“Bian Zheng” refers to the process of collecting data, symptoms, and signs through the four examinations (observation、auscultation、inquiry、palpation） to analyze and summarize the disease’s etiology, nature, location, and the relationship between pathogenic factors and the body’s righteousness, ultimately categorizing it into a specific type of syndrome.There are eight commonly used diagnostic methods in Traditional Chinese Medicine (TCM): Eight Principles Diagnosis、 Qi, Blood, Body Fluids Diagnosis、 Zang-Fu Diagnosis、 Six Excesses Diagnosis、 Six Meridians Diagnosis、 Meridian Diagnosis、 Wei, Qi, Ying, Blood Diagnosis、 San Jiao Diagnosis。In recent years, the popular constitution diagnosis is mainly based on the Eight Principles Diagnosis and Qi, Blood, Body Fluids Diagnosis, which will be briefly mentioned here (Nine constitutions: Pinghe constitution, Qi deficiency constitution, Yang deficiency constitution, Yin deficiency constitution, Qi stagnation constitution, Blood stasis constitution, Phlegm-damp constitution, Damp-heat constitution, Special constitution). (1) Eight Principles Diagnosis The Eight Principles Diagnosis is one of the most fundamental classification methods formed in the history of TCM. The Eight Principles serve as the general framework for diagnosis, including Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess. The Eight Principles Diagnosis utilizes the various clinical data obtained through the four examinations to analyze and summarize the location, nature, and the balance of pathogenic and righteous factors, categorizing the conditions into exterior syndrome, interior syndrome, cold syndrome, heat syndrome, deficiency syndrome, excess syndrome, Yin syndrome, and Yang syndrome. For example, if a patient complains of a headache, the first step is to determine the nature of the headache: is it a deficiency headache or an excess headache? Is it caused by an external pathogen or an internal organ disorder? Yin and Yang are the overarching principles of the Eight Principles. When observing symptoms that indicate inhibition, stagnation, decline, or obscurity, they are generally classified as Yin syndromes, such as a pale or dull complexion, lethargy, cold limbs, shortness of breath, low voice, pale tongue, white coating, and a weak pulse. Conversely, when symptoms of excitement, agitation, or hyperactivity are present, they often indicate an excess of internal heat or Yang Qi, such as a flushed face, irritability, fever, thirst for cold drinks, loud voice, constipation, short and red urine, red tongue with yellow coating, and a rapid pulse. Exterior and interior are used to summarize the depth of the disease and the severity of the condition. Exterior syndromes are generally milder and manifest as superficial symptoms, such as nasal congestion, runny nose, cough, and throat itch; interior syndromes are more severe and manifest as symptoms related to the internal organs, such as abdominal distension and pain, constipation, or diarrhea. Cold and heat refer to the nature of the disease. Cold syndromes are often manifestations of the body’s physiological functions declining or an inadequate adaptive response to harmful factors, such as aversion to cold and preference for warmth, clear and thin phlegm; heat syndromes are often manifestations of a vigorous response to harmful factors, such as fever, irritability, yellow and thick phlegm. Deficiency and excess reflect the state of struggle between the body and pathogenic factors. Deficiency syndromes indicate insufficient righteous Qi (referring to general physiological and defensive functions), representing a decline in overall function or the function of a specific organ; excess syndromes indicate an abundance of pathogenic Qi (symptoms often manifest acutely and significantly, reflecting a vigorous struggle between the body and harmful factors). The Eight Principles Diagnosis has several characteristics: First, the six principles can be categorized under Yin and Yang, with Yin and Yang serving as the overarching principle. Second, symptoms of the Eight Principles can coexist, such as exterior cold with interior heat, exterior excess with interior deficiency, and deficiency of righteousness with excess of pathogenic factors. Third, the syndromes of the Eight Principles can transform into their opposites under certain conditions. Generally, Yin syndromes can transform into Yang (indicating improvement), Yang syndromes can transform into Yin (indicating deterioration), exterior can transform into interior (indicating recovery), and interior can transform into exterior (indicating progression), deficiency can transform into excess (indicating a good prognosis), and excess can transform into deficiency (indicating a poor prognosis), heat syndromes can transform into cold (indicating deficiency of righteousness), and cold syndromes can transform into heat (often indicating excess pathogenic factors).(2) Qi, Blood, Body Fluids Diagnosis Qi, Blood, Body Fluids Diagnosis involves using the theories related to Qi, Blood, and Body Fluids in the context of the Zang-Fu organs to analyze the pathological changes of Qi, Blood, and Body Fluids and identify the different syndromes they reflect.
Qi, Blood, and Body Fluids are the material basis for the functional activities of the Zang-Fu organs, and their generation and movement depend on the functional activities of the Zang-Fu organs. Therefore, when the Zang-Fu organs undergo pathological changes, it can affect the changes in Qi, Blood, and Body Fluids; conversely, the pathological changes in Qi, Blood, and Body Fluids will inevitably affect the functions of the Zang-Fu organs. Thus, the changes in Qi, Blood, and Body Fluids are closely related to the Zang-Fu organs. Qi, Blood, and Body Fluids Diagnosis should be referenced alongside Zang-Fu Diagnosis.
1. Qi Syndrome Diagnosis
There are many Qi syndromes. The “Su Wen: On Pain” states: “All diseases arise from Qi,” indicating the widespread nature of Qi syndromes. However, the commonly seen clinical manifestations of Qi syndromes can be summarized into six types: Qi deficiency, Qi sinking, Qi collapse, Qi stagnation, Qi reversal, and Qi obstruction.
2. Blood Syndrome Diagnosis
Blood circulates in the vessels, flows through the Zang-Fu organs, and reaches the skin. If external pathogens interfere or the Zang-Fu organs are disordered, leading to abnormal physiological functions of Blood, symptoms of cold, heat, deficiency, or excess can appear. Based on the commonly seen clinical manifestations of Blood syndromes, they can be summarized into four types: Blood deficiency, Blood stasis, Blood heat, and Blood cold.
