TCM Diagnostics - 1.25 Flashcards
Zhi Ze
- basic/fundamental principles which guide all treatment
(after making a diagnosis and identifying the patterns, the next step is to determine treatment principles and methods)
principles: zhi ze; methods: zhi fa
Treatment Principles 1-6
- treat early and prevent change and development
- to treat disease, one must search for the root
- support Right and dispel Evil
- treatment of Root and Branch (root and manifestation; primary and secondary)
- regulate Yin and Yang
- treatment of disease according to climatic and seasonal conditions, geographical location, and individual conditions
To treat disease one must search for the root
- the underlying, root cause of an illness must be uncovered, then appropriate treatment can be administered
Support Right and dispel Evil
- tonify Right
- when there is deficiency/vacuity/emptiness
- dispel Evil
- when there is excess/repletion/fullness
- both tonify Right and dispel Evil
- when there are both deficiency and excess
Treatment of Root and Branch (root and manifestation; primary and secondary)
- in moderate conditions, treat the root
- generally in more chronic conditions
- in acute conditions, treat the branch
- generally in acute or emergency conditions
- simultaneously treat root and branch
- in mixed acute/chronic conditions
Regulate Yin and Yang
- correct, regulate imbalances of Yin and Yang
- dispel excess
- supplement/tonify deficiency
- simultaneously dispel excess and supplement dx
Treatment of disease according to
climatic and seasonal conditions,
geographical location,
and individual conditions
- treatment of disease according to time
- different seasons produce different climates
- many diseases require specific timing of treatment
- e.g. dysmenorrhea; asthma
- …according to geographical loation
- different locations have different climates
- affect body differently
- …according to individual conditions/characteristics
* age, gender, constitution
Specific Methods of treatment for any given disorder
Zhi Fa
- treatment principles are general/universal principles that apply to all treatment
- treatment methods are the specific methods used to treat a specific condition
- in accord with the specific nature and characteristics of the condition
Eight Treatment Methods from Cheng Zhong-Ling
- foundation for all current discussion of treatment methods/strategies
- not exhaustive
- serve as the building blocks for other strategies
- “The 8 methods exist in any single method. Likewise, a myriad of methods exists within the eight methods.”
What are the 8 Treatment Methods?
- Sweating – disease on skin/exterior
- Emesis/Vomiting/Ejection – disease in upper [torso]
- Draining downward/precipitation – Disease in lower [torso]
- Harmonize – Half-interior, hald-exterior; harmonizing functions that are at odds
- Warming – Cold
- Clearing – Heat
- Supplementation – Deficiency
- Dispersion – Accumulation/clump/firm
4 Methods of Examination (Si Zhen)
- Wang*
- Wen*
- Wen*
- Qie*
- interior manifests on the exterior
“In order to know the inside, one must observe the outside. Examining the outside, one knows the inside. That which is inside, must appear on the outside.”
What to we inspect? (4 examinations)
- Entire Body
- Shen
- Color
- Form
- Bearing
- Parts of the Body
- Excretions and Discharges
What are the diagnostic significances of shen?
What are the 2 basic conditions of shen?
diagnostic significance:
- Zheng Qi: Right Qi
- Organs
- Severity of Disease
- Prognosis
2 basic conditions:
- Spirited
- Spiritless
Shen: Body-shape, bearing, complexion
What is Spirited?
What is Spiritless?
Spirited
- strong, healthy body, well developed muscles, abundant energy, moist and bright complexion,
- sufficient upright qi, strong function of zang-fu,
- mild disease, good prognosis
Spiritless
- thin, weak body, emaciated muscles, listless and fatigued, dull grey or excessively bright complexion
- deficiency of upright qi, poor function of zang fu
- severe disease, poor prognosis
Shen and the
Eyes
Mental Function
Respiration and Speech
False Shen
Clouded and disordered Shen
EYES (Spirited) sparkling, agile movements
(Spiritless) dull, lack of sparkle, slow movement of eyeballs or straight/blank staring
MENTAL FUNCTION (Spirited) clear and sharp mind, active and appropriate responses to environment
(Spiritless) confused, not clear, agitated, abnormal responses to enviro
RESPIRATION & SPEECH (Spirited) calm, even, well-regulated breathing; correct, clear speech
(Spiritless) faint, weak breath, panting; abnormal speech
FALSE SHEN (Spirited) seen in cases of severe or induring illness; patient suddenly goes from spiritless to spirited; separation of Yin and Yang (yin is exhausted and can’t restrain Yang/Yang floats up and gives rise to false shen); critical sign, usually seen soon before death
CLOUDED AND DISORDERED (Clouded) consciousness is obscured or lost (Evil attacking pericardium, Phlegm or phlegm-heat misting heart orifice; debilitated Right/Zheng Qi)
(Disordered) mania, withdrawal, epilepsy, variety of causes
Inspection: Color
What do we look at?
