CCM Diagnosis Flashcards
normal tongue
good shen: vibrant, vital
body color: fresh pale red
coat: thin, white (or slight yellow), slightly thicker at root
shape: moderate, no scallops, not curled up or down
no crevices or depressions
no movement
pathological tongue color
Red = heat (excess or yin deficiency) Purple = blood stagnation Dusky = qi stagnation Pale = qi, blood, or yang deficiency
The tongue image of both Qi and blood deficiency
Qi xu: pale + tender, slightly flabby
Blood xu: pale + slightly dry or smaller
yin/yang: tongue pulse
pulse: choppy/slippery
tongue: body = yin organs/coat = yang organs
exterior/interior : pulse tongue
pulse: floating/deep
tongue: thick coat/thin or no coat
cold heat
pulse tongue
pulse: slow/rapid
tongue: pale, bluish or purple/red, crimson
xs/ xu
pulse tongue
pulse: replete/deplete
tongue: rough/tender
normal 4 seasonal pulses
Spring: floating
Summer: flooding
Fall: sinking
Winter: stony (like a stone sinking to the bottom of a pond)
Fu (floating) pulse
Quality: very superficial (heaven level)
Felt with a gentle touch and becomes weaker but never becomes empty under heavy pressure.
“ Feels like a piece of wood floating on the water.”
Indication: exterior syndrome, Qi &blood Xu in chronic disease
Exterior syndrome
Xie Qi invades the surface and the Zheng Qi rises up to fight Xie Qi.
- Floating + tight –wind cold invasion
- Floating + loose – wind dampness
- Floating + slowdown- deficient type of wind cold invasion “Zhong Feng” ·
Floating + rapid – wind heat invasion
Yang Qi floating away
Floating + scattering – collapse of Yang in critical condition
Floating + choppy – Yang Qi floating away after severe hemorrhage.
Chen Mai (deep pulse)
Quality: deep located at the earth layer, hard to feel under light pressure, revealed only when heavy pressure is applied. “ throw a stone into water and the stone sinks to the bottom”
Indication: Interior syndrome
- Deep+forceful – Shi type, pathogens deep inside the body
Deep+forceless- Xu type, Yin, Yang, Qi and blood deficiency
Chi Mai (slow pulse)
Quality: it refers to the rate of pulse (not strength or location), less than 4 beats per breath.
Indication: Cold syndrome
- Slow+forceful – cold invasion
- Slow+ forceless- deficient cold (generated from Yang deficiency)
- Slow + superficial – exterior cold
- Slow + deep – internal cold
Congested heat inside body:
Heat mixing with stools in the large intestines, block Qi flow, suppress blood vessels, cause deep and forceful pulse, which present in the Yangming Fu syndrome.
Shuo Mai (rapid pulse)
Quality: 5 beats per breath
Indication: heat syndrome
- Rapid +forceful – excessive (full) heat
- Rapid +forceless – deficient (empty) heat
- Taut, tense, tight, wiry – width consolidates and density increases
Hua Mai (slippery pulse)
Quality: kind of rapid pulse comes and goes smoothly as if it slides under your fingers. “ beads rolling on a plate”
Indication:
- Slippery and rapid – heat syndrome or damp heat , or phlegm heat, stagnant food, retention of Tan/Ying
- Healthy people: ample/abundant with Qi and blood
- Pregnant woman: blood flows into the uterus to nourish fetus instead of menstruation.
Se Mai (choppy pulse)
Quality: a pulse with rough uneven beats, it comes and goes with great difficulty, hesitant and congested. “as if a broken knife scraping a piece of bamboo” “ a sick silkworm eating a mulberry leaf”.
Indication:
- Thin, slow, choppy and forceful-Shi condition
- blood stasis, tumors
- sticky phlegm, like Xiong Bi: chest pain due to phlegm blockage.
OR
- choppy but forceless- Xu condition
- blood deficiency
- severe damage to body fluid
- loss of kidney essence, for men, impotence; for women, infertility.
Xu Mai (deplete pulse)
Quality: lack of strength, under light touch, it appear big and slow, under heavier pressure it becomes empty and loose.
Indication: deficiency syndrome
- Depleted and rapid -Yin deficiency
- Depleted and slow –Yang deficiency
- Depleted and thin – blood deficiency
- Depleted and soft – Qi deficiency
Shi Mai (replete pulse)
Quality: it is big and long, solid and strong, comes and goes with force and reveals distinctively on the three positions.
Indication: excessive syndrome, Xie Qi prevails, while Zheng Qi is still strong enough to strike back.
Chang Mai (long pulse)
Quality: It is straight, extending over the Cun and Chi positions.
Indication:
- Long and soft “as if you touch the end of a fishing rod”- ample with Qi and blood.
- Long and hard “as if you get hold of a long bamboo pole” –predominance of the Xie Qi (pathogenic factors).
Duan Mai (short pulse)
Quality: short, fails to extend (cover) the 3 positions, only feels clearly on the Guan position.
Indication: Qi problems.
- Short + forceful: Qi stagnation, unable to push blood to move through the vessels
- Short + forceless: Qi deficiency, unable to push blood to fill up the vessels.
Hong Mai (flooding , overflowing pulse)
Quality: wide and large, feel full and forceful, comes vigorously and goes gently, “as if the waves surging on”.
