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( ompiler-in-Chief Wang Lufen Translator-in-Chief Li Zhaoguo Bao Bai
( A Nt'wly Compiled Practical English-Chinese Library of TCM General Compiler-in-Chief Zuo Yanfu)
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise* without the prior permission in writing of the Publisher.
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Honorary Director Zhang Wenkang General Advisor Chen Keji
Advisors (Listed in the order of the number of strokes in the Chinese ñames)
Gan Zuwang You Songxin Liu Zaipeng Xu Zhiyin
Sun Tong Song Liren Zhang Minqing Jin Shi
Jin Miaowen Shan Zhaowei Zhou Fuyi Shi Zhen
Xu Jingfan Tang Shuhua Cao Shihong Fu Weimin
International Advisors M S. Khan (Ireland) Alessandra Gulí (Italy) Secondo Scarsella (Italy) Raymond K. Carroll (Australia) Shulan Tang (Britain) Glovanni Maciocia (Britain) David Molony (America) Tzu Kuo Shih (America) Isigami Hiroshi (Japan) Helmut Ziegler (Germany)
Director Xiang Ping
Executive Director Zuo Yanfu
Executive Vice-Directors Ma Jian Du Wendong Li Zhaoguo
Vice-Directors Huang Chenghui Wu Kunping Liu Shenlin Wu Mianhua
Chen Diping Cai Baochang
Members (Listed in the order of the number of strokes in the Chinese ñames)
Ding Anwei Ding Shuhua Yu Yong Wan Lisheng Wang Xu
Wang Xudong Wang Lingling Wáng Lufen Lu Zijie Shen J unlong
Liu Yu Liu Yueguang Yan Daonan Yang Gongfu Min Zhongsheng
Wu Changguo Wu Yongjun Wu Jianlong He Wenbin He Shuxun (specially invited) He Guixiang Wang Yue
Wang Shouchuan Shen Daqing Zhang Qing Chen Yonghui
Chen Tinghan (specially invited) Shao J ianmin Lin Xianzeng (specially invited) Lin Duanmei (specially invited) Yue Peiping Jin Hongzhu
Zhou Ligao (specially invited) Zhao Xia Zhao Jingsheng Hu Lie
Hu Kui Zha Wei Yao Yingzhi Yuan Ying Xia Youbing
Xia Dengjie Ni Yun Xu Hengze Guo Haiying Tang Chuanjian
Tang Decai Ling Guizhen (specially invited) Tan Yong Huang Guicheng Mei Xiaoyun Cao Guizhu Jiang Zhongqiu Zeng Qingqi Zhai Yachun Fan Qiaoling
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Advisors Shao Xundao Ou Ming
Translators-in-Chief Zhu Zhongbao Huang Yuezhong Tao Jinwen Executive Translator-in-Chief Li Zhaoguo
Vice-Translators-in-Chief (Listed in the order of the number of strokes in the Chinese
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Xun Jianying Li Yong’an Zhang Qingrong Zhang Dengfeng Yang Hongying Huang Guoqi Xie Jinhua
Translators (Listed in the order of the number of strokes in the Chinese ñames)
Yu Xin Wang Ruihui Tian Kaiyu Shen Guang
Lan Fengli Cheng Peili Zhu Wenxiao Zhu Yuqin
Zhu Jinjiang Zhu Guixiang Le Yimin Liu Shengpeng
Li Jingyun Yang Ying Yang Mingshan He Yingchun
Zhang Jie Zhang Haixia Zhang Wei Chen Renying
Zhou Yongming Zhou Suzhen Qu Yusheng Zhao J unqing
Jing Zhen Hu Kewu Xu Qilong Xu Yao
Guo Xiaomin Huang Xixuan Cao Lijuan Kang Qin
Dong Jing Qin Baichang Zeng Haiping Lou Jianhua
Lai Yuezhen Bao Bai Pei Huihua Xue Junmei
Dai Wenjun Wei Min
Office of the Translation Committee Director Yang Mingshan
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Director Li Zhenji
Vice-Directors Shen Zhixiang Chen Xiaogu Zhou Zhongying Wang Canhui
Gan Zuwang Jiang Yuren
Members ( Listed in the order of the number of strokes in the Chinese ñames)
Ding Renqiang Shi Yanhua Li Guoding Shao Mingxi Gu Yuehua Tao Jinwen Ding Xiaohong Qiao Wenlei Yang Zhaomin Shi Bingbing Xu Fusong Huang Yage Wang Xinhua Yi Sumei Lu Mianmian Yao Xin Gao Yuanhang Fu Zhiwen You Benlin Li Fei Chen Songyu Xia Guicheng Zhu Fangshou Cai Li
General Compiler-in-Chief Zuo Yanfu
Executive Vice-General-Compilers-in-Chief Ma Jian Du Wendong
Vice-General-Compilers-in-Chief Chinese ñames) Ding Shuhua Wu Changguo Jin Hongzhu Huang Guicheng
(Listed in the order of the number of strokes in the
Wang Xudong Wang Lufen
Wang Shouchuan Wang Yue Zhao Jingsheng Tang Decai Zhai Yachun Fan Qiaoling
Office of the Compilation Board Committee Directors Ma Jian Du Wendong
Vice-Directors Wu Jianlong Zhu Changren
Publisher Zhu Bangxian
Yan Daonan Chen Yonghui Tan Yong
( Listed in the order of the number of strokes in the Chinese ñames)
Wang Lingli Wang Deliang He Qianqian
Zhang Xingjie Zhou Dunhua Shan Baozhi Qin Baoping Qian Jingzhuang Fan Yuqi
Chinese Editors
Ma Shengying Shen Chunhui Jiang Shuiyin Pan Zhaoxi
English Editors Shan Baozhi Jiang Shuiyin Xiao Yuanchun Cover Designer Wang Lei
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* * * « i ü &b rForeword I
