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Clarifying Diagnosis

INTRODUCTION ..........................................................................................................................................1
EIGHT PRINCIPLES....................................................................................................................................7
EXCESS AND DEFICIENCY.............................................................................................................................7
HOT AND COLD ............................................................................................................................................8
YIN AND YANG ............................................................................................................................................9
DEFINITIVE DIAGNOSIS OF QI, BLOOD AND BODY FLUIDS ......................................................11
BLOOD........................................................................................................................................................11
QI ...............................................................................................................................................................12
BODY FLUIDS .............................................................................................................................................14
YIN ORGANS ..............................................................................................................................................17
FOUNDATIONAL DIAGNOSIS OF THE KIDNEYS ...........................................................................................17
FOUNDATIONAL DIAGNOSIS OF THE LIVER ................................................................................................19
FOUNDATIONAL DIAGNOSIS OF THE SPLEEN ..............................................................................................21
DEFINITIVE DIAGNOSIS OF THE LUNGS ......................................................................................................24
DEFINITIVE DIAGNOSIS OF THE HEART ......................................................................................................27
DEFINITIVE DIAGNOSIS OF YANG ORGANS ...................................................................................28
LARGE INTESTINE ......................................................................................................................................28
SMALL INTESTINE ......................................................................................................................................28
GALL BLADDER..........................................................................................................................................29
BLADDER ...................................................................................................................................................29
STOMACH ...................................................................................................................................................30

Introduction
These lists below form the foundation for Clarifying Diagnosis. Though in some
ways the signs and symptoms here seem simple and obvious, each one has been,
and continues to be considered carefully and tested in the laboratory of clinical
practice. This also continues to be a work in progress, being updated and refined
through my own experience and that of other practitioners.

A primary intention of these lists is to help the practitioner avoid a certain kind of
common oversimplification that can obstruct a clear view of what is actually going
on with a patient. This over simplification is due to jumping to conclusions such
as:
Hot flashes indicate Yin deficiency
Uterine bleeding indicates Spleen Qi not holding the blood
Fatigue indicates deficiency
Headaches indicate Liver Yang rising
Etcetera.

This type of over simplification often leads to faulty diagnosis and treatment. In
addition, it leads our minds away from seeing what is actually going on with our
patients because we are lost in seeing through our misperceptions.
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Another intention of these lists is to encourage and give practitioners a method to

actually diagnose their own patients. It may seem obvious that practitioners need
to diagnose patients yet, much of the education in the west as well as in
contemporary Chinese traditional medical colleges, encourages us to actually skip
diagnosis. At times this encouragement is explicit.1 Practitioners are erroneously
taught to analyze and categorize signs and symptoms to fit into a TCM diagnostic
pattern. In other words, we are taught that differential diagnosis is the method of
forcing our patients presentation into a pattern or patterns from a list of possible
patterns. We want to take care not to merely reduce our patients dynamic
imbalance into predetermined and fixed schemes. Because each patient is
dynamically alive and unique, they will virtually never fit exactly into any
predetermined pattern. In using this reductionist method, we will, by definition,
have to leave the loose ends of our patients presentation out. These loose ends
may or may not have great significance for their diagnosis, treatment and
prognosis.

An alternative to this, as outlined below, is to base the diagnosis on signs and

symptoms that are fundamentally valid.
Every sign or symptom tells us something definitive. Every sign or symptom may
not be indicative of what it seems to be indicative of, but it is always indicative of
what it is. For example:
A hot flash seems to be indicative of Yin deficiency or at least of empty heat,
but it may not be indicative of either of these. A hot flash is always
indicative of what it is, which is some pathological heat (maybe empty,
maybe full) flushing up.
Uterine bleeding seems to be indicative of Spleen Qi unable to wrap the
blood, but it may not be indicative of this. Uterine bleeding is always
indicative of what it is, which is blood leaving the vessels of the womb
when it shouldnt.

Some signs and symptoms by themselves, such as hot flashes or uterine bleeding,
tell us very little about underlying patho-mechanisms. Others can tell us more.
The lists below go through the 8 principles, Qi-blood-body fluid and Zang-Fu,
organizing the signs and symptoms that are fundamental for determining what the
underlying patho-mechanisms are in a given patient presentation. Utilizing these
foundational guides, we avoid utilizing branch signs and symptoms to formulate

1
Here are a couple of exemplary quotes from Treatment of Infertility by Jane Lyttleton: By gathering together the relevant
details of the case history, and looking at the tongue and taking the pulse, the pieces of the puzzle usually form an image
which roughly approximates one or more of the patterns outlined......, Although ....disease labels do not usually translate
directly into specific TCM categories ......... the symptom pictures they manifest are easily analyzed and categorized to fit a
TCM diagnostic pattern. From Bob Damones Principles of Chinese Medical Andrology Most practitioners of Chinese
medicine ultimately determine treatment by discriminating from among several possible patterns and they design their
treatment strategy accordingly.
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the base diagnosis. Rather, we are able to explain branch signs and symptoms,
such as hot flashes or uterine bleeding based on the root patho-dynamics.

As writer Rick Bass says about writing, all you have to do is avoid the pitfalls, and
youre home free.2 I quote him here because, in an important sense, what follows here is
not so much a method of diagnosis as a method of not falling off track. The result happens
to be staying on track!

The following organization of signs and symptoms begs a few questions:

One is whether any sign or symptom can really tell us anything definitively.

Another question is, if we find a fundamental patho-dynamic, does that

always mean we treat it? Another way to ask this question is how do we
prioritize multiple aspects of a diagnosis?

Another question is whether a diagnosis based on this organization is

enough to lead us to a clear understanding of our patient and an effective
and correct treatment.

The answers to these three questions are inter-related, as you will see below.

A final question is whether these lists and this method of diagnosis have
value for other methods of diagnosis within the pluralistic framework of
traditional Chinese medicine.

