Diagnostic Methods and Pattern Differentiation
Diagnostic Methods and Pattern Differentiation
This domain tests the four examinations-inspection, listening/smelling, inquiry, palpation-and the eight principles, zang-fu, six-channel, wei-qi-ying-blood, and sanjiao differentiation.
Core rules
- Inspection begins with spirit, complexion, shape, and tongue. Tongue body reflects zang-fu and qi/blood; coating reflects stomach qi and pathogenic factors. A pale body suggests deficiency/cold; red with scanty coating suggests heat/yin deficiency; thick greasy coating suggests damp or food stagnation.
- Listening/smelling covers voice, breathing, cough, and odors.
- Inquiry uses systematic questions: chills/fever, sweat, appetite, thirst, stool/urine, sleep, pain, menstrual history.
- Palpation includes pulse and body palpation. Pulse qualities are interpreted with position, strength, rate, and rhythm; a floating pulse suggests exterior, deep suggests interior, rapid heat, slow cold, wiry Liver/gallbladder, slippery phlegm/damp.
- Eight principles pair yin/yang, exterior/interior, cold/heat, deficiency/excess. Pattern differentiation requires all four examinations; no single sign is decisive.
Worked example
A patient has fever, aversion to cold, no sweating, occipital stiffness, and a floating tight pulse. This is wind-cold invading the Taiyang exterior, excess type. Reasoning: aversion to cold and floating pulse indicate exterior; no sweating and tight pulse indicate excess cold contracting; fever reflects wei qi fighting pathogen. The principle is release exterior and disperse cold.
Traps
Do not diagnose from tongue or pulse alone. Do not confuse true heat with false cold or true cold with false heat. A thick coating is not automatically damp if the tongue is dry. Record negative findings.