ASM 202: Study Notes

Lecture 2:

4 Examinations:

Keep questions open ended because TCM is very specific – know when to ask and
what to ask!

Symptoms = What patient reports to you (subjective)

Signs = what you obtain from the patient whether or not the patient is aware of it
(objective)

1) Inspection – before you even talk to the patient

1. Vitality:
• Zang-fu organs, blood, Qi, essence, body fluids and Shen are all indicators
• Bright eyes (twinkle in eye), lustrous complexion, firm muscles (lack of
vitality = soft and flaccid muscles), smooth respiration (not smooth if you
notice accessory muscle breathing), consciousness are all signs of good
vitality – window to SHEN
• Dull eyes, dark/dull expression, emaciation, rough respiration, disoriented,
maybe unconscious, serious illness with poor prognosis
• Pseudo-vitality: In a severe state of illness (bedridden and palliative),
patient’s body, in one last effort for Yin and Yang to connect, will draw all the
Yin and Yang from all parts of the body, but there will not be enough vitality
for the body to sustain this reconnection, therefore they will disconnect again
and patient will die
o Looks like patient has recovered but will only last for about a day
o Treat patient if you think there is a chance that vitality can be restored
2. Appearance:
• Appearance of patient’s body as well as MOVEMENT – should be smooth
and desired movements (without effort) – build, gait, posture and movements
• Make a note of their movements – don’t have to tell the patient, just make a
note for overall picture
• Overweight
o Yin in nature due to the excess material – Qi deficiency as well
• Underweight
o Yin OR Qi deficiency
o Yin deficiency, leading to EMPTY yang excess
o Write body size down, but don’t DDx too quickly
• Can differentiate between Yang and Yin conditions by differentiating the
patient’s preference for hot or cold
o If they feel better with cold, then there is a Yang excess, or Yin
deficiency
o Not like Homeopathy (like treating like) – in patient
 o Hemiplegia
 Phelgm in the channel
 Qi and blood deficiency
o Any condition which there is movment is Yang and any lack of
movement involves Yin
• This slide not examined until third year
• Limb paralysis slide
o Pain management – any condition where heat makes it better and cold
makes it worse involves COLD disorders – any condition where cold
makes it better and heat makes it worse involves heat disorders
 Ie. Menstural pain and using heat for relief
 Ask what patient uses for pain so you can see if it’s a hot
pattern or cold pattern

3. Skin Color
• Cheeks and temples are the easiest place to detect skin changes
• Normal skin colour is one that has luster and the patent’s natural skin colour
for the their race
• 5 colours that indicate pathology
1. Blue: cyanosis (COLD)
o Cold – easiest one to assume – cold slows down blood (YIN)
o Pain (subjective): sever, strong, contracting pain
o Blood stasis: lack of blood movement eg. hematoma
o Yin aspect
2. Red: (HEAT)
o Yang in nature
3. White: deficiency
o Lacking colour and cold – white tongue, or other area of body
o White area could be susceptible to cold
4. Yellow: generally a deficiency
o Jaudice – in sclera
o Yin Jaundice – smokey dark, grey cloudy tones, yellow = Cold,
Damp
o Yang jaundice = bright yellow = HEAT, Damp
5. Black: Kidney deficiency (BIIIIIGGG ONEEE)
o Pure black is due to a KI deficiency eg. black circles under eyes
(also could just be due to wearing glasses for many years)
o Cold: is severe when causes black – means no movement of blood
whatsoever = SEVERE – worse than blue
o Water retention – KI deficiency – eg. Edemeaous legs and dark
patches
• Purple = is the indication that blood is becoming stagnant - see lack of
movement when you see process of becoming stagnant but not as severe
 as black

4. Facial Evaluation
 Don’t need to know Head & face, hair and Ears
• Eyes are Microsystems within themselves
• Need to know this for the test *****:
o Corners – Heart - usually red – changes show pathology in heart
o Eyelids - spleen – muscle wheel – know it’s function is affected
when eyes are droopy, stys
o Sclera – Lung – breathing, Qi wheel
 Look for excess redness, decrease in moisture, paleness
o Iris – Liver – Wind Wheel
 all internal wind is controlled by the liver
 Liver functions to move Qi around the body – Px: tremors,
spastic limb movements are all related to liver function
(wind like movement)
o Pupil – Kidney – Water wheel
 iridology – can assess Kidneys through color, and texture
of the pupil
*** don’t need to know the rest of the facial evaluation section – next 5 slides are
FYI

5. Secretions and Excretions

• Don’t need to know now

6. Tongue – top figures are generally accepted systems in tongue diagnosis

 Jiao is burner
 Spleen and stomach have very close interconnection
 Liver and gallbladder is really just the edge of the tongue
• Rest of the sections not covered now

2) Auscultation
• Sudden, loud, heavy = YANG conditions (excess)
• Gradual, soft, weak = YIN conditions (deficiency)

3) Olfaction
• Mostly used in France
• North America rarely uses this in diagnosis – use colour, sound and emotions
• Ongoing scents = predisposed condition
• Rancid = sweat (liver)
• Scored burnt = heart
• Fragrant scents = lingers and lasts in the nose – smell the dirt (Spleen)
• Rotten scents = smells of metal - like when you leave steel out in the rain (Lung)
• Urine = smells like an old age home (Kidneys)
4) Case Taking (Inquiry) – NPLEX!
1. Temperature
• Always start with this!
• What is their general temperature? Ask specific questions – feeling cold
subjectively and objectively as doctor can be two different things
o Sx: what they feel – Cold, Hot (in notes)
• Always ask questions that gives you definite answers
o Eg. They’re cold but when you touch them they feel warm therefore
they might have a deficiency

2. Thirst
• How much water do they drink?
• Do they sip or gulp?
o Gulp = Yang excess (like putting out a fire)
o Sip = gradually losing Yin therefore they’re replenishing gradually
• It’s ok to drink more water than needed, unless there is a Yin excess or Yang
deficiency because water adds more YIN

3. Appetite:
 Usually relates to spleen and stomach

4. Perspiration
• Do you sweat? When?
• Any night sweats? NIGHT TIME IS YIN TIME!
o Night sweat: don’t know that they’re sweating and are very wet when
they wake up – require change clothes often
o Need to make sure you differentiate between sweating at night
and night sweats!
o YIN deficiency = Yang is evident
• Spontaneous sweating – deficiency of Wei Qi
o Wei Qi controls the pores
o Could also be excess activity ie. with a trained marathon runner

5. Energy – slide self explanatory – IMPORTANT TO LABEL ENERGY – ask

questions about patterns throughout the day
6. Respiration and Voice
7. Sleep – everyone dreams
8. Vision and Hearing
 tinnitus – 2 types – excess (yang) is sudden, deficiency (Yin) is gradual
 Liver Pathology
9. Digestion – later
10. Urine: key question – does your input = output?
11. Reproduction – 4th year
 • Menses – want to know EVERYTHING about the cycle
• Want to know about libido – ASK DURING FIRST INTAKE

5) Palpation