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by Hui Jun. Shen
Chinese Medicine Diagnostics
Hui Jun Shen
MB, MM (China), MATCM (UK) Senior Lecturer of Acupuncture Programme School of Health and Social Care University of Lincoln UK Email: firstname.lastname@example.org
Chinese Medicine Diagnostics
by Hui Jun. Shen
CM Diagnosis is based on fundamental principle that signs and symptoms on the Exterior reflect the condition of the Internal Organs Signs and symptoms present a syndrome pattern which can be identified using Chinese Medicine diagnostic techniques: Syndrome (Pattern) Differentiation The purpose of carrying out Chinese medicine diagnostic techniques is to establish syndrome (pattern) differentiation, which is the foundation on which treatment, including treatment principle(s), point selection and needling techniques is determined. 1. Diagnostic Methods - The 4 Techniques: 1) Observation, including Tongue Diagnosis - (“looking”) Vitality, complexion, body constitution, Secretions, skin etc. 2) Auscultation & Olfaction (“listening and smelling”) 3) Inquiry (“10 Questions”) (“asking”) 4) Palpation and Pulse Diagnosis (“touching”) 2. Diagnosis: Difference between WM and TCM TCM Diagnosis is combination of name of disease and name of syndrome (Western Medicine – name of disease only) e.g. Disease = common cold, Syndrome = wind/cold In CM naming can come from: Pathogenic Factor Main Symptom e.g. Headache, Dizziness Western Medical Diagnosis e.g. Common Cold due to Wind/Cold Invasion
Chinese Medicine Diagnostics
by Hui Jun. Shen
Chapter I: Observation – “Looking”
1. Vitality (Shen)
Materials for Shen : Qi, Blood, Essence and Body Fluids State of Shen = State of the Zang Fu Organs; and state of Qi, blood, body fluids. Good Vitality Eyes Bright and vivid Complexion Healthy, shiny Expression Natural Physical Condition Flexible, muscles well developed Speech Clear Mind Clear Indicating: sufficient Qi, Blood, Essence and Body Fluids. Vital Qi is strong. Disease is usually mild and prognosis is good. No Vitality Eyes Dull or loss of shiny brightness Complexion Dull or pale/discolour Expression Dull or in agony Physical Condition Heavy, slow, muscles withered Speech Slow and weak Mind Unclear, delirium, hallucinations Indicating: insufficient Qi, Blood, Essence and Body Fluids Vital Qi is damaged. Patient will struggle with illness Pseudo Vitality Patient has lacked vitality for a long time and is in critical condition. SUDDENLY there is a marked “improvement “in his condition for 1-2 days only. Indicating: Yin and Yang have separated and/or collapsed, reaching to their end… Eyes Bright but not shiny Complexion Flushed cheeks but kind of unhealthy Expression Bright but not natural looking Physical Condition Emaciated but better appetite Speech Loud voice and talkative Mind Restlessness/agitation
Chinese Medicine Diagnostics
by Hui Jun. Shen
2. Sensory Organs
A lot can be discerned by examining sense organs Nose Clear watery nasal discharge Clear thick yellow discharge Prolonged thick yellow/green Red nose at tip Ears Dry, withered, black in color Pus in ear Swelling and Pain Mouth & Lips Purple/Blue Lips Deep Red and Dry Lips Pale Lips -> Kidney Essence Deficiency -> Damp heat in Liver and GB -> Gall Bladder Fire -> Wind Cold Invasion -> Wind Heat Invasion -> Phlegm Heat/Lung -> Lung or Spleen Heat
-> Blood Stagnation (cold) -> False/Excess Heat -> Blood Deficiency (Spleen Deficiency)
Teeth & Gums Gums swollen and easy bleeding -> Stomach Heat Pale Gums -> Blood Deficiency Blue Line on Gums -> Toxic (Lead Poison) Throat Red, sore and swollen -> Wind Heat Invasion Red, sore and swollen throat with yellow/white spots -> Toxic Heat Lung/Stomach Sore, dry throat, not swollen -> Kidney Yin Def Eyes Red in corners Red in white (conjunctiva) Red swollen/painful Yellow in white Swelling under eyes -> Heart Fire -> Lung Heat -> Wind Heat Invasion or Liver Fire -> Damp/Heat (jaundice) -> Kidney Deficiency
Sides of the eyes are most important. Other areas are: under the eyes, around mouth and sides of the face Observe in natural light Relax your own eyes and “accept” colour Lots of practice! Assess with other signs if unsure
Chinese Medicine Diagnostics by Hui Jun. but no blood colour No lustre. abnormal colour “Five Colours” Blue/Green Pale face with blue tinge Cold Syndrome Pale with blue/purple Blood Stagnation Intermittent pain in chest and sternum -> Heart Blood Stagnation Pain in hypochondriac area -> Liver Qi Stag -> Liver Blood Stagnation Blue/purple face with convulsions and infantile high fever -> EXTREME excess/deficient heat Red Heat Syndrome Whole face is red -> Excess Heat Red Cheekbones -> False Heat Yellow Damp Heat Bright orange yellow ->Yang Jaundice: Damp Heat Lv/GB Pale yellow (sallow) -> Spleen & Stomach Def -> Def Qi and Blood Yellow and Puffy ->Damp accumulating due to Spleen Deficiency Damp Cold Smoky dark yellow ->Yin Jaundice -> or Long term Blood Stagnation White . blood colour (pink) Skin Lustre State of Vital Qi/Essence of Zang Organs Abnormal: Favourable Unfavourable Bright and shiny. shiny. Shen In General Always look at the face. sharp pain –> Cold Stagnation Colours associated with Five Elements: Fire – Red Earth – Yellow Metal – Grey/White Water – Blue/Black Wood – Green 4 .Cold Syndrome Dull pale white -> Blood Deficiency Bright white -> Yang Deficiency Pale severe. Qi and Blood goes to the face and face is always visible Normal: Bright. no shine.
Fire Posture Normal/natural . or patient with limited range of movement of limbs. False Heat.Kidney Yang Deficiency Colour of Skin Dull Deficiency of Body Fluids Yellow : Bright and Clear -> Damp Heat (“Yang Jaundice”) Dull yellow -> Damp Cold (“Yin Jaundice”) Red Rash Blood Heat Spots Blood Heat/Toxin Infected or weeping -> Damp Heat/Toxin 6. moist.Phlegm and Damp retention Thin Body .Chinese Medicine Diagnostics by Hui Jun.health or mild conditions Compulsory – mostly seen in pain cases. Skin Normal skin: Smooth.Yin Deficiency. Shen 4. or crucial conditions Walking Normal Abnormal Movement Whole body Whole limb Joint(s) 5. Secretions Vomit 5 . Body Condition Constitution Strong/weak Obesity/Overweight . bright Dry Skin --Blood Deficiency or Yin Deficiency Dry/Scales (Local) --Exhaustion of Body Fluids Too moist --Spontaneous Sweating due to Lung Qi Deficiency Or Wind/Heat Invasion Slight Swelling --Qi Stagnation Edema No Pit – Damp Retention from Qi Deficiency Pitting .
g. can cough up Damp Phlegm Small. no smell Cold Syndrome: Yang Def in Spleen and Kidney or Invasion of Cold into Stomach Thick.Chinese Medicine Diagnostics by Hui Jun. yellow. Shen Thin. sour odour Heat Syndrome Undigested Food Food Stagnation Water/Sputum/Saliva: Phlegm retention in the Middle Jiao Yellow/Green. e. foamy Wind Phlegm Watery. excess or deficiency (hyperactivity of Fire due to Lung Yin Deficiency. sticky Heat Phlegm Large. Tuberculosis) 6 . (Bitter): Damp Heat in Liver and Gallbladder Blood or Clots Liver Fire -> Stomach or Stomach Heat -> Blood Stagnation Sputum Thin. can’t cough up Dry Phlegm Blood Lung Heat. clear Cold Phlegm Thick.
