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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]
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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
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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
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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
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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
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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
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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)
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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.
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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- 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
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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
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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
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- 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)
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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
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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
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- 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
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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
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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
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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
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- 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
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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
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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)
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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
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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
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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
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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
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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
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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)
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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