Patterns 证候

Qi deficiency qì xū · 气虚

Described as tiredness, shortness of breath on exertion, a weak voice, spontaneous sweating and a tendency to catch colds.

Blood deficiency xuè xū · 血虚

Described as pallor, dizziness, palpitations, dry skin, poor sleep and, in the TCM model, sparse menstruation.

Yin deficiency yīn xū · 阴虚

Described as a feeling of heat in the afternoon or evening, night sweats, a dry mouth and throat, and restlessness.

Yang deficiency yáng xū · 阳虚

Described as a persistent cold feeling, cold limbs, low energy, a pale complexion and a preference for warm drinks.

Qi stagnation qì zhì · 气滞

Described as distension, discomfort that moves around, sighing, and symptoms that worsen with emotional stress.

Blood stasis xuè yū · 血瘀

Described as fixed stabbing pain, a dark complexion, dark lips and, in the classical model, masses.

Phlegm-damp tán shī · 痰湿

Described as heaviness, a muzzy head, a sensation of fullness in the chest, a sticky taste and easy weight gain.

Damp-heat shī rè · 湿热

Described as a heavy, hot, sticky feeling, a bitter taste, a yellow coating on the tongue and irritability.

Cold-damp hán shī · 寒湿

Described as cold with heaviness, joints that ache and feel worse in damp weather, and a dislike of cold drinks.

Wind-heat fēng rè · 风热

Described as a sore throat, slight fever, a yellow nasal discharge and a dislike of wind — the classical "common cold, hot type".

Wind-cold fēng hán · 风寒

Described as a marked aversion to cold, an absence of sweating, a clear nasal discharge and aching limbs.

Liver Qi stagnation gān qì yù jié · 肝气郁结

Described as irritability or low mood, a lump-in-the-throat feeling, distension in the sides of the chest, and premenstrual worsening.

Liver Yang rising gān yáng shàng kàng · 肝阳上亢

Described as headache, dizziness, ringing in the ears, a red face and a short temper.

Spleen deficiency pí xū · 脾虚

Described as poor appetite, loose stools, a bloated feeling after eating, tiredness and a sallow complexion.

Kidney Yin deficiency shèn yīn xū · 肾阴虚

Described as lower-back soreness with a feeling of heat, night sweats, ringing in the ears and dry mouth at night.

Kidney Yang deficiency shèn yáng xū · 肾阳虚

Described as a cold lower back, cold limbs, frequent night urination and a general sense of coldness.

Heart fire xīn huǒ · 心火

Described as restlessness, insomnia, a red tongue tip, mouth ulcers (in TCM reasoning) and a feeling of heat in the chest.

Disturbed Shen xīn shén bù níng · 心神不宁

Described as palpitations, anxiety, broken sleep and a sense of not feeling settled — broadly the emotional vocabulary of the Heart system.

Lung Qi deficiency fèi qì xū · 肺气虚

Described as a weak cough, shortness of breath on exertion, a low voice and easy sweating.

Lung heat fèi rè · 肺热

Described as a dry or productive cough with yellow phlegm, thirst, a sore throat and a feeling of heat.

Stomach heat wèi rè · 胃热

Described as a big appetite with a burning sensation, bad breath, thirst and a preference for cold drinks.

Stomach Qi rebelling wèi qì shàng nì · 胃气上逆

Described as nausea, belching, hiccups and a rising sensation after eating — the directional vocabulary of Qi movement made concrete.

Spleen-Stomach disharmony pí wèi bù hé · 脾胃不和

Described as alternating appetite and poor digestion, a bloated abdomen, irregular stool and fatigue after meals.

Liver-Gallbladder damp-heat gān dǎn shī rè · 肝胆湿热

Described as a bitter taste, a sensation of fullness under the ribs, a yellow tongue coating and irritability.

Heart and Spleen deficiency xīn pí liǎng xū · 心脾两虚

Described as palpititations, poor memory, broken sleep, tiredness and poor appetite together — a combined pattern.

