method of clinic practice in tcm inquiring inspection auscultation & olfaction pulse-feeling...
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Method of Clinic Practice in TCM
Inquiring
Inspection
Auscultation & Olfaction
Pulse-feeling & palpation
Heart (Ht); Liver (Liv); Spleen (Sp); Stomach (St); Lung (Lu); Kidney
(Kid); Gallbladder (GB); Large Intestine (LI); Small Intestine (SI);
<A> Inquiring:
Question 1: Fever or Cold
<1> Interior Fever
-- Deficiency: Pathology: due to internal disorders -- Excess: Pathology: Yang-Ming fever or Epidemic Qi fever
<2> Exterior Fever: Pathology: Wind-cold: no sweating, chill, headache Wind-heat: sweating, less chill, Summer-heat: high fever, thirsty, constipation
Fever due to internal disorder Exterior fever
Onset Chronic Acute
Etiology Internal injury; improper diet; emotion truma Exopathic six evil qi
Duration Long short
Character
Low fever or subjective fever or heat sensation in palms & feet
Intermittent fever that onset regular or irregular
High fever;
Persistent fever unless the exopathy is eliminated;
Heat will be reduced by perspiration
Aversion to cold
Mostly without aversion to cold or feel cold and the sensation of cold will relieved by warm clothing
Aversion to cold is always accompanied with fever and unable to be relieved by wearing more clothes
Accompanied symptoms
Internal injury & deficiency: dizziness, lassitude, shortness of breath, no desire to talk, spontaneous sweating, light sweating fever
Nasal obstruction, runny nose, headache
Tongue & pulse
Red or pale body with purple sports
Thin or no coating or thick & greasy coating
White or yellow coating
Floating rapid slippery tense pulse
<3> Interior Cold:
-- Deficiency: long illness; yang deficiency
-- Excess:
Pathology: Mostly due to exterior cold attack
Stomach directly
Sym: Acute stomach pain; diarrhea; cold
limbs; like hot drinking;
Tongue: white coating Pulse: tight
<4> Exterior Cold:
-- Wind-cold
Four clinic types of “Fever & Cold”
(I) Fever with aversion to cold
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( A pointer symptom of exterior disease )
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1. Fever being mild but “Aversion to cold” being severe
Pathology: Exterior cold invasion
Sym: No sweating, headache, tight muscle, snuff…
2. Fever being mild and “Aversion to wind”
Pathology: wind invade human body; Lung Qi or Wei Qi Def.
Sym:
3. Fever being severe but “Aversion to cold” being mild
Pathology: wind-heat invade people with ordinary or Yin-deficiency, or Yang-excess constitution
Sym: sweating, no headache, dry throat with rapid pulse
(II) “Aversion to cold” but no fever
Pathology: Exterior cold invade internal organs; Def. of Yang
Sym: cold limbs, midsection cold, like warm package, diarrhea…
Tongue: white coating Pulse: sink & tight
(III) Fever only
1. Excessive fever
Pathology: Wind-heat transform into interior heat; Yang-Ming fever;
Sym: high fever (over 103 F), red face, thirsty, severer sweating, constipation…
2. Tidal fever
Pathology: Yang-Ming fever; Yin Def. ; blood stasis cause fever
Sym: fever happen in certern time everyday
3. Low fever
Pathology: long illness; Qi Def. ; Blood Def. Yin Def.; Liver Qi Stag.
