Diagnostico Chines (Inglês)

8/7/2019 Diagnostico Chines (Ingls)

1/40

Chinese Medicine Diagnostics by Hui Jun. Shen

Chinese Medicine Diagnostics

Hui Jun Shen

MB, MM (China), MATCM (UK)

Senior Lecturer of Acupuncture Programme

School of Health and Social Care

University of Lincoln

UK

Email: [email protected]

0


2/40


Introduction

CM Diagnosis is based on fundamental principle that signs and symptoms onthe Exterior reflect the condition of the Internal Organs

Signs and symptoms present a syndrome pattern which can be identified usingChinese Medicine diagnostic techniques: Syndrome (Pattern) Differentiation

The purpose of carrying out Chinese medicine diagnostic techniques is toestablish syndrome (pattern) differentiation, which is the foundation on which

treatment, including treatment principle(s), point selection and needling

techniques is determined.

1. Diagnostic Methods - The 4 Techniques:

1) Observation, including Tongue Diagnosis - (looking)Vitality, complexion, body constitution, Secretions, skin etc.

2) Auscultation & Olfaction (listening and smelling) 3) Inquiry (10 Questions) (asking) 4) Palpation and Pulse Diagnosis (touching)

2. Diagnosis: Difference between WM and TCM

TCM Diagnosis is combination of name of disease and name of syndrome(Western Medicine name of disease only)

e.g. Disease = common cold, Syndrome = wind/coldIn CM naming can come from:

Pathogenic Factor Main Symptom e.g. Headache, Dizziness Western Medical Diagnosis e.g. Common Cold due to Wind/Cold Invasion

1


3/40


Chapter I: Observation Looking

1. Vitality (Shen)

Materials for Shen : Qi, Blood, Essence and Body Fluids State of Shen = State of the Zang Fu Organs; and state of Qi, blood, body fluids.

Good Vitality

Eyes Bright and vivid

Complexion Healthy, shiny

Expression Natural Physical Condition Flexible, muscles well developed Speech Clear Mind Clear

Indicating: sufficient Qi, Blood, Essence and Body Fluids. Vital Qi is strong. Disease is usually

mild and prognosis is good.

No Vitality

Eyes Dull or loss of shiny brightness Complexion Dull or pale/discolour Expression Dull or in agony Physical Condition Heavy, slow, muscles withered Speech Slow and weak Mind Unclear, delirium, hallucinations

Indicating: insufficient Qi, Blood, Essence and Body Fluids

Vital Qi is damaged. Patient will struggle with illness

Pseudo VitalityPatient has lacked vitality for a long time and is

in critical condition.

SUDDENLY there is a marked improvement in his condition for 1-2 days only.

Indicating: Yin and Yang have separated and/or collapsed, reaching to their end

Eyes Bright but not shiny Complexion Flushed cheeks but kind of unhealthy Expression Bright but not natural looking Physical Condition Emaciated but better appetite Speech Loud voice and talkative Mind Restlessness/agitation

2


4/40


2. Sensory Organs

A lot can be discerned by examining sense organs

Nose Clear watery nasal discharge -> Wind Cold Invasion Clear thick yellow discharge -> Wind Heat Invasion Prolonged thick yellow/green -> Phlegm Heat/Lung Red nose at tip -> Lung or Spleen Heat

Ears

Dry, withered, black in color -> Kidney Essence Deficiency Pus in ear -> Damp heat in Liver and GB

Swelling and Pain -> Gall Bladder Fire

Mouth & Lips

Purple/Blue Lips -> Blood Stagnation (cold) Deep Red and Dry Lips -> False/Excess Heat Pale Lips -> Blood Deficiency (Spleen Deficiency)

Teeth & Gums

Gums swollen and easy bleeding -> Stomach Heat Pale Gums -> Blood Deficiency Blue Line on Gums -> Toxic (Lead Poison)

Throat

Red, sore and swollen -> Wind Heat Invasion Red, sore and swollen throat with yellow/white spots -> Toxic Heat Lung/Stomach Sore, dry throat, not swollen -> Kidney Yin Def

Eyes

Red in corners -> Heart Fire

Red in white (conjunctiva) -> Lung Heat

Red swollen/painful -> Wind Heat Invasion or Liver Fire Yellow in white -> Damp/Heat (jaundice) Swelling under eyes -> Kidney Deficiency

3. Complexion

Sides of the eyes are most important. Other areas are:

under the eyes, around mouth and sides of the face

Observe in natural light Relax your own eyes and accept colour Lots of practice! Assess with other signs if unsure

3


5/40


In General

Always look at the face, Qi and Blood goes to the face and face is always visible Normal:

Bright, shiny, blood colour (pink) Skin Lustre State of Vital Qi/Essence of Zang Organs

Abnormal:

Favourable Bright and shiny, but no blood colour Unfavourable No lustre, no shine, abnormal colour

Five Colours

Blue/Green

Pale face with blue tinge Cold Syndrome Pale with blue/purple Blood Stagnation Intermittent pain in chest and sternum -> Heart Blood Stagnation Pain in hypochondriac area -> Liver Qi Stag -> Liver Blood Stagnation Blue/purple face with convulsions and infantile high fever -> EXTREME

excess/deficient heat

Red

Heat Syndrome Whole face is red -> Excess Heat Red Cheekbones -> False Heat

Yellow

Damp Heat

Bright orange yellow ->Yang Jaundice: Damp Heat Lv/GB Pale yellow (sallow) -> Spleen & Stomach Def

-> Def Qi and Blood

Yellow and Puffy ->Damp accumulating due to Spleen DeficiencyDamp Cold

Smoky dark yellow ->Yin Jaundice-> or Long term Blood Stagnation

White - Cold Syndrome Dull pale white -> Blood Deficiency Bright white -> Yang Deficiency Pale severe, sharp pain > Cold Stagnation

Colours associated with Five Elements:

Fire Red Earth Yellow Metal Grey/White Water Blue/Black Wood Green

4


6/40


4. Body Condition

Constitution

Strong/weak Obesity/Overweight - Phlegm and Damp retention Thin Body - Yin Deficiency, False Heat, Fire

Posture

Normal/natural - health or mild conditions Compulsory mostly seen in pain cases, or patient with limited range of movement of

limbs, or crucial conditions

Walking

Normal

AbnormalMovement

Whole body Whole limb Joint(s)

5. Skin

Normal skin: Smooth, moist, bright Dry Skin --Blood Deficiency or Yin Deficiency Dry/Scales (Local) --Exhaustion of Body Fluids Too moist --Spontaneous Sweating due to Lung Qi Deficiency

Or Wind/Heat Invasion

Slight Swelling --Qi Stagnation Edema No Pit Damp Retention from Qi Deficiency

Pitting - Kidney Yang Deficiency

Colour of Skin

Dull Deficiency of Body Fluids Yellow : Bright and Clear

-> Damp Heat (Yang Jaundice)

Dull yellow

-> Damp Cold (Yin Jaundice)

