TCMtest - Foundation

Question 1

Cancerous breast lumps are usually due to

Blood Stasis
Qi-Blood stasis with Phlegm
Blood and Phlegm stasis
Qi and Phlegm stasis

Answer 1

Qi-Blood stasis with Phlegm

Cancerous breast lumps are singular, hard, immovable, painless, and with an indistinct edge.
The Foundations of Chinese Medicine, Maciocia, 2015, page 393; 2005 Edition, page 372

Question 2

Different parts of the eye are related to different organs. Which of the following associations is correct

Corners of the eye / Heart
Eyelid / Lung
Iris / Kidney
Pupil / Liver

Answer 2

Corners of the eye / Heart

Corners of eyes = Heart. Pupil = Kidneys. Upper eyelid = Spleen. Lower eyelid = Stomach. Sclera = Lungs. Iris =Liver. Red color indicates Heart-Fire if on the corner of the eyes or Lung-Heat if the red color is on the sclera. A yellow color on the sclera indicates Dampness and Heat. When the whole eye is red-painful-swollen it can indicate external Wind-Heat or internal Liver-Fire. A dull-white color on the eye corners may mean Heat while a pale-white color may mean Blood Deficiency. Swelling under the eyes may mean a deficiency in the Kidneys.

Question 3

A 37 year-old male patient has chronic asthma with difficulty to inhale and without phlegm or expectoration of sputum. He generally feels tired, has a low voice, and a pale facial complexion. He also complains of back pain and of often feeling cold. The pulse was deep-weak and the tongue color was pale. Which Extraordinary Vessel is selected fortreatment?

Girdle Vessel (dai mai)
Yin Linking Vessel (yin qiao mai)
Penetrating Vessel (chong mai)
Directing Vessel (ren mai)

Answer 3

Directing Vessel (ren mai)

Looking at the patient from the perspective of organ patterns, this is a Kidney Yang Deficiency (back pain, feeling cold, pale tongue, deep-weak pulse) with the Kidneys unable to anchor and grasp the descending Lung qi which is weak (low voice, pale complexion). From the point of view of Extraordinary Vessels, this points to the ren mai which has one of its functions to promote the descending of Lung qi and the Kidney grasping and holding that qi. The opening point (LU-7) and coupled point (KI-6) would be sequentially needled. REN-17 can also be added.
The Foundations of Chinese Medicine, Maciocia, 2015, page 901

Question 4

The hand tai yin meridian originates in the Middle Burner and then goes

to LU-1 (zhong fu)

to the cardiac orifice of the Stomach

first to the Upper Burner and then to the Lower Burner

first to the Lower Burner and then to the Upper Burner

Answer 4

first to the Lower Burner and then to the Upper Burner

The Lung meridian starts the Middle Burner in the area of the Stomach, descends to connect with the Large Intestine (Lower Burner), returns upward to pass through the cardiac orifice of the Stomach, goes through the diaphragm to the Lungs (Upper Bumer), ascends to the throat and goes to LU-1 to start its external pathway to the thumb. There is a branch that separates from LU-7 to travel and connect to the Large Intestine channel at LI-1. The connection to the
throat explains the use of Lung points to treat throat disorders. The Lung meridian of hand tai yin connects with the Stomach, Large Intestine, and Lung organs. Deadman is incomplete on page 73 which does not show the Lung channel meeting with the Spleen channel. He does say on page 76 that LU-1 is the meeting point of the Lung and Spleen channels. The connection of the Lung channel to the Lung and Stomach organs confirms the Five Element relationship between Earth and Metal and the use of Stomach points to tonify the Lungs.

A Manual of Acupuncture, Deadman, 2nd Edition, page 73

Question 5

The Liver primary meridian connects with which zang fu?
Liver, Gall Bladder, Spleen, Lung, Stomach
Liver, Gall Bladder, Spleen
Liver, Gall Bladder, Lung, Stomach
Liver, Gall Bladder, Spleen, Stomach

Answer 5

Liver, Gall Bladder, Lung, Stomach

Question 6

A patient has sudden edema of the eyelids and face gradually involving the rest of the body. The patient has scanty and clear urination, aversion to wind, fever, cough, breathlessness, tongue has a sticky-white coating, and floating-slippery pulse. What is the Lung zang-fu pattem?

Damp-Phlegm Obstructing Lungs
Phlegm-Heat Obstructing Lungs
Phlegm-Fluids Obstructing Lungs
Invasion of Lungs by Wind-Water

Answer 6

Invasion of Lungs by Wind-Water

This is an external acute pattern. It is like a wind-cold attack that includes Dampness. Unlike the pure pattern of wind-cold invasion, the Lung invasion by Wind-Water disorders the Lung function of controlling the water passages. This results in sudden edema (eyelids, face, body). As the Wind-Water obstructs the Lung descending function, there will be scanty-clear urination. The Wind pathogen obstructs the warming function of wei qi and cause aversion to wind which is pretty much the same as aversion to cold. The main difference is intensity (aversion to cold is stronger) and experiential location. That is, aversion to cold is experienced outside and inside while aversion to wind is only experienced when the patient is outside. The fever arises from the struggle/friction between wei qi and the external wind trying to enter the body through the energetic skin layers. The keynote symptoms of external Wind attack are aversion to cold and “fever”. The treatment principle is Release Exterior, Expel Cold, Resolve Dampness, Descend
Lung Qi, and Open the Water Passages.

Question 7

Five Element theory

Has not always been the most popular theory of Chinese medicine

Was never systematically applied to diagnosis

Was never used in astrology, music, or politics

Has always been the dominant theory in Chinese medicine

Answer 7

Has not always been the most popular theory of Chinese medicine

As Chinese medicine developed, the theory of the Five elements (5E) was not always applied and was not always the most popular theory. 5E theory was very popular during the period of the Warring States (475-221 BC) and was applied to medicine, astrology, music, and politics. However, during the 1st century 5E theory was seen as too rigid to correctly interpret natural phenomenon where one philosopher said “If the rooster belongs to Metal and the hare belongs to Wood, why is it that roosters do not devour hares?”. With the Han Dynasty (206 BC to 220 AD) tthe 5E
theory began to wane and from the Ming Dynasty (1368 - 1644 AD) onward 5E theory decreased in influence and medicine was dominated with identification of patterns according to the Cold Diseases, Four Levels and Three
Burners.

Question 8

A 52 year-old female has muscle weakness. Which food taste should she be advised to avoid eating an excess of?
Salty taste
Pungent taste
Bitter taste
Sweet taste

Answer 8

Sweet taste

The sweet taste goes to the muscles. However, an excess sweet taste in the diet can weaken the muscles. The bitter taste goes to the bones. An excess of the bitter taste in the diet should be avoided in bone diseases. The salty taste has a drying effect and can dry the Blood. An excess of the salty taste should be avoided in Blood deficiency. The sour taste goes to the nerves. Too much sour foods affects the Liver and should not be used too much in chronic pain. The pungent taste scatters the energy and should be avoided in deficient qi conditions.
The Foundations of Chinese Medicine, Maciocia, 2015, page 40

Question 9

A patient has been diagnosed with meningitis. The initial symptoms were cough, headache, and a sore throat. After a few days the temperature rose abruptly with the presence of frontal headaches, malaise, vomiting, and loose stools.
Then there was the development of petechiae, drowsiness, and fever at night. He was admitted to the hospital where the patient now had neck rigidity and convulsions. What is the current level?

Ying level
Xue level
Wei level
Qi level

Answer 9

Xue level

Meningitis can show the progression of all four levels. At first there is the wei level (headache, sore throat, cough), then the qi level (strong fever, vomiting, loose stools). The presence of petechia, drowsiness and night fever point to the ying level while the symptoms of neck rigidity and convulsions point to the xue level (Internal Wind).
The Foundations of Chinese Medicine, Maciocia, 2015, page 771; 2005 Edition, page 726-732

Question 10

A patient has a low-grade fever, tremor of limbs, twitching, loss of weight, malar flush, listlessness, dark-red tongue without coating and dry, and a fine-rapid pulse. The clinical picture indicates which level?

