Today I want to dive into the 10 most common questions we ask each patient and how to differentiate each answer to form a TCM diagnosis.

Because once we have the right diagnosis, we can select the right acupuncture points. There is no wrong treatment in TCM, only the wrong diagnosis. This is why it’s really important. So today I’m going to look at energy, sleep, digestion, all the common questions we ask patients in order to make a diagnosis. This is how we care for our patients in the best way possible.

Whether you are a practitioner who is still trying to refine your skills or a TCM student who is baffled by diagnosis (like I was when I was in school), this differential diagnosis for 10 common symptoms in Chinese medicine will give you the right tool to effectively select the right acupuncture points for each of your patient.

So, grab your note book, and let’s jump into Chinese Medicine Diagnosis Made Easy for 10 Common Symptoms!

Keep rocking using TCM,
Clara
TCM Geek

PS: If you want more, check out A 9 STEP Framework for effective Chinese Medicine Diagnosis, and TCM Foundation & Diagnosis Resource page! And, if you haven’t invested in my book Chinese Medicine Made Easy, get your copy here! 🙏

How to EASILY differentiate 10 common symptoms when making a TCM diagnosis!

How to EASILY differentiate 10 common symptoms when making a TCM diagnosis!

TCM diagnosis

Diagnosis is considered one of the most challenging aspects of Traditional Chinese Medicine (TCM). It requires a deep understanding of the patient’s symptoms and the ability to differentiate each answer in order to form an accurate diagnosis. So let’s dive into the 10 most common questions asked by TCM practitioners to patients and explore how to differentiate each answer to provide the best possible care. I will explore energy, sleep, digestion, and more to understand how these symptoms can guide us in picking the right treatment points and caring for our patients effectively.

Sleep: Unraveling the TCM Patterns of Insomnia

When asking patients about their sleep, it’s essential to dig deeper and not settle for a vague response like “it’s fine.” Differentiating sleep patterns can provide valuable insights into the underlying imbalances. I explore various aspects of insomnia, such as the ability to fall asleep easily, interrupted sleep, feeling refreshed upon waking, and the presence of dreams or nightmares. By examining these details, TCM practitioners can identify associations with TCM Heart, Liver and Spleen imbalances, Yin and Yang deficiencies, and other underlying conditions.

Sweat: Clues About the TCM Heart Imbalances in TCM diagnosis

The next question revolves around sweat. TCM considers sweat and sleep to be connected to heart function. By asking whether someone sweats easily, we can gain insights into Heart Yin deficiencies or Heart Qi deficiencies. Additionally, discovering if someone never sweats can help identify Heart Blood deficiencies.

Energy: Assessing Physical and Mental Vitality

Asking about energy levels provides valuable information about a patient’s overall well-being. Differentiating physical and mental energy is crucial for a comprehensive diagnosis. Inquiring about energy levels throughout the day and any physical or mental fatigue helps us identify Spleen Qi deficiency, Kidney Yang deficiency, and Liver Qi Stagnation, which play a significant role in energy management.

Digestion: The Key to Nourishing the Body

To understand a patient’s digestive health, inquiring about their diet, appetite, and bowel movements is crucial. Exploring if someone experiences bloating, cravings, and bowel movement regularity helps identify imbalances related to Spleen Qi deficiency, Liver Qi Stagnation, Dampness, or Blood deficiency. By analyzing symptoms and diet, TCM practitioners can provide dietary recommendations and herbal treatments to restore optimal digestive function.

Urination: A Window into TCM Kidney & Bladder Health in TCM diagnosis

The question of urination can reveal valuable insights into TCM Kidney health. Inquiring about nighttime urination frequency and bladder control helps identify Kidney Qi deficiency or Spleen Qi sinking. Bedwetting in children may indicate underlying fears or emotional imbalances. Examining the colour, urgency, and pain associated with urination helps identify conditions such as Kidney Qi deficiencies, bladder infections, and Bladder Heat or Cold patterns.

