session 1 subject introduction review of cm physiology ... · review of cm physiology concepts of...

CMPR121

www.endeavour.edu.au

Session 1

Subject Introduction

Review of CM physiology

Concepts of CM diagnosis

Chinese Medicine Department

© Endeavour College of Natural Health www.endeavour.edu.au 2

- Welcome to TCMAD -

Chinese Landscape (Olly301, 2010).


TCM Assessment & Diagnosis

You will develop a thorough understanding of

aetiology and pathology in Chinese Medicine.

o What does aetiology mean?

Aetiology refers to why/how the disease

occurred. (A poor vegetarian diet leads to blood deficiency).

o What does pathology mean?

Pathology is the disease state. (Insufficient blood to nourish

the shen/spirit causes the insomnia).



You will be able to differentiate patterns in

reference to both the Zang fu (organs), and the

Jing Luo (channels).

Is it Spleen yang xu or Spleen qi xu?

Is it cold lodged in the Spleen channel?



You will be able to understand and apply the

various diagnostic frameworks that exist in

Chinese Medicine. Including:

8 pattern

6 division

5 element

4 level

3 vital substance



During this semester you will gain understanding

and demonstrate knowledge in relation to the 4

diagnostic methods:

o Inspection (of what?)

o Palpation (of what?)

o Inquiry (why?)

o Listening & Smelling (?)The Detective (Paurlan,2009)



By the end of this subject you will have gained the knowledge

to:

Understand the four diagnostic methods.

Understand the aetiology and pathology.

Reach an accurate Chinese Medicine diagnosis,

Using the appropriate diagnostic framework.


AssessmentAssessment tasks

Type

Learning

Outcomes

Assessed

Session Content

DeliveredWeek Due Weighting

Quiz

(1 hour)

1-5 1-8

Sunday

following week

520%

Assignment

Diagnostic folio and case study analysis.

(Word Count 2000)

1-5 1-24

Sunday

following week

1240%

Final Written Exam

(2 hours)

1-5 1-26Final Exam

Period40%


Quiz

o The Quiz focuses on testing the application of

knowledge for the 4 diagnostic methods and

the content contained in sessions 1 & 2.

o The Quiz is delivered online and needs to be

completed by the end of week 5.

o Each Quiz is different from the next, as the

questions are generated randomly by a

computer. You have 1 hour to complete the quiz

and there are 21 questions.


Quiz

o The power point slides for the subject will help

you complete the quiz. Make sure you read the

corresponding chapters in your set text for each

topic and complete the student study guide

activities.

o The Quiz focuses on testing your capacity to

apply your knowledge of the 4 diagnostic

methods. You need to ensure that you

understand each of the four diagnostic methods

well before you commence the quiz.


Quiz

o The Quiz contains multiple-choice and drop

down answer questions.

o Many of the questions are case based to test

your application of knowledge.

o There are also some case-based questions that

use photographs or diagrams.

o Do all your readings and study beforehand and

have fun!!!


Diagnostic Folio & Case Study Analysis

There are two aspects to this assessment:

o Diagnostic Folio - This part of the assessment

requires you to photograph a volunteers tongue and

provide a detailed diagnostic analysis.

o Case Study Analysis – Select one of the provided

case studies and provide a detailed explanation of how

you would use the four diagnostic methods to arrive at

an accurate diagnostic conclusion. Include insight into

the aetiology and pathology of the case.


Diagnostic Folio – Tongue Analysis

Photograph one person’s tongue and undertake a complete diagnostic

analysis.

Please include:

A photo of the tongue.

What is the TCM diagnosis based on the findings?

Consider tongue moisture, body, coat, colour, shape, movement, spirit,

cracks and sublingual veins.

What signs and symptoms would you expect with this tongue presentation?

Make mention of the pulse you would expect to find that would match this

tongue?

*This assignment needs to completed independently, using a case from one of

your classes is not acceptable.


