Jan 06, 2016
The art of diagnosis is a lifetime voyage in the interpretation of the presenting signs and symptoms of the syndrome complexes. A viable diagnosis is totally dependent on competent knowledge of TCM theory. This cannot be stressed enough. What separates a good acupuncturist from an excellent one is his understanding of TCM theory and how to apply this knowledge. On the other hand, a competent TCM theorist means nothing if they cannot interpret the data correctly.
In TCM, diagnosis of disease is the process of discriminating patterns of disharmony, or the syndrome complexes. This can be divided into two parts. The first part is to thoroughly examine the patient, like a crime scene investigator as I mentioned before. The second part of diagnosis is logically interpreting the information gathered in the examinations, or to discriminate patterns of imbalance.
Traditionally, TCM examination is divided into four parts, commonly referred to as the Four Pillars of Diagnosis. These are questioning the patient, observing the patient, palpating the patient, and auscultation / olfaction. Lets look at these in more detail.
Inquiring Questioning the Patient
It is said that if you listen to the patient, the diagnosis is rendered. This is general idea in the patient interview. When the practitioner questions the patient in TCM, I believe 80% of the time the diagnosis is correct. It is like throwing apples in a bag. The ones with the most apples is the primary diseased organ / pathway. It is there for vital to understand the presenting sign and symptoms to categorize dysfunction. In TCM this is called pattern discrimination. This is the main form of diagnosis and treatment. It is symptom based. Much of the questions reflect the five element correspondences and the primary functions of the organs. Therefore proper understanding of the functions of the internal organs and the Five Element characteristics is crucial to diagnosis.
In TCM, there are ten basic questions that lead to one hundred questions. Here are the main classic questions in TCM diagnostics:
Low energy Indicates deficiency of Qi. If energy is lower in the end of the day Yin deficiency. If patient is more deficient in the morning Yang deficiency. If the patient is constantly tired throughout the day, indicates overall Qi deficiency.
Excess or hyperactivity can be possible excess yang heat, excess interior heat, or excess yang qi rising. Chills & Fever
Chills indicate invasion of pathogenic cold.
Fever indicate invasion of pathogenic heat.
Chills with fever indicates exterior syndromes of wind/cold or wind/heat. Wind/Cold symptoms include severe chills with mild fever, no sweating, general body aches, headache, pulse will feel floating and slow. Wind/Heat symptoms include mild chills with severe fever, sweats, excess thirst, and a floating and rapid pulse.
Fever without chills with aversion to heat is do to excess heat in the interior. Symptoms include profuse sweating, severe thirst, and a surging pulse. Fever at night is mainly do to Yin deficiency.
Chills without fever indicates interior cold syndromes. Symptoms include chilled appearance, cold extremities, and a deep, slow, and weak pulse.
Alternating chills and fever indicate intermediate syndrome. Other symptoms might include bitter taste in mouth, thirst, and fullness in chest.
Absence of perspiration in exterior syndromes indicate invasion of pathogenic cold.
Presence of perspiration in exterior syndromes indicate invasion of wind or heat or both wind/heat.
Perspiration at night (night sweats), which stops upon awakening, indicates Yin deficiency with hyperactivity of Yang heat.Frequent Perspiration that worsens with activity deficient Qi and deficient Yang Qi.Profuse perspiration that is accompanied with high fever, mental restlessness\, thirst, preference to cold drinks, and a surging pulse indicates excess heat from excess Yang heat being expelled out by perspiring.Appetite
Poor appetite is a weakness in Spleen and Stomach Qi. Possible symptoms include prolonged illness and poor appetite, loose stools, lassitude, pale tongue, white thin coating on the tongue.
Poor appetite with chest fullness, abdominal fullness, thick and sticky coated tongue indicates stagnation of Qi of the Spleen and Stomach caused by food retention or stagnation of dampness.
Increased or excess appetite is typical with excess Stomach heat or Stomach fire.
Increased appetite without a desire to eat is typical of Yin deficiency causing internal heat.
Heat will produce a bitter taste in the Liver or the Heart. In Liver fire, the bitter taste isnt constant. Heart fire produces a bitter taste in the morning after a sleepless night and Heart fire is always accompanied with insomnia.
