Method of Clinic Practice in TCM Inquiring Inspection Auscultation & Olfaction Pulse-feeling & palpation Heart (Ht); Liver (Liv); Spleen (Sp); Stomach (St); Lung (Lu); Kidney (Kid); Gallbladder (GB); Large Intestine (LI); Small Intestine (SI);

Inquiring: Question 1: Fever or Cold Interior Fever -- Deficiency: Pathology: due to internal disorders -- Excess: Pathology: Yang-Ming fever or Epidemic Qi fever Exterior Fever: Pathology: Wind-cold: no sweating, chill, headache Wind-heat: sweating, less chill, Summer-heat: high fever, thirsty, constipation

Fever due to internal disorderExterior fever Onset ChronicAcute Etiology Internal injury; improper diet; emotion trumaExopathic six evil qi Duration Longshort Charact er Low fever or subjective fever or heat sensation in palms & feet Intermittent fever that onset regular or irregular High fever; Persistent fever unless the exopathy is eliminated; Heat will be reduced by perspiration Aversio n to cold Mostly without aversion to cold or feel cold and the sensation of cold will relieved by warm clothing Aversion to cold is always accompanied with fever and unable to be relieved by wearing more clothes Accomp anied sympto ms Internal injury & deficiency: dizziness, lassitude, shortness of breath, no desire to talk, spontaneous sweating, light sweating fever Nasal obstruction, runny nose, headache Tongue & pulse Red or pale body with purple sports Thin or no coating or thick & greasy coating White or yellow coating Floating rapid slippery tense pulse

Interior Cold: -- Deficiency: long illness; yang deficiency -- Excess: Pathology: Mostly due to exterior cold attack Stomach directly Sym: Acute stomach pain; diarrhea; cold limbs; like hot drinking; Tongue: white coating Pulse: tight Exterior Cold: -- Wind-cold

Four clinic types of “Fever & Cold” (I) Fever with aversion to cold ( A pointer symptom of exterior disease ) Fever being mild but “Aversion to cold” being severe Pathology: Exterior cold invasion Sym: No sweating, headache, tight muscle, snuff… 2. Fever being mild and “Aversion to wind” Pathology: wind invade human body; Lung Qi or Wei Qi Def. Sym: 3. Fever being severe but “Aversion to cold” being mild Pathology: wind-heat invade people with ordinary or Yin-deficiency, or Yang-excess constitution Sym: sweating, no headache, dry throat with rapid pulse

(II) “Aversion to cold” but no fever Pathology: Exterior cold invade internal organs; Def. of Yang Sym: cold limbs, midsection cold, like warm package, diarrhea… Tongue: white coating Pulse: sink & tight (III) Fever only 1. Excessive fever Pathology: Wind-heat transform into interior heat; Yang-Ming fever; Sym: high fever (over 103 F), red face, thirsty, severer sweating, constipation… 2. Tidal fever Pathology: Yang-Ming fever; Yin Def. ; blood stasis cause fever Sym: fever happen in certern time everyday 3. Low fever Pathology: long illness; Qi Def. ; Blood Def. Yin Def.; Liver Qi Stag. Sym: red face; palm & feet fever

Question 2: Sweating Purpose: Identify the character of evil factors; Judging body’s Qi strength Sweating or not Exterior disease: No sweating: wind-cold Sym. Sweating: wind-heat or wind sym. Interior disease: No sweating: fluid & blood Def. Or Yang Qi Def. Sweating: interior heat excess or (Yang) Qi def. or yin def. Seven characters of sweating Spontaneous sweating : Qi Def. Or Yang Def. Sleeping sweating : Yin Def. Exhausted sweating : Yin exhausted or Yang exhausted Chill sweating : exterior cold evil fight with Qi Cold sweating : Yang Qi Def. or being scared Heat sweating : interior heat excess Yellow sweating : Dampness

