Traditional Chinese Medicine

Diagnostics in TCM

In our modern science driven world, it is easy to forget that diagnosis in medicine is all about listening and paying attention to the patient. Patients have gotten used to medical providers ordering a test, or a medical imaging study to determine what is wrong. While these miraculous tools provide us with valuable information about the workings of the human body, they do not provide everything.

All systems of medical diagnosis are geared to find information that is important to eventual treatment of that patient. A surgeon does not check the psychiatrist report before surgery because it is not important to what the surgeon needs to do.

Likewise the practitioner trained in ancient traditional systems of medicine, like Traditional Chinese Medicine does not need a computerized readout to determine what a patient needs. All systems of medical treatment are tied to, and built on the diagnostic systems which determine how to evaluate and understand what is happening to the patient. Diagnosis is the the first step in treatment.

For example, in biomedical medicine if there is redness and fever indicating a bacterial infection, then the treatment is to utilize an antibiotic. To the TCM practitioner those same signs indicate "heat" or "fire" in the body functioning. The treatment would be to use acupuncture points or herbal medicines that are known to clear heat or cool the body function. Some of these treatments can be shown to be antibacterial in nature, however the goal in TCM is to treat the patient not the condition. The patient is too hot, therefore use treatments that cool that patient down.

In Traditional Chinese Medicine (TCM) there are a couple of major systems of diagnosis. These are philosophically based ways of organizing information into a pattern which is more easily understood than all the data by itself. This is not unlike the way many people put information into a pie chart as a way of taking rough data and providing a visual way of organizing the information into something useful.

TCM has several ways of organizing information into patterns so that an understanding of the patient and a treatment plan can be formulated. These diagnostic systems, often called "Pattern differentiation" are focused on the nature or dynamics of how the patient's body is functioning, rather than trying to define a disease. All practitioners have their own way of using these tools based on their training and experience. Three of the most common systems in use are the 8 principle, Zang-fu and 5 element system.

The Eight principle system is considered the least complicated. All the signs and symptoms of the patient are categorized into paired dynamics to determine the diagnosis. The categories are excess vs deficient, hot vs cold, interior vs. exterior, and yin vs yang.

So for example a person presenting with a fever that has made them weak, with no signs of skin irritation, would get a diagnosis of deficient-hot-interior-yang.

weak = deficient
fever = hot
heat is in interior of body not skin = interior
fever is constant and strong rather than intermittent = yang (active not passive symptom)

This would mean that treatment should involve methods that strengthen the body, cool or clear heat from the interior and balance the forces of yin and yang by improving yin or suppressing yang.

The Zang- Fu system relies on an understanding of the dynamics between the various organ systems of the body. All signs and symptoms are associated with an organ system. For example the heart is associated with the actual heart but also joy/ sadness, dreams, and the clarity of thought. Similar to the eight principle system the various signs can further differentiated as excess in nature, or deficient in nature. Treatment again relies on finding strategies that counter the dynamics presented by the patient.

The Five element system expands on both of these systems and provides a way to express more complicated balances of dynamics in the body. Signs and symptoms again can be categorized into the five elements of Fire-Earth-Metal-Water-Wood. There is an understanding of how for instance a wood sign affects and modifies fire and water signs. This allows for more complicated strategies for treatment. It can also help illuminate complex diagnosis that is not as clear in the 8 principle and Zang-fu systems because of their binary nature.

Depending on the training of the practitioner, they may use one or more of these systems to determine what is the best way to treat a patient. Many practitioners use various systems depending on the condition of the presenting patient.

TCM practitioners look for signs and symptoms in a variety of places depending on their training and experience. Obviously the medical history and patient description of the problem gives many clues as to what is going on. Practitioners also look for signs in various areas of the body including;

pulse and tongue
colors and textures of the skin and nails and hair
feelings on palpation
shape and disposition of the body and face
marks and shape of the ear
general demeanor of the patient
sensitivities and cravings of the patient

Some practitioners automatically pay attention various body signs which helps the practitioner identify basic "normal" characteristics of a patient. Knowing that can help a practitioner focus the questioning to things that are more likely to be a problem for a person of a given type. This can create a situation where the practitioner appears to have magical knowledge of the patient. It is in fact just experience and being able to "see" the pattern and thus be able to see where that pattern leads and what it means. In many ways the art of pattern differentiation is like putting together a jigsaw puzzle without the picture as a guide. As more signs and symptoms are put together, a picture of what is going on with that patient emerges. It is often not necessary to to complete the whole puzzle or find all the pieces to get a good idea what the picture (pattern) is. Likewise once part of the picture is clear, the practitioner will often look for symptoms that make sense given the pattern that has emerged.

In the end, the goal of pattern differentiation/ TCM Diagnosis is not to identify a disease. It is about understanding how the body is responding to a given problem and understand what the body is asking for in regards to help as it tries to function properly.

 

Books for further reading
The Web That Has No Weaver, Kaptchuk, Ted
Between Heaven And Earth, Beinfield,H; Korngold, E.

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