DIAGNOSIS AND TREATMENT ACCORDING TO VITAL SUBSTANCES

DIFFERENTIAL DIAGNOSIS ACCORDING TO VITAL SUBSTANCESA. DISEASES OF QI

I. QI VACUITY ( QI XU )

a) Organs Affected: Lu, Sp

b) Etiology:

a) Long-standing disease impairs organ function

OR recovery from acute disease

b) Insufficiency of Yuan (Source) Qi leads to hypo-function

Malfunction of Yang Qi

Yuan Qi/ Gu Qi/ Zong Qi XU

  

c) Loss of blood seriously damages Qi.

Qi loses its form or housing; accidents, surgery, hemorrhage, etc.

d) Long time accumulation of Yin pathogens: COLD or DAMP

e) Liver Qi stagnation often involved

f) Old age

  

Symptoms:

FATIGUE AND WEAKNESS: functional, physical, spiritual

  

WEAKNESS:

  

• Lung- poor stamina (worse upon exertion
• Spleen- Lethargy ( Heavy limbs) 
• Kidney – Exhaustion ( sleeping, lying down)

PALLOR: generally reflects failure of QI to transport (circulate) Blood

YUAN QI is differentiated in San Jiao according to level:

Zong Qi Sx: Respiratory problems: Shortness of breath, weak voice, spontaneous perspiration, chill, fatigue upon exertion, susceptibility to colds

Zhong Qi Sx: Weak digestion, lack of appetite, abdominal fullness after eating, impaired bowel function (soft stool), lethargy

   

Kidney Qi: Weakened bladder function, diminished libido, hearing impairment, low back pain, weakness below the waist, exhaustion-need to sleep

  

Tongue: Pale, flabby and weak

  

Pulse: Deficient, weak, soft, (fine, forceless)

   

d) Treatment Principles:

Tonify Qi

Benefit Spleen

e) Herbs:

Codonopsis ( Dang Shen), Ginseng ( Ren Shen)

 Astragalus (Huang Qi), Glycerrhiza (Gan Cao)

f) Prescription:

Si Jun Zi Tang ( Four Gentlemen Decoction)

Ginseng (Ren Shen) or Codonopsis (Dang Shen)

Atractylodes ( Bai Zhu)

Poria (Fuling)

Glycerrhiza ( Gan Cao)

II. QI (SPLEEN) SINKING- also a Qi deficiency syndrome

 a) Organs Affected: Spleen

   

b) Etiology: Upward Qi of Spleen is not strong enough to
support tissue.

c) Symptoms: prolapse of organs, hemorrhoid

sensations of heaviness, fatigue, bearing down sensations, loose stools

Tongue and Pulse: As in Qi deficiency

   

d) Treatment Principle: Raise the Qi

Supplement the Middle

Strengthen the Spleen

  

e) herbs: Astragalus ( Huang Qi ), Bupleurum (Chai Hu), Cimicifuga ( Sheng Ma)

 f) Prescription: Bu Zhong Y Qi Tang

• Supplement the Middle and Raise the QI Decoction
• Tonifies the Qi of the Middle Burner, raises sunken Yang-

 Huang Qi, Ren Shen, Bai Zhu, Gan Cao, Dang Gui, Chen Pi, Chai Hu, Sheng Ma

  

  

III. COUNTERFLOW OF QI- usually Excess, but can be a deficiency syndrome.

  

a) Organs Affected: Stomach, ( Pathology is characterized by counterflow symptoms.)

• Lung- failure of descending function ( cough, asthma)

   

b) Etiology

1. Pathogenic accumulation or attack leads to misdirection in flow of Qi.

• Upward/downward ( Sp/St, Lu, Kid) circulatory (Liver) Reflux

  

2. Qi insufficiency leads to hypofunction

c) Symptoms:

1. Upper Jiao: coughing, Asthma

2. Middle Jiao-: hiccups, belching, vomiting, nausea, Reflux.

3. Liver: (Liver Yang Rising) headache, dizziness, ringing in the ears, fainting, stroke, convulsion,

  

Tongue and Pulse:

• Vary according to pathogenic factor and Excess or Deficiency

d) Treatment Principles

1. Redirect Qi

2. Clear Pathogen

3. Regulate Organ function

.

e) Herbs Pinellia (Ban Xia) and Bambusa (Zhu Ru)

- Redirect St. Qi ( stop vomiting)

Magnolia ( Hou Pu)

-transform dampness and directs Qi downward

Perilla Seed ( Su Zi)

-stops coughing and wheezing, redirects Qi

Cortex Morus ( Sang Bai Pi)

- stops coughing and wheezing and drains heat; used when lung heat obstructs downward movement of Qi.

