Diagnostico Chines (Inglês)

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: hshen@lincoln.ac.uk
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Chinese Medicine Diagnostics by Hui Jun. Shen
Introduction
¾ CM Diagnosis is based on fundamental principle that signs and symptoms on

the Exterior reflect the condition of the Internal Organs
¾ Signs and symptoms present a syndrome pattern which can be identified using
Chinese Medicine diagnostic techniques: Syndrome (Pattern) Differentiation
¾ The purpose of carrying out Chinese medicine diagnostic techniques is to
establish 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:

¾ 1) Observation, including Tongue Diagnosis - (“looking”)
Vitality, complexion, body constitution, Secretions, skin etc.
¾ 2) Auscultation & Olfaction (“listening and smelling”)
¾ 3) Inquiry (“10 Questions”) (“asking”)
¾ 4) Palpation and Pulse Diagnosis (“touching”)
2. Diagnosis: Difference between WM and TCM

¾ TCM Diagnosis is combination of name of disease and name of syndrome
(Western Medicine – name of disease only)
¾ e.g. Disease = common cold, Syndrome = wind/cold
In CM naming can come from:
¾ Pathogenic Factor
¾ Main Symptom e.g. Headache, Dizziness
¾ Western Medical Diagnosis
¾ e.g. Common Cold due to Wind/Cold Invasion
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Chapter I: Observation – “Looking”
1. Vitality (Shen)
¾ Materials for Shen : Qi, Blood, Essence and Body Fluids

¾ State of Shen = State of the Zang Fu Organs; and state of Qi, blood, body fluids.
Good Vitality
¾ Eyes Bright and vivid
¾ Complexion Healthy, shiny
¾ Expression Natural
¾ Physical Condition Flexible, muscles well developed
¾ Speech Clear
¾ Mind Clear
Indicating: sufficient Qi, Blood, Essence and Body Fluids. Vital Qi is strong. Disease is usually
mild and prognosis is good.
No Vitality
¾ Eyes Dull or loss of shiny brightness
¾ Complexion Dull or pale/discolour
¾ Expression Dull or in agony
¾ Physical Condition Heavy, slow, muscles withered
¾ Speech Slow and weak
¾ Mind Unclear, delirium, hallucinations
Indicating: insufficient Qi, Blood, Essence and Body Fluids

¾ Vital Qi is damaged.
¾ Patient will struggle with illness
Pseudo Vitality
Patient 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…
¾ Eyes Bright but not shiny

¾ Complexion Flushed cheeks but kind of unhealthy
¾ Expression Bright but not natural looking
¾ Physical Condition Emaciated but better appetite
¾ Speech Loud voice and talkative
¾ Mind Restlessness/agitation
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2. Sensory Organs
¾ A lot can be discerned by examining sense organs
Nose
¾ Clear watery nasal discharge -> Wind Cold Invasion
¾ Clear thick yellow discharge -> Wind Heat Invasion
¾ Prolonged thick yellow/green -> Phlegm Heat/Lung
¾ Red nose at tip -> Lung or Spleen Heat
Ears
¾ Dry, withered, black in color -> Kidney Essence Deficiency
¾ Pus in ear -> Damp heat in Liver and GB
¾ Swelling and Pain -> Gall Bladder Fire
Mouth & Lips

¾ Purple/Blue Lips -> Blood Stagnation (cold)
¾ Deep Red and Dry Lips -> False/Excess Heat
¾ Pale Lips -> Blood Deficiency (Spleen Deficiency)
Teeth & Gums

¾ Gums swollen and easy bleeding -> Stomach Heat
¾ Pale Gums -> Blood Deficiency
¾ Blue Line on Gums -> Toxic (Lead Poison)
Throat
¾ Red, sore and swollen -> Wind Heat Invasion
¾ Red, sore and swollen throat with yellow/white spots -> Toxic Heat Lung/Stomach
¾ Sore, dry throat, not swollen -> Kidney Yin Def
Eyes
¾ Red in corners -> Heart Fire
¾ Red in white (conjunctiva) -> Lung Heat
¾ Red swollen/painful -> Wind Heat Invasion or Liver Fire
¾ Yellow in white -> Damp/Heat (jaundice)
¾ 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
¾ Observe in natural light
¾ Relax your own eyes and “accept” colour
¾ Lots of practice!
¾ Assess with other signs if unsure
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In General
¾ Always look at the face, Qi and Blood goes to the face and face is always visible
Normal:
¾ Bright, shiny, blood colour (pink)
¾ Skin Lustre
¾ State of Vital Qi/Essence of Zang Organs
Abnormal:
¾ Favourable Bright and shiny, but no blood colour
¾ Unfavourable No lustre, no shine, abnormal colour
“Five Colours”
Blue/Green
¾ Pale face with blue tinge Cold Syndrome
¾ Pale with blue/purple Blood Stagnation
¾ Intermittent pain in chest and sternum -> Heart Blood Stagnation
¾ Pain in hypochondriac area -> Liver Qi Stag -> Liver Blood Stagnation
¾ Blue/purple face with convulsions and infantile high fever -> EXTREME
excess/deficient heat
Red
¾ Heat Syndrome
¾ Whole face is red -> Excess Heat
¾ Red Cheekbones -> False Heat
Yellow
Damp Heat
¾ Bright orange yellow ->Yang Jaundice: Damp Heat Lv/GB
¾ Pale yellow (sallow) -> Spleen & Stomach Def
-> Def Qi and Blood
¾ Yellow and Puffy ->Damp accumulating due to Spleen Deficiency
Damp Cold
¾ Smoky dark yellow ->Yin Jaundice
-> or Long term Blood Stagnation
White - Cold Syndrome
¾ Dull pale white -> Blood Deficiency
¾ Bright white -> Yang Deficiency
¾ Pale severe, sharp pain –> Cold Stagnation
Colours associated with Five Elements:
¾ Fire – Red
¾ Earth – Yellow
¾ Metal – Grey/White
¾ Water – Blue/Black
¾ Wood – Green
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4. Body Condition
Constitution
¾ Strong/weak
¾ Obesity/Overweight - Phlegm and Damp retention
¾ Thin Body - Yin Deficiency, False Heat, Fire
Posture
¾ Normal/natural - health or mild conditions
¾ Compulsory – mostly seen in pain cases, or patient with limited range of movement of
limbs, or crucial conditions
Walking
¾ Normal
¾ Abnormal
Movement
¾ Whole body
¾ Whole limb
¾ Joint(s)
5. Skin
¾ Normal skin: Smooth, moist, bright
¾ Dry Skin --Blood Deficiency or Yin Deficiency
¾ Dry/Scales (Local) --Exhaustion of Body Fluids
¾ Too moist --Spontaneous Sweating due to Lung Qi Deficiency
Or Wind/Heat Invasion
¾ Slight Swelling --Qi Stagnation
¾ Edema No Pit – Damp Retention from Qi Deficiency
Pitting - Kidney Yang Deficiency
Colour of Skin
¾ Dull Deficiency of Body Fluids

