Dr Zijing Hu (M.B. M.

Med)

Chinese Medicine Diagnostics Lecturer: Department of

Complementary Medicine
(Acupuncture)

(Differentiation of diease nature) Faculty of Health Sciences

University of Johannesburg
Table of contents

Syndrome differentiation of qi disorders

Syndrome differentiation of blood disorders

Syndrome differentiation of fluid disorders

Syndrome differentiation of yin yang disorders

Combination of the qi, blood and fluid factors

Syndrome differentiation of qi disorders

• Deficiency syndromes
• Qi deficiency
• This syndrome manifests as insufficient yuan-primordial qi and hypofunctions of the zang-
fu organs.
• Signs and symptoms
• These include shortness of breath, no desire to talk, mental fatigue and lassitude.
• Patients may present with dizziness, blurred vision, spontaneous sweating, wind
intolerance and susceptibility to common colds.
• The symptoms aggravate upon physical exertions. The tongue is pale and tender. The
pulse is deficient.
• Key points
• Shortness of breath, no desire to talk, mental fatigue, lassitude and a deficient pulse.
• Qi sinking
• Also known as spleen-qi sinking, this syndrome manifests as spleen qi failing to ascend.
• Signs and symptoms
• These include dizziness, blurred vision, tinnitus, mental fatigue and shortness of breath.
• Patients may experience prolapse of internal organs, such as the rectum or uterus. The
tongue is pale and tender. The pulse is weak.
• Key points
• Falling of qi, prolapsed organs and typical qi-deficiency symptoms.
• Qi insecurity
• This syndrome manifests as qi failing to secure essence, blood and body fluids, etc.
• Signs and symptoms
• These include spontaneous sweating, chronic bleeding, bowel and bladder incontinence,
nocturnal emissions, premature ejaculation, miscarriages and metrostaxis and general qi-
deficiency symptoms.
• Key points
• Spontaneous sweating, insecurity of bowel and bladder movements, semen and foetus,
etc., and general qi-deficiency symptoms.
• Qi collapse
• This syndrome manifests as a critical condition due to extreme failure of yuan-primordial
qi.
• Signs and symptoms
• These include fainting, irregular breathing, unconsciousness or sudden collapse,
persistent sweating, cold limbs, a pale complexion, flaccidity of the hands and body,
bowel and bladder incontinence and an open mouth with closed eyes.
• The tongue is pale white with a white moist coating.
• The pulse is extremely feeble.
• Key points
• Faint breathing, unconsciousness or sudden collapse, persistent sweating and an
extremely feeble pulse.
• Excess syndrome
• Qi stagnation
• This syndrome manifests as obstructed qi circulation in certain body parts, zang-fu organs
or meridians.
• Signs and symptoms
• These include localized or general distension and pain.
• The pain can be distending and migratory.
• The pain varies in intensity and has no fixed positions.
• There are no masses upon pressure.
• The pain and distension can be alleviated by belching, bowel sounds, flatulence and
sighing but is aggravated by emotional fluctuations.
• The pulse is wiry.
• Key points
• Localised or general distension and pain, a wiry pulse.

• Qi counterflow
• This syndrome manifests as adverse ascending of qi.
• Signs and symptoms
• These include coughing, tachypnoea, hiccups, belching, nausea, vomiting, headache, vertigo,
dizziness, fainting and qi rushing up from the lateral lower abdomen to the chest and throat.
• Key points
• Coughing and tachypnoea; or vomiting and hiccups; or headache and vertigo.
• Qi blockage
• This syndrome manifests as a qi disorder and qi obstruction due to pathogenic factors
blocking qi activity of the zang-fu organs.
• Signs and symptoms
• These include unconsciousness and syncope.
• Patients may also present with colic pain of the zang-fu organs, obstruction of the bowel
and bladder movements, and fast breathing with a high-pitched sound
• The pulse is deep, excessive and forceful.
• Key points
• Colic pain of the zang-fu organs and obstruction of the bowel and bladder movements.
Table of contents