3. Qi and Blood Coexisting Syndrome Diagnosis
Qi and Blood have a close interdependent relationship, as they nourish and support each other. Therefore, when pathological changes occur, Qi and Blood often influence each other, resulting in the simultaneous presence of both Qi and Blood syndromes, known as Qi and Blood coexisting syndrome.
Common manifestations of Qi and Blood coexisting syndromes include Qi stagnation with Blood stasis, Qi deficiency with Blood stasis, both Qi and Blood deficiency, Qi failing to contain Blood, and Qi escaping with Blood.
4. Body Fluids Syndrome Diagnosis
Body Fluids refer to the normal fluids in the body, which nourish the Zang-Fu organs, lubricate the joints, and moisten the skin. Their generation and distribution are closely related to the functions of the spleen, lung, and kidney.
Pathological changes in Body Fluids can generally be summarized into two aspects: Body Fluids deficiency and accumulation of water and fluids. Water dampness, phlegm, blood stasis, and stones can all be seen as products of abnormal metabolism of Qi, Blood, and Body Fluids.
(3) Zang-Fu Diagnosis Zang-Fu Diagnosis analyzes and summarizes the different syndromes reflected by the physiological functions and pathological changes of the Zang-Fu organs, using them as the basis for diagnosis. This is the most commonly used diagnostic method in clinical practice. The specific content of this diagnostic method is to determine the location of the disease based on the physiological and pathological manifestations of the Zang-Fu organs and the pathways of the meridians; to distinguish the condition using cold, heat, deficiency, and excess; and to analyze the transmission patterns of the disease based on the interrelationships between the Zang-Fu organs. This method is mainly used for internal injuries and miscellaneous diseases, and it serves as the foundation for diagnosis in other specialties. For example, when we observe symptoms such as palpitations, chest tightness, shortness of breath, pale complexion, weak or irregular pulse, we can generally conclude that this is a group of symptoms related to the heart. If it is heart Qi deficiency, there may also be fatigue and weakness, with symptoms worsening after activity; if it is heart Yang deficiency, there may be cold limbs and a pale tongue; if it is heart Blood deficiency, there may be insomnia, vivid dreams, dizziness, and a sallow complexion. However, Zang-Fu Diagnosis is not a simple addition of symptoms; it requires a comprehensive assessment of the four examinations to make an accurate judgment. Zang-Fu Diagnosis can be roughly divided into isolated organ diseases, isolated bowel diseases, and concurrent organ and bowel diseases. Taking the stomach as an example, symptoms such as burning pain in the stomach, excessive hunger, acid reflux, thirst for cold drinks, or bad breath, swollen and bleeding gums, constipation, short and red urine, red tongue with yellow coating, and a slippery and rapid pulse are collectively referred to as stomach heat syndrome in TCM. Concurrent organ and bowel diseases refer to the simultaneous presence of different symptoms from two organs, such as palpitations, forgetfulness, insomnia, dizziness, poor appetite, abdominal distension, loose stools, fatigue, and a sallow complexion, which indicate symptoms of both heart Blood deficiency and spleen Qi deficiency. Such coexisting symptoms from two organs are referred to as heart and spleen Qi deficiency syndrome. Thus, Zang-Fu Diagnosis acts like a comprehensive net that connects independent symptoms, facilitating clinical treatment. Zang-Fu Diagnosis generally focuses on the five Zang organs. Below is a brief introduction to the characteristic symptoms of each Zang-Fu organ.「Lung Disease Diagnosis」
(1) Lung Qi deficiency: Often due to Qi deficiency after illness or prolonged coughing that injures Qi, leading to weakened lung function. Symptoms include weak cough, excessive clear phlegm, pale complexion, low voice, easy fatigue, spontaneous sweating, shortness of breath, cold limbs, and a pale tongue with white coating, weak pulse. This can be seen in chronic lung diseases such as chronic bronchitis, emphysema, and tuberculosis.
(2) Lung Yin deficiency: Often due to external dryness and heat injuring body fluids, leading to insufficient lung nourishment, or prolonged coughing injuring the lungs, resulting in internal heat. Symptoms may include dry cough without phlegm; or scanty and thick phlegm, sometimes with blood, tidal fever, night sweats, heat in the palms and soles, and red tongue with little coating, thin and rapid pulse. This syndrome is often seen in certain chronic wasting diseases such as tuberculosis, throat tuberculosis, and chronic bronchitis.
(3) Wind-cold obstructing the lungs: Often due to wind-cold invading the lungs, causing lung Qi to fail to disperse. Symptoms may include aversion to cold, fever, body aches, no sweating, nasal congestion, runny nose, cough, excessive clear phlegm, thin white coating, and tight floating pulse. This syndrome is commonly seen in colds (common cold, influenza), acute and chronic bronchitis, and asthma.
(4) Wind-heat attacking the lungs: Often due to external wind-heat or cold pathogens transforming into heat, causing phlegm-heat to obstruct the lungs, leading to impaired lung function. Symptoms may include fever, cough, wheezing, thick yellow phlegm, coughing up purulent blood, chest pain, nosebleeds, sore throat, irritability, thirst, preference for cold drinks, and even wind-heat obstructing the lungs, leading to shortness of breath, flaring nostrils, cyanosis of lips, constipation, short and red urine, red tongue with yellow coating, and rapid pulse. This syndrome can be seen in acute and chronic bronchitis, lobar pneumonia, bronchiectasis with infection, lung abscess, and asthma.
(5) Lung and kidney Yin deficiency: Prolonged lung disease can lead to kidney Yin deficiency. Symptoms include cough, scanty phlegm, shortness of breath upon exertion, sore lower back and legs, tidal fever, night sweats, nocturnal emissions, weight loss, thirst, red tongue with little coating, and thin rapid pulse. This syndrome can be seen in late-stage tuberculosis patients.