¤ Upper Jiao The Tip of the tongue corresponds to the Lung and the Heart.Using Tongue Diagnosis we can: 1) Ascertain the state of vital substances (Qi. Urinary Bladder. blood. 7 . Large Intestine and Small Intestine. ¤ Middle Jiao The Middle of the tongue corresponds to the Stomach and Spleen.Chinese Medicine Diagnostics by Hui Jun. The sides of the tongue correspond to the Liver and Gall Bladder. Some theories place the Gall Bladder on the left side and the Liver on the right side of the tongue. Shen Chapter II: Tongue Diagnosis A. medications – may strip or dye the coat. Introduction The tongue is the “window of the internal organs” The Formation of Tongue Tongue body – formed by muscle and blood vessels. coffee. Clinical Significance of Tongue Diagnosis . therefore both Qi (upright Qi) of the body and pathogenic Qi (evil Qi) can coagulate on the tongue surface forming the coating. full of Qi and blood Tongue coating – metabolic product of the epithelial cells of the tongue. smoking. 2) Ascertain the nature of the pathogen 3) Locate of the disease in organs 4) Infer the course of the disease (internal or external) 5) Infer a prognosis Method of Tongue Diagnosis: Combine the Diagnosis of Tongue Body and Coat Examine the Tongue in natural light wherever possible or using a full spectrum light bulb Allow for effects of diet and medication: diet – greasy food. body fluids and essence) and zang fu organs. B12 – yellow coat Tongue Areas The Tongue areas are mapped to internal organs ¤ Lower Jiao The Base of the tongue corresponds to the Kidney.
Shen Normal Tongue Body Soft.Excess Heat in Middle Jiao Deep Red Extreme Heat Condition Pathogen deep in the interior Purple Blood Stagnation Red purple: Blood stagnation due to or accompanied with Heat Blue purple: Blood stagnation due to or accompanied with Cold Blue Over whole tongue body . flexible.“Buffalo Tongue” Internal Cold. Tongue Body Diagnosis A) Tongue Body Colours and Clinical Indications Pale Deficiency of Qi. excess cold invasion or Yang deficiency Blood Stagnation B) Tongue Body Shape and Clinical Indications Swollen/Puffy Pale/Tender/Teeth Marks Qi or Yang Deficiency in Spleen and Kidney Excess Damp/Accumulation of Body Fluids Light Red/Yellow Greasy Coat Damp Heat or Phlegm Heat Deep Red/Occupies All Mouth 8 .Heart Fire Sides . shining Not too fat or thin. excess or deficiency Tip .Chinese Medicine Diagnostics by Hui Jun. pink colour Coat Thin and white with clear grains scattered evenly B. moist. blood or Yang Small/Thin Deficiency of Qi and/or Blood Puffy/Tender Spleen Qi deficiency or Deficiency Cold Syndrome due to Yang Deficiency Red Heat Syndrome.Excess Heat in Liver and GB Middle .
Greasy Coat Blue or Purple Flaccid Pale Colour Deep Red Shortened Extreme Deficiency of Qi and Blood Exhaustion of Yin Heat invading Pericardium Phlegm Retention in Pericardium Wind Stroke (or early signs of) Curved up or down or contracted. Shen Excessive Internal Heat Blue and Purple Blood Stagnation due to Blood Heat or Cold Thin Body Pale Deep Red Qi and Blood Deficiency Yang Rising or Yin Def “Thorny” Papillae on surface of the tongue (like red strawberry pips) Heat Syndrome. unable to project far. Thick. Excessive Heat in the Interior The more Heat. Dilated Blood Stagnation Thin Light Red Blood Deficiency C) Tongue Body Movement and Clinical Indications Stiff Deep Red Puffy. the more enlarged and profuse the papillae Burnt Yellow Excess Heat Deep Red/Scanty Excess Heat of Ying and Blood Stages Cracked Can be either congenital or pathological If congenital cracks will not be deep and will remain unchanged during lifetime Dry. No Water Yin Def Damp Retention. and not extending longer than phrenulum Purple.Chinese Medicine Diagnostics by Hui Jun. may be congenital 9 . as the result of damp obstructing Body Fluids Puffy and Tender Spleen Def/Damp Retention Pale Blood Deficiency Deep Red Yin Deficiency Bleeding Spleen Qi Deficiency Heart/Liver Fire Fails to contain the blood Heat causes blood to overflow Sublingual Veins Normally is slightly purple.
swollenExtreme Heat. Tongue Coating Diagnosis A) Colour of Coat and Clinical Indications White coating: Thin Normal or mild disorder: Wind Cold Invasion Thick Interior Damp or Cold Damp Syndrome Slippery/Greasy Phlegm/Damp Dry Body Fluids Severely Impacted Powdery Excess Damp and Internal Heat Infectious Diseases Internal Abscess Yellow coating: Interior Heat Syndrome – more yellow more severe the heat is Thin/Slippery Wind Heat Invasion Thin & Dry Going Internal. Liver Blood Def causing liver wind. Body fluids consumed Greasy Phlegm or Damp Heat Grey coating: Chronic Disease or Prolonged Illness of Digestive System Wet Cold Damp Syndrome Dry Internal Heat. consuming Body Fluids Thick & Dry High Fever. body fluid consumed (inc Blood) Deviated Wind Stroke (or early signs of) C. more severe than yellow Body Fluids consumed Black coating: Extreme Heat or Excessive Cold Dry. Greasy Coat Cold Stagnation Qi and Blood Deficiency Heat consumed Body Fluids ð Phlegm Damp Quivering Usually indicating prolonged and chronic disease Deficiency of Qi & Blood e. Shen Moist and Pale Pale and Tender Dry and Red Puffy. tendons not nourished Febrile Disease excess wind.Chinese Medicine Diagnostics by Hui Jun. Exhaustion of Body Fluids Tip only Extreme Heart Fire 10 .g.
