Introducing Patterns
of Disharmony
Patterns of disharmony are the ways in which the body responds to the pathogenic influences introduced in Chapter 7; they are the various types of imbalances possible as a result of those influences. When correctly diagnosed and treated, harmony can be restored long before a Western biomedical disease emerges. This is how Chinese medicine is used preventatively.
Once a Western-defined disease is present, Chinese medicine can still be employed to restore balance by reducing or eliminating all the symptoms of disease, but it can take longer if the pathogens causing the disease were present longer and created deeper, more disruptive imbalances. Even in this case, it is the pattern of disharmony that must be rectified, as that reflects the condition of the whole person and not just the disease and its symptoms. A Western diagnosis may be helpful as a shortcut to identifying a number of symptoms, but it cannot take the place of identifying the pattern of disharmony.
Many Patterns for One Disease;
One Pattern for Many Diseases
In Chinese medicine the Western disease diagnosis is not so important. The same signs and symptoms present in those diseases are observed along with other symptoms that are only relevant to a Chinese physician. That collection of symptoms is a set of indicators guiding the physician to determine the imbalance within a particular organ or among various organs that constitutes a Chinese diagnosis.
Using the example of diabetes from Chapter 7, a Chinese correlation for one common constellation of diabetes symptoms is called San Da, or “The Three Bigs”: big thirst, big hunger, and big urination. A person may have one, two, or all three of those symptoms. Big thirst is an indicator of an Upper Jiao disharmony, big hunger indicates a Middle Jiao disharmony, and big urination is a Lower Jiao disharmony. With just that understanding, there are already seven possible diagnoses based only on the involved Jiao. The organs in the related Jiao would be further examined for the full nature of the disorder, including variables in Qi, Blood, Yin, Yang, deficiency, excess, and so on. Additionally, a person’s constitution is considered, along with contributing lifestyle and environmental factors. Only then would a diagnosis and treatment plan be made. It’s entirely possible that ten patients with a Western diagnosis of Type 2 diabetes might be treated in ten different ways by a Chinese physician, based on the exact presentation of each patient. A Chinese physician cannot effectively treat a patient for Type 2 diabetes without a Chinese diagnosis.
Another category of disharmony, Wasting and Thirsting Syndrome, is seen in numerous types of Western-defined diseases, including tuberculosis, cancer, and AIDS. Depending on their presentations, which in almost every case includes the severe weight loss and dehydration that gives the syndrome its name, it’s possible that a tuberculosis patient, a cancer patient, and an AIDS patient might be given exactly the same treatment by a Chinese physician. A Western diagnosis may be a helpful adjunct toward making a Chinese diagnosis, but it will never have a one-to-one correspondence and is of limited value in this context.
The Chinese diagnosis names the nature of the imbalance. In the example of diabetes, that might be Lung Yin Deficiency for an Upper Jiao disorder, Spleen Qi or Yin Deficiency for a Middle Jiao disorder, and Kidney Yin or Yang Deficiency for a Lower Jiao disorder. For Wasting and Thirsting conditions, the root disharmony often includes Kidney Yin and/or Jing Deficiency.
Examples of other pattern names involving more than one organ include Kidneys Failing to Grasp the (Lung) Qi, which often presents as asthma; Heart and Kidney Failing to Communicate, common in types of insomnia; or Liver Invading the Spleen, which is seen when appetite and digestion are disturbed by stress or emotional upsets. These patterns of disharmony are not the cause of the distress but the result of the pathology that created the imbalance.
Any pattern of disharmony can have many possible causes as the root pathology. Sometimes the pathology is named in the pattern, as in Wind Heat Invading the Lungs, a diagnosis made in some types of common cold. In any case, the root pathology must be identified and addressed in order to completely resolve the condition, thereby restoring balance.
From a Western medical perspective, this is similar to restoring and maintaining homeostasis. The Chinese perspective is best encapsulated by the image of the Taiji (Yin Yang) symbol, a representation of the state of dynamic equilibrium introduced in Chapter 3. This includes restoring and maintaining balance within each individual organ, balance among all the internal organs, emotional balance; balanced dietary and lifestyle choices, balance between the individual and the environment, and (ideally and ultimately) balance and alignment among body, mind, and spirit. This is complete holistic balance, the highest realization of Chinese medicine.
The Lenses of Diagnosis
Chinese medicine has existed for thousands of years. During its long history, numerous medical philosophies emerged, each with its preferred diagnostic and treatment methods. Many still exist and are practiced today. Those most practiced in the West are Traditional Chinese Medicine (TCM) and Five Element. Despite its name, TCM is the newest system, developed in the 1950s as a way to incorporate and standardize most other Chinese medical systems in use today.