「Spleen Disease Diagnosis」
(1) Spleen Qi deficiency (spleen fails to transport, insufficient central Qi): Often due to physical weakness or improper post-illness care, leading to spleen and stomach Qi deficiency and impaired transportation function. Symptoms may include poor appetite, indigestion, post-meal abdominal distension, borborygmi, loose stools, weight loss, weakness in limbs, fatigue, pale tongue with white coating, and weak pulse; if there is also shortness of breath, lethargy, heavy sensation in the abdomen, chronic diarrhea, prolapse of organs (such as uterine prolapse, gastric prolapse, kidney prolapse), and a feeling of Qi sinking after exertion, this indicates spleen Qi sinking. Spleen Qi deficiency is often seen in ulcer disease, chronic enteritis, chronic gastritis, neurosis, and indigestion.
(2) Spleen Yang deficiency (spleen and stomach cold): Often due to irregular diet, prolonged illness leading to spleen deficiency, and weak spleen Yang, resulting in impaired transportation. The condition is more severe than spleen Qi deficiency, with symptoms including abdominal pain and distension, preference for warmth, poor appetite, borborygmi, loose stools, clear and long urine, or edema with short urine; some may have a pale complexion without luster, weight loss, fatigue, cold limbs, excessive salivation, pale tongue with white coating, and weak pulse. This type of deficiency can lead to malnutrition and is often seen in ulcer disease, chronic gastritis, gastrointestinal dysfunction, chronic hepatitis, cirrhosis, or certain types of edema.
(3) Spleen not controlling Blood: Often due to prolonged spleen deficiency, leading to an inability to control blood circulation, resulting in bleeding symptoms. Symptoms may include blood in stools (dark purple blood), hematuria (painless hematuria), excessive menstruation, and continuous vaginal bleeding. Accompanied by abdominal pain, poor appetite, loose stools, fatigue, lethargy, pale complexion, no thirst, long clear urine, and possibly weakness in limbs or subcutaneous bleeding, pale tongue, and weak pulse. This syndrome can be seen in bleeding from ulcer disease, excessive menstruation, functional uterine bleeding, thrombocytopenic purpura, cirrhosis with esophageal varices, or renal tuberculosis.
(4) Cold-damp obstructing the spleen: Often due to spleen Qi deficiency, or consumption of cold food, or exposure to rain, or prolonged lying in damp conditions, leading to damp obstructing spleen Yang, impairing its ability to transport water and dampness. Symptoms may include reduced appetite, abdominal fullness and heaviness, nausea, sticky mouth, or thirst without desire to drink, heavy limbs, diarrhea, or dark skin, excessive white discharge, thick white coating, and slippery or slow pulse. This syndrome can be seen in chronic gastritis, chronic hepatitis, and certain types of edema.
「Heart Disease Diagnosis」
(1) Heart Yang (Qi) deficiency: The main symptoms of heart Qi deficiency are palpitations, shortness of breath, spontaneous sweating, worsening with activity, pale complexion, pale red tongue, thin white coating, and weak or rapid pulse; if accompanied by cold limbs, it indicates heart Yang deficiency; if there is profuse sweating, unconsciousness, cold limbs, and a weak pulse that is difficult to detect, it indicates heart Yang collapse.
(2) Heart Yin (Blood) deficiency: The main symptoms of heart Blood deficiency are palpitations, irritability, forgetfulness, pale complexion, anxiety, fatigue, pale tongue, and thin pulse; if accompanied by low fever, insomnia with vivid dreams, night sweats, flushed cheeks, thirst, nocturnal emissions, red tongue with little coating or dry red tip, and thin rapid pulse, it indicates insufficient heart Yin.
(3) Heat entering the pericardium: When heat evil invades the heart, symptoms may include high fever, irritability, confusion, delirium, even agitation, red tongue, dry coating, and rapid or thin pulse. This is often seen in cases of febrile diseases with severe heat evil, resembling certain infectious diseases with altered consciousness.
(4) Phlegm obstructing the heart orifices: When phlegm-heat disturbs the heart orifices, affecting consciousness, symptoms may include difficulty falling asleep, irritability, mental dullness, incoherent speech, crying or laughing inappropriately, and severe agitation, red tongue, yellow greasy coating, and slippery rapid pulse; some may have unclear consciousness, difficulty speaking, or even coma, with phlegm sounds in the throat, often with a white coating and slippery pulse; or with a yellow coating and rapid pulse. This mainly presents as neurological symptoms and is often seen in neuroses, schizophrenia, cerebrovascular accidents, and manic episodes.
(5) Heart Blood stasis (true heart pain): Often caused by stasis obstructing the heart vessels, the main symptom is paroxysmal heart pain, sharp pain like a knife, radiating to the left shoulder and back, and may also present with cyanosis of the lips and nails, dark red tongue with purple spots, and thin coating, with a choppy pulse. This resembles angina pectoris due to insufficient coronary blood supply or myocardial infarction.
(6) Heart and spleen deficiency: The main symptoms are sallow complexion, fatigue, weakness in limbs, poor appetite, palpitations, forgetfulness, insomnia, pale red tongue, and weak pulse. This is often seen in patients with anemia, neurasthenia, and heart disease.
(7) Heart and kidney not communicating: When kidney Yin is insufficient and heart fire is excessive, symptoms may include irritability, palpitations, insomnia, dizziness, blurred vision, tinnitus, sore lower back and knees, nocturnal emissions, red tongue, little coating, and thin rapid pulse, often seen in patients with neurasthenia.
