1. 1. Determining the site of a disease and its relevant organs: - A floating pulse indicates exterior disease, a deep pulse indicates interior disease. - The correspondence of the cunkou pulse to zang-fu organs can be used to determine where the disease is. - Eg a surging rapid pulse palpated at the cun portions of both hands often indicates excess-heat in the heart and lung.

2. 1. Determining the site of a disease and its relevant organs: - A deep faint pulse palpated at the chi portions of both hands often indicates kidney qi deficiency; - A wiry and rapid pulse at the left guan portion and a deep week pulse at the right guan portion often reflect that liver qi violates the spleen or liver qi stagnation and insufficiency in the spleen.

3. 2. Distinguishing the situation of yin and yang and the nature of a disease: - A surging forceful pulse is the manifestation of excessive yang heat, indicating the interior excess heat syndrome - A deep, slow forceful pulse is the manifestation of excessive yin cold, suggesting the internal excess-cold syndrome;

4. 3. Determining wax and wane of the healthy qi and pathogenic factors and deficiency or excess of a syndrome: - Deficient, thready, fait or weak pulse reflect weak healthy qi, indicates deficiency syndrome; - Forceful, surging, slippery and tight pulse reflect exuberant pathogenic factors and insufficient healthy qi, indicating excess syndrome. - When a forceless pulse changes into a forceful one gradually, indicates the healthy qi is recovering and pathogenic factors are declining and the opposite suggests declining of healthy qi.

5. 4. Predicting the progress and prognosis of an illness: - If the pulse of a chronic disease turns to moderate and harmonious, it is a sign of qi recovery and good prognosis; - But if the pulse turns to floating and large, it usually indicates exuberance of pathogenic factors and deficient qi is a sign of deterioration and unfavorable prognosis.

6. - In a warm disease, the pulse turns to moderate and harmonious and fever subsided, it suggests qi recovery and favorable prognosis. - A deep, weak forceless pulse usually indicates deficiency and weakness of yang qi, and the interior deficiency-cold syndrome. - A thready, rapid forceful pulse often indicates deficiency and weakness of blood, and the interior deficiency-heat syndrome.

7.  When a thready, faint, weak scattered pulse appears in an excess syndrome, it means the pathogenic factors are rampant and about to prevail over the healthy qi.  If a floating, surging, rapid excess pulse is seen in a chronic disease, it indicates deficiency of the healthy qi and exuberence of pathogenic factors.

8.  Make diagnosis on the basis of pulse conditions rather than on symptoms and signs should be followed when symptoms are false but pulse conditions are true.  Making diagnosis on the basis of symptoms and signs rather than on pulse conditions should be followed when a pulse contradicts symptoms and signs.

10. ◦ General condition:  Young people have abundant qi and blood and strong resistance to illnesses and they are susceptible to the excess syndrome.  Elderly’s qi and blood are declining and have weakened resistance to illness, and they are susceptible to the deficiency syndrome.

11. ◦ History of recent illness:  Generally speaking, a sudden attack with short duration indicates the excess syndrome, and a prolonged illness that occurs repeatedly suggests the deficiency syndrome or the interlocking of deficiency and excess.  Distending hypochondriac pain due to depression is caused by stagnation of liver qi.

12.  Anamnesis ◦ Health condition  People with a strong physique tend to suffer from the excess syndrome  People of a weak build tend to suffer from deficiency syndrome.  People with yin deficiency are susceptible to the warm-dryness syndrome and  People with yang deficiency are susceptible to cold-damp syndrome.

13.  Personal life history : ◦ Accommodation  Indolence may result in stagnation of qi and blood and phlegm-dampness.  Overwork and immoderate sexual life may injure essence and qi and cause the deficiency syndrome. ◦ Spiritual and emotional state  If a present disorder is caused by emotional problems, an introvert is likely to present such symptoms as stagnation of liver qi or syndrome of fire turned from stagnated liver qi.

14. ◦ The generation of a cold or a feverish sensation is caused by the nature of pathogenic factors and abundance and decline of yin and yang in the body. Cold is a yin pathogen, so when a disease is caused by cold, chills present. Heat leads to fever, for it belongs to yang

15. ◦ Chills and Fever  Extreme chills and mild fever: when they have extreme chills and mild fever, patients suffer from exogenous wind-cold. Since it belongs to yin, it attacks the superficial portion of the body and impairs yang, leading to chills.  High fever and mild chills: Patients are afflicted by wind-heat. Since it belongs to yang and abundant yang causes fever, so fever is more obvious than chills.  Mild fever and aversion to wind: Patients are attacked by exogenous pathogenic wind. Since wind goes in different directions, the texture and interstitial spaces of the muscles are loose and yang qi is confined inside, so both fever and aversion to wind are mild.

