The Art and Practice of Diagnosis in Chinese Medicine

794 Pages·2017·2.69 MB·English

by  Nigel Ching

‘What Nigel Ching has achieved in this thorough and detailed study of
traditional Chinese diagnosis is to outline and explain clearly both the
methodology and, perhaps more importantly, the thinking behind it. It is
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especially this that I am convinced will prove to be indispensable to both
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students and interested readers.’
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– from the Foreword by Jeremy Halpin, acupuncturist,
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Zen-shiatsu therapist and teacher
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This textbook on diagnosis in Chinese medicine is unique in its clarity and e
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Divided into two parts, it is a comprehensive diagnostic manual. The first S r
part explains how to collect and collate the information required to formulate N t
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a diagnosis and is divided into four approaches: visual, palpation, interrogation N
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and listening/smelling. The second part describes the various diagnostic g
models in Chinese medicine, including the Eight Principles; zangfu organ n
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patterns; the Six Stages, Four Levels and san jiao; the 12 regular channels
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and eight extraordinary vessels; and the Five Phases.
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Nigel Ching is a lecturer in Chinese Medicine and course director at the i
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Nordisk Akupunktur Uddannelse, Denmark. With over 25 years of clinical
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experience, Nigel lectures widely in Scandinavia, Germany, the UK, Greece
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and Finland and is the author of The Fundamentals of Acupuncture, also
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SINGING DRAGON
e Nigel Ching

