TCM test practice and explain

Heart yin vacuity pattern

palpitations, insomnia, night sweating and malar flush. He often feels thirst and has low fever. His pulse is rapid and fine vacuity of yin fluids to nourish the heart-shen, manifested by insomnia, low fever, night sweating, malar flush, thirst and rapid fine pulse.

cold stagnating in stomach and intestines

Stringlike tight pulse

What are the symptoms that would lead you to a diagnosis of SI repletion Heat?

) Abdominal pain after eating, diarrhoea and borborygmus B) Low appetite, thirst, epigastric distention C) Scanty dark coloured urination, mouth ulcers, insomnia/agitation, abdominal pain D) Thirst with no desire to drink, copious clear urination, pain in lower abdomen ABCDSlider Your Answers Justification: The correct answer is C. Heat transfers from the HT via the SI to the BL, hence the symptoms of heat in the urinary tract.

Which following s/s indicates heart qi vacuity?

) Bright pale complexion B) Sallow pale complexion C) Pale complexion D) Insomnia ABCDSlider Your Answers Justification A ) Bright complexion is one of symptom of HT yang vacuity pattern. B) Sallow complexion is symptom of HT blood vacuity pattern. C) Pale complexion is one of symptom of HT qi vacuity pattern. D) Insomnia is one of symptom of HT yin deficiency pattern.

Taiyin stage - SP-yang vacuity with cold. Hence, the treatment principles are to warm the SP yang and to expel cold. HERBAL formula

A & B) Shan Yao is neutral, sweet, and tonifies the yin of the SP, which is not appropriate in this case. Hence both A & B are wrong. C) LR-4 is unlikely necessary in this case. D) CV-4 tonifies the yang qi of the body; BL-20, being the back-shu of the SP, is particularly useful in treating deficiency and cold cases ; GV-4 supplements the yang of the whole system. Gan Jiang and Wu Zhu Yu are both hot and enter the SP to warm the middle jiao. Bai Zhu is warm and enters the SP to treat SP vacuity.

Stomach yang deficiency and stomach cold repletion share some common signs and symptoms. What is one of the key differentiators that will enable the clinician to correctly stomach cold repletion?

A) Acute pain in the epigastrium with cold sensation B) Chronic pain in the epigastrium alleviated by warmth C) Aversion to cold D) Cold limbs ABCDSlider Your Answers Justification: A. CORRECT: Exterior cold blocks the stomach and prevents the qi from descending, leading to sudden, stabbing pain and vomiting. The feeling of cold is due to an external cold invasion by-passing the exterior layers and reaching the stomach directly (e.g. eating icy foods and drink); B. INCORRECT: Stomach yang deficiency leads to chronic cold in the stomach which is alleviated by warmth. Stomach cold repletion can lead to stomach yang deficiency if it is not treated. As the cold sets in, the epigastric pain will become less intense and the tongue coat less thick; C. INCORRECT: this symptom is common to both patterns. Cold injures the yang of the stomach and spleen and prevents food from being converted to qi and warming the body, leading to cold; D. INCORRECT: this symptom is common to both patterns. Cold injures the yang of the stomach and spleen and prevents food from being converted to qi and warming the body, leading to cold.

The Taiyang pattern marked by: Fever, aversion to wind, sweating, headache, a painful stiff nape of the neck, and a moderate floating pulse is which of the following?

A) Cold damage B) Heat damage C) Wind strike D) Bowel pattern ABCDSlider Your Answers Justification: The answer is C. These are typical signs and symptoms of a wind strike attack on the Taiyang channel which is usually seen in the initial stage of the contraction. A will have more fever and chills due to fighting between the zheng qi and the pathogen; Aversion to cold, absences of sweat and chills due to the wei qi constrained by the pathogenic cold; and floating tight pulse because the cold contracts blood vessels and floating indicates exterior condition. D has two possible patterns, blood assessment and water retention, both of which will have symptoms associated with pain in the lower abdominal region, blood in urine or stools, impaired urination or thirst with vomiting after drinking of fluids. B is an unlikely pattern as these patterns are from the Shang Han Lun which describe illness caused by an external attack of cold.

The four patterns in Warm Disease at the Wei aspect are: Wind heat; Summer heat; Damp heat; Dry heat. Which of the following is incorrect regarding Warm Disease (Wen Bing) in the Wei (defence qi) Level?

A) All four patterns show fever and slight aversion to cold B) All four patterns are likely to show severe sweating C) All four patterns are likely to show thirst D) Patterns involving damp progress more slowly than those without damp Justification: At the beginning of warm diseases, when they attack the Wei level, you see clear heat symptoms including: Fever, thirst, sore throat red tongue tip, rapid pulse. This is because the pathogen is warm and yang in nature, causes heat and damages fluids. Warm disease attacking the Wei level is the result of an external pathogen attacking the surface. This disrupts the wei qi so its function of warming the body is impaired ? this leads to slight aversion to cold. It is mild aversion to cold because the warm-heat pathogen is yang in nature and does not significantly constrict the wei qi (as a cold pathogen would do). Warm disease with a significant damp aspect has a slower onset and progression of disease than heat without damp. Without damp, the heat rapidly scorches fluids and progress through the levels more rapidly. So (A), (C) and (D) are not the answer ? these are correct statements. The correct answer is B ? this is because whether the patient sweats depends on if dampness is present and whether there are sufficient yin fluids to produce sweat. If dampness is present in the disease, the patient will generally not sweat. This is due to the cloying and heavy nature of damp. Further, whether or not there is sweating is important for treatment ? as this determines the level of dampness, fluids or yin present in the patient.

Which of the following signs and symptoms are common between Yangming bowel pattern and Shaoyang bowel pattern?

A) Alternate chills and fever B) Constipation, distention, pain and fullness of the abdomen, Big pulse C) Loss of appetite, irritability and vomiting D) None of the above ABCDSlider Your Answers Justification: The correct answer is D. A is specific to Shaoyang bowel pattern as this is due to the struggle between the pathogenic factor and the anti-pathogenic qi at the Shaoyang level. B is specific to the Yangming bowel pattern due to the accumulation of both excess heat and dry stools obstructing the stomach and large intestine qi. C is specific to the Shaoyang bowel pattern due to the pathological change of the Shaoyang fu (gall bladder) affecting the stomach and leading to counter flow of stomach qi.

Shaoyin cold transformation, yang vacuity water flood pattern has which of the following signs and symptoms?

A) Aversion to cold, cold hands and feet, pain in body and joints, no thirst B) Abdominal pain, diarrhoea, dizziness, oedema, heaviness in limbs C) Sweating, abdominal pain, clear diarrhoea, contraction of extremities D) Abdominal distension, poor appetite, loose stools, no desire to drink ABCDSlider Your Answers Justification: a. Shaoyin yang vacuity pattern. Sufficient yang means it cannot warm the channels leading to cold accumulation and congealing the blood causing cold s/s. yang qi cannot warm the Du mai so cold and pain primarily along the back. b. Kidney yang is deficient hence overflow of water qi leading to cold and damp accumulating in the middle jiao as spleen is unable to transform and move fluids fast enough so cold spleen means diarrhoea and accumulation of damp causes oedema. When kidney yang is weak it will manifest as dizziness and possible decline in mental function. c. Yin exuberance repelling yang pushes yang outwards manifests as false heat hence sweating. Yin is overacting causing cold to stagnate and slow qi in the abdominal area. d. Taiyin symptoms manifest as damp and cold accumulation due to deficient spleen.

What is the symptom of SP not governing blood?

A) Bruise easily, abdomen discomfort, tongue is pale and pulse is fine and weak. B) Tongue is pale and pulse thready and weak. C) The pulse is slippery and slow. D) Pulse is fast and slightly slippery. Tongue has a red body with a yellow greasy coat. ABCDSlider Your Answers Justification: B) is SP qi sinking. C) is Cold damp distresses SP. D) is SP damp heat A) is correct and blood is pale, thin and watery in consistency.

Which signs and symptoms below best differentiate between gallbladder damp heat and liver damp heat?

A) Burning on urination B) Alternating chills and fever C) Fullness of hypochondrium D) Slippery wiry rapid pulse ABCDSlider Your Answers Justification: A is Correct. As mentioned by Macioca, the dampness infuses downward and obstruct urinary passage causing burning on urination and difficulty in urination. References: Maciocia, G. 2001, The Foundations of Chinese Medicine, Churchill Livingstone, London.

Which of the following is a key sign of the pattern of intestinal heat and bowel excess?