¾ Yellow : Bright and Clear
-> Damp Heat (“Yang Jaundice”)
Dull yellow
-> Damp Cold (“Yin Jaundice”)
¾ Red Rash Blood Heat
¾ Spots Blood Heat/Toxin
¾ Infected or weeping -> Damp Heat/Toxin
6. Secretions
Vomit
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¾ Thin, no smell Cold Syndrome: Yang Def in Spleen and Kidney or Invasion of Cold
into Stomach
¾ Thick, sour odour Heat Syndrome
¾ Undigested Food Food Stagnation
¾ Water/Sputum/Saliva: Phlegm retention in the Middle Jiao
¾ Yellow/Green, (Bitter): Damp Heat in Liver and Gallbladder
¾ Blood or Clots Liver Fire -> Stomach or Stomach Heat -> Blood Stagnation
Sputum
¾ Thin, foamy Wind Phlegm
¾ Watery, clear Cold Phlegm
¾ Thick, yellow, sticky Heat Phlegm
¾ Large, can cough up Damp Phlegm
¾ Small, can’t cough up Dry Phlegm
¾ 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. Introduction
The 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:

¾ Combine the Diagnosis of Tongue Body and Coat
¾ Examine the Tongue in natural light wherever possible or using a full spectrum light bulb
¾ 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
¾ Soft, flexible, moist, shining
¾ Not too fat or thin, pink colour
Coat
¾ Thin and white with clear grains scattered evenly
B. Tongue Body Diagnosis

A) Tongue Body Colours and Clinical Indications
Pale
¾ Deficiency of Qi, blood or Yang
Small/Thin Deficiency of Qi and/or Blood
Puffy/Tender Spleen Qi deficiency or Deficiency Cold Syndrome due to Yang
Deficiency
Red
¾ Heat Syndrome, excess or deficiency
Tip - Heart Fire
Sides - Excess Heat in Liver and GB
Middle - Excess Heat in Middle Jiao
Deep Red
¾ Extreme Heat Condition
Pathogen deep in the interior
Purple
¾ Blood Stagnation
Red 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”
¾ Internal Cold, excess cold invasion or Yang deficiency
¾ Blood Stagnation
B) Tongue Body Shape and Clinical Indications
Swollen/Puffy
¾ Pale/Tender/Teeth Marks
Qi or Yang Deficiency in Spleen and Kidney
Excess Damp/Accumulation of Body Fluids
¾ Light Red/Yellow Greasy Coat

Damp Heat or Phlegm Heat
¾ Deep Red/Occupies All Mouth
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Excessive Internal Heat
¾ Blue and Purple

Blood Stagnation due to Blood Heat or Cold
Thin Body
¾ Pale Qi and Blood Deficiency
¾ Deep Red Yang Rising or Yin Def
“Thorny” Papillae on surface of the tongue (like red strawberry pips)

¾ Heat Syndrome, Excessive Heat in the Interior
The more Heat, the more enlarged and profuse the papillae
¾ Burnt Yellow Excess Heat
¾ 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
¾ Dry, No Water Yin Def
Damp Retention, as the result of damp obstructing Body Fluids
¾ Puffy and Tender Spleen Def/Damp Retention
¾ Pale Blood Deficiency
¾ Deep Red Yin Deficiency
Bleeding
¾ Spleen Qi Deficiency Fails to contain the blood
¾ Heart/Liver Fire Heat causes blood to overflow
Sublingual Veins
Normally is slightly purple, and not extending longer than phrenulum
¾ Purple, Thick, Dilated Blood Stagnation
¾ Thin Light Red Blood Deficiency
C) Tongue Body Movement and Clinical Indications
Stiff
¾ Deep Red Heat invading Pericardium
¾ Puffy, Greasy Coat Phlegm Retention in Pericardium
¾ Blue or Purple Wind Stroke (or early signs of)
Flaccid
¾ Pale Colour Extreme Deficiency of Qi and Blood
¾ Deep Red Exhaustion of Yin
Shortened Curved up or down or contracted, unable to project far, may be congenital
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¾ Moist and Pale Cold Stagnation

¾ Pale and Tender Qi and Blood Deficiency
¾ Dry and Red Heat consumed Body Fluids
¾ Puffy, Greasy Coat ð Phlegm Damp
Quivering
Usually indicating prolonged and chronic disease
¾ Deficiency of Qi & Blood e.g. Liver Blood Def causing liver wind, tendons not
nourished
¾ Febrile Disease excess wind, body fluid consumed (inc Blood)
Deviated
¾ Wind Stroke (or early signs of)
C. Tongue Coating Diagnosis
A) Colour of Coat and Clinical Indications
White coating:
¾ Thin Normal or mild disorder: Wind Cold Invasion
¾ Thick Interior Damp or Cold Damp Syndrome
¾ Slippery/Greasy Phlegm/Damp
¾ Dry Body Fluids Severely Impacted
¾ Powdery Excess Damp and Internal Heat
Infectious Diseases
Internal Abscess
Yellow coating:
Interior Heat Syndrome – more yellow more severe the heat is
¾ Thin/Slippery Wind Heat Invasion
¾ Thin & Dry Going Internal, consuming Body Fluids
¾ Thick & Dry High Fever, Body fluids consumed
¾ Greasy Phlegm or Damp Heat
Grey coating:
Chronic Disease or Prolonged Illness of Digestive System
¾ Wet Cold Damp Syndrome
¾ Dry Internal Heat, more severe than yellow
Body Fluids consumed
Black coating:
¾ Extreme Heat or Excessive Cold
¾ Dry, swollenExtreme 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 don’t smoke
¾ Wet Excessive Cold and Damp in Interior
¾ 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
¾ Thin Can see body through the coating
Pathogen is external or mild
¾ Thick Cant see body through the coating
Pathogen is internal e.g. Damp/Phlegm, Food Stagnation
Moist/Dry
Reflects State of Body Fluids
¾ Slippery Excessive moisture on surface
Cold Damp Acc due to Yang Def
¾ Dry Coarse, Lacking in Moisture
Body Fluids Consumed due to Excess Heat
Or Body Fluids Distribution obstructed by Damp in Channels
Greasy
¾ Smooth and fine, evenly distributed granules, cant remove
¾ ð Damp & Phlegm Accumulation
¾ ð Damp Heat or Food Stagnation
Curdy
Thick and coarse granules loosely scattered, like layer of bean curd, can be easily
removed, no root
¾ Food Stagnation or Phlegm Stagnation
Peeled
Coating SUDDENLY comes off either completely or partly
“Geographic” tongue, looks like a map
¾ Impacted Stomach Qi and Yin
¾ Def of Qi Yin and Blood
No Coating/”Scanty Coat”
¾ “Mirror-like” coating. Coating is peeled and body is shiny
Exhaustion of Stomach Qi and Yin
Kidney Qi and Yin compromised
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Chapter III: Enquiry - “10 Questions”
General Approach
¾ Treat patients “from the heart”
¾ Keep the focus on the Main Complaint

