Medical Dialogue

医学会话

Lecture on Four Methods of Diagnosis in TCM
讲授中医四诊

Professor Lynch is giving a lecture on TCM diagnosis at the White River School of TCM in the USA. The class is about inquiry into the types of pain.

professor:Good morning, class, and welcome to our inquiry into the types of pain.
students (in unison):Good morning, Professor Lynch.
professor:I would like to start by seeing how much you've already understood about this topic from reading your textbooks. How many types of pain might patients present with in clinic? Yes, Henry.
henry:Many, like distending pain, stabbing pain, pulling pain, scorching pain, heavy pain, aching pain, empty pain, dull pain, wandering pain, uh, fixed pain, cold pain.
professor:Pretty good, that is eleven out of the thirteen types of pain. Anyone else?
susan:Scurrying pain and intense pain.
professor:Scurrying pain is one, but not intense pain. Anyone, please, what is the last type of pain? There is no answer. OK, gripping pain. Now let's look at the mechanism that causes each type of pain according to our paradigm.
susan:Well, pulling pain usually indicates that muscles are not getting enough blood, oxygen and nutrition. Fixed pain doesn't move and is caused by intense cold and damp and by blood stasis. Dull pain is from deficiency of blood, yin or essence. Heavy pain ...
professor:That's fine, Susan, let someone else answer. Mindy.
mindy:Um, uh, so, wandering pain is from wind. And uh, distending pain is stagnation of qi. And blood stasis causes stabbing pain. Oh, and heavy pain is from pathogenic dampness.
professor:OK, that's enough, Mindy. (Henry raises his hand). Henry.
henry:Scurrying is a type of movement, so scurrying pain would be from liver qi stagnation, or some qi stagnation with liver involvement. Cold pain is from cold congealing and obstructing a meridian. Pain from heat is actually called scorching pain.
professor:Very good, Henry. Thank you for giving the name for pain from heat. Let's hear from Susan.
susan:I'm not sure yet, but there is still empty pain which is a deficient type of pain. It can be a deficiency of blood, yin or qi. Then there is aching pain. Um, that's from dampness. I don't know what causes gripping pain. (Henry raises his hand).
professor:Sorry, Henry, we need to hear from others. OK, Mindy?
mindy:Gripping pain is from stagnation. The stagnation can be caused by blood stasis, cold stasis or from calculus. I thought calculus was a mathematical subject! (Laughter)
susan:Very funny, Mindy. Calculi are also known as stones, usually in the kidneys or gall bladder, and I have heard that the pain is very intense, so intense it "grips" you!
professor:That is correct, Susan. What would cause stones to form? Anyone?
mindy:I believe that stones would be a progression from damp congealing.
professor:Elaborate, please.
mindy:Well, heat, over time, would cause the damp to become more viscous, thicker, and any solids, such as minerals and salts would get trapped in the thickness. The longer this occurs, the more heat is applied to the damp, the more solid it becomes until it is a calculus, or "stone".
professor:Excellent, Mindy, well said! Now I have some specific questions regarding types of pain. What more could be said about cold pain? Susan?
susan:External pathogenic cold can penetrate and block a meridian. But a deficiency of yang qi could also create cold pain.
professor:OK. Someone comment on different locations of fixed pain and what it would indicate. Let's hear from ...
henry:Well, fixed pain in the abdomen, chest, below the ribs, I mean anywhere from the top of the ribs to the pubic bone, would indicate blood stasis. Now a fixed pain in the joints and muscles of the arms and legs would indicate that there is dampness and cold.
professor:And if there were an achy pain instead of a fixed pain in muscles and joints, what would that indicate? Keep going, Henry.
henry:Uh, that would still be dampness, but dampness because the qi and yang are deficient due to prolonged physical exertion. And if the pain were predominately in the loins and knees, then the kidneys would be involved.
professor:Thank you, Henry, you don't say much, but you seem to understand things. In clinic you will see a lot of patients with the major complaint of headache. I would like Mindy to start telling us how to differentiate the pain of a headache.
mindy:Any of the six external pathogenic factors can create a headache. Wind, either by itself, or combined with one of the other factors can be involved. But cold and heat often cause headache by themselves, especially intense summer heat. And the liver can be involved with headache in a number of different ways.
professor:Good start, Mindy. Let's hear from someone who has yet to contribute. Susan, continue with ways the liver can be involved with a headache.
susan:If liver yin is deficient, it allows liver yang to become exuberant. That would be a liver yang ascendant headache. Then there can also be a headache from liver fire flaming upward. Both of these types of headaches bring excessive qi and blood to the head. They can also create a throbbing in the head.
professor:Well said. Anything else about the liver?
susan:There can also be a situation where the liver yin is deficient causing headache, blurry vision and some dizziness. There are usually thirst and dry eyes in this situation.
professor:Good. And we need to be careful in this situation. If there are the symptoms of a liver yin headache, accompanied by weakness and numbness in the limbs, it can indicate onset of wind stroke.
mindy:Gripping pain in the chest could indicate blood stagnation in the arteries around the heart, caused by plague or cholesterol on the sides of vessel walls obstructing the free flow of blood. Gripping in the abdomen could be calculus (stones) in the gall bladder.
professor:Good. This has been a very good discussion. Let's take a fifteen-minute break. I will continue my lecture after the break.