TCM Acupuncture Comprehensive Review 

Observation:

The observation of ‘spirit’ (shen):

 • Complexion with spirit has lustre; without spirit, no lustre, dull

 • Eyes with spirit have lustre and brightness; without spirit, dull, clouded

• State of mind with spirit is alert and clear; without spirit, dull and depressed

• Breathing with spirit is even; without spirit is laboured

The normal complexion:

• Lustre

• A subtle, slightly reddish hue  

• Moisture

Pathological colors:

• White • Yellow • Red • Green • Blue • Black

White complexion

• Blood deficiency (dull-white)

• Yang deficiency (bright-white)

• Yang deficiency with Cold (bluish-white)

Yellow complexion

• Spleen deficiency (sallow yellow)

• Damp-Heat with prevalence of Heat (bright orange-yellow)

• Damp-Heat with prevalence of Dampness (smoky, dull-yellow)

• Heat in Stomach and Spleen (withered, dried-up yellow)

• Cold-Dampness in Stomach and Spleen (dull-pale yellow)

• Spleen deficiency  (pale yellow ) 

Red complexion

• Full-Heat: whole face red

• Empty-Heat: red cheek bones

Green complexion

• Liver patterns

• Interior Cold

• Pain

• Interior Wind 

Blue complexion

• Cold in Liver channel (dark-bluish under the eyes)

• Cold or chronic pain (white-bluish)

• Severe Heart-Yang deficiency with Blood stasis (dull-bluish)

• Liver Wind (bluish complexion, in children)

Black complexion

• Cold: black and moist

• Heat: black and dried-up, burned-looking

• Kidney deficiency: Dark with low back pain

• Blood Stasis: Dark without brightness + scaly skin

Eyes

Eyes are clear and have luster indicate have Shen.

Eyes are rather dull or clouded, it shows disturbed Shen.

A red colour in the corners of the eye indicates Heart- Fire;

a red colour in the sclera indicates Lung-Heat.
A yellow colour of the sclera indicates Damp-Heat.
If the whole eye is red, painful and swollen, it indicates either an exterior invasion of Wind-Heat or rising of Liver-Fire.
A dull-white color of the corners indicates Heat and a pale-white color indicates Blood deficiency.

Infant Finger Venules

Red tongue

• Red: Heat
• Red with coating: Full-Heat
• Red without coating: Empty-Heat
• Red tip: Heart-Fire or Heart Empty-Heat (coating: latter without)
• Red sides with coating: Liver-Fire or Gall-Bladder Heat
• Red sides without coating: Liver-Yin deficiency with Empty-Heat
• Red Centre: Heat or Empty-Heat of the Stomach (depending on whether there is a coating or not)
• Red points on the tip: Heart-Fire
• Red points on the sides: Liver-Fire
• Red spots on the root: Heat in the Lower Burner
• Red points in or around the center: Stomach-Heat

Tongue-body shape

• Thin: Blood or Yin deficiency (Pale or Red without coating, respectively)
• Swollen: Dampness or Phlegm
• Partially swollen: Heat
• Stiff: interior Wind or Blood stasis
• Flaccid: deficiency of Body Fluids
• Short: severe Yang or Yin deficiency (Pale or Red without coating, respectively)
• Cracked: Heat or Yin deficiency
• Deviated: interior Wind
• Tooth-marked: Spleen-Qi deficiency

Tongue coating:

• Normal coating is thin white

• Thick coating: pathogenic factor (the thicker the coating, the stronger the pathogenic factor)
• Absence of coating: Stomach-Yin deficiency
• Total absence of coating, Red tongue body: Stomach- and Kidney-Yin deficiency with Empty-Heat
• White coating: Cold pattern
• Yellow coating: Full-Heat pattern
• Grey and black coating: extreme Cold or extreme Heat (tongue wet or dry, respectively)

Moisture of tongue
• Indicates state of Body Fluids
• Normal tongue is slightly moist
• Too wet: Yang deficiency
• Too dry: Heat or Yin deficiency
• Sticky/slippery: Dampness and/or Phlegm

Voice

• Loud voice: Full pattern
• Weak voice: Empty pattern

• Reluctance to talk: Cold pattern or Lung-Qi deficiency
• Excessive talking: Heat

• Sudden loss of voice: invasion of Wind-Heat
• Gradual loss of voice: Lung-Qi or Lung-Yin deficiency

Diagnosis by smelling

Body odour
Odour of bodily secretions
• Breath
• Sweat
• Sputum
• Urine and stools
• Vaginal discharge
• Intestinal gas

Breath smells

• Strong, foul: Stomach-Heat or retention of food
• Sour: retention of food, Accumulation Disorder (in children)
• Foul, pungent: Damp-Heat in Stomach and Spleen

Causes of pain

• Qi stagnation: distension more than pain, or a distending pain, no fixed location, coming and going
• Liver-Yang rising: chronic headaches with a distending, throbbing pain
• Blood stasis: severe, stabbing pain, with a fixed location
• Cold (Full or Empty): cramping, spastic pain aggravated by cold weather and cold foods/liquids and alleviated by the application of heat
• Damp-Heat: burning pain with a feeling of fullness and heaviness
• External Wind: occipital headache and stiffness
• External Dampness: pain in the joints or epigastrium
• Retention of food: intense pain with feeling of fullness (more in children)
• Phlegm: does not usually cause pain, but it may do so especially in the joints (as in rheumatoid arthritis)