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As we are walking into the 21st century, '‘health for all” is still an important task for the World Health Organization (W H O) to accomplish in the new century. The realization of “health for all” requires mutual cooperation and concerted efforts of various medical sciences, including traditional medi cine. W HO has increasingly emphasized the devel- opment of traditional medicine and has made fruitful efforts to promote its development. Currently the spectrum of diseases is changing and an increasing number of diseases are difficult to cure. The side effects of chemical drugs ha ve become more and more evident. Furthermore, both the governments and peoples in all countries are faced with the prob- lem of high cost of medical treatment. Traditional Chinese medicine (T C M ), the complete system of traditional medicine in the world with unique theory and excellent clinical curative effects, basically meets the need to solve such problems. Therefore, bringing TCM into full play in medical treatment and healthcare will certainly become one of the hot points in the world medical business in the 21st cen tury.
Various aspects of work need to be done to pro mote the course of the intemationalization of TCM, especially the compilation of works and textbooks suitable for international readers. The impending new century has witnessed the compilation of such a
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Foreword i
4
As we are walking into the 21st century, “health for all” is still an important task for the World Health Organization (W H O) to accomplish in the new century. The realization of “health for all” rcquires mutual cooperation and concerted efforts of various medical sciences, including traditional medi cine. W H O has increasingly emphasized the devel- opment of traditional medicine and has made fruitful efforts to promote its development. Currently the spectrum of diseases is changing and an increasing number of diseases are difficult to cure. The side effects of chemical drugs ha ve become more and more evident. Furthermore, both the governments and peoples in all countries are faced with the prob- lem of high cost of medical treatment. Traditional Chinese medicine (T C M ), the complete system of traditional medicine in the world with unique theory and excellent clinical curative effects, basically meets the need to solve such problems. Therefore, bringing TCM into full play in medical treatment and healthcare will certainly become one of the hot points in the world medical business in the 21st cen tury.
Various aspects of work need to be done to pro mote the course of the intemationalization of TCM, especially the compilation of works and textbooks suitable for international readers. The impending new century has witnessed the compilation of such a
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series of books known as A Newly Compiled Vractical English-Chinese Library o f Traditional Chinese Medicine published by the Publishing House of Shanghai University of TCM, compiled by Nan- jing University of TCM and translated by Shanghai University of TCM. Professor Zuo Yanfu, the general compilei^in-chief of this Library, is a person who sets his mind on the intemational dissemination of TCM. He has compiled General Suruey on TCM Abroad, a monograph on the development and state of TCM abroad. This Library is another important works written by the experts organized by him with the support of Nanjing University of TCM and Shanghai University of TCM. The compilation of this Library is done with consummate ingenuity and according to the development of TCM abroad. The compilers, based on the premise of preserving the genuineness and gist of TCM, have tried to make the contents concise, practical and easy to understand, making great efforts to introduce the abstruse ideas of TCM in a scientific and simple way as well as expounding the prevention and treatment of diseases which are commonly encoun- tered abroad and can be effectively treated by TCM.
This Library encompasses a systematic summa- rization of the teaching experience accumulated in Nanjing University of TCM and Shanghai University of TCM that run the collaborating centers of tradi tional medicine and the intemational training centers on acupuncture and moxibustion set by WHO. I am sure that the publication of this Library will further promote the development of traditional Chinese
med-• Foreword I • 3 •
k ine abroad and enable the whole world to have a j f c j f B | p ] 0 l»« tter understanding of traditional Chinese med
icine.
Professor Zhu Qingsheng %
Vice-Minister of Health Ministry of the People’s Republic of China
Director of the State Administrative Bureau of TCM
Foreword n
Before the existence of the modern medicine, Imman beings depended solely on herbal medicines mid other therapeutic methods to treat diseases and preserve health. Such a practice gave rise to the es- l/iblishment of various kinds of traditional medicine wilh unique theory and practice," such as traditional ( hiñese medicine, Indian medicine and Arabian medicine, etc. Among these traditional systems of medicine, traditional Chinese medicine is a most ex- traordinary one based on which traditional Korean medicine and Japanese medicine ha ve evolved.
