TCM: tongue diagnosis notes, clinical practice.


Tongue diagnosis:

1. Body of tongue is a muscle.(only muscle we can see) related to heart.
2. Shape- fullness, fineness.
3. Coating- fur/moss) from stomach qi.

Areas of tongue relate to the San jiao:
1. Root- lower jiao= kidneys, int4estines, and bladder.
2. Center- middle jiao- spllen stomach. Sides- liver and gallbladder.
3. Anterior- upper jiao- heart and lungs.

1. Need to use natural good light, white light.
2. Florescent light or dim light is not the best.
3. Patient needs to show tongue in a relaxed, un-tense way.
4. Hold out tongue no more than 15 sec.

5 attributes of tongue to observe: Body, Color, shape, coating, moisture.

Things that affect the tongue:
1. Eating and digestion affect stomach.
2. Gum, candy, coffee, tea can stain tongue.
3. Spicy foods- tend to make more red.
4. Fasting- causing thickening, empty, greasy. Stomach “vapors” rise up to tongue.
5. Medications like steroid, bronchodilators, anti-inflammatories cause tongue change.
6. Chemotherapy- blackish , dark brown color.

Normal tongue:
1. Has “spirit”, supple, life, body.
2. Pale red is good blood flow to lungs.
3. Tongue is related to heart, redness, paleness.
4. Paleness- supple fluids. Pink color.
5. Not flabby, stiff, or cracks.
6. Not thin or swollen.
7. Good body definition.
8. Thin white coat, not dry or wet.

helps determine status of:
-blood and Qi.
-yin organs,
- hot and cold,
-red= heat,
-pale= cold.

Xu= “shu” is deficiency.

There is a deficiency and heat scale-
Pale is a vacuity pattern: deficiency, blood or Yang deficiency. Cold makes pale.
Red is heat, excess or deficiency, excess heat outside like sweating vs. internal heat that is in places of body. Full heat, depressive heat. Vacuity heat.
Excessive heat burns up fluids, blood stasis- blood will congeal and slow down.

Qi follows blood, blood follows qi.

Sublingual (under side of tongue)- related to brain, stroke, headache, heart, blood vessels. Left and right side of brain and body.

Tongue forms:

Deep red- extreme heat. Exogenous= nutritive, blood stage heat.
Endogenous= yin vacuity with fire effluence.

Bluish/Purple hue- cold slowing blood, stasis, stagnation, Blue is Yang deficient and extreme.

Swollen- (teeth marks)
Yang Qi of spleen (kidney) not sufficient to move fluids- phlegm, dampness. Vertical is qi stagnation.

Thin- smaller, thinner. Thin and pale- blood and qi vacuity. Thin dry and red- yin vacuity.

Cracked- yin, blood insufficiency. Cracked and red- is yin fluid damage from heat. Cracked and pale- blood vacuity. Spleen qi vacuity.

Thorns/papules- pathogenic heat in the interior.

Deviated- wind (chaotic qi stirring within interior).

Rigid- exogenous- heat in pericardium, turbid phlegm, evil heat consuming yin fluid.
Endogenous- wind-stroke (impending).

Flaccid- extreme exhaustion of qi, blood, and yin. Flaccid and pale- qi and blood vacuity.
Flaccid and red- yin collapse.

Short/Long- presence or absence of heart qi. Short- lack of heart qi or obstruction. Long- heart heat.

White- cold. Thin- exterior invasion (normal), thick- internal retention of cold.

Yellow coating- heat, stomach heat.
Grey- interior heat or cold damp. Grayish yellow- heat consuming yin.
Grayish white- cold damp, retention of phlegm.

Black- extreme heat or excessive cold.
Black and dry/thorns- severe illness, heat.
Black slippery- severe yang vacuity.

Peeled- stomach yin vacuity, damage to stomach.

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TCM: Pulse. Clinical Observation notes, CO405 Spring 2014

I . Pulse diagnostics:
Start creating logs of patients
Radial artery- touch and feel, develop sensitivity in finger ‘pad’.
Wrist should not be up down, it anatomically changes the artery. Use a small pillow.
-Notate the pulse, describe it through words.

