Chapter 16 Diagnosis

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The tip of the tongue Organs and clinical indication: Heart, lung, small intestine;
heart fire, lung qi deficiency
Border/Edge of the tongue Organs and clinical indications: Liver, gall bladder;
liver fire, gall bladder heat
Center of the tongue Organs and clinical indications: Spleen, stomach;
spleen damp; stomach heat
Root of the tongue Organs and clinical indications: Kidney, bladder;
kidney yang deficiency
What two properties of the tongue do you observe?: The tongue proper--refers to the muscular tissue of the tongue, tongue body;
Tongue coating--refers to the moss over the surface produced by the stomach qi
Describe the normal tongue: Proper in size, soft in quality, free in motion, slightly red in color, thin layer of white coating which is neither dry nor over moist
Tongue coating sticky (greasy, creamy): Turbid damp in intestine and stomach;
retention of turbid damp and phlegm
and food
Precautions in tongue diagnosis: observe in direct natural light;
food drugs eating or tongue scraping may change the tongue coating;
each disease undergoes a complicated process
Tongue coating moist: Normal;
Dampness
Tongue coating thin: Normal;
superficial, mild disease;
exterior syndrome in febrile diseases
Tongue coating thick: dampness;
phlegm;
food stagnation;
interior syndromes
Tongue coating Dry: consumption of Yin fluids due to excessive heat;
consumption of yin fluids leading to no nourishment upward
Tongue coating White: normal;
external cold;
internal cold
Tongue coating Yellow: Internal and heat
Tongue coating Gray: Internal;
retention of damp cold;
retention of phlegm and fluid
Tongue coating Black: severe stage of disease;
extreme heat;
excessive cold;
heat evil invading blood stage
Tongue color Pink: Normal;
mild disease;
early stage of febrile diseases;
exterior syndromes
Tongue color Pale: deficiency, cold;
deficiency of yang qi;
insufficiency of qi and blood
Tongue color Red: heat;
excess of internal heat;
yin deficiency heat
Tongue color Deep red: extreme heat;
external febrile disease: invasion of the yin and blood by pathological heat;
Yin deficiency leading to hyperactivity of fire
Tongue color Purple: stagnation of blood;
heat: a deep purple, dry and lusterless;
cold: a pale purplish and moist tongue;
stagnation of blood: purple spots on the tongue surface
Tongue shape and size Swollen delicate pale w/ tooth mark: yang deficiency of spleen and kidney
Tongue shape and size Swollen deep in red: excessive heat in heart and spleen
Tongue shape and size Swollen purplish and dark: toxicosis
Tongue shape and size Thin Pale: deficiency of qi and blood
Tongue shape and size Thin dry and deep red: yin deficiency and hyperactivity of fire lead to consumption of body fluids
Tongue shape and size cracked deep red: excessive heat consuming body fluid
Tongue shape and size cracked pale: deficiency of blood
Tongue shape and size cracked not deep and remain there all the time, unchanged: normal
Tongue shape and size thorny red: accumulation of interior heat
Tongue shape and size thorny more enlarged and profuse the thorns in tip: severe heart fire
Tongue shape and size thorny thorns in edge: liver and gall bladder fire
Tongue shape and size deviated (crooked): wind stroke (liver wind)
Tongue shape and size rigid exogenous: exogenous febrile diseases invade pericardium by heat;
retention of turbid phlegm in the interior;
excessive pathogenic heat consuming body fluid
Tongue shape and size rigid endogenous: wind stroke or early sign of wind stroke
Tongue shape and size flaccid weak in motion: extreme deficiency of qi and blood;
consumption of yin fluid
Tongue shape and size flaccid pale: deficiency of qi and blood
Tongue shape and size flaccid deep red: collapse of yin
Smell of secretion or excretion stench: excess heat
smell of secretion or excretion less stink: cold deficiency
smell of secretion or excretion foul and sour: retention of food
bitter taste: hyperactivity of the fire in liver and gall bladder
sweetish taste with sticky mouth: damp heat in spleen and stomach
sour taste (regurgitation): retention of heat in liver and stomach
unable to taste: deficiency of spleen
constipation, dry stool: heat or consumption of body fluid
loose stools: spleen deficiency or retention of dampness in spleen
