Back when I was in TCM School my teachers used
to say there are no wrong treatments in Chinese medicine only the wrong diagnosis the key to
have a successful outcome for all our patients starts with the diagnosis and that's probably
the hardest part in Chinese medicine today I'm diving deep into the heart of Chinese medicine
diagnosis breaking down the complexity into a practical nine-step framework that you can apply
with each of your patients and get great results whether you are a practitioner who are still
trying to refine your skills or TCM students who still baffle by diagnosis like I was when I
was in school this framework is a game changer and I can't wait to go through each of the step with
you today 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 contents for students and practitioners making it easy to
grasp and fun to learn let's go in TCM pattern differentiation and making the right diagnosis can
be done according to the nine following options the Yin Yang theory the five elements the four
vital substances the Zang-Fu organs the pathogens the six stages four levels the three Jiaos and or
the meridians these are the nine step we're going to look at today and I'm going to go through each
of them and show you how easy it is to make a TCM diagnosis using the nine-step Frameworks let's do
it let's start with each consultations which you use your methods of inquiry palpation observation
of olfaction and auscultation once you have this done you need to put the diagnosis and as you know
it's kind of like a puzzle and it feels like it's so hard to figure out so let's start with the
basics always start with the Yin Yang Theory this is the basics right and we're looking at the
eight principles the eight principles Are Yin and Yang hot and cold internal external deficiency
excess you start with those so let's start first with internal versus external internal is going to
affect all the organs the brain the reproductive system while external is going to affect the
muscular skeletal system like the bones the muscle The Joint the ligament the tendons
the skin that's more external so if someone comes in with Carpal Tunnel syndrome that's more
external even though it could be a chronic issue or someone comes in with menstruation pain like
Dysmenorrhea that's an internal okay so you decide what the chief complaint is about because you want
to address first the chief complaint of course all the other symptoms are going to make a picture
and put the puzzle together but first we want to know what this person has come for right if they
came for insomnia insomnia is usually an internal problem if they came because they have sciatica
that's usually external make sense okay so once we decide if it's internal versus external we're
going to look at is it more cold more hot meaning can it come from Yang deficiency which that's
why the person is always cold or this excess Yin which means the person is cold but in one area
it's localized so is it that the person is cold all the time all over the body and they like warm
food warm drinks and they like to be warm or is it that they are cold in one area like with Raynaud's
disease which is Yin excess or excess Cold versus the first one is Yang deficiency Make sense or
it is excess Yang or Yin deficiency meaning it's the hot person right so Yang excess would have
big symptoms red face anger insomnia where the person doesn't sleep at all all night there's a
red tongue with yellow coat while Yin deficiency is going to be more irritability toss and turn
all night red cheeks and no coat on the tongue so we differentiate those two and then we decide is
this more of heat or cold depending if it's excess or deficiency so the eight principles were we're
going to look at deficiency and excess which we have decided if it's cold or hot deficiency or
excess and the problem is internal or external once you've got this you have a little bit of
a better idea this is your first step of that frame work second step now that we know that let's
say it's insomnia it's an internal problem and the person is always on a hot side and it's excess
Yang or excess heat let's look at why the Five Element theory is the key to figure out where it
all started so when we look at the five elements if you look at someone that comes and sees you
for low immune system they are saying I'm always sick I get colds and flu and it takes me weeks
to recover that's a immune system or a Wei Chi a defensive Chi that is not strong enough to fight
pathogens so in this instance we know that it is the metal lung and large intestine element that
is affected now what is the root cause now we can look back and with all our inquiry we realize that
this person's diet is not feeding or generating a good immune system they don't have a proper
nutritious diet so that's Earth the digestive system Spleen and stomach not generating a good
immune system so when we treat we want to treat the immune system but we also want to treat the
digestive system so now we have two things to look at but why is this person not eating properly
maybe it's because they're really stressed so stress affects liver and gallbladder which is
the wood element the wood in the Five Element Theory over controls spleen and stomach creating
some issue with spleen and stomach and in turn spleen and stomach or Earth cannot generate
a good immune system so now we have to treat the liver gallbladder or the stress we have to
treat the digestive system and we have to treat the immune system the five element always tells
you where it all started so now you have clues of what to look for in the next key frame from that
nine step so the next step is to look at the four vital substances we have four vital substances Qi
blood body fluid and Essence now it's very easy to start with Essence I'm going to go back backward
but Essence is either we are deficient or we're not and you know that the deficiency sign when it
