Download Clinical Significance of Pulse Examination

1.
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Determining the site of a disease and its
relevant organs:
A floating pulse indicates exterior disease, a
deep pulse indicates interior disease.
The correspondence of the cunkou pulse to
zang-fu organs can be used to determine
where the disease is.
Eg a surging rapid pulse palpated at the cun
portions of both hands often indicates
excess-heat in the heart and lung.
1. Determining the site of a disease and its
relevant organs:
- A deep faint pulse palpated at the chi
portions of both hands often indicates kidney
qi deficiency;
- A wiry and rapid pulse at the left guan
portion and a deep week pulse at the right
guan portion often reflect that liver qi violates
the spleen or liver qi stagnation and
insufficiency in the spleen.
2. Distinguishing the situation of yin and yang
and the nature of a disease:
- A surging forceful pulse is the manifestation
of excessive yang heat, indicating the interior
excess heat syndrome
- A deep, slow forceful pulse is the
manifestation of excessive yin cold,
suggesting the internal excess-cold
syndrome;
3. Determining wax and wane of the healthy qi and
pathogenic factors and deficiency or excess of a
syndrome:
- Deficient, thready, fait or weak pulse reflect weak
healthy qi, indicates deficiency syndrome;
- Forceful, surging, slippery and tight pulse reflect
exuberant pathogenic factors and insufficient
healthy qi, indicating excess syndrome.
- When a forceless pulse changes into a forceful
one gradually, indicates the healthy qi is
recovering and pathogenic factors are declining
and the opposite suggests declining of healthy
qi.
4. Predicting the progress and prognosis of an
illness:
- If the pulse of a chronic disease turns to
moderate and harmonious, it is a sign of qi
recovery and good prognosis;
- But if the pulse turns to floating and large, it
usually indicates exuberance of pathogenic
factors and deficient qi is a sign of
deterioration and unfavorable prognosis.
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In a warm disease, the pulse turns to
moderate and harmonious and fever
subsided, it suggests qi recovery and
favorable prognosis.
A deep, weak forceless pulse usually indicates
deficiency and weakness of yang qi, and the
interior deficiency-cold syndrome.
A thready, rapid forceful pulse often indicates
deficiency and weakness of blood, and the
interior deficiency-heat syndrome.
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When a thready, faint, weak scattered pulse
appears in an excess syndrome, it means the
pathogenic factors are rampant and about to
prevail over the healthy qi.
If a floating, surging, rapid excess pulse is
seen in a chronic disease, it indicates
deficiency of the healthy qi and exuberence
of pathogenic factors.
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Make diagnosis on the basis of pulse
conditions rather than on symptoms and
signs should be followed when symptoms are
false but pulse conditions are true.
Making diagnosis on the basis of symptoms
and signs rather than on pulse conditions
should be followed when a pulse contradicts
symptoms and signs.
◦ General condition:
 Young people have abundant qi and
blood and strong resistance to illnesses
and they are susceptible to the excess
syndrome.
 Elderly’s qi and blood are declining and
have weakened resistance to illness, and
they are susceptible to the deficiency
syndrome.
◦ History of recent illness:
 Generally speaking, a sudden attack
with short duration indicates the
excess syndrome, and a prolonged
illness that occurs repeatedly suggests
the deficiency syndrome or the
interlocking of deficiency and excess.
 Distending hypochondriac pain due to
depression is caused by stagnation of
liver qi .
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Anamnesis
◦ Health condition
 People with a strong physique tend to
suffer from the excess syndrome
 People of a weak build tend to suffer
from deficiency syndrome.
 People with yin deficiency are susceptible
to the warm-dryness syndrome and
 People with yang deficiency are
susceptible to cold-damp syndrome.
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Personal life history :
◦ Accommodation
 Indolence may result in stagnation of qi and blood and
phlegm-dampness.
 Overwork and immoderate sexual life may injure
essence and qi and cause the deficiency syndrome.
◦ Spiritual and emotional state
 If a present disorder is caused by emotional problems,
an introvert is likely to present such symptoms as
stagnation of liver qi or syndrome of fire turned from
stagnated liver qi.
◦ The generation of a cold or a feverish sensation is
caused by the nature of pathogenic factors and
abundance and decline of yin and yang in the body.
Cold is a yin pathogen, so when a disease is caused
by cold, chills present. Heat leads to fever, for it
belongs to yang
◦ Chills and Fever
 Extreme chills and mild fever: when they have extreme
chills and mild fever, patients suffer from exogenous
wind-cold. Since it belongs to yin, it attacks the
superficial portion of the body and impairs yang,
leading to chills.
