辨症汇编
四诊易知
十二经络所属：
四诊易知：
部位察其相生相克。五色察其有神无神。大抵外感不妨滞浊，久病忌呈鲜妍。惟黄色见于面目，既不枯槁，，又不浮泽，为欲愈之候。
望舌色：舌上无胎为在表，鲜红为火，淡白为寒，（指无胎言）。若有白胎为半表里。黄胎为在里。黑胎病入少阴多死。胎润有液者为寒；胎燥无液者为火。舌上无胎如去油猪腰子为亡液，名镜面舌，不治，宜与病症相参不可执一。
闻声：
气衰言微者为虚。气盛言厉者为实。语言首尾不相顾者为神昏。狂言怒骂者为实热。痰声漉漉者死。新病闻呃者为火逆。久病闻呃者胃绝。大抵语言声音不异于平时为吉。反者为凶。。
问症：
一问寒热二问汗，三问头身四问便，五问饮食六问胸，七聋八咳俱当辨，九问久病十问因。再兼服药参机变，妇人尤必问经期，迟速闭崩皆可见，再添片语告儿科，天花麻疹全占验。
切脉：
脉法统论：
何谓无病之脉，一息四至是也。
何谓五藏平脉：心宜洪、肝宜弦、肺宜濇、脾宜缓、肾宜沉。又兼一股冲和之气乃胃气也。
何谓四时平脉： 春宜弦、夏宜洪、秋宜濇、冬宜沉，四季之未宜和缓是也。
何谓男女异脉：男为阳宜寸大于尺，女为阴宜尺大于寸是也。妇人有孕之脉尺大而旺，或心脉大而旺也。妇人血崩则脉尺内虚大弦数也。妇人半产则脉革，妇人产期至则脉离乎经常也。若尺脉微弱而濇，小腹冷、身恶寒者，此则知妇人无子也。小儿之脉七至为准也。
持脉秘旨：
脉之为道
一曰浮，浮者轻手着于皮肤之上而即见为表病也。
一曰沉，沉者重手按于肌肉之上而始见为里病也。
一曰迟，迟者一息脉来二三至或一息一至为里病也。
一曰数，数者一息脉来五六至或一息七八至为热病也。
一曰细，细者脉状细小如线主诸虚之病也。
一曰大，大者脉状粗大如指主诸实之病也。
一曰短，短者脉来短缩上不及寸下不及尺为素禀之衰也。
一曰长，长者脉来迢长上指鱼际下至尺泽为素禀之盛也。
浮而数为表热，浮而迟为表寒。
沉而数为里热，沉而迟为里寒。
细，则属于虚，大，则属于实。
短，知素禀之衰，疗病须兼培其基址；
长，知素禀之盛攻邪务绝其根株此凭治病之秘法也。
辨证汇篇卷一
凡阴阳表里虚实寒热之辨，为病之根，为治之源，每症中皆有互相也。如：
阴中之阳阳中之阴
表中之里里中之表
虚中之实实中之虚
寒中之热热中之寒
阳证三阳病采薪，脉浮大数痛头身
咽干合以强项等，治法汗和兼下珍
阳症，太阳、阳明、少阳也。初病发热、头疼、项强、唇焦、口燥、烦渴、喜冷、面色赤红、手足暖温、爪甲红润、大便闭、小便赤涩、脉浮洪大数，皆阳症之候。治法宜汗和下也。
脉式濇沉细小看，面色惨黯无光凭
阴症，太阴、少阴、厥阴。初病恶寒、战栗、体重、难转侧、呕吐、泻利、小便清、倦卧、欲寐、手足冷、爪甲青、面色惨黯无光、脉沉濇细小，此症之候。治法宜温补。
表里证
里症不恶寒、反恶热、潮热、谵语、烦渴、小便赤涩、大便闭、腹胀满、脉微沉、滑、有力，为适症。
虚实证
虚乃中空神弱疲，须看脏腑用方施
实当标本有余辨，标是邪停本滞医
实者：标实是邪住久停也。
里实内中偏胜。如心有火邪；肺有风寒；脾有食积、虫痞、湿热；肝有郁怒之气；肾有火邪、寒气迫于外肾、疝痛。
寒症
外寒斩破肾关里，非是伤标病客荣
表热里热辨
炊蒸里热尿红赤，三承凉膈重轻规
发热如炊笼蒸蒸内越于外，尿赤为里热。
阳热阴热辨
舌干燥渴烦阳经，苔润宜清白虎轻
厥冷热兼清糓利，阴经舌燥白通升
发热口燥舌干烦渴者，乃阳经之热，舌苔润治法宜清，如白虎解毒之辈。
发热坚决冷、下利清糓者，乃阴经之热，舌苔燥治法宜温。四逆、白通汤之辈。
外感表症，六淫所伤也。
暑症，口渴、心烦、溺赤、身热、脉洪而虚、暑挟湿并行、舌苔必白，为适症。
从皮肤入扰荣则汗出
从鼻入迫肺则烦喘
先夏至为病瘟，后夏至为病暑。
因贪凉避热于高厦凉室香薷饮 。
湿由溃烂气蒸成，中觉沉重滞卫荣
燥乃久晴多属秋，鼻咽口舌燥无休
大便闭结不宜热，方用清凉勿误投
诸症百病难枝举，数字规模变化工
须当标本相因症，治法神机勿忘铢
实邪无汗(脉)浮紧象，恶风自汗（脉）缓虚伤
太阳府证躁烦（不眠，脉）浮，（口渴）饮呕（吐）溺无蓄水（症）愁
小腹满鞭尿自利，如狂蓄血脉沉求
阳明经症鼻中干，（一身）壮热不眠（难睡也）目痛看
（阳明经兼少阳方用葛根汤加柴胡，阳明兼太阳方用葛根汤加桂枝，阳明经本症用白虎汤）
阳明府症闭便知，潮热狂言汗四肢
寒热（于外。胸胁苦）满（不食。心）烦虚（火）喜呕，（外亦寒热郁郁微烦）胸（心痞）鞭善呕（不止）实邪（实火）干
少阳府证热寒中（在内），痞痛利呕脉必弓
胸中（有）热（作）呕胃（中有）邪（作）痛（用黄连汤），胆火下脾自利攻（乃胆火攻脾）
加减黄芩汤变用（胆火攻脾用黄芩汤，攻胃用黄连汤加半夏生姜汤），上逆胃呕是邪冲
太阴邪病化从阴，自痛腹中兼满斟
手足自温利（大便利也）不渴，再加吐食脉多沉
少阴水化而为寒，脉细沉微腹痛难
（此症有三治法：1。宜用回阳法，首重在温剂，真武汤，四逆汤之辈。2。交阴阳。吴茱萸汤。3。微发汗用麻黄附子细辛汤。）
外躁（肾脉不能上通于心则躁）内烦（心脉不能下交于肾）下利水，口干不卧尿红浓
（木）克土能肌（火邪消物）不欲食（木侮土也），病肝内火郁相攻（病相火郁）
（于内是厥阴病，发于表则为少阳病，更加心中热，闻食臭则上隔而吐出，下之利不止）
厥阴为两阴之交尽，厥阴主肝而胆存于内，则厥阴之热少阳之火内发也。辨证汇篇卷二
多以风寒两邪干，三阳具有恶风寒
潮热
潮者潮水之潮有定时也，若一日二三发无定名曰发热。
潮热于寅卯属少阳
潮热于巳午属太阳
潮热于申酉属阳明
症见少便难大便溏邪尚未全入于里不可下，
症见少便大便闭燥渴烦躁方可攻。
壮热 发热无休止之时，热气透手溱溱有汗名曰蒸蒸发热属阳明内实宜下。
寒热者一热一寒互相往来，邪正相争也。邪入阳分发热，邪入阴分发寒，居半表里者寒热交作与疟相似，只别有定时者疟，无定时者非疟也。
汗证