“what’s wrong, how long”
“Short List” other additional complaints
¾ Prompt patient but DO NOT DIRECT patient

ask about complaint symptoms but don’t describe them for them!
¾ Try and keep the language simple
¾ Keep a natural expression!
General Inquiry Points
¾ Name, address, and phone number

(hopefully on intake form!) if not “fill in”
¾ How can I help you today?

(hopefully will illicit main complaint…may not!)
¾ If it did…..“how long”
¾ Did they associate any event (physical or emotional) with the start of it
¾ Did it start quickly or gradually

(chronic or acute condition at the start….Exterior /Interior syndromes)
¾ Details of main complaints….

….location, nature, duration….which one first….
¾
¾ 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….
¾ What other symptoms are they having…..
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(the short list…relevant to main complaint? or not….)
¾ How is main condition developing….

….is it getting worse or better….
….what makes it worse or better…(e.g. hot/cold/damp)
¾ 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…
¾ Any possibility they could be pregnant? (appropriately ask..)

(has a bearing on needle point choice)
1 Chills/Fever
Chills with no Fever

¾ Aversion to chills, cannot be relieved by warmth
External Excess Wind/ Cold invasion
¾ Abdominal fullness and pain, better with warmth

Internal Excess Cold OR
Tai Yin Stage (6 Meridian Differentiation) (Spleen Yang Deficiency)
¾ 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
¾ More Chills than Fever:

External Excess Wind/Cold
¾ More Fever than Chills:
External Excess Wind/Heat
And…aversion 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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¾ Alternate Chills/Fever
Shao 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 39oC (“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

¾ Low Fever in the afternoon or at night
Malar Flush (red cheeks), 5 Palm Heat
Night Sweats, Restlessness
Red Tongue Body with Scanty Coat
Internal Deficient Heat: Yin Deficiency
¾ Fever comes or is worse between 3 and 5 pm

Abdominal 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)
¾ Fever is higher in afternoon

Chest fullness, heavy body
Skin hotter with prolonged palpation
Red Tongue Body with Yellow Greasy Coat
Damp Heat in Interior
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3). Low Fever - Between 98.6 and 100.4 F (37-38 C) or
No Fever (normal body temperature) but Feeling Hot:
Internal heat syndrome, can be excess heat or deficiency heat
¾ 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.
¾ Deficiency heat:
Tongue Body Red: Yin Def
Tongue Body Pale Blood Def or Qi Deficiency
Fever worse with physical exertion, easily tired
External Deficiency (Def of Wei Qi)
2 Sweating
Exterior Syndrome
¾ With fever, aversion to wind, sweating, sore throat, floating and rapid pulse
External Excess (Wind/) Heat
¾ With fever, aversion to wind, spontaneous sweating floating pulse
External Deficiency (Def of Wei Qi)
Interior Syndrome
¾ Big Sweat, Flooding Pulse, Fever & Thirst (4 Bigs)

Internal Excess Heat
¾ Night sweats, tidal fever, malar flush, 5 palm heat
Internal Deficient Heat – mostly Yin Deficiency
¾ Intolerant to cold, feels worse on exertion, SOB, quiet voice, spontaneous sweating
Internal Deficient Cold
Qi or Yang Deficiency Syndrome
¾ Profuse dribbling of cold sweat, pale complexion, cold limbs, weak pulse, CRITICAL
Severe Internal Deficient Cold
Yang Depletion Syndrome
Local Sweating
Head
¾ Chronic disease, red face, thirst, red tongue, thin yellow coat
Interior Heat syndrome
¾ Heavy body & head, fullness in chest & abdomen, yellow greasy coat
Damp Heat syndrome
Forehead
¾ Sweat is like oil, with cold limbs, SOB, weak pulse
Impending exhaustion of Jing (Essence)
CRITICAL – YIN AND YANG SEPARATE
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Half Body
¾ Upper/Lower/Left/Right, with paralysis
– Windstroke
Palms/Soles
¾ With Internal Organ symptoms
Yin Deficiency
¾ Tidal Fever, Constipation, Abdominal Fullness
Yang Ming Fu Syndrome
3 Pain
1) Nature of Pain
¾ Distension/Bloating
In Chest and Hypochondriac Region - Qi Stagnation
In Head and Eyes, with Migraines - Liver Fire Flares Up/Liver Yang Rising
¾ Moving
Joints in 4 Limbs - Wandering Bi Syndrome (wind invading meridians)
In Chest and Hypochondriac Region - Qi Stagnation
¾ Stabbing, Fixed
Body - Blood Stagnation
Joints in 4 Limbs - Cold Bi Syndrome
¾ Colic Pain
Sharp 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
¾ Burning, better with cold

Excess or Deficiency Heat Syndrome
¾ Dull Pain
Qi Stagnation or Deficiency Syndrome (Yin/Yang/Blood or Qi deficiency)
¾ Aching
Whole Body - Exterior or Damp Syndrome
Lumbar/Knees – Qi/blood local stagnation or Kidney Deficiency
¾ Heavy
Damp Syndrome, Damp Blocking the Channels
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¾ Hollow/Empty
Deficiency Syndrome (Yin/Yang/Blood or Qi)
2) Location of Pain
Headache
¾ Location in head: Frontal => Yangming;
Occiput => Taiyang
Vortex => Jueyin
Both Sides => Shaoyang
¾ 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 cold
Wind/Cold Headache
Better with wind/cold, worse with heat
Wind/Heat Headache
Heavy Body and Head (feels like its wrapped up)
Wind/Damp Headache
¾ Headache due to interior causes
Chronic, 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 => Damp…with dizziness too
Yang Rising taking Damp with it
Stabbing and Fixed Headache, may have a history of head trauma

Blood Stagnation
Chest Pain Heart and Lung Pathology
¾ Choking Sensation, pain -> left shoulder, tightness in chest

“Chest Bi Syndrome” (Angina Pectoris)…d/t….
Phlegm Stagnation suppressing chest yang
Qi and Blood Stagnation
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Restriction by Cold
¾ Paroxsysms, continuous gripping, convulsions, colic pain, grey face, profuse cold sweat,
chest congestion
Severe Chest Bi Syndrome
¾ Burning pain, Asthma

Excess Heat in the Lung
¾ Night Sweats, Blood in Sputum

Lung Yin Deficiency (or TB)
Hypochondriac Pain
Liver and GallBladder Pathology
¾ Sighing
Liver Qi Stagnation
¾ Jaundice
Damp Heat in Liver and GallBladder
¾ Stabbing and Fixed Pain

Liver Blood Stagnation
¾ Burning Pain with Red Face and Eyes

Liver Fire Flares Up/Liver Yang Rising
¾ Burning Pain with tidal fever and night sweats

Liver Yin Deficiency
Epigastric Pain
¾ Sudden pain after exploring in cold or eating cold food, watery vomiting
External Cold Invasion into the Stomach
¾ Distention with pain after eating too much, nausea vomiting undigested foog
Food Stagnation
¾ Dull pain with poor appetite, loose stools, fatigue
Stomach/Spleen Deficiency
¾ Stomach ache worsened by emotional change, irritability
Liver Overacting on Stomach
Abdominal Pain
¾ Better with Pressure - Deficiency Syndrome
¾ Worse with Pressure - Excess Syndrome
¾ Cold and better with warmth - Cold Syndrome
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¾ Feverish and better with cold - Heat Syndrome
Low Back Pain

¾ Soreness and weakness - Kidney Deficiency
¾ Cold Pain with heavy sensation on rainy/cloudy days - Cold Damp
¾ Stabbing and Fixed Pain - Blood Stagnation
Back Pain
¾ Extends to head/neck with external symptoms - Invasion of Bladder meridian by cold
¾ Cold Limbs, Cold Back - Yang Deficiency
¾ Hollow sensation - Jing Essence Deficiency
Painful Limbs & Joints

¾ Bi Syndrome
Not fixed Wind Bi
Fixed, worse with Cold Cold Bi
Fixed, heavy joints Damp Bi
Red & Swollen Joints Hot Bi
Whole Body
¾ Aches whole body, heaviness, chills & fever, floating and tight pulse
Exterior Wind/Cold/Damp Syndrome
¾ After chronic disease or confinement to bed
Qi and Blood Deficiency
4 Abnormal Sleep
Insomnia Heart Shen disturbance

Blood and Yin house the Shen in the Heart..
¾ Palpitations, restlessness, red tongue, scanty tongue coat

- Heart Yin Def
¾ Palpitations, weak low back and knees, red tongue tip
- Imbalance between Heart and Kidney
¾ Waking up early, cant get back to sleep, yellow greasy coat
- Phlegm Heat disturbing heart shen
¾ Can’t get to sleep, palpitations, poor appetite, pale tongue
- Heart Blood & Spleen Qi Deficiency
¾ Nightmares, dream disturbed sleep, scanty urination, red tongue tip or month ulcer
- Heart Fire (Heart Heat)
¾ Waking up many times in the night, night sweats, hot flushes
-Liver and Kidney Yin Def
¾ Stomach Distension, restlessness
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- Food Stagnation
Sleepiness (somnolence/ Drowsiness)
¾ Tired, fatigue, sleepy after eating, poor appetite, SOB

- Spleen Qi Def
¾ Sleepiness with dizziness, heavy limbs, fullness in chest, greasy tongue coat
- Damp/phlegm obstructing Clear Yang rising to the Head
¾ Extreme fatigue, intolerant to cold, cold limbs, weak thin pulse
- Kidney Yang Def
¾ Lethargy and drowsiness in Febrile Disease
- Heat invasion of Pericardium
5. Energy Level
Tiredness (Lethargy/fatigue/lassitude/sluggishness/weariness) Always tired/sleepy
¾ Tired/fatigue, sleepy after eating, poor appetite,

- Spleen Qi Def
¾ Sluggishness, dizziness, heavy limbs, fullness in chest, greasy tongue coat
- Damp/phlegm obstructing Clear Yang rising to the Head
¾ Extreme fatigue, intolerant to cold, cold limbs, weak thin pulse
- Kidney Yang Def
¾ Lethargy and drowsiness in febrile disease
- Heat invasion of Pericardium
Restlessness (listlessness/agitation/restiveness)
¾ Insomnia, dream disturbed sleep, palpitation,
- Heart Shen disturbance (by heat, phlegm etc.)
¾ Short templed, irritability, headache/dizziness
- Liver Yang rising
¾ Hot flushes, night sweats, moody and emotional
- Yin deficiency leading to heat flaring up
6. Thirst, Appetite & Taste
Thirst
¾ Body Fluid Deficiency due to Excess Heat

¾ Yin deficiency
¾ Obstruction of Body Fluid Distribution by Damp
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Thirst & drinks a lot (polydipsia)

¾ Impairment of Body Fluids
¾ Extreme thirst, high fever, profuse sweat, big pulse, wants cold drinks (“4 Bigs”) -
Excess Internal Heat
¾ Extreme thirst, lots of urine, also eats a lot (polyphagia) - Diabetes (Xiaoke in TCM,
meaning wasting and thirsting)
Thirst & doesn’t want to drink (NO polydipsia)
Slight impairment or obstruction of Body Fluids
¾ Recessive fever (hotter to touch), or tidal Fever -Damp Warm Syndrome)
¾ Fullness of chest, greasy tongue coat - Damp Heat
¾ Restlessness, delirium, fever worse at night, deep red tongue - Internal Heat entering
Ying and Xue (blood) stages
¾ Vomiting after drinking - Phlegm Retention in Middle Jiao (obstructing channels)
¾ Wants to rinse mouth not swallow, purple spots on tongue - Blood Stagnation
(obstructing channels)
Appetite
Poor Appetite
¾ Abdominal Distension, loose stools, pale complexion & tongue, weak pulse
- Spleen Qi Def
¾ Fullness of Stomach, heavy body, white greasy tongue coat
- Damp Retention in the Middle Jiao
¾ Aversion to greasy food, fullness of stomach, hypochondriac pain, jaundice, yellow
greasy tongue coat
- Damp Heat in the Liver & GB
¾ Aversion to food, belching, foul odor, stomach distension, curdy tongue coat
- Food Stagnation
Polyphagia (eats a lot)