Question one: Can any sign or symptom really tell us anything definitively?
There are two parts to the answer to this question. First, if we are careful to assign
to a sign or symptom the indication it actually is, then it really is this indication.
Uterine bleeding really is blood pathologically leaving the vessels of the womb.
Though naming signs and symptoms this way tends to be redundant (meaning
blood pathologically leaving the vessels of the womb is simply another way of
saying uterine bleeding), it keeps us grounded and accurate.

What about the signs and symptoms that tell us more specific and non-redundant
information? For example, this document tells us that weak type soreness or
weakness in the lower body indicates Kidney deficiency; pitting edema in the
lower body indicates Kidney Yang deficiency; symptoms being worse with stress
indicate Liver involvement; and scalloped edges to the tongue indicate Spleen Qi

2
From Narrative Magazine, THE 2007 STORYQUARTERLY
ANNUAL EDITED BY TOM JENKS, WITH CAROL EDGARIAN AND M. M. M. HAYES 18 Lies and 3 Truths
GREAT AMERI CAN FI CTI ON AND NONFI CTI ON
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deficiency. Do these signs and symptom always definitively have these

indications? Always and definitive are strong words! Perhaps the question
needs to be modified to become Is it clinically useful to consider these patho-
mechanisms and disease factors to be indicated by these signs and symptoms? To
this there is a clear Yes. However, this yes needs to be taken in the context of what
the alternatives are in standard TCM diagnosis. Without these foundational signs
and symptoms there is no alternative foundation for diagnosis.

An important part of the answer to this first question is the answer to the second
question.

Question Two: If we find a fundamental patho-dynamic, does that always mean

we treat it?
No. Being able to determine the patho-mechanisms and disease factors present in
our patients is only the first step in diagnosis and in determining treatment. The
next step is to synthesize and thereby focus the diagnosis and treatment. In this
next step we seek the key or heart of the pathological dynamic. In many, if not
most cases this step will reveal that parts of the dynamic are secondary or likely to
be resolved when we work with the core aspect or aspects.

When secondary aspects resolve without treating them directly, does this mean
they were not actually there? Lets say there is a flood due to a blockage in a
stream. We can drain the flooded area itself because we know definitively there
is a flood. If by removing the blockage up stream, the flood recedes without
draining the flood plain, that does not mean there was never a flood. In this same
way, the fact that Spleen Qi deficiency may improve when we simply course the
Liver Qi, should not make us doubt whether the Spleen Qi was deficient in the first
place.

Synthesis in diagnosis is beyond the scope of this document and will be covered in
other places. However, it is very important to realize that the guidelines below are
meant as a fundamental starting place and will not, by themselves, completely
reveal a synthesized diagnosis and focus your treatment. Without guidelines that
help you avoid jumping to conclusions though, you will neither be able to
approach synthesis nor ever find a focus.

Question Three: Is a diagnosis based on this organization enough to lead us to a

clear understanding of our patient and an effective and correct treatment?
This question is mostly answered in the reply to question two above. Ill add here
that a foundational perception of what is going on with our patients, unclouded by
false assumptions and misleading conclusions, though key, is still just the
foundation. It is like having a basic, clear and up-to-date map. This is essential for
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the journey but it does not tell you exactly where you want to go nor does it tell
you all the potential ways to get there or the best way to get there.

Question Four: Do these lists and this method of diagnosis have value for other
methods of diagnosis within the pluralistic framework of traditional Chinese
medicine?
Any Chinese herbal treatment method requires an articulated diagnosis that comes
directly from information our patients bodies provide. What ever the framework
one uses to come to a diagnosis, avoiding the pitfalls is essential.

I think it is important to remember the diversity in approaches to both diagnosis

and treatment evident throughout the history of Chinese medicine up to today. The
information below grew out of the fact that TCM is the foundation of most
westerners education and that TCM has great value. The faults in the manner in
which it is organized and taught should not cause us to toss out or have any scorn
for all that we have invested in.3 Nor should the prevalence of TCM cause us to
stop there and not explore the rich pluralistic traditions of Chinese medicine.
Though there is diversity in Chinese medical approaches, TCM is the one most
students come out of school being familiar with. Not only this, there is something
very basic and important about unclouded TCM. It teaches us to recognize natural
phenomenon as it plays out in our patients. We learn to see cold, heat, dryness,
stickiness, mingling of dampness and heat, wind, weakness, lack of good
flow..We learn to locate and evaluate the phenomena we perceive as well as
where it has come from and where it is going. Quality TCM gives us a language to
articulate what we see and to connect that articulation with a treatment plan.

This organization of signs and symptoms into their foundational indications could
be seen as a simple list of exactly what we want to avoid in diagnosis namely a
list of this sign or symptom = this diagnostic fact. What makes these signs and
symptoms different? The items on these lists have grown out of the study of most of
our English language textbooks as well as many case studies of respected Chinese
practitioners. It is not something I have made up but, rather, it is a reorganization
of these texts. For example, in going through the texts, each time pitting edema is
mentioned, Yang deficiency causing accumulation of fluids is diagnosed and

3
This thought comes from an attitude I have seen that scoffs at TCM as coarse and elementary in favor of
other, seemingly more sophisticated methods. What I have seen is that a clear understanding of TCM has
provides, even to those practitioners who have condescending attitudes toward it, the ground and language to
understand other methods. In my opinion, it is like scoffing at ones mother for being so limited when your
own fullness depended on her and you dont really know her very deeply anyway. In addition, when most of
our practitioners in the west have come out of school with an, albeit limited, TCM education, as educators, I
feel we want to help them get the most out of what they have invested in as a leaping off place for further
learning. To give these young practitioners the sense that what they have invested in is lower, unsophisticated
or without great usefulness, is damaging.
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treated. I could not find a reference for pitting edema in which it was an indication
for anything but Yang deficiency. Because of this, pitting edema is a foundational
symptom for Yang deficiency. On the other hand, a plethora of patho-mechanisms
is mentioned for a symptom like tinnitus. Because of this, tinnitus tells us only that
there is some pathological activity affecting the ears. The underlying patho-
mechanism that explains why there is pathological activity affecting the ears will
have to be discovered by utilizing signs and symptoms that tell us what it is.

