1. Differentiation of Heart and Small Intestine Diseases
Heart disease syndromes: Deficiency syndromes include insufficiency of Qi, blood, Yin, and Yang; Excess syndromes include Qi stagnation, phlegm-heat, cold obstruction, and blood stasis.Symptoms of heart disease: Common manifestations include mental disturbances, abnormal spirit, palpitations, insomnia, vivid dreams, forgetfulness, irritability, delirium, as well as changes in complexion, tongue appearance, and pulse.Small intestine syndromes: Deficiency syndromes include cold deficiency of the small intestine (spleen Yang deficiency); Excess syndromes include excess heat in the small intestine and small intestine Qi abscess (cold stagnation in the liver meridian).Symptoms of small intestine disease: Primarily characterized by abnormal separation of clear and turbid, manifested as abnormal urination.(1) Heart Qi deficiency, Heart Yang deficiency, and Sudden Heart Yang Collapse[Clinical manifestations] These three syndromes share common characteristics but have different presentations that should be carefully distinguished.Common points: Two points, one is the mental disturbance of palpitations; the second is the Qi deficiency symptoms of chest tightness, shortness of breath, and spontaneous sweating, which worsen with activity.Different points: The three syndromes are described as follows:Heart Qi deficiency: Primarily characterized by Qi deficiency symptoms, mainly manifested by changes in complexion, tongue appearance, and pulse. The complexion and tongue are pale, and the pulse is weak.Heart Yang deficiency: Qi deficiency symptoms are significantly aggravated, and there are also signs of deficiency-cold. Symptoms include aversion to cold, cold limbs, heart pain, pale or dull complexion, pale tongue with white slippery coating, and fine pulse.Sudden Heart Yang Collapse: Extremely severe Qi deficiency symptoms, prominent deficiency-cold signs, and severe mental disturbances. Sudden cold sweat, cold limbs, weak breathing, pale complexion, cyanotic lips, mental confusion or coma, pale purple tongue with slippery coating, and pulse barely palpable.[Syndrome Analysis] Heart Qi deficiency, Heart Yang deficiency, and Sudden Heart Yang Collapse are based on the pathological foundation of Heart Qi deficiency and overall decline of heart function; further development leads to Heart Yang deficiency, presenting deficiency-cold signs; progressing to Yang collapse results in the sudden collapse syndrome, which is a key point in syndrome differentiation.Qi deficiency, insufficient Zong Qi, and lack of mental control manifest as a series of Heart Qi deficiency symptoms, such as palpitations, shortness of breath, chest tightness, which worsen with activity.Qi deficiency leads to weak blood circulation and insufficient nourishment, resulting in blood deficiency symptoms, with pale complexion, tongue, and weak pulse.Qi deficiency and Yang loss lead to loss of warming function, hence the appearance of deficiency-cold signs, such as aversion to cold and cold limbs; Yang deficiency leads to cold obstruction, Qi and blood stagnation, and heart pain, resulting in a weak pulse.Sudden Yang collapse leads to loss of Yin fluids, resulting in cold sweat and cold limbs; significant leakage of Zong Qi, blood stasis, and loss of nourishment to the heart spirit, hence the presence of Yang collapse symptoms.In summary, the pathology can be summarized as Qi deficiency, Yang decline, and insufficient blood circulation, which is the basic process.(2) Heart Blood Deficiency and Heart Yin Deficiency[Clinical manifestations] The two syndromes share common symptoms of palpitations and mental disturbances, insomnia, and vivid dreams.Different symptoms: Heart blood deficiency presents with blood deficiency symptoms, such as dizziness, forgetfulness, pale complexion, lips, and tongue, and weak pulse. Heart Yin deficiency must also have signs of deficiency-heat, such as five hearts feeling hot, tidal fever, night sweats, red cheeks, red tongue with little fluid, and rapid pulse.[Syndrome Analysis] The causes of Yin and blood deficiency include congenital or acquired insufficiency; excessive damage, such as blood loss, febrile diseases, and emotional disturbances.Blood belongs to Yin; insufficient heart Yin and heart blood lead to loss of nourishment to the heart spirit, hence symptoms of mental disturbance, palpitations, insomnia, and vivid dreams.Heart blood deficiency syndrome focuses on insufficient nourishment of blood, which cannot ascend to nourish, hence blood deficiency symptoms.Heart Yin deficiency syndrome focuses on weakened moistening, with Yin deficiency leading to Yang excess, resulting in internal heat, hence a series of deficiency-heat signs.In terms of pathological relationships, blood deficiency gradually leads to Yin deficiency, so the key point in differentiating the two syndromes is the presence or absence of deficiency-heat signs. Deficiency without heat signs indicates Heart blood deficiency; deficiency with heat signs indicates Heart Yin deficiency.(3) Excess Heart Fire[Clinical manifestations] This syndrome has three characteristics: first, heat disturbing the heart spirit, with chest heat and insomnia, leading to severe agitation and delirium; second, heat and fluid deficiency, with red face, thirst, dark yellow urine, red tongue tip, or sores and ulcers in the mouth, with rapid and forceful pulse; third, heat forcing blood to move erratically, leading to various bleeding or Qi stagnation and blood stasis, skin sores, and ulcers.[Syndrome Analysis] The causes of excess heart fire include three aspects: external invasion of six Qi transforming into fire; internal injury from emotional disturbances; or damage from rich and heavy foods.Excess heart fire focuses on the tongue, pulse, and spirit aspects, and its nature belongs to excess heat syndrome.Internal heat rising and disturbing the heart spirit leads to symptoms of mental disturbance; heat can damage fluids, hence a series of heat excess and fluid deficiency signs. The heart governs blood vessels; heat obstructs blood vessels, or forces blood to move erratically, leading to vomiting blood, nosebleeds; or blood heat obstructing vessels, leading to skin sores, swelling, and pain.[Syndrome Differentiation] Excess heart fire and Heart Yin deficiency syndrome.Both syndromes have general symptoms of mental disturbance and heat signs. The key differentiation point is that excess heart fire belongs to excess syndrome, while Heart Yin deficiency belongs to deficiency syndrome.(4) Heart Vessel Obstruction[Clinical manifestations] The main symptoms are “pain” and “palpitations,” namely palpitations, chest tightness and pain, radiating to the shoulder and inner arm, occurring intermittently. Due to different causes, there are four sub-syndromes:Blood stasis obstruction: Characterized by typical stabbing pain, with purple and dark tongue, stasis spots, and fine, choppy pulse.Phlegm-damp accumulation: Characterized by a feeling of heaviness and pain, with overall symptoms of heaviness, fatigue, excessive phlegm, white greasy tongue coating, and slippery pulse.Cold obstruction: Characterized by cold pain, sudden severe pain, alleviated by warmth, aversion to cold limbs, pale tongue with white coating, and slow or tight pulse.Qi stagnation: Characterized by distending pain, closely related to emotional states, with pale red tongue, thin white coating, and wiry pulse.[Syndrome Analysis] This syndrome often occurs on the basis of deficiency, with blood stasis, phlegm accumulation, cold stagnation, and Qi stagnation leading to disease, hence its nature belongs to a mixed syndrome of deficiency and excess.With deficiency of Zheng Qi, insufficient Yang Qi, and abnormal blood circulation, the heart spirit loses nourishment, leading to palpitations. Deficiency leads to excess, causing blood stasis, phlegm accumulation, cold stagnation, and Qi stagnation, leading to heart vessel obstruction and pain. The pain occurs along the pathway of the heart meridian, which is a key diagnostic point.The four sub-syndromes of heart vessel obstruction often influence each other and appear mixed, manifesting as Qi stagnation and blood stasis, Qi stagnation and phlegm accumulation, Qi stagnation and blood stasis with phlegm obstruction, cold stagnation with Qi stagnation and blood stasis, among which phlegm and blood obstruction is the most common.