9 Proven Steps for Effective Chinese Medicine Diagnosis #chinesemedicine — Transcript

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1. 0:00Back when I was in TCM School my teachers used  to say there are no wrong treatments in Chinese
2. 0:06medicine only the wrong diagnosis the key to  have a successful outcome for all our patients
3. 0:13starts with the diagnosis and that's probably  the hardest part in Chinese medicine today I'm
4. 0:19diving deep into the heart of Chinese medicine  diagnosis breaking down the complexity into a
5. 0:26practical nine-step framework that you can apply  with each of your patients and get great results
6. 0:33whether you are a practitioner who are still  trying to refine your skills or TCM students
7. 0:39who still baffle by diagnosis like I was when I  was in school this framework is a game changer and
8. 0:46I can't wait to go through each of the step with  you today welcome back to my channel if it's your
9. 0:52first time here I'm Clara from AcuPro Academy and  I create Chinese medicine and acupuncture contents
10. 0:58for students and practitioners making it easy to  grasp and fun to learn let's go in TCM pattern
11. 1:05differentiation and making the right diagnosis can  be done according to the nine following options
12. 1:14the Yin Yang theory the five elements the four  vital substances the Zang-Fu organs the pathogens
13. 1:24the six stages four levels the three Jiaos and or  the meridians these are the nine step we're going
14. 1:33to look at today and I'm going to go through each  of them and show you how easy it is to make a TCM
15. 1:39diagnosis using the nine-step Frameworks let's do  it let's start with each consultations which you
16. 1:47use your methods of inquiry palpation observation  of olfaction and auscultation once you have this
17. 1:55done you need to put the diagnosis and as you know  it's kind of like a puzzle and it feels like it's
18. 2:01so hard to figure out so let's start with the  basics always start with the Yin Yang Theory
19. 2:10this is the basics right and we're looking at the  eight principles the eight principles Are Yin and
20. 2:16Yang hot and cold internal external deficiency  excess you start with those so let's start first
21. 2:24with internal versus external internal is going to  affect all the organs the brain the reproductive
22. 2:31system while external is going to affect the  muscular skeletal system like the bones the
23. 2:37muscle The Joint the ligament the tendons  the skin that's more external so if someone
24. 2:42comes in with Carpal Tunnel syndrome that's more  external even though it could be a chronic issue
25. 2:48or someone comes in with menstruation pain like  Dysmenorrhea that's an internal okay so you decide
26. 2:56what the chief complaint is about because you want  to address first the chief complaint of course all
27. 3:01the other symptoms are going to make a picture  and put the puzzle together but first we want to
28. 3:06know what this person has come for right if they  came for insomnia insomnia is usually an internal
29. 3:13problem if they came because they have sciatica  that's usually external make sense okay so once
30. 3:20we decide if it's internal versus external we're  going to look at is it more cold more hot meaning
31. 3:27can it come from Yang deficiency which that's  why the person is always cold or this excess Yin
32. 3:33which means the person is cold but in one area  it's localized so is it that the person is cold
33. 3:40all the time all over the body and they like warm  food warm drinks and they like to be warm or is it
34. 3:46that they are cold in one area like with Raynaud's  disease which is Yin excess or excess Cold versus
35. 3:53the first one is Yang deficiency Make sense or  it is excess Yang or Yin deficiency meaning it's
36. 4:00the hot person right so Yang excess would have  big symptoms red face anger insomnia where the
37. 4:07person doesn't sleep at all all night there's a  red tongue with yellow coat while Yin deficiency
38. 4:14is going to be more irritability toss and turn  all night red cheeks and no coat on the tongue so
39. 4:21we differentiate those two and then we decide is  this more of heat or cold depending if it's excess
40. 4:26or deficiency so the eight principles were we're  going to look at deficiency and excess which we
41. 4:31have decided if it's cold or hot deficiency or  excess and the problem is internal or external
42. 4:37once you've got this you have a little bit of  a better idea this is your first step of that
43. 4:43frame work second step now that we know that let's  say it's insomnia it's an internal problem and the
44. 4:51person is always on a hot side and it's excess  Yang or excess heat let's look at why the Five
45. 4:59Element theory is the key to figure out where it  all started so when we look at the five elements
46. 5:07if you look at someone that comes and sees you  for low immune system they are saying I'm always