  

f) Prescription Ju Pi Zhu Ru Tang

(Tangerine Peel and Bamboo Shavings Soup)

  

-directs rebellious QI downward, stops vomiting, harmonizes the Stomach, clears Heat.

  

Red Fu Ling, Chen Pi, Pi Pa Ye, Mai Men Dong, Zhu Ru, Ban Xia, Ren Shen, Gan Cao

  

IV. QI STAGNATION ( Blockage or Non-Flow)

   

a). Organs Affected: LIVER IS ALWAYS INVOLVED

  

b) Etiology: 1. Depressed Emotions-Liver Qi unable to circulate

“Unfulfilled Desires”

2. Accumulation of Pathogen: especially Yin pathogens: Damp, Cold.

3. Qi Deficiency- unable to move Qi

 “Disease Causes and Mechanism Resulting in Liver Depression:”

   

1. unfulfilled desires

2. sequelae of anger

3. insufficient nourishment and emolliating by blood

4. insufficient enrichment and moistening by yin

5. insufficient warming and steaming by yang

6. any four of the Yin Depressions ( see below)

7. Inhibition or damage to Lung D and D

8. Any evil qi ( pathogen) obstructing free flow of Qi

 c) Symptoms: 1. Pain- distending sensations, feelings of oppression. Pain is not fixed.

2. Distention- Fullness or tenderness of ribs, or flanks, as well ass throat, chest, epigastrium,

abdomen

  

3. Masses- soft and moveable

4. Depression/frustration/irritability

Tongue and Pulse: T- Purple body (Maciocia says either normal tongue or red on the sides)

P- Wiry, Excess

d) Treatment Principles:

1. Regulate Qi (Move Qi/ Remove Stagnation)

2. Regulate Liver function

-spread Qi

-regulate menstruation

-dissipate clumps

e) Herbs Cyperus ( Xiang Fu)- Circulates the Qi and resolves constrained Liver Qi, alleviates pain

 Bupleurum-(Chai Hu) Relaxes the Liver

 Citrus (Chen Pi)- moves Qi and strengthens

the Spleen- prevents stagnation of tonic herbs

Melia ( Chuan Lian Zi)- Clears Heat, stops pain

   

f) Prescription Jia Wei Xiao Yao San

Modified Rambling Powder

 -Spreads Liver Qi, strengthens spleen, nourishes blood, clears Heat

  

- Dang Gui, Bai Shao, Fu Ling, Bai Zhu, Gan Cao, Chai Hu, Mu Dan Pi, Zhi Zi

B. DISEASES OF BLOOD

I. BLOOD VACUITY

a) Organs Affected Heart, Liver, Spleen

b) Etiology:

1. Spleen Qi Deficiency- not producing Blood

 2. Blood Loss- hemorrhage from trauma, Menstrual flow- especially with irregular flow surgery

3. Kidney Essence failing to nourish Liver Blood,

4. Shock to Heart

5. Heat (Yang Excess),often from Liver stagnation

c) Symptoms DRYNESS, WEAKNESS, PALLOR, FATIGUE

• a) HE BLOOD XU: insomnia, poor memory, irritability of spirit; anxiety or nervousness

• b) LIVER BLOOD XU: blurred vision, spots in vision, floaters, dry eyes; headache, dizziness, scanty or delayed menstruation, dry skin, dry hair, joint problems

NOTE: Liver Blood Xu often gives rise to Liver wind, and many symptoms often listen as blood xu symptoms are really wind caused by blood xu.

Tongue: small (thin), pale, dry

Pulse: deficient, thready, hesitant, weak, hollow

d) Treatment Principles

1. Tonify the Blood

2. Strengthen Spleen to produce Blood

3. Clear Heat from the blood

4. Calm Shen

e) Herbs: Rehmannia ( Shu Di Huang), nourishes Kidney

Paeonia (Bai Shao), "softens" Liver, promotes Essence

Dang Gui-Heart, Liver Spleen- Tonifies and invigorates blood

f) Prescription Si Wu Tang (Soup of Four Things)

Tonifies the Blood and regulates the Liver

Shu Di Huang, Bai Shao, Dang Gui, Chuan Xiong

II. BLOOD STASIS

a) Organs Affected Heart, Liver

with the exception of trauma, or pathogenic accumulation, all blood stasis derives from a failure of liver function

