Holistic Evaluation Skills

Class Subject Materials

I. Holism and Reductionism. The difference between holistic

evaluation and biomedical diagnosis. Use of the term holistic evaluation
instead of diagnosis. The major constituents of an holistic evaluation:
constitution, energetics, organ systems, dynamics. Pathological processes
develop from weaknesses in the overall constitution and the dominant or
inferior organ systems. Functional and organic disease. Homeostasis,
stress, cure, healing, and disease.

Historical: “A Key to Galen’s Art of Physick,” by Nicholas Culpeper.

Shows how to take a case history looking for the three basic foundations of
differential evaluation:
Temperature (Quality, Tissue State, Energetics)
Appropriation (Organ-affinity)
Property (Dynamic)

Modern Interpretation:
1. Energetics: we use the tissue states, or the old Greek four qualities
and two tissue states to characterize the kind of pathology.
2. Organ System: we locate the source of the problem in the weak
or over active system, organ, or tissue of the body.
3. Dynamics: we establish the direction of the disease process by a
knowledge of the dynamic systems of the body, the febrile
mechanism and the blood.
4. Specific Indications.

In addition, we want to know the overall constitution.

 II. Constitution. The three primary constitutions (vata, pitta, kapha;
ectomorph, mesomorph, endomorph) and their relationship to organ systems
through the dominant fetal tissues (ectoderm, mesoderm, endoderm). The
twenty-one secondary constitutions.

The Three Primary Constitutions

Vata (Ectomorph, Nervous, Asthenic)

Pitta (Mesomorph, Motive, Pyknic)
Kapha (Endomorph, Vital/Visceral, Sthenic)

The Relationship of Constitutions to Organ Systems

Vata (Ectoderm)
Nerves
Senses
Skin

Pitta (Mesoderm)
Connective Tissue
Cartilage
Ligaments/Tendons
Muscles
Heart
Bones

Kapha (Endoderm)
Stomach
Intestines
Liver
Gallbladder
Pancreas
Spleen
Lungs
Kidneys
Bladder
Lymphatics
The Twenty One Animal Constitutions

Vata

Nervous/ Rabbit
Pituitary Cloud
Pineal Raven
Sensory/Thyroid Deer
Sensory/Nervous Fox
Atrophic
Nervi-Motive Coyote

Pitta

Cartilaginous Horse, Fire, Flint

Ligamentous Wind, Thunder, Storm
Muscular Elk
Choleric Wolf
Osseous Bull
Adrenal/MC Grizzly Bear
Adrenal/GC Black Bear

Kapha

Gastric Badger
Liver Otter
Pancreas Earth
Spleen Owl
Lymphatic Water
Lung
Kidney Panther
 III. Energetics. The four qualities and the two tissue states of Greek
medicine. The six tissue states of Physiomedicalism.

Classical Medicine

Four Elements: Earth, Water, Air, Fire.

Represents the four states of matter: solid, liquid, gaseous,
combustion. Also represents the four psychological functions: sensation
(earth), feeling (water), thinking (air), intuition (fire).

Fifth Element: Wind, Spirit, Quintessence

That which moves the other four, moves the world. In traditional
Chinese medicine it is equivalent to wood or wind.

Four Qualities of Aristotle: Hot, Cold, Damp, Dry

The four qualities are considered to be the sources of the four
elements by Aristotle (fire: hot and dry; air: hot and moist; water: cold and
damp; earth: cold and dry). However, the Stoics and the astrologers derived
the four qualities from the four elements: fire/hot, air/dry, water/damp, and
earth/dry. This is the way it is arranged for ‘planting by the moon.’

Two Tissue States: Status Strictus, Status Laxus, Status Mixta

The Methodist school of medicine rejected the four qualities and
adopted the two tissue states, with a third, mixed state. This was based on
the atomic theory of Democrates: the particles were too tight or too loose.

The Four Degrees:

The four degrees not only moderate the four qualities but give us
categories of action, or properties.

