Examination in TCM Dr. Lau Kah Yong

Transcription

1 Examination in TCM Dr. Lau Kah Yong

2 Chief Content of Diagnostic Looking Hearing and Smelling Asking Pulse Taking and Palpation

3 Looking General and Local Condition Pattern of Movement Excretion Collateral and Vessels of Infant Index Finger Tongue Characteristic

4 Inspection This is the method used by the Physician to see the abnormal changes in the patient s health

5 Observation Observation of the body shape, physique Observation of the mind Observation of the complexion color Observation of the body movement

6 Observation of the body shape, physique According to Yin and Yang Abundance in Yin Abundance in Yang Deficiency in Yin Deficiency in Yang

7 Observation of the Mind QI BODY MIND SPIRIT

8 3 Aspects of Spirit Embodiment outward manifestation of the spirit in the body Vitality outward manifestation of the spirit as reflected in the energy of the person Lustre reflected in the lustre of the eyes and complexion

9 Inspection of the Whole Body Inspection of the Vitality Strong of Vitality Lack of Vitality Pseudo-Vitality

10 Full Vitality Vitality is based on the essence of the Qi Essence vitality manifest in the eyes Strong vitality eyes active, bright and full of spirit

11 Lack of Vitality Not enough vitality Less lustrous complexion Listlessness, SOB Slower reaction Lack of Qi in the body Seen indeficiency syndrome

12 Loss of Vitality Reflection of essence insufficiency, declined vitality Failure of visceral function and unfavorable prognosis Dim complexion, dull and gloomy eyes, indifferent expression heart Qi deficiency Feeble and intermittent breath lung Qi deficiency Poor appetite and muscle weakness spleen Qi deficiency

13 False Vitality 假 神 Temporary improvement which appear suddenly at the crisis when the patient s essence and Qi are extremely declined Usually happens before the patient s death Different with real improvement Appear after the loss of vitality in fatal cases and is not in accordance with the development of the disease condition Is temporary

14 Mental Abnormality Depressive Psychosis 颠 病 Mania 狂 病 Epilepsy 癫 痫 Dementia 痴 呆

15 Full Vitality Lack of Vitality Loss of Vitality False Manifest Eye Nimble and Bright Dull Look and Spiritless Dull Look and Spiritless Seemibly Bright Complexion Lustrous and Reserved Lusterless and Dark Lucterless and Dark Seeming Lustrous Mentality Clear Mind and Expression Lassitude and Slow Response Lassitude and Low Spirit Appear to be Clear Minded, Restless Physique, Behavior Strong Muscle, Sharp Response Flaccid Muscle and Slow Response Emaciation, Slow Response Seems Active but No Movement

16 Points to Note First impression important Shen and physique important Attentive to crucial signs and symptoms

17 Inspection of Complexion Mainly inspect the face Both Qi and blood of the internal organs run upwards to the face through the meridian system By inspecting the face, can deduce the Qi and blood condition of the internal organ

18 Inspection of Complexion The normal and healthy complexion is lustrous, indicating exuberating of visceral essence and normal function of the visceral Chief Complexion refer to the color of the skin and face that never change due to race or other constitutional factor Secondary Complexion refer to the change of the facial and skin color in correspond to the season and climate Changed Normal Complexion due to different working condition

19 Conforming / Opposing Color Sickly complexion Help gauge the severity of disease Favorable color Complexion conform with disease mild Unfavorable color Complexion oppose disease severe

20 Abnormal Complexion Benign ) Five Malignant ) Color Benign presence of Qi and color, but implicit lustre Malignant withered and dim complexion

21 Color Changes and their Significance Color Blue Red Yellow White Black Zang Organ Liver Heart Spleen Lung Kidney

22 Morbid Complexion 5 major disease color Blue Red Yellow Pale Black

23 Blue / Green Complexion Indicate cold syndrome Pain syndrome Blood stasis Liver disease Infantile convulsion This is due to Qi stagnation and blood stasis When cold stays in the vessels, it will impede the flow of Qi and blood

24 Blue / Green Complexion Pale green under eye Liver Qi stagnation Dark bluish under eye Cold in liver channel Whitish blue Cold / chronic pain Dull bluish Yang deficiency with blood stasis Bluish in children Liver wind

