Diagnosis

Concept of disease in traditional Chinese medicine

In general, disease is perceived as a disharmony or imbalance in the functions or interactions of yin, yang, Qi, blood, organs, and meridians etc. and of the interaction between the human body and the environment.

In traditional Chinese medicine, a disease has two aspects: one is disease category, and the other, which is more important, is called pattern or syndrome. For example, the disease category of a common cold might present with a pattern of wind-cold in one patient, and with the pattern of wind-heat in another. Therapy is based on which “pattern of disharmony” can be identified. Thus, “pattern discrimination” is the most important step in Chinese diagnosis.

Since therapy will not be chosen according to the disease category but according to the pattern, two patients with the same disease category but different patterns will receive different therapy. Vice versa, patients with similar patterns might receive similar therapy even if their disease categories are different. This is called “different diseases, same treatment; same disease, different treatments”.

 Basic principles of pattern discrimination

The process of determining which actual pattern is on hand is called pattern diagnosis or pattern discrimination. Generally, the first and most important step in pattern diagnosis is an evaluation of the present signs and symptoms on the basis of the “Eight Principles”. These eight principles refer to four pairs of fundamental qualities of a disease: exterior/interior, heat/cold, vacuity/repletion, and yin/yang.

After the fundamental nature of a disease in terms of the Eight Principles is determined, the investigation focuses on more specific aspects. By evaluating the present signs and symptoms against the background of typical disharmony patterns of the various disease categories, evidence is collected whether or how specific entities are affected. This evaluation can be done in respect of the meridians, Qi, blood, body fluids and organs.

There are also three special pattern diagnosis systems used in case of febrile and infectious diseases only:  six division pattern, four division pattern and three burners pattern.

Causes of diseases in tradition Chinese Medicine             

There are three fundamental categories of disease recognized: external causes, internal causes (emotional factors) and non-external-non-internal causes (voracious eating, too much alcohol, sexual intemperance, trauma and parasites).

How to make Chinese diagnosis (Method of Chinese diagnosis)?

In traditional Chinese medicine, there are four diagnostic methods: inspection, auscultation and olfaction, inquiry, and palpation.

Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.

Auscultation refers to listening for particular sounds (such as wheezing).Olfaction refers to attending to body odor.

Inquiry focuses on the “seven inquiries”, which involve asking the patient about the regularity, severity, or other characteristics of chills, fever, perspiration, appetite, thirst, taste, defecation, urination, pain, sleep, menses, and leukorrhea.

Palpation includes feeling the body for tender A-shi points, palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen.

Examination of tongue and pulse

Examination of the tongue and the pulse are among the principal diagnostic methods in traditional Chinese medicine.

Certain sectors of the tongue’s surface are believed to correspond to the organs of the body. For example, teeth marks on one part of the tongue might indicate a problem with the Heart, while teeth marks on another part of the tongue might indicate a problem with the Liver.

Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each arm, for a total of twelve pulses, all of which are thought to correspond with certain organ. The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like “floating, slippery, bolstering-like, feeble, thready and quick”; each of these qualities indicate certain disease patterns.

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