Taste

• Lack of taste sensation: Spleen and Stomach deficiency
• Bitter taste: Heat in Liver or Heart
• Sweet taste: Spleen deficiency or Damp-Heat
• Sour taste: retention of food or Liver invading Stomach
• Salty taste: Kidney-Yin deficiency
• Pungent taste: Lung-Heat

Food
• Condition relieved by eating: Empty
• Condition aggravated by eating: Full

• Lack of appetite: Spleen-Qi deficiency
• Excessive hunger: Stomach-Heat
• Feeling of fullness: Dampness or retention of food
• Feeling of distension: Qi stagnation

• Preference for hot foods/drinks: Cold pattern
• Preference for cold foods/liquids: Heat pattern

Vomiting

• Sour vomiting: invasion of Stomach by Liver
• Bitter vomiting: Liver and Gall Bladder-Heat
• Clear watery vomiting: Cold in the Stomach with retention of fluids
• Vomiting soon after eating: Heat pattern

Constipation
• Aggravation of a condition after a bowel movement: Empty pattern
• Amelioration of a condition after a bowel movement: Full condition
• Acute constipation with thirst and dry yellow coating: Heat in the Stomach and Intestines
• Constipation in old people or women after childbirth: deficiency of Blood
• Constipation with small, dry, bitty stools like goat’s stools indicates stagnation of Liver-Qi and Heat in the Intestines
• Difficulty in performing a bowel movement (stools not dry): stagnation of Liver-Qi
• Constipation with abdominal pain: internal Cold, which may be Full or Empty
• Constipation with dry stools, dry mouth, desire to drink in small sips: Yin deficiency, usually of Kidneys and/or Stomach
• Alternation of constipation and diarrhea: stagnant Liver-Qi invading the Spleen

Loose stools/diarrhea
• Chronic loose stools/diarrhea: Spleen- and/or Kidney-Yang deficiency
• Chronic diarrhea every day in the very early morning: Kidney-Yang deficiency
• Diarrhea with abdominal pain: interior Cold in the Intestines
• Diarrhea with mucus in the stools: Dampness in the Intestines
• Diarrhea with mucus and blood in the stools: Damp-Heat in the Intestines
• Loose stools with undigested food: Spleen-Qi deficiency
• Stools not loose or only slightly loose but very frequent, deficiency of Spleen with sinking of Spleen-Qi

• Foul-smelling stools: Heat
• Absence of smell: Cold
• Borborygmi with loose stools: Spleen deficiency
• Borborygmi with abdominal distension and without loose stools: stagnation of Liver-Qi

• Burning sensation in the anus while passing stools: Heat

Thirst and drink

• Thirst with desire to drink large amounts of cold water: Full-Heat pattern
• Thirst with desire to drink in small sips: Yin deficiency (usually of Stomach or Kidneys)
• Absence of thirst: Cold pattern, usually of the Stomach or Spleen
• Thirst but with no desire to drink: Damp-Heat
• Desire to drink cold liquids: Heat pattern
• Desire to drink warm liquids: Cold pattern

Headache
Onset
• Recent onset, short duration: headache from exterior attack of Wind-Cold
• Gradual onset, in attacks: interior type

Time of day
• Daytime: Qi or Yang deficiency
• Evening: Blood or Yin deficiency
• Night-time: Blood stasis

Location
• Nape of neck: Greater Yang channels (can be from exterior invasion of Wind-Cold, or from interior Kidney deficiency)
• Forehead: Bright Yang channels (can be from Stomach-Heat or Blood deficiency)
• Temples and sides of head: Lesser Yang channels (can be from exterior Wind in the Lesser Yang, or from interior Liver and Gall Bladder Fire rising)
• Vertex: Terminal Yin channels (usually from deficiency of Liver-Blood)
• Whole head: exterior invasion of Wind-Cold

Character of pain
• Heavy feeling: Dampness or Phlegm
• Pain which is ‘inside’ the head, ‘hurting the brain’: Kidney deficiency
• Distending, throbbing: rising of Liver-Yang
• Boring, like a nail in a small point: stasis of Blood
• With a feeling of muzziness and heaviness: Dampness
• With a feeling of muzziness, heaviness and dizziness: Phlegm

Condition
• With aversion to wind or cold: exterior invasion
• Aggravated by cold: Cold pattern
• Aggravated by heat: Heat pattern
• Aggravated by fatigue, improved by rest: Qi deficiency
• Aggravated by emotional tension: Liver-Yang rising
• Aggravated by sexual activity: Kidney deficiency

Dizziness
• Severe giddiness when everything seems to sway and the person loses the balance: internal Wind
• Dizziness with throbbing headaches: Liver-Yang rising
• Dizziness accompanied by a feeling of heaviness and muzziness : Phlegm obstructing the head
• Slight dizziness aggravated when tired: indicates Qi and Blood deficiency

