Parallel Correlations of Chinese Medicine Diagnostics With Functional Blood Chemistry Analyses: Seven Patterns Compared

Abstract

This study demonstrates correlations between the diagnostics of Chinese medicine (CM) and evaluations of blood chemistry from a functional allopathic approach. From a conventional allopathic medicine perspective, blood chemistry analyses evaluate numbers that reflect a patient's current pathology. Serum analysis evaluations confirm pathologies such as diabetes, inflammation of the liver, kidney filtration capability, and more. From a Chinese medicine perspective, the same pathologies are termed Kidney yin ((肾 阴) and Spleen qi (脾气) deficiencies; Liver yin (肝 脏 阴), qi (气), or Blood (血) presentations; and Kidney qi (肾 气), yin (阴), or yang (阳) pathologies, respectively. (Capitalization of organs indicates Chinese medicine organ system rather than a literal organ designation.) However, if blood chemistry numbers are evaluated from a functional approach—which examines slightly narrowed or broadened ranges of numbers and relations therein—a future pathology prognosis might be made with regard to the course that metabolism (healthy or pathological) is taking in the body. This correlates with CM's ability to predict future pathology—such as qi, Blood, yin, yang, or essence (本质) imbalances—through 2 major diagnostic techniques: objective assessment of bilateral radial pulses and evaluation of the tongue. Confirmation of these correlations between functional allopathic and CM diagnostics are demonstrated by shared clinical signs and symptoms in 7-pattern comparisons. This article examines 1 pattern only.

Introduction

Blood chemistry analysis—including but not limited to the comprehensive metabolic panel, lipid profile, complete blood count (CBC) with differential, thyroid-stimulating hormone (TSH), and fasting glucose—is a valuable diagnostic tool for allopathic physicians and offers an initial profile of patient's chemical metabolism, which can direct toward further diagnostic options and treatments.¹

However, these same numbers when analyzed from a functional perspective, oftentimes produce a different diagnosis. Functional evaluations analyze numbers in either slightly narrowed and/or broadened ranges, and when appropriate, in relation to one another.² Evaluation from a functional perspective allows physicians to make a future pathology prognosis with regard to the course metabolism is taking in the body toward or away from disease, because “functional medicine acknowledges that chronic disease is almost always preceded by a lengthy period of declining function in 1 or more of the body's systems.”³

Literature reviews regarding objective evaluation of bilateral radial pulses and observation of the tongue from a Chinese medicine (CM) perspective demonstrate millennia of increasing sophistication in the accurate diagnosis of dysfunction and disease in a well-trained CM physician.^4,5,6

It is this study's intention to demonstrate in 1 pattern (although the initial study compared 7 patterns and it is the author's surmising there are more) that serum analysis from a functional perspective—and objective assessment of the bilateral radial pulses plus evaluation of the tongue— have parallel correlations, confirmed by shared clinical signs and symptoms as well as history.

It is not the scope of this study to defend efficacy of objective assessments of pulse and tongue as viable means of diagnosis. The closing discussion briefly clarifies 2 contemporary approaches regarding these diagnostic techniques. The reader is invited to contact the author for further discussion.

A simple illustration follows. The laboratory (pathological) range demonstrating possible hypoglycemia is diagnosed with a fasting glucose of <65 mg/dL. The number evaluated from a functional perspective emonstrates a fasting glucose of <85 mg/dL. The standard (pathological) interpretation implies that persons with a fasting glucose in the range of 66 to 84 mg/dL will not receive a possible diagnosis of hypoglycemia. However, repeated instances in 25 years of CM practice in this clinic demonstrate that a fasting glucose of <85 mg/dL and >65 mg/dL indeed correlates with clinical signs and symptoms of hypoglycemia including weakness, tremulousness, palpitations, confusion, anxiety.

The parallel correlation of diagnosis in CM reveals a pulse, which most likely will present as empty on the right middle (guan) or left distal (cun) pulse. The tongue color is slightly pale to normal, possibly red at the tip, swollen, and/or presenting teeth marks. The CM physician does not label this patient “hypoglycemic” but “Spleen and/or Heart qi deficient.”

Below is a basic blood chemistry panel comparing pathological and functional ranges (Table 1).⁷

Table 1.