Syndrome differentiation of qi disorders

Syndrome differentiation of blood disorders

Syndrome differentiation of fluid disorders

Syndrome differentiation of yin yang disorders

Combination of the qi, blood and fluid factors

Syndrome differentiation of blood disorders

• Deficiency syndromes
• Blood deficiency
• This syndrome manifests as blood failing to nourish the zang-fu organs, meridians and
tissues.
• Signs and symptoms
• These include a pale or sallow complexion, pale eyelids, lips, tongue and finger/toenails,
dizziness, blurred vision, dry eyes, palpitations, dream-disturbed sleep, poor memory, and
numbness in the hands and feet.
• Female patients may present with scanty menstruation pale in colour, delayed period or
amenorrhoea. The pulse is thready and weak.
• Key points
• A pale complexion, lips, tongue and eyelids and a thready pulse.
• Blood collapse
• This syndrome manifests as a critical condition due to a sudden excessive bleeding or
chronic repeated bleeding.
• Signs and symptoms
• These include a pale face, dizziness, blurred vision, palpitations and shortness of breath.
• Some patients may present with cold limbs.
• The tongue is dry and pale.
• The pulse is feeble or hollow.
• Key points
• A history of severe blood loss, a pale complexion and a feeble or hollow pulse.
• Excess syndrome
• Blood stasis
• This syndrome manifests as an obstructed circulation of blood due to stagnant blood.
• Signs and symptoms
• These include pain, lumps, bleeding and typical skin, tongue and pulse conditions
indicative of blood stasis.
• Patients may experience stabbing pain and tenderness in a fixed position and the pain is
worse at night.
• The lumps appear bluish purple on the surface of the body.
• Abdominal lumps are hard, immobile and painful upon pressure.
• Bleeding is often recurrent.
• The blood is dark purple or there are blood clots.
• Patients may have tar-like stools or uterine bleeding.
• Patients with blood stasis often have a dark complexion, cyanotic lips and finger/toenails,
subcutaneous bruises, dry, rough skin, varicose abdominal veins or filamentous, red
threads on the skin.
• The tongue is purple with stasis spots, possibly distended purple sublingual veins.
• The pulse is thready and hesitant. Sometimes the pulse can be knotted, regularly
intermittent or impalpable.
• Key points
• Stabbing pain in fixed positions, lumps, bleeding and typical skin and pulse conditions
indicative of blood stasis
• Blood heat
• Known as a heat syndrome in the blood level, this syndrome manifests as internal
exuberant fire/heat, heat affecting the blood level.
• Signs and symptoms
• This includes a variety of bleeding disorders which are deep red colour, have maculae,
sores or ulcers, fevers that worsens at night, thirst, a red face and eyes, vexation,
insomnia and restlessness. In severe cases, patients may present with mania, confusion
and delirium. The tongue is deep red. The pulse is rapid and swift.
• Key points
• Fever, thirst, maculae, restlessness, delirium, a deep red tongue and a rapid pulse.
• Blood-cold
• Known as cold syndrome in the blood level, this syndrome manifests as stagnation of qi
and blood due to cold affecting blood and blood vessels.
• Signs and symptoms
• These include cold pain and contracture in the hands, feet and/or lateral lower abdomen
that can be alleviated by warmth, dark purple skin with a cold sensation, dysmenorrhoea
with dark purple menstrual blood and clots, delayed period, cold intolerance and a bluish-
purple lips.
• The tongue is bluish-purple with a white slippery coating.
• The pulse is deep, slow and wiry.
• Key points
• Cold pain and contracture in the affected area, dysmenorrhea, cold intolerance and
bluish-purple lips and tongue.
Table of contents