It is my wish that this organization can be used to clarify diagnosis and promote
actual direct perception of our patients. I hope this is a step toward cleaning up
TCM and placing it in its rightful foundational position. All errors are my own and
I am always open and excited to receive feedback.

Sharon Weizenbaum
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Eight Principles
Excess and Deficiency

Excess symptoms are worse with pressure, stimulation and fullness. They are
improved with discharge (bowel movements, vomiting, bleeding, sweating etc.)
Any accumulation is an excess, including Blood stasis, Dampness, Food stagnation,
Phlegm and Fire Poison.

Deficiency symptoms get better with rest and are worse with fatigue. Pain related
to deficiency is better with touch while excess resists touch. Deficiency is better
before losing anything and worse after. Deficiency is better with support and
feeding. 

Is the patient Strong or Weak?

The strength and weakness of the patient is different than the question of excess and
deficiency. A strong patient can have local or systemic deficiencies and a weak patient can
have local or systemic excesses. We must differentiate the pathology from the patient. Below
is a list of the types of weak and strong patients based on the abdomen and general
musculature.
We learn early on that we should strengthen deficiency and disperse excess. Though this is
true, it is only true in a limited way. The real importance of differentiating the strong and weak
person from excess and deficient pathology is to determine the strength and method of
treatment you can give the patient. Eliminating an excess for a weak person
will be different than eliminating an excess in a strong person. In the same way, tonifying a
deficiency in a weak person will be different than tonifying a deficiency in a strong person.
Once the strength or weakness of the patient is determined, then the next step is to determine
the pathology, its nature and location. This is clear Zang, Fu, Qi, Blood, Body Fluids, and 8-
principle diagnosis.
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Hot and Cold

Heat - These are general Heat signs and symptoms. Heat will always be either
excess or deficiency Heat or a combination of excess and deficiency. You can
definitively diagnose Heat if any of the following signs and symptoms appear:
Thirst for cold beverages
Subjective sensation of heat or burning
Heat makes symptoms worse
Redness of skin or tissue
Red tongue or red areas the tongue
Yellow tongue moss
Red spots or prickles on tongue
Concentrated urine
Empty Heat Signs To definitively diagnose Empty Heat, you will see at least
one of the above Heat Signs with at least one of the following:
Heat with deficient indication (worse with fatigue etc.)
Heat of the 5 hearts
Steaming bone tidal fever Note: Empty Heat does not
Peeled or cracked tongue moss always implicate Yin Deficiency.
Red short tongue body
Excess Heat is heat indications with excess indications. Excess heat can be
Depressive Heat or it can come from the outside (hot pathogens, Heat
generating foods, smoking, radiation etc.) (If any of these signs are present,
you know there is excess heat for sure)
Yellow rooted tongue moss
Large or normal sized Red tongue body Empty or Excess Heat can mix with
Red spots on the tongue wet pathogens such as Dampness and
Heat that shows with excess signs Phlegm to form Damp Heat, Phlegm
Fire Signs you definitively diagnose Fire Heat or Fire Poison. See the section
If you see Heat Signs along with: on Qi, Blood and Body Fluids for
Bleeding differentiation of these pathogens.
Intense agitation
Intense thirst
High Fever

Cold - These are general Cold signs and symptoms. Cold will always be either
excess or deficiency Cold or a combination of excess and deficiency.
Symptoms are significantly better with the application of warmth
Subjective feeling of cold or aversion to cold
Objective feeling of cold

Empty Cold is cold that has developed because the location of the cold has
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lost it's relationship with physiological Yang. It can manifest with any of the
above symptoms in combination with symptoms of deficiency.
Excess Cold is an accumulation of Cold

Yin and Yang

Yin Excess is an excess of the Yin pathological qualities Cold, Damp, Blood Stasis,
food stasis, damp heat and Phlegm

Yin Deficiency
Kidney Yin deficiency You can definitively diagnose Kidney Yin deficiency
with any one of the following signs with or without Basic Kidney Signs.

Peeled tongue moss generalized over tongue or in patches over much of

the tongue
Rootless tongue moss
Red short tongue body
Cracks over a large area of the tongue or just in the back
Generally dry emaciated body type with heat
Steaming bone tidal fever

Lung Yin deficiency To differentiate Lung Deficiency as Lung Yin Deficiency

you must see at least one of the following signs with dry Lung signs of dry
cough or scanty thick sputum:
Kidney Yin Deficiency tongue signs
Transverse creases or peeling in the Lung area of the tongue
Generally dry emaciated body type with heat

Spleen and Stomach Yin Deficiency To definitively diagnose Spleen and Stomach Yin
Deficiency you must see digestive disturbance with
Peeled or cracked or rootless moss in center of tongue
with
Excessive satiable thirst or
Thirst with drink in small sips

Spleen Yin Deficiency To differentiate and definitively diagnose Spleen Yin

Deficiency you will see Kidney or Spleen and Stomach Yin deficiency signs with
digestive disturbance and
Failure to ascend symptoms: Loose stool
Okay appetite but difficulty digesting
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Or digestive disturbance with

Peeled edges of the tongue
Transverse cracks on edges of the tongue
Emaciation with inability to gain weight

Stomach Yin Deficiency To differentiate and definitively diagnose Stomach Yin

Deficiency you will see the signs of Spleen and Stomach Yin Deficiency with one
of the following
Ascending or failure to descend symptoms:
Constipation
Hiccups
Nausea
Vomit or dry heaves
Hunger with no desire to eat

Yang Excess Yang Excess is any Excess of a Yang Aspect such as Qi, Wind or
Yang.