• Sudden onset: Full pattern
• Gradual onset: Empty pattern

Sweating
Full
• Heat
• Damp-Heat

Empty
• Deficiency of Yang
• Deficiency of Yin

Tinnitus
Onset
• Sudden onset: Full condition, Liver-Fire, Liver-Yang rising, Liver-Wind
• Gradual onset: Empty condition, Kidney deficiency

Pressure
• Noise aggravated by pressing with one’s hands on the ears: Full condition
• Noise alleviated by pressing with one’s hands on the ears: Empty condition

Character
• Loud, high-pitched noise, like whistle: Liver-Yang, Liver-Fire, Liver-Wind
• Low-pitched noise like rushing water: Kidney deficiency

Deafness
• Sudden onset: Full condition, Liver-Fire, Liver-Yang rising, Liver-Wind
• Gradual onset: Empty condition, deficiency of Kidneys, Blood or Qi deficiency

Menstruation
Cycle
• Periods always early: Blood-Heat or Qi deficiency
• Periods always late: Blood deficiency or stagnation of Blood or Cold
• Periods irregular, sometimes early and sometimes late: stagnation of Liver-Qi or Liver-Blood, or Spleen deficiency

Amount
• Heavy loss of blood: Blood-Heat or Qi deficiency
• Scanty periods: Blood deficiency or stagnation of Blood or Cold

Colour
• Dark-red or bright-red: Blood-Heat
• Pale: Blood deficiency
• Purple or blackish blood: stasis of Blood or Cold
• Fresh-red: Empty-Heat from Yin deficiency

Quality
• Congealed blood with clots: stasis of Blood or Cold
• Watery blood: Blood or Yin deficiency

Pain
• Before the periods: stagnation of Qi or Blood
• During the periods: Blood-Heat or stagnation of Cold
• After the periods: Blood deficiency

• Pulse
• Skin
• Limbs
• Chest
• Abdomen
• Points

The normal pulse
The pulse should have three qualities, which are described as having Stomach-Qi, having spirit and
having a root.

1. Floating (Fu)
Feeling
This pulse can be felt with a light pressure of the fingers, just resting the fingers on the artery.

• Invasion of external Wind
• Yin deficiency (interior conditions)

2. Deep (Chen)
Feeling
 it can only be felt with a heavy pressure of the fingers and is felt near the bone.

• Pathogenic factor in the Interior (Deep-Full)
• Yang deficiency (Deep-Weak)

3. Slow (Chi)
Feeling
This pulse has three beats per respiration cycle (of the practitioner).

• Cold pattern
• Empty-Cold (Slow and Weak)
• Full-Cold (Slow and Full)

4. Rapid (Shu)
Feeling
This pulse has higher rate than normal, five beats per each respiration cycle or more.

Rapid pulse
• Heat pattern
• Full-Heat (Rapid and Full)
• Empty-Heat (Rapid and Floating-Empty)

5. Empty (Xu)
Feeling
The Empty pulse feels rather big but soft. this pulse is actually rather big but it feels empty on a slightly stronger pressure and is soft.

Empty pulse
• Qi deficiency

6. Full (Shi)
Feeling
This pulse feels full, rather hard and rather long.

‘Full’ is often used in two slightly different ways.

On the one hand, this term is often used to indicate any pulse of the Full type.

• Full pattern
• Full-Heat (Full-Rapid)
• Full-Cold (Full-Slow)

7. Slippery (Hua)

Feeling
A Slippery pulse feels smooth, rounded, slippery to the touch, as if it were oily. It slides under the fingers.

• Phlegm
• Dampness
• Retention of food
• Pregnancy

8. Choppy (Se)
Feeling
This pulse feels rough under the finger: instead of a smooth pulse wave, it feels as if it has a jagged edge to it.

Choppy also indicates a pulse that changes rapidly both in rate and quality.

• Blood deficiency
• Exhaustion of Body Fluids

9. Long (Chang)
Feeling
This pulse is basically longer than normal: it extends slightly beyond the normal pulse position.

• Heat pattern

10. Short (Duan)
Feeling
It occupies a shorter space than the normal position.

• Severe Qi deficiency
• Stomach-Qi deficiency

11. Overflowing (Hong)
Feeling
This pulse feels big. It extends beyond the pulse position. It is superficial and generally feels as if it overflows the normal pulse channel, like a river overflow during a flood.

• Full-Heat
• Empty-Heat (Overflowing-Empty)

12. Fine (Xi)
Feeling
This pulse is thinner than normal.

• Blood deficiency
• Dampness with severe Qi deficiency

13. Minute (Wei)
Feeling
It is extremely thin, small and difficult to feel.

• Severe deficiency of Qi and Blood

14. Tight (Jin)
Feeling
This pulse feels twisted like a thick rope.

• Cold
• Exterior Cold (Tight-Floating)
• Interior Full-Cold (Tight-Full-Deep)
• Interior Empty-Cold (Tight-Weak-Deep)
• Pain

15. Wiry (Xian)
Feeling
This pulse feels taut like a guitar string. It is thinner, more taut and harder than the Tight pulse. The Wiry pulse really hits the fingers.