  

b) Etiology

1. Qi Stagnation

2. Qi Deficiency

3. Trauma

4. Pathogenic Accumulation ( Cold Or Heat)

5. Hemorrhage

6. Long standing illness with phlegm accumulation

c) Symptoms 1. PAIN- fixed and constant

2. Masses and swellings- tumors, fibroids, etc.,
- hard and fixed, “irregular” masses

eding- obstruction of vessels

 - dark purple, clotted bleeding

4. Sooty black complexion

Tongue: Purple

Pulse: string taut, hesitant (choppy)

d) Treatment Principles

1. Move Blood/ remove stasis

2. Stop pain

3. Promote Menstruation

4. Break Up Blood

f) Herbs Curcuma (Yu Jin)- Invigorates Qi and Blood

Salvia ( Dan Shen)- Moves Heart Blood and

Benefits menstruation

Carthamus ( Hong Hua)- Dispels congealed Blood and alleviates pain, benefits Menstruation

 Persica (Tao Ren)- Breaks Up Blood

 Corydalis (Yan Hu Suo)- Moves Qi and Blood.\

Alleviates Pain

g) Prescription Tao He Cheng Qi Tang

Persica Order the Qi Decoction-

Drains Heat and Breaks Up Blood Stasis

Tao Ren, Da Huang, Gui Zhi, Mang Xiao, Gan Cao

III. BLOOD HEAT (HEAT IN THE BLOOD)

a) Organs Affected Heart, Liver

b) Etiology

1. Exogenous Heat- Invasion of Heat penetrates

Ying ( construction) Level According to Four Levels

2. Liver Heat turning to Fire- Liver stores blood;

Liver Fire can make the blood Hot"

3. Heat Toxin- can also penetrate the Four Levels

c) Symptoms 1. Skin eruptions; bright Maculo-papular eruptions and rash, burning sensation of skin.

2. Bleeding- aggravation of heat causes " reckless marauding of blood"

a. hemoptisis, epistaxis, hemafecia, hematuria,

b. menorrhagia, metrorrhagia

3. SHEN Disturbance: mania, anxiety, restlessness, mouth ulcers

Tongue: Red Body

Pulse: Excess, rapid, surging

d) Treatment Principles

1. Cool the Blood

2. Remove Toxin

3. Calm the Spirit

4. Stop Bleeding

5. Nourish Yin

e) Herbs Moutan ( Mu Dan Pi) Clears Heat/Cools Blood, clears deficiency fire

Scrophularia ( Xuan Shen), Clears Heat/ cools Blood, clears toxins, nourishes yin

Raw Rehmannia ( Sheng Di Huang) Clears Heat/ Cools Blood, cools Heart Fire

f) Prescription Qing Ying Tang

Clear the Nutritive Level Decoction

Clears Heat from Nutritive Level (Ying)

Relieves Fire toxin, drains heat, nourishes Yin

- Cornu Bubalus ( Shui Niu Jiao), Xuan Shen,

Sheng Di, Mai Men Dong, Jin Yin Hua, Lian Qiao

Huang Lian, Dan Zhu Yu, Dan Shen

C. THE SIX DEPRESSIONS

1. Qi (Qi Stagnation)

2. Blood (Blood Stasis)

3. Damp (Damp Accumulation)

4. Phlegm (Phlegm Obstruction)

5. Food (Food Stagnation)

6. Fire (Depressive Heat)

The First Five Depressions all lead to Fire:

1 Qi Depression leads to Depressive Heat

2 Food Depression leads to Food Stagnation transforming Heat

3 Damp Depression leads to Damp Heat

4 Phlegm Depression leads to Phlegm Heat

5 Blood Depression leads to Stasis Heat

DIFFERENTIAL DIAGNOSIS ACCORDING TO EIGHT PRINCIPLES

I. DIAGNOSIS ACCORDING TO EIGHT PRINCIPLES: Fundamental nature and location of Disease

A. YIN AND YANG

Differential Diagnosis according to Eight Principles gives three sets of specific polarities with which to judge the exact nature of the Yin relative to the Yang and vice versa. This implies treatment according to the Doctrine of Heteropathy; that Yin is treated with Yang, and Yang with Yin

B. INTERIOR/EXTERIOR

1) Location: Interior/Exterior-

first priority: where is the disease? If chills and fever, or in muscles the disease is exterior, and is considered wind; if it affects the organs, the disease is considered interior.