Yang Deficiency
Spleen Yang Deficiency To diagnose Spleen Yang Deficiency you must see at least one
sign of Spleen Qi deficiency, disturbance of the transportation and transformation of food
along with at least one of the following signs and symptoms
Abdominal pain that responds favorably to warmth and pressure
Clear food diarrhea (watery diarrhea with little smell and undigested food)

True Kidney Yang deficiency To definitively diagnose Kidney Yang

deficiency you must see at least one Basic Kidney sign and also an
indication of Yang deficiency. This means you will see at least one
indication of a failure to warm or warmly transform fluids:
Generalized chronic chilliness of lower limbs, buttocks, lower belly
or whole body
Pale puffy tongue
Pitting edema especially in the lower body
Clear-diarrhea (watery diarrhea with undigested food and little smell)
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Definitive Diagnosis of Qi, Blood and Body Fluids

Blood

Liver Blood Deficiency You can definitively diagnose Liver Blood deficiency if any
one of the following signs appears with or without Basic Liver Signs.
Sallow complexion
Flowery vision (blurred or dizzy vision or floaters)
 Poor night vision Since the Liver stores the blood, Blood
 Weak fingernails deficiency is Liver Blood deficiency
 Orange or extremely pale sides to the tongue
Pale tongue with a thin tongue body

Blood Stagnation You can definitively diagnose Blood Stasis if any one of the
following signs appear:
Purple or dark tongue body
Dark Stasis Spots on body or tongue body
Distended veins under the tongue
Spider Veins
Dark/Dull facial complexion
Localized stabbing pain
Dysmenorrhea
Dark purple lesions
Hard fixed masses
"Lacquer--like" stool
Clots in bleeding

Systemic Blood Stagnation You can definitively diagnose Systemic Blood Stasis if
any one of the following signs appear:
Chronic Purple or dark tongue body
Many Stasis Spots on body
Chronic Distended veins under the tongue
Extensive Spider Veins
Dark/Dull facial complexion
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Qi

Qi Deficiency To definitively diagnose Qi Deficiency, use the definitive

diagnosis for the following
Spleen Qi Deficiency To definitively diagnose Spleen Qi Deficiency, you must see at
least one of the following signs:
Scalloped edges to the tongue
Weakness of the four limbs
Pale puffy tongue body with digestive upset
Soft spongy abdominal flesh

Lung Deficiency To definitively diagnose Lung Deficiency you must see at

least one Basic Lung Sign and at least one of the following:
Deficiency Shortness of breath (worse when tired, better with rest)
Weak voice
Lung Qi Deficiency To Differentiate the Lung Deficiency as
Lung Qi Deficiency you must see at least one of the following
signs:
Spontaneous sweat worse with movement
Pale tongue
Dip in Lung area of tongue

Kidney Qi deficiency To definitively diagnose Kidney Qi deficiency you

must see at least one Basic Kidney sign and also an indication of a failure to
absorb. This means you will see at least one sign of leakage such as:
Uterine bleeding
Vaginal discharge
Premature labor or threatened miscarriage
Diarrhea
Frequent or copious urination
Spermatorrhea
Sweating
Nasal discharge
Failure to absorb the Lung Qi: Difficulty inhaling
Infertility, a failure to absorb sperm to become pregnant which
occurs with other Kidney Qi deficiency signs.
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Qi Depression You can diagnose Qi Depression if any one of the following signs
appears:
pain
There are many reasons why the Qi becomes
fullness Depressed
distention Excess Depression
Liver Depression (also called Wood
Depression)
Liver Qi Hyperactivity (also called Liver Qi)
Qi Depression is a general term, which Damp Depression
describes the phenomenon in which the Fire Depression
Qi does not flow when it should. There Blood Depression
Phlegm Depression
are many reasons why Qi does not flow.
Cold Depression
Food Depression
Deficiency Depression
Qi deficiency
Qi Depression is not always Liver Qi Blood deficiency
Depression though Qi Depression Yin deficiency
tends to effect the Liver. Yang deficiency
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Body Fluids

Phlegm and Dampness Signs You can definitively diagnose Dampness if any
one of the following signs appear:
Puffy tongue
Thick tongue moss
Wet tongue
Thirst with no desire to drink
Damp or greasy skin
Symptoms worse on damp days or in a damp environment
Puffy skin
Muzzy head If the Phlegm Dampness Sign is
Excess weight gain not Phlegm then it is Dampness
Heaviness of limbs
Water swelling
Sticky or wet feeling in the mouth
Wet discharges
Musty odor
Greasy hair

Phlegm You can differentiate and definitively diagnose the presence Phlegm of
with or without Phlegm Dampness Signs and any one of the following:
Soft nodules or masses
Lumps in glandular tissue
Thickened Skin
Thickened Tissues (scar tissue from heat simmering fluids such as scarred
fallopian tubes)
Cysts
Water filled acne that doesn't heal easily
Ovarian cysts or polycystic ovaries
Substantial mucous in the respiratory system (in the lungs or sinus)
Mucous in the stool

Thin Mucous Signs You can definitively diagnose thin mucous if you see any one
of the following signs:
Watery fluids in the Lungs (Lungs)
Edema (Limbs)
Water sloshing sounds in the abdomen (Stomach)
Vomiting thin mucous (Stomach)

Dampness Oppressing the Flesh may or may not have Spleen Qi Deficiency signs.
It will include at least one of the following;
Swelling and non-pitting edema of the four limbs
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Sensation of heaviness
Aching pain that is worse with damp exposure

Phlegm Heat: When the tongue has a thickened yellow moss this will tell you for
sure that there is a hot pathogen combined with a wet pathogen but it does not
differentiate whether this is phlegm-heat, damp-heat or food stasis.
Phlegm Heat You can differentiate and definitively diagnose the presence of
Phlegm Heat if you see a sign of Phlegm that is:
Combined with signs of Heat.
Substantial Phlegm is yellow, sticky or thick
If the fluid is thickened then it is phlegm-heat.
Adhesions after an acute or chronic infection
Sinus gunk
Yellow or green phlegm in the lungs
Thickened skin or tissue
If it is in the Lungs or Heart it is phlegm-heat.
If it combines with internal wind it is Phlegm-heat.

