Symptoms 1, general

General signs are those affecting the whole or large parts of the body such cold and heat sensations and sweating, spirit-mind conditions (e.g., heart vexation), speech disorders, and sleep disorders (e.g., insomnia). Other general signs are discussed under Symptoms 6, body and limbs. Below is a brief description of the major general symptoms, with links to entries that provide more detail.

Spirit and Affect-Mind

Lassitude of spirit and lack of strength (神疲乏力 shén pí fá lì); fatigue and lack of strength (倦怠乏力 juàn dài fá lì); fatigued limbs (肢体倦怠 zhī tǐ juàn dài): The spleen governs the flesh and limbs. It is the later-heaven source of qì and blood. Fatigue affecting both body or spirit arises when the spleen fails to produce sufficient qì and blood. It is seen in any qì vacuity pattern or dual vacuity of qì and blood.

Forgetfulness (健忘 jiàn wàng); abstraction (恍惚 huǎng hū): Forgetfulness is poor memory. It is often accompanied by abstraction, which is absentmindedness and inability to focus or refocus attention. It is mostly caused by heart blood depriving the heart spirit of nourishment or insufficiency of kidney essence, and less commonly by phlegm turbidity harassing the upper body or static blood attacking the heart. It mostly occurs in heart blood vacuity; dual vacuity of the heart and spleen; insufficiency of kidney essence; kidney yīn vacuity; and heart-liver blood vacuity.

Susceptibility to fright (易惊 yì jīng); flusteredness (心慌 xīn huāng): Susceptibility to fright is the tendency to be frightened or shocked easily. It is often associated with flusteredness (a feeling of nervousness and lack of composure) and with heart palpitation. It results from insufficiency of qì and blood failing to nourish the heart, from fire or phlegm-fire harassing the heart spirit, or from failure of the gallbladder’s governing of decision-making the heart spirit susceptible to fear and fright. It occurs in heart blood vacuity, hyperactive heart fire, phlegm-fire harassing the spirit, and in gallbladder qì vacuity, and dual vacuity of qì and blood.

Heart vexation (心烦 xīn fán): A feeling of unrest in the heart. It arises when intense heart repletion fire or vacuity fire resulting from heart yīn vacuity harasses the heart spirit.

Heat vexation (烦热 fán rè): Heart vexation with a pronounced sensation of heat.

Anguish in the heart (心中懊憹 xīn zhōng ào nóng): Severe heat vexation occurring in certain warm disease patterns.

Vexation and thirst (烦渴 fan ke): Heart vexation and thirst as a combined symptom.

Spirit abnormalities (神的异常 shén de yì cháng): Also called spirit-mind abnormalities (神志异常 shén zhì yì cháng). Any state of the spirit, temporary or lasting, in which the patient does not react normally to stimulus, does not think or speak coherently, or has abnormal moods (chronic emotional states) and difficulty relating to others or coping with daily life. The term includes clouding collapse, which occurs in epilepsy; manic agitation and delirious speech occurring in febrile disease; and mental abnormalities such as occur in mania and withdrawal and in feeble-mindedness. Spirit abnormalities are explained in terms of various vacuities, qì depression, phlegm, and fire conditions involving disturbance of the heart spirit. Spirit abnormalities were traditionally described in terms of talking to self, jumping over walls and climbing onto roofs, casting off one’s clothes and running around, violent and destructive behavior, nonsensical talk, and chiding and cursing or laughing and weeping, regardless of who is present.

Deranged spirit (神乱 shén luàn): Severe spirit abnormalities.

Clouded spirit (神昏 shén hūn): Partial or total loss of consciousness occurring in heart disease or disease affecting the heart when:

• when insufficiency of yáng qì disperses the heart spirit;
• when fire harasses the heart spirit; or
• when phlegm obstructs the orifices of the heart.

Clouded spirit can occur in vacuity and repletion patterns: Vacuity patterns include desertion patterns and fulminant desertion of heart yáng. Repletion patterns include heat entering the pericardium, intestinal heat bowel repletion patterns, heat toxin attacking the heart, summerheat patterns, phlegm-fire clouding the spirit, extreme heat engendering wind, wind-phlegm internal block patterns (as in wind stroke). Mild forms of clouded spirit are described in such terms as torpid essence-spirit (精神 迟钝 jīng shén chí dùn) or unclear spirit mind (神志 不清shén zhì bù qīng).

Clouding collapse (昏倒 hūn dǎo): Also called sudden clouding collapse (猝然昏倒 cù rán hūn dǎo). Sudden clouding of the spirit that makes the patient fall to the ground.

• When this is accompanied by drooling and foaming at the mouth, upward-staring eyes, squealing sounds, and convulsions that disappear when the patient regains consciousness, this is an epileptic seizure, which is explained as liver wind carrying phlegm counterflow to obstruct the clear orifices.
• If the patient loses consciousness without the above-mentioned signs, regains consciousness but is left with hemiplegia (paralysis of one side of the body), the disease is wind stroke (i.e., stroke in the sense of cerebrovascular accident in biomedicine).

Clouding reversal (昏厥 hūn jué): Sudden loss of consciousness attributable to a major disturbance in the movement of qì. In older texts, clouding reversal with reversal cold of the limbs that gives the impression that the patient is dead is referred to as deathlike reversal (尸厥 shī jué).

Mania (发狂 fā kuáng): (1) Manic agitation (see next); (2) a disease characterized by the same signs (狂 kuang). See mania and withdrawal.

Manic agitation (狂躁 kuáng zào): Also called anic derangement (狂乱 kuáng luàn). A condition marked by pronounced physical movements (agitation), in severe cases with flailing of the arms and legs (扬手掷足 yáng shǒu zhī zú) and deranged spirit sometimes with shouting, singing, and cursing. It is attributed to hyperactive heart fire, phlegm-fire harassing the heart spirit, or blood stasis. It may occur in externally contracted diseases such as yáng brightness (yáng míng) (yáng míng) patterns.

Indifference of spirit-affect (神情淡漠 shén qíng dàn mó): Also called indifferent facial expression (表情淡漠 biǎo qíng dàn mó). Lack of interest in the world, as visible in an indifferent facial expression and bearing. It is seen in yáng collapse, feeble-mindedness, and in mania and withdrawal.

Listlessness of essence-spirit (精神萎靡 jīng shén wěi mí): A severe lack of mental energy occurring in severe vacuity patterns such as yáng collapse or yīn collapse. It is a sign of spiritlessness.

Impatience, agitation, and irascibility (急躁易怒 jí zào yì nù): A habitually agitated state of mind that manifests in an impatient attitude to others, rash behavior, and sudden flights of anger (fulminant anger). It is a sign of excessive free coursing and occurs in ascendant hyperactivity of liver yáng and in liver fire flaming upward.

Gallbladder timidity (胆怯 dǎn qiè): Also called gallbladder timidity and susceptibility to fright (胆怯易惊 dǎn qiè yì jīng). Shyness, fearfulness, and lack of courage resulting from disturbance of the gallbladder’s governance of decision-making. It is often accompanied by susceptibility to fear and fright, heart vexation, insomnia, and profuse dreaming or nightmares. It is observed in gallbladder qì vacuity and in liver-gallbladder patterns involving heat.

Indecision (遇事不决 yù shì bù jué): Inability to make decisions. It is attributed to the gallbladder’s governance of decision-making. It is seen in gallbladder qì vacuity.

Affect-mind depression (情志优郁 shén zhì yōu yù): A depressed emotional and mental state marked by moodiness, depressed anger (irritability, grumpiness), excessive worry, and emotionality (unusual laughing or weeping). It is associated with depressed liver qì, which results from deficient free coursing.