自汗：自汗者不发散而自然汗出，卫为阳能卫外皮肤腠理禁固津液不得妄泄。
一因卫受制则皮肤腠理不固。
一因阳实外不恶风。
因荣之热乘阳之间而潜出 。
阳症：阳盛出来多热汗；
阴症：阴虚冷汗不留停；
不治症：冷汗出多如油，身体痛，淋滴如珠不治。热汗出多而痰喘亦不治。
黄汗厉节辨
黄汗无发热，厉节有发热，但厉节之湿聚关节，黄汗之湿聚膈间，故黄汗无肢节痛而厉节少上焦证也。甚则生黄疸一切诸黄
热被水遏郁交蒸汗腋则黄
黄汗者汗湿于表衣中色黄也。
厉节者肢节滞而不利也。
手足汗
一热聚胃蒸其津液傍达于四肢，故手足汗出肢热小便自利胃液干大便硬。
一中寒胃阳土虚脾不约束津液横溢手足汗出，肢冷因阳虚失运中寒不化小便不利大便虽硬不可攻。
头汗与热越汗出辨
遍身汗出谓之惹越瘀热在里不能发越而热气上达者也。
无汗
寒邪中经，腠理致密津液内渗则为无汗。然无汗中数种。有寒邪在表、有邪在里、有水饮内蓄、有亡阳久虚等皆无汗也。
一头前额痛属阳明；
一头后面痛属太阳；
一头左右两边痛属少阳；
一头顶上痛属厥阴；
辨下列数种头痛晕眩症
因风痛谓之头风必晕眩。
因热痛晕则烦渴。
因湿痛晕则头重不起。
因虚而头痛晕者动则更痛更晕也。
头眩
有眩运者、有眩冒者。运乃转运而头眩旋是也；冒乃蒙冒昏迷是也。多因少阳厥阴之风火。
实症：或因痰火内实上冲。
表症：或因外感风火遏于上。
伤寒有二：
一有异病百节解散而眩运不能运，宜补益真元。
耳症
火闭：火闭者诸经之火塞清道也。
邪症：邪闭者因风寒外感乱荣卫也。
窍塞：窍闭者因损伤或雷炮震伤或患聤耳伤。
虚症：虚闭者或肾虚或病后或劳倦过度，又肝虚耳目无所闻见如人将捕，又肺虚耳聋少气咽干。
虚实辨：
少壮火盛多实，劳衰无火多虚；
耳暴鸣而声大者多实，耳渐鸣而声细者多虚。
口症
辨证汇编
四诊易知
十二经络所属：
手太阳小肠经属小肠，手少阳三焦经属三焦，手阳明大肠经属大肠。
四诊易知：
望色（观察面色）：额头对应心，鼻子对应脾，左颊对应肝，右颊对应肺，颧骨对应肾。面部的不同部位可以反映相应脏腑的状况。
青色属肝，白色属肺，赤色属心，黄色属脾，黑色属肾。面部的五色变化可以察知病情。
通过部位观察其相生相克的关系。通过五色观察其是否有神气。大体上，外感病不妨碍面色显得滞浊，但久病忌讳呈现鲜妍之色。只有黄色出现在面目之间，既不枯槁也不浮泽光亮，这是将要痊愈的征兆。
望舌色（观察舌苔与舌质）：舌上没有苔垢说明病邪在表，舌色鲜红说明有火，舌色淡白说明有寒（指没有苔垢而言）。如果有白苔说明病在半表半里。黄苔说明病在里。黑苔说明病邪已深入少阴经，多预后不良。舌苔湿润有津液属于寒证；舌苔干燥无津液属于热证。舌上没有苔垢，像去油的猪腰子一样光滑，称为镜面舌，是津液枯竭的表现，难以治愈，应当结合病症综合判断，不可拘泥于一种看法。
闻声（听声音和呼吸）：
气息衰弱、说话声音低微的是虚证。气息旺盛、说话声音洪亮的是实证。言语前后不连贯、顾此失彼的是神志昏迷。胡言乱语、怒骂叫嚣的是实热证。痰声漉漉不断的是死证。新近患病出现呃逆的是火气上逆。久病出现呃逆的是胃气衰竭。大体上，语言声音与平时无异为吉兆。相反则为凶兆。
问症（问诊）：
一问寒热，二问汗出，三问头身疼痛，四问大小便，五问饮食情况，六问胸胁不适，七问耳聋咳嗽都应当辨别，九问久病史，十问病因。再结合服药情况进行参详以灵活变通。妇女尤其必须询问月经情况，经期迟速、闭经或崩漏都能从中看出端倪。再加几句话告知儿科医生，天花和麻疹的诊断全部包含在内。
切脉（脉诊）：
右手寸部候肺与大肠，右手关部候脾与胃，右手尺部候命门与三焦。
脉法统论：
什么是无病的正常脉象？一呼一吸之间脉搏跳动四次就是正常的。
什么是五脏的正常脉象？心脉宜洪大，肝脉宜弦，肺脉宜涩，脾脉宜缓，肾脉宜沉。同时兼有一种冲和之气，这就是胃气。
什么是四季的正常脉象？春季脉宜弦，夏季脉宜洪大，秋季脉宜涩，冬季脉宜沉，四季交替之时脉宜和缓，这就是正常的。
什么是男女不同的脉象？男子属阳，宜寸脉大于尺脉；女子属阴，宜尺脉大于寸脉。妇女怀孕时，尺脉大而旺，或者心脉大而旺。妇女血崩时，脉象尺部虚大、弦数。妇女小产时，脉象呈革脉。妇女临产时，脉象会脱离常规。如果尺脉微弱而涩，伴有小腹冷、身体怕冷，这说明妇女不能生育。小儿的脉象以每息七至为标准。
持脉秘旨：
脉道的道理：
三是迟脉，迟脉是指一呼一吸之间脉搏来两三次，或者一息一至，主里证（寒证）。
四是数脉，数脉是指一呼一吸之间脉搏来五六次，或者一息七八次，主热证。
七是短脉，短脉是指脉搏来去短缩，向上不及寸口，向下不及尺部，主先天禀赋衰弱。
八是长脉，长脉是指脉搏来去悠长，向上超过鱼际，向下到达尺泽，主先天禀赋强盛。
浮而数的脉象主表热，浮而迟的脉象主表寒。
沉而数的脉象主里热，沉而迟的脉象主里寒。
又在表、里、寒、热这四者中审察其为：
又须在表、里、寒、热、虚、实六者之中审察其为：
短脉，可知是先天禀赋衰弱，治疗疾病须兼补培根基；
长脉，可知是先天禀赋强盛，攻逐邪气务必斩草除根，这是治病的关键秘诀。
辨证汇篇卷一
凡是阴阳、表里、虚实、寒热的辨别，是疾病的根本，治疗的源头。每种症状中都有相互关联的因素。例如：
阴中之阳，阳中之阴
表中之里，里中之表
虚中之实，实中之虚
寒中之热，热中之寒
阳证见于三阳病，如同打柴人背着柴薪（形容病势沉重），脉象浮大数，头痛身痛。
手足温暖，小便涩短，面容红赤，大便陈旧难解。
咽干，配合强项（脖子僵硬）等症状，治疗方法宜用发汗、和解兼攻下之法，十分珍贵。
阳症，包括太阳、阳明、少阳经病。初起发热、头疼、项强、唇焦、口燥、烦躁口渴、喜欢冷饮、面色赤红、手足温暖、指甲红润、大便闭塞、小便赤涩、脉象浮洪大数，都是阳症的征候。治疗方法宜用汗法、下法。
身体沉重，转动困难，疼痛，身体疲倦，形体疲乏，想睡觉。
脉象涩、沉、细、小，面色惨暗无光泽。
