pattern diagnosis

[Guest guest]

I was thinking about Bob's repeated admonition to do pattern diagnosis

(assuming it was not a typo). I think many of us advocate that as the

first and last resort. Certainly, all lasting developments in

treating specific illnesses have begun with an understanding of

pattern dx. But Bob wouldn't write books like modern western diseases

and that ilk unless he also believed that the ideal situation was one

in which the physician possessed a detailed knowledge of disease from

both a western and eastern perspective. While one can certainly

achieve some clinical success with the sole recourse of pattern

diagnosis, I believe there are many conditions that will not yield to

such generalized treatment.

 

This approach is certainly ideal for patients with numerous vague

symptoms. But for those with a distinct chief complaint or a well

defined syndrome, merely addressing the patterns that one sees may not

be sufficient. One might ask, " how can this be? " What is there

besides patterns. Well, there are the symptoms that by themselves

are branches, such as bleeding. Bleeding is not a pattern, but it

must be stopped. It is rooted in a pattern (heat or qi vacuity

usually). But addressing that root pattern is not often adequate.

One must treat the disease directly. How can the qi that holds the

blood ever be restored while one continues to bleed?

 

Now the bleeding is an obvious example to which one would respond that

it could be easily addressed with a good knowledge of materia medica.

No specialized knowledge of disease treatment is necessary. But what

about those more obscure disorders like ITCHY EYES/mu yang? While it

might seem straightforward enough, are you sure you would be best

served by using everyone's favorite fallback, yin qiao san, in a wind

heat pattern. What would be your first choice in a wind cold? Would

you use long dan xie gan tang for a liver fire pattern? You might be

surpised at the options in this chapter in Sionneau.

 

How do you know these standard formulas would actually give any relief

to the chief complaint in a timely fashion? We can perhaps assume

that they will achieve some goal in the long term. But do we have any

duty to offer symptom relief immediately. I think the presence of

nagging symptoms interfere with the recovery of health and must be

relieved in order to achieve lasting progress. And what about

prognosis. Without a knowledge of internal medicine and its emphasis

on branch as well as root treatment, not only is symptom relief more

difficult, but prognosis also impeded. A knowledge of western

medicine particularly can affect prognosis.

 

So in light of all this, I would argue that TCM pattern dx is not

sufficient to treat most illnesses. And in some cases, maintenance or

palliation of the branch may be the best or only option. In which

case one not only cannot rely solely on TCM, but must actually

coordinate with MDs to achieve the optimum clinical success. I know

others will contend that TCM alone is sufficient in all or most cases,

but the evidence is not convincing to me.