Assessment of the Client

Qiworks Healers Masterclass

Client Initial Assessment

Remembering at all times our purpose.

Helping those in our midst to live optimally.

Staying, at all times, connected to Source Energy.

In helping others we help the whole, including ourselves. 

A  new client  walks in,  you know nothing about them.  What's your process?

First glance

     Notice their posture

              Is the client holding any body part?              Where is the center of gravity?              How fast or slow are they moving?

      Listen

               Is the client specific?               Are they speaking clearly?

               Are they looking directly at you?

      Ask what brings them to you.              

         Listen to the client with your whole self, what is your intuition? Do not Judge!

            ~Repeat back their issues, to make certain you heard correctly, and remember.

            ~Ask if they're getting or have received treatment

            ~Ask how long they've been experiencing discomfort

            ~Ask if there was any incident to cause the issue

            ~Ask if the client can point to the pain

            ~Ask the level of pain 1 - 10

            ~Ask when it hurts (bearing weight, sleeping, etc.)

Pulse Assessment

The pulse should be felt for at least six beats at each level to establish a clear pattern (Zhen 1985). A normal pulse is between four to six beats per breath noticed as smooth, elastic, present, and flowing (Hammer 2005). 

The following provides a guide to how pulses manifest based on specific patterns.

External conditions. Assessment of the pulse in the superficial position is used to assess for the presence of disease due to external conditions. When the pulse is floating the body has shifted the energy to the upper body or to the periphery to help fight off the pathogen. For example, this often is felt in the lung position at the onset of a cold or flu.

Internal conditions. When the pulses are deep and only felt with heavy pressure it indicates the presence of an internal condition and often a chronic condition. The blocked energy is sitting deep within the body and energy is focused at that level.

Excess. A pattern of excess creates a pulse that is full and faster than six  beats per respiration. It will feel strong, long, and thick. It often is due to excess fire or heat or Yang excess.

Tongue Assessment

Normal Tongue Body

          -Pink or light red in color

Bluish Purple or Reddish Purple Tongue Body

          -Purple can indicate both Heat and Cold conditions.

          -A reddish purple tongue indicates Heat and Blood Stagnation.

          -A dark reddish purple tongue that is dry usually indicates depleted fluids due to Excess Heat

          -A light purple, bluish purple, or greenish purple tongue body color can indicate Cold and Blood Stagnation.

Red Tongue Body

          -A red tongue body is darker than the normal red, which is pinkish in color. It indicates either Deficient or Excess Heat.

          -A red tongue body with a thick yellow coat or swollen buds indicates Excess Heat

          -A red tongue body with a bright shiny coat, little coat, or no coating indicates Deficient Heat.

Red Tip

          -Heat in the Heart Zang

          -Scarlet Tongue Body

          -A scarlet tongue that is also peeled or shiny indicates Yin Deficiency, usually of the Heart and/or Lung depending on the area             of swelling.

Dark Red Tongue Body

          -The red is darker and more crimson in color. This tongue body can indicate internal injury such as trauma (De Da), invasion of              external evil in the Ying (Nutritive) and Xue (blood) levels, or it can indicate Blood Stagnation.

           -if there are red spots with a thin coat, this usually indicates damage to the Ying or Xue level.

           -If the tongue body also has cracks and there is little or no tongue coat, this usually indicates Deficient Heat due to internal                    injury.

Pale Tongue Body

            -Indicates the quality of Blood, reflecting Blood and/or Qi Deficiency or Cold.

            -If the tongue body is also moist, tender, and swollen, this can indicate Yang Cold.

            -A pale thin tongue body usually indicates Qi and Blood Deficiency.

Green Tongue Body

            -A green tongue body usually indicates Excess Yin Cold or the presence of a strong Excess evil with weak Zheng Qi. The                       Yang is not properly moving Blood and Fluids and there is Stagnation in the body.

            -Internal Wind may also present with a green tongue body.

