Chinese Medicine Dictionary

Vomiting of fluids very soon after ingestion; a sign of water-damp collecting internally.

Vomiting of food very soon after eating. Immediate vomiting of ingested food is observed in heat vomiting, food accumulation vomiting, phlegm vomiting, and dysphagia-occlusion .

A pathomechanism involving a disturbance of the lung's functions of governing depurative downbearing and regulation of the waterways. The lung governs the qi of the whole body. If, for any reason, lung qi is inhibited, there may be signs such as cough, nasal congestion, and counterflow qi, and if the movement and distribution of water is affected, causing inhibited urination, puffy swelling and panting and cough may be observed.See lung disease.

Poor depurative downbearing. The lung governs depurative downbearing, i.e., its qi is clean in nature and cleansing in action, and it moves downward and governs regulation of the waterways. Impaired lung depuration is reflected in panting counterflow, cough, and inhibited urination.

Blockage, as in throat impediment. Blockage of the channels arising when wind, cold, and dampness invade the fleshy exterior and the joints, and manifesting in signs such as joint pain, sinew and bone pain, and heaviness or numbness of the limbs. Elementary Questions states, ``When wind, cold, and damp evils concur and combine, they give rise to impediment.'' Distinction is made between three pattern types, each of which corresponds to a prevalence of one of three evils:

Forms of impediment that develop when sinew impediment, vessel impediment, bone impediment, and skin impediment, etc., through repeated contraction of cold, wind and dampness, begin to affect the associated viscus. They may also be caused by qi and blood vacuity, essence depletion, or nonmovement of yang qi permitting evil qi to enter and gather in the chest and abdomen.

A healer employed to treat the emperor and members of the court.

Inability to perform coitus from failure to achieve or maintain a full erection. Impotence is caused by debilitation of the life gate fire, liver-kidney vacuity fire, heart-spleen vacuity, binding depression of liver qi, liver channel damp-heat pouring downward, spleen-stomach of damp-heat, or fright damaging the kidney.

Treat secondary manifestations when these are acute. For example, the sudden appearance of sore swollen throat preventing swallowing (tip) in patients suffering from yin vacuity fever (root) is an acute condition requiring immediate attention. In severe cases, swelling of the throat can cause life-threatening asphyxiation, hence its treatment is more urgent than that of the root. Compare in moderate (chronic) conditions treat the tip. See also root and tip.

Treat the root of disease when there are no secondary manifestations that are more pressing Compare in acute conditions treat the tip.See also root and tip.

Failure to take normal, adequate, or any sustenance.See reduced food intake.

Difficulty in swallowing food or difficult passage of food to the stomach; a sign of dysphagia-occlusion.

Inability of the child to take milk.

A unit of measure equal to a tenth of a cubit body-inch. Of the three positions of the wrist pulse, the one furthest from the elbow. See wrist pulse.

From The Origin and Indicators of Disease. One of the nine worm diseases. A worm disease attributed to eating raw or improperly cooked pork or other meat and characterized by abdominal pain, abdominal distention, and diarrhea with the passing of white segments (proglottids). Inch whiteworm is so called because the worm is passed in short segments.

A cut in the flesh made with a knife blade or similar object. Incised wounds in mild cases are associated with pain, bleeding and damage to the skin and flesh. In severe cases, there is damage to sinew with persistent bleeding and severe pain. Massive bleeding can cause somber white complexion, dizziness, black vision, and scallion-stalk or faint fine pulse. Minor cuts can be treated with Sagacious Incised Wound Powder or Litharge Paste and appropriately wrapped. Nowadays, major cuts are stitched, and massive bleeding is treated by transfusion.

A method of moist precipitation applied in warm disease to treat constipation due to heat bind and desiccation of humor and presenting as half vacuity, half repletion patterns.

Usually plural. The diseases or signs for which a medicinal or formula should be described.

Moxibustion performed on an insulating material such as crushed garlic or a slice of ginger that spreads the heat and reduces its intensity, as well as protecting skin from burning.See the entries listed below. Indirect Moxibustion moxibustion on garlic moxibustion on salt moxibustion on ginger moxibustion on cake moxibustion on aconite cake moxibustion on fermented bean cake moxibustion on pepper cake

Unclear vision. The Level-Line of Pattern Identification and Treatment speaks of ``indistinct vision without any internal or external eye signs.'' This is observed in various internal obstructions.

Newborn or young child. In examining infants, special attention is paid to the head. A head that is unusually small or large generally indicates depletion of kidney essence or an insufficiency of the congenital constitution that may be accompanied by water-rheum. A depressed fontanel indicates yin humor depletion, whereas a bulging fontanel indicates acute or chronic fright-wind (see fonantel). Failure of the cranial sutures to close and the inability to keep the head upright indicate an insufficiency of kidney essence and bone marrow vacuity. An uncontrollable shaking of the head indicates a wind disease. In infants, the difficulty of performing the pulse examination calls for the use of one finger instead of three, or its replacement with the finger examination. See infant's finger examination; children's diseases.

finger vein examination. A diagnostic method based on observation of the veins in the fingers of children, developed by Wang Chao of the Tang Dynasty, and further refined by Chen Fu-Zheng in The Young Child Compendium. The examination of the finger veins has considerable clinical value in diagnosing children below the age of three, before natural thickening of the skin makes the veins indistinct. The finger examination provides supplementary diagnostic data that is particularly useful in judging the severity of disease. It also helps to compensate for difficulties of pulse examination due to the infant's very short radial pulse, which must be taken with only one finger, and to disturbances of the pulse that result from the distress commonly experienced by infants in unfamiliar surroundings. The greater yin lung channel runs from the chest through the inch, bar, and cubit, and through the fish's margin (thenar eminence) to the tip of the thumb. The veins of the inner side of the index finger lie on a branch that separates from the main channel at a point proximal to the wrist, and provide diagnostic data that accords with that of the radial pulse. The finger is divided into three segments, known as bars. The first segment, from the metacarpophalangeal joint to the proximal interphalangeal joint is known as the wind bar. The second, from the proximal interphalangeal joint to the distal interphalangeal joint, is known as the qi bar. The final segment, from the distal interphalangeal joint to the fingertip, is called the life bar. The examination should be conducted with the child facing a good light source (sunlight being preferable to electric light). The practitioner holds the child's index finger in his left hand, and rubs it several times with the right hand from the life bar down to the wind bar, to enable the veins to stand out more clearly. In healthy infants, the veins appear as dimly visible, pale purple, or reddish-brown lines. Generally, they are only visible in the wind bar. In sickness, the color and degree of fullness of the veins may undergo change. The depth, color, paleness, stagnation, and length are examined. Veins that are particularly distinct and close to the surface indicate an exterior pattern. An external evil is assailing the exterior, and right qi is trying to resist, hence qi and the blood tend toward the surface. Veins that appear deep and only dimly visible indicate the presence of an evil in the interior. Bright red usually indicates wind-cold. Purple-red indicates interior heat; pale yellow indicates spleen vacuity; purple black reflects depression in the blood network vessels and indicates a severe or critical condition. A green-blue coloring is observed in fright wind and pain patterns. Black generally indicates blood stasis. Pale veins are a vacuity sign. Veins of a stagnant complexion (i.e., visually discernible impairment of blood flow) are associated with repletion patterns such as phlegm-damp, food stagnation, or binding depression of evil heat. The longer the visible veins, the more severe the disease. If the veins are distinct only in the wind bar, the condition is relatively mild. If they are also distinct in the qi bar, the condition is more severe. The infant's life may be in jeopardy if veins become distinct in the life bar (hence its name). Extension of visible veins through all the bars to the fingertip is the mark of a critical condition. In external contractions, visible veins confined to the wind bar indicate invasion of the network vessels. If they extend into the qi bar and are deeper in color, the evil has entered the channels. Extension into the life bar marks penetration into the bowels and viscera. finger vein examination.