A) Burning pain in anus B) High fever of late afternoon fever C) Paroxysms of abdominal pain D) Blood in stools Justification: The answer is B. Burning pain in anus is a key sign of large intestinal heat bind pattern which may occur due to the heat affecting and obstructing the anal area. High fever or late afternoon fever is a key sign of intestinal heat and bowel excess pattern as Yin is damaged and Yang becomes further active. Paroxysms of abdominal pain is likely to be a key sign of worms accumulating in the intestines. Blood in stools is likely to occur in blood vacuity and intestinal dryness.

In the jueyin heat reversal pattern there are signs and symptoms of heat and cold, what is the correct treatment strategy:

A) Clear the heat B) Dispel the cold C) Clear the heat first and dispel the cold D) Dispel the cold first then clear the heat Justification: The answer is A. In the jueyin heat reversal pattern there is exuberant yang heat inside but the pathogen prevents the heat from reaching the exterior. There are more heat s/s than cold s/s - this is a true heat and false cold pattern. By clearing the true heat the false cold sign would be resolved at the same time. B) is incorrect as dispelling the cold would add heat and make it worse. C) is incorrect. Although clearing the heat first is good, heat may be reintroduced through dispelling cold. D) is incorrect as dispelling cold first would make the patient worse.

What pattern do the following signs and symptoms indicate? S/S: Fever, thirst and drinking a lot, dry cough, dyspnoea, chest pain, constipation, dark urine, deep red tongue with yellow coating, full-rapid pulse

A) Lung yin deficiency B) Intense lung heat C) Wind-heat attack on the exterior D) Damp-heat obstructing the lung ABCDSlider Your Answers Justification: s/s that do not match each pattern; (A) Lung yin deficiency is the vacuity pattern and full pulse is not right for this pattern. the pulse should be ?Thin-rapid pulse? 'Drinking a lot' is not suitable for this pattern. It should be? thirst with a desire to drink in small sips'. (C) Wind-heat attack -the tongue should be ?normal coloured body?. (D) Damp-heat obstructing the LU - 'Drinking a lot' is not right and it should be ?thirst but no/little desire to drink'.

A person presenting with Yang ming bowel pattern will manifest which of the following signs and symptoms?

A) Constipation, tidal fever, epigastric distension, red tongue with dry yellow coat. B) Irritability, always thirsty, high fever and profuse sweating, dry yellow tongue coat. C) Constipation, chills and fever, epigastric cramps, red tongue and dry yellow coat. D) Bitter taste in mouth, chills and fever, chest fullness, white tongue coating. Justification: A) Heat has entered into the yangming fu and accumulated causing constipation and distending pain in the region. When yangming qi is at its peak in the afternoon fever becomes worse. B) When heat is lodged in the yangming channels if manifests as a high fever with profuse sweating as well as increasing irritability due to heat rising up and outwards. C) This is a shaoyang bowel pattern as evident with alternating chills and fever which is the body?s zheng qi struggling with the EPA. Disturbance to the gall bladder can overspill to its earth partner (ST/SP) hence the constipation from ST qi counterflow along with excess heat. D) Similar to shaoyang channel but bitterness is due to fire/heat rising in the GB channel. stagnation of qi in the TE/GB channel manifests as feeling of fullness in the chest and along the ribs.

Which of the following option includes the signs & symptoms for the pattern of stirring up of liver wind by extreme heat?

A) Convulsions B) Maculopapular rashes C) Constipation with dry black stools D) Low grade fever ABCDSlider Your Answers Justification: The answer is A. The pattern of heat stirring liver wind is due to scorching exuberance of blood heat causing stirring of liver wind. When wind transverse penetration of the channel vessels, which results in convulsions. B is the pattern of extreme heat forcing blood out of vessels. C is the pattern of combination of blood stasis and heat, in this case, heat accumulates in the lower burner, and heat forces the blood out of vessels. D is the pattern of collapse of Yin, when heat remains for a long time and is deep in the lower burner, it scorches the yin of liver and kidney, causing evil to be diminished and the vacuity to be increased, which results in low grade fever.

38 y.o male presented with genital skin rash and burning on urination, his urine is dark and scanty, he also experiences hypochondriac pain, nausea, and loose stool. What is this illness pattern?

A) Damp heat in the gallbladder and liver B) Damp heat in the spleen and stomach C) Damp heat in the gallbladder D) Damp heat in the bladder and small intestine Justification: Dampness obstruct the middle burner and prevent ST qi from descending and causes nausea, the heat dries up fluid results dark and scanty urine, hypochondriac pain is typical signs of dampness accumulation in the hypochondriac region due to GB disorders, loose stools are resulted from dampness. Liver controls the genital region, DH in the liver can result skin rash and urination problems.

Which of the following are the key signs of the stomach yang vacuity pattern?

A) Dull epigastric pain relieved by pressure, torpid intake and loss of appetite, fatigue and lack of strength, abdominal distention after eating, a pale tongue body with white fur and a weak pulse. B) Cold pain in the stomach and stomach duct, no thirst but a preference for warm fluid, a liking of pressure, hiccoughs, clear urine, vomiting of watery fluid, a pale and fat tongue with slimy tongue coat, and a deep, string-like and slow pulse. C) Continuous epigastric pain, ameliorated by warmth and pressure, stuffy sensation in the stomach, reduced food intake, aversion to cold, cold limbs, pale tongue with whitish coating and sunken slow weak pulse. D) Dry mouth and tongue, thirst with an ability to drink, loss of appetite, scorching pain of the stomach duct, constipation, retching, reddened peeled tongue, and a fine and rapid pulse. ABCDSlider Your Answers Justification: A) Stomach Qi vacuity pattern: dull pain is due to insufficient qi and blood causing inability to warm and nourish the viscera; when stomach is is vacuous there is torpid intake and diminished appetite; fatigue, pale tongue and weak pulse are all indicated for qi vacuity. B) Stomach repletion cold pattern due to cold evil invasion and stomach yang is trapped, result in hi coughs and cold pain caused by qi stagnation. Like of pressure , not thirst, clear urine and pale tongue indicate cold vacuity, string-like pulse indicates pain, deep and slow pulse indicate interior cold; vomiting of watery fluid indicates stomach cold qi stagnation with collection of rheum. C) continuous epigastric pain, stuffiness sensation in the stomach and reduced food intake are due to stomach yang vacuity induced vacuity cold generated interiorly and obstructing the stomach qi; the pain relieved by warmth and pressure indicates middle jiao vacuity cold; aversion to cold and cold limbs are due to week yang qi and lack of body nourishment and warmth; sunken pulse indicate interior pattern, slow and weak pulse indicate cold and insufficient qi and blood D) Stomach yin vacuity pattern: dry mouth, thirst, red peeled tongue, fine and rapid pulse are indicated for Yin vacuity generated interior heat; since the stomach located below the diaphragm, when there is stomach yin vacuity it will cause scorching pain; retching is due to counter-flow of the stomach qi as stomach fails to manage downbearing. Reddened peeled tongue indicates collapse of stomach Yin; fine pulse indicates vacuity taxation detriment with yin, and the rapid pulse indicates heat.

When the kidneys fail to receive qi, which of the following signs and symptoms will occur?

A) Dyspnoea with prolonged exhalation B) Weak cough C) Feeble voice D) All of the above ABCDSlider Your Answers Justification: The kidneys are in charge of grasping the qi when it is breathed in through the lungs. When the kidneys fail to grasp the qi, normal breathing is impaired and the following signs and symptoms will occur. The qi is not received by the kidneys hence why the breath feels short and the exhalation is longer as the kidneys are trying to receive the qi. The weak cough and feeble voice is again due to a weak kidney where it is unable to hold down the qi, there may also be a deficiency of qi.

What are the triggers for lurking warm diseases?

A) Excess emotion such as overstrain, stress B) Improper food C) External wind heat D) All of above ABCDSlider Your Answers *Justification: Lurking warm disease requires a secondary factor to emerge. It can be either internal or external factor. For internal factor improper diet, excess of emotion can be the triggers of the warm disease. In addition, when the disease has already lurked in the body, attack from the external wind heat can also trigger the internal warm disease to manifest outward.

All of the following are signs and symptoms of wind-cold fettering the lung except:

A) Fatigue B) Sneezing C) Itchy throat D) Sudden onset of chills with mild fever ABCDSlider Your Answers Justification: The answer is A. Sneezing occurs as a result of the wind-cold pathogen disrupting the function of the lungs to descend. Itchy throat may also be due to wind-cold disrupting lung's function to receive air and descend it downwards. Sudden onset of chills with mild fever may be due to the attack of wind-cold pathogen and its cold nature, and the wei qi rising to the surface to fight off the evil qi causing mild fever. Fatigue is caused more by lung qi deficiency and lung yin vacuity pattern.

Which of the following s/s are ying aspect pattern?

