TCM II - Lecture 2 - Part 1 - Diagnostic Methods

Class Updates and Syllabus

  • Post diagnosis will be on June 10, the last day of final.
  • Final will be at school followed by the pulse diagnosis.
  • Midterm will be online on June 17, using class marker.
  • In-person class time for final needs verification; same time as Professor Effie's TCM Acupuncture one class, but to be confirmed.
  • Midterm covers classes 1-7, with multiple-choice questions and case studies on diagnosis, emphasizing understanding and comprehension.
  • Final format similar to midterm, possibly with town pictures for diagnosis.
  • No specific review sessions due to dense content, but the instructor aims for accessibility.

Discussion Questions

Differentiating Invisible Phlegm and Turbidity

  • Need for more signs and symptoms, not relying solely on dizziness.
  • Differentiation means finding proofs (signs and symptoms) to support decisions about the disease nature.
  • Example: Differentiating headaches (tightness = cold, distending = heat/stagnation, throbbing = wind fire).
  • Look for other symptoms, e.g., bloated abdomen after eating indicates dampness, linking to brain fog.

Yin and Yang in Excess

  • Yin and Yang control each other; both cannot be in excess simultaneously.
  • Excess Yang usually depletes Yin.

Determining Dominant Pathogenic Factors

  • Identify the origin of the heat and focus on the root cause rather than treating everything altogether.
  • Focus on the root cause, e.g., if heat comes from dampness stagnation, treat stagnation first.
  • If heat is bothersome, add a little to clear stagnant heat.
  • Identify the prime factor that causes others; there is typically a sequence.

Phlegm vs. Dampness

  • Distinction not yet proven with detailed anatomy; rely on phenomenon and biomedical/pathological knowledge.

Identifying Blood Stasis in Darker Skin Tones

  • Look for differences in color, even in darker skin, where blood stasis appears even darker without luminous quality.
  • Consider other signs like scaly skin (bumpy, not smooth).

Eliminating Pathogenic Factors vs. Strengthening Body

  • Addressed later in the lecture regarding deficiency and access.

Black Spots on Lower Lip

  • Show a picture for better understanding.
  • Spots could be blood stasis signs; not necessarily spleen-related.
  • Textbook information is only 70% accurate; offers indications but not definitive conclusions.

Black Spot on Tongue

  • Possible blood stasis sign or could be a biological trait (born like this).

Case Studies Exercise

  • Identify the pathogen in the case.
  • Pathogens discussed: wind, cold, damp, heat.
  • Yin pathogens: cold, damp.
  • Yang pathogens: wind, fire, heat.
  • Specify the pathogen for treatment.

Case Study 1: Sluggish Appetite, Fatigue

  • Dampness as the main reason.
  • Fatigue and stickiness are typical signs of dampness.
  • Avoid listing every possibility; simplify and explain with one factor.
  • Deficiency is pathogenesis, not a direct pathogen.

Case Study 2: Watery Nose, Frontal Headache

  • Wind, cold, and heat are all present.
  • Cold contracts the exterior, causing stagnant heat.
  • Runny nose indicates water as well.

Case Study 3: Diarrhea

  • Loose stools, poor appetite, bloating indicates dampness.
  • Wind may be present, but it's not necessary when there are already internal signs, such as loose stool.

Pathological Sites

Key Concepts

  • Analyze the whole picture of the disease through direct pathogen, pathological site (location), and pathogenesis.
  • Determine if dampness on the exterior comes from external or internal sources.
  • Exterior: On the surface; treat with soothing, excluding, promoting sweat, moving blood, circulating, dispersing, and dredging.
  • Interior: Inner organs (five zang & six fu organs); diagnosed via stool & urination.

Location and Treatment Principles

  • Different locations require different treatment principles.
  • Meridians: 12 meridians are grouped into six types.
  • Pain Syndromes: Diagnose based on which meridian the pain is located.

Exterior vs. Interior

  • Body: Head, limbs, shoulders, back, legs, feet.
  • Common Cold: Body ache is a common symptom (treated with green onions and ginger tea).
  • Headache: Migraine often from the exterior, pathogens from the exterior.
  • Back of the body is yang, abdomen is yin.
  • Orifices above the neck are exterior syndrome.
  • Skin is exterior.

Exterior vs. Interior Syndrome

  • Exterior Syndrome: Symptoms on the exterior without interior signs.
  • If interior symptoms are present, it's no longer a purely exterior syndrome.
  • Critical for treatment; mistaking can be dangerous.

Diagnosing Exterior Syndrome

  • Use 12 meridians and consider orifices in the 12 meridians.
  • Orifices: Lip (stomach), eye (liver).

Interior Diagnosis

  • Review Zangfu organs.
  • Analyze stools and urinations.

Meridians

  • Pathway of energy (qi) connecting internal organs to different body parts.
  • Connects one organ to its internal/external related organ and body surface.
  • Example: Spleen channel begins on the foot and goes through spleen and stomach.
  • Six meridians originate from the tip of the finger, six from the tip of the toe.
  • Paired: One hand and one foot can share the same name.
  • Meridian passage influences if the organs are working together.
  • Discovered 3,000 years ago via super-natural powers.

Types of Meridians

  • Four types: prime, collateral, divergent, and sinew.

Prime Meridian

  • Aligned with artery.
  • Points are where deep artery reaches the body surface.
  • Regulates yang energies and qi energy.

Collaterals

  • Vein on the surface of body and spreads the blood.
  • Reverse direction is mostly veins on the body surface, for example, varicous veins
  • Improves blood circulation over long term and related with the chi and the blood.
  • Find the collateral in the diagnosis you can improve the circulation to improve the problem.

Divergent Channel

  • Connects the inner wrist organ to the surface, mostly orifices.

  • Also connects inner wrist to brain or the brain marrow.

  • Connects inner wrist with external diagnosis.

  • Example - hyperactive people, where they do have a sore throat. - Kids who are afraid of light.

  • Stomach channel makes you aversion to light.

  • Shows how pathogens invade the body from outside to inside.* It isn't easy to be attacked if the weak is defensive qi.

  • It determines what kind of disease the person contracted not an outside issue. It is they are not fighting something it won't spread over bodies.

  • Focuses on to what kind of person that you are treating and channel the person in the divergent channel.

Sinew Channel

  • Highly related with pain syndrome.
  • Goes through the sinews and muscles.
  • Diagnose where the pain goes through along the channel.
  • Example: Lower back pain.

Questions from Discussion

Dos with Exterior and Lung Symptoms

  • Lung channel goes to the nose, so the nose is the lung's exterior.
  • Exterior: cough, nose discharge
  • Interior: cough, wheezing.
  • Need to differentiate symptoms and locate the root pathological location.