Diagnosis I Midterm

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TCM Diagnostics

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Discipline in TCM science concerning the studies of examination of the body, diagnostics of disease, and more importantly the differentiation of syndromes under the guidance of TCM theories

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Two main components of TCM diagnostics

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1. Data Collection
2 Data Processing

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Data Collection

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Examining the Patient to collect evidence relating to the patient's health status

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Data Processing

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-Sorting out information
-Analyzing, synthesizing, and reasoning data using TCM theories
-Making clinical diagnosis of the disease and its syndrome pattern
-Predicting the change of a disease

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Data Collecting Methods in the Concept of TCM are Called

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Four Examinations

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Four Examinations Include

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1. Inquiry
2. Inspection
3. Listening and Smelling
4. Palpation

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Inquiry Examination (Wen)

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Ask about family history, of disease, general family history, and symptoms and other associated factors of the disease

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Inspection Examination (Wang)

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To inspect the patients vitality, complexion, skin color, physical fitness, behavior and movement, texture and color of tongue and its coating, body secretion and discharges (feces, urine, vaginal discharge, etc)

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Listening and Smelling Examination

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To listen to the patient's voice, breath, cough, movement of joints, smell the odor's of secretion, and discharge or general body odors in order to establish the pathological changes in the patient

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Palpation Exam

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Mainly consists of two parts: pulse taking-to establish the fullness or emptiness of the Zang Fu organs, Qi, blood, etc. Touching or pressing patient's body by hand (abdomen, chest, muscles, joints, acupoints, etc) to obtain information of the condition

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Symptom

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Abnormal phenomenon which derives from pathological conditions occurring in humans including: patient's feeling of discomfort, and information gathered through examination

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Patient's feeling of discomfort

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Fever, aversion to cold, various pains, insomnia, lack of energy, hyperactivity, etc

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Information Gathered Through Examination

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By clinician or through instruments, laboratory tests, red tongue, yellow tongue fur, etc

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Disease

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Generic name given to any disorder in the whole process and development of pathologic change

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Disease Differentiation

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the process of making analysis and identifying a disease based on the patient's symptoms. Most diagnosis in modern bio-medicine follow the disease differentiation. The treatment to a disease thus is more or less identical aming different patients

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Syndrome Differentiation

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A process of analyzing and synthesizing, under the guidance of basic TCM theories, the information obtained through four diagnostic methods to determine which syndrome the patient suffers from. This process takes in account of the environment, nature of pathologic factors, the state of the body's vital Qi and the characteristics of disease.

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Which Differentiation is TCM Generally Based On?

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Syndrome differentiation

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8 Syndrome Differentiation Methods

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1.Eight principles syndrome differentiation
2. Qi, blood and body fluid syndrome differentiation
3. Etiology syndrome diferentiation
4.Zang Fu (visceral) syndrome differentiation
5. Six meridians syndrome differentiation
6 Wei-qi-ying-xue syndrome differentiation
7.Triple jiao syndrome differentiation
8.Channels and collaterals syndrome differentiation
*mutually complimentary

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Aspects that Should be Considered in Making a Diagnosis

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1.The Holism (Zhen Ti Guan)
a.The human body as a whole
b.the balance between human body and environment
2.Taking all four examination methods into account
3.Combination of disease differentiation and syndrome differentiation

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Human Body As a Whole

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The human body is an organic whole (outer, inner, upper, lower, etc). Zang Fu are linked by meridians and illness can manifest on surface of body. If one disease isn't treated properly it can lead to another
Ex. KI weakness and lower back pain

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The Balance Between Human Body and Natural Environment

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It's important for humans to be able to adapt to their environment in order to stay healthy. Changes in environment (seasons, climate, geographical conditions, etc) will affect well being. Weak Qi leads to a weakened adaptability therefore causing small changes to feel drastic
ex. hay fever in US or asthma in polluted city

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Taking all Four Examination Methods into Account

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All four methods should be taken into consideration simultaneously and it should be noted that some diseases have false manifestations

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Combination of Disease Differentiation, and Syndrome Differentiation

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In TCM it is required to diagnose the name of disease as well as differentiate the syndrome pattern of the disease. Both aspects are important in treating with herbs.