Pain: Indications of Imbalances in the Body 

Assessing pain in different areas of the body is integral to TCM diagnosis. By examining the quality, location, and impact of pain, practitioners can differentiate between Blood Stasis, Liver Qi stagnation, Dampness, and excess or deficiency patterns. Understanding which body parts are affected allows us to identify imbalances in organs and acupuncture meridians.

Heat and Cold: Examining Body Temperature for TCM diagnosis

Lastly, understanding how a patient experiences Heat or Cold can provide valuable information. Differentiating excess Heat versus Yin deficiency based on symptoms like sweating patterns, sleep disturbances, bowel movements, and emotional states helps identify imbalances in the body. Whether a patient exhibits Yang deficiency or Yin excess, understanding their body temperature preferences allows practitioners to tailor treatments accordingly.

Making a TCM diagnosis easily

By diligently examining the answers to these 10 common questions, TCM practitioners gain significant insights into a patient’s overall health and imbalances. Through differentiation, they can form accurate diagnoses, enabling them to select the most effective treatment points and provide optimal care. Remember, the key to TCM diagnosis is attentive listening, attention to detail, and a comprehensive understanding of the interconnectedness of the body’s systems.

How to differentiate 10 common symptoms when making a TCM diagnosis Transcript

Diagnosis has to be the hardest part of Chinese medicine. Today, I want to dive into the 10 most common questions we ask each patient and how to differentiate each answer to form a diagnosis. Because once we have the right diagnosis, we can pick the right point selections. There is no wrong treatment in TCM, only the wrong diagnosis. This is why it’s really important.

So today, I’m going to look at energy, sleep, digestion, and all the common questions we ask patients in order to make a diagnosis. I’ll explain how to differentiate them all to pick the right point selection and to care for our patients in the best way possible.

Welcome back to my channel! If it’s your first time here, I’m Clara from AcuProAcademy, and I create Chinese medicine and acupuncture content for students and practitioners, making it easy to grasp and fun to learn. Let’s go!

Sleep

Let’s start with sleep. Often, we ask patients, ‘How’s your sleep?’ They might say, ‘It’s fine,’ because they’re so used to not sleeping properly that in their mind, it might be fine. So it’s really important to not just let it go at that question but dig deeper and ask more details.

‘Do you fall asleep easily, stay asleep, and wake up refreshed without being disturbed by dreams or waking up?’ Suddenly, people will say, ‘Well, maybe not.’

How to Differentiate Sleep

If someone cannot fall asleep easily, takes an hour to two hours to fall asleep, that is either Liver overcontrolling Spleen. Or Wood overcontrolling Earth. This means Liver Qi Stagnation depleting the Spleen and creating Spleen Qi deficiency. Or it could be Spleen and Heart Blood deficiency. So you need to differentiate with other symptoms in order to know which one it is between the two.

If someone tosses and turns all night, that’s a Yin deficiency. If someone wakes up between 1 and 3:00 a.m? That’s a Liver problem. Now, if they fall back asleep within a few minutes, that’s a Liver Yang rising. If they cannot fall back asleep, that’s a Liver Fire.

If someone does not feel refreshed and they feel really tired in the morning and they can’t get out of bed, that is Spleen Qi deficiency. Morning time is Spleen and Stomach time. So when someone is really tired in the morning, that is a Spleen Qi deficiency.

Dreams

Then there are dreams. If we have dream-disturbed sleep, it could be a Heart Yin deficiency. If there are nightmares, it’s flame Fire in the Heart. However, if it’s the same recurring dream, it’s a Gallbladder Qi deficiency. Very different, right? This is how we differentiate those symptoms. Make sense?

And the last one is those who don’t sleep at all, not one minute for weeks or months. That is Heart Fire. So see, this is how we differentiate a common question, ‘How is your sleep?’

Sweat

Question number two is about sweat. ‘Do you sweat easily?’

And again, sleep and sweat are related to the heart in TCM, as the Heart functions. The Heart is in charge of sweat and sleeping.