(5) Phlegm Obstructing the Heart Orifice[Clinical manifestations] Characterized by two features: first, mental disturbance symptoms, with blurred consciousness, unclear speech, and in severe cases, loss of recognition; second, phlegm obstruction symptoms, with dull complexion, chest tightness, nausea, phlegm rattling in the throat, white greasy tongue coating, and slippery pulse. The above manifestations belong to phlegm obstruction syndrome. Additionally, phlegm obstructing the heart orifice can also manifest as epilepsy or convulsions:Epilepsy: Mental depression, flat expression, confusion, mumbling, and abnormal behavior.Convulsions: Sudden collapse, loss of consciousness, foaming at the mouth, phlegm rattling in the throat, upward gaze, limb twitching, and making sounds like pigs or sheep, returning to normal after waking.[Syndrome Analysis] The causes of this syndrome are often due to dampness and turbidity brewing phlegm, or Qi stagnation and liver depression leading to phlegm formation.Key points for differentiation: mental disturbance, phlegm rattling in the throat, white greasy tongue coating. The main pathology is dampness and turbidity, with liver depression leading to phlegm, obstructing the heart orifice.Phlegm obstruction syndrome is due to phlegm and dampness obstructing, preventing clear Yang from rising, and turbid Yin from floating upwards, leading to the obstruction of the heart orifice.Epilepsy is due to liver losing its ability to disperse, Qi stagnation leading to phlegm, with phlegm rising and obstructing the heart orifice.Convulsions are due to internal phlegm and dampness disturbing the heart, coinciding with internal wind from the liver, with wind carrying phlegm upwards, obstructing the heart orifice. When wind is strong, it leads to obvious symptoms of internal wind movement.(6) Phlegm-Heat Disturbing the HeartExternal phlegm-heat disturbing the heart syndrome: Characterized by high fever, excessive phlegm, and unclear consciousness. Specific symptoms include fever with Qi obstruction, red face and eyes, thick yellow phlegm, phlegm rattling in the throat, severe agitation and delirium, red tongue with yellow greasy coating, and slippery rapid pulse.Internal phlegm-heat disturbing the heart: Mild cases primarily present with heart agitation and insomnia, excessive phlegm, chest tightness; severe cases present with disordered speech, unpredictable emotions, violent behavior, and agitation.[Syndrome Analysis] This syndrome focuses on mental disturbance, with phlegm and heat being the key points for differentiation between external and internal causes.External heat evil invades, burning fluids and transforming them into phlegm, leading to this syndrome. When heat is strong, it leads to fever, red face and eyes, and hyperactivity of functions, resulting in coarse breathing; excessive heat damages fluids, leading to thick yellow phlegm; phlegm and heat combine, disturbing the heart spirit, leading to mental disturbances.Internal injury from Qi stagnation over time leads to phlegm formation, which transforms into heat, disturbing the heart spirit, leading to disease. Mild cases present with agitation and insomnia, with clear Yang obstructed, dizziness, chest tightness, and excessive phlegm; severe cases present with phlegm-heat binding, Qi mechanism reversed, leading to mental disturbances, hence classified as manic disease.[Syndrome Differentiation] Phlegm-heat disturbing the heart, excess heart fire, and phlegm obstructing the heart orifice, all primarily present with mental disturbance symptoms. Specific manifestations:Excess heart fire syndrome primarily presents with fire-heat phlegm, with milder phlegm symptoms, hence mental disturbance symptoms are mild, with heat symptoms prominent.Phlegm-heat disturbing the heart and phlegm obstructing the heart orifice both have phlegm obstructing the heart orifice, with obvious mental disturbance symptoms; however, the former is Yang in nature, often presenting as “active,” while the latter is Yin in nature, often presenting as “passive.”(7) Small Intestine Excess Heat[Clinical manifestations] This syndrome is characterized by heart fire rising and moving down to the small intestine, leading to fluid deficiency and abnormal urination.Heart fire rising symptoms: Agitation and thirst, sores in the mouth and tongue, red tongue with yellow coating, rapid pulse.Small intestine heat symptoms: Dark, painful urination, or blood in urine.[Syndrome Analysis] This syndrome is caused by the evil heat of the heart and small intestine rising and moving downwards.Heart fire moving down to the small intestine fails to separate clear from turbid, hence the symptoms of dark, painful urination, and in severe cases, blood in urine.Heart fire rising leads to damage to fluids and disturbs the spirit, hence symptoms of agitation and thirst, sores in the mouth and tongue, red tongue with yellow coating, and rapid pulse.2. Differentiation of Lung and Large Intestine DiseasesLung disease syndromes: Differentiated into deficiency and excess. Deficiency syndromes include insufficiency of Qi and Yin; excess syndromes are often due to invasion of wind, cold, dryness, and heat, with phlegm and turbidity accumulating and invading the lungs.Lung disease symptoms: Primarily characterized by respiratory symptoms such as cough, voice changes, breathlessness, and phlegm turbidity, with symptoms often manifesting in the mouth, nose, and throat.Large intestine disease syndromes: Deficiency syndromes include Yang deficiency and fluid deficiency; excess syndromes include damp-heat descending.Large intestine disease symptoms: Abnormal bowel movements.(1) Lung Qi Deficiency[Clinical manifestations] Primarily characterized by respiratory symptoms and Qi deficiency (including Yang deficiency). Respiratory symptoms include weak cough and breathlessness; Qi deficiency symptoms include fatigue, pale complexion, aversion to cold, spontaneous sweating, and susceptibility to colds; pale tongue with white coating, weak pulse. Symptoms worsen with activity.[Syndrome Analysis] The key point for differentiation in this syndrome is based on general Qi deficiency. The causes of Qi deficiency include prolonged illness depleting Qi and insufficient generation.The lungs govern Qi and control respiration. If the lungs are deficient, the Qi of the whole body declines, leading to loss of nourishment to the spirit, inability to produce sound, inability to retain sweat, and inability to warm the body, resulting in the above symptoms. Activity depletes Qi, hence symptoms worsen. Qi does not protect the exterior, leading to recurrent colds.(2) Lung Yin Deficiency[Clinical manifestations] This syndrome is characterized by internal dryness due to fluid deficiency and deficiency-heat symptoms. Specific manifestations include respiratory symptoms, dry cough with little phlegm, or blood-streaked phlegm; fluid deficiency symptoms include weight loss, dry mouth and throat, hoarseness, deficiency-heat symptoms include five hearts feeling hot, night sweats, red cheeks, red tongue with little fluid, and rapid pulse.[Syndrome Analysis] Lung Yin deficiency often develops from overexertion, prolonged cough, or late-stage febrile diseases.Clinically, the key points are lung Yin deficiency with internal dryness and deficiency-heat symptoms. The pathogenesis can be summarized as insufficient lung Yin and fluids, leading to the lungs losing their ability to clear and moisten, causing the Qi mechanism to reverse, hence dry cough and little phlegm; insufficient fluids cannot ascend to nourish, leading to dryness in the orifices; Yin deficiency cannot control Yang, leading to internal heat, hence a series of deficiency-heat signs. If heat damages the lung vessels, blood-streaked phlegm may occur.(3) Wind-Cold Binding the Lungs[Clinical manifestations] This syndrome is primarily characterized by cough and thin white phlegm, with accompanying symptoms of slight fever, aversion to wind and cold, no sweating, thin white tongue coating, and floating tight pulse, indicating wind-cold exterior symptoms.[Syndrome Analysis] Wind-cold invades the exterior and attacks the lungs, leading to this syndrome. Wind-cold binding the lungs causes fluids to turn into phlegm, obstructing the airways, preventing the lungs from dispersing and descending, hence cough with thin white phlegm; wind-cold binding the exterior leads to accompanying wind-cold exterior symptoms.[Syndrome Differentiation] Wind-cold binding the lungs and wind-cold exterior symptoms share the same cause, both arising from external wind-cold invasion, but the pathological changes differ, hence clinical manifestations vary.Wind-cold binding the lungs: The evil enters from the exterior, focusing on the lungs, hence cough is the main symptom, with slight exterior symptoms.Wind-cold exterior symptoms: The evil is primarily in the exterior, hence aversion to cold and fever are the main symptoms, with slight or no symptoms of wind-cold invading the lungs.