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What are the Four Diagnostic Methods?
- Auscultation and Olfactory
Objective and Measured trait of disease
Subjective experienced trait of disease
A group of signs and symptoms that result from a common cause.
What are the seven methods of differentiation of syndromes in TCM?
- 1) Eight Principle
- 2) Qi, Blood and Body fluid
- 3) Zang Fu
- 4) Meridians and collaterals
- 5) Six Channels
- 6) Wei, Qi, Ying, Xue
- 7) Three burners
What are the principles of TCM Diagnosis?
- 1) Holistic concept
- 2) Comprehensive Analysis of Signs and Symptoms by all the diagnostic methods.
- 3) Combining diagnosis of diseases with differentiation of syndromes.
Describe the Holistic Concept of TCM:
- 1) The human physiology, spirit, mind, and emotions are a unit.
- 2) The human body and nature are a unit.
Describe Comprehensive analysis of all the signs and symptoms by all the diagnostic methods:
Using the four methods together, (Inspection, Auscultation and olfaction, Inquiring and Palpation.)
What does the TCM practitioner Inspect?
- Objective findings.
- The patient's vitality, color, appearance, secretion, excretion, physical condition, behavior and so on...
Describe Auscultation and Olfaction:
- Hearing and Smelling.
- Listening to the sounds and smells emitted by the patient.
What is Inquiring?
Inquiring and discussion of the patient's complaint, history, disease condition, symptons, etc...
What is palpation?
Palpation is to feel the pulse and physical body.
- Vitality is spirit or Shen.
- Broad meaning is the
- outward experience of the vital activities of the
- whole body.
- Narrow meaning is mentality, consciousness, thinking sleeping and memory.
What are the four conditions of Vitality?
- 1) Having Vitality
- 2) Lacking Vitality
- 3) Pseudo Vitality
- 4) Abnormal Vitality
Indications of having vitality?
Normal condition when a person is ill; Sufficient essence and Qi; The Zang Fu has not fallen into severe disorder.
Indications of lacking vitality?
Essence and Qi are exausted Zang Fu function is failing Serious illness.
Indications of Pseudo Vitality?
- An abnormal sign of a critical patient before impending death.
- A sudden temporary "turn for the better."
- Impending dissociation of of Yin and Yang.
Indications of Abnormal Vitality?
Special diseases such as epilepsy, mania, dementia, etc...
What vitality does a person have if displaying some of these symptoms: Dull eyes with sluggish actions, dark and dusty complexion with a dull expression, hard to move with slow
reactions, emaciation, hard breath, disoriented, even unconsciousness?
What vitality does a person have if displaying some of these symptoms: An extremely weak patient in critical condition, dull eyes and low and weak voice, dark dusty complexion who suddenly feels better, clear consciousness, bright eyes, stronger voice?
What vitality doe a person have if displaying some of these symptoms: Bright and vivid eyes, lustrous complexion with natural expression, freely movable and elastic body, firm muscles, smooth breath, clear speech and consciousness?
What is the prognosis for a person displaying signs of a strong vitality?
Good; normal person with sufficient essence and qi. Although the person is ill the essence and Qi have not been exhausted and the Zang Fu have not fallen into severe disorder.
What is the prognosis for a person displaying signs of lacking vitality?
Poor, Serious Illness, Qi and Essence are exhausted.
What is the prognosis for a person displaying signs of Pseudo Vitality?
Critical. Impending dissociation of Yin and Yang.
Why do we observe the facial skin color?
- 1) Easily Observed
- 2) Rich in Capillaries
- 3) Skin is thin and tender
- 4) Can easily learn the situation of Qi, Blood, Zang Fu and Pathogenic factors.
What are the five colors?
Red, Yellow, White, Black, Blue.
The five colors are related to what organs?
- Red = Heart
- Yellow = Spleen
- White = Lung
- Black = Kidney
- Blue/Green = Liver
The five colors are related to what elements?
- Red = Fire
- Yellow = Earth
- White = Metal
- Black = Water
- Blue/Green = Wood
Describe Normal Skin Color:
Lustrous Sheen with natural color. Qi Blood and Body fluid are sufficient. Zang Fu is functioning normally.
What is the Zhu Skin Color?
The normal color of the Race.
What is the Ke Skin color?
Temporary healthy change in skin color due to surroundings,sun, season, etc.
Describe diseased skin color in general:
No lustrous complexion. Pale or dim complexion, perhaps showing the five disease colors.
Red skin indicates:
(Heart) Heat syndromes,(can be excess, deficiency, or pseudo heat)
Yellow Skin Indicates:
(Spleen) Deficiency or Damp syndrome.