- face
- skin
- nails
- eyes
- etc.
Why does the face reflect the condition of the body?
- “The blood and qi of the 12 channels and 365 collaterals rises to face and enters the orifices”
- Foot Yangming stomach vessel transverse/distributes face (abundance of qi and blood)
- Facial skin is thin, easily reflects changes in color and luster
What are the 2 main aspects of color?
- Five colors
- blue-green
- red
- yellow
- white
- black
- Sheen
- moisture
- luster
What is considered a normal complexion?
- slightly rosy
- moist, sheen, lustrous
- vatiations:
- different types of people
- seasons
- weather
- occupation and activities
Primary color vs. Guest color
Primary color
- an individual’s normal color
- may be deviated from the average “normal”
Guest color
- normal changes in an individual’s color due to
- season, weather, temperature
- situation and activity
- living and workin environments
- age
- emotions
Color and Pathogenic Complexion
Five colors benign or malignant
Benign:
- abnormal change in color, but there is still luster
- organs, qi, essence, and blood still in decent shape
- good prognosis
Malignant
- abnormal change in color, lusterless
- organs, qi, essence and blood damaged
- poor prognosis
BLUE GREEN
- Cold, Pain, Blood Stasis, Liver Wind
- pale blue-green, black blue-green complexion, sharp and cold abdominal pain
- gray-blue complexion, cyanotic lips, stabbing chest pain (chest painful obstuction due to Heart yang deficiency)
- blue-green in area between eyebrows, bridge of nose, and border of lips (liver wind, or on verge of l.w.)
- blue-green complexion, poor appetite, irritability/anger, abdominal pain with diarrhea, irregular menstruation (liver and spleen disharmony)
RED
What does it govern?
- Governs heat
- heat causes an abundance of qi and blood to circulate in vessels
- entire face is red (excess heat, interior or exterior)
- red cheeks (deficiency-heat)
- pasty/sallow complexion with red cheeks looking like make-up (“Upcast yang; chronic or severe illness, damaged essence leads to floating yang)
YELLOW
What does it govern?
- Governs deficiency and dampness
- sallow yellow, pale yellow
- spleen and stomach qi deficiency w/ subsequent qi/blood xu
- weak transformaiton/transportation; essence of food can’t rise up to nourish face
- yellow complexion, often with swelling or overweight
- dampness
- accumulation of dampness, often due to spleen weakness with impaired trans and transf
YELLOW cont…
- dusky, smoky yellow complexion and eyes
- yin-yellow (jaundace)
- cold-damp obstructs spleen, bile obstructed by dampness and overflow to skin
- bright-yellow complexion
- yang-yellow
- damp-heat obstructs liver and fall-bladder, bile overflows
WHITE
Governs?
- governs qi xu, blood xu, yang xu, blood loss, and cold
- pale white
- qi/yang xu
- white with blue-green
- blood xu
- blood loss (acute)
- white with blue-green
- excess cold
- pale-white, lusterless, possible edema/swelling
- deficiency cold (yang qi deficiency)
BLACK
Governs?