So when it comes to sweat, do you sweat easily? There are two answers. Either the person sweats at night, and that’s Heart Yin deficiency, or sweats easily during the day without being hot, often when they’re anxious, and that’s a Heart Qi deficiency.

The other answer is, ‘I never sweat.’ Years ago, before I went back to school for TCM, I used to personal train and work in the fitness industry, and I had this client who never sweated. She worked really hard, did a lot of cardio, did a lot of workouts really hard. I was watching her; she never had a bead of sweat on her clothes. That is Heart Blood deficiency. See?

Next question is, ‘How is your energy right after sleep?’ Obviously, this is correlated.

If we don’t sleep well, we don’t have great energy. ‘How is your energy?’

Energy

What I like to do when I ask about energy is, ‘From 1 to 10, 10 being your best energy, where are you at?’ Most patients are going to say 3 or 4 when their energy is low, 7 when they don’t have top energy but they keep going. So if they say 7, they’re probably a 5. They’re just so used to going on empty that they will say 7. Make sense?

For those patients, I ask two questions: ‘How are you physically and mentally for energy?’ So physically, we also have the time of day.

If you have no energy in the morning specifically, that’s a Spleen Qi deficiency. And if you have no energy ever, you exhaust it all the time, most of the time it’s a Yang deficiency, probably a Spleen and Yang deficiency. We have to ask more questions, but that’s the result often when it comes to energy in the morning.

Mental Energy

Now we have mental energy. If someone is mentally exhausted, usually it’s due to the amount of stress. There’s Liver Qi Stagnation putting pressure on their Spleen. Which is overthinking, over worrying, and gets depleted and creating Spleen Qi deficiency.

So no matter what, mental or physical fatigue is going to affect the Spleen because the Spleen is in charge of bringing clear Qi to the mind for focus. And sometimes, when we use our minds too much and we don’t eat the right nutrients, we deplete our bodies. So that’s an easy one. It’s mostly a Spleen issue regarding low energy or fatigue.

Now, if someone is blood deficient, they can also be fatigued, but blood deficiency usually comes from spleen Qi deficiency, not able to produce blood. Make sense?

Digestion

Okay, and the next question is about digestion. So the first thing we’ll ask is, ‘Are you eating regular meals? What’s your diet?’ We need to know what the diet is in order to know what’s going on.

It’s really important also if a woman eats a lot of raw, cold food and she’s trying to get pregnant and she’s always cold, we need to know that in order to explain that we need warmer food. Right? This is really important.

So, are you bloated easily? Now, when it comes to bloating, we have bloating after meals, and that’s a Spleen Qi deficiency with dampness. Or we have bloating that gets worse and worse as the day goes and is the worst at the end of the day. And when we wake up in the morning, the stomach feels flat again. That is due to stress. That is Liver Qi stagnation bloating. See? This is how we differentiate the two.

Appetite

‘How is your appetite?‘ ‘Oh, it’s pretty good. I eat well.’ ‘Do you have cravings?’ So poor appetite, meaning there’s no appetite, is a blood deficiency.

If there are cravings, that is also a Spleen Qi deficiency, not being able to transform transport. Maybe the person is not having a good diet. If we are craving sweets, that’s a Spleen issue. If you’re craving salt, that’s a Kidney issue.

Bowel Moments

When it comes to digestion, the next step is asking that question about bowel movement. When it comes to bowel movement, we ask, ‘Do you have a bowel movement daily, and is it easy?’ Now, if this is not the answer, let’s look a little bit deeper.

Constipation means that we may strain or we don’t have a bowel movement regularly daily. Diarrhea means that we are going to have loose stools or, worse than that, which is diarrhea. It could be once a day; it could be more often, twice a day. That is a different one.

Constipation

So, let’s start with constipation first. If we are straining, if there is gas, and easily bloated with stress, that’s Liver Qi stagnation. If there is a painful abdominal region, and when we have a bowel movement, we feel better, that’s excess in the large intestine. And if the bowel movement is smelly, that’s excess heat in the large intestine. Does that make sense? Okay, so it’s looking at going a little bit deeper.