Sweet tastes indicates Spleen Qi deficiency and / or damp / heat.
Sour tastes indicates food retention in the Stomach or lack of harmony between the Liver and Stomach.
Salty tastes are caused by Kidney Yin deficiency.
Lack of taste sensation is caused by Spleen Qi deficiency.
Pungent tastes are caused by in-balances in the Lung, usually Lung heat.
Vomiting is usually caused by a form of heat. Sour vomiting is a result of Liver insulting the Stomach..Bitter vomiting is a result of Liver and Gall Bladder heat.Vomiting that occurs after eating is usually a result of heat pathogenic factor.Thirst
Cold syndromes, or any syndrome in which heat is not noticed causes lack of thirst. In this case the body fluids are not being consumed because of the cold.
The presence of thirst in a patient indicates heat or retention of damp phlegm in the interior preventing the body fluids from ascending.
Constipation is usually due to excess heat or excess usage of body fluids.
Loose stools indicate mainly deficiency of Spleen or dampness invading the SpleenWatery stools with undigested foods usually means a deficiency of Yang of the Spleen and the Kidney.
Bloody stools with mucous is usually a result of damp heat in the Intestines and stagnation of Qi in the Intestines.Urination
Dark color urine usually indicates heat syndromes.
Clear and abundant amounts of urine usually indicates coldor an absence of heat.
Turbid / Cloudy urine indicates damp heat.
Red urine usually indicates damage of a vessel due to heat.
Clear increased amounts of urine indicates weak Kidney Qi and Bladder controlling the urine.
Little volume and yellow urine with accompanied urgency and painful urination usually indicated damp heat in the Bladder.
Dribbling and felling of retention of urine usually indicates Kidney Qi deficiency, possible damp heat, and stagnation of blood or stones.Sleep
Insomnia accompanied with dizziness and palpitations is usually caused by the inability of the blood to nourish the Heart and the Spleen.Insomnia with restlessness in the mind and a dream disturbed sleep usually indicates Heart heat or fire.Dizziness
Dizziness is usually a symptom of deficiency of Qi , blood deficiency, fire, wind or phlegm.
HeadacheThe head is the meeting place of all the Yang pathways. The Qi of all the Zang and Fu flow to the head. If any of the external pathogenic evils attack the head or neck and damages the yang pathways, or if Qi and blood stagnates as a result of internal diseases, the head and brain lack nourishment and a headache is sure to follow.
Recent onset and short duration is usually a result of wind cold.
Gradual onset are usually of interior etiology.
Day-time headaches are usually a result of Qi deficiency or Yang deficiency.Evening headaches are usually caused by blood deficiency or Yin deficiency.Cervical spine headaches, especially at the nape of the neck (Greater Yang Channels) are usually caused by Kidney Qi deficiency or invasion of wind / cold.
Forehead headache Bright Yang Channels) are usually caused by Blood deficiency or Stomach heat.
Temporal headaches ( Lesser Yang Channels) are usually a result of invasion of wind / heat, wind / cold, or from interior Liver and Gall Bladder Fire rising.
Top of the head headache (Terminal Yin Channels) are usually a result of Liver blood deficiency.
Whole head headache is usually a result of invasion of wind / cold.
Heavy feeling headache is a result of either phlegm or dampness.
Headache that is inside the head is usually a result of Kidney Qi deficiency.
Throbbing headache is usually a result of Liver Yang rising.
A dull, boring headache is usually a result of blood stagnation.
Continuous and dull pain in the back is usually a result of Kidney Qi deficiency.
Recent, severe, and stiff back pain is usually a result of Blood stagnation.
Severe pain that is aggravated by cold and damp weather and is comforted by heat is usually a result of pathogenic cold and dampness invading the back.
Boring pain is usually a result of Blood stagnation.
Pain in the shoulders and upper back is usually a result of exterior conditions wind / cold, wind / heat, etc.
Pain in the Joints
Pain in the joints that moves from joint to joint is usually a result of Wind.
Fixed joint pain that is very painful is usually a result of invasion of Cold.
Fixed joint pain that is associated with swelling and numbness is usually a result of invasion of dampness
NumbnessBilateral arm and leg numbness, or hand and feet numbness is usually a result of blood