TCM III - The consultation Flashcards
Specific skills
- Asking the right questions
- Speak in language the patient understands
- Clarify (Medical) Terms
- Rapport with patient
- Assess non-verbal language and don’t believe all you were told
- Note taking, whilst maintaining rapport
Behaviour and boundaries
- Appropriate behaviour it is vital, and most registering bodies have Codes of Practice and Ethics
- Maintain an awareness of the different needs of patients
- Maintain appropriate boundaries – some are naturally good at this; others may need to work at it
Questions
- To begin with, you will go through your questions mechanically – Later you will learn to be flexible and relate your questioning to the symptoms presented
- Each consultation is a unique event. Additional questions may need to be asked, or some questions may not need to be explored to any depth
- Rapport is important –patient won’t open up to you if they do not trust you
- Open questions = “how can I help you today?”
- Closed questions = “do you have a big appetite?”
First contact
- Diagnosis starts at first contact - over the phone or when you first shake the patient’s hand
- What is the main complaint?
- How did it arise (accident, lifestyle, work, emotions, diet etc.)?
- Regardless of any Western medical diagnosis, what are the signs and symptoms that help us identify the patterns in terms of The Eight Principles, organ pathology, the Vital Substances, and pathogenic factors?
The Ten Questions
The Ten Questions refer to areas we need to cover:
1. Chills and fever
2. Sweating
3. Head and body
4. Thorax and abdomen
5. Food and taste
6. Stools and urine
7. Thirst and drink
8. Sleep
9. Ears and eyes
10. Pain
- Chills and fever
Exterior patterns:
* Aversion to cold, feels cold: External pathogenic wind cold
* Aversion to hot, feels hot: external pathogenic wind heat
Interior patterns:
* Feels cold but can be warmed by wrapping up: Cold or Yang deficiency
* Feels hot: interior heat
* Low-grade afternoon fever or night-time fever: Yin deficiency
* Constant low-grade heat: damp heat
- Sweating
- Head only: Heat in the stomach, Damp heat
- Arms / legs only: Stomach and Spleen deficiency
- Hands only: Lung Qi deficiency, nervousness
- Whole body: Lung Qi deficiency, heat, external pathogenic factor
- Palms/ soles/chest (5 palm sweat): Yin deficiency
- No sweating: Cold or dehydration
- Head and body: Headaches
Time of the day:
* Day-time: Qi or Yang Deficiency
* Evening: Blood or Yin Deficiency
Location:
* Temples: liver and gallbladder
* Vertex (top of head): Blood deficiency
* Forehead: Stomach
* Deep: kidney deficiency
Character:
* Heavy: dampness
* Throbbing: Liver Yang Rising
* Boring, stabbing: Blood stasis or cold
Condition:
Worse for heat: heat pattern
Worse for cold: Cold pattern
Worse for fatigue, improved by rest: Qi deficiency
- Head and body: Body pain
Pain in the whole body:
* Pain all over, tired: Qi and Blood Deficiency
* Pain with heaviness: Dampness
Pain in joints:
* Moves: Wind
* Fixed and painful: Cold
* Swollen and numb: Damp
Backache:
* Continuous: kidney deficiency
* Acute: Sprain causing Qi and Blood stasis
* Stabbing: Blood stasis or cold
Numbness:
* Arms, legs bilaterally: Blood deficiency
- Thorax and abdomen
Location:
* Thorax: Heart and lungs
* Flanks: Liver and gallbladder
* Abdomen: Liver, intestine, stomach, spleen, kidneys and bladder
Pain:
* Sharp chest pain: Heart Blood stasis
* Chest pain with cough and yellow sputum: Lung Heat
* Hypochondrial pain: Liver Qi stagnation
* Severe pain in hypochondrium: Liver Blood stasis
- Food and taste
Food:
* Better after eating: Deficiency
* Worse after eating: Excess
* Lack of appetite: Spleen Qi Deficiency
* Always hungry: Stomach Heat
* Fullness and distension after eating: retention of food
* Preference for hot food: Cold
* Preference for cold food: Heat
Taste:
* Constant bitter: Liver Fire
* Bitter taste after a poor night’s sleep: Heart Fire
* Sweet: spleen deficiency, damp (digestive system)
* Sour: food retention (associated with liver)
* Salty: kidney Yin deficiency
* Pungent: Lung heat
* Poor taste sensation: spleen deficiency
- Stools and urine
Stools:
* Constipation:
o Better after defecation: Excess
o Worse after defecation: Deficient
o Small, not hard: Qi stagnation
* Diarrhoea:
o Foul smell: Heat / damp heat
o Chronic: spleen Qi or kidney Yang deficiency
o Mucus: damp
o Mucus and blood: damp heat
o Undigested food: Spleen Qi or spleen Yang deficiency (severe)
Urine:
* Better after passing: excess
* Worse that passing: deficiency
* Scanty dark yellow: heat
* Copious pale: Cold
* Copious yellow: damp heat
* Dribbling: kidney/bladder weakness
* Cloudy: damp
* With pain: damp heat
- Thirst and drink
Thirst and drink
* Thirst with desire to drink lots of cold water: Full Heat
* Thirst with little desire to drink water: Damp Heat
* Thirst with desire to sip water: Yin deficiency
* Absence of the thirst: Cold
- Sleep
Sleep
* Difficulty to get to sleep: Blood Deficiency or Qi Stasis
* Wakes often: Blood or Yin Deficiency
* Desire to sleep all the time: Qi deficiency or damp
* Excessive dreaming: Liver or heart blood deficiency
- Ears and eyes
Ears:
* Tinnitus:
o Loud, high pitch: Liver Yang Rising
o Low pitch: Kidney (linked to ears) deficiency
Eyes:
* Pain , swelling, redness: EPF Wind Heat or Liver Fire
* Blurred vision and floaters: liver blood deficiency
* Pressure in eyes: Yin deficiency
* Dryness: liver or kidney Yin deficiency