16. ◦ Fever without chills  It indicates the interior heat syndrome due to abundance of yang or deficiency of yin.  1) High fever: patient with persistent high fever has no chills but an aversion to heat, usually found in the warm-heat disease in the qi system.  Tidal fever: Comes and goes in fixed time like tides. Tidal fever is due to damp-heat and deficiency of yin.  Low fever: In general, low fever lasts for a long time and is caused by internal injury. It can be divided into fever due to deficiency of yin or qi, or due to blood stasis and fever due to stagnation of qi.

17. ◦ Absence of sweating  Absence of sweating in the whole body  Absence of sweating in an exterior syndrome: indicates exterior excess and cold syndrome caused by exogenous wind-cold.  Absence of sweating in an interior syndrome: suggest protracted deficiency syndrome caused by deficiency of yang qi.  Absence of sweating in a local part  Often seen in patients with stroke, flaccidness and paraplegia, caused by obstruction of channels and collaterals in the diseased site by wind-phlegm, stasis of blood and wind-dampness, leading to impeded circulation of qi and blood.

18.  Sweating in an exterior syndrome: falls into two categories: 1)exterior excess and heat syndrome due to exogenous wind-heat: cause is wind-heat, hot and pervasive in nature, makes the textual and interstitial spaces of muscles loose; 2) exterior syndrome due to exogenous wind: cause is wind, changeable and pervasiveness tends to cause the pores open, the textual and interstitial spaces of muscles loose and body fluids release.

19. ◦ Sweating in an exterior syndrome: sweating due to the interior syndrome can be divided into the following conditions  Spontaneous sweating: a sign of deficiency of qi and deficiency of yang.  Night sweating: a sign of internal heat due to yin deficiency or deficiency of both qi and yin.  Profuse sweating: an excess of heat syndrome is marked by profuse sweating, high fever, extreme thirst and full pulse.  Exhaustion sweating: indicates collapse of yang or yin  Shiver sweating: indicates a confrontation between the pathogenic factors and healthy qi.

20.  Local sweating  On the head: common causes for it are heat in the upper- energizer, steaming of accumulated damp-heat in the middle-energizer and collapse of qi.  On the chest: deficiency in the heart and spleen or disharmony between heart and kidney.  On palms and soles: caused by steaming of accumulated damp-heat in the middle-energizer or excessive heat in the yangming channel and internal heat due to yin deficiency.  On genitals: caused by damp-heat in the lower-energizer

21. 1)Distending pain: caused by stagnation of qi. Distending pain in head and eyes tends to be seen in hyper-function of liver yang or flaming of liver fire 2) Stabbing pain: sign of blood stasis in the head, chest, hypochondria, stomach ad abdomen 3) Scurrying pain: caused by stagnation of qi in liver

22. 4) Fixed pain: Due to blood stasis, seen in cold arthralgia and damp arthalgia 5) Pain with a cold sensation: If it is caused by pathogenic cold, which blocks the zang-fu organs, tissues, channels and collaterals, it indicates the excess cold syndrome. If it is caused by deficiency of yang qi, it indicates the deficiency cold syndrome 6) Burning pain: when it is due to yang heat, it is the excess heat syndrome. When it is caused by flaming fire due to yin deficiency, it is the deficiency heat syndrome

23.  7) Pain with a heavy sensation: caused by stagnation of qi due to pathogenic dampness  8) Muffled pain: caused by blockage of the lung by phlegm  9) Colicky pain: caused by blood stasis, stagnation of qi, or obstruction of qi due to pathogenic cold  10) Pulling pain: caused by malnourishment or blockage of tendons and muscles

24. 11) Aching pain: caused by wind- dampness and impeded circulation of qi and blood, or deficiency in the kidney, insufficient qi and blood 12) Dull pain: caused by deficiency of essence, blood or deficiency of yang qi 13) Pain with a sensation of emptiness: sign of deficiency syndrome

