diagnosis has to be the hardest part of Chinese
medicine today I want to dive into the 10 most common question we ask each patient and how to
differentiate each answer to form a diagnosis because once we have the right diagnosis we can
pick the right Point selections there is no wrong treatment in TCM only the wrong diagnosis this is
why it's really important so today I'm going to look at energy sleep digestion all the common
questions we ask patients in order to make a diagnosis and how to differentiate them all in
order to pick the right Point selection and to care for our patients in the best way possible
welcome back to my channel if it's your first time here I'm Clara from AcuPro Academy and I
create Chinese medicine and acupuncture content for students and practitioners making it easy
to grasp and fun to learn let's go let's start with sleep often we ask patients how's you sleep
and they might say it's fine because they're so used to not sleep properly that in their mind it
might be fine so it's really important to not just let it go at that question but dig deeper and ask
more details do you fall asleep easily stay asleep and wake up refreshed without being disturbed by
dreams or waken up and suddenly people will say well maybe not so let's differentiate those
answers if someone cannot fall asleep easily they take an hour to two hours to fall asleep
that is either liver overcontrol spleen or wood overcontrol Earth which means Liver Qi stagnation
depleting spleen and creating Spleen Qi deficiency or it could be a spleen and hard blood deficiency
so you need to differentiate with other symptoms in order to know which one it is between the two
if someone tosses and turns all night that's a Yin deficiency if someone wakes up between 1 and
3:00 a.m. that's a liver problem now if they fall back asleep within a few minutes that's
a liver Yang Rising if they cannot fall back asleep that's a liver fire if someone does not
feel refreshed and they feel really tired in the morning and they can't get out of bed that is
a spleen she deficiency morning time is spleen and stomach time so when someone is really tired
in the morning that is a Spleen Qi deficiency and then there are dreams if we have dream Disturbed
sleep it could be a heart Yin deficiency if there are nightmares it's flam fire in the heart
however if it's the same recurring Dream It's a gallbladder Qi deficiency very different right
this is how we differentiate those symptoms make sense and the last one is those who don't sleep
at all not one minute for weeks or month that is hard fire so see this is how we differentiate a
common question how is your sleep question number two is about sweat do you sweat easily and again
sleep and sweat are related to the heart in TCM as a heart function heart is in charge of sweat
and it's in charge of sleeping so when it comes to sweat do you sweat easily so there's two answer
either the person sweats at night and that's heart Yin deficiency or sweat easily during the day
without being hot often when they're anxious and that's a heart sheet deficiency the other answer
is I never sweat years ago before I went back to school for TCM I used to personal train and work
in the fitness industry and I had this client who never sweated and she worked really hard she did a
lot of cardio she did a lot of workout really hard I was watching her she never had a bead of sweat
on her clothes that is a Heart blood deficiency see next question is how is your energy right
after sleep obviously this is correlated if we don't sleep well we don't have great energy how
is your energy what I like to do when I ask about energy is from one to 10 10 being your best energy
where you at most patients are going to say three or four when their energy is low seven when they
don't have top energy but they keep going so if they say seven they're probably a five they're
just so used to go on empty that they will say seven make sense so for those patients I asked
two questions how are you physically and mentally for energy so physically we also have time of day
if you have no energy in the morning specifically that's a Spleen Qi deficiency and if you have no
energy never you exhaust it all the time most of the time it's a young deficiency probably a Spleen
and Yang deficiency we have to ask more question but that's the result often when it comes to
energy in the morning now we have mental energy if someone one is mentally exhausted usually
it's due to the amount of stress so there's Liver Qi stagnation put upon their Spleen which is
overthinking over worrying and gets depleted and creates spleen she deficiency so no matter what
mental or physical fatigue is going to affect the spleen because the spleen is in charge of bringing
clear Qi to the mind for focus and sometimes when we use our mind too much and we don't eat the
right nutrients we deplete our body so that's an easy one it's mostly a spleen issue when it
comes to low energy or fatigue now if someone is blood deficient they can also be fatigued but
blood deficiency usually comes from screen she deficiency not able to produce blood make sense
okay and the next question is about digestion so the first thing we'll ask is are you eating
regular meals what's your diet we need to know what the diet is in order to know what's going on
it's really important also if a woman eats a lot of raw cold food and she's trying to get pregnant
and she's always cold we need to know that in order to explain that we need warmer food right
this is really important so are you bloated easily now when it comes to bloated we have bloated
after meals and that's a Spleen Qi deficiency with dampness or we have bloating that gets worse
and worse as the day goes and is the worst at the end of the day and when we wake up in the morning
the stomach feels flat again that is due to stress that is a liver qi stagnation bloating see this is
how we differentiate the two how is your appetite oh it's pretty good I eat well do you have
cravings so appetite that is poor meaning there's no appetite that's a blood deficiency if there is
Cravings that is also a spleen qi deficiency not being able to transform transport maybe the person
is not having a good diet if we are craving sweets that's a spleen issue if you're craving salt
that's a kidney issue when it comes to digestion the next step is asking that question about Bowel