The mouth of the uterus.

Postpartum lower abdominal pain caused by static blood. This pattern may stem from incomplete elimination of the lochia or wind-cold exploiting vacuity to invade the uterine vessels causing a collection of static blood. Both patterns involve stasis, but their pathomechanisms differ.

Cinnabar toxin occurring in infants.

Inability to become pregnant between menarche and menopause. In clinical practice, a woman who fails to become pregnant within three years of normal conjugal life without the use of contraception is considered infertile. Discounting male factors, Chinese medicine recognizes congenital factors (see five unwomanlinesses) and acquired factors. Infertility that can be treated is attributed to a variety of causes. See kidney vacuity infertility; liver depression infertility; blood vacuity infertility; phlegm-damp infertility; kidney vacuity infertility; uterine cold infertility; blood stasis infertility.

Term used in disease names indicating infection and permanent lodging. Examples include worm infixation, toxin infixation (both old names for pulmonary consumption), and summer infixation.

infixation. Occurs in disease names such as demonic influx, cadaverous influx, and taxation influx, all denoting pulmonary consumption. See infixation.

Sudden heart pain with dark green-blue face and eyes, clouded spirit and delirious speech, and a pulse now large, now small, different at both hands as if belonging to two different people.

An eyelash that rubs against the eyeball, usually as the result of a improperly treated peppercorn or ulceration of the eyelid rim. The eyelash should be removed.

Reduced activity of qi that disrupts the normal upbearing of the clear and downbearing of the turbid, and manifesting in signs such as hiccough, cough and panting, glomus and oppression in the chest and stomach duct, abdominal distention, abdominal pain, and disease of stool and urine.

Difficult voiding of scant urine. Inhibited urination is ascribed to nondiffusion of lung qi, devitalization of spleen yang, debilitation of kidney yang, internal damp-heat obstruction, or qi stagnation with damp obstruction. These patterns all involve reduced flow of urine to the bladder due to yang qi vacuity or the presence of evil qi. In addition, there are yin vacuity patterns, which, according to some, should not strictly be considered as inhibited urination patterns because they are essentially attributable to depletion of fluids.

From The Origin and Indicators of Disease. Difficult voiding of scant urine during pregnancy. Inhibited urination in pregnancy is attributed to accumulated heat in the small intestine and heat binding in the bladder, obstructing qi transformation. It may also be due to spleen-lung qi vacuity and impaired regulation of the waterways, preventing normal downward transportation to the bladder.

Disfluency (of qi, fluids, or dampness) or difficulty (of physical movement, urination, and speech). Methods of treating such conditions are often described as disinhibition.See stoppage.

Any disturbance of depurative downbearing of lung qi and the lung's governing of the waterways. The lung governs the qi of the whole body and governs the regulation of the waterways. The appearance of cough or nasal congestion on the one hand, or inhibited urination or water swelling on the other are signs of inhibition of lung qi. Compare nondiffusion of lung qi.

A warm disease pattern arising when evil first enters the qi aspect. The main signs include generalized heat~ effusion, thirst, heart vexation, anguish, and mixed yellow and white tongue fur. Initial-stage qi-aspect heat is treated with Gardenia and Fermented Soybean Decoction to clear heat and outthrust evils. The main formula treating exuberant lung-stomach heat is Supplemented Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction, which clears heat and diffuses the lung. This formula may be combined with heat-clearing phlegm-transforming formulas such as Minor Chest Bind Decoction and further supplemented with heat-clearing toxin-resolving medicinals such as lonicera (Lonicerae Flos), forsythia (Forsythiae Fructus), scutellaria (Scutellariae Radix), and gardenia (Gardeniae Fructus).

Intramuscular or acupoint injection fluids are made either by distillation or decoction followed by complex filtering procedures.

The inner part of the body; synonymous with interior, but used especially in the context of deep-lying and internal disease. interior.

The inner angle of the eye.

Localized pain and swelling that suddenly appears on any part of the body. The Great Compendium of External Medicine states, ``... not a welling-abscess , not a flat-abscess , not a sore, not lichen , resembling a malign sore in form, either healing or worsening; it is called an innominate toxin swelling.'' It is caused by wind, cold, or heat lodging in the channels. When due to wind evil, there is neither head nor root. When due to qi contending with the blood, there is a head but no root. When due to wind-cold, the swelling is hard and white. When due to heat toxin, the swelling is red and hot.

