When Chinese medicine was initially created in ancient times, there was no concept of the four diagnoses 四診 or the eight principles 八綱. These concepts were developed since the Ming & Qing Dynasties.
Zhang Zhong-jing did not invent the theory of six conformations, and he never gave names to diseases such as asthma or MS, but recorded symptoms and pulse of each 經 conformation.
A classical CM practitioner will never diagnose/treat based on disease names, because seldom patients with a same disease have the exact same constitution & symptoms.
Symptoms of diseases are indications of abnormal movements of Qi, Blood, Thin & Thick Fluids and Jing-Essence in the body. For instance, when a practitioner asks a patient: “How’s the digestion?” He/She is trying to understand what’s happening in the patient’s body. Some patients would answer: “It’s normal.”
It raises the question of “What’s normal.” What if a patient is used to having diarrhea or constipation for his/her entire life and considers this “normal”? Sometimes the chief complaint will disappear after digestion or bowel movement patterns are changed.
When a patient claims that he/she has a cold, what does that mean? Not everyone with a cold has the same symptoms as everyone else’s and should not be given the exact same formula.
The basic way to know internal mechanisms is to observe the body’s basic functions — the normal opening and closing of the five portals 五通:
1. 睡眠通 Sleep – how well Yang Qi descends into the Yin container
2. 出汗通 Sweat – how well the body expels heat & waste fluids through the exterior portals
3. 食慾通 Appetite – how strong and healthy the life force is
4. 體力通 Energy – how well the body metabolizes nutrients and energies
5. 二便通 Urination & Elimination – how well the body process wastes through the two turbid/lower orifices 濁竅.
Keep the normal functions and connections of the invisible portals in mind, it is not impossible to understand and treat complicated cases.