‘What Nigel Ching has achieved in this thorough and detailed study of

traditional Chinese diagnosis is to outline and explain clearly both the

methodology and, perhaps more importantly, the thinking behind it. It is

DIAGNOSIS IN Chinese Medicine

especially this that I am convinced will prove to be indispensable to both
students and interested readers.’
– from the Foreword by Jeremy Halpin, acupuncturist,
Zen-shiatsu therapist and teacher

The Art and Practice OF

This textbook on diagnosis in Chinese medicine is unique in its clarity and
accessibility.
Divided into two parts, it is a comprehensive diagnostic manual. The first
part explains how to collect and collate the information required to formulate

Nigel Ching
a diagnosis and is divided into four approaches: visual, palpation, interrogation
and listening/smelling. The second part describes the various diagnostic
models in Chinese medicine, including the Eight Principles; zangfu organ
patterns; the Six Stages, Four Levels and san jiao; the 12 regular channels
and eight extraordinary vessels; and the Five Phases.

Nigel Ching is a lecturer in Chinese Medicine and course director at the

Nordisk Akupunktur Uddannelse, Denmark. With over 25 years of clinical
experience, Nigel lectures widely in Scandinavia, Germany, the UK, Greece
and Finland and is the author of The Fundamentals of Acupuncture, also
The Art and Practice
Diagnosis
published by Singing Dragon.
OF in
Chinese Medicine
SINGING DRAGON

Nigel Ching
Fore word by Je re my Ha l pin
www.singingdragon.com
Cover design: Black Dog Design
The Art and Practice of Diagnosis
in Chinese Medicine
by the same author

The Fundamentals of Acupuncture

Nigel Ching
Foreword by Charles Buck
ISBN 978 1 84819 313 0
eISBN 978 0 85701 266 1

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Roots of Modern Practice
Charles Buck
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eISBN 978 0 85701 133 6

The Acupuncture Points Functions Colouring Book

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Forewords by Richard Blackwell, and Angela Hicks and John Hicks
ISBN 978 1 84819 266 9
eISBN 978 0 85701 214 2

The Spark in the Machine

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The Art and Practice of Diagnosis in

CHINESE MEDICINE

NIGEL CHING
Foreword by Jeremy Halpin

LONDON AND PHILADELPHIA

Disclaimer: The author and the publisher assume no responsibility for the
treatments carried out in relation to the instructions in this book.
English language edition first published in 2017
by Singing Dragon
an imprint of Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.singingdragon.com
First published in Danish as Kunsten at diagnosticere med Kinesisk medicin
by Klitrose Publishers, Copenhagen, Denmark, 2009
Copyright © Nigel Ching 2017
Foreword copyright © Jeremy Halpin 2017
All rights reserved. No part of this publication may be reproduced in any material form
(including photocopying, storing in any medium by electronic means or transmitting) without
the written permission of the copyright owner except in accordance with the provisions of
the law or under terms of a licence issued in the UK by the Copyright Licensing Agency
Ltd. www.cla.co.uk or in overseas territories by the relevant reproduction rights organisation,
for details see www.ifrro.org. Applications for the copyright owner’s written permission
to reproduce any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work may
result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
Names: Ching, Nigel, 1962- author.
Title: The art and practice of diagnosis in Chinese medicine / Nigel Ching.
Description: London ; Philadelphia : Singing Dragon/Jessica Kingsley
Publishers, 2017. | Includes bibliographical references.
Identifiers: LCCN 2016056990 (print) | LCCN 2016058175 (ebook) | ISBN
9781848193147 (alk. paper) | ISBN 9780857012678 (ebook)
Subjects: | MESH: Medicine, Chinese Traditional--methods | Diagnostic
Techniques and Procedures
Classification: LCC R601 (print) | LCC R601 (ebook) | NLM WB 55.C4 | DDC
610--dc23
LC record available at https://lccn.loc.gov/2016056990
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84819 314 7
eISBN 978 0 85701 267 8
Dedicated to my granddaughter ‘5316’, my parents
and all the family and friends between them.
If a man will begin with certainties, he shall end in doubts; but if
he will be content to begin with doubts, he shall end in certainties.
Francis Bacon 1561–1626
 CONTENTS

