Diagnosis & Pattern Differentiation Flashcards
What are the four methods of examination?
Observation/Inspection
Listening and Smelling
Interrogation
Palpation
What are the traditional 10 questions of enquiry?
- Chills and Fever
- Sweat
- Head and body
- Stools and urine
- Appetite, thirst and taste
- Chest and abdomen
- Ears and eyes
- Sleep
- Old illnesses
- Lifestyle and emotions
The symptom of ‘thirst without the desire to drink’ is typical of what condition?
Excess of damp
What is the urine like with cold and heat conditions?
Cold - pale and copious
Heat - Dark and scant
What does spontaneous sweating, night sweats and oily sweating each indicate in interior patterns?
Spontaneous sweating - Qi Deficiency
Night sweats - Deficiency of Yin
Oily sweating - Yang deficiency
If the patient has both an excess and deficiency which is treated first?
Excess
List the 8 principles for disease patterns (Ba Gang)
Exterior/Interior
Deficiency/Excess
Cold/Heat
Yin/Yang
What is the only organ affected by exterior disease?
The lungs
What are some characteristic of exterior diseases?
Generally acute, sudden onset, short duration and less serious
What are some characteristics of interior diseases?
Chronic, gradual onset, more serious. Involves ZangFu, Qi, Blood and body fluids.
What are some causes of interior disease?
An exterior evil that is not expelled by the body
Emotions
Irregular food intake
Overstrain/stress
What is the order in which disease penetrates the body? (Starting from superficial layer)
Skin Flesh (pores) Muscles Blood Bone ZangFu organs
What exterior condition are kids more prone to and why?
Wind-Heat because they are balls of Yang energy
What are the chief manifestations of exterior disease?
An intolerance to cold and wind
Why does wind cause an aversion to cold?
Wind obstructs the space between the skin and the muscles where the defensive Qi circulates; as the defensive Qi warms the muscles, when it is obstructed it cannot do so therefore the patient feels cold.
What is classified as exterior and interior of the body?
Exterior - skin, muscles and channels
Interior - Organs
What does fever and aversion to cold symptoms that occur simultaneously always indicate?
An invasion from an external pathogenic factor
What are the 5 main clinical manifestations of exterior patterns?
Aversion to cold 'Fever' Aching body A stiff neck Floating pulse
Can also have headache, sore or itchy throat, nasal congestion and chills
What are the main clinical manifestations of exterior cold patterns (wind-cold)? (8)
Slight 'fever' Pronounced aversion to cold Severe aches in body Severe stiff neck No sweating No thirst Floating-tight pulse Thin white tongue coating
What are the main clinical manifestations of exterior hot patterns (Wind-heat)? (6)
'fever' Aversion to cold Slight sweating Thirst Floating-Rapid pulse Thin white tongue coating sometimes redness of tongue on the sides and/or front
What is a full condition characterised by?
The presence of a pathogenic factor of any kind and by the fact that the body’s Qi is relatively intact.
‘Fullness’ denotes fullness of a pathogenic factor, not fullness of Qi
How do the cold, wind, dampness and heat manifest in Painful Obstructive Syndrome?
Cold - Usually only in one joint, pain is severe and relieved by heat
Wind - Pain moves from joint to joint
Dampness - Swelling in joints
Heat - Pain is severe and the joints are hot and swollen
What is the most important symptoms that mark the change from the exterior to the interior stage?
The disappearance of aversion to cold and onset of aversion to heat
What are the chief manifestations of half exterior - half interior (Shao Yang disharmony)?
Alternating chills and fever Sense of fullness in the chest Nausea Bitter taste Blurred vision Dry throat Belching Wiry pulse
What are some common causes of Full Heat?
Invasion of yang evil
Invasion of external pathogenic factors such as cold which turns into heat in the body
Over consumption of yang foods or long standing emotional disorders leading to qi/blood stagnation which overtime generates heat
What are some common causes of Deficient Heat?