Case Study Analysis

Select one of the cases provided and undertake a detailed

diagnostic analysis, focusing on the pattern differentiation

process.

Discuss how you would utilize each of the four diagnostic

methods to help you reach an accurate diagnostic

conclusion.

What information is missing? And how would the four

diagnostic methods help you differentiate the pattern?


Final Written Exam

o The written exam is a two hour exam scheduled

in the final exam block.

o It will cover all the content from the whole

semester.

o The exam will be include multiple choice, short

answer questions, and case studies.


Concepts of Chinese

Medical Diagnosis


Chinese Medical Diagnosis

Expansionist

Symptoms

Signs

Constitution

Environment & Lifestyle


Western Medical Diagnosis

Reductionist

Symptoms as

Syndromes

Scans / Surgery

Genetic Indicators

Blood Tests

Body as a machine Body as a garden

WEST EAST

VS.

(Beinfield & Korngold, 1991).(Beinfield & Korngold, 1991).


Pattern Differentiation

o Pattern differentiation is a key aspect of Chinese

medicine and sets it apart from Western medicine.

o Patients who present with the same “disease” are given

different treatment based on the cause of the disease for

them as an individual.


Pattern Differentiation

For example 2 patients present with insomnia. Each patient

may be diagnosed with the same disease name,

(insomnia), but given a different pattern name and a

different treatment.

Patient 1: Pattern diagnosis is Liver Fire – the focus of the

treatment is to clear heat from the liver.

Patient 2: Pattern diagnosis is blood deficiency – the focus

of the treatment is to nourish blood.

Diagnosis and treatment plan for schizophrenia in Western and traditional Chinese medicine.

John Rathbone et al. BJP 2007;190:379-384

©2007 by The Royal College of Psychiatrists


Constructing a CM Diagnosis

There a three important aspects to a Chinese medicine

diagnosis:

Disease Name – This should reference the patient’s

main complaint. Examples include insomnia, cough and

specific CM conditions such as bi syndrome.

Pattern Diagnosis – The CM pattern differentiation. For

cough that may be Phlegm Heat in the Lung.

Treatment Principle – The treatment principle is the

verb. What do you plan to do? This should always clearly

reflect the pattern and disease diagnosis. For example:

Clear phlegm and heat from the Lung, stop cough.


Theoretical Frameworks

o Chinese medicine uses many different theoretical

frameworks for diagnosis of a patient.

o This is often driven by the patient’s presentation and

sometimes by the practitioners training.

o The framework is the descriptor that identifies and

explains the patient’s presentation.


Theoretical Frameworks

o 3 Treasures (Shen, Qi, Jing)

o 3 Jiaos (Upper, Middle, Lower)

o 4 Levels (Wei, Qi, Ying, Blood)

o 5 Elements (Earth, Metal, Water, Wood, Fire)

o 6 Divisions (tai yang, shao yang, yang ming, tai yin, shao yin, jue yin)

o 8 Principles (Ba Gang)

o 8 Extraordinary Meridians

o 12 Zang Fu (or zang xiang meaning visceral manifestation)

o Vital substances (Qi, Blood, Jing, Jin Ye, Shen)

o According to Pathological Factor (Wind, Heat, Cold, etc)


Four Diagnostic Methods

o Inspection – (whole body, in detail, tongue)

o Palpation – (pulse, abdomen, channels, points)

o Inquiry – (asking the right questions)

o Listening & Smelling


Symptom

Subjective

Patient reports

experientially

Sign

Objective

Doctor identifies as an indicator

A symptom and a sign can sometimes be the same thing.


Chinese Medical

Physiology

Olly301, 2010


Chinese Medical Physiology

o Yin & Yang

o Qi

o Xue (blood)

o Jing (essence)

o Shen (spirit)

o Jin Ye (fluids)

Body as a garden (Beinfield & Korngold, 1991).


