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All lessons   Module 3: Reading together   Lesson 2

Module 3   Lesson 2   Bian Zheng

From finding to pattern

How do you get from what you see and feel to a pattern and a principle?

After this lesson you work along a fixed ladder (red flags first, then describe, Eight Principles, location, substance and pathogenic factor, pattern and neighbours, test against the history, principle), you read the Eight Principles straight from tongue and pulse, you recognise the thinking errors that are made most often, and you work through a case rung by rung.

0 Red flags does this need a doctor first? in tongue, pulse and history 1 Describe what do you see and feel, in fixed words, before a name? 2 Eight Principles interior or exterior, hot or cold, full or empty? 3 Location which organ, which Burner? positions, areas, symptoms 4 Substance Qi, Blood, Yin, Yang; Dampness, Phlegm, Heat, Cold, stasis? 5 Pattern which pattern, and which neighbour looks like it? 6 Test does it explain everything the client tells you? 7 Principle verb plus object: tonify Spleen-Qi does it not fit the history? back to rung 2
Schematic. The order follows the textbooks: first the Eight Principles as the foundation, then the organ, the substances and the cause, and a pattern that explains all the findings. How the book arranges interrogation, pattern recognition and the methods of identification of patterns: ch. 24 pp. 339 to 342 and the introduction to Part 6, pp. 440 to 446.

Know by heart

  • The ladder. 0 red flags; 1 describe; 2 Eight Principles; 3 location; 4 substance and pathogenic factor; 5 pattern and neighbours; 6 test against the history; 7 principle; mnemonic: safe first, then words, then ever narrower.
  • Eight Principles from tongue and pulse. Exterior: pulse superficial, tongue still normal. Heat: Red, yellow coating, rapid. Cold: Pale, white wet coating, slow. Full: strong pulse, thick coating. Empty: weak or thin pulse, little coating; mnemonic: the pulse says where and how strong, the tongue how hot and what is missing.
  • Location. The positions of the pulse and the areas of the tongue are two maps. If they agree with the symptoms, the location carries weight; otherwise the symptoms decide.
  • Substance and pathogenic factor. Pale, Thin and somewhat dry: Blood. Red without coating: Yin. Pale, wet and Swollen: Yang. Sticky coating: Dampness or Phlegm. Purple: stasis. A pulse like a string with a normal tongue: stuck Qi.
  • Neighbours. Every pattern has a neighbour that looks like "the same plus something". That something is the finding that decides: cold turns Qi deficiency into Yang deficiency, Heat turns stagnation into stagnation with Heat, and further on into Fire.
  • Five thinking errors. Closing too early; seeking only what fits; bending the pulse to the pattern; reading one feature as a pattern; using the tongue as proof for a pattern you based on the tongue; mnemonic: close, seek, bend, one, circle.
  • Test. The pattern must explain everything. What it does not explain is a second layer, a red flag or a measurement error; never something to leave out.

The rest of this lesson is reference.

Three practice questions from this lesson

Which rung always comes before describing tongue and pulse?
  1. The red flags
  2. The Eight Principles
  3. The principle

Answer: The red flags. Rung 0: does this need a doctor first? A flag does not rule out TCM, but it comes first.

Why do you first describe in fixed words, and only then give a name?
  1. So that a colleague can check what you felt
  2. Because in TCM names only come after the principle
  3. Because the book prescribes it, with no further reason

Answer: So that a colleague can check what you felt. Features can be checked and compared; a name you choose straight away colours everything that follows, and then you bend the pulse to the pattern.

Case. Man of 26, since yesterday a sore throat, fever more than shivering, thirst. Tongue Pale-Red with a redder tip and a thin white coating. Pulse superficial and rapid. Which Eight Principles?
  1. Exterior, Heat, full
  2. Interior, Heat, empty
  3. Exterior, Cold, full

Answer: Exterior, Heat, full. Acute, superficial and rapid, with fever and a sore throat: Wind-Heat. At the start the tongue is still almost normal.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 16 case-based practice questions, 18 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 3: Reading together.

Try two lessons freeSee Tongue and Pulse