Diagnosis Class Exam Notes

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Diagnosis Class Exam Notes

Inquiry - Pulse - Tongue

AREA	QUESTIONS	REASONS
TEN ASKING SONG
1) Fever and Chills	questions	determines presence or absence of heat and cold
2) Perspiration	questions	determines condition of wei qi, body fluids, and heat in the body
3) Head and Body (aches)	head: dizziness, tics and tremors, headaches. body: pain, numbness, tingling	determines existance of internal wind, or bi syndromes.
4) Stools and Urine	questions	determines presence or lack of heat and cold in body
5) Food, Taste, and Appetite	questions	mostly focuses on the functions of the middle jiao.
6) Chest and Abdomen	questions	reasons
7) Ears and Eyes	questions	reasons
8) Thirst and Beverages	questions	determines presence or lack of heat or cold
9) Sleep	questions	reasons
10) Women's Questions	period: regularity, quantity of flow, color of flow, consistance of flow.	determines the functions of the Blood and the Liver

Discharges
GLOBAL GENERALITIES
Clear and copious	cold
Yellow and scanty	heat
Cloudy	damp
Pus	toxicity
Yellow to green	heat
Thin and watery	phlegm damp
Hard and difficult to expectorate	dry phlegm
Pale pink, red, or purple urine	bleeding
Sounds
Loud	excess
Soft	deficiency
Aggravation
worse with rest	stagnation
worse with fatigue	deficiency
spicy food	yin or Qi deficiency
worse with heat	heat
worse with cold	cold
worse with pressure	excess
increases by eating	excess
after sex	kidney deficiency
with stress	Liver Qi stagnation
before period	Liver Qi stagnation
after period	Blood deficiency
Amelioration
better with rest	deficiency
better with movement	stagnation
better with heat	cold
better with cold	heat
worse with damp weather	damp in the channels
better with pressure	deficiency
diminishes with eating	deficiency
Appearances
Red	heat
Pale and flaccid	deficiency
Pink or pale red	yin deficiency
Nodular or lumpy	stagnation of Qi, Blood, or phlegm (or combination of the three)
Red with pus	heat with toxicity
Pain
pain migrates	Wind in the channels
red, swollen, hot joints	heat in the channels
dull, distended, larger area	qi stagnation
sharp, fixed, smaller area	blood stagnation
heavy pain	damp
cramping pain	cold
burning pain	heat
Onset
Acute onset, short duration	exterior
Slow onset, chronic duration	interior
excess pathologies tend to run their course quickly and are more intense.
deficiency pathologies tend to run chronically and are low-grade.
Times 'O The Day
Dawn	shao yang
Midday	tai yang
Afternoon to dusk	yang ming
Dusk to midnight	shao yin
Midnight to 3 am	tai yin
3 am to dawn	jue yin
Age
elderly	tend to suffer from deficiencies
youth	tend to suffer from excesses
children	can be excessive or deficient
Liver Signs
Pathologies that are coincidental to the period	generally indicate a Liver involvement.
Pathologies that are stress induced	generally indicate a Liver involvement.
Gender Specific Issues
Women tend to suffer from a deficiency of Blood (through menopause, then Yin)
Men tend to suffer from a deficiency of Yin or Yang or Jing
Food and Drink
desire for warm	cold
desire for cold	warm
Areas of Domination
flanks	gall bladder
hypochondrium (includes back and front)	Liver
lumbus (low back)	Kidney
epigastric region (below ribs on midline)	Stomach
"alternating" things	Shao Yang (GB)
one sided things	Shao Yang (GB)
File under "Duh"
cough	Lungs
palpitations	Heart
diarrhea	Spleen

Inquiry - Pulse - Tongue

The Pulse

The Simple Pulse Characteristics

SPEED	FAST	SLOW
STRENGTH	FORCEFUL	FORCELESS
LENGTH	LONG	SHORT
WIDTH	WIDE	THIN
DEPTH	SUPERFICIAL	DEEP
RHYTHM	REGULAR	IRREGULAR
ABNORMAL PULSE SHAPES	CHOPPY, WIRY, SLIPPERY

PULSE	INDICATIONS	MECHANISM
FAST AND SLOW
Fast Pulse	Heat	Heat accelerates movement.
fast+forceful	excess heat
fast+thin	deficiency heat

Slow Pulse Water element pulse	cold	Cold impedes movement. The so-called "Athletic Pulse" is also a slow pulse, but it only indicates cardiac health.

PULSE	INDICATIONS	MECHANISM
FORCEFUL AND FORCELESS
FORCEFUL Pulses	excess
Surging Pulse (floating, wide, forceful, comes stronger than it goes) Fire element pulse	excessive heat	mechanism presumed to be heat stimulates the Heart's function of commanding the Blood leading to increased cardiac output and the more forceful, surging pulse.

Forceless Pulses	deficiency	deficiency of Qi or Yang gives rise to the forceless pulse.