comes to Essence is really going to be low libido having reproductive system issues having gray
hair early in life not straight teeth bone issues anything that's related to Essence aging faster is
going to be your essence deficiency that's an easy one either there is or there isn't now body fluid
can either be excess or deficient Excess is too much dampness and deficiency leads to dryness easy
so if you see mucus and a lot of excess body fluid it's excess dampness if you see a lot of dryness
it's dryness is body fluid deficiency super easy maybe there's a balance between dness and dryness
and you don't see anything that's great the next one is blood blood can be deficient can have
heat or it can be stagnated so that's easy now what happen when it's deficient pale and poor pale
face pale lips pale tongue poor sleep poor energy poor memory poor vision you decide is blood
being affected and is blood deficient now the next one is blood stasis blood stasis is pain and
purple is there purple tongue purple nails purple lips and is a local fixed spin like dysmenorrhea
or sciatica or an ankle sprain if it was acute blood heat on the other hand means that there's
going to be abnormal bleeding with Heat sign so abnormal bleeding may be rectal bleeding blood
in the urine heavy heavy flooding mensturation nose bleeds that is associated with heat with
feeling hot red tongue rapid pulse irritability that shows you blood heat the last one is Qi and
Qi can be deficient it can be stagnated it can be rebelling meaning going the wrong way or the
opposite way that she is supposed to be or it could be sinking now sinking is always Spleen Qi
sinking so that's easy and that's usually prolapse or extreme fatigue Qi Rebelling affects the lung
the stomach and the liver so stomach means acid reflux heartburn nausea vomiting that is all
stomach rebelling Lung rebelling is coughing and liver rebelling is actually liver Yang Rising
which means it's like the volcano effect and we have you irritability anger maybe red eyes high
blood pressure headaches that is worse at the end of the day and with stress but feels better with a
hot compress Qi stagnation shows with irritability sighing all the time Moody for women a lot of
PMS specifically breast tenderness bloating constipation and cold hands as well that's also a
Qi stagnation that's not reaching the extremities Qi deficiency is fatigue weak a pale tongue
and a weak pulse now depending which organs is affecting there's more symptoms to it and that
leads me to the next step in our framework which is the Zang-Fu organs with the Zang-Fu organs we
are going to refine the diagnosis earlier when we talked about Qi stagnation we know it's
liver because liver moves Qi so now liver is Qi stagnation we refined the Qi stagnation to
level if it was a deficiency of Qi is it spleen is it lung is it kidney is it heart those are the
most common one so we look at differentiating the symptoms if it's Spleen Qi deficiency there's
going to be digestive system issue if there's lung Qi deficiency immune system issue if there's
Kidney Qi deficiency we're going to have usually Lower Gate incontinence so Kidney Qi is in charge
of opening and closing the lower Gates so usually when there is kidney Qi deficiency we may have
incontinence or getting up at night to pee a lot of times and we will have dizziness of course
fatigue probably knee pain low back pain that's going to show up as well when it comes to heart
Qi deficiency we're going to see abnormal day sweat and anxiety see how easy it is right you
refine your diagnosis if it's blood deficiency the only three organs that can be blood deficient
is heart spleen and liver because spleen produces blood liver stores blood and heart moves blood so
if there is a blood deficiency it could be either of those so you can refine your diagnosis a
little bit more can it be more than one of course does that Makes sense so when it comes to
the Zang-Fu organ we can refine and decide which organ is affected the most according to symptoms
observation palpation Etc yes the fifth step is figuring out which pathogens are affecting the
body now external pathogen invasion is acute and that can be a common cold a virus a bacteria
this is external pathogen Invasion it could be hypothermia or heat stroke or sunburn that is
all external pathogen Invasion which means the pathogen comes in it's acute and we may have wind
heat wind cold we may have damp heat damp cold we may have really really strong fire for example
if you have a heat stroke or a sunburn that's external pathogen fire invading the body and that
creates fever and burn etc etc so that's more for acute right makes sense most of the time we see
people when they come and it's a chronic issue so let's talk about internal pathogens internal
pathogens are going to be five while external the six because in external pathogens we also have
summer heat which doesn't occur in chronic so in chronic internal pathogens we're going to have
options of wind cold heat or fire damp and dryness those are the five they can be combined of course
we can have damp cold damp heat we can have wind fire wind cold all those things can absolutely
affect the body so let's look at examples when there is internal wind there's always
movement remember wind moves it can be Tremors ticks Twitches muscle cramps spasm it could be
Parkinson's anything that's been moving in it's abnormal in the body is internal wind dampness is
excess body fluid dryness is body fluid deficiency and then we have cold and hot and again we talked
about this when we talk about the Yin Yang so you can have internal cold due to deficiency your
excess and internal heat that could be due to excess or deficiency so now by the time you get to
the pathogens you know which one are in the body can we have more than one of course we can have a
lot of them okay you still with me for number six and seven we are going to look back into the Yin
