Chapter 6 - The 4 Examinations: Signs and Symptoms
Introduction:
How do Chinese theories and philosophies function as Chinese Medicine?
How would a Chinese physician examine a patient?
I. The Chinese examination functions as a system and a philosophy
A. Only examination of the whole can determine the meaning of a piece
B. Different from the Western view where:
1. A cannot equal not A
2. This is the cornerstone of western thought
3. Aristotelian
C. Eastern view: A and not A can simultaneously be and not be
D. Some pre-Aristotelian Greeks held this view: Heraclitus
1. "The road up and the road don is one and the same. The beginning and the end are common."
2. You can’t step into the same river once
3. Heidegger and Nietzsche
II. Chinese philosophy of interconnection and change within medicine
A. Many signs and symptoms viewed together to arrive at diagnosis
B. Pattern of signs and symptoms
C. Diagnosis and symptoms (and their meanings) depend on context
D. The word "usually" may appear quite often
1. Things are not ever 100% consistent or concrete
2. Ex: a fast heartbeat usually means excessive heat, but not always
I. The Four Examinations
A. Four Stages
1. Looking
2. Listening and Smelling
3. Asking
4. Touching
B. Interpreting the Signs
1. Physician conducts all four Examinations to look for disharmony, however giving some Examinations more weight than others
2. Signs may fall into place and point to a particular disharmony, or signs may contradict each other requiring the physician to interpret carefully and closely before making a determination
I. Looking
A. Appearance
1. First observation of doctor, least importance
2. Includes: patient’s physical shape, patient’s manner, the way patient behaves during Examination, state of patient’s Shen
B. Facial Color
1. Face and its moistness closely related to body’s Qi and Blood
a. Healthy face is shiny and moist
b. Withered face implies weakness of vital Substances
2. Abnormal facial colors have clinical significance
a. White= disharmonies of Deficiency or of Cold
b. Red= excess heat
c. Yellow= Internal Dampness produced by a weak Spleen
d. Qing ("the color of dragon’s scales," translated to "blue-green")=Congealed Blood and Stagnant Qi
e. Darkness/Black= Deficient Kidneys and Congealed Blood; color often arises from a chronic illness
C. Tongue
1. Most important part of Looking Examination, one of two pillars of the Four Examinations
2. Tongue material
a. Various shades of red and varying degrees of moisture
b. Normal tongue pale red and somewhat moist, abundant Blood carried by smoothly moving Qi
c. Disharmonies include tongues that appear: less red, scarlet, purple, dark tinge
3. Coating of the tongue (Tongue Moss/Fur)
a. Coating, Fur, Moss on tongue is related to Spleen activity
b. Moss related to digestion and reflects state of digestion system
c. Healthy moss= thin, whitish, moist, tongue material seen through it
d. Unhealthy moss includes: thin, thick, puddled, dry, greasy, shiny, white, yellow, black
4. Shape and movement of the tongue
a. Healthy tongue= balance between swollen and shriveled, big and small
b. Unhealthy tongue includes: swollen, thin, stiff, trembling, contracted, cracks, eruptions
c. Areas of tongue correspond to particular Organs (p. 151, Figure 17)
D. Secretions and Excretions
1. Principal secretions and excretions: phlegm, vomit, urine, and stool
2. Looking Examination usually includes phlegm and vomit, Asking Examination usually includes urine and stool
II. Listening and Smelling
A. Voice and Respiration
B. Two main bodily odors present during sickness
1. Odor of rancid meat or rotten eggs
a. Characterized as foul, rotten, and nauseating
b. Odor signifies Heat
2. "Fishy" smell, less nauseating
a. Smells likes fumes from bleach
b. Odor indicates Cold and Deficiency
Asking: The Third Examination
**Asking is done to discover a pattern
I. Sensations of Cold and Hot
A. In General:
1. Cold = Yin
2. Hot= Yang
B. Fevers
1. Seen as being very important
2. Focus of many Chinese medical texts and schooling
3. Can have many different meanings, depending on context
II. Perspiration
A. Occurs when pores are open
B. Non-illicited sweating:
1. Day = deficiency in Qi or Yin
2. Night = excessive Yang
C. No perspiration during illness = Cold
D. Look for patters: how the perspiration relates to other signs and symptoms
III. Headaches and Dizziness
A. Can accompany any disharmony
B. Sudden headaches:
1. External pernicious influence
2. Disturb Yang or
3. Disturb Qi
C. Chronic headaches
1. Internal disharmony
D. Severe headache = Excess of some type
E. Slight annoying headache = Deficiency of some type
F. Liver is most often associated with headaches:
1. Liver has strong Qi
2. It tend to rise when deficient
G. Dizziness = Deficient Qi or Blood
IV. Pain
A. Often the main complain of patients
B. Pain indicates disharmony
C. Different qualities (types) of pain
Examples:
Quality of Pain Signification
Diminished by heat Cold
Diminished by cold Heat
Relieved by touch or pressure Deficiency
Aggravated by touch or pressure Excess
V. Urine and Stool
A. Usually don’t take samples: They just ask
B. In General
1. Light and clear = cold
2. Heavy, dark, dry = heat
VI. Thirst, Appetite and Taste
A. Thirst = heat
B. Wet mouth = cold
VII. Sleep
A. Should get just enough sleep, but not excess (fear of disharmony)
B. Insomnia
1. "Yang unable to enter Yin"
2. "Shen not peaceful"
C. Excess Yang or fire can cause insomnia
VIII. Gynecological Concerns (still asking as opposed to examination)
A. Dark thick discharge = heat
B. Lighter, lack of fluids = cold
IX. Medical History
A. Chinese Doctor want to know medical history
1. Look for patterns
2. Consistent body deficiency or excess
B. Acute illness = excess
C. Chronic illness = deficiency
Touching
I. Taking the Pulse
A. The absolute center of Chinese examination is the pulse
B. There are from 24 - 30 types of pulses
1. Each are difficult to distinguish
2. No such thing as a normal pulse
3. Most people will have a combination of different pulses
C. Each of the three fingers actually feels a slightly different pulse