阴症，包括太阴、少阴、厥阴经病。初起恶寒、战栗、身体沉重、难以转身侧卧、呕吐、腹泻、小便清长、倦怠卧床、想睡觉、手足冷、指甲青紫、面色惨暗无光、脉象沉涩细小，这是该症的征候。治疗方法宜用温补法。
表里证
里症不恶寒、反而恶热、潮热、谵语、烦躁口渴、小便赤涩、大便闭塞、腹胀满、脉微沉、滑、有力，为适宜的症状。
虚实证
里实内中偏胜。如心有火邪；肺有风寒；脾有食积、虫积、湿热；肝有郁怒之气；肾有火邪、寒气迫于外肾、疝痛。
寒症
外寒打破肾关内部，并非损伤标病，而是病客于营分。
表热里热辨
体内蒸腾般的里热，小便红赤，依轻重选用三承气汤或凉膈散。
阳热阴热辨
厥冷、热兼下利清谷，属阴经之热，舌燥，宜用白通汤升阳救逆。
发热、口燥、舌干、烦躁口渴者，乃阳经之热，舌苔润，治法宜清热，如白虎汤解毒之类。
发热坚决伴冷、下利清谷者，乃阴经之热，舌苔燥，治法宜温，如四逆汤、白通汤之类。
外感表症，由六淫所伤引起。
六淫者，即风、寒、暑、湿、燥、火六种气候异常之气。侵袭人体肌肤则生病。
静处贪凉得寒热病，倦乏焚香面垢动作为根源。
暑症，口渴、心烦、溺赤、身热、脉洪而虚、暑挟湿并行、舌苔必白，为适宜症状。
从皮肤入扰营分则汗出。
从鼻入迫肺则烦喘。
夏至前为病瘟，夏至后为病暑。
因贪凉避热于高厦凉室，用香薷饮。
燥乃久晴多属秋季，鼻咽口舌干燥无休。
大便闭结不宜用热药，方用清凉勿误投。
诸症百病难枝举，数字规模变化工巧。
须当标本相因症，治法神机勿忘铢两。
实邪无汗，脉浮紧象；恶风自汗，脉缓虚伤。
太阳府证躁烦（不眠），脉浮；口渴，饮水呕（吐）；溺无蓄水（症）愁。
小腹满鞭，尿自利，如狂蓄血脉沉求。
阳明经症鼻中干，（一身）壮热不眠（难睡也），目痛看。
（阳明经兼少阳方用葛根汤加柴胡，阳明兼太阳方用葛根汤加桂枝，阳明经本症用白虎汤）
阳明府症闭便知，潮热狂言汗四肢。
寒热（于外。胸胁苦）满（不食。心）烦虚（火）喜呕，（外亦寒热郁郁微烦）胸（心痞）鞭善呕（不止）实邪（实火）干。
少阳府证热寒中（在内），痞痛利呕脉必弓。
胸中（有）热（作）呕胃（中有）邪（作）痛（用黄连汤），胆火下脾自利攻（乃胆火攻脾）。
加减黄芩汤变用（胆火攻脾用黄芩汤，攻胃用黄连汤加半夏生姜汤），上逆胃呕是邪冲。
太阴邪病化从阴，自痛腹中兼满斟。
手足自温利（大便利也）不渴，再加吐食脉多沉。
少阴水化而为寒，脉细沉微腹痛难。
（此症有三治法：1。宜用回阳法，首重在温剂，真武汤，四逆汤之辈。2。交阴阳。吴茱萸汤。3。微发汗用麻黄附子细辛汤。）
外躁（肾脉不能上通于心则躁）内烦（心脉不能下交于肾）下利水，口干不卧尿红浓。
（木）克土能肌（火邪消物）不欲食（木侮土也），病肝内火郁相攻（病相火郁）。
（于内是厥阴病，发于表则为少阳病，更加心中热，闻食臭则上隔而吐出，下之利不止）
厥阴为两阴之交尽，厥阴主肝而胆存于内，则厥阴之热少阳之火内发也。辨证汇篇卷二
多以风寒两邪干，三阳具有恶风寒。
潮热
潮者潮水之潮有定时也，若一日二三发无定名曰发热。
潮热于寅卯属少阳
潮热于巳午属太阳
潮热于申酉属阳明
症见少便难大便溏邪尚未全入于里不可下，
症见少便大便闭燥渴烦躁方可攻。
壮热 发热无休止之时，热气透手溱溱有汗名曰蒸蒸发热属阳明内实宜下。
寒热者一热一寒互相往来，邪正相争也。邪入阳分发热，邪入阴分发寒，居半表里者寒热交作与疟相似，只别有定时者疟，无定时者非疟也。
汗证
自汗：自汗者不发散而自然汗出，卫为阳能卫外皮肤腠理禁固津液不得妄泄。
一因卫受制则皮肤腠理不固。
一因阳实外不恶风。
因荣之热乘阳之间而潜出 。
阳症：阳盛出来多热汗；
阴症：阴虚冷汗不留停；
不治症：冷汗出多如油，身体痛，淋滴如珠不治。热汗出多而痰喘亦不治。
黄汗厉节辨
黄汗无发热，厉节有发热，但厉节之湿聚关节，黄汗之湿聚膈间，故黄汗无肢节痛而厉节少上焦证也。甚则生黄疸一切诸黄
热被水遏郁交蒸汗腋则黄
黄汗者汗湿于表衣中色黄也。
厉节者肢节滞而不利也。
手足汗
一热聚胃蒸其津液傍达于四肢，故手足汗出肢热小便自利胃液干大便硬。
一中寒胃阳土虚脾不约束津液横溢手足汗出，肢冷因阳虚失运中寒不化小便不利大便虽硬不可攻。
头汗与热越汗出辨
遍身汗出谓之惹越瘀热在里不能发越而热气上达者也。
无汗
寒邪中经，腠理致密津液内渗则为无汗。然无汗中数种。有寒邪在表、有邪在里、有水饮内蓄、有亡阳久虚等皆无汗也。
一头前额痛属阳明；
一头后面痛属太阳；
一头左右两边痛属少阳；
一头顶上痛属厥阴；
辨下列数种头痛晕眩症
因风痛谓之头风必晕眩。
因热痛晕则烦渴。
因湿痛晕则头重不起。
因虚而头痛晕者动则更痛更晕也。
头眩
有眩运者、有眩冒者。运乃转运而头眩旋是也；冒乃蒙冒昏迷是也。多因少阳厥阴之风火。
实症：或因痰火内实上冲。
表症：或因外感风火遏于上。
伤寒有二：
一有异病百节解散而眩运不能运，宜补益真元。
耳症
火闭：火闭者诸经之火塞清道也。
邪症：邪闭者因风寒外感乱荣卫也。
窍塞：窍闭者因损伤或雷炮震伤或患聤耳伤。
虚症：虚闭者或肾虚或病后或劳倦过度，又肝虚耳目无所闻见如人将捕，又肺虚耳聋少气咽干。
虚实辨：
少壮火盛多实，劳衰无火多虚；
耳暴鸣而声大者多实，耳渐鸣而声细者多虚。
口症
Bian Zheng Hui Bian (Compilation of Syndrome Differentiation)
Shanye Jushi (Hermit of the Mountains and Wilds)
Four Diagnostic Methods Made Easy
Attribution of the Twelve Meridians:
The Hand Taiyin Lung Meridian belongs to the Lung.