Even in the 21st century, traditional medicine is siill of great vitality. In spite of the fast develop ment of modern medicine, traditional medicine is
f
«lili disseminated far and wide. In many developing nmntries, most of the people in the rural areas still depend on traditional medicine and traditional medi cal practitioners to meet the need for primary health- nirc. Even in the countries with advanced modern medicine' more and more people have begun to ac- ci'pt traditional medicine and other therapeutic meth-
<kIs, such as homeopathy, osteopathy and naturopa- ihy, etc.
With the change of the economy, culture and living style in various regions as well as the aging in the world population, the disease spectrum has chnnged. And such a change has paved the way for the new application of traditional medicine. Besides,
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g £ E # í r T * f W ® f f l . l i 5 Í f í l « » fthe new requirements initiated by the new diseases and the achievements and limitations of modern med icine have also created challenges for traditional med icine.
WHO sensed the importance of traditional medi cine to human health early in the 1970s and have made great efforts to develop traditional medicine. At the 29th world health congress held in 1976, the item of traditional medicine was adopted in the working plan of WHO. In the following world health congresses, a series of resolutions were pas- sed to demand the member countries to develop, uti- lize and study traditional medicine according to their specific conditions so as to reduce medical expenses for the realization of “health for all”.
W H O has laid great stress on the scientific con- tent, saífe and effective application of traditional medicine. It has published and distributed a series of l>ooklets on the scientific, safe and effective use of herbs and acupuncture and moxibustion. It has also made great contributions to the intemational stand ardizaron of traditional medical terms. The safe and effective application of traditional medicine has much to do with the skills of traditional medical practition- ers. That is why W H O has made great efforts to train them. W H O has run 27 collaborating centers in the world which have made great contributions to the training of acupuncturists and traditional medical practitioners. Nanjing University of TCM and Shanghai University of TCM run the collaborating centers with WHO. In recent years it has, with the coo|>eration of W H O and other countries, trained al>oiit ten thousand intemational students from over
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DO countries.
In order to further promote the dissemination of traditional Chinese medicine in the world, A Newly ( \mpiled P radical English-Chinese Library o f Traditional Chinese Medicine, compiled by Nanjing University of TCM with Professor Zuo Yanfu as the H»»ii(*ral compileHn-chief and published by the Pub- linlung House of Shanghai University of TCM, aims Al Mystematic, accurate and concise expounding of Irwliiional Chinese medical theory and introducing Mlnical therapeutic methods of traditional medicine Itocording to modern medical nomenclature of disea- ■§». Undoubtedly, this series of books will be the k iic ti cal text books for the beginners with certain Bn^lish level and the intemational enthusiasts with Mrtnin level of Chinese to study traditional Chinese tlirdicine. Besides, this series of books can also irrvr as reference books for W H O to internationally
I
(Inndiirdize the nomenclature of acupuncture and Moxihustion.
The scientific. safe and effective use of tradi-
ftloruil
medicine will certainly further promote the de- V*lopment of traditional medicine and traditional lunlicine will undoubtedly make more and more con- Irlliutions to human health in the 21st century.Zhang Xiaorui W H O Coordination Officer December, 2000 £ i£ m * E 2 ? ; * : # £ ]í íS » í f ' f i í í K i S É U I ,
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The Publishing House of Shanghai University OÍ TCM published A Practical English-Chinese Li- brury o f Traditional Chinese Medicine in 1990. nhe Library has been well-known in the world ever ■llce and has made great contributions to the dis- letnination of traditional Chinese medicine in the
World. In view of the fact that 10 years has passed
lince its publication and that there are certain errors Iti the explanation of traditional Chinese medicine in the Library, the Publishing House has invited Nan- jiiiK University of TCM and Shanghai University of
TCM
to organize experts to recompile and transíate lile Library.Nanjing University of TCM and Shanghai Uni- [VírMity of TCM are well-known for their advantages in liigher education of traditional Chinese medicine mui compilation of traditional Chinese medical text- IxKíks. The compilation of A Newly Compiled Jpradical English-Chinese Library o f Traditional ( límese Medicine has absorbed the rich experience ncc umulated by Nanjing University of Traditional ( límese Medicine in training intemational students
n i’ traditional Chinese medicine. Compared with the
l'i'evious Library, the Newly Compiled Library has fllide great improvements in many aspeets, fully il. iuonstrating the academic system of traditional ( hiñese medicine. The whole series of books has nyMtcmatically introduced the basic theory and
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1. Scientific Based on the development of TCM in education and research in the past 10 years. efforts have been made in the compilation to high- light the gist of TCM through accurate theoretical exposition and clinical p rae tice, aiming at introdu cing authentic theory and practice to the world.