47. 5:13sick I get colds and flu and it takes me weeks  to recover that's a immune system or a Wei Chi a
48. 5:20defensive Chi that is not strong enough to fight  pathogens so in this instance we know that it is
49. 5:29the metal lung and large intestine element that  is affected now what is the root cause now we can
50. 5:36look back and with all our inquiry we realize that  this person's diet is not feeding or generating
51. 5:44a good immune system they don't have a proper  nutritious diet so that's Earth the digestive
52. 5:50system Spleen and stomach not generating a good  immune system so when we treat we want to treat
53. 5:57the immune system but we also want to treat the  digestive system so now we have two things to look
54. 6:03at but why is this person not eating properly  maybe it's because they're really stressed so
55. 6:10stress affects liver and gallbladder which is  the wood element the wood in the Five Element
56. 6:15Theory over controls spleen and stomach creating  some issue with spleen and stomach and in turn
57. 6:21spleen and stomach or Earth cannot generate  a good immune system so now we have to treat
58. 6:27the liver gallbladder or the stress we have to  treat the digestive system and we have to treat
59. 6:32the immune system the five element always tells  you where it all started so now you have clues of
60. 6:40what to look for in the next key frame from that  nine step so the next step is to look at the four
61. 6:49vital substances we have four vital substances Qi  blood body fluid and Essence now it's very easy to
62. 6:57start with Essence I'm going to go back backward  but Essence is either we are deficient or we're
63. 7:03not and you know that the deficiency sign when it  comes to Essence is really going to be low libido
64. 7:10having reproductive system issues having gray  hair early in life not straight teeth bone issues
65. 7:17anything that's related to Essence aging faster is  going to be your essence deficiency that's an easy
66. 7:23one either there is or there isn't now body fluid  can either be excess or deficient Excess is too
67. 7:30much dampness and deficiency leads to dryness easy  so if you see mucus and a lot of excess body fluid
68. 7:38it's excess dampness if you see a lot of dryness  it's dryness is body fluid deficiency super easy
69. 7:44maybe there's a balance between dness and dryness  and you don't see anything that's great the next
70. 7:49one is blood blood can be deficient can have  heat or it can be stagnated so that's easy now
71. 7:57what happen when it's deficient pale and poor pale  face pale lips pale tongue poor sleep poor energy
72. 8:04poor memory poor vision you decide is blood  being affected and is blood deficient now the
73. 8:10next one is blood stasis blood stasis is pain and  purple is there purple tongue purple nails purple
74. 8:17lips and is a local fixed spin like dysmenorrhea  or sciatica or an ankle sprain if it was acute
75. 8:26blood heat on the other hand means that there's  going to be abnormal bleeding with Heat sign so
76. 8:33abnormal bleeding may be rectal bleeding blood  in the urine heavy heavy flooding mensturation
77. 8:39nose bleeds that is associated with heat with  feeling hot red tongue rapid pulse irritability
78. 8:48that shows you blood heat the last one is Qi and  Qi can be deficient it can be stagnated it can
79. 8:55be rebelling meaning going the wrong way or the  opposite way that she is supposed to be or it
80. 9:01could be sinking now sinking is always Spleen Qi  sinking so that's easy and that's usually prolapse
81. 9:07or extreme fatigue Qi Rebelling affects the lung  the stomach and the liver so stomach means acid
82. 9:15reflux heartburn nausea vomiting that is all  stomach rebelling Lung rebelling is coughing
83. 9:22and liver rebelling is actually liver Yang Rising  which means it's like the volcano effect and we
84. 9:28have you irritability anger maybe red eyes high  blood pressure headaches that is worse at the end
85. 9:34of the day and with stress but feels better with a  hot compress Qi stagnation shows with irritability
86. 9:42sighing all the time Moody for women a lot of  PMS specifically breast tenderness bloating
87. 9:48constipation and cold hands as well that's also a  Qi stagnation that's not reaching the extremities
88. 9:56Qi deficiency is fatigue weak a pale tongue  and a weak pulse now depending which organs
89. 10:01is affecting there's more symptoms to it and that  leads me to the next step in our framework which
90. 10:08is the Zang-Fu organs with the Zang-Fu organs we  are going to refine the diagnosis earlier when
91. 10:16we talked about Qi stagnation we know it's  liver because liver moves Qi so now liver
92. 10:21is Qi stagnation we refined the Qi stagnation to  level if it was a deficiency of Qi is it spleen
93. 10:28is it lung is it kidney is it heart those are the  most common one so we look at differentiating the
94. 10:33symptoms if it's Spleen Qi deficiency there's  going to be digestive system issue if there's