The Hand Shaoyin Heart Meridian belongs to the Heart.
The Hand Jueyin Pericardium Meridian belongs to the Pericardium.
The Foot Taiyin Spleen Meridian belongs to the Spleen.
The Foot Shaoyin Kidney Meridian belongs to the Kidney.
The Foot Jueyin Liver Meridian belongs to the Liver.
The Hand Taiyang Small Intestine Meridian belongs to the Small Intestine.
The Hand Shaoyang Sanjiao Meridian belongs to the Sanjiao (Triple Burner).
The Hand Yangming Large Intestine Meridian belongs to the Large Intestine.
The Foot Taiyang Bladder Meridian belongs to the Bladder.
The Foot Shaoyang Gallbladder Meridian belongs to the Gallbladder.
The Foot Yangming Stomach Meridian belongs to the Stomach.
Four Diagnostic Methods Made Easy:
Observation of Complexion (Wang Se): The forehead corresponds to the Heart, the nose to the Spleen, the left cheek to the Liver, the right cheek to the Lung, and the zygomatic arches to the Kidney. The different areas of the face can reflect the condition of corresponding Zang-Fu organs.
Green color corresponds to the Liver, White to the Lung, Red to the Heart, Yellow to the Spleen, and Black to the Kidney. Changes in the five colors on the face can reveal the disease state.
Observe the relationships of generation and restriction through the facial areas. Observe whether there is "Shen" (Spirit/Vitality) through the five colors. Generally, exterior contraction does not preclude a dull or turbid complexion, but chronic illness contraindicates a bright and lustrous appearance. Only when yellow appears on the face and eyes, neither withered nor floating/lustrous, is it a sign of impending recovery.
Observation of Tongue Color (Wang She): A tongue without coating indicates the pathogen is at the Exterior; a fresh red tongue indicates Fire; a pale white tongue indicates Cold (referring to the absence of coating). If there is a white coating, the disease is at the Half-Exterior/Half-Interior level. A yellow coating indicates the disease is at the Interior. A black coating indicates the pathogen has penetrated into the Shaoyin stage, which often carries a poor prognosis. A moist tongue coating with fluid indicates Cold; a dry coating without fluid indicates Fire. A tongue without coating, smooth like a defatted pork kidney, is called a "Mirror Tongue," indicating depletion of body fluids; it is difficult to treat and must be evaluated in conjunction with other symptoms, not judged by one criterion alone.