 High fever and mild chills: Patients are afflicted by
wind-heat. Since it belongs to yang and abundant yang
causes fever, so fever is more obvious than chills.
 Mild fever and aversion to wind: Patients are attacked
by exogenous pathogenic wind. Since wind goes in
different directions, the texture and interstitial spaces
of the muscles are loose and yang qi is confined
inside, so both fever and aversion to wind are mild.
◦ Fever without chills
 It indicates the interior heat syndrome due to
abundance of yang or deficiency of yin.
 1) High fever: patient with persistent high fever has no
chills but an aversion to heat, usually found in the
warm-heat disease in the qi system.
 Tidal fever: Comes and goes in fixed time like tides.
Tidal fever is due to damp-heat and deficiency of yin.
 Low fever: In general, low fever lasts for a long time
and is caused by internal injury. It can be divided into
fever due to deficiency of yin or qi, or due to blood
stasis and fever due to stagnation of qi .
◦ Absence of sweating
 Absence of sweating in the whole body
 Absence of sweating in an exterior syndrome: indicates
exterior excess and cold syndrome caused by exogenous
wind-cold.
 Absence of sweating in an interior syndrome: suggest
protracted deficiency syndrome caused by deficiency of
yang qi .
 Absence of sweating in a local part
 Often seen in patients with stroke, flaccidness and
paraplegia, caused by obstruction of channels and
collaterals in the diseased site by wind-phlegm, stasis of
blood and wind-dampness, leading to impeded circulation
of qi and blood.
 Sweating in an exterior syndrome: falls into two
categories:
1) exterior excess and heat syndrome due to
exogenous wind-heat: cause is wind-heat, hot and
pervasive in nature, makes the textual and interstitial
spaces of muscles loose;
2) exterior syndrome due to exogenous wind: cause is
wind, changeable and pervasiveness tends to cause
the pores open, the textual and interstitial spaces of
muscles loose and body fluids release.
◦ Sweating in an exterior syndrome: sweating due to
the interior syndrome can be divided into the
following conditions
 Spontaneous sweating: a sign of deficiency of qi and
deficiency of yang.
 Night sweating: a sign of internal heat due to yin
deficiency or deficiency of both qi and yin.
 Profuse sweating: an excess of heat syndrome is
marked by profuse sweating, high fever, extreme thirst
and full pulse.
 Exhaustion sweating: indicates collapse of yang or yin
 Shiver sweating: indicates a confrontation between the
pathogenic factors and healthy qi.
 Local sweating
 On the head: common causes for it are heat in the upperenergizer, steaming of accumulated damp-heat in the
middle-energizer and collapse of qi.
 On the chest: deficiency in the heart and spleen or
disharmony between heart and kidney.
 On palms and soles: caused by steaming of accumulated
damp-heat in the middle-energizer or excessive heat in
the yangming channel and internal heat due to yin
deficiency.
 On genitals: caused by damp-heat in the lower-energizer
1) Distending pain: caused by stagnation of
qi. Distending pain in head and eyes
tends to be seen in hyper-function of
liver yang or flaming of liver fire
2) Stabbing pain: sign of blood stasis in
the head, chest, hypochondria, stomach
ad abdomen
3) Scurrying pain: caused by stagnation of
qi in liver
4) Fixed pain: Due to blood stasis, seen in cold
arthralgia and damp arthalgia
5) Pain with a cold sensation: If it is caused by
pathogenic cold, which blocks the zang-fu
organs, tissues, channels and collaterals, it
indicates the excess cold syndrome. If it is
caused by deficiency of yang qi, it indicates the
deficiency cold syndrome
6) Burning pain: when it is due to yang heat, it is
the excess heat syndrome. When it is caused by
flaming fire due to yin deficiency, it is the
deficiency heat syndrome
 7) Pain with a heavy sensation: caused by
stagnation of qi due to pathogenic dampness
 8) Muffled pain: caused by blockage of the lung by
phlegm
 9) Colicky pain: caused by blood stasis, stagnation
of qi, or obstruction of qi due to pathogenic cold
 10) Pulling pain: caused by malnourishment or
blockage of tendons and muscles
11) Aching pain: caused by winddampness and impeded circulation of qi
and blood, or deficiency in the kidney,
insufficient qi and blood