Sym: red face; palm & feet fever
Question 2: Sweating------------------------------------------------------------------------------------------------------- Purpose: Identify the character of evil factors; Judging body’s Qi strength------------------------------------------------------------------------------------------------------- <1> Sweating or not Exterior disease: No sweating: wind-cold Sym. Sweating: wind-heat or wind sym. Interior disease: No sweating: fluid & blood Def. Or Yang Qi Def. Sweating: interior heat excess or (Yang) Qi def. or yin def. <2> Seven characters of sweating <a> Spontaneous sweating : Qi Def. Or Yang Def. <b> Sleeping sweating : Yin Def. <c> Exhausted sweating : Yin exhausted or Yang exhausted
<d> Chill sweating : exterior cold evil fight with Qi <e> Cold sweating : Yang Qi Def. or being scared <f> Heat sweating : interior heat excess <g> Yellow sweating : Dampness
Question 3: Pain
<1> Character of Pain <a> Distension pain: Qi Stag. Mostly on stomach area except eye <b> Prickling pain: Blood stag. <c> Cold pain: exterior cold invade joints & meridians or Yang def. <d> Heat pain: exterior fire invade joints & meridians or Yin def. <e> Heavy pain: Dampness or liver fire flow up to head <f> Sore pain: dampness invade joints or bad circulation of qi & blood or
kidney def. <g> Empty pain: Qi & blood def. or kidney essence def. (head or
abdomen) <h> Colic pain (true heart pain): physical evil or excess cold block Qi
circulation; <i> Secret anguish: yang Qi or blood or kidney essence def. <j> Fixed pain: blood stasis (abdomen& costal & hypochondriac regions);
damp-cold or damp heat invade joints. <k> Moving pain: Qi Stag ( abdomen & costal & hypochondriac regions);
wind cold invade joints
<2> Location of Pain:
<a> Headache:
<b> Chest pain:
<c> Costal pain:
<d> Stomach pain:
<e> Abdomen pain:
<f> Back pain:
<g> limb pain:
<h> Whole body pain:
Question 4: Whole body abnormal Sym
<1> Dizziness
<2> Oppressed feeling in the chest
<3> Palpitation
<4> Costal oppressive feeling
<5> Abdominal distension
<6> Heaviness of body
<7> Numbness of skin or limbs
<8> Impotence
<9> Spermatorrhoea
Question 5: Eye & Ear
<1> Ear
<a> Tinnitus & Deafness
Acute: Excessive sym. Liver fire or damp-phlegm; Qi & blood stasis; Wind-heat; Medical side-affect
Chronic: Def. sym. (kid. Sp. Liv. )
<b> Hard of hearing
Acute: Phlegm invasion & block the ear meridian
Chronic: kidney essence def.
<c> distention in the ear: Dampness or wind-heat
<2> Eye
<a> Itching of eye: liver fire or wind-heat (acute); Liver blood def. (chronic)
<b> Ache of eye: Liver fire ; wind-heat ; Yin Def.
<c> Dazzle of eye: Liver Yang excess; Phlegm-damp; or Qi, blood Def.
<d> blurring of eye: Liver & Kidney Def.
Question 6: Sleeping
<1> Insomnia:
Pathology: Heart blood def. ; Gallbladder Qi def.; Yin def.; Liver fire excess; phlegm heat…
<2> Sleepyhead:
Pathology: Spleen Yang Def. & dampness block the yang qi.. Prodrome of coma;
Question 7: Food & taste
<1> Thirsty & Drinking water
<a> No thirsty & no desire to drink water
Pathology: Cold or Dampness diseases
<b> Thirsty & desire to drink
* Thirsty & dryness of throat and nose
* Thirsty & like cold water and high fever and big sweating
* Thirsty & yin def symptoms
* Thirsty & polydipsia, polyuria, polyorexia
* Thirsty & less drinking
* Thirsty & only gargle the water & black skin
<2> Diet & Appetite <a> Losing appetite:
<b> No appetite: Food stag in stomach; Damp-heat; Liver & GB dampness; Pregnant women <c> Excessive appetite: Stomach (St) Fire
<d> Hungary but no appetite: St Yin def. <e> Being addicted to one food or one thing:
<3> Taste <a> light taste : Sp yang def.
<b> sweet taste : Damp-heat; Sp Qi def. <c> sticky taste : Phlegm heat; Damp-heat or damp-cold <d> sore taste : Food stag; Liv & St heat
<e> bitter taste : Heart fire up; Liv & GB fire <f> salty taste : Kid disease; <g> acerbity taste : Dryness damage fluid; excessive heat
<b> Observation of the nose
* Appearance : flapping of the nose wing
* Discharge
-- Clear
-- Whilst turbid
-- Prolonged turbid discharge with stinking smell : chronic rhinitis or chronic sinusitis
<c> Observation of the ear
* Colour
-- Pale
-- Red & swollen: Liv. & GB. Damp-heat or fire evil
-- Dry & withered auricles, burnt black color: Kid. Essence exhausted
* Purulent Discharge
* Shape
<d> Observation of the gums, lips & mouth
Question 8: Stool & Urine
<1> Stool<a> Times
* Constipation* Diarrhea
<b> Quality* Dyspeptic* Dry & Soft* With puriform blood * blood
<c> Feel of anus when defecate* Hot* Heaviness* Sticky * Incontinence* prolapse
<2> Urine
<a> Times
* Frequently
* Retention of Urine
<b> Quantity of urine
* clear & increased
* descreased
<c> Sensation of Urine
* Acerbity & ache
* Unclearly
* Incontinence
* Enuresis
Question 9: Menstruate & Secretion<1> Menstruate
<a> Period
* Advanced
* Prolonged
* Not fixed
<b> Quantity
* Excessive quantity
* Decreased quantity
<c> Color & Quality
<d> Dysmenorrhea
<2> Secretion
<a> White secretion
<b> Yellow secretion
<c> Red & White secretion
<B> Inspection
(1) Observation of the Vitality
<a> Eyes
<b> Skin lustrous
<c> Expression
<d> Posture
(2) Observation of the Colour
<a> Red: malar flush; heat
<b> Pale: Def.; cold; lost blood
<c> Yellow: Sp def. ; “bright orange” or “smoky dark”
<d> Blue: Cold, Qi Stag.; Blood stasis; pain;
<e> Black: Kid def.; cold; blood stasis; pain;
<3>Observation of the Appearance
* Overweight with mental depression: Qi def. & phlegm damp
* Thin with dry skin: Blood def.
