Pattern Diagnosis

“In TCM, when we diagnose and treat menstrual symptoms, we assess multiple facets of the menstrual period, including but not limited to the length and quality, as they pertain to causes that are beyond the reproductive system itself. We treat the whole body. All aspects of Elix's proprietary Health Assessment are compiled into a profile that ultimately allows for the patient to be diagnosed as a specific ‘pattern’ type in TCM. Pattern Diagnosis helps herbal formulations target the root cause of a patient’s symptoms and needs.”  -Dr. Xia Hongsheng, Elix Medical Advisor

Ever wonder what really causes your symptoms? TCM can help pinpoint the underlying cause with its holistic approach called Pattern Diagnosis, which examines the whole body for patterns of Yin-Yang imbalance in fundamental parts of the body. In this section, we explore how TCM doctors diagnose patients.

A TCM practitioner usually begins the process of diagnosis by examining symptoms, which are considered bodily signals that point to the root cause and underlying state of health. It is important to know the whole in order to understand the parts, which is why the backbone of TCM diagnosis involves a holistic approach.

Sometimes it may be easy to pinpoint the underlying causes of symptoms, but other times it may take more careful interpretation and examination — especially if the symptoms seem to contradict each other. With numerous possible signs and elaborate connections between substances, organs, and meridian pathways, determining a pattern of imbalance can certainly seem complicated. First, we start with the four primary types of TCM examination for Pattern Diagnosis:

• Looking — visually analyzing the general appearance, face, skin, and tongue
• Listening and Smelling — examining voice, breathing, and body odors
• Touching — feeling the wrist pulse, abdomen, and pressure points
• Inquiry — gathering a patient’s comprehensive medical history and lifestyle

Tongue Analysis

We can learn a lot about our health just by looking at the tongue. TCM practitioners look at its coating and actual material to observe or confirm patterns of imbalance. For example, a redder tongue points to an excess of Yang, while tongue coating that looks greasy or filmy can indicate mucus or dampness in the body. Doctors even look at the shape of the tongue for more insight, like if it has scalloped edges, appears thin, or has swelled to an abnormal size. 

Read more about tongue analysis here: What Your Tongue Reveals About Your Health.

Taking Your Pulse

In the TCM world, feeling a pulse on the wrist involves more than just listening for heart rate. It requires incredible expertise, sensitivity, and years of practice. A skilled practitioner can sense subtle differences in a pulse due to the fingers’ positions on the wrist and identify its type based on over 20 possibilities. Doctors analyze things like each person’s pulse rhythm, speed, length, and strength; any irregularity or abnormality can help point to the underlying cause of imbalance. 

Inquiry: Getting All the Details

When a TCM practitioner asks questions about our health, no symptom is dismissed. Anything and everything is up for examination. Because all the organs, pathways, and substances are so intertwined with each other, symptoms that seem unrelated could actually be extremely informative. The first visit may seem to take longer due to the number of questions, but trust that the process is necessary to get a clear picture of the diagnosis. The extensive questions show how much Pattern Diagnosis embraces a holistic approach to healing at the root cause.

TCM doctors often ask questions about:

• Appetite, taste, and diet
• Thirst
• Perspiration
• Sleep
• Feeling cold or hot
• History on intimacy/sex
• Localized areas of pain
• Nature of pain
• Stress levels
• Major life events and changes
• Menstrual symptoms and color of blood
• Mental and emotional triggers
• Urine and poop quality/experience

The Eight Principles give insight into the complex process of TCM diagnosis.

In TCM, eight guiding principles give us a more cohesive view of how doctors name and categorize Yin-Yang imbalances in the body. Below are the Eight Principles for Pattern Diagnosis, and these principle patterns have four pairs of opposites:

Interior and Exterior
Interior patterns refer to internal disharmonies that are deep inside the body and affect the Zang-Fu organs, blood, Qi, and essence (marrow). These imbalances tend to involve more chronic, serious, and conditions that gradually onset. Exterior patterns resemble the Western medical community’s idea of infectious, contagious diseases (fever, chills, and headaches) as well as conditions affecting hair, skin, nails, and meridians. These patterns tend to be more acute and sudden, lasting a short amount of time. 