Damp Heat Signs When there is damp-heat there will be some of the signs and
symptoms of damp and phlegm above as well as signs of heat. The following signs
and symptoms tell you for sure that the damp and heat have mixed to form damp-
heat:
yellow discharge (vaginal, penile, pus)
cloudy, scanty, and dark urine
excessive sweat that is strong smelling
Damp and Heat signs: If these signs are seen together, you can know definitively
that there is damp heat:
Damp Signs:
Heavy body, heavy aching head
Thick moss on tongue
Puffy tongue
Heat Signs:
Feverishness in the afternoon
Constrained fever
Concentrated urine
restlessness
red rashes

Turbid Damp Signs You can definitively diagnose that the Dampness you see is
Turbid Dampness if you see any one of the following signs along with Dampness
Signs.
sweet or yucky taste in the mouth
chronic nausea with malaise
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Fire Poison Signs You can definitively diagnose Fire Poison and differentiate it from
Damp Heat or Phlegm Heat if you see Damp Heat Signs or Phlegm Heat Signs with
any one of the following:
Discharge is purulent (meaning it contains pus)
Odor of discharge is not just smelly but foul
Fever
Generalized feeling of being ill

Food Stagnation Signs You can definitively diagnose Food Stagnation if you see any
signs of digestive disturbance with any one of the following:
Sour smelling stool with undigested food Food Stagnation Signs appear
Poor appetite with sour regurgitation or reflux very similar to Damp Occluding
background to disruption is irregular eating or overeating the Digestion Signs. Use this list
to differentiate.

Lack of physiological body fluid If any of the following signs and symptoms
are seen you can know for sure there is dryness
Dry skin
Dry hair
Dry eyes
Dry mucous membranes (vaginal, anal, throat)
Dry cough

Use definitive diagnosis to determine the cause of the dryness:

Blood Deficiency
Yin Deficiency
Blood Stasis
Exogenous Dryness
Phlegm
Dampness
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Yin Organs
Foundational Diagnosis of the Kidneys
Basic Kidney Signs: (If any of these symptoms show up you can know there is
Kidney deficiency for sure):
Low back, knee, hip or ankle pain or weakness that is deficient.
Remember that Chronic Night urination
all Kidney Dark circles under the eyes with general deficiency signs
pathologies are Emptiness in the lower belly
deficient Concave dip in the back of the tongue
pathologies
Kidney Qi deficiency To definitively diagnose Kidney Qi deficiency you
must see Difficulty Inhaling or at least one Basic Kidney sign and also an
indication of a failure to absorb. This means you will see at least one sign of
leakage such as:
Uterine bleeding
Vaginal discharge
Premature labor or threatened miscarriage
Diarrhea
Frequent or copious urination
Spermatorrhea
Sweating
Nasal discharge
Failure to absorb the Lung Qi: Difficulty inhaling
Infertility, a failure to absorb sperm to become pregnant which
occurs with other Kidney Qi deficiency signs.

True Kidney Yang deficiency To definitively diagnose Kidney Yang deficiency

you must see at least one Basic Kidney sign and also an indication of Yang
deficiency. This means you will see at least one indication of a failure to warm or
warmly transform fluids:
Generalized chronic chilliness of lower limbs, buttocks, lower belly
or whole body
Pale puffy tongue
Pitting edema especially in the lower body
Clear-diarrhea (watery diarrhea with undigested food and little smell)
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Kidney Yin deficiency You can definitively diagnose Kidney Yin deficiency
with any one of the following signs with or without Basic Kidney Signs.
Peeled tongue moss generalized over tongue or in patches over much
of the tongue
Rootless tongue moss
Red short tongue body
Cracks over a large area of the tongue or just in the back
Generally dry emaciated body type with heat
Steaming bone tidal fever

Kidney Jing deficiency To definitively diagnose Kidney Jing deficiency you must
have at least one of the following signs with or without any Basic Kidney Sign.
Primary onset dysmenorrhea or highly irregular, scanty or late menses
Primary onset developmental disorder
Failure to mature at 2 x 7 years and 3 x 7 years
Bone disorders
Pre-mature aging

With Basic Kidney Signs (note that none of the following indicate Jing
deficiency without at least one basic Kidney sign).
Amenorrhea, late or scanty menses
Infertility and ovulation disorders
Menopausal disorders
Lack of libido
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Foundational Diagnosis of the Liver

Basic Liver signs: You can definitively diagnose Liver involvement if any one of
these signs appears:
Symptom is worse with stress
Symptom changes relative to the menstrual cycle
Difficulties with anger irritability, lack of expression of anger.

Liver Qi Stagnation: You can know that there is Liver Qi stagnation if any one of the
following signs appears with or without Basic Liver Signs.
PMS symptoms
Breast or rib-side pain or distention(subjective or objective with palpation)
Indented tongue edges
Low-grade headache in the Shao Yang or vertex area

Liver Depression: Liver depression is a repressed type of Liver Qi Stagnation.