Heat above, cold below shàng rè xià hán · 上热下寒

Described as heat symptoms in the upper body together with cold symptoms below — notably, this pattern exists precisely because TCM does not assume one uniform state.

Deficiency of both Yin and Yang yīn yáng liǎng xū · 阴阳两虚

Described as cold signs and heat signs appearing together in a person who is generally depleted — a chronic picture.

Exterior deficiency biǎo xū · 表虚

Described as a weak surface defence: easy sweating, sensitivity to wind and a tendency to catch colds easily.

Interior excess lǐ shí · 里实

Described as constipation, abdominal fullness with pain that worsens on pressure, and a thick tongue coating.

Deficiency of both Qi and Blood qì xuè liǎng xū · 气血两虚

Described as tiredness with pallor, dizziness, palpitations and a weak pulse — the two deficiencies together, common after illness or childbirth.

Spleen and Kidney Yang Deficiency pí shèn yáng xū · 脾肾阳虚

What it describes: a pattern combining a weak Spleen with a weak Kidney, so the warming and transforming functions are described as depleted. Classically recorded: cold limbs, loose stools or early-morning diarrhoea, oedema, a cold lower back, a deep weak pulse.

How it is read: as a pattern, not a disease. Conventional medicine has no equivalent category - the same symptoms would first be investigated for thyroid, kidney, gut and other causes.

What this is not: something you can diagnose from a symptom list, and not a reason to self-prescribe warming herbs.

Liver and Kidney Yin Deficiency gān shèn yīn xū · 肝肾阴虚

What it describes: depletion of the yin aspect of the Liver and Kidney systems - described as dryness, heat at night, dizziness, ringing in the ears, weakness in the lower back, and a thin rapid pulse.

How it is read: as a pattern that groups several symptoms the practitioner takes together, rather than one by one. It is not a disease and does not by itself tell you what you have.

What this is not: a self-diagnosis. Most of these symptoms have treatable medical causes and should be checked first.

Phlegm-Dampness Obstructing tán shī nèi zǔ · 痰湿内阻

What it describes: heaviness, a muzzy or foggy head, a feeling of fullness, a sticky taste in the mouth, loose or sluggish stools - grouped as phlegm and dampness obstructing the interior.

Note this carefully: the word phlegm here is a theoretical category, not sputum you can see. This is one of the most common sources of confusion for English readers, and one of the most common claims in health advertising.

How it is read: as a pattern of several symptoms taken together. Claims such as 'removes dampness' by themselves carry no measurable meaning and should not be treated as a diagnosis.

The six channels — an introduction liù jīng biàn zhèng · 六经辨证入门

The six-channel framework from the Shanghan Lun sorts illness into six stages: Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin. Taiyang is the exterior and the earliest stage, Yangming is interior heat, and Shaoyang is the half-exterior half-interior stage between them.

Its importance is historical as much as clinical. It is the earliest systematic attempt in Chinese medicine to describe illness as a process that moves over time, rather than a fixed label, and modern discussion of cold damage still uses its vocabulary.

The four levels (wei, qi, ying, xue) wèi qì yíng xuè · 卫气营血辨证

A framework from the warm-disease school that describes the depth of an acute febrile illness in four levels: wei (defence, at the surface), qi (the active stage with marked fever), ying (nutritive, with deeper disturbance), and xue (Blood, the deepest, with bleeding or rash).

It is essentially a severity ladder, and it was built to reason about epidemics. That is why it reads more like a staging system than the static patterns used elsewhere in TCM.

The three burners as a pattern framework sān jiāo biàn zhèng · 三焦辨证

A second warm-disease framework, dividing illness by the three burners: upper (Lung and Heart), middle (Spleen and Stomach) and lower (Liver and Kidney). Its logic is depth from above downward, and it is usually used alongside the four levels rather than instead of them.

For a reader new to TCM it is a useful reminder that Chinese medicine has no single unified diagnostic system. Different schools built different maps for different problems, and knowing which map is being used is part of reading the literature honestly.