Red Rash Blood Heat Spots Blood Heat/Toxin Infected or weeping -> Damp Heat/Toxin

6. Secretions

Vomit

5


7/40


Thin, no smell Cold Syndrome: Yang Def in Spleen and Kidney or Invasion of Coldinto Stomach

Thick, sour odour Heat Syndrome Undigested Food Food Stagnation Water/Sputum/Saliva: Phlegm retention in the Middle Jiao Yellow/Green, (Bitter): Damp Heat in Liver and Gallbladder Blood or Clots Liver Fire -> Stomach or Stomach Heat -> Blood Stagnation

Sputum

Thin, foamy Wind Phlegm Watery, clear Cold Phlegm Thick, yellow, sticky Heat Phlegm Large, can cough up Damp Phlegm Small, cant cough up Dry Phlegm

Blood Lung Heat, excess or deficiency (hyperactivity of Fire due to Lung

Yin Deficiency, e.g. Tuberculosis)

6


8/40


Chapter II: Tongue Diagnosis

A.IntroductionThe tongue is the window of the internal organs

The Formation of Tongue

Tongue body formed by muscle and blood vessels, full of Qi and blood

Tongue coating metabolic product of the epithelial cells of the tongue, therefore both Qi (upright Qi) of the

body and pathogenic Qi (evil Qi) can coagulate on the tongue surface forming the coating.

Clinical Significance of Tongue Diagnosis - Using Tongue Diagnosis we can:

1) Ascertain the state of vital substances (Qi, blood, body fluids and essence) and zang fu organs.

2) Ascertain the nature of the pathogen

3) Locate of the disease in organs

4) Infer the course of the disease (internal or external)

5) Infer a prognosis

Method of Tongue Diagnosis:

Combine the Diagnosis of Tongue Body and Coat Examine the Tongue in natural light wherever possible or using a full spectrum light bulb Allow for effects of diet and medication:

diet greasy food, smoking, coffee; medications may strip or dye the coat, B12 yellow coat

Tongue Areas

The Tongue areas are mapped to internal organs

Lower Jiao

The Base of the tongue corresponds to the Kidney, Urinary

Bladder, Large Intestine and Small Intestine.

Middle Jiao

The Middle of the tongue corresponds to the Stomach and Spleen.

The sides of the tongue correspond to the Liver and Gall Bladder.

Some theories place the Gall Bladder on the left side and the Liver

on the right side of the tongue.

Upper Jiao

The Tip of the tongue corresponds to the Lung and the Heart.

7


9/40


Normal Tongue

Body

Soft, flexible, moist, shining Not too fat or thin, pink colourCoat

Thin and white with clear grains scattered evenly

B. Tongue Body Diagnosis

A) Tongue Body Colours and Clinical Indications

Pale

Deficiency of Qi, blood or YangSmall/Thin Deficiency of Qi and/or Blood

Puffy/Tender Spleen Qi deficiency or Deficiency Cold Syndrome due to YangDeficiency

Red

Heat Syndrome, excess or deficiencyTip - Heart Fire

Sides - Excess Heat in Liver and GB

Middle - Excess Heat in Middle Jiao

Deep Red

Extreme Heat ConditionPathogen deep in the interior

Purple

Blood StagnationRed purple: Blood stagnation due to or accompanied with Heat

Blue purple: Blood stagnation due to or accompanied with Cold

Blue

Over whole tongue body - Buffalo Tongue

Internal Cold, excess cold invasion or Yang deficiency

Blood Stagnation

B) Tongue Body Shape and Clinical Indications

Swollen/Puffy

Pale/Tender/Teeth MarksQi or Yang Deficiency in Spleen and Kidney

Excess Damp/Accumulation of Body Fluids

Light Red/Yellow Greasy CoatDamp Heat or Phlegm Heat

Deep Red/Occupies All Mouth8


10/40


Excessive Internal Heat

Blue and PurpleBlood Stagnation due to Blood Heat or Cold

Thin Body

Pale Qi and Blood Deficiency Deep Red Yang Rising or Yin Def

Thorny Papillae on surface of the tongue (like red strawberry pips)

Heat Syndrome, Excessive Heat in the InteriorThe more Heat, the more enlarged and profuse the papillae

Burnt Yellow Excess Heat

Deep Red/Scanty Excess Heat of Ying and Blood Stages

Cracked

Can be either congenital or pathological

If congenital cracks will not be deep and will remain unchanged during lifetime

Dry, No Water Yin DefDamp Retention, as the result of damp obstructing Body Fluids

Puffy and Tender Spleen Def/Damp Retention Pale Blood Deficiency Deep Red Yin Deficiency

Bleeding

Spleen Qi Deficiency Fails to contain the blood Heart/Liver Fire Heat causes blood to overflow

Sublingual Veins

Normally is slightly purple, and not extending longer than phrenulum

Purple, Thick, Dilated Blood Stagnation Thin Light Red Blood Deficiency

C) Tongue Body Movement and Clinical Indications

Stiff

Deep Red Heat invading Pericardium Puffy, Greasy Coat Phlegm Retention in Pericardium Blue or Purple Wind Stroke (or early signs of)

Flaccid

Pale Colour Extreme Deficiency of Qi and Blood Deep Red Exhaustion of Yin

Shortened Curved up or down or contracted, unable to project far, may be congenital

9


11/40


Moist and Pale Cold Stagnation Pale and Tender Qi and Blood Deficiency Dry and Red Heat consumed Body Fluids Puffy, Greasy Coat Phlegm Damp

Quivering

Usually indicating prolonged and chronic disease

Deficiency of Qi & Blood e.g. Liver Blood Def causing liver wind, tendons notnourished

Febrile Disease excess wind, body fluid consumed (inc Blood)Deviated

Wind Stroke (or early signs of)

C. Tongue Coating Diagnosis

A) Colour of Coat and Clinical Indications

White coating:

Thin Normal or mild disorder: Wind Cold Invasion Thick Interior Damp or Cold Damp Syndrome Slippery/Greasy Phlegm/Damp Dry Body Fluids Severely Impacted Powdery Excess Damp and Internal Heat

Infectious Diseases

Internal Abscess

Yellow coating:

Interior Heat Syndrome more yellow more severe the heat is

Thin/Slippery Wind Heat Invasion

Thin & Dry Going Internal, consuming Body Fluids

Thick & Dry High Fever, Body fluids consumed Greasy Phlegm or Damp Heat

Grey coating:

Chronic Disease or Prolonged Illness of Digestive System

Wet Cold Damp Syndrome Dry Internal Heat, more severe than yellow

Body Fluids consumed

Black coating:

Extreme Heat or Excessive Cold Dry, swollen Extreme Heat. Exhaustion of Body Fluids

Tip only Extreme Heart Fire

10


12/40


Middle only Exhaustion of Stomach Qi

Root only Excessive Heat in Lower Jiao

Sides only Excessive Heat in Liver and Gallbladder

Middle, with yellow around **check that they dont smoke

Wet Excessive Cold and Damp in Interior Black greasy Severe Damp Heat in Spleen and Stomach

