Tuesday, February 21, 2012

Tongue Apperance and Mechanisms (A Quick Guide)


Tongue diagnosis is a powerful means by which a practitioner of Chinese medicine can quickly locate the solution to many issues of internal medicine.
What follows on this page are the various tongue body and coating appearances, how they came to look that way (mechanisms) and what they indicate.
Tasty!


Tongue Body Color
COLOR INDICATIONS MECHANISM
PaledeficiencyQi and/or Blood unable to fill tongue body

deficiency of QiQi too deficient to guide Blood to tongue to give it pink color.

deficiency of BloodLack of Blood can’t give tongue pink color

deficiency of YangLack of Yang can’t lift Qi and Blood to tongue to give it pink color.

PinknormalPink means adequate Qi and Blood.

Red heatHeat accelerates and expands movement of Blood which fills tongue with more red color.

excess heatOften found with a thicker tongue coating, likely yellow.

deficiency heatOften found with a thin or scanty tongue coating.

Crimson (dark red)Ying or Blood level heat.
Blood stagnation with heat
Heat damages yin, causes the red to become more concentrated and darker.
Blood stagnation with heat Blood stagnation causes purple color, heat makes it more red.

Purple Blood stagnationThe slower the Blood moves, the more depleted of oxygen it will become, giving rise to a tendency toward the blue color. Purple is a transitory color between pink and blue.
Blue-Purple Blood stagnation with, or due to cold.Cold (blue) impedes movement which causes Blood stagnation (purple)
Pale Purple (“dusky”)Blood stagnation with or due to deficiency of Qi, Blood, or YangBlood stagnation is purple, pale is deficiency.
BlueInternal coldCold impedes movement which allows red blood to lose its oxygen giving rise to the blue color. (western explaination)

Tongue Body Shape
SIZE INDICATIONS MECHANISM
Small tongue bodydeficiency of Blood or YinLack of fluids causes tongue to shrink in size.

Swollen tongue body (vertically enlarged)excess heat or alcohol/drug toxicityHeat pushes more Blood into tongue body to increase its size.

Flabby tongue body (horizontally enlarged)damp or phlegmfluids fill tongue and enlarge it horizontally.

Teeth marksdamp or phlegma continuation of the flabby tongue in which the teeth indentations are visible.

Tongue Body Cracks
CRACKS INDICATIONS MECHANISM

Cracks in tongue body
Blood or Yin deficiencyFluids unable to moisten and nourish tongue body giving rise to cracks like dried earth.
+redYin deficiencyFluids unable to moisten and nourish tongue body.
+paleBlood deficiencyFluids unable to moisten and nourish tongue body.
+teeth marks
cracks on lateral sides, look like fish’s gills
dampnessDamp prevents fluids from rising up to tongue to nourish it.

Prickles, dots, spots
SPOTS INDICATIONS MECHANISM
Prickles, dots, spots heat or stagnation
+redheatHeat causes too much Qi and Blood to rise to the tongue where it causes the body to develop dots, points, spots, etc.
+purple (brown, dark)Blood stagnationBlood stagnation always looks purple.

Tongue Bearing Issues
BEARING INDICATIONS MECHANISM
Stiff tongue Spasm due to internal windExcess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to become stiff.
Limp tonguedeficiency of Qi, Blood, or Yin.Lack of nutrients cause the tongue to become limp.

Trembling tongueSpasm due to internal windExcess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to tremble. NOTE: all tongues move, this sign is EXCESSIVE movement.
Deviated tongueInternal wind, phlegm in channelsSomething is blocking the channels and collaterals on one side of the tongue preventing its movement. This is also a “check in with a neurologist” indication due to the possibility of a tumor impinging a cranial nerve.

Engorged Sublingual VeinsQi and/or Blood stagnationBlood flow is impeded, giving rise to the appearance of backed-up Blood beneath the tongue.

Coating Color
COLOR INDICATIONS MECHANISM
WhitecoldWhite and clear things in TCM are dilute and cold.
YellowheatYellow things in TCM are more concentrated due to heat damaging the Yin.
Grayinterior cold or heatheat or cold is damaging the interior.
Blackextreme interior cold or heata further exasperation of the gray coating

Coating thickness
THICKNESS INDICATIONS MECHANISM
Thin coatingexterior syndrome or normalIf you can see through the coating to the body of the tongue, it is thin.

Thick coating excessive condition, interior, damp, phlegm, food stagnationCoating is the “smoke” of the stomach. Pathological factors rise with the Stomach Qi to the tongue coating.

Coating Moistness
MOISTNESS INDICATIONS MECHANISM
Moist coating normalthe coating is neither excessively wet, dripping, or dry

Glossy (excessively shiny or wet) coating internal cold, Yang deficiencyYang deficiency or cold that damages Yang impedes the transformation of fluids giving rise to the accumulation of dampness or phlegm which shows up on the tongue in the form of the excessively wet coating.

Dry coatingdryness, heat, Yin deficiency, Yang deficiencyHere, we have a variety of factors that damage the body fluids including heat and dryness. Yin deficiency is obviously a form of internal dryness, and Yang deficiency can give rise to dryness in the body if the Yang is too weak to transform dietary water into body fluids.

Coating Distribution
DISTRIBUTION INDICATIONS MECHANISM
Even coatingphlegm-damp accumulation in the middle JiaoThe tongue indicates the conditions throughout the entire body, but also focuses on the Spleen and Stomach in particular. One map that is laid atop the tongue suggests that the entire tongue indicates the condition of the Spleen and Stomach only. So, a coating that covers the entire tongue can sometimes indicate only a pathology of the middle Jiao.
Coating on the anterior third (front third)superficial invasion of pathogenic factorThe anterior third of the tongue is related to the Lungs and Heart. When a pathogenic factor enters the body, it generally enters through the Lungs, and so this thick coating on the anterior third of the tongue indicates this superficial invasion.
Coating in the middle only.Phlegm and/or damp in the middle JiaoMiddle of the tongue is related to the middle Jiao.
Coating on one side or the other.Shao Yang diseaseMost pathologies that are one-sided or have symptoms that flip-flop between opposites (i.e. alternating chills and fever) indicate that the pathological factor has found its way to the Shao Yang channel, level, or organ (GB).
Peeled/Scanty/CoatlessStomach Yin or Kidney Yin deficiencyBecause the tongue coating is the smoke of the Stomach, and this smoke requires some Yin to evaporate up toward the tongue, a lack of Yin will cause a lack of smoke to rise and a lack of coating.
Geographic coatingStomach Yin or Stomach Qi deficiencyCoating is the smoke of the Stomach. The Yin is what is heated to cause the smoke, while the Qi is that heating activity. In the absence of either of these factors, the coating can appear missing on portions of the tongue.

Symptomatic Diagnosis: Chest & Back

The diagnostic “Ten Asking Song” pays particular attention to the chest and back. This article describes common complaints that arise from these areas, along with their differential diagnosis and herbal treatments.
Back Pain
Weakness of the lower back and knees
Chest Pain
Mass Formation in the abdomen

Back Pain

  • Accumulation of cold and damp (bi syndrome)

    Clinical manifestations
    • Pain which can radiate to neck
    • back feels heavy, stiff.
    • symptoms aggravated by cold damp weather.
    Formula
    • Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome dampness)
  • Qi and blood stagnation due to recent trauma (acute)

    • Sudden onset of pain
    • Limited range of motion, acute symptoms
    • P: Tense
    • Could develop into chronic pain…
    • Yunnan Bai Yao (A pre-made formula)
    • Huo Lou Xiao Ling Dan (Fantastically Effective Formula to Invigorate the Collaterals)
  • Clinical manifestations Formula
  • Qi and blood stagnation due to past trauma (chronic)

    • Dull aching on & off, numbness aggravated by rest (deficiency beneath)
    • T: Purple
    • P: Thready and/or choppy
    Treatment Principle
    • Tonify and activate qi and blood
    Formula
    • Du Huo Ji Sheng Tang (Angelica Pubescens and Sang-Ji-Sheng Decoction) + Tao Ren (Sm. Persicae) and Hong Hua (Flos. Carthami)

Weakness of the lower back and knees

  • Kidney/Liver deficiency

    Formulas
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • You Gui Yin (Restore the Right (Kidney) Decoction)
    • Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
  • Jing deficiency

    Clinical manifestations
    • Infertility, tinnitus, vertigo, sore back, premature ejaculation, amenorrhea, grey hair, premature aging
    Formulas
    • Kidney/Liver formulas plus Zi He Che (Placenta Hominis), Lu Rong (Cornu Cervi)
  • Yin deficiency