¾ Thirst, restlessness, red tongue, yellow coat
- Stomach Fire
¾ Loose stools, low energy, tired
- Spleen Qi Def
¾ Thirst, drink a lot, lot of urine
- Diabetes (Xiaoke Disease)
Anorexic (don’t want to eat)

¾ Burning sensation in Stomach, red tongue and scanty coat
- Stomach Yin Def
¾ Dizziness, tinnitus, insomnia, poor memory
- Stomach and Kidney Yin Def
Taste
¾ Bitter taste - Liver and GB Heat
21
¾ Sweet & Greasy taste - Damp in Spleen

¾ Pungent - Lung Heat
¾ Salty - Kidney Yin Def
¾ Acid Reflux - Stomach & Liver Heat OR Liver overacting on Stomach
¾ Sour Odor in mouth - Food Stagnation OR Disharmony of Liver and Spleen
¾ No taste - Spleen Qi Def
¾ 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 sheep’s
droppings
¾ With scanty dark urine, stomach fullness, red tongue, yellow coat, rolling rapid pulse
- Heat in Stomach and Large Intestine
¾ With abdominal distension, borborygmus, flatulence, side pain, wiry pulse
- Liver Qi Stagnation
¾ Difficult to pass stolls, SOB, fatigue, pale tongue, weak pulse
- Qi Deficiency
¾ Palpitations, poor memory, pale tongue, thin pulse
- Blood Deficiency
¾ Malar flush, tidal fever, red tongue, scanty coat, thin pulse
- Yin Deficiency
¾ Clear profuse urine, cold limbs, better with warmth, intolerant to cold, cold pain in
abdomen, deep slow pulse
- Yang Def (Empty Cold)
Diarrhea
Frequent bowel movement with loose and watery stools

¾ Thin & watery stool, severe abdominal pain, borborygmus white greasy coat
- Cold Damp invasion of Spleen
¾ Dark brown stool, burning sensation at anus, abdominal pain, dark urine, mucous
and/or blood, yellow greasy coat
- Damp Heat in Large Intestine
¾ Abdominal pain, borborygmus, smell of rotten eggs, belching, bad breath, undigested
food in stool
- Food Stagnation
¾ Loose stools, poor appetite, abdominal fullness, low energy, pale tongue, weak pulse
22
- Spleen Deficiency
¾ “Dawn Diarrhea” with abdominal pain, borborygmus, and immediate passage of
loose stool, intolerance of cold, cold limbs, weak low back & knees
- Kidney Yang Def
Other
¾ Stools are sometimes dry or loose (IBS)

- Liver overacting on Spleen
¾ Tarry Black Stools – “Far Blood” – Bleeding in Upper GI tract
- Empty Cold in Stomach and Spleen
¾ Tenesmus (want to void but cant)
- Dysentery with Qi Stagnation
¾ Rectal Prolapse, usually after prolonged and chronic diarrhea
- Sinking of Spleen Qi
8. Abnormal Urine
Scanty/Dark Urine
Heat Syndrome in general
¾ Restlessness, insomnia
- Heat/fire in Heart and/or Small Intestine
¾ Side pain, jaundice
- Damp Heat in Liver & GB
¾ Abdominal distension, constipation
- Heat in Stomach and Large Intestine
¾ Urgent, frequent, painful urination
- Damp Heat in Bladder
Clear/Lots
Cold Syndrome in General
¾ Pale face, weak low back & knees, pale tongue, weak pulse
- Kidney Yang Def
¾ Abdominal Cold, pale tongue, deep wiry pulse
- Interior Cold
Turbid/Cloudy
¾ Urgent, frequent urination, brown color, cloudy
¾ Weak low back and knees
- Kidney Qi Deficiency
¾ Poor appetite, weak low back and knees
- Spleen and Kidney Deficiency
Frequent
¾ Profuse, polydipsia & polyphasia
- Diabetes (Xiaoke)
23
¾ Urgent and painful, brown color

¾ Frequent at night, clear profuse urine
- Kidney Yang Def
Incontinence
¾ Patient cannot control urination during the day
- Kidney Qi/ Yang Def
Dysuria
Difficult Urination
¾ Puffy eyelids, yang edema in the upper body
- Lung cannot disperse Qi
¾ Poor Appetite, low energy
- Spleen Yang Def
¾ Intolerance to cold, sore low back
- Kidney Yang Def
¾ Brownish urine, burning/stinging sensation, rapid pulse
- Damp Heat in the Bladder
Painful Urination
¾ Burning sensation (UTI/STD)
- Damp Heat in the Bladder
¾ Stabbing Pain
- Blood Stagnation
¾ Colic Pain
- Kidney Stones
Enuresis
Urination at night, bed wetting
¾ 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

¾ Blood is fresh red with large quantity, red tongue, rapid pulse
- Heat in the Blood, HEAT SPEEDS UP THE FLOW OF BLOOD
¾ Blood is dark red or purple, thick, red tongue, rapid pulse
- Liver Qi Stagnation leading to heat
¾ Thin, light red, pale tongue and weak pulse
- Spleen Qi Def, QI DEF CANNOT HOLD THE BLOOD
24
Late Period
More than 7 days late than the normal cycle of 28 days.
¾ Dark purple, scanty, clots
- Qi Stagnation ð Blood Stagnation
¾ Cold limbs, intolerance of cold, deep tight pulse
- Cold ð Blood Stagnation
¾ Light red, fullness of chest, heavy body, greasy tongue coat
- Phlegm Damp Retention obstructing the channels
¾ Thin, light red, scanty, pale complexion and weak pulse
- Qi Deficiency ð Blood Deficiency
Irregular
This month early, next month late, over a 3 month period
¾ Dark purple, scanty, blood clots, distending pain in side abdomen or chest, wiry pulse
- Heat – Early period
- Blood Stagnation – Late period
¾ Light red, thin, varying amount, sore and weak low back & knees, poor appetite, loose
stools
- 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
¾ 80% due to Qi and Blood Stagnation
¾ Before or During Period -> Qi and Blood Stagnation
¾ After Period - Qi and Blood Deficiency
¾ 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
¾ Cold pain in low abdomen, better with warmth
- Cold Stagnation ð Qi & Blood Stag
¾ 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)
¾ Palpitations, dizzy, pale face, pale tongue, thin & weak pulse
- Blood Deficiency
¾ Weak low back and knees, dizziness, tinnitus, blurred vision
- Liver and Kidney Def
¾ Depression, wiry pulse
¾ Stabbing Pain in Abdomen, purple tongue
25
- Blood Stagnation
¾ Fullness in chest and abdomen, nausea, vomiting, profuse phlegm, leukorrhea, greasy
coat, rolling pulse
- Phlegm Damp Retention
Abnormal Bleeding
From Uterus - heavy, spotting, recurring but non-cyclical
¾ Heavy bleeding, bright red, red tongue, rapid pulse
- Heat in the Blood
¾ Purple color, clots, purple spots on tongue
- Blood Stagnation
¾ Light red, thin, no clots
- Qi Deficiency
Annex: Leukorrhea
Excessive vaginal discharge – white, yellow, or bloody
¾ White profuse, watery/clear, no smell

