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辨证
Pattern differentiation is how Chinese medicine describes a body instead of naming a disease. A pattern is an account of how one particular person is behaving now — what they feel, when it worsens, what their tongue looks like, how they sleep. Two people with the same complaint often carry different patterns, which is why they are written different readings.
The five
What a pattern is
Western medicine mostly works from the illness inward: find the thing that is wrong, name it, act on the name. Chinese medicine works from the person outward. It gathers what a body is doing — warm or cold, dry or damp, quick or slow, better for rest or worse for it — and sorts that into a pattern, written 证 zhèng. The pattern is the unit everything else hangs on: the food, the points, the hour you go to bed.
The method has a name and a birthday. Zhang Zhongjing’s 伤寒论 Shanghan Lun, compiled around 200 CE and preserved in 398 numbered clauses, is the book that turned this into a discipline. Its clauses are not organised by illness. They are organised by presentation: this set of signs together, in this order, with this pulse, is one situation; the same complaint with a different set of signs is a different situation and is handled differently. Eighteen centuries later that is still how a Chinese physician is taught to think.
It is why two people who arrive in the same week saying the same sentence — I am exhausted — leave with two different readings. One is empty and warms up slowly; rest genuinely helps and exertion genuinely does not. The other is dry and lit from inside; rest does very little, evenings are worse than mornings, and the tongue is red rather than pale. In our vocabulary those are qi deficiency and yin deficiency. The same advice given to both would be right for one of them.
Observe the pulse and the signs, know where the error lies, and follow the presentation in what you do.
The five entries below are the patterns our physicians name most often in the readings they write for readers overseas. They are not the only ones — a standard Chinese textbook works with several dozen, and the older literature with more. They are the five that account for most of what people write to us about, and they are the five most legible from thirty questions and one photograph.
Read them as descriptions, not as boxes. Almost nobody is one pattern cleanly. The interesting question in a reading is rarely which one but which is underneath: what has settled on top of what, and which of the two is worth the next three months of attention.
Side by side
The fastest way to see how the patterns are told apart is to read them across rather than down. Every row links to the full entry.
| Pattern | How it tends to show up | The tongue | What tends to ease it |
|---|---|---|---|
| Qi deficiency | Worse after exertion, better after rest. Soft voice, easy sweating, frequent colds. | Pale, swollen, tooth-marked, thin white coat | Warm cooked food at set times, earlier nights, walking rather than sprinting |
| Blood deficiency | Dizzy on standing, dry eyes, pale lips, numb fingertips, waking at three. | Pale, thin, dry, often small | Building foods, dark and unbroken sleep, resting the eyes |
| Yin deficiency | Heat late in the day, night sweats, dry mouth, restless sleep from three or four. | Red, small, dry, cracked, little or no coating | Sleeping before eleven, moistening foods, less alcohol and less chilli |
| Yang deficiency | Cold hands and feet in a warm room, cold aching back, loose stools before dawn. | Pale, swollen, wet, thick white coating | Applied warmth, ginger and cinnamon, cooked breakfasts, morning light |
| Dampness | Heavy head and limbs, foggy thinking, sticky mouth without thirst, worse before rain. | Swollen, with a thick greasy coating that returns each morning | Moving until warm, plain cooked food, earlier dinners, job’s tears and poria |
How a pattern is arrived at
The tradition names four ways of gathering information: 望闻问切 — looking, listening and smelling, asking, and feeling the pulse. They are set out in the 难经 Nanjing, the Classic of Difficult Issues, around the first century CE, and every Chinese medical education since has been built on them.
Two of the four cross a distance intact. Asking is the largest of them, and it is what the thirty questions are: the same ground a physician covers out loud in a consulting room, written down. Looking survives as one photograph of the tongue, taken in daylight, which is the only internal surface a person can photograph for themselves.
Two do not cross. We cannot hear a voice or smell a room, and we cannot feel a pulse — which in this tradition is a rich, slow, three-position examination that takes a year of supervised practice to learn and cannot be done through a screen. A reading is written from two of the four, and it says so on its first page. Anyone offering you all four at a distance is describing something they did not do. How a reading is made
Questions
A pattern (证 zhèng) is a summary of how one body is behaving at one time: what a person feels, when it is worse, what their tongue and sleep and appetite look like, gathered into a single description. It is a description of a state, not the name of an illness, and it can change within a season.
Usually, yes. In forty years of clinic notes a single clean pattern is the exception. Dampness sits on top of qi deficiency; yin deficiency and blood deficiency travel together. A reading normally names one pattern as the ground and one or two others as what has settled on it, then says which to work on first.
No. It belongs to one tradition’s vocabulary and no clinician outside that tradition will recognise it. It is not the name of a disease, it identifies nothing anatomical, and it should never be used to explain away a symptom that has not been looked at by someone licensed where you live.
The comparison table on this page gets most people close, and reading the five entries gets them closer. The honest limit is that patterns overlap, and the deciding details are the ones you cannot easily judge about yourself. That is the whole reason a reading asks thirty questions and one photograph of the tongue.
The reading
These five pages are written for everyone, which means they are written for nobody in particular. A reading is the opposite: thirty questions, one photograph of your tongue, and a document written in English for you alone by a physician licensed in China, sent within 48 hours.