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Inquiry Examination Includes...

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-General Information
-History of Present Illness

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Inquiry Exam Includes

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-General information
-History of present illness
-History of previous illness
-Personal life circumstances
-History of family illness
-Ten questions

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General Information

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General intake that patient will fill out: age, DOB, marital status, ethnicity, birthplace, address, etc

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History of Present Illness

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What, when, where how, what has been done so far, what is the situation right now?

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What?

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What is the problem that brought the patient in, what is bothering the patient the most, focus on main complaint

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When?

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Acute or chronic (how long ago did it happen?), season, age, what was the circumstance when the disease began?

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Where?

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Environment, climate

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How?

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Cause

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What Has Been Done So Far?

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Prior to this visit, any self-care? Saw any other healthcare professionals? If so what were the prior doagnoses?

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What is the Situation Right now?

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MOST IMPORTANT! Present symptoms, is the current state recurring, general health status

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Personal Life Circumstances

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Living, working, eating/drinking, everyday life routine

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History of Family Illness

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Contagious diseases (if living with close family members), heredity (important for determining constitution), chronic conditions

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Detailed Symptoms

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1. Chills and fever
2. Sweat
3. Pain
4. Eating/drinking
5. Bowel movement and urination
6. Sleep
7. Energy
8. Ears, nose, throat, mouth and other body parts
9. Women
10. Children

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Chills and Fever

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A feeling of hot then cold or vice versa.
ex. cold/heat syndrome, exterior/interior syndrome, deficient/excessive

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Hot and Cold Patterns

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-Feverish with aversion to cold
-cold only
-hot only
-alternating hot and cold

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Feverish with Aversion to Cold
(Wu Han Fa Re)

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Exterior Syndrome
Aversion to cold with feverish sensation appearing simultaneously due to body's struggle btw Qi and external evil

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Aversion to Cold

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Feeling of cold which cannot be completely relieved by layering or adding heat

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Feverish

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Feeling hot with or without a raise in temperature

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Cold>Hot

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Exterior cold syndrome

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Hot>Cold

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Exterior heat syndrome

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Slight Hot with Aversion to Wind/Slight Cold with Spontaneous Sweat

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Deficient exterior syndrome
(Tai Yang Syndrome)

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Cold Only

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Interior Cold Syndrome
Caused by yang deficiency or invasion of cold evil
Two Patterns:
-deficient cold syndrome
-excessive cold syndrome

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Deficient Cold Syndrome

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Chronic conditions with deep, slow and weak pulse
(deficiency=weak pulse)

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Excessive Cold Syndrome

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Recent onset with severe cold-pain in abdomen or other local area

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Feeling Hot Only Includes Five Patterns:

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1. Hight fever
2. Tidal fever
3. Slight fever/hotness
4. Long term slight fever/hotness
5. Summer fever in child

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High Fever

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"Four big symptoms" being big fever, big pulse, big sweats, big thirst
-interior excessive heat syndrome

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Tidal Fever

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Up and down like tide. The hot/fever increasing in accordance with the time of day like tide

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Yang/Ming Tidal Fever

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High fever with constipation, temp rises from 3-5pm while yang/ming is strong and struggle with excessive heat in yang/ming channel(ST)

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Damp-Warm Tidal Fever

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Suppressed fever, increased in the afternoon with heaviness in the head and body

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Yin Deficiency Tidal Fever

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Low fever with hot flush in the afternoon or evening, five centers vexation and hot, often with night sweat

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Slight Fever/Hotness

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Low fever, usually from 98.6F to 100.4F. Appearing in some internal conditions or later stage of infectious disease