can be easily removed.Chinese Medicine Diagnostics by Hui Jun. Lacking in Moisture Body Fluids Consumed due to Excess Heat Or Body Fluids Distribution obstructed by Damp in Channels Greasy Smooth and fine. moisture. or surface coating. peeled Thick/Thin Reflects State of Vital Qi. and State of pathogen Thin Can see body through the coating Pathogen is external or mild Thick Cant see body through the coating Pathogen is internal e.g. with yellow around **check that they don’t smoke Wet Excessive Cold and Damp in Interior Black greasy Severe Damp Heat in Spleen and Stomach B) Quality of Coat and Clinical Indications Changes in thickness. Food Stagnation Moist/Dry Reflects State of Body Fluids Slippery Excessive moisture on surface Cold Damp Acc due to Yang Def Dry Coarse. no root Food Stagnation or Phlegm Stagnation Peeled Coating SUDDENLY comes off either completely or partly “Geographic” tongue. e. Coating is peeled and body is shiny Exhaustion of Stomach Qi and Yin Kidney Qi and Yin compromised 11 . looks like a map Impacted Stomach Qi and Yin Def of Qi Yin and Blood No Coating/”Scanty Coat” “Mirror-like” coating. evenly distributed granules. cant remove ð Damp & Phlegm Accumulation ð Damp Heat or Food Stagnation Curdy Thick and coarse granules loosely scattered. like layer of bean curd. Damp/Phlegm.g. slippery. greasy. Shen Middle only Exhaustion of Stomach Qi Root only Excessive Heat in Lower Jiao Sides only Excessive Heat in Liver and Gallbladder Middle.
.“10 Questions” General Approach Treat patients “from the heart” Keep the focus on the Main Complaint “what’s wrong. ….which one first….. 12 .Chinese Medicine Diagnostics by Hui Jun.where?….is there swelling associated with it….Exterior /Interior syndromes) Details of main complaints….location. duration…. and phone number (hopefully on intake form!) if not “fill in” How can I help you today? (hopefully will illicit main complaint…may not!) If it did….feels?. With pain ….) …. fixed.better with heat or pressure (or worse…. moving…. stabbing. nature. …..sharp. how long” “Short List” other additional complaints Prompt patient but DO NOT DIRECT patient ask about complaint symptoms but don’t describe them for them! Try and keep the language simple Keep a natural expression! General Inquiry Points Name.. aching.“how long” Did they associate any event (physical or emotional) with the start of it Did it start quickly or gradually (chronic or acute condition at the start….can they point to it or is general location …. address. What other symptoms are they having…. Shen Chapter III: Enquiry .
easier for pathogen to get in . better with warmth. …. listless.) How is main condition developing…. the tests done and results? What medications? (make a concise list) How is that going… Any possibility they could be pregnant? (appropriately ask.Chinese Medicine Diagnostics by Hui Jun.) (has a bearing on needle point choice) 1 Chills/Fever Chills with no Fever Aversion to chills.. …. where? What was the diagnosis.Lung Qi Def can cause Wei Qi Def) Tai Yang Stage (6 Meridian Differentiation) wind cold exterior syndrome Wei Stage (Warm Disease Differentiation): wind heat exterior syndrome 13 . cannot be relieved by warmth External Excess Wind/ Cold invasion Abdominal fullness and pain.what makes it worse or better…(e.g. profuse clear urine.is it getting worse or better…. better with warmth Internal Excess Cold OR Tai Yin Stage (6 Meridian Differentiation) (Spleen Yang Deficiency) Feels cold. what. hot/cold/damp) Did they see a western medicine doctor? Who. sleepy. Internal Deficient Cold Yang Def (constitutional) OR Shao Yin Stage (6 Meridian Differentiation) Kidney Yang Deficiency Chills with Fever More Chills than Fever: External Excess Wind/Cold More Fever than Chills: External Excess Wind/Heat And…aversion to wind and spontaneous sweating External Deficiency Syndrome Disharmony of Ying Qi & Wei Qi (Wei Qi weak . Shen (the short list…relevant to main complaint? or not….
liver/gallbladder heat Damp heat syndrome: damp/heat in middle jiao. lung heat.Between 98. stomach heat. 5 Palm Heat Night Sweats. Shen Alternate Chills/Fever Shao Yang Stage (6 Meridian Differentiation) syndrome of half exterior half interior Qi Stage (Warm Disease Differentiation) Interior heat syndrome Fever with no Chills 1). Tidal Fever . damp/heat 14 . Restlessness Red Tongue Body with Scanty Coat Internal Deficient Heat: Yin Deficiency Fever comes or is worse between 3 and 5 pm Abdominal distension. damp/heat in liver/gallbladder. Low Fever . can be excess heat or deficiency heat Excess heat: Tongue Body Red with yellow coating: Heat in organs: heart heat.Chinese Medicine Diagnostics by Hui Jun.6 and 100. Big pulse Red Tongue Body with yellow coating Internal Excess Heat OR Yang Ming jing Meridian Stage (6 Meridian Differentiation) Qi Stage (Warm Disease Differentiation) 2). Big Thirst. likes cold drinks Big Sweating.Comes at regular time in the afternoon Low Fever in the afternoon or at night Malar Flush (red cheeks).Temperature over 102.4 F (37-38 C) or No Fever (normal body temperature) but Feeling Hot: Internal heat syndrome. constipation Deep forceful pulse Red Tongue Body with Dry Burnt Yellow Coating Accumulation of Pathogenic Heat or Food Stag in Stomach or Large Intestine (Yang Ming Fu Organ Stage of 6 Meridian Differentiation) Fever is higher in afternoon Chest fullness.2oF or 39oC (“4 Bigs”) Big fever. High Fever . heavy body Skin hotter with prolonged palpation Red Tongue Body with Yellow Greasy Coat Damp Heat in Interior o o 3).
weak pulse. Flooding Pulse. red face. 5 palm heat Internal Deficient Heat – mostly Yin Deficiency Intolerant to cold. easily tired External Deficiency (Def of Wei Qi) 2 Sweating Exterior Syndrome With fever. damp/heat in bladder. SOB. thin yellow coat Interior Heat syndrome Heavy body & head. yellow greasy coat Damp Heat syndrome Forehead Sweat is like oil. sweating. quiet voice. some skin conditions etc. Deficiency heat: Tongue Body Red: Yin Def Tongue Body Pale Blood Def or Qi Deficiency Fever worse with physical exertion. fullness in chest & abdomen. spontaneous sweating floating pulse External Deficiency (Def of Wei Qi) Interior Syndrome Big Sweat. feels worse on exertion. damp/heat in lower jiao Heat in blood: various hemorrhage conditions. thirst.Chinese Medicine Diagnostics by Hui Jun. pale complexion. malar flush. sore throat. tidal fever. spontaneous sweating Internal Deficient Cold Qi or Yang Deficiency Syndrome Profuse dribbling of cold sweat. floating and rapid pulse External Excess (Wind/) Heat With fever. aversion to wind. CRITICAL Severe Internal Deficient Cold Yang Depletion Syndrome Local Sweating Head Chronic disease. cold limbs. aversion to wind. weak pulse Impending exhaustion of Jing (Essence) CRITICAL – YIN AND YANG SEPARATE 15 . SOB. Fever & Thirst (4 Bigs) Internal Excess Heat Night sweats. Shen in intestine. with cold limbs. red tongue.