Chinese Medical Diagnosis

o Is the substance healthy

and in the correct amount?

o If not, is it excessive or

deficient? Do I need to

tonify or drain?

o Which mechanism in the

body is failing? Which

organs/channels are

involved?

Body as a garden (Beinfield & Korngold, 1991).


For each patient the practitioner should reach a clear

diagnosis and a treatment principle:

o Diagnosis: Cough due to Lung qi deficiency.

o Treatment Principle: Tonify Lung qi, stop cough.


Chinese Terminology

Xu = empty/deficiency

Shi = full/excess

Yu = stasis


Increase Decrease Move Balance

Tonify Reduce Resolve Harmonise

Nourish Clear Invigorate Restore

Build Expel Release Calm

Support Drain Open Moderate

Warm Sedate Transform Regulate

Raise Eliminate Eliminate

Promote Subdue Promote

Reinforce Scatter Activate

Strengthen Disperse Spread

Fortify Pacify Disseminate

Fosters Dispel

Treatment Principle

Terminology


Qi

Sunrise (Wickramanayaka, 2014).


Qi

2Maciocia (2015, pp.45-46).

014

1. The refined energy produced by the Internal Organs,

assuming different forms in different places.

2. The functional activity of an Internal Organ.

3. An energy which manifests simultaneously on the

physical and emotional-mental-spiritual level.


Qi

“Qi can be understood as the creative or formative principle

associated with life and all processes that characterize

living entities……. Qi is an invisible substance, as well as

an immaterial force that has palpable and observable

manifestations.”

Beinfield & Korngold (1991, p32). 014


Types of Qi

Zheng Qi – Upright qi that

protects the interior.

Xie Qi – Pathogenic qi that

disrupts the body.

Vegetables (Fager, 2014). Germs (Seidel, 2008).


Qi Production

The steaming cauldron (Lark, 2012).

Upper Jiao

Middle Jiao

Lower Jiao


Qi Pathology

Upper Jiao

Middle Jiao

Lower Jiao

o Deficiency

o Excess

o Stagnation

o Improper movement


Xue - Blood

Blood (Mycatkins, 2012).


Xue – Blood Production

• Spleen

• Stomach

Gu Qi

• Lung

& Kidney• Heart

Xue

See Maciocia (2015, pp.61-63).


Xue – Blood

See Maciocia (2015, p.63)

Spleen makes

HeartGoverns

Liver Stores


Xue – Blood Pathology

Deficiency

Stagnation

Heat


Jin Ye

Fluid

Water (Burrows, 2012).


Jin = lighter

clearer fluids

Ye = heavier

thicker fluids

Water (Burrows, 2012).


Jin Ye - Fluid

o Excess causes blockage, cloudy thinking, oedema,

phlegm, nodules.

o Deficiency causes dryness and heat.

o Yin nourishes fluids

o Yang moves fluids


Jin Ye

Originates from

Spleen & Stomach

Lungs

Kidney &

BladderSmall

Intestine

Skin & Muscles

urineto Large

Intestine

See Maciocia (2015, p67).


Yin & Yang

Balance (Simon, 2009).


Yin & Yang

Yin

Cool

Passive

Fluid & Blood

Interior

Zang

Substance

Chronic

Yang

Hot

Active

Qi

Exterior

Fu

Movement

Acute


Yin & Yang

o One of the fundamental concepts of Chinese Medicine is

the balance of yin and yang.

o Diagnostically it is vital to establish what the balance of

yin and yang is in a patients body as this will alter the

approach to treatment.

Yang excess Yin excess Yang deficiency Yin deficiency



Yang excess

o An excess of yang qi and heat in the body.

o This is also referred to as full heat as the yang qi of the

body is overflowing and needs to be drained.




Yin excess

o An excess of yin in the body can result in cold type

symptoms.

o This is also referred to as full cold as the condition is

arising from a “fullness” of cold rather than a deficiency

of yang.




