Ross Rosen Lecture (Aug. 17th)

Please join the Union County Chapter of the Holistic Moms Network for a special presentation by Ross Rosen. Ross will set the stage for a new paradigm in medicine where we will finally learn why people actually get sick; how our lifestyles contribute to our illnesses (both mentally and physically); how to understand the inner workings of our bodies from a holistic perspective; how to sift through all the conflicting data on nutrition and choose foods that are healthy and nourishing for our bodies and minds, and so much more.

In this informative presentation, Ross Rosen will debunk many of the most common western medical mythunderstandings and mythperceptions about our health while presenting the foundations of the Chinese medical paradigm.

Details here.

Ross Rosen, JD, MSTOM, LAc, Dipl OM (NCCAOM) is the President, owner, founder and clinic director of the Center for Acupuncture and Herbal Medicine, one of the largest and most respected alternative medicine clinics on the east coast. He is a licensed and board certified acupuncturist and herbalist and is one of a handful of people world-wide to master the intricate art and science of Chinese pulse diagnosis, Contemporary Oriental Medicine® and Chinese medical psychology and be certified to teach it. For more information on Ross Rosen, please visit his website at http://www.acupunctureandherbalmedicine.com/ or call 908-654-4333

Acupuncture NJ

上帝的神奇藥物God's Amazing Pharmacy

I received this from a friend. I am trying to track down the original citation for it. If anyone knows, please comment so that I can give a proper reference.

上帝的神奇藥物God's Amazing Pharmacy
It's been said that God first separated the salt water from the fresh、made dry land、planted a garden、and made animals and fish、long before making man.
據說上帝在造出人類之前，首先將鹹水與淡水分離，造了陸地、在花園裏種上各種花草、造了各種動物和魚類…

To ensure healthful living、God left us some clues as to which foods we should eat to keep specific parts of our body healthy!為了確保健康的生活，上帝留給我們一些線索來告訴我們該吃什麼食物以對我們身體的一些部位有益。We call this God's Amazing Pharmacy.我們稱之為上帝的神奇藥物

A sliced carrot looks like the human eye. The pupil、iris and radiating lines look just like the human eye. And yes、science now confirms that carrots greatly enhance blood flow to our eyes. 切片的胡蘿蔔看起來像人的眼睛。瞳孔、虹膜和放射的線條，看起來完全就是人的眼睛。科學也的確證明胡蘿蔔能大大促進血液向眼部的流動、改善眼部功能。

The tomato has four chambers and is red. The heart has four chambers and is red. Research shows that tomatoes are loaded with lycopine、a wonderful heart and blood food.
番茄是紅色的有四個心房。心臟也是紅色的有四個心房。所有的研究都告訴我們番茄裏充滿了茄紅素，事實上它也是能淨化心臟和血液的食物。

Grapes hang in a cluster resembling the shape of the heart. An individual grape looks like a blood cell and research today shows that grapes are a wonderful heart and blood vitalizing food. 葡萄一串一串在一起形成心臟的形狀。每一顆葡萄看起來都像一個血液細胞，現代科學研究也都證明葡萄能極大增強心臟和血液的活力。

A walnut looks like a little brain、with left and right hemispheres、upper cerebrums and lower cerebellums. Even the wrinkles or folds on a walnut are like the neo-cortex. We now know that walnuts help develop more than three (3) dozen neuron-transmitters for brain function.
核桃看起來像小小的腦，有左、右半球和上大腦、下小腦。連它上面的褶皺看起來也很像新皮質。現在我們知道核桃能為大腦多提供三打以上的神經傳導.

Kidney beans help heal and maintain kidney function and、yes、they look exactly like the human kidneys. 菜豆能治腎並幫助維持腎功能，而且它們看起來確實很像人的腎。

Celery、bok choy、and rhubarb look like bones. These foods target bone strength. Bones are 23% sodium and these foods are 23% sodium. If you don't have enough sodium in your diet、the body pulls it from the bones、making them weak. These foods replenish the skeletal needs of the body.
芹菜、白菜、大黃葉柄看起來就像是人的骨頭。這些食物具有增強骨質的功效。骨頭含有23%的鈉，這些食物也含有23%的鈉。如果你從日常飲食中攝取不到足夠的鈉，身體就會從骨骼中吸收，從而使骨骼變弱。這些食物可補充身體對骨骼的需求。

Avocados、eggplant and pears target the health and function of the womb and cervix of the female、and they look just like these organs. Research today shows that when a woman eats one avocado a week、it balances her hormones、helps shed unwanted birth weight、and helps prevent cervical cancers. How profound is this? It takes nine (9)
months to grow an avocado from blossom to ripened fruit.... There are over 14,000 photolytic chemical constituents of nutrition in each one of these foods (modern science has only studied and named about 141 of them).
酪梨,茄子,梨具有改善女性子宮和子宮頸的功能，使之保持健康，它們看起來確實就像這些器官（子宮和子宮頸）。現在的研究證明，如果一個女人每週能吃一個酪梨，就可以調節荷爾蒙、甩掉贅肉，並且預防宮頸癌。那麼這當中究竟多少奧妙？一個酪梨從開花到瓜熟蒂落需要整整九個月的時間。它們都含有超過14，000多種以上的化學營養物質（現代科學只對其中的141種做過研究並命名）。

Figs are full of seeds and hang in twos when they grow. Figs increase the mobility of male sperm and increase the numbers of Sperm as well to overcome male sterility.
無花果裏面長滿了子並且是兩兩掛在一起生長。無花果可以促進男性精子的流動，並能增加精子數量，同時還能治癒男性不育。

Sweet potatoes look like the pancreas and actually balance the glycemic index of diabetics. 紅薯形狀像胰腺，可以調節糖尿病患者的血糖指數。

Olives assist the health and function of the ovaries 橄欖有助於改善卵巢功能、保持卵巢健康。

Oranges、grapefruits、and other citrus fruits look like the mammary glands of the female and actually assist the health of the breasts and the movement of lymph in and out of the breasts. 橘子,葡萄柚和其他種類的柑橘看起來就像女性的乳腺，事實上它們有助於保持乳房的健康，促進淋巴液進出乳房。

Onions look like the body's cells. Today's research shows onions help clear waste materials from all of the body cells. They even produce tears which wash the epithelial layers of the eyes. A working companion、garlic、also helps eliminate waste materials and dangerous free radicals from the body.
洋蔥看起來就像是人體細胞。現代研究表明洋蔥可以幫助所有人體細胞清除廢物。它們還可以導致眼淚流出沖刷眼睛的上皮細胞。它的同伴大蒜也有助於從體內清除廢物和對人體有危害的輻射。

acupuncture new jersey

Ross Rosen Lecture

The lecture I did last week on Chinese medicine, and in particular, on my upcoming book is now available at the following link.

Please let me know your thoughts.

Best of health,
Ross

Call in Support of Acupuncture Bill S1311

Good News!!! Our acupuncture bill - S1311 - is on the agenda for a vote for the Senate Commerce Committee for Thursday, December 11th.

We would like some calls made to the committee members, but NOT a blitz of phone calls. Therefore, DO NOT have everyone you know make a call. JUST you.

You will most likely be speaking to a legislative aide when you call and not one of the senators. Please be brief and courteous and thank the senator for his past support and request the senator support our bill, S1311 again on Thursday, Dec. 11th. All but one senator voted in our favor the last time our bill came up for a vote.

Only one senator is new to this committee since our bill was last up for a vote and that senator is Senator Scutari. In his case, you should just ask for his support

The phone numbers are as follows:

Senator Raymond Lesniak - 908-624-0880

Senator Gerald Cardinale - 201-567-2324

Senator Bob Singer - 732-901-0702

Senator Nicholas Scutari - 908-587-0404

Ross Rosen interview on Blog Talk Radio

Hiatus

For those of you who are wondering why my posts have been few and far between, I wanted to assure you that I have not run out of material :)

Much of my time and efforts lately have been geared towards a couple of bigger projects. One is my course of study in Classical Chinese medicine with Daoist priest Jeffrey Yuen. It is an unfathomable amount of material to get through and digest. I will post material on this content and my experience with it soon.

The other is that much of my writing these days has been diverted into a book that I have begun writing on Chinese medicine for the public. I have made lots of headway on this project and am about 100 pages in. My goal is to have a book ready for publication by the end of the year. I will post excerpts soon.

Please don't stop visiting....

Thanks,
Ross

All Disease Comes From the Heart

Check out this small article here.

Therapeutic Relationship

The ultimate aim of Chinese medicine is to treat the individual and the cause(s) of disease by distinguishing the individual from his or her illness. It seeks to understand and treat with respect for each patient as a cornerstone of therapy. This therapeutic relationship has myriad forms and like all of Chinese medicine is tailored to each person uniquely.

What distinguishes this from other systems of medicine is the relationship that is created and fostered between patient and practitioner which serves as the foundation for the initiation of the healing process. This is not a one-way street and requires cooperation by both parties.