Tetanic reversal (痉厥 jìng jué): Sudden loss of consciousness occurring in tetanic disease (diseases marked by severe spasm).

Cold and Heat

Heat effusion, fever (发热 fā rè): This term is often translated simply as fever, but also denotes heat sensation without raised body temperature, hence the literal translation heat effusion. Heat effusion is usually a sign of heat, but not always. When external evils invade the body, heat effusion is accompanied by aversion to cold. Even cold evil can give rise to mild heat effusion when defense qì rallies to combat it. However, in such a case, the aversion to cold is far more pronounced.

Vigorous heat effusion (壮热 zhuàng rè) is a continuous pronounced heat effusion without aversion to wind or cold, equated with the biomedical concept of high fever (over 39°C/102°F). The term is often replaced with the biomedical term high fever (高热 fā rè) in modern Chinese texts. Vigorous heat effusion occurs in interior heat and repletion patterns.

Slight heat effusion (微热 wēi rè) roughly corresponds to a low-grade fever (which in biomedicine is defined as a body temperature of 37–38°C 99–100°F). It most commonly occurs in yīn vacuity but may also occur in qì vacuity or in qì depression transforming into heat.

Tidal heat (潮热 cháo rè): Also called tidal heat effusion. Heat effusion occurring at set times of the day, like the ocean tides. The most common form is postmeridian tidal heat (see next item). Tidal heat in the morning may be associated with spleen-stomach qì vacuity. When heat gives rise to blood stasis as in warm disease, the heat effusion becomes more severe at night.

Postmeridian tidal heat (午后潮热 wǔ hòu cháo rè): Also called postmeridian tidal heat effusion. Fever or heat sensation occurring in the late afternoon or evening. It most commonly indicates yīn vacuity. When the heat feels as if it is emanating from deep within the body, it is called steaming bone tidal heat (骨蒸潮热 gǔ zhēng cháo rè). In externally contracted disease, tidal heat occurs after midday in damp warmth disease; it can also occur in yáng brightness (yáng míng) (yáng míng) disease between 3 and 5 p.m. (日晡潮热 rì bū cháo rè, late afternoon tidal heat).

Steaming bone tidal heat (骨蒸潮热 gǔ zhēng cháo rè): Tidal heat that upon palpation appears to emanate from bones; hence the name. It is a sign of kidney yīn vacuity. Compare generalized heat failing to surface below.

Vexing heat in the five hearts (五心烦热 wǔ xīn fán rè): Palpable heat in the palms and soles with vexation and heat felt in the center of the chest. It is a sign of yīn vacuity. Vexing heat in the hands and feet (手足烦热 shǒu zú fán rè) has the same significance.

Generalized heat failing to surface (身热不扬 shēn rè bù yáng): Heat in the body that is only felt on prolonged palpation in damp-heat patterns where the heat is trapped by dampness. Heat effusion resulting from damp-heat heat may also be fluctuating. Generalized heat failing to surface is similar to steaming bone tidal heat, but the accompanying signs are different.

Aversion to cold (恶寒 wù hán): Cold and shivering not completely relieved by addition of clothing, bedclothes, or heat source, observed mostly in external contraction exterior patterns. Aversion to cold is fundamentally a sign of externally contracted evils affecting the exterior and depressing the warming action of defense qì. It is most pronounced in wind-cold fettering the exterior and is milder in wind-heat invading the exterior.

Aversion to cold with heat effusion (恶寒发热 wù hán fā rè): Aversion to cold can occur with heat effusion. This happens when externally contracted evils enter the body and summon the resistance of defense qì. It is a major sign of exterior patterns. The heat is understood as a result of the struggle between evil qì and defense qì and does not necessarily mean that the invading evil causing the condition is heat.