「Liver Disease Diagnosis」
(1) Liver Qi stagnation: The main symptoms include fullness and pain in the chest and flanks, discomfort in the chest; or nausea, acid reflux, poor appetite, abdominal pain and diarrhea, or masses (hard and immovable objects, such as liver or spleen enlargement), or irregular menstruation in women, with a sensation of a lump in the throat. Some may also experience emotional depression, irritability, abdominal distension, belching, vomiting, constipation, or diarrhea, with a thin white or thin yellow coating, and wiry pulse. This syndrome corresponds to liver, gallbladder, or gastrointestinal dysfunction and can be seen in neuroses, chronic liver and gallbladder diseases, stomach pain, and menstrual irregularities.
(2) Liver Yang hyperactivity (including internal wind): The main symptoms include headache, dizziness, irritability, restless sleep, tinnitus, eye swelling, or flushed face, red eyes, numbness in limbs, feeling heavy in the head and light in the feet, and may also present with flushed cheeks, heat in palms and soles, numbness, tremors, dry mouth, sore lower back, and thin red tongue with wiry rapid pulse. This syndrome can be seen in hypertension, cerebrovascular accidents, neuroses, or hysteria. If liver Yang further develops, it can lead to internal wind, presenting as dizziness, fainting, coma, tremors, convulsions, drooling, and subsequent symptoms such as facial droop, slurred speech, or hemiplegia, with a red tongue and yellow coating, and a wiry pulse.
(3) Liver channel excess heat: This condition is more severe than liver Qi stagnation but less severe than liver Yang or liver wind. Common symptoms include dizziness, headache, tinnitus, deafness, burning pain in the flanks, flushed face, irritability, yellow urine, constipation, or bitter taste, dry throat, vomiting blood, nosebleeds, irritability, and even mania, with a yellow or dry coating, and wiry rapid pulse. This syndrome can be seen in hypertension, hyperthyroidism, upper gastrointestinal bleeding, ear-related dizziness, and menopausal syndrome.
(4) Liver Yin deficiency (including liver and kidney Yin deficiency): Liver Yin deficiency often presents with dizziness, blurred vision, dry eyes, pain in the flanks, persistent dull pain, dry mouth, irritability, occasional heat sensations, dry eyes, and thin red tongue with little coating, and thin rapid pulse. Since liver Yin deficiency often coexists with kidney Yin deficiency, in addition to symptoms of liver Yang hyperactivity, there may also be flushed cheeks, heat in palms and soles, tinnitus, sore lower back, nocturnal emissions, and dry mouth and throat. This syndrome is often seen in dizziness, hypertension, and neuroses.
(5) Liver and spleen disharmony: Symptoms include fullness in the flanks, reduced appetite, abdominal distension, borborygmi, or abdominal pain leading to diarrhea, or delayed menstruation, dysmenorrhea, and breast tenderness during menstruation, facial swelling, thin white coating, and wiry or slow pulse. This syndrome often arises from emotional distress, leading to liver Qi stagnation, which affects the spleen. It can be seen in chronic enteritis, colon hypersensitivity, chronic hepatitis, and certain gynecological diseases.
(6) Cold obstructing the liver channel: Often due to underlying Yang deficiency, cold obstructing the liver channel. Symptoms may include heavy pain in the head, vomiting clear fluids, abdominal and flank distension and pain, testicular heaviness, cold hands and feet, pale tongue with a slippery coating, and a slow or wiry pulse. This syndrome can be seen in ulcer disease, tension headaches, chronic gastroenteritis, and inguinal hernias.
「Kidney Disease Diagnosis」
(1) Kidney Yang deficiency: Often due to congenital insufficiency or inadequate post-illness care, leading to kidney Qi depletion and Yang deficiency. General symptoms include pale complexion, sore lower back and knees, cold intolerance, cold limbs, fatigue, dizziness, tinnitus, pale tongue with white coating, and thin rapid pulse. The manifestations of the disease can vary depending on the extent of the pathogenic influence and the patient’s constitution. In addition to the above symptoms, some may also present with impotence, nocturnal emissions, premature ejaculation, frequent clear urination, enuresis, or urinary incontinence, known as “kidney Qi instability,” often seen in patients with neurasthenia, childhood enuresis, elderly weakness, and chronic illness. Some may also present with reduced urination, abdominal distension, and generalized edema, particularly in the lower limbs, indicating “kidney not containing Qi,” which can be seen in chronic bronchitis, emphysema, and heart failure. Some may also present with physical weakness, short stature, or deformities, such as flat head, pigeon chest, hunchback, sunken fontanel, and intellectual disability, indicating “kidney Qi deficiency,” which can be seen in pituitary dysfunction, developmental deformities, cerebral edema, dehydration, and spinal tuberculosis.
(2) Kidney Yin deficiency: Often due to prolonged illness depleting kidney essence or heat illness depleting kidney Yin. Symptoms generally include physical weakness, dizziness, tinnitus, insomnia, forgetfulness, sore lower back and legs, nocturnal emissions, thirst, red tongue with little coating, and thin rapid pulse. If “Yin deficiency leads to excessive fire,” there may be flushed cheeks, red lips, tidal fever, night sweats, irritability, sore throat or cough, red urine, constipation, thin rapid pulse, and in some cases, five hearts heat, thick urine, reduced vision, amenorrhea, and infertility in women, and low sperm count in men. This can be seen in neurasthenia, prolonged illness, tuberculosis, diabetes, and systemic lupus erythematosus.
「Six Fu Diagnosis」
Six Fu Diagnosis is largely related to their physiological functions and the corresponding activities of the five Zang organs, with symptoms often manifesting as cold, heat, deficiency, or excess in the interior. The relevant diagnoses of the five Zang organs mentioned above can serve as references. For example, gallbladder syndrome often presents with bitter taste, tinnitus, and jaundice; stomach syndrome often presents with upper abdominal fullness, belching, bad breath, swollen and bleeding gums, and vomiting; large intestine syndrome may present with abdominal pain, constipation or diarrhea, or blood in stools, or red and white mucus, with a sensation of heaviness in the anus or prolapse; small intestine syndrome may present with short yellow urine, painful urination, lower abdominal pain, testicular pain, and mouth ulcers; bladder syndrome may present with lower abdominal fullness, urinary incontinence, or difficulty urinating.