2. Systematic This Library contains 14
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e i * E * BB m. ife h i + E & ®rni ir fascicles, i. e. Basic Theory o f Traditional í hiñese Medicine, Diagnostics o f Traditional i hiñese Medicine, Science o f Chinese Materia Medica, Science o f Prescriptions, Intemal Medi cine o f Traditional Chinese Medicine, Surgery o f Traditional Chinese Medicine, Gynecology o f Tra dicional Chinese Medicine, Pediatrics o f Tradition al ( hiñese Medicine, Traumatology and Orthopedics o f Traditional Chinese Medicine, Ophthalmology of Traditional Chinese Medicine, Otorhinolaryn- gology o f Traditional Chinese Medicine, Chinese Acupuncture and Moxibustion, Chinese Tuina ( Massage) , ara/ Lz/e Cultivation and Rehabilita ron o f Traditional Chinese Medicine.
3. Practical Compared with the previous Librar- y, the Newly Compiled Library has made great im- pi'ovements and supplements, systematically introdu- cing therapeutic methods for treating over 200 kinds of commonly and frequently encountered diseases, fo- Cusing on training basic clinical skills in acupuncture mui moxibustion, tuina therapy, life cultivation and Khabilitation with clinical case reports.
4. Standard This Library is reasonable in (tructure, distinct in categorization, standard in ter- minology and accurate in translation with full consid- rrnlion of habitual expressions used in countries and rcgions with English language as the mother tongue.
This series of books is not only practical for the licginners with certain competence of English to xtudy TCM, but also can serve as authentic text- lxx>ks for intemational students in universities and colleges of TCM in China to study and practice T( M For those from TCM field who are going to go
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abroad to do academic exchange, this series of books will provide them with unexpected convenience.
Professor Xiang Ping, President of Nanjing University of TCM, is the director of the Compila tion Board. Professor Zuo Yanfu from Nanjing Uni versity of TCM, General Compiler-in-Chief, is in charge of the compilation. Zhang Wenkang, Minis- ter of Health Ministry, is invited to be the honorary director of the Editorial Board. Li Zhenji, Vice-Di- rector of the State Administrative Bureau of TCM, is invited to be the director of the Approval Commit- i «c. Chen Keji, academician of China Academy, is invited to be the General Advisor. International ad visors invited are Mr. M. S. Khan,Chairman of Ire- land Acupuncture and Moxibustion Fund; Miss Alessandra Gulí, Chairman of “Nanjing Association” in Rome, Italy; Doctor Secondo Scarsella, Chief Ed itor of YI DAO ZA ZHI; President Raymond K. Carroll from Australian Oriental Touching Therapy College; Ms. Shulan Tang, Academic Executive of ATCM in Britain; Mr. Glovanni Maciocia from Britain; Mr. David, Chairman of American Associa tion of TCM; Mr. Tzu Kuo Shih, director of Chi nese Medical Technique Center in Connecticut, A- merica; Mr. Helmut Ziegler, director of TCM Cen ter in Germany; and Mr. Isigami Hiroshi from Ja- pan. Chen Ken, official of W H O responsible for the Western Pacific Región, has greatly encouraged the compilers in compiling this series of books. After the accomplishment of the compilation, Professor Zliu Qingsheng, Vice-Minister of Health Ministry and Director of the State Administrative Bureau of TCM, has set a high valué on the books in his
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Word for the Library. Zhang Xiaorui, an official front W H O ’s Traditional Medicine Program, has |mid great attention to the compilation and written a forcword for the Library. The officials from the edu- nilmnal organizations of China in other countries hit ve provided us with some useful materials in our compilation. They are Mr. Zhang Yiqun, China Cónsul to Manchester in Britain; Miss Yan Meihua, Cónsul to Houston in America; Mr. Wang Jiping, l'irst Secretary in the Educational Department in the Knibassy of China to France; and Mr. Gu Shengy- iriK• the Second Secretary in the Educational Depart- mnit in the Embassy of China to Germany. We are Kinteful to them all.
The Compilers
Note for Compilation
Diagnostics of TCM is a subject concentrating on diagnosis of diseases and differentiation of syndromes (hrough examination based on the theory and metho- dology of TCM. It serves as a bridge to connect the l>asic theory of TCM with clinical specialties and is the essential course for all clinical subjects.
This book, focusing on elucida tion of the theory and methods of TCM in examining pathological condi- tions as well as analyzing and differentiating syn dromes, is composed of introduction, diagnostic methods and syndrome differentiation. It is a sys tematic in itself and, at the same time, keeps a cióse association with the clinical specialties so as to pre serve the systematic and integral characteristics of TCM.
In the compilation, the authors have tried to preserve the unique features of TCM and demón strate the profound contení of TCM diagnostics on one hand, and unite theory and practice so as to Kiiide the clinical practice on the other. In the com pila tion, the authors have also tried to make it con- i ise, easy to read, fluent and accurate. For this pur- |x)se, some illustrations and colour pictures are in- cluded. We hope that this book will be beneficial to lx>th the intemational students with certain level of Chinese in learning traditional Chinese medicine and lite readers in China who are studying traditional Chí nese medicine or going abroad.