• Heat effusion and aversion to cold occurring simultaneously at the onset of an illness is an exterior pattern caused by external contraction. The prominence of the two signs is important.
• Strong aversion to cold with slight heat effusion is observed in external contractions of cold evil (wind-cold). In such cases, the heat effusion may be very mild and subjectively almost imperceptible to the patient, although others may detect it by touching the patient’s forehead.
• Mild aversion to cold with pronounced heat effusion occurs in heat evil contractions (wind-heat). Heat effusion with aversion to wind is a sign of wind evil contraction.
• Alternating aversion to cold and heat effusion occurs in malarial disease and lesser yáng (shào yáng) disease.
• When heat effusion with aversion to cold gives way to unabating vigorous heat effusion (high fever) without aversion to cold, this indicates that the disease has penetrated the interior.
• Persistent but fluctuating high fever unabated by sweating with intermittent abhorrence of cold (see below) and heat vexation indicates intense evil heat in the interior that prevents yáng qì from reaching the exterior.
• Note that aversion to cold without heat effusion may occur in severe illness when there is a sudden marked drop in body temperature. This indicates yáng collapse vacuity desertion.

Shivering (战栗 zhàn lì, 振寒 zhèn hán): Trembling from cold is called shivering or cold shudders (寒栗 hán lì). In Chinese texts, it usually refers to violent shivering called rigors in biomedicine. It is basically the same as aversion to cold, but more severe. It occurs in warm epidemics and malarial disease.

Abhorrence of cold (憎寒 zēng hán): External shivering with internal heat vexation arising when a deep-lying internal heat evil blocks yáng qì, preventing it from reaching the exterior.

Shiver sweating (战汗 zhàn hàn): Sweating after shivering is called shiver sweating. It occurs in patients with exuberant evil and weak right qì, when evil lies latent but fails to be eliminated. Shiver sweating is the manifestation of right qì attempting to rally its strength and engaging in a fierce struggle with evil qì. It is often seen in warm disease and cold damage. It represents a critical point in the development of the disease. Abatement of heat effusion at this point indicates that evil qì is abating and right qì is recovering. If the heat effusion does not abate and there are signs such as vexation and agitation and a pulse that is urgent or racing, this signifies that the condition is worsening.

Fear of cold (畏寒 wèi hán): A habitual feeling of cold in yáng vacuity patients.

Physical cold (形寒 xíng hán): Cold that is felt as a subjective sensation by the patient or that can be detected by the practitioner through palpation. It occurs in repletion or vacuity cold.

Curled-up lying posture (向里蜷卧 xiàng lǐ quán wò): A huddled posture adopted to preserve bodily heat. It is a sign of repletion cold or vacuity cold.

Cold limbs (肢冷 zhī lěng); lack of warmth in the extremities (手足欠温 shǒu zú qiàn wēn): Palpable cold in the extremities. Mild forms are referred to as lack of warmth in the extremities. It is a sign of repletion cold or vacuity cold.

Fear of cold and cold limbs (畏寒肢冷 wèi hán zhī lěng); physical cold and cold limbs (形寒肢冷 xíng hán zhī lěng): A chronic subjective feeling of cold with a palpable lack of warmth in the extremities. It is a sign of repletion cold or vacuity cold. Fear of cold should be distinguished from the more severe aversion to cold experienced in exterior patterns in external contractions.

Reversal cold of the limbs (四肢厥冷 sì zhī jué lěng): Also called counterflow cold of the limbs (四肢逆冷 sì zhī nì lěng), or reverse flow of the limbs (四肢厥逆 sì zhī jué nì). Pronounced cold of the extremities up to the elbows and knees; observed in critical conditions called yáng collapse.

Sweating

Absence of sweating (无汗 wú hàn) is attributed to one of two factors. It occurs when external evils, notably cold, cause the interstices (sweat glands and pores) to contract and close. Here it is accompanied by pronounced aversion to cold and slight heat effusion. It can also occur as a result of depletion of blood and fluids. In this case, there is pronounced heat effusion and dryness of the skin.