Those systems include Eight Principle and Zangfu (Internal Organs), which are among the oldest and most interrelated and are found to some degree in most other systems. Along with Pathogenic Factors, they are the systems most used in TCM. Channel and Collateral, Six Stage, Four Level (introduced in Chapter 3), and Sanjiao diagnoses are all discrete systems used primarily when a disorder clearly indicates one of those systems as the best model to choose, in specialized circumstances. In the diabetes example from the previous section, a Sanjiao model might be the most useful choice. A Four Level diagnosis of Heat in the Blood might be made in some types of bleeding disorders. There are further diagnostic systems focusing on Qi, Blood, and body fluid patterns. All these systems are contained under the TCM umbrella, often subsumed in an Eight Principle or Zangfu diagnosis, and weighted according to the needs of the patient.
When any one system is selected, it must be adhered to throughout pathology identification, diagnosis, and treatment principle. “Mix and match” is not applicable here, meaning you can’t make a Six Stage diagnosis and then employ a Five Element treatment principle. For the purposes of this book, the particulars of those specialized systems are not important to include in your self-care practice, as they are most relevant to medical professionals. Mention is made only to acquaint readers with the possibilities included in the broad scope of Chinese medicine. Here, we’ll primarily focus on the Eight Principle, Zangfu, and pathogenic factor aspects of TCM.
As the Five Element system is still widely practiced apart from TCM, a few additional comments are warranted before moving on. Five Element philosophy as included in other parts of this book presents the aspects that are most used in a TCM context. Such things as the Five Seasons with their corresponding Five Environmental Energies, the Five Tastes, the Five Emotions (with two having subdivisions, creating Seven Emotions), and the Five Elemental correspondences themselves (Wood, Fire, Earth, Metal, and Water) all originate within the Five Element/Five Phase system, and all are features commonly used by TCM practitioners. Remember that TCM is intended as a way to include and standardize all of the various traditional systems of Chinese medicine.
Strict classical Five Element practitioners have a somewhat different view of Chinese medicine, rooted in Daoist philosophies, with their own diagnostic criteria and treatment principles. Within that Five Element context, their methods are broader and deeper than the Five Elements as they are typically employed in TCM. Accordingly, the Five Element system has different patterns of disharmony, yet many of those patterns have close analogues in TCM, with slight variations. For example, the Zangfu diagnosis of Liver Invading the Spleen is nearly identical to the Five Element diagnosis of Wood Overacting on Earth. Including those variations here would be more confusing than helpful, especially for readers relatively new to Chinese medicine. Still, it’s important to understand that there are many possibilities open to you, especially when considering professional Chinese medical help.
Criteria of TCM Pattern Identification
Everything presented in this book up to this point (Qi, meridians, Yin and Yang, internal organs, pathogenesis, and all systems of Chinese medicine) is considered in TCM pattern identification. The following are three of the main criteria and among the most commonly used.
The first criterion is the Eight Principles. This is covered in detail in Chapter 3. The Eight Principles are defined by the core polarities of Yin and Yang, fundamental to every Chinese medical system, along with three subsidiary pairs of versatile, diagnostically significant polarities.
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The Eight Principles |
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Yin |
Yang |
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Interior |
Exterior |
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Cold |
Hot |
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Deficiency |
Excess |
The second criterion requires understanding the functions of the Zangfu, the internal organs. Knowing these functions allows for identifying what organs are affected by pathogenic influences—present symptoms point the way to the involved organs—and in what ways they are affected. Those ways can be determined through Eight Principle analysis and through identification of the pathogenic influences. The functions of the organs are covered in detail in Chapter 4, Chapter 5, and Chapter 6.
The third and final criterion we’ll include is identifying the pathogenic influence(s) affecting the involved organ(s). Those are covered in detail in Chapter 7.
Before introducing the specific patterns, let’s review and expand on the factors used in the Eight Principles. They inform all pattern identification and are the most simple, direct, and applicable diagnostics in all of Chinese medicine. A careful understanding of them is very helpful when selecting the most beneficial self-care practices taught in this book.
Eight Principle Considerations
Yin and Yang
Apart from representing every polar opposite, within the body Yin and Yang exist on a continuum between substance and functional energy. Yin substance includes blood and other body fluids, along with all body tissues, such as muscles, bones, organs, and so on. Yang functional energy includes Qi and its most active Yang aspect. It powers all cellular metabolism, the functions of every organ, every movement, and every thought.