Yang deficiency

o A deficiency of yang qi can often result in symptoms of

cold.

o This is also referred to as empty cold as the source of

the problem is due to an “emptiness”. In this scenario

your treatment principle would be to tonify the yang.




Yin deficiency

o A deficiency of yin can often result in symptoms of heat.

o This is also referred to as empty heat as the source of

the problem is due to an “emptiness”. In this scenario

your treatment principle would be to tonify the yin.


See Maciocia (2015, p15)


Shen - Spirit

Bagan Temple (Studio, 2013).


Shen - Spirit

o Shen refers to a persons consciousness, self awareness

and ability to follow their true path in life.

o Shen provides vitality and clarity.

o It relates to emotional health and well-being.

(See Kaptchuk 2000, pp58-59 for more info)


Shen - Spirit

There is a spiritual aspect associated with each organ:

Hun – The ethereal soul - Liver

Yi – Intellect / intention / thought - Spleen

Po – The corporeal / animal soul - Lungs

Zhi - The will – Kidneys

Shen – The mind - Heart


Jing - Essence

Moraine Lake sunrise (Wheeler, 2012).


Jing - Essence

There are two types of essence:

Pre-natal – which comes to us from our parents as a

fixed amount. It is a hereditary unit like our genes and is

linked to the kidneys.

Post-natal – which comes from food and drink. It’s

production starts in the spleen and stomach but then it’s

storage is related to the kidneys.

Maciocia also talks of a third being kidney essence which arises from

the interaction of pre and post-natal essence (2015, pp47-50).


Pre-natal Jing

Comes from our parents via sperm and ovum.

Is intrinsically linked to our constitution. Abundant jing

means a healthy robust constitution.

Is linked to the kidneys and it’s sphere of influence

includes bones, teeth and the brain.

Is responsible for long range developmental aspects,

such as growth, reproduction and aging.

Kaptchuk refers to it as “the inner essence of growth and

decline” (200, p.57).

Is finite in amount. Our body will call on this resource in

times of extreme overwork/fatigue/stress. Pregnancy and

excessive ejaculation both deplete this resource.


Post-natal Jing

Produced by the Spleen and Stomach from food and

drink.

Supports our bodies growth and development without

calling on our pre-natal essence.

Stored in the kidneys and supports Kidney Qi.


Jing - Essence

“An individual’s Qi and Essence are mutually

dependent. Qi emerges out of Essence, since

Prenatal Essence is the root of life. But Qi helps

transform food into Postnatal Essence, thereby

maintain and expanding that life.”

Kaptchuk (2000, p57).


Pre-natal Jing

Blood Post-natal Essence

Post-natal Qi

Qi - Spleen & Stomach

Yuan Source Qi

Kidneys

Lungs


The Three Treasures or Pillars

Shen

Qi

Jing

Bagan Temples (Studio KX, 2013).

Sunrise (Wickramanayaka, 2014).

Moraine Lake Sunrise (Wheeler, 2012).


References

Beinfield, H. & Korngold, E. (1991). Between Heaven and Earth. New York: Ballantine Wellspring.

Burrows, H. (2012). Water [Image]. Retrieved July 5, 2016, from https://www.flickr.com/photos/foilman/8247442551/in/photolist-

dyNikn-2PDARS-moKvwx-4nx8P5-pXWr6Y-ofyhsZ-ajx6RF-auitad-9UD2vs-jP3vcS-bgdYzg-g8W5Yn-bop3oR-6LbMCE-6dx7F9-

8VW83C-2obnSW-4nyUt-a3XHVZ-pkREpT-r2yj33-KyDN-p7WnqP-aohzY1-aiQ5Ta-c2LF73-cdTWpb-fCvsV3-6CuzQd-5Ey7xn-

qCYpsk-drpZHp-oVbqnh-9Ruz12-razwT3-CCi9E-a5RGfA-yL6ut-9Hnyzw-6W3fs8-9XRZk4-ebeyDJ-86W6ZG-f73LVJ-aEHEo9-