95. 10:39lung Qi deficiency immune system issue if there's  Kidney Qi deficiency we're going to have usually
96. 10:45Lower Gate incontinence so Kidney Qi is in charge  of opening and closing the lower Gates so usually
97. 10:52when there is kidney Qi deficiency we may have  incontinence or getting up at night to pee a lot
98. 10:59of times and we will have dizziness of course  fatigue probably knee pain low back pain that's
99. 11:06going to show up as well when it comes to heart  Qi deficiency we're going to see abnormal day
100. 11:11sweat and anxiety see how easy it is right you  refine your diagnosis if it's blood deficiency
101. 11:18the only three organs that can be blood deficient  is heart spleen and liver because spleen produces
102. 11:25blood liver stores blood and heart moves blood so  if there is a blood deficiency it could be either
103. 11:32of those so you can refine your diagnosis a  little bit more can it be more than one of
104. 11:38course does that Makes sense so when it comes to  the Zang-Fu organ we can refine and decide which
105. 11:44organ is affected the most according to symptoms  observation palpation Etc yes the fifth step is
106. 11:53figuring out which pathogens are affecting the  body now external pathogen invasion is acute
107. 12:01and that can be a common cold a virus a bacteria  this is external pathogen Invasion it could be
108. 12:07hypothermia or heat stroke or sunburn that is  all external pathogen Invasion which means the
109. 12:14pathogen comes in it's acute and we may have wind  heat wind cold we may have damp heat damp cold we
110. 12:21may have really really strong fire for example  if you have a heat stroke or a sunburn that's
111. 12:27external pathogen fire invading the body and that  creates fever and burn etc etc so that's more for
112. 12:33acute right makes sense most of the time we see  people when they come and it's a chronic issue
113. 12:38so let's talk about internal pathogens internal  pathogens are going to be five while external the
114. 12:45six because in external pathogens we also have  summer heat which doesn't occur in chronic so
115. 12:52in chronic internal pathogens we're going to have  options of wind cold heat or fire damp and dryness
116. 13:01those are the five they can be combined of course  we can have damp cold damp heat we can have wind
117. 13:07fire wind cold all those things can absolutely  affect the body so let's look at examples
118. 13:14when there is internal wind there's always  movement remember wind moves it can be Tremors
119. 13:21ticks Twitches muscle cramps spasm it could be  Parkinson's anything that's been moving in it's
120. 13:28abnormal in the body is internal wind dampness is  excess body fluid dryness is body fluid deficiency
121. 13:36and then we have cold and hot and again we talked  about this when we talk about the Yin Yang so you
122. 13:41can have internal cold due to deficiency your  excess and internal heat that could be due to
123. 13:46excess or deficiency so now by the time you get to  the pathogens you know which one are in the body
124. 13:53can we have more than one of course we can have a  lot of them okay you still with me for number six
125. 14:00and seven we are going to look back into the Yin  Yang when we talked about the Yin Yang we said it
126. 14:07was acute or chronic now if it's acute and again  in practice we don't see as many acute issues but
127. 14:13it's really important to discuss because we  obviously can treat family and ourselves when
128. 14:19it comes to acute problems looking at number six  and seven is the six stages and four levels those
129. 14:28two are big lecture the six stages and the four  levels both come from classics TCM Classics that
130. 14:37were written way back when and are the basis of  a lot of our medicine so the six stages comes
131. 14:45from the Shang Han Lun and don't quote me on  my Mandarin pronunciation because after all
132. 14:51I'm French speaking English and trying to teach  Chinese medicine mind blown so the Shang Han Lun
133. 15:01is a really big classic book and it talks about  the six stages and the school of thoughts behind
134. 15:07this book is cold Invasion would start at the top  level stage or at the most superficial stage and
135. 15:15slowly if the body cannot fight can get deeper  and deeper through each stage all the way to
136. 15:21the bottom stage where it makes everything worse  for the person's health so at the top which is
137. 15:27the Tai Yang stage which affect the bladder and  small intestine it is the most superficial so the
138. 15:34symptoms are not going to be as bad as when it  goes all the way down to the Jue Yin stage which
139. 15:40affects the liver and pericardium so this is a big  lecture I'm not going to go into it but this is a
140. 15:46really interesting one and it's more for acute  at this stage right when you see patients you