12) Dull pain: caused by deficiency of
essence, blood or deficiency of yang qi
13) Pain with a sensation of emptiness:
sign of deficiency syndrome
1) headache: caused by external
contraction, internal injury, deficiency or
excess syndrome
2) chest: indicates pathological changes in
the heart and lung. Internal deficiency and
stabbing pain indicate blockage of cardiac
vessels
3) Hypochondriac pain: stagnation of liver
qi, accumulation of damp-heat in the liver
and gallbladder and abundant fire in the
liver and gallbladder
4) Epigastric pain: pain alleviated by food intake
indicates deficiency syndrome; pain aggravated
after food intake suggests excess syndrome
5) Backache: backache involving the neck
indicates invasion of the taiyang channel by
wind-cold and pain in shoulders implies
retention of wind-dampness and obstruction of
qi
6) Pain in limbs: often seen in arthralgia due to
invasion by pathogenic cold
7) Dizziness: caused by blockage of the middle-jiao
by phlegm-dampness, accumulation of liver fire,
hyperactivity of liver yang, deficiency of qi and blood
or deficiency of kidney essence
8) Tinnitus: a sudden attack of tinnitus indicates the
excess syndrome while a gradual attack suggests
deficiency syndrome, caused by yin deficiency of the
liver and kidney and upward disturbance of liver
yang, deficiency of kidney essence, lack of marrow
and malnutrition of ears or deficiency of spleen qi
 Deafness or loss of hearing: Indicates excess syndrome
caused by adverse flow of fire in the liver and gallbladder
to ears or upward attack of ears by exogenous pathogenic
factors. Gradual attack suggests deficiency syndrome
caused by deficiency of the essence and qi
 Eye itching: when one feels as if worms moved on the eyes
with photophobia, tears and a burning sensation, it is due
to upward attack by wind-fire of the Liver Channel. When
the eyes have slight itching, it is caused by deficiency of
blood and malnutrition of eyes
 Eye pain: Acute pain indicates excess syndrome while mild
pain indicates deficiency syndrome
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Giddiness and Night Blindness: Caused by
deficiency in the liver and kidney, deficiency of
essence and blood, and malnutrition of the eyes
Chest oppression: related to impeded qi flow in the
heart and lung
Palpitation: causes are heart blood blockage,
deficiency of heart blood, deficiency of heart yin,
deficiency of heart yang and retention of fluid due
to kidney qi deficiency
 Hypochondriac distention: stagnation of liver qi
and accumulation of damp-heat in the liver and
gallbladder
 Gastric stuffiness: caused by stagnation of qi.
The pathogenesis can be deficiency or excess,
such as deficiency in the spleen and stomach,
and retention of phlegm-dampness
 Abdominal distension: caused by pathological
changes in the spleen, stomach, intestines, liver
and kidney, and impeded qi flow
 Sluggishness of the body: caused by pathogenic
dampness or dysfunction of the lung, spleen, and
kidney and retention of water in the skin
 Numbness: Can be categorized into the deficiency or
excess syndrome such as depletion of qi and blood,
internal stirring of liver wind, phlegm accumulation in
channels and blood stasis
 Fatigue : Can be categorized into the deficiency or
excess syndrome e.g. original qi deficiency, yang qi
declination, body fluid impairment and summer-heat
impairing qi and fluid, dampness pathogen obstructing
qi flow and so on
◦ State of thirst and drinks taken
 Neither thirst nor desire for drinking water indicates body
fluids are not impaired, usually seen in the cold syndrome,
dampness syndrome or syndrome without evident dryness or
heat
 Thirst with a desire to drink water indicates impairment of
body fluids, often seen in dryness syndrome and heat
syndrome
 Thirst without much drinking of water is usually caused by a
mild impairment of body fluids or failure of body fluids to
flow to the upper part of the body caused by inhibited qi
transformation and distribution. It is usually seen in the yin
deficiency syndrome, damp-heat syndrome, fluid retention,
blood stasis and syndrome of hat of a warm disease that
invades the nutrient system
◦ Appetite and diet
 Declined appetite: usually caused by weakness of the
stomach and spleen as inhibited spleen by dampness.