a) Exterior
- Nature: Hot or Cold

a) Wind Heat - Quality: always excess
b) Wind Cold- Quantity: Excess or Deficient

a) Interior-
-Nature: Hot or Cold

-Quantity: Excess or Deficient
further location:

  

1) Qi, Blood or Fluids affected

2) Zang Fu affected

3) Five Element differentiation

4) Fever Level ( Six Phases, Four Levels)

C. HOT/COLD ( Nature of Disease)

a) Location

1. Exterior

-Wind Heat

-Wind Cold

-Wind Damp in Channels with Heat or Cold

2. Interior

- reflects accumulation of hot or cold

- Heat Excess/ Heat Deficiency and further location:

1) Vital Substances; nature of pathogen implies threat to substances

2) Zang Fu

3) Fever Level

4) Five Element

D. EXCESS/DEFICIENCY

- Measures the ability of the Qi to respond to the pathogen; the more Qi, the stronger the response. Excess implies acute, shorter term: The Qi is strong, the pathogen is strong- the proper method is attack. Deficiency implies chronic; some damage has already been done to organ function- treatment method must include supplementation ( tonification).

1). Vital Substances: Excess or Deficiency of Vital Substances

1. EXCESS

a) Vital Substances- Reflect stagnation; Always Excess, but may arise from Pathogenic Excess or organ hypofunction (Deficiency)

Sx: Pain of sudden onset, aggravated by pressure, and relative severity of all symptoms- high fever, strong pain, severe nausea, vomiting, etc.

2. DEFICIENCY

a) Vital Substances- Deficiency always reflects

functional deficiency; Vital substances unable to perform their respective functions- e.g. Qi unable to warm, transport, etc.,

Sx: weakness, fatigue, shortness of breath, spontaneous perspiration; chronicity of symptoms

b). Pathogen

Pathogens can accumulate either from exterior invasion, or from organ hyperfunction

1) -Excess heat (RE)-High fever, redness, damage to BF thickening of secretions, putrid smell

-Deficiency heat (YIN XU)- weakness and heat: aggravation of heat symptoms at night

2) Excess Cold ( HAN )- differentiated by pain

-Deficiency Cold (YANG XU)- failure of Yang of Spleen  and Kidney; leads to accumultion of BF
and further location:

1) Zang Fu

2) Five Element disharmony

3) Stage of fever ( Each Phase has a relative excess, relative deficiency)

E. YIN AND YANG

1. Yin Deficiency

a. Symptoms: WEAKNESS, HEAT, HEAT SX WORSE P.M.

Nightsweats, malar flush, "tidal" fever, "Five hearts" heat thirst and dryness, dry throat, fatigue, insomnia nightly disturbances: nocturia insomnia

Heat signs: flushing up, chronic sore throat, irritability pulse: empty: rapid and thready

Tongue: small and red, possibly with geographic peeling, or with small horizontal cracks. Maciocia says No coat is definitive.

b. Etiology

1) Heat pathogen damages yin fluids

Exogenous or Endogenous (Anxiety)

2) Blood loss

3) Loss of Essence
- disease

- childbearing

- excessive life style

4) Constitutional weakness

c. Physiology

1. Kidney is the root of Yin, relies upon the tight storage of Essence, supported by Post Heaven Essence. Fuels

Kidney Yang.

Kidney Essence supports Liver Blood. If Liver generates too much heat (Yang), it can not store blood, and becomes

Blood (Yin) Deficient.

Damage to Fluids in San Jiao can damage YIN. Lung becomes dry through Heat pathogen or Qi deficiency (Failing to "regulate Water metabolism": Pores)

Stomach ("Upper Gate" to Kidney) is the "Source of Fluids"; Stomach becomes dry through Hot diet,

systemic loss of fluids, poor spleen transformation

Kidney Yin deficiency: Deficiency heat ( night time fever, malar flush, sweats, etc.)

- with fire flaring up: Sore throat, insomnia,

deficient Stomach fire

Stomach Yin Deficiency: Thirst. poor appetite

Lung Yin Deficiency: dry cough, fatigue, sweats, dry sore throat, thirst

Heart Yin Deficiency: flushing, sweating, palpitations,

insomnia, Shen disturbance

Liver Yin Deficiency: Blood deficiency leading to Liver Wind

2. Yang Deficiency

a) Symptoms: WEAKNESS AND COLDNESS, WATER

BUILD-UP
Fatigue, cold limbs, cold abdomen, urinary-genital weakness, abdo pain, low-back pain, chronic diarrhea, edema; the more pain or discomfort, the more "Accumulation" of cold.

