Diagnosis Review. ACR class 2. 4 Methods of TCM Diagnosis. Chinese diagnosis includes four methods traditionally described with four words: Looking Hearing (and smelling) Asking Feeling. DIAGNOSIS BY LOOKING. SPIRIT
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Thirst with desire to drink large amounts of cold water: Full-Heat pattern
Absence of thirst: Cold pattern, usually of the Stomach or Spleen.
Thirst, no desire to drink: Damp-Heat
With desire to sip liquids slowly, or to sip warm liquids: Yin deficiency
Desire to drink cold liquids: Heat pattern; desire to drink warm liquids: Cold pattern.
Stagnation of Qi causes distention more than pain, or a distending pain, having no fixed location.
Stasis of Blood causes a severe, boring pain, with a fixed location in a small area.
Characters of pain
Cold: better with heat
Heat: better with cold
Empty: better lying down
Full: better sitting
Empty: slow, gradual
Empty: better with rest
Full: better with movement
Periods always come early: either Heat in the Blood or Qi deficiency.
Periods always come late: either Blood deficiency of stagnation of Blood or Cold.
Irregular periods, coming sometimes early and sometimes late: stagnation of Liver-Qi or Liver-Blood, or Spleen deficiency.
Heavy loss of blood : either Heat in the Blood or Qi deficiency (further differentiate by color of blood).
Scanty periods: either Blood deficiency or stagnation of Blood or Cold.
Dark-red or bright-red: Heat in the Blood.
Pale blood : Blood deficiency.
Purple or blackish blood: Blood stasis or Cold.
Fresh-red blood: Empty‐Heat from Yin deficiency
Congealed blood with clots: stasis of Blood or Cold.
Watery blood: Blood or Yin deficiency.
Turbid blood: Blood-Heat or stagnation of Cold
Pain before periods: stagnation of Qi or Blood.
Pain during periods: Blood-Heat or stagnation of Cold.
Pain after the periods: Blood deficiency.
This must be distinguished according to color, consistency and smell.
White discharge: Cold pattern, from Spleen or Kidney-Yang deficiency, or exterior Cold-Damp, or sometimes from stagnation of Liver-Qi.
Yellow discharge: Heat pattern, usually Damp-Heat in the Lower Burner.
Greenish discharge : Damp-Heat in the Liver channel.
Red and white discharge: Damp-Heat.
Yellow discharge with pus and blood in a woman after menopause: toxic Damp‐Heat in the uterus.
Watery consistency: Cold-Damp
Thick consistency: Damp‐Heat
Fishy smell : Damp-Cold
Leathery smell : Damp-Heat
Infertility can be due to Empty conditions such as Blood or Kidney-Essence deficiency, or to Full conditions such as Damp-Heat in the Lower Burner or stasis of Blood in the uterus.
Vomiting during pregnancy : Stomach and Penetrating Vessel deficiency.
Miscarriage before three months indicates Blood or Essence deficiency and is associated with a Kidney deficiency; after three months it indicates Liver-Blood stasis or sinking of Spleen‐Qi.
Nausea and heavy bleeding after delivery : exhaustion of the Penetrating Vessel.
Sweating and fever after delivery indicate exhaustion of Qi and Blood.
Post-natal depression is usually due to Blood deficiency leading to Heart-Blood deficiency.
The three sections of the pulse at the radial artery are called "inch" (CUN), "barrier" (GUAN) and "cubit" (CHI).
Here they will be called "Front", "Middle" and "Rear" respectively.
The upper [distal] position corresponds to Heaven and reflects diseases from the chest to the head;
the middle position corresponds to Person and reflects diseases between the diaphragm and umbilicus;
the lower [proximal] position corresponds to Earth and reflects diseases from below the umbilicus to the feet".
Common assignment of pulse positions derived from “Pulse Classic”
Traditionally, the best time for taking the pulse is in the early morning when the Yin is calm and the Yang has not yet come forth.
The patient's arm should be horizontal and should not be held higher than the level of the heart.
The practitioner's fingers are all placed on the pulse, which is felt with the first three fingers.
There are 28 pulse qualities, as follows.
This pulse can be felt with a light pressure of the fingers, just resting the fingers on the artery.
Indicates an exterior pattern from invasion by an exterior pathogenic factor, such as Wind-Cold or Wind-Heat.
If Floating and Tight: Wind-Cold; if Floating and Rapid: Wind-Heat.
can only be felt with a heavy pressure of the fingers and is felt near the bone.
Indicates an Interior condition.
If Deep and Weak: deficiency of Qi and Yang. If Deep and Full: stasis of Qi or Blood in the Interior, or interior Cold or Heat.
three beats per respiration cycle.
Indicates a Cold pattern.
If Slow and Empty: Empty-Cold from deficiency of Yang.
If Slow and Full: Full-Cold.
more than 5 beats per respiration cycle
Indicates a Heat pattern.
If Empty and Rapid: Empty-Heat from Yin deficiency.
If Full and Rapid: Full-Heat.
feels rather big but soft.
The Empty pulse indicates Qi deficiency.
feels full, rather hard and long
indicates a Full pattern.