Essentials of pulse diagnosis-
1. Understand the basic concepts of what you are feeling. Absorb all pertinent information about the different pulses.
2. Inability to label the feeling correctly means the practitioner cannot correlate the Diagnostic signs/symptoms with the treatment principles and treatment plan.
3. Feeling of the pulses are dirt simple feelings, getting the correct label on that feeling is the issue.
4. Correct labeling is essential for communication with colleagues, essential also for 3rd party payment: woker comp, PPO, HMO, etc.
5. Disease mechanisms- to understand the pulses according to their disease mechanisms allow one to discern the various possible reasons that produce the various pulse images.
6. In TCM the PULSE is NOT used to make the pattern of diagnosis, it is only used to confirm or deny what the physician thinks may be the pattern. It is only to corroborate and be the LAST piece of information to be considered.

We learn from the patient. Looking for concepts from 1000’s of years ago, for modern illnesses and stress.

Huang Di Neijing (Yellow Emperor Classic) is first place of discussion.
The Nanjin (Classic of Difficulties) continued on and divided pulse into SAN BU- 3 positions.
“The lungs face the 100 vessels”, all the Qi of the body passes through the lungs and returns. The pulse is on the wrist because nanjin describes the source of all points is LU9,
Influential part of the vessels. Qi enters Lungs first, passes through lungs, returns to lung. Radial artery runs through lung channel.
12 meridians

Taiyin and Yangming meridians:
1. Lung meridian of Hand Taiyin- middle burning space to the tip of the thumb.
2. Large intestine meridian of Hand Yangming- tip of thumb and small finger to large intestine.
3. Stomach meridian of Foot-Yangming- from middle of nose to the middle of foot.
4. Spleen meridian of foot- Taiyin. From the great toe to the lower part of tongue.

Shaoyin and Taiyang meridians:
5. Heart meridian of the hand Shaoyin- from the heart to the inside of the little finger.
6. Small Intestines meridian of the hand Taiyin- from the little finger to the small intestines.
7. Bladder meridian of the Foot Taiyang- from the inner corner of eye to the little toe.
8. Kidney meridian of Foot shaoyin- from the little toe to the root of the tongue.

Jueyin and Shaoyang meridians:
9. Pericardium of the hand Jueyin- from the middle of the stomach to the top of middle finger.
10. San Jiao of hand Shaoyang- from the tip of the little finger to the 3 burning places.
11. Gall Bladder of the Foot shaoyang- from the outer angles of the eye to the little toes.
12. Liver meridian of the foot Jueyin- from the hairy spot of big toe to the vertex of the head.

See images on the Nanjin

Li Shi-zhen way used in modern pulse diagnosis.

Three positions:
Cun- upper jiao: heart, lungs chest, head, arms. Throat, sinus eye, ear, mouth, etc.
Guan- middle jiao- liver gall bladder, stomach, spleen, diaphragm to navel. Ribs, Mid-back, abdomen.
Chi- lower jiao- kidneys, bladder, intestines, navel to toes, legs, knees, ankles, pelvis, uterus, lower back, sex organs.

4 head ropes-
1. Floating/sinking: depth and force of yang qi.
2. thin/wide: blood, yin. Is it a wide or thin feeling vessel (tube)?
3. Strong/weak force: yang qi. Is it forceful or weak?
4. Fast/slow: yang qi. Is it rapid or slow?

Floating/sinking: Yang nature is to float up and out. If floating, yang is in the upper and outer part of body. Excess yang qi and insufficient yin. If sunken: yang is insufficient, something is obstructing.
Thin/Wide: latitude of the pulse tells about the content of vessels, Yin, Blood, Body fluids.
Strong/Weak: strong force is sufficiency, exuberance of yang. Weak/forceless is insufficiency of yang.
Fast/Slow: excess of Yang or yang vacuity.