Yang Xu, cont.,

tongue: pale, flabby, moist pulse: Deep, slow soft, weak

b) Etiology:

1) Constitutional weakness: Ming Men fails to thrive

a) Poor post-heaven: poor diet leads to spleen Qi deficiency

c) Physiology:

Kidney is the Root of Yang, depends on Essence to fuel Ming Men Fire to produce Warm Transformation in the San Jiao. Fire is unable to govern water and Yin predominates, leading to poor transformation and transportation. Yin dominates Ming Men fire leading to accumulation of cold and fluids.

Upper Jiao: phlegm cough with abundant sputum, fatigue, perspiration, s.o.b., coldness, weak wei qi

•  

• Heart: Chest pain or discomfort, abundant perspiration,s.o.b., cyanosis of fingers, lips, fatigue, worse with excercise
•   
• Lung: Lung has no syndrome of Yang deficiency, but failure of lung Qi leads to cold
• Middle Jiao (Spleen): fatigue, cold limbs, coldness, lack of appetite, lack of thirst, watery diarrhea, digestive weakness, thirst only for warm drinks, 
•  
• Lower Jiao (Kidney): Edema below the waist, abundant urination,weak cold low back, incontinence, impotence, loss of libido, weakness, exhaustion

 II. TREATMENT PRINCIPLES ACCORDING TO EIGHT PRINCIPLES

A. LOCATION

1) Exterior

a) Wind Cold- Release Exterior with warm acrid substances-

- Warm and activate the Yang

b) Wind Heat- Release Exterior with Cooling acrid substances-

  

-Clear Heat and toxin

c) Wind Cold Deficient –Harmonize Ying and Wei B. PATHOGEN (HOT/COLD)

1. Interior

a) Heat

Excess- Clear Heat

• Quell Fire
• Eliminate Toxin
• Clear Damp-Heat ( Clear Heat/Dry Dampness)
• Cool the Blood
• Clear Summer Heat
• Purge and drain downward
• Deficient- Nourish Yin
• Drain Kidney Fire

b) Cold

• Excess- Expel Cold/Warm Interior
• Deficient- Supplement Yang
• Restore Yang

c) Wind

 Excess- Subdue Liver Wind

• Clear Extreme Heat
•  Subdue Liver Yang
•  Restore Consciousness

 Deficient- Nourish Kid and Liv Yin

•  Nourish Liver Blood

  

d) Dampness

Excess- Disperse (Transform) dampness

•  Transform phlegm
• Soften hardness
• Reduce sores and Disperse abcess
• Eliminate food stagnation

Deficiency- Supplement Spleen

•  Strengthen the center
•  Warm the Yang
•  Tonify Kidney
•  Promote urination

  

e) Dryness

•  Excess- Expel Wind
•  Clear Heat
•  Deficiency- Generate Fluids
•  Nourish Yin
•  Nourish Blood

 f) Summer Heat

• Excess- Drain Summerheat
• Clear Heat
• Cool the Blood
• Clear heat/transform damp
• Deficiency- Supplement the Spleen
• Nourish the Yin

 C. EXCESS AND DEFICIENCY

 1. VITAL SUBSTANCES

a) Qi

 Excess- Dissolve Stagnation

•  Redirect Qi
• Unblock Qi
• Harmonize
• Spread Liver Qi
• Deficiency- Tonify Qi
• Supplement the Spleen
• Tonify Kidney
• Tonify Yang
• Restore Yang
• Astringe Body Fluids
• Tonify Yin

b) Blood

Excess-

Dissolve Stagnation:

•  -Invigorate Blood
• -Dispel stasis
• Reduce (Dissolve Masses)
• Relieve Pain
• Promote menstruation
• Cool the Blood

 Deficiency-

•  Nourish the Blood
• Tonify the Heart/ Calm the Spirit
• Nourish Yin
• Tonify Kidney Yin
• Tonify Spleen Qi

 c) Body Fluids

Excess

•  Transform damp
•  Expel Wind Damp
•  Unblock urination
• Promote Diaphoresis
• Clear Heat/Transform Damp 

Deficiency

• Tonify Spleen (Lung or Kidney)
•  Warm the Yang
•  Promote Urination
•  Astringe Body fluids
•  Nourish Yin/ Generate fluids

PULSE SUPPLEMENT

1. PULSE- measures the Qi of the Blood vessels



The movement of the Blood Humor depends upon the pulsing and stirring of the Heart Qi: The Qi of the Blood