* Great loss of weight: Exhaustion of the essential qi
* Active posture & movement: Yang Sym
* Passive manner: Yin sym.
* Violent movement of the four limbs: wind disease
* Wei Syndromes: Weakness, motor impairment & muscular atrophy of limbs
* Bi Syndromes: pain, soreness, heaviness & numbness in the tendons, bones & muscles with swelling & restricted movement
Body Diagnosis - Shape, Demeanor and Indications
Body Shape/Demeanor Indications
muscular/strong tend towards excess
abrubt/jerky movements wind
active movements tend towards yang conditions
withdrawn/slow movements tend towards qi a/or yang def
hunched over upper jiao def
overweight tend towards dampness; sp qi deficiency
Facial Diagnosis - Colors and Indications
Facial Colors Indications
white cold or def
dull white blood def
bright white qi or yang def
yellow excess damp or sp def
orange/yellow damp heat
red heat+ whole face = excess; + mallor flush = yin def
blue/green (quin) liv qi a/or blood stagnation
black/dark kd def or blood stagnation
<4> Observation of the Five Sense Organs
<a> Observation of the eye* Eye vitality* Eye shape : deep eye socket
Eye ball pop out: Graves’ disease* Eye color --Red: Sclera: Lu. fire or wind-heat Corner: Ht. fire Eyelid: Sp. dampness Whole eye: Liv. fire or wind --Yellow Sclera: damp-heat or damp cold --Pale
corner: blood def. --Black
Eyelid: kid. Def.* Unconscious Eye movement: wind
¤ Lower Jiao
The Base of the tongue corresponds to the Kidney, Urinary Bladder, Large Intestine and Small Intestine Meridians.
¤ Middle Jiao
The sides of the tongue correspond to the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patients left side and the Liver on the patients right side.
The Middle of the tongue corresponds to the Stomach and Spleen Meridians.
¤ Upper Jiao
The Tip of the tongue corresponds to the Lung and the Heart Meridians.
<5>. Observation of the tongue
Body Color Indications
Pink normal or mild disorder
Pale yang, blood a/or qi defDeficiency Cold+ thin & dry = blood def+ wet = qi def+ swollen = qi def+ swollen & wet = yang def
Red heat+ no coating = yin def empty heat+ yellow coat = excess heat+ wet = damp heat+ dry = injured fluids
Dark Red (Scarlet, Cardinal) extreme heatmore severe conditions than red
Purple stagnationlv qi stagnation is likely+ pale = cold
Blue severe internal coldstagnant blood
Tongue Body Colors and Clinical Indications
Body Shape Indications
cracked if develops during illness indicates chronic and severe, otherwise normal location of cracks relates to organ pathology+ red = empty heat consuming fluids+ pale = blood & qi defcrack runs from center to the tip = ht disorder or congenital ht problemshorizontal cracks = yin def
deviated (crooked) wind
flaccid deficiency heat + pale = blood & qi def + dark red = yin collapse
long heat in the ht
rigid stroke or early signs of stroke
short (contracted) serious conditions; blood deficiency; ht deficiency+ pale or purple = cold or yang def; + swollen = damp or phlegm;+ red = heat consuming the fluids
stiff heat in the ht: ht/sp heat; phlegm obstructing the ht qi+ normal & pale = wind, stroke
swollen Deficiency : + pale & wet - yang def + teethmarks & pale = qi def or excess fluids + dark red = excess heat usually ht/sp
thin blood or fluid def: empty heat consuming fluids+ pale = blood & qi def; + red = yin def
thorny (strawberry, granular)
Heat: congealed blood+ on tip = ht fire; + on edges = lv/gb fire; + on center = st a/or intestines heat
trembling (quivering)
Wind: + pale = qi def; + red = heat producing internal wind
Tongue Body Shapes and Clinical Indications
Tongue Coatings and Clinical Indications
Tongue Coat Indications
thin normalexterior condition, wind-cold
thick excess damp/phlegmfood stagnation
dry heat consuming yinexcess yang or firedeficiency fluids