First, the physician counsels the patient regarding the relationship between particular behavioral patterns (including diet, exercise, sex, etc.) and the illness in question, and then treatment assists and supports the body's own healing forces. A physician's job is to return physiology to normal. His effectiveness depends entirely on the accuracy of the diagnosis, on the wisdom of the counseling, on the patient's willingness to change, and on the correct choice of treatment modalities for the rebalancing of the body's physiology.

-Dr. Leon Hammer

Nobody denies that assuming responsibility for oneself is the ultimate in growth and development. The physician must identify the energy leaks, and the patient must seal them by changing his lifestyle. It is, however, only one step and cannot be taken until the organism and person are strong enough. This strengthening is a collaborative process and must often begin with help from an outside source. Chinese medicine provides this outside source in many ways.

-Dr. Leon Hammer

As health practitioners we are of value to the people who consult us only if we can offer them something significantly different from the usual response. Of course, we recognize and acknowledge the negative in all its destructiveness. However:

We are needed for our ability to recognize the positive quest for contact beneath the negative emotions and behavior.......

This is the beginning of a 'new experience' with someone who is reliably more concerned with finding, and responding to, the positive rather than the negative in them; with someone nourishing rather than condemning; with someone capable of putting, at least temporarily, another person's needs ahead of his or her own.

Only as we allow a 'new experience' and provide a new model can our contact with our patients be a truly healing, growing, therapeutic experience.

-Dr. Leon Hammer

Expressions of the Heart

My most recent article with my colleague and good friend Brandt Stickley has just been published with the Chinese Medicine Times relating to the Heart in Chinese medicine. You can access it here.

January Update on the Year of Sagely Living

The YSL is off to an ambitious start; which makes sense as everything in my life is ambitious to some degree: busy acupuncture practice, thriving family with three children; PhD program; etc.

So, what did I actually accomplish:
1. I have committed to watching a minimum of one hour of my PhD dvd lectures while taking detailed notes at least 2 nights per week after the kids go to sleep. I have been able to achieve this thus far and have been doing so 4 nights per week.
2. I have committed to a more diligent practice of Chen taijiquan. I have continued to take weekly classes, driving into NYC every Sunday morning. And each night (more like 5 nights per week) I spend approximately 1/2 hour practicing my forms after studying. It's been a great way to unwind from the less than perfect posture of watching dvds on a laptop computer.
3. More time with family: I have made a concerted effort to spend more uninterrupted time with my kids (without checking the phone, emails, etc.). I have spent Tues and Fri afternoons with the family as I finish with patients early on those days. I have taken the kids bowling, away for the weekend and have taken my son out of his kindergarten wrap around program to spend more time with him. (We are also in the process of organizing a plan to homeschool. Yes, more ambitious. I'm sure this will spur some more blogposts soon.) My lunch break has been more playtime than worktime.
4. While I have not been able to take any additional classes in Tibetan medicine as my translator is not available and Rinpoche is travelling, I have been continuing my Medicine Buddha practice.
5. As January deals with learning, I also read The Art of Learning by Josh Waitzkin. An excellent book (which also ties in my tai ji practice). See it here.
6. Publishing articles and video lectures: No additional publishing this month, however, I am starting to work on the next article which has a mid Feb deadline. The video lecture will gain some momentum in mid March after my vacation to Costa Rica and trip to Gainesville.
7. In the midst of all this, January has been a month of tremendous reflection on how I want to live my life, how I want to raise my children, where I want to live, and how to propel myself in that direction. The discussions go on daily in my household as I try to practice more of what I preach. One of my biggest lessons this month is that change must come.

So, all in all, it's been a good month. A good start with a long road ahead.

Everything Changes, Can You?

To be healthy requires that we experience a balance between yin and yang, and have a smooth flow of qi and blood throughout our bodies. This is best maintained by living a moderate lifestyle in accord with the energies of nature. As summer is not afraid to end and transmute into fall, so we too must be willing to let go and change where appropriate. Part of my path as a Buddhist and practitioner of Chinese medicine is to recognize when I fall prey to attachment towards particular behaviors, thoughts, emotions, etc. Likewise, I must point these issues out as they become relevant to my patients in the course of their healing.

While watching my dvd lectures from my teacher, Jeffrey Yuen, he discusses how so often patients come to see practitioners to rid themselves of their symptoms, but never see the connection to their lifestyles. Most look forward to getting back to their lives pain -free, cancer-free, or free of whatever ailments are plaguing them. But we must instruct our patients that their lifestyles are the problem. To do otherwise, we are simply treating the branch, the manifestation.

To heal, we need to change. We need to be brave enough to change our lives in a way that is conducive to health. On a spiritual level, this means non-attachment. It means cultivating a way of life that transmutes our physicality towards spirituality. The goal of qi gong, for example, is to alchemically transmute our jing (essence) to qi, then from qi to shen to expand our consciousness and experience emptiness, the non-duality of all things.

On a physical level, healing requires significant lifestyle modifications. Dietary changes (avoiding cold, damp, greasy, fried, preservatives, chemicals, refined sugars, etc. and eating for health, not pleasure, eating live whole foods, etc. (see the Resources page on my website for a really good introduction to Eastern nutrition), habitual patterns of movement (ie, sitting all day at a desk leaning over our keyboard which kills the qi in our chest), and perhaps most importantly our habituated emotional responses. If we are living lives of quiet desperation, unhappy in our marriage or work, unhappy with how we look or feel, we must make radical changes to secure our health. If we are having difficulty containing our anger, if we are experiencing depression, we must seek out their roots.

Dealing with roots of our habituated responses is incredibly powerful and the entire subject of humanistic psychology as detailed in Dr. Hammer's Dragon Rises, Red Bird Flies is very well laid out. Learning how one's behaviors, rooted in early life, shape our health across the entire bodymind spectrum, and gaining the tools to make the appropriate changes can spark a profound healing.

So, as we have decided this is the 'year of sagely living' we must strive towards this ideal by rooting out our behaviors that are synonymous with imbalance, and replacing them with habits that foster health and well-being.

"Year of Sagely Living"

The mark of the superior physician has traditionally been a high degree of cultivation. Eastern medicines have long held the scholar-warrior-physician as the benchmark for all doctors to aspire to. In this day and age, the scholar-physicians are few and far between. But there are a growing number of practitioners of Chinese medicine who seek to strive towards this ideal and see the importance of resurrecting this tradition.

The "Year of Sagely Living" is the brainchild of my good friend Brandt (Abdallah) Stickley (see Even Unto China) and Eric Grey (see Deepest Health) and I am fortunate to be involved in this at its inception. The idea is that over the course of the next year (beginning today) we make the commitment to cultivate the skills (academic, clinical, spiritual, etc.) of the superior physician. A syllabus of sorts has been created (see below) that will help guide the process. January 1st marks the beginning of scholarship and study. Each month will have a unique theme based on a synergy with the energies of each season and time of year. Excerpted below is the syllabus from Deepest Health.

January - Gall Bladder, Zi 子 (Rat): Scholarship/Study: This category will contain practices to develop us into true scholars in the Confucian/neo-Confucian tradition. Why this pairing? The seasonal energy is still in winter, a contemplative mood prevails, but the Yang is rising. Similar to this, we can see scholarly pursuits as ACTIVE passivity. One generally sits still, but one’s mind is hard at work.

February - Liver, Chou 丑 (Ox): Strategy/Business: This category will contain practices in the realm of business development and strategic planning in the professional world. Why this pairing? The Liver is the general of the body, so has a natural affinity for this kind of activity.

March - Lung, Yin 寅 (Tiger)- Activity/Rest: This category will contain practices having to do with appropriate cycles of rest and activity in daily life - for instance, appropriate waking times throughout the seasons. Why this pairing? This earthly branch and the essence of the Lung Zang is all about peaceful tension between opposites, like the time of the year associated with both. Further, being mindful of our need for balance between rest and activity is great preparation for the often overactive spring/summer energy.

April - Large Intestine, Mao 卯 (Rabbit) - Care of the planet/consumption: This category will contain practices that develop us into compassionate and sane consumers, while helping to develop our deep relationship with the natural world. Why this pairing? April is a time when we can see the beauty of nature all around us, so is a great time to contemplate our dependence on it and responsibility towards it. Also, the negative side of LI/Rabbit is a tendency to run rough-shod over the needs and wants of others, these practices will seek to counterbalance this.

May - Stomach, Chen 晨 (Dragon): Physical cultivation: This category will contain practices that help us to shape our physical bodies into ideal vehicles for the transmission of healing energy. Why this pairing? The natural world has exploded into full splendor and the weather in the Northern hemisphere will be warm enough in most places to warrant moving around outside. The ST is an Earth organ and is related to the flesh of the body, which we will be building with these practices. Think also of the dragon and its association with martial arts and other physical cultivation practices.

