Diagnostic Methods

DIAGNOSTIC METHODS

Four Diagnostic Methods Visual examination Auscultation and olfaction examination Inquiry Pulse taking and palpation

When a disease occurs, there must be its abnormal outward manifestations, from which the pathological changes may be inferred. The four diagnostic methods examine and learn about the pathological conditions from different angle and aspect and find out the etiology and pathogenesis, thereby providing the basis for

The four methods are related to and supplement one another. They cannot be separated from one another, each having its specific function that cannot be substituted for the others.

In clinical practice, only when the four techniques are organically combined, can a disease be understood thorough. Thus, a correct diagnosis can be made.

Visual examination is the first diagnostic procedure by which the physician may observe the patient's vitality, complexion, physical build, head, neck, five sense organs, skin, tongue, external genitalia and anus on purpose so as to understand the condition of a disease. TCM holds that the human body is an organic whole. The exterior of the body is closely related to the internal organs.

Auscultation and Olfaction examination Auscultation means listening to the patient's voice, speaking, respiration, coughing and moaning. While olfaction means smelling the patient's odor of the secretion and excretion. Both of them, the physician can learn lots of information about the pathological changes of the internal organs.

Take voice and breath for example Loud, sonorous turbid voice indicates excess syndrome Low, faint voice indicates deficiency syndrome Rough and asthmatic breath indicates excess syndrome Weak and short breath indicates deficiency syndrome

Take smell for example Sour and foul smell in the mouth indicates retention of food in the stomach Putrid and foul smell in the mouth indicates internal ulcer

Inquiry is a diagnostic method in which the patient or his companions are inquired to collect the information concerning a disease. The content of inquiry includes the chief complaints, present case history, past history, life history, family history, as well as age, sex, native place, occupation, address and so forth. Inquiry, though covering a wide range of topics, should be conducted step by step in a planned way, with questions focused

Therefore, when asking a patient. The physician should focus his attention on the chief complaint to understand both the main reasons for the disease and clearest, the most suffered symptoms of the patient. Besides, the physician should understand the occurrence, progress, diagnosis and treatment of a disease through asking.

Cold and heat 1.Fever and aversion to cold—— patient feel cold with high body temperature. Invasion of the exterior body by exogenous pathogens.

2.Cold without fever Interior-deficiency-cold syndrome.

3.Fever without aversion to cold Exterior excess heat syndrome.

4.Tidal fever: fever arises or peaks at a definite time, usually in the afternoon

Yangming tidal fever: from 3 to 5 P.M. Accumulation of pathogenic heat in Yangming Fu organs (stomach and intestines), presenting excess heat syndrome.

Damp-warm tidal fever: recessive fever peaks at late afternoon Due to damp-heat restriction in the interior preventing the heat to reach at and disperse from the exterior, unabated by sweating.

Yin deficiency tidal fever: a lower fever occurs in the afternoon or evening, accomplished by night sweating, feverish sensation in palms, soles and chest, flushed cheeks, dryness in the mouth and throat. Due to deficiency of Yin leading to internal heat, also known as steaming bone tidal fever.

5.Alternation of fever and chills Malaria or some other disease in which pathogenic heat is in between exterior and interior.

Perspiration Spontaneous sweat: Qi(Yang) deficiency Night sweat: Yin deficiency Because of the deficiency of Qi, the function of controlling the open-close of the pores is out of order, and sweat happen.

Pain Distention pain Due to Qi retardation

Heavy pain Damp factor Because damp is heavy, turbid and sticky, when obstructing the channel and impeding the Yang Qi, it will cause pain and heavy sensation.

Prickling pain Blood stasis

Burning pain Due to pathogenic fire burning the collateral veins, or deficiency of Yin giving rise to Yang heat.

Cold pain Due to obstruction of collateral by pathogenic cold, or Yang Qi insufficiency, Zang-Fu organs and channels lacking in warmth.

Dull pain Due to Yin cold accumulation and Qi-blood circulation obstruction as a result of Qi-blood insufficiency.

Location Chest pain——lung Hypochondriac pain——liver Epigastric pain——stomach Abdominal pain——spleen and stomach Lumbago pain——kidney

Diet (food, drink, taste) Poor appetite due to weakness and deficiency of the spleen and stomach indicates deficiency syndrome. Poor appetite due to damp factor disturbing the spleen Qi indicates excess syndrome. Anorexia (disgust at the sight or thought of food) is due to injury caused by improper diet, or damp-heat accumulated in the liver and gallbladder.

Thirst with preference for cold fluid is due to interior heat syndromes Absence of thirst, or thirst with preference for only small amount of warm fluids, indicates colddamp syndromes.