Blood Chemistry Panels

Comprehensive Metabolic Panel
Marker	Functional Range	Pathological/Laboratory Range
Glucose	85 to 99 mg/dL	65 to 99 mg/dL
Iron	85 to 130 µg/dL	♀ 35 to 155 µg/dL ♂ 40 to 155 µg/dL
TIBC	250 to 350 µg/dL	250 to 390 µg/dL
Ferritin	♀ 10 to 122 ng/mL to cycling ♀ 10 to 263 ng/mL– menopause ♂ 33 to 236 ng/mL	♀ 13 to 50 ng/mL ♂ 30 to 400 ng/mL
SGOT (AST)	10 to 26 IU/L	0 to 40 IU/L
SGPT (ALT)	10 to 26 IU/L	0 to 40 IU/L
GGTP	10 to 26 IU/L	♀ 0 to 60 IU/L ♂ 0 to 65 IU/L
LDH	140 to 180 IU/L	♀ 0 to 214 IU/L ♂ 0 to 225 IU/L
Alk.Phos.	27 to 90 IU/L	25 to 150 IU/L
Total Bilirubin	0.1 to 1.2 mg/dL	0.0 to 1.2 mg/dL
Total Protein	6.9 to 7.4 g/dL	6.0 to 8.5 g/dL
Albumin	4.0 to 5.0 g/dL	3.5 to 5.5 g/dL
Globulin	2.4 to 2.8 g/dL	1.5 to 4.5 g/dL
A/G Ratio	1.5 to 2.0	1.1 to 2.5
Sodium	135 to 140 mmol/L	135 to 145 mmol/L
Potassium	4.0 to 4.5 mmol/L	3.5 to 5.2 mmol/L
Chloride	100 to 106 mmol/L	97 to 108 mmol/L
Carbon Dioxide	25 to 30 mmol/L	20 to 32 mmol/L
Anion Gap	7 to 12 mmol/L	5 to 13 mmol/L
BUN	13 to 18 mg/dL	♀ 6 to 20 mg/dL ♂ 6 to 24 mg/dL
Creatinine	♀ 0.65 to 0.90 mg/dL ♂ 0.85 to 1.10 mg/dL	♀ 0.57 to 1.00 mg/dL ♂ 0.76 to 1.27 mg/dL
Calcium	9.2 to 10.1 mg/dL	8.7 to 10.2 mg/dL
Magnesium	2.0 to 2.5 mg/dL	1.6 to 2.6 mg/dL
Phosphorus	3.5 to 4.0 mg/dL	2.5 to 4.5 mg/dL
Uric Acid	♀ 3.2 to 5.5 mg/dL ♂ 3.7 to 6.0 mg/dL	♀ 2.5 to 7.1 mg/dL ♂ 3.7 to 8.6 mg/dL

Lipid Panel
Marker	Functional Range	Pathological/Laboratory Range
Cholesterol	150 to 200 mg/dL	<200 mg/dL
Triglycerides	75 to 100 mg/dL	<150 mg/dL
LDL	<100 mg/dL	<100 mg/dL
HDL	>55 mg/dL	>40 mg/dL
Chol/HDL Ratio	<3.1	<3.7
CBC With Differential
Marker	Functional Range	Pathological/Laboratory Range
Hgb	♀ 13.5 to 14.5 g/dL ♂ 14 to 15 g/dL	♀ 11.5 to 15.0 g/dL ♂ 12.5 to 17 g/dL
Hct	♀ 37% to 44% ♂ 39% to 55%	♀ 34% to 44% ♂ 36% to 50%
RBC	♀ 3.9 to 4.5 x10E6/µL ♂ 4.4 to 4.9 x10E6/µL	♀ 3.8 to 5.10 x10E6/µL ♂ 4.1 to 5.60 x10E6/µL
MCV	85 to 92 fL	80 to 98 fL
MCH	27.7 to 32 pg	27 to 34 pg
MCHC	32 to 36 g/dL	32 to 36 g/dL
RDW	11.7% to 15.0%	11.7% to 15.0%
Platelets	140 to 415 x10E3/mL	140 to 415 x10E3/mL
WBC	5.0 to 8.0 x10E3/µL	4.5 to 10.5 x10E3/µL
Neutrophils	40% to 60%	40% to 74%
Lymphocytes	25% to 40%	14% to 46%
Monocytes	4% to 7%	4% to 13%
Eosinophils	<3%	<7%
Basophils	<3%	<3%
Tyroid Panel
Marker	Functional Range	Pathological/Laboratory Range
TSH	1.8 to 3.0 µIU/µL	0.45 to 4.5 µIU/µL
T4	6 to 12 µg/dL	4.5 to 12 µg/dL
T3 Uptake	28% to 38%	24% to 39%
T3	100 to 180 ng/dL	71 to 180 ng/dL
FTI	1.2 to 4.9	1.2 to 4.9

Note: Panels courtesy of Datis Kharrazian, Mastering Functional Blood Chemistry Manual.

