Diagnosis by observation

Spirit – observed through the eyes, complexion, breathing, vitality, & aura – describe, either strong or weak

Body constitution

wood – tall & slender

 fire – small pointed head and small hands

metal – broad square shoulders, strongly built and a triangular face

earth – slightly fat, large head belly and thighs, wide jaws

water – round face and body, and a long spine

Demeanour – how the person moves should correspond with their constitution

– rapid jerky movements (Yang excess, or Heat)

– slow or lack of movement (Yin deficiency, or Cold)

Hair

– falling hair (Blood deficiency)

– premature graying (Kidney Essence deficiency)

– dull splitting (Lung deficiency)

Face

– clear and moist (Stomach Qi healthy)

– dry and lusterless (Stomach Qi deficiency)

– green (Liver, interior Cold, pain, internal Wind)

– red (whole face – excess Heat, malar – deficiency Heat)

– yellow (Spleen deficiency, Damp)

– bright orange-yellow (Damp/Heat)

– dry yellow (Spleen or Stomach Heat)

– dull pale yellow (Spleen Stomach Damp/Cold)

– white dull (Blood deficiency)

– white bright (Yang deficiency)

– black moist (Cold)

– black dry (Kidney – black moist (Cold)

– black dry (Kidney Yin deficiency)

***Important to use corresponding facial areas to aid in diagnosis.

Eyes (there are differing theories, only one will be discussed)

– red inner corners (Heart Fire)

– red sclera (Lung Heat)

– yellow sclera (Damp/Heat)

– whole eye red painful swollen (Wind/Heat, or Liver Fire)

– pale white corners & lids (Blood deficiency)

– dark or swelling under the eye ‘bags’ (Kidney deficiency)

Nose

– green-blue (abdominal pain)

– yellow (Damp/Heat)

– white (Blood deficiency)

– red (Lung Spleen Heat)

– grey (impairment of water movement)

– dry tip (Stomach or Large Intestine Heat)

– dry black (Toxic Fire)

– clear discharge (Cold)

– yellow discharge (Heat)

Ears

– blue-black (pain)

– white (Cold)

– lobes dry withered black (Kidney deficiency – prognosis bad)

– lobes shiny and moist (prognosis good)

– lobes long and full (strong Kidneys)

– lobes thin and small (weak Kidneys)

– infection with pain (Fire in Shaoyang meridians)

Mouth & lips

– pale lips (Blood or Yang deficiency)

– red dry lips (Spleen Stomach Heat)

– purple-bluish lips (Blood Stasis)

– mouth always slightly open (deficiency)

– breathe though mouth (Lung Qi deficiency)

– green around mouth (Liver Blood Stasis, and Wood overact on Earth)

Teeth and gums

– dry teeth (Kidney Yin deficiency, or Yangming Heat)

– poor tooth development (Kidney deficiency)

– swollen painful gums with possible bleeding (Stomach Heat, if no pain deficiency Heat)

– pale gums (Blood deficiency)

Throat

– pain, redness, swelling (Wind/Heat, or Stomach Fire)

– sore and dry, not red and swollen (Kidney Yin deficiency Heat)

 Nails and limbs

– pale nails (Blood deficiency)

– purple-blue (Liver Blood Stasis)

– dry lifeless skin around the wrists and ankles (body fluid deficiency)

– in children, the first joint on the index finger is the ‘gate of wind’, the second is the ‘gate of Qi’, and the third is the ‘gate of life’.

                – after rubbing the finger towards the body…

                – veins appear only beyond the ‘gate of wind’ (mild, exterior invasion)

                – veins appear beyond the ‘gate of Qi’ (internal, more serious)

                – veins appear beyond the ‘gate of life’ (serious life threatening disease)

                – blue veins (Cold)

                – red veins (Heat)

Skin

– dry (Blood deficiency)

– itchiness (Wind)

– pitting edema (Kidney Yang deficiency)

– non-pitting edema (Qi stagnation)

– bright clear yellow Yang jaundice (Damp/Heat)

– dull yellow Yin jaundice (Damp/Cold)

Tongue

– root (Kidney)

– middle (Spleen Stomach)

– sides (Liver Gallbladder)

– tip (Heart)

– behind tip (Lungs)

body colour indicates condition of blood, Ying Qi, and Zang organs

– pale red (normal)