Within Eight Principle diagnostics, Yin and Yang both summarize the other six principles—Interior, Cold, and Deficiency are Yin qualities; Exterior, Hot, and Excess are Yang qualities—and are related attributes used in differentiating and honing a diagnosis. For example, heat is a Yang quality, but the appearance of Heat in the body is not enough on its own to determine if it’s caused by a Yang pathogen or syndrome. In the case of Excess Heat, there is in fact too much Yang, as you might expect. Cool or Cold is a Yin quality, which normally balances the warming Yang. In the case of a Deficiency Heat pattern, there is insufficient Yin to balance the Yang, and even if Yang is completely normal, there will be the appearance of Heat. There are numerous signs and symptoms used to make this distinction, discussed under “Cold and Hot.”
The insufficiency of Yin illustrates a type of simple Yin deficiency, Deficiency Heat. There are comparable Yang deficiencies causing Deficiency Cold.
Interior and Exterior
Interior and Exterior, or Deep and Superficial, are used to determine the location of a disharmony.
The most interior parts of the body include nerves, organs, blood, and bones. Any pattern affecting these parts of the body is considered internal. IPFs (emotions and internally generated climates) and other Yin-Yang imbalances are internal and are the most typical causative factors.
The most exterior parts of the body include skin, muscles, and meridians. Any pattern affecting these parts of the body is considered external. The EPFs are external and are the most typical cause of external patterns.
There can be confusing presentations, as when an EPF may cause an internal disharmony. EPFs typically cause external patterns unless they invade deeper and transform into IPFs. External Wind Cold is an EPF, and if it causes a pattern that remains on the surface of the body, such as a simple cold with possible headaches, muscle aches, and sinus congestion, then it is an external pattern. But if the Wind Cold invades deeper, disrupts normal Lung functions, and causes the difficult breathing and wheezing characteristic of asthma, then the pattern is an internal one, regardless of its origins as an EPF.
Similarly, an internal pattern can cause external symptoms. Blood Heat, or Fire Toxins in the Blood, is frequently seen in biomedically defined conditions like viral infections or food poisoning and can cause rashes to appear on the skin. Despite the external symptom, further analysis will reveal it to be due to an internal pattern. As another example, Internal Heat from any cause will frequently cause the blood to dry and inadequately nourish muscles, presenting stiff, tight, achy muscles. By itself, superficial muscle tension may be taken as evidence of an external pattern, but here it is a symptom of an internal pattern, which may require further differentiation to ascertain.
Cold and Hot
Cold is Yin, and Hot is Yang. They help identify the basic nature of a pathology and are most advantageously viewed in combination with Deficiency and Excess to determine their most accurate nature.
Cold may be present from either a deficiency or an excess. There are distinguishing symptoms for each type. Excess Cold is a true Yin cold presentation. Yang energies may be completely normal, but Yin is present in excess, overwhelming Yang and causing Excess Cold symptoms. (In practice, excess Yin will consume some Yang, so it’s likely there will be some Yang deficiency.) This is a Yin pathology. Deficiency Cold occurs when Yin energies may be normal, but Yang is deficient, unable to balance the cooling quality of Yin. This is a Yang pathology.
In just the same way, Heat may be present from either a deficiency or an excess. Excess Heat is a true Yang heat presentation. Yin energies may be completely normal, but Yang is present in excess, overwhelming Yin and causing Excess Hot symptoms. (In practice, excess Yang will consume some Yin, so it’s likely there will be some Yin deficiency.) This is a Yang pathology. Deficiency Heat occurs when Yang energies may be normal, but Yin is deficient, unable to balance the warming quality of Yang. This is a Yin pathology.
Deficiency and Excess
Deficiency and Excess are used to describe the strength of the pathogenic influence relative to the body’s defensive (Wei) and normal (Zheng) Qi. A strong EPF or IPF confronting strong defensive and normal Qi will produce symptoms consistent with an Excess condition. This is most common in acute conditions. Whether a pathogen is present or not, if the body’s energy is low, the symptoms will almost always indicate a Deficiency condition. This is most common in chronic conditions.
The attributes considered in Deficient and Excess conditions are Yin, blood, Cold, Heat, Qi, and Yang. All can be deficient throughout the body. Yin, Cold, Heat, and Yang can be excessive throughout the body, but Qi and blood are almost always only excessive in relatively small, localized regions. Liver Qi Stagnation is a common pattern of disharmony indicating an excess of Qi localized within the Liver. Qi can become obstructed—excessive—in the channels, which can cause localized joint pain. Common to everyone’s experience, the black and blue mark from a bruise is visible Blood Stasis, a local excess of unmoving blood under the skin.