Yang when we talked about the Yin Yang we said it was acute or chronic now if it's acute and again
in practice we don't see as many acute issues but it's really important to discuss because we
obviously can treat family and ourselves when it comes to acute problems looking at number six
and seven is the six stages and four levels those two are big lecture the six stages and the four
levels both come from classics TCM Classics that were written way back when and are the basis of
a lot of our medicine so the six stages comes from the Shang Han Lun and don't quote me on
my Mandarin pronunciation because after all I'm French speaking English and trying to teach
Chinese medicine mind blown so the Shang Han Lun is a really big classic book and it talks about
the six stages and the school of thoughts behind this book is cold Invasion would start at the top
level stage or at the most superficial stage and slowly if the body cannot fight can get deeper
and deeper through each stage all the way to the bottom stage where it makes everything worse
for the person's health so at the top which is the Tai Yang stage which affect the bladder and
small intestine it is the most superficial so the symptoms are not going to be as bad as when it
goes all the way down to the Jue Yin stage which affects the liver and pericardium so this is a big
lecture I'm not going to go into it but this is a really interesting one and it's more for acute
at this stage right when you see patients you use this for acute mostly not that you can't use
it for internal and chronic but I'm not going to go into it now because it's a big lecture like
I said when it comes to the four levels it comes from the classic Wen Bing Xue which is the school
of thought that everything starts with heat it starts at the Wei level the defensive Qi level
heat penetrates and we have a sore throat and then it gets deeper into the Qi level and now we
have fever and it can go to the ying level y i n g which is the nutritive level and then goes deeper
into blood level where we have hallucination high fever and it becomes really more dangerous so
those are again are acute and so I'm going to let them be for now now the next key frame is
the three Jiaos I think we're still confused how we use the three Jiaos the upper Jiao the
middle Jiao and the lower Jiao each of the Jiao contain different organs the Zang-Fu organ so the
upper Jiao is heart and long the middle Jiao is the digestive system so spleen and stomach some
school of thought think that liver and gallbladder is also part of the middle Jiao other school of
thoughts put liver and gallbladder bladder at the bottom with kidney small intestine large intestine
and bladder so I like to put liver gallbladder in the middle just because on the tongue it's on the
side so it kind of encompasses the middle that's my school of thoughts but you have to follow what
you think is right so if someone comes in with dampness in the spleen and heat in the stomach
right stomach heat rebelling so acid reflex burn bad breath but at the same time dampness in the
spleen bloating loose tools fatigue that is a damp heat in the middle Jiao you could still
treat The Damp in the spleen and the heat in the stomach but also pick points so choose points
from the San Jiao Meridian to really consolidate your treatment that's how we use the three Jiaos
the last step to this framework is the meridians the meridians I think sometimes we forget get
to use those remember we have a lot of meridians including dermatomes and dermatomes are all on the
skin they're the part of the Meridian on the skin right so if we do have some eczema or a patient
has eczema on the large intestine meridian now we know the large intestine meridian is affected
and we can go deeper into it and see what else is being affected most often it's going to be the
large intestine organ and the lung organ because they are paired and they're part of the immune
system in the skin when you look at meridians it's really important to know the meridians for example
the collaterals the liver collateral starts at liver five and goes up in the medial aspect of the
thigh and wraps up around the external genitalia so when there is acute external genitalia issue
like a herpes attack those are a Meridian issue and often it's a liver collateral Meridian issue
which which means remember I just said the liver collateral starts at liver 5 we need to use liver
5 and liver 5 is the best point when there is external genitalia issue by the way if you haven't
seen my Chinese medicine Made Easy my green book it has all the TCM foundation and diagnosis and
it comes with my fillable intake form that you can use on your patients check out the link below
and if you haven't got your copy yet what are you waiting for so the 9 step framework starts with
the basics with the Ying Yang looks at the Five Element to figure out which one started at all
then goes into the side which four substances are affected maybe more than one and then we
refine it with which organ is being affected so we can treat this much more successfully
and then we look at is there pathogens do we need to get rid of dampness or heat or cold or
wind and then we can look if the upper middle or lower Jiaos are affected and use more of the
San Jiao meridian to help our treatment and then we use the Meridian specifically when there is
muscular skeletal or skin problem that we could see is affecting certain Meridian when it come to
the six stages and the four levels and external pathogens this is more acute I truly hope this was
useful and you could start using this framework to make the right diagnosis for your patients so
then you can come up with the treatment that is the perfect treatment for your patients with
a successful outcome I think the hardest one is the Zang-Fu organ so make sure to watch this
video it'll help you refine your diagnosis when it comes to the Zang-Fu have a fantastic day
and no matter what keep rocking it using TCM