Defecation and urination Constipation +dryness stools, thirst, dry tongue with yellow coat——excess heat syndrome. +fatigue, weak pulse——deficiency of Qi

Diarrhea +foul mucoid stools——dampnessheat in the intestines +watery stools, limbs cold, white coat——interior cold syndrome

Urination Polyuria: deficiency-cold syndrome Oliguria: excess-heat syndrome

Hearing and vision Ears are the portals of the kidney, Tinnitus and hearing problems are mostly associated with deficiency of kidney essence.

Eyes are the portals of the liver, Eyes troubles are attributable chiefly to the liver condition.

Palpation is the fourth diagnostic method, including pulse taking and other palpation of different parts of the body. The former is a diagnostic procedure by which the physician may feel the patient's radial arteries with the fingertips to judge pulse condition, thus learning and inferring the condition of illness. The latter is also a procedure by which the physician may touch, feel, push and press certain parts of the body to detect local abnormal changes, thereby determining the

Pulse examination It is the diagnostic methods performed by pressing the radial artery posterior to wrist to examine the conditions of the pulse. It is the most frequently used method in TCM to diagnose diseases.

Why Pulse examination can diagnosis the diseases  Heart govern the blood vessels, and

  

receive blood from the vein and pump it through the artery by alternate dilation and contraction, then pulse is formed. Spleen control the blood Liver store the blood Qi is the commander of blood So by palpation the blood vessels in specific parts of body, it is possible to detect the state of Qi-blood and Zang-Fu organs.

What Pulse examination can do?  Detect the state of Qi-blood and Zang-Fu organs.  Ascertain the location and nature of the disease  Assess whether the condition is improving or deteriorating  Forecast the chances of recovery

Pulse-taking in general Position: Cun-kou pulse (radial styloid pulse) is common used. 2. Guan: is located on the anterior face of the radial styloid process. 3. Cun: is on its distal side. 4. Chi: is on its proximal side.

Time for pulse-taking Pulse should be taken in a quiet, relaxed, and friendly atmosphere, let the patient feel at ease, so that disturbances from both external and internal factors can be reduced to be minimum. In the early morning

Posture The patient should seat upright or lie down, and stretch out his forearm in a horizontal position level with the heart, the palm facing upward, the wrist resting on a soft pad.

Method for taking the pulse  The middle finger on the Guan part  The index finger on the Cun part  The ring finger on the Chi part The three fingers should be in bowshaped with their tips in the same line.

Chi Guan Cun

The spacing of the three fingers depend on the height of the individual 2. for a tall patient, the fingers should be spaced apart 3. For a short patient, the fingers should be keep comparatively close to together 4. The pulse of infant, is more shorter, so feeling the pulse with one finger is suggested.

Three-steps palpation 1. First apply finger force but lightly——

on skin, examining Yang, the Fu organs, and also the heart and lung 2. Then apply finger force moderately (neither too forceful nor too light)——in muscle and blood, examining the harmonious between Yin and Yang, also the state of the spleen and stomach 3. Finally press down firmly——between sinew and bone, examining Yin, the Zang organs, especially the liver and

Heart Liver Kidney Left hand

Lung Spleen Kidney Right hand

General pulse taken Feel the pulse simultaneous with the index, middle and ring fingers respectively on Cun, Guan and Chi.

Individual pulse taken Apple the fingers individually to the three parts. For example, apple only the middle finger on the Guan part of the left pulse to get further information about the liver condition. In clinical practice, general pulse taken and individual pulse taken are often used in cooperation.

Palpation may provide data of the depth, rate, rhythm, strength, smoothness, and form of the pulse which are valuable for determining the location and nature of disease. The pulse should generally be felt attentively for at least two to three minutes.

Normal pulse Smooth and forceful with regular rhythm and approximately four beats per respiration, i.e. 60-80 T/M. Neither too deep nor too superficial.

1.Ratea. Slow pulse Slow pulse: less than 60 T/M. Indicates: Cold syndrome. The coagulation of cold lead to the retarding of the blood circulation. It just like the water The more cold The more slow

1.Rateb. Rapid pulse Rapid pulse: more than 90 T/M. Indicates: Heat syndrome. The pathogenic heat accelerates the blood circulation. It just like the water The more heat The more fast

Heat and cold syndrome are two principles used to differentiate the nature of diseases. Heat and cold syndrome reflect the states of Yin and Yang in the body. Cold syndrome is attributable to the invasion of pathogenic cold factor, or to depletion of Yang, excess of Yin. Heat syndrome denotes to symptom complex that is attributed to invasion of pathogenic heat, or excess of Yang, depletion of Yin, hyperactivity of the organism.