B) Quality of Coat and Clinical Indications

Changes in thickness, moisture, or surface coating, e.g. slippery, greasy, peeled

Thick/Thin

Reflects State of Vital Qi, and State of pathogen

Thin Can see body through the coating

Pathogen is external or mild Thick Cant see body through the coating

Pathogen is internal e.g. Damp/Phlegm, Food Stagnation

Moist/Dry

Reflects State of Body Fluids

Slippery Excessive moisture on surfaceCold Damp Acc due to Yang Def

Dry Coarse, Lacking in MoistureBody Fluids Consumed due to Excess Heat

Or Body Fluids Distribution obstructed by Damp in Channels

Greasy

Smooth and fine, evenly distributed granules, cant remove Damp & Phlegm Accumulation Damp Heat or Food Stagnation

Curdy

Thick and coarse granules loosely scattered, like layer of bean curd, can be easily

removed, no root

Food Stagnation or Phlegm StagnationPeeled

Coating SUDDENLY comes off either completely or partly

Geographic tongue, looks like a map

Impacted Stomach Qi and Yin Def of Qi Yin and Blood

No Coating/Scanty Coat

Mirror-like coating. Coating is peeled and body is shinyExhaustion of Stomach Qi and Yin

Kidney Qi and Yin compromised

11


13/40


Chapter III: Enquiry - 10 Questions

General Approach

Treat patients from the heart Keep the focus on the Main Complaint

whats wrong, how long

Short List other additional complaints

Prompt patient but DO NOT DIRECT patient

ask about complaint symptoms but dont describe them for them!

Try and keep the language simpleKeep a natural expression!

General Inquiry Points

Name, address, and phone number(hopefully on intake form!) if not fill in

How can I help you today?(hopefully will illicit main complaintmay not!)

If it did..how longDid they associate any event (physical or emotional) with the start of itDid it start quickly or gradually

(chronic or acute condition at the start.Exterior /Interior syndromes)

Details of main complaints..location, nature, duration.which one first.

With pain .feels?...sharp, stabbing, aching, fixed, moving.

.better with heat or pressure (or worse.)

.where?.can they point to it or is general location

.is there swelling associated with it.

What other symptoms are they having..12


14/40


(the short listrelevant to main complaint? or not.)

How is main condition developing..is it getting worse or better.

.what makes it worse or better(e.g. hot/cold/damp)

Did they see a western medicine doctor? Who, what, where?What was the diagnosis, the tests done and results?

What medications? (make a concise list) How is that going

Any possibility they could be pregnant? (appropriately ask..)(has a bearing on needle point choice)

1 Chills/Fever

Chills with no Fever

Aversion to chills, cannot be relieved by warmthExternal Excess Wind/ Cold invasion

Abdominal fullness and pain, better with warmthInternal Excess Cold OR

Tai Yin Stage (6 Meridian Differentiation) (Spleen Yang Deficiency)

Feels cold, better with warmth, sleepy, listless, profuse clear urine,Internal Deficient Cold

Yang Def (constitutional) OR

Shao Yin Stage (6 Meridian Differentiation) Kidney Yang Deficiency

Chills with Fever

More Chills than Fever:

External Excess Wind/Cold More Fever than Chills:

External Excess Wind/Heat

Andaversion to wind and spontaneous sweating

External Deficiency Syndrome

Disharmony of Ying Qi & Wei Qi

(Wei Qi weak - easier for pathogen to get in

- Lung Qi Def can cause Wei Qi Def)

Tai Yang Stage (6 Meridian Differentiation) wind cold exterior syndrome

Wei Stage (Warm Disease Differentiation): wind heat exterior syndrome

13


15/40


Alternate Chills/FeverShao Yang Stage (6 Meridian Differentiation) syndrome of half exterior half interior

Qi Stage (Warm Disease Differentiation) Interior heat syndrome

Fever with no Chills

1). High Fever - Temperature over 102.2oF or 39

oC (4 Bigs)

Big fever, Big Thirst, likes cold drinks

Big Sweating, Big pulse

Red Tongue Body with yellow coating

Internal Excess Heat OR

Yang Ming jing Meridian Stage (6 Meridian Differentiation)

Qi Stage (Warm Disease Differentiation)

2). Tidal Fever - Comes at regular time in the afternoon

Low Fever in the afternoon or at nightMalar Flush (red cheeks), 5 Palm Heat

Night Sweats, Restlessness

Red Tongue Body with Scanty Coat

Internal Deficient Heat: Yin Deficiency

Fever comes or is worse between 3 and 5 pmAbdominal distension, constipation

Deep forceful pulse

Red Tongue Body with Dry Burnt Yellow Coating

Accumulation of Pathogenic Heat or Food Stag in Stomach or Large Intestine

(Yang Ming Fu Organ Stage of 6 Meridian Differentiation)

Fever is higher in afternoonChest fullness, heavy body

Skin hotter with prolonged palpation

Red Tongue Body with Yellow Greasy Coat

Damp Heat in Interior

3). Low Fever - Between 98.6 and 100.4o

F (37-38o

C) or

No Fever (normal body temperature) but Feeling Hot:

Internal heat syndrome, can be excess heat or deficiency heat

Excess heat:Tongue Body Red with yellow coating:

Heat in organs: heart heat, lung heat, stomach heat, liver/gallbladder heat

Damp heat syndrome: damp/heat in middle jiao, damp/heat in liver/gallbladder, damp/heat

14


16/40


in intestine, damp/heat in bladder, damp/heat in lower jiao

Heat in blood: various hemorrhage conditions, some skin conditions etc.

Deficiency heat:Tongue Body Red: Yin DefTongue Body Pale Blood Def or Qi Deficiency

Fever worse with physical exertion, easily tired

External Deficiency (Def of Wei Qi)

2 Sweating

Exterior Syndrome

With fever, aversion to wind, sweating, sore throat, floating and rapid pulseExternal Excess (Wind/) Heat

With fever, aversion to wind, spontaneous sweating floating pulseExternal Deficiency (Def of Wei Qi)

Interior Syndrome

Big Sweat, Flooding Pulse, Fever & Thirst (4 Bigs)Internal Excess Heat

Night sweats, tidal fever, malar flush, 5 palm heatInternal Deficient Heat mostly Yin Deficiency

Intolerant to cold, feels worse on exertion, SOB, quiet voice, spontaneous sweatingInternal Deficient Cold

Qi or Yang Deficiency Syndrome

Profuse dribbling of cold sweat, pale complexion, cold limbs, weak pulse, CRITICALSevere Internal Deficient Cold

Yang Depletion Syndrome

Local Sweating

Head

Chronic disease, red face, thirst, red tongue, thin yellow coatInterior Heat syndrome

Heavy body & head, fullness in chest & abdomen, yellow greasy coatDamp Heat syndrome

Forehead

Sweat is like oil, with cold limbs, SOB, weak pulseImpending exhaustion of Jing (Essence)

