Charmaine Tsang

Registered Chinese Medicine Practitioner

30 Sep 2020
 What is Chinese Medicine
 2 Cardinal characteristics: holistic concept &
treatment determination based on syndrome
differentiation
5 viscera, 6 bowels, essence, qi, blood,
body fluids
yin & yang theory
5 elements theory
 Principles of TCM Diagnosis
 Four Diagnostic Methods
 From the exterior to know the interior (以外知
內)
 From small changes to know the overall
condition (見微知著)
 From normal health state to find out abnormal
changes (以常衡變)
Change of a disease is complicated, we apply the
following rules to diagnose:
- Overall Observation (整體審察): internal &
external environment.
- Equal Importance Attached to the Diagnostic
Methods (診法並重)
- To take differentiation of disease and
syndrome into consideration (病證合參)
 Syndrome – is a pathological summary in a
given stage of a disease in its course made by
the doctor includes the cause of disease; focus of
disease; nature of disease; situation of disease;
relationship between the pathogenic and the vital.
 Disease – is a complete morbid process
including cause, mode of onset, typical clinical
presentation, development and outcome
 Symptom – is a discomfort felt subjectively by
patient eg pain, dizziness, nausea (sign –
objectively presented eg red tip of tongue,
rapid pulse)

 Signs and Symptoms are the exterior

manifestations of a disease, and they are the
basis for diagnosing and differentiating
syndromes / diseases
Inspection
Palpation

Inquiry

Auscultation & Olfaction

 Inspection refers a diagnostic method by CMP
visually inspects a patient’s external conditions to
know the patient’s health condition and infer the
state of an illness.

 Mainly consists of 5 parts:

 Spirit (Shen, 神)
 Complexion (色)
 Physique (形)
 Pattern of movement, excretions, collaterals (態) and
Infant’s index finger
 Tongue characteristics (舌)
Content:

General Shen: exterior manifestation of life activities

Complexion: color and luster of skin
Physique: body build
Pattern of movements: include posture, body movement
Local Head & Face, 5 sense organs, neck, trunk, limbs, skin

Excretions Sputum, Saliva, Vomit, Feces and Urine

Tongue Body of Tongue (vitality, color, shape, pattern)

Coating of Tongue (texture and color)

Infant’s Children under age of 3, look at the superficial palmar

index side of index finger
fingers
 Shen & Complexion: closely
related to essence, qi and zang-fu
organs
 When there is abundance of qi,
noruished by acquired essence
from food and drinks, the zang-fu
functions well then the
complexion and shen is unique
and healthy.
 Traditional Chinese Medicien
emphasize that “the body build
and shen stay together (形神合一)”
meaning the body build is strong
and shen is vigorous.
External Healthy Unhealthy
Manifestations
Eyes Bright eyes with Dull look and
dexterous movement spiritless eyes with
and good vision clumsy movement
and blurred vision

Mentality & facial Conscious, rational State of delirium,

expressions thought, natural irrational thoughts,
expressions apathetic expression
& sluggish responses
Observe Color and Luster of Skin

Color: blue, red, yellow, white, black

Luster: changes in brightness (lustrous or

wizened)

Clinically: facial complexion is very important

Luster 明潤: a sign of vitality indicating
abundance of qi, blood and body fluids and
sound condition of zang-fu functions

Concelament 含蓄: means the luster is not

totally exposed but concealed in the skin
indicating abundance of qi and essence

Chief colors 主色: unchanged for life: race

and prenatal difference ( mainly 5 colors:
reddish, white, yellow, blue, black)

Secondary colors客色: changes temporarily

under the influence of external factors such
as season, day and night, climate also
activities such as emotions, sports, drinking,
environment
Appears when one falls ill
 Favorable color 善色:
indicate the disease is mild
with fair prognosis (the
luster remains)
 Unfavorable color 惡色:
indicate poor prognosis and
severe conditions (dull look)
 Blue Liver Pains
Red Heart Heat Syndrome
Yellow Spleen Heat Syndrome
White Lung Cold Syndrome
Black Kidney Pains

Clinically, we should focus on the blood, qi and body fluids deficiency and not
the correspondence of color to which zang/fu organs.
RED – suggest a heat syndrome or floating-yang
syndrome (陽浮) syndrome, usually caused by
heat which dilates facial blood vessels and
accelerates flow of qi and blood to the face or by
upward movement of deficiency yang.

