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IDENTIFICATION OF PATTERNS OF DYSHARMONY

The identification of patterns underlying the basic imbalance or disharmony in the patient is the
most important “diagnostic” activity in Chinese medicine. This activity is consistent with Chinese
philosophy where relationships rather than causes are of paramount importance. There are several
methods used to define these patterns. Each method is more applicable in certain disease pro-
cesses, and this distinction will become more apparent in the next pages, and with clinical
experience.
The methods of pattern identification are according to
1. The Eight Diagnostic Principles.
2. Qi, Blood, and Body Fluids.
3. Pathogenic factors (the Six Evils).
4. Internal organs.
5. The five elements.
6. The Channels (Meridians).
7. The Six Stages.
8. The Four Levels.
9. The Three Burners or Heaters.
THE EIGHT DIAGNOSTIC PRINCIPLES
The Eight Diagnostic Principles are:
1. Yin and Yang
2. Cold and Heat (Wet and Dry)
3. Interior or Exterior
4. Deficiency and Excess
When we look at a patient in TCM we need to define the patient in reference to each of the
paired four diagnostic principals. We will address the clinical presentations of these paired concepts
and then go on to understand the concepts of the external factors that cause disharmony — the six
evils — and the constituents of the body — the five fundamental substances and the Zang-Fu organs.
Yin and Yang


When we look at a patient in TCM we need to define the patient in reference to each of the
paired four diagnostic principals. We will address the clinical presentations of these paired concepts
and then go on to understand the concepts of the external factors that cause disharmony — the six
evils — and the constituents of the body — the five fundamental substances and the Zang-Fu organs.
Yin and Yang — Yin/Yang is a symbolic representation of the universe that embodies the
concept of change, relationships, patterns, process, or flow from one concept into the other, at all
levels of existence. Yin and Yang can only be defined in relationship to each other. This relationship
is seen graphically in the Yin/Yang symbol (Figure 5.1), where Yin gradually turns into Yang, but
even when Yang is full, it still has a small dot of Yin contained within it. The same is true of a full
Yin. Another way of looking at it is that a part can only be understood in relationship to the whole.
Yin and Yang are two convenient polar opposites that are used to explain how things function in
relation to one another and to the universe. No entity can be seen in isolation; everything is connected
and related in some fashion — so are Yin and Yang. Everything in the universe has two aspects to
its nature — a Yin and a Yang aspect. Any Yin or Yang aspect can be further subdivided into another
level of Yin and Yang and so on until infinity. This aspect of self-similarity on every level should
remind you of the concept of fractal geometry, which relates to nonlinear dynamics and chaos
theory that was discussed under the energetics of the body. Yin and Yang mutually create each
other and they depend on each other for definition. Yin and Yang also control each other; when
one is weak, the other is strong and vice versa. If the imbalance between the two occurs for a

prolonged period, without the possibility of rebalancing, then the extreme disharmony means that
the deficiency of one cannot support the excess of the other and they will transform into the opposite
pole, or existence will cease. This is reminiscent of the concepts of chaos theory where, unless
there is unimpeded change and unrestricted flow, the attractor will cause maladaption and reduced
reactivity and adaptability of the organism, and cause a quantum jump to another chaotic level, or
result in permanent stability, which means death of the organism. A good clinical example of this
collapsing concept is seen in the diabetic patient who has a superficial skin infection with strepto-
coccus, seen as a boil. The lesion is on the surface, is red and hot, and, therefore, qualifies as being
a Yang presentation (see below). The patient neglects the problem and the streptococcus invades
the body and becomes systemic in nature. The body responds with fever (excessive Yang) and
finally cannot hold off the invading organism and goes into septic shock, a cold, inert, collapsed
Yin state.
The qualities of Yin and Yang are polar opposites. Yin has all the feminine attributes and is
quiescent, yielding, static, and contracting, while Yang is masculine and dynamic, active, and
expansive. Yin is at the core, sinking, condensed, and internal; Yang is at the surface, rising,
dispersed, and external. Clinically, Yin and Yang are related mostly to the two elements, which in
combination, permit life to exist on this planet, that is, sunlight or heat, and water. Yin is cold, wet,
and dark; Yang is hot, dry, and light. If we consider Hering’s Laws of Cure, it is then apparent that
Yang symptoms are more on the surface, acute, and less dangerous than Yin symptoms, which are
internal, chronic, and more at the core of the patient. The Yin aspects of the human body are then
internal and, because we can curl up into a fetal position and bury our chest and abdomen under
our arms and legs, at the front of the body. The upper body closest to heaven tends to be Yang,
while the lower body closest to the earth tends to be Yin. The exposed back of the body and skin
are considered to be Yang. The internal organs, while having both Yin and Yang elements, are
usually considered to be predominantly one or the other. When I refer to organs, it will be in the
Chinese sense, that is, not just meaning the physical organ, but the whole emotional, energetic, and
functional attributes of that “organ.” The Chinese were not allowed to vivisect and had no concept
of the organ anatomy. Some “organs” have similar or overlapping Western attributes such as the
Lung, but the Spleen, for instance, is seen in TCM to be the center of the digestive function in the
body. All the parenchymal, solid, or dense organs (Zang organs) are considered to be Yin and more
essential for life and include the Liver, Heart, Spleen, Lung, and Kidneys. The hollow organs (Fu
FIGURE 5.1 Yin/Yang.


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