June - Spleen, Si 巳 (Snake)- Food choices - This category works in tandem with the previous one to help maintain the physical form of the body in an optimal way. Why this pairing? June is actually a great time to do fasting or other food restriction activities because most of us don’t feel any great desire to eat excessively in the summer heat. Further, reducing the burden on digestion will help us to focus on absorbing the pure Yang energy so abundantly available in June.
July - Heart, Wu 午 (Horse) - Community building/charity - This category speaks to our need to be an integral and contributing member of a number of communities. It also involves the practice of compassion in a world where inequality is the norm. Why this pairing? The summer is a wonderful time to participate in community-oriented projects! Also, the Heart and Fire (the Heart’s element) are about intimacy, about connection to Spirit — both of which are well represented in the idea behind this category.

August - Small Intestine, Wei 未 (Sheep)- Ethical Behavior - This category will include practices not covered in other categories that have some ethical dimension. These practices are likely to be very individual and defined by a person’s background, spiritual/religious practice and culture. For example, practicing “Right Speech” through abstinence from cursing. Why this pairing? The Fu (hollow, Yang) organs are said to transmit the essence of their associated Zang (solid, Yin) organs. SI exemplifies this relationship in its devotion to sacrifice as a way to manifest the Heart’s mandate of connection to Spirit in the purest sense. Also because many of the “ethical behavior” practices we discussed are somewhat prohibitive, it resonates with the descent into metal energy that the earthly branch Wei represents.

September - Bladder, Shen 申 (Monkey)- Arts/Aesthetics: This category involves the use of our creative faculties - particularly as they pertain to the arts associated with Chinese medicine, such as calligraphy. Why this pairing? These activities are Yin within Yang - they are still, yet active - like scholarship. More importantly is the symbolism of 申. One of the meanings of this character is to stretch, and the oracle bones show it as two hands pulling something in opposite directions. We might think about this as the intercourse between Heaven and Earth, the Human Being in the middle being the substrate that is stretched between those two poles. I think Art facilitates this threefold communication.

October - Kidney, You 酉 (Rooster/owl): Chinese medicine specific skills: This category includes the refinement of Chinese medicine related skills, such as hand techniques in acupuncture. For those not in the field, you might look into developing skills that will help you in your work. Why this pairing? The Kidney is often said to be the root of all skill and expertise. Also, with the cool calm energy of autumn, one can become focused enough to substantially increase specific skills.

November - Pericardium, Xu 戌: Relationships: This category will involve practices that help us develop more mature and meaningful relationships with others. Why this pairing? Pericardium is frequently said to mediate intimate relationships. One interesting symbolic note is the association of the earthly branch Xu, which means - essentially - weapon. This speaks on many levels to me. For instance, we must be careful to avoid violence in relationships, on whatever level. Also, relationships are a bit like handling weapons — if you’re not careful and mindful, it can come back to bite you. Finally, the late fall and winter are good times for relationship oriented activity, given that most of us desire to stay at home with family and friends as the weather cools.

December - Triple Burner, Hai 亥: Spiritual cultivation: Although we will be looking at spiritual dimensions of all kinds of activity throughout the year, this month we will give it special attention. These practices will probably be quite individual, but there may be some shared goals - such as having a daily meditation practice. Why this pairing? I’ve always learned about TB as being the mysterious “in between,” the mover between worlds, the ultimate stillness. What a metaphor for spiritual practice!

While all these categories are areas that many of us are already cultivating to various degrees, the syllabus will allow a renewed commitment and strengthened focus on a monthly basis. Each of us involved will also share our experiences online on our respective blogs.

To assist in this endeavor, I will also institute some ground rules. As I have been ongoingly engaged in studying pulse diagnosis and writing about it, I am committed to publishing articles regularly on this topic and have an agreement to publish a series with the Chinese Medicine Times. (The first article can be found here.) I also have plans with others to publish a video lecture on the same topic.

As I have recently begun a PhD program in Classical Chinese medicine, I also commit to studying the video lectures at least twice weekly and integrating the information into my practice.

I have been involved in martial arts since the age of 8, however, the demands of raising a family and running a busy practice have sidelined that passion for approximately 5 years. In November I have once again begun the study and practice of tai ji quan and commit to regular practice and qi cultivation.

I also have the unique opportunity of a close personal relationship with Lama Doctor Tsewang Ngodrup Rinpoche (see Rangnang Ogminling Bendirya Kunphen Ling) a gifted spiritual teacher and traditional Tibetan doctor. I have begun private classes with Him in Tibetan medicine and will continue to pursue this avenue of cultivation. My Buddhist practice is tied in with this study, and my commitment to bring this spirituality into my practice and life in a more authentic way is strengthened.

I also dedicate uninterrupted time to spend with my wife and three children. So often the busy days pass with squeezing in work and family time, the two often commingled into the same block of time. I will make separate time for work and for family, the latter being more active and involved.

More to come....

The Seasons

When asked how many seasons we have or how long each season lasts, many would argue 4 and that they last 90 days each. In Tibetan and Chinese medicine, we say that there are 5 and that they each last 72 days. Where the difference comes from is aligning the 5 seasons with the 5 elements/phases of nature: Wood, Fire, Earth, Metal Water.

Wood is associated with spring; Fire with summer, Metal with autumn and Water with winter. Earth is seen as mediating and bridging each season together harmoniously. Thus, the 18 day period between summer and fall, between fall and winter, between winter and spring and between spring and summer is earth.

So, typically in the lunar calendar of Tibetan and Chinese medicine, when we are starting winter according the western calendar on December 21st, winter is actually half over. The shortest day of the year (the least light), marks mid-winter. As our bodies are a microcosm of our world, this becomes very important and instructive on the kinds of behaviors and lifestyle that we should be following. And, as clinicians, it is equally important that we advise our patients appropriately and that we do not misinterpret signs on the pulse and symptoms incorrectly.

Call to Action: OPPOSE Chiropractic Acupuncture Bill

I urge all supporters of acupuncture and Chinese medicine to please take 5 minutes out of your day to call and email the following two assembly persons regarding this bill. Please leave a message with their office OPPOSING this bill. In addition, please send an email (you can use the text below, just cut and paste it). This is urgent. Chiropractors are trying to pass a bill that would allow them to practice acupuncture without going to acupuncture medical school. Their training would consist of a couple hundred hours (a weekend course and home study). Acupuncturists spend 4 years in school and over 3,000 hours studying acupuncture. Should this bill pass, the quality of care will be dangerously low and the risk to public safety dangerously high.

Assemblyman Joseph Roberts: asmroberts@njleg.org: 856-742-7600
Assemblywoman Bonnie Watson Coleman: aswWatsonColeman@njleg.org: 609-292-0500

Hi. My name is __________ and I am requesting that Assemblyman Joseph Roberts and Assemblywoman Bonnie Watson Coleman OPPOSE Assembly Bill 3122, the Chiropractic Scope of Practice Bill. This bill allows chiropractors to practice acupuncture (an entire system of Chinese medicine) with abbreviated (barely any) training and presents a significantly increased risk to public safety. Unless all references to acupuncture are removed from the bill, I am OPPOSED to A3122. This is a significant public safety issue and I urge an opposition to this bill.

Thank you very much for considering my position on this issue.

Coca Cola and Chinese Medicine? I don't think so!

Big pockets are constantly trying to cash in on alternative medicine. This is another attempt. Check out the following link. Imagine how difficult it will be for this Center (owned by Coca Cola) to conclude from its research and tell the world how dangerous Coca Cola is to one's health. This is such an egregious conflict of interest and attempt to misappropriate and co-opt Chinese medicine. I suppose we'll start hearing soon how healthy aspartame and splenda are with the new Coca Cola funded research. There is a lot of truth to Sun Tzu's words: Keep your friends close, and your enemies even closer. I guess Coca Cola has been studying.....

The Four Examinations, Part 6 (Palpation Diagnosis)

Palpation

Pulse: (mostly TCM here, not Contemporary Chinese Pulse Diagnosis, except for a few concepts)


Left Right
Distal = cun (inch) = heart and small intestine lungs and large intestine
Middle = guan (bar) = liver and gall bladder spleen and stomach
Proximal = chi (cubit) = kidney (yin) and bladder kidney (yang)/san jiao and PC


Speed: hot/cold
Location: interior/exterior
Strength: excess/vacuity
Yin/yang

Pulse has a close relationship to HT
Depends on HT qi
Can reflect pathogenic changes in
The HT, yin, yang, qi, blood; as well
As viscera, bowels, and channels

Location, speed, strength, form tell
About location, form and nature of disease
And the strength of the evil and right qi,
Strength of disease circumstances and
Prognosis of patient

Rate, Rhythm and Stability

Rate and rhythm are considered “larger segments” of the pulse along with the Stability of the pulse, uniform qualities on the entire pulse, at all depths or in each burner. The qualities at individual positions are unreliable signs until the larger picture is addressed. It is possible to deal only with the larger issues and achieve the greatest impact on the patient in terms of their needs and treatment.

“Big is Big”.

