This article is based on notes from a course in East Asian Medicine I took between April and October 2019, expanded from the standpoint of September 2026. A note at the end sets out what became visible only later.
The Final Session
October 6, 2019, a Sunday. The sixth day of the course, and the last. The subject was pattern differentiation.
Western Medicine Is Built on Language
Before pattern differentiation, the Western side, for comparison.
Western medicine rests on three ideas. That it can be generalized — universality. That it is objective. And that it is logical. A curriculum has been established in medical schools through which anyone can acquire it systematically.
Treatment runs in a fixed order: presenting complaint, examination, diagnosis, treatment. The process is proceduralized — the protocol — and recorded in the chart, with the emphasis on making it reproducible by anyone. Diagnosis quantifies data through blood tests, MRI, CT, and X-ray, and settles on a name for the disease.
I worked on that side for a long time.
I worked as a researcher in a graduate school of medicine, and then at a pharmaceutical company on drug development and commercial strategy. Assuring quality — what each step of the manufacturing process looks like. Assuring safety and efficacy — whether the clinical trial ran according to protocol and demonstrated efficacy in patients. And the marketing and communication of the drug — whether information reaches physicians in accordance with the approved indication. Three steps, carried out within a framework of law and industry self-regulation.
What matters most there is language.
Adverse reaction. Adverse event. Presenting complaint. Each term has a settled definition, and the pharmaceutical industry maintains them in databases. Without firm definitions, logical rigor cannot be assured.
Being able to speak about illness in a shared language is a considerable strength.
Pattern Differentiation Means Establishing the Pattern
So how does East Asian Medicine diagnose?
Pattern differentiation means judging the condition of mind and body, of organs and bowels, of meridians. It is also described as establishing the pattern.
In East Asia, the same symptom can have different causes. So the emphasis falls on seeing the whole rather than a single symptom.
There are three approaches to establishing a pattern: the eight principles, qi-blood-fluids, and the organs and bowels.
The point here is the order.
You do not begin by thinking in terms of the five elements (also called the five phases) or the five organs. Look first at the fine detail — the state of an organ — and you will lose sight of the whole.
Root and Branch
East Asian Medicine works with two ideas: treating the root, and treating the branch.
Treating the branch addresses the symptom currently showing at the surface. Treating the root addresses its cause.
Western medicine, oriented toward symptomatic treatment, does not have these terms in its vocabulary of treatment.
Take lower back pain. Treating the branch means working on the back, on the kidney that governs it, and giving guidance on food and daily life. Treating the root means working on whatever it is that makes a person want to live in a way that weakens the kidney.
In practice, the two are combined.
The Eight Principles
East Asian Medicine uses the interview to understand the present condition, and the eight principles are what help there.
The eight are yin and yang, deficiency and excess, cold and heat, exterior and interior — four pairs.
Yin and yang come first. Which is stronger? You find out by listening.
Then deficiency and excess. You judge from the strength of resistance and vitality, and from whether the illness is gaining or receding. Insufficient qi is deficiency: symptoms are mild and persist. The presence of a pathogen is excess: symptoms are strong, come on suddenly, and appear intermittently.
Cold and heat asks whether cold or heat is affecting the person. Exterior and interior judges from the depth of the external cause and the severity of the illness.
Causes Divide into Three
The way pathogenic causes are handled struck me as particular to East Asian Medicine.
They divide into three: external, internal, and neither-external-nor-internal. External causes are climatic; internal causes are psychological and emotional; the third category covers social and lifestyle conditions.
For a headache: cold as the external cause, stress as the internal, overeating as the third.
Psychological, social, and emotional conditions are placed on the same level as the seasons. That is what interests me.
Internal causes are judged through the emotions — the seven affects. Here the five elements return. The heart holds spirit, which is to have emotion. The kidney holds will, which is to regulate emotion. That the kidney, when weakened, makes a person emotional was something I had learned with the water phase; coming back to it here, it made sense.
Anger belongs to the liver, joy to the heart, thought to the spleen, sorrow to lung and heart, melancholy to the lung, fear and shock to the kidney. Each organ has its emotion, and reading them through the generating and restraining relationships lets you see internal causes more deeply.
Under the third category, food and drink were covered. Overeating; too much rich food; too much raw and cold food; an unbalanced diet. What matters is looking at what effect each produces.
Building It Through the Interview
In the interview, the eight principles are used to ask two things.
Since when has the person been in this state? And what caused it — a change of season, a change in circumstances, in work, diet, sleep, environment?
Then, to find the underlying cause, the symptoms are laid out in time order and built into a single connected account.
At the end of the final session, two case studies were introduced using an intake form. Between them they covered the fundamentals of the whole approach.
East Asian Medicine also builds an account through logical reasoning. In that respect it felt similar to Western medicine.
After Six Months
The largest thing this course gave me was learning that medicine has another scale.
Not that East Asian Medicine is better, or that Western medicine is. Each has its strengths, its angle. That is how I came to see it.
My thanks to Abe for sharing so much so clearly across six months, and to Kei Kobayashi for providing the space to learn.
Note, September 2026
I want to set down where the order I learned here eventually led.
Do not start with the organs. Look at the whole through the eight principles, then qi, blood, and fluids, narrow to the five elements, and only then look at the organs. Start with the detail and you lose the whole.
In the 2019 article I wrote about this as a procedure within East Asian Medicine. I set it against the proceduralization of Western medicine and got as far as saying both build an account through logical reasoning.
In 2025 I took the Advanced Rolfing Training. There I learned Jeffrey Maitland’s three questions. Where do you start? What do I do next? How do I know when I’m done?
The first of the three points at the same place as this.
In Rolfing, body reading comes before any hands-on work. You look at the whole, then decide where to reach. IMAC begins by measuring range of motion. Pattern differentiation in East Asian Medicine enters through the whole — is qi circulating?
All three enter through the whole and descend into the detail. And all three carry the same warning: do the reverse and you will lose the whole.
There is one more thing.
In the 2019 article, I located the strength of Western medicine in the definition of its terms. Adverse reaction, adverse event, presenting complaint — each with a settled meaning, maintained in databases. Definitions that line up, and from them logical rigor. The strength of a shared language.
Reading it back now, I notice that I failed to see East Asian Medicine doing the opposite right next to it.
Yin and yang are a comparison, made after you have decided the basis for yourself. That the basis is not fixed is what makes East Asian Medicine useful — I was taught that on the first day. A system that works because its definitions line up, and a system that works because you get to set the basis yourself. I was learning both at once, over six months.
Neither is the right one. But holding both, there is more you can say about the body in front of you. It took seven years for that to become clear.
Related Articles on This Course
East Asian Medicine — A Summary of Six Days Across Six Months of Study
- The Five Elements as a Way of Dividing — The Body Moves Toward Balance on Its Own
- Qi, Blood, and Fluids — Dividing the Invisible into Three
- What the Meridians Are — Channels for Qi and Blood, and the Center Line