Now, the stool. If they’re dry, little pebbles, that’s a Yin deficiency. If they’re big, formed stools and large amounts, that’s excess in the large intestine. When it comes to IBS, which is alternating constipation with diarrhea, this is often due to stress. So it’s Liver Qi Stagnation creating some Spleen Qi Deficiency or Wood overcontrolling Earth.

Diarrhea

When it comes to diarrhea at 5 a.m. or early morning diarrhea, basically the one we have when we wake up, it’s excess in Kidney Yang deficiency. A really smelly diarrhea is damp heat in the lower Jiao. No matter what, when there is diarrhea, there’s Spleen Qi Deficiency. I’m talking if it’s chronic.

If it’s acute, it’s external pathogen invasion. So that’s different. But if it’s chronic, then that’s a Spleen Qi Deficiency. And then it depends on when it happens, what it looks like, and the smell of it. Then we can have damp heat if it’s smelly like I said. If it’s urgent, painful diarrhea, often it’s liver overacting on the spleen again. And it’s kind of like IBS or irritable bowel syndrome. Diarrhea that is better with a warm compress on the abdominal region is often a cold, damp diarrhea.

See? This is how we differentiate those questions, simple, straight to the point, and that’s how we make a diagnosis.

Urination

Next question, let’s talk about the question about urination. The first thing I ask is, ‘Do you get up at night to pee?’ And if the person drinks a lot of tea before they go to bed and they get up once, that’s pretty normal. But if they don’t drink anything, I have lots of patients that say, ‘I stop drinking anything by five, and I still wake up three to four times a night to pee.’ We know that’s the problem with Kidney Qi not opening and closing the lower gate properly. So that’s a Kidney Qi deficiency.

Also, if there’s bladder incontinence, that is either a Spleen Qi Sinking if the bladder is prolapsing. Or it’s a Kidney Qi Deficiency, which we know is worse when we cough, laugh or run. Bedwetting is another one that if I treat children specifically, we can ask the parents about bedwetting.

And bedwetting is literally the child has fear. It could be irrational fear or rational fear, but a child that is bedwetting or wetting the bed is definitely a child who is fearful of something. So you need to dig a little bit deeper and figure out what is the child scared of because that fear is controlling the Kidney, and the Kidney is not able to do its job.

Bedwetting

And then there’s bedwetting. When it comes to urination, the color of the urine is also going to play a role in how we diagnose. So if someone has a urinary tract infection or a bladder infection, this is usually damp heat in the bladder. And it’s going to look like murky, dark urination that is going to be urgent, painful, and burning. That’s easy.

The second one, also urgent, painful, and burning urination, is not an infection. So that’s a chronic issue like interstitial cystitis. And that is usually Heart Fire moving down to the Small Intestine. Because, in Chinese medicine, the Small Intestine is in charge of separating the clear from the turbid.

And Heart Fire moving down to the Small Intestine means that the emotional state of the Heart is not quite healthy, and it’s creating a problem with urination. And I see this with interstitial cystitis a lot. Patients usually have insomnia and a lot of traumatic emotional trauma that creates that interstitial cystitis or that painful urination that is dark, and urgent as well, but there’s no infection, right?

Painful urination after Intercourse

The other one is when there is painful urination after intercourse. That is usually damp heat or fire in the Liver meridian, the Lu collateral meridian. Because the Lu collateral starts at Liver 5 and comes up and wraps around the external genitalia.

So when there’s a herpes outbreak or there is urination that’s painful and urgent after intercourse, that is a Liver Fire or Damp Heat in the Liver meridian. Usually, this person also has anger or irritability issues and a headache that feels better with a cold compress.

The last one is if there is dark, scanty urine accompanied by constipation and thirst for cold drinks. And that’s chronic. That is large intestine heat, which also reflects into the urination. That’s bladder heat and large intestine heat.

See? This is how we differentiate. Good? I hope you’re really enjoying this.