• Liver disharmony
• Pain
• Phlegm

16. Slowed down (Huan)
Feeling
This pulse has four beats for each respiration cycle.

• Generally, a healthy pulse

The Eight Principles
1. Interior–Exterior
2. Hot–Cold
3. Full–Empty (or Excess–Deficiency)
4. Yin–Yang

1. Interior–Exterior

Skin, muscles and channels are the ‘Exterior’ of the body, and the Internal Organs the ‘Interior’.

Clinical manifestations of exterior patterns
Aversion to cold, ‘fever’, aching body, a stiff neck and a Floating pulse

Clinical manifestations of exterior Cold pattern
Slight ‘fever’, pronounced aversion to cold, severe aches in the body, severe stiff neck, no sweating, no thirst, a Floating-Tight pulse and a thin white tongue coating

Clinical manifestations of exterior Heat pattern
Aversion to cold, ‘fever’, slight sweating, thirst, a Floating-Rapid pulse, a thin white tongue coating and sometimes redness of the tongue on the sides and/or front

2. Hot–Cold

Full-Heat
Manifestations
• Thirst, a feeling of heat, mental restlessness, red face, dry stools, scanty dark urine, Rapid-Full pulse, Red tongue with yellow coating (Internal Full-Heat)
Etiology
• Emotional problems
• Diet (too much red meat, spices, alcohol)
• An external pathogenic factor that has penetrated into the Interior and transformed into Heat

Empty-Heat
Manifestations
• A feeling of heat in the afternoon or evening, a dry mouth with desire to drink in small sips, a dry throat at night, night sweating, a feeling of heat in the chest, palms and soles (five-palm heat), dry stools, scanty dark urine, Floating- Empty and Rapid pulse, Red tongue without coating
Etiology
• Overwork (in the sense of working long hours)
• Irregular eating
• Excessive sexual activity
• Persistent, heavy blood loss (such as in menorrhagia)

Full-Cold
Manifestations
• Feeling cold, cold limbs, no thirst, pale face, abdominal pain aggravated on pressure, desire to drink warm liquids, loose stools, clear abundant urination, Deep-Full-Tight pulse and a Pale tongue with thick white coating (Internal Full-Cold)
Etiology
• Cold foods (salads, fruit, iced drinks)

Empty-Cold
Manifestations
• Feeling cold, cold limbs, a dull pale face, no thirst, listlessness, sweating, loose stools, clear abundant urination, a Deep-Slow or Weak pulse and a Pale tongue with thin white coating
Etiology
• Excessive physical work
• Excessive sexual activity (Kidney-Yang)
• Internal Cold injuring Yang

COMBINED HOT AND COLD

• Cold on the Exterior and Heat in the Interior
• Heat on the Exterior and Cold in the Interior
• Heat above and Cold below
• Combination of Heat and Cold patterns
• False Heat–True Cold and False Cold–True Heat

3. Full–Empty (or Excess–Deficiency)

Full conditions
Acute onset, restlessness, irritability, a strong voice, coarse breathing, pain aggravated by pressure, high-pitched tinnitus, scanty urination, constipation, Full pulse

Empty conditions

1. Empty Qi: • Pale face, weak voice, slight sweating, slight shortness of breath, tiredness, loose stools, poor appetite, Empty pulse
2. Empty Yang: Chilliness, a bright pale face, cold limbs, no thirst, a desire for hot drinks, loose stools, frequent pale urination, a Weak pulse and a Pale and wet tongue (in addition to the manifestations of Empty Qi)
3. Empty Blood: • Dull pale face, pale lips, blurred vision, dry hair, tiredness, poor memory, numbness or tingling, insomnia, scanty periods, Fine or Choppy pulse, Pale-Thin tongue
4. Empty Yin: • Feeling of heat in the afternoon or evening, a dry throat at night, night sweating, thin body, a Floating-Empty pulse and a Red-Peeled and dry tongue

Mixed Full–Empty conditions
Examples
• Kidney-Yin deficiency with Liver-Yang rising
• Liver-Blood deficiency with Liver-Yang rising
• Spleen-Qi deficiency with Phlegm
• Deficiency of Blood with Blood stasis
• Kidney-Yang deficiency with Dampness

BLOOD PATTERN IDENTIFICATION

Blood deficiency
• Dull-white sallow complexion, dizziness, poor memory, numbness or tingling, blurred vision, insomnia, pale lips, scanty periods or amenorrhoea, depression, slight anxiety, Pale and slightly dry tongue, Choppy or Fine pulse

Stasis of Blood
Dark complexion, purple lips, pain which is boring, fixed and stabbing in character, abdominal masses that do not move, purple nails, bleeding with dark blood and dark clots, painful periods with dark clots, Purple tongue, Wiry, Firm or Choppy pulse. 