Excess Heat Syndrome(實熱證) : flushing in

entire face

Asthenic Yin Syndrome (陰虛證): flushing over

cheekbones in the afternoon

Chronically / seriously ill (虛陽外越): migratory

red color as heavy make-up in a pale face
Observe: strong or weak; obese or emaciated, in
combination with body build and abnormal
manifestations

Principle: five zang-fu and five body structures (skin,

body hair, muscles, blood vessels, tendons and bones)
are all inter-connected and nourished by essence and qi.

Strong body-build: characterized by big and sturdy

bones, wide and thick chest, powerful muscles, lustrous
skin and strong tendons = a sign of abundant qi and
blood and strong physique. Seldom falls ill / quick
recovery.

Weak body-build: characterized by thin and fragile

bones, narrow chest, thin muscles, withered skin and
weak tendons = a sign of deficiency of qi, hypo-
functioning of organs, insufficient qi and blood.
Susceptible to disease and hard to cure.
Obese body: with poor appetite,
flaccid muscles and shortness of breath
are signs of deficiency of yang and qi.
Often characterized by yang deficiency
and hypofunctioning of spleen,
resulting in retention of phlegm and
fluide. Often says “obese people tend
to produce phlegm and dampness 肥
人多濕”

Emaciated body: tidal heat, night

sweat, red cheeks, dry throat with
good appetite implies yin deficiency,
which fails to supply nutrition to body.
Often says “the emaciated people have
exuberant fire瘦人多火”
An important diagnostic
procedure
Is a reflection of the changes
of internal organs. Any
deficiency of qi or zang-fu
organs dysfuction will show
on tongue

Contents:
Body of tongue (舌質):
vitality, color, shape, pattern
Coating of tongue(舌苔):
texture and color
Different parts of the tongue
corresponds to different internal
organs:

Tip of tongue: Heart & Lungs

Middle part: Spleen and Stomach

Root: Kidneys

Both sides: Liver and gall bladder

Normal tongue signs:
• Properly sized
• Soft in quality
• Free in motion
• Pale red in color
• With a thin layer of white coating which is neither dry nor overly moist

Diagnostic:
To look for abnormal signs
Indications: zang-fu functions, abundance in qi, blood, body fluids
During examination:
 Make sure patient sits back and relax
 Enough light shines on the surface of the tongue
 Tongue should stick out naturally, tongue body
relaxes and exposed sufficiently. Surface flat and
tip slightly downward.
1) Observe the vitality
Healthy tongue 榮舌: bright red, moist & moves freely
Wizened tongue 枯舌:dark, dull, moves with difficulty
2) Tongue color: pale red, pale,
red, crimson, bluish and purple

Pale-red Tongue
Characteristics: pale red and lustrous
Clinical significance: often seen in
healthy people, or in mild case when
seen in patients.
Pale Tongue
Characteristics: lighter than normal
Clinical significance: deficiency of qi,
blood or yang

Pale thin tongue: deficiency of blood

and qi
Pale, moist and puffy tongue: suggest
yang deficiency, retention of fluids,
deprivation of blood and qi
Red Tongue:
Characteristics: redder than normal or
even brightly red
Clinical significance: excess heat or
internal heat from yin deficiency

Tip of tongue / slightly red tongue:

exterior heat syndrome at early stage
Both edges of tongue red: excess in
liver and gall bladder
Crimson Tongue:
Characteristics: deep-red
Clinical significance: indicates excessive
heat or hyperactivity of fire from
deficiency of yin

