Diagnostics of TCM is a subject concentrating on diagnosis of diseases and differentiation of syndromes (hrough examination based on the theory and metho- dology of TCM. It serves as a bridge to connect the l>asic theory of TCM with clinical specialties and is the essential course for all clinical subjects.
This book, focusing on elucida tion of the theory and methods of TCM in examining pathological condi- tions as well as analyzing and differentiating syn
dromes, is composed of introduction, diagnostic methods and syndrome differentiation. It is a sys
tematic in itself and, at the same time, keeps a cióse association with the clinical specialties so as to pre
serve the systematic and integral characteristics of TCM.
In the compilation, the authors have tried to preserve the unique features of TCM and demón
strate the profound contení of TCM diagnostics on one hand, and unite theory and practice so as to Kiiide the clinical practice on the other. In the com
pila tion, the authors have also tried to make it con- i ise, easy to read, fluent and accurate. For this pur-
|x)se, some illustrations and colour pictures are in- cluded. We hope that this book will be beneficial to lx>th the intemational students with certain level of Chinese in learning traditional Chinese medicine and lite readers in China who are studying traditional Chí
nese medicine or going abroad.
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Introduction ... ... i 1... Diagnostic m ethods... 7
1.1 Inspection... 8 1.1.1 Inspection of the whole body... 8 1. 1.1.1 Inspection of spirit ... ... 9 1. 1. 1. 2 Inspection of complexión ... 12 1. 1. 1. 3 Inspection of body ... 17 1. 1. 1. 4 Inspection of postures... 19 1. 1. 2 Inspection of local regions ... 22 1. 1. 2. 1 Inspection of head and hair ... 22 1. 1. 2. 2 Inspection of the five sense organs ... 25 1. 1. 2. 3 Inspection of neck ... 30 1. 1. 2. 4 Inspection of skin ... 31 1.1. 2. 5 Inspection of infantile index finger veins ... 35 1.1. 2. 6 Inspection of excreta ... 38 1.1. 3 Inspection of tongue ... 42 1. 1. 3.1 Methods for inspection of tongue ... 42 1. 1. 3. 2 Normal states of the tongue ... 44 1. 1. 3. 3 Inspection of the tongue body ... 44 1. 1. 3. 4 Inspection of tongue fur ... 52 1. 1. 3. 5 Comprehensive analysis of the body of the tongue and tongue fu r ... 58 1. 2 Listening and olfaction ... 60 1. 2. 1 Listening to sounds ... 60 1. 2. 1. 1 Speech ... 61 1. 2. 1. 2 Respiration ... 63 1. 2. 1. 3 Cough ... 65 1. 2. 1.4 Hiccup and belching ... 66 1.2.2 Olfaction ... *67
1. 2. 2.1 Smelling body odor ... 68
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1. 2. 2. 2 Odor in the room... 69 1.3 Inquiry ... 69 1.3.1 General information ... 70 1. 3. 2 Inquiry of chief complaint and history of present illness ... 71 1. 3. 2. 1 Inquiry of chief complaint ... 71 1. 3. 2. 2 Inquiry of the history of present illness ... 72 1. 3. 3 Inquiry of the present symptoms ... 73 1. 3. 3. 1 Inquiry of fever and coid... 73 1. 3. 3. 2 Inquiry of sweating ... 80 1. 3. 3. 3 Inquiry of pain ... 84 1. 3. 3. 4 Inquiry of sleep ... 90 1. 3. 3. 5 Inquiry of diet and partiality ... 92 1. 3. 3. 6 Inquiry of urination and defecation ... 97 1. 3. 3. 7 Inquiry of the head and face... 102 1. 3. 3. 8 Inquiry of chest and abdomen ... 106 1. 3. 3. 9 Inquiry of the symptoms over the loins, back and four limbs ... 108 1. 3. 3. 10 Inquiry of symptoms in andropathy ... 109 1. 3. 3. 11 Inquiry of symptoms in gynecology ... 111 1. 3. 3. 12 Inquiry of symptoms in pediatrics ... 114 1.3.4 Inquiry of anamnesis ... 116 1. 3. 4. 1 Inquiry of past physique ... 117 1. 3. 4. 2 Inquiry of previous illness ... 117 I. 3. 5 Inquiry of family history ... 117 1.4 I’ulse-taking and palpation ... 118 1. 4. 1 Pulse-taking... 118 1.4. 1. 1 Regions and methods for taking pulse... 119 1. 4.1. 2 Normal pulse ... ... 123 1. 4.1. 3 Morbid pulse ... 125 1.4.2 Palpation ... 131 1. 4. 2. 1 Methods for palpation ... 132 1. 4. 2. 2 Pressing the chest and abdomen ... 133 1. 4. 2. 3 Palpation of the four limbs ... 136 1. 4. 2. 4 Palpation of acupoints ... 137