PULSE	INDICATIONS	MECHANISM
LONG AND SHORT
Long Pulse	excessive heat	Heat accelerates and expands. When the pulse is long and too forceful, this is excessive heat. When the long pulse is moderate in force, this is a healthy pulse.

Short Pulse
short+forceful	Qi stagnation	Stagnation prevents Blood from filling the vessel.
short+forceless	Qi deficiency	Qi can't push Blood hard enough to fill the vessel.

PULSE	INDICATIONS	MECHANISM
WIDE AND THIN
Wide Pulse	heat
wide+forceful	excessive heat	Heat accelerates and expands.
wide+forceless	deficiency heat	Yang expands the width of the vessel because Yin is too deficient to anchor it.

Thin Pulse	deficiency of Qi, Blood, or Yin	Qi, Blood, or Yin can't fill the vessel with fluid or pressure to expand the width of the vessel.

PULSE	INDICATIONS	MECHANISM
SUPERFICIAL AND DEEP
Superficial Pulse Metal element pulse
superficial+forceful	exterior syndrome	Yang floats to the exterior (as Wei Qi) to fight off invasion of exterior pathogenic factor. This is reflected metaphorically in the superficial pulse.
superficial+forceless	Yin deficiency	Yang floats to the exterior because Yin cannot anchor it. This is reflected metaphorically in the superficial pulse.

Deep Pulse
deep+forceful	internal cold	pathological cold both injures Yang and impedes its rising. This is reflected metaphorically in the deep pulse.
deep+forceless	Yang deficiency	A deficiency of Yang gives rise to the inability for Qi and Blood to lift upwards. This is reflected metaphorically in the deep pulse.

PULSE	INDICATIONS	MECHANISM
REGULAR AND IRREGULAR
Regular Pulse	health
Intermittent Pulse (regularly irregular)	Rather than focusing too much on the indications of this pulse, I want you to remember that this may be a red flag for you and a referral to a cardiologist may be indicated.
Abrupt Pulse (rapid, irregular rhythm)	heat stagnation or stagnation heat	This pulse indicates stagnation that gives rise to heat, or heat that is causing stagnation. In either case, we have stagnation and heat.
Knotted Pulse (slow, irregular rhythm)	Blood Stagnation	pathological factors (likely cold) impede movement of Blood

PULSE	INDICATIONS	MECHANISM
ABNORMAL PULSE SHAPES
Choppy Pulse	Blood Stagnation
choppy+forceful	Blood Stagnation	excessive pathological factors impede movement of Blood
choppy+forceless	Blood Stagnation	lack of Qi, Blood, or Jing leads to vessels that aren't filled which inhibits free flow of Blood.

Wiry Pulse Wood element pulse	Stagnation	Nei Jing says "tendons are the mother of vessels" which is to say that when the Liver becomes dry, so do the tendons, which leads to a hardness in the pulse as it loses the vessels lose their flexibility. Another mechanism is Qi stagnation prevents Blood from circulating outward and so the pressure remains high in the vessels causing the hard (wiry) pulse.

Slippery Pulse Earth element pulse	Dampness	Dampness in the Blood increases its viscosity giving rise to a pulse that lacks corners.
	Heat	Heat accelerates the movement of the Blood giving rise to the perception of the pulse losing its corners.

Inquiry - Pulse - Tongue

COLOR	INDICATIONS	MECHANISM
Tongue Body Color
Pale	deficiency	Qi and/or Blood unable to fill tongue body
	deficiency of Qi	Qi too deficient to guide Blood to tongue to give it pink color.
	deficiency of Blood	Lack of Blood can't give tongue pink color
	deficiency of Yang	Lack of Yang can't lift Qi and Blood to tongue to give it pink color.

Pink	normal	Pink means adequate Qi and Blood.

Red	heat	Heat accelerates and expands movement of Blood which fills tongue with more red color.
	excess heat	Often found with a thicker tongue coating, likely yellow.
	deficiency heat	Often found with a thin or scanty tongue coating.

Crimson (dark red)	Ying or Blood level heat. Blood stagnation with heat	Heat damages yin, causes the red to become more concentrated and darker. Blood stagnation with heat Blood stagnation causes purple color, heat makes it more red.

Purple	Blood stagnation	The slower the Blood moves, the more depleted of oxygen it will become, giving rise to a tendency toward the blue color. Purple is a transitory color between pink and blue.
Blue-Purple	Blood stagnation with, or due to cold.	Cold (blue) impedes movement which causes Blood stagnation (purple)
Pale Purple ("dusky")	Blood stagnation with or due to deficiency of Qi, Blood, or Yang	Blood stagnation is purple, pale is deficiency.
Blue	Internal cold	Cold impedes movement which allows red blood to lose its oxygen giving rise to the blue color. (western explaination)

SIZE	INDICATIONS	MECHANISM
Tongue Body Shape
Small tongue body	deficiency of Blood or Yin	Lack of fluids causes tongue to shrink in size.

Swollen tongue body (vertically enlarged)	excess heat or alcohol/drug toxicity	Heat pushes more Blood into tongue body to increase its size.

