Chapter twoChapter two

Diagnostics of TCMDiagnostics of TCM

• The contents of traditional Chinese medicine diagnostics

• Diagnostic methods

• Syndrome differentiation

Traditional Chinese Medicine( 中医学 ) Diagnostics of Traditional Chinese Medici

ne( 中医诊断学 )

• The four diagnostic methods

• Inspection

• Ausculation and olfaction

• Inquiry

• Pulse-taking (pulse-feeling) and palpation

• Inspection

• the general condition of the body

• the mental faculty ; spirit

• secretions and excretions of the patients

• color of complexion

• physical condition and behavior

The content of InspectionThe content of Inspection Inspection of spirit ( 望神 ) Inspection of complexion ( 望面色 ) Inspection of body and postures ( 望形态 ) 　 Inspection of head, cervical part and five sense organs

( 望头颈五官 ) Inspection of skin ( 望皮肤 ) Inspection of two lower orifices( 望二阴 ) Inspection of tongue ( 望舌 ) Inspection of excreta ( 望排出物 ) Inspection of infantile index finger veins ( 望小儿食指络

脉 )

　 Inspection of spirit

The concept of spirit in TCM:

a. broad definition （广义） : the all appearance of the lifeb. narrow definition （狭义） : the appearance of mind , consciousness and thinking –human being

Inspection of spirit :

To observe the patient‘s spirit, clearness of consciousness ；

coordination( 协调 )and vigour( 活力 )of movements ； keenness( 敏感 )of response ；

To judge the excess or deficiency of yin, yang, qi, and blood in the zang-fu organs

Make a prognosis( 预后 ) of the disease condition.

Having the mind will prosper, the abse

nce will perish. 得神者昌，失神者亡得神者昌，失神者亡 《素问《素问 .. 移精变气论》移精变气论》

The ways and keys of inspection of spirit　　• Appearance of spirit ： many aspects

Keys of inspection of spirit ： sight( 目光 ) 　 emotional expression( 表情 ) 　• dynamic state( 动态 ) 　　

The classification and judge of spirit ( 神的分类和判断 )

having spirit 得神 ( 有神 )

spirit lessen 失神

spirit absence 少神

false spirit 假神

mental disturbance 神乱

　 Inspection of complexion 望面色

a. To observe the changes of the color and luster of the facial skin to get the messages of the disease.

颜色和光泽b. Why should we do this in clinic?

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面部分候脏腑面部分候脏腑《灵枢 五色》《灵枢 五色》

• Normal complexionNormal complexion: : • it is the normal and healthy complexion.

• To be ruddy and lustrous, indicating exuberance of visceral essence and normal functions.

• 红黄隐隐，明润含蓄

• normal individual complexion :

• to refer to the color of the skin and face that never changes due to racial and constitutional factors. .

与生俱来 基本不变

• varied normal color :

• to refer to the changes of the skin and facial color in correspondence to the variations of the seasons and climates. 季节 气候 环境

《医宗金鉴》： 四时之色，随四时加临，推迁不常，故为客色。

• morbid complexion ：• it is facial color during the course of dise

ase .

• 有善色和恶色之分 .

• Morbid complexion have two parts : favorable and unfavorable complexion.

• favorable complexion :

• to be bright and moist color ,no matter what color it is, indicates mild illness, normal condition of the visceral essence, easiness to cure and better prognosis.

• 面色虽有异常 , 但光鲜润泽。• 病轻 , 预后好。

• unfavorable complexion :

• to be dull and dry color, maybe malignant or indicates serious illness, impairment of the visceral essence, difficulty to cure and bad prognosis.

• 面色异常 , 而且晦暗枯槁。• 病重 , 预后不好。

• Diseases reflected by five colors • 五色主病

• According to the theory of TCM and clinical experience, the five kinds of color correspond to disorders of the five zang organs.

Blue corresponding to the liver 青 -- 肝 Red corresponding to the heart 赤 -- 心 Yellow corresponding to the spleen 黄 -- 脾 White corresponding to the lung 白 -- 肺 Black corresponding to the kidney 黑 -- 肾

• a diagnostic method observing thea diagnostic method observing the changes of theof the body and coating of the tonof the tonguegue （舌质、舌苔）

• anan important part of inspectionof inspection

Inspection of tongueInspection of tongue

• The patient is asked to sit down or lie in The patient is asked to sit down or lie in suspiration.suspiration.

• 患者取坐位或仰卧位• The tongue is protruded naturally and tThe tongue is protruded naturally and t

he tip of the tongue is kept slightly downhe tip of the tongue is kept slightly downwards.wards.