25 Red Heat syndrome Qi and blood will flow when there is heat and the circulating blood in the meridian and skin Excess heat Fully flushed face Deficiency heat Hectic cheek

26 Yellow (Sallor) Suggest spleen deficiency Dampness retention Spleen dominates transport and transformation Source of regeneration of Qi and blood

27 Yellow (Sallor) Associated with puffiness Jaundice Yin dim yellow Due to internal retention of cold dampness which encumbers spleen yang Yang bright yellow Due to internal retention of damp heat

28 Yellow Complexion Color Pale yellow spleen Qi deficiency, blood def Greyish yellow spleen Qi deficiency with liver Qi stagnation Dry yellow heat accumulation in stomach /spleen Ash-like yellow dampness Rich yellow Qi and blood deficiency with dampness Bright yellow - Jaundice

29 White Cold syndrome Deficiency syndrome White Loss of Qi and blood, insufficient blood and Qi to nourish the body AW puffiness deficiency of yang and Qi AW emaciation ( 消 瘦 ) deficiency of blood

30 White Bright white Yang deficiency Dull white More severe Yang deficiency Pale white Qi deficiency Sallow white Blood deficiency Bluish white Cold accumulation

31 Black Kidney deficiency Water retention and fluid retention Blood stasis, pain and cold syndrome

32 Facial Portions Corresponding to Viscera Viscera have certain corresponding portion on the face Combine with the color contributory, will be able to make better diagnosis

33 Figure 形 体 1) Robustness/Weakness/Corpulence/ Emaciation 2) Five Body 3) Five House 4) Constitution

34 Robustness 壮 Strong physique Means the viscera is good with exuberant of Qi and blood Means good prognosis

35 Weak ( 弱 ) Feeble physique Fragile skeleton, insufficient Qi and blood Unfavorable prognosis

36 Corpulence ( 胖 ) Good appetite exuberant figure Poor appetite - exuberant figure with Qi deficiency Susceptible to suffer from phlegm and dampness accumulation

37 Emaciation ( 瘦 ) Good appetite fire flaming in the middle jiao Poor appetite deficiency of the function of the spleen and stomach Fever sensation and night sweating implies yin and blood deficiency

38 Five House Head ( 头 ) house of essence assembles Back ( 备 ) dwelling place of organs of the chest. Pigeon chest/tortoise back Limbos ( 腰 ) house of kidney Knee ( 膝 ) assembly place of tendons Bone ( 骨 ) weakness of bone, manifested by inability to stand too long

39 Five Body Constitution Skin can interpret the defensive Qi from the lustre and the moisture of the skin Muscle can indirectly deduce the function of the spleen and stomach Vessels flow of Qi Tendons liver blood status Bone function of the kidney

40 Posture Lying position Sitting position Abnormality in activity

41 Lying Position Yang Supine, does not face the wall Feels restless, toss in bed Yin Prone Face the wall

42 Sitting Position Sit upright with raised head and breathlessness, with phlegm++ Lung excess Sitting with droopy head and SOB with minimal talking Lung deficiency

43 Abnormality in Activity Stiffness in the neck and back Twitching of the face, lip and upper limb Shiver

44 Local Observation Head Observation Face Observation Hair Observation Eye Observation Ear Observation Nose Observation Lip Observation Teeth and Gum Observation Throat Observation Neck Observation Chest and Abdomen Observation Limbos and Back Observation Limbs Observation Genital and Anus Skin

45 Head Observation Confluence of all Yang meridian + Ren and Du meridian Head is the house of promordial mind ( 元 神 之 府 ) Raised head pertain to Yang Droopy head - pertain to Yin Stiffness of neck excess of evil Unsuspended head (lean to one side) deficiency of original Qi

46 Head Observation Skull Big Small Fontanel Protruding Sunken Hair Yellow Grey Loss of hair

47 Head Observation Soft neck insufficiency of kidney Qi Shaking head presymptom of liver wind For children - fontanel

48 Head Signs Dry scalp liver/kidney Yin deficiency Red/painful scalp wind heat, liver fire Tremor of head liver wind Swelling of head wind heat with toxic heat Boils on scalp liver fire/damp heat Late closure of fontanelle poor hereditary kidney constitution