Foreword by Jeremy Halpin . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Art of Diagnosis or How to Diagnose in Chinese Medicine 17
Diagnostic prerequisites . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Western diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The diagnostic process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Diagnostic models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Treating complex patients with many patterns of imbalances . . . . . . . . . 34

Part 1: The Diagnostic Pillars

Introduction to the Diagnostic Pillars 36
Section 1: The Diagnostic Pillar: Visual Observation 39
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Visual diagnosis of a person’s shen . . . . . . . . . . . . . . . . . . . . . . . 41
Visual diagnosis of the body shape and posture . . . . . . . . . . . . . . . . 44
Visual diagnosis of a person’s movements . . . . . . . . . . . . . . . . . . . 49
Visual diagnosis of a person’s clothing . . . . . . . . . . . . . . . . . . . . . 52
Visual diagnosis of the face . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Visual diagnosis of the eyes . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Visual diagnosis of the area around the eyes . . . . . . . . . . . . . . . . . . 65
Visual diagnosis of the forehead, the root of the nose and the area
between the eyebrows . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Visual diagnosis of the nose . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Visual diagnosis of the ears . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Visual diagnosis of the lips. . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Visual diagnosis of the mouth . . . . . . . . . . . . . . . . . . . . . . . . . 72
Visual diagnosis of the gums . . . . . . . . . . . . . . . . . . . . . . . . . 73
Visual diagnosis of the tongue . . . . . . . . . . . . . . . . . . . . . . . . . 73
Visual diagnosis of the hair . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Visual diagnosis of the body hair . . . . . . . . . . . . . . . . . . . . . . . 96
Visual diagnosis of the throat . . . . . . . . . . . . . . . . . . . . . . . . . 97
Visual diagnosis of the chest and the back . . . . . . . . . . . . . . . . . . . 98
Visual diagnosis of the back . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Visual diagnosis of the limbs . . . . . . . . . . . . . . . . . . . . . . . . . 99
Visual diagnosis of the joints . . . . . . . . . . . . . . . . . . . . . . . . . 100
Visual diagnosis of the hands . . . . . . . . . . . . . . . . . . . . . . . . . 101
Visual diagnosis of the skin . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Visual diagnosis of veins . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Visual diagnosis of skin lesions . . . . . . . . . . . . . . . . . . . . . . . . 109
Visual diagnosis of acupuncture points and channels . . . . . . . . . . . . . 112
Visual diagnosis according to micro-systems such as ear acupuncture . . . . . 113
Appendix to Section 1: Visual Diagnosis of Children . . . . . . . . . . . . . 117
 Section 2: The Diagnostic Pillar: Listening and Smelling 124
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Auditory diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Auditory diagnosis of the person’s voice . . . . . . . . . . . . . . . . . . . . 126
The Five Phases in the voice . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Quality of the voice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Auditory diagnosis of other sounds coming from the mouth, nose and chest . 138
Diagnosis of sounds from the abdominal cavity . . . . . . . . . . . . . . . . 141
Olfactory diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Section 3: The Diagnostic Pillar: Palpation 148
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Pulse diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Palpation of the abdomen, including Hara diagnosis . . . . . . . . . . . . . 183
Palpation of the thorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Palpation of the skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Palpation of the hands and feet . . . . . . . . . . . . . . . . . . . . . . . . 190
Palpation of acupuncture points, channels and micro-systems . . . . . . . . 191
Section 4: The Diagnostic Pillar: Interviewing 195
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Interviewing techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
The 10 questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
General questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Disease history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Energy levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Sweating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Thirst, appetite and taste . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Stools and urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Heart, thorax and Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Skin, hair and nails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
The ears and eyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Enquiry that is specific to women . . . . . . . . . . . . . . . . . . . . . . . 241
Enquiry that is specific to men . . . . . . . . . . . . . . . . . . . . . . . . 248
Enquiry with regard to the emotions and mental state . . . . . . . . . . . . . 251
Lifestyle and diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Part 2: The Diagnostic Models