White Skin Indicates:
(Lung) Deficiency Syndrome, Cold syndrome, blood loss.
Black Skin Indicates:
(Kidney) Kidney deficiency, cold syndrome, blood stasis, water retention.
Blue/Green Skin indicates:
(Liver) Cold, Pain, blood stasis and convulsion syndromes.
Entire face is red accompanied by excess heat signs:
Heart Condition - High fever caused by exterior pathogen. - Zang-fu Yang excess
Malar flush accompanied by night sweating:
Heart Condition Yin deficiency
Sudden malar flush seen in a "lacking vitality" patient:
Heart condition, Pseudo heat
Yellow and pale face accompanied by fatigue and poor appetite:
Spleen qi deficiency; qi and blood not nourishing.
Yellow and puffy face accompanied by fatigue and poor appetite:
Spleen qi deficiency; dysfunction of transportation function.
Entire body is yellow, including the eyes, face and skin. Distinguished by yellow sclera:
Jaundice, Spleen condition
Jaundice with bright orange:
Jaundice with smokey dark from cold damp:
Bright white and puffy complexion:
Lung condition Yang deficiency
Pale face, lips with pale nails:
Lung Condition, Blood deficiency, blood loss
Pale and bluish complexion:
Lung condition; Yin excess cold syndrome
Dark and dry face:
Kidney yin defficiency
Darkness around the orbit:
Kidney deficiency; Water retention; Leukorrhagia due to cold damp.
Dark face with scaly skin:
Kidney Condition; Blood stasis.
Bluish and pale face accompanied by severe pain in the abdomen:
Cold invasion or yin excess
Blue and purplish face and lips accompanied by intermittent stabbing chest pain:
Liver Condition; Heart yang deficiency; blood stasis
Blue and purplish face most obvious at the nose bridge and between the eyebrows accompanied by a high fever in infants:
Liver condition; Omen of convulsion; Convulsion Syndrome.
Describe the relationship between appearance and health:
- Internal Exuberance leads to External strong
- Internal Deficiency leads to external weak appearance.
Corners of eyes?
Heart Blood wheel.
Spleen Muscle wheel.
Sclera white of eye:
Lung, Qi wheel.
Iris of eye?
Liver Wind wheel.
Pupil of eye?
Kidney Water wheel.
What is "Wei syndrome"?
Weakness of motor impairment and muscular atrophy.
What is "Bi syndrome"?
Pain, heaviness, swelling, restricted movement in joints, (arthritis).
Describe a normal tongue:
Light red tongue with thin white coating. Soft and flexible body, neither too large or too small with normal shape. Thin white coating with clear grains that are evenly scattered and cannot be wiped off. Coating neither wet or dry; not sticky or greasy.
Color of normal tongue:
Color of abnormal tongue:
Pale, red, deep red, purple and blue.
Shape of normal tongue:
Well defined, neither too large or too small.
Abnormal shape of tongue:
Rough and tender; swollen with teeth prints; thin and small; prickled fissured and mirror tongue.
Motility of normal tongue:
Soft, flexible and mobile body.
Motility of abnormal tongue:
Rigid; flaccid; trembling; deviated.
What does a pale tongue indicate?
Deficiency syndrome (Qi blood or Yang deficiency); Cold syndrome.
What does a red tongue indicate?
Heat syndrome. Excess heat or yin deficiency heat.
What does a deep red tongue indicate?
Extreme heat syndrome. (Excess heat syndrome; Yin deficiency producing fire; Yin exhausted.)
What does a purple tongue indicate?
Excess heat, Cold congelation, blood stasis.
What does a blue tongue indicate?
Cold congelation, Blood stasis
What does a rough tongue indicate?
Rough tongue texture indicates excess syndrome.
What does a tender tongue indicate?
What does a swollen tongue indicate?
Damp and phlegm accumulation; Yang deficiency.
What does a tongue with teeth prints indicate?
Damp and phlegm accumulation Qi deficiency Yang deficiency normal person.
What does a thin and small tongue indicate?
Qi and blood deficiency; Yin deficiency.
What does a prickled tongue indicate?
What does a fissured (cracked) tongue indicate?
Yin deficiency, blood deficiency, heat syndrome, healthy person.
What does a mirror tongue indicate?
Stomach qi or stomach yin exhausted; Serious condition.
What does a rigid tongue indicate?
Heat invading the pericardium; Excess heat impairing the body fluids; Phlegm accumulation: Wind stroke.
What does a flaccid tongue indicate?
Qi, blood and yin deficiency; heat impairing the body fluids.
What does a Trembling or uncontrollable tongue indicate?
Qi blood or Yang deficiency; Extreme heat producing wind.