– pale (Blood or Yang deficiency)

– red (excess or deficient heat)

– red spots/papillae (Heat or Blood Stasis)

– deep red (more severe Heat)

– purple (Blood Stasis)

– blue (Cold causing Blood Stasis)

body shape shows blood and Ying Qi

– thin (blood or Yin deficiency)

– swollen (Yang deficiency causing Damp or Damp/Heat)

– stiff (internal Wind)

– flaccid (body fluid deficiency)

– long (Heart Heat)

– short (interior Cold or severe Yin deficiency)

– cracked (horizontal = Stomach Yin deficiency, midline to tip = Heart, midline shallow wide = Stomach Yin deficiency)

– quivering (Spleen Qi deficiency)

– tooth-marked (Spleen Qi deficiency)

coat shows the Fu organs (in particular the Stomach, the coat is the left over from the digestion)

– thin white (Stomach is digesting normally)

– thick (Wind, Cold, Damp, retention of food, Phlegm, Heat, Fire, the thicker the more severe)

– no coat (Stomach or Kidney Yin deficiency)

– white (Cold)

– yellow (excess Heat)

– grey or black (severe Cold or Heat depending on the moisture)

moisture shows body fluids

– dry (Heat has injured the body fluids)

– slightly moist (normal)

– too wet (Yang Qi deficiency Damp)

– sticky or slippery (Damp or Phlegm)

Meridian diagnosis

The following symptoms are signs which apply only to the specific meridian, organ symptoms have been left out.  In addition to the following clinical manifestations, any pain, heat or coldness, numbness, stiffness, knots, tingling, aches, redness, or any other sign along the course of a meridian is also an obvious meridian symptom.

Lungs (hand Taiyin) → External pathogenic invasion, accumulation of Lung heat: i.e. fever, aversion to cold, stuffiness of the chest, pain in the clavicle, shoulders & arms.

Large Intestine (hand Yangming) → Wind/cold/damp blockage, accumulation of heat: i.e. sore throat, toothache, epistaxis (nosebleed), runny nose, swollen & painful gums, swollen eyes

Stomach (foot Yangming) → External pathogenic invasion, Stomach heat rebelling: i.e. pain in the eyes, epistaxis (nosebleed), swelling of neck, facial paralysis, cold legs & feet

Spleen (foot Taiyin) → Wind/cold/damp, heat rebelling: i.e. vaginal discharge, weakness of the leg muscles, tongue stiffness/pain

Heart (hand Shaoyin) → Wind/cold/damp blockage, heat rebelling: i.e. pain in the eyes, pain on the inner side of the arm, pain along the scapula, eye jaundice, tongue ulcers, pyogenic infections

Small Intestine (hand Taiyang) → External pathogenic invasion, heat rebelling: i.e. pain  &/or stiffness of the neck &/or elbow, red eyes, sore throat, mandible swelling, ear trouble

Bladder (foot Taiyang) → Wind/cold/damp blockage, heat rebelling: i.e. fever & aversion to cold, headache, stiff neck, pain in lower back &/or eyes, pain in the posterior leg, hard to bend, nosebleed, hemorrhoids

Kidneys (foot Shaoyin) → Cold: i.e. pain in lower back &/or sole of foot

Pericardium (hand Jueyin) → Cold, heat, Liver Qi stagnation: i.e. stiff neck, contraction of elbow or hand, Bi and Wei syndromes, armpit swelling, hot palms, chest pain, shaking arms (anger)

San Jiao (hand Shaoyang) → Wind/cold/damp, heat: i.e. sore throat, scrofula, goiter, axillary swelling, pain in the elbow, alternation of chills & fever, deafness, pain & discharge from the ear, pain at the top of the shoulders

Gallbladder (foot Shaoyang) → Cold stagnation, heat rebelling: i.e. alternation of chills & fever, headache, deafness, pain in hip & lateral side of legs, pain & distension of breasts, difficult leg movements, 4^th and 5^th toe disorders, inner ear pain, migraine, bitter taste

Liver (foot Jueyin) → Cold stagnation, Wind Fire rebelling: i.e. headache, pain & swelling of the eye, leg cramps, pain in side of lower abdomen, hernia, one sided testicle pain radiating to low abdomen, dizziness, blurred vision, eyelid twitching, difficulty swallowing, facial deviation