You can definitively diagnose Liver depression if there are Liver Qi
Stagnation symptoms along with
Repressed expression

Liver Qi Hyperactivity; You can diagnose Liver Qi hyperactivity definitively

if you have Liver Qi Stagnation signs along with
Irritability and touchiness

Liver Blood Deficiency You can definitively diagnose Liver Blood deficiency if any
one of the following signs appears with or without Basic Liver Signs.
Sallow complexion
Flowery vision (blurred or dizzy vision or floaters)
 Poor night vision Since the Liver stores the blood, Blood
 Weak fingernails deficiency is Liver Blood deficiency
 Orange or extremely pale sides to the tongue
Pale tongue with a thin body
Pale watery menstruate

Liver Depressive Heat You can definitively diagnose Liver Depressive Heat if you
have at least one Basic Liver Sign or Liver Qi stagnation sign with one of the following
Red spots on the tongue
Red tongue edges
Red tight tongue body

Liver Fire You can definitively diagnose Liver Fire if you definitively diagnose
Depressive Liver Heat and at least one of the following signs appears;
 20
Clarifying Diagnosis

Bleeding In my experience, if it is stable it is heat and if it

Intense agitation is moving it is fire Qin Bowei
Intense thirst
High Fever
Very strong headache located in the Shao Yang or Vertex area with
Light sensitivity
Seeing auras
Red eyes
Worse with stimulation like touch or noise

Liver Yin Deficiency You can definitively diagnose Liver Yin Deficiency if there is
definitively Kidney Yin Deficiency and Liver Involvement.

Liver Yang Rising You can definitively diagnose Liver Yang Rising if, with Basic Liver
Signs or Liver Stagnation Sign or Liver or Kidney Yin deficiency Signs you see:
curled up edges on the tongue
mild to moderate head, neck or jaw ache
mild tinnitus
mild dizziness

Liver Wind You can definitively diagnose Liver Wind if you see at least one of the
following symptoms with other Liver signs.
Tremors
Tics
Dizziness
If it moves involuntarily it is Wind
Convulsions
If it is internal Wind it is Liver Wind.
Numbness
Paralysis
Quivering or deviated tongue
Deviated face
Spastic Headache

The literature I have looked at is vague in its differentiation of Liver Yang, Liver Wind
and Liver Fire. When some Yang aspect of the Liver, such as Qi, Wind or Heat is out
of right relationship and rising, this is Liver Yang Rising. Liver Yang Rising is a
foundational term. Liver Wind is an exacerbation of the movement aspect of the
Yang rising, with tremors, convulsions, extreme dizziness etc.
Liver Fire is an exacerbation of the heat aspect of Liver Yang rising to the point that
the signs become aggressive.
In addition, Liver Yang rising, in most texts, implies deficiency of Liver or Kidney Yin
below, yet not in all texts. In some texts the term Liver Yang rising can also refer to a
pure excess of Qi wafting upward due to intense anger.
Liver Yang can also mix with Phlegm or Phlegm Heat.
 21
Clarifying Diagnosis

Cold in the Liver Channel You can definitively diagnose cold in the Liver Channel
if there is genital or uterine pain that is better with warmth and worse with cold.

Damp Heat in the Liver Channel You can definitively diagnose Damp Heat in
the Liver Channel if you definitively diagnose Damp Heat that is located in the liver
channel (inner leg, genitals, pelvic area, rib-side, eyes and scalp.

Foundational Diagnosis of the Spleen

Disruption of Transformation and Transportation function of the Spleen this

pathology may or may not involve Spleen Qi deficiency and can be caused by several factors:
Food stagnation
Damp obstructing the Spleen (also see causes of damp)
Liver invading the Spleen
Liver Qi failing to course the Spleen
Liver Invading the Spleen
Spleen Qi deficiency
Spleen Yang deficiency
Spleen or Stomach Yin deficiency
Dryness in Yang Ming Fatigue is NOT a definitive sign
of Spleen Qi Deficiency!
Symptoms are those of digestive upset
Nausea
Vomiting
Abdominal distention
Abdominal pain
Flatulence
Irregular bowel movements
Borborygmus
Poor appetite
Gnawing hunger

Spleen Qi Deficiency To definitively diagnose Spleen Qi Deficiency, you must see at least
one of the following signs:
Scalloped edges to the tongue
Weakness of the four limbs
Pale and/or puffy tongue body with digestive upset
Soft spongy abdominal flesh
 22
Clarifying Diagnosis

Sinking Spleen Qi may occur because the Spleen Qi is weak and/or because the Qi is asked
to carry too much flesh or fibroids. If the former predominates then there will be the above signs
of Spleen Qi Deficiency with the sinking signs. If it is the later then there will be signs of phlegm
damp predominating with the sinking signs. Sinking signs are as follows:
Literally prolapsed organs
Sagging distention of the abdomen
Sinking Earth abdominal pattern

Spleen Yang Deficiency To diagnose Spleen Yang Deficiency you must see at least one sign
of Spleen Qi deficiency, disturbance of the transportation and transformation of food along with
at least one of the following signs and symptoms
Chilly limbs (not just hands and feet)
Abdominal pain that responds favorably to warmth and pressure
Clear food diarrhea (watery diarrhea with little smell and undigested food)

Spleen and Stomach Yin Deficiency To definitively diagnose Spleen and Stomach Yin
Deficiency you must see digestive disturbance with
Peeled or cracked or rootless moss in center of tongue
with
Excessive satiable thirst or
Thirst with drink in small sips

Spleen Yin Deficiency To differentiate and definitively diagnose Spleen Yin Deficiency
you will see Kidney or Spleen and Stomach Yin deficiency signs with digestive
disturbance and
Failure to ascend symptoms: Loose stool
Okay appetite but difficulty digesting
Or digestive disturbance with
Peeled edges of the tongue
Transverse cracks on edges of the tongue
Emaciation with inability to gain weight

Stomach Yin Deficiency To differentiate and definitively diagnose Stomach Yin

Deficiency you will see the signs of Spleen and Stomach Yin Deficiency with one of the
following
Ascending or failure to descend symptoms:
Constipation
Hiccups
Nausea
Vomit or dry heaves
Hunger with no desire to eat
 23
Clarifying Diagnosis

Spleen Not Controlling Blood will have Spleen Qi or Yang Deficiency signs along with
bleeding pathology including easy bruising.