Qi level (qi)
Defensive-Qi level (wei)
Blood level (xue)
Nutritive-Qi level (ying)

Answer 10

Blood level (xue)

This is Empty-Wind Agitating the Interior. Heat at the xue stage has penetrated the yin of the body. The Heat damages the yin and depletes the yin of both the Liver and Kidneys. The deficiency of yin can generate internal Empty Wind (tremors, limb twitching). The low-grade fever, malar flush, tongue without coating, and fine pulse are all caused by a deficiency of yin. The treatment principle is Clear Blood Heat, Tonify Liver and Kidney Yin, Extinguish Wind.
The Foundations of Chinese Medicine, Maciocia, 2015, page 777; 2005 Edition, page 732

Question 11

The main drawback of pulse diagnosis is that it

is influenced by short-term influences
is subjective
can give too much information
is a difficult to learn skill

Answer 11

is subjective

The pulse gives not only specific diagnostic data on the state of individual internal organs but can also give an overall diagnosis of the whole body state of qi, blood, yin, and yang. The main drawback to pulse diagnosis is that it is very much a subjective interpretation. It takes a long learning curve to be able to subjectively identify a choppy or a soggy pulse, for example. One can objectively see a red tongue or a pale face but pulse diagnosis is a subtle subjective skill but still learnable. The pulse is also affected by short-term influences such as running producing a rapid pulse (not to be interpreted as Heat) or the pulse can be weak not as a chronic problem but as a result of a short term overworking with little sleep.
The Foundations of Chinese Medicine, Maciocia, 2015, page 374

Question 12

Where does the Original Qi (yuan qi) exit?

Ming men
Between the two Kidneys
The triple burner
Source points

Answer 12

Source points

Yuan qi passes through the San Jiao to nourish the zang fu and comes out of the yuan-source points.
The Foundations of Chinese Medicine, Maciocia, 2015, page 49; 2005 Edition, page 49; 1989 Edition, page 42

Question 13

Small, movable breast lumps with distinct edges that change their size with the menstrual cycle usually indicate

Blood stagnation
Qi and Blood stagnation
Phlegm and Qi stagnation
Qi stagnation

Answer 13

Phlegm and Qi stagnation

This indicates a fibrocystic disease. A single, somewhat hard-movable lump with distinct edges and slightly painful can indicate fibroadenoma (Phlegm-Blood stagnation). Any lump which is soft, has distinct edges, and mobile is related to Phlegm. Any lump which is relatively hard and immovable indicates Blood stagnation. A lump which has indistinct edges and is immovable indicates Toxic Heat.
The Foundations of Chinese Medicine, Maciocia, 2015, page 393; 2005 Edition, page 372

Question 14

Sadness and grief are often associated with shallow or short breath because

The emotions are translated into negative qi that must be exhaled quickly

Lungs work harder to increase blood flow to the limbs

The corporeal soul wants to avoid sadness and grief which escape through the breath

The emotions have a constricting effect on the corporeal soul and therefore the lungs

Answer 14

The emotions have a constricting effect on the corporeal soul and therefore the lungs

The Lungs are directly affected by worry, grief, and sadness. With worry, Lung qi is knotted which can be seen in shoulder-chest tension. With grief-sadness, Lung qi is depleted which can be palpated on the radial Lung pulse (weak, thin) and tone of voice (weak, weepy). In addition to depleting the Lung qi, sadness and grief can also stagnate the qi in the chest (tight chest, breathlessness).
The Foundations of Chinese Medicine, Maciocia, 2015, page 140; 2005 Edition, page 139; 1989 Edition, page 86