141. 15:52use this for acute mostly not that you can't use  it for internal and chronic but I'm not going to
142. 15:58go into it now because it's a big lecture like  I said when it comes to the four levels it comes
143. 16:02from the classic Wen Bing Xue which is the school  of thought that everything starts with heat it
144. 16:08starts at the Wei level the defensive Qi level  heat penetrates and we have a sore throat and
145. 16:13then it gets deeper into the Qi level and now we  have fever and it can go to the ying level y i n g
146. 16:20which is the nutritive level and then goes deeper  into blood level where we have hallucination high
147. 16:26fever and it becomes really more dangerous so  those are again are acute and so I'm going to
148. 16:32let them be for now now the next key frame is  the three Jiaos I think we're still confused
149. 16:38how we use the three Jiaos the upper Jiao the  middle Jiao and the lower Jiao each of the Jiao
150. 16:45contain different organs the Zang-Fu organ so the  upper Jiao is heart and long the middle Jiao is
151. 16:52the digestive system so spleen and stomach some  school of thought think that liver and gallbladder
152. 16:58is also part of the middle Jiao other school of  thoughts put liver and gallbladder bladder at the
153. 17:03bottom with kidney small intestine large intestine  and bladder so I like to put liver gallbladder in
154. 17:09the middle just because on the tongue it's on the  side so it kind of encompasses the middle that's
155. 17:15my school of thoughts but you have to follow what  you think is right so if someone comes in with
156. 17:21dampness in the spleen and heat in the stomach  right stomach heat rebelling so acid reflex burn
157. 17:29bad breath but at the same time dampness in the  spleen bloating loose tools fatigue that is a
158. 17:36damp heat in the middle Jiao you could still  treat The Damp in the spleen and the heat in
159. 17:42the stomach but also pick points so choose points  from the San Jiao Meridian to really consolidate
160. 17:49your treatment that's how we use the three Jiaos  the last step to this framework is the meridians
161. 17:56the meridians I think sometimes we forget get  to use those remember we have a lot of meridians
162. 18:02including dermatomes and dermatomes are all on the  skin they're the part of the Meridian on the skin
163. 18:07right so if we do have some eczema or a patient  has eczema on the large intestine meridian now
164. 18:14we know the large intestine meridian is affected  and we can go deeper into it and see what else
165. 18:20is being affected most often it's going to be the  large intestine organ and the lung organ because
166. 18:26they are paired and they're part of the immune  system in the skin when you look at meridians it's
167. 18:32really important to know the meridians for example  the collaterals the liver collateral starts at
168. 18:37liver five and goes up in the medial aspect of the  thigh and wraps up around the external genitalia
169. 18:46so when there is acute external genitalia issue  like a herpes attack those are a Meridian issue
170. 18:54and often it's a liver collateral Meridian issue  which which means remember I just said the liver
171. 19:01collateral starts at liver 5 we need to use liver  5 and liver 5 is the best point when there is
172. 19:07external genitalia issue by the way if you haven't  seen my Chinese medicine Made Easy my green book
173. 19:13it has all the TCM foundation and diagnosis and  it comes with my fillable intake form that you
174. 19:20can use on your patients check out the link below  and if you haven't got your copy yet what are you
175. 19:24waiting for so the 9 step framework starts with  the basics with the Ying Yang looks at the Five
176. 19:31Element to figure out which one started at all  then goes into the side which four substances
177. 19:38are affected maybe more than one and then we  refine it with which organ is being affected
178. 19:45so we can treat this much more successfully  and then we look at is there pathogens do we
179. 19:52need to get rid of dampness or heat or cold or  wind and then we can look if the upper middle
180. 19:57or lower Jiaos are affected and use more of the  San Jiao meridian to help our treatment and then
181. 20:04we use the Meridian specifically when there is  muscular skeletal or skin problem that we could
182. 20:11see is affecting certain Meridian when it come to  the six stages and the four levels and external
183. 20:18pathogens this is more acute I truly hope this was  useful and you could start using this framework
184. 20:26to make the right diagnosis for your patients so  then you can come up with the treatment that is
185. 20:32the perfect treatment for your patients with  a successful outcome I think the hardest one
186. 20:38is the Zang-Fu organ so make sure to watch this  video it'll help you refine your diagnosis when
187. 20:45it comes to the Zang-Fu have a fantastic day  and no matter what keep rocking it using TCM