CCM Diagnosis

Question 1

normal tongue

Answer 1

good shen: vibrant, vital
body color: fresh pale red
coat: thin, white (or slight yellow), slightly thicker at root
shape: moderate, no scallops, not curled up or down
no crevices or depressions
no movement

Question 2

pathological tongue color

Answer 2

Red = heat (excess or yin deficiency) 
Purple = blood stagnation 
Dusky = qi stagnation 
Pale = qi, blood, or yang deficiency

Question 3

The tongue image of both Qi and blood deficiency

Answer 3

Qi xu: pale + tender, slightly flabby

Blood xu: pale + slightly dry or smaller

Question 4

yin/yang: tongue pulse

Answer 4

pulse: choppy/slippery
tongue: body = yin organs/coat = yang organs

Question 5

exterior/interior : pulse tongue

Answer 5

pulse: floating/deep
tongue: thick coat/thin or no coat

Question 6

cold heat

pulse tongue

Answer 6

pulse: slow/rapid
tongue: pale, bluish or purple/red, crimson

Question 7

xs/ xu

pulse tongue

Answer 7

pulse: replete/deplete
tongue: rough/tender

Question 8

normal 4 seasonal pulses

Answer 8

Spring: floating
Summer: flooding
Fall: sinking
Winter: stony (like a stone sinking to the bottom of a pond)

Question 9

Fu (floating) pulse

Answer 9

Quality: very superficial (heaven level)

Felt with a gentle touch and becomes weaker but never becomes empty under heavy pressure.

“ Feels like a piece of wood floating on the water.”

Indication: exterior syndrome, Qi &blood Xu in chronic disease

Question 10

Exterior syndrome

Answer 10

Xie Qi invades the surface and the Zheng Qi rises up to fight Xie Qi.

• Floating + tight –wind cold invasion
• Floating + loose – wind dampness
• Floating + slowdown- deficient type of wind cold invasion “Zhong Feng” ·
  Floating + rapid – wind heat invasion

Question 11

Yang Qi floating away

Answer 11

Floating + scattering – collapse of Yang in critical condition

Floating + choppy – Yang Qi floating away after severe hemorrhage.

Question 12

Chen Mai (deep pulse)

Answer 12

Quality: deep located at the earth layer, hard to feel under light pressure, revealed only when heavy pressure is applied. “ throw a stone into water and the stone sinks to the bottom”

Indication: Interior syndrome

• Deep+forceful – Shi type, pathogens deep inside the body
  Deep+forceless- Xu type, Yin, Yang, Qi and blood deficiency

Question 13

Chi Mai (slow pulse)

Answer 13

Quality: it refers to the rate of pulse (not strength or location), less than 4 beats per breath.

Indication: Cold syndrome

• Slow+forceful – cold invasion
• Slow+ forceless- deficient cold (generated from Yang deficiency)
• Slow + superficial – exterior cold
• Slow + deep – internal cold

Congested heat inside body:
Heat mixing with stools in the large intestines, block Qi flow, suppress blood vessels, cause deep and forceful pulse, which present in the Yangming Fu syndrome.

Question 14

Shuo Mai (rapid pulse)

Answer 14

Quality: 5 beats per breath
Indication: heat syndrome

• Rapid +forceful – excessive (full) heat
• Rapid +forceless – deficient (empty) heat
• Taut, tense, tight, wiry – width consolidates and density increases

Question 15

Hua Mai (slippery pulse)

Answer 15

Quality: kind of rapid pulse comes and goes smoothly as if it slides under your fingers. “ beads rolling on a plate”

Indication:

• Slippery and rapid – heat syndrome or damp heat , or phlegm heat, stagnant food, retention of Tan/Ying
• Healthy people: ample/abundant with Qi and blood
• Pregnant woman: blood flows into the uterus to nourish fetus instead of menstruation.

