10 questions Flashcards
10 questions (one hot day)
- hot/cold
- sweat
- thirst
- urination
- bowels/digestion
- ribs/abdomen
- head/face ENT
- pain
- sleep
- gyn/sexual function
EXTERIOR
HOT/COLD
acute
rapid onset
INTERIOR
HOT/COLD
chronic
gradual onset
HOT
HOT/COLD
fever/chills
- fever predominant: WIND HEAT
- fever only: INTERIOR HEAT (can be EXCESS/VACUOUS)
INTERIOR HEAT EXCESS
HOT/COLD
INTERIOR HEAT - EXCESS:
- big thirst (gulps)
- forceful (P)
- thick/darkred (T) with yellow coat
- 4 BIGS
INTERIOR HEAT VACUITY
HOT/COLD
INTERIOR HEAT - VACUOUS:
- big thirst (sips)
- forceless (P)
- thin/red (T) with no coat
- NIGHTSWEATS
COLD
HOT/COLD
FEVER/CHILLS
- chills predominant: WIND COLD
- chills only: INTERIOR COLD (can be EXCESS/VACUOUS)
INTERIOR COLD EXCESS
HOT/COLD
INTERIOR COLD - EXCESS:
- intense pain (worse with pressure)
- forceful/slow (P: tight/wiry/deep/confined)
- bluish/pale (T)
INTERIOR COLD VACUITY
HOT/COLD
INTERIOR COLD - VACUOUS:
- cock’s crow diarrhea (yang vacuity)
- undigested diarrhea/lethargy (SP T&T fail)
- profuse sweating without exertion
- forceless (P)
- bluish/pale (T) wet/thick/swollen
- bright white complexion
- T&T FAILURE
- most often overweight (obesity = yang vacuity)
THIRST progression
THIRST/APPETITE/TASTES
yin vac > heat > fire
* yin is always vacuous
BIG THIRST
THIRST/APPETITE/TASTES
drink in gulps
- excess, interior heat
LITTLE THIRST
THIRST/APPETITE/TASTES
drink in sips
- yin vacuity + vacuity heat
- starting to dry, but not hot yet
THIRST, NO DESIRE
THIRST/APPETITE/TASTES
drink in sips (because it’s hot; no desire)
- due to damp-heat (excess yin)
THIRST, WARM FLUIDS
THIRST/APPETITE/TASTES
cold (interior cold)
can be excess/vacuous
- usually due to exterior cold invasion
SWEAT
ask about abnormal varieties:
- sweating without exertion
- sweating when it’s not hot outside
EXCESS SWEATING
SWEAT
excess heat
big sweat
running hot
excess yang
VACUOUS SWEATING - YIN
SWEAT
YIN VAC
- night/tidal sweating
- 5-centered heat
VACUOUS SWEATING - YANG
SWEAT
YANG VAC
- spontaneous/profuse sweating without exertion; worse during day
VACUOUS SWEATING - QI
SWEAT
ZHONG QI VAC
- sweaty palms/feet (SP T&T fail)
- damp to wet depending on SP’s vacuity
WEI QI VAC
- leaking qi, moist
- pores not closed
MIXED SWEATING
SWEAT
(EXCESS/VACUITY)
- damp accumulation
- superficially moist
- usually excess pathology; rises from vacuity pathology
LACK OF SWEATING
SWEAT
abnormal variety
something’s blocking surface
excess cold = no sweat (block)
unsurfaced dampness
NORMAL BOWELS
BOWELS
1 to 3x daily
- well-formed (not loose/hard; - no undigested food)
- no blood/pus
- not much odor
- easily evacuated (no straining; sense of completion)
CONSTIPATION
BOWELS
less than 1x daily
- dry bowels (due to EXCESS/VACUOUS HEAT)
- common in yin deficient, elderly patients
TYPES OF CONSTIPATION
BOWELS
- cold LI (excess heat; rare)
- binding LI (damp-heat; not enough fiber)
- LV qi stagnation (little pellets)
- SP qi vacuity (pencil shape)