Abbreviations: TIBC, total iron binding capacity; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGTP, gamma-glutamyl transpeptidase; LDH, lactate dehydrogenase; BUN, blood urea nitrogen; LDL, low-density lipoprotein; HDL, high-density lipoprotein; CBC, complete blood count; RBC, red blood cell; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; RDW, red cell distribution width; WBC, white blood cell; TSH, thyroid-stimulating hormone; FTI, free thyroxine index.

It is no exaggeration to suggest that blood chemistry analysis is to the allopathic physician what objective assessment of pulses and evaluation of the tongue are to the CM physician.

Physicians' understanding of the discriminating tools of diagnosis in both functional allopathic medicine and Chinese medicine enables us to understand one another's language and diagnostic strengths more clearly.

Goal of this Study

The goal of this study is to explore the possibility that the discipline of CM diagnostics parallels the diagnostics of interpreting blood chemistry from a functional approach.

This goal is sought with the following objective: to reveal that specific CM diagnostics, namely objective assessment of the bilateral radial pulses and evaluation of the tongue, compared with specific functional blood chemistry analyses for 7 separate patterns—coupled with clinical signs and symptoms and history (genetic and environmental)—arrive at similar, if not the same, diagnosis, although described with different nomenclature.

Methods

The method of demonstrating parallel correlations of Chinese medicine diagnostics with that of functional allopathic medicine diagnostics was initially accomplished by comparing 7 patterns of pathology commonly seen by physicians in both disciplines.

The diagnostic technique examined for allopathic medicine is analysis of blood chemistry from a functional approach. The diagnostic technique examined for CM is objective assessment of the bilateral radial pulses and evaluation of the tongue. The shared clinical signs and symptoms and history of each pattern complete a diagnostic workup and concurrently confirm the parallel correlations.

Each of the 7 patterns was examined in 3 parts:

1. Brief overview of the pattern's presentation from a CM and allopathic perspective.

2. Table of CM diagnostics; functional blood chemistry numbers; shared clinical signs and symptoms.

3. Narrative of the pattern being compared.

Results

Due to space limitations, the seventh pattern is the one that will be reviewed.

Overview of Pattern 7 Presentation From a CM and Allopathic Perspective

The individual who enters into their physician's office with chronic pain, congestion in the sinuses, distension/pain in the abdomen, swollen joints, plugged ears, burning in the rectum, lesions on the skin, cough, chronic and unabating anxiety, and other types of intractable symptoms obviously suffers from inflammation. Perhaps it is their first visit to a physician; it may be their umpteenth visit to multiple physicians.

Along with clinical signs and symptoms, the CM physician assesses bilateral radial pulses, evaluates the tongue, perhaps palpates, and takes history, which includes initial onset. Causation is an important factor for the CM physician, because treating the root (etiology) simultaneously and appropriately is just as important as treating the branch (symptoms). There is no idiopathic etiology in Chinese medicine.

The physician of functional allopathic medicine will assess initial complaint, take a review of systems, study a detailed history, and order a comprehensive metabolic panel, CBC with differential, homocysteine, and perhaps more. These blood chemistry panels point toward etiology, when read from a functional perspective. A treatment plan will then be proposed addressing both symptoms and etiology.

A conventional allopathic physician may miss chronic infection as a possible factor in persistent inflammatory patterns as evidenced by the following narrative. Only total white blood cell (WBC) with differential is presented in Table 4. These numbers are a basis for this pattern. As will be seen in the case study that follows, other numbers were also taken into consideration to arrive at this parallel comparison.

Table 4.