25. 1) headache: caused by external contraction, internal injury, deficiency or excess syndrome 2) chest: indicates pathological changes in the heart and lung. Internal deficiency and stabbing pain indicate blockage of cardiac vessels 3) Hypochondriac pain: stagnation of liver qi, accumulation of damp-heat in the liver and gallbladder and abundant fire in the liver and gallbladder

26. 4) Epigastric pain: pain alleviated by food intake indicates deficiency syndrome; pain aggravated after food intake suggests excess syndrome 5) Backache: backache involving the neck indicates invasion of the taiyang channel by wind-cold and pain in shoulders implies retention of wind-dampness and obstruction of qi 6) Pain in limbs: often seen in arthralgia due to invasion by pathogenic cold

27. 7) Dizziness: caused by blockage of the middle-jiao by phlegm-dampness, accumulation of liver fire, hyperactivity of liver yang, deficiency of qi and blood or deficiency of kidney essence 8) Tinnitus: a sudden attack of tinnitus indicates the excess syndrome while a gradual attack suggests deficiency syndrome, caused by yin deficiency of the liver and kidney and upward disturbance of liver yang, deficiency of kidney essence, lack of marrow and malnutrition of ears or deficiency of spleen qi

28.  Deafness or loss of hearing: Indicates excess syndrome caused by adverse flow of fire in the liver and gallbladder to ears or upward attack of ears by exogenous pathogenic factors. Gradual attack suggests deficiency syndrome caused by deficiency of the essence and qi  Eye itching: when one feels as if worms moved on the eyes with photophobia, tears and a burning sensation, it is due to upward attack by wind-fire of the Liver Channel. When the eyes have slight itching, it is caused by deficiency of blood and malnutrition of eyes  Eye pain: Acute pain indicates excess syndrome while mild pain indicates deficiency syndrome

29.  Giddiness and Night Blindness: Caused by deficiency in the liver and kidney, deficiency of essence and blood, and malnutrition of the eyes  Chest oppression: related to impeded qi flow in the heart and lung  Palpitation: causes are heart blood blockage, deficiency of heart blood, deficiency of heart yin, deficiency of heart yang and retention of fluid due to kidney qi deficiency

30.  Hypochondriac distention: stagnation of liver qi and accumulation of damp-heat in the liver and gallbladder  Gastric stuffiness: caused by stagnation of qi. The pathogenesis can be deficiency or excess, such as deficiency in the spleen and stomach, and retention of phlegm-dampness  Abdominal distension: caused by pathological changes in the spleen, stomach, intestines, liver and kidney, and impeded qi flow

31.  Sluggishness of the body: caused by pathogenic dampness or dysfunction of the lung, spleen, and kidney and retention of water in the skin  Numbness: Can be categorized into the deficiency or excess syndrome such as depletion of qi and blood, internal stirring of liver wind, phlegm accumulation in channels and blood stasis  Fatigue : Can be categorized into the deficiency or excess syndrome e.g. original qi deficiency, yang qi declination, body fluid impairment and summer-heat impairing qi and fluid, dampness pathogen obstructing qi flow and so on

32. ◦ State of thirst and drinks taken:  Neither thirst nor desire for drinking water 口不渴饮 indicates body fluids are not impaired, usually seen in the cold syndrome, dampness syndrome or syndrome without evident dryness or heat  Thirst with a desire to drink water 口渴欲饮 indicates impairment of body fluids, often seen in dryness syndrome and heat syndrome  Thirst without much drinking of water 渴不多饮 is usually caused by a mild impairment of body fluids ； or failure of body fluids to flow to the upper part of the body caused by inhibited qi transformation and distribution.  It is usually seen in the yin deficiency syndrome, damp-heat syndrome, fluid retention, blood stasis and syndrome of heat of a warm disease that invades the nutrient system

33. ◦ Appetite and diet  Declined appetite: usually caused by weakness of the stomach and spleen as inhibited spleen by dampness. Declined appetite in a recent disease is a protective reaction of qi fighting against pathogenic factors  Anorexia: can be seen in food retention in the stomach, accumulation of damp-heat in the spleen or damp-heat in the liver and gallbladder. Can also be caused by upward reversed flow of qi in the Thoroughfare Vessel (Chong Meridian), which prevents stomach qi from descending and is a physiological phenomenon