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Contents
Introduction ... ... i 1... Diagnostic m ethods... 7
1.1 Inspection... 8
1.1.1 Inspection of the whole body... 8 1. 1.1.1 Inspection of spirit ... ... 9 1. 1. 1. 2 Inspection of complexión ... 12 1. 1. 1. 3 Inspection of body ... 17 1. 1. 1. 4 Inspection of postures... 19 1. 1. 2 Inspection of local regions ... 22 1. 1. 2. 1 Inspection of head and hair ... 22 1. 1. 2. 2 Inspection of the five sense organs ... 25 1. 1. 2. 3 Inspection of neck ... 30 1. 1. 2. 4 Inspection of skin ... 31 1.1. 2. 5 Inspection of infantile index finger veins ... 35 1.1. 2. 6 Inspection of excreta ... 38 1.1. 3 Inspection of tongue ... 42 1. 1. 3.1 Methods for inspection of tongue ... 42 1. 1. 3. 2 Normal states of the tongue ... 44 1. 1. 3. 3 Inspection of the tongue body ... 44 1. 1. 3. 4 Inspection of tongue fur ... 52 1. 1. 3. 5 Comprehensive analysis of the body of the tongue and tongue fu r ... 58
1. 2 Listening and olfaction ... 60
1. 2. 1 Listening to sounds ... 60 1. 2. 1. 1 Speech ... 61 1. 2. 1. 2 Respiration ... 63 1. 2. 1. 3 Cough ... 65 1. 2. 1.4 Hiccup and belching ... 66 1.2.2 Olfaction ... *67
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1. 4. 1 Pulse-taking... 118 1.4. 1. 1 Regions and methods for taking pulse... 119 1. 4.1. 2 Normal pulse ... ... 123 1. 4.1. 3 Morbid pulse ... 125 1.4.2 Palpation ... 131 1. 4. 2. 1 Methods for palpation ... 132 1. 4. 2. 2 Pressing the chest and abdomen ... 133 1. 4. 2. 3 Palpation of the four limbs ... 136 1. 4. 2. 4 Palpation of acupoints ... 137
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2. 1 Syndrome differentiation with eight principies ... .138 2. 1. 1 Extemal and internal differentiation of syndromes ... .139 2.1. 1. 1 Extemal syndrome ... .140 2.1. 1. 2 Internal syndrome ...141 Appendix: Half external and half internal syndrome ... ...142 • 2. 1. 2 Syndrome differentiation of coid and heat ...142
2. 1. 2. 1 Coid syndrome ... .143 2. 1. 2. 2 Heat syndrome ... .144 2. 1. 3 Syndrome differentiation of asthenia and sthenia ... .145 2. 1. 3. 1 Asthenia syndrome ... .145 2. 1. 3. 2 Sthenia syndrome ... .147 Z. 1. 4 Syndrome differentiation of yin and yang... .148 2. 1. 4. 1 Yin syndrome and yang syndrome ... .148 2. 1. 4. 2 Yin asthenia syndrome and yang asthenia syndrome ...150 2. 1. 4. 3 Yin depletion syndrome and yang depletion syndrome ...152 2. 1. 5 Relationship among the eight principal syndromes ... .154 2. 1. 5.1 Relationship between two principies in a pair ... .154 2. 1. 5. 2 Relationship between different pairs of principies ... .167
2. 2 Syndrome differentiation of qi, blood and body fluid ... .172
2. 2. 1 Syndrome differentiation of qi disorders ... .172 2. 2. 1. 1 Qi asthenia syndrome ... .173 2. 2. 1. 2 Qi sinking syndrome ... .173 2. 2. 1. 3 Qi stagnation syndrome ...174 2. 2. 1. 4 Qi reversión syndrome ... ...175 2. 2. 2 Syndrome differentiation of blood disease ...176 2. 2. 2. 1 Blood asthenia syndrome ...176 2. 2. 2. 2 Blood stasis syndrome ... .177 2. 2. 2. 3 Blood coid syndrome ... .179 2. 2. 2. 4 Blood heat syndrome... .180 2. 2. 3 Syndrome differentiation of simultaneous disorder of qi and blood ... .181 2. 2. 3.1 Asthenia of both qi and blood ...181 2. 2. 3. 2 Qi asthenia and hemorrhagia syndrome ...182 2. 2. 3. 3 Depletion of qi with bleeding syndrome ...183 2. 2. 3. 4 Qi nmhenifl and blood stasis syndrome ...183
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2. 3. 4. 2 Syndrome of liver yin asthenia...221 2. 3. 4. 3 Syndrome of liver qi stagnation ... .222 2. 3. 4. 4 Syndrome of liver fire hyperactivity ... .223 2. 3. 4. 5 Syndrome of liver yang hyperactivity ... .225 2. 3. 4. 6 Syndrome of endogenous liver w ind... .226 2. 3. 4. 7 Syndrome of coid stagnation in the liver meridian ... .230 2. 3. 5 Syndrome differentiation of kidney disease ...231 2. 3. 5. 1 Syndrome of kidney yang asthenia ... .232 2. 3. 5. 2 Syndrome of edema due to kidney asthenia ... .233 2. 3. 5. 3 Syndrome of kidney yin asthenia ... .234 2. 3. 5. 4 Syndrome of kidney essence insufficiency ...235 2. 3. 5. 5 Syndrome of kidney qi weakness ... .236 2. 3. 5. 6 Syndrome of kidney failing to receive qi ...238 2. 3. 6 Syndrome differentiation of stomach disease ...239 2. 3. 6.1 Syndrome of stomach coid ...239 2. 3. 6. 2 Syndrome of stomach heat ...241 2. 3. 6. 3 Syndrome of food retention in the stomach ...242 2. 3. 6. 4 Syndrome of asthenic stomach yin ... .243 2. 3. 7 Syndrome differentiation of gallbladder disease ... .244 Syndrome of gallbladder stagnation and phlegm disturbance ... .245 2. 