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Patterns of Diagnosis in Traditional Chinese Medicine

I am not going to rediscuss allopathic or Western medicine, as I think I have dealt with its basic
elements in the foregoing chapters. When each integrated therapy is discussed for an individual
disease, the appropriate issues of allopathic treatment will be raised, for and against. Let it suffice
that allopathic or Western medicine is important in the quick acute rescue, the replacement of
necessary nutritional, hormonal, or chemical elements, and the removal or reconstruction of physical
deformity. Our time would be better spent trying to understand other paradigms of illness and how
we can integrate them into allopathic medicine.
Traditional Chinese medicine (TCM) was introduced to the U.S. by James Reston’s account
of his acupuncture analgesia during an emergency appendectomy in Beijing, while he was covering
the Sino-American ping-pong tournament in 1971. His account, on the front page of the New York
Times, was the first popular account of Chinese medicine to reach the mass media in the U.S. There
were Chinatowns and practicing acupuncturists and herbalists in many major American cities,
especially on the West Coast, but there was little public awareness of Chinese medicine until that
report. President Nixon’s visit to China with his personal physician in 1972, and the earlier visit
of three American physicians in 1971, added credence to Chinese medicine with a positive report
in JAMA on several observed surgeries using acupuncture analagesia.38
The history of TCM in China goes much farther back. The roots are probably from the natural
and folk medicine practiced during the Warring States period (475–221 B.C.) of the Zhou dynasty
(1027–221 B.C.). The first classical book on traditional Chinese medicine was the Huang Di Nei
Jing (The Yellow Emperor’s Classic of Internal Medicine) and is ascribed to the Yellow Emperor,
Huang Di, with its nucleus being written in the first century B.C. during the Han dynasty. It is
presented as an 81 part dialogue between the Yellow Emperor and his private physician, Chi Po.
The book is in two sections: the Su Wen (simple questions), which deals with preventative medicine
and Chinese medical principles; and the Ling Shu, which deals with therapeutics. There are over
10,000 ancient Chinese medical treatises surviving from previous centuries and each has had its
share of influence as Chinese medicine has evolved and matured over time. The introduction of
Chinese medicine into Japan, Korea, and Southeast Asia, starting in the sixth century A.D., led to
a regional and secular approach to Chinese medicine that was specific for each country that
embraced the medical system. This development of Chinese medicine continues to this day in
France and the United States.
Traditional Chinese medicine is composed of an array of therapeutics: acupuncture, moxibus-
tion, herbal medicine, diet, exercise, and spiritual approaches. We will discuss herbal medicine,
acupuncture, and moxibustion as useful therapeutic modalities in the Western medical office. The
modalities of Chinese food therapy, Tai Qi, and Qi Gong are too impractical to be used in the office
and will not be discussed in detail here.
DIAGNOSIS IN TRADITIONAL CHINESE MEDICINE
TCM has at its basis the maintenance of balance in the body. Illness or disease always represents
a state of imbalance. We could consider this concept the need to find the most appropriate and
stable chaotic state, with a strong attractor. Over time, TCM has elucidated methods of restoring
balance to the body, thus curing disease. The two most important methods are herbal therapy and
acupuncture. Although many imbalances can be treated by either method, herbal medicine is
excellent at tonification, that is, increasing the energy of a particular organ or the whole body, while
acupuncture is more successful at removing energy blockages or stagnations of energy, and bal
ancing the energy when there is excess in one part of the body and deficiency in another. Of course
in integrated medicine we often end up using acupuncture and herbal medicines together —
acupuncture for the acute problem, and herbs to shore up the underlying deficiency that allowed
the acute disease to manifest.
THE LANGUAGE OF CHINESE MEDICINE
Chinese medicine is somewhat simplistic in the language it uses for diagnosis. The diagnosis is
not the name of a disease, but the description of a pattern that seems to be preeminent in the whole
person. The pattern is elucidated by the Chinese physical exam, which includes:
1. Looking — examination of the eyes, tongue, lips, nose, and ears (five senses); exami-
nation with special reference to color (the five colors).
2. Listening — to the breathing and the voice (five vocal expressions).
3. Smelling — the skin, sweat, breath, and urine.
4. Palpating — the abdomen (the Hara), the Channels or Meridians (Alarm Points and Ah-
Shi points).
5. Asking — relevant questions as to the nature of the imbalance.
6. Pulse diagnosis — taking the radial pulses.
7. Tongue diagnosis — inspecting the color, shape, coating, and quality of the tongue tissue.
(All these diagnostic issues will be discussed in practical detail in the section: The Integrated
Physical Exam).
The Chinese physical exam is able to show a predominant pattern of imbalance in the patient,
which, in the Chinese physician’s eyes, is the disease to be treated. Many dissimilar Western
diagnoses will have similar Chinese patterns of disharmony, and many similar Western diagnoses
will have different Chinese patterns of disharmony. In Chinese medicine there have been periods
in which one theory of harmony and disharmony dominated over another. Thus, during one period,
the Five Element Theory of disharmony reigned supreme and during another period, the Yin–Yang
and Eight Principles Theory of disharmony reigned supreme. In this paradigm of healing, the
Western diagnosis is unimportant, as we are treating the patient’s explicit response to his or her
inner disturbance, which is going to be different for each patient according to his or her initial
condition.
The language and concepts of Chinese medicine describe the ways we get out of balance. The
most important issue in the Chinese way of thinking about disease is not, is X causing Y, but what
is the relationship of X to Y? In order to differentiate these patterns we have to learn the language
of these patterns under the headings: The Eight Diagnostic Principles, The Six Evils, and The Five
Fundamental Substances. These headings relate more to a herbal therapeutic diagnosis than to an
acupunctural imbalance. The Five Element Theory, the Channels, the Six Stages, the Four Levels,
and the Three Burners will be considered under the section dealing specifically with acupuncture
as they specifically explain disharmonies and movements of Qi or energy. The Six Evils act as
stressors on the body and produce a reactive change in the Chinese Zang-Fu organs and the Five


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