- Cold Damp in Lower Jiao
- Spleen Qi Deficiency
¾ Yellow profuse, thick, foul smell
- Damp Heat in Lower Jiao
¾ Slightly bloody, thick, sticky, slight smell
- Liver Qi Stagnation ð Heat in Lower Jiao
10. Special Questions regarding Children
¾ Emotional shocks or physical traumas during pregnancy, use of smoking, alcohol or

drugs during pregnancy
- Kidney (pre-heaven or congenital essence/qi) impairment
¾ Slow body development, late teething, etc
- Kidney (pre-heaven or congenital essence/qi) impairment
¾ Birth trauma – Lungs, brain
¾ Breast feeding or weaning problems - Food Stagnation
¾ Convulsions - Heat and/or Wind
¾ Hereditary Diseases - Zang Fu Organs
¾ Infectious Diseases – e.g. whooping cough, measles,
¾ chicken pox - weak Lung Qi and/or Wei Qi
¾ Diet - Spleen
26
Chapter IV: Auscultation & Olfaction
1. Auscultation (listening)
Voice/Speech
Shows state of Vital Qi and Nature of Pathogen (Cold/Heat)

¾ Loud Excess Syndrome
¾ Weak Def Syndrome
¾ Talkative/Restless Heat Syndrome
¾ Quiet Cold Syndrome
¾ Deep/Stuffy Exterior Syndrome (nasal obstr)
¾ Hoarse/LOV Abrupt - Exterior Pathogen
Gradual/Recurrent - Lung & Kid Yin Def
Chronic/Prolonged – Exhaustion of Vital Qi
Incoherence
Shows Shen and Mental Disturbance

¾ Ravings/Mania Liver Fire
“Phlegm obstr Heart Orifices”
¾ Soliloquy/Repeating Def of Heart Qi
¾ Delirium/Loss of consciousness CRITICAL, high fever disease - Ying and Xue
(blood) stages
¾ Fading/Broken sentences Severe Heart Qi Def or Exhaustion of Vital Qi
Breathing
Reveals condition of Lungs and Kidneys.

¾ Weak Lung Qi Def
¾ Coarse/Loud Lung Heat
¾ Asthmatic/SOB Lung Qi and Kidney Qi Def
¾ Coarse/Asthmatic Excess Pathogens retained in Lungs
¾ Sighing Liver Qi Stagnation
Coughing
Main symptom of Lung disorders.

¾ Coarse/Loud Voice Excess Syndrome
¾ Weak Voice Deficiency Syndrome
¾ Thick Yellow Spit Wind Heat -> Lung Heat
¾ Thin White Spit Wind Cold -> Spleen & Kid Yang Def
¾ Whooping Cough Phlegm retention in Lung
27
Lung Qi Stagnation
¾ Spasmodic Cough Toxic Heat attacks throat
Lung & Kidney Yin Def
2. Olfaction (smelling)
Odour smelt from patient’s secretions or excretions
Fetid/Sour
¾ Mouth/Vomit Stomach Heat
¾ Stool Damp Heat in Large Intestine
¾ Leukorrhea Damp/Toxic Heat Syndrome
** CERVICAL/UTERINE CANCER
¾ Sour Smell Food Stagnation
Fish Stench
¾ Blood/Pus in Spit Lung Abscess
¾ Loose Stools Spleen Yang Def
-> Def Cold Diarrhoea
¾ Sticky Leukorrhea Cold Damp in Lower Jiao
Strange Odour
¾ Rotten Apples Diabetes
¾ Urine Kidney Failure from Nephritis
28
Chapter V: Palpation
A. In General
Feel, touch, press patients body surface for local abnormal changes
¾ Superficial
Fingers palpate the superficial tissues, gently but with increasing force
Used on Body Surface and Joints
¾ Deep
Press fingers hard with heavy pressure to feel deep tissues and organs
Used on Abdominal Cavity & Deeper Soft Tissues
B. Temperature
¾ Hot/Cold at first touch, the longer it is felt the less it is

- Exterior Wind/Heat or Exterior Wind/Cold
¾ Maintains Heat or Hot on deep pressure
- Internal Excess Heat or Yin Deficiency
¾ Maintains Cold or Cold on deep pressure
- Internal Excess Cold or Yang Deficiency
¾ Cold on Loins, Low Back, Low Abdomen
- Kidney Yang Def
¾ 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
¾ Thyroid moves up/down on swallowing, large, unclear on edges, skin colour ok, soft if
pressed
- Def of Iodine
¾ Thyroid edges clear, enlarged, smooth surface, not painful if pressed
- Phlegm & Damp Ret
- Qi & Blood Stag
¾ Thyroid is “as Hard as Stone”, uneven surface, unmovable, painful if pressed.
Thyroidal Cancer
- Phlegm & Damp Ret
- Qi & Blood Stag
- Toxic Heat
29
- Vital Qi Def
Lymph Nodes
¾ Enlarged lymph nodes in the neck, acute onset, rapidly growing, hurt on pressing
- Wind/Heat Invasion
- Heat toxin (TONSILITIS)
¾ Enlarged lymph nodes in the neck, chronic onset, slow growth, do not hurt if pressed
- Phlegm Retention (TB)
D. Chest
¾ Palpation of apex of the heart

Regular pulsation -> Zong Qi normal
Faint -> Deficiency of Zong Qi
Too Strong -> “Outpouring of Zong Qi”
No pulse -> Phlegm Retention in Chest
-> Heart Yang collapse
E. Breast Nodules
¾ smooth on surface, hard in texture, moveable, can feel edges

- Phlegm/Blood/Qi Stagnation
¾ uneven surface, hard in texture, immovable, indistinct edges, liquid oozing, skin looks like
tangerine peel - BREAST CANCER
- Phlegm & Damp Retention
- Qi & Blood Stagnation
- Toxic Heat
- Vital Qi Def
F. Abdominal Diagnosis
¾ Use the pads of the three middle fingers