Exterior or Damp Syndrome Lumbar/Knees – Qi/blood local stagnation or Kidney Deficiency Heavy Damp Syndrome. with paralysis – Windstroke Palms/Soles With Internal Organ symptoms Yin Deficiency Tidal Fever.Cold Bi Syndrome Colic Pain Sharp and violent like a knife twisting in the body .Qi Stagnation Stabbing.Wandering Bi Syndrome (wind invading meridians) In Chest and Hypochondriac Region .Excess Syndrome (e. Fixed Body .Liver Fire Flares Up/Liver Yang Rising Moving Joints in 4 Limbs .Kidney Yang Deficiency Burning.Cold Bi Syndrome Loins . Abdominal Fullness Yang Ming Fu Syndrome 3 Pain 1) Nature of Pain Distension/Bloating In Chest and Hypochondriac Region . better with cold Excess or Deficiency Heat Syndrome Dull Pain Qi Stagnation or Deficiency Syndrome (Yin/Yang/Blood or Qi deficiency) Aching Whole Body .Qi Stagnation In Head and Eyes.Excess or False Cold Syndrome Joints . Kidney Stones) Cold cramps.Chinese Medicine Diagnostics by Hui Jun. Damp Blocking the Channels 16 .g.Blood Stagnation Joints in 4 Limbs . Constipation. with Migraines . better with heat . Shen Half Body Upper/Lower/Left/Right.
dizziness. Shen Hollow/Empty Deficiency Syndrome (Yin/Yang/Blood or Qi) 2) Location of Pain Headache Location in head: Frontal => Yangming. whole body aches.Phlegm Stagnation Distending Headache. Greasy Tongue Coat . Phlegm Stagnation suppressing chest yang Qi and Blood Stagnation 17 . with other symptoms…. may have a history of head trauma Blood Stagnation Chest Pain Heart and Lung Pathology Choking Sensation. pain -> left shoulder. Severe. Heavy Head.Blood Deficiency Hollow. Loose Stools Spleen Deficiency => Damp…with dizziness too Yang Rising taking Damp with it Stabbing and Fixed Headache.Kidney Deficiency Fullness in Chest. with Bitter Taste. worse when exposed to wind cold Wind/Cold Headache Better with wind/cold. worse with heat Wind/Heat Headache Heavy Body and Head (feels like its wrapped up) Wind/Damp Headache Headache due to interior causes Chronic. Heavy Head. chills & fever Exterior syndrome: Wind Heat/wind Cold/Wind Damp Stiff Neck. tightness in chest “Chest Bi Syndrome” (Angina Pectoris)…d/t…. and pale complexion . comes and goes Dull and worse after exertion . Diarrhea. and Dry Throat Liver Fire or Liver Yang Rising Fullness in Abdomen.Qi Deficiency Dull. soreness in low back and knees .Chinese Medicine Diagnostics by Hui Jun. Occiput => Taiyang Vortex => Jueyin Both Sides => Shaoyang Acute headache. continuous headache.
profuse cold sweat. convulsions. Asthma Excess Heat in the Lung Night Sweats. Shen Restriction by Cold Paroxsysms. nausea vomiting undigested foog Food Stagnation Dull pain with poor appetite. chest congestion Severe Chest Bi Syndrome Burning pain. colic pain. continuous gripping. watery vomiting External Cold Invasion into the Stomach Distention with pain after eating too much.Deficiency Syndrome Worse with Pressure .Excess Syndrome Cold and better with warmth . Blood in Sputum Lung Yin Deficiency (or TB) Hypochondriac Pain Liver and GallBladder Pathology Sighing Liver Qi Stagnation Jaundice Damp Heat in Liver and GallBladder Stabbing and Fixed Pain Liver Blood Stagnation Burning Pain with Red Face and Eyes Liver Fire Flares Up/Liver Yang Rising Burning Pain with tidal fever and night sweats Liver Yin Deficiency Epigastric Pain Sudden pain after exploring in cold or eating cold food. fatigue Stomach/Spleen Deficiency Stomach ache worsened by emotional change.Cold Syndrome 18 . grey face.Chinese Medicine Diagnostics by Hui Jun. irritability Liver Overacting on Stomach Abdominal Pain Better with Pressure . loose stools.
Blood Stagnation Back Pain Extends to head/neck with external symptoms . red tongue tip .Invasion of Bladder meridian by cold Cold Limbs. dream disturbed sleep.Cold Damp Stabbing and Fixed Pain .Yang Deficiency Hollow sensation . poor appetite. heaviness.Imbalance between Heart and Kidney Waking up early. red tongue tip or month ulcer . restlessness.Heart Blood & Spleen Qi Deficiency Nightmares.Jing Essence Deficiency Painful Limbs & Joints Bi Syndrome Not fixed Wind Bi Fixed. yellow greasy coat . scanty urination. floating and tight pulse Exterior Wind/Cold/Damp Syndrome After chronic disease or confinement to bed Qi and Blood Deficiency 4 Abnormal Sleep Insomnia Heart Shen disturbance Blood and Yin house the Shen in the Heart. chills & fever. night sweats. Shen Feverish and better with cold . heavy joints Damp Bi Red & Swollen Joints Hot Bi Whole Body Aches whole body. worse with Cold Cold Bi Fixed. red tongue. cant get back to sleep. pale tongue .Heart Fire (Heart Heat) Waking up many times in the night. hot flushes -Liver and Kidney Yin Def Stomach Distension. Palpitations.Phlegm Heat disturbing heart shen Can’t get to sleep.Heat Syndrome Low Back Pain Soreness and weakness ..Kidney Deficiency Cold Pain with heavy sensation on rainy/cloudy days . weak low back and knees. Cold Back . restlessness 19 .Chinese Medicine Diagnostics by Hui Jun. scanty tongue coat .Heart Yin Def Palpitations. palpitations.
Liver Yang rising Hot flushes. fullness in chest.Spleen Qi Def Sleepiness with dizziness. palpitation. . cold limbs. fatigue. . greasy tongue coat . Energy Level Tiredness (Lethargy/fatigue/lassitude/sluggishness/weariness) Always tired/sleepy Tired/fatigue.Food Stagnation Sleepiness (somnolence/ Drowsiness) Tired. night sweats. weak thin pulse . poor appetite.Chinese Medicine Diagnostics by Hui Jun. greasy tongue coat . Thirst.Spleen Qi Def Sluggishness. intolerant to cold. headache/dizziness .) Short templed. cold limbs. moody and emotional . Appetite & Taste Thirst Body Fluid Deficiency due to Excess Heat Yin deficiency Obstruction of Body Fluid Distribution by Damp 20 .Kidney Yang Def Lethargy and drowsiness in Febrile Disease .Heat invasion of Pericardium Restlessness (listlessness/agitation/restiveness) Insomnia.Yin deficiency leading to heat flaring up 6. dizziness. SOB .Kidney Yang Def Lethargy and drowsiness in febrile disease . Shen . heavy limbs. poor appetite. intolerant to cold.Heart Shen disturbance (by heat. phlegm etc. dream disturbed sleep. sleepy after eating. heavy limbs.Damp/phlegm obstructing Clear Yang rising to the Head Extreme fatigue. sleepy after eating.Damp/phlegm obstructing Clear Yang rising to the Head Extreme fatigue. fullness in chest. irritability.Heat invasion of Pericardium 5. weak thin pulse .
