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Dampness
Etiology Dr. Lau Kah Yong 2011 1 Dynamic balance Nature (Environment) Dynamic Balance Internal Steady State 2 Steady State 肝Gan Wood Liver Nature (Environment) Dynamic 肾Sheng 心Xin Water Kidney Fire Heart Balance 肺Fei 脾Pi Metal Lung Earth Spleen 3 Xie邪 ( Etiogical factors) Xie 邪 Pathogenic factors Etiological factors Evil Cause Upset Dynamic Balance Unsteady state （Disease state） 4 Establishment of etiology • Analyzing the clinical manifestation of disease Deduce • Nature & features of different pathogenic factors 5 Establishment of etiology Nature & features of pathogenic factors Clinical manifestations Analyze deduce 6 Establishment of etiology Xie (邪) Pathogenic factors Functional disorder Zheng (正) Clinical signs & symptoms syndrome Differentiation Antipathogenic factors Seeking the cause of disease by analyzing the manifestations 7 Classification of etiological factors Primary factors Secondary factors • Exogenous six climatic factors Pestilence • Endogenous •Phlegm •Fluid retention •Blood stasis •Stone formation Seven emotions Dietary Over working or resting • Others Traumatic injuries Injuries caused by physical or chemical factors Injuries caused by insects & animals Hereditary 8 Six climatic factors六气 • • • • • • Wind 风 Cold 寒 Summer-heat 暑 Dampness 湿 Dryness 燥 Heat （fire）火 9 Six pathogenic factors Six natural climatic factors Harmonious relationship Extreme or sudden changes Human body Change in adaptability Six pathogenic factors 10 Establishment of six pathogenic factors Sign & symptoms Compare Climate things phenomena in nature Generalize classify deduce Nature & Characteristics 11 Establishment of six pathogenic factors e.g. Climate Pathogenic Common factor features Clinical symptoms Wind Wind Migrating pain Tremor of limbs Dizziness Dampness Dampness Mobile Migrating Moving upwards Heavy Sticky Flowing downwards Edema of the lower limbs Heavy Sticky excretion 12 Six pathogenic factors Characteristics • Season & environment related • May individually or collectively cause disease • Can be transformed into other factors • Route of transmission may be cutaneous nasal, or orally 13 Six pathogenic factors • Season & environment related Spring Summer Late summer Wind 风 Dampness Dryness Cold 湿 燥 寒 Summer heat 暑 Heat (fire) 火 Autumn Winter 14 Six pathogenic factors • May individually or collectively cause disease e.g. Wind + Heat = Wind heat 风热 Wind + Cold = Wind cold 风寒 Dampness + Heat = Damp heat 湿热 Dampness + Cold = Damp cold 寒湿 15 Six pathogenic factors • Nature of disease caused may be transformable under certain circumstances e.g. Cold pathogen invades deeper Heat Transform into pathogens Accumulation of Dampness pathogen 16 Six pathogenic factors Due to difference in body constitution Persistent 1. Abundance of yang + Exogenous pathogens Heat 2. Deficiency of Yin 17 Six pathogenic factors Due to difference in body constitution Persistent 1. Abundance of yin + Exogenous pathogens Cold 2. Deficiency of Yang 18 Six pathogenic factors Due to difference in body constitution Persistent 1. Abundance of dampness + Exogenous pathogens Dampness 2. Deficiency of Spleen 19 Five endogenous pathogenic factors • Due to dysfunction of viscera and , or indirectly related to the six climatic factors • Manifestation appeared are similar to those caused by six climatic factors • Namely endogenous heat, wind ,dampness, dryness and cold 20 Wind tends to float Floating features Attack upper part of body Dispersing features Attack skin Headache Running nose Itchy throat Fever Sweating Aversion to cold 21 Wind tends to move Migrating character Migrating Migrating pain s/s Tremor Motility Convulsion Spasm Dizziness 22 Wind tends to change Changing tendency Rapid Onset & Recovery Urticaria 风疹 23 Wind Leader of all disease Leader of other pathogens Associate with Syndrome produced Cold Wind cold 风寒 Dampness Wind dampness 风湿 Heat Wind heat 风热 Dryness Wind dryness 风燥 24 Cold • Prevalent in cold environment • Two types of diseases caused: Superficial :-attacked by cold on the superficies Internal :- attacked zangfu & impaired yang qi • Two types of pathogenic cold Exogenous: attacked by exogenous cold Endogenous : result of impaired yang qi Mutually affecting 25 Cold tends to impair yang Cold pertains to yin pathogen Superficies Stagnated defensive (yang) qi Aversion to cold fever, anhidrosis 无汗 Internal : Yang qi of viscera Spleen, stomach Cold pain, vomiting, diarrhea Heart, kidney Aversion of cold curling posture, languid/spiritless cold limbs diarrhea with undigested food, profuse & clear urine thin & indistinct pulse 26 Cold tends to coagulate Stagnated flow or obstruction of qi, blood & body fluid Meridians & vessels : Pain Head: headache Viscera : abdominal pain Muscles & joints : severe pain pain 27 Cold tends to contract Restrain activity of qi Spasm of vessels Stagnation of qi & blood Contraction of meridians Inward movement of qi Contraction of muscles tendons, meridians & vessels Closing of the striae of muscles Inability of defensive qi to disperse Headache pantalgia（全身痛） Tense pulse Numbness stiffness spasm & coldness of limbs Chills Fever Anhidrosis （无汗） Papules 28 Dampness • Exogenous dampness Predominant in late summer Other predispose situations • Wet climate • Drench • Living in damp area • Endogenous dampness Cause by failure of Spleen to transform & transport water 29 Dampness • Heavy • Heavy body or limbs • Heavy head • Lassitude • Turbid • • • • • • Turbid secreta & excreta Dirty complexion Sticky lacrima Loose stool, mucous & bloody dysentery Turbid urine Oozing eczema 30 Dampness tends to obstruct Qi • Heaviness Tends to retain in the viscera and meridians Disharmony of ascending & descending Qi Obstruction of meridians Obstructs & disrupts activities of qi Tight chest and bloated abdomen Scanty & unsmooth urination Inhibited defecation 31 Dampness tends to impair yang qi Impairs spleen & yang qi (Spleen like dryness & dislike dampness) Irregular water metabolism Diarrhea, oliguria （尿少）, edema, ascites（腹水） 32 Dampness • Sticky & stagnant Diseases caused usually present with Unsmooth discharge of secretions & excretion Long course of disease & tends to recur e.g. eczema, arthralgia （关节痛） 33 Dampness • Tends to descend Tends to invade lower part & yin portions of body e.g. Stranguria（淋浊） , leukorrhea （带下）, diarrhea Edema is usually more severe on the lower limbs 34 Dryness • Predominant in autumn • Early autumn – warm dry • Late autumn – cool dry 35 Dryness • Xerotic （干燥） & rough • Tends to deplete body fluid – – – – Dry mouth, nose, throat, skin, Cracked skin & lips Scanty urine Retention of dry feces 36 Dryness • Tends to impair lung • Depletes lung fluid • Affect depurating & descending functions – – – – Dry cough with scanty phlegm Sticky sputum which is difficult to expectorate Bloody sputum Dyspnea （呼吸困难） & chest pain 37 Heat (fire) • Predominant in summer • Tends to flare up – High fever, red face, red tongue, aversion to heat, extreme thirst, sweating, full pulse. • Disturbs mental activities – Dysphoria （烦躁）, insomnia, mania （狂躁）, coma, delirium （谵妄） • Irritability & rapid movement – Diseases caused has rapid onset & transmission 38 Heat (fire) • Consume qi & impair body fluid depletes Heat fluid consume Qi Sweating Thirst dry throat dry tongue scanty urine Dry feces or constipation Qi Deficiency 39 Heat (fire) • Tends to cause endogenous wind Heat Scorch liver meridian deplete fluid deprive nourishment of tendons Liver wind High fever epistaxis （鼻衄） coma delirium convulsion stiff neck opisthotonos （弓 角反张） eyeball rolling upwards 40 Heat (fire) • Tends to agitate blood Blood Flow faster Flow out of vessels Vessels Scorched Heat Hemorrhage hematemesis hematochezia hematuria, Skin eruptions profuse menorrhea, sudden profuse uterine bleeding 41 Heat (fire) • Cause swelling & ulceration Heat Putrefy blood & muscles Abscess Furuncle Ulceration Redness swelling heat pain 42 Summer-heat 暑热 • Hot in nature • Pertains to yang evil • Appears after summer solstice (夏至 Jun21-Jun22） & before autumn solstice （立秋Aug 7-Aug 8） • No corresponding endogenous evil 43 Summer-heat Produces yang symptoms • • • • • High fever Dysphoria Reddish complexion Thirst