Tongue Body Shape

The body shape reflects the state of Blood and Ying (Nutritive) Qi, and indicates Excess or Deficiency. Constitution can also affect the shape of the tongue body.

  Stiff

         -A stiff or rigid tongue is difficult to move (protrude, retract, side to side). This may cause speech abnormalities such as slurring            or mumbled speech. A stiff tongue is an indication of Excess, and often one of Internal Wind.

         =If a stiff tongue is accompanied by a bluish purple tongue body, this usually indicates potential or impending Wind-Stroke.

         -If a stiff tongue is accompanied by a bright red tongue body, this usually indicates heat in the Heart and Pericardium                              disturbing the Shen (Spirit)       .

        -If a stiff tongue is accompanied by a thick sticky tongue coating, this usually indicates "Phlegm Misting the Heart".

  Flaccid

        -The flaccid tongue is the opposite of the stiff tongue. It is weak and lacks strength. It usually indicates Deficiency. When heat                has consumed and damaged body fluids, they can not rise to nourish the tongue. This can indicate Yin Deficiency, Qi                             deficiency  and/or Blood Deficiency.

        -A flaccid tongue that is also pale usually indicates Qi and Blood Deficiency.

        -A flaccid tongue that is also dark red, dry, and has cracks usually indicates extreme heat injuring fluids.

        -A flaccid tongue body with a scarlet tongue body usually indicates Exhaustion of Yin.

  Swollen

         -This is a very large tongue body and can indicate both Excess and Deficiency.

         -A swollen tongue that is also pale can indicate Qi Deficiency

         -A swollen tongue that is also bright red and painful can indicate Heart and Spleen Heat. This could also be due to excess alcohol consumption.

  Big or Enlarged Tongue

         -An enlarged tongue can indicate Phlegm, Damp, or Water Stagnation.

         -An enlarged tongue with a pale body and a moist coat may indicate Spleen and Kidney Yang Deficiency

         -An enlarged tongue with a red body and a greasy yellow coat may indicate Spleen and Stomach Damp-Heat.

  Half the Tongue Is Swollen

         -A half swollen tongue may indicate general weakness of the Channels.

  Hammer Shaped

         -This is where the front half or third of the tongue is enlarged at the sides.

         -A hammer shaped tongue usually indicates Spleen, Stomach, and Kidney Deficiency

         -This tongue is almost always indicative of a serious condition, and may indicate mental illness.

  Local Swelling on One Side

         -Localized swelling of tongue with a normal tongue body color indicates Qi Deficiency

         -Localized swelling of tongue with a red tongue body color indicates Qi and/or Blood Stagnation

  Swollen Sides

         -A tongue with swelling in Liver and Gallbladder area usually indicates Rising Liver Yang or Liver Fire.

  Swollen Between the Tip and the Central Surface

         -This area corresponds to the Lung area and usually presents with a normal or pale tongue body.

         -This tongue is usually found in patients with chronic Lung and Spleen Deficiency, which tends toward Damp and Phlegm                    accumulation.

  Swollen Edges

          -This tongue may indicate Spleen Qi or yang Deficiency.

          -If Spleen Yang is Deficient, the edges will also be wet.

  Swollen Tip

          -When the very tip of the tongue is swollen, it usually indicates Heart problems.

          -If the tongue is also deep red, this may indicate Heart Fire.

          -If the tongue is normal in color or pale, this may indicate Heart Qi Deficiency.

  Short and Contracted

          -When the patient can not show the entire tongue, it usually indicates a more severe disease.

          -If the tongue is also moist and pale, this indicates stagnation of Cold (bluish/purple) in the meridians or Spleen Yang                                deficiency.

          -If a contracted tongue also has a sticky tongue coating, this may indicate Turbid-Phlegm blocking the channels.

          -If the tongue is also deep red and dry, excessive heat has consumed Body Fluids and stirred up internal Wind.