Blood Heat
Feeling of heat, skin diseases with red eruptions, thirst, bleeding, Red tongue, Rapid pulse

Loss of Blood
• Epistaxis (nose), haematemesis (ST), haemoptysis (Lung), melaena (Stool), menorrhagia,  haematuria

Body Fluid pattern identification

Deficiency of Body Fluids may be caused by dietary factors (excessive consumption of drying foods It may also arise from a heavy and prolonged loss of fluids such as in sweating, vomiting and diarrhea.
It is also derived from a heavy, acute loss of Blood, such as during childbirth, or from a heavy, chronic loss of Blood such as in menorrhagia.
Severe and chronic deficiency of Blood can cause dryness and deficiency of fluids

Deficiency of Body Fluids
Dry skin, mouth, nose, cough, lips, dry tongue

Oedema

Oedema arises from a Yang deficiency of either Spleen, Lungs or Kidneys or all three of them.

• Lung-Yang deficiency: oedema of face and hands
• Spleen-Yang deficiency: abdomen and limbs
• Kidney-Yang deficiency: lower part of the body, the legs and ankles

• Pitting: deficiency of Yang of Spleen, Lungs and/or Kidneys
• Non-pitting: Qi stagnation or Dampness

Essential manifestations of Phlegm
• Tongue and pulse: Swollen tongue body with sticky tongue coating; Slippery or Wiry pulse
• Other symptoms: a feeling of oppression of the chest, nausea, a feeling of heaviness, a feeling of muzziness of the head and dizziness

Substantial Phlegm
Substantial Phlegm is Phlegm in the Lungs.

Non-substantial Phlegm

Under the skin: Lumps under the skin, nerve ganglia swellings, swelling of lymph nodes, swelling of the thyroid, lipoma

In the channels: Numbness

Misting the Heart: Mental illness

In Gall Bladder or Kidneys: Gall bladder or kidney stones
In the joints: Bone deformities in chronic rheumatoid arthritis

LV Full patterns

Liver-Qi stagnation 

Clinical manifestations

1. Feeling of distension of hypochondrium, chest, epigastrium or abdomen

2. Depression, moodiness, fluctuation of mental state, feeling of lump in the throat

3. Irregular periods, distension of breasts before the periods, premenstrual tension and irritability

Tongue: the body colour may be normal. In severe cases, it may be slightly Red on the sides

Pulse: Wiry, especially on the left side

Stagnant Liver-Qi turning into Heat 

Clinical manifestations

Hypochondrial or epigastric distension, a slight feeling of oppression of the chest, irritability, melancholy, depression, moodiness, a feeling of lump in the throat, a feeling of heat, red face, thirst, propensity to outbursts of anger, premenstrual tension, irregular periods, premenstrual breast distension, heavy periods, tongue Red on the sides, Wiry pulse

Liver-Blood stasis 

Clinical manifestations

Hypochondrial pain, abdominal pain, vomiting of blood, epistaxis, painful periods, irregular periods, dark and clotted menstrual blood, infertility, masses in abdomen, purple nails, purple lips, purple or dark complexion, dry skin (in severe cases), Purple tongue, Wiry or Firm pulse

Liver-Fire blazing 

Clinical manifestations

Irritability, propensity to outbursts of anger, tinnitus, deafness, temporal headache, dizziness, red face and eyes, thirst, bitter taste, dream-disturbed sleep, constipation with dry stools, dark-yellow urine, epistaxis(nose), haematemesis(vomit), haemoptysis(cough), Red tongue, redder on the sides, dry yellow coating, Full-Wiry- Rapid pulse

Damp-Heat in the Liver 

Clinical manifestations

Fullness of the hypochondrium, abdomen or hypogastrium, bitter taste, sticky taste, poor appetite, nausea, feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, vulvar eczema or sores, mid-cycle bleeding and/or pain, pain, redness and swelling of the scrotum, genital, papular or vesicular skin rashes and itching, urinary difficulty, burning on urination, dark urine, Red tongue with redder sides, sticky yellow coating, Slippery-Wiry-Rapid pulse

Stagnation of Cold in the Liver channel

Clinical manifestations

Fullness and distension of the hypogastrium with pain which refers downwards to the scrotum and testis and upwards to the hypochondrium, the pain is alleviated by warmth, straining of the testis or contraction of the scrotum, vertical headache, feeling of cold, cold hands and feet, vomiting of clear watery fluid or dry vomiting. In women there can be shrinking of the vagina, Pale and wet tongue with a white coating, Deep-Wiry-Slow pulse

LV Empty patterns

Liver-Blood deficiency 

Clinical manifestations

Dizziness, numbness or tingling of limbs, insomnia, blurred vision, ‘floaters’ in eyes, diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without lustre, pale lips, muscular weakness, cramps, withered and brittle nails, dry hair and skin, depression, a feeling of aimlessness, Pale tongue, Thin and slightly dry, Choppy or Fine pulse

Liver-Yin deficiency 

Clinical manifestations

Dizziness, numbness or tingling of limbs, insomnia, blurred vision, ‘floaters’ in eyes, dry eyes, diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without luster but with red cheekbones, muscular weakness, cramps, withered and brittle nails, very dry hair and skin, depression, a feeling of aimlessness, red tongue without coating or with rootless coating, Floating-Empty pulse