A) Fever and worse at night, but still present during day B) Feverish, restlessness, maculopapular rashes, wiry and deep pulse C) Restlessness, aphasia, faint rashes, fine and deep pulse D) A & C ABCDSlider Your Answers Justification: D is correct answer. Because fever and worse at night due to injury to the yin. Aphasia due to disturbs the shen, which controls tongue. As yin/blood is damaged, there is insufficient blood to expand the blood vessel, it leads to fine and deep pulse. B is key sighs of blood aspect pattern.

Which of the following is the key symptom of kidney essence insufficiency pattern?

A) Forgetfulness B) Ringing in the ear C) Loosening of teeth D) Dizziness ABCDSlider Your Answers Justification: The kidney governs the bones (and teeth) and when the essence is diminished, this result in weak bones (and loosening teeth).

If a patient came to you complaining of painful dark urination and with further questioning you uncover the symptoms listed below, which pattern do you think is the best diagnosis? Symptoms: Fever, thirst, mouth ulcers, reddened tongue tip with a yellow coating, rapid pulse and you notice he has difficulty concentrating.

A) Heat in the pericardium B) Small intestine vacuity cold C) Small intestine qi stagnation D) Small intestine replete heat Justification: D is the pattern that best fits these symptoms. The differentiating symptom is the painful dark urination. The pattern is closely related to heart fire (the heart and small intestines are interiorly externally related), which causes mouth ulcers and the mental unease. The heart heat is transmitted to the small intestines where it impairs its important function of moving and separating dirty from clean fluids. The heat burns away the fluids causing dark, scanty and painful (because it is hot and very concentrated) urination. Answer A) would have fever and thirst but would also have delirium (heat clouds the mind) rather than mental restlessness. The whole tongue would be red, not just the tip. The face would be red and the breathing coarse. Answer B) would have dull abdominal pain, borborygmus, diarrhoea and cold signs such as cold limbs and a desire for hot drinks. Answer C) would have borborygmus, flatulence and abdominal pain.

What are the characteristics of warm disease blood level patterns?

A) Interior heat signs B) Exterior heat signs C) Wind signs and bleeding D) Mental confusion ABCDSlider Your Answers Justification: A Incorrect: It is qi level, the location is in chest, diaphragm, stomach, intestines, and gallbladder. S/s High fever, profuse sweating, severe thirst, flooding rapid pulse. B Incorrect: It is wei level, the location is lung and exterior. s/s chills and fever, headache, sore throat, red tongue tip with yellow thin tongue coating, floating rapid pulse. C Correct: It is blood level, the location is heart, liver, kidney. s/s fever aggravated at night, irritability, bleeding, weak hearing, five palm fever, convulsions or tremors of the fingers and toes. D Incorrect: It is ying level. The location is pericardium. s/s Fever aggravated at night, irritability, even delirium, loss of consciousness, dark red tongue without coating, thin and rapid pulse.

Which of the following is a key sign for the shaoyang pattern?

A) Irritability, severe thirst, flooding pulse. B) Bitter taste in the mouth, nausea, wiry pulse. C) Profuse sweating, great thirst, high fever, flooding and rapid pulse. D) Fever, absence of sweating, floating tense pulse. ABCDSlider Your Answers The answer is B. Yangming pattern - impairment of body fluid, promotion of blood circulation. Heat in Yangming - classical patter "big four" taiyang pattern due to cold. Gallbladder qi steaming upward, stagnation of gallbladder qi leading to stomach qi reversal.

Which of the following s/s indicates a pericardium pattern?

A) Irritability, sores in tongue and mouth, red tongue with coating, rapid pulse. B) Thirst, delirium, reddened tongue with yellow coat, slippery rapid pulse. C) Thirst, insomnia, anxiety, yellow greasy tongue, rolling and rapid pulse. D) Hyperactive appetite, bad breath, constipation, scores in mouth, red tongue with yellow coating. ABCDSlider Your Answers Justification: A (Incorrect) It is a sign of small intestine excess heat. B (Correct). C (Incorrect) It is upward flaring of phlegm fire affecting the mind (heart). D (Incorrect) It is stomach fire repletion.

Which of the following BEST describes the qi level syndrome in regards to the four stages?

A) It is a disharmony between the Ying and Wei B) It is considered life threatening C) The yin is injured by the heat and as a result the shen can become disturbed D) It is an invasion of the interior by excessive yang-heat Justification: A) This relates to Taiyang stage illness. B) Not yet life threatening, would be more serious at the deeper levels. C) This describes the Nutrient system syndrome. D) Correct! It is when excessive yang heat invades the interior and then a conflict of the pathogen and the zheng qi begin.

Which of the following is a patho-mechanism of the lung that leads to production of phlegm, cough and dyspnoea

A) Kidney not grasping the Qi B) Lung failing to consolidate the exterior C) Lung failing to distribute fluids D) Spleen dampness ABCDSlider Your Answers Justification: Answer: C is correct answer for the production of phlegm and causing cough and dyspnoea.

A 30-year-old patient came to the clinic, she looked very tired and listless, she has been trying to get pregnant for at least a year, without success. The patient also complains of lower back pain. When you felt her hands, they were chilled. The pulse was forceless at the chi position and the tongue had whitish coating. Which of the following is the pattern diagnosis for this patient?

A) Kidney qi vacuity pattern B) Kidney essence insufficiency pattern C) Kidney yang vacuity pattern D) Kidney yin vacuity pattern Justification: The answer is C. D is directly excluded, since kidney yin vacuity pattern manifests vacuity heat signs, in this case, there is no heat signs. Kidney qi, essence and yang vacuity all have the possibility, but the key sign in this case is cold limbs, which specifically indicates yang vacuity: kidney yang functions warm the body, and kidney yang vacuity can generate internal cold. The lumbar region is the residence of the kidney, and the kidney engenders marrow and governs the bone, thus when there is kidney vacuity, the patient can present with lower back pain. Since kidney stores the essence that promotes reproduction, infertility patterns may be related to kidney vacuity. Listlessness and tiredness are the general signs of the qi vacuity pattern. The pulse and tongue both suggest kidney vacuity pattern (more towards cold).

Which of the following manifest as: Lower back pain, lassitude, dizziness, tinnitus, nocturnal emission in men and oligomenorrhea in women, emaciation, dry throat, thirst, flushed cheeks hot sensation in the palms and soles, afternoon fever, night sweating, reddened tongue with little or no coat, and rapid fine pulse.

A) Kidney yang vacuity. B) Kidney qi not consolidating. C) Kidney qi vacuity. D) Kidney yin vacuity. ABCDSlider Your Answers Justification: The correct answer is D. option A is incorrect as there would be a presence of cold limbs with aversion to cold, whitish tongue coating and forceless pulse especially at the chi position. Option B is incorrect as there are no signs of frequent urination, dribbling urine after voiding, incontinence of urine or faeces, or continuous dribbling of menstrual discharge/liability to miscarriage in women. This is because of the kidney?s responsibility in governing the lower orifices, so if the kidney qi is not consolidating then the kKidney?s ability to govern the lower orifices is impaired. Option C has the least signs and symptoms out of the lot. It does not have fever, sweating or temperature differences in the limbs.

A sixty-year-old man presents with lethargy and tiredness. He has palpitations and a stuffy feeling in the chest. He occasionally has pain in the chest that is aggravated by exercise. He also says he has shortness of breath. His feet and legs look slightly puffy and feel cold to touch. You also notice he is sweating and has a pale face. On observation his tongue looks pale and swollen and the coat is white and moist looking. The pulse is deep, slow, weak and knotted. What pattern do you think it is?

A) Kidney yang water flood B) Shaoyin cold C) Kidney yang vacuity D) Spleen qi vacuity ABCDSlider Your Answers Justification: The answer is A. A) Correct, the combination of heart s/s (palpitations, shortness of breath) and kidney s/s (dizziness, tiredness) when the spleen (lethargy) and kidney yang is vacuous, water qi floods and runs counterflow and intimidates the heart. B) The tiredness and lethargy hasn?t worsened to somnolence, no diarrhoea s/s. C) No cold symptoms such as back pain, body aches or aversion to cold. D) The palpitations and shortness of breath are not spleen s/s, more likely indicate lung or heart dysfunction. Liu, G.H. 2001, Warm Diseases: A Clinical Guide, Eastland Press, Seattle. Wang, T.F. 2007, Diagnostics of Traditional Chinese Medicine, vol. 2, People's Medical Publishing House, Beijing.

A 35 years old woman present to the clinic with chronic lower back pain. She described pain as aching and cold. She also complained of cold knee pain. On observation, she has bright white complexion and there is lower leg oedema. She complained of feeling tired and decreased libido. She also suffers from infertility. Her pulse is weak especially at chi position. Her tongue has whitish tongue coat. In terms of KD pattern, which one of the following is the correct pattern for this patient?s condition?