CRITICAL YIN AND YANG SEPARATE

15


17/40


Half Body

Upper/Lower/Left/Right, with paralysis Windstroke

Palms/Soles With Internal Organ symptoms

Yin Deficiency

Tidal Fever, Constipation, Abdominal FullnessYang Ming Fu Syndrome

3 Pain

1) Nature of Pain

Distension/BloatingIn Chest and Hypochondriac Region - Qi Stagnation

In Head and Eyes, with Migraines - Liver Fire Flares Up/Liver Yang Rising

MovingJoints in 4 Limbs - Wandering Bi Syndrome (wind invading meridians)

In Chest and Hypochondriac Region - Qi Stagnation

Stabbing, FixedBody - Blood Stagnation

Joints in 4 Limbs - Cold Bi Syndrome

Colic PainSharp and violent like a knife twisting in the body - Excess Syndrome (e.g. Kidney

Stones)

Cold cramps, better with heat - Excess or False Cold Syndrome

Joints - Cold Bi Syndrome

Loins - Kidney Yang Deficiency

Burning, better with coldExcess or Deficiency Heat Syndrome

Dull PainQi Stagnation or Deficiency Syndrome (Yin/Yang/Blood or Qi deficiency)

AchingWhole Body - Exterior or Damp Syndrome

Lumbar/Knees Qi/blood local stagnation or Kidney Deficiency

HeavyDamp Syndrome, Damp Blocking the Channels

16


18/40


Hollow/EmptyDeficiency Syndrome (Yin/Yang/Blood or Qi)

2) Location of Pain

Headache

Location in head: Frontal => Yangming;Occiput => Taiyang

Vortex => Jueyin

Both Sides => Shaoyang

Acute headache, with other symptoms.Severe, continuous headache, whole body aches, chills & fever

Exterior syndrome: Wind Heat/wind Cold/Wind Damp

Stiff Neck, worse when exposed to wind coldWind/Cold Headache

Better with wind/cold, worse with heat

Wind/Heat Headache

Heavy Body and Head (feels like its wrapped up)

Wind/Damp Headache

Headache due to interior causesChronic, comes and goes

Dull and worse after exertion - Qi Deficiency

Dull, dizziness, and pale complexion - Blood Deficiency

Hollow, soreness in low back and knees - Kidney Deficiency

Fullness in Chest, Heavy Head, Greasy Tongue Coat - Phlegm Stagnation

Distending Headache, with Bitter Taste, and Dry Throat

Liver Fire or Liver Yang Rising

Fullness in Abdomen, Heavy Head, Diarrhea, Loose Stools

Spleen Deficiency => Dampwith dizziness tooYang Rising taking Damp with it

Stabbing and Fixed Headache, may have a history of head trauma

Blood Stagnation

Chest Pain Heart and Lung Pathology

Choking Sensation, pain -> left shoulder, tightness in chestChest Bi Syndrome (Angina Pectoris)d/t.

Phlegm Stagnation suppressing chest yang

Qi and Blood Stagnation

17


19/40


Restriction by Cold

Paroxsysms, continuous gripping, convulsions, colic pain, grey face, profuse cold sweat,chest congestion

Severe Chest Bi Syndrome

Burning pain, AsthmaExcess Heat in the Lung

Night Sweats, Blood in SputumLung Yin Deficiency (or TB)

Hypochondriac Pain

Liver and GallBladder Pathology

SighingLiver Qi Stagnation

JaundiceDamp Heat in Liver and GallBladder

Stabbing and Fixed PainLiver Blood Stagnation

Burning Pain with Red Face and EyesLiver Fire Flares Up/Liver Yang Rising

Burning Pain with tidal fever and night sweatsLiver Yin Deficiency

Epigastric Pain

Sudden pain after exploring in cold or eating cold food, watery vomiting

External Cold Invasion into the Stomach Distention with pain after eating too much, nausea vomiting undigested foog

Food Stagnation

Dull pain with poor appetite, loose stools, fatigueStomach/Spleen Deficiency

Stomach ache worsened by emotional change, irritabilityLiver Overacting on Stomach

Abdominal Pain

Better with Pressure - Deficiency Syndrome Worse with Pressure - Excess Syndrome Cold and better with warmth - Cold Syndrome

18


20/40


Feverish and better with cold - Heat SyndromeLow Back Pain

Soreness and weakness - Kidney Deficiency Cold Pain with heavy sensation on rainy/cloudy days - Cold Damp Stabbing and Fixed Pain - Blood StagnationBack Pain

Extends to head/neck with external symptoms - Invasion of Bladder meridian by cold Cold Limbs, Cold Back - Yang Deficiency Hollow sensation - Jing Essence DeficiencyPainful Limbs & Joints

Bi Syndrome

Not fixed Wind BiFixed, worse with Cold Cold Bi

Fixed, heavy joints Damp Bi

Red & Swollen Joints Hot Bi

Whole Body

Aches whole body, heaviness, chills & fever, floating and tight pulseExterior Wind/Cold/Damp Syndrome

After chronic disease or confinement to bedQi and Blood Deficiency

4 Abnormal Sleep

Insomnia Heart Shen disturbance

Blood and Yin house the Shen in the Heart..

Palpitations, restlessness, red tongue, scanty tongue coat

- Heart Yin Def Palpitations, weak low back and knees, red tongue tip

- Imbalance between Heart and Kidney

Waking up early, cant get back to sleep, yellow greasy coat- Phlegm Heat disturbing heart shen

Cant get to sleep, palpitations, poor appetite, pale tongue- Heart Blood & Spleen Qi Deficiency

Nightmares, dream disturbed sleep, scanty urination, red tongue tip or month ulcer- Heart Fire (Heart Heat)

Waking up many times in the night, night sweats, hot flushes-Liver and Kidney Yin Def

Stomach Distension, restlessness19


21/40


- Food Stagnation

Sleepiness (somnolence/ Drowsiness)

Tired, fatigue, sleepy after eating, poor appetite, SOB- Spleen Qi Def Sleepiness with dizziness, heavy limbs, fullness in chest, greasy tongue coat

- Damp/phlegm obstructing Clear Yang rising to the Head

Extreme fatigue, intolerant to cold, cold limbs, weak thin pulse- Kidney Yang Def

Lethargy and drowsiness in Febrile Disease- Heat invasion of Pericardium

5. Energy Level

Tiredness (Lethargy/fatigue/lassitude/sluggishness/weariness) Always tired/sleepy

Tired/fatigue, sleepy after eating, poor appetite,- Spleen Qi Def

Sluggishness, dizziness, heavy limbs, fullness in chest, greasy tongue coat- Damp/phlegm obstructing Clear Yang rising to the Head

Extreme fatigue, intolerant to cold, cold limbs, weak thin pulse- Kidney Yang Def

Lethargy and drowsiness in febrile disease- Heat invasion of Pericardium

Restlessness (listlessness/agitation/restiveness)

Insomnia, dream disturbed sleep, palpitation,- Heart Shen disturbance (by heat, phlegm etc.)

