Traditional Chinese Medical Diagnosis
Ulrike Wurth, BVSc, Dip Acup., IVAS Certified
Victoria, Australia

Traditional Chinese Medical (TCM) diagnosis is a highly developed skill of closely observing the patient and correlating these observations to form a pattern of disease. Once the pattern of disease has been diagnosed, then the treatment principle is formulated, points are chosen with the action required and treatment can begin. Veterinarians already are skilled observers, so we can use this method of diagnosis in addition to our current diagnostic skills and learn to interpret our observations in a different way.

CAUSES OF DISEASE

The cause of disease in TCM is an important aspect of diagnosis, treatment and disease prevention. A healthy body is a dynamic balance of Yin and Yang. This balance is sustained by the activity of complimentary forces that generate and limit one another. When the balance of Yin and Yang loses this fine adjustment, then the body becomes susceptible to disease.

In the healthy body, the Qi flows around the body in a particular sequence through all twelve meridians during a twenty four hour period. The energy is at its maximum for two hours in each meridian. Starting at 3 am the sequence is: Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Triple Heater, Gall Bladder, Liver, Lung.

However no one is perfect, we are all individuals and each being is born with a particular constitutional make up. This makes us more susceptible to particular types of disease and our lifestyle, type of work and where we live can also have an effect. In TCM the factors that cause disease are classified as constitutional, six external or environmental factors, seven internal factors and lifestyle.

THE CONSTITUTIONAL TYPES--Fire, Earth, Metal, Water and Wood

 The Fire Type: e.g., Australian Terrier, Poodle, Cocker spaniel.

 The Earth Type: e.g., Labrador, Rottweiler.

 The Metal Type: e.g., Staghound, Greyhound, Whippet.

 The Water Type: e.g., German Shepherd.

 The Wood Type: e.g., Border Collie, Kelpie, Jack Russell.

EXTERNAL CAUSES OF DISEASE

In TCM aspects of disease are defined in terms of the environment. These pathogenic factors are really models or images for bodily processes that mimic climatic conditions and are treated accordingly. The disease may be due to the climatic factor e.g., Wind, or it may mean the disease manifests as a Wind pattern, although the patient has not actually been exposed to the wind. External factors can denote both a cause and a pattern of disease. Each factor has characteristics and produces particular clinical signs. (See Table 1)

External pathogens usually enter the body via the skin, nose and mouth. They usually invade the skin and muscles first, however they may also penetrate deeper into the body and affect the organs. The progression of the disease depends on the relative strength of the body's defensive Qi (Wei Qi) and the external pathogen.

Generally illnesses caused by external pathogenic factors are acute diseases, and are characterized by an aversion to that factor. E.g., if Wind is the pathogenic factor, then the patient will dislike Wind. If it is Cold, then the patient will dislike Cold and will seek warmth.

Table 1. Six External Factors

Factor

Type

Characteristic

Clinical signs

Wind

Yang

Movement

Changing symptoms

Cold

Yin

Contraction

Cold, cramping, sharp pain

Damp

Yin

Wet, heavy, slow

Lingering pain, affects lower part of body

Dryness

Yang

Consumes yin fluids

Affects lungs

Summer heat

Yang

Injures yin

Convulsions fainting

Fire/heat

Yang

Movement

Skin, haemorrhages, delirium

INTERNAL CAUSES OF DISEASE

One of the main differences between Chinese and Western medicine is the recognition of the interactions of the emotions and the function of the organs of the body. The body, mind and emotions are part of an integral whole, which means that the emotions can affect the function of an organ and the function of an organ can alter the emotions. (See Table 2)

The seven emotional factors are all normal emotional responses. They appear in healthy individuals and are appropriate to the circumstances, e.g., grief is normal when a loved one dies, whereas laughter and joy would seem an inappropriate reaction if one is actually grieving. An imbalance in the emotions can occur if the emotion is either excessive or insufficient over an extended period of time, or arises suddenly with great force. The seven emotional factors directly affect the Qi, Blood and the organs of the body. Disharmony of a particular organ can also cause an imbalance of the corresponding emotion. E.g., Kidney deficiency can produce fear when there is no reason to be fearful.