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2 Differentiation of syndrome ... 138 2. 1 Syndrome differentiation with eight principies ... .138
2. 1. 1 Extemal and internal differentiation of syndromes ... .139 2.1. 1. 1 Extemal syndrome ... .140 2.1. 1. 2 Internal syndrome ...141 Appendix: Half external and half internal syndrome ... ...142 • 2. 1. 2 Syndrome differentiation of coid and heat ...142
2. 1. 2. 1 Coid syndrome ... .143 2. 1. 2. 2 Heat syndrome ... .144 2. 1. 3 Syndrome differentiation of asthenia and sthenia ... .145 2. 1. 3. 1 Asthenia syndrome ... .145 2. 1. 3. 2 Sthenia syndrome ... .147 Z. 1. 4 Syndrome differentiation of yin and yang... .148 2. 1. 4. 1 Yin syndrome and yang syndrome ... .148 2. 1. 4. 2 Yin asthenia syndrome and yang asthenia syndrome ...150 2. 1. 4. 3 Yin depletion syndrome and yang depletion syndrome ...152 2. 1. 5 Relationship among the eight principal syndromes ... .154 2. 1. 5.1 Relationship between two principies in a pair ... .154 2. 1. 5. 2 Relationship between different pairs of principies ... .167 2. 2 Syndrome differentiation of qi, blood and body fluid ... .172 2. 2. 1 Syndrome differentiation of qi disorders ... .172 2. 2. 1. 1 Qi asthenia syndrome ... .173 2. 2. 1. 2 Qi sinking syndrome ... .173 2. 2. 1. 3 Qi stagnation syndrome ...174 2. 2. 1. 4 Qi reversión syndrome ... ...175 2. 2. 2 Syndrome differentiation of blood disease ...176 2. 2. 2. 1 Blood asthenia syndrome ...176 2. 2. 2. 2 Blood stasis syndrome ... .177 2. 2. 2. 3 Blood coid syndrome ... .179 2. 2. 2. 4 Blood heat syndrome... .180 2. 2. 3 Syndrome differentiation of simultaneous disorder of qi and blood ... .181 2. 2. 3.1 Asthenia of both qi and blood ...181 2. 2. 3. 2 Qi asthenia and hemorrhagia syndrome ...182 2. 2. 3. 3 Depletion of qi with bleeding syndrome ...183 2. 2. 3. 4 Qi nmhenifl and blood stasis syndrome ...183
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2. 3. 4. 2 Syndrome of liver yin asthenia...221 2. 3. 4. 3 Syndrome of liver qi stagnation ... .222 2. 3. 4. 4 Syndrome of liver fire hyperactivity ... .223 2. 3. 4. 5 Syndrome of liver yang hyperactivity ... .225 2. 3. 4. 6 Syndrome of endogenous liver w ind... .226 2. 3. 4. 7 Syndrome of coid stagnation in the liver meridian ... .230 2. 3. 5 Syndrome differentiation of kidney disease ...231 2. 3. 5. 1 Syndrome of kidney yang asthenia ... .232 2. 3. 5. 2 Syndrome of edema due to kidney asthenia ... .233 2. 3. 5. 3 Syndrome of kidney yin asthenia ... .234 2. 3. 5. 4 Syndrome of kidney essence insufficiency ...235 2. 3. 5. 5 Syndrome of kidney qi weakness ... .236 2. 3. 5. 6 Syndrome of kidney failing to receive qi ...238 2. 3. 6 Syndrome differentiation of stomach disease ...239 2. 3. 6.1 Syndrome of stomach coid ...239 2. 3. 6. 2 Syndrome of stomach heat ...241 2. 3. 6. 3 Syndrome of food retention in the stomach ...242 2. 3. 6. 4 Syndrome of asthenic stomach yin ... .243 2. 3. 7 Syndrome differentiation of gallbladder disease ... .244 Syndrome of gallbladder stagnation and phlegm disturbance ... .245 2. 3. 