movement when it comes to Bowel Movement we ask do you have a bowel movement daily and is it easy now
if this is not the answer let's look a little bit deeper constipation means that we may strain or we
don't have a b movement regularly daily diarrhea means that we are going to have loose tools or
worse than that which is diarrhea it could be once a day it could be more often twice a day
that is a different one so so let's start about constipation first if we are straining if there is
gas and easily bloated with stress that's a liver qi stagnation if there is a painful abdominal
region and when we have a bowel movement we feel better that's excess in the large intestine and if
the bowel movement is smelly that's excess heat in the large intestine does that makes sense okay so
it's looking at going a little bit deeper now the stool if they're dry little Pebbles that's a Yin
deficiency if they're big formed stools and large amount that's excess in the large intestine when
it comes to IBS which is alternating constipation with diarrhea this is often due to stress so
it's a liver qi stagnation creating some spiny deficiency or wood overcontrolled earth when it
comes to diarrhea 5 a.m. diarrhea or early morning diarrhea basically the one we have when we wake
up is EXP and kidney yang deficiency a diarrhea that's really smelly is damp heat in a lower gel
no matter what when there is diarrhea there's a spleen she deficiency I'm talking if it's chronic
if it's acute it's external pathogen Invasion so that's different but if it's chronic then that's
a Spleen qi deficiency and then it depends when it happens what it looks like the smell of it
then we can have damp heat if it's smelly like I said if it's urgent painful diarrhea often it's
a Li overact on spleen again and it's kind of like IBS or irritable bowel syndrome and diarrhea that
is better with a warm compress on the abdominal region is often a cold damp diarrhea see this
is how we differentiate those questions simple straight to the point and that's how we make
a diagnosis next question let's talk about the question about urination the first thing I ask is
do you get up at night to pee and if the person drinks a lot of tea tea before they go to bed and
they get up once that's pretty normal but if they don't drink anything I have lots of patients that
say I stop drinking anything by five and I still wake up three to four times a night to pee we know
that's the problem with Kidney Qi not opening and closing the lower gate properly so that's a Kidney
Qi deficiency also if there's Bladder incontinence that is either a Spleen Qi sinking if the bladder
is prolapsing or it's a Kidney Qi deficiency which we know is worse when we cough or laugh or run bed
wedding is another one that if I treat children specifically we can ask the parents about bed
wedding and bed wedding is literally the child has fear it could be irrational fear or rational fear
but a child that is bed wedding or wedding the bed is definitely a child that is fearful of something
so you need to dig a little bit deeper and figure out what is the child scared of because that fear
is controlling the kidney and the kidney is not able to do its job and then there's bad wedding
when it comes to urination the color of the urine is also going to play a role in how we diagnose
so if someone has a urinary tract infection or a bladder infection this is usually damp heat in
the bladder and it's going to look with murky dark urination that is going to be urgent painful
and burning that's easy the second one also urgent painful and burning urination is not an infection
so that's a chronic issue like Interstitial cystitis and that is usually hard fire moves down
to the small intestine because in Chinese medicine the small intestine is in charge of separating the
clear from the turbid and heart fire moving down to the small intestine means that the emotional
state of the heart is not quite healthy and it's creating a problem with the urination and I see
this with interstitial cystitis a lot patients usually have insomnia and a lot of traumatic
emotional trauma that create that Interstitial cystitis or that painful urination that is dark
urgent as well but there's no infection right the other one is when there is painful urination after
intercourse that is usually damp heat or fire in the liver Meridian the Lu collateral Meridian
because the Lu collateral starts at liver five and comes up and wraps around the external
genitalia so when there's a herpes outbreak or there is urination that's painful and Urgent
after intercourse that is a liver fire or damp heat in the liver Meridian usually this person
also has anger or irritability issue and headache that feels better with a cold compress the last
one is if there is dark scanty urine accompanied with constipation and thirst for cold drinks and
that's chronic that is large intestine heat which also reflects into the urination that's bladder
heat and large intestine heat see this is how we differentiate good I hope you're really enjoying
this and by the way if you haven't got your copy of my green book which is Chinese medicine Made
Easy it has all the diagnosis all the graphics you seeing today to help you really narrow down
your diagnosis and improve your skill when it comes to this difficult part that is TCM the
hard copy ships all over the world or the PDF digital version has video links to complemented
no matter what they both come with my fillable intake form that you can use for your patient the
next question is pain obviously some people come to see you because they're in pain but in general
we're going to ask do you have any pain anywhere in the body and people might answer with headaches
knee pain back pain whatever the pain is first we have to look at the Quality of the pain if it is
constant meaning it's always there versus it comes and goes if it's constant it's blood stasis if it
comes and goes it's a liver Chi stagnation If It Moves it's a liver Chi stagnation if it's fixed
in the same area it's a blood stasis let me give you some example this dysmenorrhea the pain is in
the lower abdominal it's fixed it's stabbing it's strong and it's constant during the menstruation
that is blood stasis liver stagnation pain would be come and go so the pain that comes and goes
could be arthritis and the person can say yeah you know sometimes it's my wrist sometimes it's
my knees so it changes location it's not always in the same spot it moves and it's not constant