Auditory and Olfactory Examination (Wen Sheng):
Weak breath and low voice indicate Deficiency. Robust breath and loud voice indicate Excess. Speech that is disjointed and incoherent indicates clouding of the Spirit (Shen Hun). Delirious speech and cursing indicate Excess Heat. Continuous rattling phlegm sounds indicate death. New onset of hiccups indicates rebellious Fire Qi. Chronic hiccups indicate exhaustion of Stomach Qi. Generally, if speech and voice are unchanged from normal, it is an auspicious sign; reversal indicates an ominous sign.
Inquiry (Wen Zheng):
First inquire about chills and fever, second about sweating, third about head and body pain, fourth about urination and defecation, fifth about diet, sixth about chest discomfort, seventh about deafness and coughing—all must be differentiated. Ninth, inquire about chronic illness history; tenth, inquire about the cause. Further, consider medication history for flexible adjustment. For women, menstruation must be asked about; delays, rapidity, amenorrhea, or metrorrhagia are all visible indicators. Add a few words for pediatrics: diagnosis of smallpox and measles is fully covered.
Pulse Diagnosis (Qie Mai):
Left Cun position probes the Heart and Small Intestine; Left Guan probes the Liver and Gallbladder; Left Chi probes the Kidney and Bladder.
Right Cun position probes the Lung and Large Intestine; Right Guan probes the Spleen and Stomach; Right Chi probes the Mingmen (Gate of Life) and Sanjiao.
General Principles of Pulse Methodology:
What is the pulse of a healthy person? Four beats per respiration cycle.
What are the normal pulses of the Five Zang organs? The Heart pulse should be洪 (Hong/Full/Surging); the Liver pulse should be弦 (Xian/String-like/Taut); the Lung pulse should be涩 (Se/Rough/Choppy); the Spleen pulse should be缓 (Huan/Lazy/Sluggish); the Kidney pulse should be沉 (Chen/Deep). Additionally, there must be a harmonious and gentle quality, which is the Wei Qi (Stomach Qi).
What are the normal pulses of the four seasons? Spring pulse should be Xian (String-like); Summer pulse should be Hong (Surging); Autumn pulse should be Se (Rough); Winter pulse should be Chen (Deep). At the transition of the four seasons, the pulse should be harmonious and slow.
What are the differences between male and female pulses? Men belong to Yang, so the Cun pulse should be larger than the Chi pulse. Women belong to Yin, so the Chi pulse should be larger than the Cun pulse. In pregnant women, the Chi pulse is large and vigorous, or the Heart pulse is large and vigorous. In women with metrorrhagia (blood flooding), the pulse is empty, large, taut, and rapid in the Chi position. In women with miscarriage, the pulse is Ge (Leather-like). When childbirth approaches, the pulse deviates from the norm. If the Chi pulse is weak and Se (choppy), accompanied by cold lower abdomen and aversion to cold, this indicates infertility. For children, seven beats per respiration cycle is the standard.
Secrets of Holding the Pulse:
The principles of the pulse:
One is Fu (Floating): The pulse is felt lightly on the skin surface, indicating Exterior disease.
Two is Chen (Deep): The pulse is felt only with heavy pressure on the muscle layer, indicating Interior disease.
Three is Chi (Slow): The pulse comes two or three times per respiration, or once per respiration, indicating Interior disease (Cold).
Four is Shuo (Rapid): The pulse comes five or six times per respiration, or seven or eight times, indicating Heat disease.
Five is Xi (Fine/Thready): The pulse is thin as a thread, indicating various Deficiency diseases.
Six is Da (Large): The pulse is thick as a finger, indicating various Excess diseases.
Seven is Duan (Short): The pulse is short, not reaching up to Cun or down to Chi, indicating congenital weakness.
Eight is Chang (Long): The pulse is long, extending beyond Yuji above and Chize below, indicating strong congenital endowment.
Fu and Shuo together indicate Exterior Heat; Fu and Chi together indicate Exterior Cold.
Chen and Shuo together indicate Interior Heat; Chen and Chi together indicate Interior Cold.
Furthermore, within the categories of Exterior, Interior, Cold, and Heat, examine:
If Xi (Fine), it belongs to Deficiency; if Da (Large), it belongs to Excess.
Also, within the six categories of Exterior, Interior, Cold, Heat, Deficiency, and Excess, examine:
Duan (Short) indicates congenital weakness; treatment must include tonifying the foundation.
Chang (Long) indicates strong constitution; eliminating pathogens requires eradicating the root. This is the secret method of treating disease.
Compilation of Syndrome Differentiation, Volume I
Differentiation of Yin/Yang, Exterior/Interior, Deficiency/Excess, and Cold/Heat is the root of disease and the source of treatment. Each symptom contains mutual interactions. For example:
Yin containing Yang, Yang containing Yin.
Interior within Exterior, Exterior within Interior.
Excess within Deficiency, Deficiency within Excess.
Heat within Cold, Cold within Heat.
Yang Syndromes
Yang syndromes appear in the Three Yang diseases, resembling a woodcutter carrying firewood (heavy burden). Pulse is Fu (Floating), Da (Large), Shuo (Rapid), with headache and body pain.
Lips are cracked, irritability and thirst prefer cold drinks, mouth dry, spirit manic, high heat preferring pungent dispersants.
Hands and feet are warm, urine is scanty and涩 (astringent/hot), face is red, stool is old/hard.
Dry throat, combined with stiff neck, etc. Treatment methods include sweating, harmonizing, and purgatives, which are precious.
Yang syndromes refer to Taiyang, Yangming, and Shaoyang diseases. Initial symptoms include fever, headache, stiff neck, cracked lips, dry mouth, irritability and thirst, preference for cold, red face, warm hands and feet, red nails, constipation, dark/scanty urine, and Fu/Hong/Da/Shuo pulses. These are all signs of Yang syndromes. Treatment should use sweating and purgative methods.
Yin Syndromes
Yin diseases involve the Three Yin meridians, characterized by aversion to cold, shivering, and ice-cold limbs.
Body weightiness, difficulty turning, pain, fatigue, desire to sleep.
