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TCM-NESA
Diagnosis in CM
| Question | Answer |
|---|---|
| 2 Fundamental principles of diagnosis | Chinese diagnosis provides the diagnostic tools necessary to identify the patterns and is based on 2 fundamental principles-Inspect the exterior to examine the interior & a part reflects the whole |
| Inspect the exterior to examine the interior | Outward signs and symptoms (clinical manifestations) reflect the condition of the internal organs. According to the basic idea underlying Chinese diagnosis, practically everything, such as skin, complexion, bones, channels, smells, sounds, mental state |
| Inspect the exterior to examine the interior-2 | preferences, emotions, tongue, pulse, demeanor, body build, reflects the state of the internal organs and can be used in diagnosis. |
| A part reflects the whole | the state of the whole organism can be determined from examination of a part of it |
| Four methods of examination | observation, auscultation (hearing and smelling), interrogation, palpation |
| Diagnosis by observation | 2 important principles regarding diagnosis by observation-Correspondence between and individual part and the whole & Observation of Constitutional traits |
| Correspondence b/t and individual part and the whole | One of the principles on which diagnosis by observation is based is that each single, small part of the body reflects the whole. Important examples of this are the face, the tongue, the pulse, and the ear. |
| Observation of constitutional traits | 1) A constitutional type indicates the tendency to certain disharmonies and it allows us to forecast, and prevent a possible pathological development. |
| Observation of constitutional traits-2 | Observation of a constitutional type and tendency allows us to put the presenting disharmony into perspective, helping us to gauge it's severity |
| Observation of constitutional traits-3 | Observation of constitutional types is important to give patients and underlying treatment irrespective of the presenting disharmony |
| Observation of constitutional traits-4 | Observation of constitutional type and tendency allows us to forecast the type of disharmony that such a patient might be subject to |
| Diagnosis by observation | Involves looking at the following aspects-spirit, body, demeanor, head and face, eyes, nose, ears, mouth, teeth-gums, throat, limbs, skin, tongue, channels |
| Spirit | In a general state it indicates a state of vitality; if this person is thriving, the person has "spirit". The "Simple Questions" says: If there is a spirit the person thrives, if there is no spirit the person dies. |
| Spirit-2 | The presence or absence of spirit can be observed in the complexion, the eyes, the state of mind and breathing |
| Spirit-> | Complexion is healthy, muscles are firm, face color is clear, eyes have glitter and reveal inner vitality, the mind is clear, the breathing even |
| No Spirit | complexion is dull, muscles are withered, face color is dark, eyes move uncontrollably, show no inner vitality and are not clear, the mind is unclear and breathing is labored or shallow |
| Mento-emotional aspect | Spirit of a person also refers to the mental-emotional-spritual state of the person |
| Strong- Spirit | Clear voice that projects outwards well, the eyes and complexion have luster (even if the complexion color is pathological) the expression is lively, the mind is clear and alert, the person walks with erect posture and has a naturally optimistic |
| Stong-sprit-2 | enthusiastic, and mentally strong attitude |
| Body | There are three aspects to consider when examining the physical appearance of a patient-Constitutional type, Long term changes in physical appearances, short term changes |
| Demeanor | This includes the way a person moves, and also the movement of individual parts of the body, such as eyes, face, mouth, limbs and fingers. The general principle: excess movement or rapid jerky movements-yang, full or hot patterns. |
| Demeanor-2 | Lack of movement or slow movements-yin, empty or cold patterns Movements such as tremors or convulsions always indicate the presence of interior wind of the liver. These could be convulsions of the whole body, or just tremors of an eyelid or cheek. |
| head and face | Hair- the state of hair is related to the condition of blood or Kidney-essence. Falling hair may indicate a condition of blood deficiency, while pre-mature grey hair indicates a decline of kidney-essence |
| Head and Face-face color | Observation of face color is an extremely important part of visual diagnosis. The face color reflects the state of Qi and Blood and is closely related to the condition of the mind. |