watery stools with undigested food: spleen and kidney yang deficiency
bloody stools with mucus and tenesmus: intestines damp heat and stagnation of qi
urine yellow: heat or consumption of body fluid
clear, profuse urine: cold syndromes
scanty yellow urine, urgent and painful: damp heat downward
red urine: heat injury vessels
dribbling or retention of urine: kidney deficiency;
damp-heat;
obstructed Bladder qi;
stagnant blood;
stones
watery leukorrhea, whitish in color, profuse in amount: deficiency cold
thick leukorrhea, yellow or red, offensive smell: excess heat
menstruation light in color, flow profuse amount, thin in quality, dull pain in the lower abdomen during or after period which is alleviated by pressure: qi deficiency
menstruation thin, scanty, light colored flow, dull pain in the lower abdomen during or after period which is alleviated by pressure: blood deficiency
menses shortened cycle, excessive amount, deep red in color, thick in quality: blood heat
prolonged menstrual cycle, scanty purplish dark discharge, blood clots, cold pain in lower abdomen during the period: blood cold stagnation
Secretion,excretion clear,white: deficiency cold
Secretion, excretion turbid yellow: excess heat
Body shape overweight mental depression: deficiency of qi;
excess of phlegm;
damp
irregular menstrual cycle: liver qi stagnation
premenstrual or menstrual pain in the breasts, lower abdomen which intensifies on pressure: qi and blood stagnation
Body shape thin dry skin: insufficiency of blood
body shape great loss of weight long illness: exhaustion of essential qi
Inquiring: To ask the patient or the patient's companion about the disease condition in order to understand the pathological process; made systematically w/ questions focused on the chief complaint of the patient, according to the knowledge in differentiation of syndromes
Exterior cold; Fever Chills Sweating Thirst: Mild fever
Severe chills
No sweating
No thirst
Exterior heat; fever chills sweating thirst: Severe fever;
mild chills;
sweating
thirst
Intermediate syndrome; fever chills sweating thirst: alternate fever
alternate chill
thirst
Interior cold; fever chills sweating thirst: No fever
alternate chills
no sweating
no thirst
Interior heat; fever chills sweating thirst: high fever;
no chills;
thirst
Appetite inquiry Poor appetite; emaciation, loose stools, lassitude, pale tongue, thin white coating: weakness of spleen and stomach
Appetite inquiry; Poor appetite; stuffiness in chest; fullness in abdomen; red tongue; thick, sticky coating: stagnation of spleen and stomach; food dampness retention
Appetite inquiry; Excessive appetite, hungry, skinny: excessive stomach fire
Appetite inquiry; Hunger, no desire to eat, or eats small amounts: Stomach yin deficiency
Sleep inquiry; Insomnia with dizziness and palpitations: blood deficiency of heart due to spleen and heart deficiency
Sleep inquiry; insomnia, restlessness, dream-disturbed sleep: hyperactivity of heart fire
Sleep inquiry; difficulty in falling asleep, uncomfortable, empty sensation after a full meal: derangement (mixed up) of stomach qi
sleep inquiry; lethargy, with dizziness and palpitation: damp-phlegm in the interior
sleep inquiry; light sleeper, general lassitude: yang deficiency of heart and kidney
Bi syndrome; wandering pain in the joints: Wind bi
Bi syndrome; severe stabbing pain, cold and fixed: Cold bi
Bi syndrome; numbness and heavy sensation: Damp Bi
Bi syndrome; local burning sensation with redness: Heat bi
Bi syndrome; chronic and difficult pain in bones and joints: Deficiency bi of blood and qi
Bi syndrome; muscular stiffness and spasm: deficiency bi of yin and blood
Left cun: Heart and small intestine qi
Right cun: lung and liver blood
left guan: liver and gall bladder qi
right guan: spleen and stomach blood
left chi: kidney, bladder qi
right chi: kidney (mingmen), bladder blood
Normal pulse: smooth, even, forceful, four beats per breath
Pulse--floating group floating superficial: external syndrome
Pulse--floating group; surging/flooding: excessive heat
Pulse--floating group; soft, soggy: deficiency; dampness
Pulse--Deep group; deep: interior syndrome
Pulse--deep group; weak: deficiency of qi and blood
Pulse--rapid group; rapid: heat syndromes
Pulse--rapid group; abrupt: cu mai;
hurried, rapid, irregular missed beat