Short templed, irritability, headache/dizziness- Liver Yang rising

Hot flushes, night sweats, moody and emotional

- Yin deficiency leading to heat flaring up

6. Thirst, Appetite & Taste

Thirst

Body Fluid Deficiency due to Excess Heat Yin deficiency Obstruction of Body Fluid Distribution by Damp

20


22/40


Thirst & drinks a lot (polydipsia)

Impairment of Body Fluids Extreme thirst, high fever, profuse sweat, big pulse, wants cold drinks (4 Bigs) -

Excess Internal Heat

Extreme thirst, lots of urine, also eats a lot (polyphagia) - Diabetes (Xiaoke in TCM,meaning wasting and thirsting)Thirst & doesnt want to drink (NO polydipsia)

Slight impairment or obstruction of Body Fluids

Recessive fever (hotter to touch), or tidal Fever -Damp Warm Syndrome) Fullness of chest, greasy tongue coat - Damp Heat Restlessness, delirium, fever worse at night, deep red tongue - Internal Heat entering

Ying and Xue (blood) stages

Vomiting after drinking - Phlegm Retention in Middle Jiao (obstructing channels)

Wants to rinse mouth not swallow, purple spots on tongue - Blood Stagnation

(obstructing channels)

Appetite

Poor Appetite

Abdominal Distension, loose stools, pale complexion & tongue, weak pulse- Spleen Qi Def

Fullness of Stomach, heavy body, white greasy tongue coat- Damp Retention in the Middle Jiao

Aversion to greasy food, fullness of stomach, hypochondriac pain, jaundice, yellowgreasy tongue coat

- Damp Heat in the Liver & GB

Aversion to food, belching, foul odor, stomach distension, curdy tongue coat- Food Stagnation

Polyphagia (eats a lot)

Thirst, restlessness, red tongue, yellow coat- Stomach Fire

Loose stools, low energy, tired

- Spleen Qi Def Thirst, drink a lot, lot of urine

- Diabetes (Xiaoke Disease)

Anorexic (dont want to eat)

Burning sensation in Stomach, red tongue and scanty coat- Stomach Yin Def

Dizziness, tinnitus, insomnia, poor memory- Stomach and Kidney Yin Def

Taste

Bitter taste - Liver and GB Heat21


23/40


Sweet & Greasy taste - Damp in Spleen Pungent - Lung Heat Salty - Kidney Yin Def Acid Reflux - Stomach & Liver Heat OR Liver overacting on Stomach Sour Odor in mouth - Food Stagnation OR Disharmony of Liver and Spleen No taste - Spleen Qi Def Cravings Sugar - Spleen Def

Sour - Liver Def

Salt - Kidney Def

Pungent - Lung Def

Bitter - Heart Def

7. Abnormal Stools

Constipation

Frequency of voiding is low or difficult to pass stool, dry stool even like small sheeps

droppings

With scanty dark urine, stomach fullness, red tongue, yellow coat, rolling rapid pulse- Heat in Stomach and Large Intestine

With abdominal distension, borborygmus, flatulence, side pain, wiry pulse- Liver Qi Stagnation

Difficult to pass stolls, SOB, fatigue, pale tongue, weak pulse- Qi Deficiency

Palpitations, poor memory, pale tongue, thin pulse- Blood Deficiency

Malar flush, tidal fever, red tongue, scanty coat, thin pulse- Yin Deficiency

Clear profuse urine, cold limbs, better with warmth, intolerant to cold, cold pain inabdomen, deep slow pulse

- Yang Def (Empty Cold)

Diarrhea

Frequent bowel movement with loose and watery stools

Thin & watery stool, severe abdominal pain, borborygmus white greasy coat- Cold Damp invasion of Spleen

Dark brown stool, burning sensation at anus, abdominal pain, dark urine, mucousand/or blood, yellow greasy coat

- Damp Heat in Large Intestine

Abdominal pain, borborygmus, smell of rotten eggs, belching, bad breath, undigestedfood in stool

- Food Stagnation

Loose stools, poor appetite, abdominal fullness, low energy, pale tongue, weak pulse22


24/40


- Spleen Deficiency

Dawn Diarrhea with abdominal pain, borborygmus, and immediate passage ofloose stool, intolerance of cold, cold limbs, weak low back & knees

- Kidney Yang Def

Other

Stools are sometimes dry or loose (IBS)- Liver overacting on Spleen

Tarry Black Stools Far Blood Bleeding in Upper GI tract- Empty Cold in Stomach and Spleen

Tenesmus (want to void but cant)- Dysentery with Qi Stagnation

Rectal Prolapse, usually after prolonged and chronic diarrhea- Sinking of Spleen Qi

8. Abnormal Urine

Scanty/Dark Urine

Heat Syndrome in general

Restlessness, insomnia- Heat/fire in Heart and/or Small Intestine

Side pain, jaundice- Damp Heat in Liver & GB

Abdominal distension, constipation- Heat in Stomach and Large Intestine

Urgent, frequent, painful urination- Damp Heat in Bladder

Clear/Lots

Cold Syndrome in General

Pale face, weak low back & knees, pale tongue, weak pulse- Kidney Yang Def

Abdominal Cold, pale tongue, deep wiry pulse

- Interior Cold

Turbid/Cloudy

Urgent, frequent urination, brown color, cloudy- Damp Heat in Bladder

Weak low back and knees- Kidney Qi Deficiency

Poor appetite, weak low back and knees- Spleen and Kidney Deficiency

Frequent

Profuse, polydipsia & polyphasia- Diabetes (Xiaoke)

23


25/40


Urgent and painful, brown color- Damp Heat in Bladder

Frequent at night, clear profuse urine- Kidney Yang Def

Incontinence Patient cannot control urination during the day

- Kidney Qi/ Yang Def

Dysuria

Difficult Urination

Puffy eyelids, yang edema in the upper body- Lung cannot disperse Qi

Poor Appetite, low energy- Spleen Yang Def

Intolerance to cold, sore low back

- Kidney Yang Def Brownish urine, burning/stinging sensation, rapid pulse

- Damp Heat in the Bladder

Painful Urination

Burning sensation (UTI/STD)- Damp Heat in the Bladder

Stabbing Pain- Blood Stagnation

Colic Pain- Kidney Stones

Enuresis

Urination at night, bed wetting

Old people with weak constitution, children 3-12 years old-Kidney Qi/Yang Def

9. Menstruation

Regularity,quality, quantity, color, and accompanying symptoms

Early Period

More than 7 days early than the normal cycle of 28 days

Blood is fresh red with large quantity, red tongue, rapid pulse- Heat in the Blood, HEAT SPEEDS UP THE FLOW OF BLOOD

Blood is dark red or purple, thick, red tongue, rapid pulse- Liver Qi Stagnation leading to heat

Thin, light red, pale tongue and weak pulse- Spleen Qi Def, QI DEF CANNOT HOLD THE BLOOD

24


26/40


Late Period

More than 7 days late than the normal cycle of 28 days.

