Back to previous page Search again ↑

Identification of morbid states of the body. Chinese medical diagnosis is a process of gathering information through the four examinations (inspection, smelling and listening, inquiry, and palpation) and classifying the information according to the various methods of disease and pattern identification. See list below.

NB: The Chinese term zhěn duàn is the equivalent of diagnosis in Western medicine and is now commonly used in Chinese medical texts.

Elements of Diagnosis

Four examinations

• Inspection
• Listening and Smelling
• Inquiry
• Palpation

 Main symptoms

• Signs 1, general
• Signs 2, complexion
• Signs 3, tongue
• Signs 4, pulse
• Signs 5, head and neck
• Signs 6, body and limbs
• Signs 7, lumbus and knees
• Signs 8, chest and rib-side
• Signs 9, stomach and abdomen
• Signs 10, two yīn
• Signs 11, men and women
• Signs 12, infants and children

Disease identification

Pattern identification

• Eight-principle pattern identification
• Bowel and visceral pattern identification
• Qì, blood, and fluids pattern identification
• Channel pattern identification
• Externally contracted disease pattern identification
  • Cold damage six-channel pattern identification
  • Warm disease pattern identification (including four-aspect and triple burner pattern identification)

Illness, Disease, Pattern, Symptom

Pathological phenomena are described in terms of illness, disease, pattern, and symptom (sign).

Illness (病 bìng): Any instance of being affected by a morbid state or a succession of morbid states. Examples: enduring illness (久病 jiǔ bìng) or severe illness (重病 zhòng bìng).

Disease (病 bìng, 疾病 jí bìng): Any morbid state of the body, especially one that can be identified by specific signs and course of development similar in all those suffering from it. Examples: strangury, identified by painful dribbling urination; malarial disease, identified by alternating aversion to cold and heat effusion (alternating cold and heat).

Major symptoms, such as cough, constipation, and insomnia, are traditionally regarded as diseases. Some diseases that manifest in various ways are sometimes referred to as patterns. Wilting patterns and impediment patterns are examples of this.

A broad distinction is made between external contractions and internal damage and miscellaneous diseases. External contractions are also called externally contracted febrile diseases or simply febrile diseases because they are usually associated with fever (heat effusion). Internal damage and miscellaneous diseases are those arising within the body from other causes, such as dietary irregularities or excessive activity or inactivity. External injury is usually considered distinct from these two broad classes.

Disease pattern, pattern (征候 zhēng hòu, 病证 bìng zhèng, 证 zhèng): Also called syndrome in English. A morbid condition resulting from one or more specific pathomechanisms. It is formulated in terms of evil, state, and locus:

• Locus: the bowel, viscus, or other entity (e.g., the spirit), substance (qì, blood, essence), or aspect (yīn, yáng, defense, provisioning) affected by a morbid state.
• Evil: one or more specific disease-causing entities (wind, cold, summerheat, dampness, dryness, fire, phlegm-rheum, static blood, worms, food).
• State: an abnormal condition of the locus, expressed as the relative strength or right and evil qì, that is, as vacuity or repletion (usually vacuity, since repletion is usually implied by the mention of an evil).

For example, wind-heat invading the lung is a morbid state in which the lung is the locus and wind-heat is the offending evil. Spleen qì vacuity is a state in which the spleen is the locus and vacuity is the state. Insecurity of kidney qì is a morbid state in which the qì of the kidney is the locus and insecurity is the state (insufficiency of kidney qì affecting its ability to retain urine and semen). Ascendant hyperactivity of liver yáng is the morbid state in which liver yáng is the locus and ascendant hyperactivity is the state.

Any given disease may be attributable to different causes and give rise to different patterns, each of which is marked by slightly different signs. So, for example, strangury, which is always characterized by painful dribbling urination, can present in different patterns (damp-heat, qì vacuity, or qì stagnation).

Sign, symptom (征候 zhēng hòu,症候 zhèng hòu, 证 zhèng, 象 xiàng): Any morbid condition as an indication of illness or disease, e.g., runny nose, abdominal pain, or itchy skin. Note that Chinese medicine does not, as biomedicine does, distinguish between quantifiable objective signs and subjective symptoms. In this text, the terms sign and symptom are used interchangeably.

Pathocondition (症 zhèng) loosely refers to any illness, pattern, or symptom.

Disease versus Patterns

The question as to whether diseases (病 bìng) or patterns (证 zhèng) are more important in Chinese medicine deserves attention. The pattern as a diagnostic entity and the principle of pattern identification as the basis for determining treatment (辨证论治 biàn zhèng lùn zhì) is often lauded as a foremost feature of Chinese medicine. However, historically, this has not always been the case. The Nèi Jīng stated the principle of treating one and the same illness or disease in different ways and treating different illnesses in the same way. This implies that any disease is not necessarily treatable by a single strategy and that, depending on the way in which the disease arises (pathomechanisms) and on the presenting signs, different treatments might be necessary. A corollary of this is that different diseases that arise in the same way and that that present with the same signs can be addressed by a similar treatment. The implication of this is that mere identification of a specific disease does not necessarily provide the basis for effective treatment. In the later Hàn Dynasty, not long after the appearance of the Nèi Jīng, Zhāng Jī (Zhòng-Jǐng) developed the idea of treatments based on configurations of signs, which he presented in the Shāng Hán Zá Bìng Lùn (伤寒杂病论 On Cold Damage and Miscellaneous Diseases). In his treatment of externally contracted disease (cold damage), he analyzed each stage of the progression of disease into commonly occurring presentations that could each be treated by a specific formula. Zhāng used the word证 zhèng to mean symptoms, not a meaningful collection of symptoms. In Zhāng Jī’s work and for many centuries after him, 证 zhèng only meant sign or symptom. Only later did it take on the meaning of pattern. For centuries, morbid states were called either symptoms or diseases. The treatment of disease was differentiated according to different pathomechanisms manifesting in different signs. Only later did the concept of a group of symptoms systematically reflecting specific pathomechanisms arise and come to be referred to as 证 zhèng. The term pattern identification as the basis for determining treatment is rarely seen before the latter half of the twentieth century. The complex system of pattern identification seen in modern textbooks represents a relatively new approach to the teaching of diagnosis. Many Westerners believe that Chinese medicine deals only with patterns and not with disease, largely because Western training in Chinese medicine is based on textbooks derived from Chinese texts introducing basic theory. While Chinese students study disease through internal medicine (內科 nèi kē) texts, internal medicine has still not been fully integrated in Chinese medical education in Western countries.

Back to previous page Search again