with preference for cold drink Full & large pulse 44 Summer-heat • Tends to: • Disperse • Induces sweating • Consumes body fluid • Elevate • Disturbs mind Thirst reddish & scanty urine lost of qi shortness of breath lassitude dysphoria, dizziness comma 45 Summer-heat • Often complicated by dampness • • • • • • • Persistent fever （持续高热） Extreme thirst but less intake of water Heaviness of the body Lassitude of limbs Chest fullness Nausea or vomiting Loose stool or diarrhea 46 Pestilence (Epidemic exogenous pathogen) Group of pathogenic factors with strong infectious property (Toxic pathogen 温毒) Wen Yi （瘟疫 ） (infectious disease) Yi Li （疫疬） (fulminating infectious disease) 暴发性传染病 47 Pestilence • Similar to heat in the six climatic pathogens but more potent and infectious. • Spreads by air or direct contamination • Enter body through nose and mouth • Related to the environment, diet & sanitary condition • Also related to economic & cultural environment of the society 48 Pestilence • Diseases caused usually have : – – – – – – Sudden onset Progress rapidly Severe pathological condition Similar manifestations on infected patients Spread fast & easily High mortality rate 49 Five endogenous pathogenic factors Dysfunction of viscera Wind Cold Dampness Dryness Heat (Fire) 50 Endogenous wind 1 • Produced in Liver Liver Wind Internal disturbance of liver wind • Caused by: 1. 2. 3. 4. Extreme heat Transformation of liver yang Yin deficiency Blood deficiency 51 Endogenous wind 2 Extreme heat scorch Liver yin 热极生风 Hyperactivity of liver yang Deprives tendons of nourishment Symptoms of mobility Convulsion, tremor, rigidity of neck, opisthotonos 弓角反张, up-rolling of eyeballs, complicated by high fever, coma or delirium 52 Endogenous wind 3 Emotional disturbances or over fatigue Impairment of liver or kidney yin 肝阳化风 Excess Liver yang transform into wind Yin unable to restrict yang Disturbs upper orifices Facial palsy Dizziness Muscle cramp or spasm Convulsion Hemiplegia 偏瘫 Syncope 53 Endogenous wind 4 Protracted diseases or later stage of febrile diseases 阴虚生风 Failure of yin to control yang & nourish tendons Depleting Yin Convulsion Muscular spasm Involuntary movement of limbs Signs of heat due to yin deficiency 54 Endogenous wind 5 Inadequate production or excessive lost of blood Blood deficiency 血虚生风 Failure to nourish liver tendons & meridians Muscular tremor Numbness Rigidity of limbs Convulsion 55 Endogenous wind 6 Protracted disease Old Age Malnutrition Blood stasis Impairment of yin exhaustion of blood depletion of body fluid & essence 血燥生风 Dryness Lost of nourishment in skin＆ muscle Disharmony of meridians Dry skin, itching Desquamation or squamous 鳞状 & dry skin 56 Endogenous cold Congenital deficiency 寒从中生 Malnutrition Protracted diseases Internal dispersion of cold pathogen Depletion of Yang qi Lost of warming & transformative effect Hypo function of viscera & tissues Excessive yin Cold 57 Endogenous cold Yang deficiency Deficiency of Kidney yang Deficiency of Spleen yang Cold Deficiency of Heart yang 58 Endogenous cold Yang deficiency Fail to restraint yin Excessive yin Decline of warming effect Aversion to cold , Cold limbs Pallor, Diarrhea Loose stools Moist tongue Decline of steaming effects Water retention, phlegm, edema Frequent, profuse & clear urine Thin, cold & clear saliva, sputum & nasal discharge 59 Endogenous dampness Protracted diseases Deficiency of kidney yang Excessive intake of raw, cold, greasy & fatty food Impaired spleen Fail to transform & transport food & water 湿浊内困 Disturbed body fluid metabolism Excessive phlegm or dampness 60 Endogenous dampness Positions of obstruction by dampness Meridians Signs & symptoms Upper energizer Chest distention, cough Middle energizer Fullness & distention in the epigastric region or abdomen Abdominal distention, loose stools, oliguria.少尿 edema Lower energizer Skin & muscle Heavy head, limbs, inflexibility. 