Four Diagnosis and Eight Principles of Traditional Chinese Medicine
I. Four Diagnosis and Eight Principles
1. The Four Diagnosis include observation, listening, questioning, and palpation.
These four methods are used in clinical practice to understand the overall condition of the patient and provide diagnosis and treatment based on the concept of holism. The human body is an organic whole, and local diseases can affect the entire body, while systemic diseases can manifest in specific parts of the body. Therefore, by observing the various manifestations of the disease in different aspects of the body and analyzing them through the Four Diagnosis, we can understand the cause, nature, and internal connection of the disease.
(1) Observation: The doctor observes the patient's appearance, form, movements, tongue coating, and affected areas to understand the condition. For example, pale complexion in chronic illness is often associated with qi deficiency; sudden paleness after trauma with sweating suggests shock, possibly due to bleeding or traumatic injury; a pale complexion and pale tongue indicate blood deficiency; facial cyanosis in children with high fever may be a sign of febrile convulsions.
If a disease affects the function of a particular part of the musculoskeletal system, there will be corresponding disruptions in movement. For example, a child with a dislocated radial head cannot raise their hand; a patient with shoulder arthritis may have limited shoulder movement and crepitus; a patient with ankle sprain may have difficulty walking and rely on their hands for support; a knee joint sprain may result in a semi-flexed position while walking; a wrist joint sprain may affect hand movements, and so on. By observing the patient's static and dynamic postures, various movements, and facial expressions, we can obtain diagnostic results.
In addition, fingerprint changes can be used to diagnose diseases in children. For example, blue fingerprints extending to the fingertips indicate lung heat; pale fingerprints suggest accumulation of phlegm in children.
(2) Listening: The doctor listens to the patient's voice, speech, breathing, cough, heart sounds, joint crepitus, and smells emitted from bodily secretions. For example, loud cries may indicate severe pain; rapid breathing or delirium may indicate high fever; crepitus may be present in patients with arthritis or joint laxity; crackling sounds may be heard in patients with bursitis.
(3) Questioning: The doctor asks the patient, family members, neighbors, and friends targeted questions to gather information about the disease. This includes the patient's age, occupation, lifestyle, onset and course of the disease, symptoms, treatment history, constitution, medical history, and family history. Detailed understanding of these factors can only be obtained through questioning. For example, a history of cold exposure is often associated with rheumatoid arthritis; patients with excessive liver yang are prone to stroke; joint dysfunction is often related to injury and degenerative changes; bone and joint diseases are related to living environment; and musculoskeletal disorders are closely related to occupation.
It should be noted that during questioning, the focus should be on gathering relevant information and not on subjective speculation, suggestion, or leading questions, in order to avoid drawing incorrect conclusions.
(4) Palpation: The doctor uses their hands to palpate the patient's major arteries to understand their pulsations, such as the depth and location of pulsations, speed, strength, regularity, and the presence of any changes in form, such as smoothness or stringiness. This helps determine the location and nature of the disease, whether it is superficial or deep, and its characteristics.
2. The Eight Principles: The Eight Principles refer to yin, yang, exterior, interior, cold, heat, deficiency, and excess. These principles are derived from the materials obtained through the Four Diagnosis and are used to categorize the patterns of symptoms into general types. They have a universal guiding significance for the diagnosis of diseases. Therefore, before using massage therapy to treat diseases, it is necessary to diagnose according to the Eight Principles to provide a theoretical basis for treatment.
Although the manifestations of diseases may be extremely complex, they can be classified into yin patterns and yang patterns. The location of the disease is either on the surface (exterior) or inside the body (interior). The nature of the disease is either hot (heat) or cold. The relationship between pathogenic factors and healthy qi determines whether it is an excess pattern or a deficiency pattern. Therefore, the Eight Principles categorize the patterns of symptoms into four opposing pairs: exterior and interior, heat and cold, deficiency and excess, and yin and yang. Among them, yin and yang can summarize the other six principles, namely exterior, heat, and excess patterns belong to yang patterns. Therefore, yin and yang are the overall principles within the Eight Principles.
The Eight Principles are interconnected and inseparable. For example, from exterior patterns to interior patterns, there are differences between cold and heat and deficiency and excess. It is necessary to pay attention to both individual principles and comprehensive analysis. Additionally, the various patterns within the Eight Principles are not static and unchanging; they can transform under certain conditions. For example, an exterior pattern can transform into an interior pattern, a cold pattern can transform into a heat pattern, an excess pattern can transform into a deficiency pattern, and a yang pattern can transform into a yin pattern, and so on. Therefore, in the process of diagnosis, one must constantly pay attention to the development and changes of the disease and conduct a comprehensive analysis of the specific situation in order to grasp the main contradictions and understand the essence of the disease.
II. Palpation: Palpation, also known as touch diagnosis, involves the doctor using their hands to feel the affected area to assess the severity, nature, size, depth, temperature, skin tension, hardness of scars, and the presence of tenderness or fixed tender points. For example, fresh hematomas are softer, while organized hematomas become harder, and ossifying myositis is the hardest. Swelling is prominent in fresh injuries, and local skin temperature may be slightly elevated. Acute sprains may cause muscle spasms and high muscle tension. Chronic overuse injuries may cause muscle contraction and reduced muscle tension, which can be a manifestation of muscle atrophy. Tendon sheath cysts can be palpated as nodules, and tenosynovitis can cause tenderness and nodules. Muscle adhesions can affect muscle elasticity and flexibility.