Shen Thirst & drinks a lot (polydipsia) Impairment of Body Fluids Extreme thirst. big pulse. fullness of stomach. curdy tongue coat . yellow greasy tongue coat . stomach distension. purple spots on tongue . fever worse at night.Spleen Qi Def Thirst. hypochondriac pain. jaundice. greasy tongue coat . low energy. red tongue and scanty coat . belching. deep red tongue . restlessness. loose stools. foul odor.Chinese Medicine Diagnostics by Hui Jun. also eats a lot (polyphagia) . meaning wasting and thirsting) Thirst & doesn’t want to drink (NO polydipsia) Slight impairment or obstruction of Body Fluids Recessive fever (hotter to touch).Damp Heat Restlessness.Liver and GB Heat 21 .Phlegm Retention in Middle Jiao (obstructing channels) Wants to rinse mouth not swallow. white greasy tongue coat . tinnitus.Stomach Yin Def Dizziness. or tidal Fever -Damp Warm Syndrome) Fullness of chest.Spleen Qi Def Fullness of Stomach. tired . pale complexion & tongue.Internal Heat entering Ying and Xue (blood) stages Vomiting after drinking .Diabetes (Xiaoke in TCM. profuse sweat.Stomach Fire Loose stools.Diabetes (Xiaoke Disease) Anorexic (don’t want to eat) Burning sensation in Stomach.Damp Retention in the Middle Jiao Aversion to greasy food. wants cold drinks (“4 Bigs”) Excess Internal Heat Extreme thirst. high fever. yellow coat . drink a lot. delirium.Damp Heat in the Liver & GB Aversion to food. heavy body. insomnia.Food Stagnation Polyphagia (eats a lot) Thirst.Blood Stagnation (obstructing channels) Appetite Poor Appetite Abdominal Distension. lot of urine . poor memory . red tongue. weak pulse .Stomach and Kidney Yin Def Taste Bitter taste . lots of urine.
red tongue. thin pulse . abdominal pain.Damp in Spleen Pungent .Kidney Yin Def Acid Reflux .Spleen Def Sour .Stomach & Liver Heat OR Liver overacting on Stomach Sour Odor in mouth . red tongue. severe abdominal pain. flatulence. deep slow pulse .Kidney Def Pungent . cold limbs.Liver Qi Stagnation Difficult to pass stolls. stomach fullness. fatigue.Liver Def Salt . tidal fever.Spleen Qi Def Cravings Sugar .Chinese Medicine Diagnostics by Hui Jun. smell of rotten eggs. pale tongue. weak pulse 22 .Blood Deficiency Malar flush. poor memory. pale tongue. belching.Yin Deficiency Clear profuse urine.Cold Damp invasion of Spleen Dark brown stool. SOB.Damp Heat in Large Intestine Abdominal pain. wiry pulse . Shen Sweet & Greasy taste . pale tongue. abdominal fullness. cold pain in abdomen.Food Stagnation Loose stools. low energy. mucous and/or blood. borborygmus white greasy coat . weak pulse . poor appetite.Heat in Stomach and Large Intestine With abdominal distension. bad breath. scanty coat.Yang Def (Empty Cold) Diarrhea Frequent bowel movement with loose and watery stools Thin & watery stool. yellow greasy coat . borborygmus. borborygmus. dry stool even like small sheep’s droppings With scanty dark urine. yellow coat.Heart Def 7.Qi Deficiency Palpitations. Abnormal Stools Constipation Frequency of voiding is low or difficult to pass stool.Food Stagnation OR Disharmony of Liver and Spleen No taste .Lung Def Bitter . intolerant to cold. better with warmth. burning sensation at anus. rolling rapid pulse . undigested food in stool .Lung Heat Salty . dark urine. side pain. thin pulse .
Chinese Medicine Diagnostics by Hui Jun. jaundice . weak low back & knees.Damp Heat in Liver & GB Abdominal distension. weak pulse . pale tongue.Kidney Yang Def Abdominal Cold.Damp Heat in Bladder Weak low back and knees .Kidney Yang Def Other Stools are sometimes dry or loose (IBS) . usually after prolonged and chronic diarrhea . frequent urination.Dysentery with Qi Stagnation Rectal Prolapse.Spleen Deficiency “Dawn Diarrhea” with abdominal pain. weak low back and knees . frequent.Sinking of Spleen Qi 8.Interior Cold Turbid/Cloudy Urgent.Liver overacting on Spleen Tarry Black Stools – “Far Blood” – Bleeding in Upper GI tract .Heat in Stomach and Large Intestine Urgent. intolerance of cold. cold limbs.Diabetes (Xiaoke) 23 .Spleen and Kidney Deficiency Frequent Profuse. polydipsia & polyphasia . Shen .Empty Cold in Stomach and Spleen Tenesmus (want to void but cant) . insomnia . Abnormal Urine Scanty/Dark Urine Heat Syndrome in general Restlessness.Damp Heat in Bladder Clear/Lots Cold Syndrome in General Pale face. brown color. pale tongue.Heat/fire in Heart and/or Small Intestine Side pain. constipation . cloudy . borborygmus. painful urination .Kidney Qi Deficiency Poor appetite. weak low back & knees . deep wiry pulse . and immediate passage of loose stool.
Kidney Stones Enuresis Urination at night.Spleen Qi Def.Liver Qi Stagnation leading to heat Thin. HEAT SPEEDS UP THE FLOW OF BLOOD Blood is dark red or purple. red tongue.Kidney Qi/ Yang Def Dysuria Difficult Urination Puffy eyelids.Lung cannot disperse Qi Poor Appetite.Kidney Yang Def Brownish urine. sore low back .Damp Heat in Bladder Frequent at night.quality.Damp Heat in the Bladder Stabbing Pain . red tongue. quantity. Menstruation Regularity. pale tongue and weak pulse . rapid pulse .Kidney Yang Def Incontinence Patient cannot control urination during the day . rapid pulse . light red. clear profuse urine . burning/stinging sensation.Chinese Medicine Diagnostics by Hui Jun. color. bed wetting Old people with weak constitution.Kidney Qi/Yang Def 9. children 3-12 years old .Heat in the Blood. and accompanying symptoms Early Period More than 7 days early than the normal cycle of 28 days Blood is fresh red with large quantity.Blood Stagnation Colic Pain . low energy . rapid pulse .Damp Heat in the Bladder Painful Urination Burning sensation (UTI/STD) . Shen Urgent and painful. yang edema in the upper body . brown color .Spleen Yang Def Intolerance to cold. thick. QI DEF CANNOT HOLD THE BLOOD 24 .
