Lecture on TCM Diagnosis

Introduction

• Importance of diagnosis in Traditional Chinese Medicine (TCM)
• Saying: No wrong treatments, only wrong diagnosis
• Success hinges on correct diagnosis
• Introducing a nine-step framework for TCM diagnosis

Nine-Step Framework

1. Yin Yang Theory

• Basic principles: Yin and Yang, hot and cold, internal and external, deficiency and excess
• Internal vs. External
  • Internal: Affects organs (e.g., brain, reproductive system)
  • External: Affects musculoskeletal system (e.g., bones, muscles, tendons, skin)
• Cold vs. Hot
  • Yang deficiency: Always cold, likes warm food/drinks
  • Excess Yin: Localized cold (e.g., Raynaud's disease)
  • Excess Yang: Heat symptoms (e.g., red face, anger, insomnia)
  • Yin deficiency: Mild heat symptoms (e.g., irritability, red cheeks)

2. Five Elements Theory

• Identify root cause using the five elements: Wood, Fire, Earth, Metal, Water
• Example: Low immune system (Metal) affected by poor diet (Earth) due to stress (Wood)
• Treat interconnected elements to address root cause

3. Four Vital Substances

• Essence
  • Deficiency signs: Low libido, reproductive issues, early gray hair, bone issues
• Body Fluid
  • Excess: Dampness
  • Deficiency: Dryness
• Blood
  • Deficiency: Pale face, poor sleep, poor memory
  • Stasis: Pain and purple marks (e.g., purple tongue)
  • Heat: Abnormal bleeding with heat signs
• Qi
  • Deficiency: Fatigue, weak pulse
  • Stagnation: Irritability, PMS
  • Rebelling: Acid reflux, cough
  • Sinking: Prolapse, extreme fatigue

4. Zang-Fu Organs

• Refine diagnosis based on affected organs
• Examples:
  • Qi deficiency in Spleen, Lung, Kidney, Heart
  • Blood deficiency in Heart, Spleen, Liver
• Match symptoms to specific organs

5. Pathogens

• External Pathogens: Viruses, bacteria, heat stroke, and their acute impacts (e.g., wind-heat)
• Internal Pathogens
  • Types: Wind, Cold, Heat/Fire, Damp, Dryness
  • Examples of internal conditions (e.g., internal wind causing tremors)

6. Six Stages

• Based on Shang Han Lun
• Progression of cold invasion from superficial to deeper levels (Tai Yang to Jue Yin)
• Mainly used for acute cases

7. Four Levels

• Based on Wen Bing Xue
• Heat progression from Wei (defensive) to Blood level
• Mainly used for acute heat conditions

8. Three Jiaos

• Upper Jiao: Heart, Lung
  • Example Diagnosis: Damp-Heat in Middle Jiao (Stomach, Spleen)
• Middle Jiao: Stomach, Spleen (sometimes Liver/Gallbladder)
• Lower Jiao: Kidney, Bladder, Intestines, etc.

9. Meridians

• Importance of considering meridians in diagnosis
• Examples: Dermatome-related conditions (e.g., eczema on large intestine meridian)
• Use specific points for targeted issues (e.g., Liver 5 for genital issues)

Conclusion

• Review of nine-step framework
• Encouragement to practice and refine diagnosis skills using this framework
• Final tips: Focus on most affected Zang-Fu organs and how to tackle chronic vs. acute issues