Diagnosis I Midterm

Examining the patient to collect evidence relating to the patient's health status.

1) Sorting out information; 2) Analyzing, synthesizing, and reasoning data using TCM theories; 3) Making clinical diagnosis of the disease and its syndrome patter; 4) Predicting the change of the disease

Inquiring (interrogating/asking), Inspection (visual exam/observation), Austcultation & Olfaction (listening and smelling), Palpation

Ask the patient, or his/her family, about the history of the disease, family history, symptoms, and other associated factors of the disease

To inspect visually the patient's mental mental activity/vitality, complexion and skin color, physical fitness, behavior and movement, texture and color of the tongue and its coating, body secretion and discharges (feces, urine, vaginal discharge, etc.)

To listen to the patient's voice, breath, cough, movement of joints, and to smell the odors of secretion, and discharges or general body odor to establish the pathological changes in the patient.

Mainly consists of two parts: Pulse-taking - to establish the fullness or emptiness of the Zang Fu organs, Qi and Blood etc. Touching or pressing some part of the body by hand (ab, chest, muscles, joints, acupoints, etc) to obtain information of the condition

Abnormal phenomenon derives from pathological conditions occurring in humans, including: Patient's own feeling of discomfort (fever, aversion to cold, various pains, insomnia, lack of enegy, etc), Info gathered through examination by clinician or through instruments, tests

Generic name given to any disorder in the whole process and development of pathological change

the process of making analysis and identifying a disease based on the patient's symptoms. The treatment of a disease is more or less identical among different patients, like eczema manifests in different forms, but is treated always with cortizone

Summarization of the nature and characteristics of a disease based on the information obtained through the 4 diagnostic methods, like wind-heat invading the upper jiao

process of analyzing and synthesizing, under the guidance of basic theories of TCM, the information obtained through four diagnostic methods to determine which syndrome the patient suffers from

1) General information; 2) History of present illness; 3) History of previous illness; 4) Personal life circumstances; 5) History of family illness; 6) Ten questions

What is the situation right now

the subjective feeling of hot and cold

exterior syndrome

Aversion to cold and feverish sensation appearing simultaneously due to the struggle between the body's qi and external evils.

Feeling cold and it can't be relieved totally by putting on clothes or being close to heat

Feeling hot with or without a raise in body temp

exterior cold syndrome

exterior heat syndrome

Deficient exterior syndrom (Tai Yang syndrome)

Interior cold syndrome

Feeling cold only with relief from wearing more clothes or sitting near the fire. Yang deficiency interior cold: Chronic condition with deep, slow, weak pulse; Excessive cold interior cold: recent onset with severe cold-pain in abdomen or other local area.

Interior heat syndrome

High fever, tidal fever, slight fever/hotness, long term slight fever/hotness, Summer fever in child

4 bigs: continuous high fever, big thirst, big sweat, big surging pulse. Interior excessive heat syndrome

high fever with constipation, T rise from 3pm-5pm while yang ming channel qi is strong, struggle w/ excess heat in yang ming channel

suppressed fever, increased in afternoon with heavy head and body

low fever or hot flush in the afternoon or evening, five centers vexation and hot, often with night sweat and anxiety

Low fever, usually from 98.6 - 100.4, appears in some internal conditions or later stage of infectious diseases

Lingering low fever, increased with exertion, accompanied by SOB, low energy, spontaneous sweating, indicates heat due to qi deficiency. (stagnation --> heat)

Lingering low fever in summer with vexation, thirst, no sweat, profuse urine. Fever dies away without treatment when weather gets cooler. Indicates QI YIN deficiency

Shao Yang syndrome, malaria

Alternating hot and cold in an IRREGULAR manner, bitter mouth, dry throat, dizziness, chest distention, poor appetite, wiry pulse

Fever and chills alternating, accompanied by a headache, sweat, and thirst. Occurs daily or every two to three days.

Body fluids

exterior cold syndrome

deficient exterior syndrome (wind attacking Tai yang)

exterior heat syndrome

Yang deficiency

Yin deficiency

excessive heat syndrome, critical condition called depletion of yang

Struggle between body qi and evils, ie malaria

heat in upper jiao, or critical condition with floating yang

Obstruction or dysfunction on affected side

SP/ST problems, yin deficiency

Onset/time, location, nature, degree, how body part can function, exacerbating/mitigating factors, preference of pressure, accompanying symptoms

distending

stabbing/prickling pain

wandering/moving pain

fixed pain

colic pain

dull pain

heavy pain

dragging/pulling pain

hollow/vacuous pain

cold, damp. Not a heat syndrome.

