Acupuncture Science 4: Chinese diagnosis

Part 4:  Chinese Medicine Diagnosis: A Balancing Act

Traditional Chinese Medicine (TCM) diagnosis constitutes the four basic methods of; inspection (of the physical body or coating on the tongue), auscultation (listening to speech, breathing or coughing) and olfaction (of mouth or body odour), inquiry (of symptoms) and palpation (of pulse or abdomen), very much similar to modern medical clinical methods. Along with the history each symptoms and sign is analysed singularly, but also generally to recognise the cause, nature and relationships to identify the syndrome. In addition, the patient’s personal and environmental factors are also taken into consideration.

Essentially, diagnosis is based on the two philosophical systems of Yin-Yang polarity and the Five Element theory. Based on the Eight diagnostic criteria (Ba Gang), signs and symptoms are classified according to their opposing characteristics represented by four polar extremes;

  • Ying -Yang
  • Internal and external
  • Deficiency and excess
  • Cold and heat

Any imbalances in the body are described according to the Eight diagnositic criteria and a ‘pattern of disharmony’ is established which is then referred to as a ‘syndrome’.  The flow of Qi (vital energy) through a system of channels (also called meridians) and a concentration of Qi in the organs is an important part of the regulation of the body functions. Assessment of the overall Yin-Yang balance is one of the primary aims of a Chinese medicine assessment and any diagnosis based on the interior-exterior, deficiency-excess, and cold-heat is under the general umbrella of Yin and Yang criteria.

  • Internal and External: Internal disturbances (known as Li in Chinese) are usually related to imbalances in the Zang or Fu organs and usually associated with chronic conditions, often caused by poor nutrition or emotional excesses of anxiety, fear, sadness or excitement. Examples of internal disturbances are diarrheoa, nausea and abdominal pain. External illnesses (known as Biao in Chinese) are disturbances in the channels or meridians particularly in the peripheral or superficial areas. There is sensitivity to environmental and climactic changes. Examples include peripheral neuralgia or arthritis of a few joints.
  • Deficiency and Excess: Deficiency diseases are usually chronic, typical symptoms are tiredness, exhaustion, dizziness, pallor and low blood pressure. This usually originates from a deficiency of Qi, blood or Jing (elementary essence). When these are in excess symptoms include acute pain, cramps, hypertension, insomnia and hyperactivity.
  • Cold and Heat: Cold disturbances (Han in Chinese) relate to a weakened body Qi resulting from effects of environmental cold influences. Examples are cold extremities and pallor. Heat disturbances (Re in Chinese) is due to increased Yang activity of the body Qi, which eventually overcomes the body Yin resulting in an imbalance between the two forces. Heat symptoms include; fever, redness, constipation, pain and agitation.

The above diagnostic criteria can be described in various combinations depending on the type of symptom and the functional or organ disturbances. Characteristically, symptoms of excess and heat will usually occur together, termed as ‘Yang in Yang’ e.g. acute pain and fever. Other combinations can be excess and cold (cramps and pallor), or deficiency and heat (exhaustion and agitation). Using this syndrome method Chinese medicine treats either the acute or chronic nature of the disease, or in some cases both. Whilst maintaining a balance the primary aim is to strengthen the body Qi but at the same time also dispel any excessive pathogenic Qi.

An acute infection resulting in fever is an example of an external cause of excessive heat (Yang). In western medicine it is very successfully treated with antibiotics therefore ‘clearing the heat’. Once the infection has been rid of, it is assumed that the body will fully recover of its own accord. In TCM no such assumptions are made. Instead, at this stage an inherent part of every TCM treatment plan is focused on strengthening the body systems to optimum health. A strong Qi includes a healthy immune system. Consequences of a weakened Qi are an increased susceptibility to frequent low-level health problems e.g. colds, flu, runny nose, low moods, easy fatigability and general tiredness. Such an approach encompassing greater recovery outcomes may be an extremely helpful addition to the more linear and absolute western treatment methodology.

In Part 5 we will discuss, Integrating Western Physiology and Traditional Chinese Medicine Philosophies.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory