TCM Theory – Illness Differentiation

Pattern identification is the process used in TCM that enables a practitioner to determine the significance of symptoms and to create a coherent picture of a client’s state of ill/well being.

This process is what makes TCM one of the most superior approaches toward health due to its focus on understanding the patterns of disharmony. It looks at the bigger picture, the totality of a human being and not merely looking at individual signs and symptoms in isolation, the term used for this in TCM is “chasing the Dragons tail”.

Eight-Principle pattern identification

The most basic and fundamental system used in TCM is the Eight-Principle pattern identification. Within it the fundamental nature and location of any given disease can be determined which makes this both the first and most important system.

The eight principles are:

Exterior – Interior (measures the depth of the disease)

Hot – Cold (describes the nature of the disease)

Excess – Deficiency (indicates the strength of good and evil)

`Yang – Yin (the general principal that embraces the other six)

I would like to example how once a pattern is identified with the eight principles, a disharmony can be explored in greater depth via the other sub-systems of pattern identification.

E.g. At the eight principle level a heat pattern is identified,

Qi-Xue pattern identification will show whether the heat is located in the Qi or Xue,

Organ pattern identification will determine what organ or organs are affected,

And Disease-evil pattern identification will identify any evil present.

Qi-Xue pattern identification

The state of harmony and normal functioning of all the Zang-fu and tissues is dependent on the flow of Qi and Xue throughout the body. In TCM theory however, mutual support is a fundamental concept as in this case the production and movement of Qi and Xue is dependent on the functioning of the bowels and viscera. This understanding explains how disease in a given Zang-fu may give rise to disorders of Qi and Xue of that organ and may also affect the Qi and Xue of the whole body.

The Qi and Xue patterns are:

• Qi deficiency (usually of the spleen, lung, kidney)
• Qi sinking (if Qi is Xu it can sink; prolapse caused by spleen Xu)
• Qi stagnation (mostly liver Qi)
• Qi rebellious (Qi can flow in wrong direction)

Xue is governed by the heart, stored by the liver, and produced and managed by the spleen.

• Xue deficiency (usually from spleen Qi Xu)
• Xue stagnation (may be caused by Qi stasis, mostly of the liver, by heat, or by cold)
• Xue heat (mostly due to liver heat)
• Xue loss (not normally added but is another important factor)

The Qi and Xue relationship is the most fundamental of the mutual support systems apart from the root level of Yin and Yang. In order to apply this system in a diagnostic way it is vital to understand how Qi and Xue support each other. Qi generates Xue, food-Qi is the basis for Xue, and also lung Qi is essential for the production of Xue. Therefore if Qi is Xu, Xue will also eventually become Xu. Qi moves Xue, Qi is the motive force for Xue, when Qi moves Xue follows, if Qi stagnates, Xue congeals. Qi holds Xue, Qi has the function of holding Xue in the blood vessels. Xue nourishes Qi, Qi relies on the nourishment of Xue.

Organ pattern identification

This method of identification of patterns is used mostly for interior and chronic conditions, however it does also include a few exterior and acute patterns. The focus of Organ pattern identification is to determine what organs are affected by disease and to identify any changes in their Qi-Xue and yin-yang aspects.

The first stage of Organ pattern identification is to identify which organ(s) have been affected and this is done so by understanding the organ functions and organ to organ relationships.

By understanding harmony one can see where there is disharmony, by understanding how the organs function and what their role is, both an individual sense and also as a part of a entire system, one can discern which pattern of disharmony is present. Once the affected organ has been identified, the relative states of yin, yang, Qi, and Xue can be determined via the application of the Eight principles and Qi and Xue pattern identification. Once a picture has been made of the presenting illness via the examination of these systems, a conclusion can be made as to the underlying pattern of disharmony.

Disease-evil pattern identification

Pathogenic factors can invade the body from both the interior and the exterior but will always correspond to full patterns according to the eight principles.

The patterns are:

• Wind Disease Patterns
• Cold Disease Patterns
• Heat, fire and summer heat Disease Patterns
• Dampness Disease Patterns
• Dryness Disease Patterns
• Food accumulation
• Phlegm Disease Patterns

Disease-evil pattern identification is the method used to determine which evil is the cause of the illness and is done so via the information gathered through the four examinations. In TCM this process is what they call “identifying the pattern and determining the cause”

Pattern identification according to the Five phases

The five phases are often used to describe clinical processes and relationships and to help in the conceptualization of correct treatments. It is an effective system that explains pathological changes via understanding disharmony at an elementary level. The five phases outlines the inter-connection of the internal organs and their dependency on one another for harmony and correct functioning.