Deviations from normal in the larger segments of the pulse are generally the most critical in terms of seriousness of disharmony and order of treatment. Rhythm, rate and stability are clinical issues that take precedence over any quality or combination of qualities in diagnosis and treatment. Frequently when rate, rhythm and stability are brought into order and balance, other qualities and findings will automatically change.


Rate

Alteration from a normal rate is much more often a sign of significantly more far reaching processes than Heat and cold influences. In Dr. Hammer’s experience the rate more commonly involves factors that affect the Heart function and circulation, such as shock, over-exercise, overwork, physical and emotional trauma.

Normal Rates according to Dr. Shen (Hammer, 152)
Age Rate
Birth to 4 years 84-90/min
4-10 years 78-84/min
10-15 years 78-80/min
16-40 years 72-78/min
40-50 years 72/min
50+ years 66-72/min

Rapid Rate—
Common causes are External: pathogenic factor (wind-heat), heat stroke or trauma (physical or emotional) or Internal: heat from Excess (Heat in Qi level, Heat in the Blood: heat or Thick, liver Qi stagnation with heat, Nervous system Tense or “vigilance” pulse).
--Deficiency heat—Tight and less rapid than with Excess heat.
--Trauma—Effects of trauma on the pulse will depend on the condition of the True Qi of the person at the time of the trauma and since then depending on lifestyle, whether the trauma was local or extensive, time elapsed since the trauma.
Extensive physical trauma causes the pulse to be Very Rapid, Bounding, Tight to Wiry.
Local trauma will produce a less Rapid pulse with Tight to Wiry quality in the area of pain.
Emotional trauma leads to a very Rapid Bounding pulse with a very Tight quality over the entire pulse, especially in the Pericardium position at first, and later the left distal position. Change in Intensity and Rough vibration may occur over the entire pulse. The tongue and eyes are normal. (Hammer, 154)

Trauma is a shock to the circulation. Circulation into and out of the area is compromised. If the True qi is strong the pulse will become Inflated, meaning the energy is trapped in an area and it can’t get out. If the True qi is deficient, the pulse will become Flat, meaning the outside energy can’t get in due to the diminished Qi.
If the stagnation persists without intervention for a long time, energy is gradually depleted and the pulse becomes increasingly Reduced. It will be Feeble-Absent in the position corresponding to the body site affected by the trauma.


Slow rate—External cause: Cold from external pathogenic influence.
Internal causes:
--Cold from deficiency of qi and yang (chronic disease, overwork, over-exercise, over-sex, protracted emotional stress)
--Heart qi and yang deficiency—Heart is unable to circulate qi and blood which leads to a slowing of the rate. If constitutional, the left distal and proximal positions are Feeble-Absent; if the cause of the deficiency occurs after birth, the entire pulse is Feeble and the left distal Feeble or Absent.
--Aerobic exercise
--Poisoning/Toxicity
--Shock—over time will lower the Ht rate if unresolved.

Rhythm

Rhythm is the single most significant aspect of pulse diagnosis. It is a measure of Heart and circulatory function. Instability in the Emperor is tantamount to chaos in the empire. This must be dealt with first. Irregularity is considered in terms of whether it occurs at rest or with movement, whether we are able to count a rate, whether the changes in rate are small or large, and whether it occurs constantly or occasionally.

Interrupted: Misses beats with no fixed cadence. If able to measure a rate, indicates moderate Heart qi deficiency. If unable to count a rate due to the arrhythmia, indicates Heart qi and yang deficiency.

Intermittent: Misses beats with regular cadence (every 2 beats or every 3 beats). Indicates Heart qi, blood and yang deficiency. (Hammer, 121)

Change of rate at rest: Heart Qi Agitation, if found occasionally (Heart Yin Deficiency, page 409). Heart Qi Deficiency if found consistently.

Rate on exertion: An 8-12 beat increase is normal. An increase greater than 12 denotes Heart blood deficiency. A decrease in rate on exertion is a sign of Heart qi and yang deficiency. The method for assessing the change in rate on exertion will be demonstrated in the hands-on portion of class.

Normal Pulse

The normal pulse is resilient, compressible, of moderate strength and with spirit. The qualities, intensity and amplitude are consistent over time and in each position. Seasonal variations occur in rare instances where there is little pathology. Normally the pulse is somewhat stronger on the right side in women, and on the left side in men.

Three features: (1) Stomach Qi: reflection of post-natal qi (even, calm, good rate)
(2) Spirit: orderly w/o chaos, not changing (in rate, rhythm, stability…)
(3) Root: reflects KI: prenatal qi. Is there a KI pulse?; also reflected in deep level of all positions

The following are some characteristics of the Normal pulse which serve as a baseline and standard for health:
1. Rhythm - Consistently regular
2. Rate - Consistent with age
3. Quality - Compressible, resilient and elastic
4. Shape - Long, smooth and continuous without turbulence
5. Strength - Moderate with spirit - luster
6. Spirit - Moderate Spirit (languid, Leisurely, Relaxed, Slowed-Down) depending on body build
7. Root and depth - Balanced between superficial, middle and deep. The greatest strength should be in the root, at the deepest or Organ depth and becoming lighter as one ascends to the Qi depth. There is strength in the proximal positions. The pulse is deeper in heavy people and more superficial in thinner people.
8. Balance - Balanced between positions with the middle position occupying the most space, the proximal position the next most area and the distal position being the most confined.
9. Intensity (buoyancy, elasticity and resilience of the pulse) - Stable over time
10. Amplitude (height of the pulse) - Stable over time
11. Consistency - Qualities stable and consistent over time.
12. Wave - Sine curve that begins at the Organ depth and gradually rises to the Qi depth, and then subsides again to the Organ depth.


Qualities, intensity, rhythm and rate are consistent over time and in each position. The pulse is resilient, compressible, moderate strength with spirit.

Pulses of women and children tend to be more rapid than those of men. Athletes tend to have slower rates. Normally, the pulse is somewhat stronger on the left for men and on the right for women. Seasonal variations occur in rare instances where there is little pathology.

Buoyancy: The normal pulse in a child and sometimes in a vegetarian may be more yielding. In a woman it may be more thin and in a man more wide.

Shape: Pregnant women usually have more slippery and more rapid pulses.

Wave Form: Normal is a sine curve that begins at the organ depth, gradually rises to the qi depth, and subsides again to the organ depth.
The wave form is the movement of the blood through the vessel. The fingers can perceive the shape of this movement. Abnormal waves give us information about the condition of the patient.

Depth:
Tells about location of disease
Floating: exterior disease (usually): can be internal wind
Deep: interior


Strength: tells of length of disease: chronic or acute
New onset will be forceful b/c evil and right qi are strong
Chronic and enduring, qi will be forceless due to evil qi and right qi weakened


Does pulse match signs and symptoms? If no, prognosis is more difficult.

Considerations in taking pulse:
Time of day: best time is b/w 3:00am to 5:00am
State of mind: of you and patient. Must be calm, concentration, etc.
Time:
Rate: count for 60 seconds
Each position: spend a few minutes, check for abnormalities, changes in qualities, intensity…
Position of Patient: should be sitting down with hands at height of just below HT. Pillow under arms
Pressure/Techniques:
See 3 depths.
Rolling methods to access aspects of both principal and complementary positions. Soulie de Morant and Maciocia document rolling the fingers as an integral part of pulse diagnosis. Maciocia states: “Nearly all ancient Chinese texts on pulse diagnosis say that the pulse is felt not by keeping the fingers absolutely still on the artery, but by moving the fingers in five different ways: (1) lifting tells you whether the pulse is Floating; (2) pressing (down) tells you whether the pulse is Deep; (3) searching (not moving the finger) is used to count the rate; (4) pushing (from side to side) tells you about the shape of the pulse (5) rolling (distally to proximally) tells you whether the pulse is Long or Short
Watch for abnormalities:
Fan Guan
San Yin Mai
Ganglion Cysts
Trauma
Sex and Age:
Men’s pulse usually larger, and stronger on left
Women’s pulse thinner and stronger on right
Menstrual cycle affects: weaker after period; stronger before
Kids: faster rates
Elderly: weaker due to decline in qi and blood
Emotions:
Excess joy damages HT and causes pulse to be vacuous, or in extreme conditions deep
Overthinking injures SP/HT and pulse becomes bound, when extreme, string-like
Anxiety damages LU/HT/KI and pulse becomes rough, when extreme, surging
Anger damages LV and pulse becomes soggy; when extreme, rough
Fear injures KI and pulse becomes deep, when extreme, soggy
Taxation/inactivity/poor diet:
With poor nutrition: weak and forceless
After meals may become surging, slippery
Alcohol: rapid (choppy LV)
4 seasons:
spring: string-like
summer: surging
fall: floating
winter: deep



Depth:
Floating
a. Floating: exterior, superficial, usually associated w/ Lung; cork floating on water
i. forceful: exterior repletion
ii. forceless: exterior vacuity