Technique: thumb anchors on triple warmer point, apply one figer at a time after relocating under the boney landmark. 10 sec. feel pulse, patient and self breathing, press deep and shallow, side to side, in and out, long and short.
Duration of examination: short period to long period, up to 15 minutes.
Cultivate stillness, feel calm, meditation- mind of no judgment, no expectations, open, and logical.
Time of day- Chinese clock.
Season- is it summer, fall, winter, spring.
Circumstance/situation: patient eat? Come from gym, traffic, stress.
Posture- patient can sit or lying. Practitioner is upright, relaxed and not distracted.

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Yang Tai Chi Chuan: Mapping out my place in the Tai Chi Universe.

“Lineage is not a true indication of skill, though I have trained, and still continue to train with outstanding people. Kung fu is “ever progressing”, humbly learning from everyone within common reason. We believe in hard work, the same way steel has to be forged with fire and water. 24 years of Tai Chi Chuan is really only a starting point on this pagoda of life. Many floors to continue to walk up and see the view from higher stand points on the journey”. -Matt Stampe

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TCM for Allergies: seminar notes

TCM and Allergies:
Allergies is a hypersensitivity disorder of the immune system.
Body releases histamine- inflammation response: phlegm, red eyes, sneezing, etc.

Symptoms include:
Nose swelling,
sinus infection,
eyes red and itchy,
airways- sneeze, cough, bronchoconstriction, asthma.
Ears- full or pain.
Skin- rash, eczema, hives.
G.I. tract- abdominal pain, vomit, diarrhea.

Western drugs- hide symptoms, histamine is body way of telling you something.
Alternative to drugs: herbs, acupuncture, tea, qigong.

Common allergic reactions:
Foods: milk, shellfish, peanuts.
Skin- poisonous plants, animals, pollen, latex.
Injection: bee sting, medication.
Medication: various drugs, nuts-shellfish.
Inhalation: pollen, dust, mold, mildew, animal dander.

1. Host factor: age, gender, hereditary etc.
2. Environment: pollen, diet, ect.

Allergic Rhinitis: symptoms of nose: dust, pollen, dander.

1. Lifestyle: avoid allergens
2. Medications: anti-histamines, corticosteroids, decongestants.
3. Herbal: “Jade wind screen”- immunity boosting herbal formula.
4. Prognosis- is good with patient willing to try alternatives.
5. Acupuncture- strengthen the “defensive Qi” immune system.
6. Herbs: list of herbs provided.
7. Teas- sample various teas. Common teas: green tea, astragalus tea, flower tea (chrysanthemum).
8. Qigong: 8 piece brocade/”ba dua jin” is a basic set to try.

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TCM: Qigong Notes. Spring 2014 semester

Qigong Class:
Qi- vital energy, everything is generated by movement of qi.
Gong: accumulation of “time”, or “work” or “energy level”.
Qigong- time spent accumulating your vital energy and reaching a higher energy level.
Neigong- Internal work and adjustments.

1. Health by balance of vital energy: physical, mental, emotional improvement.
2. Ability to treat disease.
3. Martial arts/self-defense: above average human ability.
4. Mind-Body communication: body is basis of mind, mind commands the body.
5. Latent abilities- develop more than 10-20% of normal brain ability.

Influences of Qigong:
1. Taoist- focus on present life and accumulating energy, longevity.
2. Buddhist- focus on next life, relieve suffering in present life.
3. Medical- heal and improve health.
4. Martial art- qi for martial arts purposes.
5. Folk qigong- “catch-all” of various other types of qigong.

Types of Qigong Practice:
1. Static- holding still postures, no outside movement.
2. Dynamic- coordination of movement with breathing.
3. Meditation- can be sitting, lying down, standing, moving. Deep consciousness training.

Mediation Types:
1. Guided meditation: teacher guides.
2. Mindfulness meditation: let thoughts come and go. Observe thoughts.
3. Transcendental meditation: small and smaller, less thoughts. counting numbers smaller and smaller.
4. Moving types: Qigong, Taiji, yoga, etc.