Diagnosis by hearing & smelling

Sounds

Voice

– sudden loss (Wind/Heat)

– gradual loss (Lung Qi or Yin deficiency)

– loud coarse (excess)

– weak (deficiency)

– talk too much (Heat), quiet/reserved (Cold)

– shouting (Liver)

– laughing (Heart)

– singing (Spleen)

– whimpering (Lung)

– groaning (Kidney)

Cough

– loud (excess)

– weak (deficiency)

– dry (Lung Yin deficiency)

Breathing

– loud coarse (excess)

– weak (deficiency)

Vomiting (same as breathing)

Hiccup (same as breathing)

Borborygmi (same as breathing)

Smell

– strong foul (Heat)

– no smell (Cold)

– bad breath (Stomach Heat)

– smelly urine (Damp)

Must Read: Si Ni Tang – rescues devastated Heart Kidney Yang (shock), warms mid Jiao, stop diarrhea, warm cold hands & feet

Diagnosis by inquiry

(pattern identification through 8 principles, Zang Fu, pathogenic factors, & meridians)

Chills and fever (feeling of heat)

– aversion to cold (Wind/Cold or Wind/Heat)

– fever and chills (Wind/Cold, Taiyang stage), more fever than chills (Wind/Heat, Wei Qi level)

– fever without aversion to cold (internal Heat, Yangming stage)

– alternating chills and fever (exterior invasion of Wind/Cold or Wind/Heat at Shaoyang stage)

– relief of coldness (clothing/covering relieves – internal yang deficient cold, no relief – Wind/Cold)

– low grade fever worse in afternoon or at night with sweats (Yin deficiency)

– constant low grade fever (Damp/Heat)

Sweating

– sweat with exterior symptoms (Wind/Heat, or Wind/Cold with deficiency)

region

– only on head (Stomach Heat, or Damp/Heat)

– on forehead, oily (Yang collapse)

– only on arms and legs (Spleen Stomach deficiency)

– only on hands (Lung deficiency, or nerves)

– whole body (Lung deficiency)

– 5 centers (Yin deficiency)

time

– daytime (Yang deficiency)

– night (Yin deficiency)

condition

– profuse cold sweats (Yang collapse)

– oily sweat on forehead like pearls not following Yang collapse (danger of imminent death)

Quality

– oily (severe Yang deficiency)

– yellow (Damp/Heat)

Pain

excess

obstruction of Qi flow in the meridians, more severe, constant

– exterior pathogenic invasions

– internal Cold or Heat

– Qi stagnation (distension/throbbing more than pain, no fixed location)

– Blood stagnation

– Phlegm stagnation

– food retention

– Blood Stasis (stabbing, fixed location)

deficiency

dull intermittent

– Qi and/or Blood deficiency

– Yin deficiency consuming body fluids

	deficiency	excess	cold	heat
character	dull/lingering	sharp/intense	cramping	burning
pressure	relieves	aggravates
food	relieves	aggravates
temperature			heat helps	cold helps
bowel movement	pain after	relieved after	pain after	relieved after
posture	prefer lying down	prefer sitting
onset	slow, gradual	sudden
vomiting	pain after	relieved after	pain after	relieved after
rest/movement	better with rest	better with movement	better with movement	worse with movement

Head and body

headache

onset

– recent, short duration (Wind/Cold)

– gradual onset, come in attacks (interior)

time of day

– day time (Qi or Yang deficiency)

– evening (Blood or Yin deficiency)

location

– nape of neck: taiyang (Wind/Cold, or Kidney deficiency)

– forehead: yangming (Stomach Heat, or Blood deficiency)

– temples/temporal region: Shaoyang (Liver Gallbladder Fire)

– vertex: jueyin (Liver blood deficiency)

– whole head (Wind/Cold)

pain characteristics

– heavy (Damp or Phlegm)

– inside the head/brain (Kidney deficiency)

– pounding, distending, throbbing (Liver Yang rising)

– boring, like a small nail point (Blood Stasis)

condition

– with exterior symptoms (Wind/Cold, or Wind/Heat)

– aggravated by cold (Cold)

– aggravated by heat (Heat)

– aggravated by fatigue, better with rest (Qi deficiency)

pain in whole body

– sudden onset with chills and fever (Wind/Cold)