Develops from red tongue, caused by

excessive heat that injures yin and
condenses blood, or consumption of fluids
due to yin deficiency and flaming of
asthenic fire. It is more severe than red
tongue.
Blue / Purple Tongue:
Characteristics: refers to whole or part of the
tonuge is blue or purple or bluish purple
Clinical significance: indicates impedes flow
of blood
Pale red tongue with bluish purple Light purple or
spots: suggest stasis of blood moist cyanotic
tongue: blockage
of vessels due to
preponderant
cold
Tough (老): texture is coarse / crimpled, color is dark – indicate
excess syndrome
Delicate (嫩): fine texture, color is light – indicate deficiency
syndrome often by qi and blood
Size – enlarged / swollen: larger and thicker than normal –
indicates retention of phlegm and fluid
Size - small & thinner than normal – indicates deficiency of qi
and blood and exuberant fire from deficiency of yin
Speckled & prickled (點刺舌) : speckle – red or purple spots on
the tongue; prickle – thorn-like protrusions on its surface –
caused by retention of heat
Cracked tongue (裂紋舌): various cracks or fissures with no
tongue coating or very little indicating deficiency of blood and
injury to body fluids due to exuberant heat or fire
Tongue pattern: refers to the movement of the
tongue body
Normal: moves flexibly, free to stick out or draw
back, indicating abundance of qi and blood,
normal function of channels and the zang-fu
organs.
Example:
- Deviated tongue

- Shortened tongue
Deviated Tongue:
Characteristic: tongue that
deviates to one side when
extended
Clinical significance: seen in
stroke patients or prodrome of
apoloplexy
Shortened tongue:
Characteristics: tongue that
cannot fully extend from the
mouth and appears to be
contracted
Clinical significance: a sign of
critical condition of cold
retained in the vessels or
deficiency of qi and blood
Coating of tongue: a layer of moss-like spreading
on the surface of the tongue produced by the
upward steaming of stomach qi and upward flow
of stomach fluid

Healthy coat: thin, even, white and moderately

moist layer

Clinically should focus on the color and texture

Thin or thick: reflects the condition of pathogenic
factors and healthy qi and the site of the disease
Moist or dry: reflects the condition and
distribution of body fluids
Greasy or curd-like: reflects the condition of yang
qi and dampness, indicating phlegm retention,
damp existence and indigestion
Peeled or Peel-like coating: reflects the stomach
qi is not sufficient, stomach yin dries up or blood
and qi are deficient too
Auscultation (listening) and olfaction (smelling) are
two methods used to diagnose a disease.

Listening to the voice, respiration, cough, vomiting,

speech etc…

Smelling the odor of body, excretions, secretions, the

ward etc.
Breathing:
- Panting 喘 – dyspnea or flaring of nares in a
severe case
- Wheezing 哮 – caused by retention of phlegm-
fluid. There is a whistle-like sound in the throat.
- Shortness of breath 短氣 – often accompanies
with faint breathing, dizziness, poor health due
to deficiency of qi
- Asthenic breathing 少氣 – condition marked
by feeble breathing and low sound in speech
Coughing:
Heavy coughing with expectoration of clear white sputum
indicates external contraction of wind-cold

Coughing with a muffled voice and expectoration of

yellow dense sputum suggests accumulation of lung heat

Dry cough with expectoration of a little sputum or bloody

sputum indicates deficiency of lung yin or invasion of the
lung by dryness.
Questioning the patient for items below:
- Personal particulars

- Chief complaint

- Medical history

- Family history

- Social history

- Life style

- History of present illness

First ask hot and cold, second ask sweat
一問寒熱, 二問汗
Third ask head and body, fourth ask stools and urine
三問頭身, 四問便
Fifth ask food and drink, sixth ask chest
五問飲食, 六胸腹
Seventh ask hearing, eight ask thirst
七聾八渴俱當辨
Ninth ask past medical history, tenth ask cause
九問舊病, 十問因
In taking medicinal, what changes appear
再兼服藥參機變
Women especially ask the time, changes, color of menses
婦女尤必問經期, 遲速崩閉皆可見
Then for Child please enquire about measles and chicken pox
再添片語問兒科,天花麻疹全占驗
Palpation, is a form of diagnosis made by feeling
and tapping local areas of the body

