Symptoms 6, body and limbs

Below is a brief description of the major head and neck symptoms, with links to entries that provide more detail.

Pain, Bleeding, Swelling

Pain of unfixed location (痛无定处 tòng wú dìng chù): Pain that appears in different places at different times. When it moves quickly from one place to another quickly, it is called scurrying pain (窜痛 cuàn tòng). Pain of unfixed location is the pain associated with qì stagnation, which is often referred to as qì pain (气痛 qì tòng). Note that wind diseases are often associated with limb pain that moves from place to place; this is usually referred to as wandering pain and is typically associated with wind impediment.

Pain of fixed location (痛有定处 tòng yǒu dìng chù): Pain that is always in the same place. It is associated with blood stasis and external injuries. Pain due to blood stasis, referred to as stasis pain (瘀痛 yū tòng), is often described as stabbing pain (刺痛 cì tòng) or pain like the piercing of an awl (痛如锥刺 tòng rú zhuī cì). In the abdomen, it takes the form of gripping pain (绞痛 jiǎo tòng). Duller pain of fixed location also occurs in impediment (bì) patterns with prevalence of cold and dampness (cold impediment and damp impediment).

Bleeding (出血 chū xuè): Bleeding results from

• damage to the vessels by external injury;
• blood stasis blocking the vessels so that pressure of blood flow causes them to burst;
• blood heat causing increased pressure in the vessels (frenetic movement of hot blood); and
• qì failing to retain the blood in the vessels (spleen failing to control the blood).

Bleeding attributed to internal causes (the last three of the above) includes nosebleed, vomiting of blood, expectoration of blood, flooding and spotting, bloody urine, and bloody stool. In older texts, the term spontaneous external bleeding (衄血 nǜ xuè) referred to bleeding of the flesh, bleeding from the ears, bleeding of the gums, bleeding from the nipples, bleeding of the tongue, and especially to nosebleed, the most common form.

Bruise (瘀青 yù qīng): Local purple or green-blue coloring of the skin attributable to blood stasis caused by external injury. Bruises indicate blood stasis.

Puffy swelling (浮肿 fú zhǒng): Diffuse swelling of the flesh, most commonly affecting the lower limbs but sometimes the face and upper limbs. Puffy swelling indicates water swelling or qì swelling, which are considered to be disease categories.

Generalized pain (身痛 shēn tòng), generalized aching pain, body aches (周身酸痛 zhōu shēn suān tòng): Pain felt throughout the body, notably the limbs and neck. It is due to external contraction of wind-cold, to dampness lodged in the fleshy exterior, or stasis obstruction of the network vessels. Cold, dampness, and static blood are all yīn evils that can obstruct qì and blood. When there is stoppage, there is pain.

Obesity, Emaciation, and Subjective Heaviness

Emaciation (形体消瘦 xíng tǐ xiāo shòu): Pathological thinness of the body. The spleen governs the flesh and limbs. It arises when insufficiency of the spleen’s yáng qì affecting the production of qì and blood deprives the flesh of nourishment. Since spleen’s yáng qì is dependent on kidney yáng to maintain its warming and transforming functions and because the blood is closely related to the liver, emaciated patients often present with spleen-kidney yáng vacuity or liver-kidney yīn vacuity signs.

Obesity (形体肥胖 xíng tǐ féi pàng): A condition of excessive bodily weight. It is attributed to insufficiency of the spleen’s yáng qì or to phlegm-damp. Fat flabby people, i.e., people with copious soft flesh, are usually found to have yáng vacuity constitutions. The spleen governs the flesh and limbs. When its yáng qì is insufficient, it fails to move the fluids adequately and hence invariably allows some degree of water-damp to accumulate in the flesh that is also reflected in the enlarged tongue of yáng vacuity. Very often, the dampness gathers and concentrates to form phlegm-rheum; hence obese people may also present other signs of phlegm-rheum such as a slimy tongue fur and slippery pulse. This explains the traditional maxim Obese people tend to have copious phlegm (肥人多痰 féi rén duō tán).

Heavy cumbersome limbs (四肢困重 sì zhī kùn zhòng), generalized heaviness (身重 shēn zhòng): A subjective sensation that the limbs or whole body are heavy and difficult to lift. It is a sign of dampness encumbering the spleen.

Skin

Yellowing of the body and eyes (身目发黄 shēn mù fā huāng): This is a sign of jaundice, which is due to damp-heat or cold-damp affecting the liver and gallbladder. A bright coloration like tangerines is attributed to damp-heat, while a dull coloration is attributed to cold-damp.

Maculopapular eruption (斑疹 bān zhěn): Eruption of macules or papules. Macules are colored (usually red) patches that are not elevated above the surface of the skin and vary in size. A papular eruption is a rash, papules being elevations of the skin resembling grains of millet in shape and size (or may be larger). They most commonly occur in externally contracted febrile diseases and indicate heat penetrating provisioning-blood.

Wheals (风疹块 fēng zhěn kuài): Also called hives. Localized itchy papular eruptions of the skin that appears in different places at different times. As a disease, they are called dormant papules, corresponding to urticaria in biomedicineand are attributed to wind in combination with heat or cold. Their association with itching and unfixed location reflects the changeable nature of wind.

Itchy skin (皮肤瘙痒 pí fū sào yǎn): Itching is an irritation of the skin from which the sufferer seeks relief by scratching. Itching is largely attributable to wind, liquid depletion and blood dryness, or to damp-heat. It is seen in genital itch, pudendal itch, foot qì sores, damp sores, lichen, and scab.