A) Kidney yin deficiency B) Kidney vacuity with water flood pattern C) Kidney essence insufficiency pattern D) Kidney yang vacuity ABCDSlider Your Answers Justification: The answer is D. Lower back pain is common sign for all above listed KD patterns. KD located in the lower back, the vacuity patterns of KD will cause the lower back pain. A: KD yin deficiency will produce lots of empty heat signs, which are not in this case. B: This is the pattern arises when insufficient kidney qi transformation fail and lead to water flooding. It can cause lower leg oedema. However, in this case, the tongue is pale and with slippery coat due to untransformed fluids. In this case study, the tongue is not wet. C: KD essence will not manifest the signs and symptoms in this case study. D: it is correct. One of the important sign for this patient is the cold lower back and knee pain. When KD yang is vacuous, the KD has not enough qi to give strengths to the bones and the back, thus knee pain and lower back pain. When yang qi is deficient, the fire of gate of life fails to warm the body, therefore, people could feel cold always and the pain will be cold pain. When KD yang is deficient, it fails to transform the fluids, which accumulates and results in oedema. Deficient KD yang fails to warm the essences, thus the sexual energy is deprived of the nourishment of the essences and warmth of KD yang. This results in decreased libido, and infertility. Weak pulse indicates deficiency.

A TCM student went to bikram yoga classes every day since the start of Spring semester. Since then he had been experiencing symptoms of night sweating and tinnitus. Can you help figure out which pattern these symptoms does belong to?

A) Kidney yin vacuity with fire effulgence pattern B) Kidney vacuity with water flood pattern C) A & B D) Kidney yang vacuity pattern Justification: A) Kidney yin vacuity with fire effulgence pattern - has night sweats and tinnitus. B) Kidney vacuity with water flood pattern - has tinnitus. C) A & B. D) Kidney yang vacuity pattern - has none of the above: - aversion to cold, cold limbs - listlessness - weak, sore, aching lower back and knees - premature ejaculation or impotence in men - infertility - nocturia - whitish tongue coating - forceless pulse at cubit (chi) section.

Choose the correct statement from the following:

A) LR-3 and GB-20 subdue liver yang and extinguish liver wind B) Liver yang rising is a full heat condition C) Liver fire is treated by subduing yang using herbs that sink qi (e.g. Shi jue ming and mu li) D) If liver yang rising stems from liver blood deficiency, Yi Guan Jian (One Linking Decoction) should be used ABCDSlider Your Answers Justification: A) This statement is correct. LR-3 is the yuan point and takes neutral earth qi into the organ to soothe it and to regulate the function of the liver and its qi throughout its channel (Rogers & Rogers 2012). This point also harmonises earth and wood (Rogers & Rogers 2012). According to Rogers & Rogers (2012) GB-20 is a major point for wind problems of the head (both internal and external). It also soothes the Liver, pacifies yang, eliminates wind and expels heat (Rogers & Rogers 2012). B) This is incorrect as liver yang rising is not a condition of full heat but simply an imbalance of qi with qi and yang rising excessively towards the head (Maciocia 2007). Although there are a few symptoms of heat due to the rise of yang to the head (e.g. red face), it is neither a full condition nor a condition of full heat (Maciocia 2007). Liver fire instead, is a condition of full heat (with symptoms of thirst, bitter taste, feeling of heat, red face, red eyes, dark urine, dry stools) (Maciocia 2007). C) There is a very important difference between the herbal treatment of liver fire and that of liver yang rising (Maciocia 2007). The statement in this selection is incorrect as subduing yang using herbs that sink qi are used for liver yang rising - not liver fire (Maciocia 2007). The correct statement is: liver fire is treated by draining fire with bitter-cold herbs such as Huang Qin Radix Scutellariae and Long Dan Cao Radix Gentianae (Maciocia 2007). As Fire is more of an intense heat, the fire needs to be drained by moving downwards which are what the bitter herbs in these formulas do (Maciocia 2007). D) This is incorrect as Yi Guan Jian (One Linking Decoction) is a formula used for liver yin deficiency (Chen & Chen 2009). This is evident as the formula contains mainly Yin nourishing herbs such as Sha Shen and Mai Men Dong. The formula actions are also to enrich kidney and liver yin as well as spreading liver qi (Chen & Chen 2009). The correct herbal formula to use when liver yang rising stems from liver blood deficiency is Si Wu Tang (Four Substances Decoction) (Chen & Chen 2009). This formula is more suitable as its formula actions are to nourish the blood and regulate blood circulation. It is also indicated for general Blood deficiencies (Chen & Chen 2009).

Which following pattern is LEAST likely to cause dizziness?

A) Liver wind due to liver blood deficiency B) Liver wind due to yin deficiency C) Liver wind due to liver yang rising D) Liver wind due to extreme heat ABCDSlider Your Answers Justification: A) Liver blood deficiency leading to poor nourishment of the head (Chen 2004). B) Liver yin deficiency leading to poor nourishment of the head (Chen 2004). C) Liver yang rising leading to rising yang bring the qi and blood upward (Chen 2004). D) Extreme heat is more likely to cause convulsion due to depleted fluids (Chen 2004).

A patient is prescribed the formula Yi Guan Jian for their condition: Sheng Di Huang 18-45g; Gou Qi Zi 9-18g; Sha Shen 9g; Mai Men Dong 9g; Dang Gui 9g; Chuan Lian Zi 4.5g. Which pattern do you think is most likely what the formula treats?

A) Liver yin and blood deficiency B) Liver-overacting on deficient spleen C) Kidney yin deficiency D) Liver yang harassing the heart ABCDSlider Your Answers Justification: This formula enriches the yin and spreads the liver qi. Jun > Gou Qi Zi Nourishes the liver blood and kidney yin. Chen > Dang Gui nourishes the blood but also facilitates the movement of qi and blood. Zuo (all tonify the yin) > Sheng Di Huang enrich the fluids, soften the liver, and clear heat from constraint. Sha Shen and Mai Men Dong nourish the Yin fluids (Stomach & Lung) - Enhancing of LU and ST Qi (descending) helps counteract Liver excess. Shi > Chua n Lian Zi's disperses the constained liver qi, addressing pain. This formula addresses symptoms of liver qi constrait due to Liver blood and Yin vacuity.

What is the following key symptom belongs to the pattern Phlegm Heat obstructing the Lung?

A) expectoration of thick, yellow or blood-stained sputum B) unproductive cough C) chronic cough with profuse phlegm easy to expectorate D) cough with thin white phlegm ABCDSlider Your Answers Justification: The answer is A: Thick sputum -> phlegm . Yellow or blood -> heat. B: Unproductive cough could be due to LU qi vacuity therefore there is no force to expectorate. Or LU yin is depleted hence it is too dry to produce sputum. C: Phlegm which is easy to expectorate -> thin ( more likely to be caused by the cold). Profuse phlegm: excess of cold -> profuse phlegm. D: Thin, white phlegm -> cold phlegm.

Stagnant liver qi can cause static blood. In the case of this dual pattern of liver qi stagnation and blood stasis, which of the following sets of signs and symptoms would be the most likely clinical presentation in a young female.

A) Muscular tension, impaired blurred vision, absence of menstruation, pale purplish tongue body B) Pain and distension in the sides of ribs, irritability, red tongue and a rapid, wiry pulse C) Stabbing pain and distension in the sides of ribs, depression, purple tongue body, wiry pulse D) Dizziness, impaired blurred vision, distension in the abdomen, sharp rib-side pain, wiry pulse ABCDSlider Your Answers Justification: All of the above symptoms can be attributed to liver pathology in its variety of forms. However, it is the most likely combination of signs and symptoms that would indicate a pattern of liver qi stagnation and blood stasis that the question asks for. A) Collectively, these signs and symptoms are more commonly seen in cases of liver blood vacuity. As the liver nourishes the sinews, if there is a deficiency in blood there is consequently a lack of nourishment causing tense muscles (Maciocia 1989 & Garvey, 2016). The complete absence of menstruation shows a deficiency in blood. B) Pain and distension in the sides of the ribs and a wiry pulse could definitely be a sign of liver qi and blood stasis, however irritability along with a red tongue and a rapid pulse are clear signs of heat (Maciocia, G, 1994), a more appropriate diagnosis for these symptoms would be liver qi stagnation transforming into heat/fire (Garvey, 2016). C) This answer is correct. The liver channel pathway crosses over the side of the ribs, and therefore stagnation can manifest with pain along the channel. The liver functions to allow free movement of qi and blood and if this movement/flow is impaired due to stagnation, there will be a consequential lack of nourishment to areas that are not reached. If liver qi/blood cannot reach the mind, disturbances in a person?s spirit may arise such as depression (Yan, 2007). ?A purple tongue body always indicates blood stasis? (Maciocia, 1987 p.57). A wiry pulse usually reflects repletion in the liver (Zhen, 1981) Answer D shows a combination of both deficiency and repletion and not a likely match for the pattern of liver qi stagnation and blood stasis.