2.Depth – a. Superficial pulse Superficial pulse: it can be easily felt by slight touch on the skin, but becomes less perceptible when further pressure is applied. Indicates: exterior syndrome

Exterior syndrome indicates the exterior parts of body is affected by exogenous pathogenic factors and the disease is in its primary stage and relatively mild. When the exogenous pathogenic factors attacks the muscles, the defensive Qi resists, and meridian Qi goes outside, hence the superficial pulse.

if the enemy invades our border, our army will go out for fight, and then the border will become the battlefield at this moment. And the Superficial pulse reflects the place which is battlefield, if you feel the Superficial pulse, it show you the state of struggle between healthy Qi and pathogenic factors is in the exterior place. So it indicate the exterior syndrome.

2.Depth – b. Deep pulse Deep pulse: it can be felt only with heavy pressure. Indicates: Interior syndrome

Interior syndrome indicates the disease is in the interior parts of the body. if our army are unable to resist the enemy's invasion, then the enemy will invade into our city, even the capitalbeijing, the condition is more serious at this time. So the Deep pulse shows us the state of struggle between healthy Qi and pathogenic factors is in the interior place.

2.Depth – c. Hidden pulse Hidden pulse: deeper than the deep pulse, it can be detected only by pressing forcefully through the sinew right to the bone. Indicates: in cases with syncope, severe pain, invasion of the interior body by pathogen which impedes the flow of Qi and blood.

3.Strength – a. Vacuity pulse Vacuity pulse: weak and vacuous upon three-steps pulse-taking. Indicates: deficiency syndrome. The weakness of pulse beating is due to the deficiency of Qi “too weak to move the blood”, and as the blood is also vacuous, the vessels become less flourish.

Deficiency syndrome chiefly denotes to insufficiency of health Qi. Deficiency of the essence in the body, so pulse taking will be weak.

3.Strength – b. Repletion pulse Repletion pulse: forceful in response to each of the three-steps pulse-taking. Indicates: excess syndrome. Though the pathogenic factors are exuberant, the body resistance is not deficient, and the struggle between them makes the Qi and blood excessive and the vessels and and full, so the pulse is forceful and responds to the fingers.

Excess syndrome denotes to excess of pathogenic factors. Because of excess of pathogenic factors, so too much evil Qi is in the body make the vessels Repletion.

3.Strength – c. Weak pulse Weak pulse: an extremely soft, deep and thready pulse can be felt only by heavy pressure. Indicates: depletion of Qi and blood. Because of the insufficient blood is unable to fill the vessels and the weakness of Yang Qi fails to promote the blood circulation, the pulse is deep, thready, and soft.

4.Rhythm——heart illness Intermittent pulse Abrupt pulse Knotted pulse Indicates: heart illness

arrhythmia

4.Rhythm—— a. Intermittent pulse Intermittent pulse: a slow and weak pulse that makes a fairly long pause at regular intervals before it starts to beat again. Indicates: debilitation of Zang Qi, and heart disease.

4.Rhythm—— b. Abrupt pulse Abrupt pulse: the beating of the pulse is sudden and hasty with irregular intermittence. Indicates: excess heat syndrome, attributable to Yang heat exuberance, Qi-blood stasis, phlegm and food retention, or swollen pulse.

4.Rhythm—— c. Knotted pulse Knotted pulse: the pulse is slow with pause at irregular intervals. Indicates: Yin exuberance, Yang disharmony, Qi stagnation, cold phlegm, blood stasis, channel Qi retardation.

5.Smoothnessa. Rolling pulse Rolling pulse: a pulse coming and going smoothly, feeling slick to the fingers like pearls rolling in a dish. Indication: excess heat syndrome, phlegm retention, food stagnation. Health people, pregnant women which implies an abundance of Qi and blood, and should not be mistaken as a morbid pulse.

This pulse often appears when pathogenic factors of the excess type due to phlegm humor and retention of food are stagnated inside the body and the body resistance is still very strong, causing excess of Qi and surging of blood. If the pulse is rolling and harmonious, it is a normal pulse condition, showing that Health people. A smooth and rapid pulse in pregnant women is a vigorous and harmonious phenomenon of Qi and blood.

5.Smoothnessb. Rough pulse Rough pulse: the pulse is coming and going un-smoothly and in choppy a way like a knife scrapping the bamboo. Indication: depletion of essence, blood, and fluid; Qi and blood stasis.

 The deficiency of essence and blood is unable to nourish the meridians and vessels, causing retardation of blood circulation and uneven flow of the meridian Qi, hence the unsmooth and weak pulse.  The stagnation of Qi and blood stasis and the retained phlegm and food can cause obstruction of Qi and blood circulation, therefore, the pulse is unsmooth and forceful.

Rolling pulse and Rough pulse The circulation of Qi and blood in the body are like the flow of the river, Qi and blood circulate smooth in the body, it will be Rolling pulse, while the circulation of Qi and blood are unsmooth when they are blocked, and you fell Rough pulse.