(4) Cold Evil Invading the Lungs[Clinical manifestations] The main respiratory symptoms are cough and breathlessness, with thin white phlegm, accompanied by signs of excess cold, such as cold limbs, pale tongue with white coating, and slow pulse.[Syndrome Analysis] This syndrome often presents with sudden onset of cough and breathlessness, with significant cold signs.Cold evil invading the lungs leads to stagnation of Yang Qi, causing Qi reversal and cough; loss of warmth leads to cold limbs; cold obstructs Qi and blood, leading to pale tongue with white coating and slow pulse.[Syndrome Differentiation] Cold evil invading the lungs and wind-cold binding the lungs share symptoms of cough and thin white phlegm.Differences: Cold evil invading the lungs presents with more severe symptoms, cough with breathlessness, accompanied by excess cold signs; wind-cold binding the lungs presents with milder symptoms, with accompanying wind-cold exterior symptoms. Additionally, the former has a longer course, while the latter has a shorter course.Cold evil invading the lungs and phlegm accumulation in the lungs share symptoms of cough and thin white phlegm.Common symptoms include cough and thin white phlegm.Differences: Cold evil invading the lungs presents with little phlegm; the course is acute; it is an excess syndrome. Phlegm accumulation in the lungs presents with abundant phlegm that is foamy and watery; it has a chronic recurrent course; it is a mixed deficiency-excess syndrome.(5) Phlegm-Damp Obstructing the Lungs[Clinical manifestations] Characterized by cough, excessive phlegm that is sticky and white, and difficulty in expectoration. Chest tightness, and in severe cases, breathlessness with phlegm rattling, pale tongue with white greasy coating, and slippery pulse.[Syndrome Analysis] The pathological basis of this syndrome is often due to inherent spleen and lung Qi deficiency, leading to dampness accumulation and phlegm excess, often triggered by exposure to cold and dampness, leading to acute onset. Although acute cases can present with isolated excess symptoms, chronic cases are more common.In acute cases, cold and dampness invade the lungs, preventing the lungs from distributing fluids, leading to water dampness accumulating as phlegm. The evil obstructs the airways, preventing the lungs from dispersing and descending, which is the main pathological mechanism.In chronic cases, spleen and lung Qi deficiency leads to dampness accumulation, phlegm rising and obstructing the lungs.[Syndrome Differentiation] Phlegm-damp obstructing the lungs and phlegm accumulation in the lungs share symptoms of cough, breathlessness, and thin white phlegm. Differences include that phlegm-damp obstructing the lungs presents with thin phlegm, while phlegm accumulation in the lungs presents with thick, sticky phlegm. Both conditions can exhibit a mixed deficiency-excess syndrome, but phlegm-damp obstructing the lungs can also present with acute excess symptoms.(6) Wind-Heat Invading the Lungs[Clinical manifestations] Characterized by lung heat cough, with yellow sticky phlegm and wind-heat exterior symptoms. Symptoms include slight fever, aversion to wind and cold, nasal congestion with yellow thick discharge, dry mouth and sore throat, red tongue tip with thin yellow coating, and floating rapid pulse.[Syndrome Analysis] Wind-heat invades the exterior, affecting the lung defense. Wind-heat burns, leading to thick yellow phlegm, preventing the lungs from clearing and descending, hence cough and breathlessness, nasal congestion with thick discharge; the evil invades the lung defense, leading to Yang Qi stagnation, hence exterior heat symptoms; excessive heat damages fluids, leading to dry mouth and sore throat.(7) Heat Evil Obstructing the Lungs[Clinical manifestations] Characterized by cough and breathlessness with internal heat symptoms. Symptoms include coarse breathing, thick yellow phlegm, strong thirst, agitation, constipation, short red urine, red tongue with yellow coating, and rapid pulse.In severe cases, there may be flaring of the nostrils, hemoptysis, or chest pain with purulent blood-stained phlegm, indicating lung abscess.[Syndrome Analysis] Damp-heat evil enters through the mouth and nose, or wind-cold or wind-heat enters and transforms into heat, burning the lung fluids and turning them into phlegm. Phlegm-heat obstructs the lungs, preventing them from clearing and descending, hence cough and breathlessness; internal heat rises, leading to excessive thirst, agitation, constipation, and short red urine; excessive heat damages blood vessels, leading to hemoptysis; phlegm-heat obstructs, causing Qi and blood stagnation, which can lead to lung abscess.[Syndrome Differentiation] Heat evil obstructing the lungs and wind-heat invading the lungs share common symptoms of lung heat. The difference is that the former primarily presents with internal heat symptoms, has a longer course, and is more severe; the latter presents with both exterior and interior symptoms, with the disease primarily in the lung system but also showing wind-heat exterior symptoms, with a shorter course and milder severity.(8) Dry Evil Invading the Lungs[Clinical manifestations] Characterized by lung symptoms of dryness and insufficient fluids. Dry cough with little or no phlegm, sticky phlegm that is difficult to expectorate, and in severe cases, hemoptysis; dryness in the lips, tongue, mouth, throat, and nose.May also accompany cold or heat exterior symptoms, but due to the presence of cold or heat, there are differences between warm dryness and cool dryness:Warm dryness: Exterior symptoms lean towards wind-heat, with significant fluid deficiency, leading to heat damaging the vessels, resulting in chest pain and hemoptysis, red tongue with yellow coating, and rapid pulse.Cool dryness: Exterior symptoms lean towards wind-cold, with mild fluid deficiency, red tongue with thin white coating, and floating rapid pulse.[Syndrome Analysis] External invasion of dry heat or wind-heat transforms into dryness, burning lung fluids, leading to dry cough, with little sticky phlegm that is difficult to expectorate. Excessive dryness leads to insufficient moisture, hence various symptoms of dryness. Warm dryness leans towards heat, while cool dryness leans towards cold, hence different exterior symptoms, with varying degrees of fluid damage.[Syndrome Differentiation] Dry evil invading the lungs and heat evil obstructing the lungs share common symptoms of insufficient fluids.Differences: The former often occurs in autumn, with main symptoms of dry cough with little sticky phlegm and dryness in the orifices, accompanied by cold or heat exterior symptoms; the latter often occurs in winter and spring, with main symptoms of high fever, cough, breathlessness, thick yellow phlegm, and accompanying symptoms of internal heat damaging fluids, leading to hemoptysis or lung abscess.(9) Large Intestine Damp-Heat[Clinical manifestations] This syndrome is characterized by abnormal bowel movements, accompanied by symptoms of general damp-heat. Abnormal bowel movements include diarrhea with red and white sticky stools, or explosive diarrhea, yellow and foul-smelling; accompanying symptoms include abdominal pain, urgency, burning sensation in the anus; general damp-heat symptoms include thirst with little drinking, short red urine, or cold and heat exterior symptoms, red tongue with yellow greasy coating, and slippery rapid pulse.[Syndrome Analysis] Damp-heat descends and obstructs the large intestine, blocking Qi mechanism, leading to abnormal bowel movements; damp-heat burns, damaging blood vessels, leading to blood and pus in the stool; Qi stagnation leads to abdominal pain and urgency; excessive heat damages fluids, leading to thirst and short red urine.If the exterior symptoms are unresolved, there may be cold and heat exterior symptoms; if there is only internal heat, it is heat without cold.If dampness is heavier than heat, the pulse is slippery and rapid; if heat is heavier than dampness, the pulse is rapid and slippery.(10) Large Intestine Fluid Deficiency[Clinical manifestations] Characterized by constipation that is difficult to pass, with a longer time between bowel movements. Generally, there is no abdominal pain, but accompanying symptoms may include dry mouth, dizziness, and bad breath, with red tongue and little fluid, and fine choppy pulse.[Syndrome Analysis] Large intestine fluid deficiency can be caused by febrile diseases, prolonged illness, or postpartum women with inherent Yin deficiency. Insufficient fluids lead to dryness in the intestines, causing constipation; internal dryness leads to turbid Qi rising, hence symptoms of fluid deficiency and turbid Yin rising.