Diagnosis is a complicated process of logical thinking. Clinical syndromes make their appearance with different symptoms and signs, some apparent, some hidden, some with false implications, some with pathological changes of more than one organs. Some symptoms appear first, some others follow with the developments. Each individual patient has his own different conditions and changes. They are not at all the same as what is written in textbooks, clearly stating what comes first and what comes second, or with a standard format.
A patient is a human, not a machine. It’s not about cutting off the bad things or replacing the bad parts with good ones. TCM diagnosis relies on the doctor’s common sense, his knowledge of the basic theory, his techniques, his personal experience, his ability to make adjustments and assumptions, his way of logic thinking in observing, analyzing, making use of related information. The process of diagnosis also includes some kind of intuition and inspiration.
The analogy or comparison between one thing or another for the purpose of clarification. A doctor can compare the clinical signs of a patient to something he already known in books or experience. For example, if a patient shows signs of a fever, aversion to cold, sweating, and slow floating pulse, we can say that he has caught a cold.
Classification is a process related to categorization, in which symptoms and signs are recognized, differentiated, and understood. For example, if a patient shows signs of bloating, bad appetite, and loose stools, we can say he has a problem with the spleen. If a patient has a chest tightness, asthma, bad sleep, and hurried pulse, we can see he has a problem at the heart.
By taking away other possibilities, or removing the factors that is not closely related, a doctor gets into the real causes of an illness and thus focus on those factor closely related. For example, if a patient comes in with signs of a fever but not feeling cold, and the doctor feels his pulse to be strong, his tongue reddish, and the patient feels thirsty, this means that the patient has an excess of heat in the blood. And if the patient coughs, short of breaths, with yellow and sticky phlegm, we can say there is problem with the lungs. The excess of heat is in his lungs.
Judge by experience or reasoning
When the information collected from symptoms and others is not clear enough for an accurate diagnosis, a TCM doctor shall use his judgement by experience or “similarities”. The guess based on reasoning may not be that much “scientific”, but it is based on analyzing all data collected for the diagnosis. Making some “tries” or assumptions is good for monitoring the developments of an illness, which helps for an accurate conclusion along the process. For example, if a patient feels weak, abdomen tightness, short of breaths, some bloating, sort of carrying weight, bitter in the mouth, a dizzy head, sore at the back, aversion to cold, with a pale face, pulse difficult to feel, etc. He carries too many symptoms that the exact cause and location cannot be determined, a doctor has to use his reasoning with experience.
Focusing on the main symptoms
All health problems must show syndromes. Diagnosis targets the main sufferings. In the process, the focus shall be put on the main symptom or symptoms, or the main sufferings.
These main symptoms normally include headache, abdomen pain, loss of appetite, hard mass felt within the body, bleeding, bad sleep, high pressure, etc.
Because of these main symptoms may be coupled with minor symptoms like fever, sweating, pain in the head, depression, difficulty in vision or hearing, tooth ache, loss of voice, coughing, short of breaths, chest tightness, fastening heart beats, heart pain, vomiting, stomach pain, diarrhea, blood in stools, smelly discharge, etc. These symptoms may only be symptoms, but they reflect the pathological changes within the body. They are the main clues to correct judgement. Diagnosis is a process analyzing these symptoms to determine the causes, the location, and the nature of the disease.
In conclusion, one or two symptoms are set as the main symptoms, and the doctor is going to focus on this.
Analyzing the main symptom
Once the main symptom is determined, we must study it carefully. Its exact location, the timing, seriousness, properties, worsening or improving conditions, urgent or chronic, all these must be analyzed in detail.
For example, when a patient is found to have blood out of the mouth, we should have a careful look? Is not vomiting with blood, or coughing with blood? If it is vomiting with blood, mixed with undigested food, and the blood is red or reddish black, then blood is coming out of the digestive channels, and the location should be the stomach. If a patient is coughing out blood, coupled with phlegm, then the blood comes from the respiratory channels, the location in the lungs. The differentiation can be obtained from past records like stomach ache, disease in the liver or lungs, use of drugs or alcoholic.
The doctor’s inquiries or questions shall be closely related to or focus on the main symptoms, besides others. And his checks either by hand or machines are based on this analysis.
Make a conclusion in diagnosis
An accurate diagnosis is based on overall understanding of the patient’s health conditions. The analysis of syndromes is aimed at making a good conclusion that leads to targeted treatments. This conclusion includes the following:
- Location of the disease or suffering; in the lung, liver, kidney, or bowel.
- A statement of the disease properties: cold or heat, excess or deficiency, properties of the qi, blood, body liquids, yin and yang factors, etc.
- Seriousness of the disease: judgement on the seriousness of the disease, to determine whether an emergency treatment is necessary and predict the developments of the disease.
- Pathological analysis: To give an overall explanation according to TCM theory on the causes, the seriousness, the stage of development, the location, and other related factors.
- Give a name to the disease: the determination of a name is important at this step as it helps with follow-up treatments and the use of medicines.
Talk to you next time.