Chinese Medicine Made Easy Book

And, by the way, if you haven’t got your copy of my green book, which is ‘Chinese Medicine Made Easy‘ it has all the diagnoses, all the graphics you’re seeing today to help you really narrow down your diagnosis and improve your skill when it comes to this difficult part that is TCM. The hard copy ships all over the world, or the PDF digital version has video links to complement it. No matter what, they both come with my fillable intake form that you can use for your patients.

Pain

The next question is pain. Obviously, some people come to see you because they’re in pain. But, in general, we’re going to ask, ‘Do you have any pain anywhere in the body?’ And people might answer with headaches, knee pain, back pain, or whatever the pain is.

First, we have to look at the quality of the pain. If it is constant, meaning it’s always there, versus it comes and goes. If it’s constant, it’s blood stasis. If it comes and goes, it’s Liver Qi stagnation. If it moves, it’s Liver Qi stagnation. If it’s fixed in the same area, it’s blood stasis. Let me give you some examples.

Dysmenorrhea

Dysmenorrhea, the pain is in the lower abdomen. It’s fixed; it’s stabbing, it’s strong, and it’s constant during the menstruation. That is blood stasis. Liver stagnation pain would come and go. So the pain that comes and goes could be arthritis, and the person can say, ‘Yeah, you know, sometimes it’s my wrist, sometimes it’s my knees,’ so it changes location. It’s not always in the same spot; it moves, and it’s not constant. That’s liver Qi stagnation.

Arthritis

Now that the pain that’s arthritic may worsen with cold, hot, or damp weather, it indicates Liver stagnation with dampness, heat, or cold. Does that make sense?

Okay, so pain that improves with a cold compress suggests excess heat, while pain relieved by a heating pad indicates excess cold. Yes, dull and weak pain always signals a deficiency, while strong, heavy, or swollen pain is always damp. Now, where is the pain, and what does it affect? If it impacts joints, ligaments, tendons, or sinews, it’s likely a gallbladder or liver issue.

If it affects bones, it’s related to the kidneys.

For muscles, it’s associated with the spleen and stomach. Does that make sense? If it affects nerves, it’s usually a liver problem, as the liver is more connected to the central nervous system.

Pain Location

Depending on the location of the pain, we can determine the affected meridian. Kidney issues often manifest as knee or lower back pain.

Liver issues such as ankle or rib pain, Large Intestine. Small Intestine issues such as elbow and shoulder pain, and spleen-related problems as hip pain. Jaw pain as a spleen and stomach-related issue. Jaw pain is typically associated with clenching due to worry, overthinking, and stress.

Neck pain involves both the lung and bladder meridians, with the Lung 7 point being the commander point for the neck and head.

So, by examining the pain’s location, we can make an accurate diagnosis.

Headaches

Moving on to headaches, it’s crucial to explore the details. Differentiating factors include the whole head indicating blood deficiency, a tight band suggesting dampness, and temple pain pointing to liver or gallbladder issues. Frontal pain related to the Stomach meridian, and occipital pain is linked to the bladder. Migraines with pounding and intense pain usually signify blood stasis.

Temperature Preferences

Lastly, regarding temperature preferences, being hot or cold easily indicates excess Yang or Yin deficiency. Excess heat symptoms include a red face, excessive sweating, and disrupted sleep, while yin deficiency is characterized by night sweats. For excess Yang, sleep is completely disturbed. While Yin deficiency involves disturbed sleep or frequent waking. Bowel movements, pulse, and emotions further help differentiate between excess and deficiency.

These were the ten crucial questions we ask each patient. For more resources, courses, and case studies, visit my website acuproacademy.com. Additionally, check out my podcast, “The Acupro Show,” available on Spotify, Apple, and other platforms. It’s free and releases every Wednesday. I hope this detailed discussion aids in narrowing down TCM diagnoses for better patient outcomes. Don’t forget to explore my diagnosis videos on my channel for additional insights. Have a fantastic day, and keep rocking it with TCM!