61 Endogenous dryness • Caused by impairment of yin – – – – Heat pathogen impairing body fluid Over-use of diaphoresics 发汗剂 Severe vomiting or diarrhea Lost of blood or essence 62 Endogenous dryness Yin deficiency Body fluid deficiency Intestine, Stomach, Lung, Orifices Dry nose, throat, tongue, eyes, lips dry & lusterless skin, desquamation or even cracked skin, constipation, dry feces, scanty dark urine, dry cough without sputum. 63 Endogenous heat (fire) • Fire transformed from – Excessive yang – Stagnated pathogens • Exogenous: e.g. wind cold dryness, heat etc. • Endogenous : e.g. qi, blood stasis. Phlegm etc – Emotional stress – Yin deficiency 64 Endogenous heat (fire) • Types of endogenous heat (fire ） – Excessive type – Deficient type 65 Endogenous heat (fire) Excessive yang Stagnated pathogens Excessive type of endogenous fire Rapid progression Short course High fever, red face Thirst & desire for cold drink Dark urine, constipation Oral ulcer or erosion Red eyes Yellow & dry tongue coating Full & rapid pulse Or coma, mania 66 Endogenous heat (fire) Depletion of essence & blood Hyperactivity of yang Deficiency type of endogenous fire Hot sensation in the soles, palm & chest Tidal fever Malar flush in the afternoon Insomnia, tinnitus Red tongue with little coating Fine & rapid pulse Slow progress long disease course 67 The seven emotions Environmental stimuli Body Seven emotions Joy Anger Anxiety Contemplation Grief Fear Terror 68 The seven emotions Sudden, violent, persistent Emotional stimuli Exceed adaptive capacity of the body Disturb Flow of Qi, Harmony of Yin & Yang, Coordination of Qi & Blood of Zangfu 69 The seven emotions Seven emotions Zangfu Qi Blood Yin Yang Physiological responses affect Joy Anger Anxiety Contemplation Grief Fear Terror 70 The seven emotions Zangfu Emotions Heart Joy Liver Anger Spleen Contemplation Lung Grief Kidney Terror Terror & anxiety are also closely related to the activity of qi in the five zangs 71 Mechanism of Effects • Direct injury • Disturb activity of Qi • Affect harmony between Qi & Blood 72 Direct injury Emotions affect Zangfu Joy Heart Anger Liver Contemplation Spleen Grief Lung Terror Kidney 73 Direct injury Liver Heart Spleen (master) Lung Kidney 74 Direct injury Heart dominates blood & house spirit disturbs Emotional injury Qi & Blood Liver stores blood & governs free flow of Qi Spleen source of qi & blood & pivot of qi’s movement 75 Disordering the activity of Qi’s Disorder of activity of Qi Excessive emotional fluctuation Fire Disorder of blood circulation Disharmony between ying & yang 76 Excessive Joy affects heart dismiss qi Normal effect Relief emotional stress Promotes flow of the defensive and nutritive Qi Over joy Dismissed Heart Qi Heart fails to house spirit Inability to concentration or even dementia and mania. 77 Excessive anger affects liver drives qi upwards Drives Liver qi & blood upwards Excessive anger Liver qi flow adversely Dizziness distending headache reddish complexion redness of eyes hematemesis or even syncope Transversely attacks spleen & stomach Anorexia chest oppression belching or even 78 Excessive contemplation affects spleen stagnates qi Excessive contemplation Stagnation of Spleen Qi prolong Consumes yin blood Deprives Heart Blood Spleen fail to transforms & transports Stomach fail to receives & ripens Anorexia Gastric & abdominal fullness loose stool. Palpitation Insomnia amnesia insomnia 79 Excessive grief affects lung exhausts qi Excessive grief Exhaust lung qi Dizziness lassitude dispiritedness Lung fail to depurate disperse descend Fail to distribute nutrient qi Consume pectoral qi 80 Excessive terror affects kidney drives qi downwards Sudden terror kidney qi fail to fixate Incontinence of urine & feces kidney fail to store essence Weakness & atrophy of bones seminal emission Drives qi downwards prolong Failure of qi to elevate Decline of visceral functions and inability of healthy qi to defend 81 Excessive fear disturb qi Disturb heart qi Derangement of mind indecision bewilderment 困惑 Disorder of qi Disharmony between qi & blood Weakened defensive qi invasion of pathogens Excessive fear 82 Excessive anxiety inhibits qi Depression of lung qi Chest compression Unsmooth breath Stagnation of liver qi Hypochondriac distension or pain unhappiness reduce appetite Excessive anxiety 