Question 3: Pain Character of Pain Distension pain: Qi Stag. Mostly on stomach area except eye Prickling pain: Blood stag. Cold pain: exterior cold invade joints & meridians or Yang def. Heat pain: exterior fire invade joints & meridians or Yin def. Heavy pain: Dampness or liver fire flow up to head Sore pain: dampness invade joints or bad circulation of qi & blood or kidney def. Empty pain: Qi & blood def. or kidney essence def. (head or abdomen) Colic pain (true heart pain): physical evil or excess cold block Qi circulation; Secret anguish: yang Qi or blood or kidney essence def. Fixed pain: blood stasis (abdomen& costal & hypochondriac regions); damp-cold or damp heat invade joints. Moving pain: Qi Stag ( abdomen & costal & hypochondriac regions); wind cold invade joints

Location of Pain: Headache: Chest pain: Costal pain: Stomach pain: Abdomen pain: Back pain: limb pain: Whole body pain:

Question 4: Whole body abnormal Sym Dizziness Oppressed feeling in the chest Palpitation Costal oppressive feeling Abdominal distension Heaviness of body Numbness of skin or limbs Impotence Spermatorrhoea

Question 5: Eye & Ear Ear Tinnitus & Deafness Acute: Excessive sym. Liver fire or damp-phlegm; Qi & blood stasis; Wind-heat; Medical side-affect Chronic: Def. sym. (kid. Sp. Liv. ) Hard of hearing Acute: Phlegm invasion & block the ear meridian Chronic: kidney essence def. distention in the ear: Dampness or wind-heat Eye Itching of eye: liver fire or wind-heat (acute); Liver blood def. (chronic) Ache of eye: Liver fire ; wind-heat ; Yin Def. Dazzle of eye: Liver Yang excess; Phlegm-damp; or Qi, blood Def. blurring of eye: Liver & Kidney Def.

Question 6: Sleeping Insomnia: Pathology: Heart blood def. ; Gallbladder Qi def.; Yin def.; Liver fire excess; phlegm heat… Sleepyhead: Pathology: Spleen Yang Def. & dampness block the yang qi.. Prodrome of coma;

Question 7: Food & taste Thirsty & Drinking water No thirsty & no desire to drink water Pathology: Cold or Dampness diseases Thirsty & desire to drink * Thirsty & dryness of throat and nose * Thirsty & like cold water and high fever and big sweating * Thirsty & yin def symptoms * Thirsty & polydipsia, polyuria, polyorexia * Thirsty & less drinking * Thirsty & only gargle the water & black skin

Diet & Appetite Losing appetite: No appetite: Food stag in stomach; Damp-heat; Liver & GB dampness; Pregnant women Excessive appetite: Stomach (St) Fire Hungary but no appetite: St Yin def. Being addicted to one food or one thing: Taste light taste : Sp yang def. sweet taste : Damp-heat; Sp Qi def. sticky taste : Phlegm heat; Damp-heat or damp-cold sore taste : Food stag; Liv & St heat bitter taste : Heart fire up; Liv & GB fire salty taste : Kid disease; acerbity taste : Dryness damage fluid; excessive heat

Observation of the nose * Appearance : flapping of the nose wing * Discharge -- Clear -- Whilst turbid -- Prolonged turbid discharge with stinking smell : chronic rhinitis or chronic sinusitis Observation of the ear * Colour -- Pale -- Red & swollen: Liv. & GB. Damp-heat or fire evil -- Dry & withered auricles, burnt black color: Kid. Essence exhausted * Purulent Discharge * Shape Observation of the gums, lips & mouth

Question 8: Stool & Urine Stool Times * Constipation * Diarrhea Quality * Dyspeptic * Dry & Soft * With puriform blood * blood Feel of anus when defecate * Hot * Heaviness * Sticky * Incontinence * prolapse

Urine Times * Frequently * Retention of Urine Quantity of urine * clear & increased * descreased Sensation of Urine * Acerbity & ache * Unclearly * Incontinence * Enuresis

Question 9: Menstruate & Secretion Menstruate Period * Advanced * Prolonged * Not fixed Quantity * Excessive quantity * Decreased quantity Color & Quality Dysmenorrhea Secretion White secretion Yellow secretion Red & White secretion

