counterattacks Lung
Liver can harm Gall Bladder (Yin Yang paired Organ)

Inability to make decisions (I'm so angry, I can't think straight)

Grief or Sadness - Lung and Metal Element
Weakens, Depletes, or Dissolves the Qi - Joy Controls Grief (Fire controls Metal)
Tightness in the Chest (SOB)Excessive Crying
Frequent Colds and Flu (Wei Qi is weakened)
Skin problems
Grief Affecting the Heart
Zong Qi is weakened affecting Heart
Metal counterattacking Fire
Circulation Becomes Impaired
Worry and Pensiveness - Spleen and Earth Element
Stagnates or Knots the Qi - Wood controls Earth (Anger controls Worry and Pensiveness)
Harms the Heart
Son depleting the Mother, and ultimately the Shen
Spleen Qi Deficiency

Heart Blood Deficiency

Fright (Terror, Shock) - Gallbladder and Wood Element
Fright Confuses or Scatters the Qi - Grief controls Fright (Metal controls Wood)
Note: There is a difference between fear and fright: Fright: startling, scared by things that are
present. Fear: deeper, more chronic; scared by things not present
Lack Courage
Harms the Kidneys
Son depleting mother; Wood depleting Water
Long-term fright turns to fear (child abused once causes fright; ongoing abuse leads to fear of when
it will happen again)
Harms Liver
Gallbladder and Liver are Yin Yang paired organs
become angry at what frightened us (a mother becomes angry with a child that loves to startle her
as a joke)
Harms the Heart
Wood fails to nourish Fire, Fright un roots the Shen
Fear - Kidneys and Water Element
Makes Qi Descend - Concentration and thinking controls Fear (Earth Controls Water)
Note: Less sudden, more chronic and internal than fright
Kidneys are weakened when living in fear
might lose bladder control
Harms Liver and Gallbladder
Water not nourishing Wood)
Lack Courage

Harms the Heart

Water not controlling Fire
Heart Fire blazes out of control
anxiety, restlessness

General Deficiency and Excess of Yin and Yang

Quality of:

Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


Yang Xu Chronic


Rapid, Strong.

Rapid, Weak.


Slow, Weak.

Pink/Light Red

Red Body, Yellow


Pale/Pink Or

Pale Body,


- Could Be

Yellow Due To
Heat Burning
Body Fluids.


Red Body,
Thin/No Coat
Light Mild
Heat/Slow Boiling
Map Coating
(Partial Peel: Only
Part Of Tongue
Has Coat).

Only Cheeks Red.

- Poss. Thick Coat

- Poss. Swollen
Thickness Due To
Excess Body


- Poss. Teeth
Marks Over
Months Or
Not Excess Or
Additive Cold,
More Of A Xu
Has Nothing
To Do W/Yin
Chronic Water


Quality of:



Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


- Poss. Dryness

- Poss. Dryness

- Poss. Swollen


Red, Dry.

If Inflammation Is
Involved There
Will Be Burning
Any Burning
Sensation Is

Dryness Due To
Fluid Xu, And
Heat Excess.

Edema Around

Red, Inflamed.

Dry Skin.

- Poss. Skin

- Poss. Rash, But

No Puss Or

If Patient Sweats,
It Will Be A
Profuse Sweat.

- Poss. Sweat, But

Only In Late
Afternoon, Or At
- Poss. Five Palm

Yang Xu Chronic

Dark Circles.
Dark Circles
Due To
Kidney Qi Xu,
Or Kidney
Yang Xu.

Oily Skin, Body

Odor, Pale.
- Poss. Rashes
W/Puss If There Is
- Poss. Cysts,
Masts, Edema Due
To Fatty Tissue
If There Is Sweat,
It Will Be Greasy
And Oily.
Dampness Tries
To Protect The
Evil By Pulling It
Down, Inhibiting
Sweat From

Sweat W/Wo
Notes: Door Is
Yang Energy
Xu, So Sweat
Leaks Out.

