Diagnosis: Safety

Safety comes before the pattern

A well-built pattern does not authorise treatment. Facing a red flag you refer, however impeccable the TCM reasoning is, and you refer before treating, not after.

Radiating chest pain

urgent referral

Sudden one-sided weakness

urgent referral

Unexplained weight loss

medical assessment

Common mistake: Treating anyway «because the pattern fitted so well».

You have the pattern clear and the patient mentions chest pain going down the left arm. What do you do?

1. Treat the pattern and book a review
2. Treat gently and tell them to keep an eye on it
3. Stop and refer for assessment

The signs that change the plan, not the pattern

Some findings are not interpreted: they are referred. They do not compete with the diagnosis or qualify it; they suspend it. Knowing them by heart is part of the job, like locating a point.

Sudden headache, the worst ever felt

emergency

Unexplained weight loss

medical assessment

Bleeding that will not stop

emergency

Persistent high fever

medical assessment

Common mistake: Noting the sign, treating anyway, and deciding to refer if it is still there next session.

Sort each situation by what has to be done.

• Sudden weakness on one side of the bodyRefer urgentlyRecommend medical assessmentSafe to treat and continue
• Lost eight kilos in three months without dietingRefer urgentlyRecommend medical assessmentSafe to treat and continue
• Mechanical low back pain that eases with movementRefer urgentlyRecommend medical assessmentSafe to treat and continue
• Abrupt, extremely severe headache, unlike their usualRefer urgentlyRecommend medical assessmentSafe to treat and continue
• A new lump that keeps growingRefer urgentlyRecommend medical assessmentSafe to treat and continue
• Months of work-related insomniaRefer urgentlyRecommend medical assessmentSafe to treat and continue

Fatigue and poor appetite fitting Spleen deficiency perfectly, but they have lost ten kilos in four months without trying. What do you do?

1. Treat the Spleen deficiency, which explains all three symptoms
2. Recommend a medical assessment before going further
3. Treat and weigh them weekly to monitor

Order the response to a red flag.

1. Stop what you were doing↑↓
2. Confirm the finding with two or three specific questions↑↓
3. Explain to the patient why it needs assessing↑↓
4. Say where to go and how urgently↑↓
5. Record the finding and the referral in writing↑↓

The patient says they are going to stop their medication because the sessions make them feel better. What do you say?

1. That it sounds fine if they feel better
2. That they should taper it down on their own
3. That any change is for whoever prescribed it, and they can raise it there

Match each finding with the corresponding action.

During the session the patient turns pale, breaks into a cold sweat and says they feel faint. What comes first?

1. Remove the needles and lay them down with legs raised
2. Finish the session quickly and then attend to them
3. Ask them to breathe deeply without touching anything

Sort each situation: does it require special precautions, or is it routine practice?

• A pregnant patientSpecial precautionsRoutine practice
• A patient with shoulder pain and good general healthSpecial precautionsRoutine practice
• A patient on anticoagulant treatmentSpecial precautionsRoutine practice
• A patient coming for stress and poor sleepSpecial precautionsRoutine practice
• A patient who has not eaten all daySpecial precautionsRoutine practice
• A patient who has had uneventful sessions beforeSpecial precautionsRoutine practice

A young child with high fever, markedly listless and with a stiff neck. How is it classified?

1. External heat attack: release the surface
2. Red flag: urgent referral
3. Interior heat pattern: drain it

The patient asks you whether their blood test is fine and what an abnormal value means. What do you do?

1. Interpret it, since you trained to read lab results
2. Tell them it means nothing important
3. Explain that the interpretation belongs to whoever ordered it, and encourage them to ask there

You have referred a patient for a red flag and they insist on being treated today anyway. What do you do?

1. Do not treat until they have been assessed, and explain why clearly
2. Treat with gentle points only so they do not leave empty-handed
3. Treat if they sign that they accept the risk

Match each action with whether it falls within scope.

Why do you record a red flag and the referral you advised in writing?

1. In case the patient returns and does not remember the conversation
2. Because it evidences what was seen, what was advised and when, and that protects both sides
3. Because the clinic software asks for it