tinnitus. over a 3 month period Dark purple.Cold Stagnation ð Qi & Blood Stag Dull pain low abdomen after period. light red. wiry pulse . pale face. cramps before during or (rarely) after period 80% due to Qi and Blood Stagnation Before or During Period -> Qi and Blood Stagnation After Period .Blood Stagnation – Late period Light red. pale tongue. breast distension. Shen Late Period More than 7 days late than the normal cycle of 28 days. scanty. thin.Qi Deficiency ð Blood Deficiency Irregular This month early.Spleen & Kidney Def .Liver Qi Stagnation Stabbing Pain in Abdomen.Liver Qi Stagnation . pale complexion and weak pulse . dizziness.Chinese Medicine Diagnostics by Hui Jun. pale face.Heat – Early period . deep tight pulse . better with warmth . irritable.Qi and Blood Deficiency Amenorrhea No periods.Liver Qi Stagnation -> Qi & Blood Stag Cold pain in low abdomen. varying amount.Phlegm Damp Retention obstructing the channels Thin. scanty. Primary (never) or Secondary (stop for 3+months) Palpitations. distending pain in side abdomen or chest. poor appetite. purple tongue 25 . next month late.Qi and Blood Deficiency Distending pain in low abdomen before or during period.Blood Def so no store in Chong/Ren Channels – Late period Dysmenorrhea Painful periods. wiry pulse . blurred vision . sore and weak low back & knees. sore low back . intolerance of cold. dizzy.Cold ð Blood Stagnation Light red. greasy tongue coat .Qi Stagnation ð Blood Stagnation Cold limbs. scanty.Spleen Def cannot hold the blood – Early period .Liver and Kidney Def Depression. blood clots. clots . loose stools . fullness of chest. Dark purple.Blood Deficiency Weak low back and knees. pain in chest and side. heavy body. thin & weak pulse . wiry pulse .
sticky. or bloody White profuse. brain Breast feeding or weaning problems . thick.Spleen Qi Deficiency Yellow profuse.Blood Stagnation Fullness in chest and abdomen.Food Stagnation Convulsions . thin.Zang Fu Organs Infectious Diseases – e. rapid pulse .Blood Stagnation Light red. whooping cough. use of smoking.Kidney (pre-heaven or congenital essence/qi) impairment Birth trauma – Lungs. measles.Spleen 26 . Shen . yellow.Kidney (pre-heaven or congenital essence/qi) impairment Slow body development. chicken pox .Liver Qi Stagnation ð Heat in Lower Jiao 10.weak Lung Qi and/or Wei Qi Diet . rolling pulse . thick.Chinese Medicine Diagnostics by Hui Jun. greasy coat. no clots . leukorrhea. no smell . recurring but non-cyclical Heavy bleeding. nausea. alcohol or drugs during pregnancy . purple spots on tongue . late teething.Cold Damp in Lower Jiao . clots. foul smell . etc . profuse phlegm.Heat in the Blood Purple color. spotting. bright red.Heat and/or Wind Hereditary Diseases .Qi Deficiency Annex: Leukorrhea Excessive vaginal discharge – white. red tongue.g. vomiting. slight smell .Phlegm Damp Retention Abnormal Bleeding From Uterus . watery/clear.Damp Heat in Lower Jiao Slightly bloody. Special Questions regarding Children Emotional shocks or physical traumas during pregnancy.heavy.
Lung & Kid Yin Def Chronic/Prolonged – Exhaustion of Vital Qi Incoherence Shows Shen and Mental Disturbance Ravings/Mania Liver Fire “Phlegm obstr Heart Orifices” Soliloquy/Repeating Def of Heart Qi Delirium/Loss of consciousness CRITICAL. Coarse/Loud Voice Excess Syndrome Weak Voice Deficiency Syndrome Thick Yellow Spit Wind Heat -> Lung Heat Thin White Spit Wind Cold -> Spleen & Kid Yang Def Whooping Cough Phlegm retention in Lung 27 . high fever disease . Auscultation (listening) Voice/Speech Shows state of Vital Qi and Nature of Pathogen (Cold/Heat) Loud Excess Syndrome Weak Def Syndrome Talkative/Restless Heat Syndrome Quiet Cold Syndrome Deep/Stuffy Exterior Syndrome (nasal obstr) Hoarse/LOV Abrupt . Weak Lung Qi Def Coarse/Loud Lung Heat Asthmatic/SOB Lung Qi and Kidney Qi Def Coarse/Asthmatic Excess Pathogens retained in Lungs Sighing Liver Qi Stagnation Coughing Main symptom of Lung disorders.Chinese Medicine Diagnostics by Hui Jun.Ying and Xue (blood) stages Fading/Broken sentences Severe Heart Qi Def or Exhaustion of Vital Qi Breathing Reveals condition of Lungs and Kidneys. Shen Chapter IV: Auscultation & Olfaction 1.Exterior Pathogen Gradual/Recurrent .
Shen Lung Qi Stagnation Spasmodic Cough Toxic Heat attacks throat Lung & Kidney Yin Def 2. Olfaction (smelling) Odour smelt from patient’s secretions or excretions Fetid/Sour Mouth/Vomit Stomach Heat Stool Damp Heat in Large Intestine Leukorrhea Damp/Toxic Heat Syndrome ** CERVICAL/UTERINE CANCER Sour Smell Food Stagnation Fish Stench Blood/Pus in Spit Lung Abscess Loose Stools Spleen Yang Def -> Def Cold Diarrhoea Sticky Leukorrhea Cold Damp in Lower Jiao Strange Odour Rotten Apples Urine Diabetes Kidney Failure from Nephritis 28 .Chinese Medicine Diagnostics by Hui Jun.
press patients body surface for local abnormal changes Superficial Fingers palpate the superficial tissues.Internal Excess Cold or Yang Deficiency Cold on Loins. enlarged. uneven surface. In General Feel.Excess Heat Syndrome (with false cold symptoms) (** “internal heat pushes the Yin outside”) C. Chest and Abdomen are hot .Qi & Blood Stag . Temperature Hot/Cold at first touch. smooth surface.Def of Iodine Thyroid edges clear.Exterior Wind/Heat or Exterior Wind/Cold Maintains Heat or Hot on deep pressure . Neck Thyroid Gland Thyroid moves up/down on swallowing. Shen Chapter V: Palpation A. painful if pressed.Qi & Blood Stag Thyroid is “as Hard as Stone”. Low Abdomen .Internal Excess Heat or Yin Deficiency Maintains Cold or Cold on deep pressure . unmovable. gently but with increasing force Used on Body Surface and Joints Deep Press fingers hard with heavy pressure to feel deep tissues and organs Used on Abdominal Cavity & Deeper Soft Tissues B. not painful if pressed .Kidney Yang Def 4 Limbs are cold.Phlegm & Damp Ret . soft if pressed . touch. large. unclear on edges. Thyroidal Cancer .Toxic Heat 29 . skin colour ok.Phlegm & Damp Ret . the longer it is felt the less it is .Chinese Medicine Diagnostics by Hui Jun. Low Back.