Flabby tongue body (horizontally enlarged)	damp or phlegm	fluids fill tongue and enlarge it horizontally.

Teeth marks	damp or phlegm	a continuation of the flabby tongue in which the teeth indentations are visible.

CRACKS	INDICATIONS	MECHANISM
Tongue Body Cracks
Cracks in tongue body	Blood or Yin deficiency	Fluids unable to moisten and nourish tongue body giving rise to cracks like dried earth.
+red	Yin deficiency	Fluids unable to moisten and nourish tongue body.
+pale	Blood deficiency	Fluids unable to moisten and nourish tongue body.
+teeth marks cracks on lateral sides, look like fish's gills	dampness	Damp prevents fluids from rising up to tongue to nourish it.

SPOTS	INDICATIONS	MECHANISM
Prickles, dots, spots
Prickles, dots, spots	heat or stagnation
+red	heat	Heat causes too much Qi and Blood to rise to the tongue where it causes the body to develop dots, points, spots, etc.
+purple (brown, dark)	Blood stagnation	Blood stagnation always looks purple.

BEARING	INDICATIONS	MECHANISM
Tongue Bearing Issues
Stiff tongue	Spasm due to internal wind	Excess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to become stiff.
Limp tongue	deficiency of Qi, Blood, or Yin.	Lack of nutrients cause the tongue to become limp.

Trembling tongue	Spasm due to internal wind	Excess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to tremble. NOTE: all tongues move, this sign is EXCESSIVE movement.
Deviated tongue	Internal wind, phlegm in channels	Something is blocking the channels and collaterals on one side of the tongue preventing its movement. This is also a "check in with a neurologist" indication due to the possibility of a tumor impinging a cranial nerve.

Engorged Sublingual Veins	Qi and/or Blood stagnation	Blood flow is impeded, giving rise to the appearance of backed-up Blood beneath the tongue.

COLOR	INDICATIONS	MECHANISM
Coating Color
White	cold	White and clear things in TCM are dilute and cold.
Yellow	heat	Yellow things in TCM are more concentrated due to heat damaging the Yin.
Gray	interior cold or heat	heat or cold is damaging the interior.
Black	extreme interior cold or heat	a further exasperation of the gray coating

THICKNESS	INDICATIONS	MECHANISM
Coating thickness
Thin coating	exterior syndrome or normal	If you can see through the coating to the body of the tongue, it is thin.

Thick coating	excessive condition, interior, damp, phlegm, food stagnation	Coating is the "smoke" of the stomach. Pathological factors rise with the Stomach Qi to the tongue coating.

MOISTNESS	INDICATIONS	MECHANISM
Coating Moistness
Moist coating	normal	the coating is neither excessively wet, dripping, or dry

Glossy (excessively shiny or wet) coating	internal cold, Yang deficiency	Yang deficiency or cold that damages Yang impedes the transformation of fluids giving rise to the accumulation of dampness or phlegm which shows up on the tongue in the form of the excessively wet coating.

Dry coating	dryness, heat, Yin deficiency, Yang deficiency	Here, we have a variety of factors that damage the body fluids including heat and dryness. Yin deficiency is obviously a form of internal dryness, and Yang deficiency can give rise to dryness in the body if the Yang is too weak to transform dietary water into body fluids.

DISTRIBUTION	INDICATIONS	MECHANISM
Coating Distribution
Even coating	phlegm-damp accumulation in the middle Jiao	The tongue indicates the conditions throughout the entire body, but also focuses on the Spleen and Stomach in particular. One map that is laid atop the tongue suggests that the entire tongue indicates the condition of the Spleen and Stomach only. So, a coating that covers the entire tongue can sometimes indicate only a pathology of the middle Jiao.
Coating on the anterior third (front third)	superficial invasion of pathogenic factor	The anterior third of the tongue is related to the Lungs and Heart. When a pathogenic factor enters the body, it generally enters through the Lungs, and so this thick coating on the anterior third of the tongue indicates this superficial invasion.
Coating in the middle only.	Phlegm and/or damp in the middle Jiao	Middle of the tongue is related to the middle Jiao.
Coating on one side or the other.	Shao Yang disease	Most pathologies that are one-sided or have symptoms that flip-flop between opposites (i.e. alternating chills and fever) indicate that the pathological factor has found its way to the Shao Yang channel, level, or organ (GB).
Peeled/Scanty/Coatless	Stomach Yin or Kidney Yin deficiency	Because the tongue coating is the smoke of the Stomach, and this smoke requires some Yin to evaporate up toward the tongue, a lack of Yin will cause a lack of smoke to rise and a lack of coating.
Geographic coating	Stomach Yin or Stomach Qi deficiency	Coating is the smoke of the Stomach. The Yin is what is heated to cause the smoke, while the Qi is that heating activity. In the absence of either of these factors, the coating can appear missing on portions of the tongue.

Inquiry - Pulse - Tongue

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