Exterior cold with interior heat biǎo hán lǐ rè · 表寒里热

A mixed pattern in which signs described as exterior cold, such as chills, absence of sweating and body aches, appear together with signs described as interior heat, such as thirst, a red tongue or a rapid pulse.

Mixed patterns are the norm rather than the exception in real consultations, and this is why formulas are so often modified: a single label rarely fits the whole person. Presentation of this kind should still be medically assessed, since chills with fever of unclear cause is not something to manage at home.

Mixed Cold and Heat hán rè cuò zá · 寒热错杂

In this framework cold and heat signs are not opposites that exclude each other - they can appear together in the same person, and often in different parts of the body.

Classical descriptions include heat above with cold below, cold in the interior with heat on the surface, and intermingled cold and heat in the middle. The reason it matters is practical: treating it as if it were simply hot, or simply cold, tends to make part of the picture worse.

What it is not: a diagnosis, and not something to sort out alone. Cold and heat here are pattern descriptions, not temperatures. Persistent or worsening symptoms belong with a clinician.

True and False Cold or Heat hán rè zhēn jiǎ · 寒热真假

A classical caution about appearances: a picture that looks like heat can in fact be cold at root, and the reverse also occurs. The tradition uses this to argue that the most obvious sign is not always the decisive one.

Criteria proposed in the classical literature include whether the person wants to be covered or uncovered, whether they want cold drinks, the character of the pulse, and how the tongue looks. None of these is decisive alone.

This is the clearest example of why the library does not do diagnosis. What looks like one thing and is another is exactly the situation where self-assessment is most likely to be wrong. If someone is very unwell, the answer is medical care, not pattern analysis.

Mixed Deficiency and Excess xū shí jiā zá · 虚实夹杂

Classical writing treats deficiency and excess as a pair that frequently coexists rather than as a strict either-or. A person may be depleted while also carrying something that needs to be cleared.

The practical consequence is a well-known classical warning: tonifying too early can strengthen the wrong thing, and draining too hard can leave the person weaker than before. This is why the order of approach is discussed at length in the texts.

What it is not: a self-check list. Deciding which is dominant, and in what order to work, is precisely the judgement that requires training and a full examination.

Heart Yang deficiency xīn yáng xū · 心阳虚

Heart yang deficiency is the pattern name used when the warming and motivating function associated with the heart is described as insufficient. In the classical vocabulary yang is what moves and warms; when it is said to be deficient at the heart, the picture is one of a circulation that is not being driven hard enough and a chest that is not being kept warm.

The features recorded for it are: palpitation, or a sense of the heart beating uncomfortably, sometimes with an undercurrent of fearfulness; a feeling of oppression or emptiness in the chest; shortness of breath on slight effort; cold hands and feet and a general intolerance of cold; spontaneous sweating; a pale or bluish complexion; a pale, swollen tongue; and a pulse described as deep, slow, or intermittently interrupted. It is usually understood as a development out of heart qi deficiency rather than as something arising on its own.

The pattern overlaps with several modern conditions that produce the same cluster of complaints, including heart failure, marked bradycardia and conduction block, hypothyroidism, and anaemia. The overlap is real but it is not identity: a pattern name is not a test and cannot sort those conditions out. Two people can be given the same name for quite different reasons, and one person's name can change while the underlying disease is unchanged.

Two things are not negotiable. Chest pain - especially pain with a pressing quality, or pain spreading to the jaw, back or arm, or accompanied by sweating, nausea or breathlessness - is assessed as an emergency, not interpreted. New breathlessness that wakes a person at night, breathlessness that prevents lying flat, progressive leg swelling, and a faint are reasons to be seen promptly.

Whether the warming methods recorded for this pattern change any long-term outcome has not been established. This entry describes a way of talking about symptoms; it does not diagnose and it does not give a treatment.

Spleen Yang deficiency pí yáng xū · 脾阳虚

Spleen yang deficiency describes the classical picture in which the warming and transforming function attributed to the spleen is underactive. The spleen in this vocabulary is not the anatomical organ that can be removed without digestion stopping; it is a way of grouping appetite, abdominal comfort, stool form and the sense of having enough energy.