Question 15

You palpate for the temperature on the forehead and palms of your patient. The forehead feels hotter than the palms. This can indicate

invasion of Wind
Invasion of Wind-Cold
Internal heat
External Wind-Heat

Answer 15

External Wind-Heat

The Chinese term “fa re” is often translated as fever but it literally means “emission of heat”. The fever translation is not totally correct as a patient can have an objective sensation of heat on the forehead without having an actual fever. When the forehead feels hot on palpation while the patient complains of fear of cold, then that indicates external invasion of Wind. When the forehead feels hot on palpation and the patient has a subjective experience of feeling hot,
then that indicates internal Heat. If the forehead feels hotter than the palms, this can indicate external Heat but if the palms feel hotter than the forehead, this can indicate interior Heat.
Diagnosis in Chinese Medicine, Maciocia, 2004, page 517

Question 16

A patient has acute pancreatitis with fever, vomiting, loose stools, scanty yellow urine, slippery-rapid pulse. What is your assessment?

Xue level

Qi level

Wei level

Ying level

Answer 16

Qi level

Symptoms of acute pancreatitis include upper abdominal pain radiating to the back, with pain worsening when eating, especially high fat foods, a swollen-tender abdomen, nausea/vomiting, and fever. Along with the symptoms of loose stool, scanty yellow-urine, slippery-rapid pulse this describes Stomach and Spleen Damp-Heat at the qi level. The qi
level is characterized by the symptoms of fever, thirst, no aversion to cold, feeling of heat, and sweating.
The Foundations of Chinese Medicine, Maciocia, 2015, page 774; 2005 Edition, page 730

Question 17

What can characterize Yang syndromes?

Inhibition; Bright complexion; Hyperactivity; Fidgeting

Bright complexion; Hyperactivity; Fidgeting

Inhibition; Hyperactivity

Hyperactivity; Fidgeting; Inhibition

Answer 17

Bright complexion; Hyperactivity; Fidgeting

This is the most complete and accurate answer. In Eight Principles, Yin is a summary of Interior, Cold, Deficient and Yang is a summary of Exterior, Hot, Excess. Yin and Yang are also applied to zangfu syndrome pathologies. Yin syndromes result from a deficiency of Yang qi in the body and the retention of pathogenic cold. Yang syndromes result from an hyperactivity of Yang qi and an excess of pathogenic heat. Generally, excitation, fidgeting, hyperactivity, and bright complexion are a part of yang syndromes. Inhibition, quiescence, hypoactivity, and a sallow
complexion are part of yin syndromes.
Chinese Acupuncture and Moxibustion, 3rd Edition, page 302; 2nd Edition, 1999, page 294

Question 18

A patient has palpitations, dizziness, insomnia, sleep disturbed by dreams, anxiety, poor memory, startles easily, a dull and pale face, and pale lips. What tongue is expected?

Bluish-purple tongue
Pale, thin and dry tongue
Pale, wet and swollen tongue
Pale tongue

Answer 18

Pale, thin and dry tongue

The diagnosis is Heart Blood Deficiency. The tongue is the sprout of the Heart. When Heart Blood is insufficient, there will be a lack of blood to nourish the tongue which results in a pale tongue. As Blood deficiency is a subset of yin, the dry tongue indicates that the Body Fluids are being impacted by the deficiency. When Blood fails to chronically reach
the tongue, it will cause a thin tongue.The pulse in this pattern is choppy or fine. The key symptoms are palpitations, insomnia, bad memory, and a pale tongue. The treatment principle is Nourish Blood, Tonify the Heart, and Calm the Shen.
The Foundations of Chinese Medicine, Maciocia, 2015, page 496; 2005 Edition, page 469; 1989 Edition, page 205

Question 19

Which pulses have an empty quality?

scattered pulse (san mai), tight pulse (jin mai), slippery pulse (hua mai)

soggy pulse (ru mai), scattered pulse (san mai), minute pulse (wei mai)

soggy pulse (ru mai), scattered pulse (san mai), tight pulse (jin mai)

soggy pulse (ru mai), scattered pulse (san mai)

Answer 19

soggy pulse (ru mai), scattered pulse (san mai), minute pulse (wei mai)