49 Face Observation Observe the complexion and facial figure Complexion Blue (Liver) Red (Heart) Yellow (Spleen) Pale (Lung) Black (Kidney)

50 Face Observation Facial figure Swelling feverish face upward invasion of wind heat Yang edema Yin edema Wry mouth and eye

51 Hair Observation Color and texture of hair Black lustrous of hair due to sufficient essence and blood Alopecia areata due to wind attacking on the deficient blood Curved hair like spike infantile malnutrition

52 Alopecia Blood heat Dries out hair follicles Kidney deficiency Unable to nourish hair follicles Blood stasis Prevent new blood from nourishing hair

53 Eye Observation Window for the liver Theory of five ring Inner and outer canthus of the eye heart White of the eye lung Black of the eye liver Pupils of the eye kidney Eyelid - spleen

54 Eye Observation Vitality of the eye Good vision; distinguishable black and white of eye, lustrous eye light; little tears

55 Eye Observation Color of the eye Red excess heat Lung fire if at the white of eye In the canthus represent heart fire Whole congested eye wind heat of the liver meridian Reddish eyelid spleen fire Pale Canthus blood deficiency Yellow jaundice Dull and dark kidney deficiency Black around orbit kidney deficiency with cold dampness

56 Eye Observation Shape of the eye Swelling pain of the eye excess Qi Simple puffiness without pain, slowly with flabbiness spleen deficiency Swelling of the lower eye lid deficiency of both spleen and kidney Sunken eye insufficient fluid and blood Protrusive eyeball with breathlessness adverse rising of Qi Canthus hyperemia and protruding granulation wind heat on the eyelid

57 Eye Observation State of the eye Eye open and like light Yang syndrome Eye closed and dislike Yin Pupils dilation exhaustion of the kidney essence Eyelid twitching attach of the wind heat or deficiency of and blood to nourish the meridian Sleeping with eye half close hypofunction of the spleen Ptosis spleen and kidney deficiency

58 Ear Observation Window of the kidney Thick and large ear Thin and small ear Swelling of the ear external excess pathogenic Qi, damp heat or heat toxin of the liver Dry and black helix deficiency of Qi, due to deficiency of kidney essence and Yin Bluish black helix excessive cold or acute pain

59 Nose Observation Bright and lustrous nose adequate stomach Qi Nostril dryness with black color - heat depleting Yin Red and ulcerous nose stomach heat or blood heat Nares flaring wind fire and excessive heat accumulating in the lung Swelling of the nose exorbitance of pathogenic Qi Sunken nose deficiency of genuine Qi Nasal polyp stagnant heat in the Yangming meridian Clear nasal discharge external wind cold Turbid nasal discharge external wind heat

60 Lip Observation Color of the lip Red and lustrous normal Pale deficiency of both Qi and blood Dark red and dry lip heat excess Bright red lip (carmine) Yin deficiency Blue and dark purple lip blood stasis and cold Blackish kidney Qi deficiency

61 Lip Observation State of the lip Dry and chopped lip dryness heat Lockjaw excessive syndrome Open mouth deficiency syndrome Involuntary drooling spleen deficiency Tight mouth and purplish lip umbilicus wind

62 Lip Observation State of the lip Aphthous stomatitis Damp heat from the spleen and stomach Canker core (follicles at the lips) Heat in heart and spleen Infant mycotic stomatitis Fetal heat accumulation of the heart and spleen

63 Teeth and Gum Observation Teeth are surplus of bone Bone is dominated by kidney Gum is where the Yangming meridian of the hand and foot travel Observing them inspection of the kidney, stomach

64 Teeth and Gum Observation Teeth Yellow and dry pathogenic heat affecting body and deplete body fluid Dry teeth kidney Yin exhaustion Grinding teeth in sleep stomach heat or parasite Loss of teeth/shaky insufficiency of kidney Yin

65 Teeth and Gum Observation Gum Pale blood deficiency Atropic gum insufficiency of kidney and stomach Yin Reddish swelling gum due to stomach fire