Therefore, TCM’s method of diagnosis based on the five Zang organs and six Fu organs is quite similar to the organ classification diagnostic methods commonly used in modern medicine.
(4) Six Excesses Diagnosis Wind, cold, summer heat, dampness, dryness, and fire are the six climatic factors that can affect health. When the body’s righteous Qi is insufficient to adapt to climatic changes, or when there are abnormal or drastic changes in the climate, these six factors can become pathogenic, referred to as the six excesses. Additionally, epidemic diseases are also considered external pathogenic conditions, thus discussed here. The characteristics of the six excesses (wind syndrome, cold syndrome, summer heat syndrome, damp syndrome, dryness syndrome, fire syndrome) include three aspects: first, they often have seasonal patterns, such as more cold diseases in winter and more summer heat diseases in summer, often related to sudden climatic changes. Second, the six excesses can occur independently or in combination, such as simultaneous invasion of wind, cold, and dampness, and the six excesses can also transform into one another, such as wind-cold transforming into heat, dampness transforming into heat after prolonged stagnation, and transforming into dryness. Third, diseases caused by external pathogens often initially present with exterior symptoms, which gradually develop into interior symptoms as the disease progresses.Diagnosis of Wind Syndrome
Wind is a Yang pathogen, the leader of all diseases, characterized by its lightness and rapid changes, with the ability to cause diseases quickly and to dissipate just as fast, often presenting with symptoms that are erratic and variable, such as convulsions, tremors, numbness, itching, dizziness, and vertigo. In clinical practice, there are also symptoms that arise from internal pathological changes that are unrelated to external wind pathogens, referred to as “internal wind,” which will be detailed in Zang-Fu Diagnosis and are not within the scope of this chapter.
1. Common cold: aversion to wind, slight fever, headache, sweating, nasal congestion, runny nose, throat itch, cough, insomnia with vivid dreams, thin white coating, and floating pulse.
2. Wind Bi: migratory pain in the joints and limbs.
3. Wind edema: fever, aversion to wind, facial swelling, and difficulty urinating.
4. Wind rash: skin itching, appearing in various places, with papules that may be red or white, appearing and disappearing, worsening with wind exposure.
5. Wind stroke: sudden facial numbness, drooping of the mouth, and in severe cases, drooling.
6. Tetanus: after an external injury, stiffness in the neck, inability to open the mouth, convulsions, spasms, and opisthotonos.
Diagnosis of Cold Syndrome
Cold is a Yin pathogen that can harm Yang Qi, characterized by stagnation, leading to obstruction of Qi and Blood, which causes pain. Cold primarily constricts and obstructs the pores, causing tightness in the meridians. When cold pathogens invade the body, Yang Qi cannot protect the exterior, allowing the pathogenic factors to enter and cause disease. There are distinctions between exterior cold and interior cold. If the cold pathogen harms the skin, it is called exterior cold; if it penetrates the internal organs, it is called interior cold. As for internal cold, it refers to insufficient Yang Qi in the body, which does not fall under the category of six excesses. However, internal cold and cold pathogens often influence each other, as individuals with internal cold due to Yang deficiency are more susceptible to external cold; conversely, external cold can damage Yang Qi, leading to internal cold.
1. Exterior cold: aversion to cold, fever, no sweating, headache, body aches, or cough, shortness of breath, nasal congestion, floating tight pulse, thin white coating.
2. Interior cold: vomiting clear fluids, borborygmi, abdominal pain, sudden and severe pain, worsening with cold, thick white coating, and deep tight or wiry pulse.
3. Cold Bi: pain in the joints and limbs, stiffness, difficulty in flexing and extending, worsening with cold.
Diagnosis of Summer Heat Syndrome
Summer heat is a Yang pathogen characterized by heat, which easily depletes Qi and injures body fluids. The heart governs fire, and summer heat is also a type of fire, which can easily transmit internally and harm the heart and Ying. Summer heat is often accompanied by dampness, commonly combining with dampness to cause disease.
1. Summer heat injury: body heat, excessive sweating, thirst, red urine, fatigue, thin red tongue, rapid pulse, or loss of appetite, nausea, abdominal distension, and loose stools.
2. Heat stroke: sudden high fever in summer, profuse sweating, cold hands and feet, thirst, rapid breathing, and in severe cases, coma and convulsions, with a dry red tongue and rapid pulse.
3. Heat syndrome: sudden onset of high fever, excessive sweating, thirst, red tongue with yellow coating, rapid pulse, and rapid progression of symptoms, with severe cases often presenting with confusion and convulsions.
Diagnosis of Damp Syndrome
Among the four seasons, dampness is most prevalent in late summer, leading to many damp diseases. In addition to seasonal factors, living in a humid environment can also cause disease. Internal dampness caused by spleen dysfunction does not fall under this chapter.
Dampness is a Yin pathogen that easily harms Yang Qi. The spleen prefers dryness and dislikes dampness; when dampness invades the body, it easily harms spleen Yang. Dampness can obstruct the movement of Qi, characterized by heaviness and stickiness, often leading to chronic and difficult-to-treat conditions. Dampness tends to move downward, often presenting with lower body symptoms, and can easily combine with other pathogens, such as summer heat, cold dampness, and wind dampness.
1. Damp injury: aversion to cold, fever, headache, chest tightness, nausea, or no thirst, heavy limbs, fatigue, thin white greasy coating, and slow or soft pulse.
2. Dampness: heavy sensation in the head, aching limbs, and general fatigue.
3. Damp Bi: swelling and pain in the joints and limbs, heaviness, and difficulty in movement.
4. Damp-heat: body heat that is not relieved, lighter in the morning and heavier in the evening, sweating without relief, persistent symptoms, poor appetite, and fatigue.