This is the most complete and accurate answer. Other empty pulses are the weak pulse (ruo mai), the short pulse (duan mai), and the fine pulse (xi mai). The TIGHT PULSE is a type of full pulse. This pulse feels hard like a twisted rope. It is strong and when the pressure is released it feels like a spring but not as springy as a wiry pulse. The tight pulse indicates Cold either internal or external. Like a wiry pulse it can mean chronic pain. The SLIPPERY PULSE is one of the eight basic pulses and is generally a full type pulse. This pulse feels oily and slippery. It slips and slides
under the fingers and has a very smooth flow. The slippery pulse indicates primarily Phiegm or food retention. It can also indicate stuck Blood or pregnancy. When the pulse is combined with a weak pulse it can indicate qi xu with Dampness/Phlegm. The WEAK PULSE is an empty type of pulse. It is felt at the the deep level and not superficially. It
feels soft without any strength. The weak pulse indicates yang xu and is common in chronic disorders. The SOGGY PULSE is an empty type of pulse. It is palpated only on the superficial level. It is like a wet cotton wool that disappears when more pressure is applied. This pulse also goes by the name of weak-floating pulse. The soggy pulse indicates chronic qi xu with Dampness retention. The FINE PULSE is a type of empty pulse. It is a thin pulse like a thread and yet clear, straight, and soft. If feels like a fine line under the palpating finger. The fine pulse indicates
severe xu of Blood and also qi. A fine-weak pulse in young patients indicates weak Original Qi. The MINUTE pulse is a type of empty pulse. This pulse is very thin and is an extreme version of the fine pulse. It almost cannot be felt and the lines feel blurred.

Question 20

All three yang divergent meridians of the leg go to the

stomach
heart
vertex
kidneys

Answer 20

heart

The Bladder divergent, the Stomach divergent, and the Gall Bladder divergent all connect with the Heart zang. The Small Intestine primary meridian also connects with the Heart. This shows that there are four yang meridians that connect with the Heart. The Qi from these yang meridians assist the Heart yang qi in its function of moving blood. This Heart connection via the yang divergent meridians explains why certain points on the leg yang primary meridians can treat emotional problems. Divergent meridians do not have their own points or their own pathology.
A Manual of Acupuncture, Deadman, 2nd Edition, page 127, 229, 253, 419

Question 21

The primary channel that focuses on treating the face, shoulder, and elbow area is the

Small Intestine primary channel

Triple Burner primary channel

Large Intestine primary channel

Stomach primary channel

Answer 21

Large Intestine primary channel

Large Intestine channel symptoms include tooth pain, swollen neck, red sclera, dry mouth, nasal obstruction, runny nose with bloody discharge, throat pain, swollen and painful gums, shoulder pain, feeling cold or numbness or pain along the channel. Large Intestine primary channel disorders commonly manifest on the face, the shoulder, and the
elbow. LI-4 is a major distal point for treating any type of disorders on the face (tooth pain, nasal obstruction, runny nose, epistaxis, painful gums, etc). The Large Intestine channel goes to the lower teeth and gums while the Stomach channel flows to the upper teeth and gums. LI-15 is frequently selected as a local point to treat the shoulder should near the acromioclavicular joint. It is often combined with LI-4 or LI-11 as distal points. The Large Intestine channel is
almost always involved in tennis elbow or epicondylitis. The Stomach channel has two branches that go to ST-30. One branch goes from the clavicular fossa to enter ST-30. The other goes from the opening of the Stomach to ST-30. It is important to differentiate channel from organ symptoms which are often included in a channel symptom list.
Organ symptoms for the Large Intestine channel include pain after eating.
The Channels of Acupuncture, Maciocia, 2006, page 84, 99

Question 22

Which is an accurate pathway of the Yin Linking Vessel (yin wei mai)?

the yin wei mai terminates at the inner canthus

the yin wei mai connects with six Spleen channel points

the yin wei mai goes to the throat

the yin wei mai connects with two Liver channel points

Answer 22

the yin wei mai goes to the throat

The yin wei mai connects all the yin channels. The yin wei mai terminates at the throat (REN-22, REN-23). The yin qiao and yang qiao mai both go to the eye (BL-1). It starts at its xi-cleft point (KI-9), ascends the medial leg, connects with Spleen points (SP-13, SP-15, SP-16, [Deadman also lists SP-12]) and one Liver point (LR-14), goes through the diaphragm, the chest, and terminates at the throat. The yin wei mai is used to Nourish Blood and Yin and to treat Mental-Emotional problems.
A Manual of Acupuncture, Deadman, 2nd Edition, page 25; The Foundations of Chinese Medicine, Maciocia, 2015,page 932, 933