Quality of:

Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


Yang Xu Chronic

Benefiting Fever


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

Weak/Dry Cough.
- Poss. Aftermath
Of Illness

Profuse Thick

Smokers Cough.

Asthma Has
Both Lung
And Kidney

- Poss. Blood


Stimulants Such
As Coffee &
Cigarettes Are
Excess Yang
Additives Into The

Shortness Of
Breathing, Or
Weak Shallow

Rapid/Weak Beat.
- Poss.
Around The Heart

Very Poor Blood

- Poss. Heart Pain
- Congestion:
Blood Clots Due
To Blood
Heart Failure
When There Is
Stagnation There
Is Pain, No
Stagnation, No

Weak Heart
And Low
Energy, Lots
Of Heart
- Poss.
Heart Rates
- Poss.
Cardiac Pain,
And Cardiac

Quality of:

Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


Yang Xu Chronic



Hungry, But Can

Not Eat.

Very Low

Very Low
Appetite, No
Energy To

Patient May Eat A
Lot, But Do Not
Gain Weight

- Poss. Gas,
Abdominal Pain,
Deficient Fluids
(Insufficient To
Digest Food).

Crave Foods That

Create Dampness,
Such As Raw Or
Greasy Foods,
Makes Patient Feel
Could Be Cause
Of Illness.

- Poss.
Food In Stool


High Thirst, Likes

High Quantity Of
Cold Drinks.

Thirsty, Sips Cool

Drinks, But Can
Not Drink Very

Might/Might Not
Have Low Thirst.

Low Thirst,
Likes Warm


Bloating, Stool
Will Be Dry,
W/Difficult Bowel
Extending Pain,
Sharp Pain, Does
Not Like Pressure,
Does Not Like

Dry Hard Stool

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

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

Mild, Dull,
Pain. Likes
Heat, Likes

- Poss. Burning
W/Damp Heat Or
From Extreme
Heat Stagnation.

- Poss. Diarrhea

- Poss. Early

Quality of:

Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


Yang Xu Chronic

Scant, Light
Yellow Urine,
Low Grade UTI.

Copious Urination,

- Poss. Chronic

- Poss. Cloudy Or
W/Puss Due To

Usually Night

Truly A
Condition Where
Only Fluids Can
Be Passed
(Appears To Be
Diarrhoea), But
Solids Are Not
Do Not Give
Patients Warm
Water Or Spicy
Kidney /

Dark, Scant,
Yellow Urine,
Strong Urinary
- Poss.
UTI Symptoms:
Frequency, And


Strong/Excess Sex
- Poss. High

- Poss. Feeling
Of Not Being
Finished, Due
To Lack Of
Kidney Yang

Slightly Higher
Sex Drive, But
Tires Easily (Hard

Prone To STD's,
Yeast, Infections,
Warts, Cysts.

Low Sex
Drive, Can't

Quality of:

Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Chance Of
Illness (Fatigue,
PID's, STD's,

Time Performing).

Excess Yin - Acute


- Poss.
Low Sperm

- Poss. Vaginal

- Poss. Hormone

Regular, No
Cramps, No
Clots, No

Very Red Color,

Short Cycle.

Brown Or Dark
Red, Scanty.

- Poss. Early
Menstruation (5
To 7 Days)

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

Long Cycle,
Thin, Or Light

- Poss. Blood Clots

- Poss.
Cycle (No

Wants To Sleep,
Groggy After

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

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

Does Not Like To

Sleep, Toss And
Turn, Restless.
Coffee Is A Good
Example Of
Excess Functional
Energy Added To
The System.


High Level Of

Trouble Falling
Symptoms Worse
At Night.
- Poss. Day Time
Naps, Easier To
Fall Asleep

Yang Xu Chronic

Clear Yang Gets
Pulled Down By

Blood Deficiency.
Restless, But
Exhausted. Tired,

Often Feel Tired,

Lethargic w/no

Weak, Due To
No Functional

Quality of:


Excess Yang Acute

(Excess Heat

Yin Xu - Chronic
(Deficient Heat

Excess Yin - Acute


Yang Xu Chronic

Energy, Restless.