6.Forma. Full pulse Full pulse: a pulse that is felt like waves surging, full, large, and forceful. However, forceful in rising but feeble in falling. Indication: exuberance of pathogenic heat. Abundant internal heat causes the blood vessels to expand and accelerate Qi and blood circulation, thus leading to a bounding pulse.

6.Formb. thready pulse Thready pulse: a pulse feel like a welldefined thread under the fingers and is feeble yet easily perceptible. Indication: exhaustion of Qi and blood, various deficiency syndromes. Because the insufficiency of nutrient and blood fails to fill the blood vessels and deficiency of Qi is unable to propel the blood circulation, this pulse is very fine and weak.

6.Formc. Wiry pulse Wiry pulse: is straight and long, and felt like the string of musical instrument to the touch. Indication: pain syndrome, liver and gallbladder diseases, retention of phlegm and fluid.

Wiry pulse is the manifestation of the retention of meridian Qi The liver dominates the free flow of Qi and blood and regulates the flow of Qi. Usually, the meridian Qi is soft. When pathogenic factors are stagnated in the liver, the free flow of Qi and blood and the Qi activity dysfunction, or the meridian Qi is obstructed by pain syndrome or phlegm retention, the wiry pulse will appear due to the tension of the meridian Qi.

6.Formd. tense pulse Tense pulse: felt tense and forceful, like a stretched twisted cord. Indication: the presence of cold and pain, or retention of undigested food.

When pathogenic cold invades the human body, the Yang Qi is disturbed. The struggle between the cold and the body resistance makes the vessels tight and contracted, hence the tense pulse appears. The tense pulse found in severe pain and retention of food also results from the struggle between the cold and the body resistance.

6.Forme. hollow pulse Hollow pulse: is floating, large, soft and hollow, classically described as “a scallion stalk pulse”. Indication: a sign of heavy blood loss, Yin impairment, as can usually be observed in cases of major hemorrhage.

The appearance of the hollow pulse is always related to the loss of blood, which is unable to fill the vessels. This pulse results from a sudden decrease of blood or from the deficiency of body fluids because insufficient blood cannot fill the vessels. The Yang Qi has nowhere to adhere to and scatters outwardly, then the hollow pulse results.

6.Formf. soft pulse Soft pulse: is floating, thready and soft by gentle touch, but becomes indistinct on heavy press. Indication: deficiency syndrome, damp syndrome.

In case of deficiency of Qi and weakness of Yang, the deficiency Yang results in a superficial, soft, and thready pulse. If dampness restricts the blood vessels, the soft pulse may appear.

Question slow and deep pulse appear at the same time What is syndrome?

slow pulse indicates cold syndrome deep pulse indicates interior syndrome judged synthetically, the meaning of this pulse station is cold and interior syndrome.

we just talk basic knowledge about pulse examination, in the clinical practice there are lots of pulse, so it need everybody to understand and master further by practice in the future.

Classification of pulses Name of pulse Superficial

Pulse condition

Indication

To be felt only by light touch, but grows faint on heavy pressure

Exterior syndrome

Deep

Hardly felt by light touch, but distinct under heavy pressure To be felt only by deep pressure to the level of the bone, and even then the beats seem to come from a deeply located place

interior syndrome

Hidden

Slow Rapid

Only three beats per respiration More than five beats per respiration

Stagnation of pathogenic factors in the interior, syncope, severe pain cold syndrome heat syndrome

Vacuity

Repletion

Weak

Intermittent Abrupt Knotted

Forceless and empty in the three regions Vigorous and forceful in the three regions Extremely soft, deep, and thready Irregular heart beat

Deficiency syndrome Excess syndrome Deficiency of Qi and blood Heart illness

Full

Surging like roaring waves which come vigorously and away Thread fade Thready like a fine thread, y but very distinct and clear

Preponderance of pathogenic heat

Wiry

Taunt and long, like the string of a musical instrument

Tense

Diseases of the liver and gallbladder, all kinds of pain, phlegm retention Cold, pain, retention of

Hollow

Tight and forceful, like a tightly stretched and twisted food rope Superficial, large, and hollow Loss of blood, injury of like pressing the tubal leaf Yin of spring onion

Soft

Superficial, thready, and soft Deficiency, dampness

Exhaustion of Qi and blood deficiency and dampness syndromes

General palpation Skin Four limbs Abdomen Acupoints

Cold——Yang deficiency or Yin excess Heat——Yin deficiency or Yang excess

Abdomen Pain alleviated by pressure deficiency syndrome

Pain aggravated by pressure excess syndrome

Review Visual examination Auscultation and olfaction examination Inquiry Pulse taking and palpation

Conclusion----eight principles Slow pulse Indicates Cold syndrome. Rapid pulse Indicates Heat syndrome. Superficial pulse Indicates exterior syndrome. Deep pulse Indicates Interior syndrome. Vacuity pulse Indicates deficiency syndrome. Repletion pulse Indicates excess syndrome.