34.  Polyphagia and frequent hunger 消谷善饥 : caused by exuberance of stomach fire and fast digestion. Excessive eating and frequent hunger accompanied by polydipsia 多食 欲饥, hyperdiuresis 多饮多尿 (excessive drinking and urination) and wasting away are seen in diabetes, which is caused by yin deficiency and exuberate fire of the stomach and kidney  Hunger without a desire to eat 饥不欲食 : usually due to deficiency of stomach yin and disturbance of deficiency fire. Internal disturbance of stomach fire leads to a hungry feeling quickly, yin deficiency and weakness of the stomach, hyper － function of the stomach to receive, and digest food

35.  Bland taste in the mouth: refers to hypogeusesthesia （口中淡 而乏味， feeling tasteless), usually accompanied by anorexia, and seen in qi deficiency of the spleen and stomach of the cold syndrome  Bitter taste in the mouth: usually seen in syndromes such as fire blazing and upward adverse flow of gallbladder qi due to exuberant fire in the liver and gallbladder or interior retention of damp-heat  Sweet taste in mouth: usually seen in syndromes such as damp-heat in the spleen and stomach or spleen insufficiency  Sour taste in mouth: usually seen in the syndromes of heat accumulation in the liver and stomach, disharmony between the liver and stomach and retention of food

36.  Salty taste in the mouth: usually due to deficiency in the kidney and upward flow of cold water  Puckery taste in the mouth 口涩， taste like after eating pessimom: caused by dryness and heat impairing body fluids, or predominant yang heat in the zang-fu organs and upward adverse flow of qi and fire  Sticky and greasy taste in mouth: caused by retention of phlegm and dampness and often comes together with parageusia ( a disordered or abnormal sense of taste )

37.  Abnormal frequency  Constipation: has different causes ， cold or heat, deficiency or excess.  Excess constipation is caused by pathogen obstruction in the stomach and intestines, resulting in obstruction of fu-organ qi.  It can be seen in heat accumulation in the intestines or congealing cold in the intestines.  Deficiency constipation is usually caused by yin and yang, qi and blood deficiency

38.  Diarrhea: Diarrhea before dawn with pain suggests interior retention of cold-dampness due to deficiency in the spleen and sufficient kidney yang.  Sudden diarrhea accompanied by pain in the abdomen and difficulty in emptying bowels and burning pain in the anus is due to accumulation of damp-heat in the large intestine.  Watery stools accompanied by cold pain in the abdomen, borborygmus 肠鸣（ a rumbling or gurgling noise made by the movement of fluid and gas in the intestines ） and white greasy tongue coating are due to cold-dampness

39.  Abnormal quality (texture) Undigested food stuff in stools 完谷不化 : usually seen in deficiency-cold in the spleen and stomach or diarrhea due to deficiency in the kidney and declined fire of the life gate  Alternate loose and dry stools 溏结不调 : occasional dry and loose stools are usually due to liver qi stagnation and deficiency in the spleen and disharmony between the liver and spleen. Dry stools followed by loose stools are usually due to qi deficiency of the spleen and stomach

40.  Burning sensation in anus 肛门灼热 : usually due to downward pouring of damp-heat in the large intestine or heat accumulated in the large intestine which invades the rectum, often seen in diarrhea due to damp-heat  Tenesmus 里急后重（ a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness. ） caused by collection of damp-heat and qi stagnation in the intestines  Unsmooth defecation 排便不爽 : due to accumulation of damp-heat and disturbance of intestine qi, or due to invasion of the spleen by liver qi and obstruction of intestine qi or retention of food in the stomach and intestines and disturbance of qi flow

41.  Prolonged and uncontrolled diarrhea 滑泻失 禁 : usually caused by deficiency in the spleen and kidney or failure of the anus to control.  Fulminant diarrhea in a recent disease or spontaneous defecation with coma is also due to failure of the anus to control, but it is caused by invasion of the large intestine by heat or loss of consciousness

42.  Drooping of the anus: refers to a dragging sensation in the anus.  Usually due to sinking of qi of the middle- energizer caused by deficiency in the spleen, and this condition is often seen in patients with lingering dysentery or diarrhea

43.  Abnormal amount of urine  Increased amount: clear and profuse urine accompanied by aversion to cold and preference for heat is a cold syndrome due to insufficiency of yang qi and failure of qi to transform body fluids  Decreased amount: scanty deep yellow urine is caused by excessive heat or impairment of body fluids. Oliguria （ the production of abnormally small amounts of urine ） with edema is caused by retention of dampness and fluid due to dysfunction of the lung, spleen and kidney and water metabolism