(11) Intestinal Prolapse[Clinical manifestations] Notable for diarrhea and abdominal pain. Diarrhea may be excessive or uncontrollable, leading to prolapse. Abdominal pain is vague, relieved by warmth and pressure, with pale tongue and white coating, and weak pulse.[Syndrome Analysis] Often caused by prolonged diarrhea or dysentery damaging Yang Qi. Yang deficiency leads to inability to hold, hence excessive diarrhea; Yang deficiency leads to insufficient warmth, causing internal cold, hence abdominal pain with cold characteristics.3. Differentiation of Spleen and Stomach DiseasesThe spleen and stomach reside in the middle jiao, jointly completing the entire process of digestion, absorption, and distribution of food. Therefore, their pathologies often influence each other.Spleen disease syndromes are primarily deficiency syndromes, while stomach disease syndromes often present as excess syndromes, but both organs can have both cold and heat deficiency and excess syndromes. Deficiency syndromes often refer to deficiency of spleen and stomach Yin fluids and insufficient Yang Qi, such as spleen and stomach Qi deficiency, spleen Yang deficiency, spleen Qi sinking, spleen not governing blood, and stomach Yin deficiency syndromes. Excess syndromes often refer to invasion of external evils or internal injury from food, such as cold-damp obstructing the spleen, spleen and stomach damp-heat, stomach cold syndromes, and food stagnation in the stomach.Spleen disease symptoms: Spleen Yang deficiency leads to impaired metabolism of food, abnormal distribution of fluids, and inability to govern blood, leading to common symptoms such as reduced appetite, abdominal distension, loose stools, edema, and bleeding; stomach disease is characterized by abnormal intake, insufficient digestion, and upward reversal of stomach Qi, leading to common symptoms such as reduced appetite, abdominal pain, vomiting, belching, and hiccups.(1) Spleen Qi Deficiency[Clinical manifestations] Includes insufficient digestive function and general Qi deficiency symptoms. Insufficient digestive function refers to insufficient digestion, with symptoms of reduced appetite, abdominal distension, and loose stools; it also refers to reduced nutrient absorption, with symptoms of weight loss and pale yellow complexion. General Qi deficiency symptoms include fatigue, low energy, pale tongue with white coating, and weak pulse.[Syndrome Analysis] Spleen deficiency syndrome often results from overwork or dietary imbalance. Clinically, the key points are Qi deficiency and impaired transportation. Poor appetite leads to food stagnation and inability to transform, leading to a series of symptoms of undigested food; the spleen is the source of postnatal Qi and blood production, and deficiency leads to insufficient Qi and blood, hence general nutritional deficiency symptoms.(2) Spleen Yang Deficiency[Clinical manifestations] Characterized by spleen Qi deficiency and deficiency-cold symptoms. Symptoms include reduced appetite, abdominal distension, and loose stools, which are the basic symptoms of spleen Qi deficiency. Additionally, there are other deficiency-cold symptoms: abdominal pain relieved by warmth and pressure, pale tongue with white coating, and slow pulse.[Syndrome Analysis] Spleen Yang deficiency generally develops from spleen Qi deficiency, hence there are general digestive disorders and nutritional insufficiency. Additionally, Qi deficiency and Yang deficiency lead to insufficient warming, resulting in cold limbs, water retention, and other cold-damp symptoms.[Syndrome Differentiation] Spleen Qi deficiency and Spleen Yang deficiency.Common points: Both have symptoms of digestive dysfunction, such as reduced appetite, abdominal distension, and loose stools.Differences: Spleen Yang deficiency presents with deficiency-cold signs, primarily manifested as insufficient warmth and inability to transform cold dampness.(3) Middle Qi Sinking[Clinical manifestations] This syndrome is characterized by prominent sinking symptoms on the basis of general spleen Qi deficiency.General spleen Qi deficiency symptoms include fatigue, low energy, and dizziness. The main clinical symptoms include abdominal distension and heaviness, worsened by eating, a feeling of heaviness in the anus, frequent urge to defecate, or persistent diarrhea, and even prolapse, with cloudy urine or uterine prolapse. The tongue is pale with white coating, and the pulse is weak.[Syndrome Analysis] Middle Qi sinking syndrome often develops from spleen Qi deficiency, but can also arise from prolonged diarrhea, dysentery, or excessive labor. The key pathological mechanism is that spleen Qi deficiency leads to three pathological changes: first, insufficient Qi and blood production, leading to failure to open the Yang; second, Qi deficiency leads to inability to lift; third, overall decline in bodily functions. Therefore, in addition to general symptoms of spleen deficiency, there are prominent symptoms of organ prolapse, especially gastric prolapse.(4) Spleen Not Governing Blood[Clinical manifestations] Spleen not governing blood is characterized by various bleeding symptoms on the basis of spleen Qi deficiency symptoms.The bleeding symptoms of spleen not governing blood are primarily seen in the lower body and muscles, such as blood in stools, blood in urine, skin bleeding, gum bleeding, or excessive menstrual bleeding in women. The blood is often pale, thin, and without clots.Additionally, there are symptoms of spleen Qi deficiency: reduced appetite, abdominal distension, loose stools, fatigue, low energy, pale complexion, pale tongue with white coating, and weak pulse.[Syndrome Analysis] Spleen not governing blood syndrome often arises from excessive labor or prolonged illness leading to spleen Qi deficiency. When the spleen is deficient, it loses its ability to govern blood, hence bleeding symptoms are the key point of this syndrome, but must also be accompanied by symptoms of spleen Qi deficiency. Spleen Qi deficiency leads to impaired transportation, insufficient Qi and blood production, hence a series of spleen Qi deficiency symptoms.[Syndrome Differentiation] Spleen Qi deficiency syndrome and Spleen Yang deficiency, Middle Qi sinking, and Spleen not governing blood syndrome.These four syndromes should particularly note the relationship between Spleen Qi deficiency and the other three syndromes, summarized as follows:Pathological process: Spleen Qi deficiency is the basis for the other syndromes. In other words, Spleen Yang deficiency, Middle Qi sinking, and Spleen not governing blood syndrome often develop from prolonged Spleen Qi deficiency.Clinical manifestations: All have general symptoms of spleen Qi deficiency, especially common symptoms of insufficient digestion, such as reduced appetite, abdominal distension, loose stools, and overall nutritional deficiency. Spleen Yang deficiency primarily presents with deficiency-cold signs; Middle Qi sinking syndrome is characterized by organ prolapse; Spleen not governing blood syndrome is characterized by bleeding symptoms.(5) Cold-Damp Obstructing the Spleen[Clinical manifestations] Cold-damp obstructing the spleen has two characteristics: first, spleen deficiency leads to impaired transportation of food; second, cold-dampness accumulates internally, leading to symptoms of reduced appetite, abdominal distension, and pain, indicating digestive disorders. Nausea and vomiting, pale tongue with white greasy coating, and slow pulse.[Syndrome Analysis] This syndrome often occurs in individuals with a constitution prone to dampness, often triggered by dietary irregularities, excessive consumption of cold foods, and invasion of cold-dampness from the exterior. Hence, the underlying cause is spleen Yang deficiency, while the manifestation is cold-dampness accumulation.Yang Qi deficiency leads to inability to transform cold, hence digestive disorders, reduced appetite, abdominal distension, and loose stools. Yang deficiency leads to internal cold, hence nausea and vomiting, pale tongue with white greasy coating, and slow pulse.[Syndrome Differentiation] Cold-damp obstructing the spleen and Spleen Yang deficiency.Common points: Both have symptoms of digestive dysfunction, deficiency-cold symptoms, and internal dampness symptoms.Differences: Cold-damp obstructing the spleen is characterized by internal invasion of cold-dampness, obstructing Yang, hence it is an excess syndrome with a short course, with white greasy coating and slow pulse. Spleen Yang deficiency is characterized by Yang deficiency leading to impaired transportation, with a long course, white slippery coating, and slow pulse.