Dark purple, scanty, clots- Qi Stagnation Blood Stagnation

Cold limbs, intolerance of cold, deep tight pulse- Cold Blood Stagnation Light red, fullness of chest, heavy body, greasy tongue coat

- Phlegm Damp Retention obstructing the channels

Thin, light red, scanty, pale complexion and weak pulse- Qi Deficiency Blood Deficiency

Irregular

This month early, next month late, over a 3 month period

Dark purple, scanty, blood clots, distending pain in side abdomen or chest, wiry pulse

- Liver Qi Stagnation- Heat Early period

- Blood Stagnation Late period

Light red, thin, varying amount, sore and weak low back & knees, poor appetite, loosestools

- Spleen & Kidney Def

- Spleen Def cannot hold the blood Early period

- Blood Def so no store in Chong/Ren Channels Late period

Dysmenorrhea

Painful periods, cramps before during or (rarely) after period

80% due to Qi and Blood Stagnation Before or During Period -> Qi and Blood Stagnation After Period - Qi and Blood Deficiency Distending pain in low abdomen before or during period, pain in chest and side, breast

distension, irritable, wiry pulse

- Liver Qi Stagnation -> Qi & Blood Stag

Cold pain in low abdomen, better with warmth- Cold Stagnation Qi & Blood Stag

Dull pain low abdomen after period, pale face, sore low back- Qi and Blood Deficiency

Amenorrhea

No periods. Primary (never) or Secondary (stop for 3+months)

Palpitations, dizzy, pale face, pale tongue, thin & weak pulse- Blood Deficiency

Weak low back and knees, dizziness, tinnitus, blurred vision- Liver and Kidney Def

Depression, wiry pulse- Liver Qi Stagnation

Stabbing Pain in Abdomen, purple tongue25


27/40


- Blood Stagnation

Fullness in chest and abdomen, nausea, vomiting, profuse phlegm, leukorrhea, greasycoat, rolling pulse

- Phlegm Damp Retention

Abnormal Bleeding

From Uterus - heavy, spotting, recurring but non-cyclical

Heavy bleeding, bright red, red tongue, rapid pulse- Heat in the Blood

Purple color, clots, purple spots on tongue- Blood Stagnation

Light red, thin, no clots- Qi Deficiency

Annex: Leukorrhea

Excessive vaginal discharge white, yellow, or bloody

White profuse, watery/clear, no smell- Cold Damp in Lower Jiao

- Spleen Qi Deficiency

Yellow profuse, thick, foul smell- Damp Heat in Lower Jiao

Slightly bloody, thick, sticky, slight smell- Liver Qi Stagnation Heat in Lower Jiao

10. Special Questions regarding Children

Emotional shocks or physical traumas during pregnancy, use of smoking, alcohol ordrugs during pregnancy

- Kidney (pre-heaven or congenital essence/qi) impairment

Slow body development, late teething, etc- Kidney (pre-heaven or congenital essence/qi) impairment

Birth trauma Lungs, brain Breast feeding or weaning problems - Food Stagnation Convulsions - Heat and/or Wind Hereditary Diseases - Zang Fu Organs Infectious Diseases e.g. whooping cough, measles, chicken pox - weak Lung Qi and/or Wei Qi Diet - Spleen

26


28/40


Chapter IV: Auscultation & Olfaction

1. Auscultation (listening)

Voice/Speech

Shows state of Vital Qi and Nature of Pathogen (Cold/Heat)

Loud Excess Syndrome Weak Def Syndrome Talkative/Restless Heat Syndrome

Quiet Cold Syndrome

Deep/Stuffy Exterior Syndrome (nasal obstr) Hoarse/LOV Abrupt - Exterior Pathogen

Gradual/Recurrent - Lung & Kid Yin Def

Chronic/Prolonged Exhaustion of Vital Qi

Incoherence

Shows Shen and Mental Disturbance

Ravings/Mania Liver FirePhlegm obstr Heart Orifices

Soliloquy/Repeating Def of Heart Qi Delirium/Loss of consciousness CRITICAL, high fever disease - Ying and Xue

(blood) stages

Fading/Broken sentences Severe Heart Qi Def or Exhaustion of Vital QiBreathing

Reveals condition of Lungs and Kidneys.

Weak Lung Qi Def

Coarse/Loud Lung Heat

Asthmatic/SOB Lung Qi and Kidney Qi Def Coarse/Asthmatic Excess Pathogens retained in Lungs Sighing Liver Qi StagnationCoughing

Main symptom of Lung disorders.

Coarse/Loud Voice Excess Syndrome Weak Voice Deficiency Syndrome Thick Yellow Spit Wind Heat -> Lung Heat Thin White Spit Wind Cold -> Spleen & Kid Yang Def Whooping Cough Phlegm retention in Lung

27


29/40


Lung Qi Stagnation

Spasmodic Cough Toxic Heat attacks throatLung & Kidney Yin Def

2. Olfaction (smelling)

Odour smelt from patients secretions or excretions

Fetid/Sour

Mouth/Vomit Stomach Heat Stool Damp Heat in Large Intestine Leukorrhea Damp/Toxic Heat Syndrome

** CERVICAL/UTERINE CANCER

Sour Smell Food StagnationFish Stench

Blood/Pus in Spit Lung Abscess Loose Stools Spleen Yang Def

-> Def Cold Diarrhoea

Sticky Leukorrhea Cold Damp in Lower JiaoStrange Odour

Rotten Apples Diabetes Urine Kidney Failure from Nephritis

28


30/40


Chapter V: Palpation

A. In General

Feel, touch, press patients body surface for local abnormal changes

SuperficialFingers palpate the superficial tissues, gently but with increasing force

Used on Body Surface and Joints

DeepPress fingers hard with heavy pressure to feel deep tissues and organs

Used on Abdominal Cavity & Deeper Soft Tissues

B. Temperature

Hot/Cold at first touch, the longer it is felt the less it is- Exterior Wind/Heat or Exterior Wind/Cold

Maintains Heat or Hot on deep pressure- Internal Excess Heat or Yin Deficiency

Maintains Cold or Cold on deep pressure- Internal Excess Cold or Yang Deficiency

Cold on Loins, Low Back, Low Abdomen- Kidney Yang Def

4 Limbs are cold, Chest and Abdomen are hot- Excess Heat Syndrome (with false cold symptoms)

(** internal heat pushes the Yin outside)

C. Neck

Thyroid Gland

Thyroid moves up/down on swallowing, large, unclear on edges, skin colour ok, soft ifpressed

- Def of Iodine

Thyroid edges clear, enlarged, smooth surface, not painful if pressed- Phlegm & Damp Ret

- Qi & Blood Stag

Thyroid is as Hard as Stone, uneven surface, unmovable, painful if pressed.Thyroidal Cancer