What does a tongue deviated to one side indicate?
Wind stroke; Threatening sign of wind stroke.
What is the normal coating for a tongue?
Thin and white coating with clear grains which are evenly scattered and cannot be wiped off; neither too wet or too dry; not sticky or greasy.
What is a thin coating on the tongue?
The tongue proper can be seen through the tongue.
What is a thick coating on the tongue?
The tongue proper cannot be seen through the coating.
A thin coating on the tongue indicates:
Normal person; Exterior syndrome; Light interior syndrome.
A thick coating on the tongue indicates:
Interior syndrome, damp and phlegm accumulation, Food stagnation.
Describe a sticky coating:
Turbid fine greasy coating which is difficult to scrape off.
Describe a curdy coating:
Coarse, loose and thick like soy bean curds... easy to scrape off.
Sticky coating indicates:
Damp and phlegm accumulation. Food stagnation.
Curdy coating indicates:
Phlegm, food stagnation, heat damp.
A dry coating indicates:
Heat impairing the body fluids; Yin deficiency.
A slippery (Excessive moisture) coating indicates:
Cold damp, yang deficiency, water retention.
Describe mirrored tongue:
Without coating like a mirror.
A mirrored tongue indicates:
Stomach qi or stomach yin exausted. Serious condition.
Describe geographic tongue:
Part of the coating is peeled and looks like a map.
Geographic tongue indicates:
Stomach qi and stomach yin deficiency.
Normal condition under the tongue:
Two veins under the tongue; should not have branches and no blue or purple spots around the veins.
Describe abnormal condition under the tongue:
- Lots of branches and distended, blue, purple or
- red spots around the veins (Caviar tongue); indicates blood stasis, or cardiovascular disease.
What three parts of the tongue are inspected?
- Tongue proper
Why do we inspect the tongue?
- 1) The tongue is the mirror of the Zang fu.
- 2) The tongue connects directly and indirectly with many Zang Fu organs through channels and collaterals.
What meridians connect to the tongue?
- 1) Deep branch of the heart meridian
- 2) Spleen meridian
- 3) Kidney meridian.
What forms the tongue coating?
The rising of stomach qi.
Describe what you inspect on different parts of the tongue?
- Tip: heart and lung
- Central: spleen and stomach
- Root: kidneys
- Border: liver and gall bladder
How do you judge interior or exterior syndromes?
Thin coating: Exterior coating or onset of disease. Thick coating: Interior syndrome or severe syndrome. No coating: More severe interior syndrome.
Describe Ying Liu:
Diffuse swelling on one or both sides of the neck without distinct boundary, soft, moves when patient swallows. May vary in size when patient swallows.
TCM Diagnosis of Ying Liu:
Liver qi stagnation; phlegm fire accumulating.
Describe Lou Li:
Cervical lymph nodes infected by Tuberculosis.
TCM Diagnosis Lou Li:
Lung and kidney Yin deficiency, phlegm accumulation, wind and toxin invasion.
Clear nasal discharge:
Wind Cold syndrome.
Turbid nasal discharge:
Wind Heat syndrome.
Which Zang Fu associated with the Nose?
Lung opens into the nose; ST and LI pass through nose.
Which Zang Fu associated with the mouth and lips?
Spleen opens into the mouth and manifests on the lips.
Which Zang Fu is associated with the Ear?
Kidney opens into the ears. All meridians connect with the ears.
Pale gums mean?
Red gums mean?
Heat; Deficient or Excess.
Which Zang Fu associated with the Throat?
Door of the lung, or stomach.
What does it mean if it feels like there is a lump in the throat?
Liver Qi Stagnation.
Skin squamous and dry:
Skin connected to what Zang Fu?
- Epidermis connected to the lungs.
- Dermis connected to the Spleen.
Exterior invasion; lung not ventilating.
Spleen or Kidney Yang deficiency.
Yang deficiency is:
Qi deficiency with cold.
Yang excess is:
Qi Excess with heat.
Yin Deficiency is:
Heat with dry.
Yin excess is:
Cold with wet or damp.
What does a thick coating mean? .
What is auscultation?
Listening to the sound emitted by the patient.
What are the Three Gates?
Gates of health on infants finger. (Under 3)
Which of the Three Gates is most proximal?
Gate of wind.
Which of the Three Gates is most distal?
Gate of Life.
Which of the Three Gates is in the middle?
Gate of Qi.
What do the Three Gates mean?
The more distal the abnormal venules the more severe the condition.
What are four abnormal conditions in relation to the Three Gates?
- Shallow: Exterior syndrome.
- Deep: Interior syndrome.
- Red color: Heat syndrome.
- Pale color: Deficiency syndrome.
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