Internal Medicine and Clinical Therapeutics
Internal Medicine and Clinical Therapeutics
This domain tests pattern differentiation, treatment principles, and formula selection for common internal conditions such as cough, asthma, chest bi, stomach pain, diarrhea, edema, jaundice, and xiaoke.
Core rules
- Start with the chief complaint, then identify location (zang-fu) and nature (cold/heat, deficiency/excess). Treatment principle follows pattern: disperse Lung for exterior cough; clear heat and resolve phlegm for heat-phlegm; tonify Spleen for deficiency diarrhea.
- Cough: wind-cold has white watery sputum and aversion cold; wind-heat has yellow sputum and sore throat; dry cough with scanty sputum suggests Lung yin deficiency.
- Stomach pain: cold causes sharp pain relieved by warmth; Liver qi stagnation causes distension related to stress; blood stasis causes fixed stabbing pain.
- Edema: distinguish yang edema (acute, upper body, exterior) from yin edema (chronic, lower body, deficiency). Diarrhea: distinguish damp-heat, cold-damp, food stagnation, and Spleen/Kidney deficiency.
- Always screen for red flags requiring modern referral: dyspnea at rest, chest pain, hematemesis, melena, focal neurologic deficit, severe dehydration.
Worked example
A patient has cough with thin white sputum, aversion to cold, no sore throat, and a white coating. This is wind-cold cough. Reasoning: thin white sputum and cold signs indicate wind-cold; yellow sputum or sore throat would suggest heat. The principle is disperse Lung and stop cough; a formula such as Xing Su San may be considered if the pattern fits. If fever becomes high and sputum turns yellow, reassess for heat.
Traps
Do not treat the disease label while ignoring the pattern. Do not miss deficiency beneath excess. Do not continue warming herbs when heat signs appear. Do not delay referral for emergency signs.