3. 8 Syndrome differentiation of small intestinal disease ... .246 Sthenic heat syndrome of small intestine ... .246 2. 3. 9 Syndrome differentiation of large intestinal disease... .247 2. 3. 9. 1 Syndrome of large intestinal fluid consumption ... .248 2. 3. 9. 2 Syndrome of large intestinal damp-heat ... .249 2. 3. 10 Syndrome differentiation of bladder disease ...250 Syndrome of damp heat in the bladder ...250 2. 3. 11 Syndrome differentiation of accompanying diseases of viscera ...251 2. 3. 11.1 Asthenia syndrome of heart and lung qi ...252 2. 3. 11. 2 Asthenia syndrome of heart and spleen...253 2. 3. 11. 3 Asthenia syndrome of heart and kidney yang ... .254 2. 3. 11.4 Syndrome of disharmony between the heart and kidney ...255 2. 3. 11. 5 Syndrome of lung and spleen qi asthenia ...256 2. 3. 11. 6 Syndrome of spleen and kidney yang asthenia ... .257 2. 3. 11.7 Syndrome of kidney and liver yin asthenia ...258
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2. 3. 11. 10 Syndrome of incoordination between liver and stomach...262 2. 3. 11. 11 Syndrome of damp-heat in liver and gallbladder... .263
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Introduction
% • &I )iagnostics of TCM is a subject concentrating on di- hHIiduín of diseases and differentiation of syndromes
iIihmikIi examination based on the theory and methodology mI | l M. Correct diagnosis and prognosis require thorough Utttk'i'Mtanding of the nature of the disease in question.
llioiHore, correct diagnosis is prerequisite to the treat- iiit ni, prognosis and prevention of disease. So diagnostics ni IVM serves as a bridge to connect the basic theory of IVM with clinical specialties and is the essential course Im ull clinical subjects, playing a very important role in
H M.
The diagnostics of TCM has been developed under llw fuidance of the basic theory of TCM and based on the i ||ni( ii I practice done by numerous doctors in the past
Um h in u ikIs of years. It is mainly composed of diagnostic
iiii'IIhkIs and syndrome differentiation. Diagnostic meth-
ml« iiic the methods used to examine patients and collect |Ml|lological data, mainly including inspection, listening mihI olíaction, inquiry and pulse-taking, known as the four illii(HOHtic methods. Syndrome differentiation means to ivnllifsize and analyze the pathological data so as to decide lht> imlure of the syndrome. The theory and methods for nyinhome differentiation include syndrome differentiation wllli i*ight principies, syndrome differentiation of causes, «ylidióme differentiation of qi, blood and body fluid, «yndrome differentiation of viscera, syndrome differentia- IItii| ol meridians, syndrome differentiation of six meridi- •in». syndrome differentiation of defensive qi, qi, nutrient
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qi and blood as well as syndrome differentiation of triple energizer. Various ways to differentiate syndrome are the theory and methods for analyzing and understanding the na ture of disease. They, though with their own charac- teristics and specific range, supplement each other and to- gether form the syndrome differentiation system in TCM.
Concept of organic wholeness is the main character- istics of the theoretic system of TCM which is thoroughly demonstrated by the diagnostics of TCM. In diagnosing pathological condi tions, deciding the category of disease and differentiating syndrome, TCM emphasizes the en- tirety.
1. Examination of entirety
The human body is an organic whole and constantly communicates with the extemal environment TCM lays much stress on the characteristics of the human body, such as the integrity, unity and association with the outer world. This idea is summed up as “ concept of organic wholeness” which is reflected as examination of entirety in the diagnostics of TCM.
Firstly, the human body is composed of various or- gans, viscera, meridians, constituents and orífices as well as essence, qi, blood and body fluid. Though possessing different functions, they are not isolated. Such an integral association of the human body is accomplished through the domination of the five zang-organs, supplementation of the six fu organs, association of the five constituents and five sensory organs and nine orífices, the extensive distri bu tion of the meridians and the transportation of essence, qi, blood and body fluid by the net of meridians. There- fore disorder of the viscera, essence, qi, blood and body fluid can be manifested on the superficial tissues and or gans. The local pathological changes can affect the whole
i.