One of the four examinations; examination by questioning the patient or those attending him. According Zhang Jing-Yue (Ming, 1563--1640), inquiry should be based on ten questions: 1.~Heat~effusion and aversion to cold. 2.~Sweating. 3.~Head and body. 4.~Stool and urine. 5.~Food and drink. 6.~Chest. 7.~Deafness. 8.~Thirst. 9.~Identifying yin and yang from the pulse and complexion. 10.~Noting any odors or abnormalities of the spirit. The first eight of these items, actually the only ones that are essentially part of inquiry, are still to this day considered to apply. To those eight, can be added hearing and vision, sleep, previous disease, emotional problems, and diseases specific to women and men. The practitioner should inquire whether the patient suffers from sensations of cold or heat. Heat and cold can sometimes be felt, but sometimes not. The term `` heat~effusion'' generally denotes heat that can be felt, but in some case refers to what the patient experiences. Aversion to cold is a patient's subjective feeling of cold; in the patient suffering from aversion to cold, heat~effusion may sometimes be detected by an observer palpating the skin. This combination of heat~effusion and aversion to cold is a typical indication of the onset of external diseases. The prominence of aversion to cold indicates the presence of external wind-cold; a milder aversion to cold, often called aversion to wind, with a more pronounced heat~effusion indicates wind-heat. Alternating heat~effusion and aversion to cold is usually seen in midstage penetration patterns, such as malaria. An unabating high fever without aversion to cold indicates that the disease has already entered the interior. A persistent but remittent high fever, unabated by sweating, with intermittent aversion to cold, indicates that the evil is intense and the condition is relatively severe. Late afternoon tidal heat~effusion, a persistent high fever that peaks from about 3 to 5 p.m., is principally associated with gastrointestinal heat bind. Persistent heat~effusion accompanied by signs of dampness evil indicates lingering damp-heat. A low fever (often little more than hot palms and soles and flushed cheeks) that occurs in the afternoon or evening, and abates after night or morning sweating, is known as steaming bone tidal heat~effusion, and is attributable to yin vacuity. Heat~effusion that is present during the day and rises at night indicates a relatively severe condition. If the patient feels hot and vexed, but has a normal or slightly high body temperature, the condition is generally found to be heat in the bowels and viscera. An irregularly intermittent low fever with lassitude and weakness usually indicates qi vacuity. Aversion to cold usually accompanies heat~effusion, but occurring alone, it is a sign of yang vacuity. Often resulting from a sudden drop in body temperature, such a condition demands special attention since it may indicate vacuity desertion due to collapse of yang. A fluctuating generalized heat~effusion, i.e., one characterized by alternating reduction and increase, indicates damp-heat lodged in the qi aspect. An unsurfaced heat, i.e., one that can only be felt by extended palpation, indicates dampness and heat binding together, with the former preventing the latter from being easily detected at the surface of the body. Shivering is pronounced trembling due to cold. In malaria, it comes at regular intervals and is followed by high fever; in other febrile diseases, shivering is a sign of exuberant interior heat preventing yang qi from effusing to the exterior. As aversion to cold, it may also be the sign of pronounced yang vacuity. Sweat is produced from the fluids and blood, and is said to be formed by the heart (see heart forms sweat). Normal secretion is regulated by construction and particularly by defense. Abnormal secretion, therefore, reflects the state of the fluids and blood, as well as that of construction and defense. Excessive sweating during the daytime or sweating at the slightest physical exertion is termed spontaneous sweating. This most often occurs in patients suffering from qi vacuity or yang vacuity and is an indication of vacuous defense qi and a slackening of the interstices. Sweating during the night is termed night sweating and generally occurs in patients suffering from yin vacuity. It indicates yin vacuity internal heat and insecurity of construction qi. Heat~effusion with dry skin and absence of sweating may occur either in depletion of blood and fluids, or in external disease when the exterior is assailed by an evil, depressing defense qi and blocking the interstices. Correlation with other signs is necessary to ensure a right diagnosis. Sweating provides a valuable indicator of the patient's condition. Oily sweat streaming constantly from the skin indicates yang collapse vacuity desertion, and is a severe condition. If, as a result of sweating, the body temperature drops and the pulse stabilizes, right qi is dispelling the evil from the body. A much less common sign of evil expulsion is shiver sweating. This refers to a shivering bout followed by sweating that reduces a persistent high fever. Sweating fails to abate heat~effusion in two cases: a)~in exterior patterns with construction-defense disharmony preventing the expulsion of an exterior evil, characterized by continuing, intermittent, but not severe heat~effusion with aversion to wind, and spontaneous sweating; b) in great qi-aspect heat patterns where high fever and great sweating are accompanied by aversion to heat and great vexation and thirst. Inquiry about the head entails asking about headache, dizziness, and heavy-headedness. The head contains the brain marrow and is an area where the channels are highly concentrated. Most of the regular and irregular channels, in particular the yang channels, pass through the head. Headache is among the most common signs of disease, occurring in both external diseases and internal damage. The nature, severity, and duration of headaches are all important factors in diagnosis. Headache of recent onset usually indicates external disease. Enduring headache indicates internal damage. Severe headaches usually form part of repletion patterns, whereas dull headaches are generally associated with vacuity. If the pain is exacerbated by exposure to wind and cold, the patient is likely to be suffering from a wind-cold disease. Exacerbation by warmth generally indicates ascendant hyperactivity of liver yang. A headache accompanied by heavy-headedness, known as a head heavy as if swathed (bag-over-the-head sensation), is generally attributable to phlegm-damp clouding the upper body. Frontal headaches are often associated with the yang brightness channel; pain in the temporal area is generally associated with the lesser yang channel; pain in the back of the head and neck is associated with the greater yang channel; and pain at the vertex is generally associated with the reverting yin channel. Dizziness, which in some literature includes a vague distinction between dizzy head and dizzy vision, may be associated with liver yang, wind-phlegm, and vacuity diseases. The ears are the orifices of the kidney, and vacuity of kidney essential qi may cause tinnitus (ringing in the ears) and deafness. Because the ears are located on the path of the lesser yang channel, disease affecting the lesser yang may lead to deafness. Loss of hearing may also occur in warm disease repletion patterns where evil qi clouds the clear orifices. Loss of hearing acuity and deafness, occurring in some chronic diseases, generally are part of qi or kidney vacuity patterns. Gradual loss of hearing in old age is due to vacuity. Tinnitus and deafness fundamentally have identical meaning in pattern identification. The eyes are the orifices of the liver. Dizzy vision and flowery vision are generally associated with liver fire or ascendant hyperactivity of liver yang, and liver-kidney essence-blood depletion. Loss of visual acuity and dry eyes are usually attributable to liver-kidney insufficiency. Inquiry about the body involves asking the patient about pain, discomfort, lumps, or similar irregular phenomena in the trunk or limbs. Generalized aching accompanied by heat~effusion and aversion to cold generally occurs in exterior patterns. Pain of specific location, or wandering pain in the joints, generally indicates an impediment pattern. Insufficiency of qi and blood with blood failing to nourish the sinews may cause relatively mild aching and numbness in the sinews and bones. Heavy body and fatigued limbs usually indicates damp encumbrance. Asking about the patient's urine is indispensable part of the inquiry examination. Urine provides a valuable indicator of repletion, vacuity, cold, and heat. It is produced from fluids and its production and voiding depend on qi transformation; hence urination can provide useful information about the state of the fluids and qi transformation. Urinary incontinence, the total loss of control over voidings is most commonly a sign of severe qi vacuity or wind stroke desertion patterns. Enuresis, also called bedwetting especially when observed in children, as is most commonly the case, is due to bad sleeping and waking habits, spleen-lung qi vacuity affecting regulation of the waterways, or insecurity of kidney qi. Long voidings of clear urine and in particular profuse urination at night (nocturia) indicate vacuous kidney yang failing to perform its containing function. Short voidings of reddish urine, when not due to inadequate replacement of fluids lost through sweating in hot weather, indicate repletion heat. Inhibited urination is any reduction of urine volume or difficulty in discharge of urine attributed to qi vacuity or the presence of evil resulting in inhibition of the qi transformation. Shifted bladder is a specific form of inhibited urination characterized by frequent short voidings of scant urine, which arises in pregnancy due to pressure on movement of the bladder. Strangury inhibited urination with frequency and stinging pain on voiding, sometimes with the passing of stones or blood. Bloody urine conventionally refers to the presence of bloody urine in patterns other than strangury, and is attributed either to insufficiency of kidney yin with effulgent heart-liver fire spreading to the small intestine or to dual depletion of the spleen and kidney preventing the blood from being contained. Stool changes are largely attributable to morbidity of the spleen, stomach, and intestines, but may also be associated with liver and kidney dysfunction. Constipation and hard, dry stool are mainly attributable to heat and repletion, although cold and vacuity are not uncommon causes. Constipation with fullness, distention, and pain in the abdomen occurring in externally contracted heat (febrile) disease is a result of gastrointestinal heat bind repletion pattern of heat constipation. Constipation marked by dry hard stool without pronounced abdominal distention is a vacuity pattern attributed to insufficiency of intestinal humor due to blood and fluid depletion. Vacuity constipation includes cold constipation, which involves difficult defecation experienced by the elderly as a result of yang vacuity affecting movement and transformation of food. Diarrhea and sloppy stool occur in vacuity, repletion, cold, and heat patterns. Fulminant diarrhea