    Clinical manifestations
    • Emaciation, tidal fever, heat signs, five center heat.
    Formulas
    • Kidney/Liver formulas plus Huang Bai (Cx. Phellodendri), Zhi Mu (Rz. Anemarrhenae)
  • Yang deficiency

    Clinical manifestations
    • Cold signs such as cold hands and feet.
    Formula
    • Kidney/Liver tonic formulas plus Fu Zi (Rx. Aconiti Lateralis Praeparata), Ba Ji Tian (Rx. Morindae Officinalis), Bu Gu Zhi (Fr. Psoraleae)
  • qi deficiency

    Clinical manifestations
    • Weakness of the lower gates (urethra, colon, etc.) incontinence, premature ejaculation, urination problems
    Formula
    • Kidney/Liver tonic formulas plus astringent herbs such as Sang Piao Xiao (Ootheca Mantidis), Yi Zhi Ren (Fr. Alpiniae), Wu Wei Zi (Fr. Schisandrae), Fu Pen Zi (Fr. Rubi)

Chest Pain (often connected to the heart)

  • Heart qi deficiency

    Clinical manifestations
    • Mild pain
    • Neurosis, heart condition,
    • dull achy chest pain on one or both sides.
    • Chest congestion, palpitations
    • Spontaneous sweating, fatigue
    • T: Pale
    • P: Weak and thready
    Treatment Principle
    • Tonify Heart qi
    Formula
    • Bao Yuan Tang (Preserve the Basal Decoction)
  • Cold accumulation (yang deficiency) Painful

    Clinical manifestations
    • Coronary Heart Disease,
    • chest pain, usually on the left side which could radiate tot he right, back shoulder,
      and arm.
    • Pale complexion, spontaneous sweating, cold extremities.
    • T: Pale, swollen, teeth marks
    • P: Deep, slow, knotty and intermittent
    Treatment Principle
    • Tonify heart yang, promote circulation of blood
    Formula
    • Gua Luo Xie Bai Bai Jiu Tang (Trichosanthis, Allii, and White Wine Decoction)
  • Heart blood stagnation (still a form of yang deficiency)

    Clinical manifestations
    • Typical angina pectoris. Intense pain that can make the patient lose consciousness due to its intensity
    • Spontaneous cold sweating, fear, fatigue
    • T: Pale purple
    • P: Deep, thready, choppy, knotty, intermittent
    Herb:
    • Dan Shen (Salviae Miltiorrhizae) for chest pain
    Formula
    • Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction)
    • Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction)
  • Phlegm accumulation (Involving the Lungs)

    Clinical manifestations
    • Cough
    • excess phlegm, pain with cough

Mass Formation in the abdomen

  • Qi and blood stagnation

    Clinical manifestations
    • Enlargement of the Liver and Spleen
    • Abdominal mass begins soft, but becomes harder as time goes by.
    • Distention, emaciation, fatigue,
    • Dark dull facial complexion
    • low appetite, dry skin
    • T: Purple spots
    • P: Wiry, tense
    • Cancerous tumors tend to be more blood stagnation than qi stagnation
    Treatment Principle
    • Activate blood, yin deficiency unimportant now
    Formula
    • Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction) + Shi Xiao San (Sudden Smile Powder)
  • Phlegm Stagnation

    Clinical manifestations
    • Abdominal mass, no pain yet distended and uncomfortable..
    • Mass is movable and soft, but patient dislikes touch.
    • T: Pale
    • P: soft and Slippery
    Formula
    • Bao He Wan (Preserve Harmony Pills)
    • Er Chen Tang (Two Aged Decoction)
  • Zhong qi deficiency (sinking, or organ prolapse)

    Clinical manifestations
    • Pulling down, or bearing down sensation
    • qi deficiency symptoms
    Formula
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)

Symptomatic Diagnosis: Metabolic Disorders

Metabolic disorders are functional and systemic health issues for which Chinese medicine has many well-developed differentiations, treatment principles, and herbal formulas.
Obesity
Emaciation
Fatigue

Obesity

  • Accumulation of phlegm and damp (excess condition)

    Clinical manifestations:
    • Obesity, XS appetite
    • Likes sweet and fatty, greasy food
    • heavy sensations in body, foggy thinking
    • Aversion to heat
    • T: Flabby; thick, greasy coat
    • P: Wiry/slippery.
    • Slippery can suggest any earth element disharmony such as abundant phlegm, heat, or food stagnation, while wiry suggests any stagnation.
    • Left untreated, the phlegm can lead to heat, leading to yin deficiency, leading to wind, leading to stroke.
    Treatment principle
    • Remove damp and phlegm
    Formula
    • Wen Dan Tang + Ping Wei San (Calm the Stomach Powder)
  • Qi deficiency (deficiency condition)

    Clinical manifestations:
    • Fatigue, weak voice, shortness of breath
    • phlegm damp accumulation
    • Aversion to cold, edema, puffy face, poor digestion, sleepy, hypofunctions.
    • Not necessarily an over eating problem, but an “under-metabolism” issue.
    • T: Pale with white coating
    • P: Thready and weak.
    Treatment principle
    • Tonify yang, raise metabolism

Emaciation

  • Spleen/Stomach deficiency (more focused on digestion)

    Clinical manifestations:
    • Anemia, malnutrition, indigestion, thin constitution with indigestion. Poor appetite, chronic loose stool, fatigue, shortness of breath, weak voice
    • Sallow or pale complexion
    • T: Pale
    • P: Weak
    Treatment principle
    • Tonify Spleen
    Formula
    • Si Jun Zi Tang (Four Gentlemen Decoction)
    • Ba Zhen Tang (Eight Treasure Decoction)
  • Qi and blood deficiency (less focused on digestion)

    Clinical manifestations:
    • Anemia, malnutrition.
    • Pale face, nails, tongue, lips
    • fatigue, dizziness, vertigo
    • yang qi and blood unable to rise to nourish head
    • T: Pale
    • P: Thready/Weak
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)
    • Stress tonic herbs such as He Shou Wu (Rx. Polygoni), E Jiao (Colla Corii Asini), Ji Xue Teng (Caulis Spatholobi)
  • Lung yin deficiency (any yin deficiency leads to a certain amount of emaciation)

    Clinical manifestations:
    • Thin, emaciated body
    • Chronic dry cough, i.e. allergies
    • Lung TB, AIDS, both lead to this sort of emaciation
    • Cough with blood streaked sputum
    • Hematemesis
    • Dry mouth, tidal fever, night sweats, five center heat
    • T: Red with scanty coat
    • P: Thready, rapid
    Treatment principle
    • Tonify yin
    Formula
    • Bai He Gu Jin Tang (Lily Combination)
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) for any yin deficiency
  • Stomach Heat (genetic, or acquired, usually chronic)

    Clinical manifestations:
    • excessive appetite, hypermetabolism, bad breath, thin constitution
    • Craves cold drinks
    • Irritability
    • Scanty urine, tends to be constipated
    • T: Red with dry coat
    • P: Thready, rapid, forceful
    Formula
    • Qing Wei San (Clear the Stomach Powder)
    • Yu Nu Jian (Jade Woman Decoction) for Stomach yin deficiency due to Stomach heat
  • Liver Fire (XS heat)

    Clinical manifestations:
    • Easily angered
    • Chest and hypochondriac pain or burning
    • Bitter taste, dry mouth
    • Insomnia, restlessness
    • Dark yellow urine, constipation
    • T: Red with yellow coat
    • P: Wiry, rapid, forceful
    Formula
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction)

Fatigue

  • Summerheat

    Often associated with damp, because the heat weakens the Spleen, leading to production of damp.
    Clinical manifestations:
    • Symptoms follow excessive sweating, sun stroke, and always include an exposure to heat or hot weather.
    • fatigue and weakness in extremities
    • Dehydration, shortness of breath
    • fever
    • Weak voice, thirst
    • Dusky face color if damp is involved
    • Possible loose stool
    • T: Possible greasy coat
    • P: Weak and rapid, may be soft
    Formula
    • Qing Shu Yi Qi Tang (Clear Summer-heat and Augment the Qi Decoction)
  • Accumulation of damp

    Could be associated with a Spleen deficiency if the symptoms stress it.
    Clinical manifestations:
    • Sluggish and heavy sensations.
    • Cloudy, foggy head
    • Spleen qi Def.
    • indigestion, loose stool, bloating, low appetite
    • T: Greasy coat
    • P: Soft and slippery
    Treatment principle
    • Dry damp, stimulate digestion
    Formula
    • Ping Wei San (Calm the Stomach Powder)
    • Then later, tonify spleen
  • Qi and blood deficiency