hard in texture.Qi & Blood Stagnation . chronic onset. indistinct edges.Wind/Heat Invasion . resilient but not tight. or normal? Abnormalities -> imbalance in associated organ Abdomen palpation Solid but not hard. Chest Palpation of apex of the heart Regular pulsation -> Zong Qi normal Faint -> Deficiency of Zong Qi Too Strong -> “Outpouring of Zong Qi” No pulse -> Phlegm Retention in Chest -> Heart Yang collapse E.Phlegm/Blood/Qi Stagnation uneven surface. liquid oozing. Shen . acute onset. rapidly growing. immovable. do not hurt if pressed . hurt on pressing .Vital Qi Def Lymph Nodes Enlarged lymph nodes in the neck.Vital Qi Def F. Abdominal Diagnosis Use the pads of the three middle fingers Press down on exhalation with firm and slow pressure Go down to a maximum of two inches/five centimetres Painful. hard in texture.BREAST CANCER . slow growth.Heat toxin (TONSILITIS) Enlarged lymph nodes in the neck. Breast Nodules smooth on surface. just uncomfortable.Phlegm & Damp Retention . skin looks like tangerine peel .Phlegm Retention (TB) D.NORMAL Upper Abdomen (below Xyphoid process) 30 .Liver Qi Stagnation .Chinese Medicine Diagnostics by Hui Jun. moveable. can feel edges . elastic but not soft .Toxic Heat .
fixed pain. flabby -> Essence (Yuan Qi) Def Cold.Intestinal Spasms and Cramps . Palpation of Points Alarm Points (“Front Mu”) Palpate with one finger and with less pressure Make a note of any areas of tenderness Front Mu points located on chest or abdomen One point associated with each organ Indicate disease or imbalance of organ Qi of the organ collects at this point Yuan Source Points Located on wrist or ankle One point associated with each organ Indicates more major disease/imbalance in Zang organs Original Qi of the organ collects at this point Yin source points tonify yin organs Yang source points expel pathogenic factors Kidney GB25 Zang organ Lung Spleen Heart Front Mu Point LU1 Liv13 Ren14 Fu organ Front Mu Point Large ST25 Intestine Stomach Ren12 Small Ren4 Intestine Bladder Ren3 San Jiao Ren5 Gall GB24 Bladder Pericardium Ren17 Liver Liv14 Zang organ Lung Spleen Heart Kidney Yuan Point LU9 SP3 HT7 KI3 Fu organ Yuan Point Large LI4 Intestine Stomach ST42 Small SI4 Intestine Bladder BL64 San Jiao SJ4 Gall GB40 Bladder Pericardium PC7 Liver LIV3 31 . Shen full and painful ->Liver Qi Stagnation hard and knotted ->Lung Qi Stagnation Lower Abdomen (below navel) soft. better on palpation -> Def Syndrome Abdominal Masses Mass of no definite shape.Blood Stagnation (Tumour) G.Chinese Medicine Diagnostics by Hui Jun. pain and mass movable .Qi Stagnation Mass of definite shape. better with cold -> Heat Syndrome Pain. worse on palpation -> Excess Syndrome Pain. unmovable . better with warmth -> Cold Syndrome Hot.
Why? Reflects the function and state of the Zang Fu Organs Indicates the location and nature of disease Helps determine the nature of pathogens Helps predict the prognosis of disease 2. How? Methods of Pulse Taking Wrist should be at same level as the heart (sitting up or lying down) Use your index finger.position for ring finger Three Depths: Superficial: fingers pressing gently just under the skin Middle: fingers pressing moderately Deep: fingers pressing hard to the bone 4. only wrist pulse is used. 3.position for middle finger . but usually no more than 3 minutes Three Positions: Cun (front position) Guan (middle position) Chi (rear position) distal (nearest to palm) medial to Styloid Process proximal (nearest to elbow) . Pulse positions correspondent to internal organs Left: Cun Heart (SI) Right: Cun Guan Liver (GB) Guan Chi Kidney Yin (Bl) Chi Lung (LI) Spleen (St) Kidney Yang (Mingmen) 32 .Chinese Medicine Diagnostics by Hui Jun. Introduction Pulse diagnosis– one of most important diagnostic techniques in TCM 1. and ring finger Cun Index Finger Guan Middle Finger Chi Ring Finger At superficial. Shen Chapter VI: Pulse Diagnosis A.position for index finger . middle finger. Where? In ancient time: three places are used for pulse diagnosis: Side of neck (carotid artery) Radial aspect of wrist (radial artery) Top of foot (dorsal artery of the foot) Nowadays. middle and deep levels Feel the pulse in each wrist for more than 1 minute.
forceful . What is a normal pulse? Smooth. wiry pulse ….” Even. A Glance at Pulse Diagnosis Floating .heat Slow .deficiency (vital qi compromised) Characteristic feelings of the pulse (28 of them!) e.acute/exterior Deep . gentle. not fast or slow .has (stomach) Qi Feel also at deep level and at Chi position .Liver/GB Dysfunction or pain….excess (vital qi is strong) Weak .Chinese Medicine Diagnostics 5. Factors that affect Pulse Age : between 5 –12 pulse is more rapid…(90-100 bpm) elderly patients have a soft and weak pulse Gender: women have tendency to blood deficiency. gentle at all 3 levels and positions (Cun/Guan/Chi and superficial/middle/deep) Moderate force. regular rhythm 4 beats per breath (synchronize breathing) (60-90 BPM) “A normal pulse should have Shen.shows state of Spirit (Shen) Not floating or deep.cold Strong ..chronic/interior Rapid .g. rolling pulse…Excess Damp/Phlegm or Food Stagnation 8. pulse is slightly rapid and thin if pregnant pulse is rolling/slippery 33 .has “Root” 7. have Qi and have root. even. Pulse diagnosis record Left Front (Cun) Superficial Middle Deep Overall Middle (Guan) Rear Front (Chi) (Cun) Right Middle (Guan) Rear (Chi) 6.
By Thickness Big/Flooding 6. By Rhythm Long Knotted 34 . 16 Common Types of Pulses 1. By Frequency Rapid 3.Chinese Medicine Diagnostics Body Constitution Tall people Pulse is longer Short people Pulse is shorter Thin people Shallow pulse Obesity Deep pulse Profession Heavy physical laborer Stronger pulse More Mental work Weaker pulse Season Summer Flooding Pulse Heart pos Autumn Floating Pulse Lung pos Winter Deep Pulse Kidney pos Spring Wiry Pulse Liver pos Other Drink Alcohol Fast Hungry Slow/weak Exercise Rapid Night Slow Moved to Altitude Fast 9. B. therefore. Limitations of Pulse diagnosis Not always in consensus with other symptoms. By Depth Superficial/ floating Deep/ Sinking Slow Weak Wiry Thin/Thready Short Intermittant Hurried/Hasty Choppy 2. Not always reflecting the function and state of the Zang Fu organs Not always reflecting the location and nature of disease Not always reflecting the nature of pathogens Not always reflecting the prognosis of disease 2-5% of people can have wrist pulse in a different anatomic location due to a congenital reason. By Strength 4. can indicate differently. By Quality Full/Forceful Slippery 5. By Length 7.
