Mini-Systems in Chinese Medicine
If we ask our our patient about their bowel movements, we get a lot of information, but we do not get everything we need in order to create a branch and root diagnosis. (One question we should ask ourselves as Chinese medicine practitioners is, “What makes us think that we can get everything we need from a pulse diagnosis?” This will de-mystify what pulse diagnosis has to offer.)
Each health ‘system’ in Chinese medicine yields very important, yet limited, information. For example, tongue diagnosis only shows us the following:
Colour
- Pale to slightly red: Normal
- Pale: Cold or Blood Deficiency
- Red/Red Prickles: Heat
- Purple/Purple Spots: Blood Stasis
Coating
- Thin-white: Normal
- Thin-yellow: Heat
- Thick-white: Dampness
- Thick-yellow: Damp-Heat
- Peeled: Yin Deficiency
Cracking
- No cracking: Normal
- Cracking throughout: Yin Deficiency
- Location: Organ specific or Mental-emotional concerns
Shape
- U-shape: Normal
- Swollen/Thick: Dampness
- Thin: Blood or Yin Deficiency
- Teeth marks: Spleen Qi Deficiency
- Deviated: Wind
- Forked or Hammerhead: Mental-emotional concerns
It is so important to ask about many health systems during the initial interview. Chinese medicine is about creating a diagnosis based on the sum, or total, of imbalances where one system is not of more diagnostic importance than another. We look for many branches that are related to a common root (eg: lower back pain, soreness/weakness in the knees, hot flashes, five-palm heat, and dry-cracked heels).
When learning Chinese medicine, it can get very confusing because of the amount of memorization that has to take place. Also, we tend to learn Chinese medicine backwards in regards to how our patients will present themselves in the clinic. A patient does communicate they have Kidney-Yin Deficiency. Instead, the patient communicates two to three symptoms verbally (if we’re good enough to lead them to), and then the tongue and/or pulse may contribute to their symptoms to confirm the diagnosis.
The initial interview is very much like Yin and Yang - two separate sides that have elements of one in the other. On one side of the Grand Ultimate symbol we have these underlying, guiding principles throughout the medicine. On the other side we have these separate systems that are ‘out there’ on their own. During school we learn a lot about the underlying principles. It is my belief that after school and exams are finished, our goal is to master each system.
Mini-Systems
Another idea I want to present is the idea of mini-systems within a system. Looking at sleep, there are many, many diagnostics we can glean from sleep. Perhaps a simpler approach is to ask three or four specific questions about that system, effectively creating a mini-system for ourselves to reflect on in regards to diagnosis. Then, by mastering a mini-system first, it opens up many doors of confidence and treatment.
Here’s an example, using sleep as the topic of questioning, and how we can master a mini-system of information:
Sleep
- Problems falling asleep: Heart-Blood Deficiency
- Problems waking up at night alert: Liver-Qi Stagnation or Yin Deficiency
- Problems tossing and turning throughout the night: Heart and Gallbladder Deficiency
- Vivid dreams, sleep walking, and/or sleep talking: Liver-Blood Deficiency
- Not waking rested: Spleen Qi Deficiency
Using sleep as our jump-off point, we can then add those symptoms to other symptoms or signs to confirm our diagnosis. An example of this could be:
problems falling asleep + heart palpitations + weak Heart pulse = Heart-Blood Deficiency
problems waking up at night alert + tight trapezius + Wiry pulse = Liver-Qi Stagnation
vivid dreams disturbing sleep + history of heavy menses + pale and peeled sides of the tongue = Liver-Blood Deficiency
not waking rested + abdominal distension + teeth marks on the tongue = Spleen-Qi Deficiency
If you’re feeling lost in the sea of the of symptoms, I suggest creating three or four questions you can ask your patient when speaking about their urination, defecation, areas of pain, sleep, menstruation, etc, etc. For a guide that’s already made for you, check out The Initial Interview: How to Diagnosis Quickly and Effectively.