- qi vacuity (cc is not constipation; 7-8 days; lack of energy to move bowel, although reasonable diet; just diminished peristalsis function)
VACUITY
BOWELS
exhaustion after evacuation
- downward pressure qi doesn’t hold up)
EXCESS
BOWELS
feeling better after evacuation
- damp-heat remnants; fudgy, pungent aroma
YANG VACUITY
BOWELS
pain (due to vacuity cold)
DIARRHEA
BOWELS
more than 3x daily
- loose, unformed
DIARRHEA - YANG VACUITY
BOWELS
“cock’s crow” because early morning
- wake up at dawn with urgent need to go
- undigested food
DIARRHEA - QI VACUITY
BOWELS
SP QI VACUITY
- loose, not well-formed stools
- 1 to 3x daily
- gasy/bloaty (T&T)
- excessive volume
DIARRHEA - DAMP-HEAT
BOWELS
LI DAMP-HEAT
- explosive, urgent need to go
- foul odor (due to excess heat)
ALTERNATING CONSTIPATION + DIARRHEA
BOWELS
MIXED
- LV qi stagnation (LV/wood overacting on SP/earth)
- LV qi weak: constipation
- SP qi weak: diarrhea
- diarrhea x constipation
FOOD POISONING
BOWELS
TOXIN
- rapid onset
- pain/cramping
- explosive
- foul odor
- ACUTE
URINE
URINE
light yellow (straw/hay color)
- 7 to 10x daily
- no night urination
- odorless
- no blood
- no pain
- no urgency
- no cloudiness
- exceptions: vitamins, asparagus, morning (darker)
POLYURIA
URINE
excess urination
- KD qi vac: leaking
- KD essence vac: leaking
- too many kids cause uterine prolapse
- laughing and coughing cause leakage
FREQUENT URINATION: KD YANG VACUITY
URINE
KD yang vacuity
- clear
- copious
- frequent
- large volumes
- BACK PAIN
- failure of T&T
- yang fails the holding function; also may be due to damp
FREQUENT URINATION: KD YIN VACUITY
URINE
KD yin vacuity
- darker
- cold
- frequent but SCANTY
- night time
- BACK PAIN
- also could be SP yang vacuity (immediate need to urinate after drinking)
FREQUENT URINATION: HEAT
URINE
typical heat patterns
- excess
- frequent (heat is irritating)
- strong odor
- dark colors
- usually scanty
- possible bleeding from heat
- may be burning (UTI)
- may be heat in L.JIAO
- may be HT heat (HT clears through SI, connects through UB)
URINARY INCONTINENCE
URINE
loss of control over urinary functions
- more serious, problematic condition
- KD essence and yang debility
ANURIA EXCESS
URINE
blockage of urine from
- damp
- damp-cold > damp-heat
- lin syndrome: stones
ANURIA VACUITY
URINE
KD yang vacuity
- pitting edema
- absence of urination
BEDWETTING CHILDREN
URINE
delayed UB qi
developmental issues; not pathological
- when older and still unable to control, QI VACUITY
QUESTIONS
THIRST/APPETITE/TASTES
quantity - how much
frequency - how often
processing - how well
EXCESS ST HEAT
THIRST/APPETITE/TASTES
SUDDEN BIG HUNGER (spontaneous/ravenous)
- eat frequently
- bad breath
- mouth sores
- reflux/GERD, belching
- gas (if present, odor)
- constipation (heat drying)
- diarrhea (heat causing things to move quickly without processing)
- ST channel facial acne
- big red face, bright red cheeks
- (T): red body, thick yellow coat (especially center)
- (P): rapid, maybe surging
- usually underweight due to fast metabolism
DEFICIENT ST HEAT