• 伸舌自然，舌体放松，舌面平展，舌尖略向下；尽量张口使舌体充分暴露。

• To begin from theTo begin from the tip tip of the tongue, the of the tongue, then n middlemiddle and and marginmargin . .

• 舌尖—舌中 --- 舌边 --- 舌根• The inspection begins with The inspection begins with the tongue the tongue

bodybody first and then moves to first and then moves to the tongue the tongue coatingcoating..

• 先察舌质，后察舌苔• The inspection should be The inspection should be completecomplete and and

quickquick..

• The light (the day , naturally.)The light (the day , naturally.)

• The diet (the milk, orange.)The diet (the milk, orange.)

• The drugs (antibiotic )The drugs (antibiotic )

• The oral cavity The oral cavity

normal states of the tonguesnormal states of the tongues正常舌象

• ““light-reddish tongue with thin and light-reddish tongue with thin and whitish coating”whitish coating”

• 淡红舌 , 薄白苔

• normal functions of the visceranormal functions of the viscera

• The tongueThe tongue proper (body) proper (body) is composed of is composed of muscles and vessels.muscles and vessels.

• Spirit Spirit 神• Color Color 色• Shape Shape 形• Texture and movement Texture and movement 态

inspecting the tongue bodyinspecting the tongue body( 望舌质 )

The tongue spirit 舌神舌神

flourish （荣）（荣）

withering （枯）（枯）

• inspection of the tongue color (four inspection of the tongue color (four kinds) kinds) 　　

• a light-reddish tonguea light-reddish tongue （淡红舌）（淡红舌）• b light-whitish tongueb light-whitish tongue （淡白舌）（淡白舌）• c red and deep-red tonguec red and deep-red tongue （红舌）（红舌）• d cyanotic and purplish tongue d cyanotic and purplish tongue (( 青紫舌 青紫舌 ))

• inspection of the tongue shape 舌形

• a rough and tender tongue( 老嫩舌）• b corpulence tongue （胖大舌）• c swollen tongue （肿胀舌）• d thin and emaciated tongue （瘦薄舌）• e fissured tongue （裂纹舌）• f prickly tongue （芒刺舌）• g tooth-marked tongue （齿痕舌）• h hypoglossal 　 vessels (vessels below tongue )

( 舌下络脉 )

• inspection of the tongue movement 舌态

• The changes of movement of the tongue

• There are six kinds of different movement of the pathologic tongue.

• a stiff tongue 　强硬舌• b shivering tongue 颤动舌• c deviated tongue 歪斜舌• d flaccid tongue 痿软舌• e shrunk tongue 短缩舌

inspecting the tongue coatinginspecting the tongue coating(( 望舌苔望舌苔 ))

• The tongue coating refers to the lichThe tongue coating refers to the lichen-like material formed on the surfaen-like material formed on the surface of the tongue.ce of the tongue.

• the color the color 苔色• the properthe proper 苔质

• nature of the tongue coating 苔质

• a thickness of the tongue coating 厚薄• 　　 thin and thick 　• “bottom visible”

• “bottom invisible”

• b moistening and dryness of the tongue coating 　润燥

• moist tongue coating• slippery tongue coating• excessive dampness • dry tongue coating • without fluid or even fissured • rough tongue coating• being dry, rough and sandy

• c greasy and putrid of the tongue coating 腐腻

• The tongue coating compact 致密的 and difficult to exfoliate 剥落 which is thick on the center and thin on the margins is called greasy tongue coating.

• The tongue coating being loose, sparse 稀疏的 and easy to exfoliate with thickness on both the center and margins is called putrid tongue coating.

• d Exfoliating tongue coating 剥落• On the tongue coating has exfoliated partially

or completely during the course of a disease.

• Exfoliation of the tongue coating is usually due to failure of deficient gastric qi to fumigate the tongue or due to failure of the exhausted gastric yin to moisten the tongue.

• color of the tongue coating 苔色• 　　　• a white tongue coating 白苔• The color of the tongue coating is white.• b yellow tongue coating 黄苔• c grayish black tongue coating 灰黑苔

•

• Ausculation and olfaction

• Sounding• Speech• Respiration • Cough

• Vomiting• Hiccup 呃逆 • Belching 嗳气• Sigh 太息 • Sneeze 喷嚏• Bowl rumbling 肠鸣

• Sounding • Hoarseness 声嘶 : • Aphonia 失音 :

• “a solid bell does not sound”• “broken bell does not sound”

新病——外邪侵袭，肺气失宣 —金实不鸣 久病——精气内伤，肺肾津枯 —金破不鸣 暴怒高喧——气阴耗伤 妊娠后期——胎儿压迫肾经——子喑