Table 2. Seven Internal Factors

 Emotion - Organ

 Anger - Anger

 Joy - Heart

 Sadness - Lungs

 Anxiety & pensiveness - Spleen

 Fear - Kidneys

 Fright - Heart and Kidneys

LIFESTYLE

This includes our way of Life, Exercise, Sexual Activity, Diet, Trauma, Epidemics, Parasites, Heredity.

OTHER DISEASES

Chronic diseases can also cause new disease, which cannot be treated until the original disease is treated.

DIAGNOSIS

In TCM numerous observations are made of the patient. The classic ones are looking, listening and smelling, asking and palpating. The results of these observations give the practitioner the means to determine the location of the disease, the cause of the disease, the severity of the disease and the condition of the patient.

TCM EXAMINATION

1. Asking

History: Medications, Diet Supplements

Constitution: Yin/Yang, Fire/Earth/Metal/Water/Wood

Chills/Fever..........

Thirst......

Pain:-

Sweating (equine).....

Urine..................

location

Heat prefer/avoid ....

Appetite....

better/worse--rest

Cold prefer/avoid.....

Vomiting....

better/worse--exercise

Sleep pattern.........

Stools.....

better/worse--massage

Time of signs.........

Reproduction

type of pain.......

Season of signs.......

Other.......

2. Looking

It is important to look at the patient's overall demeanour and appearance. Body tissues relate to the organs according to the five elements i.e., sinews/eyes-Liver, hair/skin-Lungs, muscles-Spleen, bones-Kidney, blood vessels-Heart.

Shen...........

Tongue:-

Skin--dry/oily/scaly...

Head...........

colour........

Hair--dry/oily/loss...

Eyes...........

coating........

Abdomen:-

Ears...........

shape/size....

soft/tense........

Mouth/lips.....

dry/wet.......

pain..............

Teeth/gums.....

Respiration:-

masses............

Throat.........

strong/weak...

Other.............

3.Listening

Breathing

loud

soft

moist

dry

Cough

loud

soft

no bark

 

Groaning

loud

soft

 

 

Abdominal sounds

loud

soft

 

 

4. Smelling

Breath

Ears

Nose

Skin

Genital

5. Palpation

General Pulse Assessment: Floating/Deep, Fast/Slow, Full/Empty, Slippery/Choppy

Limbs:

Hot ...........................Cold...........................

Pain:

Alarm Points.................................Better/worse with pressure

Associated Effect Points............. Better/worse with pressure

SUMMARY OF CLINICAL SIGNS

Once all the clinical observations have been completed, the diagnosis is made by deciding if the condition is Yin or Yang, External or Internal, Hot or Cold, Full or Empty, which organ or organs are affected. Once the diagnosis is made, the treatment principle is decided and points chosen that will have the required effect. TCM diagnosis is very comprehensive. As veterinarians we already make many of these observations as part of our conventional diagnosis. The signs and symptoms however are interpreted differently. This can be particularly useful for those difficult clinical cases that do not respond to our conventional western treatment. It is a way of looking at the clinical signs from a different view point and being able to apply a different and often complementary method of treatment.

References

1.  Acupuncture -A Comprehensive Text. Shanghai College of Traditional Chinese Medicine. 1983.

2.  Maciocia G. The Foundations of Chinese Medicine. Churchill Livingstone 1989.

3.  Schoen A. Wynn S. Complementary and Alternative Medicine. Mosby 1997.

4.  Schoen A. Veterinary Acupuncture. Second Edition, Mosby 2000.

5.  Xinnong C. Chinese Acupuncture and Moxibustion. Foreign Language Press 1987.

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Ulrike Wurth, BVSc, Dip Acup., IVAS Certified
Victoria, Australia


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