- governs Kidney xu, stasis pain, water rheum
- dim/dusky black cheeks and forehead
- kidney yang xu
- Yang xu and cold, ming-men fire can’t warm and nourish the vessels, qi and blood stagnate
- dry, burnt black cheeks and forehead
- kidney essence/yin deficiency
- essence/yin can’t nourish face
- purple-black, blue-green-black, rough skin
- qi and blood stasis causing pain
- cold and other possible etiologies
- black eye sockets, puffy under eye
- water rheum, phlegm rheum (qi and blood impaired by stagnant fluids; spleen and kidney qi/yang xu causing impaired metabolism and circulation of fluids)
Inspection of Color: Floating and Deep
Floating
- visible on the surface of the skin
- disease in the exterior, in bowels
Deep
- color deeper in skin
- disease in interior, in viscera
Changing from floating to deep: disease moves from exterior to interior
Changing from deep to floating: interior to exterior
Inspection of Color: Clear and Turbid
Clear
- color and sheen are clear and distinct
- yang syndromes
Turbid
- colors are dark and turbid
- yin syndromes
Clear to Turbid (disease moving from yang to yin)
Turbid to Clear (yin to yang)
Inspection of Color: Faint and Extreme
Faint
- color and sheen are shallow and light
- deficiency fo Right qi
Extreme
- colors and sheen are deep and thick
- excess evil qi (xie qi)
Changing from faint to extreme
- disease changing from deficiency to excess
Changing from extreme to faint
- disease changing from excess to deficiency
Inspection of Color: SCattered and Concentrated
Scattered - color is dispersed or scanty; illness is new, mild, or resolving
Concentrated: illness is enduring or serious
Changing from scattered to concentrated: disease worsening
Changing from concentrated to scattered: disease improving
Inspection of Color: Sheen and Perishing
Sheen:
- color is moist; viscera and essence not depleted, mild illness, good prognosis
Perishing:
- color is dry and withered; viscera and essence depleted, severe illness, poor prognosis
Sheen to perishing: disease worsening
Perishing to Sheen: disease improving
Facial diagnosis
- Ling Shu*
- Su Wen*
*need to memorize
- Ling Shu*: head/face, throat, lung, heart, liver, gall bladder, spleen, stomach, small intestine, large intestine, urinary bladder, uterus, kidney
- Su Wen*: heart, lungs, spleen, liver, kidneys
Inspection of Body Shape
Robust:
- solid sang fu organs, exuberant qi and blood
Weak:
- hypofunction of the zang fu organs, insufficiency of qi and blood
Inspection of Body Form: Corpulent and Skinny
Corpulent:
- overweight, pasty skin tone, fatigue, dyspnea
- deficiency of yang qi with subsequent accumulation of phlegm and dampness
Skinny
- underweight, green-yellow complexion, dry and withered skin
- deficiency of yin and blood with deficiency heat
“Skinny people have much fire”
Inspection of Bearing: Bi Syndromes
What is Bi syndrome?
What are the 3 main Bi syndromes?
-“Bi”: Obstruction; Obstruction Syndrome
- swelling and pain of the joints with limited movement, inability to bend or extend/stretch
- invasion of pathogenic wind, cold and damp
WANDERING Bi Syndrome (wind)
PAINFUL Bi Syndrome (cold)
HEAVY/FIXED Bi Syndrome (damp)
4th - Heat Bi Syndrome - red, swollen and painful joints, usually with deformity
Wei Syndroms
what are they due to?
- “Wei”: atrophy
- weakness, flaccidity, or atrophy of the limbs with motor impairment
- due to malnourishment of tissues
** doesn’t have to be deficiency, can also be excess
Wei Syndromes
- accumulation of damp-heat
- obstructs qi and blood, causing malnourishment
- xu of spleen and stomach
- subsequent xu of qi and blood
- xu of liver and kidney
- atrophy of tendons and bones
- traumatic injury
- bleeding and stasis
- excessive heat congesting the lung
- consumes body fluids and qi
Inspection of Bearing: Wind Stroke
- Sudden collapse, unconsciousness, one-sided paralysis or numbness and insensitivity of the hand and food, inflexible movement, deviation of the mouth and eye
Channel stroke: wind attacking collaterals or channels; more superficial, less severe, no loss of consciousness
Zangfu stroke: wind attacking the bowels or viscera; deeper, more severe, loss of consciousness
Inspection of Bearing: Sitting and Lying
Sitting
- arching backward: yang
- curving forward: yin
Lying
- face turned outward, legs outstretched, clothes torn off, bedcovers discarded, desire for cold (YANG)
- face turned in, bundled up, wearing clothes, desire for heat (YIN)
Inspection of the Head
Physiology:
- meeting place of yang; residence of essence/spirit, stores brain (sea of marrow); governed by kidney
- too large or too small, possibly with mental insufficiency (pre-heaven xu, kidney essence xu)
- BULGING excess heat; SUNKEN xu cold, slightly sunken is normal w/in first 6 months; DELAYED CLOSURE kidney xu
- Uncontrollable movements (internal wind)