But Cannot Sleep.


Energy, True

Angry, Anxious,
Agitated, Restless
All The Time.

Angry And
Anxious, But Less
Energy Behind
The Emotion.

Clinical, Mental,
Or Neurological

Depressed, No
Afraid, Low
Self Esteem.

Two Types Of
Mental Illness.
Phlegm Misting
The Heart: Not
Social, Hide In A
Corner. Phlegm
The Heart.

Loud, Rapid,
Talks A Lot.

Speaks Quickly,
But Not Loud Or

Slow Speech,
Heavy Or Phlegmy
Voice, Speech
Disorders, Esp.

Slow And
Weak. Mainly
Yes Or No


Hot, High Fever,

Sensitive To Heat.

Low Grade Fever,

5 Palm Heat (Also
called 5 Center

Cold, Sensitive To

Very Cold,
Sensitive To

General Symptoms and Their Meaning in TCM

Colours of the Face

Chills and Fever




Appetite, Eating, and Taste


Defecation and Urination





Lips and Mouth


Colours of the Face


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


Bright Orange

Yang Jaundice (Damp Heat)

Colours of the Face


Smoky Dark

Yin Jaundice (Cold Damp or Long Term


Pale Yellow (Not Bright)

Blood and Qi Xu

Blue (Cold, Pain, Blood Stagnation, Convulsions)

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

Excess Yin and Cold

Bluish Purple Face and Lips with Intermittent Pain

Behind the Sternum or Pericardial 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



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




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 One

Side of the Body

Hemiplegic or Wind Stroke



Redness and Swelling

Wind Heat or Liver Fire

Yellow Sclera


Ulceration or Canthus

Damp Heat

Upward, Straight Forward, or Sideways Staring

Liver Wind



Flapping of Ala Nasi

Heat in the Lungs or Qi Xu of both Lung and


Clear Discharge

Wind Cold

Turbid Discharge

Wind Heat

Prolonged Turbid Discharge, with Stinking


Rhinitis or Chronic Sinusitis



Burnt Black and Dry and Withered Auricles in

Severe Illness

Consumption of Kidney essence

Purulent Discharge

Damp Heat of Liver and Gall Bladder



Pale Gums

Blood Xu

Redness and Swelling

Stomach Fire

Redness and Swelling with Bleeding

Injury of Vessels by Stomach Fire

Lips and Mouth


Pale Lips

Blood Xu

Bluish Purple Lips

Retention of Cold or Blood Stagnation

Red and Dry Lips

Excess Heat

Sudden Collapse with Open Mouth


Sudden Collapse with Lockjaw




Redness, Swelling, and Soreness

Lung and Stomach Heat

Redness and Swelling with Yellow or White Ulcer


Toxic Heat in Lung and Stomach



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.

Chills and Fever


Chills Accompanied by Fever (External Pathogen Fighting with Antipathogenic Qi (Zheng Qi))
Severe Chills, Mild Fever, Absence of Sweating,
Headache, General Aching, and a Superficial Tight

Wind Cold

Mild Chills, Severe Fever, Thirst, Sweating, and a

Superficial Rapid Pulse

Wind Heat

Alternating Chills and Fever

Alternating Chills and Fever with a Bitter Taste in
the Mouth, Thirst, Fullness and Stuffiness in the
Chest and Hypochondrium

Intermediate Syndrome

Alternating Chills Occurring at Specific Times of

the Day


Fever without Chills

High Fever with Aversion to Heat, Profuse
Sweating, Severe Thirst, and a Surging Pulse