Which of the following signs and symptoms differentiate cold-dampness encumbering the spleen pattern from spleen vacuity with dampness encumbrance pattern?

A) Nausea B) Jaundice with dull yellow discolouration C) Oedema of the face and limbs D) Epigastric distension Justification: The answer is B. A) Nausea may occur in both patterns of differentiate cold-dampness encumbering the spleen and spleen vacuity with dampness encumbrance. B) Jaundice with dull yellow discolouration occurs as a specific symptom of cold-dampness encumbering the Spleen. C) Oedema of the face and limbs does not occur in both patterns. D) Epigastric distension may also occur in both patterns.

Which of the following is the best descriptor of kidney qi insecurity pattern?

A) Nocturia B) Abundant clear urination C) Dribbling after urination D) Oliguria ABCDSlider Your Answers Justification: Kidney qi insecurity is arising from kidney yang deficiency. They share common signs and symptoms as nocturia and abundant clear urination. Therefore, it?s not A and B. For kidney qi insecurity, the kidney cannot provide qi to the bladder. Thus, the urine cannot be held properly, causing leaking. This leads to dribbling after urination, which is the distinguishing feature from the other patterns. Therefore, C is correct. Oliguria is an abnormally small amount of urine. In this pattern, there is an abundance of urine so D is ruled out.

A 25yr old female presents to the clinic with a primary complaint of insomnia. She has had problems with her sleep for the past 5months but had put it down to the fact she had moved house 4 months ago. The patient experiences dry eyes, mouth and throat and often feels thirsty. Observation showed dull pale complexion but with red cheek bones. She also described feeling of general tension aches and pains all over. Following further investigation, the patient works as a PA for several sales agents and expressed she feels her job is quite stressful and she often comes home at night irritated with a headache. The patient presented with a red tongue with scanty to no coating and a fine pulse. Select the most appropriate treatment principle and herbal formula for this case.

A) Nourish and tonify the yin - Qi Ju Di Huang Wan B) Nourish liver and kidney yin and sooth liver qi - Yi Guan Jian C) Tonify the blood - Dang Gui Shao Yao San D) Harmonize the liver and spleen - Xiao Yao San ABCDSlider Your Answers Justification: Chen (2007) describes the above signs and symptoms as manifestations of Liver Yin deficiency. Deficient heat inside the body results from consumption of yin fluids in the liver and the yin not capable of controlling the yang. The s/s of scanty tongue coating, dry eyes and red cheek bones distinguish this case from liver blood deficiency (Maciocia 2015). Although all of the treatment principals could have a positive effect on the patient, the most appropriate would be to nourish liver and kidney yin and sooth liver qi with Yi Guan Jian (Maciocia 2015).

What s/s indicates the LU yin vacuity pattern?

A) Pale complexion, shortness of breath, worse with exercise, spontaneous sweating B) Unproductive cough or dilute phlegm with blood streak, afternoon fever, red and dry tongue C) Aversion to wind, fatigue, feeble voice and empty pulse D) Aversion to cold, fever, no sweat and floating tight pulse ABCDSlider Your Answers Justification: LU yin vacuity leads to dryness, so the dry cough, dry throat. When yin deficiency is overtime, vacuity heat is produced resulting in feeling heat in the afternoon. Red and dry tongue indicative of yin deficiency with empty-heat.

Which of the following pulse is a key sign of the pattern large intestinal heat bind?

A) Rapid slippery pulse B) Sunken forceful pulse C) String like tight pulse D) Full slippery pulse ABCDSlider Your Answers Justification: B) Sunken forceful pulse is a sign of large intestinal heat bind. A) Rapid slippery pulse is a sign of large intestinal dampness heat. C) Stringlike tight pulse is a sign of cold stagnating in stomach and intestines. D) Full slippery pulse is a sign of pathogenic damp cold invading the large intestine.

Which of the following pulse is a key sign of the pattern large intestinal heat bind?

A) Rapid slippery pulse B) Sunken forceful pulse C) String like tight pulse D) Full slippery pulse Justification: B) Sunken forceful pulse is a sign of large intestinal heat bind. A) Rapid slippery pulse is a sign of large intestinal dampness heat. C) Stringlike tight pulse is a sign of cold stagnating in stomach and intestines. D) Full slippery pulse is a sign of pathogenic damp cold invading the large intestine.

Which sign and symptom is considered the main factor differentiating the penetration of warm disease to the ying/xue levels from the wei or qi levels:

A) Red tongue B) Fever higher at night C) Delirium D) Thirst Justification: The answer is B. At wei level, there is slight fever and aversion to cold, slight thirst, tongue with red sides, rapid and floating pulse. At qi level, there is high fever without chills, strong thirst, delirium, reddened tongue, rapid pulse. At ying/xue level there is fever stronger at night, dry mouth with desire only to sip, delirium, red tongue with no coat, fine and rapid pulse. The main differentiating factor is therefore the fever which is stronger at night.

Which of the following tongue and pulse signs and symptoms would you see in the liver yang hyperactivity pattern?

A) Red tongue with yellow dry coating, wiry rapid pulse B) Red tongue with scanty saliva, wiry powerful or wiry thready and rapid pulse C) Red tongue with white greasy or yellow greasy coating, wiry powerful pulse D) Red tongue with yellow greasy coating, soggy rapid pulse Justification: You would see A) signs and symptoms in the blazing liver fire patterns. a: B

A patient is presenting with fever, they feel sweaty are coughing and finding it hard to catch their breath. They have a pain in their chest, like someone is pressing on it. They ask for a glass of water and say they can't quench their thirst. Their tongue is red with a yellow coat and their pulse is rapid and overflowing. What would your treatment principle be?

A) Release the exterior, expel wind heat and restore the descending of lung qi B) Clear lung heat, resolve phlegm, restore the descending of lung qi C) Clear heat in the pericardium, restore consciousness and promote fluids D) Clear heat and resolve dampness in the middle jiao ABCDSlider Your Answers Justification: A) Is the treatment principle for wind-heat in the lung's defense qi portion of san jiao. The patient would have a runny nose with yellow discharge, a slight thirst but not a big thirst, and have a white tongue coat. B) The correct answer. Heat in the lungs (Qi level). C) Is the treatment principle for heat in the pericardium. The patient would have symptoms of high fever at night, a burning sensation in the epigastrium, cold limbs, delirium, aphasia, a deep red stiff tongue and a fine-rapid pulse. D) Is the treatment principle for damp-heat in the spleen. The patient would have symptoms of epigastric fullness, heaviness of body and head, nausea, vomiting and a soggy-rapid pulse. Reference: Maciocia, G. 2015, The Foundations of Chinese Medicine, 3rd Edn, Elsevier, Edinburgh London, UK.

Which of the following s/s indicate a Taiyin pattern?

A) Reverting cold limbs, with lienteric diarrhoea B) Aversion to cold on the back, cold hands and feet C) Dry mouth, night sweats D) Fullness of abdomen, no desire for food and vomiting ABCDSlider Your Answers Justification: A, B, C are fit Shaoyin disease pattern. but D) indicates s/s of Taiyin disease pattern. As fullness of abdominal due to poor transformation and transportation function of SP, which leads to dampness.

A 40-year-old male presents with emaciation, lack of strength, hunger with an inability to eat, dry lips and mouth, yellow urine, bound stools, indigestion, vexing heat of the five hearts, red tongue with little fur and a fine and rapid pulse. What is the most likely pattern? ??????????????????? Sp yin vacuity and ST yin vacuity???????

A) ST yin deficiency B) LR yin deficiency C) HT yin deficiency D) SP yin deficiency ABCDSlider Your Answers Justification: The spleen transforms and transports food essence. Impairment of this function reduces appetite which causes weight loss and therefore a thin body. Spleen yin deficiency has ying and blood deficiency. As the spleen opens into the mouth and lips, a key symptom is dry mouth and lips. As there is a lack of ying and blood, the stools are bound and the pulse is fine. Yin deficiency results in relative excess of yang or empty heat. This manifests as yellow urine, vexing heat of the five palms, red tongue with little fur and a rapid pulse. Stomach and spleen yin deficiency share common signs and symptoms, however stomach yin deficiency results in deficiency of jinye, presenting clinical manifestations such as dull epigastric pain, a dry mouth especially in the afternoon, red tongue that's peeled in the centre or without coat and a floating or empty pulse on the right guan position, dry retching and belching.

