TCM III - TCM Diagnosis Flashcards
What are the four pillars of TCM diagnosis
- Looking
- Hearing (and smelling)
- Feeling (Palpating)
- Asking (10 questions / areas)
What things do you take into account when (diagnosis by) looking?
- Spirit
- Body type
- Skin
- Face
- Hair and Ears
- Eyes
- Mouth and lips
- Demeanour
- Movements
- Colours
What do the colours of the Skin indicate?
- Strong red = Excess heat
- Pale red or malar flush = Yin deficiency
- Purple = Blood stasis
- Blue = Cold
- Dull white = Blood deficiency
- Bright weight = Qi deficiency
What do the textures of the Skin indicate?
- Puffy = Damp or Yang deficiency
- Dry = Blood or Yin deficiency, dehydration
- Itchy = Wind or Wind Heat
- Pitting Oedema = Kidney Yang deficiency
- Non-pitting oedema = Qi stasis
- Flakes and scales = Damp
- Oozing = Damp heat
What can we look for - Eyes?
Liver opens to the Eyes
- Red sclera = Heat
- Red and itching sclera = Wind heat
- Yellow and murky sclera = Dampness
- Under eyelid pale = blood deficiency
- Bright red eyelid = heat in the blood
What can we look for - Nose?
Lungs open to the Nose
- Flaring and closing nostrils = Heat in the lungs
- Dry nostrils = Heat in the lungs
- Tip red = Heart disorder
- Clear runny mucus = damp cold
- Sticky mucus = damp heat or phlegm
What can we look for - Ears?
Kidneys open in the ears
The kidneys open into the ears in TCM
* Long, full, free hanging earlobe = Good constitution, Strong essence (Jing)
* Small earlobe, joined to head = Poor constitution
* Small ears = poor constitution
* White ears = Cold
* Dry, withered or black earlobes = exhaustion of kidney Qi
What can we look for - Chin?
- A weak chin can donate kidney weakness
What can we look for - Mouth, lips and gums?
Spleen opens to the mouth
Normal lips should be pale red, moist and shiny
- Dull white = Qi and Blood deficiency
- Purple or blue = cold, stagnant Qi and blood
- Deep red = Excess heat
- Dry = body fluids injured, spleen deficiency
- Green colour around mouth = liver and spleen disharmony
- Pale gums = blood deficiency
- Bleeding gums with pain = heat in the stomach
- Bleeding gums with no pain = empty heat
What can we look for - Nails?
- Ridged, thin or brittle = Blood deficiency
- Thickened = Blood stasis (Or a fungal infection)
- Yellow = damp heat
- White = blood deficiency
- Purplish = blood stasis
- Red = heat
What can we look for - Hair?
The kidneys govern the hair on the head, whilst hair generally as an extension of the blood
* Thin and dry = blood deficiency
* Falling out = blood deficiency
* Falls out in patches = blood deficiency and wind
* Poor Lustre = lung deficiency
* Premature greying = kidney deficiency
What can we look for - Shen (Spirit)?
The vitality of the mental and emotional state might be assessed through observation:
- Spirit:
o Healthy complexion
o Firm muscles
o Normal facial colour
o Normal breathing
o Spark in the eyes - No spirit:
o Unhealthy complexion
o Withered muscles
o Dark facial colour
o Erratic or laboured breathing
o Disturbed or dull eyes
What qualities to we diagnose by Hearing?
- Listening to the sound of the voice, cough or breathing
- Sighing = Qi stagnation
- Loud sounds indicate excess
- Weak sounds indicate deficiency
What do Qualities of the voice indicate?
- Shouting: Liver Qi statis, Liver Yang Rising or Liver Fire Blazing
- Weeping voice: Sadness or grief
- Unenthusiastic voice: depression
How does voice type relate to the Eight Principles?
- Reluctance to talk: Cold
- Incessant talking: Heat
- Loud sounds: Excess
- Weak sounds: Deficiency
- Coarse, loud breathing: Full
- Weak thin breathing: Empty
- Loud explosive cough: Full
- Weak cough: Empty
How is Smelling used in TCM diagnosis?
