1 4 IMBALANCES AND 5 ORGANS A New System for Diagnosis and Treatment DIFFERENTIAL QUESTIONS Jeremy Ross
2 DIFFERENTIAL QUESTIONS A New System for Diagnosis 90 Organ syndromes In Chinese medicine, it is necessary to able to distinguish between 90 different Organ syndromes. 4 Imbalances These Organ syndromes can be divided according to the 4 Imbalances to give some clarity organization to a large number of syndromes. 3 Differential questions The new system gives three differential questions for each one of these syndromes. This structured system makes differential diagnosis easier, faster, and more accurate. Every-day language The questions are phrased in every-day language that can make diagnosis engaging for both patient and practitioner.
3 SYNDROME ORGANIZATION In this system, the syndromes are organized in 4 levels: 4 Imbalances 4 Imbalance syndromes Organs Organ syndromes
4 4 IMBALANCES 4 IMBALANCES DEFICIENCY STAGNATION DISTURBANCE EXCESS tonify move calm drain
5 DEFICIENCY Do you feel tired or exhausted? Would you like me to put herbs in the combination to give you energy? Do you have an empty sensation in the head or body, esp. when you are tired? Are your symptoms worse with vigorous physical exertion, and better with rest or after food and drink? DISTURBANCE Do you have coughing, belching, hiccups, vomiting, or borborygmus? Does stress easily make you restless, nervous, Do you have a strong desire for peace and quiet? Are your symptoms better with peaceful surroundings and worse with emotional stress? 4 IMBALANCES Differential Questions Diagram STAGNATION Do you have sensations of local or generalized blockage or obstruction, maybe with ache or pain? Are your symptoms worse with emotional constraint such as depression, frustration, or sadness? Do you have a desire for movement, and are your symptoms better with vigorous physical exertion? EXCESS Do you have a sensation of too much energy, full or bursting sensation, maybe pain? Are your symptoms worse with adding something: pressure, heat, food, etc.? Are your symptoms better with removing something: energy, heat, food, stools, phlegm etc.?
6 4 IMBALANCE SYNDROMES 4 IMBALANCE SYNDROMES DEFICIENCY tonify Deficient Qi Deficient Yang Deficient Yin Deficient Fluids Deficient Blood Deficient Jing 4 IMBALANCE SYNDROMES DEFICIENCY tonify Stagnant Qi Stagnant Blood Stagnant Cold Stagnant Phlegm DISTURBANCE calm General EXCESS drain Excess Heat Excess Cold
7 DEFICIENCY SYNDROMES Deficient Qi 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS Do you feel tired or exhausted? Does your energy fluctuate from slightly low to definitely low? Do you feel more or less normal in temperature, or slightly cool? Do you prefer warm rooms, or do you dislike both hot and cold environments? Do you ever feel low mood due to lack of energy, and do you feel worse with vigorous exercise? Deficient Yang Do you feel exhausted or even sometimes near collapse of energy? Do you feel cold, do you have aversion to cold, and do you prefer warm or hot environments? Do you ever feel very apathetic and really lacking interest in life, due to lack of energy? Deficient Yin Do you feel tired or exhausted but restlessness, maybe even slight overactive? Do you feel too warm, esp. in afternoon or night, esp. hands, feet, and head, do you have a preference for cool environments and cool drinks, and are you often thirsty, esp. at night? Do you have restlessness, insomnia, and a desire for peace and rest?
8 DEFICIENCY SYNDROMES Deficient Fluids 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS Do you often have dry mouth, dry throat, and thirst? Do you have dry hair, dry skin, dry eyes, dry inside your nose? Have you had dehydration from excessive sweating, inadequate fluid intake, or diarrhea? Deficient Blood Do you have tiredness or exhaustion that is worse with blood loss or low-iron nutrition, and have you ever been anemic? Are you ever faint on standing up, and do you have headache + empty sensation, blurred vision, or floaters in visual field? Have you a history of scanty menstruation, amenorrhea, infertility, or insufficient lactation? Deficient Jing When you were a teenager, were you a bit slower than the others in gaining height, entering puberty, or a bit behind for your age in school? Do you have problems with weak bones and teeth? Do you think you have more problems with vision, hearing, or memory than you expect for your age?
9 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS, cont. STAGNATION SYNDROMES Stagnant Qi Is your discomfort with a sensation of obstruction or blockage, and is it better with vigorous exercise? Is your discomfort of variable rather than of fixed location, so that you can t tell me exactly where it is? Are your symptoms worse when you feel emotionally blocked, eg. you when you swallow your anger, or when you are sad, frustrated, or depressed? Stagnant Blood Is it pain or severe pain rather than discomfort, and is the pain better or worse with vigorous exercise? Is the pain of fixed and definite location, rather than pain of vague or changing location? Are your symptoms no worse when you feel emotionally blocked, and no better with vigorous exercise?