1. floating and moderate: wind damp in exterior
2. floating and slow: wind stroke
3. floating and tight: wind cold
4. floating and slippery: wind phlegm or food stag
5. floating and rapid: wind heat
6. floating and scallion stalk: blood loss
7. floating and scattered: extreme taxation
8. floating and rough: blood damage

b. Scallion Stalk/Hollow: floating and large, hollow in center; arrives softly, when pressed, center is empty
indicates severe blood loss and yin damage

1. hollow and rapid: vacuity heat
2. hollow and slow: blood loss w/ vacuity cold (shock)
3. hollow and skipping: blood stasis binding internally (usually from trauma)

c. Soft/Soggy: floating, fine and soft; like cotton floating on water
governs vacuity taxation and vacuity cold of SP/ST and warm damp diseases, ie (uterine bleeding, post partum bleeding)

d. Scattered: floating large and scattered. No root. Empty at middle level and disappears at deep w/ pressing. Abnormal rhythm and feels chaotic. May be seen before delivering baby; HIV
severe KI qi vacuity

e. Leather/Drumskin: floating stringlike and large. Tight on outside and empty inside. Hard and straight w/ light pressing, empty within as if pressing on skin of drum w/ heavy pressure. Like scallion stalk but also stringlike and tight
blood collapse, essence defic; uterine bleeding; chemotherapy, hemorrhage


Deep
a. Deep/Sinking: felt only w/ heavy pressure
interior diseases

1. deep and forceless: interior vacuity
2. deep and forceful: interior excess
3. deep and slow: interior cold
4. deep and fast: interior heat
5. deep and tight: cold pain
6. deep and stringlike: swelling and pain
7. deep and slippery: phlegm food accum
8. deep and rough: accum of qi (masses)

b. Hidden: deeper than deep pulse; deepest part of muscle/ b/w tendon and bone; need heavy pressure
1. hidden and forceful: repletion evil hiding internally and obstructing movement of qi and blood; can be accompanied by diarrhea, vomiting
2. hidden and forceless: chronic and enduring diseases

c. Confined/Firm: hard, confined and fixed; deep in muscle layer; replete, large, stringlike and long; vessel feels hard and fixed
chronic diseases w/ deep evil; usually masses, obstructions and stagnations

Speed:
Rapid
a. Rapid: can indicate heat (interior or exterior; repletion or vacuity) or can indicate HT shock, etc. (see Hammer)
1. rapid and surging: exuberant yang repletion heat
2. rapid and fine: vacuity heat
3. rapid and stringlike: phlegm fire or heat in LV/GB
4. rapid and rough: yin or blood stasis causing heat

b. Racing: usually infection or severe HT shock; extreme repletion of yang when yin is exhausted and can’t control yang. Or if racing and forceless, yin of lower burner is exhausted and yang of upper burner is hyperactive. Beginning of separation of yin and yang.

c. Spinning Bean/Moving/Stirred: only felt at middle position (I’ve felt it at special lung pulse); feels like spinning bean; slippery rapid forceful
very serious, impending death or illness in organ system; or with extreme pain, palps or w/ pregnancy (3 mos.)

d. Slippery: arrives and departs smoothly; round and slippery; pearls sliding under finger
strong qi and blood
overabundance of qi and blood, ie heat, phlegm, dampness, food accum

1. slippery and floating: wind phlegm
2. slippery and deep: phlegm rheum or food stag
Hammer: can be infection, damp heat in organ
3. slippery and rapid: damp heat or phlegm fire
4. slippery and slow: lower bowel problems (dysentery)

Slow
a. Slow: cold patterns (interior or exterior; repletion or vacuity) or can indicate HT qi defic; toxicity
1. slow and floating: exterior cold
2. slow and deep: interior cold
3. slow and slippery: cold phlegm
4. slow and fine: yang defic
5. slow and stringlike: pain
6. slow and forceful: cold damp obstructions

b. Moderate/Leisurely: rate neither fast nor slow. But when combined w/ other qualities can be abnormal. Can be slightly slow/retarded.

c. Rough/Choppy: opposite of slippery. Knife scraping bamboo. Feels rough, w/ edges
Stagnation of blood (in tissues). TCM says also stag of qi, food, phlegm.
Can also have change in rate or rhythm. If pulse consistently rough/choppy, look for masses. Can be stringlike and rough if qi stagnation.

Force
Deficiency:
a. Empty/Vacuous: slow large forceless. Felt w/ light pressure only.
Vacuity of qi and blood
1. empty/vacuous and floating: qi defic
2. empty/vacuous and rough: blood defic (can lead to stasis)
3. empty/vacuous and rapid: yin defic heat
4. empty/vacuous and slow: yang defic

b. Minute/Faint: extremely fine, extremely soft; sometimes disappears. Extreme qi and blood defic; serious loss of blood or fluids (diarrhea, sweating, vomiting)

c. Weak: deep fine and forceless. Vacuity of qi and blood, but more of an internal condition where original qi is being consumed.

Excess:
a. Replete: arrives w/ force, full and large.
Excess heat, fever, food stag, constip.
Watch for replete pulse w/ chronic condition. Can be separation of yin and yang
Good in healthy person

b. Tight: like a twisted string vibrating under finger and hitting w/ force
indicates cold, pain, fright-wind, cold phlegm, hernia

c. Flooding/Surging: comes w/ strength and goes softly like a wave. Usually large vessel and loose. Normal in summer.
Yang ming pattern: 4 Bigs (pulse, sweat, fever, thirst)
May also appear in vacuity patterns where it will be forceless waves

Rhythm
a. Abrupt/Skipping: rapid, skips beats w/o pattern
1. skipping and forceful: yang repletion w/ evil blocking flow of blood
2. skipping and forceless: HT palps or chronic vacuity cough

b. Knotted/Bound: slow and irregular
1. Bound and forceful: qi and blood stag; phlegm and food accum; masses; emotional problems (depression….)

c. Regularly Intermittent: forceless and skips w/ regular rhythm
indicates organ qi vacuity, esp Heart; extreme pain patterns or extreme fright; can be (normal if 3 mos. Pregnant?)

Form
a. Large: vessel is large
heat: repletion or vacuity
if forceful, beginning of disease
b. Fine/Thready/Small/Thin: clearly felt like a thread
qi and blood vacuity; yin defic
c. Long: exceeds normal pulse positions; soft and flexible, yet forceful
normal in spring
surplus of yang qi
repletion patterns

d. Short: felt in middle positions, but not in others
Lung or HT qi vacuity

e. String-like/Wiry: long and straight and stiff under fingers (violin string); like a tight pulse w/o vibrating. Usually thin and narrow
Liver pulse: liver stag, wind, fire; LV/GB heat
Slightly string-like is normal in spring
Phlegm accum or masses



Head:
Feel for temperature, quality (rough, smooth), moisture, lumps, bumps
Look for discoloration and visible lumbs
General color
Use back of hand to feel face
Feel forehead for heat and feel hands at same time
If palm is hotter than forehead: vacuity heat
If dorsum is equal or hotter than forehead: repletion heat

Neck/Head:
Look at fontanel in child/infant.
If protruding: liver wind stirring
If sunken: fluid depletion

Feel for lumps/bumps on neck. Are they soft and moveable (qi stag) or hard and fixed (blood stag)? Are they painful? Hot?

Forearms:
Feel for temp, moisture/dryness, swelling
Hotter on inside: yin defic heat
Hotter on outside: yang repletion

Skin:
Exterior heat: scorching when first touch, then diminishes
Internal heat: gets hotter and hotter
Heat blocked: don’t feel heat right away, then gets hot
Sweat on body: info on body fluids
Skin rough/dry: yin, blood vacuity
Skin swollen and sinks when touched: water swelling
Skin swollen and tight and doesn’t sink: qi swelling

Hands and Feet
If hot: hyperactive yang
If body and limbs are cold: yang defic
If limbs ice cold: reverting cold; yang exhaustion
Palms hot, body not hot: yin defic heat
Dorsum hot, body hot: external evil
Children w/ high fever: if fingers get cold watch for convulsions
If hands and feet both cold: SP/ST yang defic

Body
If sores on body, palpate sores: hot or cold? Soft or hard?
If protrudes the skin and hot and pain worse w/ pressure: yang type sore
If level w/ skin, not hot, only slightly painful: yin type sore
If hard and painful when press, pus hasn’t developed
If soft, pus has developed

Chest/Abdomen
Lying down comfortable w/ knees slightly bent (supported from underneath)
Make sure your hands are warm





HT


SP


LU LV

KI






If pain in abd relieved by warmth: cold pattern
If pain in abdomen relieved by cold: heat
If better when pressed: vacuity
If worse when pressed: excess

If lumps: where are they? What do they feel like:
If soft and moveable: jia: conglomeration (middle jiao)
Qi-type Ju: gathering (lower jiao)

If hard and fixed: zheng: concretions (middle jiao)
Blood-type Ji: accumulations (lower jiao)


Channels and Points
Palpate bilaterally (note differences)
Palpate 5 shu points; front mu; back shu; xi cleft; yuan source; luo connecting (tell about repletion/vacuity in channel itself and associated channel); lower he sea

Look for tenderness, abnormalities, lumps, muscle tone (tense=repletion; soft=vacuity), changes in color and temperature

Palpate A-shi points

Lung: LU 1, KI 27, UB 13, LU 6
HT: UB 15, Ren 14, HT 1
Women: SP 6,9, Ren 4
General Constitution: Ren 4,6

The Four Examinations, Part 5 (Inquiry/Asking Diagnosis)

The "10 Questions"

Inquiry/Asking

Demographics: name, age, sex, profession, life circumstances, birth place, where they live…

Past Medical History: Birth history (did mom have trouble conceiving, did she have any health problems during or prior to pregnancy, early, late, induced, breech, forceps, stuck in birth canal, cord wrapped around neck, jaundiced, blue, other complications…)

Childhood illnesses, learning disabilities

Traumas: sudden death of loved one, abuse (sexual, physical, emotional, verbal), major accidents, broken bones……………

Vaccinations

Medication history: antibiotics

Smoking/Recreational Drugs/Coffee

Exercise history: child athlete?………….