Question 16

Se Mai (choppy pulse)

Answer 16

Quality: a pulse with rough uneven beats, it comes and goes with great difficulty, hesitant and congested. “as if a broken knife scraping a piece of bamboo” “ a sick silkworm eating a mulberry leaf”.

Indication:
- Thin, slow, choppy and forceful-Shi condition
- blood stasis, tumors
- sticky phlegm, like Xiong Bi: chest pain due to phlegm blockage.
OR

• choppy but forceless- Xu condition
• blood deficiency
• severe damage to body fluid
• loss of kidney essence, for men, impotence; for women, infertility.

Question 17

Xu Mai (deplete pulse)

Answer 17

Quality: lack of strength, under light touch, it appear big and slow, under heavier pressure it becomes empty and loose.

Indication: deficiency syndrome

• Depleted and rapid -Yin deficiency
• Depleted and slow –Yang deficiency
• Depleted and thin – blood deficiency
• Depleted and soft – Qi deficiency

Question 18

Shi Mai (replete pulse)

Answer 18

Quality: it is big and long, solid and strong, comes and goes with force and reveals distinctively on the three positions.

Indication: excessive syndrome, Xie Qi prevails, while Zheng Qi is still strong enough to strike back.

Question 19

Chang Mai (long pulse)

Answer 19

Quality: It is straight, extending over the Cun and Chi positions.

Indication:

• Long and soft “as if you touch the end of a fishing rod”- ample with Qi and blood.
• Long and hard “as if you get hold of a long bamboo pole” –predominance of the Xie Qi (pathogenic factors).

Question 20

Duan Mai (short pulse)

Answer 20

Quality: short, fails to extend (cover) the 3 positions, only feels clearly on the Guan position.

Indication: Qi problems.

• Short + forceful: Qi stagnation, unable to push blood to move through the vessels
• Short + forceless: Qi deficiency, unable to push blood to fill up the vessels.

Question 21

Hong Mai (flooding , overflowing pulse)

Answer 21

Quality: wide and large, feel full and forceful, comes vigorously and goes gently, “as if the waves surging on”.

Indication: mostly the excessive heat

• Flooding and forceful: excessive heat
• Qi in the Qi phase (4 levels of Wenbing)
• Yangming heat syndrome (6 channels of Shanghan)

OR

Flooding but forceless: appears in the critical stage in which weak Yang excluded by excessive Yin.

Question 22

Wei (fainted pulse)

Answer 22

Quality: extremely fine and soft on superficial level, almost disappears on the deep level, “ as if pressing on a spider web that is going to break any time.” Faint, vague, indistinct, frail, and minute.

Indication: extreme deficiency

• Yang Qi deficiency
• Shaoyin disease
• Acute collapse of Yang Qi

Question 23

Jin Mai (tight pulse)

Answer 23

Quality: tense, taut pulse with high tension, “as if you feel a stretched, twisted rope”.

Indication:

• Cold syndrome: cold congeals Qi and blood, and contracts the vessels
• Severe pain
• Retention of undigested food /parasites
• Wind cold invasion- floating and tight.

Question 24

Huan Mai (leisurely pulse)

Answer 24

Quality: it refers to both rate and tension of the pulse. As to rate, it has 4 beats per breath (neither slow nor rapid). As to tension, it is a little bit loose.

Indication:

• Healthy person: relaxed and moderate
• Disease: spleen deficiency, accumulation of dampness
• A good sign of recovery during the disease.

Question 25

Kou Mai (hollow pulse)

Answer 25

Quality: floating and large at superficial level and becomes hollow and empty under heavy pressure. “as if pressing on a scallion stalk.” Indication: - not enough blood /fluid to fill up the vessel - Loss of blood - Consumption of body fluid

Question 26

Xuan Mai (wiry pulse)

Answer 26

Quality: straight, long, taut, forceful on all three levels, “as if pressing on a guitar string.” Indications: - Liver /gall bladder problems - Pain syndrome - Dilute phlegm- Tan Yin - Malaria

Question 27

Ge Mai ( leathery)

Answer 27

Quality: it is similar to Kou Mai, wiry and big on the superficial level, and becomes hollow under heavy pressure, “as if pressing on the tough surface of a drum” Indication: in general, blood deficient inside and Qi flees outward, extreme deficiency. Loss of blood from severe hemorrhage. Consumption of kidney essence, Kidney Yang deficiency, impotence and spermatorrhea of men, miscarriage and uterine bleeding of women.