¾ Press down on exhalation with firm and slow pressure
¾ Go down to a maximum of two inches/five centimetres
¾ Painful, just uncomfortable, or normal?
Abnormalities -> imbalance in associated organ
Abdomen palpation
¾ Solid but not hard, resilient but not tight, elastic but not soft
- NORMAL
¾ Upper Abdomen (below Xyphoid process)
30
full and painful ->Liver Qi Stagnation

hard and knotted ->Lung Qi Stagnation
¾ Lower Abdomen (below navel)
soft, flabby -> Essence (Yuan Qi) Def
¾ Cold, better with warmth -> Cold Syndrome
¾ Hot, better with cold -> Heat Syndrome
¾ Pain, worse on palpation -> Excess Syndrome
¾ Pain, better on palpation -> Def Syndrome
Abdominal Masses
¾ Mass of no definite shape, pain and mass movable

Zang Front Fu Front
- Intestinal Spasms and Cramps
organ Mu organ Mu
- Qi Stagnation
Point Point
¾ Mass of definite shape, fixed pain, unmovable
- Blood Stagnation (Tumour) Lung LU1 Large ST25
Intestine
G. Palpation of Points Spleen Liv13 Stomach Ren12
Heart Ren14 Small Ren4
Alarm Points (“Front Mu”) Intestine
Kidney GB25 Bladder Ren3
Palpate with one finger and with less pressure
Make a note of any areas of tenderness Pericardium Ren17 San Jiao Ren5
¾ Front Mu points located on chest or abdomen Liver Liv14 Gall GB24

¾ One point associated with each organ Bladder
¾ Indicate disease or imbalance of organ
¾ Qi of the organ collects at this point
Zang Yuan Fu Yuan

Yuan Source Points
organ Point organ Point
¾ Located on wrist or ankle Lung LU9 Large LI4

¾ One point associated with each organ Intestine
¾ Indicates more major disease/imbalance in Zang organs Spleen SP3 Stomach ST42
¾ Original Qi of the organ collects at this point Heart HT7 Small SI4
¾ Yin source points tonify yin organs Intestine
¾ Yang source points expel pathogenic factors
Kidney KI3 Bladder BL64
Pericardium PC7 San Jiao SJ4
Liver LIV3 Gall GB40

Bladder
31
Chapter VI: Pulse Diagnosis
A. Introduction
Pulse diagnosis– one of most important diagnostic techniques in TCM
1. Why?
¾ Reflects the function and state of the Zang Fu Organs
¾ Indicates the location and nature of disease
¾ Helps determine the nature of pathogens
¾ Helps predict the prognosis of disease
2. Where?
¾ 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)
¾ Nowadays, only wrist pulse is used.
3. How? - Methods of Pulse Taking
¾ Wrist should be at same level as the heart (sitting up or lying down)

¾ Use your index finger, middle finger, and ring finger
Cun Index Finger
Guan Middle Finger
Chi Ring Finger
¾ At superficial, middle and deep levels
¾ Feel the pulse in each wrist for more than 1 minute, but usually no more than 3 minutes
¾ 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
¾ 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) Right: Cun Lung (LI)
Guan Liver (GB) Guan Spleen (St)
Chi Kidney Yin (Bl) Chi Kidney Yang (Mingmen)
32
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?

¾ Smooth, even, gentle at all 3 levels and positions
(Cun/Guan/Chi and superficial/middle/deep)
¾ Moderate force, regular rhythm
¾ 4 beats per breath (synchronize breathing) (60-90 BPM)
“A normal pulse should have Shen, have Qi and have root.”

¾ Even, gentle, forceful - shows state of Spirit (Shen)
¾ Not floating or deep, not fast or slow - has (stomach) Qi
¾ Feel also at deep level and at Chi position - has “Root”
7. A Glance at Pulse Diagnosis

¾ Floating - acute/exterior
¾ Deep - chronic/interior
¾ Rapid - heat
¾ Slow - cold
¾ Strong - excess (vital qi is strong)
¾ Weak - deficiency (vital qi compromised)
¾ Characteristic feelings of the pulse (28 of them!)
e.g. wiry pulse …..Liver/GB Dysfunction or pain….
rolling pulse…Excess Damp/Phlegm or Food Stagnation
8. Factors that affect Pulse

¾ Age :
between 5 –12 pulse is more rapid…(90-100 bpm)
elderly patients have a soft and weak pulse
¾ Gender: women have tendency to blood deficiency, pulse is slightly rapid
and thin
if pregnant pulse is rolling/slippery
33
¾ Body Constitution Tall people Pulse is longer

Short people Pulse is shorter
Thin people Shallow pulse
Obesity Deep pulse
¾ Profession Heavy physical laborer Stronger pulse
More Mental work Weaker pulse
¾ Season Summer Flooding Pulse Heart pos
Autumn Floating Pulse Lung pos
Winter Deep Pulse Kidney pos
Spring Wiry Pulse Liver pos
¾ Other Drink Alcohol Fast
Hungry 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,
¾ Not always reflecting the function and state of the Zang Fu organs
¾ Not always reflecting the location and nature of disease
¾ Not always reflecting the nature of pathogens
¾ 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/ Deep/

floating 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
34
1. By Depth
Superficial/Floating Pulse
Superficial with light pressure, weak on pressing hard, “like wood floating on water”
(rebounds back up)
- External Syndrome
¾ Floating & strong - External Excess Syndrome
¾ Floating & weak - External/Internal Def Syndrome
¾ Floating & rapid - External Heat Syndrome
¾ 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
¾ Deep & strong ð Internal Excess
¾ Deep & weak ð 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
¾ Rapid & Strong ð Excess Heat
¾ Rapid & Weak ð Deficient Heat
¾ Rapid & Floating ð External Heat
¾ Rapid & Deep ð Internal Heat
Rapid pulse is normal in young children or infants
Slow pulse
Less than 4 beats per respiration, below 60 bpm- Cold Syndrome
¾ Slow & Strong ð Excess Cold
¾ Slow & Weak ð Deficient Cold
¾ Slow & Floating ð External Cold
¾ Slow & Deep ð 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
Ö Normal pulse in healthy people
Ö Excess syndrome
35
Weak Pulse
Small, less forceful, “like a worm creeping in a cotton wool”
Ö Deficiency syndrome
4. By Quality
Rolling/Slippery
Smooth, rounded, slippery, “like pearls rolling in a dish” or “fish swimming in water”
¾ Characteristic pulse for Phlegm syndrome
¾ Obstruction by Food Stagnation or Wind/Phlegm
¾ Also seen in a NORMAL person
¾ Also seen in PREGNANT WOMEN
¾ 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”
¾ Liver & GB Problems e.g. Liver Qi Stag/Liver Fire/Liver Yang Rising