Not commonly used now as most people wash frequently and use fragrances
* A strong foul smell = heat
* The absence of smell = cold
* Bad breath = stomach heat
* Smelly urine or stools = damp heat
How is Feeling used in TCM diagnosis?
- Palpation of the pulse, skin, limbs, abdomen, channels and points
- This skill of pulse diagnosis ranges from simple to incredibly detailed levels of diagnosis
How is Asking used in TCM diagnosis?
- The traditional way to collect information verbally is known as ‘The Ten Questions’
- Rather than being specific questions, these are 10 areas that need to be questioned
What are the acupuncture channels?
A continuous circuit of Qi moving around the body
Where are the Acupuncture points located?
- At precise anatomical locations
- Usually in spaces between anatomical features
What are the Primary Channels in Acupuncture?
The Primary Channels run vertically,
joining the arms legs, head and torso.
What is the relationship between the channels and the TCM organs?
Each Channel connects with the organ it is
named after and its paired Yin or Yang organ
How many channels are there?
Six Yang channels:
Large Intestine, Stomach, Small Intestine, Bladder, Gall Bladder, San Jiao
Six Yin channels:
Lung, Spleen, Heart, Kidney, Liver, Pericardium
What are some examples of acupuncture points for Headaches?
Depends on the type/location of the headache:
- Temporal headache might be treated by needling points on the gallbladder channel
- Frontal headache might be treated by needling points on the stomach channel
- Occipital headaches might be treated by needling points on bladder channel
What is Fascia and how can it map to Qi?
- Fascia consists mainly of collagen, which is semi-crystalline in structure
- When it bends fascia generates tiny electrical currents
- Qi is described as electrical in nature, a ‘substance of intelligent cooperation’
What does Daniel Keown’s book Spark in the Machine propose?
That the physical location of acupuncture channels correlate with the fascia
The complex folding and unfolding of the developing embryo into organs and limbs creates enduring fascial connections, which have identifiable relevance to the acupuncture channels
The practioner skilled in channel palpation is said to have developed what?
The skilled practitioner develops ‘Finger eyes’ to see below the surface
How should Channel palpation be approached?
- Use a light touch at first and then gently increased pressure
- Always ask for feedback
- Be aware of issues surrounding touch and exposing the body
- Support the limb
- Look at the person and feel the reaction of the tissues and for signs of discomfort
- Follow along the channel, looking and ‘listening’ with your thumb
What can Channel palpation diagnose?
- Channel imbalances may affect organ functions
- Organ imbalances may show up in the channels
Note: There is therapeutic value as soon as you begin to palpate the channels, so be mindful of your touch
What should be observed during Channel palpation?
- Muscle tone
- Colour: paleness, redness, discolouration etc.
- Temperature
- Moisture (or dryness)
- Pain and ‘reactivity’
- Nodules and textures beneath the surface
What can be revealed during Palpation?
- Mild redness = Qi Stagnation
- Intense redness = Heat
- Weak of soft tissue = Qi Deficiency
- Clammy or puffy = Dampness
- Dry = Yin, Blood or Fluid deficiency
- Cold = Cold or Qi deficiency
- Hot = Heat
- Tender or tight = Qi stagnation
- Nodules = Phlegm or Blood stasis
- String of small nodules = Dehydration
Describe the pathway of the Lung channel
- The Lung channel starts in the stomach
- It joins the large intestine (its Yang pair) & travels up through the cardiac orifice.
- It enters the lungs, ascends to the throat, and then emerges on the anterolateral surface of the chest at LU-1
- It descends lateral to the biceps brachii to the cubital crease at LU-5, and on through the radial aspect of the anterior wrist
- It ends at the radial nail point of the thumb at LU-11
Describe the Spleen channel
- The Spleen channel begins at the medial nail point of the big toe at SP-1.
- It runs along the medial border of the foot, follows the groove along the medial border of the tibia, and the antero-medial aspect of the thigh to the lower abdomen, before entering the stomach (its Yang pair).
- It emerges again and rides up the lateral border of the rectus abdominis to LU-1, and descends to terminate on the mid-axillary line at SP-21
How can localised stagnation be treated?
Localised stagnation of Qi, Blood, Phlegm or Heat are best treated with acupuncture or massage.
Where are the pulses of the six Yin organs located?