Question 23

In older adults, fear and chronic anxiety more commonly are the cause of

Kidney qi not firm and Lung qi xu
Kidney-yin xu and Heart Empty Fire
Kidney qi xu
Liver and Heart Blood xu

Answer 23

Kidney-yin xu and Heart Empty Fire

The emotion of fear includes chronic fearfulness, anxiety, and sudden fright. Fear makes the qi descend which in children can cause urinary incontinence or diarrhea in adults after a sudden-unexpected-big fright experience. However, the most common effect in adults of chronic fear is Kidney yin xu and Heart Empty Fire. If the Heart is strong, fear will cause the qi to descend. If the Heart is weak, then fear will cause the qi to move up in the form of Empty Heat which is more common in the elderly and in women because fear weakens Kidney yin which affects the Heart yin and give rise to Empty Fire (sweating, malar flush, dry mouth, rapid pulse, peeled tongue).
The Foundations of Chinese Medicine, Maciocia, 2015, page 264; 2005 Edition, page 252; 1989 Edition, page 132

Question 24

A patient has a dry cough, dry skin, dry mouth, dry eyes, thirst, and a hoarse voice. What tongue is expected?

Pale or normal colored tongue
Red peeled tongue with cracks
Thin yellow coating
Dry tongue

Answer 24

Dry tongue

The diagnosis is Lung Dryness. Lung Dryness with deficient fluids is the stage that precedes Lung Yin Xu. It is dryness which has not developed into deficient yin. The dryness is reflected in the tongue being dry. The pulse in this pattern is empty, particularly on the right front pulse position. A dry cough, a dry throat, and a voice that is hoarse are sufficient to make the diagnosis of Lung Dryness. The treatment principle is Moisten the Lungs and Nourish Body Fluids.
The Foundations of Chinese Medicine, Maciocia, 2015, page 578; 2005 Edition, page 549; 1989 Edition, page 234

Question 25

The capacity for sensation, feeling, hearing and sight are granted by the

Shen
Yi
Po
Hun

Answer 25

Po

The po is the corporeal soul. It is that part of the soul which is attached to the body and decays with the body at death. The po is the somatic expression of the soul. As such, the po is associated with body ability to sense, feel, hear, and see.
The Foundations of Chinese Medicine, Maciocia, 2015, page 111; 2005 Edition, page 111; 1989 Edition, page 73

Question 26

A 24 year-old woman has painful periods with clots. The pain occurs during the period and is very intense and cramp-like. It is relieved by the application of a hot-water bottle. Which vessel would you treat?

chong mai (Penetrating Vessel)

ren mai (Directing Vessel)

dai mai (Girdle Vessel)

Yin wei mai (Yin Linking vessel)

Answer 26

chong mai (Penetrating Vessel)

The clinical picture points to the obstruction of the chong mai by cold. The hot applications improving the pain points to a cold pathogenic factor coagulating the Blood. Since the chong mai is the Sea of Blood, it can treat many gynecological disorders. The three menstrual disorders that can be treated with the chong mai are Blood deficiency, Blood heat, and Blood stasis. The chong mai can thus be selected to to invigorate Blood when there is Blood stasis in the uterus. The chong mai points of SP-4 and PC-6 are the main selected points with moxa on REN-4. The chong mai influences the feet, medial aspect of legs, uterus, lumbar spine, abdomen, chest, heart, throat, face, and head.
Foundations of Chinese Medicine, Maciocia, 2015, page 911, 916; 2005 Edition, page 864

Question 27

Which of the following pulses signify Blood Deficiency?