usually indicates repletion. Enduring diarrhea generally indicates vacuity, or a vacuity-repletion complex. Diarrhea characterized by frequent evacuation of small amounts of stool with tenesmus and a burning sensation indicates damp-heat in the large intestine. Abdominal pain is observed in vacuity and repletion patterns. Abdominal pain followed, and relieved, by diarrhea is most often attributable to food accumulations. Bouts of diarrhea with abdominal pain that is unrelieved by defecation are brought on by emotional stimuli. This is due to liver-spleen disharmony. Diarrhea occurring shortly after eating indicates spleen-stomach qi vacuity. Diarrhea each day before dawn is known as early morning diarrhea and is attributable to spleen-kidney yang vacuity. Diarrhea with loss of the voluntary control over bowel movements, sometimes accompanied by prolapse of the rectum, is known as intestinal vacuity efflux desertion, and is attributed to vacuity cold or to center qi fall. Dietary considerations are categorized in three parts: thirst and fluid intake; food intake and digestion; and taste in the mouth. (1) Thirst and fluid intake: Inquiry about thirst and fluid intake provides a valuable indicator of heat and cold. Absence of thirst, or intake of warm fluids in small amounts, indicates a cold pattern. Thirst with little or no desire to drink, or immediate vomiting of ingested fluids, indicates water-damp collecting internally and impaired upbearing of fluids. Thirst with a preference for cold fluids and severe thirst with large fluid intake are signs of heat. Thirst unallayed by a large fluid intake, together with a high increase in urine volume, indicates dispersion-thirst. (2) Food intake and digestion: Information concerning the patient's intake of solid foods is particularly valuable in prognosis. Maintenance of a good appetite and digestion in spite of long or severe illness shows that the stomach qi has not expired and the patient's prospects for recovery are good. Hence it is said, ``If sustenance is taken, the body thrives.'' Persistent poor appetite may affect the prospects for recovery. Most illnesses characterized by a reduced food intake, distention, and oppression after eating are traceable to spleen-stomach vacuity or inner body damp-heat obstruction. A normal appetite with indigestion signifies a strong stomach and a weak spleen. Increased eating with rapid hungering and clamoring stomach after eating indicates stomach heat. Stomach pain slightly relieved by eating signals a vacuity. Predilection for rich and fatty foods increases susceptibility to phlegm-damp. A perverted appetite indicates worm accumulations. (3) Taste in the mouth: Taste changes are of corroborative value in pattern identification. If the taste in the mouth is unaffected by illness, the mouth is said to be in harmony. This indicates that there is no heat in the interior. A bitter taste in the mouth is a sign of heat, and usually indicates stomach heat, liver heat, or liver-gallbladder damp-heat. A sweet or bland taste or slimy sensation in the mouth indicates damp obstruction or spleen vacuity with dampness. A sour putrid taste is usually attributable to food stagnation. Intermittent acid upflow usually indicates stomach heat, or invasion of the stomach by liver fire. All the major organs, with the exception of the brain, are located within the chest and abdomen. Most diseases of the bowels and viscera are therefore reflected by pain or discomfort in this region. Inquiry thus involves identifying possible glomus, fullness, distention, and pain, and determining the presence of cold or heat and vacuity or repletion. Glomus and fullness possibly with pain, and accompanied by coughing and copious phlegm indicates chest impediment or a cold-rheum pattern. If the same signs are accompanied by vexation heat, thirst, and slimy tongue fur, the pattern is one of phlegm-heat. A feeling of oppression in the chest with weak breathing indicates vacuity. rib-side pain and distention indicates either binding depression of liver qi or liver-gallbladder damp-heat. Both of these are readily identifiable by the correlation of other signs. Lancinating pain and oppression around the heart, with ashen complexion, and dripping cold sweat, is termed true heart pain and is a critical condition. Abdominal pain occurs in vacuity and repletion patterns. When the pain likes pressure, it is ascribed to vacuity; if it refuses pressure, it is ascribed to repletion. Pain soothed by the application of heat is attributable to cold. Stabbing or lancinating pain of specific location indicates accumulation of static blood forming an internal welling-abscess. Remittent scurrying pain of nonspecific location is usually qi pain. Intermittent scurrying pain in the umbilical region may indicate a worm accumulation. Abdominal distention relieved by the passing of flatus or belching is usually related to qi stagnation or food accumulation; it is often further characterized by torpid intake. Continued distention without relief, together with hard stools, indicates repletion. Periodically abating vacuity distention combined with sloppy stool form a vacuity pattern. Essential Prescriptions of the Golden Coffer describes the former as ``abdominal fullness with little or no relief,'' and the latter as ``abdominal fullness recurring after periods of relief.'' Sleep disturbances include insomnia, somnolence, and clouding sleep. Sleeplessness (insomnia), the inability to gain a full night's rest, is observed in a number patterns. When marked by reduced and unquiet sleep, profuse dreaming, heart palpitations, and susceptibility to fright and fear, it is attributable to insufficiency of heart blood, disquieting of the heart spirit, or liver blood insufficiency. When characterized by heart vexation and interior heat, initial insomnia, or, in severe cases, nightlong sleeplessness, it is attributable to effulgent yin vacuity fire. Persistent, severe insomnia with signs of both heart fire and kidney vacuity indicate noninteraction of the heart and kidney. Insomnia due to phlegm-fire harassing the upper body, spleen-stomach vacuity, or indigestion, is loosely termed unquiet sleep due to stomach disharmony. Somnolence, pronounced drowsiness and tendency to sleep for long periods, occurs most notably in external diseases such as heat entering the pericardium or phlegm clouding the orifices of the heart. It may also be a sign of debilitation of yang qi, which is referred to in On Cold Damage, where it states, ``When the lesser yin is affected by disease... there is desire only for sleep.'' Patients suffering from yang vacuity may fall asleep almost instantly, but readily awaken. This condition is distinguished from the former by the absence of heat signs. Clouding sleep, equivalent to hypersomnia in Western medicine, occurs in heat entering the pericardium. Old illness includes both long-standing illnesses and previous illnesses. Information about the patient's history of illness is important when judging new conditions. (4) Presence of long-standing ailments: The practitioner should ask patients whether they were already suffering from any long-standing complaint when the present condition arose. Liver fire and liver yang disease is a predisposing factor for stirring of internal wind and sudden wind strokes. Enduring diarrhea or water swelling frequently indicates spleen-kidney yang vacuity. Patients ordinarily suffering from phlegm-rheum may be found to have insufficiency of lung, spleen, and kidney qi transformation. (5) Previous treatment and its implications for medication: Patients should be questioned about previous treatment and its effects. If, for example, a condition was previously identified as a heat pattern, yet treatment with cold or cool medicinals produced no marked effect, either the pattern was wrongly identified, or the diagnosis was right but the formula chosen was inappropriate. Possibly, the formula was simply not strong enough. Reappraisal in the light of presenting signs should pinpoint the error. People who are taciturn and melancholy by nature are more prone than others to binding depression of liver qi. Impulsiveness, rashness, and impatience are predisposing factors for liver fire flaming upward and upstirring of liver yang. Predilection for cold, raw, and fatty foods, and smoking may cause phlegm-damp. Attention should be paid to the diseases commonly associated with the patient's occupation; for example, the occupational diseases of outdoor manual laborers include low back pain and aching legs, and cold-damp bi. Menstruation and childbearing are associated not only with the uterus, but also the heart, the liver, the spleen, and kidney, as well as the thoroughfare and controlling vessels. Information concerning menstruation, pregnancy, and childbirth is therefore relevant in many nongynecological diseases. The practitioner should ask about menstruation, history of pregnancy and childbirth, and future plans with regard to having children. When inquiring about menstrual history, attention should be paid to the length of the menstrual period (premature or delayed arrival of periods), flow, color (light red, red, purple), and the consistency (thin, thick, clotted) of the discharge. Any abnormalities in these are called menstrual irregularities. Advanced menstruation (i.e., premature arrival of periods) with a heavy flow and a thick red discharge, generally indicates blood heat. Delayed menstruation (i.e., late periods) with reduced flow and a light-colored discharge generally implies blood vacuity. A heavy flow with a thin pale discharge indicates qi vacuity. Purple discharge with clots indicates blood stasis. Menstruation at irregular intervals (i.e., periods sometimes early sometimes late) is due to binding depression of liver qi, spleen vacuity, or kidney vacuity. A clotted flow indicates binding depression of liver qi, a pale thin flow indicates either spleen or kidney vacuity. A scant pale thin flow indicates kidney vacuity, while a copious flow indicates spleen vacuity (blood management failure). Excessive childbearing frequently leads to depletion of the thoroughfare and controlling vessels. Women with histories of miscarriage and difficult deliveries may be suffering from nongynecological diseases such as insufficiency of qi and blood or liver-kidney depletion. Information concerning menstruation and pregnancy is vitally important in selecting medication for nongynecological diseases, since in pregnancy qi-breaking and blood-quickening medicinals and needling of SP-6 (Three Yin Intersection), GB-21 (Shoulder Well), and any points on the lower abdomen can cause miscarriage. Vaginal discharge many be normal if scant and white. A copious clear white discharge without malodor is called white vaginal discharge and is caused by cold-damp pouring downward with spleen vacuity. A foul-smelling copious thick yellow discharge is called yellow vaginal discharge and is due to damp-heat pouring downward. Problems specific to men include notably seminal emission, impotence, and premature ejaculation which are broadly attributed to kidney vacuity. For infants and children, general inquiry about their development is important for assessing the state of their kidney essential qi and spleen-stomach function. When infants are breast-fed, inquiry about lactation may be pertinent.