THIRST/APPETITE/TASTES
CONSTANT HUNGER (grazers; hungry all the time, but nibble; can’t take large amounts)
- sweet tooth
- small/quite burping
- small sips with thirst
- (T): red body, no coat; peeled center
- (P): rapid, forceless, thin
LACK OF APPETITE
THIRST/APPETITE/TASTES
DAMP ACCUMULATION (excess over vacuity)
- start with underlying SP xu, then internal damp with no T&T
- NO DESIRE/APPETITE
- can’t process well and feel full
- eat normal amount or less, but still gain weight
- ROTUND BODIES
- crave sweets (carbs, alcohol, candy)
- (T): pale, swollen (fluid accumulation), wet, greasy
- associated with SP deficiency
SP QI VACUITY W/O DAMP
THIRST/APPETITE/TASTES
NOT SO MUCH HUNGER
- bloating
- gas (no odor)
- compromised T&T (not processing)
- need nap after eating; energy goes into digestion
- (T): thin, pale, white coat (on sides)
TASTES
THIRST/APPETITE/TASTES
LV - sour/bitter SP - sweet/bland LU - spicy/acrid KD - salty HT - bitter
HEENT
headache
dizziness
hearing
vision
EXCESS HEADACHE: BLOOD STASIS
HEENT
STABBING; ICE PICK
- can point to exact spot
- often from injury, head trauma
- debilitating headache
- ASK ABOUT HEAD TRAUMA
EXCESS HEADACHE: DAMP
HEENT
TIGHT; VICE AROUND HEAD
- internal damp gets aggravated with external damp
- often associated with food (cold or damp food; good diet will eliminate)
- ask about weather patterns
EXCESS HEADACHE: LV FIRE
HEENT
THROBBING/POUNDING
- pure excess headache
- clear heat signs (dry, red eyes; flushing)
- angry all the time; quick to anger
- bitter taste in mouth
- PAIN OFTEN TEMPORAL (GB/LV)
- PAIN SOMETIMES BEHIND EYES
- emotional outburst
EXCESS HEADACHE: LV YANG RISING
HEENT
THROBBING/POUNDING
- excess over vacuity (yin/blood)
- less heat signs
- less angry, but easily frustrated
- emotional element
- dry eyes
VACUITY HEADACHE
HEENT
dull/achy
better with rest, better with pressure
aggravated with exertion
VACUITY HEADACHE: QI
HEENT
WHOLE HEAD
- worse earlier in the day (more yang than yin)
- loose stools
- SOB
- other qi vacuity symptoms
VACUITY HEADACHE: BLOOD
HEENT
TOP OF HEAD
- worse later in the evening and afternoon (yin time)
- dizzy
- poor memory
- worse during menses
VACUITY HEADACHE: KD ESSENCE
HEENT
IN THE BRAIN
- dull and achy brain
- worse during sex; can occur after sex (using up essence)
EEYORE S/SX
- pale
- spiritless
- premature aging signs
- craving salt
- lack of energy
- need to preserve energy (sleep, fix diet, exercise)
DIZZINESS: EXCESS
HEENT
LV fire
LV yang rising
phlegm: often associated w/ nausea
DIZZINESS: VACUITY
HEENT
KD essence/yin/yang
- lack of nourishment to the brain
BLOOD VACUITY
- orthostatic
EAR RINGING: KD VACUITY
HEENT
dull, droning
incessant/constant
EAR RINGING: LV EXCESS
HEENT
high pitched
quick onset; episodic
- often emotional component
HEARING LOSS: SLOW
HEENT
KD
gradual hearing loss due to aging
HEARING LOSS: RAPID
HEENT
RAPID ONSET
SJ enters ears
congestion/blockage
VISION: LV BLOOD VACUITY
HEENT
BLURRY
flowery/floaters
night blindness
VISION: KD VACUITY
HEENT
DIMINISHED EYESIGHT