Dry skin (皮肤干燥 pí fū gān zào): Skin that is dry and even rough to the touch is a sign of dryness evil invading the exterior or internal dryness attributable to insufficiency of blood and fluids.

Encrusted skin (肌肤甲错 jī fū jiǎ cuò): Coarse, dry, squamous (scaly) skin. It is usually a sign of blood stasis with yīn vacuity.

Sand speckles (沙点 shā diǎn): Tiny red papules that appear all over the body, as in putrefying throat sand (scarlatina).

Sinews: The liver governs the sinews, which can spasm in various ways and from various causes.

Hypertonicity of the sinews (筋脉拘挛 jīn mài jū luán): Also called hypertonicity of the limbs (四肢拘急 si zhi ju ji). Tension in the sinews marked by inhibited bending and stretching. It is attributed to liver blood vacuity; cold-damp; damp-heat; external contraction of wind-cold; exuberant heat; yáng collapse and humor desertion.

Convulsions (抽搐 chōu chù): Also called tugging and slackening (瘈瘲 chì zòng). Convulsions are violent involuntary movements of the limbs. They occur in liver wind stirring internally.

Arched-back rigidity (角弓反张 jiǎo gōng fǎn zhāng): Backward arching of the back, called opisthotonos in biomedicine. It occurs most commonly in fright wind attributable to extreme heat engendering wind, in lockjaw attributable to external wind toxin damage, and other tetany patterns.

Jerking sinews and twitching flesh (筋惕肉膶 jīn tì ròu shùn); wriggling of the extremities (手足蠕动 shǒu zú rú dòng); tremor of the extremities (手足震颤 shǒu zú zhèn chàn):Jerking sinews and twitching flesh refers to sporadic sudden motions in the flesh, such as in the twitching of the eyes. Wriggling of the extremities refers to gentle movements of the hands and fingers or feet and toes. Tremor refers to quivering motions of the extremities. All three are mild signs of liver wind stirring internally.

Shaking of the head (头摇 tóu yáo): Uncontrollable wobbling of the head. It is a sign of liver yáng transforming into wind.

Unsteady gait (步履不正 bù lǜ bù zhèng): Inability to walk smoothly and straight. It is a sign of liver yáng transforming into wind.

Hemiplegia (半身不遂 bàn shēn bú suì): Paralysis of one side of the body; a major sign of wind stroke. In older literature, it is also referred to as hemilateral wind (偏 风 piān fēng). In severe cases, gradual emaciation occurring with it is called hemilateral withering (偏枯 piān kū).

Numbness and tingling of the limbs (肢体麻木 zhī tǐ má mù): Also called insensitivity (不仁 bù rén). Reduced or abnormal sensation in the skin and flesh. It is mainly attributed to liver blood vacuity depriving the network vessels of nourishment. Other causes include wind-cold entering the network vessels; qì stagnation and blood stasis; liver wind stirring internally; wind-phlegm obstructing the network vessels; damp-heat.

Heavy head and light feet (头重脚轻 tóu zhòng jiǎo qīng): A sensation of top-heaviness. A sign of ascendant hyperactivity of liver yáng.

Nails: The nails are the surplus of the sinews. Their condition reflects the state of liver yīn blood.

Lusterless nails (爪甲不荣 zhǎo jiǎ bù róng): Nails that lack a fresh, bright coloring. They are the result of liver blood vacuity depriving the nails of nourishment. A more severe condition of dry nails (爪甲干枯 zhǎo jiǎ gān kū) is attributable to severe depletion of liver blood and liver yīn.

Bones

Joint pain (骨节疼痛 guān jié téng tòng): Enduring limb joint pain often exacerbated by damp weather is observed in impediment (bì) patterns, a term that includes conditions known in biomedicine as arthritis and sciatica. Pain moving from one joint to another is a sign of wind impediment. Painful red swollen joints (关节红肿痛 guān jié hóng zhǒng tòng) are observed in heat impediment. Joint pain of limited duration is observed in some externally contracted febrile disease patterns such as wind-cold exterior patterns and qì-aspect heat. Joint pain may also attend certain sores such as streaming sores (流注 liú zhù) and red bayberry sores.

Deformed joints (关节变形 guān jié biàn xíng): A sign of impediment (bì).

Bone fracture (骨折 gǔ zhé): Any break in a bone. Bone fractures result from knocks and falls or pulling of sinews and flesh. They occur more easily in old age, vacuity detriment, and disease affecting the bone. They are marked by local blood stasis, painful swelling, displacement or deformity, the sound of bones grating against each other, and abnormal movement.

Enlarged swollen knees (膝部肿大 xī bù zhǒng dà):

• Enlarged red swollen knees with difficulty bending and stretching are seen in heat impediment (热痹 rè bì), which develops when wind and dampness that have remained depressed for a long time transform into heat.
• Enlarged swollen knees with emaciated calves is called crane’s-knee wind (鹤膝风 hè xī fēng), which is mostly attributed to cold-damp lodging for a long time with qì-blood vacuity.

Deformities of the legs (足内翻 zú nèi fān): These include knock-knee, inversion of the foot (pes varus), and bowleg, eversion of the foot (pes valgus). These are all attributed to poor development resulting from earlier-heaven insufficiency or poor later-heaven nourishment and resultant weakness of kidney qì.

Deformities of the spine (脊柱畸形 jǐ zhù jī xíng): These include kyphosis (hunchback, humpback), scoliosis (abnormal sideways curvature), lordosis (excessive inward curvature of the lower back), and flat back (lack of curvature). These are attributed to depletion of kidney qì, poor development, diseases of the spine, external injury, poor posture, and aging.