Insects that have found their way into the ear should be removed as quickly as possible. Drip oil, scallion juice (Allii Fistulosi Herbae Succus), garlic juice (Allii Sativi Bulbi Succus), or alcohol into the affected ear, and remove the insect, taking care not to damage the ear drum.

Failure to secure or be secured; vulnerability (to invasion by evils or loss of essential elements). The word ``insecurity'' occurs in the term ``insecurity of defense qi,'' which denotes weakness of defense qi and a consequent loosening of the interstices, laying the body open to invasion by external evils. It also occurs in ``insecurity of kidney qi,'' which denotes impairment of the kidney's function of storing essence, and is characterized by seminal emission, seminal efflux, and premature ejaculation, or urinary frequency, enuresis, and incontinence.

Weakness of bladder qi failing to retain urine (often stemming from kidney yang vacuity) and manifesting as urinary incontinence or enuresis.

Vacuity of the yang qi that defends the body. Yang qi vacuity manifests in fear of cold, and because it causes looseness of the interstices (sweat pores), there is spontaneous sweating. Elementary Questions states, ``Yang protects the outer body and thereby assures security.'' Insecurity of exterior qi is a failure of this function.

A condition in which the heart spirit floats astray, characterized by dissipated spirit, forgetfulness, susceptibility to fright, heart palpitations, spontaneous sweating or sweating at the slightest exertion.

Breakdown of the kidney's governing of opening and closing or storing of essence that manifests in urinary disturbances, such as frequent and long voidings of clear urine, incontinence, enuresis, and dribbling urination, or disturbances of the reproductive function such as seminal emission, seminal efflux, and premature ejaculation. Insecurity of kidney qi results from debilitation of kidney qi in old age or maldevelopment of kidney qi in youth, or from damage through sexual intemperance or early marriage (early commencement of sexual activity). It is usually, therefore, accompanied by signs of general kidney vacuity such as fatigued spirit, lumbar back pain, limpness of the knees, a tongue that tends to be pale, and a fine weak pulse. Mild cold signs are also observed. Furthermore, stirring fetus due to kidney vacuity may also be considered as a manifestation of insecurity of kidney qi (see stirring fetus).

Inability to withhold semen manifesting in signs such as seminal emission, seminal efflux, and premature ejaculation. See essence gate.

Damage to the thoroughfare and controlling vessels with dual vacuity of qi and blood, causing flooding and spotting, miscarriage, or vaginal discharge.

A condition of numbness of the skin and flesh with inability to sense pain or itching, and sometimes aching pain in the extremities.

Inability to experience pain, itching, cold or heat in the flesh. Elementary Questions states, ``When spleen qi is hot, then the stomach is dry, there is thirst and insensitivity of the flesh. This develops into flesh wilting.'' The Clear Rationale of Cold Damage states, ``Insensitive means not lithe, not knowing itching, not knowing pain, not knowing cold, and not knowing heat. Any bending and stretching, moxibustion and acupuncture treatment is not felt. This is called insensitivity, which arises when evil qi is congested, right is qi blocked and hidden by evil qi that lies depressed and fails to effuse, and when construction and defense qi are vacuous and scant, and cannot move freely.'' See wilting; impediment; and wind stroke.

Numbness of the skin. Essential Prescriptions of the Golden Coffer states, ``When evil is in the network vessels, there is insensitivity of the skin.'' See numbness and tingling of the skin.

One of the four examinations; looking at the patient and his phlegm, urine, and stool for diagnostic information. In inspection, attention is paid to the spirit, general physical appearance, and any part of the body where there is discomfort. Special attention focuses on the complexion and tongue, which are important indicators of the bowels and viscera. Inspection theoretically covers products discharged from the body (stool, urine, vomitus, phlegm), although, in practice, information concerning these matters is gleaned through inquiry. See spirit; bearing; facial complexion; infant's finger examination; tongue; tongue fur; head; stool; urine. See also sand veins; fish network vessels.

One of the three positions and nine indicators. A pulse 1.5 body-inches in front of ST-41 (Ravine Divide) on the upper side of the foot. The instep pulse lies on the foot yang brightness stomach channel, and indicates the state of the stomach and spleen.

Lack (of substance) or incompleteness (of function); opposite of superabundance. Compare vacuity and repletion. See also exuberance and debilitation.

Weakness of the spleen and stomach qi in the center burner with movement and transformation failure. Signs include yellow facial complexion with little luster, pale or dull lips, poor appetite, abdominal distention after eating, dizziness, low voice, shortness of breath, fatigue with lack of strength, sloppy stool, tender-soft tongue with thick fur, and a vacuous pulse. In some cases, there is stomach pain that likes pressure.

A combined pattern of insufficiency of kidney essence and liver blood vacuity.

Reduction of body fluids (see fluids) as a result of vigorous heat~effusion with great sweating, profuse urination, vomiting, and diarrhea. It may also result from misappropriate use of sweat-effusing medicinals, water-disinhibiting medicinals, draining precipitant medicinals, or warm dry medicinals. Distinction is made between the mild form, damage to liquid, and the severe form, damage to yin (humor desertion).

A pattern arising after illness as a result of dysfunction among the internal organs. Signs include vacuity vexation, insomnia, susceptibility to fright, bitter taste in the mouth, doubt and suspicious, and frequent sighing. It is treated by warming the gallbladder and quieting the spirit.

A disease pattern resulting from enduring illness or improper development during the fetal stage. Insufficiency of kidney essence differs from kidney yin and yang vacuity in that vacuity signs are accompanied by neither cold nor heat signs of any marked degree. The kidney governs the bones and engenders marrow, and the brain is the sea of marrow. Only when kidney essential qi is abundant can the bone, marrow, and brain fulfill their functions. Insufficiency of kidney essence may thus lead to signs of essence-marrow depletion and sea-of-marrow vacuity, such as impairment of intellectual function, osteodystrophy, and deficiency of the reproductive function. Insufficiency of kidney essence is generally characterized by dizziness, tinnitus, limp aching lumbus and knees, deficient reproductive function, loss of head hair, and loosening of the teeth. Insufficiency of essence-marrow or sea-of-marrow vacuity manifests in different ways according to age. In children, it can result in retarded growth and development, short stature, sluggishness of physical movement, low intelligence, weak bones, or retarded closure of the fontanels. In adults, it may lead to premature senility, or weakness in the legs, difficulty in walking, dullness of essence-spirit, and slowness of physical movement.

Rib-side pain characterized by continuous dull pain and accompanied by dizzy head and vision, lusterless complexion, menstrual irregularities, pale red tongue with scant fur, and a fine rapid pulse.

The Magic Pivot says, when the brain is insufficient, the brain turns and the ears ring.

To blow (into the nose, throat, or ear). See insufflation.

A topical powder for ear, nose, throat, and mouth diseases that is blown into the nose, traditionally through rolled up paper, fine bamboo tubes or straws. A sore swollen throat with qi block in children, for example, can be treated by insufflating ground raw licorice (Glycyrrhizae Radix Cruda) and impure mir-a-bil-ite (Mirabilitum Non-Purum) ( Throat Insufflation Powder) into the throat. Chronic paranasal sinusitis can be treated by insufflating powdered calcined yellow croaker's otolith (Pseudosciaenae Otolithum) into the nose. Common cold with nasal congestion can be treated by insufflating powdered centipeda (Centipedae Herba cum Radice) into the nose.See nasal insufflation.

Heat stronger than exuberant heat.

A pattern characterized by heart vexation, insomnia, fearful throbbing, and, in severe cases, manic agitation, delirious speech, and incessant laughing. Treat by clearing heat and draining fire, assisted by nourishing the heart and quieting the spirit. Use Cinnabar Spirit-Quieting Pill plus scutellaria (Scutellariae Radix), gardenia (Gardeniae Fructus), and forsythia (Forsythiae Fructus).

Bleeding during or after intercourse. Intercourse bleeding is usually attributed to frenetic liver fire preventing blood storage and a vacuous spleen failing to contain the blood.

