International Medicine The diagnostic process starts with
of Oriental Medicine UK Ltd
BSc (Hons) Acupuncture
Briefly Discuss the
traditional East Asian View of the body reflecting on its similarities and
differences with the Western Description
Student Number: 001007580
of Submission: 8th January 2018
Word Limit: 2000
Western Medicine has its roots
in Europe with texts dating back to 500 BC whilst Eastern Medicine has its
roots in Asia and is traditionally seen as dating back to -2000 BC, with
Medicine of some description probably being performed before these dates.
The two disciplines share both
differences and similarities, though the eastern approach is to look at the
body as a whole system as opposed to the western method of finding and treating
a specific issue within the body in isolation. The East adapt to their
environment and acclimatise to fit In with the natural cycles of the seasons,
taking note of the effects that each has on the system. The west looks to
change the environment to suit the needs of the patient.
In this essay I will cover the
basics of the diagnosis process to highlight the East Asian view of the body
compared to the Western view.
The differing diagnosis
Comparing the diagnostic
process of both Eastern and Western Medicine.
The diagnostic process starts
with the consultation between practitioner and patient, this is the same no
matter what discipline you practice. In western Medicine various models for
diagnostics have been suggested for clinical practice, Sackett describes four
main strategies (Sackett, et al., 1991)
Instant recognition of a disease
Undertake tests to check a hypothesis
Using a preformatted decision tree
Using questioning of patient’s history of the
problem. Questions should relate to ‘OLD CARTS’:
Onset, Location/radiation, Duration, Character, Aggravating
factors, Reliving factors, Timing and Severity (Baerheim,
A patient will present with a
symptom. The presentation will solely rely on the patient’s ability to
understand his symptoms, to read them correctly and to be able to verbalise
them efficiently to the consultant. The medical practitioner will then
ascertain which of the strategies listed above to use. Further tests and
diagnostics are run, other means of diagnosing involve blood tests, radiology,
ultrasound, nuclear scintigraphy, MRI or CT Scans and a medical diagnosis is
formed by elimination of hypothesise. The whole process is streamlined and
focused on the symptom that you presented with.
As an example, consider the
spleens role in Western medicine and the approach for diagnosing and treating a
The spleen is found under the
ribcage, ribs 9-12, in the upper left part of the abdomen, in the epigastric
region. It varies in size dependent on factors such as weight, height etc. It
averages about 10-12 cm and weighs around 200g. It works to protect the body as
part of the lymphatic system by clearing out red blood cells and other foreign
bodies from the blood helping to fight off infection (Yamini Durani, 2015). The
spleen is split into two compartments, the red pulp and the white pulp and is
surrounded by a fibrous coating.
Spleen has a superficial role in western medicine (Keown, 2014). States ‘the
spleen has little to do with digestion,’, this is despite it drawing its blood
from the same root as the digestive tract, growing out of the gastrointestinal
tract and it being the only organ not involved in digestion to drain into the
liver. The spleen carries out a number of important roles though. It Filters
and purifies blood as part of the immune system, it removes microbes and
recycles worn out or damaged red blood cells and it produces and stores
platelets and white blood cells that fight infections. Despite this, Western
Medicine believes the body can function without this organ, although your
immune system will be compromised.
infected or enlarged spleen can be palpated (a healthy spleen should not be
able to be palpated). Once the initial diagnosis of splenomegaly is made
(unhealthy spleen), further tests are carried out on the blood to ascertain the
seriousness. Treatment in the form of antibiotics will be given and the spleen
monitored (Thomas, 2017). In severe cases and case of trauma to the spleen, the
spleen can be removed.
The spleen and stomach are in
the Middle Jiao. The approach from eastern practitioners is very different to
their western counterparts – the eastern practitioner reads the body through,
well, practically everything! The complexion, the face, tongue, colour, smells,
sounds, mental state demeanour and through the pulses. Through this
multifaceted approach, the practitioner gets an overall view of how each organ
is working and the knock-on effects it has to the other organs in the body. In
a way, talking about a specific symptom contradicts the whole Chinese spirit of
diagnosis (Maciocia, 1989). To understand this
a little better, you must have a basic understanding of Yin and Yang, a world
inside a world, an eco-system living inside an ecosystem and the 5 elements.
The concept of Yin and Yang is
probably the most important to understand in Chinese medicine. The earliest
reference to it is in the I Ching (book of changes) in approx. 700bc. All medical diagnosis, pathology and
treatment can be boiled down to Yin and Yang. Each organ in Chinese medicine
lends itself to Yin or Yang. The Yang organs transform, digest and excrete
‘impure’ waste of food and drink. The Yin organs store the ‘pure’ essences.
There are four aspects to Yin and Yang (Maciocia,
The opposition of Yin and Yang
Opposing ends of a cycle. I.e. day and night…
The interdependence of Yin and Yang
Yin is not possible without Yang and vice versa
(i.e. day cannot happen without night nor night happen without day)
Mutual consumption of Yin and Yang
Think of a spirit level. Where the bubble is,
liquid is not and vice versa. Or consider that the dawn is the beginning of
Yang’s growth in Yin.
Inter-transformation of Yin and Yang
Yin and Yang transform into each other, day
into night, summer into winter etc.