8 Syndrome differentiation of small intestinal disease ... .246 Sthenic heat syndrome of small intestine ... .246 2. 3. 9 Syndrome differentiation of large intestinal disease... .247 2. 3. 9. 1 Syndrome of large intestinal fluid consumption ... .248 2. 3. 9. 2 Syndrome of large intestinal damp-heat ... .249 2. 3. 10 Syndrome differentiation of bladder disease ...250 Syndrome of damp heat in the bladder ...250 2. 3. 11 Syndrome differentiation of accompanying diseases of viscera ...251 2. 3. 11.1 Asthenia syndrome of heart and lung qi ...252 2. 3. 11. 2 Asthenia syndrome of heart and spleen...253 2. 3. 11. 3 Asthenia syndrome of heart and kidney yang ... .254 2. 3. 11.4 Syndrome of disharmony between the heart and kidney ...255 2. 3. 11. 5 Syndrome of lung and spleen qi asthenia ...256 2. 3. 11. 6 Syndrome of spleen and kidney yang asthenia ... .257 2. 3. 11.7 Syndrome of kidney and liver yin asthenia ...258
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Introduction
% • &I )iagnostics of TCM is a subject concentrating on di- hHIiduín of diseases and differentiation of syndromes iIihmikIi examination based on the theory and methodology mI | l M. Correct diagnosis and prognosis require thorough Utttk'i'Mtanding of the nature of the disease in question.
llioiHore, correct diagnosis is prerequisite to the treat- iiit ni, prognosis and prevention of disease. So diagnostics ni IVM serves as a bridge to connect the basic theory of IVM with clinical specialties and is the essential course Im ull clinical subjects, playing a very important role in
H M.
The diagnostics of TCM has been developed under llw fuidance of the basic theory of TCM and based on the i ||ni( ii I practice done by numerous doctors in the past
Um h in u ikIs of years. It is mainly composed of diagnostic
iiii'IIhkIs and syndrome differentiation. Diagnostic meth- ml« iiic the methods used to examine patients and collect
|Ml|lological data, mainly including inspection, listening mihI olíaction, inquiry and pulse-taking, known as the four illii(HOHtic methods. Syndrome differentiation means to ivnllifsize and analyze the pathological data so as to decide lht> imlure of the syndrome. The theory and methods for nyinhome differentiation include syndrome differentiation wllli i*ight principies, syndrome differentiation of causes,
«ylidióme differentiation of qi, blood and body fluid,
«yndrome differentiation of viscera, syndrome differentia- IItii| ol meridians, syndrome differentiation of six meridi-
•in». syndrome differentiation of defensive qi, qi, nutrient
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qi and blood as well as syndrome differentiation of triple energizer. Various ways to differentiate syndrome are the theory and methods for analyzing and understanding the na ture of disease. They, though with their own charac- teristics and specific range, supplement each other and to- gether form the syndrome differentiation system in TCM.
Concept of organic wholeness is the main character- istics of the theoretic system of TCM which is thoroughly demonstrated by the diagnostics of TCM. In diagnosing pathological condi tions, deciding the category of disease and differentiating syndrome, TCM emphasizes the en- tirety.
1. Examination of entirety
The human body is an organic whole and constantly communicates with the extemal environment TCM lays much stress on the characteristics of the human body, such as the integrity, unity and association with the outer world. This idea is summed up as “ concept of organic wholeness” which is reflected as examination of entirety in the diagnostics of TCM.