that's a liver qi stagnation now that pain that's arthritic maybe it's worse when there is cold
weather or when there's hot weather or when there's damp weather now that means there's liver
qi stagnation with damp or with heat or with cold does that make sense okay so a pain that feels
better with a cold compress is excess heat a pain that feels better with a heating pad that's excess
cold yes a pain that is dull not very strong is always a deficiency a pain that is always strong
is always a excess heavy pain or swollen pain is always the dampest now where is the pain pain and
what does it affect if it affects joints ligament tendon sinews it's a gallbladder liver issue if
it affects bones its kidney if it affects muscles it's spleen and stomach make sense right and if
it affects nerves it's usually a liver problem as well because the liver is more connected to
the central nervous system and then depending on the location of the pain we can figure out what
Meridian is affected like kidney is always knee pain or low back pain liver is ankle pain and rib
pain large intestine and small intestine are going to be elbow and shoulders hip pain is going to be
a spleen related problem jaw pain is a spleen and stomach related problem jaw pain usually people
clench when they worry over think and stress and that's where the jaw pain comes up make sense the
neck pain is actually a lung Meridian issue with a bladder Meridian issue because the lung seven is
the commander point of the neck and head right so we look at all those pain and location and we
try to figure out what is affected and we can make the proper diagnosis yes next question is do
you have headaches and a lot of people that have headaches weekly think it's normal because they
think maybe everybody else has a headache every week so I always have to tell patients you know
a lot of people don't have headaches do you have headaches never ever ever and they're like well
no maybe once or twice a month okay is it prior to menstruation if it is then it's part of PMS
is this a liver Qi stagnation right so we have to dig and ask the question the details TCM is
all about the details when it comes to headache the first thing is if it's the whole head it's a
blood deficiency if it's a tight tight band that's squeezing the head that's flam if it's on the
temple area it's a liver gallbladder if it's on the frontal area it's a stomach that is usually
called a Ying headache because the stomach is a Ying Meridian if it's occipital behind the neck
usually that's a bladder related headache and we can use long seven as a really good point for it
right makes sense and then if it is on the top or the vertex it's usually going to connect with
the kidney and the liver and if it's a splitting migraine and really really really painful pounding
that is usually blood stasis this is how we answer pain and the last question is the Heat and the
cold are you someone that is hot easily or cold easily now a lot of people might say I'm pretty
even temperature and that's okay that means that those people are more balanced but if the person
is really really really hot all the time they either have excess yon or Yin deficiency and we
have to make the difference between the two now sometimes people have both that can happen as
well when it comes to temperature with excess heat it's big symptoms and in deficiency is small
symptoms young excess red face Yin deficiency red cheeks yang excess sweating profusely yang
deficiency just night sweats when it comes to Yang excess we don't sleep at all the the sleep
is completely Disturbed while yang deficiency we sleep or we wake up we sleep or we wake up the
tongue for the excess is red with a yellow coat and for yin deficiency it's red without a coat the
pulse for yang excess is rapid big large full and the yin deficiency pulse is rapid but thin when it
comes to bowel movement when there's young excess the bowel movement is large big amount of stools
while the yin deficiency is small little pebbles for emotions when there's young excess it's anger
it's like the Volcano it's bursting out while y deficiency is more irritability nervousness
anxiety so if the person is more on the cold side it's either a yang deficiency or Yin excess
with Yin excess we're going to have pain because that means that when there's y excess there's
excess cold which means it congeals it becomes like an ice cube and it stops blood circulation
and it creates blood stasis so Yin excess is going to have pain that is better with heat but
it's local fixed strong pain like rain's disease where everything turns purple but if you put heat
it feels better like this dysmenorrhea that feels so painful but when you put the heating pad on
the lower abdominal region it feels better like hypothermia for something that's more acute and
we're really really really really cold but once we start wrapping ourselves into warm clothes we
feel much better compared to Yang deficiency where the symptoms are going to be very fatigued very
weak feeling cold all over not just in one area but all over we love warm drinks we love warm
food and warm clothes usually there's edema of the lower leg or ankle area we have low libido
were tired all the time mentally and physically that is your yang deficiency no fire no heat no
energy so that's the difference between the yang deficiency and the Yin excess those were the 10
most important questions that we inquire with each patient of course there's other questions
but those are so key to help us in our diagnosis because they're very prevalent in everyone's
life and if you want more I have so much more on my website acuproacademy.com I have tons of
resources free courses PDF case study all you need is on that website and by the way I also
have a podcast now where I invite guests and we have great conversation on TCM the acupro show can
be found on Spotify apple and anywhere you love to listen to your podcast it's completely free every
Wednesday make sure to follow the show so I hope that this was very detailed and really help you
into narrowing down the TCM diagnosis and help you reach better outcome for your patients and if
you haven't watched yet my diagnosis videos check them out here there's a whole playlist it will
help you tremendously because I go in detail with each pattern of TCM diagnosis have a fantastic
day and no matter what keep rocking it using TCM