          -A short, swollen, tender, and pale tongue usually indicates Qi and Blood Deficiency.

          -A short or small frenum may be inherited and is normal.

  Long

          -If there is difficulty in retracting the tongue, this indicates interior Excess Heat, Heart Fire, or Phlegm-Fire Misting the Heart.

  Front Swollen

          -Swelling towards the front one-third of the tongue may indicate Phlegm retention in the Lungs.

  Thin

          -This can indicate that Qi and Blood are deficient and not able to properly nourish and moisturize the tongue. The tongue body              will also usually be pale in color with Qi and Blood Deficiency.

          -A thin tongue that is also dark red and dry may indicate Yin Deficient Fire.

 Tongue Body Features

  Rough or Tender Texture

          -A tender tongue that appears smooth, delicate, and is possibly swollen indicates deficiency.

          -A rough tongue that appears wrinkled and rough indicates Excess.

  Red Spots

          -Red spots may indicate Heat Toxins in the Blood or Heat Toxins attacking the Heart.

          -Red spots can indicate the presence of Damp-Heat in the Xue Level, where the internal organs are accumulating toxins.

          -Red spots on the Tip (Lung/Heart area) is usually not severe and may present in the beginning stages of illness.

          -Red spots on the entire tongue may indicate a more severe illness.

          -Red spots on the sides of the tongue (Liver/Gallbladder area) may also indicate a more severe illness.

          -Red spots on the back of the tongue (Kidney area) may indicate the advanced stage or chronic nature of an illness.

  White Spots

          -White spots are usually due to Spleen and Stomach Qi Deficiency together with excess heat accumulating in the body. In this             case, the tongue may also have sores and pus.

  Black Spots

          -Black spots usually indicate Qi and Blood Stagnation or heat in the Blood.

  Deviated Tongue Body

          -This is where the tongue tends toward one side of the mouth

          -This is due to Wind, either from exterior Pathogenic Wind or internal Wind-Damp patterns.

  Moving, Lolling, Wagging, Playful Tongue Body

           -This usually indicates heat in the Heart and Spleen channels stirring up internal Wind.

          -In children, this may indicate developmental problems.

  Teeth Marks on Tongue Body (Scalloped)

          -If the tongue body has normal color, this usually indicates Spleen Qi Deficiency

          -If there are teeth marks together with a swollen tongue, this may indicate Spleen Yang and/or Qi Deficiency.

          -If the tongue is also pale and moist, it is more likely Spleen Yang Deficiency or a Cold-Damp pattern.

  Quivering or Trembling Tongue Body

          -Trembling of the tongue that can not be controlled may be due to external febrile disease or excess heat consuming Yin. The                excess heat stirs up Side effects of some western medications (pharmaceuticals) and may cause trembling of the tongue.

Tongue Coating

Indicates the state of the Yang organs, especially the Stomach.

  White Tongue Coat

          -A thin white tongue coating is normal.

          -A thin white tongue coating can also indicate external Cold patterns when the appropriate clinical symptoms are present.

          -With a moist and pale tongue, a thicker white coating can indicate Damp-Cold.

          -A dry white coating can indicate Cold turning to Heat and starting to dry body fluids.

  White Like Powder Tongue Coat

          -A white and thick tongue coating like powder indicates turbidity and external pathogenic heat. This coating will usually                       change to yellow after a short time if the patient is not treated.

          -If the tongue body is dark red, interior toxins may be present.

  White Like Snow Tongue Coat

          -This may indicate exhaustion of Spleen yang with Damp-Cold in the Middle Jiao

  Yellow Tongue Coat

          -A slightly yellow coating indicates Wind-Heat or Wind-Cold turning to Wind-Heat

          -A yellow tongue coat indicates an interior heat pattern. The deeper the color of yellow, the more severe heat. A burnt yellow                indicates further accumulation of heat in the body.

