Diagnostic Essentials for Syphilis in Chinese medicine:
1. Present history
There is a history of unclean sexual intercourse, or homosexuality, or spouse infection. The incubation period is about three weeks

2. Phase I syphilis 
The main symptoms are hard chancre and nearby lymphadenectasis. It occurs about 2 - 4 weeks after sexual intercourse and most commonly in the genital region, and also in the lips, throat, tongue, breast and around the anus. The typical hard chancre is, in size of 1 - 2 cm in diameter and round or ovary shape, distinctive border, obvious infiltration, flat ulcerous sores, manifested by chondroid hardness, no pain and tenderness. It is called "Chancre Sore" in Chinese medicine and accompanied by nearby lymphadenectasis, namely syphilis bubo.

3. PhaseⅡsyphilis
1) Skin Rash: There are skin rashes of macules (roserash), maculopapule, papule, papulosquamous syphilid, pityriasis rosea-like eruption, psoriasis-like eruption and multiform erythema-like eruption, follicular eruption, pustular eruption, rupia and ulceration on the body trunk, four limbs, face, and palmar and plantar region.

2) Flat Condyloma: It occurs frequently in the friction and wet regions of the skin around the anus and in the external genitalia, formed by flat papules.

3) Syphilitic Alopecia: It is shown in moth-eaten form, frequently on the temporal region, and is temporary.

4) Syphilitic Leukoerma: After the macules or maculopapules subsides , there can be pigment loss for several months, mostly on the neck and back.

5) Mucous Lesions: There are mucous congestion and tumefaction and superficial erosion in the genital region, oral cavity, pharynx and larynx. If the vocal cord is involved, there can be hoarse voice.
 
(1) Osteroarticular Lesion in PhaseⅡ: Periostitis and arthritis can occur, aggravated at night and rest and relieved in the daytime and exertion. There can be a fierce reaction in the first antisyphilitic treatment.
(2) PhaseⅡ Ocular Syphilis Iritis, iridocyclitis, choroiditis, optic neuritis and retinitis can happen.
(3) PhaseⅡ Nervous Syphilis: There is no clinical symptom. But, there is abnormal change in cerebrospinal fluid. Meningitis, craniocerebral neuroparalysis and meningovascular syphilis can be seen.

4. PhaseⅢ Syphilis
(1) PhaseⅢ Mucocutaneous Syphilis
1)  Nodular Syphilid: It occurs 5 - 10 years after infection. In most cases, subcutaneous nodes are listed in the cyclic, polycyclic or horseshoe forms. They are frequently seen on the face, four limbs, or scapula and between the scapulae, and can disappear naturally to leave atrophic macules, or superficial ulceration. Mter healing, scars can be left with new lesions on the border.

2) Syphiloma: Small hard nodes under the skin enlarges gradually and adheres to the skin to form infiltrative plaques and cause perforating ulceration after gradual softening in the center, mostly in the extension aspects of the four limbs, forehead, head, sternum region, legs and buttocks. Syphiloma in the upper palate and nasal septum can invade the bone to discharge the dead bone and to cause perforation in the upper palate and nasal septum and saddle nose.

3) Juxa-Articular Nodes: Subcutaneous nodes occur near the big joints of the hip, elbow, knee and sacral joints.