fine pulse (xi mai), scattered pulse (san mai)

choppy pulse (se mai), fine pulse (xi mai), scattered pulse (san mai)

choppy pulse (se mai), fine pulse (xi mai)

choppy pulse (se mai), fine pulse (xi mai), deep pulse (chen mai)

Answer 27

choppy pulse (se mai), fine pulse (xi mai), scattered pulse (san mai)

This is the most complete and accurate answer. The DEEP PULSE is one of the eight basic types of pulses. This pulse can only be palpated at the middle and deep levels but particularly at the deep level. The pulse feels sunken as if underneath the muscle. Deepness is relative to the body build. What is normal for an obese patient might be abnormal for a thin patient. The deep pulse indicates that the patient has an interior pattern. A deep-full pulse indicates inner and full Cold, Heat, food retention, stuck qi or Blood. A deep-weak pulse indicates yang xu. The SCATTERED PULSE is an empty type pulse. Rather than the pulse flowing, the scattered pulse feels like it is broken
into tiny dots. The pulse is relatively superficial and disappears with stronger palpation. The scattered pulse indicates severe qi and Blood xu, especially xu of Kidney qi and Original Qi. This pulse indicates a serious disorder. If this pulse manifests in pregnancy, it can indicate a miscarriage can occur. The FINE PULSE is a type of empty pulse. It is a thin pulse like a thread and yet clear, straight, and soft. It feels like a fine line under the palpating finger. The fine pulse
indicates severe xu of Blood and also qi. A fine-weak pulse in young patients indicates weak Original Qi. The CHOPPY PULSE is one of the eight basic pulses. This pulse feels rough, jagged, and is short. It does not have a wave like a normal pulse does which flows from the rear to the front in a smooth and continuous wave. The choppy

Question 28

For the past five years, this patient has had severe palpitations, shortness of breath on exertion, fatigue, listlessness, discomfort in the chest, cold feelings, cold hands, and a bright pale face. What pulse is expected?

Minute pulse
Knotted pulse
Choppy pulse
Hollow pulse

Answer 28

Knotted pulse

In severe cases the pulse is knotted but otherwise it can be deep-weak. The diagnosis is Heart Yang Deficiency. This pattern is an Internal and Deficient condition. It has the same symptoms of Heart Qi deficiency but with the additional symptoms of Empty Cold. The expected pulse in this pattern is either a Deep-Weak pulse or in severe cases the pulse can be Knotted. A Deep-Weak pulse indicates an Internal and Deficient condition. A Knotted pulse is a slow pulse (indicates Cold) that has irregular pauses. A Knotted pulse indicates Heart Yang Deficiency with Empty Cold. The expected tongue in this pattern is a pale-wet tongue. The Heart Yang fails to transport Blood to the tongue resulting in a pale tongue. The tongue is wet because a weak Heart Yang fails to transform Body Fluids leading to an accumulation. The key symptoms are palpitations, cold hands, and a deep and weak pulse. The treatment principle is
Tonify and Warm Heart Yang.
The Foundations of Chinese Medicine, Maciocia, 2015, page 493; 2005 Edition, page 466; 1989 Edition, page 203

Question 29

Which of the following Extraordinary Vessels is most closely related to the luo-connecting meridians?

dai mai (Girdle Vessel)
ren mai (Directing Vessel)
du mai (Governing Vessel)
chong mai (Penetrating Vessel)

Answer 29

chong mai (Penetrating Vessel)

The chong mai, also called “Avenues of Qi”, controls all of the abdominal meridians, including luo meridians. The chong mai controls all superficial, minute, regular, and deep blood luo connecting meridians. The chong mai, also called “Sea of Blood”, controls the deep Blood connecting meridians. SP-4, the opening point for the chong mai and also a luo point, has an
influence on all luo meridians, especially the deep or blood luo, and is an important point in treating chronic Blood stagnation. Generally speaking, one of the functions of the Extraordinary vessels is to absorb excess Qi from the primary meridians. This is done through the luo points, many of which are the opening points of the Extraordinary Vessels (SP-4, LU-7, TB-5, PC-6).
The Channels of Acupuncture, Maciocia, 2006, page 272, 276