Inspection (1) Observation of the Vitality Eyes Skin lustrous Expression Posture (2) Observation of the Colour Red: malar flush; heat Pale: Def.; cold; lost blood Yellow: Sp def. ; “bright orange” or “smoky dark” Blue: Cold, Qi Stag.; Blood stasis; pain; Black: Kid def.; cold; blood stasis; pain;

Observation of the Appearance * Overweight with mental depression: Qi def. & phlegm damp * Thin with dry skin: Blood def. * Great loss of weight: Exhaustion of the essential qi * Active posture & movement: Yang Sym * Passive manner: Yin sym. * Violent movement of the four limbs: wind disease * Wei Syndromes: Weakness, motor impairment & muscular atrophy of limbs * Bi Syndromes: pain, soreness, heaviness & numbness in the tendons, bones & muscles with swelling & restricted movement

Body Diagnosis - Shape, Demeanor and Indications Body Shape/DemeanorIndications muscular/strongtend towards excess abrubt/jerky movementswind active movementstend towards yang conditions withdrawn/slow movementstend towards qi a/or yang def hunched overupper jiao def overweighttend towards dampness; sp qi deficiency Facial Diagnosis - Colors and Indications Facial ColorsIndications whitecold or def dull whiteblood def bright whiteqi or yang def yellowexcess damp or sp def orange/yellowdamp heat redheat + whole face = excess; + mallor flush = yin def blue/green (quin)liv qi a/or blood stagnation black/darkkd def or blood stagnation

Observation of the Five Sense Organs Observation of the eye * Eye vitality * Eye shape : deep eye socket Eye ball pop out: Graves’ disease * Eye color --Red: Sclera: Lu. fire or wind-heat Corner: Ht. fire Eyelid: Sp. dampness Whole eye: Liv. fire or wind --Yellow Sclera: damp-heat or damp cold --Pale corner: blood def. --Black Eyelid: kid. Def. * Unconscious Eye movement: wind

¤ Lower Jiao The Base of the tongue corresponds to the Kidney, Urinary Bladder, Large Intestine and Small Intestine Meridians. ¤ Middle Jiao The sides of the tongue correspond to the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patients left side and the Liver on the patients right side. The Middle of the tongue corresponds to the Stomach and Spleen Meridians. ¤ Upper Jiao The Tip of the tongue corresponds to the Lung and the Heart Meridians.. Observation of the tongue

Body ColorIndications Pinknormal or mild disorder Paleyang, blood a/or qi def Deficiency Cold + thin & dry = blood def + wet = qi def + swollen = qi def + swollen & wet = yang defthindrywetswollen wet Redheat + no coating = yin def empty heat + yellow coat = excess heat + wet = damp heat + dry = injured fluidswetdry Dark Red (Scarlet, Cardinal)extreme heat more severe conditions than red Purplestagnation lv qi stagnation is likely + pale = coldpale Bluesevere internal cold stagnant blood Tongue Body Colors and Clinical Indications

Body ShapeIndications cracked if develops during illness indicates chronic and severe, otherwise normal location of cracks relates to organ pathology + red = empty heat consuming fluids + pale = blood & qi def crack runs from center to the tip = ht disorder or congenital ht problems horizontal cracks = yin defredpale deviated (crooked) wind flaccid deficiency heat + pale = blood & qi def + dark red = yin collapse long heat in the ht rigid stroke or early signs of stroke short (contracted) serious conditions; blood deficiency; ht deficiency + pale or purple = cold or yang def; + swollen = damp or phlegm; + red = heat consuming the fluidspalepurpleswollenred stiff heat in the ht: ht/sp heat; phlegm obstructing the ht qi + normal & pale = wind, strokepale swollen Deficiency : + pale & wet - yang def + teethmarks & pale = qi def or excess fluids + dark red = excess heat usually ht/sppalewetpaledark red thinblood or fluid def: empty heat consuming fluids + pale = blood & qi def; + red = yin defpalered thorny (strawberry, granular) Heat: congealed blood + on tip = ht fire; + on edges = lv/gb fire; + on center = st a/or intestines heat trembling (quivering)Wind: + pale = qi def; + red = heat producing internal windpalered Tongue Body Shapes and Clinical Indications