– pain everywhere with tiredness (Qi blood deficiency)

– after childbirth

                dull pain (Blood deficiency)

                severe (Blood Stasis)

                pain in arms only when walking (Liver Qi stagnation)

– pain in all muscles & hot sensation of the flesh (Stomach heat)

– pain with heavy feelings (Damp obstructing muscles)

pain in joints

– wondering from joint to joint (Wind)

– severe fixed (Cold)

– fixed with swelling & numbness (Damp)

backache

– continuous dull (Kidney deficiency)

– acute severe with stiffness (Blood Stasis)

– severe, aggravated by cold and damp weather (Cold/Damp invasion of the meridians)

– boring pain, tough to turn waist (Blood Stasis)

– extending up to the shoulders (exterior attack)

numbness

– arms and legs only, or hands and feet only (Blood deficiency)

– fingers, elbow and arm on one side only, especially the first three fingers (Wind and Phlegm, possible Wind stroke)

dizziness

Mostly diagnosed through identification of other symptoms

– usually root cause is Blood deficiency

– giddiness when everything seems to sway, lose balance (internal Wind)

– mild, with heaviness and cloudiness in head (Phlegm)

– aggravated when fatigued (Qi deficiency)

Thorax and abdomen

– chest pain (Heart Blood Stasis due to Yang deficiency)

– chest pain with cough and copious yellow sputum (Lung Heat)

– hypochondriac distension (Liver Qi stagnation, if severe – Liver Blood Stasis)

– epigastric pain (food retention, Stomach Heat)

– dull epigastric pain (deficient Cold of Stomach)

– epigastric fullness (Spleen deficiency or Damp)

– low abdominal pain (internal Cold, Liver Qi stagnation, Liver Blood stagnation, Damp/Heat, intestinal or uterine Blood Stasis)

– hypogastric pain (Damp/Heat in Bladder, or Liver Fire moving down to the Bladder)

Diet & appetite, & taste

– discomfort relieved by eating (deficiency), aggravated by eating (excess)

– no appetite (Spleen deficiency)

– always hungry (Stomach Heat)

– fullness and bloating after meals (food retention)

– prefer hot temperature foods (Cold)

– prefer cold temperature foods (Heat)

taste

– bitter taste (Liver or Heart Heat)

– sweet taste (Spleen deficiency, or Damp/Heat)

– sour taste (food retention, or Liver Stomach disharmony)

– salty taste (Kidney Yin deficiency)

– lack of taste (Spleen deficiency)

– pungent taste (Lung Heat)

vomit

– sour vomit (Stomach insult Liver)

– bitter vomit (Liver Gallbladder Heat)

– clear watery (Stomach Cold with fluid retention)

– soon after eating (Heat)

Stool

constipation

– pain after movement (deficiency)

– pain relieved after movement (excess)

– acute with thirst, dry yellow tongue coat (Stomach and intestine Heat)

– old people or after childbirth (Blood deficiency)

– small bitty rabbit stools (Blood deficiency, Liver Qi stagnation, or Heat)

– difficult to move but not dry (Liver Qi stagnation)

– with abdominal pain (deficient Yang Cold)

– dry stools without thirst (Kidney and/or Stomach Yin deficiency)

– alternating constipation and diarrhea (Wood overact on Earth)

diarrhea

– painful (Liver, or Heat)

– foul smell (Heat), no smell (Cold)

– chronic (Spleen and/or Kidney Yang deficiency)

– 5am (Kidney Yang deficiency)

– abdominal pain (Cold in intestines)

– with mucous (Damp), mucous and blood (Damp/Heat)

– undigested food (Spleen deficiency)

– burning sensation (Heat)

– bowel incontinence (Spleen Qi sinking)

– black tarry stools (blood stasis), if blood comes first (Damp/Heat in intestines)

– if blood comes first, is dirty, and anus feels heavy and painful (Heat in Blood)

– if stool comes first then blood that is thin and watery (Spleen can’t keep blood in vessels)

– borborygmi with loose stool (Spleen deficiency)

– borborygmi without loose stool (Liver Qi stagnation)

– flatulence (Liver Qi stagnation)

– flatulence with smell (Damp/Heat in Spleen , or Stomach Heat), no smell (Spleen Yang deficient Cold)

Urine

function

– enuresis or incontinence (Kidney deficiency)