Family Medical History:diabetes, hepatitis, high blood pressure………….

Chief Complaint: why did they come in, when did it start (acute, chronic, what induced it), where is it located, progression, what makes it better or worse…..

10 Questions: 1. temperature: hot/cold; fever/chills
w/ chronic heat, can be from too much yang or too little yin
acute pathogenic invasion: wind-cold, wind-heat
yang pathogens: w-h, dryness, summerheat
yin pathogens: cold, damp
simultaneous fever and chills:
a. wind cold: more chills than heat (subjective), strong aversion to cold (wei qi can’t get to surface and warm you up; blankets don’t help), body aches; tongue normal b/c acute; pulse floating tight. This is the tai yang level of disease –most superficial
b. wind heat: more fever than chills, slight aversion to cold, sore throat, rashes, tongue normal or thin yellow coat, pulse slightly rapid and floating.
Alternating fever and chills: bitter taste in mouth, hypochondriac pain (malaria at its worst). The pathogen has penetrated into shao yang level.
Fever and no chills: internal heat
Chills and no fever: internal cold

Temperature can also tell us about vacuity/repletion
Vacuity:
Cold: maybe spontaneous sweating, body/limbs cold, clothes help, fear of cold
Heat: no aversion ot cold, heat in 5 centers, chronic

Repletion:
Cold: strong aversion to cold, bland taste in mouth, no thirst, diarrhea, clothes don’t help
Heat: acute, strong fever, 5 bigs

2. sweating
lungs disperses wei qi; fluid of heart; spleen and kidney w/ fluid metabolism; yin or qi defic? Excess yang or heat
a. where is person sweating?
a. Only on hands: nervous condition or lung qi defic
b. Only on extremities: spleen qi defic
c. Only on head and back of neck: ST heat or dampheat
d. Only on chest, palms and soles: yin defic
e. On head only: defic
f. All over body plus constip: repletion heat
b. What time of day?
a. Spontaneous sweat during day: qi is not holding/regulating pores/qi defic
b. Sweats in evening or during sleep: yin defic
c. Quality of sweat
a. Oily: yang defic. Looks like pearls
b. Profuse cold sweat after chronic illness: yang defic
c. Yellow: damp heat
d. W/ external pathogen: wind cold or wind damp: if doesn’t resolve: wei qi defic
d. Smell of sweat
e. Quantity of sweat


3. pain/head (dizziness)
head is most yang aspect of the body. All yang channels meet there. Sense organs on head

a. headaches:
i. acute: exterior attack, usually wind cold
ii. gradual onset: interior condition
iii. severe: excess/repletion
iv. annoying dull: defic/vacuity
v. daytime headache:
i. yang defic (annoying/dull)
ii. qi defic
vi. night headache: annoying: yin defic/ blood defic
Location: locations of meridians are important.
i. back of neck into eye: Tai yang channels
ii. frontal HA: yang ming
iii. side of head: shao yang
iv. vertex: liver
v. whole head band around: dampness
vi. pain inside head: damp; phlegm
What makes it better or worse.
i. worse w/ cold: cold pathogen. Better w/ heat
ii. averse to heat: heat pathogen
iii. better w/ pressure: vacuity
iv. aggravated by pressure: excess
v. fixed location/stabbing: blood stasis
vi. pain moves location and intensity: qi stag
vii. heavy: damp
viii. worse w/ activity: defic. Better w/ rest
ix. worse w/ rest: repletion. Better w/ activity

b. dizziness: due to wind, fire, defic of qi, or phlegm
i. swaying, losing balance: vertigo: internal wind
ii. head and ear clogged: phlegm

i.and ii. Are both excess conditions w/ fire components bringing up phlegm

iii. worse w/ fatigue, change of position: qi defic


4. hearing and vision
kidneys open to ears; liver to eyes. Gb and SJ have special affinity w/ ear

Ears:

Pain:
i. acute and repletion patterns: dealing more w/ channels involved and EPI and occasionally w/ externally/internally related channel (liver)
ii. chronic and gradual onset: vacuity. Dealing more w/ Kidneys
iii. better w/ pressure: defic
iv. worse w/ pressure: excess

Quality of Sound
v. tinnitus:
a. low pitch: KI defic
b. high pitch/whistle: repletion/Liver
vi. deafness:
a. sudden onset: repletion
b. gradual: vacuity

Vision:
Liver opens to eyes. Many meridians feed eyes (ht, st, gb, ub, sj)
Repletion:
Pain, swelling, itching, redness (wind-heat (acute) or internal liver fire)
Sharp stabbing pain like needles: toxic heat, fire poison in heart channel
Sand in eyes: spleen damp
Deficiency:
Blurred vision, floaters, flowery, photophobia, chronic dryness: liver blood defic
Pressure in eyes: kidney yin defic

5. stool and urine
Stool:
no pain w/ bloating: LV qi stag (harmonize ST and SP)
amount and color; well formed w/ no undigested food; easily eliminated
better w/ bowel movement: replete
energy of bowel movement tires you: defic
constipation: due to excess, defic, defic qi, blood, yin, yang, liver qi stag
acute: full heat in ST or intestines (yang ming). Tongue red w/ thick yellow coat
constip: from dryness in intestines
goat stools: small hard droppings (heat in intestines drying or LV qi stag)
abd cold to touch: cold or yang defic
abd hot: heat
alternating constip: LV qi stag invading SP and ST

diarrhea: could be same etiology as above; could be SP qi not transforming
foul smelling: heat
lack of smell: cold
cock’s crow: first thing in morning: KI and SP yang defic
blood in stool: damp heat in intestines
black stools: more serious: blood stasis (high in GI tract)
pus/mucus in stool: dampness
flatulence: LV qi stag
w/ odor: damp heat
no odor: cold in ST
borborygmus: gurgling: SP qi defic
Urine:
Ask about color, amount, pain, inhibition, etc.
Color:
pale/clear: cold in bladder or kidney
Dark yellow/brown: heat
Cloudy/turbid: damp
Amount:
scanty: heat (dried out fluids), KI yin defic (scanty but frequent), KI qi defic
copious: KI qi defic not consolidating (KI should mist up to Lungs and control bladder)
dribbling: KI qi defic
Pain:
Pain before urination, relief after: qi stag in lower jiao
Painful urination: heat in bladder
Retention of urine: damp-heat in bladder
Inhibited urine: can also be LV qi stag

6. appetite and thirst (taste)
Appetite: tells about SP and ST
Aggravated by eating: replete
Alleviated by eating: vacuity
Better w/ bowel movement: replete
Lack of appetite: SP qi defic
Excess appetite: ST heat
Appetite (hunger) w/o desire to eat: ST heat turning to yin defic heat. (May have red tongue w/ no coat)

Taste:
Desire for hot temp: cold
Desire for cold temp: heat
5 Element correspondences
craving or aversion for 5 element tastes
little stimulates: too much dampens/weakens
odd taste in mouth: look to 5 element correspondence; (ie bitter taste = LV/GB disharmony)
No taste: SP
7. sleep
shen is stored in HT and blood peacefully stored in LV. Sleep depends on state of blood and yin in body. If enough blood and yin, you sleep peacefully
Insomnia:
Can’t fall asleep, but once asleep, stays asleep: HT blood defic
Wakes easily: KI yin defic, HT yin defic
Combo of first two: HT and KI not communicating: usually more severe sx
Excess HT fire
Excess LV fire
ST heat due to food stagnation
Lethargy/Somnolence:
Sleepy after eating: SP qi defic
Fatigue (extreme) and cold: yang defic
Fatigue and heavy limbs: damp
Lethargy w/ signs of stupor and heat: external invasion of PC
Wakes up and doesn’t feel rested: GB qi defic
Grinding teeth:
Parasites
Emotional

8. chest and abdomen: pain/pressure, etc.
tightness in chest: lungs, heart, muscular
pain in sides/ribs/hypochondria: LV qi, GB qi stag (binding, constricted, can’t take deep breath, gas, bloating)
pain in lower abd/navel: intestinal cramping (SP), menstrual (LV/KI)
pain in epigastrium/solar plexus: ST region, food stag, or ST qi defic (differentiate by how pressure makes it feel)
pain in inguinal region/testicles: liver channel

9. gynecological: thorough history, first onset, timing, quantity and quality of blood, PMS, pain before, during or after periods, pregnancy and contraceptive, and sexual history, discharges, etc.
Chong and Ren: Need good LV blood and storage to fill Chong. Need enough KI yin and essence to make blood and SP to hold blood
If periods to frequent or comes early: heat: Liver gets hot; or SP qi not holding or LV qi not storing
Excess: thick, fire engine red
Defic: thin, watery
Period too late (more than 35 days): pregnant?:
Cold: congealed blood
Qi blood stagnation
Not enough blood: blood defic
Little blood: obstruction (qi, blood, cold) or defic
Lots of blood: qi defic (not holding) if pale, thin, or heat (more bright red and thick)
Leukorrhea:
White discharge: no odor: cold (yeast infection?)
Yellow discharge: smell: heat (yeast infection?)