- YIN VAC: dry version macular degeneration
- YANG VAC: wet version macular degeneration
LOSS OF SMELL: EXCESS
HEENT
FAILURE OF NOURISHMENT DUE TO BLOCKAGE
- phlegm
- damp accumulation
- sinusitis is due to damp-heat
LOSS OF SMELL: VACUITY
HEENT
FAILURE OF NOURISHMENT DUE TO INSUFFICIENCY
LUNG QI VACUITY
- weak pulse (right cun)
- regular/recurrent cold (always sick)
- possible SOB/asthma/bronchitis
GOOD SLEEP
SLEEP
- need 8 to 9 hours
- not waking up through the - – night (urination, nightsweat, restlessness)
- 10pm to 6am is most optimal
- no dreaming
- waking refreshed
INSOMNIA
SLEEP
getting 8 hours sleep doesn’t mean good sleep
- all types will have FATIGUE due to sleep deprivation
EXCESS INSOMNIA: LV FIRE
SLEEP
VIVID NIGHTMARES, DISTURBED DREAMS
- red eyes; angry
- waking up during night mostly because of dreams
- (T): red sides, or red all over depending on heat quality
- (P): rapid, surging
EXCESS INSOMNIA: HT FIRE
SLEEP
VIVID DREAMS OF FLYING
- mentally restless/agitated
- palpitations; red face
- waking up during night; can go back to sleep but not well-rested
- bitter taste in mouth
- (T): red tip, tongue sores
- (P): rapid
EXCESS INSOMNIA: PHLEGM HEAT
SLEEP
NIGHTMARISH DREAMS
- tossing and turning
- fair amount of nausea
- low appetite
- chest oppression; heaviness; tightness
- (T): swollen, red, greasy, yellow coat
- (P): rapid, slippery
*
VACUITY INSOMNIA: HT/SP VACUITY
SLEEP
DIFFICULTY FALLING ASLEEP
- anxiety
- worriers
VACUITY INSOMNIA: KD-HT DISHARMONY
SLEEP
TROUBLE STAYING ASLEEP; TOSS AND TURN
- wake up for 20-30min then go back to sleep
- KD YIN VACUITY: nightsweats
- HT HEAT
VACUITY INSOMNIA: LV YIN + BLOOD VACUITY
SLEEP
WAKE UP FREQUENTLY
- sleepwalk, sleeptalk
- big dreamers
- HUN cannot settle, so it wanders
VACUITY INSOMNIA: GB VACUITY
SLEEP
wake up at 3am and stay up for hours
- light sleepers
- easily startled; timid personalities
ACUTE SOMNOLENCE
SLEEP
EXTERIOR PATTERN; WEI QI
- fighting pathogens, leading to exhaustion
CHRONIC SOMNOLENCE: YANG VACUITY
SLEEP
CHRONIC YANG VACUITY
- overweight
- may sweat with no exertion
- fall asleep pretty much anywhere
- not enough yang to stay awake
- some element of damp accumulation
CHRONIC SOMNOLENCE: DAMP
SLEEP
DAMP (with underlying QI VAC)
- difficulty staying awake and alert
- lethargy; beyond fatigue
- T&T problem
BODY/TRUNK QUESTIONS
onset isolated event or episodic aggravating factors alleviating factors how it responds to pressure timing of onset: rapid/gradual location: fixed/migratory
EXCESS PAIN
BODY/TRUNK
RAPID ONSET
WORSE WITH PRESSURE
stabbing pain
wake up at night
VACUITY PAIN
BODY/TRUNK
GRADUAL ONSET
BETTER WITH PRESSURE, WORSE WITH EXHAUSTION
dull, achy pain; need to use heating pads
- may be KD vacuity
BI SYNDROME PAIN
BODY/TRUNK
EXCESS OVER VACUITY (QI/BLOOD/WEI); always BI is present with underlying vacuity
- heat (joint will be hot)
- cold
- damp (any precipitation; snow/humidity)
- with or without WIND
- if combined with WIND, pain is migratory
- climactic response
PAIN LOCATION