(6) Damp-Heat Accumulating in the Spleen[Clinical manifestations] Can be analyzed in three points.Middle Jiao damp-heat symptoms: Abdominal fullness, poor appetite, nausea, and vomiting are the main symptoms of this syndrome.General damp-heat symptoms: Fluctuating body temperature, sweating that does not relieve, heaviness in the limbs, skin itching, and jaundice.Lower Jiao damp-heat symptoms: Abnormal bowel movements, loose stools that are sticky and foul-smelling, and yellow-red urine.Red tongue with yellow greasy coating, and slippery rapid pulse.[Syndrome Analysis] This syndrome generally arises from external invasion of damp-heat evil or excessive consumption of rich, fatty foods leading to dampness and heat accumulation. Damp-heat accumulates in the middle jiao, obstructing the spleen and stomach Qi mechanism, leading to impaired intake and transportation, with abnormal ascending and descending Qi mechanisms, damp-heat obstructing the large intestine, overflowing throughout the body, steaming the liver and gallbladder, leading to various symptoms.[Syndrome Differentiation] Damp-heat accumulating in the spleen and Cold-damp obstructing the spleen.Both syndromes have the same internal cause of spleen deficiency, often easily affected by external factors or dietary injuries.Pathology: Damp-heat obstructs spleen Qi, leading to spleen deficiency and impaired function.Key differentiation point: Accompanying cold symptoms indicate cold-damp obstructing the spleen; accompanying heat symptoms indicate damp-heat accumulating in the spleen.(7) Stomach Yin Deficiency[Clinical manifestations] This syndrome is characterized by stomach symptoms and accompanying Yin deficiency symptoms.Stomach symptoms: Dull pain in the stomach, lack of appetite, or fullness and discomfort in the stomach, dry retching, and hiccups.Yin fluid deficiency symptoms: Dry mouth and throat, dry stools, and short urination. Red tongue with little fluid, and rapid pulse.[Syndrome Analysis] Stomach Yin deficiency can be summarized in four points: prolonged stomach disease, late-stage febrile diseases, excessive consumption of spicy foods, and emotional disturbances leading to Qi stagnation and fire transformation.The stomach is a dry organ, rich in Qi and blood, and is easily affected by Yang heat, leading to damage to stomach Yin, with internal fire disturbing the stomach, hence the development of this syndrome.(8) Food Stagnation in the Stomach[Clinical manifestations] Food stagnation in the stomach is characterized by fullness and pain in the stomach, with sour belching and vomiting as the main symptoms. Symptoms include obstruction of the Qi mechanism and abnormal ascending and descending of stomach Qi.The characteristics of stomach pain are fullness and distension, with relief after vomiting. The characteristics of vomiting are sour and rotten; the characteristics of bowel movements are loose stools or foul-smelling diarrhea. Yellow greasy tongue coating, and slippery pulse.[Syndrome Analysis] Food stagnation in the stomach is often due to weakness of the spleen and stomach, often caused by dietary irregularities.Food accumulation in the middle jiao obstructs the Qi mechanism, leading to abnormal ascending and descending of stomach Qi, with turbid Yin Qi mixed with rotten food rising, leading to symptoms of stomach pain, fullness, sour belching, and foul-smelling diarrhea. The turbid Qi rising leads to thick tongue coating, and the strong Qi leads to a slippery and forceful pulse.(9) Stomach Cold[Clinical manifestations] Characterized by stomach pain and cold symptoms. Stomach pain is characterized by cold pain, worsening with cold and alleviating with warmth. Mild cases present with persistent dull pain; severe cases present with sudden sharp pain.Cold symptoms primarily include Yang deficiency and inability to transform cold. Symptoms include fatigue, cold limbs, preference for warmth, and rumbling sounds in the stomach. Pale tongue with white slippery coating, and slow or wiry pulse.[Syndrome Analysis] Stomach cold syndrome often occurs in individuals with Yang deficiency or due to external cold invasion or consumption of cold foods. This leads to damage to the middle Yang, insufficient stomach Yin, and cold evil invasion, leading to cold pain. Cold fluids rising leads to vomiting clear fluids; downward movement leads to rumbling sounds in the stomach.(10) Stomach Heat[Clinical manifestations] This syndrome is characterized by typical stomach pain and heat symptoms.Heat accumulation in the stomach: Stomach pain with burning sensation, sour belching, preference for cold drinks, and increased appetite.Fire evil rising: Bad breath, swollen and painful gums, and bleeding gums.Heat forcing down: Constipation, short red urine.Red tongue with yellow coating, and slippery rapid pulse.[Syndrome Analysis] This syndrome often arises from excessive consumption of spicy and rich foods, with pre-existing stomach fire, or heat evil invading the stomach, or Qi stagnation transforming into fire.Internal fire leads to stagnation of Qi and blood, hence burning pain in the stomach, heat evil damaging fluids, leading to thirst and preference for cold drinks; if liver fire invades the stomach, it leads to sour belching; if fire evil rises, it leads to bad breath, swollen and painful gums, and bleeding gums. Yangming heat or fluid damage leads to constipation and short red urine, with red tongue and yellow coating, and slippery rapid pulse.[Syndrome Differentiation] Stomach heat syndrome and Stomach Yin deficiency syndrome.The fundamental difference between stomach heat and stomach Yin deficiency is that stomach heat belongs to excess syndrome, while stomach Yin deficiency belongs to deficiency syndrome. Stomach heat presents with burning pain, sour vomiting, preference for cold drinks, constipation, and short red urine, with red tongue and yellow coating, and slippery rapid pulse. Stomach Yin deficiency presents with dull pain, dry retching, dry mouth and throat, dry stools, pale tongue with little coating, and fine rapid pulse.4. Differentiation of Liver and Gallbladder DiseasesLiver disease syndromes: Liver Yin and blood are often insufficient, presenting deficiency syndromes, while liver Yang and Qi are often excessive. Cold and damp evils frequently invade.Liver disease symptoms: Symptoms include distension and pain in the chest and flanks, irritability, dizziness, tremors, twitching of limbs, and eye diseases, menstrual irregularities, and testicular pain.Gallbladder disease syndromes: Gallbladder disease syndromes, in addition to gallbladder Qi stagnation and phlegm disturbance, can also present as liver-gallbladder damp-heat syndrome.Gallbladder disease symptoms: Symptoms of gallbladder Qi rising include bitter taste in the mouth, along with mental symptoms such as insomnia and palpitations.(1) Liver Qi Stagnation[Clinical manifestations] This syndrome has two aspects: emotional disturbances and Qi stagnation. Symptoms include emotional depression, irritability, distension and pain in the chest and flanks, chest tightness, or the sensation of a plum pit in the throat, or the presence of tumors or masses. Women may experience breast tenderness and menstrual irregularities.[Syndrome Analysis] The causes of liver Qi stagnation include two aspects: one is emotional disturbances leading to disease; the other is disease leading to emotional disturbances. Changes in emotions and invasion by other diseases can lead to liver Qi stagnation. Emotional disturbances lead to phlegm and Qi stagnation, hence symptoms of emotional depression. Distension and pain occur in areas traversed by the liver meridian, as well as menstrual irregularities in women.(2) Liver Fire Rising[Clinical manifestations] Symptoms are concentrated in the head and face, characterized by Yang heat, often accompanied by bleeding symptoms. Symptoms include irritability, insomnia, dizziness, burning pain in the flanks, constipation, yellow urine, tinnitus, headache, red face and eyes, dry mouth, or vomiting blood and nosebleeds, with red tongue and yellow coating, and wiry rapid pulse.[Syndrome Analysis] Liver fire rising is often caused by emotional disturbances leading to Qi stagnation, which transforms into fire. The nature of fire is to rise, hence it attacks the head and face, damaging fluids and causing Qi and blood to surge, leading to various symptoms.