2. PULSE POSITIONS



INCH PULSE ( CUN) Lu(R), He (L)



BAR PULSE ( GUAN) Sp/St (R), Liv/Gb (L)



CUBIT (CHI) Kid Yang (R), Kid Yin (L)



3. RIGHTEOUS PULSE



Contains these three elements:



1) St Qi- The Pulse of the Right (Zheng) Qi;

Calm, even, moderate; must have form and supple strength:

Good Prognosis



Lacking St. Qi: hard, and lacks moderation and evenness; rhythm is chaotic and incomplete; lacks organization



Pulse lacking in Stomach Qi often lacks Spirit and Root



2) Spirit- Force; strength, liveliness



Pulse lacking Spirit: deep, deficient. Can be hidden or floating (forceless)



3) Root- Righteous Qi



Basis for the existence or collapse of Righteous Qi; Kidney Pulse





ACCORDING TO HAMMER:



These three components reflect the levels of Qi, Blood and organs, respectively, relative to their depth.

E.G., the Spirit component reflects the condition of the Qi at that position; the middle, or Stomach Qi component reflects the Blood, and Root reflects the organ.



NOTE:



1) These elements be balanced within the context of the pulse



2) Pulses will change with the seasons:





a) Spring- more string-taut and wiry



b) Summer pulse- exuberant



c) Fall- sl. Soggy



d) Winter- deep





4. The Concept of Congruity



Pulses are evaluated not only according to the qualities of each pulse, that is Slippery, Wiry, Surging, etc., nor the relative depth or strength, or the presence or absence of root or spirit, but by the congruity of all these components. One expects a deep pulse to be weak and lack spirit. It is significant if a pulse is deep and has a lot of spirit or strength. One expects a superficial pulse to have spirit predominant and to be excessive. Any anomalies are significant.

PULSE DIAGNOSIS

tmonline.org

I. General Information



A. Positions



1. “ INCH” -CUN- Most distal

R- Lu/L.I.

L- He/S.I.

2. “ BAR” -GUAN- middle

R- St/Sp

L- Liv/G.B

3. “CUBIT”-CHI-Most proximal

R- Kidney Yang

L- Kidney Yin



B. Levels

1. SUPERFICIAL- External Attack

2. MIDDLE- ST/Sp pathology ( Middle Jiao)

3. DEEP- Internal Injury or disease


C. Main Characteristics

1. Rate- Indicates Heat or Cold; normal is 4-5 beats per breath

2. Force- relative force of the pulse flow indicates strength of the Qi

3. Constraint- indicates lack of free-flow, String taut pulse indicates Qi or Blood stagnation

4. Shape- (Fat or thin) indicates excess or deficiency of either Qi or Blood

5. Length- Short indicates deficiency of Blood; deficiency or damage

in general. Long means abundance of Qi.

6. Depth- refers to the level at which the pulse qualities are most pronounced.


D. Normal Pulses

1. Heart- Superficial level pulse feels big and scattered; gets rougher as you press down, but remains broad, big.

2. Lung- Superficial, feels choppy and short

3. Liver- deep, the pulse feels wiry, taut

4. Kidney- Deep, feels, full, strong, slippery

5. Spleen- regular in middle position; gentle, relatively slow, with

"Spirit" and "Root"

E. General Rules For Pulse taking

1. Best to take the pulse in the morning, before the Yang emerges

2. Patient should be calm, lying down.

3. Drugs, alcohol, food, exercise, traffic, can all effect pulse; to be accurate, the patient must rest for some time.

4. At least five beats at each level to establish a pattern.

5. Pulse will change throughout the day

6. Arm should be level, not held higher than the heart

7. The normal pulse of pregnancy is full and Rolling

8. Pulse is more superficial in summer, deeper in winter

9. Men's dominant pulse:Left; Women's dominant pulse: Right

II. Pulse Qualities

1. SUPERFICIAL ( FLOATING)- (FU MAI)

- external Excess; pure and slightly rising, like
wood floating on water. “ Felt moving above the muscle”
a. HONG MAI-( Overflowing/Surging); Excess pulse; indicates heat, a big, rough body, rises and falls like a large wave

b. XIAN MAI- WIRY (STRING TAUT); Liver Qi stagnation; also indicates pain. Excess. Feels taut like a guitar string

c. HUA MAI- SLIPPERY (ROLLING) Phlegm or dampness accumulation. Feels smooth, rounded and slippery to the touch. Oily, slides under fingers.

d. RUO MAI- SOGGY/SOFT/ WEAK-FLOATING; soft, palpable near the surface, but disappears when more pressure is applied.

