All lessons Module 3: Reading together Lesson 3
Case work: twelve cases
Can you read twelve real pictures from start to finish?
Twelve clients, from one simple pattern to mixed pictures with Deficiency and Excess and two organs. Each case has a drawn tongue, a pulse wave and a short history with the answers that decide. Read it yourself first, using the ladder from lesson 2; the worked answer is behind the button, with the red flags first and then the reasoning through to the principle.
Know by heart
- The method. Flags; describe; Eight Principles; location; substance and pathogen; pattern and neighbours; check; principle; mnemonic: safe first, then ever narrower.
- Pale. Thin and somewhat dry: Blood (Liver with eyes, tendons and menstruation; Heart with sleep and palpitations). Teeth marks with an empty pulse: Spleen-Qi. Wet and Swollen with a deep, weak pulse: Yang; the complaints choose Spleen or Kidneys.
- Red. The coating chooses Full (yellow, sticky) or Empty (none); the location chooses the organ: tip Heart, sides Liver, root the Lower Burner.
- The pulse chooses. Floating and tight: Exterior and Cold. A wiry pulse with a normal tongue: Qi that is stuck. Slippery and rapid: Damp-Heat. Thin and rapid: Empty-Heat. Deep, weak, slow: Yang deficiency.
- Stasis. Purple sides or spots, full veins underneath, a choppy or tense pulse, fixed stabbing pain; mnemonic: what stands still turns dark.
- Two layers, two organs. Sticky coating on a Pale tongue with a weak pulse: root Empty, branch Full. Left guan wiry, right guan weak: Liver invading the Spleen. A redder tip without coating with Kidney complaints: Heart and Kidneys. Throbbing headache with a Red tongue without coating: Yang rising on Yin deficiency.
- Flags in the cases. Tired: Hb, ferritin, TSH, glucose. Burning urination with fever or flank pain: the same day. Fever with neck stiffness or breathlessness: a GP or primary care doctor, or emergency services (112 in Europe, 999 in the UK, 911 in North America). Throbbing headache: blood pressure first; with weakness or loss of function, emergency services (112).
The rest of this lesson is reference.
Three practice questions from this lesson
Case. Woman, 26, tired, poor appetite, soft stools; also three colds every winter, weak voice, sweats easily. Tongue Pale with teeth marks. Pulse empty, right cun and guan weakest. Which pattern?
- Lung- and Spleen-Qi deficiency
- Spleen-Qi deficiency, without the Lungs
- Wind-Cold
Answer: Lung- and Spleen-Qi deficiency. Spleen signs (appetite, stools, teeth marks, right guan) and Lung signs (colds, weak voice, sweating easily, right cun): two organs, one substance. Wind-Cold is acute, with a floating pulse.
Case. Man, 44, for one day more fever than chills, sore throat, thirst. Tongue Pale-Red with a redder tip, thin coating. Pulse floating and rapid. Which pattern?
- Wind-Heat
- Wind-Cold
- Lung-Heat
Answer: Wind-Heat. Exterior (floating, acute) and Heat (fever predominates, sore throat, rapid). Lung-Heat lies deeper: high fever, the pulse no longer floating.
Case. Man, 50, high fever for three days, cough with a lot of yellow phlegm, thirst, breathless on the stairs. Tongue Red, Swollen, sticky yellow coating. Pulse slippery and rapid. What is the first step?
- A GP the same day: rule out pneumonia
- Clear Phlegm-Heat first, a GP if there is no improvement
- Wait two days for the fever to come down
Answer: A GP the same day: rule out pneumonia. Fever for more than three days with breathlessness comes first: have pneumonia ruled out the same day. In TCM terms it is Phlegm-Heat in the Lungs; that comes afterwards.
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 3: Reading together.