Cold and Heat
Cold patterns refer to an aversion to the cold and a general deficiency of Yang. They also have exterior and interior combinations. With interior, there can be Yang deficiency and Dampness (think internal humidity) that manifest as symptoms such as diarrhea, nausea, and pale features. Cold exterior patterns come from environmental or pathological factors that go into the body such as cold weather and wind, resulting in body aches, chills, fever, and headaches. 

Heat patterns refer to Yin deficiency and internal Damp Heat, with symptoms like a slow pulse and a preference for cold drinks. External influences like summer heat, dryness, and wind can cause symptoms that range from a rapid pulse and dehydration to fever and sore throat. 

Deficiency and Excess
Deficiency usually refers to a lack of Qi or blood and can lead to symptoms like dizziness, lack of appetite, constant urination, and a slow pulse. It is often associated with chronic conditions. Excess patterns come from a buildup of Qi or blood, and they could also arise from pathological or external factors attacking the body. Symptoms include sharp abdominal pain, a quick pulse, and sweaty palms. 

Yin and Yang
In TCM, Yin-Yang disharmonies are the overarching patterns of imbalance. Note that cold, interior, and deficiency patterns are Yin while heat, exterior, and excess patterns are Yang. But that does not mean that someone’s condition can easily be categorized as only Yin or Yang. Most people have a combination of both Yin and Yang signs. Some who experience menstrual cramps exhibit cold and Yin patterns that are relieved by heat, but their pulse may be rapid (Heat and Yang) and thin (deficient and Yin). 

A Holistic Approach to Diagnosis

The Eight Principles help TCM doctors get a strong sense of the patterns of imbalance affecting their patients, but the analysis can go even deeper. From here, we can map out in-depth, detailed patterns that involve Qi, blood, meridians, and organs. There are patterns of deficient Qi and Yang, deficient Qi and blood, stagnant Qi, blood and Heat, and more. As a result, TCM contains an extensive library of patterns that enables us to effectively pinpoint which one corresponds to each patient’s unique bodily signs and symptoms. This healing approach is not about addressing a medical problem from one symptom alone; it employs a holistic perspective that considers the myriad of reasons for that problem.

How Elix Embraces Pattern Diagnosis

There are so many menstrual symptoms (cramps, fatigue, bloating, and mood swings, just to name a few) that alert us to imbalance in our cycles, but then there are also things like lifestyle, diet, stress, and sleep to examine. 

The Elix Health Assessment takes all these factors into account with a detailed inquiry that takes just ten minutes to help you understand the root cause of your symptoms. It is followed by a request for a tongue photo to confirm the pattern of imbalance. As a holistic approach to healing, Elix blends the ancient wisdom of TCM with science-backed clinical studies to determine the unique herbal formula for your body’s hormonal imbalances and empower you to become your own best healer. 

Read more about our mission here and take our Health Assessment to restore your body to a more balanced cycle. 

Case Studies for Pattern Diagnosis

Interested in learning more about Pattern Diagnosis? We asked Elix Medical Advisor Dr. Liem Le to help us understand how TCM doctors diagnose patients. Read these sample case studies to see this process at work.

Example 1

Context

• Sarah is a 25-year-old young professional who recently started a new job.
• She has been experiencing irregular periods and has a history of irregular periods since the age of 16, missing her period especially during times of high stress.
• Her menses have always been scant and light-colored with some clots. Her flow is bright red and lasts 1-2 days only. 
• She experiences breast distension, along with dull and achy pain in the lower abdomen. She sighs throughout the day and can get easily irritable. 
• Additional symptoms that she experiences throughout the month but are more pronounced during menstruation are gas, bloating, fatigue, and sometimes loose stools.
•  Her tongue has slightly red sides and imprints of teeth marks.
  
  

Doctor’s Diagnosis
Tongue analysis: The sides of the tongue point to the liver. In this case, the red sides are an indication that there is liver Qi stagnation present. In addition, the tongue has teeth marks, which might indicate Qi deficiency as there is not enough of it to metabolize fluids efficiently.  The tongue becomes puffier or larger than normal, pressing up against the teeth.