Excess Heat in the Interior

Fever at a Fixed Hour of the Day

Tidal Fever

Tidal Fever in the Afternoon or Evening, with Night

Sweating, and a Red Tongue with Little Moisture

Yin Xu

Chills and Fever


Fever more Pronounced in the Afternoon with

Constipation, and Fullness and Pain in the

Yangming Fu Syndrome

Chills without Fever

Chilled Appearance, Cold Limbs, and a Deep,
Slow, and Weak Pulse

Interior Cold Xu



Absence of Sweating in Exterior Syndromes

Invasion by Pathogenic Cold

Presence of Sweating in Exterior Syndromes

Exterior Xu from Exposure to Wind, or Exterior

Heat from Invasion of Pathogenic Wind Heat

Night Sweating (May also have Tidal Fever, and a

Red Tongue with Little Coat

Yin Xu with Hyperactivity of Yang Heat

Spontaneous Sweating (May also have Chills,

Listlessness, and Lassitude)

Qi and Yang Xu

Profuse Sweating with High Fever, Mental

Restlessness, Thirst for Cold Drinks, and a Surging

Excess Interior Heat

Profuse Sweating with Listlessness, Feeble Energy,

Cold Limbs, and a Deep Thread Pulse in a Severe

Total Exhaustion of Yang Qi

Appetite, Eating, and Taste


Poor Appetite in a Prolonged Illness with

Emaciation, Loose Stools, Lassitude, and a Pale
Tongue with Thin White Coat

Spleen and Stomach Weakness

Poor Appetite with Stuffiness in the Chest, Fullness

Stagnation of Qi of the Spleen and Stomach Caused

Appetite, Eating, and Taste


in the Abdomen, and a Thick Sticky Tongue Coat

by Retention of Food or Dampness

Excessive Appetite and Easily Hungry in a Skinny


Excess Stomach Fire

Hunger with no Desire to Eat, or Eating Small

Amounts of Food

Impairment of Stomach Yin, Producing Internal Xu


Lack of Thirst During an Illness

Body Fluids are not Consumed (Usually present in

a Cold Syndrome, or where Heat is not Noticeable)

Presence of Thirst During an Illness

Consumption of Body Fluid or Retention of Phlegm

Damp in the Interior Preventing Fluid from

Bitter Taste in the Mouth

Liver and Gallbladder Fire

Sweet Taste in the Mouth

Damp Heat in the Spleen and Stomach

Sour Regurgitation

Retention of Heat in the Liver and Stomach


Spleen Xu

Defecation and Urination


Constipation from Dryness of the Stool

Accumulation of Heat or Consumption of Body


Loose Stools

Spleen Xu, or Damp Retention in the Spleen

Watery Stool with Undigested Food

Spleen and Kidney Yang Xu

Bloody Stool with Mucus and Tenesmus

Damp Heat in the Intestines and Stagnation of Qi in

the Intestinal Tract

Yellow Urine

Heat Syndrome

Clear and Profuse Urine

Absence of Pathogenic Heat, or Cold Syndrome

Defecation and Urination


Turbid Urine

Damp Heat Pouring Downward, or Downward

Leakage of Turbid Essence.

Red Urine

Injury of Vessels by Heat

Clear Urine with Increased Volume

Infirmity of Kidney Qi, and Bladder Dysfunction in

Controlling Urine

Scanty, Yellow Urine, with Urgent and Painful


Downward Movement of Damp Heat in to the


Dribbling Urination or Retention of Urine in Severe


Exhausted Kidney Qi (Xu) or Stagnant Bladder Qi

(Excess) due to the Downward Infusion of Damp
Heat, Stagnant Blood, or Stones.



Severe Dissention and Mild Pain Moving from

Place to Place, Often Occurring in the Chest,
Epigastria, Hypochondriac, and Abdomen

Qi Stagnation

Headache with Distending Sensation in the Head

Upward Disturbance by Fire and Heat

Prickling Pain, Sharp and Fixed in Location, Often

Occurring in the Chest, Epigastria, Hypochondriac,
and Lower Abdominal Regions.

