Courtesy: ISO/TS 17948:2014 health information traditional chinese medicine literature metedata
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 entities, evidence is collected whether or how specific entities are affected. This evaluation can be done
- in respect of the meridians (经络辩证; jīngluò biàn zhèng)
- in respect of qi (气血辩证,; qì xuè biàn zhèng)
- in respect of xuè (气血辩证; qì xuè biàn zhèng)
- in respect of the body fluids (津液辩证; jīnyè biàn zhèng)
- in respect of the zàng-fǔ (脏腑辩证; zàngfǔ biàn zhèng) – very similar to this, though less specific, is disharmony pattern description in terms of the Five Elements [五行辩证; wǔ xíng biàn zhèng])
There are also three special pattern diagnosis systems used in case of febrile and infectious diseases only (“Six Channel system” or “six division pattern” [六经辩证; liù jīng biàn zhèng]; “Wei Qi Ying Xue system” or “four division pattern” [卫气营血辩证; weì qì yíng xuè biàn zhèng]; “San Jiao system” or “three burners pattern” [三焦辩证; sānjiaō biàn zhèng]).
Considerations of disease causes
Although TCM and its concept of disease do not strongly differentiate between cause and effect, pattern discrimination can include considerations regarding the disease cause; this is called 病因辩证 (bìngyīn biàn zhèng, “disease-cause pattern discrimination”).
There are three fundamental categories of disease causes (三因; sān yīn) recognized:
- external causes: these include the Six Excesses and “Pestilential Qi”.
- internal causes: the “Seven Affects” (七情; qī qíng, sometimes also translated as “Seven Emotions”) – joy, anger, brooding, sorrow, fear, fright and grief. These are believed to be able to cause damage to the functions of the zàng-fú, especially of the Liver.
- non-external-non-internal causes: dietary irregularities (especially: too much raw, cold, spicy, fatty or sweet food; voracious eating; too much alcohol), fatigue, sexual intemperance, trauma, and parasites (虫; chóng).
Diagnostics
In TCM, there are five major diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation. These are grouped into what is known as the “Four pillars” of diagnosis, which are Inspection, Auscultation/ Olfaction, Inquiry, and Palpation (望，聞，問，切).
- 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 person about the regularity, severity, or other characteristics of: chills, fever, perspiration, appetite, thirst, taste, defecation, urination, pain, sleep, menses, leukorrhea.
- Palpation which includes feeling the body for tender A-shi points, and the palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen.
- Tongue and pulse
- Examination of the tongue and the pulse are among the principal diagnostic methods in TCM. Details of the tongue, including shape, size, color, texture, cracks, teeth marks, as well as tongue coating are all considered as part of tongue diagnosis. Various regions of the tongue’s surface are believed to correspond to the zàng-fŭ organs. For example, redness on the tip of the tongue might indicate heat in the Heart, while redness on the sides of the tongue might indicate heat in 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 zàng-fŭ. 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 indicates certain disease patterns. Learning TCM pulse diagnosis can take several years