    Clinical manifestations:
    • Fatigue and Pale color
    • Pale skin, face, lips, nails… etc.
    • Dizziness, palpitations
    • T: Pale
    • P: Deep thready, weak
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)

Symptomatic Diagnosis: Limbs & Extremities

The channels that pass through the extremities can be functionally regulated via the internal organs. This article describes the differentiation, treatment principles, and formulas of common health concerns associated with the limbs and extremities.
Edema of the extremities – Stiffness of the extremities – Flaccid paralysis of extremities “wei syndrome” – Varicose veins of the lower extremities – Feet pain


Edema of the extremities

  • Accumulation of Heat and damp (“Heat Bi”)

    Clinical Manifestations
    • Edema in small joints
    • Acute achy swollen arthritis
    • Combined with fever, thirst and irritability
    • T: Red body with yellow greasy coat
    • P: Slippery and rapid
    Formula
    • Bai Hu Tang (White Tiger Decoction) + Gui Zhi (Rm. Cinnamoni) and Cang Zhu (Rz. Atractylodis)
  • Accumulation of Cold and damp (“Cold Bi”)

    Clinical Manifestations
    • Cold, achy arthritis with edema
    • T: Greasy white coat
    • P: Slow
    Formula
    • Wu Tou Tang (Aconite Decoction)
  • qi Stagnation

    Clinical Manifestations
    • Pitting edema
    • Chest constriction and hypochondriac distending pain
    • T: Pale with white coating
    • P: Wiry
    Etiology
    • Because this a channel pathology, the etiology is often an external pathogen associated with wind.
    Treatment Principle
    • Harmonize ying and wei qi
    Formula
    • Xiang Ru San (Elsholtzia Powder)
    • + Xiang Fu (Rz. Cyperi) which activates qi
    • + Zi Su Ye (Fo. Perillae) which expels wind
  • Qi and blood Stagnation (post stroke sequelae, paralysis, hemiplegia)

    Clinical Manifestations
    • Edema (mostly lower extremities), weakness, numbness
    • Color of the skin at affected site is purple
    • T: Pale with purple spots
    • P: Wiry, choppy
    Etiology
    • phlegm remaining in channels after stroke
    Formula
    • Huang Qi Gui Zhi Tang (Astragalus and Cinnamon Twig Decoction)

Stiffness of the extremities

  • Wind Cold and damp

    Clinical Manifestations
    • Cold, achy arthritis
    • T: Greasy white coat
    • P: Slow
    Formula
    • Gui Zhi Tang (Cinnamon Twig Decoction)
    • Ge Gen Tang (Kudzu Decoction)
  • Heat and phlegm

    Clinical Manifestations
    • High fever, stiffness of extremities
    • Irritability, delirium
    • Possibly associated with convulsions, muscle spasms
    • “Extreme Heat leads to Liver Wind”
    Formula
    • Ling Yang Ge Gen Tang (Antelope Horn and Kudzu Decoction)

Flaccid Paralysis of Extremities “Wei Syndrome”

Usually without pain.
  • Body Damaged by Lung Heat

    Clinical manifestations
    • Follows febrile disease
    • Usually affects the lower extremities
    • Low grade fever and yin impairment
    • T: Red with yellow or scanty coat
    Treatment Principle
    • Tonify yin and jin-ye
    Formula
    • Sha Shen Mai Men Dong Tang (Glehnia and Ophiopogonis Decoction) + San Miao Wan (Three Marvel Pill)
    • Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lungs Decoctions)
    Acupuncture points:
    • yang ming points. Stomach channel for legs, Large Intestine channel for arms.
  • Qi deficiency of the Spleen/Stomach

    Clinical manifestations
    • Weakness (not paralysis) of limbs, normal movement, but very weak.
    • Bloating, indigestion, loose stool, aversion to cold, pale complexion.
    • T: Pale
    • P: Thready and weak
    • Prevalent during post illness recovery period.
    Formula:
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Deficiency of Liver and Kidney

    Clinical manifestations
    • Old age, or following illness.
    • Hyposensitivity of extremities leading to weakness leading to paralysis
    • Sore lower back, dysmenorrhea, premature ejaculation
    • Dizziness, vertigo, fatigue
    • T: Pale
    • P: Deep, thready, weak
    • jing deficiency, sometimes combined with qi or yin deficiency.
    Treatment Principle
    • Tonify jing and Liver (for tendons)
    Formula:
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • You Gui Yin (Restore the Right (Kidney) Decoction)
    • Da Bu Yin Wan (Great Tonify the Yin Pill)
  • Blood Stagnation

    Clinical manifestations
    • Weakness leading to numbness
    • Possible spasm leading to paralysis
    • T: Purple
    • P: Choppy, thready
    Etiology
    • Post stroke sequelae or tissue trauma
    • Phlegm remains in channels after stroke
    Treatment Principle
    • Promote blood circulation.
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)

Varicose Veins of the Lower Extremities

    • Varicose veins are combined with red, swollen legs. Veins are hot and burning
    • Fever, bitter taste in the mouth, irregular bowel movements
    • T: Red with yellow greasy coating
    • P: Wiry/rapid
    • excessive alcohol intake, damp and heat producing foods
    • Clear heat, drain damp
    • San Miao Wan (Three Marvel Pill)
    • Local points are inserted around the varicose veins like Hua Tou Jia Jie Points around the spine. Needles are considered more effective than herbs for this sort of varicose condition.
  • Accumulation of heat and damp (acute condition)

    Clinical manifestations Etiology Treatment Principle Formula Points
  • Accumulation of cold and damp (chronic condition)

    Clinical manifestations
    • Varicose veins are combined with heavy extremities and distention.
    • Blue or purple veins, chronic
    • Copious urine, loose stools
    • T: White Greasy coat
    • P: Soft
    Etiology
    • Standing up too much, working environment
    Treatment Principle
    • Remove cold and damp
    Formula
    • Ji Ming San (Powder to Take at Cock’s Crow)
  • Qi deficiency and blood stagnation

    Clinical manifestations
    • Chronic physical weakness or qi deficiency
    • Etiology: Chronically carrying heavy things and/or standing for a long time.
    • Purple veins. Not as “big” as in damp/cold accumulation.
    • Achy, but not distended.
    • Fatigue, shortness of breath, pale complexion.
    • T: Pale
    • P: Weak
    Treatment Principle
    • Harmonize ying, tonify qi, activate blood
    Formula
    • Bu Yang Huan Wu Tang (Tonify the Yang to Restore Five (Tenths) Decoction)

Feet Pain

  • Liver and Kidney deficiency (old age, jing deficiency)

    Clinical manifestations
    • Pain in heal (key symptom)
    • No skin change
    • Pain worsened by walking or fatigue
    • Tinnitus, Sore back
    Formula
    • Hu Jian Wan (A pre-made formula, unknown translation)
  • Accumulation of cold and damp

    Clinical manifestations
    • Achy joints exasperated by cold and damp
    • T: White coat
    • P: Soft
    Formula
    • Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities)

Symptomatic Diagnosis: Head & Neck

Health complaints that arise from the neck and head and lumped together in Chinese medicine diagnostics. Here, we see common complaints complete with their differential diagnosis, treatment principles and formulas.
Flaccidity of neck and head due to weakened muscles – Involuntary twitching of Head Muscles – Tinnitus (ear ringing) – Sore gums – Bleeding gums – Dark black teeth – Stiffness of neck – Goiter (enlargement of the thyroid gland)



Flaccidity of Neck and head due to weakened muscles

A serious condition, wherein the patient is unable to raise the head.
  • Zhong qi deficiency

    More often effects children with sever malnutrition, jing deficiency, Down’s syndrome. Clinical manifestations:
    • severe emaciation
    • Pale or sallow complexion
    • disorientation, confusion, extreme fatigue
    • indigestion, loose stool
    • middle jiao deficiency leads to zhong deficiency
  • Bone Marrow deficiency

    A critical condition Clinical manifestations:
    • Comes due to old age, sexual hyperactivity, associated with tinnitis, low back pain, difficulty in walking or straightening back.
    • T: Pale with scanty coating
    • P: Deep, very weak, or feeble
    Treatment principle
    • Tonify Kidney jing
    Formulas
    • Herbs made of animal products to quickly tonify.

Involuntary Twitching of Head Muscles

  • Liver Wind, Liver Fire (Acute excess condition)

    Clinical manifestations:
    • Twitching, acute, dizziness, bodily twitches in extremities especially.
    • Red face, eyes, bitter taste in mouth
    • T: Red with yellow coat
    • P: Rapid and wiry
    Formula
    • Ling Jiao Gou Teng Tang (Antelope Horn and Uncaria Decoction)
    • Removes wind, clears heat
  • Liver wind (chronic deficiency condition) i.e. Parkinson’s Disease

    Clinical manifestations:
    • Tidal Fever, night sweats, insomnia, fatigue
    • T: Red with scanty coat
    • P: Thready and rapid
    Treatment principle
    • Tonify yin, soothe Liver, disperse wind
    Formula
    • Da Ding Feng Zhu (Major Arrest Wind Pearl)

Tinnitus Cranii (ringing in the ears or head)

  • Bone marrow deficiency

    Clinical Manifestations
    • Tinnitus
    • Weakness/soreness in the lower back and/or knees.
    • Vertigo/dizziness
    • Possibly associated with ear tinnitus
    • T: Pale with scanty coat
    • P: Deep, thready, weak
    Etiology
    • Constitution, age, over sexed, jing deficiency fails to produce jing
    Treatment Principle:
    • Tonify jing
    Formula:
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • He Che Da Zao Wan (Placenta and Date Pills)
    • Animal derivative herbs are good for jing deficiency
  • Damp Heat accumulation

    Clinical Manifestations
    • Tinnitus
    • Headache, heavy sensation in head
    • Nausea /Vomiting
    • Low appetite
    • Dizziness
    • Chuan yang (carbuncles on head)
    • T: Red with greasy yellow coat
    • P: Slippery, rapid
    Etiology
    • excess conditions due to diet of sweet, greasy, alcohol, or over eating creates damp heat in the channels which obstructs the flow of yang qi.
    • Obstruction in upper jiao effects the head channels.
    Treatment Principle
    • Clear heat, dry damp.
    Formula:
    • Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) plus blood activators such as Chuan Xiong (Rz. Chuanxiong) for sharp fixed pain.
  • Liver qi stagnation

    Clinical Manifestations
    • Tinnitus triggered by anger or emotion.
    • Distention or pain in the hypochondrium, chest tightness
    • Bitter taste in mouth
    • Irritability, restlessness
    • T: Normal
    • P: Wiry and rapid
    Etiology
    • Anger leads to disturbance in flow of qi leads to stagnation of qi in the head.
    Treatment Principle
    • Soothe Liver qi
    Formula
    • Xiao Yao Wan (Rambling Powder)
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction) if Fire is present.

Sore Gums

  • Deficiency of Kidney and Spleen (teeth and gums)

    Clinical Manifestations
    • Sore gums aggravated mostly by cold drinks and weather, sometimes hot drinks as well.
    • Teeth feel weak while chewing.
    • T: Pale
    • P: Deep and Weak
    Etiology
    • Old age, chronic conditions.
    Treatment Principle
    • Tonify Spleen and Kidney
    Formula
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • You Gui Yin (Restore the Right (Kidney) Decoction)
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
    • Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
    • Chew and eat walnuts (Hu Tao Ren (Sm. Persicae))
  • Wind Cold

    Clinical Manifestations
    • Sore gums, prefer warm drinks and food to cold
    • T: White slippery coat (slightly greasy)
    • P: Floating and Tense
    Formula
    • Xi Xin (individual herb) can be chewed raw, or decocted as a tea.
    • Ma Huang Xi Xin Fu Zi Tang (Ephedra Asarum and Prepared Aconite Decoction)
    • Ma Huang (Hb Ephedra) and Xi Xin (Herba cum Radice Asari) are currently unavailable in the US due to misuse.

Bleeding Gums (ulcerative gingivitis)

  • Heat & Fire in Stomach/Large Intestine (excess condition, acute)

    Clinical Manifestations
    • Swollen, red aching bleeding gums
    • Fresh, bright red blood
    • Bad breath, prefers cold drinks, constipation
    • T: Red body, thick yellow coat
    • P: Forceful and rapid
    Formula
    • Qing Wei San (Clear the Stomach Powder) + Yu Nu Jian (Jade Woman Decoction) + herbs to cool and activate blood
  • Stomach yin deficiency (deficiency condition, chronic)

    Clinical Manifestations
    • Swollen gums with pale blood, gums not bright red, sometimes painful, sometimes not.
    • T: Red with scanty coat
    • P: Slippery, rapid, thready
    Formula
    • Yu Nu Jian (Jade Woman Decoction) + herbs to cool and activate blood
  • Kidney yin deficiency with excess heat (associated with old age, a chronic condition)

    Clinical Manifestations
    • Slightly sore gums combined with loose teeth.
    • Dizziness, tinnitus
    • Sore back and weak knees
    • T: Red body with scanty coat
    • P: Thready and rapid
    Formulas
    • (with heat) Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)+ Gu Sui Bu (Rz. Drynariae) and/or Xu Duan (Radix Dipsaci)
    • (without heat) You Gui Yin (Restore the Right (Kidney) Decoction) or Zuo Gui Yin (Restore the Left (Kidney) Decoction) + Gu Sui Bu (Rz. Drynariae) and/or Xu Duan (Radix Dipsaci)
  • Spleen qi deficiency (Spleen unable to govern blood, chronic condition)

    Clinical Manifestations
    • Pale gums, lips, and nails due to blood deficiency
    • Easily bruised
    • T: Pale with white coat
    • P: Soft, weak
    Formula:
    • Gui Pi Tang (Bolster the Spleen Decoction)

Dark Black Teeth (Black from inside of teeth, not a stain due to
coffee etc.)

  • Blood stage heat in the lower Jiao

    Clinical Manifestations
    • High fever, delirium, semi-conscious, coma, convulsions
    • Irritability
    • Shriveling and dry lips
    • T: Red with very dry coat, shrunken
    • P: Extremely rapid
    Etiology
    • Heat has damaged yin and jin-ye (body fluids), Stomach qi damaged (shrunken mouth). Kidney unable to nourish teeth, turning them black, the color of the Kidneys.
    Formula
    • Salty, cold, sweet and moist herbs
    • Fu Mai Tang (Restore the Pulse Decoction)

Stiffness of Neck

  • Wind Cold

    Clinical Manifestations
    • More chills than fever, etc.
    • T: White slippery coat (slightly greasy)
    • P: Floating and Tense
    Formula
    • Ge Gen Tang (Kudzu Combination)
  • Wind Cold damp (a Bi syndrome such as arthritis)

    Clinical Manifestations
    • Heavy sensation in the head, head ache, aching joints, fever/chills sometimes
    • T: Greasy coat
    • P: Floating and slippery
    Formula
    • Ge Gen Tang (Kudzu Combination) + Qiang Huo (Rz. et Rx. Notopterygii), Jian Huang (Rz. Curcumae) and/or Sang Zhi (Rm. Mori)
  • Blood Stage Heat

    Clinical Manifestations
    • High fever, stiffness of head
    • Irritability, delirium
    • Possibly associated with convulsions, muscle spasms
    • “Extreme Heat leads to Liver Wind”
    Formula
    • Ling Yang Ge Gen Tang (Antelope Horn and Kudzu Decoction)

Goiter (enlargement of the thyroid gland)

  • Accumulation of phlegm and qi Stagnation

    Clinical Manifestations
    • Swelling of thyroid, which is soft without pain
    • Sense of obstruction in throat
    • Chest constriction and hypochondriac distending pain
    • Irritability
    • T: Greasy white coat
    • P: Wiry and slippery
    Etiology
    • Stress leads to qi stagnation leading to impairment of body fluid metabolism, leading to phlegm congealing in throat.
    Formula
    • Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) + Hai Zao (Sargassum) and Kun Bu (Laminariae)
  • Qi and blood Stagnation

    Clinical Manifestations
    • Tumors or cancer of the thyroid gland developing from accumulation of phlegm and qi stagnation.
    • Swelling is harder than simple phlegm and qi stagnation
    • More defined pain and sense of obstruction effecting ability to breath and/or swallow.
    • Chest constriction and hypochondriac distending pain
    • Irritability
    • T: Dark purple
    • P: Deep and choppy
    Etiology
    • Prolonged qi stagnation with phlegm leads to hardening of the phlegm leading to tumor
      formation
    Formula
    • Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) + blood activators such as E Zhu (Rz. Curcumae), San Leng (Rz. Sparganii), Dan Shen (Salviae Miltiorrhizae), Ru Xiang (Olibanum), Mo Yao (Myrrha) and anti-cancer herbs (not available in the US).
  • Yin deficiency of the Heart and Liver

    Clinical Manifestations
    • Typical hyperthyroidism, swollen thyroid, though not hard
    • Palpitations, insomnia, nervous, trembling
    • Easily sweats, shortness of breath, irritability,
    • dizziness/vertigo
    • Dry eyes, hot flashes, night sweats
    • Nocturnal emissions, premature ejaculation
    • irregular menstruation
    • T: Red with scanty coat
    • P: Wiry and rapid, or thready and rapid
    Treatment principle
    • Tonify yin and clear fire
    Formulas
    • Suan Zao Ren Tang (Sour Jujube Decoction)
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)
    • Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart)
    • Yi Guan Jian (Linking Decoction)

Symptomatic Diagnosis: Female Reproductive

Female reproductive issues make up the bulk of many a Chinese medicine herbalist’s practice. This article describes some of the key symptoms along with their differentiations, treatment principles, and formulas. Complaints include:
Light menstrual flow – Dark purple flow or thick flow – Thick menstrual flow – Thin flow – Early menstruation – Late menstruation – Amenorrhea (lack of period) – Metrorrhagia (heavy flow) – Irregular menstrual cycle – Fever during menstruation


Light menstrual flow

  • qi and blood deficiency

    Clinical Manifestations
    • Light flow, delayed cycle,
    • abdominal aching, fatigue, dizziness
    • T: Pale
    • P: Thready
    • Anemia
    • Heavy flow possible in the case of qi deficiency with no blood deficiency.
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)
  • Accumulation of phlegm damp

    Clinical Manifestations
    • Light flow, obese patient, irregular cycles,
    • heavy sensation in body
    • T: Swollen tongue body with greasy coat
    • P: Soft and slippery
    Formula:
    • Jia Wei Er Chen Tang (Modified Two Aged Decoction)

 Dark Purple Flow or Thick Flow

  • Qi and blood stagnation

    Clinical Manifestations
    • Dark purple flow with clots, sever abdominal pain, sever PMS symptoms
    • T: Purple
    • P: Choppy
    Formula
    • Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi)
  • Heat and blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)
  • Cold stagnation leading to blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    • Lower back cold, patient prefers warmth
    • T: White coat
    • P: Deep and tense
    Formula
    • Wen Jing Tang (Warm the Menses Decoction)

Thick Menstrual Flow

  • Qi and blood stagnation

    Clinical Manifestations
    • Dark purple flow with clots, sever abdominal pain, sever PMS symptoms
    • T: Purple
    • P: Choppy
    Formula
    • Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi)
  • Heat and blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)
  • Cold stagnation leading to blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    • Lower back cold, patient prefers warmth
    • T: White coat
    • P: Deep and tense
    Formula
    • Wen Jing Tang (Warm the Menses Decoction)
  • Damp Heat accumulation

    Clinical Manifestations
    • Dark thick flow, strange oder, burning and itching in the vaginal region.
    • Phlegm accumulation
    • Clinical Manifestations
    • Thick, though not dark flow. Congestion, dizziness, leukorrhea
    • T: Greasy coat
    • P: Slippery

Thin flow (the quality of the blood, see “light”
flow).

Early menstruation (early in the month, not early in life)

  • Blood heat

    Clinical Manifestations
    • Bright red, copious flow. Could lead eventually to very dark red if the heat goes
      untreated.
  • yin deficiency heat in the blood

    Clinical Manifestations
    • scanty quality, red.
  • blood stagnation leading to heat in the blood.

    Clinical Manifestations
    • Clots, abdominal pain
    • Early or late period, heavy or light amount, spotting,
  • qi deficiency

    Clinical Manifestations
    • Light and thin flow.
    • Abdominal pulling or bearing down sensation, fatigue
    • P: Weak

Late menstruation (In the month, not in life)

  • Cold and blood stagnation

    Clinical Manifestations
    • Abdominal pain, patient desires warmth, flow with clots.
    • T: Purple
    • P: Deep, slow, possibly choppy.
  • phlegm/damp accumulation

    Clinical Manifestations
    • Delayed, or lack of menses
    • Pale red thick flow
    • Obesity, indigestion
    • T: Greasy coat
    • P: Soft
  • deficiency of qi and blood

Amenorrhea (Lack of period)

  • Kidney qi deficiency

    Clinical Manifestations
    • Congenital Kidney qi deficiency (Primary amenorrhea)
    • No period as of the 15th birthday
    • Emaciation, Lower back pain, fatigue,
    • slow development
    • P: Weak
    • T: Pale
    Treatment principle
    • Tonify Kidney
  • Qi and blood deficiency

    Clinical Manifestations
    • Usually found after an illness or post partum
    • No pain, no period
    • Palpitations
    • Fatigue, weakness
    • P: Weak
    Treatment principle
    • Tonify qi and blood
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)
  • Qi and blood stagnation

    Clinical Manifestations
    • Amenorrhea following traumatic injury or stress.
    • Lots of distention and pain
    • fatigue, depression, anger
    • T: Varies
    • P: Deep and wiry
  • Damp and phlegm accumulation

    Clinical Manifestations
    • Menopausal symptoms
    • Delayed cycle, quantity of flow is light.
    • Amenorrhea, weight gain, water retention
    • T: Pale with white greasy coat
    • P: Soft and slippery

Metrorrhagia (heavy flow)

  • Qi and blood deficiency

    Clinical Manifestations
    • Heavy quantity, thin quality and light color.
  • Heat in blood

    Clinical Manifestations
    • Dark Red flow
    • blood stagnation
    • Clinical Manifestations
    • Irregular flow, spotting, dark purple color clots, pain in abdomen, which gets better
      after the onset of the flow.
    • T: Purple
    • P: Deep and choppy, or wiry and slippery

Irregular Menstrual cycle

  • Liver qi stagnation (accounts for 95% of cases)

    Formula
    • Xiao Yao San (Rambling Powder)
  • Kidney qi deficiency

Fever during menstruation

  • Liver qi stagnation with Liver fire (most common)

    Clinical Manifestations
    • Fever alternating with chills, more often before period, sometimes during.
    • Early or irregular cycle, irritation, dizziness
    • Thirst, dry mouth
    • T: Red with yellow coat
    • P: Wiry and Rapid
      • Jia Wei Xiao Yao San (Modified Rambling Powder) (aka Dan Zhi Xiao Yao San)
    • Formula
  • Yin deficiency Fever

    Clinical Manifestations
    • Fever following illness of post partum.
    • This fever tends to happen before or during the period.
    • Emaciation, irritability, dry mouth, thirst.
    • T: Red and thin
    • P: Thready and rapid
      • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)
    • Formula
  • Wind cold

    Clinical Manifestations
    • Chong and Ren channels are weak just prior to menses
    • Tai yang syndrome
    Formula
    • Gui Pi Tang (Bolster the Spleen Decoction) even if there’s no sweating.
    • Xiao Chai Hu Tang if fever is also associated with chills.
  • blood stagnation before or during period

    Clinical Manifestations
    • Abdominal pain, dark complexion
    • Flow is purple with clots.
    Formula
    • Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction)
  • Qi deficiency or qi and blood deficiency fever

    Clinical Manifestations
    • Fever before or during the period
    • Light color and thin quality, scanty quantity
    • T: Pale
    • P: Weak
    Formula
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)

Symptomatic Diagnosis: Male Reproductive

Blood in Seminal Fluid
Thin and scanty ejaculate
Inability to ejaculate
Premature ejaculation
Nocturnal Emissions
Impotence
Persistent Erection
Coldness in the external genitalia
Flaccid retraction of the penis
Itching and Burning in the genitalia

Blood in Seminal Fluid

  • Yin deficiency with intense empty heat

    Clinical Manifestations
    • blood in ejaculate
    • Distention & pain in testes or penis
    • Burning sensation in urinary tract
    • emaciation
    • thirst, irritability
    • T: Red with scanty coat
    • P: Thready and rapid
    Treatment Principle
    • Tonify yin, clear fire, harmonize blood, stop the Bleeding.
    Formula
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) or Da Bu Yin Wan (Great Tonify the Yin Pill) + E Jiao (Colla Corii Asini) for bleeding.
  • Damp Heat accumulation (STD)

    Clinical Manifestations
    • blood in ejaculate
    • Frequent painful urination
    • Pain, burning, itching in U.T.
    • Spasms of pain in testicles
    • blood in urine
    • T: Greasy yellow coat
    • P: Slippery, wiry, rapid
    Formula
    • Ba Zheng San (Eight Herb Powder for Rectification) + Da Qing Ye (Fo. Isatidis), Huang Qin (Rx. Scutellariae), Huang Bai (Cx. Phellodendri), Zhi Zi (Fr. Gardeniae), Bai Bu (Rx. Stemonae)

Thin and scanty ejaculate

Western differentiation: low sperm count
  • Kidney qi deficiency, or Kidney yang deficiency