Blood Stagnation

Pain with and Heavy Sensation (Weighty Pain),

Often Occurring in the Head, Four Limbs and
Lumbar Regions

Dampness Blocking Qi and Blood

Colicky Pain

Abrupt Obstruction of the Qi by Substantial

Pathogenic Factors

Pulling Pain which is Spasmodic in Nature and

Short in Duration

Liver Wind



Burning Pain with a Burning Sensation and a

Preference for Coolness, Often Occurring in the
Hypochondriac regions on Both Sides, and in the
Epigastria Region

Invasion of the Collaterals by Pathogenic Fire and

Heat or from Excessive Yang Heat due to Yin Xu

Pain with a Cold Sensation and a Preference for

Warmth, Often Occurring in the Head, Lumbar,
Epigastric, and Abdominal Regions.

Pathogenic Cold Blocking the Collaterals or Lack

of Warmth and Nourishment in the Zang Fu and
Meridians due to Yang Qi Xu

Dull Pain that is not severe, lingers, and lasts for a

long time

Xu Cold Syndrome


1. Disturbance of the Clear Yang by Pathogenic

Factors (Usually Excess) 2. Stagnation of Qi and
Blood in Endogenous Diseases Blocking the
Meridians and Depriving the Brain of Nourishment
3. Blood and Qi Xu Failing to Nourish the Head,
and the Sea of Marrow Becomes Empty.

Chest Pain

Pathological Change in the Heart and Lungs

Hypochondriac Pain

Obstruction or Undernourishment of the Liver and

Gallbladder Meridians

Epigastric Pain (Upper, Middle. Lower)

Invasion of the Stomach by Pathogenic Cold,

Retention of Food in the Stomach, or Invasion of
the Stomach by Liver Qi

Abdominal Pain

Excess Causes: Retention of Cold, Accumulation of

Heat, Stagnation of Qi, Stagnation of Blood,
Retention of Food or Parasitic Diseases

- Upper is SP
- Lower is KI, BL, LI, SI, Uterus
- Sides are LIV

Xu Causes: Qi Xu, Blood, Xu, Deficiency of Cold


Obstruction of the Kidney Meridian or Deficiency

of the Kidney Failing to Nourish the Lumbar

Pain in the Limbs (Joints, Muscles, or Meridians)

Retardation of Qi and Blood Circulation due to

Invasion of the Exogenous Pathogenic Factors



Persistent Pain in a Recent Disease or Pain that is

Aggravated by Pressure

Excess Condition

Intermittent Pain that is Alleviated by Pressure

Xu Condition



Insomnia with Palpitations and Dizziness

Failure of Blood to Nourish the Heart due to Heart

and Spleen Xu

Insomnia with a Restless Mind, and Dream

Disturbed Sleep

Hyperactive Heart Fire

Difficulty Falling Asleep due to an Uncomfortable

and Empty Sensation in the Stomach or Gastric
Discomfort After a Full Meal

Derangement of Stomach Qi Leading to Mental


Lethargy Accompanied by Dizziness

Phlegm Damp in the Interior

Half Asleep with General Lassitude

Heart and Kidney Yang Xu



Menses of Shortened Cycle, Excessive in Amount,

Deep Red in Colour, and Thick in Quality

Excess Heat in the Blood

Menses that are Light Colour, Profuse in Amount,

and Thin in Quality

Failure of Qi to Command Blood

Prolonged Cycle with Scanty Purplish Dark

Discharge or Clots

Stagnation of Blood due to Cold

Thin, Scanty, Light Colour Flow

Blood Xu

Irregular Menstrual Cycle

Disharmony of the Flush and Conception Vessels

due to Obstruction of Liver Qi



Premenstrual or Menstrual Distending Pain in the

Breasts and Lower Abdomen which Intensifies on
Pressure During Menses

Stagnation of Blood due to Cold

Dull Pain in the Lower Abdomen During or After

Menses which is Alleviated by Pressure

Qi and Blood Xu

Weak Constitution

Constitution depends on:

Parents' health in general, especially at conception
Mother's health in pregnancy
Adverse Factors:
Conception in state of drunkenness
Mother conceiving when too old
Consuming alcohol or smoking during pregnancy
Receiving a shock during pregnancy (affects fatal Heart Qi)
A person's basic constitution is largely determined at conception, and it can also be affected during
the mother's pregnancy.
At conception, fusion of Qi of "heaven and earth" produces human being.
Ancestral Energy of parents is passed to fetes.
Constitution is largely fixed at this time.
However, those with weak constitution can develop Qi by balanced lifestyle, avoidance of stress and
excess (work or sexual activity), adequate rest, right nutrition, breathing exercises, and
strengthening "inner" exercises such as Qi Gong and Tai Ji Quan (that originated in ancient Taoist
longevity and immortality practices but are still applicable for health promotion).

Assessment of constitution in clinic: detailed history including childhood diseases (especially

peruses; indicates inherited weakness of Lungs)
Appearance: small ears indicate weak constitution
Pulse: scattered, minute or leather pulse: weak constitution
Tongue: very flabby, with no "spirit"
Assessment of constitution is essential for accurate prognosis; what can realistically be expected
from treatments.

Over Exertion
Common cause of disease in West.
Need to have balance of rest and exercise.
When we work or exercise we use up Qi; when we rest we restore Qi.
(Post-Heaven Qi, i.e., Qi transformed from food and drink on a daily basis).
In daily activities we use Qi: Jing provides material base for long term changes but is foundation of
our inner strength and vitality.

Qi used in normal work and exercise is quickly replenished by proper food and rest. (If your patient
appears weak and depleted, ask about recent excesses of work or study or lack of sleep).
Qi is used up quickly but rapidly restored.

If overwork occurs over months or years, Qi cannot be restored quickly enough by Spleen. Person
then draws on the Jing as a reserve. This way the Jing can become depleted and signs of Deficiency
of Yin may begin to appear. This situation takes a long time to remedy.

Mental Overwork
Very common in western society: long hours of stress and mental activity very common together
with irregular meals taken in hurry. These things affect Stomach, Spleen and Kidneys. Irregular diet
(or eating late at night) can cause deficient Stomach Qi or Stomach Yin.
Physical Overwork
Depletes primarily Spleen Qi (SP dominates flesh and muscles). However, excessive physical exercise
also demands that the Liver supply its Blood and Yin to the tendons/muscles; therefore excessive
exercise can deplete Liver Blood and Yin (including workouts).

Excessive use of one part of body (i.e., repetitive movement) can cause Qi to stagnate in that part.
Excessive lifting weakens Kidneys and lower back.
Excessive standing weakens the Kidneys.

The Classics discuss the 'Five Taxations':

Excessive use of the eyes injures the Blood (the Heart)

Excessive lying down injures Qi (the Lungs)
Excessive sitting injures the muscles (the Spleen)
Excessive standing injures the bones (the Kidneys)
Excessive exercise injures the sinews (the Liver)
Excessive Physical Exercise
Exercising to exhaustion depletes Qi, also Liver Blood and Yin.
Especially bad during puberty for girls (leads to later menstrual problems).
Certain types of exercise can cause stagnation of Qi in one area
E.g. Weightlifting: lower back
E.g. Jogging: knees
E.g. Tennis: elbows
Lack of Exercise
Regular exercise ensures proper circulation of Qi.
Lack of exercise can lead to stagnation of Qi.
Certain exercises (e.g., Yoga and Tai Ji Quan) are aimed at developing Qi rather than muscles and are
useful for those with Deficient Qi who have to little energy for Western style exercises.
Excessive Sexual Activity
i.e., leading to ejaculation or orgasm
Depletes Kidney Jing, mostly in males.
Male sexual fluids are external manifestation of Kidney Jing: hence loss of these lead to temporary
loss of Kidney Jing. Female sexual fluids primarily Jin-Ye.
Normally this is made up (by postnatal Jing) and does not lead to depletion. However, when sexual
activity is excessive, body does not have time to restore the Jing.
What is "excessive" = resulting in marked fatigue, especially if accompanied by dizziness, blurring of
vision, low back pain, weak knees, and frequent urination.
Adjust sexual activity according to constitution, age, physical condition. (See chart in book pg. 138 as
broad guideline).