66 Throat Observation Throat is the door to the lung and stomach, the pathway for breathing and eating and the region where the kidney meridian circulate. Reddish painful throat heat in the stomach and lung Severe swelling with yellowish purulent spot pharynigitis/tonsillitis Bright red and tender throat with slight swelling Yin deficiency with flaring of fire

67 Neck Observation Goitre stagnation of liver Qi with phlegm accumulation Scrofula, clustered cervical nodules Yin deficiency of the lung and kidney, with deficient fire concentrating the liquid into phlegm -- lump

68 Neck Observation Flaccid neck Deficiency of kidney Qi Stiff neck Wind cold invading the Taiyang meridian Stagnation of flow of Qi Ascend of fire in pathogenic fire Tetanus

69 Chest and Abdomen Observation Shape of chest Abdominal mass 积 Abdominal gathering 聚 Parasite ( 虫 症 )

70 Chest Flat chest thin people with Yin deficiency, Yin deficiency of the lung and kidney Barrel chest obstruction and stagnation of lung Qi Chicken chest deficiency of kidney Qi and mal development of bone

71 Abdomen Bulged abdomen Depressed abdomen Blue veins on abdomen wall

72 Limbos and Back Observation Kyphosis deficiency of kidney Qi Scoliosis congenital / deficiency of kidney Qi Stiffness of back invasion of cold dampness

73 Limbs Observation Hand and foot Fatty hand and feet excess syndrome Thin hand deficiency syndrome Twitching of hand deficiency of Qi and blood Flaccid limb suggest withering syndrome Painful joints arthralgia syndrome, damp heat Paralyzed hand (open) external collapse of Yang Qi Grasped hand Internal closure of pathogenic Qi

74 Limbs Observation Wrist and palm Lustrous skin at the wrist and palm sufficient body fluid Dry skin insufficiency of body fluid Thick palm plenty of visceral Qi Thin palm insufficiency of visceral Qi Flaccid muscle insufficiency of stomach Qi Thenar eminence stomach Qi Red heat in the stomach Blue cold in the stomach

75 Limbs Observation Fingers, toes and nails Clasping finger, unable to straighten failure of blood to nourish tendon, after wind cold attach Wrinkle finger tip reduced body fluid Dark purple toe with pain internal cold dampness transforming into fire Swelling and deformed joints internal accumulation of wind and dampness

76 Limbs Observation Nail Outside manifestation of liver Dark red nail exorbitance of heat Bright red nail Yin deficiency Pale nail cold syndrome Yellow nail blood deficiency

77 Observing Index Finger Collateral Index finger lung meridian, boys left, girls right Observing the finger vein as good as palpation Location of the 3 pass: Wind pass Qi pass Life pass

78 Observing Index Finger Collateral Depth Superficial external disease Deep internal disease Intensity Thin benign Thick severe Vein that disappear deficiency Vein that do not disappear excess Color Scarlet exterior disease Blue wind syndrome / pain Pale deficiency syndrome Purplish black obstruction of blood vessels

79 Observing Index Finger Collateral Method Floating and deep Dark / light Color Scarlet exterior disease Blue wind syndrome Pale deficiency syndrome Purplish black obstruction of blood vessels

80 Genital and Anus Observation Confluence of tendons, Yangming and Taiyin meridian pass Orifice concerning reproduction connects with the kidney Orifice concerning urination connects with the urinary bladder External genitals is connected with the liver and the Du meridian

81 External Genitals Swelling of external genitals Hernia Damp heat invading liver meridian Contraction of external genitals External cold pathogens Stagnation of Qi and blood Eczema of scrotum Damp heat / Yin deficiency Prolapse of uterus Deficiency of the spleen and sinking of middle Qi

82 Skin Observation Color Red - internal heat; Yellow jaundice Moisture and dryness Moist exuberance of lung Qi Dry and scaly skin due to blood stasis Swelling and distention

83 Observation of excreta Sputum Heat yellow and sticky Cold white and clear Wind watery and foam Damp white and profuse Dry scanty and thick Bloody heat accumulation in the lung