- Phlegm & Damp Ret

- Qi & Blood Stag

- Toxic Heat

29


31/40


- Vital Qi Def

Lymph Nodes

Enlarged lymph nodes in the neck, acute onset, rapidly growing, hurt on pressing- Wind/Heat Invasion- Heat toxin (TONSILITIS)

Enlarged lymph nodes in the neck, chronic onset, slow growth, do not hurt if pressed- Liver Qi Stagnation

- Phlegm Retention (TB)

D. Chest

Palpation of apex of the heart

Regular pulsation -> Zong Qi normalFaint -> Deficiency of Zong Qi

Too Strong -> Outpouring of Zong Qi

No pulse -> Phlegm Retention in Chest

-> Heart Yang collapse

E. Breast Nodules

smooth on surface, hard in texture, moveable, can feel edges- Phlegm/Blood/Qi Stagnation

uneven surface, hard in texture, immovable, indistinct edges, liquid oozing, skin looks liketangerine peel - BREAST CANCER

- Phlegm & Damp Retention

- Qi & Blood Stagnation

- Toxic Heat

- Vital Qi Def

F. Abdominal Diagnosis

Use the pads of the three middle fingers Press down on exhalation with firm and slow pressure Go down to a maximum of two inches/five centimetres Painful, just uncomfortable, or normal?Abnormalities -> imbalance in associated organ

Abdomen palpation

Solid but not hard, resilient but not tight, elastic but not soft- NORMAL

Upper Abdomen (below Xyphoid process)30


32/40


full and painful ->Liver Qi Stagnation

hard and knotted ->Lung Qi Stagnation

Lower Abdomen (below navel)soft, flabby -> Essence (Yuan Qi) Def

Cold, better with warmth -> Cold Syndrome Hot, better with cold -> Heat Syndrome Pain, worse on palpation -> Excess Syndrome Pain, better on palpation -> Def Syndrome

Abdominal Masses

Mass of no definite shape, pain and mass movable Zangorgan

Front

Mu

Point

Fu

organ

Front

Mu

PointLung

- Intestinal Spasms and Cramps

- Qi Stagnation

Mass of definite shape, fixed pain, unmovableLU1 Large

Intestine

ST25

Spleen

- Blood Stagnation (Tumour)

Liv13 Stomach Ren12

Heart

G. Palpation of Points

Ren14 Small

Intestine

Ren4

Kidney

Alarm Points (Front Mu)

GB25 Bladder Ren3

PericardiumPalpate with one finger and with less pressure

Ren17 San Jiao Ren5

Liver

Make a note of any areas of tenderness

Liv14 Gall

Bladder

GB24 Front Mu points located on chest or abdomen One point associated with each organ Indicate disease or imbalance of organ Qi of the organ collects at this point

Zang

organ

Yuan

Point

Fu

organ

Yuan

Point

Lung

Yuan Source Points

LU9 Large

Intestine

LI4

Spleen

Located on wrist or ankle One point associated with each organ Indicates more major disease/imbalance in Zang organs SP3 Stomach ST42

Heart Original Qi of the organ collects at this point HT7 Small

Intestine

SI4

Kidney

Yin source points tonify yin organs Yang source points expel pathogenic factors KI3 Bladder BL64

Pericardium

PC7 San Jiao SJ4

Liver LIV3 Gall

Bladder

GB40

31


33/40


Chapter VI: Pulse Diagnosis

A. Introduction

Pulse diagnosis one of most important diagnostic techniques in TCM

1. Why?

Reflects the function and state of the Zang Fu Organs Indicates the location and nature of disease Helps determine the nature of pathogens Helps predict the prognosis of disease

2. Where?

In ancient time: three places are used for pulse diagnosis:

Side of neck (carotid artery)Radial aspect of wrist (radial artery)

Top of foot (dorsal artery of the foot)

Nowadays, only wrist pulse is used.3. How? - Methods of Pulse Taking

Wrist should be at same level as the heart (sitting up or lying down) Use your index finger, middle finger, and ring finger

Cun Index Finger

Guan Middle Finger

Chi Ring Finger

At superficial, middle and deep levels Feel the pulse in each wrist for more than 1 minute, but usually no more than 3 minutes Three Positions:

Cun (front position) distal (nearest to palm) - position for index finger

Guan (middle position) medial to Styloid Process - position for middle finger

Chi (rear position) proximal (nearest to elbow) - position for ring finger

Three Depths:Superficial: fingers pressing gently just under the skin

Middle: fingers pressing moderately

Deep: fingers pressing hard to the bone

4. Pulse positions correspondent to internal organs

Left: Cun Heart (SI)

Guan Liver (GB)

Chi Kidney Yin (Bl)

Right: Cun Lung (LI)

Guan Spleen (St)

Chi Kidney Yang (Mingmen)

32


34/40


5. Pulse diagnosis record

Left Right

Front Middle Rear Front Middle Rear

(Cun) (Guan) (Chi)(Cun) (Guan) (Chi)

Superficial

Middle

Deep

Overall

6. What is a normal pulse?

Smooth, even, gentle at all 3 levels and positions(Cun/Guan/Chi and superficial/middle/deep)

Moderate force, regular rhythm 4 beats per breath (synchronize breathing) (60-90 BPM)A normal pulse should have Shen, have Qi and have root.

Even, gentle, forceful - shows state of Spirit (Shen) Not floating or deep, not fast or slow - has (stomach) Qi Feel also at deep level and at Chi position - has Root

7. A Glance at Pulse Diagnosis

Floating - acute/exterior Deep - chronic/interior Rapid - heat Slow - cold Strong - excess (vital qi is strong) Weak - deficiency (vital qi compromised) Characteristic feelings of the pulse (28 of them!)

e.g. wiry pulse ..Liver/GB Dysfunction or pain.

rolling pulseExcess Damp/Phlegm or Food Stagnation

8. Factors that affect Pulse

Age :between 5 12 pulse is more rapid(90-100 bpm)

elderly patients have a soft and weak pulse

Gender: women have tendency to blood deficiency, pulse is slightly rapidand thin

if pregnant pulse is rolling/slippery

33


35/40


Body Constitution Tall people Pulse is longerShort people Pulse is shorter

Thin people Shallow pulse

Obesity Deep pulse

Profession Heavy physical laborer Stronger pulseMore Mental work Weaker pulse Season Summer Flooding Pulse Heart pos

Autumn Floating Pulse Lung pos

Winter Deep Pulse Kidney pos

Spring Wiry Pulse Liver pos

Other Drink Alcohol FastHungry Slow/weak

Exercise Rapid

Night Slow

Moved to Altitude Fast

9. Limitations of Pulse diagnosis

Not always in consensus with other symptoms, can indicate differently, therefore,

Not always reflecting the function and state of the Zang Fu organs Not always reflecting the location and nature of disease Not always reflecting the nature of pathogens Not always reflecting the prognosis of disease

2-5% of people can have wrist pulse in a different anatomic location due to a

congenital reason.