It includes:
Pulse examination
General palpation of different parts on body
surface (eg pressing the skin, hands, feet, chest,
abdomen etc)
Where the pulse is palace of blood, it is governed
by heart and commanded by qi (vital energy)

The pulse reflects the causes of disease,

abnormalities or pathological changes

So pulse-taking helps in
judging the location and
nature of a disease and
the prosperity and decline
of qi (vital energy) and
pathogens to infer
prognosis of the disease
and form the basis for
treatment
Location of pulse: the pulse, often
know as cunkou (寸口) is located at
the superficial part of the
posterocarpal radial artery.

Placing fingers: the first three fingers

are placing on cun, guan, and chi
regions (寸關尺)

Correspondence to particular organs:

generally acknowledged that the
three regions of the left hand reflect
respectively the conditions of the
heart, liver and kidney; and those of
the right hand reflect the conditions
of the lung spleen and kidney
Positional when taking pulse:
When feeling the pulse, the patient places the arm at the
same level with the heart. The wrist is extended and the
palm faces upward. This position facilitates smooth
circulation of qi (vital energy) and blood.

How to talk the pulse:

The physician usually uses his left hand to check the right
sided pulse, and the right hand to check the left sided
pulse. Generally fingers are pressed on the three regions
with the same strength, and then each region is felt
separately according to the actual pathological conditions.
Each pulse reading should be at least 50 pulse counts.
 Pulse is differentiated in terms of depth, speed,
strength, shape and rhythm
 Different conditions of the pulse indicate different
syndromes
 NORMAL PULSE:
Smooth, even and forceful with frequency
of 4 beats per breath
(approx 60/ min)
 Vary due to age, sex, body constitution, emotional
state and climatic changes
 There are 28 types of different pulses
 The younger the faster the pulse (infants
120-140/ min)
 Juveniles’ pulse tend to be stronger and
forceful
 Elderly tend to have weaker pulse
 Women tends to have weaker but faster
pulse than men
 People who are slim tends to have floating
pulse; whereas those who are fat tends to
have deep pulse
 After drinking / exercise/ food/ motional,
pulses are quicker
 Pulses are weaker when hungry
Floating Pulse (浮脈類) Floating, surging, soggy, scattered, hallow, drum
skin (浮洪濡散芤革)
Deep Pulse (沉脈類) Deep, hidden, firm, weak(沉伏弱牢)
Slow Pulse (遲脈類) Slow, moderate, rough, knotted(遲緩澀結)
Rapid Pulse (數脈類) Rapid, hasty, racing, bouncing (數疾促動)
Deficient Pulse (虛脈類) Deficient, faint, thready, intermittent, short (虛細
微代短)
Excess Pulse (實脈類) Excess, slippery, tight, tense, wiry (實滑弦緊長)
Pulse type Characteristics Clinical Significance
Floating pulse Pulse responds to finger Exterior syndrome
on light pressure but
becomes weak on heavy
pressure

Deep Pulse Not clear with light Interior syndrome

pressing, clear with
heavy pressing
Slow Pulse Rate is less than 4 beats Cold Syndrome
per breath (less than
60/mins)
Rapid Pulse Rate is more than 5 Heat Syndrome
beats per breath (more
than 90/min)
Pulse Type Characteristics Clinical Significance
Deficient Pulse Lack of force, empty and Deficiency in qi (vital
vacuous with pressure energy) and blood
Excess Pulse Forceful with touching Excess syndrome, heat
and pressing syndrome
Slippery Pulse Smooth and flowing like Phlegm and fluid
pearls rolling on a dish detention, excess heat
and food retention. But it
is also usual in healthy
people with ample qi
(vital energy) and blood,
and in pregnant women.
~ THE END ~