84 Observation of excreta Saliva Clear and profuse deficiency and cold in the spleen and stomach Dribbling of sticky saliva damp heat in the spleen and stomach Nocturnal salivation heat or food retention in the stomach

85 Observation of excreta Urine Profuse clear urine deficiency cold syndrome Scanty yellow urine excess heat syndrome Turbid urine downward movement of damp heat Bloody urine heat in the bladder / kidney Yin deficiency

86 Tongue Observation The relation between tongue and viscera Significance of tongue inspection

87 The Relation between Tongue and Viscera Tongue is the sprout of the heart Tongue is the entrance of food. The spleen dominates transportation and transformation. Spleen is closely related to splenic function. Tongue coating has special relation with stomach Qi.

88 The Relation between Tongue and Viscera The 3 Yin and Yang meridian of the foot Hand Taiyang and Shaoyang meridian All pass through the tongue

89 Tongue Diagnosis, Theory of Oriental Medicine 1. Tongue diagnosis is an example of Traditional Chinese Medicine (TCM) external observation of internal processes. 2. To fully understand the tongue diagnosis, knowledge of the Eight Principles: Yin and Yang; Internal and External; Excess and Deficiency; Hot and Cold are necessary. 3. The tongue body and coating are affected mostly by short-term events, changing constantly. 4. A blue tongue and face is normal for a pregnant woman, showing there is activity in the womb.

90 Tongue Diagnosis, Theory of Oriental Medicine 5. A normal tongue has a medium white coat and is very red. 6. The shape is not as important as the coating. 7. The coating is a physiological by-product of the digestion of food and fluids depending on the Spleen for transportation and the Stomach for ripening the food.

91 Tongue Diagnosis, Theory of Oriental Medicine 1. The tongue observation is a very precise indication of the source of the larger problem that the patient has. 2. The most important aspects of the tongue are the color, shape and coating. 3. The external factors of food, drugs, and self-care can also influence the tongue color and coating. 4. The centre of the tongue indicates the most about the digestion history of the patient.

92 Tongue Diagnosis, Theory of Oriental Medicine 5. To understand the state of the heart, look way back at the root of the tongue for redness. 6. If the tongue is very pale, it indicates a very high fever is imminent and the coating would be white. 7. The sides of the tongue are swollen, with crevices and red, indicating frostbites on the extremities. 8. The tongue is a reddish purple especially around the tip, you question the patient further about his/her cardiac history.

93 Tongue Diagnosis Tongue closely related to the viscera and meridian Tip heart Middle spleen and stomach Sides liver and GB Root kidney

94 TONGUE PICTURE

95 Significance of Tongue Inspection Tongue body conditions of zang viscera Qi deficiency Severity of disease Tongue coating fu viscera Cold/heat pathogens Location of disease

96 Special Attention Light Posture of patient Diet Content of tongue diagnosis

97 Tongue Vitality Flourish of tongue texture Withering of tongue texture

98 Tongue Color 1. Pale tongue 2. Red tongue 3. Crimson 4. Purple 5. Blue

99 Pale Tongue Lighter in color Decline of Yang and Qi Deficiency of blood

100 Tongue Picture

101 Pale Tongue Pale and slight moist Yang deficiency Pale and slightly dry Yin deficiency Pale Qi deficiency Pale at the side liver blood deficiency Pale at the centre spleen blood deficiency

102 Red Tongue The reddness is heavier than normal Internal heat/yang excess Different locations indicate different area of heatiness Deficiency syndrome causing pseudo heatred tongue with little or no coating

103 Tongue Picture

104 Crimson Tongue 绛 红 Heavy and redder than red tongue Extreme fever or exogenous febrile disease Internal injury

105 Purple Tongue Dark purple heat Heat pathogens entering from ext to int With crack in the tongue Exhaustion of Yin Whole tongue extreme heat in viscera Localized to the area Blood stasis Whole tongue Qi and blood stagnation Phlegm dampness Alcohol toxin Yin exhaustion