Introduction 258
Section 5: Diagnosis According to the Eight Principles 261
Interior and exterior imbalances . . . . . . . . . . . . . . . . . . . . . . . . 263
Exterior imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Interior imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Hot and Cold imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
 Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Combined Hot and Cold patterns . . . . . . . . . . . . . . . . . . . . . . 288
Xu and Shi imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Xu conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Shi conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Yin and yang imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Section 6: Diagnosis According to Xie Qi . . . . . . . . . . . . . . . 305
Wind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Invasion of exogenous Wind . . . . . . . . . . . . . . . . . . . . . . . . . 311
Internally generated Wind . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Dampness and Damp-Heat . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Exogenous Dampness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Internally generated Dampness . . . . . . . . . . . . . . . . . . . . . . . . 324
Summer-Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Heat and Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Shi Heat and Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Xu Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
Dryness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Exogenous Dryness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Internal Dryness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Phlegm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
Xue stagnation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Food stagnation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
Section 7: Diagnosis According to Qi, Xue and Jinye Imbalances 355
Qi imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Xue imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Jinye imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Section 8: Diagnosis According to Zangfu Organ Patterns 393
Lung imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Large Intestine imbalance . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Stomach imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
Spleen imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
Heart imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Small Intestine imbalance . . . . . . . . . . . . . . . . . . . . . . . . . . . 524
Urinary Bladder imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . 532
Kidney imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
Pericardium and san jiao imbalances . . . . . . . . . . . . . . . . . . . . . 577
Gall Bladder imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 580
Liver imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590
Section 9: Diagnosis According to the Six Stages,
Four Levels and San Jiao 641
Diagnosis according to the Six Stages . . . . . . . . . . . . . . . . . . . . . 642
Diagnosis according to the Four Levels . . . . . . . . . . . . . . . . . . . . 669
Diagnosis according to San Jiao theory . . . . . . . . . . . . . . . . . . . . 696
Section 10: Diagnosis According to the 12 Regular Channels 712
Lung channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 715
Large Intestine channel imbalances . . . . . . . . . . . . . . . . . . . . . . 715
Stomach channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . 716
Spleen channel imbalances. . . . . . . . . . . . . . . . . . . . . . . . . . . 717
Heart channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 717
Small Intestine channel imbalances . . . . . . . . . . . . . . . . . . . . . . 718
Urinary Bladder channel imbalances. . . . . . . . . . . . . . . . . . . . . . 718
Kidney channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Pericardium channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . 719
San jiao channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Gall Bladder channel imbalances . . . . . . . . . . . . . . . . . . . . . . . 720
Liver channel imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 720
Section 11: Diagnosis According to the
Eight Extraordinary Vessels 722
Du mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 723
Ren mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 724
Chong mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725
Dai mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725
Yin qiao mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 726
Yang qiao mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Yin wei mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Yang wei mai imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 728
Section 12: Diagnosis According to the Five Phases 729
Sheng phase patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729
Ke phase dominating patterns . . . . . . . . . . . . . . . . . . . . . . . . . 732
Ke phase ‘insulting’ patterns . . . . . . . . . . . . . . . . . . . . . . . . . . 735

Appendix 1: Supporting the Treatment of the Patient through YANGSHEN . . 738

Appendix 2: The Energetic Properties of Certain Foods. . . . . . . . . . . . 754
Appendix 3: Herbal Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . 758
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 768
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 771
Endnotes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 773
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 775