Degree
––––––––––––––––––––––––––––––––––––––
Quality First Second Third Fourth
Hot Opens Thins Warms Burns
Cold Refreshes Sedates Cools Benumbs
Damp Moistens Softens Nourishes Purges
Dry Closes Dries Hardens Strengthens
Nature
 So, for example, hot medicines (1) open the periphery to drive cold
out of the body, (2) thin the fluids to dissipate cold blockage, and (3) warm
the interior to raise the heat and drive cold to the surface. In the fourth
degree they (4) burn, or are escharotic (remove warts and cancers). Cold
remedies (1) refresh or cools on hot summer day, (2) thicken (agglutinate or
brings together the lips of a wound), (3) block the upward rising of vapors or
restlessness and hysteria, and (4) dull consciousness and stop pain. Dry
remedies (1) close pores and passageways to prevent loss of watery fluids,
(2) bind, astringe, or tone loose, saggy tissue, (3) harden tissue, and (4) stop
severe loss of fluids, as in cholera or tb. Damp medicines (1) nourish in the
first degree, (2) moisten, (3) soften, and (4) move the stool.
 Physiomedicalism

Excitation, Irritation, Over Stimulation. Equivalent to heat.

Excessive tendencies to inflammation, autoimmune excess. Face pink red;
tongue elongated, flame-shaped, carmine pink; pulse rapid or high or both.

Depression, Lack of Stimulation. Equivalent to cold. Lack of

reactivity to stimulation, mental or physical. Stupor, numbness of mind,
apathy. Lack of reaction in nerves, skin, blood flow. Blood thickens,
coagulates. Face pale, gray, dark; tongue darkish; pulse slow or low or both.

Atrophy. At first dry, from lack of oil and water, then atrophic from
lack of nutrtition. Complexion pale; tongue dry, latter dry, withered, thin;
pulse thin on one arm, tense on the other.

Torpor, Stagnation, Equivalent to damp stagnation, or excess of the

oily fluids, catarrhal. Maybe equivalent to hypothyroidism. Skin lesions,
acne, eczema. Mucus production chronic. Tongue: coated. Pulse: obscure,
difficult to feel through a haze of phlegm.

Constriction, Tension. Equivalent to wind. Tension psychological

or physical or both. Symptoms alternate, or come on suddenly and go
suddenly. Pulse: wiry. Tongue: shakes.

Relaxation. Equivalent to damp quality and lax tissue state. Lack of

tone in mucosa or skin, free secretion of watery fluids, skin cool and
clammy, loss of fluids by skin, kidneys, colon, or lungs. Mucus thin and
clear, latter heavier and coating the mucosa. Pulse: relaxed. Tongue: moist
“streamers.”
 Traditional Chinese Medicine

The Five Elements

Yin/Yang

Qi/Blood

The Eight Parameters

Hot/Cold
Excesss/Deficiency
External/Internal
Yang/Yin
 IV. The Twelve Organ Systems. The crucial organ systems, or basic
functional spheres of the body, are twelve, according to both Eastern and
Western traditional sources. There are about a dozen, according to modern
biomedicine. Pathological processes often trace back to weaknesses or
overstimulation in the basic functional spheres of the body.

TCM Western Astrological

Heart Protector Aries Head Ext. Thermoregulation

Triple Burner Taurus Throat Int. Thermoregulation
Lungs Gemini Neck/Arms Lungs
Stomach Cancer Middle Stomach
Heart Leo Chest Heart
Small Intestine Virgo Abdomen Small Intestine
Kidneys Libra Waist Kidneys
Large Intestine Scorpio Groin Large Intestine, Sex
Liver Sagittarius Thigh Liver
Gallbladder Capricorn Knee Capricorn
Bladder Aquarius Calf Bladder
Spleen Pisces Feet Spleen, Lymphatics
 V. Dynamics I: The Febrile Mechanism. The body protects the
periphery of the body from external environmental influences through the
manipulation of the ‘vents’ at the surface (sweat pores, sebaceous glands,
capillary fullness, etc.) The most common stress is probably ambient
temperature change. These mechanisms are traumatized long before the
immune response is triggered.
In biomedical terms, the ‘febrile mechanism’ is equivalent to the
thermoregulation mechanisms that govern the periphery or ‘shield’ of the
body, under the direction of the hypothalamus. The latter also directs the
‘core’ thermoregulation, keeping it coordinated with the ‘shield,’