10 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS, cont. STAGNATION SYNDROMES Stagnant Cold Do you have distension, discomfort, or pain associated with sensations of cold and of obstruction? Is the discomfort better with warmth, massage, or exercise? Stagnant Phlegm Do you have a lot of phlegm in the nose or chest? Do you have sensations of heaviness and dullness in head or body or limbs? Do you have mental dullness or mental confusion?
11 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS, cont. DISTURBANCE SYNDROMES* General Do you have cough, palpitations, belching, hiccupping, nausea, vomiting, or borborygmus? Do you have restlessness or insomnia, and are your symptoms better with peaceful surroundings and worse with emotional stress Are you easily affected by stress, and often feel irritable, anxious, or fearful?
12 EXCESS SYNDROMES Excess Heat 4 IMBALANCE SYNDROMES - DIFFERENTIAL QUESTIONS, cont. Do you have heat sensations in your whole body that may be severe, with severe restlessness? Do you have sensations of fullness in the affected area? When you feel so hot, do you feel strong emotions such as anger or over-excitement? Excess Cold Is your pain with cold sensations and better with warmth? Did it start after exposure to very cold wind, or after a lot of very cold food and drink?
13 ORGANS 5 ORGANS HEART SPLEEN LUNG KIDNEY LIVER
14 5 ORGANS - DIFFERENTIAL QUESTIONS HEART Do you have arrhythmias, or palpitations? Do you ever have discomfort or pain in heart area? Do you get anxiety, panic, or insomnia related to these? SPLEEN Do you reduced appetite? Do you have digestive weakness or other digestive problems? Do you have chronically loose stool? LUNG Do you have weak voice or weak breathing with shortness of breath? Do you have cough, whether dry, nervous, phlegmy, or hacking? Have you had a recent loss, or are you, under the surface still affected by a previous past loss?
15 5 ORGANS - DIFFERENTIAL QUESTIONS KIDNEY Do you have weak bones or teeth, weak back or knees, urinary disorders, or deafness? Do you think that your sexual drive is excessive, or do you have premature ejaculation, impotence, or, alternatively, lack of sexual drive and interest? Do you suffer from fearfulness or frightening dreams; are your symptoms made worse by fear? LIVER Do you have brittle nails, and brittle and dry prematurely grey hair? Do you have recurring headaches or migraines? Do you think that you are a little more easily frustrated, irritable, or angry than others?
16 HEART SYNDROMES HEART SYNDROMES DEFICIENCY HT Deficient Qi HT Deficient Yang HT Deficient Yin HT Deficient Blood STAGNATION HT Stagnant Qi HT Stagnant Blood HT Stagnant Cold HT Stagnant Phlegm HEART SYNDROMES DISTURBANCE HT Spirit Disturbance HT Qi Irregularity Phlegm misting the mind HT Phlegm Heat EXCESS HT Excess Heat
17 SPLEEN SYNDROMES SPLEEN SYNDROMES DEFICIENCY SP Deficient Qi SP Deficient Qi + Deficient Blood SP Deficient Qi + Damp SP Qi sinking SP Qi not holding blood SP Deficient Yang ST Deficient Yin IN Dryness SPLEEN SYNDROMES STAGNATION SP, ST, IN Stagnant Qi SP Stagnant Qi +Damp ST Stagnant Blood SI Qi tied DISTURBANCE ST Rebellious Qi IN Qi Disturbance SPLEEN SYNDROMES EXCESS Retention of food in ST ST Excess Heat IN Excess Heat IN Damp Heat Cold invades SP
18 LUNG SYNDROMES LUNG SYNDROMES DEFICIENCY LU Deficient Qi LU Deficient Yang LU Deficient Yin LU Dryness STAGNATION LU Stagnant Qi HT Stagnant Blood HT Stagnant Cold HT Stagnant Phlegm LUNG SYNDROMES DISTURBANCE LU Rebellious Qi EXCESS LU invasion by Wind Cold LU invasion by Wind Heat LU Retained Pathogen LU HT Phlegm Heat LU Phlegm
19 KIDNEY SYNDROMES KIDNEY SYNDROMES DEFICIENCY KI Deficient Qi KI fails to receive Qi KI Qi not firm KI Deficient Yang KI Deficient Yang + Water overflowing KI Deficient Yin KI Deficient Jing KIDNEY SYNDROMES STAGNATION KI Stagnant Qi BL Stagnant Qi + Damp/Phlegm DISTURBANCE KI fear EXCESS KI Excess will BL Heat BL Damp Heat
20 LIVER SYNDROMES LIVER SYNDROMES DEFICIENCY LR Deficient Qi LR Deficient Blood LR Deficient Yin STAGNATION LR Stagnant Qi LR Stagnant Qi + Phlegm, Damp, Cold Cold Stagnation in LR channel LR Stagnant Blood LIVER SYNDROMES DISTURBANCE LR Hyperactive Yang LR Wind + LR Hyperactive Yang LR Wind + Deficient Blood EXCESS LR Excess Heat LR Damp Heat