5. Eczema: also known as immersion sores, detailed in the observation of skin.
Diagnosis of Dryness Syndrome
Dryness is a pathogen associated with autumn, often affecting the lungs, which prefer moisture and dislike dryness. Severe dryness can lead to dehydration, with clinical manifestations often characterized by dryness and reduced body fluids. Internal dryness caused by depletion of Yin fluids does not fall under this chapter.
【Clinical manifestations】 Cool dryness—mild headache, aversion to cold, no sweating, cough, throat itch, nasal congestion, dry tongue, floating pulse; Warm dryness—body heat with sweating, thirst, dry throat, cough with chest pain, and even blood-streaked phlegm, with dry tongue and yellow coating, floating rapid pulse.
Diagnosis of Fire Syndrome
Fire and heat are similar, with fire being the extreme of heat and heat being the gradual increase of fire. Fire syndrome can be divided into external and internal types; any direct exposure to fire pathogens or other six excesses transforming into fire are considered external. Internal fire syndrome does not fall under this chapter.
Fire heat is a Yang pathogen characterized by upward movement, easily depleting Qi and injuring body fluids, and can easily generate wind and move blood, with clinical manifestations often including high fever, thirst, sweating, confusion, convulsions, and bleeding.
【Common manifestations of fire syndrome include:
1. Excess fire: flushed face, red eyes, high fever, thirst for cold drinks, irritability, constipation or diarrhea, short red urine, agitation, and even confusion, convulsions, rashes, and bleeding.
2. Fire toxicity: appearance of sores and abscesses, localized redness, swelling, heat, and pain, with pus and blood present. Accompanied by high fever, dry mouth, confusion, and a rapid pulse.
Diagnosis of Epidemic Diseases
“Epidemic” refers to infectious diseases, while “disease” refers to severe conditions. This category includes highly infectious diseases that present acutely and rapidly change, often with severe symptoms. This is similar to modern medicine’s classification of highly infectious diseases with a wide range of transmission and high mortality rates. Epidemic diseases can be divided into three main categories:
1. Plague: symptoms caused by infectious epidemic toxins.
【Clinical manifestations】 Initial chills followed by fever, then both internal and external heat without cold, high fever in the afternoon, body aches, headache, excessive sweating, a complexion resembling smoke, irritability, and even confusion, with a white coating resembling accumulated powder.
2. Epidemic rash: symptoms caused by infectious dry heat epidemic toxins leading to rashes.
【Clinical manifestations】 Initial fever with widespread inflammation, severe headache, rashes appearing, either red or purple, rapid pulse, and if accompanied by sore throat and swelling, a bright red tongue with large red spots indicates severe throat infection; if accompanied by red rashes on the face, neck, shoulders, and hands that develop into blisters and subsequently necrose, it indicates anthrax. If the patient initially presents with a weak pulse, pale complexion, cold limbs, confusion, severe headache, and abdominal pain, it indicates a critical condition.
3. Sudden jaundice: symptoms caused by infectious epidemic toxins combined with damp heat leading to sudden jaundice.
【Clinical manifestations】 Initial fever with chills, followed by sudden jaundice, or cold limbs, deep yellow skin, and yellowing of the eyes, indicating severe internal damage.
(5) Six Meridians Diagnosis Six Meridians Diagnosis is a method of classification and summarization of the symptoms presented during the development of external pathogenic cold, as described in the “Shang Han Lun” by Zhang Zhongjing during the Eastern Han Dynasty.
The six meridians refer to the six channels: Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin. Zhang Zhongjing summarized the experiences of predecessors based on the “Neijing” and classified the various symptoms presented during the evolution of external pathogenic cold according to the strength of the body’s resistance, the severity of the pathogenic factors, and the progression of the disease, in conjunction with the Eight Principles, meridians, Zang-Fu organs, and Qi and Blood, categorizing them into Taiyang disease, Yangming disease, Shaoyang disease, Taiyin disease, Shaoyin disease, and Jueyin disease, to explain the location, nature, and the dynamics of the struggle between righteousness and pathogenic factors, as well as the transformation relationships between the six types of diseases.
Six Meridians Diagnosis categorizes external diseases into two major categories: three Yang diseases and three Yin diseases; Taiyang, Yangming, and Shaoyang diseases are classified as three Yang diseases, while Taiyin, Shaoyin, and Jueyin diseases are classified as three Yin diseases. Generally speaking, three Yang diseases are mostly Yang syndromes, heat syndromes, and excess syndromes, while three Yin diseases are mostly Yin syndromes, cold syndromes, and deficiency syndromes. In terms of exterior and interior, Taiyang is considered exterior, while the other meridians are considered interior, but the concepts of exterior and interior are relative. For example, three Yang is exterior, while three Yin is interior; Yangming disease is exterior, while Taiyin disease is interior, etc.
According to the theories related to meridians and Zang-Fu organs, each meridian is associated with specific Zang-Fu organs. The six meridian diseases reflect the pathological changes of the meridians and Zang-Fu organs, where three Yang diseases are based on the changes in the six Fu organs, and three Yin diseases are based on the changes in the five Zang organs; thus, Six Meridians Diagnosis essentially summarizes the pathological changes of the twelve meridians and Zang-Fu organs.
Six Meridians Diagnosis serves as the guiding principle for diagnosis and treatment in the “Shang Han Lun,” while Eight Principles Diagnosis provides a comprehensive overview of the location and nature of all diseases, with both methods complementing each other and being inseparable. This is because diseases are clinical reflections of the struggle between righteousness and pathogenic factors under the influence of external pathogens, and the dynamics of righteousness and pathogenic factors determine the development and changes of diseases, which relate to the nature of the symptoms. Therefore, the specific application of Six Meridians Diagnosis is intertwined with the concepts of Yin and Yang, exterior and interior, cold and heat, deficiency and excess.