9XGsox-9xXyjU-brjSXE-eemzhR-9HjFGK

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okZr2T-bua5Bm-dTsW94-k6iuV-y7w45-ahg5ub-bH4RQk-caiXdf-6Uj6dQ-uLxsf-9nkR6B-8dGzHs-aj1ojg-rr9Jd5-7XLKZp-edQr1M-

6Vj4Tw-jWkfq-oZYgxY-4D5zDF-tk8i9-qRtpEd-nsf5bK-aVh7gB-6b3S1n-e41LW-6sie6R-2BVMvf-5rG6Yn-HKshfY-pMp1Px-

c8faYm-oB5Cc5-ahg6Xq-rZAboA-2AFmTn-eNtyn2-2mz5Kh-6snpYs-7zWPY8-dE6eFn-6YYSWX-8p4oK6

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fyD4k-5x9rG-7gvtmJ-aAyaJv-gVrmPc-78wL17-78wKLf-78sSfT-78wGWW-oXzQiX-9JYMoZ-3YgHi-c4Xev3-xfSDV-CHiCv-e9rwj4-

gPVyzB-nY2jq4-5ucm6d-8vhPHF-8vhNTD-bx66db-cge6vS-dy79mf-kZS3y7-8rKCQy-2KRsFm-cfHnZJ-ewDn52

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pNd6rD-gWqryZ-eTfyQt-hJhFVx-oRDfHX-dNwstB-7FE1Kp-dt89Uc-oRDeyx-GAFupQ-dYMoxd-7M4F1R-2WVYx4-7edJu5-9zN4jp-

aCiwaw-rk4NXS-7FE21K-bbqmjc-dt8kw3-7KivRn-8owrA4-7FE2da-9iTBrp-2NMzLa-DEucPo-vPAWLn-7EzikC-bxSEos-v5Rygv-

8gWtUq-douHWm-9omTQH-7SpmuQ-gUHx5h-uuYWaY-7F6jVt-5xndhJ-7F5PyE-96k8iB-7CQTHZ-8gTdhz-dMSL8P-f15SLw


References

Kaptchuk, T. (2000). Chinese medicine: The web that has no weaver. London, England: Rider.

Maciocia, G. (2015). The foundations of Chinese medicine (3rd edn). Seattle: Eastland Press.

Mycatkins. (2012). Blood [Image}. Retrieved June 23, 2016, from

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6KVBst-4kuh7Z-rpUf8Q-8YVruY-jMbyA-5QQ7Mp-6Z9P8T-xdkZA-EcGLnQ-37agx4-omdXyC-okYdZg-oo1G92-pySy1J-omdWPb-

o4M39H-om3Srf-o4LboG-7CaA6-o4M5LM-sy1dsR-eVwEGq-26HRk-fm7L9r-fmdvxC-cEDCW1-rgsrm4-5y83kN-peaf7b-fAL27j-

8cWKoA-aaeeVF-62aSQ6-7t388s-Pu5ZL-8sK6gM-7cKeTP-9nbwdT-asdcje-7fMJuo-byvDHc-aguYw4-buQ1sm

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dE1Awr-apfKMb-6D47MF-kBFqBv-LgUzN-9YELAA-ajsJyP-o8zmAG-9YLN93-9M6AhX-eaBFRw-nNepD4-7r4Ci4-8eoApk-2EJojE-

4QVM99-j2R4UQ-oufnpu-9YELW9-8RedLN-nTpm8S-efM842-9UGprs-p8dScW-qr7NBR-hLjYp9-9JZt9b-8GBNyt-pPaFFR-

kmkyob-2EJn85-ppCAm2-hKPW6R-6rFdN-7htjwt-bpLwce-oatLt9-4jGdHz-2EDwzp-daG9E3-n8JZ7z-oaBFTc/