Damp Oppressing the Spleen is excess, will have signs of Spleen Involvement and may or
may not involve Spleen Qi deficiency. It will include at least one of the following symptoms:
Lack of taste discrimination
Thirst with little desire to drink
Scanty clear urination

Dampness Oppressing the Flesh may or may not have Spleen Qi Deficiency
signs. It will include at least one of the following;
Swelling and non-pitting edema of the four limbs
Sensation of heaviness
Aching pain that is worse with damp exposure

Food Stagnation Signs You can definitively diagnose Food Stagnation if you see
any signs of digestive disturbance with any one of the following: Food Stagnation Signs appear
Foul smelling stool with undigested food very similar to Damp Occluding
Poor appetite with sour regurgitation or reflux the Digestion Signs. Use this list
background to disruption is irregular eating or overeating to differentiate.

Phlegm Damp in the Flesh means that the flesh is too corpulent and may or may not appear
with Spleen Qi deficiency or disruption of transformation and transportation of the Spleen. Look
at the causes of phlegm and damp to determine the particular cause of the phlegm damp in each
individual case.
 24
Clarifying Diagnosis

Definitive Diagnosis of the Lungs

Basic Lung Signs You can definitively diagnose Lung Involvement if any one of the
following signs appears:
Cough Poor resistance to external evils can
Wheeze only be attributed to Lung Qi
Shortness of Breath Deficiency if the definitive signs are
Sneezing there!
Rhinitis and Sinusitis

Lung Deficiency To definitively diagnose Lung Deficiency you must see at least one
Basic Lung Sign and at least one of the following:
Deficiency Shortness of breath (worse when tired, better with rest)
Weak voice
Background of Spleen or Kidney Qi or Yang deficiency with pale tongue.
Background of Kidney Yin Deficiency with red tongue
Lung Qi Deficiency To Differentiate the Lung Deficiency as Lung Qi
Deficiency you must see at least one of the following signs:
Spontaneous sweat worse with movement
Pale tongue
Dip in Lung area of tongue
Background of Spleen or Kidney Qi or Yang deficiency with pale
tongue

Lung Yin deficiency To differentiate Lung Deficiency as Lung Yin Deficiency

you must see at least of the following signs:
Kidney Yin Deficiency tongue signs
Transverse creases or peeling in the Lung area of the tongue
Dry cough
Scanty thick sputum
Background of Kidney Yin Deficiency with red tongue

Dormant Wind and Phlegm in the Lungs You can definitively diagnose
recalcitrant Wind and Phlegm if you see one Basic Lung Sign that
runs a chronic course with exacerbations and remissions and
It is triggered by irritants such as inhalants, seasonal changes, wind, cold, humidity,
heat, stress or diet or it is found in combination with triggered skin itchiness. A helpful
way to identify and pathogen as an irritant is if it is removed the symptoms get
better

The category of dormant wind and phlegm in the lungs is a general category and a
branch category. This means that you must have further differentiation such as
wind heat, wind cold etc and differentiate the relative extent of wind and phlegm.
In addition, as a branch category, the root must be determined.
 25
Clarifying Diagnosis

Lung Dryness does not involve deficiency signs but does include some Basic Lung
Signs and some of the following symptoms
Dry cough and dry orifices (mouth, nose, eyes)

Lung Blood Stasis You can definitively diagnose Lung Blood Stasis if you see
definitive signs for Lung involvement that are chronic combined with
Systemic blood stasis signs

Lung Excess You can definitively diagnose Lung Excess if you have at least one Basic
Lung Sign along with the following signs:
Lung sign worse with laying down
Loud Cough
A strong type person with no or few deficiency signs.

Phlegm Excess Obstructing the Lungs You can definitively diagnose Phlegm
Obstructing the Lungs if you have Lung Excess Signs and
Cough with profuse phlegm
Chest oppression
Excessively wet or thick tongue moss

Phlegm Heat Excess Obstructing the Lungs You can definitively diagnose
Phlegm Heat Obstructing the Lungs if you have Lung Excess Signs and
Cough with profuse yellow, green or dark phlegm
Thick yellow tongue moss

Phlegm Rheum Obstructing the Lungs You can definitively diagnose Phlegm
Rheum Obstructing the Lungs if you have Lung Excess Signs and
Cough with profuse watery, dilute and frothy phlegm
Splashing sounds in the chest

External Invasion of the Lungs To definitively diagnose External Invasion of the

Lungs you must see a Basic Lung Sign along with the feeling of coming down
with something and at least one of the following
Achy body
Feverishness and Chills
Scratchy or Sore Throat
Aversion to wind
 26
Clarifying Diagnosis

Wind Cold Invading the Lungs To diagnose Wind Cold Invading the
Lungs you must see a sign of External Invasion of the Lungs with one of
the following:
Predominance of chills
Pale mucous membranes in the nose and throat

Wind Heat Invading the Lungs To diagnose Wind Heat Invading the
Lungs you must see a sign of External Invasion of the Lungs with one of
the following:
Chills less than Fever
Hot feeling in the orifices
Stuffy nose with yellow mucous
Red mucous membranes in the nose and throat

Wind Water Invading the Lungs To diagnose Wind Water Invading the
Lungs you must see a sign of External Invasion of the Lungs with one of
the following:
Gradually spreading swelling in the upper body
Scanty pale urine
 27
Clarifying Diagnosis

Definitive Diagnosis of the Heart

Basic Heart Signs You can definitively diagnose Heart Involvement if any one of
these signs appear:
Disturbances of the heart beat
The Basic Heart Signs may be present
Sleep disturbance
whether it is deficiency of Yin, Yang, Qi or
Poor memory or concentration
Blood or an Excess such as Phlegm, Phlegm
Spirit disturbance
Heat or Blood stasis,
Heart Yin or Blood Deficiency Signs You can definitively diagnose Heart Yin
or Blood Deficiency if you have at least one Basic Heart Sign along with
indented tongue tip
Heart Yin Deficiency can be differentiated if there are signs of Kidney, Liver,
Lung or Spleen Yin Deficiency or
A peeled tongue tip
Foundational Yin deficiency signs
Heart Blood Deficiency can be differentiated if there are signs of Liver Blood
Deficiency.