Indication: mostly the excessive heat
- Flooding and forceful: excessive heat
- Qi in the Qi phase (4 levels of Wenbing)
- Yangming heat syndrome (6 channels of Shanghan)
OR
Flooding but forceless: appears in the critical stage in which weak Yang excluded by excessive Yin.
Wei (fainted pulse)
Quality: extremely fine and soft on superficial level, almost disappears on the deep level, “ as if pressing on a spider web that is going to break any time.” Faint, vague, indistinct, frail, and minute.
Indication: extreme deficiency
- Yang Qi deficiency
- Shaoyin disease
- Acute collapse of Yang Qi
Jin Mai (tight pulse)
Quality: tense, taut pulse with high tension, “as if you feel a stretched, twisted rope”.
Indication:
- Cold syndrome: cold congeals Qi and blood, and contracts the vessels
- Severe pain
- Retention of undigested food /parasites
- Wind cold invasion- floating and tight.
Huan Mai (leisurely pulse)
Quality: it refers to both rate and tension of the pulse. As to rate, it has 4 beats per breath (neither slow nor rapid). As to tension, it is a little bit loose.
Indication:
- Healthy person: relaxed and moderate
- Disease: spleen deficiency, accumulation of dampness
- A good sign of recovery during the disease.
Kou Mai (hollow pulse)
Quality: floating and large at superficial level and becomes hollow and empty under heavy pressure. “as if pressing on a scallion stalk.”
Indication:
- not enough blood /fluid to fill up the vessel
- Loss of blood
- Consumption of body fluid
Xuan Mai (wiry pulse)
Quality: straight, long, taut, forceful on all three levels, “as if pressing on a guitar string.”
Indications:
- Liver /gall bladder problems
- Pain syndrome
- Dilute phlegm- Tan Yin
- Malaria
Ge Mai ( leathery)
Quality: it is similar to Kou Mai, wiry and big on the superficial level, and becomes hollow under heavy pressure, “as if pressing on the tough surface of a drum”
Indication: in general, blood deficient inside and Qi flees outward, extreme deficiency.
Loss of blood from severe hemorrhage.
Consumption of kidney essence, Kidney Yang deficiency, impotence and spermatorrhea of men, miscarriage and uterine bleeding of women.
Lao Mai (firm pulse)
Quality: firm, big, long and wiry felt only on the deep level.
Indication:
- extreme excess
- Cold congealation
- Zhen Jia (abdominal tumor)
- Stubborn pathogens hidden inside
Ru Mai (soggy pulse)
Quality: thin, soft and superficial. In another word, it appears distinctively under a light touch, and vague under heavy pressure. “ cotton floating on water”
Indication:
- Dampness
- Deficiency, consumptive diseases (Xu Lao)
Ruo Mai (weak pulse)
- Quality: very similar to Ru Mai, soft and thin, but deep. -Indication: deficiency of Qi and blood
- Qi- strength of pulse -Blood- size of pulse
- This pulse is common among the elderly, very bad sign if it appears on the young.
- Normal in chronic disease and bad sign in acute disease.
San Mai (scattered pulse)
Quality: floating and big, but not solid, gathering, easily felt with light touch, and becomes empty under moderate pressure, and completely gone under heavy pressure. “ dandelion seeds blown in the wind”, “ scatter away without any trace.”
Indication: this is a critical sign pointing to scattering of Yang Qi when a person is dying.
Xi Mai ( thready pulse)
Quality: thin and fine like a thread, but distinct on all three levels.
Indication:
● Deficiency of Qi and blood
● Damage of body fluid by heat-thin and rapid
● Dampness- thin and Ru
Fu Mai (hidden pulse)
Quality: very very deep, as if the “pulse hides itself behind the bones and tendons. Only felt when you push away the tendons.
Indications
- Evil Qi blockage
- Jue syndrome
- Intense pain, like colic pain
Dong Mai (rolling pulse)
Quality: similar to slippery pulse, but it is quicker and stronger. It is short with round shape, like “peas jumping under the fingers”. Felt more on the Guan position (“no head and tail”) and more distinct on the middle level. -
Indication:
Fear, panic
Severe pain
Pregnancy
Cu Mai (hasty pulse)
Quality: fast (as fast as rapid pulse, over 90b/min) and stops at irregular intervals. Pulse is in a hurry and suddenly it stumbles. As if “ a person stumbles while walking briskly.”
Indication:
Hasty and forceful
excessive heat, like a gust of fury, madness, asthma attack, heart attack, etc.
Hasty but forceless- exhaustion of Yuan Qi. Like palpitation and Zhen Xin Tong.
Jie Mai (knotted pulse)
Quality: It is slow (less than 60 b/ min), stops at irregular intervals.
Indication:
Knotted and forceful
congestion of Yin pathogens, such as blood stasis, food stagnation, phlegm accumulation, etc.
Knotted and forceless-deficiency
Dai Mai (intermittent pulse)
Quality: It is slow and stops at regular intervals. And the interval is longer than Jie Mai. It is compared to a weak person carrying heavy loads, heading on the way, stopping every mile for a rest.
Indication:
Exhaustion of Zang Qi. One beat missing in 50 beats, one organ exhausted.
Deficiency of both Qi and blood- poor prognosis, worse than Jie Mai.
Ji Mai (racing pulse)
Quality: It is very fast (7 b/ breath, > 120 b/ min)
Indication:
Extreme heat in febrile diseases
Critical condition-impending death, separation of Yin and Yang.
