Chinese Medicine notes 04-02

From DmesWiki

TCM04-02

Sept 25, 2005

Four assessments (cont.):

Second assessment: Listen/smell

Listen – different levels of subtlety but mainly:

1 – sound of respiration – when we listen for these things, we want to listen with our hearts, to what’s trying to be comveyed by the person in the person’s body. When we listen to many different breaths, we’ll get an idea of what is normal and what is a problem. For example asthma, chronic lung diseases, etc. have specific sounds. In TCM you’re listening to the sound to determine how the chi blood moisture yin and yang are out of balance. If you’re around someone who is having hard time breathing, ask if they’re afraid, and ask if you’re afraid. If so, call for professional help. If they can’t complete a sentence without stopping to breathe, it’s a serious problem.

• weak, short, hardly moving – sign of a deficiency of lung chi, overall chi, etc.

• forceful, harsh – excess (includes rattling)

• inhalation, exhalation – listening for sounds being out of balance, ie. long inhalation, etc. Indicates air coming in and not being grasped by the kidneys.

2 – sound of voice

• Quality – (from five correspondences)

Yelling (liver), laughing (heart), quivery (stomach, spleen), sobbing (metal),

Groaning (water) If you listen for these, you’ll start to hear them.

• Sounds that express pain, physical or emotional.

Ex. groaning when you get up. Depending on the sound and circumstances, you can use as clues.

• Voice changes with respiration

Ex. can’t get through a sentence, or starts out strong and tapers off, etc. You can tell if they’re forceful – yang or weak – yin.

• Verbal expression and response to questioning – appropriateness of response reflects the general state of shen spirit, either depressed or excited.

Fire might be excited and enthusiastic, earth is deliberate and explanative, etc. A person who isn’t earth but whose earth element is out of balance might be like this as well.

Metal – precise and specific.

Water is all over the place, using analogies that are indirect.

Wood – forceful and direct.

• Also listen to the actual words they use in response to questions. Ex: someone can come with pain. Obvious clue is they say it’s hot and burning. Someone else says it feels like there’s something stuck in their abdomen. It sounds peculiar, and you try to think what it means – stagnation (left liver 4 and lung 5, then immune point). Or if they’re stressed, they might say there’s pressure somewhere. If you’re listening, you can elicit the right description to make the diagnosis. Listen to repeated or similar words – if you listen to casual conversations you’ll start to pick things like that up.

3 – sounds of bodily noises.

*Cough – ex. moist rattling cough is phlegm imbalance and dry hacking cough is dry. Feeble cough is chi deficient. If they cough until they throw up, it needs antibiotic – could be pneumonia.

*Belching

*Hiccoughs

*Borborygmus

*Flatus

*Joint cracking

If someone is keeping still and saying ouch when they move, their joints hurt. If their voice is weak and indistinct, there’s pain in their chest and diaphragm – they’re not letting it move. If voice is clear but they won’t speak up, it’s a headache, and probably a vascular headache.

Smell

• Excreta

Phlegm, urine, feces, discharges – we don’t take samples but historically they did. If they say it’s putrid, etc. it’s a damp heat, ie. infection. Fishy odor indicates cold condition or deficiency.

• Breath – we commonly blame it on teeth and gums. It could be hot damp accumulation there (infection), or it could be from stomach imbalance – stagnant chi or stomach heat, which is more acute.

• Belching, flatus – if it’s regular or really foul, it’s called digestate imbalance. The intestinal flora is out of balance – usually and excess of fat, spicy, alcohol, etc., ie. too hot, or else too cold, or too much. In the long run it will lead to spleen deficiency.

You can gather most of this information simply by talking casually with a person and thinking of the quality of their chi flow. Listen to the quality more than the aspect. If they’re coming to you for help, you need to ask specific questions to narrow down the information.

We’ll learn this next week – how to ask the questions to narrow down the information. This means asking specific questions, and confidentiality becomes an issue. Anything they say and any interaction has to be totally confidential, except for when there’s a legal issue. Within class you can share in order to get an idea of how to proceed – don’t use their name or try to figure out who it is. People assume that from a professional, but you have to tell them so they’ll feel free to talk openly so you can help them in a better way. Also when writing up cases for class, don’t use their name.

You have to cultivate a feeling of caring and non-judgmental listing. And don’t bring it up again unless they do. If you can’t do that, don’t take a history. You can still do the general treatment protocol and help them.

Second part of hour, practice tuning our ear to how people say describe their situation.