Reply To: Acupuncture Bootcamp
I’m going to copy your text and intersperse my answers below in bold.
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1) A patient presents with dull pain in the epigastrium, feels better after eating, likes massage and pressure, no appetite, like warm drinks, vomits clear fluids, no thirst, cold limbs, tired, pale complexion. The Tongue is pale and wet, and the Pulse is Deep (Chen), Weak (Ruo), Slow (Chi) especially the right middle position.
I see ST cold signs… but then the tongue shows Yang deficiency so I got confused what to focus on. I’ve been told that the tongue and pulse trump everything else said … Pulse is deep which is indicative of Yang Qi def… but the Slow pulse isn’t I guess that’s the give away for cold?
Just trying to figure out how to reason this out!
First, I must say, that the tongue and pulse NEVER trump everything else said. What you’re doing is looking for the *collection* of signs and symptoms. No sign (or symptoms) can stand alone. A one-legged stool is not stable. A five-legged stool is very stable. If we are to rely solely on the tongue or pulse, then we have a wobbly stool.
You are correct with your initial diagnosis: Stomach Deficiency and Cold (a Maciocia-worded diagnosis). Now, let’s discuss the tongue and pulse!
If a tongue is pale, it can mean two different things: Cold or Blood Deficiency. In this case, the tongue is wet, which points us more in the direction of Cold. Why is there Cold present? We don’t know via the tongue alone.
The pulse is deep (interior), weak (deficient), and slow (cold). But wait! This case study is so good to us – the pulse is *especially* these qualities in which position? Right middle. What organs are here? Spleen and Stomach. Did the pulse say the right rear position, where the Kidney Yang is read? No.
The key here is, “Which organs are being affected?” Clearly, the Stomach is being affected by this Cold. Looking at the case study, do you see any lower back pain? Any soreness or weakness in the knees? Any dribbling of urine or clear, abundant urine? No. We don’t. The Kidneys are not involved. Only the Stomach.
So, to recap:
1. The collection of signs and symptoms makes up a case study. No one diagnostic stands alone. Not even the pulse.
2. Do you think that another organ is involved? If you can’t prove it with a couple of signs or symptoms, it’s not.
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2) Poor appetite, slight abdominal distension after eating, tiredness, lassitude, weak limbs, loose stools, pale complexion, depression, scanty periods, insomnia, thin body. The Tongue is pale, thin, slightly dry and the Pulse is Thready (Xi). What is the TCM diagnosis?
I see blood def signs and see Spleen signs… but seeing the Depression I picked this to be a Sp and LV problem…. The answer was Sp Blood def. And as I look through my books, I don’t see this as a syndrome .. am I missing soothing here?
Do you own the second edition of Foundations of Chinese Medicine by Maciocia? If so, please turn to page 574. These signs and symptoms are right out of his book. Here are two quotes from this passage:
“Therefore, ‘Spleen-Blood deficiency’ simply indicates a deficiency of Spleen-Qi that leads to deficient Blood; as mentioned above, a diet lacking in Blood-nourishing foods is often the cause of this condition.”
“Note that there is some depression and insomnia as the deficiency of Blood may affect the Heart and that the body is likely to be thin (from Blood deficiency) rather than tending to obesity as it is in Spleen-Qi deficiency.”
If I may be so bold to say: I see a pattern in which you are breaking down case studies. One sign or symptom is throwing you down another diagnostic pathway. Do you see any hypochondriac pain, distension in the hypochondrium or chest, sighing, painful or irregular menstruation, irritability – any of the signs and symptoms associated with Liver? No.
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3)An individual harbouring long-standing resentment affecting the Liver can appear:
* irritable and red faced subdued and pale
How can someone have irritability OR subdued emotions… seem like opposite symptoms
Do you remember where you saw this question as I’d like to review it before making any comment. I am unsure of the context.
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4) Sadness dissolves Qi and affects:
* Heart and Lungs
Can you please explain why the answer is not LU and SP?
Please review emotions in Foundations of Chinese Medicine by Macioica, second edition, page 464.
“Sadness and grief induce Qi deficiency of the Lungs, which, in time, affects the Heart and makes Heart-Qi deficient. The ‘Simple Questions’ in chapter 39 says: ‘Sadness dissolves Qi’.”
“Worry knots Qi, which means that it causes stagnation of Qi, and it affects both Lungs and Spleen: the Lungs because when one is worried breathing is shallow, and the Spleen because this organ is responsible for thinking and ideas. Chapter 8 of the ‘Spiritual Axis’ confirms that worry knots Qi: ‘Worry causes obstruction of Qi so that Qi stagnates.'”
