Course: Diagnostics I Date: August 14, 2007 Class #: 7 For quiz review the 10 trad questions, 16 questions. And more. 10 Traditional q s (cont d) Thirsty? Ask this first. Most important question. Drinking (pt of Q5) If no: Body fluid metab distrib normal. Is tongue normal coat, no yellow? Moist coat? If pt is thirsty: Heat sign. Is tongue yellow? Coating dry? (This is true in about 80% of cases) Water retained inside doesn t go where it should. Quality? Do you drink cold or hot? If wants warm/hot water, aversion to cold = internal cold. If wants cold/ice water, is internal heat. Quantity? How much water do you drink? If Large qty due to excessive heat inside loss of fluids (i.e., after diarrhea, vomiting) Due to weather/sweating? Could be both of the above. chronic disease hurting kidney yin, maybe deficient. Thirsty but doesn t want to drink? Heat, but deficient heat. Yin deficient. (yin def = everything is less: less pulse, slender body/tongue, less thirst, less eating, etc.) 1) Dampness, 2) phlegm 3) damp/heat or 4) phlegm/heat Water retention, but water not going to the right places. Water distrib problem. Water might actually make the person sick to their stomach ugh! Full and resisting consuming more water. This is phlegm or damp. Dry in the mouth, but when try to drink, just want to rinse mouth and moisten it. Might also have purple tongue: blood stasis. Is a form of protection. Page 1 of 5
Chest and Abdomen Q 6 Very similar to head and body same questions Chest and ab pain? When you got it, where it is, nature of pain, fixed/moving, cold/heat, better with/without pressure? Take care -- stomach pain can be heart pain. Pinpoint the location. Abdominal pain. Can be acute abdom syndrome: acute, burning, severe. If ab is hard, press hurts bad, fever, stool black. Refer this patient to the hospital! Could be perforated ulcer. Can also be gallbladder: stone = fever, colic pain. Acu can stop the pain, but pt still need ER. Pain in stomach, slowly pain goes to lower right, ab is very hard = appendicitis. Excessive diarrhea can be pancreatitis. Combined with tinitis in TCM Deafness Q7 Tinitis Can be malnourishment, blockage (though not total because there is some sound) What side? R = more yin, L = more yang. What is the sound of tinitis? Loud or dim? What is the pitch high or low? Loud/high pitch = generally excess Low noise = generally deficiency Deafness Excess, usually. Total block. Can t hear clearly, but not totally deaf. Kind of hear double. Like an echo. Can be Liver Wind, Liver Heat, Kidney vacuity. LJ deficiency of yin, so yang goes up wind like. Deafness difficult to treat. Is an excess usually. Can also be blockage or deficiency. Can also be due to meds! More acute is more difficult. Many meridians cross here in a very small space. Qi and blood flow slowly. Thirst Q 8 Previous illness Q 9 Causes of disease Q 10 Know what is included in the 10 Traditional Questions. Page 2 of 5
The 16 Questions This section only covers the questions that differ from those in the 10 Traditional Questions. Taste Bland no differentiation of tastes can be Spleen/Stomach qi deficiency can cause variations in taste. Sweet taste in mouth: Spleen/Stomach damp/heat. Acid regurgitation taste in mouth: heat in Liver or Stomach. Sour taste in mouth: food retention. Smell of this pts breath will also be sour like an infant with sour milk smell. Bitter in mouth: o Stomach heat (red tongue, yellow/greasy coating, pulse large and fast, hungry, eat a lot, etc. ) o Gallbladder: irritable, hypochondriac distension, pain in GB channel. Salty taste in mouth. Kidney deficient or Cold Metallic taste in mouth. Many possibilities. Think Lung first, but can by endocrine disorders. Low = qi deficiency Energy Level Very important Sleep Q 9 of 16 Fall asleep during class, can t stay awake. Yang qi going inside. When moving around, working, yang qi supports you so you can work. At night, yang qi not at surface, goes internally to blood level. Yang going in = sleep. Skin colder than when working, moving. At night, no defensive qi on surface easier to get sick. Cannot sleep well Do you have trouble falling asleep? Difficulty staying asleep? How long do you sleep? Can be disturbed post trauma because sleep circuits disturbed. At waking do you feel rested? (quality of sleep) Dream a lot? Vivid? How long has it been this way? Determines chronic or acute. Page 3 of 5
Types Insomnia problems. Difficult to fall asleep, palpitations, lots of dreams, night sweating, lower back soreness. Heart and Kidney disharmony Easily wakes light sleeper, palpitations, poor appetite, pale tongue. Heart/Spleen deficiency. Restless sleep, tossing/turning, belching, ab distention. See if pt s tongue is bean curd coat. Food retention. If stomach is not harmonized cannot sleep well. Stomach merid has branches that go to the heart. Sleep too much Too much sleep = tired. It s not rest. The qi scatters, cannot organize. 1/3 of life = sleep, 2/3 = movement/waking. Can cause qi deficiency. Causes lethargy. Usually dampness, blocked Spleen yang. Spleen ctrls 4 extrem s. Dampness blocks. Women s Diseases Menstrual problems General questions to ask. How long has it lasted? When did it start? Is there pain? Where? Any special thing that causes the pain? Cold/heat make it better or worse? Pain related to period? Nature of the period? Color? Amount? Smell? Strong = excess, heat/damp heat. Weak smell = deficiency Clots? If yes = stasis inside. Early menstrual disorder Usually 8-9 days ahead of time. Pt will often have large amount of blood. Cause = blood heat or qi def (incl spleen qi def) Late menstrual disorder. Usually 8-9 days late. Less or scanty amount. Cause = blood def or cold contractions Often with ab pain. Remember to ask where it is. Page 4 of 5
Irregular menstrual disorder Liver qi stagnation. Amenorrhea. 3 months or longer with no period. Cause = qi/blood deficiency. Look for pale symptoms with bld def. Uterine Bleeding Ask when? Reason? Color? Amount? Clots? Ab pain after period? Lower ab, dull pain. Cause = deficiency. Maybe qi, kidney, blood. if before = liver qi stagnation with blood stasis often fixed pain at night is worse. During period: could be qi stag and bld def combined If after trauma (car wreck?) could be blood stasis. Will usually be a fixed pain. Short period. shortened cycle, profuse amount, thick blood, fresh color. This is an excess (freshness) = excess blood heat. Not fresh red? qi deficiency Scanty, pale menses. blood deficiency. 7 emotions. Emotional symptoms 40 questions on quiz 2, MC. focus on 10 traditional questions. Tongue diagnosis, all details. Please exactly make sure. Order of observ of tongue. Color, coating colors. Will test in detail. Look at the handouts! Indications of the color combinations. Go thru observations facial observations. Interrogations, what is proper/not proper to ask. Know what is included in 10 trad q s. Page 5 of 5