Chronic illness Overwork Excessive sexual activity Depletion of body fluids Loss of blood Dry environment
What is in excess/deficiency in Full Heat, Full Cold, deficient heat and deficient cold?
Full Heat - Excess Yang
Full Cold - Excess Yin
Deficient Heat - deficient Yin
Deficient Cold - deficient Yang
What are some symptoms of Cold deficiency “false cold’?
Cold limbs Light shivering Mild aversion to cold Preference of warmth Pain alleviated by pressure (dull pain) Slow weak movement Spontaneous sweating Clear frequent copious urination Loose stool with food particles
How does the tongue present with cold deficiency?
Pale, swollen, teeth marks, thin white wet coat
How does the tongue present with full cold?
Pale, thick white coat
How does the pulse differ from false cold to full cold?
False: Slow, weak
Full: Deep, slow, full
How does pain differ from false cold to full cold?
False: alleviated by pressure
Full: Aggravated by pressure
What are some symptoms of excess Cold “full cold”?
Cold limbs and body Strong shivering Marked aversion to cold Marked preference of warmth Pain aggravated by pressure (sharp pain) Strong forceful movement Little or no sweating Clear frequent copious urination Loose stool
How does the tongue present in empty heat and full heat?
Empty: Small red, peeled coat
Full: Red, large, thick yellow coat
How does the pulse differ from deficient heat to full heat?
Deficient: Thin, rapid
Full: Full, rapid
What are some symptoms of Empty Heat?
Tidal fever, afternoon 'temperature' Night sweats Malar flush; 5 palm heat (chest, palms and soles) Desire to drink in small sips Better with cold and pressure Weak rapid movement No bitter taste Feeling of heat in afternoon or evening Fidgety, wakes frequently Vague anxieties Flat scarlet blotches or indented ulcers Bleeding not so profuse Dark scanty urination Dry stool
What are some symptoms of full heat?
Fever Sweating Whole face red, hot face and body Desire to drink cold Better with cold, worse with pressure Strong rapid movement Bitter taste in mouth Feeling of heat all day Very restless, insomnia Irritable, delirium Red hot raised skin lesions Bleeding profuse Dark scanty urination Dry stool or explosive diarrhoea
Why are there usually signs of Spleen Yang deficiency in Deficient cold?
Because the Kidneys are the root of all Yin and Yang and if the Kidney Yang is weak then the Kidneys will fail to support the Spleen
What is the difference in internal patterns for deficiency and excess?
Deficiency - Generally refers to chronic internal patterns associated with deficiency with one or more of the substances, and one or more of the Zang Fu organs
Excess - Generally more acute and refers to the invasion of the body by external disease factors, or the over activity of one or more Zang Fu, or local obstruction of Qi, Blood, Body fluids or emotions, improper diet and lifestyle
Which Qi is weak in deficiency?
The right Qi
What are the conditions of Yin and Yang patterns?
Collapse of Yin Yang
Exhaustion of Yin Yang
Separation of Yin Yang
How does the tongue appear differently in Yin deficiency alone and Yin deficiency with Empty Heat?
Yin Deficiency: lacks a coating and colour is normal
Empty Heat: lacks a coating and colour is red
What are the 5 combinations of combined Hot and Cold?
Cold on the Exterior and Heat in the Interior
Heat on the Exterior and Cold in the Interior
Heat above and Cold below
Combination of Heat and Cold patterns
False Heat - True Cold and False Cold - True Heat
What is an Empty condition characterised by?
Weakness of the body’s Qi and the absence of a pathogenic factor
What is a Full-Empty condition characterised by?
An Emptiness of the Upright Qi with the presence of a lingering pathogenic factor that the Upright Qi is not fighting effectively
What is Upright Qi?
All types of Qi that play a role in the defence of the body from invasion by external pathogenic factors
Defensive Qi, Nutritive Qi and Kidney-Essence
What are the 4 types of Emptiness that can be distinguished?
Empty Qi
Empty Yang
Empty Blood
Empty Yin
What are the main manifestations of collapse of Yin?