moist normal or mild imbalance
wet excess fluids from yang defdampness
sticky (greasy, creamy) dampness or phlegmretention of food
Coat Coloration Indications
white internal or external coldif coat looks like cottage cheese = ST heat+ thin coat & body aches = exterior wind-cold+ thin coat & thorny = wind-heat
yellow internal or external heateffected by coffee, tea a/or smoke intake
gray hot or cold internal conditionretention of phlegm heat+ dry = heat consuming body fluids+ moist = damp cold
black hot or cold internal conditionretention of phlegm heat+ dry = heat consuming body fluids+ moist = damp cold
Coat Rooting Indications
rootedmoss appears firmly implanted
strong st/sp qi
rootlessmoss appears to float on the surface
st/sp qi def
peeled sp qi defdeficient yin or fluids
<C>. Auscultation & Olfaction
<1> Listening
<a> Speech
<b> Respiration
<c> Cough
<2> Smelling
<a> Breathing
<b> Sweating: body odor
<c> Phlegm
<d> Stools
<e> Women’s secretion
<f> vomiting
Listening Diagnosis - Voice and Breath
Quality Indications
sudden loss of voice wind heat
gradual loss of voice lu qi or yin def
loud excess
soft deficiency
reluctance to speak cold or def
excessive speaking heat or excess
Smelling Diagnosis – Body Odors
Quality Indications
strong scent heat
bad breath st heat a/or food stagnation
strong smelling stools heat and dampness
strong smelling urine heat and dampness
<D> Pulse-feeling & palpation
Common Pulse Locations and Related Meridians
Left Wrist Right Wrist
Cun (inch) - 1st position HT / SI LU / LI
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / UB KD / Ming Men
Designation Sensation Indications
By Depth
Floating (superficial) easily felt at the superficial level not as significant as you feel deeper
external condition/pathogen+ empty = yin a/or blood def+ rapid = wind heat+ tight/slow = wind cold
Sinking (deep) felt only at the deep level interior condition/obstruction+ rapid = internal heat+ slow = internal cold+ slippery = internal damp/phlegm+ empty = qi or yang def
By Frequency:
Slow less than 4 beats per breath (< 60bpm )
cold condition a/or pathogenic factor+ floating = exterior wind cold+ sinking/empty = yang def
Rapid more than 5 beats per breath ( > 90bpm )
hot condition a/or pathogenic factor+ floating = external wind heat+ sinking = internal heat+ full = excess heat+ empty = empty heat
Designation Sensation Indications
By Quality/Shape:
Hesitant (choppy) rough and uneven blood a/or jing stagnation
Slippery smooth with a viscous sensation excess dampness, retention of food, pregnancy+ rapid = damp heat+ slow = cold damp obstruction
Tight tension with side to side movements (thicker than a wiry pulse)
excess cold - interior or exterior, commonly associated with pain
Wiry tension with no side to side movements (thinner than a tight pulse)
LV/GB disharmony
By Width:
Big (excess, overflowing) broad but with distinct edges excess heat, commonly in ST or Intestines
Thin (thready, fine) fine but with distinct edges blood a/or qi deficiency
Designation Sensation Indications
By Strength:
Empty (deficient) wide but not strong, disappears with slight pressure, forceless
blood a/or qi deficiency
Full (excess) wide and strong, felt with strength at all levels
excess condition, often excess heat with rebellious Qi
By Length:
Short not felt in all 3 positions qi deficiency
Long felt beyond the 3 positions excess, heat, generally considered normal in absence of other qualities
By Rhythm:
Hurried (abrubt) rapid with irregularly missed beats
heat agitating qi & blood
Intermittent regularly skipped beats heart disharmony, exhaustion of zang qi
Knotted slow with irregularly missed beats
cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing
Writing of medical report in TCM Internal Medicine
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