Adjustments: body, mind, breath. integrate 3 as one.
Body adjustment:
1. external:
standing postures: holding, raising, pressing, lifting.
sitting: plain chair, single cross leg, double cross leg (lotus).
Lying down- supine, lateral (3 connectings).

2. Internal adjustments:
head and neck- raise head, tongue on roof of mouth.
upper limbs- empty in the armpits.
chest and back- pulling the chest.
waist and hips- sitting on stool.
Lower limbs- relaxed and steady.

Warm-up: neck, shoulders, wrist, waist, knees, ankels.
Standing basic: feet hip apart, hands at tan tien (below navel center), breathing normally, naturally, no force.
Qi feeling exercise:
1. Rub hands, feel energy between palms, palms move close and far from each other.
2. Sword fingers- point sword fingers at laogong in center of palm, circle sword fingers to feel qi.

Baduajin: 8 brocade qigong
1. Uphold sky with both hands- 3 warmer/san jiao. Lu, Ht, Kd.
2. Draw bow, shoot hawk- heart and lung channel.
3. Separate heaven and earth- spleen and stomach channel.(middle jiao) GB LV.
4. Look back- heart calming fire.
5. Sway head/shake tail-
6. Two hands hold feet- kidney and bladder channel.
7. Punch with fist, widen eyes- liver and gallbladder.
8. Raise toes, drop heel-

Close qigong.

Guided meditation: tree mediation: seed, to root, to tree growing.



Adjustments of breath:
chest breathing
abdominal breathing
fetal breathing
pause breathing
anus lifting breathing
sound producing breathing

Breathing Air:
wind breathing- scatters Qi
pant breathing: Blocks qi (often used in martial arts, sharp exhale on a punch)
Air breathing- exhausts qi
Rest breathing- Calms Qi- motionless undetectable type of breathing.

using qigong in medicine:
-Yin-yang theory:
excess and deficiency
breathing in (yang) vs breathing out (yin): expelling toxins.
mental visualization

five elements:
organs: liver, heart, spleen, lungs, kidneys (tonify or sedate). Mother theory: if son is weak build up the mother.
example: if heart is weak, strengthen the Liver.
emotions: anger-joy-over thinking-sadness-fear.

Zhang-fu organs:
Relationships amoung fu and zhang organs.

Meridian theory

3 treasures: Essence-Qi-Spirit or Jing-Qi-Shen.

Medical Qigong:
scanning of qi flow.
manipulation of qi flow.

Clinical application of microcosmic orbit.
Qigong: non-drug therapy.
-like acupuncture and Tui-na.
-Self-cultivation methods.
-Teaching patients to self-practice.
-helping others by manipulating qi flow.

Some common examples prescribed with Baduanjin:

-Chronic fatigue syndrome, Insomnia, Lower back issues, Leg pain, Cervical Spondylosis.

Microcosmic Orbit
Movement of Qi:
Ren 4- Lower Dan tien. tonify Yuan Qi, Defiency of yin, Yang, Qi and blood.
Ren 1- Perineum. Regulate lower yin orifices, CV, GV, and chong mei channels.
Du 1- Tip of Coccyx. calm spirit, Lou connection point.
Du 4- Mingmen. tonify kidney, lumbar spine, clear heat, gate of life, heat of the 5 zhang.
Du 14- below spine process of C7. relieve exterior syndrome, clear heat, tonify deficiancy pacify wind.
Du 16- EOP (external occipital proturbance). eliminate wind, nourish the “sea of marrow” head, neck, spirit.
Du 17- Eliminate wind and pain, benefit the eyes, calm spirit.
Du 20- Bai Hui vertex. Crossing of Bladder, San jiao, and Liver meridians. Subdue Yang, help sense organs and brain.
Yintang (Extra 2)- upper dan tien. Hall of Seal. calm spirit, stress, anxiety.
Ren 17- Middle dan tien. Tonify and move qi of chest and lungs, gather Qi.

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