Declined appetite in a recent disease is a protective
reaction of qi fighting against pathogenic factors
 Anorexia: can be seen in food retention in the
stomach, accumulation of damp-heat in the spleen or
damp-heat in the liver and gallbladder. Can also be
due to upward reversed flow of qi in the Thoroughfare
Vessel, which prevents stomach qi from descending
and is a physiological phenomenon
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Anorexia: can be seen in food retention in the stomach,
accumulation of damp-heat in the spleen or damp-heat in the
liver and gallbladder. Can also be due to upward reversed flow of
qi in the Thoroughfare Vessel, which prevents stomach qi from
descending and is a physiological phenomenon
Polyphagia and frequent hunger: caused by exuberance of
stomach fire and fast digestion. Excessive eating and frequent
hunger accompanied by polydipsia, hyperdiuresis and wasting
away are seen in diabetes, which is caused by yin deficiency and
exuberate fire of the stomach and kidney
Hunger without a desire to eat: usually due to deficiency of
stomach yin and disturbance of deficiency fire. Internal
disturbance of stomach fire leads to a hungry feeling quickly, yin
deficiency and weakness of the stomach, hyperfunction of the
stomach to receive, and digest food
 Bland taste in the mouth: refers to hypogeusesthesia, usually
accompanied by anorexia, and seen in qi deficiency of the
spleen and stomach of the cold syndrome
 Bitter taste in the mouth: usually seen in syndromes such as
fire blazing and upward adverse flow of gallbladder qi due to
exuberant fire in the liver and gallbladder or interior
retention of damp-heat
 Sweet taste in mouth: usually seen in syndromes such as
damp-heat in the spleen and stomach or spleen insufficiency
 Sour taste in mouth: usually seen in the syndromes of heat
accumulation in the liver and stomach, disharmoney between
the liver and stomach and retention of food
 Salty taste in the mouth: usually due to deficiency in
the kidney and upward flow of cold water
 Puckery taste in the mouth: caused by dryness and
heat impairing body fluids, or predominant yang heat
in the zang-fu organs and upward adverse flow of qi
and fire
 Sticky and greasy taste in mouth: caused by retention
of phlegm and dampness and often comes together
with parageusia
 Abnormal frequency
 Constipation: has different causes as cold
or heat, deficiency or excess. Excess
constipation is caused by pathogen
obstruction in the stomach and intestines,
resulting in obstruction of fu-organ qi.
 It can be seen in heat accumulation in the
intestines or congealing cold in the
intestines.
 Deficiency constipation is usually caused
by yin and yang, qi and blood deficiency
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Diarrhea: Diarrhea before dawn with pain suggests
interior retention of cold-dampness due to
deficiency in the spleen and sufficiency kidney
yang.
Sudden diarrhea accompanied by pain in the
abdomen and difficulty in emptying bowels and
burning pain in the anus is due to accumulation of
damp-heat in the large intestine.
Watery stools accompanied by cold pain in the
abdomen, borborygmus and white greasy tongue
coating are due to cold-dampness
 Abnormal quality
 Undigested food stuff in stools: usually seen
in deficiency-cold in the spleen and stomach
or diarrhea due to deficiency in the kidney
and declined fire of the life gate
 Alternate loose and dry stools: occasional dry
and loose stools are usually due to liver qi
stagnation and deficiency in the spleen and
disharmony between the liver and spleen. Dry
stools followed by loose stools are usually
due to qi deficiency of the spleen and
stomach
 Burning sensation in anus: usually due to
downward pouring of damp-heat in the large
intestine or heat accumulated in the large intestine
which invades the rectum, often seen in diarrhea
due to damp-heat
 Tenesmus: caused by collection of damp-heat and
qi stagnation in the intestines
 Unsmooth defecation: due to accumulation of
damp-heat and disturbance of intestine qi, or due
to invasion of the spleen by liver qi and
obstruction of intestine qi or retention of food in
the stomach and intestines and disturbance of qi
flow
 Prolonged and uncontrolled diarrhea:
usually caused by deficiency in the
spleen and kidney or failure of the anus
to control. Fulminant diarrhea in a
recent disease or spontaneous
defecation with coma is also due to
failure of the anus to control, but it is
caused by invasion of the large
intestine by heat or loss of
consciousness
 Drooping of the anus: refers to a dragging
sensation in the anus.
 Usually due to sinking of qi of the middleenergizer caused by deficiency in the spleen,
and this condition is often seen in patients
with lingering dysentery or diarrhea
 Abnormal amount of urine
 Increased amount: clear and profuse urine
accompanied by aversion to cold and
preference for heat is a cold syndrome due to
insufficiency of yang qi and failure of qi to
transform body fluids
 Decreased amount: scanty deep yellow urine
is caused by excessive heat or impairment of
body fluids. Oliguria with edema is caused by
retention of dampness and fluid due to
dysfunction of the lung, spleen and kidney
and water metabolism
 Frequent urination: usually due to
disturbed water metabolism caused
by damp-heat in the bladder.