Imdy and vice versa. So by observing the changes of the five aensory organs, shape of the body, complexión and |H,ilrir states, we can get to know the pathological changes tif the viscera, essence, qi, blood and body fluid. From IimmI changes one can get to know the pathological changes ni Ihe whole body. In this way correct diagnosis can be mude.
Secondly, there is a cióse relationship between man MHil nature. Weather changes and geographical changes
muiv affect the human body. On the other hand. the hu- MMti Ixxly is subjectively adaptable to the natural environ- (Ht’Ml. Ilowever, the dysfunction of the regulating ability ni Ihe human body or sudden violent changes of the na tu mi environment may lead to diseases. Besides, social en-
vlronment
frequently brings about stimulation to the mind «lid Hpirit of human beings, which may affect the visceral hllictions and lead to diseases. Therefore, natural and so- i luí íactors must be taken into consideration in the diagno- •Ih ni diseases.Thus, clinical diagnosis of disease must be done un- ilet Ihe guidance of concept of organic wholeness and with Inll n lien tion given to the unity and integration of the hu- litiin body as well as its cióse relationship with the envi- inninental factors. Only comprehensive inspection and ex- tVIMlve collection of data with thorough analysis ensures innei l diagnosis.
2. Combination of disease differentiation and ayndrome differentiation
I his ineans to decide the ñame of the disease and to illllei entiate the manifestations of the disease.
Disease means a pathological development course
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with certain rules caused by destruction of the healthy state due to certain pathogenic factors. This pathological development course manifests several special symptoms and syndromes corresponding to certain stages. Each dis ease has its own occurrence, development and varia tion principies. The disease ñame is the label of the disease in question. suchas dysentery, measles and asthina, etc.
Symptom refers to various abnormal manifestations of a disease, including the subjective sensation, such as headache, dizziness and thirst, etc. , and the signs ob- served by other people, such as reddish tongue, yellowish fur and rapid pulse, etc.
Syndrome is a summarization of the development of a disease at a certain stage, including cause, location, na- ture, pathogenesis and the relevant symptoms and signs. Take “external syndrome due to exogenous wind and coid” for example. It suggests that the cause is the invasión of wind and coid; the location is in the superficies; the na- ture is coid; the pathogenesis is wind and coid encumbe ring the superficies and the pulmonary qi failing to dis perse. The main symptoms brought about are mild fever, anhidrosis, pain of head and body, stuffy nose with clear nasal discharge, or cough, thin whitish fur as well as floating and tense pulse, etc. This problem can be re- lieved by expelling wind and dispersing coid or dispersing the lung and relieving superficial pathogenic factors. Oth- erwise, coid pathogenic factors may enter into the body and transform into heat, therefore worsening the prob lem.
Symptoms are the evidences for the differentiation of disease and syndrome. Both disease and syndrome
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wílect the understanding of llir tinturo ol disenso, liowev- t't. they emphasize on difíoreni aspeéis. Disease reflects lile general principies and characteristics of a disease. which is the primary contradiction of a disease. While nyndiome reflects the contradiction of a disease at the
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mi ve ral different syndromes known as “ the same disease With different syndromes”. While different diseases at a i e l liiin stage may manifest the same syndrome, known as "(lili erent diseases with the same syndrome”. Therefore, lite differentiation of disease and the differentiation of «yudrome refer to the understanding of the nature of a dlw ase from different angles. The differentiation of dis- PHM' is beneficial to the understanding of the nature of a i linease and the grasping of the developing tendeney and proKnosis from the whole developing course and charac- U’i iHtics. The differentiation of syndrome emphasizes on lite changes of a disease at a certain stage and the under- nliinding of the nature of a disease according to the present i lltiical manifestations to provide evidence for present llrjitment
Clinically, combined use of the di-fferentiation of (linease and the differentiation of syndrome is made of so im lo make them supplement each other for the benefit of lovealing the nature of the disease in question and making llie diagnosis more accurate, correct and specific.
What should be made clear here is that the differenti- nIion of disease is the main work of all clinical specialties, wlik h is not discussed in detail in this book.
3. Synthetic use of all diagnostic methods
This means that, in diagnosing a disease, one must
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try to collect as detailed as possible the data for compre- hensive analysis of the disease. The manifestations of a disease are múltiple and complicated. The data collected with the four diagnostic methods are the evidences for the differentiation of both disease and syndrome. Whether the data collected with the four diagnostic methods is accurate or not directly affect the accuracy of the differentiation of lx>th disease and syndrome. The four diagnostic methods
are used to examine disease and collect data from different angles. They are significant in diagnosis, however, they still have some limitations and cannot replace each other. So it is improper to stress on one of them and neglect the others. In order to fully understand the pathological con di tions of a disease and collect reliable and detailed data, these four methods should be used together and the data collected should be analyzed synthetically.