David is 25 years old and he came to you because he has been having alternate chills and fever with pain and discomfort in his chest and side ribs. He feels irritable and dizzy and wants to vomit, he can?t eat or drink even though he feels thirsty. His tongue has a white coating and his pulse is stringlike. What pattern would you diagnose?

A) Shao yang channel pattern B) Yang ming channel pattern C) Shao yang bowel pattern D) Yang ming bowel pattern Justification: A is the pattern that fits these symptoms. B would have irritability, but the thirst would be strong and there would be high fever with no chills and profuse sweating, the heat signs would induce a dry yellow tongue coating. C Although there would be alternate chills, fever and pain and discomfort in the chest and ribs, and irritability there would be constipation vomiting and epigastric cramping, the tongue would be redden with a yellow coating. The pulse would be stringlike but also forceful. D This pattern would have constipation with abdominal distension and pain. There would be Heat signs e.g. tidal fever but no chills. The tongue would be red with a dry yellow coating, and the pulse would be slippery rapid and forceful.

What sign is specific to the pattern "worms accumulating in the intestines"?

A) Short voiding of reddish urine B) Ungratifying diarrhoea C) Dry mouth and throat D) Teeth grinding during sleep ABCDSlider Your Answers Justification: The answer is D. Short voiding of reddish urine is a s/s of intestinal head and bowel excess. Ungratifying diarrhoea is a s/s of gastrointestinal qi stagnation. Dry mouth and throat is a s/s of Large intestine fluid depletion. Teeth grinding during sleep in a large intestine pattern is specific to worm accumulation in the Intestines.

Isabel is aged 60, she is a smoker with a history of epigastric pain and constantly tired. She has changed her diet to eat more salads and protein and cut down on carbohydrates. From palpation, her abdomen feels cold and she sometimes feels bloated around her abdominal area. What TCM pattern could this be?

A) Spleen qi vacuity B) Spleen yang vacuity C) Taiyin vacuity D) Not enough information to make a diagnosis ABCDSlider Your Answers Justification: The answer is B. A) It is beyond spleen qi vacuity (with cold signs). B) Correct, the cold signs of pain indicate depleted yang qi and eating cold foods further damages yang qi. C) No dryness (throat) or coughing signs to indicate taiyin vacuity. D) More information about the stools, pulse and appetite would be helpful however patient is not disclosing abnormalities in stools or appetite as presenting problems. There is no oedema in limbs or ascites to indicate a more severe spleen vacuity with water flood.

Jack, a 24-yro male, presents in your clinic experiencing chronic persistent diarrhoea with often an urgent desire to defecate. Jack's other accompanying signs and symptoms include dizziness, fatigue and shortness of breath. Jack's tongue is pale with a white coating and his pulse is forceless. What is the presenting TCM pattern? ??????????????????????

A) Spleen yang vacuity B) Spleen vacuity pattern w/ dampness C) Spleen vacuity pattern w/ water flood pattern D) Sunken spleen qi pattern ABCDSlider Your Answers Justification: A) Spleen yang vacuity pattern - Although chronic diarrhoea is a symptom there is no persistence and the patient would be presenting with accompanying cold signs. Other s/s for spleen yang vacuity includes abdominal fullness, poor appetite coldness and pain in the abdomen, cold limbs, emaciation, fluid retention and a deep forceless pulse. B) Spleen vacuity pattern w/ dampness - thick and slippery tongue coating, a thirst with no desire to drink, borborygmi, epigastric distension. C) Spleen vacuity pattern w/ water flood pattern - Oedema of the face and limbs or together with ascites, associated with reduced food intake, sloppy stools, pale complexion, lassitude and a pale plump tongue with white slippery coating. The pulse would be soggy or forceless. D) ANSWER Sunken spleen qi pattern - The main identifying symptom is the chronic persistent diarrhoea.

A patient (35 years old, female) presents to the clinic with dizziness and twitching of her right eye, which began a week ago, a few days after she had recovered from 'a cold'.You notice that while the rest of her facial muscles are unimpaired, her tongue is stiff with a weak pulse. Upon further investigation, she mentions that she has been experiencing occasional tremors in her hands and spasms around her body for a year now, but they were never 'that bad', thus did not really worry her. What is the most likely pathomechanism for this case?

A) Stagnation of Liver qi causing Fire to stir and generate Wind B) Unresolved external wind attack lodging in the muscles causing spasms C) Blood deficiency failing to nourish the sinews D) SP vacuity generating phlegm, which stagnates and forms Heat and hence Wind ABCDSlider Your Answers Justification: The correct answer is C T he weakness of the pulse and the minor nature of the chronic tremors suggest that this case has an underlying vacuity aspect to it, thus likely eliminating A & B. A) Much more heat and greater severity of signs would be expected if this were the case, along with likely a wiry pulse. B) Only with interior wind will tremors, convulsions and paralysis be seen; exterior wind primarily causes facial paralysis or a stiff neck (Maciocia 2004). Not to mention this option does not account for the year long tremors. C) Tremors or convulsions caused by blood deficiency are characteristically slight/mild in nature (Maciocia 2004). And in the absence of other symptoms, this was the most likely answer - hence TRUE D) Similar to A, though signs of phlegm, such as nausea and chest oppression should also be present

Eileen is a 65 year old woman who came to you complaining of constipation. When you questioned her further you found that she has no appetite, has a dry mouth and is thirsty. Her tongue is reddened and peeled. Which of the following patterns fits her symptoms?

A) Stomach qi vacuity B) Stomach heat C) Stomach yin vacuity D) Stomach yang vacuity ABCDSlider Your Answers Justification: Although A) would have a loss of appetite (because of the loss of qi), this pattern would also have dull epigastric pain which is relieved by pressure, and the tongue would be pale not red. B) Stomach heat would have constipation and a reddened tongue but it would have a yellow coating, there would also be other heat signs such as scanty dark urine, excessive appetite, and mouth ulcers and bad breath. C) This is the most fitting pattern. D) Stomach yang vacuity would have a reduced appetite but would have cold signs ? aversion to cold and cold limbs, a pale tongue with a whitish coating, there would also be pain in the epigastric area.

A friend was complaining to you of feeling feverish and chilly at the same time, and that her head and neck was aching and she didn't want to go out in the cold, when you felt her pulse you noticed it was floating. Which pattern do you think best fits her symptoms?

A) Tai yang wind strike B) Tai yang cold damage C) Tai yang blood amassment D) Tai yang water retention Justification: A) Would have fever and sweating, this case has fever and chills but no sweating; B) The symptoms fit this this pattern C) This pattern has abdominal cramps or rigidity, possibly polyuria, delirium and/or amnesia, dark stools with blood in the stool or urine and a choppy or sunken bound pulse; D) Although this pattern has chills and fever with a floating pulse, like our patient, there is urinary impairment and thirst, and vomiting after drinking water

A man has fever with perspiration, stiffness and pain in nape and head, whitish thin tongue coating and floating slow pulse. What is main pattern for his S/S?

A) Taiyang wind attack syndrome B) Wind cold attacking lung C) Taiyang cold attack syndrome D) Wind heat attacking lung Justification: The answer is A. A mostly manifests S/S which the man has. Fever due to invasion of external pathogenic wind into skin between wei qi and pathogenic factor; sweating due to loose muscular interstice since wind tend to be open and disperse. B wind cold attacking lung should indicate no sweating due to cold tend to be close. C Taiyang cold attack should manifest no sweating as well because of cold. D Wind heat attacking lung normally should have superficial and rapid pulse and yellow tongue fur rather than slow pulse and whitish thin tongue coating.

A Fine pulse and a desire to sleep is a primary symptom in which pattern?

A) Taiyin disease pattern B) Shaoyin disease pattern C) Jueyin disease pattern D) None of the above ABCDSlider Your Answers Justification: The answer is B. A desire to sleep does not appear in A) Taiyin or C) Jueyin disease patterns. A fine pulse and desire to sleep is a primary symptom of B) Shaoyin disease patterns making D) False.

After taking Da Cheng Qi Tang for the treatment of his severe constipation, a 70-year-old patient, who has chronic lower back pain, experienced severe diarrhoea. With little desire to drink, he is now feeling cold again, lacking energy and starting to lose his usual mental sharpness. What can his current illness pattern be?