Question 28

Lao Mai (firm pulse)

Answer 28

Quality: firm, big, long and wiry felt only on the deep level. Indication: - extreme excess - Cold congealation - Zhen Jia (abdominal tumor) - Stubborn pathogens hidden inside

Question 29

Ru Mai (soggy pulse)

Answer 29

Quality: thin, soft and superficial. In another word, it appears distinctively under a light touch, and vague under heavy pressure. “ cotton floating on water” Indication: - Dampness - Deficiency, consumptive diseases (Xu Lao)

Question 30

Ruo Mai (weak pulse)

Answer 30

- Quality: very similar to Ru Mai, soft and thin, but deep. -Indication: deficiency of Qi and blood - Qi- strength of pulse -Blood- size of pulse - This pulse is common among the elderly, very bad sign if it appears on the young. - Normal in chronic disease and bad sign in acute disease.

Question 31

San Mai (scattered pulse)

Answer 31

Quality: floating and big, but not solid, gathering, easily felt with light touch, and becomes empty under moderate pressure, and completely gone under heavy pressure. “ dandelion seeds blown in the wind”, “ scatter away without any trace.” Indication: this is a critical sign pointing to scattering of Yang Qi when a person is dying.

Question 32

Xi Mai ( thready pulse)

Answer 32

Quality: thin and fine like a thread, but distinct on all three levels. Indication: ● Deficiency of Qi and blood ● Damage of body fluid by heat-thin and rapid ● Dampness- thin and Ru

Question 33

Fu Mai (hidden pulse)

Answer 33

Quality: very very deep, as if the “pulse hides itself behind the bones and tendons. Only felt when you push away the tendons. Indications - Evil Qi blockage - Jue syndrome - Intense pain, like colic pain

Question 34

Dong Mai (rolling pulse)

Answer 34

Quality: similar to slippery pulse, but it is quicker and stronger. It is short with round shape, like “peas jumping under the fingers”. Felt more on the Guan position (“no head and tail”) and more distinct on the middle level. - Indication: Fear, panic Severe pain Pregnancy

Question 35

Cu Mai (hasty pulse)

Answer 35

Quality: fast (as fast as rapid pulse, over 90b/min) and stops at irregular intervals. Pulse is in a hurry and suddenly it stumbles. As if “ a person stumbles while walking briskly.” Indication: Hasty and forceful excessive heat, like a gust of fury, madness, asthma attack, heart attack, etc. Hasty but forceless- exhaustion of Yuan Qi. Like palpitation and Zhen Xin Tong.

Question 36

Jie Mai (knotted pulse)

Answer 36

Quality: It is slow (less than 60 b/ min), stops at irregular intervals. Indication: Knotted and forceful congestion of Yin pathogens, such as blood stasis, food stagnation, phlegm accumulation, etc. Knotted and forceless-deficiency

Question 37

Dai Mai (intermittent pulse)

Answer 37

Quality: It is slow and stops at regular intervals. And the interval is longer than Jie Mai. It is compared to a weak person carrying heavy loads, heading on the way, stopping every mile for a rest. Indication: Exhaustion of Zang Qi. One beat missing in 50 beats, one organ exhausted. Deficiency of both Qi and blood- poor prognosis, worse than Jie Mai.

Question 38

Ji Mai (racing pulse)

Answer 38

Quality: It is very fast (7 b/ breath, > 120 b/ min) Indication: Extreme heat in febrile diseases Critical condition-impending death, separation of Yin and Yang.