Foreword by Jeremy Halpin
www.singingdragon.com
Cover design: Black Dog Design

The Art and Practice of Diagnosis
in Chinese Medicine
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The Art and Practice of Diagnosis in
CHINESE MEDICINE
NIGEL CHING
Foreword by Jeremy Halpin
LONDON AND PHILADELPHIA
Disclaimer: The author and the publisher assume no responsibility for the
treatments carried out in relation to the instructions in this book.
English language edition first published in 2017
by Singing Dragon
an imprint of Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.singingdragon.com
First published in Danish as Kunsten at diagnosticere med Kinesisk medicin
by Klitrose Publishers, Copenhagen, Denmark, 2009
Copyright © Nigel Ching 2017
Foreword copyright © Jeremy Halpin 2017
All rights reserved. No part of this publication may be reproduced in any material form
(including photocopying, storing in any medium by electronic means or transmitting) without
the written permission of the copyright owner except in accordance with the provisions of
the law or under terms of a licence issued in the UK by the Copyright Licensing Agency
Ltd. www.cla.co.uk or in overseas territories by the relevant reproduction rights organisation,
for details see www.ifrro.org. Applications for the copyright owner’s written permission
to reproduce any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work may
result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
Names: Ching, Nigel, 1962- author.
Title: The art and practice of diagnosis in Chinese medicine / Nigel Ching.
Description: London ; Philadelphia : Singing Dragon/Jessica Kingsley
Publishers, 2017. | Includes bibliographical references.
Identifiers: LCCN 2016056990 (print) | LCCN 2016058175 (ebook) | ISBN
9781848193147 (alk. paper) | ISBN 9780857012678 (ebook)
Subjects: | MESH: Medicine, Chinese Traditional--methods | Diagnostic
Techniques and Procedures
Classification: LCC R601 (print) | LCC R601 (ebook) | NLM WB 55.C4 | DDC
610--dc23
LC record available at https://lccn.loc.gov/2016056990
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84819 314 7
eISBN 978 0 85701 267 8
Dedicated to my granddaughter ‘5316’, my parents
and all the family and friends between them.
If a man will begin with certainties, he shall end in doubts; but if
he will be content to begin with doubts, he shall end in certainties.
Francis Bacon 1561–1626
CONTENTS
Foreword by Jeremy Halpin . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Art of Diagnosis or How to Diagnose in Chinese Medicine 17
Diagnostic prerequisites . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Western diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The diagnostic process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Diagnostic models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Treating complex patients with many patterns of imbalances . . . . . . . . . 34
Part 1: The Diagnostic Pillars
Introduction to the Diagnostic Pillars 36
Section 1: The Diagnostic Pillar: Visual Observation 39
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Visual diagnosis of a person’s shen . . . . . . . . . . . . . . . . . . . . . . . 41
Visual diagnosis of the body shape and posture . . . . . . . . . . . . . . . . 44
Visual diagnosis of a person’s movements . . . . . . . . . . . . . . . . . . . 49
Visual diagnosis of a person’s clothing . . . . . . . . . . . . . . . . . . . . . 52
Visual diagnosis of the face . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Visual diagnosis of the eyes . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Visual diagnosis of the area around the eyes . . . . . . . . . . . . . . . . . . 65
Visual diagnosis of the forehead, the root of the nose and the area
between the eyebrows . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Visual diagnosis of the nose . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Visual diagnosis of the ears . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Visual diagnosis of the lips. . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Visual diagnosis of the mouth . . . . . . . . . . . . . . . . . . . . . . . . . 72
Visual diagnosis of the gums . . . . . . . . . . . . . . . . . . . . . . . . . 73
Visual diagnosis of the tongue . . . . . . . . . . . . . . . . . . . . . . . . . 73
Visual diagnosis of the hair . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Visual diagnosis of the body hair . . . . . . . . . . . . . . . . . . . . . . . 96
Visual diagnosis of the throat . . . . . . . . . . . . . . . . . . . . . . . . . 97
Visual diagnosis of the chest and the back . . . . . . . . . . . . . . . . . . . 98
Visual diagnosis of the back . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Visual diagnosis of the limbs . . . . . . . . . . . . . . . . . . . . . . . . . 99
Visual diagnosis of the joints . . . . . . . . . . . . . . . . . . . . . . . . . 100
Visual diagnosis of the hands . . . . . . . . . . . . . . . . . . . . . . . . . 101
Visual diagnosis of the skin . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Visual diagnosis of veins . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Visual diagnosis of skin lesions . . . . . . . . . . . . . . . . . . . . . . . . 109
Visual diagnosis of acupuncture points and channels . . . . . . . . . . . . . 112
Visual diagnosis according to micro-systems such as ear acupuncture . . . . . 113
Appendix to Section 1: Visual Diagnosis of Children . . . . . . . . . . . . . 117
Section 2: The Diagnostic Pillar: Listening and Smelling 124
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Auditory diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Auditory diagnosis of the person’s voice . . . . . . . . . . . . . . . . . . . . 126
The Five Phases in the voice . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Quality of the voice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Auditory diagnosis of other sounds coming from the mouth, nose and chest . 138
Diagnosis of sounds from the abdominal cavity . . . . . . . . . . . . . . . . 141
Olfactory diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Section 3: The Diagnostic Pillar: Palpation 148
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Pulse diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Palpation of the abdomen, including Hara diagnosis . . . . . . . . . . . . . 183
Palpation of the thorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Palpation of the skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Palpation of the hands and feet . . . . . . . . . . . . . . . . . . . . . . . . 190
Palpation of acupuncture points, channels and micro-systems . . . . . . . . 191
Section 4: The Diagnostic Pillar: Interviewing 195
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Interviewing techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
The 10 questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
General questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Disease history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Energy levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Sweating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Thirst, appetite and taste . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Stools and urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Heart, thorax and Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Skin, hair and nails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
The ears and eyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Enquiry that is specific to women . . . . . . . . . . . . . . . . . . . . . . . 241
Enquiry that is specific to men . . . . . . . . . . . . . . . . . . . . . . . . 248
Enquiry with regard to the emotions and mental state. . . . . . . . . . . . . 251
Lifestyle and diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Part 2: The Diagnostic Models
Introduction 258
Section 5: Diagnosis According to the Eight Principles 261
Interior and exterior imbalances . . . . . . . . . . . . . . . . . . . . . . . . 263
Exterior imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Interior imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Hot and Cold imbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . 270