BODY/TRUNK
ribside: LV/GB LB/back: KD/UB frontside (umbilicus to pubic symphysis): UB/SI chest/thoracic: LU/HT middle: SP/ST shoulder: SI
GYN/SEXFX
NEED TO KNOW THE ONSET OF
- menstrual cycle
- fertility
- cessation of menses
MENSES
GYN/SEXFX
HISTORICALLY 2 x 7
- but now earlier (10, 11) due to environmental factors
NORMAL MENSES
GYN/SEXFX
- 5-7 days
- no flooding/spotting
- healthy red color
- normal viscosity (not 5. tacky/watery)
- no significant pain
- cycle 25-31 days
- 2x7
- 6x7 (peri-menopause)
- 7x7 (menopause)
EARLY MENSES, <25 DAYS
GYN/SEXFX
SHORTENED CYCLE
HEAT
- reckless blood
- excess/vacuity
- darker red, tacky
SP QI VACUITY
- failure to hold blood in vessels
- pale, watery (poor quality of blood)
DELAYED MENSES, >33 DAYS
GYN/SEXFX
LENGTHENED CYCLE
COLD
- dark, red
- clotting due to lack of flow
- excess: much more pain, worse with pressure, better with heat
- vacuity: dull pain, better with pressure, well with heat
BLOOD STASIS
- purple color
- clotting due to lack of flow; size of clot tells magnitude of stasis
- stabbing pain
BLOOD VACUITY
- rusty quality
- discharge-like; scanty
QI VACUITY
- pale; copious
- insufficient energy to move, then CAN’T HOLD
IRREGULAR MENSES
GYN/SEXFX
LIVER ISSUE
LV QI STAGNATION
- emotional stress
- dull pain
LV QI STAG W/ BLOOD STASIS
- even darker w/ deficient clotting
- more pain; stabbing
- over time, overactive LV affects SP qi
SP QI VACUITY
- semi-monthly bleeding
IRREGULAR MENSES PATTERNS
GYN/SEXFX
spotting: blood vacuity
irregular/delayed: stagnation
- need to open dai mai
any blood vacuity: chong
AMENORRHEA
GYN/SEXFX
PRIMARY
- taxation, lifestyle, athletes, fatigue
SECONDARY
- menarche @ 14, then no menses until 17 or 18 (nonpathological)
AMENORRHEA: VACUITY
GYN/SEXFX
yin, blood, jing
AMENORRHEA: STAGNATION
GYN/SEXFX
generally emotional component; can be combined with
- qi, blood
- cold, heat
- phlegm excess
qi vac > stag (cold/heat) > phlegm accumulation
BEFORE DYSMENORRHEA
GYN/SEXFX
QI/BLOOD STAGNATION
pain goes away when there is movement/period
- LV patient
- classic PMS s/sx (breast tenderness, ribside pain, emotional, headache/migraine)
DURING DYSMENORRHEA
GYN/SEXFX
HOT/COLD PATHOLOGY
(often combined with stagnation)
- cold: debilitating pain
- hot: uterine heat
AFTER DYSMENORRHEA
GYN/SEXFX
QI/BLOOD VACUITY
- dull, achy pain
- fatigue after period finished
LEUKORRHEA: COLD-DAMP
GYN/SEXFX
profuse discharge (clear/white) fishy odor
LEUKORRHEA: DAMP-HEAT
GYN/SEXFX
thick/creamy/sticky discharge (white/yellow)
strong foul odor
LEUKORRHEA: SP QI VACUITY
GYN/SEXFX
thick/creamy/sticky (white)
NO odor
PERI-MENOPAUSE
GYN/SEXFX
DYSREGULATION OF REN AND CHONG
KD yin vacuity
- irregularity in menstrual flow (flooding, missed, multiple, less predictable per month)
- yin vacuity symptoms (hot flash, nightsweats
- yang is not anchored so emotional s/sx
MENOPAUSE
GYN/SEXFX
SYSTEM IS REBALANCED; 12 CONSECUTIVE MONTHS OF NO PERIOD
consists of AGING S/SX
- dryness (vagina, eyes, skin)
- knee/back pain
- supported well with herbs