    Clinical Manifestations
    • infertility, very chronic fatigue, pale complexion, sore or weak lower back, senility,
      hair loss and loose teeth, hearing loss, frequent urination-especially in the evening
    • T: Pale
    • P: weak in Kidney position
    Treatment principle
    • Tonify Kidney qi, yang, and essence
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction)
  • Cold stagnation (a yang deficiency condition)

    Clinical Manifestations
    • Scanty semen
    • infertility, very chronic fatigue, pale complexion, sore or weak lower back, senility,
      hair loss and loose teeth, hearing loss, frequent urination-especially in the evening
    • Cold extremities, testicles
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction) + Fu Zi (Rx. Aconiti Lateralis Praeparata), Ba Ji Tian (Rx. Morindae Officinalis), Suo Yang (Hb. Cynomorii)

Inability to ejaculate during intercourse

  • Yin deficiency with empty heat

    Clinical Manifestations
    • distention in scrotum
    • Possible nocturnal emissions, irritability, scanty urine, constipation, thirst
    • T: Red
    • P: Thready and rapid
    Treatment Principle
    • Tonify yin to move stagnation
    Formula
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) + Mu Tong (Caulis Akebiae), Wang Bu Liu Xing (Sm. Vaccariae)
  • Blood stagnation due to chronic stress

    Qi stagnation leading to blood stagnation. Liver stagnates qi, and the Liver channel passes through the gonads.
    Clinical Manifestations
    • easily angered, chest congestion
    • Varicose veins in the scrotum (varicocele)
    • T: Purple
    • P: Deep and choppy
    Formula
    • Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) + Che Qian Zi (Sm. Plantaginis)

Premature ejaculation

  • Kidney qi or yang deficiency

    Clinical Manifestations
    • impotence, sore back, hair loss, loose teeth, senility
    • T: Pale
    • P: weak at kidney point
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction), Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
  • Deficiency of Heart and Spleen

    Clinical Manifestations
    • Neurosis (if there’s a psychological component)
    • Impotence, emaciation, fatigue, pale complexion
    • Palpitations, insomnia, forgetfulness
    • indigestion
    • T: Pale
    • P: Weak
    Formula
    • Gui Pi Tang (Bolster the Spleen Decoction)

Nocturnal Emissions (more heat)/Spermatorrhea (more cold)

  • Heart and Spleen deficiency

    Clinical Manifestations
    • Impotence, emaciation, fatigue, pale complexion
    • Palpitations, insomnia, forgetfulness
    • indigestion
    • T: Pink or red
    • P: Weak or thready
    Treatment principle
    • Clear heat, subdue fire and calm shen. Astringe essence.
    Formula
    • Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart) + Bai Shao (Rx. Paeoniae Alba), E Jiao (Colla Corii Asini)
  • Liver Fire (nocturnal emissions)

    Clinical Manifestations
    • Bitter taste in mouth
    • Dark urine
    • Easily angered
    • P: Wiry
    Formula
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction)
  • Kidney qi deficiency (Spermatorrhea)

    Clinical Manifestations
    • Tinnitus, dizziness, fatigue, sore or weak lower back.
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction) + astringent herbs
  • Accumulation of damp heat

    Clinical Manifestations
    • Irritability, fever, itching
    • burning sensation in lower abdomen, or testicles.
    • Scanty yellow urine
    • T: Yellow greasy coat
    • P: Wiry, slippery
    Formula
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction) + Ba Zheng San (Eight Herb Powder for Rectification)

Impotence

  • Kidney yang deficiency

    Clinical Manifestations
    • Cold testes, soreness and weakness in the lower back and knees.
    • Poor memory, hearing and hair loss, loose teeth, aversion to cold and cold extremities
    • qi deficiency symptoms
    • T: Pale and swollen with teeth marks.
    • P: Deep thready, weak, especially in Kidney positions.
    Etiology
    • Age, too much sexual activity, constitutional weakness
    Treatment principle
    • Warm and stimulate Kidney yang
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction)
  • Heart/Spleen deficiency

    Psychogenic, in Western terms
    Clinical Manifestations
    • Palpitations, shortness of breath, emaciation, insomnia, restlessness, vivid dreams,
      fatigue, indigestion, bloating, loose stools
    • T: Pale
    • P: Thready
    Etiology
    • Thinking or worrying too much creates the Spleen Zi deficiency which leads to qi and blood deficiency which creates a Heart blood deficiency leading to various neurosis. Plus, the qi and blood can’t support the essence, which leads to impotence.
    Treatment Principle
    • Tonify Heart and Spleen
    Formula
    • Gui Pi Tang (Bolster the Spleen Decoction) + Kidney tonic herbs which will warm the Spleen such as Bu Gu Zhi (Fr. Psoraleae), Ba Ji Tian (Rx. Morindae Officinalis), Xian Mao (Rz Curculiginis).
  • Impotence due to fear

    Clinical Manifestations
    • frustration, easily panicked, insomnia, vivid dreams and nightmares, erection up until
      intercourse begins.
    • Tongue and Pulse can be normal
    Treatment Principle
    • Calm Shen
    Formula
    • Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) + Shi Chang Pu (Rz. Acori Tatarinowii), Ren Shen, Yuan Zhi

Persistent Erection

  • Damp heat in Liver (lasts days or even months)

    Clinical Manifestations
    • Penis is dark purple, distended pain, difficult urination, scanty dark yellow urine, fear, bitter taste in mouth, thirst, constipation.
    • T: Red with yellow coat
    • P: Wiry, slippery, rapid
    Treatment Principle
    • Clear heat, dry damp
    Formula
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction)
  • Yin deficiency with intense empty heat

    Clinical Manifestations
    • emaciation, high sex drive, distention and pain, though slight compared to damp heat in
      Liver.
    • Sometimes scanty urine
    • Malar flush, nervousness, hyperactive, easily anxious.
    • T: Red and narrow, scanty coat
    • P: Thready and rapid
    Treatment principle
    • Tonify yin clear heat.
    Formula
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)

Coldness in the external genitalia (both men and women)

  • Kidney yang deficiency with interior cold or Ming Men deficiency

    Clinical Manifestations
    • Kidney yang deficiency Symptoms
    • Impotence, premature ejaculation (male)
    • Low sexual desire (female)
    • T: Pale with teeth marks
    • P: Deep, slow and weak
    Formula
    • Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) + Lu Rong (Cornu Cervi) and Wu Zhu Yu (Fr. Evodiae)

Flaccid retraction of the penis

  • Cold stagnation

    Clinical Manifestations
    • Cold extremities and body, purple lips, sever muscle aches and abdominal cramping,
      maybe diarrhea
    • T: Normal
    • P: Deep, slow and weak, or deep, slow and tense.
    Etiology
    • Constitutional yang deficiency+ pathogenic cold or just pathogenic cold in the Liver channel
      leading to cold stagnation which blocks qi and blood in the channels that pass through the
      genital area.
    Treatment principle
    • Warm and remove cold stagnation
    Formula
    • Wu Zhu Yu Tang (Evodiae Decoction) or Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities)
  • Yang Collapse

    This is a critical condition, the Liver is dying.
    Clinical Manifestations
    • Spontaneous cold sweating
    • Semiconsciousness or unconsciousness
    Treatment Principle
    • Obviously the penile retraction will be secondary to the more immediate need to rescue and restore the yang before the patient expires.
    Formula
    • The formula provided in this lecture is impossible to locate, unsure of the accuracy of its name, besides, this condition is likely better treated in an emergency room, anyway.

Itching and Burning in the genitalia

  • Damp heat in the Liver channel

    Clinical Manifestations
    • Burning, difficult, dark, painful and frequent urination
    • cloudy urine, fever thirst
    • T: Yellow greasy
    • P: Slippery, wiry, rapid
    Treatment principle
    • Clear damp, clear heat.
    Formula
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction)
  • Heat and fire accumulation

    Clinical Manifestations
    • Burning and heat in genitals, fever, mouth ulcers, thirst, more heat symptoms
    • T: Red, especially the tip
    • P: Rapid
    Treatment Principle
    • Clear heat, clear fire
    Formula
    • Dao Chi San (Guide out the Red Powder)
  • blood stagnation

    Clinical Manifestations
    • Severe, excruciating pain, burning in urinary tract
    • Kidney, or urinary tract stones, bloody urine, cloudy urine.
    • Pain referred to the abdomen or lower back.
    • T: Purple spots
    • P: Deep and choppy
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach) + Ba Zheng San (Eight Herb Powder for Rectification)

Symptomatic Diagnosis: Elimination

Tenesmus (sense of incomplete bowel movement)
Constipation
Incontinence of feces
Incontinence of urine
Cloudy urination
Frequent urination
Oliguria, or difficult urination
Seminal fluid in urine

 Tenesmus

  • Accumulation of damp, heat, and toxic heat

    Clinical manifestations
    • Tenesmus, diarrhea, abdominal pain, blood and mucus in stool.
    • Pus and burning sensation in anus, possible fever
    • Yellow scanty urine
    • T: Red with yellow coat
    • P: Slippery and rapid
    Formula
    • Dang Gui Shao Yao Tang (Angelica and Peony Decoction)

Constipation

  • Yang Ming Heat (Yang Ming Organ=L.I.)