Full/Empty patterns

Liver-Yang rising 

a) Liver-Yang rising deriving from Liver-Yin deficiency

b) Liver-Yang rising deriving from Liver- and Kidney-Yin deficiency

c) Liver-Yang rising deriving from Liver-Blood deficiency

Liver-Wind

• Extreme Heat generating Wind

• Liver-Yang rising generating Wind

• Liver-Fire generating Wind

• Liver-Blood deficiency generating Wind 

Gall Bladder Full patterns

Dampness in the Gall Bladder

Clinical manifestations

Jaundice, dull-yellow eyes and skin, hypochondrial pain, fullness and distension, nausea, vomiting, inability to digest fats, dull-yellow sclera, turbid urine, no thirst, sticky taste, dull headache, feeling of heaviness of the body, thick sticky white tongue coating, either bilateral in two strips or unilateral, Slippery-Wiry pulse

Damp-Heat in the Gall Bladder

Clinical manifestations

Hypochondrial pain, fullness and distension, nausea, vomiting, inability to digest fats, yellow complexion, scanty and dark yellow urine, fever, thirst without desire to drink, bitter taste, dizziness, tinnitus, irritability, feeling of heaviness of the body, numbness of the limbs, swelling of the feet, loose stools or constipation, alternation of hot and cold feeling, yellow sclera, feeling of heat, thick sticky yellow tongue coating, either bilateral in two strips or unilateral, Slippery-Wiry-Rapid pulse

Empty patterns

Gall Bladder deficient

Clinical manifestations

Dizziness, blurred vision, floaters, nervousness, timidity, propensity to being easily startled, lack of courage and initiative, indecision, sighing, waking up early in the morning, restless dreams, tongue Pale or normal, Weak pulse

HT Deficiency patterns

Heart-Qi deficiency 

Clinical manifestations

Palpitations, shortness of breath on exertion, pale face, spontaneous sweating, tiredness, slight depression, Pale tongue, Empty pulse

Heart-Yang deficiency 

Clinical manifestations

Palpitations, shortness of breath on exertion, tiredness, spontaneous sweating, a slight feeling of stuffiness or discomfort in the heart region, feeling of cold, cold hands, bright-pale face, slightly dark lips, Pale tongue, Deep-Weak pulse

Heart-Yang Collapse 

Clinical manifestations

Palpitations, shortness of breath, weak and shallow breathing, profuse sweating, cold limbs, cyanosis of lips, greyish-white complexion, in severe cases coma, very Pale or Bluish tongue, Hidden-Minute-Knotted pulse

Heart-Blood deficiency 

Clinical manifestations

Palpitations, dizziness, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, dull-pale complexion, pale lips, Pale and Thin tongue, Choppy or Fine pulse

Heart-Yin deficiency

Clinical manifestations

Palpitations, insomnia, dream-disturbed sleep, propensity to be startled, poor memory, anxiety, mental restlessness, dry mouth and throat, night sweating, red tongue without coating, Floating-Empty pulse

HT Excess patterns

Heart-Fire blazing

Clinical manifestations

Palpitations, thirst, mouth and tongue ulcers, mental restlessness, feeling agitated, feeling of heat, insomnia, dream-disturbed sleep, red face, dark urine or blood in urine, bitter taste, Red tongue, tip redder and swollen with red points, yellow coating, Full-Rapid-Overflowing pulse

Phlegm-Fire disturbing the Heart

Clinical manifestations

Palpitations, thirst, red face, bitter taste, a feeling of oppression of the chest, expectoration of phlegm, rattling sound in the throat, mental restlessness, insomnia, dream-disturbed sleep, agitation, incoherent speech, mental confusion, rash behavior, tendency to hit or scold people, uncontrolled laughter or crying, shouting, muttering to oneself, mental depression and dullness, manic behavior, Red tongue, redder and swollen tip with red points, yellow dry sticky coating, deep Heart crack, Full-Rapid-Slippery or Rapid-Overflowing- Slippery or Rapid-Full-Wiry pulse

Phlegm misting the Mind

Clinical manifestations

Mental confusion, unconsciousness, incoherent speech, vomiting of phlegm, rattling sound in the throat, mental depression, emotional lability, aphasia, very dull eyes, Swollen tongue with thick-sticky coating, Heart crack, Slippery pulse

Heart-Blood stasis

Clinical manifestations

Palpitations, stabbing or pricking pain in the chest which may radiate to the inner aspect of the left arm or to the shoulder, a feeling of oppression or constriction of the chest, cyanosis of lips and nails, cold hands, tongue Purple in its entirety or only on the sides in the chest area, Choppy, Wiry or Knotted pulse

Small intestine Full patterns

Full-Heat in the Small Intestine

Clinical manifestations

Mental restlessness, insomnia, tongue and/or mouth ulcers, pain in the throat, deafness, uncomfortable feeling and heat sensation in the chest, abdominal pain, thirst with desire to drink cold liquids, scanty and dark urine, burning pain on urination, blood in urine, Red tongue with redder and swollen tip, yellow coating, Overflowing-Rapid pulse especially in the Front position

Small Intestine-Qi pain

Clinical manifestations

Lower abdominal twisting pain which may extend to back, abdominal distension, dislike of pressure on abdomen, borborygmi, flatulence, pain in the testis, white tongue coating. Deep-Wiry pulse, especially on the Rear positions

Infestation of worms in the Small Intestine

Clinical manifestations

Abdominal pain and distension, bad taste in mouth, sallow complexion

Roundworms (ascarid): abdominal pain, vomiting of roundworms, cold limbs

Hookworms: desire to eat strange objects such as soil, wax, uncooked rice or tea leaves

Pinworms: itchy anus, worse in the evening

Tapeworms: constant hunger

Spleen Empty patterns

Spleen-Qi deficiency

Clinical manifestations

Poor appetite, slight abdominal distension after eating, tiredness, lassitude, desire to lie down, pale complexion, weakness of the limbs, loose stools, Pale tongue, Empty pulse

Spleen-Yang deficiency

Clinical manifestations

Poor appetite, slight abdominal distension after eating, tiredness, lassitude, desire to lie down curled up, pale complexion, weakness of the limbs, loose stools, feeling cold, cold limbs, oedema, Pale and wet tongue, Deep-Weak pulse

Spleen-Qi sinking

Clinical manifestations

Poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, depression, tendency to obesity, a bearing-down sensation in the abdomen, prolapse of stomach, uterus, anus or bladder, frequency and urgency of urination, menorrhagia, Pale tongue, Weak pulse

Spleen not controlling Blood

Clinical manifestations

Poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale-sallow complexion, weakness of the limbs, loose stools, depression, blood spots under the skin, blood in the urine or stools, excessive uterine bleeding, Pale tongue, Weak or Fine pulse

Stomach Empty patterns

Stomach-Yin deficiency

Clinical manifestations

No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon, with desire to drink in small sips, slight feeling of fullness after eating

Tongue: red without coating in the centre, or with rootless coating

Pulse: Floating-Empty on the Right-Middle position

Stomach Full patterns

Stomach-Heat 

Clinical manifestations

Burning epigastric pain, intense thirst with desire to drink cold liquids, mental restlessness, bleeding gums, dry stools, dry mouth, mouth ulcers, sour regurgitation, nausea, vomiting soon after eating, excessive hunger, foul breath, a feeling of heat, tongue Red in the centre with a dry yellow or dark yellow(or even black) coating, Rapid and slightly Overflowing pulse on the Right-Middle position

Cold invading the Stomach

Clinical manifestations

Sudden severe pain in the epigastrium, a feeling of cold, cold limbs, preference for warmth, vomiting of clear fluids (which may alleviate the pain), nausea, feeling worse after swallowing cold fluids which are quickly vomited, preference for warm liquids, thick white tongue coating, Deep-Tight-Slow pulse

Retention of Food in the Stomach

Clinical manifestations

Fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite Tongue: thick coating (which could be white or yellow) Pulse: Full-Slippery

Lung Empty patterns

Lung-Qi deficiency

Clinical manifestations

Slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike of speaking, bright pale complexion, propensity to catch colds, tiredness, dislike of cold, Pale tongue, Empty pulse, especially on the Right-Front position

Lung-Yin deficiency

Clinical manifestations

Cough which is dry or with scanty sticky sputum, weak and/hoarse voice, dry mouth and throat, tickly throat, tiredness, dislike of speaking, thin body or thin chest, night sweating, red tongue, dry without coating, Floating-Empty pulse

Lung Dryness

Clinical manifestations

Dry cough, dry skin, dry throat, dry mouth, thirst, hoarse voice, dry tongue, Empty pulse, especially on the Right-Front position

Lung Full patterns

Exterior

• Invasion of Lungs by Wind-Cold

Clinical manifestations

Aversion to cold, fever, cough, itchy throat, slight breathlessness, stuffed or runny nose with clear, watery discharge, sneezing, occipital headache, body aches, thin white tongue coating, Floating-Tight pulse

• Invasion of Lungs by Wind-Heat

Clinical manifestations

Aversion to cold, fever, cough, sore throat, stuffed or runny nose with yellow discharge, headache, body aches, slight sweating, slight thirst, swollen tonsils, tongue slightly Red on the sides in the chest areas or on the front part, Floating-Rapid pulse

• Invasion of Lungs by Wind-Water

Clinical manifestations

Sudden swelling of eyes and face gradually spreading to the whole body, bright shiny complexion, scanty and clear urination, aversion to wind, fever, cough, slight breath lessness, sticky white tongue coating, Floating-Slippery pulse

Interior

• Lung-Heat

Clinical manifestations

Cough, slight breathlessness, feeling of heat, chest ache, flaring of nostrils, thirst, red face, Red tongue with yellow coating, Overflowing-Rapid pulse

• Damp-Phlegm in the Lungs

Clinical manifestations

Chronic cough coming in bouts with profuse sticky white sputum which is easy to expectorate, white pasty complexion, a feeling of oppression in the chest, phlegm in the throat, shortness of breath, dislike of lying down, wheezing, nausea, a feeling of heaviness, muzziness and dizziness of the head, Swollen tongue with a sticky white coating, Slippery or Soggy pulse