| Four attributes of a normal complexion | Luster (slightly shiny, vibrant in color), Subtle, slightly reddish hue (reddish hue indicates a good supply of heart-blood and good state of mind, Contained-veiled color, moisture |
| Pathological Colors of complexion | White: dull white-blood deficiency, bright white-yang deficiency Red: whole face red-full heat, red cheekbones-empty heat Yellow: sallow yellow-St Sp deficiency or Blood deficiency Green: green face-liver patterns, interior cold, pain or interior wind |
| Pathological colors of complexion-2 | Green: green complexion with red eyes-liver fire, dark reddish-green complexion-stagnant liver Qi turning into heat Blue: white bluish-cold or chronic pain Black: in general-cold, pain, or KD disease, usually Kd Yin, blk & moist- cold, Blk & dried up-he |
| Pathological colors of complexion-moist color | Moist color is a sign of good prognosis, while a dry color is a sign of poor prognosis |
| Eyes | eyes reflect the state of the mind and essence. If the eyes are clear and glitter, they indicate that the mind and the essence are in a good state of vitality. If the eyes are rather dull or clouded, it shoos that the mind is disturbed and |
| eyes-2 | the essence has been weakened. It is very common to see very dull and clouded eyes in people who have been suffering from deep emotional problems for a long time. |
| eye signs | dull or clouded-mind disturbance, essences of 5 yin organs weakened whole eye, red painful, swollen-invasion of wind heat, liver fire |
| nose | flaring nostrils with high fever-extreme heat in lungs nose slightly moist and shiny-good prognosis |
| ears | ear lobes and prognosis: if they are shiny and slightly moist, the prognosis is good; if they are dry and withered, the prognosis is poor. The shape of the ear also helps to distinguish Full and empty patterns: a swollen ear indicates the presence of |
| ears-2 | a pathogenic factor, hence a full pattern. A thin ear indicates deficiency of Qi or Blood |
| Mouth and lips | The normal color of the lips should be paltered and rather moist and shiny. |
| mouth and lip signs | pale lips-yang or blood deficiency, red & dry lips-heat in St&Sp, purple or bluish-blood stasis, mouth slightly open-empty pattern, breathing through mouth-lung Qi defic, green around mouth-liver blood stasis or Lv-Qi stagnation |
| teeth and gums | the teeth are considered an extension of the bones and are under the control of the kidneys. The gums are under the influence of the Stomach. Swollen&painful gums-St heat, swollen not painful-empty heat of St, pale gums-Bl defic |
| Throat | obs of the throat includes observation of the pharynx and tonsils. acute pain, redness, swelling of throat-invasion of wind heat, chronically sore and dry throat (not swollen or red)-Lu/Kd-yin deface w/ empty heat, erosion, red&swelling-toxic heat |
| Limbs | a healthy color and firmness of the flesh around the ankles and wrists indicates a good state of the body fluids. If the skin on these joints lacks luster and is dry & the flesh shriveled, it indicates exhaustion of body fluids |
| Swelling of the joints and the four limbs | this is always due to painful obstruction syndrome (Bi)-especially deriving from Dampness. In chronic conditions, dampness develops into phlegm, which obstructs the joints and causes further swelling and bone deformities. |
| swelling of the joints and four limbs-2 | if the joints are also red and hot to the touch, this indicates retention of damp heat. |
| Edema of the four limbs | two types of edema-water edema, Qi edema |
| Water edema | due to yang deficiency-the fluids that it is unable to transform transp and excr properly accumulate in the space b/t skin & muscle. This is the most common cause of edema. Lu-hands, Kd-primarily feet, Sp-hands and feet. Always pitting |
| Qi edema | due to Qi stagnation or dampness. Skin does not pit or change color on pressure |
| Tremor or spasticity of the four limbs | This includes shaking, trembling or quivering of arms and legs or both. Ranges from pronounced shaking with wide amplitude to a quiver that is so fine and in amplitude that it is almost imperceptible. The cause is always LV wind & may be full or empty |
| Skin | The skin is physiologically related to the Lu. However, it is also related to the condition of the Blood & through this the Lv. hence, not all skin conditions are related to the Lu. |
| Skin-2 | many skin conditions are due to heat or stasis of blood and are related to the condition of th eviler. Furthermore, heat in the blood can also derive from St-heat so that some skin disease are related to St. |
| Skin-3 | dry skin usually indicates deficiency of Lv-blood, whilst itchy skin is due to wind |
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lamsee
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