    Clinical manifestations
    • Fever, constipation, abdominal discomfort,
    • dislikes palpation
    • feels mass in abdomen
    • P: Deep, strong and slow due to stagnation
    Treatment Principle
    • Purge heat and stagnation
    Formula
    • Da Cheng Qi Tang (Major Order the Qi Decoction)
  • Qi Stagnation

    Clinical manifestations
    • Constipation
    • depression, easily angered, chest congestion discomfort in hypochondria,
    • distention and discomfort in breast, water retention (due to digestive problems,
      secondary to the stagnation)
    Formula
    • Chai Hu Shu Gan Tang (Bupleurum and Cyperus Combination) + lubricative herbs such as Tao Ren (Sm. Persicae) or Huo Ma Ren (Fr. Cannabis).
  • Qi deficiency

    Clinical manifestations
    • Constipation, sometimes loose
    • extreme fatigue especially after a bowel movement
    • Weak voice
    • possible rectal prolapse
    • T: Pale with white coat
    • P: Weak
    Formula
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Blood and yin deficiency

    Clinical manifestations
    • Chronic, old age patients
    • Constipation, emaciation, dry skin
    • palpitations, pale complexion
    • T: Pale, or Red or Narrow
    • P: Thready and rapid
    Herbs:
    • Dang Gui (Rx. Angelicae Sinensis), Sheng Di Huang (Rx. Rehmanniae), Rou Cong Rong (Hb. Cistanches)
    Formula
    • Wu Ren Wan (Five Seed Pills)

Incontinence of Feces (all serious conditions)

  • Accumulation of heat and toxins.

    Clinical manifestations
    • Blood level heat and toxin
    • High fever, delirium
    • Semi consciousness, coma, XS diarrhea with pus and blood
    • T: Red with yellow coat
    • P: Rapid
    Treatment Principle
    • Clear blood level heat
    Formula
    • Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction)
  • Spleen, Kidney yang deficiency

    Clinical manifestations
    • Chronic Diarrhea/dysentery
    • Diarrhea with mucus, incontinence of feces
    • Fatigue, cold, low back pain,
    • T: Pale
    • P: Deep, thready, weak
    Formula
    • Zhen Ren Yang Zang Tang (Immortal’s Decoction to Nourish the Organs)
  • Spleen Qi Sinking (Extreme weak condition)

    Clinical manifestations
    • Incontinence of feces, rectal prolapse, tired disoriented
    • T: Pale
    • P: Feeble
    Formula
    • Shen Fu Tang (Ginseng and Prepared Aconite Decoction)

Incontinence of urine

  • Kidney Qi Deficiency

    Common among the elderly and those recovering for serious illness.
    Clinical Manifestations
    • Frequent urination and incontinence, mostly in the evening.
    • Kidney qi and/or yang deficiency symptoms
    • T: Pale
    • P: Deep, weak especially in the kidney positions.
  • Lung and Spleen qi deficiency

    The problem begins with Spleen qi sinking and is worsened by the spasmodic action of the abdomen with coughing.

Cloudy Urination

  • Accumulation of damp Heat (excess turbid damp, acute)

    Clinical Manifestations
    • Cloudy urine with white or yellow urine.
    • Frequent, burning, urgent, painful urination
    • fever, thirst
    • T: Red with yellow coat
    • P: Wiry and thready
    Formula
    • Ba Zheng San (Eight Herb Powder for Rectification) + Shi Chang Pu (Rz. Acori Tatarinowii)
    • Bei Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate the Clear)
  • Kidney yin or yang deficiency (deficiency syndrome in which the essence leaks out with the urine)

    Clinical Manifestations
    • Chronic cloudy urine
    • yin deficiency symptoms,
    • Scanty yellow urine
    • T: Red
    • P: Thready and rapid
    • or yang deficiency symptoms
    • Copious clear urine
    • T: Pale
    • P: Deep and weak
  • Kidneys are unable to govern the essence in the Kidneys

    Treatment principle
    • Tonify kidneys
    • Astringe essence
    Formulas
    • For Kidney yin deficiency
      • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) + Pi Xia, Fu Pen Zi (Fr. Rubi), Wu Wei Zi (Fr. Schisandrae), Tu Si Zi (Sm. Cuscutae) (all astringents)
    • For Kidney yang deficiency
      • You Gui Yin (Restore the Right (Kidney) Decoction) or Wan (pills)+ Fu Pen Zi (Fr. Rubi), Wu Wei Zi (Fr. Schisandrae), Tu Si Zi (Sm. Cuscutae) (all astringents)

Frequent Urination in Evening

often found in the elderly
  • Kidney qi deficiency

  • Kidney yang deficiency

    Formulas
    • Sang Piao Xiao San (Mantis Egg-Case Powder) + You Gui Yin (Restore the Right (Kidney) Decoction)
    • for prostate problems: Kai Kit Wan (Pre-made formula)

Oliguria, or difficult urination

  • Damp heat

    • Clinical Manifestations
    • Cloudy yellow urine
    • Frequent, burning, urgent, painful urination
    • incontinence
    Formula
    • Ba Zheng San (Eight Herb Powder for Rectification) + Shi Chang Pu (Rz. Acori Tatarinowii)
    • Bei Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate the Clear)
  • Lung qi Stagnation (Lungs unable to descend the water)

    Clinical Manifestations
    • Cough, dyspnea, chest congestion, constipation
    • T: Red
    • P: Soft and rapid
  • Zhong qi deficiency (Spleen Qi Sinking)

    Clinical Manifestations
    • Urination lacking strength, sluggish stream
    • fatigue, bearing down sense
    • Urine, frequent but small amounts
    • Loose stool
    • T: Pale
    • P: Thready and weak
    Formula
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Kidney qi deficiency

    Clinical Manifestations
    • difficult urination, sluggish stream, incontinence.
    • frequent urination
    • Kidney problems in Western medicine.
    Treatment Principle
    • Tonify Kidney
    Formula
    • Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
  • Stagnation of Urinary Tract (common after abdominal surgery or trauma)

    • Sluggish, difficult urination
    • Abdominal distention of pain
    • T: Purple, possible with raised purple bumps
    • P: Choppy
  • Clinical Manifestations

Seminal Fluid in Urine

  • Accumulation of Damp Heat

    This section is what the Western world would call a STD, or sexually transmitted disease.
    Clinical Manifestations
    • Frequent, cloudy, sluggish, burning urine
    • White sticky discharge following urination
    • Bitter taste in mouth
    • Thirst, chest congestion, sluggish BM
    • T: Red with Yellow greasy coat
    • P: Soft and rapid (if more damp), or Slippery and rapid (if more heat)
    Treatment Principle
    • Dry damp, clear heat
    Formula
    • Bei Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate the Clear)
  • Kidney yin deficiency with empty heat

    Clinical Manifestations
    • Frequent, cloudy, burning urine
    • White or red discharge after urination
    • Dizziness, vertigo, insomnia, restlessness
    • Tidal fever, yin deficiency symptoms
    • T: Red with dry coat
    • P: Thready and rapid
    Treatment Principle
    • Tonify yin and jing
    Formula
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) + astringents such as Tu Si Zi (Sm. Cuscutae), Jin Ying Zi (Fr. Rosae Laevigatae), Wu Wei Zi (Fr. Schisandrae).
  • Kidney qi or yang deficiency (very weak people, not an STD)

    Clinical Manifestations
    • Frequent, copious, clear urine
    • seminal fluid discharge following urination
    • Premature ejaculation, impotence, nocturnal emissions.
    • T: Pale
    • P: Deep and weak
    Formula
    • You Gui Yin (Restore the Right (Kidney) Decoction) plus astringents

Symptomatic Diagnosis: Fever & Chills


Chinese medicine has a long history, back to the year 200 at least, of treating viral and bacterial infections. This article describes the differentiations, treatment principles and formulas for said infections and indications such as:
Aversion to wind and cold along with chills
Shivers or “severe chills”
Alternating fever and chills
Aversion to heat without chills
Tidal fever (low grade fever)
Five center heat
Night sweats