(3) Liver Blood Deficiency[Clinical manifestations] Symptoms are seen in the head, face, ears, and limbs, characterized by insufficient nourishment of blood. Symptoms include dizziness, tinnitus, pale complexion, brittle nails, numbness in the limbs, joint stiffness, tremors, inability to hold objects, and blurred vision, with pale tongue and white coating, and fine pulse.[Syndrome Analysis] The liver stores blood and essence; if liver essence and blood are deficient, it leads to loss of nourishment to the ears, eyes, tendons, and face. Pale tongue and fine pulse are common signs of blood deficiency.(4) Liver Yin Deficiency[Clinical manifestations] Characterized by internal heat due to Yin deficiency, with prominent symptoms in the head, face, eyes, and flanks. Symptoms include dizziness, tinnitus, dry eyes, facial heat, burning pain in the flanks, five hearts feeling hot, dry mouth and throat, or twitching of limbs, with red tongue and little fluid, and fine rapid pulse.[Syndrome Analysis] Liver Yin deficiency leads to insufficient nourishment to the head and tendons; Yang excess leads to internal fire disturbances, hence this syndrome. Red tongue and fine rapid pulse are signs of liver Yin deficiency.(5) Liver Yang Rising[Clinical manifestations] Characterized by excess Yang above and deficiency below, with symptoms of excess above and deficiency below. Symptoms include dizziness, tinnitus, headache, red face and eyes, irritability, insomnia, and weakness in the lower back and knees, with red tongue and wiry pulse.[Syndrome Analysis] Deficiency of liver and kidney Yin leads to excess liver Yang rising, causing Qi and blood to surge, leading to dizziness, tinnitus, headache, red face and eyes; liver Qi stagnation leads to irritability; liver and kidney Yin deficiency leads to inability to nourish the spirit, hence insomnia and vivid dreams; excess liver Yang above and kidney Yin deficiency below lead to heaviness in the head and lightness in the feet; red tongue and wiry pulse are signs of liver and kidney Yin deficiency and liver Yang rising.Liver Qi stagnation, liver fire rising, liver blood deficiency, and liver Yin deficiency often have changing pathological mechanisms that influence each other. For example, prolonged liver Qi stagnation can transform into fire; liver fire rising can damage liver Yin; liver Yin deficiency can lead to liver Yang rising. Therefore, in syndrome differentiation, it is essential to grasp the clinical characteristics of each syndrome while analyzing their internal relationships to make accurate judgments.(6) Liver Wind Internal Movement1. Liver Yang Transforming into Wind[Clinical manifestations] Characterized by pre-existing liver Yang excess, now presenting with internal wind movement. Symptoms include convulsions, dizziness, stiff neck, tremors, spasms, or sudden loss of consciousness, with slurred speech, red tongue with white or greasy coating, and wiry pulse.[Syndrome Analysis] As the saying goes, “All wind disturbances belong to the liver,” and “All violent contractions belong to wind.” Liver Yang transforming into wind is often due to long-term deficiency of liver and kidney Yin, leading to excess liver Yang. If a patient has pre-existing liver Yang excess and suddenly presents with wind movement symptoms, a diagnosis can be made. Excess liver Yang leads to heat generating wind, and when wind is strong, it leads to convulsions, dizziness, stiff neck, and tremors; when wind rises violently, it leads to Qi and blood disturbances, causing sudden loss of consciousness and slurred speech; when wind and phlegm disturb the meridians, it leads to poor circulation on the affected side, hence slurred speech. Red tongue with white or greasy coating and wiry pulse are signs of wind disturbance.2. Heat Generating Wind[Clinical manifestations] Characterized by high fever, agitation, and severe wind movement. Symptoms include high fever, mental confusion, agitation, convulsions, stiff neck, and in severe cases, opisthotonos, upward gaze, and clenched teeth, with red or dark tongue and wiry rapid pulse.[Syndrome Analysis] Excessive heat leads to wind movement, hence the diagnosis is based on the presence of high fever and wind symptoms. Excessive heat disturbs the spirit, leading to high fever and mental confusion; excessive heat damages fluids, leading to wind movement, hence convulsions and opisthotonos; excessive heat disturbs the Ying and blood, leading to red or dark tongue and wiry rapid pulse.3. Yin Deficiency Generating Wind: This syndrome is characterized by Yin fluid deficiency leading to wind movement, often occurring after the late stage of an external heat disease or prolonged internal injury leading to Yin fluid deficiency. The clinical manifestations and syndrome analysis can refer to “Differentiation of Wei, Qi, Ying, and Blood.”4. Blood Deficiency Generating Wind: This syndrome is characterized by blood deficiency leading to insufficient nourishment of the tendons, often caused by excessive acute or chronic bleeding or prolonged illness leading to blood deficiency. The clinical manifestations and syndrome analysis can refer to “Liver Blood Deficiency Syndrome.”(7) Cold Stagnation in the Liver Meridian[Clinical manifestations] Characterized by cold symptoms in the lower abdomen and external genitalia. Symptoms include pulling pain in the lower abdomen radiating to the testicles, or contraction of the scrotum causing pain, worsening with cold and alleviating with warmth, with white slippery tongue coating and slow wiry or tight pulse.[Syndrome Analysis] The liver meridian traverses the external genitalia and reaches the lower abdomen; cold evil invading the liver meridian leads to stagnation of Yang Qi, causing poor circulation of Qi and blood, hence symptoms of pulling pain in the lower abdomen radiating to the testicles. White slippery tongue coating and slow wiry or tight pulse are also signs of cold stagnation in the liver meridian.(8) Liver-Gallbladder Damp-Heat[Clinical manifestations] In addition to the symptoms of damp-heat in the liver and gallbladder, there may also be changes in the spleen and stomach, with symptoms of burning pain in the flanks, poor appetite, abdominal distension, bitter taste in the mouth, nausea, and abnormal bowel movements, with red tongue and yellow greasy coating, and wiry rapid pulse.[Syndrome Analysis] Damp-heat evil accumulates in the liver and gallbladder, leading to loss of regulation, hence symptoms of burning pain in the flanks. The liver wood fails to disperse, obstructing the spleen earth, leading to poor appetite and abdominal distension, with red tongue and yellow greasy coating, and wiry rapid pulse, indicating damp-heat accumulation in the liver and gallbladder.(9) Phlegm Disturbing the Gallbladder[Clinical manifestations] Characterized by internal phlegm disturbing the gallbladder, leading to symptoms of mental disturbance, insomnia, irritability, bitter taste in the mouth, nausea, chest tightness, and abdominal distension, with yellow greasy tongue coating and slippery rapid pulse.[Syndrome Analysis] Emotional disturbances can often lead to loss of liver and gallbladder regulation, causing Qi stagnation. Over time, this can transform into fire and phlegm, leading to internal disturbance of the gallbladder, hence symptoms of mental disturbance, insomnia, irritability, and nausea.5. Differentiation of Kidney and Bladder DiseasesKidney disease syndromes: Kidney diseases are often deficiency syndromes, such as insufficiency of Qi, essence, Yin, and Yang.Kidney disease symptoms: Characterized by developmental disorders, premature aging, reproductive system issues, and water metabolism disorders, such as lower back and knee pain, tinnitus, premature graying, loose teeth, impotence, infertility, edema, and abnormal urination.Bladder disease syndromes: Bladder damp-heat.Bladder disease symptoms: Characterized by abnormal urination, such as frequent urination, urgency, painful urination, urinary retention, and incontinence.(1) Kidney Yang Deficiency[Clinical manifestations] Characterized by deficiency-cold symptoms, with prominent symptoms of insufficient downward movement. Symptoms include lower back pain, cold limbs, especially in the lower extremities, dizziness, fatigue, pale or dark complexion. Pale tongue with white coating, and weak pulse. Symptoms may include impotence, infertility, chronic diarrhea, or loose stools, or edema, especially in the lower body, with deep pressure leading to indentation, and in severe cases, abdominal distension and generalized edema, palpitations, and cough.