Dynamic diagnosis · Clinician-review draft
TCM headache diagnosis: a pattern-differentiation framework
A useful headache interview starts with the complaint, not a memorized pattern checklist. First classify the headache’s timing, location, quality and modifiers; then ask only the questions that separate the plausible pattern families.
Try an interactive headache case- Start with
- Onset, course and red flags
- High-yield dimensions
- Location · quality · modifiers
- External clues
- Tongue, pulse, face and eyes
- Output
- Ranked patterns with evidence gaps
1. Establish the clinical frame
- Onset: sudden or gradual; recent or longstanding.
- Course: constant, intermittent or episodic; progressive or fluctuating.
- Location: temples, vertex, occiput, forehead, behind the eyes or whole head.
- Quality: distending, throbbing, stabbing, heavy, dull or empty-feeling.
- Modifiers: stress, exertion, weather, pressure, rest, food or the menstrual cycle.
- Associated findings: dizziness, nausea, visual symptoms, fever, neck stiffness or neurological change.
2. Open the relevant pattern families
| Pattern family | Clues that make it worth testing | Next discriminators |
|---|---|---|
| External Wind | Recent onset with exterior symptoms | Cold vs Heat signs, aversion, sweating and pulse quality |
| Liver Yang or Fire | Temporal/vertex headache, stress aggravation, irritability or dizziness | Full Heat signs versus an underlying deficiency context |
| Phlegm/Damp | Heavy head, cloudiness, nausea or oppressive fullness | Coating, slippery pulse and digestive-fluid clues |
| Blood Stasis | Fixed, stabbing, persistent or post-traumatic pain | Purple signs and resistance to ordinary modifiers |
| Qi/Blood/Yin deficiency | Dull or empty pain with fatigue, weakness or chronicity | Which deficiency cluster is actually present |
3. Use observations as evidence, not decoration
Tongue body, coat and pulse should be captured as separate observations. A red tongue with yellow coat and rapid pulse supports Heat; a pale tongue and weak pulse support deficiency; purple changes can support stasis. None is diagnostic in isolation.
If an observation was not made, mark it as unknown. Never fill it from the expected textbook pattern.
Move from reading to reasoning
Test the distinctions in an interactive case.
The assistant asks for evidence that can change the ranking and keeps missing observations visible.