Great thrist with desire for cold drink - heat syndrome; Great thirst and drink a lot with profuse urine, big appetite, and weight loss (wasting and thirsting) LU/ST heat, KI Yin deficiency; Great thirst and drinks a lot after profuse sweating or severe vomiting, diarrhea - loss of body fluids.

Hot flush, night sweat - yin deficiency; heaviness of head and body, suppressed fever, epigastric fullness with greasy tongue fur - damp heat; desire for hot/warm drink, small amount of vomiting after brinking, accompanied w/ dizziness, stomach-intestinal watery sound - phlegm fluids (Tan Yin); Dry mouth, desire for washing but not swallowing water - blood stasis

Tiredness, ab bloating, loose stools - SP & ST qi def; Epigastric distending oppression, head & body heaviness, loose stool, greasy tongue coat - damp obstructing SP; Aversion to oily food, hypochondriac pain, jaundice - DH in LV & GB; Aversion to food, burping, acid regurg, ab distending pain - food stagnation

Thirst, bad breath, constipation - ST fire; loose stools - strong ST, weak SP; Loss of weight - wasting & thirsting (xao ke)

ST Yin deficiency

Pregnancy, parasite

SP & ST deficiency, cold syndrome

With sticky greasy fur, DH in SP & ST; with thin-white fur, SP deficiency

LV qi stagnation producing fire; disharmony between LV & ST

Food stagnation

LV & GB heat; HT fire

KI deficiency

Fever, ab distention and pain, red tongue, yellow-dry fur

Dry stools, red tongue with little fur

Pale complexion, like to drink hot things, deep slow pulse

Weak constitution or old age, post deliver, soft stools

Small, round, hard stool

Reduced appetite, ab bloating and dull pain

Diarrhea with ab pain before dawn, pain relief after defecation, cold-soreness in LB

Burping with putrid smell, ab distending pain, pain relief after defecation

Burping with strong smell, sticky stool

Depressed, comes on worse when feeling stressed, ab pain, pain relief after defecation

Pain and heat, hemorrhoids, fissures

Incomplete feeling, gassy

Tenesmus, dysentery

Heavy and prolapsed sensation

SP & KI Yang def

Mixed with stool like asphalt - heat in blood or DH; After stools - hemorrhoid; Before stool or on surface of stool - internal hemorrhoid

Frequent, small amount, yellow-red, painful

Frequent, large amount, clear

Frequent, clear, incontinence, nocturia

Scanty urine with edema

Urinary retention

dreamy, waking up frequently, palp, poor memory, poor appetite, loose stool, low energy, pale complexion and tongue, weak pulse

difficulty falling asleep, dreamy, palpitation, vexation, soreness in low back and knees, hot flash, night sweat

Restless, disturbed sleep, irritability, urination problems, UTI

Damp obstructing SP Yang (most common); HT KI yang deficiency, SP qi deficiency (feel better w/ lots of sleep)

Diet, appetite, sleep, what do you do? what is your life routine, how busy are you?

Excessive condition: common LV/GB fire or damp obstructing the SP

Deficient condition: usually KI essence deficiency

fire toxin in HT channel

interior of eye channels by ext wind heat, or internal LV fire

LV blood deficiency

LV and/or KI yin def

wind

wind

damp, phlegm, and heat if yellow

lung qi congestion

heat or qi xu

heat

wind

qi stagnation w/ phlegm

yang ming

shao yang

tai yang

jue yin

exterior condition

wind-cold, wind-heat, wind-damp

deficiency of qi/blood, KI def, LV yang rising, LV fire blazing, phlegm turbid obstruction, blood stasis

severe giddiness when everything seems to sway and the person looses balance, w/ tinnitus, red face, bitter mouth, dry throat

dizzy with heavy and fuzzy head, nausea

slight dizziness aggravated by exertion, palpitation

dizziness with tinnitus, poor memory, chronic LBP, knee pain

stasis of blood in HT which is usually due to insufficient Yang

Lung Heat

LV qi stagnation, if severe LV blood stasis

deficient pattern

more than one week early

heat in blood

qi deficiency

more than one week late

blood deficiency

cold coagulation, with blood stasis b/c cold congeals blood

more than one week of difference in either direction

LV qi stagnation

SP KI deficiency

stagnation of blood and qi

more than three months (excluding pregnancy, etc)

blood stasis, LV qi stag, wasting condition

deep red blood with clots - heat; light red blood without clots - sunken middle qi, SP qi def