– retention of urine (Damp/Deat in Bladder)

– difficulty (Damp/Heat in Bladder, or Kidney deficiency)

– frequent copious (Kidney deficiency)

– frequent scanty (Qi deficiency)

pain

– before urination (Low Jiao Qi stagnation)

– during urination (Bladder Heat)

– after urination (Qi deficiency)

colour

– pale (Bladder or Kidney Cold)

– dark (Heat, or external pathogen has entered deeply)

– turbid or cloudy (Damp in Bladder)

– copious clear pale during exterior attack (pathogen has not entered deeply)

amount

– copious (Kidney Yang deficiency)

– scanty (Kidney Yin deficiency)

Sleep

insomnia

– can’t get to sleep, but sleep well after falling to sleep (Heart Blood deficiency)

– light sleep, waking frequently (Kidney Yin deficiency)

– dream disturbed (Liver or Heart Fire)

– restless sleep with lots of dreams (food retention)

– wake very early in morning, can’t get back to sleep (Gallbladder deficiency)

lethargy

– sleepy after eating (Spleen deficiency)

– heaviness (Damp), if with dizziness (Phlegm)

– very fatigued with cold feelings (Kidney Yang deficiency)

– tired stupor with external heat (Heat invaded the Pericardium)

– tired stupor with rattling in throat, slippery pulse, sticky tongue coat (Phlegm misting the mind)

Ears

tinnitus

onset

– sudden (Liver Fire, or Liver Wind)

– gradual (Kidney deficiency)

pressure

– aggravated by pressing the ears (excess)

– relieved by pressing the ears (deficiency)

tone

– loud high pitched like whistle, constant (Liver Yang, Liver Fire, or Liver Wind)

– low pitched, intermittent (Kidney deficiency)

deafness

– sudden onset (Liver Fire, or Liver Wind)

– gradual onset (deficiency)

– chronic (Kidney deficiency, Heart blood deficiency, deficiency of Qi of the upper Jiao, Yang Qi deficiency)

Eyes

pain

– needle like pain with redness and headache (Toxic Fire in the Heart meridian)

– pain swelling and redness, (Wind/Heat, or Liver Fire)

– blurred vision and/or floaters (Liver Blood deficiency)

– photophobia (Liver Blood deficiency)

– eye pressure (Kidney Yin deficiency)

dryness

– dryness (Liver and/or Kidney Yin deficiency)

Thirst and drink

– desire to drink large amounts of cold water (excess Heat of any organ)

– desire to drink warm water (Cold)

– no thirst (Spleen or Stomach Cold)

– thirst but no desire to drink (Damp/Heat)

– thirst with desire to sip slowly (Stomach or Kidney Yin deficiency)

Women

menstruation

cycle

– early (Heat in Blood or Qi deficiency)

– late (Blood deficiency, Blood stagnation, Cold)

– irregular (Liver Qi stagnation, Liver Blood stagnation, Spleen deficiency)

quantity

– heavy flow/loss (Heat in Blood or Qi deficiency)

– scanty (Blood deficiency, Blood stagnation, Cold)

colour

– dark or bright red (Heat in the Blood)

– pale red (Blood deficiency)

– purple or blackish (Blood Stasis, Cold)

– fresh red (Yin deficiency Heat)

quality

– thicker blood with clots ( Blood Stasis or Cold)

– watery (Blood or Yin deficiency)

– turbid (Heat in Blood or Cold stagnation)

pain

– before period (Qi or Blood stagnation)

– during period (Heat in Blood or Cold stagnation)

– after periods (Blood deficiency)

leukorrhea

colour

– white (Cold from Spleen or Kidney Damp, Cold/Damp, Liver Qi stagnation)

– yellow (Damp/Heat in low Jiao)

– greenish (Damp/Heat in Liver meridian)

– red and white (Damp/Heat)

– yellow with pus and blood after menopause (Toxic Damp/Heat in Uterus)

consistency

– watery (Cold/Damp)

– thick (Damp/Heat)

odour

– fishy (Damp/Cold)

– putrid (Damp/Heat)

pregnancy

infertility

– Blood or Kidney Essence deficiency, Damp/Heat in low Jiao, Blood Stasis in Uterus

vomiting

– Stomach and Chong mai deficiency

miscarriage

– before 3 months (Blood or Essence deficiency)

– after 3 months (Liver Blood Stasis or Spleen Qi sinking)

childbirth

– sweating and fever after delivery (Qi and Blood exhaustion)

– post partum depression (Blood deficiency leads to Heart Blood deficiency)

Pulse

Traditionally the pulse is said to have 3 qualities: Stomach Qi, Spirit, and Root

Stomach Qi – a pulse that feels soft, gentle, calm, and relatively slow.  If it is rough or hard the Stomach is injured.