Pulse--slow group; slow: cold syndromes
Pulse--slow group; hesitant: qi stagnation;
blood stasis
Pulse--slow group; knotted: jie mai;
slow, irregular missed beats
Pulse--deficiency group; deficiency: deficiency syndromes
Pulse--deficiency group; thready: deficiency due to overstrain and stress; deficiency of blood and qi
Pulse--deficiency group; regularly intermittent: dai mai;
slow, weak, missed beats at regular intervals
Pulse--excess group; excess: excess syndromes;
heat stagnation
Pulse--excess group; slippery, rolling: pregnant pulse;
phlegm
Pulse--excess group; wiry, string taut: liver and gall bladder diseases;
pain
Pulse--excess group; tense: cold;
pain
Index fingerprint for an infant: ming guan (tip)
qi guan (middle)
feng guan (inner segment)
The eight principles: Yin and yang
Interior and exterior
Cold and heat
Deficiency and excess
The categories of interior and exterior are used to determine...: the depth of the disease
Exterior syndrome: aversion to cold; fever; thin tongue coating; superficial pulse
Interior syndrome: high fever; no aversion to cold; thirst; dark tongue; sinking pulse
Intermediate syndromes: alternating fever and chill; fullness and discomfort in chest and hypochondriac region; bitter taste; dry throat; wiry pulse
Cold syndromes are from...: exogenous pathogenic cold or deficiency of yang
Heat syndromes are from...: exogenous pathogenic heat or deficiency of yin
Cold syndrome: pale face; aversion to cold; not real thirsty; loose stools; clear urine, increased in volume; pale tongue; white moist coating; slow pulse
Heat syndrome: Red face; fever; preference for cold drink; constipation; scanty, deep-yellow urine; red tongue; yellow and dry coating; rapid pulse
Deficiency refers to...: insufficiency of the anti-pathogenic qi
Excess refers to ...: hyperactivity of the pathogenic factor
Deficiency syndrome: long-term, chronic; weak; dull pain, likes pressure; lassitude, talklessness with low voice; shortness of breath; clear urine; loose stools; tongue pale with little coating; thin-weak pulse
Excess syndrome: short-term, acute; strong body; dislikes pressure; hyperactivity; high voice; strong breath sound; scanty yellow urine; dry stools; red tongue w/ greasy coating; forceful pulse
Yin's other three principles: interior;
cold;
deficiency
Yang's other three principles: exterior;
heat;
excess
Yin syndromes result from...: deficiency of yang qi in the body and retention of pathogenic cold
Yang syndromes result from...: hyperactivity of yang qi in the body and excess of pathogenic heat
Yin (blood) deficiency syndrome symptoms: follows heat syndrome; afternoon fever; heat sensation in palms and soles, malar flush; night sweating; thirsty, dry throat and mouth, cold drinks; yellow urine; dry stools; red tongue with little coating; thin rapid pulse
Yang deficiency syndrome symptoms: follows cold syndrome; chill; spontaneous sweating; clear urine with increased volume; loose stools; pale tongue with white coating; weak pulse
Qi deficiency symptoms: pale face; shortness of breath; low voice; lassitude; spontaneous sweating; pale tongue with little coating; weak pulse
Qi sinking symptoms: dizziness; blurred vision; lassitude; prolapse of internal organs; pale tongue with little coating; weak pulse
Qi stagnation symptoms: distention; wandering pain; normal or white tongue; wiry soggy pulse (Pulse most important)
Rebellious Qi symptoms: cough; asthmatic breathing; vomiting; hiccup; normal or white tongue; wiry soggy pulse
Blood stagnation symptoms: stable local sharp pain and masses, hemorrhage; tongue purple with dark spots (most important); thin, soggy pulse
Blood deficiency symptoms: pale face and lips; lassitude; numbness; dizziness; palpitations; pale tongue with little coating; thin weak pulse
Blood heat symptoms: Irritability, dry mouth; hemorrage; prouse and red menses; fever; red tongue; rapid pulse
Jin Ye deficiency symptoms: dryness in mouth and skin; desire to drink; dry stools; fever; scanty urine; tongue red without coating; thin rapid pulse
Jin Ye retention symptoms: cough, profuse sputum (Lung); palpitations (heart); abdominal distentions (spleen or stomach); edema (spleen or kidney); white, moist tongue with moist coating; wiry sinking pulse

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