Heart Qi deficiency You can definitively diagnose Heart Qi Deficiency if you

see a Basic Heart Sign with any signs of Lung, Spleen or Kidney Qi deficiency.
.
Heart Yang deficiency You can definitively diagnose Heart Yang Deficiency if
you see a Basic Heart Sign with any signs of Spleen or Kidney Yang deficiency.
.
Phlegm misting the orifice of the Heart You can definitively diagnose Phlegm
misting the orifice of the Heart if you see a Basic Heart Sign with any sign of
Phlegm

Heart Blood Stasis You can definitively diagnose Heart Blood Stasis if you see a
Basic Heart Sign with any sign of Phlegm

Heart Heat You can definitively diagnose Heart Heat if you see a Basic Heart
Sign with any sign of Excess Heat or
Red long tongue Protuberance of tongue tip
Uplifted tongue tip Red swollen tongue tip

Phlegm Fire harassing the Heart You can definitively diagnose Phlegm Fire in
the Heart if you see a Basic Heart Sign with any sign of Phlegm Fire or
Yellow greasy tongue moss.
 28
Clarifying Diagnosis

Definitive Diagnosis of Yang Organs

Large Intestine

Large Intestine You can know definitively that the Large Intestine is involved if
you see bowel issues that are Excess or Dry

Large Intestine Excess You can definitively diagnose excess in the Large Intestine if
you see bowel and/or abdominal symptoms that are better after a bowel
movement.

Large Intestine Damp Heat You can definitively diagnose Large Intestine
Damp Heat if you see
Diarrhea with an offensive odor
Mucous and Blood in stool
Large Excessive Heat You can definitively diagnose Large Intestine Heat if
you see Large Intestine Excess combined with
Normal or large sized red tongue
Yellow-brown or yellow-black tongue moss
Dry Constipation
Burning or Red anus
Large Intestine Obstructive Heat You can definitively diagnose Large
Intestine Obstructive Heat if you see Large Intestine Excess or Heat Signs

Cold in the Large Intestine You can definitively diagnose Cold in the Large
Intestine if you see Large Intestine Excess combined with
Bowel symptoms that are worse with cold and better with warmth

Large Intestine Qi Stagnation can be definitively diagnosed if you see signs

Large Intestine of Qi Stagnation combined with bowel symptoms
Dryness can
be caused by Large Intestine Dryness can be definitively diagnosed if you see dry
Blood Xu, constipation
Yin Xu or
Heat. Small Intestine

Heat in the Small Intestine: You can definitely diagnose Heat in the Small
Intestine if you have
-Definitive Heat in the Heart or Hot type mouth ulcers combined with
Burning or concentrated urination or
-Definitive Excess Heat in the Large Intestine with Burning or concentrated
urination
 29
Clarifying Diagnosis

Worms in the Small Intestine: You can definitively diagnose Worms in the
Small Intestine if you have any one of the following
Itchy anus with presence of pinworms or tapeworms
Desire to eat strange things
Abdominal pain with vomiting of round worms

Gall Bladder

Gall Bladder Dampness can be definitively diagnosed if you see definitive signs
for Dampness effecting the digestion along with hypochondrial fullness.

Gall Bladder Damp-Heat can be definitively diagnosed if you see definitive

signs of Damp-heat effecting the digestion along with hypochondrial pain.

Bladder

Bladder Signs: You can definitively diagnose Bladder involvement if there is at

least one of the following signs or symptoms:
Painful urination
Difficult urination
Concentrated urination
Burning urination
Cloudy urination
Blood in the urine

Bladder damp-heat can be definitively diagnosed if you see any Bladder Sign
combined with at least one Damp-heat sign.

Bladder damp-cold can be definitively diagnosed if you see any Bladder Sign
combined with any one of the following
A thick white tongue moss
A pale wet tongue
A pale tongue with no yellow greasy moss
A feeling of cold in the lower abdomen

Bladder Heat can be definitively diagnose if there are any Bladder Signs combined
with any one of the following:
A red tongue
Concentrated urine
Burning urine
 30
Clarifying Diagnosis

Stomach

Stomach Signs can be definitively diagnosed if you find any one of the following
symptoms:
Nausea or Vomiting
Poor Appetite
Regurgitation
Hiccough
Indeterminate Gnawing Hunger

Stomach Deficiency can be definitively diagnosed if there are Stomach Signs

combined with symptoms that are better with food and rest and touch.

Stomach Yin Deficiency can be definitively diagnosed if you see any

one of the above symptoms and at least one of the following;
Peeled or cracked or rootless moss in center of tongue
Excessive satiable thirst
Thirst with desire to drink small sips

Stomach Qi Deficiency can be definitively diagnosed if you see any

one of the above symptoms combined with Qi deficiency Signs.

Stomach Excess can be definitively diagnosed if there are Stomach Signs that
are worse with eating or touch and can be further differentiated as below:

Stomach Cold can be definitively diagnosed if you see any Stomach

Signs combined with any one of the following symptoms:
Vomit of watery or frothy liquid
Preference for warm drinks and heat
Dislike of cold drinks and food

Stomach Heat can be definitively diagnosed if you see any Stomach

Signs combined with any one of the following symptoms:
Burning sensation in epigastrium
Intense thirst with desire for cold beverage
Red in center of tongue with dry yellow moss

Stomach Phlegm Heat can be definitively diagnosed if you see any

Stomach Heat signs combined with a thick greasy yellow tongue
moss.

Food Stasis in the Stomach can be definitively diagnosed if you see

any Stomach Signs combined with Food Stasis Signs.