A) Taiyin pattern B) Shaoyin cold pattern C) Shaoyin heat pattern D) Jueyin pattern ABCDSlider Your Answers Justification: The answer is B. "The inappropriate use of Da Cheng Qi Tang may cause the transmission of a yangming bowel pattern into a shaoyin pattern after severe diarrhoea" (Chen 2004, p .236). The patient's predisposed yang and KD deficiencies (hints: feeling cold again, chronic LBP) have made him vulnerable to yang damage by the cold draining purging nature of Da Cheng Qi Tang. A) and D) are incorrect as there is no abdominal discomfort. C) is incorrect for there is no heat sign.

In heart yang collapse, one of the sign is sudden profuse sweating, what most likely causes this to happen?

A) There is underlying heart qi vacuity. B) Heart?shen is agitated causing internal heat to rise, hence sweat. C) Heart yang is unable to hold the sweat, as result there is sweat. D) Lack of yang to transform the fluid causing fluid leakage in the skin pores. ABCDSlider Your Answers Justification: Correct Answer is C. Yin reaches its extremity leading to yin and yang separation. As a result the heart yang collapses causing yang qi to float to the exterior, unable to control the pores and hold the sweat. A) In heart qi vacuity, there is spontaneous sweating. D) Water qi intimidating the heart and kidney due to yang vacuity, there will be oedema, not leakage. B) This more of a heart yin vacuity pattern.

Which symptom below is not associated with defence aspect (wei) pattern?

A) fever, chills, slight aversion to wind and cold B) slight or absent sweating C) headache, sore throat, nasal congestion D) mental restlessness, delirium ABCDSlider Your Answers Justification: D is the answer because mental restlessness, delirium usually happens in the later stage of an epidemic febrile disease and it would not appear in the wei level. Defence aspect pattern is the only exterior pattern, characterised by presence of pathogenic wind on the body exterior, marked by fever, chills, slight aversion to wind and cold, slight or absent sweating, headache, sore throat, nasal congestion. So A, B, C are not the answer.

Which one of the following is the signs and symptoms of SI replete heat pattern?

A) Thirst, constipation, excessive appetite, reddened tongue with yellow coat B) Thirst, mouth ulcers, mental restlessness, scanty urine or blood in urine C) Oral ulceration, palpitation, mental restless, red tip of the tongue D) Thirst, bad breath, constipation, rapid pulse, reddened tongue with yellow coating ABCDSlider Your Answers Justification: The answer is B. B: repletion heat in SI is closely associated with blazing of heart fire. In terms of channel relationship, SI is related to the HT and they both belong to the fire element. The heat or fire in the heart can transmit to the SI and affect its functions. SI heat causes mental restlessness, mouth ulcers due to its channel relationship with the heart. Heat depletes fluids, and therefore people feel thirsty. The heat interferes the SI function of separating fluids in the lower jiao and it burns the fluids and causing scanty concentrated urine. In severe case, heat may cause blood extravasate resulting blood in urine. A: Combining all signs together, it is likely be the ST heat pattern. Heat in the stomach depletes the fluids, hence thirst, and constipation. ST fire or heat cause excessive appetite. Reddened tongue with yellow coat indicate heat. C: palpitation is not the sign of SI heat. It is a signs of heart organ heat but not the channel problem. D: all signs in D together could be due to ST heat pattern, especially the bad breath.

Which of the following is the key sign of the pattern of large intestine distension (cold dampness)?

A) Ungratifying diarrhoea, epigastric and abdominal distending pain or moving pain, belching, nausea, borborygmi alleviated by the passing of flatus. B) Loose stools, urgent, foul smelling; abdominal pain, worse with pressure, tenesmus, thirst and hunger with no desire to eat or drink. C) Watery diarrhoea, aversion to cold with cold limbs, sudden pain in epigastric region and abdomen, aggravated by cold and alleviated by warmth, aversion to cold with cold limbs, bland taste. D) Watery diarrhoea, abdominal pain aggravated by pressure and alleviated by warmth, cold hands and feet, tastelessness, no thirst. ABCDSlider Your Answers Justification: A) most likely indicates gastrointestinal qi stagnation pattern; and B) indicates large intestinal dampness-heat pattern. C) indicates cold stagnating in stomach and intestines. D) indicates the pattern of Large intestine distension ? cold dampness.

Which of the following can be a common sign or symptom observed in all of the Kidney Vacuity (qi, jing, yin and yang) pattern?

A) Urinary dysfunction B) Tinnitus C) Lower limb oedema D) All of the above ABCDSlider Your Answers Justification: The answer is B. A) Urinary dysfunction is only seen in KD Yang deficiency (abundant clear urine, nocturia) and KD Yin deficiency (dark scanty urine). B) Although tinnitus is not a key symptom in KD Yang Vacuity pattern, it can still be part of the clinical presentation. C) Leg oedema may manifest in KD Yang Vacuity but not in the other patterns. D) This is obviously not the answer as A & C are incorrect. Reference: Maciocia, G. 2005, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists, Churchill Livingstone, Elsevier.

During a period of hot summer weather, the sixteen-year-old son of one of your regular patients presents with a bad headache and strong fever. He is uncomfortable with the cool air-conditioning and dislikes palpation with any pressure on his upper abdomen. He is thirsty and feels achy and heavy all over. His tongue has a greasy white coat and red sides; his pulse is rapid and slippery. What pattern do you think this is?

A) Wind heat B) Damp heat C) Summer heat D) Dry heat Justification: C is the correct answer. A) Although the patient presents with strong fever, he has aversion to cold and wind and the pathogen shows signs of going beyond the Wind Invasion entry points of nose and throat, as the patient feels achy and heavy all over. B) The patient does have the other damp signs such as tidal fever and the pulse is not yet Soggy. C) Correct. Summer heat happens in the season of Summer, the patient has aversion to wind and cold and damp signs. The epigastrium discomfort is a sign of heat causing stagnation, and is not present in wei wind heat pattern D) There are no dry signs, for example, cough, sore throat, dry skin. Liu, G.H. 2001, Warm Diseases: A Clinical Guide, Eastland Press, Seattle.

Henry is aged 10 years old has caught a cold from his classmates. He is feverish however not sweating, stiff neck and headaches, productive cough and superficial pulse. What is the TCM pattern?

A) Wind heat attack B) Taiyang disease pattern C) Wind cold attack D) Both B and C ABCDSlider Your Answers Justification: The answer is D. A) Not wind heat, as patient is not sweating, cough is productive not dry .B) Not just Taiyang external attack - need to differentiate whether it is cold damage or wind strike for effective treatment strategy. C) Although it is wind cold, this has invaded by an external attack as opposed to direct strike to an organ. D) is the correct answer as superficial pulse gives it away as an external attack and the cold signs of headache pain, stiff neck and no sweating. Mitchell, Feng, Wiseman, 1999, Shang Han Lun, Paradigm Publications.

What lung pattern is identifiable through the symptom of "stuffy nose with clear nasal discharge"?

A) Wind-heat invading the lung B) Wind-cold fettering the lung C) Cold-phlegm obstructing the lung D) Lung yang vacuity Justification: The answer is B. Wind-cold fettering the lung will present with clear nasal discharge as the wind-cold attack has hindered the lung qi and thus affected the nose (the lung opens to the nose). As the lung qi is hindered in its role for fluid metabolism the clear nasal discharge is present. When wind-heat invades the lung the nasal secretions will begin to congeal and thus the nose will feel "blocked" rather than stuffy; also due to the heat present the discharge will be yellow. Cold-phlegm obstructing the lung does not present with nasal discharge, rather "chronic cough with profuse phlegm". Lung yang Vacuity also does not present with nasal discharge, manifesting "cough with thin expectoration".

A patient enters the clinic with a complaint of feeling nauseous. The patient also tells you that he sometimes feels cold but also has a fever with thirst and a dry throat. The patient says he is drinking more water to soothe the dry throat and to wash out a bitter taste in the mouth. He also complains that feels very agitated when he sits for a long time and often goes to the toilet however each time it is in small amounts and yellow in colour. The pulse feels wiry and rapid. The tongue is red and has a yellow coat. What pattern does this patient have?

A) damp heat in the spleen and stomach B) accumulation of heat in the lungs C) stomach heat D) heat constraint in the gallbladder ABCDSlider Your Answers Justification: A) INCORRECT: There is not much s/s of dampness such as heaviness of the limbs or sticky yellow tongue. B) INCORRECT: There are no signs of coughing or wheezing or sputum. C) INCORRECT: The pulse would be flooding and fever would be worse during the afternoon. D) CORRECT: The key characteristic to differentiate heat constraint in the GB is the bitter taste in the mouth. The bitter taste is due to bile running out of the normal course.

Which of the following are characteristics of the heart zang?