          -If the coating is yellow and moist and the tongue body is swollen and tender, this indicates interior Damp-Heat or Yang                        deficiency. In the case of Yang Deficiency, the tongue is showing false heat signs, as the Yin has forced the Yang to the                          surface of the body.

  Dirty Yellow Tongue Coat

          -This tongue coating may indicate Stomach and Intestinal Damp-Heat

  Simultaneous White and Yellow Tongue Coating

          -Can indicate a Shao yang pattern

          -Can indicate a simultaneous Heat and Cold pattern, or a Cold pattern turning to Heat

         -Can indicate a simultaneous Interior and Exterior pattern

  Gray Tongue Coat

          -This tongue coating usually indicates an internal pattern of either Heat or Damp-Cold.

          -A dry gray coating can indicate internal Excess Heat scorching Body Fluids or Yin Deficient Fire.

          -A wet or moist gray coating usually indicates Cold-Damp Stagnation or Damp-Phlegm retention.

  Black Tongue Coat

         -Similar to the Gray coating above, but more severe.

         -The black coating usually develops from gray or a burnt yellow coating.

         -A dry black coating (usually with cracks) may indicate excessive Heat burning body fluids.

         -A moist black coating and a pale tongue body may indicate Yang Deficiency, Internal Excess Cold, with or without the                           presence of Dampness.

         -Both Gray and Black tongue coating can indicate extreme Cold (wet tongue) or extreme Heat (dry tongue).

         -Western drugs such as antibiotics can also cause a black tongue coating.

  Half Yellow, Half White (Longitudinally)

         -This coating may indicate Heat in the Liver and Gallbladder

  Yellow Root With A White Tip

         -This may indicate that exterior Pathogenic Heat is penetrating more deeply into the interior of the body.

  Black in the Center, White and Slippery on the Sides

         -This may indicate Spleen Yang Deficiency with interior Damp-Cold

Tongue Coat Thickness

 Thin Coating

          -Normal

          -In disease, it indicates the disease is either external or an internal disease that is not severe.

          -If the tongue coating changes from thick to thin, this indicates pathogens are moving to the exterior of the body and the                       disease is waning.

  Thick Coating

          -A thick coating usually indicates more of an internal disease that is more severe.

          -It may also indicate that exterior pathogenic factors have penetrated more deeply into the body.

          -A thick tongue coating may also indicate retention of food.

          -If the tongue coating changes from thin to thick, this indicates pathogens are penetrating deeper into the interior of the body.

  Peeled, Mirrored, Shiny, No Coating

          -With a mirrored tongue, there is no coating on the tongue. In less severe cases, there may be a partial coating on the tongue.

          -If the body of the tongue is also red, it usually indicates that Stomach Qi and Yin is severely damaged.

          -If the tongue body is also light in color, this may indicate that Qi and Blood of the Spleen and Stomach is damaged and                         deficient.

          -If the tongue body is also red or dark, Stomach and Kidney Yin is damaged (body fluids dried up) due to heat.

Tongue Body Cracks

 Horizontal Cracks

          -Yin Deficiency

  Transverse Cracks On the Sides of the Tongue

          -Spleen Qi and/or Yin Deficiency

          -Scalloped Tongue

          -Spleen Qi Deficiency Usually with Dampness

   Crack in the Center

          -Stomach and/or Spleen Qi Deficiency

  Crack Down the Center to Tip

          -Heart Pathology

  Cracks Like Ice Floes

          -Yin Deficiency

  Vertical Cracks in the Center

          -Spleen Qi Deficiency

  Irregular Cracks

          -Stomach Yin Deficiency

Tongue Coat Root

  Tongue Coat Has Root

          -The normal tongue coating has Root, which means that is "rooted" or attached to the surface of the tongue body. It can not                  be easily scraped off or removed.

  Tongue Coat Has No Root

          -A coating without root rests on the surface of the tongue, but can easily be removed or scraped off. A coating without root                   usually indicates impairment of Spleen, Stomach, and Kidneys.