TCM Diagnosis — Four Examinations, Pulse Diagnosis & Pattern Identification

TCM Diagnosis (辨证, biàn zhèng) is fundamentally different from Western methodology. A Western doctor asks: "What disease does this patient have?" A TCM physician asks: "What pattern does this patient express?" Two patients with the same Western diagnosis may receive completely different TCM treatments because their underlying patterns differ.

「有诸内者，必形诸外。」

— Huangdi Neijing (黄帝内经)

"What is within must manifest without."

The Four Examinations · 四诊

1. Inspection (望, Wàng) — Tongue Diagnosis

Feature	Normal	Abnormal	Indicates
Body Color	Pale red	Pale	Qi/Blood deficiency, cold
		Red → Deep red	Heat in Blood, Yin deficiency
		Purple/Bluish	Blood stasis, severe cold
Shape	Proportionate	Swollen, teeth marks	Spleen qi deficiency, dampness
		Thin, shrunken	Yin/Blood deficiency
Coating	Thin, white, moist	Thick white	Cold, dampness, phlegm
		Yellow	Heat, damp-heat
		Greasy	Dampness, food stagnation
		No coating (mirror)	Severe Yin deficiency

2. Auscultation & Olfaction (闻, Wén)

Listening & Smelling

Voice: Loud → Excess. Weak → Deficiency.
Breathing: Wheezing → Phlegm. Short → Qi deficiency.
Odor: Strong/foul → Heat. Faint → Cold.

3. Inquiry (问, Wèn) — The Ten Questions

#	Area	Chinese	Key Clues
1	Chills & Fever	寒热	Aversion to cold → Exterior. Alternating → Shaoyang
2	Sweating	汗	Spontaneous → Qi deficiency. Night → Yin deficiency
3	Head & Body	头身	Pain location reveals meridian
4	Stool & Urine	二便	Heat/cold, dampness, Kidney function
5	Appetite	饮食	No appetite → Spleen deficiency
6	Chest/Abdomen	胸腹	Fullness, pain patterns
7	Ears/Eyes	耳目	Tinnitus → Kidney/Liver
8	Thirst	渴	Cold drinks → heat. Can't drink → dampness
9	Sleep	睡眠	Insomnia → Heart. Excess sleep → Spleen Yang deficiency
10	Women's Health	经带	Menstruation reveals Blood/Liver status

4. Palpation (切, Qiè) — Pulse Diagnosis

Pulse	Chinese	Quality	Indicates
Floating	浮脉	Surface	Exterior pattern
Deep	沉脉	Firm pressure	Interior pattern
Slow	迟脉	<4 beats/breath	Cold
Rapid	数脉	>5 beats/breath	Heat
Wiry	弦脉	Guitar string	Liver stagnation
Slippery	滑脉	Pearls	Phlegm, pregnancy
Thready	细脉	Thin	Yin/Blood deficiency

The Eight Principles · 八纲

Principle	Yin	Yang	Distinction
Interior vs Exterior	里	表	Where: organs vs skin
Cold vs Heat	寒	热	Thermal nature
Deficiency vs Excess	虚	实	Body lacks vs pathogen present
Yin vs Yang	阴	阳	Master principle

Common Patterns · 常见证型

Pattern	Chinese	Symptoms	Tongue	Pulse	Formula
Liver Qi Stagnation	肝气郁结	Irritability, sighing	Red sides	Wiry	Xiao Yao San
Spleen Qi Deficiency	脾气虚	Fatigue, loose stools	Pale, teeth marks	Weak	Si Jun Zi Tang
Kidney Yin Deficiency	肾阴虚	Night sweats, tinnitus	Red, no coat	Rapid	Liu Wei Di Huang Wan
Blood Deficiency	血虚	Pale face, dizziness	Pale, thin	Thready	Si Wu Tang
Phlegm-Dampness	痰湿	Overweight, brain fog	Greasy	Slippery	Er Chen Tang