Sweating (汗 出 hàn chū): Sweating is normal when attributable to warm environments and physical exertion. Abnormal sweating can result from external evils in the exterior or heat in the interior; it can stem from insufficiency or yáng qì preventing normal containment of fluids; it may also be the result of insufficiency of yīn humor (yīn vacuity) when yīn fails to constrain yáng.

• Exterior patterns: Sweating occurs in greater yáng (tài yáng) (tài yáng) wind strike patterns with wind evil and exterior vacuity. It is also seen in exterior heat patterns caused by wind-heat. Wind causes opening and discharge, making the interstices loosen and open. In exterior vacuity with defense yáng failing to keep the interstices closed, sweating is even more likely.
• Interior patterns: Sweating occurs in repletion heat patterns, yīn vacuity with internal heat, and yáng qì debilitation, and yáng collapse or yīn collapse patterns. Yīn vacuity manifests in night sweating, while yáng vacuity manifests in spontaneous sweating (see below).

Spontaneous sweating (自汗 zì hàn): Spontaneous sweating is a general tendency to sweat more than usual, especially after exertion. It is a sign of qì vacuity or yáng vacuity and is usually attended by shortness of breath, lassitude of spirit and lack of strength, fear of cold, and a pale tongue and weak pulse. Yáng qì vacuity makes defense yáng unable to keep the interstices closed so that fluids escape from the body in the form of sweat. This is exacerbated by exertion. Note that the term spontaneous sweating is sometimes also used to refer to the sweating of external contractions.

Night sweating (盗汗 dào hàn): Sweating during sleep that ceases upon waking. It results from insufficiency of yīn humor and is most common in kidney yīn vacuity.

Great sweating (大汗 dà hàn): Great sweating means the production of large amounts of sweat. A distinction is made between repletion and vacuity. Repletion patterns in which this occurs are repletion heat, while vacuity patterns are yīn collapse or yáng collapse patterns.

• Intestinal heat bowel repletion is marked by great sweating with great heat effusion (high fever), accompanied by great thirst with a desire for cold drinks and a large surging pulse (four greats). It occurs in yáng brightness (yáng míng) (yáng míng) disease in cold damage and qì-aspect patterns in warm disease.
• Yīn collapse manifests in incessant sweating with sticky and oily hot sweat. It is accompanied by heat effusion, thirst, rough breathing, and a pulse that is fine and rapid or racing. It is attributed to severe damage to yīn-humor with vacuity heat forcing the fluids to discharge.
• Yáng collapse is characterized by clear thin cold sweat that forms pearly droplets on the skin and drips off the body. Hence it is often described as great dripping sweating or cold sweating. It is accompanied by a somber-white complexion, reversal cold of the limbs, and a faint pulse on the verge of expiration.

Expiration sweating (絕 汗 jué hàn): Great sweating in critical conditions is a sign of yīn collapse or yáng collapse. See great sweating above.

Cold sweat, cold sweating (冷汗 lěng hàn): Sweating in which the sweat feels cold. It is a sign of yáng collapse or fright. See great sweating above.

Hot sweat, hot sweating (热 汗 rè hàn): Sweating in which the sweat feels hot. It is a sign of interior heat or yīn collapse. See great sweating above.

Oily sweat (汗出如油 rú yóu): When oily sweat starts streaming constantly from the skin in severe illness, this indicates yīn collapse. See great sweating above.

Great dripping sweat (大汗淋漓 dà hàn lìn lí): Severe sweating, as observed yáng collapse, qì deserting with liquid, and qì deserting with blood.

Pearly sweat (汗出如珠 hàn chū rú zhū): Clear thin sweat appearing as pearly droplets on the skin. See great sweating above.

