ZANG FU I

WEEK 1
DIFFERENTIAL DIAGNOSIS

• What is Differential Diagnosis?

• The process of differentiating between two or more conditions that share
similar signs or symptoms.
• Differential Diagnosis is a process where a list of possible causes of a patient’s
condition can be made. It is a ‘process’ and works at each step of interaction
with a patient. One makes differential diagnosis at each step
STEPS TO DIFFERENTIAL DIAGNOSIS

• Patient presents with Chief Complaint

• Consider all options for diagnosis based on training, prior to differential
diagnosis
• Ask questions
• Consider history
• Examination
• Continue investigation based on differentials until narrowed down
WE USE DIFFERENTIAL DIAGNOSIS TO:

• Take all the TCM theories and patterns

• and put them to use understanding manifestations of symptoms,
• analyzing changes and progression of dz,
• understanding the pathomechanisms of dz,
• predicting the transformation of dz,
• and diagnose disease
HOLISTIC APPROACH

• 1.) Interior reflects exterior, and vice versa.

• 2.) The whole body condition can be known by observing local changes
• 3.) Abnormal changes can be understood by understanding normal physiology
TCM DIAGNOSIS
• Examination, collection of information and data “Four Pillars” (Zhen)
• 1. Inspection
• 2. Smelling and listening
• 3. Inquiry
• 4. Palpation
• Judgement, decision (Duan)
• 1. Identify disease
• 2. Identify pattern
DISEASE IDENTIFICATION
WHAT IS DISEASE?
• Any deviation from normal structure or function of body part or system, or organ.
• There will be a characteristic set of signs/symptoms, of which we know possible
• etiologies,
• pathologies,
• anatomical locations,
• and future prognosis.
• The disease will be the summary of these distinct features of a disorder,
• including the process,
• manifestation,
• and progression of pathologic development
DISEASE IDENTIFICATION
HOW DOES DISEASE DEVELOP?

• Pathogenic factors (6 xie, 7 emotions) attack Zang fu or Meridians ->

pathological changes create signs or symptoms
• We use examination methods to collect data relates to changes in the
patient’s health.
• We analyze data to identify disease.
• Based on the data, we differentiate the pattern of disease
HOW DO WE DIAGNOSE DISEASE?

• Observe signs or symptoms -> identify the nature of

the pathological change and the location ->
determine causative factors (see the past)
• Look at Etiology (causes), Location, Signs and
symptoms, Pathology, determine prognosis (predict
the future!)
QI REVIEW

• Zheng Qi v Evil Qi • Ying Qi

• Yuan Qi • Wei Qi
• Gu Qi • Zhong Qi
• Zong Qi • Zheng Qi
• Zhen Qi
DEFINITIONS OF SIGNS/SYMPTOMS (S/SX) AND PATTERN
• Symptoms/signs: Any manifestation. A s/sx standing alone has almost
no diagnostic value

• Diarrhea.
• -> DH, CD, SP Qi xu, SP yang xu, SP and KD yang xu

• HA.
• ->SP qi sinking, SP qi xu, PH, CP, LV yang rising, LV xue xu…

• No s/sx can be treated without understanding the context and

relationship of it to all other s/sx
PATTERN: THE WHOLE PICTURE, OR ANY/ALL OF THE
RELATED S/SX THAT MANIFEST AT ANY GIVEN ONE TIME

• The pattern includes s/sx, and this includes cause, location, and nature of dz.
This also includes the relationship between evil and righteous qi.
• The pattern may be an acute cause of disease (ex. exterior WH invasion)
• But, the pattern may not be an acute cause of disease (ex KD yang xu caused
by aging and the passage of time/lifestyle choices)
• Putting together a pattern is like playing detective! Piece together a number
of clues (s/sx) to determine the whole picture. The more clues, the better!
Some clues are more valuable than others!
CHINESE CONCEPT OF DISEASE:

• Chinese medicine idea of disease- traditional names for diseases, such as bi

pain, cough, HA, constipation.
• Sometimes the idea of Chinese disease is the whole picture, or sometimes it is
the chief complaint. But sometimes there may be multiple symptoms that all
are diseases that the same person is suffering from, and they all fit into a
bigger overarching pattern
• Chinese “diseases” are oftentimes regarded as symptoms by western
medicine
DISEASE V PATTERN

• The same disease may be rooted in different patterns in different people

• OR
• Different diseases may have the same pattern and treatment!!
DISEASE NAMING

• A summary of pathology and disease process.

• May include etiology, pathomechanisms, signs/symptoms.
• May provide insight into the nature of the dz- incidence, outcome,
prognosis all may be inferred by the name.
• Naming helps not only in diagnosis, but in classification of disease.
DISEASE NAMING (EXAMPLES)

• Based on pathological picture or symptoms- edema, asthma, jaundice,

wheeze
• Named after pathology- restless organ disorder
• Named for ZF organ or structure involved- LU abscess, chest bi (painful obst)
• Named for etiology- windstroke, sunstroke, wind heat attack
 INTRODUCTION OF DIFFERENTIATION OF
EIGHT PRINCIPLES PATTERNS

• Many different methods of differentiation:

• 8-Principle (what we’re learning today)
• 6-stage (ZZZ- SHL) Cold dz
• 4-Level Wen Bing Warm dz
• Etiology differentiation (7 emotions, 6 exogenous pathogens, misc dz)
• Qi, Blood, Fluids
• Zang-Fu
• San Jiao
• Channel
8 PRINCIPLES

• Yin Interior, Cold, Deficient

• Yang Exterior, Heat, Excess

• Location- exterior v interior

• Six Stage, 4 Level, San Jiao, Zang Fu, Channel
• Nature- heat v cold, excess v deficient; Qualitative
• Qi Blood Fluids, Etiology (exopathogen attack/ 7 emotions)
CONCLUSION-

• Disease: The entire pathological process and the principle disorder

• Pattern: The particular disorder in it’s current stage
RELATIONSHIP BETWEEN DISEASE AND PATTERN

• Disease through Time

•
• ----------------------------------------------------------------------
• Pattern Stage A Pattern Stage B Pattern Stage C
• Treatment A Treatment B Treatment C
• : One disease can have different patterns, and one pattern can appear in
different diseases