Pattern 7 Comparison Table

Chinese Medicine pattern: Wind-Damp; interior Wind; Fire; Damp/Phlegm; Heat; deficient interior Cold; Heat toxins

Functional allopathic pattern: Chronic subclinical inflammation

Chinese Medicine Diagnostics	Functional Blood Chemistry	Clinical Signs & Symptoms
PULSE depends on the location of the pathogenic factor congestion in the sinuses, plugged ears: slippery (huá) right cun or guan continual distension in the abdomen: empty (xū) right guan painful joints: wiry (xuán) and tight (jĭn) burning in the rectum: slippery (huá), rapid (shŭ) quality of pulse therefore depends upon type and location of pathogenic factor	WBC 5.0 to 8.0 x10E3/µL Neutrophils 40% to 60% Lymphocytes 25% to 40% Monocytes 4% to 7% Eosinophils <3%	SUBJECTIVE Depends upon location of pathogenic factor: Liver, Heart, Spleen, Lungs, Kidneys, Gallbladder, Small Intestine, Stomach, Large Intestine, Urinary Bladder, or Pericardium Triple Burner Nutritive level Blood level Yin level Shaoyang stage, Taiyin stage, Shaoyin stage (hot or cold), or Jueyin stage
TONGUE can appear totally denuded and void of any coat may have a thick or thin coat of white, yellow, black, grey can be swollen, withered, extremely red, pale, dusk areas of darkness dry, quite moist, or greasy	Basophils <3% IF NEEDED— PLEASE REFER TO PATHOLOGICAL RANGES IN TABLE 1.	OBJECTIVE depends on location of the pathogenic factor HISTORY inappropriately or incompletely expelled pathogens, occurring in any organ system especially the GI tract, heart, lungs, kidneys, urinary bladder, liver, brain, joints

Abbreviations: WBC, white blood cell; GI, gastrointestinal.

Narrative of Pattern 7

This narrative begins with 2 general premises: First, it is this author's line of reasoning that all infection is inflammation, though not all inflammation is infection. Second, there exists an immunological, neurological, and endocrinological axis,⁸ functionally and structurally. Given these premises, the physician must seek to reduce chronic inflammation without negatively affecting other organs or systems. In CM, this is known as preserving the upright qi, while at the same time expelling pathogenic factors in the appropriate manner and timing. It is a physician's duty to ascertain origin of inflammation (infectious or otherwise—long-term chronic inflammation can be multifaceted) and then proceed to expel the pathogen and tonify the upright qi.

Long-term chronic inflammation—or, as it is known in CM, latent pathogenic factors —may be treated with much success, contained, or perhaps never completely or adequately expelled. When treating infectious chronic inflammation, it is important to keep this maxim in mind: “CM states that if the upright qi is strong, one can drink the bowl of virus, drink the bowl of bacteria and never get sick.”⁹

Research continues to reveal incredible discoveries concerning the microbes populating the average human body—10 microbes to 1 human cell.¹⁰ Most of these microorganisms are symbiotic. So although physicians must not perseverate upon a chance that inflammation very well might be infectious, the possibility of unexplained inflammation may have an etiology of chronic subclinical infection. This is where functional blood chemistry analysis of a total WBC count with differential can provide insight.

A comparison is noted concerning functional and laboratory differences in total WBC counts (Table 5).

Table 5.

Total WBC Count

Functional Range	Laboratory Range
5.0 to 8.0 x10E3/ µL	4.5 to 10.5 x10E3/ µL

Abbreviation: WBC, white blood cell.

Although there is only a 0.5 x10E3/µL difference between the low end of the functional and pathological ranges, there is a far more significant 2.5 x10E3/µL difference in the higher range. From a functional perspective, low WBCs reflect chronic infection, and high WBCs reflect active infection. (Please remember that in the clinic these assessments are not independent of other labs and diagnostic criteria.) Thus, if a patient presents with an acute infectious state with a total WBC count of 8.9 x10E3/µL, the conventional allopathic physician will not recognize it as such. The functional physician, however, will recognize 8.9 x10E3/µL as a possible acute infectious response.

Of course, this singular reading of total WBC count must be analyzed in conjunction with the differentiation. For example, neutrophils can be out of functional range even though the total WBC count remains within the functional range. Decreased neutrophils (functionally) indicate possible chronic infection as the “slide” from acute infection (high total WBC) to chronic infection (low total WBC) takes time to occur. Another example using the differentials is described in Table 6.

Table 6.

