Patterns, symptoms and what you can look up

Chinese medicine prescribes against patterns rather than complaints. The practitioner works out which pattern a patient’s findings fit, and the points follow from the pattern; the complaint is what brought the patient in. An index of acupuncture prescriptions therefore holds many terms that are not complaints, and a search goes better for knowing which they are.

Two different kinds of term

A symptom is what the patient reports: a headache, loose stools, ringing in the ears. A pattern is what the practitioner concludes: damp-heat in the lower burner, Liver qi stagnation, Spleen qi deficiency. The pattern is a compressed description of how a set of findings hang together, and it is the thing a classical prescription is written against. The WHO’s 2007 standard terminology for traditional medicine in the Western Pacific draws the same line: it defines a symptom as an indication perceptible to the patient, and a pattern as a diagnostic conclusion about the location, cause and nature of the illness.

The difference changes the prescription. Two patients with the same headache can receive different points because they were differentiated into different patterns, and two patients with unrelated complaints can receive the same points because they landed in one. A prescription indexed by complaint alone throws away the step that produced it. The eight principles covers the first, broadest sort a practitioner makes, and Common patterns gives the WHO definitions of six pattern terms that recur in the index.

What is in the index

AcuiQ indexes 14,457 terms, of which 11,226 are canonical concepts and the rest are variant spellings resolved onto them. Three categories say in their own name that they are not symptoms:

The counts above are read from the database as the page is served, so they are what the index holds now rather than what it held when this was written. The same is true of the corpus figures on how AcuiQ is built.

The largest category is not a category

4,820 terms, about 33 in every hundred, are filed under general. It is the biggest group in the index by a wide margin, and it is a residual rather than a clinical grouping: it is where a term went when the labelling pass could not place it. Most of it is ordinary biomedical diagnosis (copd), but patterns land there too: liver yang rising and exuberant heat stirring wind are differentiated patterns, and spill pulse is a pulse finding. Therapeutic actions no longer do; every one the index holds now sits under tcm-action.

The three labelled categories are the site’s only machine-readable warning that a term is not a complaint, and the label is what the code acts on: the popular-symptom lists drop tcm-action by name, and a point page leaves action terms out of the structured data it gives search engines, although its visible indication list still shows them. A pattern filed under general carries no label at all, so it is treated as a symptom because nothing in the record says otherwise.

Why they are in there at all

Because that is how the sources are written. AcuiQ takes its terms from two places, both described in How AcuiQ is built: the published prescriptions it reads, recording what each one says it treats, and the indication lists of the points in its catalogue. Pattern terms arrive by both routes. Broad patterns such as qi stagnation and blood deficiency are attached to published prescriptions, and dropping them would discard those prescriptions. Narrower ones such as damp-heat diarrhea are attached to none. Rewriting either kind into a plain complaint would assert a differentiation nobody made.

An action term records a therapeutic intent rather than a complaint: “benefit bladder” appears in the index because a point’s indication list recorded it. The WHO terminology files terms of this kind, such as move qi and dispel dampness, under methods of treatment rather than under diagnostics, and almost none of the action terms in the index is attached to a published prescription. They are useful for reading a point’s indications and close to useless for searching from a complaint.

What this means for a search

Search from the complaint. A complaint has the most prescriptions behind it: diarrhea has dozens of entries and damp-heat diarrhea has none, so a search for the pattern answers with the diarrhea entries instead. A pattern search works only where someone published a prescription against that pattern, which holds for fewer than a third of the pattern concepts in the index, and the search box does not suggest a term with no prescription behind it. If a result comes back that reads like an instruction rather than a condition, you have landed on an action term. Nothing on that page says so.

AcuiQ will not get you from one to the other. It does not differentiate patterns, and What AcuiQ does not do says so among the other things the tool deliberately leaves alone. Differentiation is the part of the consultation that requires the patient in the room: the pulse, the tongue, the history, the questions whose answers change the conclusion. A search box has none of that, and a tool that inferred a pattern from a typed complaint would be inventing the clinical step it skipped.