Syndrome differentiation of qi disorders

Syndrome differentiation of blood disorders

Syndrome differentiation of fluid disorders

Syndrome differentiation of yin yang disorders

Combination of the qi, blood and fluid factors

Syndrome differentiation of fluids disorders

• Insufficiency of fluids
• This syndrome manifests as failure of body fluids to moisten, nourish and enrich the zang-
fu organs, tissues and sense organs.
• Signs and symptoms
• These include a dry mouth, nose, lips, tongue, throat and stools.
• Patients may present with dry, withered and non-elastic skin, sunken eyes, thirst with a
desire to drink water and scanty, yellow urine.
• The tongue is red.
• The pulse is thready, rapid and weak.
• Key points
• Thirst, scanty urine and a dry mouth, nose, lips, tongue, skin and stools.
• Internal retention of fluids
• Phlegm retention
• This syndrome manifests as retention of phlegm-turbidity in certain body areas or
throughout the entire body.
• Signs and symptoms
• These include cough with profuse, thick, sticky phlegm, chest and stomach fullness,
nausea, vomiting, and a poor appetite.
• Alternatively, patients may experience dizziness, blurred vision, obesity, numbness of the
limbs and hemiplegia.
• In some cases, signs and symptoms my include unconsciousness, phlegm gurgling in the
throat, mental confusion including depression, mania, dementia, epilepsy and/or smooth
flexible lumps in certain body area such as scrofula, goiter, breast nodules and
subcutaneous nodules.
• The tongue coating is greasy.
• The pulse is slippery.

• Key points
• Cough with profuse phlegm, chest and stomach fullness, nausea, vomiting, dizziness,
obesity, localized lumps, a greasy tongue coating and a slippery pulse.
• Fluid retention
• This syndrome manifests as fluid retention in the stomach, intestines, chest, pericardium,
lung and surface of the body.
• Signs and symptoms
• These include gastric and abdominal fullness and distension, vomiting, splashing sounds
in the stomach, gurgling sounds in the intestines.
• Some patients may present with rib fullness and pain upon coughing, spitting and/or
rolling over.
• In some cases, signs and symptoms may include chest tightness, palpitations, rapid
breathing, shortness of breath with an inability to lie flat, body or joint pain, coughing with
a thin, clear sputum, wheezing sounds in the throat, dizziness and blurred vision.
• The tongue coating is white and slippery. The pulse is wiry.
• Key points
• Chest and stomach fullness, vomiting of phlegm-drool, coughing with thin clear sputum,
rib fullness, a slippery tongue coating and a wiry pulse.

• Water retention
• This syndrome mainly manifests as water retention in the skin or abdominal cavity.
• Signs and symptoms
• These include facial puffiness, oedema of the lower limbs or pitting oedema, or abdominal
fullness, distension and swelling with a dull sound upon percussion, scanty urine,
inhibited urination and body heaviness.
• The tongue is pale and enlarged with a white and slippery coating.
• The pulse is soft and moderate.
• Oedema can be categorised into yang oedema and yin oedema.
• Yang oedema (excess in nature) is often caused by exogenous pathogenic wind or water
dampness and associated with the lung and spleen.
• Clinically, patients may experience sudden onset of facial puffiness, oedema spreading
from the eyelids to the entire body, scanty urine, and present with tight, shiny skin.
• In case of failure of the lung to regulate the water passages, also known as struggling
between wind and water, associated symptoms include chills, fever, joint soreness and
pain, a thin, white tongue coating/red tongue tip with thin yellow coating, and a tight,
floating pulse/rapid, floating pulse.
• In case of internal dampness due to spleen deficiency, associated symptoms include a
gradual onset of general pitting oedema, a heavy sensation of the body, lassitude, scanty
urine, gastric fullness, a poor appetite, nausea, vomiting, a white, greasy tongue coating
and a deep pulse.
• Yin oedema (combined deficiency and excess) is often caused by deficiency of healthy qi
due to chronic conditions, overstrain and sexual indulgence. It is mainly associated with
yang deficiency of the spleen and kidney.
• Clinically, patients may experience oedema in the lower limbs (below the waist) pitting
oedema, a gray-dark skin colour, scanty urine, gastric fullness, abdominal distension, a
poor appetite, loose stools, a pale complexion with facial oedema, cold intolerance,
mental fatigue, soreness and cold sensation in the lower back and knee joints, a pale
enlarged tongue with a white, slippery coating and a deep, slow and weak pulse.

• Key points
• Oedema of the lower limbs/abdominal fullness and distension, inhibited urination and a
pale, enlarged tongue.
Table of contents