A) manifests on the face, lodges the shen, opens to the mouth B) manifests on the cheeks, lodges the shen, opens to the tongue C) manifests on the face, governs joy, opens to the mouth D) manifests on the face, governs blood, opens to the tongue ABCDSlider Your Answers Justification: A) does not open to the mouth, but instead the tongue as there is a direct channel connection. B) The cheeks are usually a manifestation of the lungs. C) While the first two are correct, again, the heart does not open to the mouth. D) Correct! The Emperor shows in the face and complexion, is responsible for the governing of blood and vessels and opens to the tongue? e.g when the qi is scattered and the emperor becomes affected one becomes "speechless".

The patient has bitter taste in the mouth, dry throat, dizziness, fever come and go, full in the epigastric area, don't feel like to eat, wiry pulse, what pattern is this

A) shao yang pattern B) yang ming pattern C) tai yang pattern D) tai yang jing pattern ABCDSlider Your Answers Justification: the answer is a. a)all of above are the key signs of symptoms for shao yang pattern. b)yang ming pattern will have relate to stomach and large intestine, usually have full big pulse or sunken full pulse c)will relate to floating pulse d)will also have floating pulse

A) Red tongue with yellow dry coating, wiry rapid pulse B) Red tongue with scanty saliva, wiry powerful or wiry thready and rapid pulse C) Red tongue with white greasy or yellow greasy coating, wiry powerful pulse D) Red tongue with yellow greasy coating, soggy rapid pulse Justification: You would

A) signs and symptoms in the blazing liver fire patterns. b)liver yang hyperactivity pattern? C) signs and symptoms in the liver yang transforming into wind pattern. D) signs and symptoms in the spleen and stomach damp-heat pattern. hyperactivity of liver yang is an imbalance between liver yin and liver yang. It arises when liver-kidney yin is vacuous, fails to counterbalance liver yang, and therefore allows it to upbear and stir excessively.' These signs of Liver yang hyperactivity indicate deficiency of liver and kidney yin and yang hyperactivity.

A patient recently has decreased appetite, he often feels abdominal distension after the meal and he has a lot of gas as well. What pattern will that be?

A) small intestinal qi stagnation pattern B) small intestine repletion heat C) small intestinal vacuity cold D) none of the above Justification: the answer is A. the liver attack the spleen/stomach, so the TT function has been affected. The small intestine is part of stomach, and unable to do its work. B.it will have more heat s/s, like ulceration, mental restlessness due to the heart and small intestine connection. C for the small intestinal deficient cold, would usually have diarrhoea due to the cold impairing SI function.

Damp-heat accumulating in the Spleen and Cold-damp accumulating in the Spleen share similar signs and symptoms, which sign and symptom is specific to cold-damp accumulating in the Spleen?

A) yellow face and eyes B) heaviness in the head and body C) distress and pain in the abdomen D) edema ABCDSlider Your Answers Justification: the answer is D. Cold-dampness obstructs yang leading to water accumulation as the Spleen Yang cannot warm the fluids for transformation and transportation. A) both leak bile, yin or yang jaundice B)damp accumulating causes heaviness in head and body C) damp heat/cold causes dysfunction in the middle jiao leading to pain and distress with heat or cold.

Taiyang organ pattern of water retention

As the body is retaining fluid, its inability to ?steam? fluids causes more intake to result in vomiting like the body is overflowing. Thirst, but instant vomiting after intake

SP not governing blood

Bruise easily, abdomen discomfort, tongue is pale and pulse is fine and weak

Which of the following s/s indicate SP qi vacuity illness pattern?

C) No appetite, tiredness, loose stool Justification: The SP qi deficiency will impairing the SP transformation and transportation function causes the various digestive symptoms such as above lack of appetite, loose stool. Because the SP is responsible for transporting food qi to the four limbs, when SP qi is deficient, the nourish qi is unable to transport throughout the body, hence the tiredness experienced.

stomach yang vacuity pattern

Continuous epigastric pain, ameliorated by warmth and pressure, stuffy sensation in the stomach, reduced food intake, aversion to cold, cold limbs, pale tongue with whitish coating and sunken slow weak pulse.

Damp-heat obstructing the LU

Drinking a lot' is not right and it should be ?thirst but no/little desire to drink'.

pathogenic damp cold invading the large intestine.

Full slippery pulse

qi level syndrome in regards to the four stages

It is when excessive yang heat invades the interior and then a conflict of the pathogen and the zheng qi begin

Which type of skin lesion requires clearing heat from ST and cooling the blood treatment methods?

Macules is correct. Treatment for papules (B) is to disperse LU, dispel wind heat, clear heat in ying level, vent papules. Treatment for vesicle (C) is to disperse heat, resolve damp and promote qi circulation.

Heart yang vacuity

Palpitations and dyspnoea

blood stasis

Palpitations and stabbing pain in the precordial region are typically signs and symptoms of Heart blood stasis pattern, the stabbing pain occurring

heart vessel obstruction pattern

Paroxysms of palpitations with fearful throbbing, and pain and a feeling of pressure in the heart and chest referring to the shoulder or upper arm

large intestinal dampness heat

Rapid slippery pulse

large intestinal heat bind

Sunken forceful pulse

Stomach yin vacuity

The symptoms of loss of appetite could be common to all four patterns. However Emilie states that she needs water with her meals. This suggests she has dry mouth and throat and the water assists in her eating. This is a key symptom of stomach yin vacuity. Stomach yin vacuity is a chronic condition that involves chronic heat and insufficient yin fluids to moisten the stomach. It can also involve the liver where endogenous fire from the iver contributes to the drying up stomach yin and fluids over time. This can certainly be the case with Emilia, due to stressful episodes of her work arousing liver fire. However (D) is not the most correct answer as the key symptoms of spleen yang vacuity are not present: lassitude, emaciation and diarrhoea. These are also symptoms common to spleen yang and Qi vacuity; hence A and C are not the right answers either. Emilie also has retching, which is a particular indicator of stomach yin vacuity. Retching is associated with abnormal ascendance of stomach qi, and insufficiency of stomach yin causes heat to rise. Qi ascendance can also be exacerbated by tension and worry.

Yi Guan Jian

This formula enriches the yin and spreads the liver qi. Jun > Gou Qi Zi Nourishes the liver blood and kidney yin. Chen > Dang Gui nourishes the blood but also facilitates the movement of qi and blood. Zuo (all tonify the yin) > Sheng Di Huang enrich the fluids, soften the liver, and clear heat from constraint. Sha Shen and Mai Men Dong nourish the Yin fluids (Stomach & Lung) - Enhancing of LU and ST Qi (descending) helps counteract Liver excess. Shi > Chua n Lian Zi's disperses the constained liver qi, addressing pain. This formula addresses symptoms of liver qi constrait due to Liver blood and Yin vacuity. References: Barolet R., Bensky D., Ellis A. & Scheid V. 2009, Chinese Herbal Medicine: Formula's and Strategies, 2nd Ed, Eastland Press Inc, Washington, Seattle.

Stomach repletion cold pattern

cold evil invasion and stomach yang is trapped, result in hi coughs and cold pain caused by qi stagnation. Like of pressure , not thirst, clear urine and pale tongue indicate cold vacuity, string-like pulse indicates pain, deep and slow pulse indicate interior cold; vomiting of watery fluid indicates stomach cold qi stagnation with collection of rheum

Stomach yin vacuity pattern

dry mouth, thirst, red peeled tongue, fine and rapid pulse are indicated for Yin vacuity generated interior heat; since the stomach located below the diaphragm, when there is stomach yin vacuity it will cause scorching pain; retching is due to counter-flow of the stomach qi as stomach fails to manage downbearing. Reddened peeled tongue indicates collapse of stomach Yin; fine pulse indicates vacuity taxation detriment with yin, and the rapid pulse indicates heat.

Stomach Qi vacuity pattern

dull pain is due to insufficient qi and blood causing inability to warm and nourish the viscera; when stomach is is vacuous there is torpid intake and diminished appetite; fatigue, pale tongue and weak pulse are all indicated for qi vacuity

Intense lung heat

ever, thirst and drinking a lot, dry cough, dyspnoea, chest pain, constipation, dark urine, deep red tongue with yellow coating, full-rapid pulse

Lung yin deficiency

is the vacuity pattern and full pulse is not right for this pattern. the pulse should be ?Thin-rapid pulse?Drinking a lot' is not suitable for this pattern. It should be? thirst with a desire to drink in small sips'.

Heart blood vacuity pattern

manifested by dizziness, dream-disturbed sleep, forgetfulness and pale or sallow complexion

Heart qi vacuity pattern

marked by shortness of breath and spontaneous sweating

Heart yang vacuity pattern

unable to warm and activate the heart, marked by dyspnoea aversion to cold with cold limbs, pale complexion, dark lips and tongue