 Clear, profuse urine and frequent
urination in a chronic disease, worse
at night, is usually due to
insufficiency of kidney yang,
insecurity of kidney qi and failure of
the bladder in control urine
 Difficulty in urination and retention of urine: related to
dysfunction of the triple-energizer, lung, spleen and
liver.
 Difficulty in urination and retention of urine can be seen
in both deficiency and excess syndromes.
 In the former, it is due to deficiency of yang qi of the
kidney, disturbed water metabolism, interior
accumulation of body fluids, or failure of open-close
caused by deficiency of spleen-qi and dysfunction of the
spleen in sending up the mobile and sending down the
unusable.
 The latter one is due to retention of damp-heat in the
bladder, heat and qi accumulation in the lung, blood
stagnation or stone obstruction in the lower-energizer
 Difficulty and pain in urination: caused by dampheat in the urinary bladder and disturbed water
metabolism
 Dribble of urine: due to poor reservation of kidney
qi and failure of bladder to control urine
 Incontinence of urine: due to poor reservation of
kidney qi and deficiency-cold in the lowerenergizer or dysfunction of the urinary bladder
 Enuresis: means bed-wetting in sleep caused by
insufficient kidney qi and dysfunction of the
urinary bladder
◦ Depression: caused by functional disorder of the liver,
heart, spleen, kidney and qi and blood. Commonly seen
in the syndromes such as stagnation of liver qi and
insufficiency in the spleen, deficiency in the heart and
spleen and spleen-kidney yang deficiency
◦ Hyperthymia: usually due to interior agitation of
phlegm-fire, or yin deficiency of the heart and kidney
leading to stirring of deficiency-fire
◦ Dysphoria: usually caused by deficiency in the zang0fu
organs, malnutrition of the heart, or interior agitation of
pathogenic host and unsteadiness of the mind, and is
usually seen in syndromes such as heart-gall bladder, qi
deficiency, heart-spleen insufficiency, interior heat due
to yin deficiency and gallbladder qi stagnation with
phlegm disturbance
◦ Fear: caused by both deficiency and excess
syndrome. Tremendous, irresolute, melancholy
temperament accompanied by pain are due qi
deficiency of the liver and gallbladder.
◦ Tendency to worry accompanied by tiredness,
lusterless complexion, a pale tongue with thin and
white coating is due to deficiency of both qi and
blood
◦ Upset and restlessness: caused by both excess and
deficiency. Excess category is due to pathogenic
heat, phlegm-fire and blood stasis. Deficiency
category is due to fire hyperactivity resulting from
yin deficiency
◦ Insomnia: caused by disharmony between yin and yang,
and mental derangement. Its formation has deficiency
and excess causes.
◦ The deficiency syndrome of insomnia is usually caused
by deficiency of blood and malnutrition of the heart,
while the excess syndrome interior exuberance of
pathogenic qi and disturbance of the mind
◦ Lethargy: due to yang deficiency and yin excess.
◦ When accompanied by lassitude, heaviness in the head,
eyes and limbs, oppression and fullness of the chest,
usually caused by exuberance of phlegm-dampness in
the spleen and failure of yang to rise.
◦ Lethargy after meals accompanied by lassitude, declined
appetite and indigestion is often due to deficiency of
middle qi and failure of the spleen to transform and
transport
 Abnormal menstrual cycle
 Preceded menstrual cycle: menstruation that occurs more
than 7 days earlier in at least two successive menstrual
cycles. Often caused by qi deficiency or predominance of
yang and blood heat, liver qi stagnation and blood heat and
fire hyperactivity, resulting from yin deficiency, leading to
heat disturbance of the Thoroughfare and Conception
Vessels
 Delayed menstrual cycle: menstruation that occurs more
than 7 days later in at least two successive menstrual cycles.