TCM diagnosis: Liver Qi Stagnation and Qi Deficiency

Explanation of Diagnosis
There is a saying in Chinese Medicine: “When there is free flow, there is no pain. When there is no free flow, there is pain.”

The liver is in charge of the flow of Qi and blood throughout the body, and its meridian channel runs through the pelvic region and the uterus. Thus, it is the motivating force that supports menstruation. 

Stress is a common root cause for the liver Qi to become stagnant (lack of free flow), which explains why S. F. experiences missed, shorter, or scanty/light periods when there should be productive blood flow. Since the liver rules the hypochondrium/upper torso and its Qi is stagnant, S.F. experiences dull, achy pain in the lower abdomen and breast distension. 

The emotions associated with the liver are anger, frustration, and irritability. When liver Qi is stagnant, there can be a sense of constriction in the chest. Sighing is the body's natural attempt to relieve the pressure, as pointed out by S.F.’s sighing and irritable moods. Deep breaths are highly recommended for people with liver Qi stagnation.

As for the additional symptoms she experiences particularly during menstruation, they also point to Qi deficiency. A common sign of possible Qi deficiency is fatigue and digestive issues such as gas, bloating, and loose stools. You can have the symptom of fatigue with blood deficiency, but usually, there would also be light-colored blood. So in this case, the diagnosis is Qi deficiency.

Treatment Plan
Treatment strategy: Move liver Qi and tonify (increase) Qi

Herbs that might be used to move liver Qi: Angelica, Bupleurum, Cyprus, Toosendan, Mint, Szechuan Lovage Root, and Peony

Herbs that might be used to tonify liver Qi: Licorice, Ginger, Poria, Atractylodes, Ginseng, Jujube, Astragalus, Reishi


Example 2

Context

• Megan is a 32-year-old who has been experiencing painful periods. 
• She describes the pain to be intense and sharp before and during the period. Her flow is heavy, accompanied by dark blood and large clots. 
• Other symptoms that she experiences during her periods are restlessness, irritability, outbursts of anger, thirst, feeling warm but not really sweating, and constipation. The pain is debilitating, and she often has to miss work. Pain is relieved after passing clots. 
• Her tongue is slightly red, with dull purple sides.

Doctor’s Diagnosis
Tongue analysis: The tongue reflects the state of Qi and Blood in the body. The dull purple sides suggest blood stagnation. 

TCM Diagnosis: Liver Qi and Blood Stagnation with Heat

Explanation of Diagnosis
The liver is in charge of the flow of Qi and blood throughout the body. If liver Qi becomes stagnant, blood does not move properly and results in pain. It is also said that dark blood alone sufficiently diagnoses blood stagnation. Because Y.H.’s blood is not moving efficiently, she experiences intense, sharp pain, dark blood, and large clots. Y.H. gets some pain relief once the clots are able to pass through because blood is finally able to move properly again. 

The emotions associated with the liver are anger, frustration, and irritability. The restlessness that Y.H. is experiencing could be from the lack of Qi and blood movement. In fact, Heat can also cause agitation and restlessness. When Qi and blood are stagnant, think of friction because friction causes heat. Qi and blood want to move freely, and the forceful movements trying to help them flow better create an accumulation of Heat. As a result, long-term Qi and blood stagnation can lead to internal Heat. 

Megan’s diagnosis includes Heat because of her other symptoms of thirst, the sensation of warmth, and constipation. Thirst and constipation can manifest due to Heat (Yang) drying up internal moisture (Yin). Although Heat does not cause painful menstruation, it tends to lead to a heavy flow. 

Other sources of Internal Heat are holding in our emotions, eating fried, greasy, and spicy foods, not drinking enough water (Yin deficiency), not sleeping during the night (Yin deficiency), overworking, and stress. It boils down to an imbalance of Yin and Yang.