Thus, Six Meridians Diagnosis explains the characteristics of the stages of external diseases from the perspectives of the struggle between righteousness and pathogenic factors, the location of the disease, and the progression of the disease, serving as a guiding method for treatment.(6) Meridian Diagnosis Meridian Diagnosis is a method of analysis and synthesis based on the theory of meridians, used to determine which meridian, Zang, or Fu organ is affected based on the symptoms and signs presented by the patient, and to identify the cause, nature, and pathogenesis of the disease.
The classification of the affected meridian is derived from the “Neijing,” with many developments in later generations. The “Ling Shu: Meridians” contains detailed discussions on the diseases of the twelve meridians. The diseases of the eight extraordinary meridians are discussed in detail in the “Su Wen: On the Bones” and “Nan Jing: Difficulties” as well as in Li Shizhen’s “Study of the Eight Extraordinary Meridians,” which still serve as the main basis for Meridian Diagnosis.
The meridians distribute throughout the body, running Qi and Blood, connecting the Zang-Fu organs and limbs, and communicating between the internal and external, allowing various physiological activities to occur. When the body is ill, the meridians also serve as pathways for pathogenic factors. External pathogens invade the body through the skin and nose, leading to an initial disturbance of Qi in the meridians, which then transmits to the Zang-Fu organs. Conversely, if the Zang-Fu organs undergo pathological changes, they can also reflect on the surface through the meridians, particularly at the acupoints where Qi gathers, presenting various abnormal reactions such as numbness, soreness, pain, abnormal sensitivity to temperature, or changes in skin color. Thus, it is possible to identify the affected meridian and Zang-Fu organ. For instance, lung diseases often present with tenderness at the lung Shu and Zhongfu acupoints; similarly, the “Su Wen: On the Qi of the Zang” states: “In liver disease, pain occurs under the ribs and radiates to the lower abdomen,” due to the liver meridian running through the ribs and lower abdomen.
Renowned physician Liu Duzhou’s view on meridians is that “the treasure temple appears at the tip of a hair.” The treasure temple refers to a Buddhist temple, appearing at the tip of a hair, indicating that the small is contained within the large. Why is this said? “The meridians are interconnected; you connect with me, and I connect with you, forming a whole. The hand Taiyin meridian connects with the large intestine, thus linking to the large intestine. In summary, the five Zang organs and six Fu organs are interconnected through the meridians, transforming isolated phenomena into an organic objective entity, interrelated and mutually influential. Liu’s words contain profound wisdom. The twelve meridians include the three Yin and three Yang meridians of the hands and feet. Each meridian disease includes the diseases of the meridian pathways and the associated Zang-Fu organs. Their clinical manifestations have three characteristics: First, when a meridian is affected, the symptoms often relate to the pathway it follows; for example, if the foot Taiyang bladder meridian is affected, pain may be felt in the neck, back, waist, popliteal fossa, and heel; Second, the symptoms of Zang-Fu organ diseases may coincide with the symptoms of the associated meridian; for example, lung meridian diseases may present with cough, shortness of breath, chest fullness, and pain in the inner side of the upper arm; Third, if one meridian is affected, it can influence other meridians, presenting symptoms of multiple meridians; for example, if the spleen meridian is affected, stomach pain and nausea may occur. The eight extraordinary meridians are the eight meridians outside the twelve regular meridians, namely Chong, Ren, Du, Dai, Yangwei, Yinwei, Yangqiao, and Yinqiao. The eight extraordinary meridians connect the twelve meridians and regulate the body’s Yin and Yang Qi and Blood. The diseases of the eight extraordinary meridians are determined by their pathways and special functions. Among them, the Chong meridian is the sea of blood, the Ren meridian governs the uterus, indicating that diseases of the Chong and Ren meridians are related to menstruation and pregnancy. Since the Chong, Ren, and Du meridians all originate from the lower extremities and diverge into three branches, they are all related to reproductive functions. Therefore, in clinical practice, “regulating the Chong and Ren meridians” is often used to treat menstrual disorders, and “nourishing the Du and Ren meridians” is used to treat reproductive dysfunction, which is commonly practiced. Meridian Diagnosis complements and assists Zang-Fu Diagnosis, especially in acupuncture and massage treatments, where Meridian Diagnosis is frequently applied.(7) Wei, Qi, Ying, Blood Diagnosis Wei, Qi, Ying, Blood Diagnosis is a method summarized by Qing Dynasty physician Ye Gui (Ye Tianshi) based on the “Neijing,” “Shang Han Lun,” and other texts, reflecting the general rules of the development of external warm diseases.
Wei, Qi, Ying, Blood Diagnosis categorizes the clinical manifestations during the development of external warm diseases into various syndromes, including Wei stage, Qi stage, Ying stage, Blood stage, and pericardium stage, reflecting the different syndromes at different stages of external warm diseases, as well as the dynamics of the struggle between righteousness and pathogenic factors, revealing the general rules of external warm diseases transitioning from exterior to interior and from superficial to deep, thus providing a basis for treatment. Wei, Qi, Ying, Blood Diagnosis compensates for the shortcomings of Six Meridians Diagnosis and enriches the methods of diagnosis and treatment for external warm diseases.