Syndrome differentiation of qi disorders

Syndrome differentiation of blood disorders

Syndrome differentiation of fluid disorders

Syndrome differentiation of yin yang disorders

Combination of the qi, blood and fluid factors

Syndrome differentiation of yin yang disorders

• Yin deficiency
• This syndrome manifests as deficiency and heat due to yin fluids failing to cool, moisten
and nurture the body.
• Signs and symptoms
• These include feverish sensations in the palms, soles and chest, tidal fever, night sweats,
flushed cheeks, a dry mouth and throat, weight loss, scanty and yellow urine and dry
stools.
• The tongue is red with scanty coating.
• The pulse is thready and rapid.
• Key points
• These include tidal fever, night sweats, a dry mouth and throat, a red tongue with a scanty
coating and a thready, rapid pulse.
• Yang deficiency
• This syndrome manifests as deficiency and cold due to failure of yang qi to warm,
promote and transform.
• Signs and symptoms
• These include cold intolerance, cold limbs, mental fatigue, lassitude, shortness of breath,
tastelessness with an absence of thirst or thirst with a preference for hot water, loose
stools, clear profuse urine or scanty difficult urination and a pale complexion with facial
oedema.
• The tongue is tender and enlarged with a white, slippery coating. The pulse is deep, slow
and weak.
• Key points
• Cold intolerance, cold limbs, tastelessness with an absence of thirst, a tender enlarged
tongue, and a deep, slow and weak pulse.
• Yin depletion
• This syndrome manifests as a critical condition due to severe consumption or exhaustion
of yin fluid.
• Signs and symptoms
• These include hot, sticky sweats (oily sweat beads), restlessness, agitation, flushed face/
cheeks, hot skin, warm hands and feet, aversion to heat, rapid breathing, thirst with a
desire to drink water, dry skin, extremely scanty urine and dry lips and tongue.
• The pulse is thready, rapid, swift and weak upon heavy pressure.
• Key points
• Oily sweats, fever, restlessness, thirst and a thready, rapid and swift pulse.
• Yang depletion
• This syndrome manifests as a critical condition due to extreme debility and exhaustion of
yang qi.
• Signs and symptoms
• This includes dribbling of clear, cold sweats, cold skin, cold hands and feet (below the
elbows and knees), a pale complexion, faint breath and a dull facial expression.
• The tongue is pale.
• The pulse is extremely feeble.
• Key points
• Cold sweats, cold hands and feet, a pale face and a feeble pulse.
 Sweats Cold/heat Hands/ Facial Breath Thirst Lips Pulse
feet complexion /tongue
Yang Clear cold Cold skin, Cold Pale Faint No thirst or Pale lips Extremely
depletion cold thirst with a and tongue feeble
intoleranc preference with a
e for hot white,
water moist
coating
Yin Sticky, hot Fever, Warm Flushed Rapid Thirst with a Dry red lips Thready,
depletion (salty) aversion face/cheeks preference and tongue rapid, swift
to heat for cold and weak
water
Table of contents