Speech

Delirious speech (谵语 zhān yǔ): Incoherent speech in a state of unclear spirit-mind, usually in high fever. It mostly occurs in repletion patterns. It is seen in intense heart and phlegm-fire harassing the heart spirit, patterns that are mostly attributable to internal evils, although external heat may play a role. In febrile disease, delirious speech can occur in yáng brightness (yáng míng) (yáng míng) patterns and in heat entering the provisioning aspect (or the pericardium). It occurs in desertion patterns when the heart-spirit is deprived of nourishment, but with less stridor (see Muttering below).

Manic raving (狂言 kuáng yán): Incoherent speech and manic cursing and chiding in patients who are mentally deranged. It is usually attributable to affect-mind frustration causing qì depression that transforms into fire, which in turn binds with phlegm to harass the heart spirit (phlegm-fire harassing the heart spirit). It is similar to delirious speech but is more severe and only occurs in repletion patterns.

Muttering (郑声 zhèng shēng): Also called mussitation. The act of mumbling to oneself haltingly and with frequent repetitions. Muttering is a sign of dissipation of essence-spirit and is observed in yīn or yáng collapse patterns when the heart spirit is clouded. Muttering is similar to delirious speech but only occurs in severe vacuity patterns.

Talking to self (独语 dú yǔ): Also called soliloquy. When a person talks to herself incessantly and incoherently but stops when another person appears, this is called talking to self or soliloquy. It may be attributable to insufficiency of heart qì depriving the heart spirit of nourishment or to qì vacuity engendering phlegm that clouds the orifices of the heart (as in withdrawal disease or depression patterns).

Sluggish speech (言謇 yán jiǎn), stiff tongue and sluggish speech (舌强言謇 shé jiàng yán jiǎn): Inhibited movement of the tongue that makes speech unclear. Sluggish speech may appear as a sign of impending wind stroke or as a sequela of wind stroke.

Sleep

Insomnia (失眠 shī mián): Also called sleeplessness (不寐 bù mèi). Difficulty getting to sleep, a tendency to wake with difficulty falling asleep again, or sleep that leaves the patient unrefreshed. It is considered a disease as well as a symptom. It is often associated with profuse dreaming, the tendency to dream more than usual. The main pathomechanisms are:

• insufficiency of heart yīn blood depriving the heart-spirit of nourishment and failing to constrain heart yáng;
• repletion fire or phlegm-fire harassing the spirit;
• failure of the gallbladder’s governing of decision causing susceptibility to fear and fright;
• stomach disharmony (as reflected in the axiom when the stomach is in disharmony, there is unquiet sleep).

Insomnia occurs in heart blood vacuity; heart yīn vacuity; dual vacuity of the heart and spleen (insufficiency of heart blood and spleen qì vacuity); intense heart fire; phlegm-fire harassing the heart; noninteraction of the heart and kidney; ascendant hyperactivity of liver yáng; gallbladder qì vacuity; residual heat in the final stages of warm disease; and stomach patterns involving severe disharmony of stomach qì.

Profuse dreaming (多梦 duō mèng): A tendency to dream more often than normal. It often accompanies insomnia. When dreaming is profuse, it is often confused, hence the term profuse confused dreaming (多梦纷纭 duō mèng fēn yún) is a commonly used synonym. It occurs in heart blood vacuity and heart yīn vacuity. It can also occur in intense heart fire or phlegm-fire harassing the spirit, as well as in heart-gallbladder qì vacuity.

Hypersomnia (嗜睡 shì shuì): Also called profuse sleeping (多睡 duō shuì). Sleeping for excessive periods day or night. The patient may awaken when called but easily goes back to sleep. It is attributable to dampness encumbering spleen yáng, dual vacuity of the heart and spleen, kidney yáng vacuity, or insufficiency of kidney essence.

Miscellaneous General Signs

Susceptibility to common cold (易于感冒 yì yú gǎn mào): A sign of insufficiency of lung qì and failure of defense qì to protect the exterior against the invasion of external evils (insecurity of the defensive exterior).

See also Body and Limbs.