106 Purple Tongue Bluish purple Yang deficiency Yin deficiency of the liver and kidney Blood stasis Phlegm stagnation

107 Blue Tongue Yin cold Blood stasis

108 Tongue Shape Delicate 娇 嫩 Toughness 苍 老 Corpulence 胖 大 Swelling 肿 胀 Thinness 瘦 弱 Crack 裂 纹 Prickle 芒 刺 Smoothness 光 滑 Teeth mark 齿 印

109 Delicate 娇 嫩 Texture of the tongue is fine, tongue color light Deficiency syndrome Pale plump delicate Yang deficiency Pale delicate tongue Qi and blood deficiency 嫩 舌

110 Tough 苍 老 Texture of tongue is coarse Tongue body is hard Tongue color is dark Seen in excess syndrome

111 Enlarged Tongue 肥 大 Retention of fluid or phlegm 润 苔

112 Swollen Tongue 肿 胀 Exuberant heat in the heart and spleen

113 Thin Tongue 瘦 弱 Qi and blood deficiency Pale Qi deficiency Red Yin deficiency 瘦 薄 舌

114 Prickle 芒 刺 Purple spots on the tongue Exuberant Yang heat in the organs or excessive heat in the blood

115 Prickle 芒 刺 点 舌 星 舌

116 Crack 裂 纹 裂 纹 舌 ( 横 行 ) 裂 纹 舌 ( 川 字 型 )

117 Crack 裂 纹 Deficiency of blood and deficiency of body fluid, due to heat or fire Yin deficiency

118 Teeth Mark Deficiency of spleen and internal accumulation of dampness 齿 痕 舌

119 Sublingual Veins Less than 2.7 mm in diameter Less than 3/5 of the distance between the sublingual caruncle and tip of tongue Thin, short vein deficiency of Qi and blood Cyanotic, purple and dark vein stagnation of blood

120 Sublingual Veins Distended Qi deficiency Thin Yin deficiency Distended and dark blood stasis Reddish damp heat Yellowish dampness Pale - cold

121 Moving State of Tongue Flaccid Weak tongue, unable to move easily Injury to Yin or Qi deficiency Stiff Stiff rigid tongue, hard to move around Invasion of pericardium by heat, injury to body fluid by heat, obstruction of channel by wind Deviated tongue

122 Moving State of Tongue Tremor Internal stirring of liver wind Protruding & moving tongue Heat in heart & spleen Shortness Cold retention or critical condition

123 强 硬 舌 菱 软 舌

124 舌 淡 红 强 硬 歪 斜 舌

125 Tongue Coating Make up of stomach Qi Normal coating is thin and white, slightly moist Observing tongue coating include looking at Color Texture

126 Color of Coating White External syndrome Cold syndrome Damp syndrome Yellowish white Partially external and internal disease

127 White Coating White, thin and dry coating External syndrome due to wind heat White, slippery and greasy coating Cold dampness; deficiency of spleen Yang White and thick coating Retention of dampness Phlegm retention

128 白 苔

129 Yellow Coating Spleen disease Interior disease Heat syndrome

130 Yellow Coating Yellow and thin coating Yellow and thick coating Yellow, thick and greasy coating Yellow, thick and dry coating

131 黄 腻 灰 黑 苔 淡 黄 苔

132 Grey Black Coating Severe cases interior syndrome Excessive heat, Yin cold or long term retention of phlegm dampness

133 Grey Black Coating 老 舌

134 Black Coating Excessive heat, Yin cold or long term phlegm dampness Moist retention of cold dampness Dry heat syndrome

135 Texture of Tongue Thick and thin Bottom can/cannot be seen Indicate the disease is exterior/mild thin Disease interior/severe thick Progress of thin - - thick

136 Texture of Tongue Moist/dry Distribution of body fluid Too moist seen in dampness retention/cold syndrome Dry insufficient body fluid due to heat; depletion of Yin Yang deficiency

137 White Greasiness Diagram

138 Texture of Coating Putrid 腐 /Greasiness 腻 Putrid coating look like coarse granules Caused by excessive Yang heat exudating the putrid pathogenic Qi out Caused by: Food retention 食 积 Internal Abscess pus putrid coating 脓 腐 苔 Poor stomach Qi/digestion mouldy putrid coating 霉 腐 苔 Dampness