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All lessons   Module 5: Going deeper   Lesson 6

Module 5   Lesson 6   Jian Zheng

Case work: mixed pictures

How do you read a picture with two or more patterns, a tongue and pulse that clash, and a red flag hiding among the TCM findings?

After this lesson you separate the layers in a mixed picture (what is old, what is new), you assign every finding to a pattern, you resolve the four familiar clashes between tongue and pulse, you find the red flag that sits among fitting signs, and you choose root, branch and a principle with an emphasis. Twelve cases, each with a drawn tongue and pulse.

Tongue body weeks: Qi, Blood, Yin, Yang what is old Coating days: the pathogen, the Stomach what is new Pulse now: Qi, strength, location shifts quickly; the first to be masked History the sequence: what came first and what never belongs 1 Separate the layers each finding with a pattern what is old, what is new 2 Resolve the clash time, context, location what weighs for what 3 Look for the flag fits nothing, or too neatly with an alarm symptom Answer root and branch principle with emphasis and what you monitor Refer see a doctor first
Schematic. What each source shows and how fast it changes: textbook, as in module 1, lesson 1 and module 3, lesson 1. The order of the three questions is the method of this lesson.

Know by heart

  • Layers. The body is old (weeks, the substances), the coating is new (days, the pathogen), the pulse is now (Qi, strength, location); mnemonic: the body is the climate, the coating the weather, the pulse the moment.
  • Two patterns at once. Assign every finding to a pattern. If something is left over, there is a second pattern, or a flag; mnemonic: nothing may be left over.
  • Root and branch. What came first and feeds the other is the root; when acute the branch first, when chronic the root, often both with an emphasis; mnemonic: what came first carries.
  • Four clashes. Red tongue with a slow pulse; Pale tongue with a rapid pulse; full coating with an empty pulse; Cold and Heat in one pulse. Resolve them with time, context and location; mnemonic: time, context, location.
  • What weighs for what. Substance and duration: the body. Pathogen: the coating. Strength and location: the pulse. The rate: only if nothing masks it.
  • The hidden flag. If one finding fits no pattern, or a pattern fits an alarm symptom too neatly (newly irregular, pressure on the chest on exertion, smooth red tongue with tingling, new headache after fifty, black stools, weight loss), medical care first; mnemonic: a fitting pattern rules nothing out.
  • The answer. Red flag; patterns with their findings; clash and resolution; root and branch; principle with emphasis.

The rest of this lesson is reference.

Three practice questions from this lesson

What does the tongue body show best in a mixed picture?
  1. The substances and what has been going on for weeks
  2. The pathogen that was added this week
  3. The strength and location of the Qi at this moment

Answer: The substances and what has been going on for weeks. The body changes over weeks and shows Qi, Blood, Yin and Yang. The coating changes over days and shows the pathogen.

What does the pulse show best when tongue and pulse say different things?
  1. Qi, strength and location, as they are now
  2. How long a complaint has existed, in weeks
  3. Which pathogen lies on the Stomach

Answer: Qi, strength and location, as they are now. The pulse shifts quickly. That is why it shows the now, and where it sits; the duration you read rather in the body and the history.

A picture began with years of Spleen-Qi deficiency; three weeks ago Damp-Heat was added. What is the root?
  1. Spleen-Qi deficiency
  2. Damp-Heat
  3. Neither of the two

Answer: Spleen-Qi deficiency. What came first and feeds the other is the root. An empty Spleen makes Dampness; with Heat added it becomes Damp-Heat.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 16 case-based practice questions, 15 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.

Try two lessons freeSee Tongue and Pulse