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Rathbone, J, Zhang, L, Zhang, M, Xia, J, Liu, X, Yang, Y, Adams, C 2007, ‘Chinese herbal medicine for schizophrenia: Cochrane

systematic review of randomised trials’, British Journal Psychiatry, 190, pp.379-384. Viewed 16 June 2016,

http://bjp.rcpsych.org/content/190/5/379.long

http://bjp.rcpsych.org/content/190/5/379.long


References

Seidel, Russ. 1st Dec 2008. Germs [Image]. Retrieved June 30, 2015, from

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a4xHAi-4MTLcN-7mmb1d-f3dCiQ-66D8fe-33hoYi-bUxgN-Nqhaa-e3au4-8AhmZ-8Fsb2j-oPnHF-7VnpaM-zfKVY

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dzaU3R-9TMZfi-55ZnMm-3anSPA-9qpXTK-5fbTUB-98na9g-HkTHB-CoJCH-dovahH-8SsX6L-5VdYwE-7NEHh7-hnLxVK-HkTta-

ksGq1-j53UC8-4EWAtR-6vexEg-9Fn-7tSEko-8ep3t5-7e5jbm-9DZpY6-8q6bdU-eC45ac-dpZz8S-dX6LqG-37w1aF-9n6NSM-

3CTxL-69duGG-dC33nf-9o8cRz-r48VyF-EgD621-3TstV-8rdc8R-5BGNH3-b9TRDz-dWf2Bn-4x69kG-7NhqsR

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yGWXA-rz7s8d-gtY3g-fL7ySk-kw6ZLy-4eXNQu-6WWFmF-qTjsM6-4eTYmX-7xsEwM-3FJa7-qTjx9H-dATu5p-4GnRwR-4eTUNZ-

9uAeep-rPZRrw-4eTVtX-7Ezm8a-hZryHD-4eXsud-9376n-4eTTJn-hZqh77-4eTTox-qyoUze-4Mibbd-qD8yKr-g3az9G

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HxhhLL-e4dduQ-n88rSG-3i8PX-rnJKp1-fvzVB6-7RoBdT-rdZmYy-a4gUhk-2rfwnz-dfWRKS-s9MNUk-bnkKo8-CoT3Uh-cBbRsC-

7QTP8H-fN5NXZ-7jiMiV-yy4aV-ayxoBL-2FRsbN-bUL2we-6okS9v-69Ch7a-7n32mt-kjs1PZ-ir92UA-qRHvy-eeeVEX-edBip3-

63793L-4uWzz5-kfaiM2-njxf8E-anmJGw-cucwqh-4r18mz-bSWvE4-dd3QEx-55yUQJ-cdbe11-6gLAy6-6JoshD

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4Qz3Di-fYsSPm-74pRwd-7WnTkq-7WnTww-4QDgpN-5SxkGa-kuMbBg-4fs8fW-b9hm5e-fFbYf6-4dwLRj-6agpWC-rxFNQ1-

gwauGf-7x3Eqn-5WoCjm-7t6ZTV-4zHQyH-zxyPn-3RAfab-7iY5Di-ausMzs-gwaMaf-auq7BV-4seq1x-oofL4-j694ua-7wRFoo-

aLzg46-7WjB7B-ausTvq-4zUVa8-3f8PrG-33aRDZ-8DvkL8-dXFEso-oofKV-7xjjHQ-5Ux2mE-7UxaFw-b9hjir-guqygS-p67B1S

https://www.flickr.com/photos/10159247@N04/3073171418/in/photolist-5rsqQK-5FyNN7-8yRg7T-cmxYYw-6s2avC-91MisK-a4xHAi-4MTLcN-7mmb1d-f3dCiQ-66D8fe-33hoYi-bUxgN-Nqhaa-e3au4-8AhmZ-8Fsb2j-oPnHF-7VnpaM-zfKVY

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