83 Causes or aggravates diseases Pre existing disorder (sub-clinical) sudden emotional fluctuation Diseases (clinical) 84 example Superabundance of liver yang sudden violent rage Hyperactivity of liver yang Syncope ,unconsciousness, paralysis, distorted face 85 example Sudden terror Causes or aggravates Heart diseases 86 Improper Diet • Starvation Prolonged (continuously) lack of food Protracted insufficient intake of food • Overeating Crapulence 暴饮暴食 Protracted excessive intake of food • Unhygienic food & water • Food partiality Partiality to cold or hot food Partiality to the flavors 87 Starvation Prolonged (continuously) lack of food Protracted inadequate intake of food Insufficient production of Qi & Blood Declination of functions of the viscera Lower body’s immunity to diseases 88 Overeating Crapulence 暴饮暴食 Protracted excessive intake of food Impair Spleen & Stomach Delayed or failure of transformation of nutrients into Qi & Blood Failure to digest transform & transport Produce phlegm & hinder flow of Qi & Blood 89 Unhygienic food Poisoning Unhygienic food or contaminated water Gastrointestinal disorders Parasitic diseases Abdominal pain diarrhea vomiting dysentery Coma Or even death 90 Food partiality Excessive cold or uncooked food Impair yang Qi of Spleen & Stomach Endogenous colddampness Abdominal pain Diarrhea 91 Food partiality Excessive hot , warm or dry food Heat accumulation in Stomach Thirst Abdominal fullness Distension & pain Constipation Hemorrhoids 92 Partiality to flavors Flavor Zang Fu Sour Liver Bitter Heart Sweet Spleen Acrid 辛 Lung Salty Kidney 93 Five flavors & five zangs Sour Liver Salty Kidney Inter-promoting Acrid Lung bitter Heart sweet Spleen Inter-restraint 94 Partiality to salty flavor Salty Kidney bitter Heart Restricts Water Fire Stagnation of vessels 95 Partiality to sweet flavor Salty Kidney Sweet Spleen Less transformation of essence into marrow & blood Restricts Earth Water Osteodynia 骨痛 loss of hair early senility 96 Partiality to bitter flavor Bitter Heart Acrid Lung Restricts Fire Metal Hypoactive of lung qi Retention of food nutrients in the middle energizer Malnutrition of skin & hair 97 Partiality to acrid flavor Acrid Lung Metal Restricts Sour Liver Hypoactive liver qi Liver blood fail to nourish tendons Wood Spasm Flaccidity of tendons 98 Partiality to sour flavor Sour Liver Wood Restricts sweet Spleen Weakened spleen qi Earth Abdominal distension loose stool poor appetite 99 Overwork • Excessive physical fatigue consume Qi & blood • Excessive mental fatigue consume heart- blood & impair spleen- Qi • Excessive sexual activity consumes kidney-essence, weakens Qi & blood 100 Excessive physical fatigue Consume Qi & Blood •Deficiency of qi & blood •Reduce physical strength •Listlessness 倦怠 •Emaciation 101 Excessive mental fatigue • Consume Heart- blood Malnourishment of heart spirit Palpitation Forgetfulness Insomnia Dream disturbing sleep • Impair Spleen- Qi Fail to transform & transport Anorexia abdominal fullness Loose stool 102 Excessive sexual activity Kidney deficiency Early senility Consumes Kidney-essence weakens Qi & Blood Malnourishment of five zangs Ache & weakness of waist & knees Dizziness, tinnitus listlessness Decline of sexual functions Nocturnal emission Premature ejaculation Impotence 103 Over-rest (Deficient of physical activity) Hypofunction of visera Prolonged lack of activity Sluggish flow of Qi & Blood Production of phlegm, dampness & blood stasis Various diseases Diminished immunity to exogenous pathogens 104 Secondary pathogenic factors Primary pathogens Diseases • Phlegm & rheum • Blood stasis More diseases 105 Phlegm & Rheum Diseases Disturbed water & fluid metabolism Phlegm Rheum (thicker type) (thinner type) Abnormal accumulation of fluid 106 Types of Phlegm • Substantial form Visible, palpable, audible e.g. sputum, scrofula (淋巴结核) & nodules in skin or muscles, borborygmus 腹鸣. • Insubstantial form Invisible, impalpable, inaudible 107 Classic categorization of phlegm Classify according to location of phlegm (1) Abdomen – Phlegm rheum 痰饮 (2) Chest & diaphragm – Suspending rheum 悬饮 (3) Ribs – Sustaining rheum 支饮 (4) Skin & muscles – Overflowing rheum 溢饮 Jingui Yaolue (Synopsis of Golden Chamber) 108 Formation of Phlegm & rheum Spleen Transportation & transformation of water & dampness Lung Regulates water passage Kidney Governs water Normal Water metabolism Liver Promote metabolism of water & fluid Triple energizer Serves as water passage 109 Formation of Phlegm & rheum Abnormal water metabolism Viscera Dysfunction Production of Phlegm & Rheum 110 Formation of Phlegm & rheum Cold Pathogenic factors Exogenous Disharmony of viscera yin & yang Slow transformation of water & fluid Endogenous Production of rheum or Phlegm Heat Scorches fluid 111 Characteristics of diseases cause by Phlegm & Rheum • Hinder flow of Qi & Blood • Hinder ascending & descending movement of Qi • Confuse mind frequently • Cause varying & complicated symptoms 112 Hinder flow of Qi & Blood flow of Qi & Blood Meridians Numbness & stiffness of limbs Phlegm \Rheum Localized Scrofula 瘰疬 Subcutaneous nodules Cold abscess 阴疽流注 113 Hinder ascending & descending movement of Qi Disturbed water metabolism Retention of water & dampness Hinder movement of Qi Various symptoms Affects function of viscera 114 Confuse mind frequently Invades head Blocks heart With or without transforming into fire Dizziness Chest congestion Palpitation Coma Delirium Mania 115 Cause varying & complicated symptoms Phlegm & Rheum follow Movement of Q1 Changes with movement of Qi reaches Anywhere in the body Affects various parts & produce various symptoms 116 Various symptoms cause by phlegm & Rheum Location Symptoms Lung Asthma with sputum Heart Stomach Tight chest , palpitation, coma, delirium, mania. Vomiting, abdominal distension Meridians, collateral, tendons, bones Head Scrofula, subcutaneous nodule, numbness of limbs, hemiplaralysis, gangrenous symptoms. Diszziness, mental confusion Throat Feeling of obstruction 117 Blood Stasis Pathogenic factors Stagnated Blood circulation Retention of blood in vessels or viscera Blood stasis Blood overflow out of vessels 118 Blood Stasis Substantial form Blood clot Subcutaneous purpura Lumps Insubstantial form Pain Palpitation mania Blood stasis 119 Formation of blood stasis • • • • • • Qi stagnation Qi deficiency Blood- cold Blood- heat Traumatic injury Hemorrhage 120 Qi stagnation Exogenous cold Dampness Excessive anxiety Failure of liver Qi to disperse Phlegm blockage Stagnated flow of Qi Stagnated blood flow Blood stasis 121 Qi deficiency Hypo-function of viscera Consumptive disease Overstrain Improper diet Protracted diseases Puerperium 产后期 Deficiency of Qi Failure to drive blood flow Blood stasis 122 Blood- cold Exogenous cold in vessels Dampness Excessive intake of cold food Decline of fire in kidney Insufficient primordial qi Damage of yang qi Blood stasis Coagulation of blood 123 Blood- heat Blood overflow Excessive heat Blood stasis Condense blood 124 Trauma Injury to vessels Blood stasis Trauma Retained blood in the body 125 Hemorrhage Viscera dysfunction Spleen Liver Qi deficiency Abnormal flow of blood Hemorrhage Blood stasis Transformation of excessive emotions into fire Heat Trauma 126 Characteristics of blood stasis • • • • • • Pain Lump Hemorrhage Cyanosis Tongue features Pulse features 127 Pain cause by blood stasis • Characteristics of pain due to blood stasis: Stabbing pain, fix location, aggravate on palpation, worsening at night. • Characteristic of pain due to qi & blood deficiency: Vague & lingering pain 128 Lump Subcutaneous Protracted blood stasis Lump Cyanotic skin Hard & localized Viscera Hard mass 129 Cyanosis • Cyanotic – Complexion – Lips – Nails 130 Tongue features • Cyanotic • Ecchymosis 瘀斑 • Petechia 瘀点 131 Pulse features • • • • • Thin Unsmooth Deep & taut Knotted Slow, regular and intermittent 132 Other features • • • • • Dark or black complexion Squamous & dry skin Purpura 紫斑 Amnesia Mania 133 Other diagnostic leads • History of trauma, hemorrhage, menstruation, pregnancy or labor. • No response to all other treatment methods other than blood stasis resolving therapy. • Protracted diseases usually cause blood stasis in collaterals. 134