Spirit – soft but with strength, neither big or small, and regular.  This shows healthy Heart Qi and blood.

Root – deep level can be felt clearly, and Kidney position can be felt clearly.  This shows that the Kidneys are strong.

Slow or Rapid

Average normal pulse rates per minute
Age	rate (beats/minute)
1 – 4	90+
4 – 10	84
10 – 16	78-80
16 – 35	76
35 – 50	72-70
50+	68

Slow

significance – Cold, empty- Yang deficiency, full- excess Cold, athlete

Rapid

significance – Heat, empty- Yin deficiency, full- excess Heat

Superficial (floating)

feel – can be felt by just resting the fingers on the radial artery.

significance – Wind/Cold or Wind/Heat (tense- cold, rapid- heat).  Floating at superficial level but empty at deep level it is due to Yin deficiency.

Deep

feel – can only be felt with heavy pressure, near the bone.

significance – Zang disease.  Weak- Qi Yang deficiency, full- Qi or blood stagnation, or interior Cold or Heat.

Empty

feel – big but soft (green onion stalk)

significance – Qi deficiency

Full

feel – full, hard, and long

significance – excess Heat or excess Cold

Slippery

feel – smooth, rounded, slippery or oily as it slides under the fingers

significance – Phlegm, retention of food, pre-menstrual, or pregnant

Choppy (Uneven)

feel – rough like it has a jagged edge

significance – Blood deficiency, possibly Heart Blood, exhaustion of body fluids

Long

feel – extends beyond the normal pulse position

significance – Heat

Short

feel – does not run under all fingers

significance – severe Qi deficiency, usually appears in the front positions.  Shows Stomach Qi deficiency

Overflowing

feel – big and long, superficial and feels too large for the vessel like a river flooding

significance – extreme Heat, empty- deficient Heat

Thin

feel – thin

significance – Blood or Yin deficiency, may also show Damp with severe Qi deficiency

Minute

feel – extremely thin like thread, difficult to feel

significance – severe Qi and blood deficiency

Tight

feel – like a tightly strung twisted rope

significance – internal or external Cold, pain

Wiry

feel – like a guitar string, thinner, more taut and harder than tight pulse.  Hits fingers.

significance – Liver disharmony, pain, Phlegm

Hollow

feel – very similar to a green onion stalk but not as big as an empty pulse, can feel at superficial and deep levels, middle is empty

significance – post hemorrhage, if rapid and slightly hollow- impending hemorrhage

Leather

feel – like the skin of a stretched drum, empty at deep level, large

significance – severe Kidney Yin or Essence deficiency

Firm

feel – similar to wiry and deep but only at deep level, hard and wiry

significance – internal Cold if it is slow, stagnation, pain

Soft

feel – disappears when strong pressure is applied, may be slightly floating, similar to floating empty

significance – Dampness, Yin and Essence deficiency

Weak

feel – only felt at deep level, soft

significance – Yang deficiency

Scattered

feel – broken like a dotted line, usually deep

significance – severe Qi and Blood deficiency

Hidden

feel – hiding behind the bone, extremely deep and hard to feel

significance – extreme Yang deficiency

Moving

feel – round and short like a bean, trembles under the fingers, no definite shape, slippery

significance – shock, anxiety, fright, extreme pain, deep rooted emotional fears

Hasty

feel – rapid and stops at irregular intervals

significance – extreme Heat and deficiency of Heart Qi, may show with Heart Fire

Knotted

feel – slow and stops at irregular intervals

significance – Heart Qi or Heart Yang deficiency, Cold

Intermittent

feel – stops at regular intervals

significance – serious problem of one or more Zang organ, stops every 4 beats or less- very severe.  Serious Physical Heart problem

Hurried

feel – very rapid, agitated and urgent

significance – Yang excess with Fire consuming the Yin