Diagnosis: Unit assessment

Empty heat or full heat?

• Flushes only in the afternoonEmptyFull
• High constant feverEmptyFull
• Red tongue without coatingEmptyFull
• Thick yellow coatingEmptyFull
• Night sweatsEmptyFull
• Strong thirst for cold waterEmptyFull

The patient says they feel very cold, but the tongue is red and the pulse rapid. Which do you follow?

1. The story: the patient knows what they feel
2. Tongue and pulse, and I look for why they feel cold
3. Neither: the consultation has to be repeated

Fatigue, cold limbs, pale tongue with white coating, deep slow pulse. Which pattern?

1. Yang deficiency
2. Yin deficiency
3. Exterior cold excess

Sort each finding onto the axis it settles.

• A picture established three years agoInterior or exteriorCold or heatDeficiency or excess
• Prefers cold drinksInterior or exteriorCold or heatDeficiency or excess
• The pain improves with pressureInterior or exteriorCold or heatDeficiency or excess
• Aversion to cold with fever since yesterdayInterior or exteriorCold or heatDeficiency or excess
• Scanty, very dark urineInterior or exteriorCold or heatDeficiency or excess
• Full, forceful pulseInterior or exteriorCold or heatDeficiency or excess

Stabbing pain always in the same spot, worse at night, purple tongue and rough pulse. Which pattern?

1. Blood deficiency
2. Qi stagnation
3. Blood stagnation

Irritability, tension along the sides, symptoms shifting with mood and a wiry pulse. Build the diagnosis.

The pattern fits perfectly and there is also a clear red flag. Which rules?

1. The pattern, if it explains every symptom
2. The red flag, always
3. The patient, who decides whether to be treated

Match each pattern with the finding that confirms it.

Normal pulse in every position except the proximal, very weak in both wrists. What does it suggest?

1. A short Kidney reserve
2. Heat in the Heart
3. Liver stagnation

Order the full diagnostic reasoning.

1. Rule out red flags↑↓
2. Close the three principle axes↑↓
3. Identify the substance affected↑↓
4. Locate the organ involved↑↓
5. Write the diagnosis and choose the treatment↑↓

Heaviness, yellow greasy coating, dark urine and foul-smelling stools. Which pattern?

1. Spleen qi deficiency
2. Damp with heat
3. Stomach yin deficiency

Sort each element of the case into root and branch.

• Years of Kidney yin deficiencyRoot (Ben)Branch (Biao)
• Insomnia for the past two weeksRoot (Ben)Branch (Biao)
• Established Spleen qi deficiencyRoot (Ben)Branch (Biao)
• Bloating after meals this weekRoot (Ben)Branch (Biao)
• Reserve spent by overworkRoot (Ben)Branch (Biao)
• A headache that started on MondayRoot (Ben)Branch (Biao)

You have settled that the picture is interior and hot, but not whether it comes from deficiency or excess. Can you treat?

1. Yes: cool it, which is what heat asks for
2. Yes, with general heat points
3. No: cooling deficiency heat makes the picture worse

Match each sign with what it reports best.

45-year-old man: months of insomnia, wakes at three, irritable, bitter taste, tension along the sides, red tongue with redder edges, wiry and somewhat rapid pulse. Diagnosis?

1. Heart blood deficiency
2. Liver fire, with the timing and the area confirming it
3. Kidney yin deficiency