Pulse is Se (Choppy), Chen (Deep), Xi (Fine), Xiao (Small). Face is pale and dull.
Diarrhea, vomiting, clear urine. Medication should employ warming and tonifying methods.
Yin syndromes refer to Taiyin, Shaoyin, and Jueyin diseases. Initial symptoms include aversion to cold, shivering, heaviness, difficulty turning, vomiting, diarrhea, clear urine, lethargy, desire to sleep, cold hands and feet, blue nails, pale/dull face, and Chen/Se/Xi/Xiao pulses. These are signs of this syndrome. Treatment should use warming and tonifying methods.
Exterior and Interior Syndromes
Exterior disease features aversion to cold and fever, double pain in head and body, floating pulse, and skin changes.
Interior disease features delirium, aversion to tidal fever, hard stool, and deep forceful pulse.
Exterior syndrome: Fever, aversion to cold, headache, body pain, floating pulse are appropriate symptoms.
Interior syndrome: No aversion to cold, but aversion to heat, tidal fever, delirium, irritability and thirst, dark/scanty urine, constipation, abdominal fullness, deep/sluggish/forceful pulse are appropriate symptoms.
Deficiency and Excess Syndromes
Deficiency feels hollow in the pulse, with weak spirit and fatigue. One must examine the Zang-Fu organs before prescribing.
Excess requires distinguishing between Root (Ben) and Branch (Biao). Branch is where evil stays; Root is where stagnation needs medical intervention.
Deficiency includes: Yin Deficiency, Yang Deficiency, Branch Deficiency, Root Deficiency.
Excess includes: Branch Excess, which is long-standing evil retention.
Interior Excess involves partial predominance inside. E.g., Heart has Fire evil; Lung has Wind-Cold; Spleen has food stagnation, parasites, damp-heat; Liver has stagnant anger; Kidney has Fire evil, cold air pressing on external genitalia, hernia pain.
Cold Syndromes
Jue (Rebellious) Qi reverses and accumulates in the chest due to emotions. The Kidney gate relates to the Stomach, forming Stomach Cold.
External cold breaks the internal Kidney gate; it is not damaging the branch, but the disease enters the Ying (Nutrient) level.
Differentiating Exterior Heat and Interior Heat
Exterior heat persists with white urine; apply Mahuang Tang (if no sweat) or Guizhi Tang (if sweat).
Internal steaming heat with red urine; regulate with light or heavy doses of San Chengqi Tang or Liangge San.
Persistent fever with white urine indicates Exterior Heat. Use Guizhi Tang if sweating; Mahuang Tang if no sweat.
Fever like a steamer radiating outward with red urine indicates Interior Heat.
Differentiating Yang Heat and Yin Heat
Dry tongue, thirst, irritability indicate Yang Meridian Heat. Moist coating suggests using Baihu Tang (White Tiger Decoction) lightly for clearing.
Cold extremities with heat and clear watery diarrhea indicate Yin Meridian Heat. Dry coating suggests using Baitong Tang (White Connective Decoction) to raise Yang.
Fever, dry mouth, dry tongue, irritability and thirst are Yang Meridian Heat. With moist coating, treatment should clear heat, such as with Baihu Tang.
Fever with firm coldness and clear watery diarrhea are Yin Meridian Heat. With dry coating, treatment should warm, such as with Sini Tang or Baitong Tang.
Exterior contraction syndromes are caused by the Six Evils (Liu Yin).
The Six Evils are the six abnormal climatic factors: Wind, Cold, Summer-Heat, Dampness, Dryness, and Fire. They invade the skin and muscles to cause disease.
Wind Strike
Wind is Yang Qi, first injuring Wei (Defensive) Qi, causing thirst, irritability, and superficial heat.
Floating pulse, aversion to wind, headache. Medication should resolve the Exterior, which is best.
Cold Damage
Cold is cold Qi, first injuring Ying (Nutrient) Qi, causing cold body, aversion to cold, and tight pulse.
Preference for hot drinks, limb stiffness. Medication should combine warming and dispersing.
Summer-Heat Strike
Summer-heat causes dark urine, thirst, and coma. Ying-level disease with excessive sweating, lung wheezing, and irritability.
Stillness and greed for coolness cause alternating cold and heat. Fatigue, burnt smell, and movement are roots.
Summer-heat syndrome: Thirst, irritability, dark urine, body heat,洪 (surging) and empty pulse, summer-heat with dampness, white tongue coating are appropriate symptoms.
Entering from skin disturbs Ying, causing sweating.
Entering from nose presses Lung, causing irritability and wheezing.
Entering from mouth enters Stomach, causing vomiting.
Before Summer Solstice is Epidemic Disease; after is Summer-Heat Disease.
Due to walking long distances under the scorching sun, use Liuyi San or Baihu Tang.
Due to seeking coolness in high pavilions, use Xiangru Yin.
Dampness Strike
Dampness forms from rotting and steaming vapors. Feeling heavy midway, blocking Wei and Ying.
Soreness and numbness in bones and muscles, many difficulties. Withered tendons, heat, swelling arise mutually.
Dryness Strike
Dryness follows long sunny days, mostly in Autumn. Nose, throat, mouth, and tongue are constantly dry.
Constipation should not use hot medicine; use cooling formulas, do not err.
Fire Strike
Heat vaporizes into Fire disease, Yang nature. Body and mind feel frantic heat, discarding clothes.
Constipation and dark urine. Treatment should unblock and use cooling medicines.
Internal Injury refers to Interior syndromes distinguished by four characters: Qi, Blood, Phlegm, and Stagnation.
Qi
Qi originates from Kidney and Lung, opening through the nose. It may be injured at the Root or attacked at the Branch.
Countless symptoms and diseases cannot be listed individually; numerical patterns show intricate changes.
Blood
Heart generates blood and controls the Spleen. It resides in the Liver meridian, holding the Sea of Blood.
Hematemesis, epistaxis, and bloody stools—distinguish internal injury from external contraction appropriately.
Phlegm
Phlegm disease results from loss of transport pivot in the Center. Grain fluids do not distribute and turn into Phlegm.
Must match Root and Branch symptoms; do not forget the subtle mechanisms of treatment.
Stagnation
Stagnation arises from long retention and sudden release. Seven Emotions curl inward and must be extended.
Which meridian is diseased by external Six Evils pressing? Medication should unblock, distinguishing old from new.