Aversion to wind and cold along with chills

  • Exterior syndrome

    Fever and chills caused by wind, though it can be combined with other factors.
    • Muscle aches, headache
    • Wind with cold
    • Chills and aches
    • Formula:
      • Ma Huang Tang (Ephedra Decoction)
      • Ma Huang is currently banned in USA. Replacement: consider Qiang Huo Sheng qi Tang (Notopterygium Decoction to Overcome dampness)
    • Wind with heat
    • Fever and sore throat
    • Formula:
      • Yin Qiao San (Honeysuckle and Forsythia Powder)
    • Wind with damp
    • stuffiness, aching in joints
    • Formula:
      • Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome dampness)
  • yang deficiency

    Clinical Manifestations:
    • Aversion to cold
    • Cold hands and feet
    • Fatigue, bloating, gas, loose stools (Spleen yang deficiency)
    • Palpitations, shortness of breath, fatigue, cyanosis (Heart yang deficiency)
    • Low back pain, frequent urination, infertility or impotence, low libido (Kidney yang deficiency)
    Formula:
    • Heart yang deficiency, use Gui Zhi Tang (Cinnamon Twig Decoction) with more Zhi Gan Cao (Honey-fried Licorice Root) and using Rou Gui (Cinnamon bark) instead of Gui Zhi (Cinnamon twig)
    • Spleen yang deficiency, add Li Zhong Tang
    • Kidney yang deficiency add Jin Gui Shen qi Tang AKA Ba Wei Di Huang Wan
  • Yang Collapse (more severe than yang deficiency)

    Clinical Manifestations:
    • Feeble or faint pulse
    • Very low energy
    • Confusion and disorientation
    • Cold sweat, cold body, cold extremities
    • Low blood pressure
    • Patient prefers fetal position
    • Diarrhea with undigested food
    • Clear copious urine
    Treatment principle:
    • Restore yang from Collapse
    Formula:
    • Shen Fu Tang (Ginseng and Prepared Aconite Decoction)
    • Note: this is a critical state and emergency biomedical treatment is indicated.
  • True Heat, False Cold

    An excess condition due to a variety of etiologies which pushes the yin from the interior to the superficial.
    Clinical Manifestations:
    • Cold symptoms externally
    • Aversion to cold
    • Cold skin (which warms upon prolonged touch)
    • Warm symptoms internally
    • Doesn’t desire warm clothes
    • Bad breath, constipation
    • T: Red with yellow coat (hint on the interpretation of “false” signs, the “tongue doesn’t lie”)
    • P: Forceful and Rapid
    Formula:
    • Bai Hu Tang (White Tiger Decoction)
  • phlegm Accumulation

    A condition in which a yin evil blocks the flow of yang energy, leading to aversion to cold.
    Clinical Manifestations:
    • Thirst, with no desire to drink
    • Aversion to cold
    • T: Thick greasy white coat
    • P: Slippery
    Formula: Er Chen Tang (Two Aged Decoction)

Shivers or “Severe Chills”

  • Exterior syndrome

    Severe stagnation caused by exterior factors, skin pores close, Wei qi pushes up against the closed pores in an attempt to push out the pathogenic factor. This creates shivering.
    • Formula:
      • Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)
  • Febrile Disease

    Any attack of pathogenic heat. According to Wen Bing theory, the heat is generally located in the Wei and qi stages.

Alternating fever and chills

  • Shao Yang disease

    Clinical Manifestations:
    • Bitter taste in mouth
    • Dry mouth
    • Chest and hypochondriac discomfort
    • Irritability
    • Nausea and vomiting
    • T: Red tip with thin yellow coat
    • P: Wiry
    Treatment principle
    • “Harmonize interior and exterior” which means disperse exterior and clear interior.
    Formula:
    • Xiao Chai Hu Tang (Minor Bupleurum Decoction)
    Note: Chai Hu (Rx. Bupleurum) doesn’t get along well with interferon therapy. Avoid using both at the same time.

Aversion to heat without chills

An interior excess condition effecting the Lung and Stomach
  • Hot phlegm in Lung (Phenomena, Bronchitis)

    Clinical Manifestations:
    • Fever
    • Cough
    • Chest pain
    • Sputum is thick and yellow, brown, or green
    • Thirst
    • Constipation
    • Note: one can also remove heat from Lungs by purging the bowels when constipation is present.
    • T: Red with thick greasy yellow coat
    • P: Rapid and slippery
    Formula:
    • Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)
  • Yang Ming Jing Disease (Stomach channel)

    No chills because the pathogen is too far interior
    Clinical Manifestations:
    • “Four Big Symptoms”
    • Big thirst
    • Big fever
    • Big sweating
    • Big pulse
    Formula:
    • Bai Hu Tang (White Tiger Decoction)
  • Yang Ming Fu (Large Intestine organ disease)

    Clinical Manifestations:
    • Heat leads to…
    • Fever
    • Constipation
    • Bloating
    • Palpable hardnesses in abdomen (dry stool)
    • P: Deep, strong, rapid (due to heat) or slow (due to stagnation)
    Formula:
    • Da Cheng Qi Tang (Major Order the Qi Decoction)
  • Ying (Nutritive) or Xue (blood) level syndromes (Pericardium heat)

    Clinical Manifestations:
    • High fever (104 degrees F. and above)
    • Mental manifestations (confusion, delirium, etc…)
    • T: Red tongue with scanty, or no coat (yin deficiency)
    Formula:
    • Important herbs include: Xi Jiao (rhino horn, no longer used), Ling yang Jiao (antelope horn) and Shui Niu Jiao (water buffalo horn)
    • Qing Ying Tang (Clear the Nutritive Decoction)

Tidal fever (Low grade fever which comes and goes on a regular basis like the tide)

  • yin deficiency

    Clinical Manifestations:
    • Low grade fever in the afternoon or evening
    • Five center heat
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
  • Qi deficiency (Spleen/Stomach qi deficiency

    Clinical Manifestations:
    • Low grade fever at no regular time
    • Fever + qi deficiency symptoms
    Formula:
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Blood stagnation (Late stage stagnation leads to blood deficiency, as in late stage cancer)

    Clinical Manifestations:
    • Low grade fever in evening
    • Aches
    • Dry skin
    • Dark circles under eyes
    • Tumor formation
    • T: Purple
    • P: Choppy and thready
    Treatment principle:
    • Remove blood stagnation
  • Yang Ming Fu syndrome (Large Intestine)

    Clinical Manifestations:
    • Low fever possible, due to stagnation
    • Fever
    • Constipation
    Formulas:
    • Da Cheng Qi Tang (Major Order the Qi Decoction), or any of the related “Cheng Qi Tang” formulas.

Five Center Heat

  • yin deficiency with deficiency heat

    Clinical Manifestations:
    • Five center heat, which is heat manifesting on the yin surfaces of the body, such as
      the palms, bottom of the feet, and the chest.
    • Night sweats, hot flashes.
    • T: Red, narrow, scanty coat
    • P: Thin and rapid
    Treatment principle
    • Nourish yin, remove heat
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) (Tonifies yin)
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) (Clears deficiency heat)
    Important herbs:
    • Huang Bai (Cx. Phellodendri), Zhi Mu (Rz. Anemarrhenae). Bitter and cold, they cool both deficiency and excess heat.
  • blood deficiency leading to deficiency heat.

    Clinical manifestations:
    • Five center heat especially in the afternoon and evening.
    • Fatigue, poor appetite, palpitations, dizziness, vertigo, pale complexion.
    • T: Pale
    • P: Thready, soft, or choppy.
    Treatment principle:
    • Nourish blood
    Formula:
    • Si Wu Tang

Night Sweats (Think Heart, since sweat is the fluid of the heart)

  • Heart blood deficiency

    Clinical manifestations:
    • Night sweats
    • Palpitations, insomnia, pale complexion, fatigue
    • T: Pale
    • P: Weak
    Treatment principle:
    • Tonify Heart blood, astringe sweat.
    Formula
    • Si Wu Tang, plus an astringent such as Wu Wei Zi (Fr. Schisandrae), Long Gu (Os Draconis), Mu Li (Concha Ostreae), Fu Xiao Mai (Fr. Tritici).
    • Gui Pi Tang (Bolster the Spleen Decoction)
  • Yin deficiency with deficiency heat.

    Clinical manifestations:
    • Night sweats
    • Palpitations, insomnia, pale complexion fatigue
    • T: Red with scanty coating
    • P: Thin and rapid
    Treatment principle
    • Tonify yin
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) + astringent such as Fu Xiao Mai (Fr. Tritici).