The inner part of the body as opposed to the exterior, especially the bowels and viscera. See exterior and interior. Compare internal.

From Elementary Questions. Heat accumulated in the interior cannot be eliminated unless cold precipitants are used. Cold in the abdomen giving rise to cold constipation can also be treated with cold precipitants provided these are suitably combined with other medicinals. Cold constipation can be treated with Rhubarb and Aconite Decoction, which consists of rhubarb (Rhei Rhizoma), aconite (Aconiti Tuber Laterale Salsum), and asarum (Asiasari Herba cum Radice). Rhubab is cold and bitter, while aconite is greatly acrid and hot and asarum is warm and acrid. These medicinals combined together to form a warm precipitation formula.

Cold patterns of the bowels and viscera attributable to insufficiency of yang qi or external cold passing to the interior and characterized by cold limbs and aversion to cold, somber white complexion, cold aching lumbus and knees, sloppy stool and diarrhea, long voidings of clear urine, pale tongue with glossy white fur, and a sunken slow or faint fine pulse.

Any heat pattern arising when external evils enter the interior and transform into heat, or when internal depression engenders heat, usually taking the form of gastrointestinal or lung-stomach repletion heat or depressed liver-gallbladder heat. Interior heat is characterized by heat~effusion, aversion to heat rather than cold, thirst with intake of fluid, vexation and agitation or vexation with bitter taste in the mouth, short voiding of reddish urine, red tongue with yellow fur, and a rapid surging or forceful rapid stringlike pulse.

The chest cavity. The Magic Pivot states, ``The kidney foot lesser yin vessel... A branch goes out to the pericardium from the lung, and enters the interior of the chest. Elementary Questions states, ``When there is trouble in the interior of the chest, the throat becomes blocked and there is coughing.'' In The Classified Canon, Zhang Jing-Yue annotates this line, saying: ``The interior of the chest is the location of the lung.''

Any disease pattern that indicates disease of the interior. (1) Any disease of the internal organs, in contradistinction to externally contracted heat (febrile) disease, e.g., liver disease characterized by dizziness, rib-side pain; heart disease characterized by heart palpitations or fearful throbbing; spleen disease characterized by abdominal distention and diarrhea; and kidney disease characterized by lumbar pain and seminal emission. (2) In externally contracted heat (febrile) disease, an interior pattern arises when an evil that has caused an exterior pattern passes into the interior. Rarely, external evils may strike the interior directly; in most cases, they pass through the exterior. Hence febrile disease interior patterns are identified when aversion to wind or cold---which may or may not be accompanied by heat~effusion or sweating---gives way to high fever or tidal heat~effusion, vexation and agitation, thirst, clouded spirit, abdominal pain or distention, diarrhea or See also interior cold; interior heat; interior repletion; interior vacuity.constipation, short voidings of reddish urine or inhibited urination, dry yellow tongue fur, and a rapid sunken pulse.

Any disease pattern resulting from external evil transforming into heat and entering the interior to bind in the stomach and intestines and thereby causing vigorous heat~effusion, vexation and thirst, abdominal pain and constipation (bowel repletion pattern). Binding depression of qi and blood, gathering of phlegm, food stagnation, and worm accumulation.

Any pattern that arises when the yin, yang, qi, or blood or one or more of the bowels and viscera is debilitated, and that is marked by shortage of qi, laziness to speak, heart palpitations, lassitude of the spirit, dizziness, cloudy vision, decreased food intake, fatigued limbs, aching lumbus and limp knees, insomnia, dream emission, pale tongue fur, and weak vacuous pulse.

The joint between the coccyx and sacrum.

From The Origin and Indicators of Disease. Dysentery that goes on for months and years, continually starting and stopping; hence the name. Intermittent dysentery usually arises from inappropriate treatment or stems from such factors as qi-blood vacuity or insufficiency of the spleen and kidney, causing right vacuity and lingering evil, whereby damp-heat lies latent in the stomach and intestines. During periods of remission, the only signs that remain are lassitude of spirit and lack of strength, poor appetite, emaciation, and lack of warmth in the extremities.

A moderate weak pulse that pauses at regular intervals. It indicates debilitation of the visceral qi and is seen in heart disease, fear and fright, and severe knocks and falls. See pulse condition; spleen pulse is moderate.

Located or arising within the body, especially of diseases due to excesses of the seven affects (internal damage) and evils resembling their external counterparts (e.g., internal wind, internal dampness). Compare interior.

Clouding reversal (clouding of consciousness due to abnormal qi flow) in internal block patterns in which evil is trapped in the interior.See block.

A mammary welling-abscess occurring during pregnancy, attributable to effulgent fetal qi and depressed heat evil. It heals with difficulty after birth and special attention is needed to preserve the fetus. See mammary welling-abscess. Compare external blowing.

One of the three causes of disease; the seven affects---joy, anger, anxiety, thought, grief, fear, and fright---as causes of disease. The seven affects are normal responses of the individual, but when excessively intense or persistent, they can disturb the yin-yang and qi-blood balance and cause diseases of the bowels and viscera. This is known as internal damage or affect damage. Internal causes are not to be confused with evils that arise internally. (Internal fire and internal wind, for example, may be the result of affect damage, but they can also develop from insufficiency or from transformation of external evils, which are not internal causes.) Internal damage to the heart and spirit is characterized by heart palpitations or fearful throbbing, forgetfulness, and insomnia, or by abstraction, sorrow or anxiety with tendency to weep, and visceral agitation with frequent stretching and yawning. It may also take the form of fulminant exuberance of heart fire, characterized by manic agitation or mental derangement. Internal damage to the liver manifests as binding depression of liver qi characterized by mental depression, irascibility, pain in the rib-side, belching, and plum-pit qi. In women, this condition may cause swelling of the breasts, painful distention in the lower abdomen, and menstrual irregularities. Affect-mind disturbance that damages both the heart and spleen takes the form of disquieting of the heart spirit and impairment of spleen-stomach movement and transformation. This is characterized by attacks of abdominal pain, together with retching and nausea; or rumbling intestines and diarrhea. Other patterns include glomus and oppression in the chest and stomach duct, little thought of food and drink, and menstrual block. If the spleen fails to manage the blood, flooding and spotting may also occur. Mental and emotional factors have a distinct bearing on physical health. In treating internal damage conditions, a dual approach is necessary. Patients must be encouraged to deal with their emotional problems, while a proper physical analysis should be made of the state of yin and yang, blood and qi, and the organs. See three causes.

Cold arising from within when yang qi is debilitated and cannot warm the body. Internal cold affects the movement and transformation of water humor and causes the retention of turbid yin. When yang is vacuous, yin is exuberant, and when yin is exuberant, there is internal cold. The spleen governs the movement and transformation of water-damp. The kidney governs the regulation of water-humor, and kidney yang is the root of the yang qi of the whole body. This pattern is therefore essentially one of spleen-kidney yang vacuity. Its clinical characteristics are vomiting and diarrhea, abdominal pain, and counterflow coldof the limbs, in some cases with water swelling and phlegm-rheum, etc. The patient's snivel, phlegm, drool and spittle, and urine are clear and cold, while his stool is thin. This reflects the statement in Elementary Questions, ``All disease with watery humors that are clear, pure, and cold is ascribed to cold.'' Internal cold is the opposite of external cold, i.e., cold entering the body from outside. These two forms of cold are to some degree mutually conducive. For example, individuals whose yang qi is weak are especially vulnerable to external cold evil; and damage to the body's yang qi by cold can cause internal cold.

Any detrimental effect on bowel and visceral qi produced by intemperance of the seven affects (mental and emotional problems) or excesses of hunger, satiety, taxation fatigue, and sexual activity. Any disease pattern resulting from such causes.