The recorded features are: poor appetite and a bland taste in the mouth; abdominal fullness, especially after eating; loose stools, sometimes containing undigested food; a dragging or cold discomfort in the abdomen that improves with warmth and with pressure; cold limbs; fatigue and bodily heaviness; absence of thirst, or a preference for warm drinks; a pale, swollen tongue with teeth marks along the edges; and a deep, slow, weak pulse. It is commonly described as developing out of spleen qi deficiency, and the classical literature attributes it to prolonged illness, to excessive consumption of cold or raw food, and to the overuse of cold-natured or bitter medicinals.

The same symptom cluster appears in coeliac disease, chronic pancreatitis, bile acid diarrhoea, small intestinal bacterial overgrowth, diarrhoea-predominant irritable bowel syndrome, hypothyroidism and chronic kidney disease, among others. The pattern name does not sort them out.

What does sort some of them out is investigation. Blood in the stool or black stools, unintentional weight loss, diarrhoea that wakes a person from sleep, fever, the first appearance of digestive symptoms after the age of forty, and signs of dehydration in an infant or an older adult are reasons to be examined rather than described. Liking warmth and pressure is not a discriminating sign either: functional pain often does, and the classical peritoneal signs of an acute abdomen can be absent in older people, in people who are immunosuppressed, and in people taking corticosteroids.

Whether the warming methods recorded for this pattern change any outcome has not been established. This entry does not diagnose and does not recommend a treatment.

Liver Blood deficiency gān xuè xū · 肝血虚

Liver blood deficiency is the pattern name for the picture produced when the nourishing and moistening role attributed to the liver's stored blood is described as insufficient. In the classical framework the liver stores blood, opens at the eyes, manifests in the nails and governs the sinews, which is why the features are spread across vision, nails, limbs and menstruation instead of staying in one place.

They are: dizziness and dim or blurry vision, sometimes described as night blindness; dry, brittle or ridged nails; numbness, cramping or a tight stiffness in the limbs; scanty and pale menstrual flow, delayed periods, or absent periods; a lustreless complexion; unsettled sleep with many dreams; a pale tongue; and a fine pulse. The classical texts connect the picture to blood loss, to convalescence, and to a general failure of the sources of blood.

The modern conditions that can produce the same list include iron deficiency anaemia, vitamin A deficiency, vitamin B12 deficiency, hypothyroidism, and chronic blood loss from heavy periods or from the digestive tract. Numbness additionally carries a long differential of its own: diabetic neuropathy, cervical radiculopathy, multiple sclerosis and stroke are all capable of beginning as numbness.

Three of those are matters of hours or minutes rather than of pattern names. Sudden visual loss, loss of part of the visual field, or a new headache with tenderness over the temple and jaw pain on chewing can be giant cell arteritis, in which the loss of sight is permanent and the window is measured in hours. Numbness or weakness that comes on suddenly together with slurred speech or a drooping face is treated as a stroke. Absent periods are assessed for pregnancy first.

Whether the nourishing methods recorded for this pattern change any of those outcomes has not been established. This entry does not diagnose and does not recommend a treatment.

Lung Yin deficiency fèi yīn xū · 肺阴虚

Lung yin deficiency is the pattern name used when the moistening and cooling aspect attributed to the lung is described as depleted. Yin is the quieter, cooler, more material aspect; deficiency of it leaves a picture of dryness together with low-grade heat.

The recorded features are: a dry cough with little sputum, or sputum that is scanty, sticky and difficult to bring up; a dry mouth and throat; a hoarse voice; feverishness in the afternoon or evening; night sweating; a sense of heat in the chest, palms and soles; loss of weight; a red tongue with little coating or with cracks; and a fine, rapid pulse. The classical texts attribute the picture to prolonged coughing, to consumption-like illness, to the aftermath of a febrile disease, and to dryness.