Abundant perspiration Dry throat Thirst Restlessness and agitation Thin, dry skin Scant urine Skin hot too touch Tongue is red and dry with scant or absence coat Pulse is rapid, weak, and thin or thready
What are the main manifestations of collapse of Yang?
Feverishness Aversion to cold Profuse oily sweating Frequent, profuse urination or incontinence Cold limbs Preference for lying curled up No thirst Pale, moist, swollen tongue Pulse is thready, weak and fading
What are the six divisions and what organs do they each organs do each contain?
Tai Yang - Bladder, SI Yang Ming - Stomach, LI Shao Yang - Gall Bladder, San Jiao Tai Yin - Lung, Spleen Shao Yin - Heart, Kidney Jue Yin - Liver, Pericardium
Which of the six divisions are exterior?
Tai Yang
Shao Yang - is both exterior/interior
What are the 4 categories of penetration for the six divisions?
- Two or more divisions affected simultaneously
- The disease of on division is not cured and another division is affected
- Disease is transmitted to next division
- Direct invasion of Yin division, no preceding yang disease
What two organs are most affected by Blood deficiency?
Heart and the Liver
What does the exterior/interior principle measure?
- Location and depth of disease
- Direction of development of the disease
- Prognosis of disease
Why do you get a Floating pulse in exterior diseases?
Because the Qi and Blood of the body moves to the exterior to try and expel the exterior pathogen causing the pulse to feel as if it is Floating
What is Tai Yang division affected by and what are 3 essential symptoms?
Wind-cold.
Aversion to cold
Headache and stiff neck
Floating pulse
How does pathogenic factor enter the Yang Ming division?
Pathogenic factor enters the interior directly or passes from the Tai Yang and has transformed into Heat
In which division do you see the 4 Bigs - big pulse, big sweat, big thirst and big fever?
2nd division - Yang Ming
What symptoms do you see in the Yang Ming stage?
Heat scorches fluids leading to: Fever Constipation Thirst Sweating Abdominal pain
Irritability and Delirium because the heat disturbs the Shen
Where is the pathogenic factor in the Shao Yang division?
The pathogenic factor oscillates between the exterior (Tai Yang) and the interior (Yang Ming)
When do fever and chills alternate in the Shao Yang stage?
Fever = strong Zhen Qi (True Qi) and more of Yang Ming stage Chills = strong Xie Qi (Evil Qi) and more of Tai Yang stage
What is the Tai Yin pattern characterised by?
Spleen Yang deficiency with Cold
What are some symptoms of Tai Yin division?
Lack of appetite Diarrhoea No thirst Tiredness Phlegm Pale, greasy tongue
What is the pathology of the Shao Yin divison?
Kidney Yang deficiency or Kidney Yin deficiency
What is the Jeu Yin stage characterised by?
Yin and Yang fail to connect therefore person develops Heat above (thirst, mania, heat sensation, insomnia) and Cold below (Cold extremeties, diarrhoea, lack of appetite, vomiting)
What are some symptoms seen in the Shao Yin stage?
Aversion to cold Cold limbs Tired Undigested food in stool No thirst Desire for warm drinks Clear copious urination Pale, swollen tongue
What are the forms of Excess (Shi)?
Qi stagnation Blood stagnation Damp accumulation Phlegm accumulation Food stagnation Heat/Fire Liver Yang rising Cold
What are some common causes of Deficiency (Xu)?
Stress Lifestyle Emotions Diet Illness Accidents/trauma Surgery Treatment Hereditary
What organ is never in excess?
The Kidneys
Why is Damp and Phlegm accumulation with Yin deficiency so difficult to treat?
Because most herbs that treat Yin deficiency are damp herbs. Damp needs to be treated with Yang herbs that will dry the damp and leave the deficiency for after the damp is fixed
What are some symptoms of excess Phlegm?
Numbness Tingling Cloudy head Slippery pulse Incoherent speech
What are some symptoms of Food stagnation?
Pain Reflux Burping Constipation Aversion to food Tongue: Full and slippery
What are some symptoms of Qi deficiency?