Range Comparison for WBC Differential

	Functional Range	Laboratory Range
Neutrophils	40% to 60%	40% to 74%
Lymphocytes	25% to 40%	14% to 46%
Monocytes	4% to 7%	4% to 13%
Eosinophils	<3%	0% to 7%
Basophils	<3%	0% to 3%

Abbreviation: WBC, white blood cell.

There is a significant difference between most of the ranges compared previously. Even 1 WBC differential out of the functional range in a patient who presents with chronic inflammation (pain, swelling, redness, mental agitation, etc) demands further investigation. We must not continually suppress, for example, the enzymes cyclo-oxygenase 1 and 2 proinflammatory responses with nonsteroidal anti-inflammatory drugs when, in different biochemical pathways, the same basic enzymes, or slight derivations therein, are anti-inflammatory.

It is additionally important to remember in general that inflammation is a good occurrence, because it is the mechanism by which healing occurs. Chronic inflammation does not heal; it denudes tissue. The question for physicians who treat chronic pain and disease must be stated as follows: What specific interventions are needed to complete the healing cycle so that subclinical inflammation can be reverted, thus preventing more serious, irreversible, structural degeneration and increasingly entrenched disease?

A brief case study follows. Lucy (pseudonym) is presently a 66-year-old female who reported 8 years ago in early summer with issues of increasing mental agitation, and feelings of “doom and gloom.” Her bilateral radial pulses were empty (xū) overall but with a slippery (huá) quality on both right and left cun (distal) positions. The pulse rate was 80 beats per minute. Her tongue displayed dusk, thin coat, slight dry, and severe blood stagnation. Bowels, sleep, and appetite were “regular and normal.” Weight was normal. She had feeling of heaviness in her chest from time to time, as well as occasional head congestion, cough, and little to no color to the phlegm but yellow not uncommon in the morning. She regularly suffered from fall and spring allergies but “never takes anything for them.” Her case of vitiligo is long term and widespread. She has all her organs.

CM diagnosis of Lucy, as evidenced by her skin (vitiligo), seasonal allergies, pulse and tongue, and mental cogitation is that of a latent pathogenic factor manifesting as Phlegm Fire misting her Orifices, and a deficiency of qi and Blood accompanied by Blood Stagnation in her Upper Jiao (chest). This pathogenic factor (Heat and Phlegm) is in her Upper Jiao (chest) as evidenced by the slippery (huá) quality to both cun pulse positions. The deficiency of first Blood and (lung) qi is evidenced by her overall empty pulses, long-term vitiligo, and marked seasonal allergies. The Blood Stagnation also reflects in the venous congestion and distention of the lingual frenulum.

Pertinent to this case study, Lucy's blood work from 2008 revealed the following:

• TSH: 0.971 µIU/µL (functional range is 1.8 to 3.0 µIU/µL).

• WBC: 5.1 x10E3/ µL (functional range is 5.0 to 8.0 x10E3/ µL).

• Neutrophils: 82% (functional range is 40% to 60%).

• Lymphocytes: 15% (functional range is 25% to 40%).

The functional allopathic physician most certainly would have delved deeper into etiology for the severely aberrant neutrophil and lymphocyte counts and low TSH. For example, “hyperfunction” of thyroid or anterior pituitary hypofunction can be induced by chronic infection or inflammation. The aforementioned numbers, analyzed functionally, indicate a need for further testing regarding possible infection or other abnormalities.

Lucy also obtained a magnetic resonance image (MRI), which revealed a 13 mm × 11 mm × 11 mm sella and supra sellular lesion. It was deemed benign. She was prescribed Lexapro, a mild mood-altering drug. Lucy also used CM medicinal botanicals (Xue Fu Zhu Yu Wan) and acupuncture, (20Tx total, every other week after an initial series of 6 Txs 6 weeks in a row) using LU-5, LU-10, KI-10, SP-10, SP-9, GB-34, SP-6, ST-40, Sichencong, BL-2, LI-3, ST-45, and HT-8, unilaterally, with minor variations as demanded by her presentation that day and interspersed every 4 to 5 Tx with Huatojiaji, BL-43, BL-40, bilaterally, treating only front or back, at any given session. Lifestyle changes (better diet and regular exercise) were also implemented. In all, Lucy's mood improved immensely and 10 months later, she stopped using Lexapro. A few months later, Lucy also stopped the CM protocols, coming in only periodically for acupuncture treatment (2 to 4 mo apart) and/or medicinal herbs for allergy, cold, or flu. Lucy was back to her “old self.” A subclinical infection, as discerned by the author, was never appropriately followed through because Lucy “felt fine” and did not want to continue with further assessments and recommended CM treatments, nor did she follow through with any more lab work or repeat the MRI.