Blood in the sputum is the line this library does not walk around. Any amount is assessed, and no pattern name makes it less urgent. A cough lasting more than three weeks, weight loss, night sweating, fever, or hoarseness lasting more than three weeks are also reasons for imaging and investigation rather than for interpretation: tuberculosis and lung cancer both live in this symptom space, and tuberculosis keeps transmitting while it is undiagnosed.

The same chronic cough can come from asthma, reflux, an ACE inhibitor, post-nasal drip, bronchiectasis or interstitial lung disease. The ACE inhibitor example is worth pausing on: in many people the cough stops when the medicine is stopped, which is a matter of prescribing rather than of yin.

Whether the moistening methods recorded for this pattern change any outcome has not been established. The identification of classical consumption with tuberculosis was made long after the texts were written; those texts contain no concept of the organism.

Stomach Yin deficiency wèi yīn xū · 胃阴虚

Stomach yin deficiency is the pattern name for the picture in which the moistening, cooling aspect attributed to the stomach is described as depleted, leaving a stomach that is dry and slightly hot.

The recorded features are: a dull burning discomfort in the upper abdomen; hunger without any desire to eat, or eating only a little; a dry mouth and throat, worse at night; retching or hiccups; dry, constipated stools; a red tongue with little fluid, sometimes with cracks, and with a reduced or absent coating - in advanced descriptions, a mirror-smooth tongue; and a fine, rapid pulse. The classical texts attribute it to a febrile illness that has consumed fluids, to prolonged illness, to a diet of hot and spicy food, and to the overuse of drying or warming medicinals.

The conditions that produce a similar list include atrophic gastritis - including the autoimmune form that leads to pernicious anaemia - reflux, functional dyspepsia, Sjogren's syndrome, and the dry mouth produced by anticholinergic and antihistamine medicines. A smooth, denuded tongue is not specific to this pattern either: iron deficiency, folate deficiency, B12 deficiency and oral candidiasis all produce one.

The features that call for investigation rather than description are: progressive difficulty swallowing; vomit that contains blood or looks like coffee grounds; black stools; unintended weight loss; anaemia; and the first appearance of indigestion after the age of fifty. Sudden severe upper abdominal pain with a rigid, board-like abdomen is treated as a perforation and is an emergency. The association between atrophic gastritis and gastric cancer risk is real, but who gets screened and how is decided by local guidelines and by what endoscopy shows, not by a pattern name.

Kidney Qi Not Firm shèn qì bù gù · 肾气不固

Kidney qi not firm is the pattern name used when the holding and storing function attributed to the kidney is described as weakened, so that the things classical texts say should be retained are not retained.

The recorded features are: passing urine often and urgently; urine passed in small amounts; dribbling after the stream has finished; incontinence, or bed-wetting in a child; loss of urine on coughing, laughing or lifting; in men, seminal emission or ejaculation earlier than wanted; in women, a thin, watery vaginal discharge; together with a sore and weak lower back and knees, a sense of cold, tiredness, a pale tongue with a white coating and a deep, weak pulse. The classical texts attribute the picture to a weak constitution from birth, to ageing, to prolonged illness, and to exhaustion through overwork.

Two different kinds of loss are described under this one name and they do not share a cause: the leak that happens on effort is usually pelvic floor and sphincter mechanics, while the constant urge with a bladder that never feels empty is usually detrusor overactivity. The same list of symptoms also comes from urinary tract infection, an enlarged prostate with overflow, poorly controlled diabetes, diabetes insipidus, pregnancy and childbirth, pelvic surgery, neurological disease, and common medicines - diuretics, SGLT2 inhibitors, lithium, some antihypertensives and sedatives.

Where this library stops describing and says see someone now: new loss of bladder or bowel control together with severe back pain, numbness around the sitting area and the genitals, or weakness in the legs can be cauda equina syndrome and is an emergency; being unable to pass urine with a painful, distended lower abdomen is an emergency; fever with flank pain and vomiting suggests infection reaching the kidney; blood in the urine is assessed even when it stops by itself; passing large volumes of urine with thirst and losing weight is checked for diabetes. In a child, bed-wetting is usually not regarded as a problem before about five years of age.

