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Diagnosis | A Brief History

Diagnosistic methods in Chinese medicine can be traced to Li Ji (Book of Rites), written 3000 years ago, in which the nature of disease and prognosis were identified and predicted according to five elements and pulse diagnosis, recorded in the story of Bian Que, a renowned physician listed in Shi Ji (Book of History).

However it was the completion of Huang Di Nei Jing (Huangdi Classic of Medicine (475 - 221 BC)) that is considered to mark the formal establishment of the Chinese medical system. It was this book that gave Chinese medicine a record of diagnostic methods and their theoretical foundation, with methods and principles.

Shang Han Za Bing Lun, nowadays known as Shang Han Lun (The Discussion of Cold-Induced Diseases) and Jin Gui Yao Lue (Essentials from the Golden Cabinet) written by Zhang Zhongjing during the Eastern Han dynasty (2nd - 3rd Century) is generally acknowledged as a monograph on the key principle of treatment based on differentiation of syndromes. Zhang constructed a theory of six conformations as the series of differential principles for diease caused by exogenous pathogenic factors. Thereby developing a complex and profound system to understand the body's functional reaction. The functional medicine is the cornerstone of my medicine.

The next real development in diagnositic theory, took place some thousand years later in the Jin-Yuan Dynasties. This renaissance in Chinese medicine, alongside the development of Imperial Colleges and printing led to four new schools of practice and four great masters: Li Gao (aka Li Dong-Yuan), Liu He-jian (aka Liu Wan-su), Zhang Cong-zheng (aka Zhang Zi-he) and Zhu Zhen-heng (aka Zhu Dan-zi).

This renaissance in Chinese medicine was the result of a number of different factors, a cleansing and rationalisation of acupuncture theory by the Dou Han Qing, the Song Dynasty physician. Which ran concurrent to the philosophical developments in Confucianism regarding freewill and led to the rise of organ theory (zangfu) and the pivotal focus on the Spleen and Stomach as the root to all postnatal change.

Although separated into four schools, three were ultimately a development of one another; Liu Wan-su focus emphasised heat evils in disease, Li Dong-yuan refined the role of aetiology in this and Zhu Dan-xi further focused on nourish the root. Therefore although all were many concerned with treatment using herbs, it is their development of a diagnostic theory, which moved disease from being an externally contracted phenomemon to an internally developed pathology for which they are particularly remembered. In particular, it was Li Dong-yuan who emphasised the main cause of chronic enduring disease as internally generated. Thus elevated the Spleen and Stomach (in Pi Wei Lun (Treatise on the Spleen and Stomach)) to the pre-eminence, which they now occupy in zang fu theory as the root and conduit for all post-natal supplementation.

Physicians throughout the ages have constantly renewed the traditional diagnositc methods and ways of differentiation of syndromes dependent upon circumstances. The next development of diagnositic note was the Wen Bing Xue (School of Febrile Diseases). This praxis again was generated through the use of Chinese herbal medicine (as the only treatment) and lead to the development of the four level theory: qi, ying, blood, organ. A paradigm thought more suitable to map the development of highly infectious diseases in particular Small Pox. Which became epidemic as China moved away from an agregrian society, as the cities in the south of China developed rapidly in the Qin Dynasty. In acupuncture this theory is less commonly used because of its focus on febrile diseases, however it is occasionally used to understand the entry of diseases like meningitis into the body.

In recent years, the research and application of traditional Chinese medicine has moved closer to the Western medical paradigm. This has been mainly as a consequence of the Cultural Revelution, which has seen Chinese medicine as one of the treasures of the nation and has therefore tried to modernise it in way to seen more appropriate for the modern era.