Thomsonian Interpretation: the fire in the stomach radiates

warmth and sustenance out in all directions to the periphery of the
body. It is opposes by the cold that comes in from the exterior and
blocks it – cutting off healthy perspiration – and by dying down of the
fire of life in the stomach so that the radiative power is curtailed. It is
also opposed by canker, or cold, heavy, damp, sticky, impure
substances that block the fire and the transmission of heat and
nutrtition.

Greek/Arabic Interpretation: heat radiates out and up from

the core, thins the fluids to provide good passage of warmth and
nutrients, and opens the peripheral pores to keep the radiation going to
the surface.

Ayurvedic Interpretation: the agni, the fire in the core of the

body, located at the pyloric sphincter, is the source of all digestive and
metabolic heat. From it, warmth and nutrition radiates out in all
directions, to warm and feed the body. The agni is opposed by ama,
which is cold, heavy, damp, sticky, and impure in nature. It blocks
the outward radiation of the agni, or ‘fire in the belly.’

Traditional Chinese Medicine Analogues: the periphery

protects the interior from ambient temperature changes in the
environment. This power is called the wei qi. Another analogue is
found in the Heart Protector, a peripheral field around the heart that
protects it from extreme changes in temperature and emotion.
 The Febrile Mechanism

Periphery

Sweat Pores open to cool, close to warm

Sebaceous Glands open to warm, close to cool

Capillaries (open) keep blood in the core to prevent heat loss

Capillaries (close) move blood to the surface to release heat

Gooseflesh warms by capturing air near skin

Shivering warming involuntary movement warms

Internal Passages

Thin fluids

Maintain circuation to move blood

Maintan lymphatic flow to move waste products and nutrients

Center

Warm the center

Feed the stomach

Do not drink cold warm

Remove canker (ama, phlegm) from the stomach

 VI. Dynamics II: Southern Blood Typology. In traditional Western
medicine the dynamics of the body was measured in terms of blood flow,
not the qi or meridians, as in traditional Chinese medicine. The local and
general disposition of the blood shows where the circulation needs
stimulation or sedation. Southern Blood Typology. The Six Tissue States
and the blood.
 Southern Blood Typology
In the summer the sap is high, thin, fast, and clean, in the winter it is
low, thick, slow, and dirty. If there is a blockage, unseasonal hot or cold is
created.

Location High 1. Blood high in head, towards surface, hyperemia.

2. High in nutrients, rich blood.
3. High blood pressure.
4. Hyperactive.

Low 1. Blood low in feet, deep inside; not in head.

2. Low in nutrients; anemia.
3. Low blood pressure.
4. Senile, memory loss.

Viscosity Thin 1. Thin, watery, cool blood; better in summer.

2. Poor blood; renal anemia.
3. Watery discharges.
4. Bleeds easily.

Thick 1. Thick, oily, warm; better in winter.

2. Thick from nutrients (rich blood).
3. Thick from toxins (bad blood).
4. Thick from viscosity and coagulation.

Speed Fast 1. Blood moves faster than the nerves.

2. Restlessness.

Slow 1. Blood moves slow; strokes.

2. Sluggish, ‘slouchy.’

Toxicity Good 1. Good inheritance.

2. Good morality.
3. Well balanced

Bad 1. Taint to the blood.

2. Toxins in blood.
3. Humors in blood.
4. Congealed blood.
 Tempera- Hot 1. Fever attacking surface, pulse rapid/high/tense.
ture 2. Fever lingering inside, pulse rapid/nonresistant.
3. Hot-blooded; emotions lead over mind.

Cold 1. Chill, chills and fever, pulse slow/tense/high.

2. Cold from lack of heat; pulse slow/low.
3. Cold-blooded; mind leads over emotions.

Six Tissue States and the Blood

Excitation Blood excited, localized; red, swollen, hot, tender.