10. lifestyle: rest/sleep/stress/emotions/tendencies
previous illnesses
old illnesses may show root of present disease
prior successes, failure
habits contributing to illness
demographics and emotional life and exercise, working conditions, etc.

The Four Examinations, Part 4 (Listening and Smelling Diagnosis)

Some info on the Listening and Smelling exam

Listening and Smelling
Quality of voice: faint, frail, diffic getting words out: Lung qi defic or Yuan qi depleted

Rough, loud, full: repletion of yang qi

Hoarse voice: repletion if something blocking voice (will have other sx)
Defic if other defic sx

Reluctant speech, withdrawn, slow: coldness

Incessant speech: heat

Sudden loss of voice: wind heat

Gradual loss of voice: lung vacuity

5 element sounds:

Quality of Shen thru verbal expression:
full and impaired consciousness and talking loud: dampheat

listless and mumbling: heart qi vacuity

Listening to movements: keeps still but utters groans: joint pain
Clear voice but distinct and low and succinct: headache
Weak and indistinct: chest constriction/weakness
Respiration:
Coarse and loud: repletion/fullness
Difficulty breathing: vacuity/feeble/emptiness

Asthma: Diffic inhaling: feeble/empty: feels better w/ deep breath: Kidney qi not grasping Lung qi (slight wheezing)
Acute: coarse and loud: better w/ exhale (can’t exhale): repletion pathogen in lung: phlegm

Coughs: loud: fullness/repletion
Dry: unproductive, no phlegm: lung yin defic
Dry w/ tickle at night: kidney yin defic (KI 6)

Hiccoughs: if short, just diaphragmatic spasm
Loud: repletion heat –usually stomach qi
Long-term, but low and weak: weak stomach qi (usually coldness)

Smell: bad breath: stomach heat or oral dental decay
Belching: foul or sour belch is retention of food in stomach
5 phase smells:
hepatic problems: sticky sweet
cancer and diabetes: ammonia

strong or foul smells usually associated with heat and repletion.
Absence of smell or ammonia: cold diseases and vacuity

The Four Examinations, Part 3 (Pediatrics: Diagnosing Children with Chinese Medicine)

PEDIATRIC DIAGNOSIS – WIND, QI AND LIFE GATES
In pediatrics, we have this problem in that we can’t really palpate the way we palpate adults. So we have a very special diagnosis, which is part of the Looking diagnosis for children. And we look at a vein on the index finer. This is only good for children under the age of 3, because after that the area in this space thickens. Basically, we look at this vein (lateral side of index finger). Now if you look at your own hand you have all these little joints, phalangeal joints… you stretch the skin and then you rub it 40-50 times (in China they actually use different mediums – ginger based water or water – to act as a medium and magnification). So you rub and you watch to see how far the vein comes up. These are called Gates or Bars. This (proximal joint) is called the Wind Gate or Bar. The middle one is called the Qi Bar or Gate. And the distal one is the Life Bar or Gate. Wind, Qi or Life.

As you massage, the vein becomes more distended. How much it rises gives you your prognosis. If it rises just a little past the Wind Bar, the diagnosis is mild, external Wind attack. The prognosis is very good. If it goes up past the Qi Bar, then the diagnosis is usually that the internal Qi has been affected; usually the disease is in the Zang Fu organs – there might be problems with digestion, constipation; there might be more of an organ problem. Still manageable, but more deep. If it goes past the Life Bar, then we have a very serious condition. It just gives us how deep has it penetrated (doesn’t tell us what it is or where it is).

Now in a healthy child this vein is really thinly visible, but it’s visible. Usually pale purple, maybe a little brownish in color. And only in that Wind Bar area. As you massage it, if it goes up, you’re developing a pathogen interiorly. If it turns more red, it usually indicates more heat. Green or blue indicates more cold. If it turns black, that’s usually blood stasis.

The Four Examinations, Part 2 (Tongue Diagnosis in Chinese Medicine)

TONGUE
The tongue is one of the major pillars of diagnosis, the other main one being the pulse. The tongue body proper is going to give you information more about the Yin organs, the blood organs in particular. How much is it feeding? The tongue coating is the result of digestion. So we’re looking at two overall things. We’re looking at a body and we’re looking at a fur coat. Now the body itself is going to have not only color, but a size and shape to it. And it might have cracks, and it might have red raised areas. And whether or not you can hold it out and it stays firms or moves around and quivers is going to mean something. And the tongue fur, it’s going to have a color and a thickness to it. And it’s going to have areas that it’s distributed in, and maybe some areas that it’s not.

When reviewing the tongue, the best light to look it is natural light. And foods also affect the tongue (change the color, etc.). Pepto Bismal does a nice job on a black tongue. Eggs make it yellow and orange juice also makes it yellow. Cigarettes do lots of things… stain it a little bit of brown.

The tongue is a muscle. It reflects the Yin organs. All channels are indirectly reflected in the tongue. SP connects w/ root of tongue and scatters over bottom; KI goes to root; HT connecting vessel goes to root; UB and SJ tendinomuscular channels go directly to tongue. Mostly it reflects the state of the Spleen and Heart. It shows the state of the Blood and it shows the state of Yin. The tongue coat shows the state of digestion. When you digest, the Stomach and Spleen digests, part of the Essence is said to go up to the tongue to become dirty dampness – it coats the tongue. Tongue coat shows the effect of the organs, especially the Stomach Qi. Now, when you’re dealing with a pathogenic invasion, the tongue coat tells you about the penetration of the pathogen. For instance, when you first get sick, the coat doesn’t change. As it (pathogen) progresses in, it (tongue coat) gets thicker; it might change color.

Eg. Somebody comes in with a Wind Cold attack. The cold penetrates in. Two days later, it’s now trapped heat. The tongue coat was nothing; now it’s thicker white. Then it becomes thicker and it’s going to turn yellow. Now the cold has changed to heat, they now have a fever of 104-105. They’re sick. Now the tongue is very red and the tongue coat is yellow. Three days later this person has burnt up all their Yin. The tongue coat falls off. Now they have a bright red tongue with cracks and it’s peeled. It’s absolutely glossy. Now it’s really deep in. They break out with delirium, macules and now they’re dead.

A normal tongue should be pale red (they say the color of fresh meat). So it should be red, but not bright red. It should be supple, soft and flexible, even shaped and it should have no cracks. And it should have an even, slightly moist, thin, white coat.


TONGUE MAP
The very tip of the tongue – that’s said to be the Heart. The area behind the tip, that’s associated with the Lung. The area in the middle is associated with the Stomach and Spleen. The rear of the tongue is associated with the Kidneys, but also with the whole Lower Jiao area, so it also includes the intestines, both small and large, the bladder and the uterus. Now the Liver and Gallbladder are on the sides. The right side is thought to be more associated with the Gallbladder and the left side is associated with the Liver, but most folks just say Liver and Gallbladder. So that’s the most common use. Another easier way is to say that the back of the tongue is the Lower Jiao, the middle of the tongue is the Middle Jiao and the front of the tongue is the Upper Jiao.

The tongue body shows the condition of Zang Fu organs, especially Zang, the Yin organs. Especially about blood. The overall color, that’s the state of the blood. The tongue is the only muscle that you can see and reflects what the muscles look like inside; that’s how much they’re nourished.

SPIRIT reflects good moisture/fluids, qi and blood
1. thriving: soft, flexible, moist
2. withered: dry, stiff, can’t protract, emaciated, dusky: no spirit

COLOR AND SHEEN
We look at the color first. It’s either going to be paler, redder or purplish or bluish.

Pale: A tongue can be slightly pale, but when you see a pale tongue, it almost looks white. It looks like it’s not being fed blood. Pale being Qi and Blood deficiency, Yang deficiency and Cold.
Difference between Qi insufficiency and Blood insufficiency is going to be in the moisture. If the tongue is insufficient in Qi or Yang, it’s going to be moist. If a tongue is insufficient in Blood, that’s going to be more of a dry tongue.