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1 Diasnostic methods
^ c á rDiagnostic methods are the methods used to collect dula related to pathological conditions, including inspec- tlon. listening and smelling, inquiry and pulse-taking. In- H|H-clion means to examine the external manifestations and excreta; listening and smelling means to examine the H|X'ech, breath and odor of the patient; inquiry means to «el to know the occurrence, development and treatment of the disease as well as the present symptoms and other Information relevant to the disease by asking the patient Or the people accompanying the patient; pulse-taking means to examine the pulse and the related regions of the IKitient.
The human body is a organic whole. Under morbid conditions, local pathological changes may affect the Whole body; internal pathological changes can be manifes- lr<l Ihrough the five sensory organs. the four limbs and lile superficies. With the examination of the symptoms «lid signs of a disease by means of the four diagnostic methods, one can understand the cause of the disease and niiülyze the pathogenesis of the disease so as to provide pvideuce for deciding treatment based on syndrome differ- ciiliation.
The four diagnostic methods are used to examine dis- ciisc l'rom different angles and they cannot. replace each nther in diagnosis. So in clinical practice, they are usually liNed in combination for systematic understanding of a dis- rnse in order to ensure comprehensive analysis and correct
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diagnosis.
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Inspection
■*& m.í i?Inspection means that the doctor use his or her eyes to examine the vitality, colour, shape and posture of the patient’s whole body or local región as well as inspect the colour, quantity and texture of the excreta for the purpose of understanding pathological conditions.
Inspection is a convenient and important method for diagnosing disease. It not only enables the doctor to get necessary data, but also provides trace for further diagno sis. Therefore, doctors must have keen powers of obser- vation in clinical practice.
Inspection should be done in the place with full light, especially natural light. If done in the light of lamp, cares should lx; takeii to avoid the influence of the light itself.
The rango for inspection is extensive, including all iih|xv!h visible lo the naked eyes. In general, the aspects for inspection include the whole body, local región and tongue.
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Inspection of the whole body
Inspection of the whole body, also known as general inspection, refers to purposeful examination of the spirit, colour, shape and posture of the whole body so as to have a general understanding of the disease.
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Inspection of spirit
Spirit refers to the general manifestations of life ac-
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The material base of spirit is essence. The congenital pnnoikv depends on the cereal nutrients to nourish and piomote as well as the normal visceral functions to pro- Im l That is why the spirit is said to be the external man- |frntations of the conditions of visceral essence. Inspec-I Inspec-Ion of spirit can enable one to understand whether the es- wini e is exuberant or deficient and whether the visceral functions are strong or weak. Such an understanding is lin|X)rtant to the analysis as whether the pathological con- ililions are light or serious and whether the prognosis is Irnign or malignant.
Inspection of spirit mainly focuses on the examination ni Hit' mental states and emotional conditions, including Itilínl expressions, complexión, eye expressions, speech, lircath, physical conditions and response to the external «llmulation, etc. Since the visceral essence infuses up- wnnl into the eyes and the ocular system is connected with llir brain, and also because the eye is the orífice related to lili' liver, governed by the heart and housing the spirit the Itmpi'ction of eye expressions is very important. Inspec- llnn of spirit means, by examining of the aspects men- llont'd abo ve, to differentiate whether the spirit is in ex- lnli'iice, deficient, lost, false or in disorder for the pur- |Mii4c of deciding whether the healthy qi is abundant or de- llcieiil, the visceral functions are strong or weak, the INithological conditions are light or serious and the progno sis is Ix-nign or malignant.
1 .1 .1 .1 .1 Existence of s p irit
The manifestations are mental consciousness, normal vitahly. natural facial expressions. ruddy complexión,
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flexible eyes with brightness and vitality, accurate verbal expression and reply, normal voice and breath, normal and natural movement of the limbs. These manifestations suggest non-impairment of healthy qi, normal visceral functions, mild pathological conditions, or favourable prognosis even for serious diseases.
1 .1 .1 .1 .2 Lack of spirit, also known as insuf- ficiency of spirit
The manifestations are mental consciousness, dispiri- tedness, palé complexión, dull expressions of eyes, short of breath. no desire to speak and low voice. These mani festations suggest mild consumption of healthy qi, weak visceral functions, more serious disease and better prog nosis. These manifestations are usually seen in patients at the rehabilitating stage or with weak constitution.
1 .1 .1 .1 .3 Loss of spirit, also known as deple- tion of spirit
The manifestations are dispiritedness, palé complex ión, dull eye expressions, weak breath or dyspnea, ema- ciation, difficulty in'movement, retard response or even unconsciousness; or coma with delirium and floccitation. The former suggests great impairment of the primordial qi and decline of the visceral functions, usually seen in chro- nic disease and serious disease with unfavourable progno sis. The latter suggests exuberance of pathogenic factors and serious disturbance of the viscera, often seen in criti- cal pathological conditions with unfavourable prognosis.
1 .1 .1 .1 .4 False spirit
False spirit is usually seen in prolonged disease, seri ous disease and extreme exhaustion of essence with the talse manifestations in disagreement with the na ture of the disease. For example, dull or palé complexión suddenly
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