• Phlegm-Heat in the Lungs

Clinical manifestations

Barking cough with profuse sticky yellow or green sputum, shortness of breath, wheezing, a feeling of oppression of the chest, phlegm in the throat, a feeling of heat, thirst, insomnia, agitation, a feeling of heaviness and muzziness of the head, dizziness, Red, Swollen tongue with a sticky yellow coating, Slippery-Rapid pulse

Larger Intestine Full patterns

Damp-Heat in the Large Intestine

Clinical manifestations

Abdominal pain that is not relieved by a bowel movement, abdominal fullness, diarrhea, mucus and blood in stools, offensive odour of stools, burning in the anus, scanty dark urine, fever, sweating which does not decrease the fever, a feeling of heat, thirst without desire to drink, feeling of heaviness of the body and limbs, Red tongue with sticky yellow coating, Slippery-Rapid pulse

Heat in the Large Intestine

Clinical manifestations

Constipation with dry stools, burning sensation in the mouth, dry tongue, burning and swelling in anus, scanty dark urine, thick yellow (or brown or black) dry tongue coating, Full-Rapid pulse

Cold invading the Large Intestine

Clinical manifestations

Sudden, cramping abdominal pain, diarrhea with pain, feeling of cold, cold sensation in abdomen, thick white tongue coating, Deep-Tight pulse

Bladder Full patterns

Damp-Heat in the Bladder

Clinical manifestations

Frequent and urgent urination, burning on urination, difficult urination (stopping in the middle of flow), dark-yellow and/or turbid urine, blood in the urine, fever, thirst with no desire to drink, hypogastric fullness and pain, feeling of heat, thick sticky yellow tongue coating on the root with red spots, pulse Slippery-Rapid and slightly Wiry on the Left-Rear position

Damp-Cold in the Bladder

Clinical manifestations

Frequent and urgent urination, difficult urination (stopping in mid-stream), feeling of heaviness in hypogastrium and urethra, pale and turbid urine, white sticky tongue coating on root, pulse Slippery-Slow and slightly Wiry on Left-Rear position

Greater Yang stage (Tai Yang)

 • Invasion of Wind-Cold with prevalence of Wind (Zhong Feng)
 • Invasion of Wind-Cold with prevalence of Cold (Shang Han)

Bright Yang stage (Yang Ming)
  • Bright Yang channel pattern
  • Bright Yang organ pattern

Lesser Yang stage (Shao Yang)

Greater Yin stage (Tai Yin)

Lesser Yin stage (Shao Yin)
 • Cold transformation
 • Heat transformation

Terminal Yin stage (Jue Yin)

Bright Yang stage (Yang Ming)

Bright Yang channel pattern
Clinical manifestations
High fever, profuse sweating, intense thirst, red face, feeling of heat, irritability, delirium, Red tongue with yellow coating, Overflowing-Rapid or Big-Rapid pulse

Bright Yang organ pattern
Clinical manifestations
High fever that is worse in the afternoon, profuse sweating, sweating on limbs, abdominal fullness and pain, constipation, dry stools, thirst, dark urine, Red tongue with thick dry yellow coating, Deep-Full-Slippery-Rapid pulse

Greater Yin stage (Tai Yin)

Clinical manifestations
Abdominal fullness, feeling cold, vomiting, no appetite, diarrhea, no thirst, tiredness, Pale tongue with sticky white coating, Deep-Weak-Slow pulse

Lesser Yin stage (Shao Yin)

Lesser Yin Cold transformation
Clinical manifestations
Chills, feeling cold, lying with body curled, listlessness, desire to sleep, cold limbs, diarrhea, no thirst, frequent pale urination, Pale and

Lesser Yin Heat transformation
Clinical manifestations
Feeling of heat, irritability, insomnia, dry mouth and throat at night, dark urine, night sweating, Red tongue without coating, Fine-Rapid pulse

Terminal Yin stage (Jue Yin)

Clinical manifestations
Persistent thirst, feeling of energy rising to the chest, pain and heat sensation in heart region, hungry but no desire to eat, cold limbs, diarrhea, vomiting, vomiting of roundworms, Wiry pulse

The Four Levels

Defensive Qi level (Wei)
Qi level (Qi)
Nutritive Qi level (Ying)
Blood level (Xue)
 • Invasion of Wind-Cold with prevalence of Wind (Zhong Feng)
 • Invasion of Wind-Cold with prevalence of Cold (Shang Han)

Qi level (Qi)

fever, thirst, sweating, feeling of heat, mental restlessness, Red tongue with thick yellow coating and a Rapid-Full pulse.

These are just general symptoms as other manifestations depend on the pattern involved, of which there are five: Lung-Heat (Heat in chest and diaphragm), Stomach-Heat, Intestines Dry-Heat, Gall Bladder-Heat and Damp-Heat in Stomach and Spleen.

Blood level (Xue)

• There is Yin deficiency
• Heat is affecting the Blood, causing bleeding
• Heat is affecting the Mind, causing delirium or coma
• Heat in the Blood causes bleeding under the skin with the appearance of macules
• Internal Wind develops, causing convulsions and tremors
• Collapse of Yin or Yang may occur

12 regular channels passing route.

THE XI-CLEFT POINTS