Qi Xu with Dampness

2. DEEP- (CHEN MAI)-

Can only be felt with heavy pressure, near the bone;
In general, indicates an Internal Injury; implies Zang viscera are affected..

a. XU MAI- EMPTY/DEFICIENT Typically Deep; usually deficiency of QI and Yang. Feels big, but soft; lacks resistance, elasticity of vessel wall.

1. XI MAI- THREADY; Blood deficiency

2. RU MAI- SHORT; Qi Deficiency; espec. Stomach

3. RUO MAI- WEAK; short, deep, weak- Yang Xu or Xue Xu

b. EXCESS (SHI MAI) and Deep, accumulation, usually of cold,
or stagnation of Qi or Blood.

1. JIN MAI- TIGHT; Interior cold, or stagnation

2. SLOW (CHI MAI) -

usually indicates Cold; can be excess or deficient

Three beats/per respiration



a. HUAN MAI- LEISURELY; even in all respects, usually about four beats per breath. When this pulse has Spirit and Root, it is considered good health. When it is lacking, it usually indicates Dampness.



b. SE MAI- CHOPPY, can be slow or rapid, with rough, thin, uneven beats at surface; if lacking Spirit indicates Blood Deficiency; if spirited Blood stagnation.

c. JIE MAI- KNOTTED; leisurely with irregularly missed beats;

usually indicates Heart Yang Deficiency; usually Deficient

d. DAI MAI- REGULARLY INTERMITTENT; leisurely and weak with regular pauses, indicates serious problem , decline, or failure of one or more Zang.

4. RAPID (SHU MAI)-

usually indicates Heat, can be excess or deficient;

five or more beats per breath.

a. HONG MAI- SURGING



b. CU MAI- ABRUPT. Excess Yang has damaged Yin. Irregular.

tmonline.org
5. WEAK/DEFICIENT

a. RU-SOGGY



b. KOU-HOLLOW- Felt at superficial level, and again at deep level, but empty in the middle. Also called Scallion Stalk. Indicates Desertion or sudden loss of blood.



c. GE- LEATHER- hard and tight at surface, like a stretched drum skin, but empty below. It is large, not thin, and indicates severe depletion of Kidney Yin or Essence. This seen more and more commonly in chronic immune compromised situations, especially caused by toxicity like environmental toxin or heavy metal.



d. XI MAI- FINE/THREADY



e. RU MAI- SHORT



f.. RUO MAI- WEAK



g. WEI MAI- Minute- fine thready, but extremely weak



h FU MAI- HIDDEN; very, very deep; very, very weak



6. STRONG/EXCESS



A XIAN-WIRY



B. HONG- OVERFLOWING



C. HUA- SLIPPERY



D. CHANG-LONG



E. JIN- TIGHT





III. EXCESS AND DEFICIENCY



A. EXCESS



1. Superficial



2. Excess



3. Surging



4. Slippery



5. Wiry



6. Tense



7. Choppy



B. DEFICIENT

1. Deep


2. Deficient


3. Thready


4. Choppy


5. Soft


6. Weak

7. Abrupt

8. Knotted

9. Regularly Intermittent

This information comes from David Cohen's Traditonal Chinese Theory Notes.

TONGUE DIAGNOSIS

- " It is axiomatic in Chinese medicine that any part of the body may carry in it traces of events occurring throughout the whole body." - Prof. Song Tian Bin, Tongue Atlas





I. Conditions for Tongue Diagnosis



1. Proper Lighting



2. Proper extension of the tongue



3. Length of Time tongue is extended- 15-20 seconds maximum



4. Presence of stains from highly colored foods or sweets

5. Certain spicy foods can create instant heat; coffee can make the tongue yellow



6. Smoking makes the tongue yellow



7. Antibiotics will either thicken the coat or cause peeling



8. There are congenital factors



II. Aspects of Diagnosis



A. Tongue body versus tongue coating

TONGUE BODY reflects the state ( hypo or hyper function) of Zheng (True) Qi. The Zang-Fu which principally affect the Tongue include:





Heart- The tongue is the sprout of the Heart. Heart governs blood. The tongue is full of blood. The HEART is fire and fire ascends.

When the Qi of the Heart is damaged, the ZHEN HUO (True Fire)

ascends and is manifest on the tongue. Shen which is stored in the Heart Blood also manifests on the tongue.