44.  Frequent urination: usually due to disturbed water metabolism caused by damp-heat in the bladder.  Clear, profuse urine and frequent urination in a chronic disease, worse at night, is usually due to insufficiency of kidney yang, insecurity of kidney qi and failure of the bladder in control urine

45.  Difficulty in urination and retention of urine: related to dysfunction of the triple-energizer, lung, spleen and liver.  Difficulty in urination and retention of urine can be seen in both deficiency and excess syndromes.  In the former, it is due to deficiency of yang qi of the kidney, disturbed water metabolism, interior accumulation of body fluids, or failure of open-close caused by deficiency of spleen-qi and dysfunction of the spleen in sending up the mobile and sending down the unusable.  The latter one is due to retention of damp-heat in the bladder, heat and qi accumulation in the lung, blood stagnation or stone obstruction in the lower-energizer

46.  Difficulty and pain in urination: caused by damp- heat in the urinary bladder and disturbed water metabolism  Dribble of urine: due to poor reservation of kidney qi and failure of bladder to control urine  Incontinence of urine: due to poor reservation of kidney qi and deficiency-cold in the lower- energizer or dysfunction of the urinary bladder  Enuresis: （ bed-wetting in sleep ） caused by insufficient kidney qi and dysfunction of the urinary bladder

47. ◦ Depression: caused by functional disorder of the liver, heart, spleen, kidney and qi and blood. Commonly seen in the syndromes such as stagnation of liver qi and insufficiency in the spleen, deficiency in the heart and spleen and spleen-kidney yang deficiency ◦ Hyperthymia 情绪高涨 (excessive emotionalism) : usually due to interior agitation of phlegm-fire, or yin deficiency of the heart and kidney leading to stirring of deficiency-fire ◦ Dysphoria 焦虑 a state of unease or generalized dissatisfaction with life, usually caused by deficiency in the zangfu organs, malnutrition of the heart, or interior agitation of pathogenic host and unsteadiness of the mind, and is usually seen in syndromes such as heart-gallbladder, qi deficiency, heart-spleen insufficiency, interior heat due to yin deficiency and gallbladder qi stagnation with phlegm disturbance

48. ◦ Fear: caused by both deficiency and excess syndrome. Tremendous, irresolute, melancholy temperament accompanied by pain are due qi deficiency of the liver and gallbladder. ◦ Tendency to worry accompanied by tiredness, lusterless complexion, a pale tongue with thin and white coating is due to deficiency of both qi and blood ◦ Upset and restlessness 烦躁 : caused by both excess and deficiency. Excess category is due to pathogenic heat, phlegm-fire and blood stasis. Deficiency category is due to fire hyperactivity resulting from yin deficiency

49. ◦ Insomnia: caused by disharmony between yin and yang, and mental derangement. Its formation has deficiency and excess causes. ◦ The deficiency syndrome of insomnia is usually caused by deficiency of blood and malnutrition of the heart, while the excess syndrome interior exuberance of pathogenic qi and disturbance of the mind ◦ Lethargy: due to yang deficiency and yin excess. ◦ When accompanied by lassitude, heaviness in the head, eyes and limbs, oppression and fullness of the chest, usually caused by exuberance of phlegm-dampness in the spleen and failure of yang to rise. ◦ Lethargy after meals accompanied by lassitude, declined appetite and indigestion is often due to deficiency of middle qi and failure of the spleen to transform and transport

50.  Abnormal menstrual cycle  Preceded menstrual cycle: menstruation that occurs more than 7 days earlier in at least two successive menstrual cycles. Often caused by qi deficiency or predominance of yang and blood heat, liver qi stagnation and blood heat and fire hyperactivity, resulting from yin deficiency, leading to heat disturbance of the Thoroughfare and Conception Vessels  Delayed menstrual cycle: menstruation that occurs more than 7 days later in at least two successive menstrual cycles. Often caused by deficiency blood, decline of yang qi and lack of nourishment, obstruction of the Chong Meridian and Ren Meridian