To simplify the use of Yin and
Yang in medicine is to say everything can be boiled down to its Yin or Yang
property. So, the 4 major treatment plans are:
Tonify Yin (raise the Yin)
Tonify Yang (raise the Yang)
Eliminate excess Yin
Eliminate excess Yang
course, it’s not quite as simple as that. Each organ, as well as having a Yin
or Yang characteristic, also has a corresponding ‘element’.
we did in Western medicine we will look at the spleen (which in Chinese
medicine includes the Pancreas) and its Biao Li, the stomach (Yin Yang
pairing). The spleen is a Yin organ because it is an internal organ and its
function is to store the essences (although the spleen does also have a Yang
function). The Spleen shares a place on the viscera hierarchy with the stomach
(Yang), the 6th position, the central position as is the spleen and
stomachs element, the Earth (Vallee, 1990).
stomach and the spleen are both the main organs of digestion (in TCM). The
spleen is a Yin organ but also has a Yang aspect (because nothing is completely
Yin or Yang). It transforms and transports Gu QI (food Qi) which goes to make
blood, which is Yin in nature (and the structure of the organ itself) (Maciocia,
Spleen in Chinese medicine also takes on functions that it doesn’t have in western
medicine. These are:
Spleen is in charge of Ascending and Descending
Transportation of qi, fluids
and nourishment to the body is done through the spleen and stomach.
The Spleen Governs transformation and
is the spleens role in separating the usable from the unusable. Clear fluids go
to the lung to be distributed and the unclear goes down toward the intestines
to be further separated. Food and drink enter the system, the spleen extracts
the Gu Qi (food qi) and sends it to the lungs to combine with Dah Qi (Air Qi)
to form Zong Qi and onto the heart to form blood (Maciocia,
The Spleen Presides over blood ‘The spleen is in charge of holding the
blood together’ (Flaws, 1999). It is the spleen’s
job to keep the blood in the blood vessels. Therefore, if the spleen is healthy
then the blood will flow.
The spleen controls the muscles and the
four limbs As the
spleen extracts GU QI from the food that is ingested, the refined qi is
transported through the body to the muscles (Maciocia, 1989).
The Spleen opens into the mouth and
manifests in the lips The
state of the spleen is show in the lips. The colour and moisture of them will
give you part of the prognosis (Maciocia, 1989).
The Spleen houses thought The spleen houses the Yi, one of the 5
Shen. Yi is intention, ideas, thoughts and intellect. A person with a poor
digestive system usually has problems thinking clearly. Also, if a person
worries too much, this can lead to digestive issues (Maciocia, 1989).
the spleen is under-functioning or the stomach is over-functioning then the earth
element becomes imbalanced.
the spleen cannot absorb, transform and transport then the patient will exhibit
signs of vomiting, aversion to food and drink, frequent belching, loose stools,
diarrhoea, undigested food, fatigue and internal dampness which can cause
phlegm. If the stomach cannot descend the unclear to the small intestines there
will be signs of distension, vomiting and hiccupping. If the spleen cannot
raise the clear there will be signs of diarrhoea, stomach prolapse, uterus
prolapse or other prolapse. If the spleen is injured and cannot get qi to the
muscles the patient will have weak muscles and in worse case scenarios muscle
atrophy. If the spleen is unable to manifest in the mouth and lips the signs
will be chronic gum bleeding, sever dryness in the mouth, tooth aches, poor
appetite and no taste (Maciocia, 1989).
Diagnosing the Eastern way.
As well as having the symptoms
from the effected organ there is the myriad of other diagnostic tools that a
Chinese medical practitioner will use.
(Jing-Nuan, 1993) “I have
heard that to see the patients colour is to know his illness. It is called a
gift of vision. Taking the patients pulse is to know his disease. It is called
a gift of spirit. Questioning the patient about his disease is to know its
location. It is called a gift of technique”
Diagnosis in Chinese medicine
is complicated yet very telling. We can find out about the health and disease
of organs. There are several forms of information gathering. They involve the
face and its topography, colour, shine etc., the individual organs of the face
hold clues, like the ears, nose and mouth, and of course the pulses which can
inform us of not only which organs aren’t performing but also which elements.
The tongue is a very reliable
diagnostic tool, areas of the tongue relate to organs. There are 4 main aspects
to diagnosing a tongue: Body colour, Body shape, Coating, Moisture.
The pulse can give very
detailed information about the state of the organs, the state of yin and yang
and the state of qi. It can be palpated on the radial artery as per the
‘classic of difficulties’ or at the nine different arteries. 3 on the head, 3
on the hands, 3 on the legs. ‘Simple questions’ ch20
In looking at the diagnostic
process for both eastern medicine and western medicine it appears that both
disciplines aim for the same outcome, a healthier and disease-free patient. The
western approach is streamlined to find a specific issue within the body that
can be isolated and treated accordingly with medicines or even surgery. The
eastern approach is to look at the body as a whole system of working parts that
only function well in conjunction with all the other parts. To ascertain which
organs are overworking and which are underworking a full and thorough investigation
of the system as a whole is carried out, the premise of the treatment is then
based on boosting or sedating the element/organs that are causing
the instability helping the body’s system to return to its natural rhythm.