Taiyang (Small Intestine, Heart; Bladder, Kidney are paired via Exterior-Interior)
Taiyang Meridian Syndrome: Aversion to cold, fever, headache connecting to stiff neck.
Excess evil: No sweat, Fu (floating) and Jin (tight) pulse.
Deficiency evil: Aversion to wind, spontaneous sweating, Huan (slow) and Xu (empty) pulse.
(For excess evil, use Mahuang Tang; for deficiency evil, use Guizhi Tang.)
Taiyang Fu Organ Syndrome: Irritability (insomnia), Fu (floating) pulse. Thirst, drinking leads to vomiting. No water retention in urine.
Fullness and hardness in lower abdomen, free urination, mania-like state, deep pulse seeking blood stasis.
(For water retention, use Wuling San; for blood stasis, use Taoren Chengqi Tang.)
Yangming (Large Intestine, Lung; Stomach, Spleen are paired via Exterior-Interior)
Yangming Meridian Syndrome: Dry nose, high fever, insomnia, eye pain.
Combined with Shaoyang: bitter taste. Combined with Taiyang: single aversion to cold.
(For Yangming combined with Shaoyang, use Gegen Tang plus Chaihu; for Yangming combined with Taiyang, use Gegen Tang plus Guizhi; for primary Yangming meridian syndrome, use Baihu Tang.)
Yangming Fu Organ Syndrome: Constipation known. Tidal fever, delirium, sweating on four limbs.
Dry stool, Shaoyang evil transmitting to Stomach. Taiyang frequent urination, delayed hard/closed stool.
(For Yangming Fu combined with Taiyang, use Maren Wan; for Yangming Fu combined with Shaoyang, use Mi Jian Dao.)
Shaoyang (Sanjiao, Mingmen; Gallbladder, Liver are paired via Exterior-Interior)
Shaoyang Meridian Syndrome: Bitter taste, dry throat. Two Fires cause dizziness, distinguish Deficiency/Excess.
Chills and fever externally, chest/flank fullness, poor appetite, heart irritability, deficiency-fire likes vomiting. Externally also chills/fever, slight irritability. Chest/heart palpitations, good at vomiting continuously. Excess evil (excess fire) dryness.
(For deficiency evil, use Xiaochaihu Tang; for excess evil, use Dachaihu Tang.)
Shaoyang Fu Organ Syndrome: Heat/Cold internally, fullness/pain/diarrhea/vomiting, bowstring pulse.
Fullness after vomiting (due to vomiting causing fullness) often lacks pain; use Banxia Xiexin Tang.
Heat in chest causes vomiting; evil in stomach causes pain (use Huanglian Tang). Gallbladder fire attacks Spleen causing self-diarrhea.
Modified Huangqin Tang variations: Gallbladder fire attacking Spleen uses Huangqin Tang; attacking Stomach uses Huanglian Tang plus Banxia and Shengjiang. Upward rebellion to Stomach vomiting is evil rushing.
Taidyin (Lung, Large Intestine; Spleen, Stomach are paired via Exterior-Interior)
Taidyin evil disease transforms following Yin. Self-pain in abdomen with fullness.
Hands and feet naturally warm, diarrhea (free stool), no thirst, plus vomiting food, pulse mostly Chen (deep).
(Use Lizhong Tang, Sini Tang, etc.)
Shaoyin (Heart, Small Intestine; Kidney, Bladder are paired via Exterior-Interior)
Shaoyin Water transforms into Cold. Pulse is Xi (fine), Chen (deep), Wei (weak), difficult abdominal pain.
Aversion to cold on back, desire to sleep. Mouth harmonious, urine white, clear diarrhea.
(This syndrome has three treatments: 1. Return Yang method, focusing on warming agents like Zhenwu Tang, Sini Tang. 2. Interact Yin and Yang, Wu Zhu Yu Tang. 3. Mildly induce sweating, Mahuang Fuzi Xixin Tang.)
Shaoyin Fire transforms Heat evil following. Pulse is Shuo (rapid), Chen (deep), Yu (stagnant), sleepy appearance.
External restlessness (Kidney pulse cannot reach Heart causes restlessness), Internal irritability (Heart pulse cannot descend to Kidney), diarrhea with water, dry mouth, inability to lie down, concentrated red urine.
(Treatment should save Yin, tonify righteousness and attack evil.)
Jueyin
Jueyin Xiao Ke (wasting-thirst, excess fire) Qi rises and rushes (fire rebellion). Eating causes vomiting of roundworms, wind transformation in center.
(Wood overcomes Earth, muscles [fire evil consumes] do not want food [Wood insults Earth], disease Liver internal fire stagnation attacks each other [Minister Fire stagnation].)
(Internally this is Jueyin disease; manifesting externally becomes Shaoyang disease. Plus heart heat, smelling food odor causes upper obstruction vomiting. Purging causes continuous diarrhea.)
Jueyin is the intersection and end of two Yins. Jueyin governs Liver, with Gallbladder stored internally. Thus, Jueyin heat and Shaoyang fire emit internally. Compilation of Syndrome Differentiation, Volume II
Aversion to Wind
Mostly due to Wind and Cold evils interfering. All Three Yang have aversion to wind and cold.
Yang aversion to wind follows Exterior methods. Three Yin only have aversion to cold singly.
Three Yang having both aversion to cold and wind indicates Exterior disease.
Three Yin syndromes have aversion to cold but no aversion to wind.
Differentiating Aversion to Cold and Back Aversion to Cold
Fever and aversion to cold originate from Yang Exterior meridians. Aversion to cold without heat stops in Yin Interior.
Back cold without dryness is Shaoyin syndrome. Dryness and thirst are Yangming syndrome with fixed form.
Fever and aversion to cold originate from Yang Exterior syndrome (Sweating indicates deficiency, use Guizhi Tang; no sweating indicates excess, use Mahuang Tang.)
No heat and aversion to cold originate from Yin Interior syndrome (Sweating use Guizhi Jia Fuzi Tang; no sweating use Mahuang Fuzi Xixin Tang.)
Back aversion to cold with harmonious mouth and no dryness is Yin disease Shaoyin; use Fuzi Tang.
Back aversion to cold with dry mouth and thirst is Yang disease Yangming; use Baihu Jia Renshen Tang.
Tidal Fever
"Tidal" means regular timing like tide. If occurring two or three times a day without fixed name, it is called fever.