Seasons: increase in Spring; decrease in Winter.

In treating sexual problems, i.e., impotence, often a decrease in sexual activity is important.
In men, the Kidney Jing is depleted by excessive sexual activity; in women it is depleted by repeated
Lack of sexual activity can traditionally be a cause of disease.
Sexual desire is measure of strong Kidney Qi and Kidney Yang.
Deficient Kidney Yang: lack of libido.
Deficient Kidney Yin: excessive interest in sex and inability to be satisfied, erotic dreams and
nocturnal emissions.
Other important causes of unsatisfactory sexual life: (e.g., lack of warmth and love, relationship
issues) can be causes of disease especially where they cause a lot of anxiety and unhappiness.

Diet and Nutrition

Important cause of disease
However, Chinese dietary theories do not take into account our modern food preservatives,
colourings, pesticide residues, etc.
Dietary habits can cause disease: e.g., poor quality or imbalanced quantity of food. Malnutrition not
only in 3rd world countries but also in the west, from poverty and "fad" diets.
Trying to slim by "starving" weakens SP Qi and can actually cause increase in weight because SP will
be too weak to transform and transport fluids and food. Proper foods need to be eaten to
strengthen SP & St.
Overeating also weakens SP & ST and leads to accumulation of Phlegm and stagnation of food.
Excessive consumption of cold energy and raw food can weaken the Spleen.
Refrigerated food and iced water, ice cream are contraindicated.
Raw vegetables, salads and fruit in excess can weaken Spleen Yang:
Contraindicated in those with pre existing weakness in this area.
Excessive consumption of hot energy and spicy foods (curry, chilli, hot sauce, lamb, beef) causes
Heat especially of Stomach and Liver.
Excessive consumption of greasy/fried foods (deep fried foods, milk, cheese, cream, butter, bananas,
fatty meats, nuts) cause Phlegm or Damp which can obstruct Spleen function of transformation and

How food is consumed is important.

Eating in a hurry, eating late in evening, eating when upset, discussing work while eating, etc.,
interfere with digestion and cause deficiency of Stomach Yin.
NOTE: Foods, like herbs, have their own energetic properties and can be used therapeutically to
strengthen the body and treat disease. It is very useful to understand Chinese dietary therapy in
order to be able to suggest to the patient the foods they should eat and those they should avoid.
Physical Trauma
Cause local stagnation of Blood & Qi
Slight trauma causes stagnation of Qi
Severe trauma causes stagnation of Blood
(Both produce swelling, bruising and pain)
Trauma can affect an area for a long time and produce local stagnation of Qi and/or Blood.
Old accidents/falls can cause or contribute to current disease especially if compounded by later reinjury or later contraction of pathogen (e.g., Wind Damp will often invade a previously injured area
where there is an underlying weakness in the circulation of Blood & Qi).

Parasites and Poisons

Infestation of worms is more common in children.
Contributory factor: poor diet, especially excessive consumption of greasy and sweet food which
leads to Dampness (perfect breeding ground for worms and also Candidacies).
Incorrect Treatment
Acupuncture can cause ill effects.
Incorrect use of moxa (i.e., use where heat is present) can aggravate a heat condition. Chinese herbs
however have more specific effect than acupuncture.
E.g., if one tonifies Yang (heating herbs) by mistake when there is deficient Yin (producing heat signs)
one can seriously aggravate the condition.