Repletion cold: fur is white slippery and thick, pale body
Vacuity cold: body pale and enlarged and tender, damp and scalloped

Red tongue. This is going to be either a full heat or empty heat.
Full/replete heat, the whole tongue is red.
Empty heat, the tip of the tongue is redder. The tip of the tongue is the Upper Burner (heat rises). Can be tender, with little or no fur.
If red in specific area, heat in that organ

Crimson, scarlet or deep red color – it just means there’s some extreme heat in the body. Usually they’ll have some febrile disease or you’re really insufficient in Yin. Can also be blood stasis. Heat in blood level.
Vacuity heat: little fur left/peeled
Blood stasis: crimson w/ stasis macules: usually skin disorders, too

Purple or dusky – usually the Qi or Blood is static. Now purple’s a mixture of two colors – blue and red. If it’s more blue-purple, it’s usually dealing with some cold. And if it’s a red-purple, it’s usually dealing with more heat stagnating.
Cold: cold in LV/KI and tends to be dampness
Qi and blood stagnation creating heat: stasis macules, a dry mouth (w/o desire to drink)
Purple: heat in blood
Swollen and large: alcohol toxins affecting HT
Purple or Blue-Green: less severe stasis, just certain areas, usually LV/GB first

Every once in a while there’s an orange color to a tongue (on the sides). Giovanni and Hammer say it’s liver blood insufficiency.

SIZE, SHAPE AND FORM
When you talk about size and shape, you’re talking about something that’s either too big or too small. Flabby or swollen usually has to do with either Qi or Yang is insufficient to hold it, or there’s excess Damp that’s making it too big. Sometimes there’s teethmarks on the side. That’s called scalloping. It’s usually worse in the morning.

Tough and Tender:
a. Tender: looks like beaten meat; indicates vacuity
b. Tough: appears hard and rough: indicates repletion

Swollen
Swollen w/ scallops: spleen qi defic w/ dampness
Swollen and pale: yang qi defic: replete yin
Swollen pale white tender and moist: SP/KI yang vacuity
Swollen and red: damp heat

Thin or narrow:
Thin and red: Yin insufficiency
Thin and pale: Qi insufficiency. Can also still be Yin/Blood Insufficiency as they often come together.

Prickles: if papillae stick up high
Usually reddish: heat

Fissures/Cracks: usually yin defic.
Crack down center, depending on length, can indicate severity of disease and progression
Crack in Center: SP/ST yin defic
Crack down center to tip: HT pathology

Scallops: SP qi vacuity often w/ dampness

Tongue Sores: usually LV/GB and HT
Protruding, tight, painful, red: heat toxins in HT
Ulcers, herpes-type: heat in LV usually (can be HT)
Less painful and not protruding or tight: yin defic heat

Sublingual Veins/Network Vessels: under tongue
If dark and distended: blood stagnation
How far does the vein go?

DEMARCATIONS
The demarcations that you look for are cracks or raised areas. The cracks, they might be congenital, otherwise they mean something has eaten up the fluids. If you find cracks that are horizontal, that almost always means Yin Insufficiency. If you find cracks on a pale tongue, it usually means that the Qi and the Blood is deficient. And if you find cracks on a red tongue, it usually means that there’s heat – either excess heat that’s burned up the tongue or there’s insufficiency of Yin, usually Stomach Yin. You’ll start finding that (vertical) central crack that usually gets deeper and deeper. That’s usually Stomach Yin burning up.

The eruptions, the red areas that get raised, the little prickles – they’re always replete heat. Most people have it in the back of the tongue and the other place you’ll find them is on the side.

MOTILITY/BEARING
How one moves the tongue. Now the tongue should be able to be flexible and it should be able to sit there for a little while without shaking or moving around like a snake.
Rigid, can’t stick out – Wind. Or it can be a problem with Phlegm heat or Heat, but really extreme though. Delirium.
Deviated, that actually pulls off to the side, shows that there’s some obstruction of Wind and Phlegm in the channels. Wind stroke.
Trembling: heat creating wind; Wind or Qi or Yin Insufficiency. When it’s Qi or Yin insufficiency it’s really mild. When it’s Wind… their tongue is wandering all over.
Dog tongue, the panting or lolling tongue: replete heat.
Limpness: floppy soft w/o strength, hard to turn from side to side or curl: usually in serious conditions
Limp and pale: serious qi and blood defic
Limp dry and red: heat burning yin
Stiffness: hard stiff and straight, not flexible, diffic to stick out or retract: lack of ST qi (critical)
Contracted: unable to extend out of mouth. Critical sign: wind-stroke or extreme heat burning yin
Protrusion and Worrying: licking lips constantly
Developmental problems, ie source qi defic
If adult and red: heat in HT and SP
If adult and purple: epidemic toxin affecting HT
If occurs suddenly in children: fright wind (childhood epilepsy)
Tongue Doubling: veins under tongue swollen and distended, looks like second tongue: due to fire heat surging up HT channel
Palsy: numb and doesn’t move flexibly: due to blood defic causing stirring of LV wind or wind-phlegm
Protracted: extends out, difficult to retract; long and hangs out
If numb: qi and blood defic
If deep red and drool: wind phlegm, phlegm fire


SUBLINGUAL VEINS
Tell us about circulation. When diseased, they are swollen, distended; one side or the other or both. They become bluish-purplish – tells us about blood stasis. The distention tells more of Qi stag; the purple/blue/black tells of blood stasis.

TONGUE COATING
This is the excess of the turbid Stomach qi. Good stomach qi produces a good tongue coat. It’s part of the healthy digestive process. Normal coat is thin white smooth and evenly distributed and slightly moist. Abnormal coat is generated by evil qi.

The coat can also tell of a pathogenic invasion and location. How deep the pathogen has penetrated.
Color:
white: cold, exterior conditions, dampness
body red, coat thin white moist: external wind heat
body normal, coat thin white moist: wind cold
thin white and dry fur: ext evil transforming into heat and damaging fluids (body usually red)
thick white glossy: damp turbidity or cold damp, usually w/ pale white body
thick white can mean heat in certain situations: if looks like snow powder and body is red can be damp heat internally or epidemic type disease or hidden heat
Yellow: heat, deeper the color means stronger the pathogen
Yellow thin: wind heat or wind cold transforming
Yellow thin and dry: heat damaging fluids
Yellow thin and moist: fluids still ok
Yellow thick and glossy: damp heat accum and stag in SP/ST
Yellow thick and dry: heat evil damaging fluids
Yellow thick w/ pale white enlarged body: SP/ST defic w/ water dampness
Yellow slimy: damp heat in SP/ST or phlegm or food accum
Yellow burnt w/ cracks and prickles: extreme heat consuming qi and yin
Yellow and white together: evil moving internal
Grey black: extreme heat (w/ crimson body) or cold (w/ pale body and moist/swollen)
White → yellow → grey (chronic) → black
Repletion Heat: black dry burnt w/ red body
(Yang) Deficiency Cold: thin black damp w/ pale white body and tender or pale purple

Moldy Sauce: mixed colors: yellow/red/black
Long term chronic damp heat complicated w/ summerheat

Peeling: where is it peeling?
If many sections: depletion of ST qi/yin

True fur has root (ST qi rooted). If fur can be scraped off → false fur (no ST qi)

Thickness/Texture:
Thin: can see thru coat: normal
Thick: can’t see tongue body: excess repletion. Thicker the coat: stronger the pathogen
Tofu: large clumps of fur, unrooted,
Loose: can be brushed off: severe dampness; stomach not transforming; repletion heat evaporating and transforming turbid dampness in SP/ST
Moldy: over entire tongue or in spots: improper rottening and ripening of ST
Pus-like: thick and sticky and looks like sores: internal abscess
Greasy: pathogen plus dampness
Slimy: greasy and dirty; smaller pellets/clumps which are sticky: damp turbidity
Peeled: no coat: either stomach yin defic (can’t make coating) or Kidney yin defic if no coat all over and red

Topography: see diagram above

Moisture: tells about state of body fluids; normal is moist w/ no pooling, supple
Too wet: yang qi not transforming or dampness
Dry: heat or body fluid dryness (blood)

Water makes tongue more moist
Olives, coffee, plums, turn fur black/yellow
Vitamins C, riboflavin, tea, cigarettes, stain yellow
Milk makes fur white
Antibioitics cause tongue to peel and/or thick tongue fur
Eggs stain fur orange
Candy will change fur color

Tongue Body reflects:
a. circumstances of right qi: change in color, form or bearing reflect right qi, viscera and bowels; ie. Thin=qi vacuity; pale=blood vacuity; deviated=wind/blood stasis
b. vacuity and repletion of zang fu
c. debility/exuberance of qi and blood

Tongue Fur reflects:
a. circumstances of evil qi: yellow=heat; white=normal or cold
b. depth of disease: tongue fur thicker if interior.
c. existence of ST qi