51.  Irregular menstrual cycle: caused by stagnation of liver qi or blood stasis, deficiency and impairment of the spleen and kidney leading to qi and blood disorder of the Thoroughfare and Conception Vessels and dysfunction of the sea of blood  Abnormal amount of menses  Menorrhagia 月经过多 : evident increase of menses with normal menstrual cycle. Usually caused by heat in the blood resulting in impairment of the Chong Meridian and Ren Meridian and failure to control blood, or qi deficiency  Metrorrhagia and metrostaxis 崩漏 : sudden large amount of uterine bleeding not in periods. Caused by heat impairing the Chong Meridian and Ren Meridian and driving blood to flow out; or by spleen kidney qi deficiency and debility of the Thoroughfare and Conception Vessels, or by blood stasis in the Thoroughfare and Conception Vessels and failure of blood to circulate in vessels

52.  Scanty menstruation: refers to normal menstrual cycle with evident reduction of menstrual blood or even scanty of menses.  It is usually caused by deficiency of essence and blood or both qi and blood, or coagulation cold and blood stasis and inhibited circulation of the Chong Meridian and Ren Meridian.

53.  Amenorrhea 闭经 : it refers to no menstruation when a woman is after 18 or cessation of menstruation for over three months without pregnancy of not during lactation in women.  Cessation of menstruation in some adolescent women after menstruation without other discomfort is not considered as amenorrhea.

54.  Pathological amenorrhea is usually due to deficiency in the spleen and kidney, deficiency of qi and blood in the Chong and Ren Meridians, or qi stagnation, cold coagulation and blood stasis, or phlegm-dampness accumulating in the uterus and obstruction of uterine vessels.  Some women do not have menstruation for life and they are fertile, it is called “Adverse Menstruation.”  Adverse rise of menses during menstruation resulting in hematemesis, nosebleed or bleeding from eyes or ears are called “Vicarious menstruation.”

55.  Abnormal color and quality of menses: light red and thin discharge usually indicates qi or blood deficiency, while dark red and viscous menses suggests exuberant heat in blood. A dark purplish menstruation flow with blood clots accompanied by cold pain in the lower abdomen is caused by cold coagulation and blood stasis.

56.  Excessive and continuous leukorrhea with abnormal color, quality or smell is called pathological leukorrhea.  A minor increase of discharge before or after menstruation, ovulation period or trimester of pregnancy is a normal phenomenon. Inquiry of leukorrhea should focus on its amount, color, quality and odor.

57.  White vaginal discharge: indicates yang deficiency of the spleen and kidney and pouring down of cold-dampness; white viscous, curd-like discharge with offensive smell usually suggests pouring down of dampness.

58.  Yellow vagina discharge: yellowish, viscous discharge with offensive odor usually suggests pouring down of damp-heat.  Red and white vagina discharge: indicates retention of heat in the liver meridian or pouring down of damp-heat.  Continuous red yellow and light brown discharge with offensive odor in women of middle-aged or the elderly is usually caused by pouring down of dampness-heat with toxins, the prognosis is usually bad and immediate examination is recommended.

59.  Dysmenorrhea: it refers to intermittent lower abdominal pain before, after or during menstruation, or pain involving the lower back and sacrum or even unbearable pain.  Clinical syndrome differentiation is mainly based on the characteristics and time of the pain.  Lower abdominal distending pain or sharp pain during or before menstruation is usually caused by qi stagnation or blood stasis;  Lower abdominal pain alleviated with warmth or often due to cold coagulation or yang deficiency, and lower abdominal dull pain during or after menstruation is usually caused by deficiency of both qi and blood and malnutrition of the uterus.

60. ◦ Impotence 阳痿 : refers to inability to erect penis or weak erection of penis  Impotence has deficiency and excess syndromes. Generally speaking, recent, acute or secondary disease in young people is of the excess syndrome, while prolonged, gradually developed and primarily happened in the aged is of the deficiency syndrome.  Impotence due to excess of sexual activities or worry is usually seen in the deficiency syndrome of declination of fire of the life gate and insufficient qi of the heart and spleen, while impotence due to emotional dissatisfaction, interior stagnation of pathogenic qi in penis is usually seen in the excess syndromes of liver qi stagnation, downpoouring of damp heat and stagnant blood obstructing collaterals

61.  Postcoital protrusion 阳强 : refers to a prolonged erection  The deficiency syndrome is usually due to disturbance of liver fire, while the excess syndrome is usually due to yin deficiency of the liver and kidney leading to frenetic stirring of fire of the life gate  Premature ejaculation 早泄 : usually caused by insecurity of kidney qi, deficiency of kidney yang, deficiency of liver kidney yin and frenetic stirring of ministerial fire