Wei, Qi, Ying, Blood Diagnosis is an advancement of Six Meridians Diagnosis and is a commonly used method for diagnosing external warm diseases, representing four different levels or stages of disease, explaining the severity of the disease, the location of the disease, the changes in cases at different stages, and the patterns of disease progression. This is the principle behind the saying in TCM: “After Wei, then Qi, after Qi, then Ying, after Ying, then Blood.” Warm diseases generally progress through the stages of Wei, Qi, Ying, and Blood. When the disease is in the Wei or Qi stage, it is considered superficial; when it is in the Ying or Blood stage, it is considered deep. So what are warm diseases? It is a TCM term that refers to infectious febrile diseases, collectively known as warm diseases. The characteristics of warm diseases include sudden onset, rapid progression, and frequent changes, such as common colds, influenza, measles, pneumonia, meningitis, and typhoid fever, among many infectious and epidemic diseases that fall under this category. TCM often uses Wei, Qi, Ying, and Blood to diagnose and treat these diseases. For example, the following symptoms: fever, aversion to wind and cold, headache, body aches, fatigue, cough, nasal congestion, little or no sweating, thirst or no thirst, red tongue with a thin white or thin yellow coating, and floating rapid or tight pulse. These symptoms belong to the Wei stage and are commonly seen in the early stages of colds, influenza, or other infectious diseases. “Wei” represents the body’s exterior (the body’s defensive power), which is the initial stage of warm diseases. Although the manifestations of Wei stage symptoms may vary due to seasonal and climatic differences, they share common major symptoms, such as the exterior symptoms of wind warmth, summer warmth, damp warmth, and autumn dryness, all of which present with fever, aversion to cold, heavier heat than cold, thin coating, and slight thirst or no thirst, cough, and floating or rapid pulse. The Qi stage often appears later than the Wei stage, with high fever, skin bleeding, and specific pathological changes corresponding to certain infectious diseases. The Ying stage is a continuation of the Qi stage, with more severe changes, possibly leading to internal bleeding and severe mental symptoms. The Blood stage is the critical stage of warm diseases, with the main manifestations being irreversible confusion, severe damage to multiple organs such as the heart, lungs, liver, and kidneys, and a significant decrease in the body’s reactivity and resistance. Wei, Qi, Ying, Blood are originally parts of the body’s normal tissues and functions, and when warm diseases occur, they can undergo corresponding pathological changes in succession, following a certain pattern. Therefore, TCM uses Wei, Qi, Ying, Blood to summarize the symptoms of warm diseases at four different stages, explaining the depth of the disease, the severity of the condition, the progression of the disease, and providing a basis for treatment. Thus, the Wei, Qi, Ying, Blood Diagnosis of warm diseases differs from their physiological meanings; it refers to the four stages of warm diseases transitioning from exterior to interior and from light to severe, also indicating the complex relationship between pathology and physiology when a person is ill, resembling the prototype of modern pathophysiology, and is more similar to modern medicine’s diagnostic methods of staging diseases.(8) San Jiao Diagnosis When discussing San Jiao Diagnosis, one must mention its founder—Qing Dynasty physician Wu Jutong. At the age of 19, his father passed away due to illness, and he felt that “if my father fell ill and I did not know medicine, how could I face the world?” He realized that as a son, not understanding medicine meant he could not fulfill his filial duty, so he resolved to study medicine. Wu Jutong diligently studied and mastered medical skills, eventually becoming a prominent figure in warm disease theory, achieving the highest accomplishments in this field. He once reviewed the “Siku Quanshu” in Beijing and was deeply impressed by the powerful and insightful discussions in Wu Youke’s “On Warm Epidemics,” which presented ideas that had not been previously articulated and were highly relevant to reality, inspiring him greatly. He held Ye Tianshi in high regard but believed that Ye’s theories were “mostly southern syndromes and overly simplistic, with medical cases scattered among miscellaneous diseases, often overlooked and not deeply studied.” Therefore, he built upon Ye Tianshi’s theories, integrating ancient and modern knowledge, and combined clinical experience to write the “Differentiation of Warm Diseases” in five volumes, further developing the theory of warm diseases. Since the publication of the “Differentiation of Warm Diseases,” which discusses the symptoms and treatment of warm diseases based on the upper, middle, and lower San Jiao, San Jiao Diagnosis has become one of the methods for diagnosing warm diseases. This method is based on the concept of the locations of the three Jiao in the “Neijing,” and on the foundations of the “Shang Han Lun” and Ye Tianshi’s Wei, Qi, Ying, Blood Diagnosis, summarizing the pathological changes, symptom characteristics, and transformation patterns of the Zang-Fu organs during the warm disease process. Taking the upper Jiao as an example, the symptoms of wind-heat attacking the exterior refer to the invasion of wind-heat pathogens affecting the lung’s defensive function. Symptoms include fever, slight aversion to wind and cold, headache, cough, slight thirst, thin white coating, and floating rapid pulse. The symptoms of heat obstructing the lungs refer to the stagnation of heat pathogens within, leading to lung Qi obstruction. Symptoms include fever, sweating, cough, shortness of breath, thirst, yellow coating, and rapid pulse. The symptoms of pathogens invading the pericardium refer to the invasion of warm phlegm-heat pathogens into the pericardium, obscuring the heart orifices and disturbing the spirit. Symptoms include fever, confusion, red tongue, yellow or greasy coating, and slippery rapid pulse. San Jiao Diagnosis explains the pathological changes and symptoms of the Zang-Fu organs associated with the upper, middle, and lower Jiao, while also illustrating the different stages of warm diseases. San Jiao Diagnosis posits that warm diseases generally begin in the upper Jiao (hand Taiyin lung), then progress to the middle Jiao (spleen and stomach), and finally reach the lower Jiao (liver and kidneys). However, due to the various types of warm diseases, such as wind warmth, spring warmth, summer heat, damp warmth, autumn dryness, and epidemic diseases, their onset and transformation patterns can vary. For instance, summer heat may initially present as middle Jiao disease. Additionally, symptoms from different Jiao can also coexist; for example, damp warmth may initially affect both the upper and middle Jiao. Regardless of the diagnostic method, they are all valuable ancestral treasures with vibrant life force, and under current conditions, they should continue to be promoted.
Medical Path, Heart Path, Human Path
Compassion, Confidence, Equanimity
I am on the medical path ❤ My heart is for you
Click to read the original text to view The search function tutorial for this public account