Week 1

TCM Methodologies
One Disease, Different Treatments, Different Disease, Same Treatments
Basis of Pattern Discrimination
Pattern Discrimination is based on Signs and Symptoms
Thus Know Patterns (about 60-200 patterns)
Gather Signs and Symptoms through the 4 Examinations -
Questioning/Observing/Listening-Smelling/Palpitation
Know Statement of Fact (TCM Physiology) to Understand manifestation of Signs and Symptoms
to come to a conclusion on Patient Pattern
In the State of CA, it is legally required for TCM Doctors to ONLY use the 4 Examinations to come to the conclusions of Pattern Discrimination to form a treatment plan. It is illegal/immoral to use "modern" tools, technology to use as evidence for signs and symptoms.

A typical examination should be 20 minutes total.
The ultimate Doctor will be able to do pattern discrimination through only Observation
The efficient Doctor will ask Questions
The technical Doctor will Palpitate to confirm the pattern discrimination.

Thus, strive to become a Doctor through pattern discrimination based on Observation. From the Tongue, Age, Gender, Complexion, Gait, Body constitution, etc, 70-80% of the diagnosis.
Question to confirm the diagnosis.
Palipate to become 100%.

The Nei Jing says that the mediocre Doctor will know the Right hand, (needling hand). The Master Doctor will know the Left Hand (palpitating/point location hand)

Zhang Jie Bin - Doctor who made up the 10 Questions of Examination.
Use the hypothesis that comes from Observation to GUIDE the 10 questions to gather more complete details.
Use the Chief complaint to guide the 10 questions. CC is usually in modern disease or physical complaint. TCM LEGALLY requires us to ignore Modern Disease noclemanture.
Always know what the patients MEAN in terms of their experience.
"I have allergies" "What do you mean? Running nose, is it the eyes, skin? Reaction? Frequency?" "ohhh, I sneeze a lot, itchy eyes, and runny nose in Spring"
Boom, translate Modern medical terms down to Key Clinical Manifestations.
Therefore, it is illegal for TCM practioniers to use lab tests, imaging, x-rays, etc to come to conclusions about Pattern Diagnosis.

CC- Allergies
What is it? - Allergric Rhinitis - running nose, clear, watery discharge. sneezing
Pattern Discrimination - Wind Cold Invasion - Acute Stage
Treatment Principle - Resolve Exterior, Warm, Expel Wind.
Use Cang Zu Er/Xin Yi Hua (Resolves Ext/Warms/Expels Wind)

Translate ALL CC and signs and symptoms into the clinical manifestations, then use that to create the pattern discrimination basis.

TCM Disease = Sometimes same disease, sometimes not. Infertility = Inferitility, Back pain = back pain, Read up on Nigel Wiseman's Practical Dictionary.

Acupoints 1-3 = Points and Channels From CAM (Chinese Acupuncture Moxibustion) (first half of the book)
Acutech 4 = Techniques from CAM
Actech 5-6 = Last half of CAM - Treatment Principles

Questions shouldn't be "random". Only Ask with a Purpose. Confirm or Deny Patterns.
Questions can follow up from main questions.


Follow up questions should be location, quality, severity, frequency, triggers, palitive, provocative. Use follow up questions to triangulate signs/symptoms.

Questions should be targeted. Only ask questions about related targets. Become efficient. People want to show up, talk about a problem, and pay less, get the problem resolved, and let them go on fucking themselves up. Be effective, Resolve the problem first. Then the patients will come running back. Then do the rest of the "holistic" treatments.

TCM Hypothesis -
1 - Watch House MD. Use algorithmic thinking. Cause and effect.
2 -Watch Monk - Think OCD. Use Deductive Reasoning.
3 - Use Global Thinking. Think the least number of explanations to describe the manifestation. Try to draw an individual thread back to a common cause.

1 Acquire Info - 4 Exams
2 Evaluate - Triangulate/Cross Reference - Potential Patterns. Prioritize.
3 List hypothesis
4 Confirm or Deny Hypothesis - Clinical Reasoning

State Law requires retention of appropriate patient records for 7 years. Appropriate is to withstand the scrutiny of peer review. A record should be able to show another doctor of what the problem is, what the reasoning of behind the problem, and why the reasoning of the treatment.



Treatment Room-
Lighting
Location
Comfort
Appearance and mood
Use Reveal bulbs. No Flourescent lights.
Inquiry - get information from the patient directly
Everybody leaves during intake.

F
35
Tai Yin
Pale

Hypothesis
Ht-Sp Dual Xu
Damp
Lv Qi

CC- Insomnia
Algorimithic Thinking - Ht Blood/Yin Xu
Ht-Sp Dual Xu
Ht- Kd not joined
Lv Fire
Phlegm Fire
Food Stagnation
Retained Heat
Liv Blood Xu w/ Heat

Triangulate -
HT-Sp Dual Xu
Two types of Insomnia - Onset/Magnitudial (Replete/Vacuity)

Doctor's Efferent.
Patient, Compassionate, Confident, but in Control.
Be present in the moment all the time. "what does it mean?"
Don't space out.
Try not to burn out.
Schedule Availability
Mentally arouse the patients, in the beginning, open ended, in the end, confirm details with yes/no
Reframe things into TCM
Ammanesis - Patient version of disease history

1 Primary pattern - 1 Treatment Principles
2 2nd pattern - 2 2nd treatment principles
3 Treatment PLAN - Things to Do
4 Reassess