Pattern identification according to channel pathology

This method of pattern identification allows you to distinguish symptoms and signs according to the involved channel and it is therefore concerned with the pathological changes occurring in the channel rather than the organ.

Channel pathology can arise from invasion of exterior pathogenic factors, such as cold, wind, dampness or heat; therefore the Disease-evil pattern identification is also used. Qi-Xue pattern identification is also used in channel pathologies as another common cause of channel pathology is due to the quality of circulation of Qi and Xue through the channels. In relation to the eight principles, exterior relates to the exterior of the body, which includes the skin, muscles and channels.

Excess and deficiency is used to describe the pathology in terms of Qi and Xue. Intense pain, stiffness, contractions and cramps characterize excess conditions in the channels. Deficient conditions are characterized by dull ache, weakness of the muscles, atrophy of the muscles and numbness. Organ pattern identification may also be used as channel pathologies can also manifest due to an internal disharmony moving outward.

Externally contracted febrile disease pattern identification

Externally contracted febrile diseases are caused by invasion of external evils and manifest as fever in their early stages. There are two main characteristics of externally contracted febrile diseases: fever and stage by stage development.

Fever results from the battle between ones Zheng Qi and evil Qi and its progress reflects the changing relationship between them. High fever reflects the strength of ones Zheng Qi to a highly toxic evil Qi. Gradually the fever will subside as the Zheng Qi overcomes the evil Qi.

There are three main stages in the development of externally contracted febrile diseases:

1. the initial stage: the fever is not so severe.
2. the exuberant heat stage: the fight becomes more intense, and the symptoms are most pronounced which indicates that the disease has reached a climax. This is the most crucial stage, as the strength of patients Zheng Qi determines if he/she shall enter the recovery stage or deteriorate even more, which could lead to death.
3. the recovery stage: may occur at any time if evil Qi weakens and Zheng Qi strengths that could happen spontaneously or with correct treatment

Six channel patterns

Six-channel pattern identification belongs to the theoretical system expounded in the book On Febrile Diseases Due to Invasion of Cold and explains the degree of penetration, severity, and acuteness of diseases. This method of identification is not only used for diagnosing and treating diseases caused by external cold, but also for hot internal conditions. It also represents the development and application of the theory of channels and collateral’s from The Internal Classic.

Eight-principle in relation to the six levels:

Taiyang – exterior cold

Shaoyang – interior heat, interior fullness

Yangming – evil that is half in the exterior and half in the interior

Taiyin – damage to spleen by cold

Juiyin – interior deficiency and cold-heat complex

Shaoyin – heart/kidney deficiency and general weakness

The four aspects pattern identification

The four aspects are used to determine the origin and development of externally contracted febrile diseases. This system was divised by Ye Tian Shi (1667-1746) in his book Discussion of Warm Diseases and it describes the pathological changes caused by exterior Wind-heat. The four aspects used in the identification and treatment of warm disease patterns are: defensive, Qi, construction (nutritive), and blood.

Ye Tian-shi states

The general conception is that Qi comes after defense and that blood comes after construction. When disease affects defense, sweating can be administered. Only when the disease reaches the Qi aspect can Qi-clearing treatment be prescribed. When it enters construction, treatment involves outthrusting heat to the Qi aspect. Finally, when the disease reaches blood and causes depletion and frenetic movement, treatment involves cooling and dissipating the blood.

Identification of patterns according to the Three Burners (Sanjiao theory)

This system was devised by Wu Ju Tong (1756-1836) in his book A Systematic Identification of Febrile Diseases. This method of identification of patterns is usually combined with the four aspects method for diagnosing and treating febrile infectious diseases caused by invasion of wind-heat.

The patterns of the three burners are:

Upper burner

Wind-heat invading the lungs – this patterns is the same as the defense aspect of the four aspects pattern identification.

Heat in the lungs – corresponds to the Qi aspect of the four aspects pattern identification.

Heat in the pericardium – corresponds to the construction aspect of the four aspects pattern identification.

Middle burner

Heat in the Yangming – the patterns are the same as the Organ pattern identification for
the Large intestine and the Stomach. It is also the same as the
Yangming level of the Six channel pattern identification.

Damp-heat invading the spleen

Lower burner

Various damp to damp-heat patters which are usually identified under Organ pattern identification.