Damage to yin, yang, qi, and blood, etc., by excesses of the seven affects (joy, anger, anxiety, thought, sorrow, fear, and fright). Powerful or lasting emotions and certain mental activities can damage yin, yang, qi, blood, and eventually the bowels and viscera. Elementary Questions describes the effect of six of the affects specifically on qi. See joy causes qi to slacken; anger causes qi to rise; thought causes qi to bind; sorrow causes qi to disperse; fright causes derangement of qi; fear causes qi to precipitate; excess among the five minds.See also affect.

Headache due to internal damage to the bowels and viscera or qi and blood, or to the presence of phlegm-damp or stasis, i.e., not due to external causes. Internal damage headaches develop gradually, are periodic, and are accompanied by other signs of insufficiency of bowels and visceral qi or internal evils. See entries listed below. See also headache. Internal Damage Headache qi vacuity headache blood vacuity headache yin vacuity headache yang vacuity headache kidney vacuity headache static blood headache phlegm-damp headache phlegm reversal headache phlegm fire headache food damage headache liquor damage headache liver yang headache greater yin headache lesser yin headache

Lumbar pain due to liver, spleen, or kidney vacuity, to damp phlegm or static blood, or else to internal injury. See lumbar pain; kidney vacuity lumbar pain; vacuity-taxation lumbar pain; damp phlegm lumbar pain; blood stasis lumbar pain.

Various diseases due to internal damage, i.e., to causes other than externally contracted heat (febrile) diseases.

From Pathoconditions, Causes, Pulses, and Treatments. Sleeplessness due to internal damage by liver fire, gallbladder fire, lung congestion, stomach disharmony, heart blood vacuity, heart qi vacuity, etc. For example, in the case of lung congestion, panting and cough with shoulders leaning forward can be exacerbated by lying down. See sleeplessness and the entries listed below. Internal Damage Sleeplessness liver fire sleeplessness gallbladder fire sleeplessness stomach disharmony sleeplessness heart blood vacuity sleeplessness heart qi vacuity sleeplessness lung congestion sleeplessness

Pain in the stomach due to a variety of internal damage factors including accumulated cold, accumulated heat, spleen-stomach vacuity cold, yin vacuity, food accumulation, phlegm-rheum, qi depression (qi stagnation), blood stasis, and worm accumulation.

Dampness that arises when the spleen is vacuous and fails to move and transform fluids, and that is characterized by poor appetite, diarrhea, abdominal distention, scant urine, yellow face, puffy swelling, a pale tongue with glossy fur, and a moderate soggy pulse. Since the spleen action of moving and transforming the fluids relies on the warming action of kidney yang, internal dampness is often observed in patients with spleen-kidney yang vacuity. Internal dampness and external dampness are mutually conducive. Spleen vacuity makes the body vulnerable to external dampness but also may spontaneously cause internal dampness. External dampness entering the body may easily damage the spleen, causing internal dampness.See dampness.

One of the three main methods of treating sores. It involves the use of dispersing and dissipating medicinals to eliminate sores in the initial stage prior to suppuration.

Depletion of the bodily fluids and yin blood not attributable to dryness evil. Internal dryness is not caused by any evil, either external or internal, but by an insufficiency of blood and fluids. These conditions are usually called damage to fluids, damaged yin, or exhaustion of the blood and fluids.

Pushing (toxin) outward from within; one of the three main methods of treating sores (see sore). It involves the use of qi and blood-supplementing medicinals to support right qi, express the toxin, and prevent it from falling inward.

Fire (or heat) arising within the body due to internal factors (affect damage), transformation of externally contracted evils, or insufficiency of yin-humor. Internal fire or heat may form a repletion or vacuity pattern. Repletion fire (heat) may arise internally as a result of an imbalance between yin and yang or excesses of the five minds. For example, liver fire, resulting from transformation of liver qi depression, manifests in red eyes, dry mouth, sudden deafness or tinnitus, vomiting of sour or bitter fluid, dry stool, and slippery, stringlike pulse. The red eyes and the stringlike pulse are clear indicators of repletion. Vacuity fire (vacuity heat) arises internally from yin vacuity, or in some cases (e.g., effulgent heart fire due to heart yin vacuity) from excesses of the five minds. Vacuity heat differs from repletion heat in the following ways: (1) Signs of yin vacuity are present. (2) The fire and heat signs are less pronounced than in repletion heat, the most common being vexation and a red, dry, or mirror tongue. (3) Generally, there is no high fever. (4) Thirst, if present, is generally not severe. (5) The pulse is generally rapid but forceless.

Tetany (arched-back rigidity, clenched jaw, convulsions, etc.) resulting from food stagnation causing damage to the stomach and spleen. Internal food damage tetany occurs after vomiting or diarrhea and is characterized by tetanic reversal (tetany and clouding of consciousness due to abnormal qi flow) and is accompanied by lassitude of the spirit, and pale white complexion; it is attributable to spleen-stomach yang vacuity and exhaustion of fluids.

Heat signs due to excessive wear on yin humor, such as tidal heat~effusion, night heat~effusion, vexing heat in the five hearts, night heat~effusion, vexation and thirst, dry bound stool, short voidings of reddish urine, red tongue with scant fur, and a fine rapid pulse. Elementary Questions states, ``When yin is vacuous, there is internal heat.'' Evil heat entering the interior, characterized by red face and eyes, heart vexation, heat~effusion, thirst with a liking for cold drinks, constipation, short voidings of reddish urine, red tongue with dry yellow tongue fur, and a rapid sunken pulse. In severe cases, there is clouded spirit and delirious raving.

Damage to the bowels and viscera and other deep structures of the head, chest, and abdomen through knocks and falls, lifting heavy weights, or spraining. Mild swelling and distention with pain of unfixed location indicates damage to qi. Pronounced pain with red, green-blue, or purple coloration of the skin, and spillage of blood from the vessels, and signs such as heat~effusion and shivering, retching of blood, bloody stool, blood urine, or coughing of blood indicate damage to the blood. Acute pain in the chest, ribs, or abdomen, with clouding reversal, blood ejection, and bloody stool indicate damage to bowels and viscera.

Any of a number of diseases of the spirit pupil and inner eye manifesting in poor vision. Internal obstructions mostly occur in vacuity patterns and are most commonly attributable to insufficiency of the liver and kidney or dual depletion of qi and blood. Other causes include effulgent yin vacuity fire, qi stagnation and blood stasis, wind-fire and phlegm-damp harassing the clear orifices, and external injury. Signs include subjective sensations like mouches volantes, black floaters, lights and flames appearing to be surrounded rainbow-like halos, clouded vision, night blindness, or sudden blindness. Very often there are no visible objective signs, although the pupil may be dilated or contracted, deformed, or abnormal in color. Internal obstructions include green-blue wind internal obstruction and green wind internal obstruction (corresponding to glaucoma). Compare external obstruction.

Any block pattern either attributed by phlegm turbidity invariably associated with wind or heat or arising from other causes and causing phlegm turbidity signs. A block pattern developing from damp-heat in warm heat disease.

A suppuration within the chest or abdomen affecting the organs.See liver welling-abscess; intestinal welling-abscess; pulmonary welling-abscess; welling-abscess of the stomach duct; welling-abscess.

An ancient term denoting a disease arising in sexual taxation with sweating when wind evil invades. Liver wind. In the early phase of Chinse medicine, all wind was believed to be of external origin. However, subsequent theories posited that certain signs such as dizziness, tremor, and convulsions previously attributed to the invasion of external wind were due to a ``wind'' arising internally due to a yin-yang imbalance. See liver wind stirring internally.

A method of treating malaria applied two to three hours before an episode to prevent its arrival. Interrupting malaria makes used of medicinals such as dichroa (Dichroae Radix), areca (Arecae Semen), tsaoko (Amomi Tsao-Ko Fructus), and ginger pinellia (Pinelliae Tuber cum Zingibere Praeparatum), and formulas such as Malaria-Interrupting Seven-Jewel Beverage or Spleen-Clearing Beverage, or by needling points such GV-14 (Great Hammer), SI-3 (Back Ravine), and PC-5 (Intermediary Courier), needling with drainage.See malaria.