Firstly, the human body is composed of various or- gans, viscera, meridians, constituents and orífices as well as essence, qi, blood and body fluid. Though possessing different functions, they are not isolated. Such an integral association of the human body is accomplished through the domination of the five zang-organs, supplementation of the six fu organs, association of the five constituents and five sensory organs and nine orífices, the extensive distri
bu tion of the meridians and the transportation of essence, qi, blood and body fluid by the net of meridians. There- fore disorder of the viscera, essence, qi, blood and body fluid can be manifested on the superficial tissues and or
gans. The local pathological changes can affect the whole
i.
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Imdy and vice versa. So by observing the changes of the five aensory organs, shape of the body, complexión and
|H,ilrir states, we can get to know the pathological changes tif the viscera, essence, qi, blood and body fluid. From IimmI changes one can get to know the pathological changes ni Ihe whole body. In this way correct diagnosis can be mude.
Secondly, there is a cióse relationship between man MHil nature. Weather changes and geographical changes
muiv affect the human body. On the other hand. the hu- MMti Ixxly is subjectively adaptable to the natural environ- (Ht’Ml. Ilowever, the dysfunction of the regulating ability ni Ihe human body or sudden violent changes of the na tu
mi environment may lead to diseases. Besides, social en- vlronment frequently brings about stimulation to the mind
«lid Hpirit of human beings, which may affect the visceral hllictions and lead to diseases. Therefore, natural and so- i luí íactors must be taken into consideration in the diagno-
•Ih ni diseases.
Thus, clinical diagnosis of disease must be done un- ilet Ihe guidance of concept of organic wholeness and with Inll n lien tion given to the unity and integration of the hu- litiin body as well as its cióse relationship with the envi- inninental factors. Only comprehensive inspection and ex- tVIMlve collection of data with thorough analysis ensures innei l diagnosis.
2. Combination of disease differentiation and ayndrome differentiation
I his ineans to decide the ñame of the disease and to illllei entiate the manifestations of the disease.
Disease means a pathological development course
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4 it with certain rules caused by destruction of the healthy
state due to certain pathogenic factors. This pathological development course manifests several special symptoms and syndromes corresponding to certain stages. Each dis
ease has its own occurrence, development and varia tion principies. The disease ñame is the label of the disease in question. suchas dysentery, measles and asthina, etc.
Symptom refers to various abnormal manifestations of a disease, including the subjective sensation, such as headache, dizziness and thirst, etc. , and the signs ob- served by other people, such as reddish tongue, yellowish fur and rapid pulse, etc.
Syndrome is a summarization of the development of a disease at a certain stage, including cause, location, na- ture, pathogenesis and the relevant symptoms and signs.
Take “external syndrome due to exogenous wind and coid”
for example. It suggests that the cause is the invasión of wind and coid; the location is in the superficies; the na- ture is coid; the pathogenesis is wind and coid encumbe
ring the superficies and the pulmonary qi failing to dis
perse. The main symptoms brought about are mild fever, anhidrosis, pain of head and body, stuffy nose with clear nasal discharge, or cough, thin whitish fur as well as floating and tense pulse, etc. This problem can be re- lieved by expelling wind and dispersing coid or dispersing the lung and relieving superficial pathogenic factors. Oth- erwise, coid pathogenic factors may enter into the body and transform into heat, therefore worsening the prob
lem.
Symptoms are the evidences for the differentiation of disease and syndrome. Both disease and syndrome
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which is the primary contradiction of a disease. While
"(lili erent diseases with the same syndrome”. Therefore,
lite differentiation of disease and the differentiation of
«yudrome refer to the understanding of the nature of a dlw ase from different angles. The differentiation of dis- PHM' is beneficial to the understanding of the nature of a i linease and the grasping of the developing tendeney and proKnosis from the whole developing course and charac- U’i iHtics. The differentiation of syndrome emphasizes on lite changes of a disease at a certain stage and the under- nliinding of the nature of a disease according to the present i lltiical manifestations to provide evidence for present llrjitment
Clinically, combined use of the di-fferentiation of (linease and the differentiation of syndrome is made of so im lo make them supplement each other for the benefit of lovealing the nature of the disease in question and making llie diagnosis more accurate, correct and specific.
What should be made clear here is that the differenti- nIion of disease is the main work of all clinical specialties, wlik h is not discussed in detail in this book.
3. Synthetic use of all diagnostic methods