Pale bright face SOB Cough Aversion to cold Dizziness Blurred vision Lack of energy Poor appetite Weak voice Bloating Spontaneous sweating (during daytime) Loose stool or constipation Palpitations Excessive urination Heavy bleeding Prolapse Pulse superficial and weak
What are some symptoms of Blood deficiency?
Pale dull face Insomnia Palpitations Numbness Weakness Dizziness Dry skin Blurred vision Poor memory Scanty, irregular periods Insufficient lactation Tongue: pale and dry Pulse: Weak, deep, choppy and thin
What organs are mostly affected by Blood deficiency?
Heart and Liver
What are some symptoms of Qi stagnation?
Irritability Distension Chest pain Feeling better with movement Depression Alternating diarrhoea and constipation Distending pain that is better with massage Dull and wandering pain Hypochondriac pain Belching Irregular periods Mood swings Migraines Hypertension Dysmenorrhoea Tongue: Red or purple Pulse: Wiry
What are some symptoms of Blood stasis?
Dark skin blotches Stabbing pain of fixed nature that is consistent and worse with pressure Abdominal masses Cardiac pain Migraines CVA Endometriosis Excessive menstruation with dark blood and clots Intermittent flow Tongue: Purple Pulse: Wiry, knotted, choppy
What organ is most prone to Qi stagnation?
The Liver
What organs are most prone to Qi deficiency?
Spleen and Lungs
- because they are the source of Qi
What are some causes of Qi deficiency?
Severe, chronic disease Overwork Excessive exercise Over thinking Old age Weak constitution Injury to Spleen/Stomach by inappropriate diet
What are some symptoms of Qi sinking?
Chronic diarrhoea Prolapse Fatigue Bearing/dragging down sensation Heavy bleeding Easily bruised
What are some causes of Qi stagnation?
Emotions - stop the free flow of Qi
Overeating
Trauma causing local stagnation
What are some causes of Rebellious Qi?
Obstruction of the Lungs in dispersing and descending by phlegm or pathogenic factor
Inappropriate eating
Emotional constraint disrupts the Liver generating fire that ascends upwards
Yin deficiency may lead to rising of Yang
What are some symptoms of Rebellious Qi?
Hiccups Belching Vomiting Nausea Dizziness Headache Irritability Cough Insomnia Prolapse
What are some causes of Blood stagnation?
Trauma or surgery
Loss of Blood
Qi deficiency (Qi fails to drive blood)
What are some causes of Blood deficiency?
Loss of blood Blood stagnation Diet Dehydration Heat pathogens Insufficient intake of blood building foods Weak Spleen or Stomach Overthinking/worrying damages Heart and Spleen blood
Why do you see tremors, spasms and dizziness in Liver Blood deficiency?
Because wind enters the empty spaces in the blood vessels causing an internal wind
What does heat in the Blood cause?
The reckless movement of blood and scorches the blood vessels causing them to rupture
What 3 organs are responsible for moving body fluid?
Lungs, Kidneys and Spleen
What are the symptoms of Body fluid deficiency?
Dry mouth Dry skin Thirst Shortened urination Dry stools Dry cough
What are some causes of Body fluid deficiency?
Fluid loss due to sweating, diarrhoea or vomiting
Severe, chronic blood deficiency
Dietary irregularities such as too many drying foods (baked goods)
What is Body fluid stagnation due to?
A Yang deficiency of the Spleen, Kidneys and/or Lungs
How do wind-cold and wind-heat evils invade differently?
Cold - Back of the neck and shoulders
Warm - Via the nose and mouth
What are some symptoms of Wei level invasion of wind-heat?
Strong fever Mild aversion to cold Slight sweating Slight thirst Frontal headache Sore throat Tongue: Red, thin white tongue with red dots on Lung area (tip) Pulse: floating, rapid
What are some symptoms of Qi level invasion of wind-heat?
The 4 bigs - sweat, thirst, pulse and fever Aversion to heat Thirst Tongue: dry yellow Pulse: Rapid
What are some symptoms of Construction (Ying) level invasion of wind-heat?