External/Internal Def Syndrome Floating & rapid .Cold Syndrome Slow & Strong ð Excess Cold Slow & Weak ð Deficient Cold Slow & Floating ð External Cold Slow & Deep ð Internal Cold Slow pulse can be normal in athletic/sporty people 3. press hard to feel clearly. strong. like a stone in water” .External Excess Syndrome Floating & weak .External Heat Syndrome Floating & slow .External Syndrome Floating & strong . below 60 bpm. on all 3 positions at 3 levels Normal pulse in healthy people Excess syndrome 35 . weak on pressing hard. By Depth Superficial/Floating Pulse Superficial with light pressure. “like wood floating on water” (rebounds back up) .External Cold Syndrome (Floating pulse is NORMAL if person is taking BP/ vasodilation medication) Deep/Sinking Pulse At a deep level. By Strength/Force Full/Forceful Pulse Big.Chinese Medicine Diagnostics 1. long. “press to the bone. By Frequency Rapid pulse Over 90 bpm.Pathogen has gone into interior Deep & strong ð Internal Excess Deep & weak ð Internal Deficiency Deep pulse is NORMAL in an obese person 2. (or over 5 beats per respiration) -Heat Syndrome Rapid & Strong ð Excess Heat Rapid & Weak ð Deficient Heat Rapid & Floating ð External Heat Rapid & Deep ð Internal Heat Rapid pulse is normal in young children or infants Slow pulse Less than 4 beats per respiration.
fever.Blood Stagnation from Cold/Damp Accumulation etc. wide and slippery -> Liver Yang Rising Wiry. By Length 36 .Chinese Medicine Diagnostics Weak Pulse Small. long. “scratching bamboo with a knife”. slippery. rebounds and hits fingers on all 3 positions. By Quality Rolling/Slippery Smooth. “like an ill silkworm eating a leaf” Choppy & Strong . rounded. “like ocean waves” . Choppy & Weak .Qi/Blood//Essence Deficiency combined with blood stasis 5. vigorous in coming. “like a worm creeping in a cotton wool” Deficiency syndrome 4. no passing wave sensation. summer heat Thin/Thready Pulse Distinctive on pressing.Qi/Blood/Yin Def 6. “thin as silk thread” .g. fine.Excess Heat e. clearly felt. Liver Qi Stag/Liver Fire/Liver Yang Rising Can also occur with Pain Wiry. By Width/Thickness Big/Flooding Pulse Big. tends to be slow. less forceful. can be any width “like a tight bowstring. about to shoot an arrow” “like the plucked string of a musical instrument” Liver & GB Problems e. taut. gentle in going. moves at different levels. STRAIGHT.g. “like pearls rolling in a dish” or “fish swimming in water” Characteristic pulse for Phlegm syndrome Obstruction by Food Stagnation or Wind/Phlegm Also seen in a NORMAL person Also seen in PREGNANT WOMEN If also rapid -> Excess Yang Rising Wiry pulse Forceful. slow and tight -> Qi stagnation due to or accompanied with cold Choppy Pulse Rough and jagged.
can be slow or fast. firm and hard. unclear either end ->Qi and Blood Deficiency Short & Deep -> Qi//blood/Yang Deficiency Short & Rapid -> Deficiency with Heat Short & Slow -> Deficiency Cold 7. loses beats at irregular intervals -> Internal Heat & Obstruction of Qi and Blood (from Qi.Chinese Medicine Diagnostics Long Pulse Longer than three positions. Moderate/Leisurely Pulse **NORMAL 37 . “like a stick of bamboo” Excess Interior syndrome Maybe also generating Wind/Phlegm Long and GENTLE is NORMAL. can stop for longer than one beat. indicating sufficient Qi and Blood Short Pulse Pulse clear at Guan. depending on where the weakness is. loses beats at irregular intervals -> Internal Cold & Obstruction Qi and Blood (from excess Yin or Body Fluids or Yang Def) Floating and Strong -> External Cold invading Channels Deep and Strong -> Accumulated Internal Cold * Can also come from chronic disease causing Qi and Blood Deficiency and failure of upright Qi Intermittant puls Stops at regular intervals.Partial weakness of Yuan Qi or Essence Can come from chronic disease or trauma Can be more severe prognosis than hasty or knotted. Hurried/Hasty Rapid. Blood. By Rhythm Knotted Pulse Slow. Phlegm or Food Stagnation) Hurried & Weak -> Deficiency of Zang Fu C: Other Types of Pulses 1. and then “double up” .Weakness of Zang organ Qi (not all at once) .
Leathery Pulse Superficial. 140 bpm. and …SHORT Severe Pain Fear or Fright scatters Qi Yin and Yang fighting and neither winning…. 5.can be athletes. Soggy/Soft Floating and weak. strong and wiry Interior Excess Cold and excessive Qi Stagnation 4. THIN “like a strand of cotton floating on water” Qi & Blood Def Damp Accumulation (usually from Spleen Deficiency) 38 . Firm Pulse DEEP. and empty in middle and deep levels “like a drumskin” Deficiency of Essence & Blood (over 40 years old) (from loss of blood and internal deficient cold) 7. Tight Pulse Strong. regular ** HEART DISEASE Extreme Yang & Exhaustion of Yin Impending Exhaustion of Vital Qi 6. TIGHT. large. gentle. 60 bpm. manual laborers …and going deeper …. forceful. like a bean” on Guan (middle) position Strong. regular. thick. TWISTED rope” Cold Syndrome Pain Syndrome 3. relaxed “elegant like a willow branch in a gentle breeze” If slightly slower….Chinese Medicine Diagnostics 4 beats per respiration. rapid. wiry “stretched. slippery. Racing Pulse **CRITICAL Over 7 beats per respiration.Spleen Qi Def & Damp 2. Moving Pulse **can feel like its irregular “round.
loses strength on pressure Yin/BF Deficiency with damage to upright Qi 9. big and soft. fades in and out on pressure Extreme Qi & Blood Deficiency Exhaustion of Yang Qi (SHOCK) 11. weak on all 3 positions at 3 levels Disappears on pressing “like dandelion seeds in the wind” Collapse of Kidney Yang or Essence Failure of Zang Fu Organs 39 . “like pressing a spring onion stalk” Yin/BF Deficiency 10. sensation of emptiness while walls are hard. “press below the bone” Yin or Cold Pathogens obstruct Channels or Zang Fu External/Internal Excess Cold or Phlegm/Damp 12 Scattered Pulse ** CRITICAL Floating and big. WIDE. Empty Pulse Floating. Hidden Pulse **CRITICAL Deep.Chinese Medicine Diagnostics 8. Minute Pulse ** CRITICAL Extremely thin and weak. weak and THIN. Hollow Pulse Floating and weak.
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