Whether the approaches described as firming the kidney qi change any of these outcomes is not established.

Spleen Not Governing Blood pí bù tǒng xuè · 脾不统血

Spleen not governing blood is the pattern name used when the function of keeping blood inside the vessels - attributed in classical texts to the spleen - is described as failing, so that bleeding occurs without heat, force or injury to account for it.

The recorded features are: bleeding that is slight, repeated, prolonged and pale rather than bright and forceful; bruising that appears readily or without a remembered knock; pinpoint red or purple spots in the skin; nosebleeds and bleeding gums; blood in the stool, dark or fresh; unusually heavy or prolonged menstrual bleeding, or bleeding between periods; together with the qi-deficiency picture of tiredness, a poor appetite, loose stools, a sallow complexion, a pale tongue and a weak pulse. Bleeding from above - vomiting blood - and bleeding from below are discussed under the same classical heading.

The classical texts did not know of platelets, clotting factors or vessel wall integrity; the spleen here is a functional role, not the anatomical organ. The same presentation is shared by immune thrombocytopenia, thrombocytopenia from medicines, alcohol or liver disease, inherited and acquired clotting factor disorders, von Willebrand disease, leukaemia and myelodysplasia, vitamin K deficiency, disseminated intravascular coagulation, and the effect of anticoagulant or antiplatelet medicines. Heavy menstrual bleeding carries its own large differential - fibroids, adenomyosis, polyps, endometrial disease, thyroid disease, the perimenopause, and an intrauterine device.

The lines this library does not cross: rectal bleeding is investigated rather than named, at any age, because colorectal cancer sits inside the same symptom; blood in the stool with iron-deficiency anaemia in a man, or in a woman after the menopause, is a gastrointestinal referral; black tarry stools or vomiting blood is an emergency; bleeding after the menopause needs the endometrium assessed; widespread pinpoint spots with fever, or with a severe headache and a stiff neck, is an emergency; and anyone taking an anticoagulant or antiplatelet medicine who notices unusual bleeding should contact the clinician who ordered it rather than change anything alone. Some medicinals used in this tradition affect bleeding or interact with anticoagulants, which is worth raising with a clinician.

Whether the approaches described as strengthening the spleen so that it contains the blood change bleeding outcomes is not established.

Gallbladder Depression with Phlegm Harassment dǎn yù tán rǎo · 胆郁痰扰

Gallbladder depression with phlegm harassing is the pattern name given when the classical role of the gallbladder in deciding and judging is described as constrained, and phlegm is described as moving upward and disturbing what is above.

The recorded features are: being timid, easily startled and unable to settle on a decision; dizziness or a spinning sensation; a bitter taste in the mouth; nausea or vomiting; a sense of fullness and oppression in the chest and below the ribs; sighing; palpitations; disturbed sleep with unsettling dreams; irritability; a sensation of a lump in the throat that neither comes up nor goes down; a yellow, greasy tongue coating and a wiry, slippery pulse.

The gallbladder here is a functional role inside a descriptive system. The anatomical gallbladder has no part in deciding anything, and people who have had it removed do not become indecisive. Timidity and being easily startled are descriptions of temperament in the classical texts, not findings.

What shares the list: panic attacks and generalised anxiety; vestibular disorders such as benign paroxysmal positional vertigo, Meniere disease and vestibular migraine; reflux and bile reflux as causes of a bitter taste - together with many medicines, zinc deficiency, poor oral health and pregnancy; and insomnia, shift work, caffeine, alcohol and withdrawal from sedatives for the sleep picture.

Where description has to stop: sudden confusion, or a change in thinking and behaviour, is an emergency rather than a temperament, and in an older person the common causes are infection, low oxygen, low blood sugar and medicines; vertigo with sudden severe headache, double vision, slurred speech, facial droop, limb weakness or numbness, or an inability to stand, is treated as stroke until it is not; palpitations with chest pain or blackouts are assessed; and anxiety that arrives with weight loss, heat intolerance, tremor or a racing pulse at rest has a thyroid and a cardiac differential.