Approximately 7 years later, mental agitation and “doom and gloom” feelings descended again upon Lucy quite rapidly. Her pulses were amazingly similar, being empty (xū) overall but with a slippery (hua) quality on both right and left cun (distal) positions. Once again, the rate was 80 beats per minute. Her tongue again displayed dusk, thin coat, slight dry, and severe blood stagnation. Her 2014 blood work revealed the following:

• TSH: 1.030 µIU/µL (functional range is 1.8 to 3.0 µIU/µL).

• WBC: 6.5 x10E3/µL (functional range is 5.0 to 8.0 x10E3/µL).

• Neutrophils: 83% (functional range is 40% to 60%).

• Lymphocytes: 13% (functional range is 25% to 40%).

This time, the decline is more severe and Lucy is refusing all treatment, although her husband tries to give her pharmaceutical medicine disguised in food. She will not wash and sits all day doing nothing and says she has “no food or money.” She does not want to eat. Lucy spent 30 days in a psychiatric treatment facility.

During the time this author has known Lucy, she has eschewed allopathic medicine and had great curiosity of all things “alternative” in the world of health care. In these past 7 years, Lucy was involved with a person ostensibly performing diagnostics using a Voll machine and was using a myriad of homeopathic remedies. “Heavy metal toxicity” was being addressed. The operator said the remedies would improve her health and were deemed appropriate by the machine's assessment of “diagnosis” and “treatment.” Lucy also combed the Internet and bought neutraceuticals online, which she believed would help her with her vitiligo and allergies. Lucy used CM only when she had been sick for several weeks and the homeopathic or self-medications were not working. Then, CM would put her back to her “old self,” as she used to say.

Upon reflection and further study, this author realized that, yes, there had to be, in fact, heavy metal toxicity in Lucy's presentation. What was her history prior to her initial presentation? Lucy was an incredible artist of all manner: murals, interior design, cloth, lighting, etc. She could literally make a silk purse out of a pig's ear and used oil paint and aerosols liberally with little to no protection, except toward the end of her career at this author's insistence. It was too late. This author's professional opinion is that there was indeed heavy metal toxicity, exasperating an already congested Upper Jiao, and severe constraint of the Liver qi (lack of liver ability to vigorously deconjugate the heavy metals from her work). Her Liver pulse was empty due to the depletion of Liver qi and from years of chemical overload. The heavy metal overload could have reflected with aberrant WBC differentials. Had this author been able to bring Lucy back into the office, heavy metal testing (as a confirmation to the Voll machine) would surely be in order with appropriate therapies.

In part, this case study indicates to the author that if the functional allopathic physician and the CM physician had been able to collaborate together concerning initial blood work, with further laboratory findings (this author's education with functional blood chemistry analyses at the time was fledgling, alanine aminotransferase and aminotransferase levels not accounted for), perhaps Lucy might not be literally losing her mind today.

Discussion

True integrative medicine will take the best from diagnostics and treatments of time-honored disciplines to address patient population needs.

It is this author's belief that more pattern comparisons can be set forth. These patterns are most useful before extreme changes occur; that is to say, when dysfunction is present, covertly or overtly. (Are there not “norms” of function today that, 50 years ago, were not normal? [eg, knee replacements as early as the fourth and fifth decades]). In addition, to be noted, when dysfunctions are slight, some physicians refer to the patient's presentation as psychosomatic. Let the reader be reminded of the body/mind connection.

Chinese and allopathic medicine can and do work well together if given opportunity, with no contraindications.

Clarification of the Role of Pulse and Tongue in Diagnosis

There are 2 schools of thought about the manner in which CM physicians approach pulse and tongue diagnostics. One approach suggests that if clinical signs and symptoms corroborate with pulse and tongue, then the pulse and tongue confirm the clinical signs and symptoms. The other approach posits that the physician can identify type and location of pathology through the diagnostics of pulse and tongue without knowing specific clinical signs and symptoms. This second approach is similar to the Western physician's use of blood chemistry numbers to assess pathology to some degree without the patient in the office.