21 DEFICIENCY SYNDROMES LR Deficient Qi LR AND GB SYNDROMES - DIFFERENTIAL QUESTIONS Do you have intolerance of fatty food, chocolate, alcohol, or medications, and do you feel more tired after taking these? Do you have lack of confidence, indecision and procrastination, or lack of self- assertion? Are these symptoms worse with increasing tiredness? LR Deficient Blood Have you ever had anemia, exhaustion, faintness on standing up, dull empty headache worse after blood loss, blurred vision, or floaters in visual field, tics, or tremors? Do you have thin brittle nails, thin dry hair, or prematurely greying of hair (women)? Have you ever had scanty menstruation with pale blood, amenorrhea, or infertility? LR Deficient Yin Are you tired or exhausted, but with restlessness, impatience, and irritability? Do these symptoms occur with heat sensations in palms or soles, or feverishness or sweating especially in afternoon or night? Do you get headaches that are associated with any of these symptoms?
22 STAGNATION SYNDROMES LR Stagnant Qi LR AND GB SYNDROMES - DIFFERENTIAL QUESTIONS Do you ever have distension or pain in your sides (hypochondrium), or do you have problems with your gallbladder? Do you have PMS with swollen breasts and irritability or depression, or do you have irregular menstruation? Are you easily frustrated, do you tend to suppress your anger, and do you ever have depression related to either of these; and are these symptoms better after vigorous physical exercise? LR Stagnant Qi + Damp and Phlegm Have you had weight gain or chronic catarrhal conditions with phlegm in nose or chest? Do you have a sensation of dullness, slowness and heaviness in body, mind, or emotions? Do you often feel frustrated or depressed and sluggish, and is this worse in damp climate or when you eat phlegm-forming foods?
23 LR AND GB SYNDROMES - DIFFERENTIAL QUESTIONS STAGNATION SYNDROMES Cold Stagnation in Liver channel Do you have pain and sensation of fullness and distension in lower abdomen: - especially over bladder? - referring to scrotum and testes, maybe with contraction of testes? - pain better with warmth? LR Stagnant Blood Do you have pain in a fixed location that may be severe, eg. - severe epigastric pain with vomiting blood? - dysmenorrhea with dark clots? - abdominal swellings or masses of fixed location?
24 LR AND GB SYNDROMES - DIFFERENTIAL QUESTIONS DISTURBANCE SYNDROMES LR Hyperactive Yang Do you have headaches in the area of temples or eyes? Are these headaches associated with stress, eyestrain, photophobia, hypersensitivity to noise, or dizziness? Do you tend to irritability, impatience, or anger, and are the headaches associated with any of these? LR Wind + LR Hyperactive Yang Have you had headache, dizziness, muscle tremors, or convulsions? Have you had sudden loss of consciousness, hemiplegia, deviation of eye and mouth, or restricted speech? Do you tend to have chronic irritability, suppressed anger, frustration, or depression? LR Wind + Deficient Blood Have you ever had anemia, exhaustion, faintness on standing up, blurred vision, or floaters in visual field? Have you ever had tics, limb tremors, repetitive head movements; worse with tiredness, or after blood loss? Have you ever had muscular weakness, or numb sensation in the limbs?
25 LR AND GB SYNDROMES - DIFFERENTIAL QUESTIONS EXCESS SYNDROMES drain LR Excess Heat Do you ever have severe throbbing headache with heat sensations, whole body hot, and whole face red? Do you have hypertension that may be severe, or redness, dryness, and pain of the eyes? Do you ever have severe restlessness, explosive anger, shouting, or maybe violence? LR-GB Damp Heat Do you have sensations of heat or heaviness in body, maybe with fullness and pain in the sides (hypochondrium), or gallbladder problems? Do you have dysuria with urine that is cloudy, scanty and dark, or with strong smell? Do you have red itchy rashes with fluid- filled blisters, esp. in genital area, or do you have yellow discharge?