Often caused by deficiency blood, decline of yang qi and lack
of nourishment, obstruction of the Chong Meridian and Ren
Meridian
 Irregular menstrual cycle: caused by stagnation of liver qi or
blood stasis, deficiency and impairment of the spleen and
kidney leading to qi and blood disorder of the Thoroughfare
and Conception Vessels and dysfunction of the sea of blood
 Abnormal amount of menses
 Menorrhagia月经过多: evident increase of menses with normal
menstrual cycle. Usually caused by heat in the blood resulting in
impairment of the Chong Meridian and Ren Meridian and failure
to control blood, or qi deficiency
 Metrorrhagia and metrostaxis崩漏: sudden large amount of
uterine bleeding not in periods. Caused by heat impairing the
Chong Meridian and Ren Meridian and driving blood to flow out;
or by spleen kidney qi deficiency and debility of the
Thoroughfare and Conception Vessels, or by blood stasis in the
Thoroughfare and Conception Vessels and failure of blood to
circulate in vessels
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Scanty menstruation: refers to normal
menstrual cycle with evident reduction of
menstrual blood or even scanty of menses.
It is usually caused by deficiency of essence
and blood or both qi and blood, or
coagulation cold and blood stasis and
inhibited circulation of the Chong Meridian
and Ren Meridian.
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Amenorrhea闭经: it refers to no menstruation
when a woman is after 18 or cessation of
menstruation for over three months without
pregnancy of not during lactation in women.
Cessation of menstruation in some
adolescent women after menstruation without
other discomfort is not considered as
amenorrhea.
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Pathological amenorrhea is usually due to
deficiency in the spleen and kidney, deficiency of
qi and blood in the Chong and Ren Meridians, or
qi stagnation, cold coagulation and blood stasis,
or phlegm-dampness accumulating in the uterus
and obstruction of uterine vessels.
Some women do not have menstruation for life
and they are fertile, it is called “Adverse
Menstruation.”
Adverse rise of menses during menstruation
resulting in hematemesis, nosebleed or bleeding
from eyes or ears are called “Vicarious
menstruation.”
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Abnormal color and quality of menses: light
red and thin discharge usually indicates qi or
blood deficiency, while dark red and viscous
menses suggests exuberant heat in blood. A
dark purplish menstruation flow with blood
clots accompanied by cold pain in the lower
abdomen is caused by cold coagulation and
blood stasis.
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Excessive and continuous leukorrhea with
abnormal color, quality or smell is called
pathological leukorrhea.
A minor increase of discharge before or after
menstruation, ovulation period or trimester of
pregnancy is a normal phenomenon. Inquiry
of leukorrhea should focus on its amount,
color, quality and odor.
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White vaginal discharge: indicates yang
deficiency of the spleen and kidney and
pouring down of cold-dampness; white
viscous, curd-like discharge with offensive
smell usually suggests pouring down of
dampness.
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Yellow vagina discharge: yellowish, viscous
discharge with offensive odor usually suggests
pouring down of damp-heat.
Red and white vagina discharge: indicates
retention of heat in the liver meridian or pouring
down of damp-heat.
Continuous red yellow and light brown discharge
with offensive odor in women of middle-aged or
the elderly is usually caused by pouring down of
dampness-heat with toxins, the prognosis is
usually bad and immediate examination is
recommended.
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Dysmenorrhea: it refers to intermittent lower
abdominal pain before, after or during menstruation,
or pain involving the lower back and sacrum or even
unbearable pain.
Clinical syndrome differentiation is mainly based on
the characteristics and time of the pain.
Lower abdominal distending pain or sharp pain
during or before menstruation is usually caused by qi
stagnation or blood stasis;
Lower abdominal pain alleviated with warmth or often
due to cold coagulation or yang deficiency, and lower
abdominal dull pain during or after menstruation is
usually caused by deficiency of both qi and blood and
malnutrition of the uterus.
◦ Impotence阳痿: refers to inability to erect penis or
weak erection of penis
 Impotence has deficiency and excess syndromes.
Generally speaking, recent, acute or secondary disease
in young people is of the excess syndrome, while
prolonged, gradually developed and primarily
happened in the aged is of the deficiency syndrome.
Impotence due to excess of sexual activities or worry
is usually seen in the deficiency syndrome of
declination of fire of the life gate and insufficient qi of
the heart and spleen, while impotence due to
emotional dissatisfaction, interior stagnation of
pathogenic qi in penis is usually seen in the excess
syndromes of liver qi stagnation, downpoouring of
damp heat and stagnant blood obstructing collaterals
 Postcoital protrusion阳强: refers to a prolonged
erection
 The deficiency syndrome is usually due to
disturbance of liver fire, while the excess
syndrome is usually due to yin deficiency of
the liver and kidney leading to frenetic stirring
of fire of the life gate
 Premature ejaculation早泄: usually caused by
insecurity of kidney qi, deficiency of kidney
yang, deficiency of liver kidney yin and frenetic
stirring of ministerial fire