Full and Rapid: Full-Heat; Full and Slow: Full-Cold.
feels smooth, rounded, slippery to the touch, as if it were oily. It slides under the fingers.
indicates Phlegm, Dampness, retention of food or pregnancy;
if Weak: Phlegm or Dampness with a background of Qi deficiency.
feels rough under the finger: instead of a smooth pulse wave, it feels as if it had a jagged edge to it.
also indicates a pulse that changes rapidly both in rate and quality
indicates deficiency of Blood, or exhaustion of fluids after profuse and prolonged sweating or vomiting.
longer than normal: it extends slightly beyond the normal pulse position.
It indicates a Heat pattern.
occupies a shorter space than the normal position
indicates severe deficiency of Qi, or of Stomach-Qi; frequently appears on the Front positions of left or right.
feels big, extends beyond the pulse position, it is superficial and generally feels as if it overflows the normal pulse channel, like a river overflows during a flood.
indicates extreme Heat, either in fever, or in chronic interior Heat diseases.
If also Empty on pressure, it indicates Empty-Heat from Yin deficiency.
thinner than normal
indicates deficiency of Blood or internal Dampness with severe deficiency of Qi.
extremely thin, small and difficult to feel
indicates severe deficiency of Qi and Blood.
feels twisted like a thick rope
indicates Cold, either interior or exterior
If Tight and Floating: exterior Cold
If Tight and Deep: interior Cold.
may also indicate pain from an interior condition
feels taut like a guitar string. It is thinner, more taut and harder than the Tight pulse.
indicates Liver disharmony, Pain, or Phlegm
Slowed-down (Moderate) pulse
has 4 beats for each respiration cycle.
indicates health; no pathological significance
Hollow (Scallion-stalk) pulse
can be felt at the superficial level, but if one presses slightly harder to find the middle level it is not there; it is then felt again at the deep level with a stronger pressure. In other words, it is empty in the middle
appears after a hemorrhage; if rapid and slightly Hollow it may indicate a forthcoming loss of blood.
Leather (Drumskin) pulse
feels hard and tight at the superficial level and stretched like a drum, but it feels completely empty at the deep level. It is a large pulse, not thin.
indicates severe deficiency of the Kidney-Essence or Yin.
Firm (Confined) pulse
felt only at the deep level and it feels hard and rather wiry. It could be described as a Wiry pulse at the deep level.
indicates interior Cold (if it is also Slow) or interior stagnation and pain.
can be felt only on the superficial level. It feels very soft and is only slightly floating. It disappears when a stronger pressure is applied.
indicates the presence of Dampness, against a background of Qi deficiency.
It may also indicate deficiency of Yin and Essence.
cannot be felt on the superficial level, but only at the deep level. It is also soft.
indicates deficiency of Yang or of Blood.
feels very small and is relatively superficial. Instead of feeling like a wave, the pulse feels as if it were "broken" in small dots.
indicates very severe deficiency of Qi and Blood, and in particular of Kidney-Qi. It always indicates a serious condition.
feels as if it were hidden beneath the bone. It is very deep and difficult to feel. It is basically an extreme case of a Deep pulse.
indicates extreme deficiency of Yang.
Moving (Spinning Bean) pulse
has a round shape like a bean, it is short and it "trembles" under the finger. It has no definite shape, having no head or tail, just rising up in the centre. It feels as if it is shaking and is also somewhat slippery.
indicates shock, anxiety, fright or extreme pain. It is frequently found in persons with deep emotional problems particularly from fear, or in those who have suffered an intense emotional shock, even if many years previously.
Rapid and stops at irregular intervals.
indicates extreme Heat and a deficiency of Heart-Qi; also felt with Heart-Fire.
Slow and stops at irregular intervals.
indicates Cold and deficiency of Heart-Qi or Heart-Yang.
stops at regular intervals
always indicates a serious internal problem of one or more Yin organs.
If it stops every 4 beats or less, the condition is serious.
It can also indicate a serious heart problem (in a Western medical sense).
very rapid, very agitated and urgent
indicates an Excess of Yang, with Fire in the body exhausting the Yin.
PALPATING THE ABDOMEN
If the abdomen feels full on touch and no pain is elicited on pressure it indicates an Empty pattern; if pain is elicited, it indicates a Full pattern.
The elasticity and strength of the abdomen is important: it should feel solid but not hard, resilient but not tight, elastic but not soft.
If it feels like this it indicates the good state of the Original Qi. If it feels too soft and flabby, it indicates deficiency of Original Qi.
The relative tightness or softness of the upper and lower part of the abdomen is significant.
The upper part of the abdomen just below the xyphoid process reflects the state of the Upper Burner, i.e. Lung and Heart Qi and Gathering Qi.
This area should be relatively softer than the rest, indicating a smooth flow of Lung and Heart Qi. If it feels hard and knotted, it indicates a constraint of Lung and Heart Qi and a constriction of the Corporeal Soul due to emotional tension.
The lower part of the abdomen below the umbilicus should feel relatively tenser (but elastic) than the rest, indicating a good state of the Original Qi of the Kidneys.
If it feels soft and flabby, it indicates a weakness of the Original Qi.
Abdominal masses that move under the fingers indicate stagnation of Qi: if they do not move and feel very hard, they indicates stasis of Blood.
Nan Jing Abdominal Diagnosis Areas
SP - Umbilical, CV7 to CV12
HT - Substernal, CV12 to CV15
LU- right side of navel / right abdomen
LV- lower left of navel / left side of abdomen
KD- Subumbilical, CV7 to os pubis
Deficient (kyo) areas will manifest depression, coolness, roughness, weakness, etc.
Excess (jitsu) areas will manifest tautness, hardness, discomfort or pressure pain.