[Syndrome Analysis] Decline of the Mingmen fire leads to abnormal warming, resulting in a pathological process of overall deficiency-cold. The kidneys govern the bones, and the lower back is the residence of the kidneys; if kidney Yang is insufficient, it cannot nourish the lower back and bones, hence the above symptoms. Insufficient Yang Qi leads to inability to warm the heart, hence fatigue; Yang deficiency leads to weak Qi and blood circulation, hence dizziness and pale complexion; pale tongue with white coating and weak pulse are signs of kidney Yang deficiency.The kidneys govern reproduction; if kidney Yang is insufficient, it leads to decline in reproductive function, hence impotence in men and infertility in women. Insufficient Mingmen fire leads to failure to nourish the spleen, hence diarrhea. Kidney Yang deficiency leads to inability to transform water, hence edema. Excessive water can rise and affect the heart and lungs, leading to abdominal distension and palpitations.(2) Kidney Yin Deficiency[Clinical manifestations] Characterized by deficiency of kidney water below, with internal fire rising. Symptoms include lower back and knee pain, dizziness, tinnitus, insomnia, vivid dreams, nocturnal emissions, or menstrual irregularities, weight loss, tidal fever, night sweats, five hearts feeling hot, dry throat and cheeks, yellow urine, and dry stools, with red tongue and little fluid, and rapid pulse.[Syndrome Analysis] Kidney Yin deficiency leads to empty marrow, insufficient nourishment of bones, and insufficient nourishment of the brain, hence symptoms of lower back and knee pain, dizziness, and tinnitus. The heart and kidneys are interdependent; if kidney water is deficient, it leads to excess heart fire, causing mental disturbances, hence insomnia and vivid dreams; if fire is unstable, it leads to nocturnal emissions; if kidney Yin is deficient, it leads to internal fire, hence weight loss, tidal fever, night sweats, five hearts feeling hot, dry throat and cheeks, yellow urine, and dry stools.(3) Kidney Essence Deficiency[Clinical manifestations] Characterized by delayed development in children and premature aging in adults. Symptoms include delayed growth in children, short stature, slow intelligence and movement, delayed closure of fontanelles, and soft bones. In men, symptoms include low sperm count and infertility; in women, symptoms include amenorrhea and infertility. In adults, symptoms include premature aging, hair loss, loose teeth, tinnitus, forgetfulness, and mental dullness.[Syndrome Analysis] The kidneys store essence and govern reproduction, being the foundation of growth and development. If kidney essence is insufficient, it cannot generate Qi and blood, hence delayed growth in children and premature aging in adults; the kidneys govern reproduction, hence low sperm count and infertility in men, and amenorrhea and infertility in women; kidney essence deficiency leads to insufficient nourishment of the brain, hence forgetfulness, tinnitus, and hair loss.(4) Kidney Qi Instability[Clinical manifestations] Characterized by instability in the lower body. Symptoms include pale complexion, fatigue, reduced hearing, lower back and knee pain, frequent clear urination, or residual urine after urination, or incontinence. In men, symptoms include premature ejaculation and early leakage; in women, symptoms include clear and thin vaginal discharge, or unstable fetal movement.[Syndrome Analysis] Kidney Qi instability is caused by kidney Qi deficiency. The kidneys store Yuan Yin and Yuan Yang, being the root of growth and development, and the foundation of organ function. If kidney Qi is deficient, it leads to reduced organ function, hence reduced hearing. Kidney deficiency leads to instability in the essence, hence premature ejaculation and early leakage; instability in the belt vessel leads to unstable fetal movement.(5) Kidney Not Receiving Qi[Clinical manifestations] Characterized by difficulty in inhalation, especially during exertion. Symptoms include lower back and knee pain, pale tongue with white coating, and weak pulse.[Syndrome Analysis] Kidney deficiency leads to inability to receive Qi, hence symptoms of cough and breathlessness, with difficulty in inhalation, especially during exertion; kidney deficiency leads to insufficient nourishment of the lower back and knees, hence pain; lung and kidney Qi deficiency leads to inability to protect the exterior, hence spontaneous sweating and reduced energy.(6) Bladder Damp-Heat[Clinical manifestations] Characterized by frequent urination, urgency, and painful urination. Symptoms include yellow-red urine, abdominal distension, and may be accompanied by fever and lower back pain, or blood in urine, or sand and stones in urine, with red tongue and yellow greasy coating, and rapid pulse.[Syndrome Analysis] Damp-heat accumulates in the bladder, leading to heat forcing the urinary tract, hence frequent urination and painful urination. Bladder Qi transformation is impaired, hence yellow-red urine and abdominal distension. Damp-heat steams the skin, leading to fever; if it affects the kidneys, it leads to lower back pain; if it burns the Yin vessels, it leads to blood in urine; if it accumulates over time, it can lead to sand and stones in urine.6. Concurrent Zang-Fu Syndromes(1) Heart and Kidney Disharmony[Clinical manifestations] Characterized by insomnia and palpitations. Symptoms may include signs of Yin deficiency and excess fire, such as dizziness, tinnitus, forgetfulness, lower back pain, nocturnal emissions, five hearts feeling hot, dry throat, red tongue, and rapid pulse. Hence, there may also be signs of Yang deficiency and cold, such as lower back and knee pain, and cold limbs.[Syndrome Analysis] Any factor that leads to heart Yin deficiency or kidney Yin deficiency can be a cause of heart and kidney disharmony. This syndrome is characterized by water deficiency below and fire excess above, leading to disharmony between water and fire, with heart Yang being excessive and the heart spirit being disturbed, hence insomnia and palpitations; water deficiency leads to Yin deficiency, leading to dizziness, tinnitus, and forgetfulness; kidney Yin deficiency leads to lower back pain and nocturnal emissions. Water deficiency and fire excess lead to five hearts feeling hot, dry throat, red tongue, and rapid pulse. If heart fire is excessive, it leads to Yang deficiency and cold, hence lower back and knee pain, and cold limbs.(2) Heart and Spleen Deficiency[Clinical manifestations] Characterized by symptoms of heart blood deficiency and spleen Qi deficiency, including palpitations, forgetfulness, insomnia, poor appetite, abdominal distension, loose stools, fatigue, and pale tongue with weak pulse.[Syndrome Analysis] Heart and spleen deficiency syndrome is characterized by insufficient heart blood and weak spleen Qi. Spleen Qi deficiency leads to insufficient blood production, leading to heart blood deficiency; heart blood deficiency leads to insufficient Qi production, leading to spleen Qi deficiency. Therefore, the two syndromes influence each other. Insufficient heart blood leads to palpitations, forgetfulness, insomnia, and vivid dreams; insufficient spleen Qi leads to poor appetite and other symptoms; pale tongue and weak pulse are signs of heart and spleen deficiency.(3) Heart and Liver Blood Deficiency[Clinical manifestations] Characterized by mental disturbance and insufficient nourishment of the eyes, nails, and limbs. Symptoms include palpitations, forgetfulness, insomnia, dizziness, dry eyes, blurred vision, brittle nails, numbness in the limbs, tremors, and menstrual irregularities in women.[Syndrome Analysis] The heart governs blood, and the liver stores blood. If there is prolonged illness or emotional disturbances leading to Yin and blood depletion, such as heart blood deficiency, then the liver has no blood to store, leading to liver blood deficiency, which in turn leads to insufficient blood entering the vessels, hence heart and liver blood deficiency. Heart blood deficiency leads to palpitations, forgetfulness, insomnia, and vivid dreams; blood deficiency leads to insufficient nourishment, hence dizziness and blurred vision; liver blood deficiency leads to insufficient nourishment of the body and orifices, hence dry eyes, brittle nails, and menstrual irregularities in women.(4) Heart and Kidney Yang Deficiency[Clinical manifestations] Characterized by overall deficiency-cold symptoms, with palpitations, anxiety, reduced urination, and edema as the main symptoms. Symptoms include aversion to cold, cold limbs, cyanosis of lips and nails, pale or dark tongue, white slippery coating, and weak pulse.