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