Tongue Coatings and Clinical Indications Tongue CoatIndications thinnormal exterior condition, wind-cold thickexcess damp/phlegm food stagnation dryheat consuming yin excess yang or fire deficiency fluids moistnormal or mild imbalance wetexcess fluids from yang def dampness sticky (greasy, creamy)dampness or phlegm retention of food

Coat ColorationIndications whiteinternal or external cold if coat looks like cottage cheese = ST heat + thin coat & body aches = exterior wind-cold + thin coat & thorny = wind-heatthin coat thorny yellowinternal or external heat effected by coffee, tea a/or smoke intake grayhot or cold internal condition retention of phlegm heat + dry = heat consuming body fluids + moist = damp colddrymoist blackhot or cold internal condition retention of phlegm heat + dry = heat consuming body fluids + moist = damp colddrymoist Coat RootingIndications rooted moss appears firmly implanted strong st/sp qi rootless moss appears to float on the surface st/sp qi def peeledsp qi def deficient yin or fluids

. Auscultation & Olfaction Listening Speech Respiration Cough Smelling Breathing Sweating: body odor Phlegm Stools Women’s secretion vomiting Listening Diagnosis - Voice and Breath QualityIndications sudden loss of voicewind heat gradual loss of voicelu qi or yin def loudexcess softdeficiency reluctance to speakcold or def excessive speakingheat or excess Smelling Diagnosis – Body Odors QualityIndications strong scentheat bad breathst heat a/or food stagnation strong smelling stoolsheat and dampness strong smelling urineheat and dampness

Pulse-feeling & palpation Common Pulse Locations and Related Meridians Left WristRight Wrist Cun (inch) - 1st positionHTHT / SISILULU / LILI Guan (barr) - 2nd positionLVLV / GBGBSPSP / STST Chi (foot) - 3rd positionKDKD / UBUBKD / Ming Men

DesignationSensationIndications By Depth Floating (superficial)easily felt at the superficial level not as significant as you feel deeper external condition/pathogen + empty = yin a/or blood def + rapid = wind heat + tight/slow = wind coldemptyrapidtightslow Sinking (deep)felt only at the deep levelinterior condition/obstruction + rapid = internal heat + slow = internal cold + slippery = internal damp/phlegm + empty = qi or yang defrapidslowslipperyempty By Frequency: Slowless than 4 beats per breath (< 60bpm ) cold condition a/or pathogenic factor + floating = exterior wind cold + sinking/empty = yang deffloatingsinkingempty Rapidmore than 5 beats per breath ( > 90bpm ) hot condition a/or pathogenic factor + floating = external wind heat + sinking = internal heat + full = excess heat + empty = empty heatfloatingsinkingfullempty

DesignationSensationIndications By Quality/Shape: Hesitant (choppy)rough and unevenblood a/or jing stagnation Slipperysmooth with a viscous sensationexcess dampness, retention of food, pregnancy + rapid = damp heat + slow = cold damp obstructionrapidslow Tighttension with side to side movements (thicker than a wiry pulse) excess cold - interior or exterior, commonly associated with pain Wirytension with no side to side movements (thinner than a tight pulse) LV/GB disharmony By Width: Big (excess, overflowing)broad but with distinct edgesexcess heat, commonly in ST or Intestines Thin (thready, fine)fine but with distinct edgesblood a/or qi deficiency

DesignationSensationIndications By Strength: Empty (deficient)wide but not strong, disappears with slight pressure, forceless blood a/or qi deficiency Full (excess)wide and strong, felt with strength at all levels excess condition, often excess heat with rebellious Qi By Length: Shortnot felt in all 3 positionsqi deficiency Longfelt beyond the 3 positionsexcess, heat, generally considered normal in absence of other qualities By Rhythm: Hurried (abrubt)rapid with irregularly missed beats heat agitating qi & blood Intermittentregularly skipped beatsheart disharmony, exhaustion of zang qi Knottedslow with irregularly missed beats cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing

Writing of medical report in TCM Internal Medicine