Treatment Plan
Treatment strategy: Move liver Qi and blood, clear Heat

Herbs that might be used to move liver Qi: Angelica, Bupleurum, Cyprus, Toosendan, Mint, Szechuan Lovage Root, Peony

Herbs that might be used to move blood: Angelica, corydalis, white peony, motherwort, safflower, bugleweed

Herbs that might be used to clear Heat: Gardenia, moutan, skullcap, anemarrhenae, andrographis


Example 3

Context

• Jenny is a 42-year-old who has been experiencing severe night sweats for the past year. She is unable to sleep through the night, feels restless, and wakes up frequently. She wakes up with her clothing drenched in sweat. She gets so hot at night that she wakes up with no blanket and sheets on her. 
• She has a history of heavy periods ever since she started menstruating when she was 14 years old, but they have been getting lighter in the last year. 
• In addition, she has had chronic lower back pain for the last six months. The last couple of years, she has also experienced spots in her vision, weak nails, and brittle hair. 
• Lastly, in the last three months, it has been increasingly hard for her to concentrate. She has been having poor memory and palpitations about one week after her period. 
• Her tongue looks red with pale sides, and the coating appears thin on top.

Doctor’s Diagnosis
Tongue Analysis: The red tongue indicates heat, specifically Yin deficiency heat due to the imbalance of Yin and Yang. The thin coat indicates a possible lack of bodily fluids (Yin deficiency) possibly consumed by the heat. The sides of the tongue reflect the condition of the liver; paleness might indicate liver blood deficiency. Observing the tongue can help support the patient's TCM Pattern Diagnosis of liver blood deficiency and kidney Yin deficiency.

TCM Diagnosis: Liver Blood, Kidney Yin, and Heart Blood Deficiency

Explanation of Diagnosis
The liver regulates and stores blood (Yin). The patient's long history of heavy menstruation might lead to liver blood deficiency. Poor diet and lifestyle would exacerbate Qi and blood deficiency as well, if not addressed appropriately. In addition, the patient has been having lighter periods in the last year, which further confirms the deficiency in liver blood. 

In TCM, liver blood also nourishes the eyes, nails, and hair. Since the patient shared that she has been experiencing spots in her vision and changes in the quality of her nails and hair, her signs further support a diagnosis of liver blood deficiency.

There is a mutual relationship between the kidney and liver. Kidney essence (Yin, bone marrow) contributes to the production of liver blood. If there is a decline in kidney Yin, it might also lead to a decline in liver blood. As a woman begins to age, there is a natural decline of Yin (which represents the female side, moisture, coolness, blood, and night) aspect of the body and might result in an imbalance of Yin and Yang. At night, blood is stored in the liver, and Yin (night) should be abundant. However, the patient is experiencing night sweats, restlessness, and waking frequently, which are signs of Yin deficiency.

This pattern supports the conclusion that she is experiencing Yin deficiency and more Heat — an imbalance in Yin and Yang. There is not enough Yin to cool the Yang (heat). In addition, the kidney is closely connected to the lower back, so her chronic back pain could be due to Kidney deficiency.

The heart and kidneys have a mutual relationship as well, where the heart is Yang and the kidneys are Yin. Since there is a deficiency of Yin (blood), there would be a deficiency in heart blood post-menstruation as well, leading to palpitations. In addition, the heart governs blood and the mind — the patient’s poor memory further supports the idea of heart blood deficiency post-menstruation.

Treatment Plan
Treatment Strategy: Nourish liver blood, kidney Yin, and heart blood

Herbs for liver blood deficiency: Angelica, Rehmanniae, Jujube

Herbs for kidney Yin deficiency: Anemarrhenae, Water Plaintain, Moutan

Herbs for heart blood deficiency: Reishi

Foods you can eat to support:

Liver blood — apples, beets, broccoli, cherries, duck, eggs, grapes, lotus root, liver, oysters, green vegetables

Kidney Yin – almonds, apple, banana, barley, black beans, bone marrow, coconut, duck, eggs, flaxseed, kelp, mung beans, mushrooms,  rice, spirulina, squash, tofu, wood ear mushrooms

Heart blood — beef, chicken, black sesame, grapes, oats, rice, oysters