Diagnosis: Differential

Look for what separates, not what they share

Two similar patterns share almost everything. Listing what is common decides nothing: you have to find the finding that appears in one and is missing from the other, and check whether it is there.

Insomnia and palpitations

shared: decides nothing

Red tongue without coating

Yin deficiency only

Pallor and dizziness

Blood deficiency only

Common mistake: Picking the pattern that explains the most symptoms rather than the one that explains the separating ones.

Build the full diagnosis for the insomnia case with night flushes.

Insomnia and palpitations in both. Which finding tips it towards Heart Yin deficiency?

1. Palpitations worsening on lying down
2. Pre-dawn flushes with a tongue lacking coating
3. That it has lasted four months

Order the steps of a differential.

1. Gather every finding, discarding none↑↓
2. Propose the two or three compatible patterns↑↓
3. Identify the sign present in one and absent in another↑↓
4. Check whether that sign is there↑↓
5. Write the full diagnosis↑↓

Fatigue, weak voice and loose stools in both. What separates qi deficiency from yang deficiency?

1. How long the picture has lasted
2. How severe the fatigue is
3. The presence of clear cold signs

Insomnia, palpitations and dizziness in both. What tips it toward blood deficiency rather than yin deficiency?

1. That it is worse at night
2. Pale lips and nails, with no heat signs at all
3. That it has lasted over a year

Sort each finding: shared by both patterns, or does it separate them?

• InsomniaShared: decides nothingSeparating: decides
• Red tongue with no coatingShared: decides nothingSeparating: decides
• PalpitationsShared: decides nothingSeparating: decides
• Flushes at a fixed hourShared: decides nothingSeparating: decides
• FatigueShared: decides nothingSeparating: decides
• Pale lips and nailsShared: decides nothingSeparating: decides

Heaviness, bloating and loose stools. What distinguishes Spleen qi deficiency from established damp?

1. The coating: thin in deficiency, thick and greasy in damp
2. The presence of fatigue
3. That the stools are loose

Match each pair of patterns with the sign that decides it.

Fatigue, loose stools, pale toothmarked tongue and a weak pulse. Build the diagnosis.

The findings fit two patterns well and there is no contradiction between them. What do you do?

1. Pick the more serious one and treat only that
2. Write both and decide which to start with
3. Keep questioning until only one is left

Sort each element into the root and the branch of the picture.

• Years of Spleen qi deficiencyRoot (Ben)Branch (Biao)
• Bloating that started this weekRoot (Ben)Branch (Biao)
• Spent Kidney reserveRoot (Ben)Branch (Biao)
• Acute back pain since yesterdayRoot (Ben)Branch (Biao)
• Underlying blood deficiencyRoot (Ben)Branch (Biao)
• Insomnia that began three nights agoRoot (Ben)Branch (Biao)

Three sessions with the correct treatment for the chosen pattern and no improvement. What do you consider first?

1. Increase the intensity of the treatment
2. Add more points from the same pattern
3. Revisit the diagnosis: the pattern holding it up may be missing

Which of these diagnoses is complete enough to choose a treatment?

1. Kidney yin deficiency
2. A Kidney problem
3. General energetic imbalance

Match each pattern with its most characteristic sign.