Spleen- The Spleen/Stomach attaches to the bottom of the tongue.

The fluids that fill the tongue and separate the five tastes are controlled by the digestive fire of the Middle Jiao. The center of

the tongue is ruled by the Spleen/Stomach. This energy also determines the coating. ( See below...)





Kidney- The Kidney connects to the root of the tongue. The Kidney

energy is the root of ZHENG (True) QI. The Kidney is the root of the body's FIRE AND WATER







TONGUE BODY

1.Color-



A healthy tongue body is pink, especially at the tip if the Ming Men fire is still vibrant. When the tongue loses the Zheng Qi, it begins to turn pale. If fluids become deficient, the tongue will begin to dry out.

Heat will make the tongue turn red:



a. Heat Excess will be a bright red, and the tongue will have Shen and moisture. It often produces a coat which will be yellow.





b. Deficiency Heat the red color is deeper, more scarlet. The tongue body is usually diminished due to damage to Yin fluids. There is no coating. It may have begun to lose its lustre.



c. Stagnation of Qi or Blood will make the tongue body purple, reflecting venous congestion. Maciocia says it must indicate Blood Stasis, Other sources disagree .The more stagnation accumulates, the darker the color. Thus “ black”= Blood stagnation

Bluish purple is Stagnation Cold, Reddish purple is stagnation Heat.



d. Severe Heat or Cold may turn the tongue black

2. Shape-



The shape reflects the overall condition of the body fluids. If the tongue is swollen, it reflects the hypo-functionality of Spleen Yang. If the tongue is shrunken it reflects damage to the Yin fluids



3. Moisture-



This reflects the strength of SPLEEN YANG, and the condition

and transport of body fluids

4. Motility-



When the ZHENG (True) QI is healthy the tongue moves smoothly in and out. When the Spleen/Stomach Qi is deficient, the tongue

is weak. When Interior (Liver) Wind is stirring, the tongue will be stiff

and its movements erratic.







5. Spirit (Shen)-



The overall evaluation of the other components reflects very directly on the overall strength of the ZHENG QI. This might as well be the QI of the tongue, as well.





TONGUE COATING

Reflects the condition of the STOMACH (WEI) QI

and the relative degree of accumulation of PATHOGENS. When there is a

tongue coating, two important diagnostic factors must exist:



1. There must be an EXCESS (Accumulation) of Pathogen

2. The Pathogen must be INTERIOR.



The relative presence or lack of tongue coating indicates the relative fullness or emptiness of the Stomach Qi. It also reflects the progression of disease and the prognosis.



a) A coating that is getting thinner indicates

recovery from a disease.

b) A coating that is getting thicker indicates

that the disease is going deeper.

c) A coating can be YOUNG OR OLD (Rooted)

1. Thickness-



Thickness indicates the relative strength or extent of the Pathogen

and the relative weakness of the ZHENG (True) QI. The change from thick to thin indicates an improved prognosis; the increasing thickness indicates that the disease has penetrated deeper.



2. Color-



a) YELLOW=HEAT



b) WHITE=COLD

.-The brighter and cleaner the color, the more acute the pathogen.



3. Texture



- Pathogenic heat mingling with Yin accumulations will dry out the coating and produce anomalies. Over time, Heat causes the coating to curdle and stick to the surface.





4. Distribution-



Location of the coating corresponds to certain Zang-Fu,

most noticeably according to the three jiaos.





5. Root-



When Stomach Qi is exhausted, the Coating loses its root.

The Chinese call this ZHEN (Real) TAI or JIA (False) TAI







III. Correspondences-



Upper Jiao- HEART AND LUNG-





The front of tongue; the very tip reflects the relationship between

Ming Men and the Heart Fire; If it healthy, the tip will be slightly red.

The Lung QI dominates the Upper Jiao and controls Body Fluids; damage to

these functions will reflect in cracks on the anterior one-third of the tongue body.

Middle Jiao- STOMACH/SPLEEN.

Connects to the bottom of the tongue.

Pathology manifests in the middle. Stomach heat resulting from spleen weakness

will create a central crack, that in some cases can extend all the way to the tip depending on the extent of the weakness.

Lower Jiao- LARGE INTESTINE/KIDNEY

The organs of the lower jiao are ruled

by the Kidney. The Kidney attaches to the root of the tongue. Congestion and

toxic accumulation in the lower jiao is most likely to take place in the Large

Intestine.

Sides of Tongue- LIVER AND GALL BLADDER


This information comes from David Cohen's Traditonal Chinese Theory Notes.