Traditional Pattern Differentiation in TCM

What pattern differentiation is

In traditional Chinese medicine (TCM), a practitioner often chooses treatment by "pattern" (in Chinese, zheng, sometimes translated "syndrome") rather than only by the name of a disease. One overview explains that in TCM the manifestation and differentiation of syndromes, rather than diseases, are essential to selecting the intervention. [1] The same overview describes syndromes as the signs of disturbances of visceral function and "yin yang" balance, and notes that they can be detected in tongue and pulse diagnosis. [1]

Treating people by individual pattern is described in acupuncture research as an important feature of acupuncture rooted in TCM. [2] Two people with the same medical diagnosis may therefore be given different patterns, and so different herbs or treatment points. A third person with a different diagnosis might be given the same pattern.

This is a traditional framework, described in its own terms. It is not a medical diagnosis, and the pattern names are not measurements of anything a laboratory can read. For the ideas behind the terms, see Qi, Yin and Yang, Five Phases and Meridians as Traditional Concepts.

How a pattern is reached

A practitioner gathers information by looking, listening and smelling, asking and touching, then fits it to one or more patterns. The steps are on The Four Examinations. Patterns can be sorted several ways in the tradition, for example by the broad pairs of cold and heat or deficiency and excess (see Eight Principles Pattern Analysis), or by the organ systems described in Zang-Fu. Common named examples are explained in Common TCM Patterns Explained.

Where patterns sit next to medical diagnoses

The World Health Organization's ICD-11 includes a supplementary chapter, "Traditional medicine conditions", for optional dual coding. WHO states that coding should always include a category from the main chapters as well. [3] In plain terms, the pattern chapter is meant to sit beside a standard diagnosis, not replace it.

How consistent is it? What the studies found

Several studies asked whether different practitioners reach the same pattern for the same person.

Evidence label: mixed to limited. These were small studies of mostly acupuncturists, so they do not describe every practitioner or every style. Together they suggest that two trained practitioners may reach different patterns from the same information. A review of the field reached a similar overall picture, finding that studies of pattern diagnosis in general had not found a high level of reliability. [7]

Researchers are trying to improve this. One 2022 paper describes a statistical method that builds score-based rules for patterns, and says that without standardized rules agreement among practitioners is unsatisfactory. [8] These methods are still being developed.

Does pattern-based treatment give better outcomes than treatment without it? Proper evidence not found in the sources we read. We looked at the reliability literature above and did not find a source comparing the two.

What this means for you

• A pattern label is a practitioner's judgement within a framework, not a test result.
• Two practitioners may describe different patterns for you. That alone does not show that either is wrong or right.
• Ask any practitioner what medical diagnosis they are working from and what they expect to change, so you and your doctor can follow progress.
• We do not provide checklists for working out your own pattern. See Online TCM Quizzes and Self-Diagnosis for why.

Who should seek conventional care first

New, severe, persistent or worsening symptoms need medical assessment before any traditional approach. NCCIH advises not using TCM to replace or delay conventional care, and telling all your providers about it. [9] For what a visit involves, see TCM Consultation. For how to check a practitioner, see TCM Qualifications, Licensing and Medical Care.