[Syndrome Analysis] Prolonged illness or excessive labor often leads to heart and kidney Yang deficiency, with internal cold excess. Yang Qi is weak, leading to insufficient nourishment of the heart, hence palpitations; Yang deficiency leads to insufficient warmth, hence aversion to cold and cold limbs; Yang deficiency leads to Qi transformation failure, hence reduced urination and edema; Yang deficiency leads to Qi stagnation, hence cyanosis of lips and nails, pale or dark tongue, white slippery coating, and weak pulse.(5) Heart and Lung Qi Deficiency[Clinical manifestations] Characterized by palpitations and cough, with symptoms of heart palpitations, breathlessness, fatigue, and worsening symptoms with activity, with clear phlegm, chest tightness, pale complexion, and weak pulse.[Syndrome Analysis] The lungs govern respiration, and the heart governs blood vessels, relying on Zong Qi for coordination. Heart and lung Qi deficiency often influence each other. Insufficient heart Qi leads to palpitations; lung Qi deficiency leads to overall decline in bodily functions, hence dizziness, fatigue, and weak voice. Insufficient Qi and blood lead to pale tongue and weak pulse.(6) Spleen and Lung Qi Deficiency[Clinical manifestations] Characterized by persistent cough, breathlessness, thin white phlegm, poor appetite, abdominal distension, fatigue, and in severe cases, facial swelling and edema in the feet. Pale tongue with white coating, and weak pulse.[Syndrome Analysis] The spleen governs transportation and is the source of Qi production; if spleen Qi is insufficient, it cannot nourish the lungs, leading to lung Qi deficiency. Spleen deficiency leads to dampness accumulation, which rises and obstructs the lungs, hence the saying that “the spleen is the source of phlegm, and the lungs are the storage for phlegm.” Lung Qi deficiency leads to cough and breathlessness; Qi deficiency leads to insufficient distribution of fluids, leading to thin white phlegm; spleen Qi deficiency leads to poor appetite, abdominal distension, fatigue, and facial swelling and edema. Pale tongue with white coating and weak pulse are signs of Qi deficiency.(7) Spleen and Kidney Yang Deficiency[Clinical manifestations] Characterized by prominent symptoms of insufficient transformation of fluids. Symptoms include cold limbs, pale complexion, lower back and knee pain, chronic diarrhea, or loose stools, or clear urine, or facial swelling and edema, and in severe cases, abdominal distension. Pale tongue with white coating, and weak pulse.[Syndrome Analysis] The spleen is the source of postnatal Qi, governing transportation and transformation, relying on the warmth of Mingmen fire; the kidneys are the source of pre-natal Qi, nourishing the organs and tissues, and relying on the nourishment of spleen essence. If prolonged illness depletes Qi and damages Yang, or if prolonged diarrhea or dysentery occurs, it leads to kidney Yang deficiency, which cannot nourish spleen Yang, or spleen Yang deficiency cannot nourish kidney Yang, leading to both spleen and kidney Yang deficiency.Spleen and kidney Yang deficiency leads to inability to warm the body, hence cold limbs and pale complexion; spleen and kidney Yang deficiency leads to diarrhea; Yang deficiency leads to inability to transform fluids, hence frequent urination; water and dampness accumulate, leading to facial swelling and edema; if the earth does not control water, it leads to abdominal distension.(8) Lung and Kidney Yin Deficiency[Clinical manifestations] Characterized by internal heat symptoms with dryness in the lungs. Symptoms include cough with little phlegm, blood-streaked phlegm, dry mouth and throat, weight loss, lower back and knee pain, tidal fever, red cheeks, night sweats, nocturnal emissions in men, and menstrual irregularities in women. Red tongue with little coating, and rapid pulse.[Syndrome Analysis] Lung and kidney Yin deficiency is characterized by insufficient Yin fluids in both organs. Lung Yin deficiency leads to internal heat, causing dry cough with little phlegm, and heat damaging the lung vessels, leading to blood-streaked phlegm; insufficient fluids lead to dry mouth and throat; insufficient nourishment leads to weight loss; kidney Yin deficiency leads to lower back and knee pain; excessive fire leads to tidal fever, red cheeks, and night sweats; fire disturbs the essence, leading to nocturnal emissions and menstrual irregularities. Red tongue with little coating and rapid pulse are signs of Yin deficiency.(9) Liver and Kidney Yin Deficiency[Clinical manifestations] Characterized by dizziness, tinnitus, forgetfulness, insomnia, dry mouth and throat, lower back and knee pain, flank pain, five hearts feeling hot, red cheeks, night sweats, nocturnal emissions in men, and menstrual irregularities in women. Red tongue with little coating, and rapid pulse.[Syndrome Analysis] Physiologically, there is a saying that “the liver and kidneys share the same origin”; pathologically, liver Yin deficiency can lead to kidney Yin deficiency, leading to insufficient kidney Yin, which cannot nourish the liver, hence liver Yang deficiency. Therefore, both organs often present with the same symptoms when they are excessive or deficient.Kidney Yin deficiency leads to insufficient nourishment of the liver, hence dizziness, tinnitus, forgetfulness; internal heat disturbs the spirit, leading to insomnia; insufficient fluids lead to dry mouth and throat; insufficient nourishment leads to lower back and knee pain; Yin deficiency leads to internal heat, hence five hearts feeling hot. Fire disturbs the essence, leading to nocturnal emissions and menstrual irregularities. Red tongue with little coating and rapid pulse are signs of internal heat due to Yin deficiency.(10) Liver and Spleen Disharmony[Clinical manifestations] Characterized by liver Qi stagnation and spleen Qi deficiency. Symptoms include distension and pain in the chest and flanks, irritability, emotional depression or irritability, poor appetite, abdominal distension, loose stools, and flatulence, or abdominal pain with a desire to defecate, with relief after defecation. White or greasy tongue coating, and wiry pulse.[Syndrome Analysis] The liver governs dispersal, and the spleen governs transportation, with both organs supporting each other. If the liver fails to disperse, Qi stagnation can lead to spleen dysfunction, termed “wood obstructing earth”; conversely, if the spleen fails to function, Qi stagnation can also affect liver Qi, termed “earth obstructing wood.”Liver Qi stagnation leads to distension and pain in the chest and flanks; emotional disturbances lead to Qi stagnation; spleen dysfunction leads to poor appetite and abdominal distension; loose stools and flatulence occur due to Qi stagnation; abdominal pain occurs due to Qi stagnation, with relief after defecation. White or greasy tongue coating and wiry pulse indicate liver Qi stagnation.(11) Liver and Stomach Disharmony[Clinical manifestations] Characterized by liver Qi stagnation and stomach dysfunction. Symptoms include distension and pain in the stomach and flanks, belching, hiccups, sour regurgitation, red tongue with thin yellow coating, and wiry or rapid pulse. In some cases, there may be headache, worsened by cold, alleviated by warmth, vomiting clear fluids, cold limbs, pale tongue with white coating, and tight pulse.[Syndrome Analysis] Liver and stomach disharmony often presents in two forms: one is liver Qi stagnation transforming into fire, obstructing the stomach, leading to distension and pain in the stomach and flanks; the stomach loses its ability to descend, leading to belching, hiccups, and sour regurgitation. Red tongue with thin yellow coating and wiry rapid pulse indicate liver Qi stagnation. The second form is cold evil invading the liver and stomach, leading to cold symptoms in the head and neck, with headache worsened by cold and alleviated by warmth, leading to vomiting clear fluids, and cold limbs. Pale tongue with white coating and tight pulse indicate internal cold symptoms.(12) Liver Fire Invading the Lungs[Clinical manifestations] Characterized by dry heat cough as the main symptom, with burning pain in the chest and flanks, irritability, red face and eyes, bitter taste in the mouth, and cough with thick yellow phlegm, and in severe cases, hemoptysis. Red tongue with thin yellow coating, and wiry rapid pulse.[Syndrome Analysis] The liver meridian connects to the lungs; excessive liver Qi leads to fire rising, invading the lungs, resulting in liver fire invading the lungs syndrome. Liver Qi stagnation leads to burning pain in the chest and flanks; liver fire rising leads to irritability; liver fire invading the lungs leads to cough; heat damages fluids, leading to thick yellow phlegm; if heat invades the lung vessels, it leads to hemoptysis. Red tongue with thin yellow coating and wiry rapid pulse indicate internal heat due to liver fire.