Syndrome differentiation of qi disorders

Syndrome differentiation of blood disorders

Syndrome differentiation of fluid disorders

Syndrome differentiation of yin yang disorders

Combination of the qi, blood and fluid factors

Syndromes of combined disorders involving
qi, blood, body fluids, yin and yang

• Deficiency of qi and blood

• This syndrome manifests as deficiency of both qi and blood.
• Signs and symptoms
• These include mental fatigue, lassitude, no desire to talk, shortness of breath,
spontaneous sweating, a pale face, lips, tongue and finger/toenails, numbness in the
hands and feet, scanty menstruation, dizziness, blurred vision, palpitations and dream-
disturbed sleep.
• The tongue is pale.
• The pulse is thready and weak.
• Blood stasis due to qi deficiency
• This syndrome manifests as blood stasis due to failure of qi to circulate blood.
• Signs and symptoms
• These include mental fatigue, lassitude, a low voice with no desire to talk, shortness of
breath, spontaneous sweating, stabbing pain in a fixed position, tenderness and dark,
purple menstrual blood containing clots.
• The tongue is purple or with stasis patches or spots.
• The pulse is hesitant and weak.
• Qi failing to constrain blood
• This syndrome manifests as failure of qi to keep blood within the blood vessels.
• Signs and symptoms
• These include lassitude, shortness of breath, no desire to talk, spontaneous sweats,
bloody urine and stools, bleeding of the gums, heavy menstruation with a pale colour and
a pale, white complexion.
• The tongue is pale white.
• The pulse is weak or hollow.
• Qi stagnation and blood stasis
• This syndrome manifests as blood stasis due to qi stagnation.
• Signs and symptoms
• These include distending or migratory pain in the chest, rib, lateral, lower abdomen and
breast, depression, masses in the rib area, stabbing pain and tenderness.
• Alternatively, female patients may present with amenorrhea or dysmenorrhea with dark-
purple menstrual blood that may contain clots.
• The tongue is dark purple or with stasis patches.
• The pulse is wiry and hesitant.
• Qi collapse following blood loss
• This syndrome manifests as a critical condition due to sudden collapse of qi following
massive blood loss.
• Signs and symptoms
• These include massive bleeding (haematemesis, uterine bleeding, postpartum
haemorrhage or traumatic bleeding, etc.), faint breath, a pale complexion, dribbling of
profuse sweating and cold hands and feet (below the elbows and knees).
• The tongue is pale.
• The pulse is extremely feeble or scattered or hollow.
• Qi collapse following fluid loss
• This syndrome manifests as a critical condition due to heavy loss of body fluids.
• Signs and symptoms
• These include persistent, profuse sweating, severe vomiting and diarrhoea, faint breath, a
pale face, dribbling sweats and cold hands and feet (below the elbows and knees).
• The tongue is dry and thin.
• The pulse is extremely feeble.
• Deficiency of fluid and blood
• This syndrome manifests as deficiency of both body fluids and blood.
• Signs and symptoms
• These include a dry mouth, nose, lips, tongue, throat and skin, a pale white face,
dizziness, blurred vision, palpitations, dream-disturbed sleep, numbness in the hands and
feet, limb spasm and weight loss.
• The tongue is pale, tender and thin.
• The pulse is thready and rapid.
• Phlegm-turbidity and blood stasis
• This syndrome manifests as retention of phlegm-turbidity and blood stasis in certain areas
of the body.
• Signs and symptoms
• These include distending pain in the head and eyes, dementia, mania and haemiplegia,
or oppressive or colic pain in the chest, coughing, tachypnoea, wheezing sounds in the
throat, hard abdominal masses, joint enlargement or deformation, numbness in the limbs
and a gray-dark complexion.
• The tongue is dark purple or with stasis patches or spots and a thick, greasy coating.
• The pulse is wiry and slippery or deep and hesitant.
• Deficiency of qi and yin
• This syndrome manifests as deficiency of both qi and yin.
• Signs and symptoms
• These include mental fatigue, lassitude, shortness of breath, spontaneous sweating, a dry
mouth and throat, feverish sensations in the palms, soles and chest, tidal fever, night
sweats, weight loss, lower back soreness, tinnitus, dizziness and blurred vision.
• The tongue is red with scanty coating.
• The pulse is thready, rapid and weak.
• Deficiency of yin and yang
• This syndrome manifests as deficiency of both yin and yang.
• Signs and symptoms
• These include feverish sensations in the palms, soles and chest, a dry mouth and throat,
tidal fever, tinnitus, spontaneous sweating, night sweats, listlessness, shortness of breath,
no desire to talk, lassitude, cold limbs, thin and weak body, dizziness and blurred vision.
• The tongue is pale with scanty coating.
• The pulse is rapid and slightly thready.
• Case
• A 42-year-old man presented with a dragging and distending sensation in the stomach and
abdomen for the last three years, which has aggravated for a month. During the last three years
this sensation only occurred after meals. One month ago, his condition worsened due to
overwork and now he has this sensation especially after meals, accompanied by lassitude, poor
appetite, and loose stools. The patient has a weak constitution and has a pale, tender tongue,
thin, white coating, and a weak pulse.
• Analysis
• Syndrome: Qi deficiency (Spleen qi deficiency).
• Analysis: This patient has a weak constitution with qi deficiency, so there is lassitude,
poor appetite, a pale and delicate tongue and a weak pulse. As deficient qi fails to keep
the circulation, the patient presents distending sensation in the stomach and abdomen.
• Distension in the stomach and abdomen, and loose stools indicate that the disease
location is in the spleen and stomach. Combined with syndrome differentiation according
to the zang-fu organs, this case should be diagnosed as the syndrome of spleen qi
deficiency.
 Dr Zijing Hu (M.B. M.Med)
Lecturer: Department of Complementary Medicine
(Acupuncture)
Room 7106d John Orr Building DFC
Faculty of Health Sciences
University of Johannesburg
Tel: 011 559 6999
E-mail: zhu@uj.ac.za