Fever grows stronger at night Thirst Insomnia Delirious Unsurfaced skin blotches (macules) Tongue: red Pulse: Fine, rapid
What are some symptoms of Blood level invasion of wind-heat?
**Bleeding (vomit, stolls, urine, nose, chest) Fever Agitation Tongue: Crimson red with no coat Pulse: Wiry, rapid
What are the different diagnosis’ of insomnia?
Difficulty getting to sleep - Spleen and Heart blood deficiency or Liver overacting on Spleen
Waking in the middle of the night (normally 1-3am) - Liver Yang rising or Liver fire
Tossing and turning all night - Heart and Kidney yin deficiency
Nightmares:
Reoccurring - Gallbladder Qi deficiency
Frequent but change - Heart Phlegm fire
What are the different diagnosis’ of chronic sweating?
Sweats when anxious - Heart Qi deficiency
Night sweats - Heart Yin deficiency
Never sweats - Heart Yin and Heart Blood deficiency
How should the pulse feel different in the different seasons?
Summer - Superficial and overflowing (more Yang in nature)
Winter - Deep (Yin time, everything draws inwards)
Spring - Wiry (Young Yang, wood phase)
Autumn - Softer (Yang is decreasing, Yin increasing)
How does the pulse vary in gender?
Male - stronger on left and cun position
Female - stronger on right and chi position
How does the pulse feel before and after mensturation?
Before - slippery
Post - Weak
What type of pulse can indicate the threat of miscarriage?
Choppy pulse
What side is Qi and Blood reflected in the pulse?
Qi - Right wrist
Xue - Land wrist
What are the two ways the pulse presents after a person has just eaten?
Fuller and slippery in the right guan position - because of an accumulation of food and Qi in the stomach
Weaker in the right guan position - because Spleen Qi is burdened by having to transform the food
How does the pulse feel when a female is pregnant?
More slippery
A deep and weak pulse in the rear or chi position is a sign of what condition?
Kidney Blood condition
What do the 3 levels of pulse represent?
Superficial - Qi and Yang (and all Yang organs) - Lung and Heart
Middle - Blood - Stomach and Spleen
Deep - Yin (and all Yin organs) - Liver and Kidney
What is the pulse model for the organs?
Cun:
Left - Heart and Chest
Right - Lung and chest
Guan:
Left - Liver and Gall Bladder
Right - Stomach and Spleen
Chi:
Left - Kidney (yin), Bladder, SI
Right - Kidney (yang), LI
What qualities should be noted when feeling the pulse?
- Whether the pulse has shen, stomach and root
- the depth
- the width
- the strength
- the rate
- the rhythm
- other qualities
- the cun, guan and chi positions
What is meant by the pulse having stomach?
That the pulse is relatively slow (60-66bpm) is calm and soft
What is meant by the pulse having root?
The pulse can be felt at the deepest level and in the chi position.
The Kidneys give the pulse root
What are the 8 qualities of a Pulse?
Depth Frequency Length Width Strength Smoothness Tension Rhythm
What is the Ben and Biao in diagnosis?
Ben - is the root cause (Primary)
Biao - means ‘to which it is arising’ = the symptoms (Secondary)
How do joy, sadness, anger and grief affect the Heart?
Joy - slows down Heart and makes it larger
Sadness - depletes Heart Qi
Anger - may cause Heart Fire
Worry - Causes Heart Qi stagnation
What does Heart-Yang Collapse derive from?
A chronic and severe deficiency of Kidney Yang
The total collapse of Qi always derives from what?
The collapse of Kidney energy (Kidney Yin or Kidney Yang)
How do palpitations differ in Heart Blood def and Heart Qi def?
Blood - Occur more commonly in the afternoon/evening
Qi - Occur more in the daytime
How does the taste of bitterness differ in Liver fire and Heart fire?
Liver fire - Occurs every day
Heart fire - occurs only after a bad nights sleep
Clinically what is an AMI diagnosed as in TCM?
Heart Yang collapse