Depression Putrescence, sepsis.

Atrophy Anemia, malnutrition

Torpor Bad blood, impure, humors in the blood, toxins.

Constriction Neurovascular spasm.

Relaxation Passive venous congestion.

 VII. Evaluation Methods I: The Four Examinations. Taking a
case history through observation, palpation, questioning, and listening.

VIII. Evaluation Methods II: Complexion, Face, Skin. Observing

the color of the complexion, face, skin, according to the prevalence of the
four humors: red, white, yellow, blue/black. Differential evaluation of
bruises.
 The Meaning of Colors

Pale With blue vessels seen through the skin; thin bld.

White 1. Dry; anemia.

2. Lack of circulation to the surface.
3. Mucus (white bile).
4. Cold.

White/Yellow 1. Peripheral vessel constriction.

Slight Yellow 1. Digestive stagnation

2. Liver, gallbladder stagnation.
3. Lymphatic congestion.

Intense Yellow Jaundice.

Green 1. Jaundice.
2. With yellow and blue: congealed blood.
3. Tendency to cancer.

Blue 1. Congealed blood.

2. Varicose veins.

Blue/Grey 1. Congealed blood/

2. Circulatory deposition.

Blue/Black 1. Congealed blood with black bile.

Black 1. Sepsisi, necrosis.

2. Black bile.

Purple Sepsis, not yet necrotic.

Dark Red Inflammation deep in tissues.

Carmine Pink Excitation, immune excess, fever.

 Bruises

Blue and Red. Bruise with active oxidation, Arnica, Achillea, Carthamus.

Blue and Pale. Bruise with edema, especially in joints, Sambucus.

Blue, red, pale, mottled, Sambucus.

Blue and Yellow. Old bruise, blue with yellow around it, homeopathic
Carbo vegetabilis.

Blue, Yellow, Green, and Gray. Angelica.

Blue and Gray. Bruises and blood coagulation from aging, Rubia, Salvia.

Blue and Black. Bruise with ‘black bile,’ Sassafras.

Black. In very old people bruises turn black, Conium.

Wounds

Inflammation. First phase, tissue red, swollen, warm, and tender.

Calendula, Hypericum, Plantago.

Granulation. Second phase. Regrowth inside wound. If excess

granulation it is called ‘proudflesh.’
Potato poultice, Inula helenium.

Scar Tissue.
Artemisia absinthium (wormwood), Dipsacus sylvestris (teasel)
IX. Evaluation Methods III: Physiognomy. Evaluation from the face and
external geography.
 X. Evaluation Methods: Pulse, Tongue, Skin. Observing the pulse
and tongue. Also examining the temperature, dampness, and oiliness of the
skin.

Pulse

High Blood to the surface; acute disease, fever. “High blood.”

Low Blood to the interior, feet: chronic disease, internal cold.

“Low blood.”

Rapid Fever, heat, excitation of the heart and mind, restlessness.

Slow Cold. Slow, low, and soft: cold from lack of internal
heat. Slow, hard: cold from external cold invasion.

Tense Resistant, constriction: tension, chills.

Hard Very resistant. Hurts the finger to take the pulse.

External cold invasion.

Nonresistant Relaxed

Thin diameter Atrophy

Thin walled (soft) Compressible, like a onion stalk; iron deficiency anemia.

Thin walled (hard) Sodium excess, anemia.

Thick Full. “Thick blood.”

Obscure Humors in the blood, bad blood.

Choppy Congealed blood

 Skin

Cool, clammy Watery perspiration too much

Tacky, warm Oily perspiration too much

Dry, skin conditions Not enough water, oil, or both

Red, swollen, warm, tender Inflammation, heat

Red cheeks, palms Capillary congestion

Red cheeks, palms, turn white on pressure and stay for a second or two

Capillary irritation, lack of oils in cells

Red palms, turn white on pressure, yellow complexion

Histaminic irritation

Skin easily turns red for a long time on pressure or slightly scratched

Histamine irritation, immune excess