Any point at which two or more channels intersect. Intersection points have the ability to transmit a stimulus through both or all channels that intersect at the point.

An anatomical entity of unclear identity, explained in modern dictionaries as being the ``grain'' of the skin, flesh, and organs or the connective tissue in the skin and flesh. Elementary Questions, ``Clear yang effuses through the interstices.'' Usage of the term suggests that the interstices correspond to the sweat ducts in Western medicine. See sweating.

The interstices located in the flesh. See interstice.

(In ancient texts) dysentery. blood arrow; bloody stool due to intestinal stasis.

A disease characterized by the spurting of blood from the anus, described in The Gateway to Medicine as ``enduring swill diarrhea stemming originally from wind damage invasion of the stomach and allowing damp toxin to form an aggregation and to pour into the large intestine to contend with the lesser yin, giving rise to what is called `intestinal aggregation', known popularly as `blood arrow' because of the forceful issue of blood like an arrow that shoots far.''

Impediment disease affecting the large and small intestine causing thirst with desire for fluids, inhibited urination, and diarrhea. Owing to obstruction of the large and small intestine qi, the waterways suffer blockage, so that waste is not transformed and the clear and the turbid are not separated.

Enduring diarrhea culminating in reduced uplift of yang qi manifesting in persistent diarrhea with periodic fecal incontinence or prolapse of the rectum resulting from bowel movements. Generally there is dull abdominal pain, general physical debilitation, and vacuity cold signs.

Welling-abscess of the intestine; attributed to congealing blood that stems from damp-heat or from general qi and blood stagnation. Intestinal welling-abscess was first mentioned in Elementary Questions, which attributed it to lesser yang reverse flow and claimed it to be uncurable and fatal. Zhang Ji (2nd--3rd centuries ), in On Cold Damage and Miscellaneous Diseases, described the presuppurative and suppurative stages in detail and prescribed treatments. Essential Prescriptions of the Golden Coffer gives his description as follows: ``Intestinal welling-abscess is marked by swollen glomus in the lesser abdomen that is painful when pressed and like strangury although though urine is normal, and [by] periodic heat~effusion and spontaneous sweating followed by aversion to cold. If the pulse is slow and tight, pus has not yet formed, and it can be treated by precipitation, which should be manifest in blood in the stool. If the pulse is surging and rapid, pus has formed; precipitation cannot be administered. Rhubarb and Moutan Decoction is the main treatment.'' Distinction is made between large intestinal welling-abscess and small intestinal welling-abscess on the basis of the location of pain. If the pain is in the vicinity of ST-25 (Celestial Pivot), it is called a large intestinal welling-abscess, whereas if in the vicinity of CV-4 (Pass Head), it is called a small intestinal welling-abscess. Any intestinal welling-abscess that makes it difficult to the stretch out the right leg is called a leg-flexing intestinal welling-abscess. However, these distinctions are now considered to have little clinical significance. The first perceptible sign of large intestinal welling-abscess is abdominal pain that gradually localizes on the right side. The pain is of fixed location and refuses pressure, and is accompanied by coughing or sneezing. The right leg may flex and be difficult to stretch out. There is aversion to cold and heat~effusion, with nausea and vomiting, constipation (or diarrhea in some cases), and reddish urine. The tongue fur is thin, slimy and yellow. The pulse is rapid and forceful. As the condition advances, the abdomen becomes tensed and tender, and in some cases a lump may be felt. As vigorous heat~effusion develops, the pulse becomes surging and rapid.

Bleeding hemorrhoids. See hemorrhoids. Bloody stool resulting from taxation detriment to the bowels and viscera, disharmony of qi and blood, and wind-cold and heat toxin contending in the large intestine. Precipitation of blood before the passage of stool; proximal bleeding. It is attributed either to external wind entering and settling or to internal wind exploiting the lower body.

Either of the two intestines.See large intestine; small intestine.

To threaten. ``Intimidate'' describes the harmful effects of water qi, as in the expression ``water qi intimidating the heart,'' a pattern in which water qi developing as a result of spleen-kidney yang vacuity collects above the diaphragm hampering heart yang, and characterized by heart palpitations and hasty breathing.

A small needle, such as the wheat-grain and thumb-tack needles, implanted in the skin for extended periods. See needle implantation.

To intrude. Describes, for example, evils entering the body, and liver qi entering the stomach.

A comment by Wang Bing of the Tang dynasty on the line in Elementary Questions that reads ``Wherever cold is applied, but heat [remains], treat the yin.'' The implication of this comment is that wherever the use of cold or cool medicinals to treat heat patterns produces no effect or makes the heat worse, the heat pattern is one of yin vacuity with hyperactive yang, i.e., a condition essentially of yin vacuity that is treated by enriching kidney yin (the true water of the kidney viscus). According to this principle, insufficiency of kidney yin with yin vacuity flaming upward causing dizzy head and vision, aching lumbus and limp legs, dry throat, and steaming bone with aching pain is treated with Six-Ingredient Rehmannia Pill. Invigorating the governor of water to restrain the brilliance of yang is now often called invigorating water to restrain yang, enriching water to restrain fire, or enriching yin to moisten yang.

A method of treatment used to strengthen the yang qi of the body with warming and supplementing medicinals. Invigorating yang usually refers to strengthening the yang qi of the heart and kidney, and especially the latter. See supplementation.

A disease attributed to erosion by worms.

A heat sore in the area of the nostrils caused by wind-heat lodged in the lung channel, or by a continually runny nose, or developing from a heat sore. Invisible worm sores of the nose are most commonly observed in children, and are characterized by a purple coloration, ulceration, a thick exudate, and itching without pain.

Passage (of evils) into the inner body, due to exuberance of the evil or vacuity of right. For example, when measles is erupting, if the measles toxin is especially strong, or if the wind-cold is contracted, right qi cannot resist, and the evil ``falls inward.'' When this happens, the measles papules suddenly disappear, the face becomes white, and breathing becomes rapid and hasty. Inward fall is also observed in patients suffering from welling-abscess and sores when the sore-toxin falls inward and enters construction blood, i.e., it starts to affect the whole body in a process corresponding to what Western medicine describes in terms of the development of toxemia (see fall pattern). Distinction is made between fire fall, dry fall, and vacuity fall. Compare running yellow.

Proneness to anger. Anger is the mind of the liver, and irascibility is seen in patterns such as ascendant liver yang, binding depression of liver qi, and five minds forming fire.

The colored part of the eye between the white of the eye and the pupil that expands and contracts. The iris corresponds to the wind wheel among the five wheels.

An irritation relieved, at least temporarily, by scratching. Itching over extensive areas of the body is a sign of wind or blood diseases. If it refuses heat and is accompanied by general heat signs, it is attributable to blood heat, which generally occurs in young people. If it is more pronounced in the autumn and winter and is accompanied by a lusterless complexion, heart palpitations, insomnia, dizziness or flowery vision, it is a sign of blood vacuity, which is more common among the elderly. If scratching gives rises to vesicles that emit a watery discharge, the pattern is one of wind-damp. Itching on the face, chest, neck, and hands, that refuses cold and likes warmth, and accompanied by a tight or moderate floating pulse is a sign of wind-cold.

Irritation of the ears, attributed to liver wind and that may be attended by thickening of the skin due to continual scratching.

Irritation of the eyes, attributed to wind-fire, damp-heat, blood vacuity engendering wind, or to abatement of an evil and restoration of right after enduring disease.

Irritation in the throat, sometimes associated with swelling and soreness. Itchy throat is attributed to scorching yin vacuity fire depriving the throat of nourishment or to stomach fire fuming the lung.

A doctor that roams from place to place, ringing a bell to attract customers, and usually offering herbal or simple cures passed on orally from master to student.