B. 16 Common Types of Pulses

1. By Depth Superficial/

floating

Deep/

Sinking

2. By Frequency Rapid Slow

3. By Strength Full/Forceful Weak

4. By Quality Slippery Wiry Choppy

5. By Thickness Big/Flooding Thin/Thready

6. By Length Long Short

7. By Rhythm Knotted Intermittant Hurried/Hasty

34


36/40


1. By Depth

Superficial/Floating Pulse

Superficial with light pressure, weak on pressing hard,

like wood floating on water(rebounds back up)

- External Syndrome

Floating & strong - External Excess Syndrome Floating & weak - External/Internal Def Syndrome Floating & rapid - External Heat Syndrome Floating & slow - External Cold Syndrome

(Floating pulse is NORMAL if person is taking BP/ vasodilation medication)

Deep/Sinking Pulse

At a deep level, press hard to feel clearly, press to the bone, like a stone in water- Pathogen has gone into interior

Deep & strong Internal Excess Deep & weak Internal Deficiency

Deep pulse is NORMAL in an obese person

2. By Frequency

Rapid pulse

Over 90 bpm, (or over 5 beats per respiration) -Heat Syndrome

Rapid & Strong Excess Heat Rapid & Weak Deficient Heat Rapid & Floating External Heat Rapid & Deep Internal Heat

Rapid pulse is normal in young children or infants

Slow pulse

Less than 4 beats per respiration, below 60 bpm- Cold Syndrome

Slow & Strong Excess Cold Slow & Weak Deficient Cold Slow & Floating External Cold Slow & Deep Internal Cold

Slow pulse can be normal in athletic/sporty people

3. By Strength/Force

Full/Forceful Pulse

Big, long, strong, on all 3 positions at 3 levels

Normal pulse in healthy people Excess syndrome

35


37/40


Weak Pulse

Small, less forceful, like a worm creeping in a cotton wool

Deficiency syndrome4. By Quality

Rolling/Slippery

Smooth, rounded, slippery, like pearls rolling in a dish or fish swimming in water

Characteristic pulse for Phlegm syndrome Obstruction by Food Stagnation or Wind/Phlegm Also seen in a NORMAL person Also seen in PREGNANT WOMEN

If also rapid -> Excess Yang Rising

Wiry pulse

Forceful, STRAIGHT, long, taut, no passing wave sensation, rebounds and hits

fingers on all 3 positions, can be any width

like a tight bowstring, about to shoot an arrow

like the plucked string of a musical instrument

Liver & GB Problems e.g. Liver Qi Stag/Liver Fire/Liver Yang Rising Can also occur with Pain

Wiry, wide and slippery -> Liver Yang Rising Wiry, slow and tight -> Qi stagnation due to or accompanied with cold

Choppy Pulse

Rough and jagged, scratching bamboo with a knife, tends to be slow, moves at

different levels, like an ill silkworm eating a leaf

Choppy & Strong - Blood Stagnation from Cold/Damp Accumulation etc. Choppy & Weak - Qi/Blood//Essence Deficiency combined with blood

stasis

5. By Width/Thickness

Big/Flooding Pulse

Big, vigorous in coming, gentle in going, like ocean waves

- Excess Heat e.g. fever, summer heat

Thin/Thready Pulse

Distinctive on pressing, fine, clearly felt, thin as silk thread

- Qi/Blood/Yin Def

6. By Length

36


38/40


Long Pulse

Longer than three positions, firm and hard, like a stick of bamboo

Excess Interior syndrome Maybe also generating Wind/Phlegm Long and GENTLE is NORMAL, indicating sufficient Qi and Blood

Short Pulse

Pulse clear at Guan, unclear either end ->Qi and Blood Deficiency

Short & Deep -> Qi//blood/Yang Deficiency Short & Rapid -> Deficiency with Heat Short & Slow -> Deficiency Cold

7. By Rhythm

Knotted PulseSlow, loses beats at irregular intervals

-> Internal Cold & Obstruction Qi and Blood (from excess Yin or Body

Fluids or Yang Def)

Floating and Strong -> External Cold invading Channels Deep and Strong -> Accumulated Internal Cold

* Can also come from chronic disease causing Qi and Blood Deficiency and failure of

upright Qi

Intermittant puls

Stops at regular intervals, can be slow or fast, can stop for longer than one beat, and

then double up

- Weakness of Zang organ Qi (not all at once)

- Partial weakness of Yuan Qi or Essence

Can come from chronic disease or trauma Can be more severe prognosis than hasty or knotted, depending on where the

weakness is.

Hurried/Hasty

Rapid, loses beats at irregular intervals-> Internal Heat & Obstruction of Qi and Blood

(from Qi, Blood, Phlegm or Food Stagnation)

Hurried & Weak -> Deficiency of Zang Fu

C: Other Types of Pulses

1. Moderate/Leisurely Pulse **NORMAL

37


39/40


4 beats per respiration, 60 bpm, gentle, regular, relaxed

elegant like a willow branch in a gentle breeze

If slightly slower.can be athletes, manual laborers and going deeper .Spleen Qi Def & Damp

2. Tight Pulse

Strong, forceful, wiry stretched, thick, TWISTED rope

Cold Syndrome Pain Syndrome

3. Firm Pulse

DEEP, strong and wiry

Interior Excess Cold and excessive Qi Stagnation4. Moving Pulse **can feel like its irregular

round, like a bean on Guan (middle) position

Strong, rapid, slippery, and SHORT

Severe Pain Fear or Fright scatters Qi Yin and Yang fighting and neither winning.

5. Racing Pulse **CRITICAL

Over 7 beats per respiration, 140 bpm, regular

** HEART DISEASE

Extreme Yang & Exhaustion of Yin Impending Exhaustion of Vital Qi

6. Leathery Pulse

Superficial, large, TIGHT, and empty in middle and deep levelslike a drumskin

Deficiency of Essence & Blood (over 40 years old) (from loss of blood and internal deficient cold)

7. Soggy/Soft

Floating and weak, THIN

like a strand of cotton floating on water

Qi & Blood Def Damp Accumulation (usually from Spleen Deficiency)

38


40/40


8. Empty Pulse

Floating, big and soft, loses strength on pressure

Yin/BF Deficiency with damage to upright Qi9. Hollow Pulse

Floating and weak, WIDE, sensation of emptiness while

walls are hard, like pressing a spring onion stalk

Yin/BF Deficiency10. Minute Pulse ** CRITICAL

Extremely thin and weak, fades in and out on pressure

Extreme Qi & Blood Deficiency Exhaustion of Yang Qi (SHOCK)

11. Hidden Pulse **CRITICAL

Deep, weak and THIN, press below the bone

Yin or Cold Pathogens obstruct Channels or Zang Fu External/Internal Excess Cold or Phlegm/Damp

12 Scattered Pulse ** CRITICAL

Floating and big, weak on all 3 positions at 3 levels

Disappears on pressing

like dandelion seeds in the wind

Collapse of Kidney Yang or Essence Failure of Zang Fu Organs

Diagnostico Chines (Inglês)

Documents

Transcript of Diagnostico Chines (Inglês)