This study operates from the latter approach a CM physician can take—that of using assessment of bilateral radial pulses and evaluation of the tongue as a first determiner before clinical signs and symptoms and a detailed history are detailed. This author's conclusions on this subject have been drawn with the following in mind:

1. Pulse evaluation is useful in context.

2. Pulse evaluation is currently considered to be in a grey area because it is deemed by many as subjective, but yet it is classified as objective in SOAP notes.

3. Some will state that theoretically there is no reproducibility of pulse and tongue evaluation (nuance, richness, perspective and there are “many ways up the mountain”) (personal communication, Given S, April 2014).

4. “[I]nter-rater reliability” is of paramount importance (personal communication, Given S, April 2014).

Literature reviews over millennia document ample and long-standing standard presentation of the 28 basic pulse patterns with exhaustive and detailed explanations therein on at least a total of 12 specific superficial and deep levels on the bilateral radial arteries.¹¹ This is true for evaluation of the tongue as well, and the 2 diagnostic methods confirm each other's presentations. This collusion of pulse and tongue diagnostics points toward specific clinical signs and symptoms. If any one of the 4 major diagnostics (pulse, tongue, clinical signs and symptoms, or history) do not concur with the findings of the other 3, additional investigation is required. There is no idiopathic causality in CM.

It is this author's belief that, in most cases of functional or structural pathology, the type and location of pathology can be specifically determined with a well-trained physician of CM in evaluations of bilateral radial pulses and of the tongue. The patient's history, present signs and symptoms, and other palpations and observations will further lead the physician to a working diagnosis. This was the author's training and the premise upon which this study was conducted: the incredible astuteness of CM diagnostics.

It is not the scope of this article to provide training in analysis of blood chemistry from a functional viewpoint. This article purports to show to the CM and functional allopathic physicians that both can utilize functional diagnostic techniques and ultimately evaluate the same data. This alignment occurs with matching clinical signs and symptoms plus history. Differences are found in the specific diagnostic techniques, nomenclature, and treatment.

In the People's Republic of China, allopathic and Chinese medicine have been successfully integrated for decades, each upholding the best of the other's treatment modalities. To that end, all physicians must strive to have some understanding of the others' medicine to give patients more accurate and early diagnoses and a wider range of treatment options.

It is a duty and a pleasure to be able to offer choices, in a spirit of camaraderie and grace. Thank you.

Figure 1.

Pattern Seven

Table 2.

Equivalence of Diagnostic Techniques

Blood Chemistry Evaluation		Pulse and Tongue Evaluation
laboratory ranges… functional ranges…	are of equivalent value as	bilateral radial pulse assessment tongue evaluation

Table 3.

List of 7 Patterns To Be Compared

	Chinese Medicine Description	Western Description
Pattern 1	Qi and/or Blood deficient; Spleen qi deficienta	Early iron storage depletion; iron deficiency (nonanemia); iron-deficiency anemia
Pattern 2	Liver qi stagnation invading the Stomach and/or Lungs; Stomach qi rising	Heart burn pain—uncomplicated gastroesophageal reflux disease
Pattern 3	Liver qi stagnation with damp heat in the Liver and Gallbladder	Intrahepatic cholestasis; cholelithiasis; early chronic cholecystitis
Pattern 4	Impairment of Spleen function of transportation (blockage of Nutritive qi in the Middle Warmer); Phlegm and/or Blood stasis; Kidney deficient	Reactive hypoglycemia; insulin resistance; early metabolic syndrome
Pattern 5	Kidney and Heart not harmonized; Heart and Spleen deficient	Hypothalamus-pituitary-adrenal (HPA) axis dysfunction; adrenal stress syndrome
Pattern 6	Kidneys failing to receive qi; Lung and Spleen qi deficiency	Insufficient buffering system for acid/alkaline balance
Pattern 7	Wind-Damp; interior Wind; Fire; Damp/Phlegm; Heat; deficient interior Cold; Heat toxins	Chronic subclinical inflammation

^aCapitalization of organs indicates Chinese medicine organ system rather than a literal organ designation.

Biography

Paula Kristian, DAOM, is a doctor of acupuncture and Oriental medicine in Ocean City, Maryland.