¾ Can also occur with Pain
¾ Wiry, wide and slippery -> Liver Yang Rising
¾ 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”
¾ Choppy & Strong - Blood Stagnation from Cold/Damp Accumulation etc.
¾ 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
36
Long Pulse
Longer than three positions, firm and hard, “like a stick of bamboo”
¾ Excess Interior syndrome
¾ Maybe also generating Wind/Phlegm
¾ Long and GENTLE is NORMAL, indicating sufficient Qi and Blood
Short Pulse
Pulse clear at Guan, unclear either end ->Qi and Blood Deficiency
¾ Short & Deep -> Qi//blood/Yang Deficiency
¾ Short & Rapid -> Deficiency with Heat
¾ Short & Slow -> Deficiency Cold
7. By Rhythm
Knotted Pulse
Slow, loses beats at irregular intervals
-> Internal Cold & Obstruction Qi and Blood (from excess Yin or Body
Fluids or Yang Def)
¾ Floating and Strong -> External Cold invading Channels
¾ 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
¾ Can come from chronic disease or trauma
¾ 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)
¾ Hurried & Weak -> Deficiency of Zang Fu
C: Other Types of Pulses
1. Moderate/Leisurely Pulse **NORMAL
37
4 beats per respiration, 60 bpm, gentle, regular, relaxed

“elegant like a willow branch in a gentle breeze”
¾ If slightly slower….can be athletes, manual laborers
¾ …and going deeper ….Spleen Qi Def & Damp
2. Tight Pulse
Strong, forceful, wiry “stretched, thick, TWISTED rope”

¾ Cold Syndrome
¾ Pain Syndrome
3. Firm Pulse
DEEP, strong and wiry

¾ Interior Excess Cold and excessive Qi Stagnation
4. Moving Pulse **can feel like its irregular
“round, like a bean” on Guan (middle) position

Strong, rapid, slippery, and …SHORT
¾ Severe Pain
¾ Fear or Fright scatters Qi
¾ Yin and Yang fighting and neither winning….
5. Racing Pulse **CRITICAL
Over 7 beats per respiration, 140 bpm, regular

** HEART DISEASE
¾ Extreme Yang & Exhaustion of Yin
¾ Impending Exhaustion of Vital Qi
6. Leathery Pulse
Superficial, large, TIGHT, and empty in middle and deep levels

“like a drumskin”
¾ Deficiency of Essence & Blood (over 40 years old)
¾ (from loss of blood and internal deficient cold)
7. Soggy/Soft
Floating and weak, THIN

“like a strand of cotton floating on water”
¾ Qi & Blood Def

¾ Damp Accumulation (usually from Spleen Deficiency)
38
8. Empty Pulse
Floating, big and soft, loses strength on pressure

¾ Yin/BF Deficiency with damage to upright Qi
9. Hollow Pulse
Floating and weak, WIDE, sensation of emptiness while

walls are hard, “like pressing a spring onion stalk”
¾ Yin/BF Deficiency
10. Minute Pulse ** CRITICAL
Extremely thin and weak, fades in and out on pressure

¾ Extreme Qi & Blood Deficiency
¾ Exhaustion of Yang Qi (SHOCK)
11. Hidden Pulse **CRITICAL
Deep, weak and THIN, “press below the bone”

¾ Yin or Cold Pathogens obstruct Channels or Zang Fu
¾ 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”
¾ Collapse of Kidney Yang or Essence
¾ Failure of Zang Fu Organs
39

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Chinese Medicine Diagnostics by Hui Jun.

Chinese Medicine Diagnostics

Hui Jun Shen

¾ CM Diagnosis is based on fundamental principle that signs and symptoms on

1. Diagnostic Methods - The 4 Techniques:

2. Diagnosis: Difference between WM and TCM

Chapter I: Observation – “Looking”

¾ Materials for Shen : Qi, Blood, Essence and Body Fluids

Indicating: insufficient Qi, Blood, Essence and Body Fluids

¾ Eyes Bright but not shiny

Mouth & Lips

Teeth & Gums

¾ Dull Deficiency of Body Fluids

Chapter II: Tongue Diagnosis

The Formation of Tongue

Clinical Significance of Tongue Diagnosis - Using Tongue Diagnosis we can:

Method of Tongue Diagnosis:

B. Tongue Body Diagnosis

B) Tongue Body Shape and Clinical Indications

¾ Light Red/Yellow Greasy Coat

¾ Deep Red/Occupies All Mouth

Excessive Internal Heat

¾ Blue and Purple

“Thorny” Papillae on surface of the tongue (like red strawberry pips)

C) Tongue Body Movement and Clinical Indications

Shortened Curved up or down or contracted, unable to project far, may be congenital

¾ Moist and Pale Cold Stagnation

C. Tongue Coating Diagnosis

A) Colour of Coat and Clinical Indications

Middle only Exhaustion of Stomach Qi

B) Quality of Coat and Clinical Indications

Changes in thickness, moisture, or surface coating, e.g. slippery, greasy, peeled

Chapter III: Enquiry - “10 Questions”

¾ Treat patients “from the heart”

¾ Keep the focus on the Main Complaint

¾ Prompt patient but DO NOT DIRECT patient

¾ Try and keep the language simple

¾ Keep a natural expression!

General Inquiry Points

¾ Name, address, and phone number

¾ How can I help you today?

¾ Did it start quickly or gradually

¾ Details of main complaints….

¾ What other symptoms are they having…..

(the short list…relevant to main complaint? or not….)

¾ How is main condition developing….

¾ Did they see a western medicine doctor? Who, what, where?

¾ Any possibility they could be pregnant? (appropriately ask..)

Chills with no Fever

¾ Abdominal fullness and pain, better with warmth

Chills with Fever

¾ More Chills than Fever:

And…aversion to wind and spontaneous sweating

Fever with no Chills

1). High Fever - Temperature over 102.2oF or 39oC (“4 Bigs”)

2). Tidal Fever - Comes at regular time in the afternoon

¾ Fever comes or is worse between 3 and 5 pm

¾ Fever is higher in afternoon

Internal heat syndrome, can be excess heat or deficiency heat

in intestine, damp/heat in bladder, damp/heat in lower jiao

¾ Big Sweat, Flooding Pulse, Fever & Thirst (4 Bigs)

¾ Burning, better with cold

¾ Headache due to interior causes