Differential Diagnosis in Chinese / Asian Medicine:
As acupuncturists / herbalists, we sometimes hear people say things like, “I’ve heard this particular herb helps [some condition]. Should I take it?” and so starts a conversation about how Chinese medicine works.
One thing to consider is that Chinese Medicine doesn’t tend to use herbs singularly. They’re often combined with other herbs to create custom formulas based on the individual presentation of the patient. These formulas may be modifications of base formulas and there are many, many options here. It’s sort of like being a cook in the kitchen deciding whether your chicken preparation will be based predominantly by flavors in a curry, a basil-cream, lemon-tarragon, or whatever sauce. The options are endless.
There are advantages of using multiple herbs over singular herbs. An herb in a formula may be considered a primary herb in the formula and be called its Chief. We might use herbs that reduce or increase the effects of other herbs making them stronger or weaker in the formula, depending on what we’re looking to achieve. We may have Deputy, Assistant – Envoy herbs depending on the function of a particular herb, or group of herbs, in the formula.
A formula that works wonders for one patient may not be effective for another patient with the same condition.
This is because in Chinese medicine, we look at varying patterns present in a person, ascertain Chinese medical diagnoses that represent those patterns, and recommend herbs, acupuncture, or other modalities/procedures based on those working (and changing) diagnoses.
Let’s consider an example. A patient comes in with a request for herbs and acupuncture to help resolve previously diagnosed eczema. The practitioner will take a look at the patient’s primary concern and consider common Chinese diagnoses that those with eczema may have, ask broad questions to consider other patterns of disharmony, come up with a working Chinese medical diagnosis or diagnoses, and make treatment recommendations based on the diagnoses. Please note that diagnoses change over time as do individual practitioner approaches to treatment.
It’s not uncommon for a patient to seek treatment for one particular health concern, but have other health issues. For example, someone’s little toe is bothering them every time they walk and so they may be looking for support in this one area. An herbalist building a custom formula will take into consideration whether that person has ample digestive strength to tolerate an herb formula, if they sleep poorly, are in a high stress environment, etc. Herbs will be added or removed from base formulas to accommodate the individual presentation of the person seeking remedy.
We choose treatments based on the constellation of multiple patterns of disharmony present and we change the formula as that constellation changes.
So here’s the thing: this is also true for acupuncture. The practice of acupuncture includes individual or combinations of points. There are countless approaches to point selection. The practitioner may select points based on their unique studies under specific teachers who may have their own stylistic approaches.
The medicine is old, but it’s not stagnant and evolves over time. The options are also endless.
I’m always saying to people that when choosing an acupuncturist, ask them questions about how they approach treatment, what kinds of studies they undertake (we keep studying long after school), and look to see if you resonate with the conversation and approach. Be open to new ideas but understand that if one practitioner doesn’t “fit” with you, there’s many more in practice who may have a style that feels better to you.