Tidal fever at Yin/Mao hours belongs to Shaoyang.
Tidal fever at Si/Wu hours belongs to Taiyang.
Tidal fever at Shen/You hours belongs to Yangming.
Symptoms showing difficult urination and loose stool mean evil has not fully entered Interior; do not purge.
Symptoms showing difficult urination, closed stool, dryness/thirst, irritability allow attacking/purging.
High Fever: Fever without cessation. Heat penetrates hand, profuse sweating named "Zheng Zheng Fa Re" (Steaming Fever) belongs to Yangming Interior Excess, suitable for purging.
Chills and Fever
Chills and fever alternate, fighting between evil and righteous Qi. Evil entering Yang branch causes fever; evil entering Yin branch causes chills. Located at Half-Exterior/Half-Interior, chills and fever occur together, similar to malaria. Only those with fixed timing are malaria; those without fixed timing are not malaria.
Sweating Syndromes
Spontaneous Sweating (Zi Han): Sweating occurs naturally without dispersion. Wei (Defensive) is Yang, guarding exterior skin and pores, securing fluids preventing leakage.
One cause: Wei is constrained, so skin and pores are not secure.
One cause: Yang Deficiency, external aversion to cold.
One cause: Yang Excess, external no aversion to wind.
Night Sweating (Dao Han): Sweating during sleep, stopping upon waking. Mostly belongs to Yin Deficiency, Heart Deficiency insecurity, Fire injuring Yin.
Due to Ying heat taking advantage of Yang space to seep out.
Yang Syndrome: Yang Excess produces much hot sweat.
Yin Syndrome: Yin Deficiency produces cold sweat, not lingering.
Untreatable Syndrome: Cold sweat flowing like oil, body pain, dripping like pearls is untreatable. Hot sweat flowing much with phlegm-wheezing is also untreatable.
Differentiating Yellow Sweat and Bi-Joint Syndrome
Yellow sweat has no fever; Bi-joint syndrome has fever. But Bi-joint dampness gathers in joints; Yellow sweat dampness gathers in Diaphragm. Thus Yellow sweat has no joint pain, while Bi-joint has fewer Upper Jiao symptoms. Severe cases produce Jaundice and all types of yellowness.
Heat suppressed by water, depression and steaming, sweat in armpits turns yellow.
Yellow sweat: Sweat wets exterior, color yellow in clothes.
Bi-joint: Limb joints stagnant and unsmooth.
Hand and Foot Sweat
One: Heat gathers in Stomach, steaming fluids reaching limbs. Thus hand/foot sweat, limb heat, free urination, Stomach fluid dry, hard stool.
Two: Middle Cold, Stomach Yang/Earth deficiency, Spleen fails to constrain fluids overflowing to hands/feet. Limb cold due to Yang Deficiency failing transport, Middle Cold not transforming, difficult urination, though stool hard, cannot purge.
Differentiating Head Sweat and Heat Yue Sweat
Whole body sweating is called Re Yue (Provoking Release). Stagnant heat in Interior cannot release, so heat Qi reaches upward.
No Sweat
Cold evil strikes meridians, pores dense, fluids seep inward, thus no sweat. However, there are several types of no sweat. Cold evil at Exterior, evil at Interior, water-fluid retention internally, Yang collapse chronic deficiency—all result in no sweat.
Headache
Frontal headache belongs to Yangming.
Occipital headache belongs to Taiyang.
Temporal (left/right side) headache belongs to Shaoyang.
Vertex (top) headache belongs to Jueyin.
Taidyin originally has no headache; due to Phlegm-Fire rushing upward.
Shaoyin has no headache; feeling emptiness in middle of head is due to insufficient brain marrow Qi.
Differentiating Several Types of Headache and Dizziness
Headache due to Wind is called Tou Feng (Head Wind),必定 dizzy.
Headache due to Heat causes dizziness with irritability/thirst.
Headache due to Qi Stagnation causes dizziness with depressed will.
Headache due to Phlegm causes dizziness with vomiting phlegm-saliva.
Headache due to Dampness causes dizziness with heavy head unable to lift.
Headache due to Deficiency causes dizziness worsening with movement.
True Headache connects to brain interior, hands/feet cyan and cold past elbows/joints, morning onset evening death.
Dizziness (Xuan Xuan)
There is Xuan Yun (spinning dizziness) and Xuan Mao (clouded dizziness). Yun is rotation/spinning; Mao is clouded/coma. Mostly due to Wind-Fire of Shaoyang and Jueyin.
Deficiency Syndrome: Or Qi/Blood deficiency, internal deficiency from sweating/vomiting/purging.
Excess Syndrome: Or Phlegm-Fire interior excess rushing upward.
Exterior Syndrome: Or external contraction Wind-Fire suppressed upward.
Internal Injury: Or excessive sexual desire, Kidney Qi deficiency, True Yang deficiency causing eye dizziness.
Heavy Head
Two types of Shang Han:
One Taiyang syndrome: Aversion to cold, stiff neck, headache unable to lift. Should disperse Cold evil.
One異病 (different disease): Hundred joints dissipate, dizziness unable to rotate. Should tonify True Yuan.
Ear Syndromes
Fire Closure: Fire closure is Fire of all meridians blocking clear pathways.
Qi Closure: Qi closure is Liver/Gallbladder Qi rebellion knotted by depression.
Evil Syndrome: Evil closure is Wind-Cold external contraction disrupting Ying/Wei.
Orifice Blockage: Orifice closure is due to injury, thunder/explosion shock, or otitis media injury.
Deficiency Syndrome: Deficiency closure is Kidney deficiency, post-illness, or over-fatigue. Also Liver deficiency ears/mouths hear/see nothing like being hunted. Lung deficiency deafness, short breath, dry throat.
Differentiating Deficiency/Excess:
Young/strong fire excess mostly Excess; labor/decay no fire mostly Deficiency.
Ear closure morning is Yang Qi Excess; ear closure afternoon is Yin Blood Deficiency.
Sudden loud ringing is mostly Excess; gradual quiet ringing is mostly Deficiency.
Mouth Syndromes
Mouth is governed by Spleen. Spleen harmonious means mouth knows five flavors.
Spleen disease: Dry mouth (Heat).
Liver disease: Sour taste (Heat Excess).
Heart disease: Bitter taste (Heat).