Whether the approaches aimed at freeing constrained gallbladder qi and transforming phlegm change any of these outcomes is not established. New or worsening anxiety with thoughts of harming oneself needs a person, not a pattern name.

Bladder Damp-Heat páng guāng shī rè · 膀胱湿热

Bladder damp-heat is the pattern name for the classical picture of painful urinary difficulty - the strangury group - in which dampness and heat are described as pouring down into the bladder and obstructing the passage of urine.

The recorded features are: passing urine often, urgently and in small amounts; a burning or scalding sensation on passing it; urine that is dark, scanty, cloudy or foul-smelling; sometimes blood in the urine, or gravel and stones; a sense of distension, fullness or pain in the lower abdomen; fever, with or without chills; thirst; a yellow, greasy tongue coating and a rapid, slippery pulse. The classical texts divide the picture by what is seen in the urine - the heat, blood, stone and cloudy forms.

What shares it: bacterial infection of the lower urinary tract and of the kidney; stones in the urinary tract; urethritis from chlamydia, gonorrhoea or another sexually transmitted infection; prostatitis; interstitial cystitis; and chemical or irritant causes. In women, burning on passing urine is common in infection but is not specific to it.

Where this library stops describing: fever with flank pain, shaking chills or vomiting suggests the infection has reached the kidney and needs assessment the same day; pregnancy changes the calculation - any urinary infection in pregnancy is followed up, including one that causes no symptoms at all; urinary infection in a man or in a child is uncommon enough to be investigated rather than explained; being unable to pass urine with a painful, distended lower abdomen is an emergency; visible blood in the urine is assessed even after the burning stops, because cancer of the bladder and of the upper urinary tract presents that way; and in diabetes, immune suppression or old age, infection may be present without any burning.

Drinking more fluid has not been shown to clear an infection that is already established. Whether the approaches described as clearing heat and draining damp change any of these outcomes is not established.

Heart-Kidney Disharmony xīn shèn bù jiāo · 心肾不交

Heart-kidney disharmony is the pattern name for the picture in which the fire of the heart above and the water of the kidney below are described as no longer meeting - the heart fire is said to blaze because the kidney water does not rise to cool it.

The recorded features are: difficulty falling asleep, or waking and being unable to get back to sleep; a mind that will not settle and a feeling of inner restlessness; palpitations; poor memory and difficulty concentrating; dizziness and tinnitus; a dry mouth and throat, worse at night; night sweating; a sore and weak lower back and knees; a red tongue with a thin coating, or with little coating at all, and a fine, rapid pulse. The classical texts also mention nocturnal emission and a sense of heat in the chest, palms and soles.

The heart and kidney here are functional roles. No anatomical connection between them has been demonstrated, and nothing in this pattern name corresponds to a finding on an electrocardiogram or a kidney function test.

What shares the list: chronic insomnia and anxiety; obstructive sleep apnoea - snoring, witnessed pauses in breathing, morning headache and sleepiness in the day; restless legs; reflux on lying down; caffeine, alcohol and shift work; medicines including beta blockers, some antidepressants, corticosteroids and decongestants; an overactive thyroid; the menopause; and depression, which is present in a large share of people with chronic insomnia.

Where description has to stop: insomnia together with thoughts of ending one's life needs a person, not a pattern name, and in many countries a helpline exists; a reduced need for sleep together with elation, rapid speech and risk-taking is not insomnia and is assessed urgently; loud snoring with witnessed pauses needs a sleep study rather than an explanation; chest pain, breathlessness at rest or on lying flat, and blackouts are not part of this pattern; tinnitus on one side, or pulsing in time with the heartbeat, or with neurological signs, is assessed; and a new severe headache is not covered by this framework. For chronic insomnia, cognitive behavioural therapy for insomnia is recommended as first-line in most clinical guidelines, ahead of medicines.

Whether the approaches described as restoring the meeting of heart and kidney change sleep outcomes is not established.