by Gene Chuah
Q: “How do you eat an elephant?”
A: “One bite at a time.”
We are all familiar with the phrase “divide and conquer”. Sculptors know this. They start with a big piece, hack away big chunks, make sure all the proportions are correct, before refining the features. Even modern Web browsers do this — they preload a fuzzy image before overlaying increasingly finer layers. In Traditional Chinese Medicine, we go from general to specific in making a diagnosis. There are several key “ley lines” in this troubleshooting system, and they are the 8 Principles Of Pattern Identification. Pain, in relation to these 8 Principles, is also an indicator that can give us more clues to solve the puzzle (chart below).
|(1) Yin †
(see physical traits list below)
|vs.||(2) Yang ‡
(see physical traits list below)
to treat: heat up
to treat: cool down
|(5) Interior (organs)
to treat: harmonize organ(s)
|vs.||(6) Exterior (limbs, skin)
to treat: push out, expel
to treat: increase, tonify
to treat: reduce, sedate, detox
|Yin †||Yang ‡|
(longer-term, usually at interior)
(shorter-term, usually at exterior)
|slow onset of symptoms||sudden onset of symptoms|
|pale complexion||flushed complexion|
|cold limbs & body||hot limbs & body|
|likes heat, hates cold||likes cold, hates heat|
|prefers hot drinks||prefers cold drinks|
|likes to curl up||throws clothes off|
|quiet and still||loud and hyperactive|
|obsessive, nervous, agitated, timid
|aggressive, angry, confrontational
|calculating and meticulous||takes risks|
|shortness of breath||heavy breath|
|reduced appetite||excessive appetite|
|watery stools||dry stools|
|frequent, abundant, pale urination||scanty dark urination|
+ nausea <- Excess
+ vomiting with strong force <- Excess
+ heartburn / acid reflux <- Heat
: this is Stomach (Interior)
Treatment: reduce Excess Heat in Stomach.
A wrong treatment is made when, rather than reducing something extreme (and bringing it back into the middle of the scale), we instead make it even more extreme. For instance, instead of reducing Heat, we increase it. This could happen if we don’t identify symptoms from the 8 Principles correctly. A bit of a misnomer actually, I would prefer calling them The 4 Dimensions, so let’s also use this term.
Some examples of wrong treatments involving the Interior-Exterior dimension:
1. Fever-reduction medications -> lower fever -> impede Wei-Qi expelling-Heat -> drive pathogen inwards instead of expelling outwards -> illness is worsened, becomes chronic.
2. Corticosteroids to treat skin issues (at Exterior) -> push Heat inward rather than expel -> Liver damage (eventually).
Notes on some of these Dimensions:
Cold vs. Heat
2. Diet (food & drink)
3. Emotions (from Day 10)
Sadness -> Cold
Worry, Pensiveness -> Cold
Fear, Shock -> Heat -> Cold
Joy (Overexcitement) -> Heat
4. Overexertion (physical)
With physical overexertion, whichever “level” is lower (this chart above) than the other, will be amplified (even lower). So someone with a Yin Deficiency will have even less Yin and therefore relatively more overall Heat in their system.
B. Mixed patterns for Cold vs. Heat
Transformation of energy.
Example: Fevers -> burn out Qi -> Cold
C. True vs. False Cold & Heat
Example: body core has high Heat, but limbs are Cold. Stagnation somewhere blocking the flow to the limbs is correct here, but this may or may not be the root cause; dig deeper; in any case Heat is the true problem here, not Cold (false).
Excess vs. Deficiency
B. Expressed through the strength/weakness of the symptoms (how big or small).
There may be clusters of symptoms which can be grouped under an Organ. As a practitioner, once you know the general direction of your diagnosis, dig in deeper in that direction to find confirmation — this may entail asking the patient more questions to confirm your hunch.
An example of the “full vs. partial” concept:
Yang Excess : full red face
Yin Deficiency : partial (cheeks only) / less red
Some examples on how to identify Excess vs. Deficiency:
Example: general weakness and fatigue <- Qi Deficiency
Example: strong, stabbing, sharp headaches <- Blood Stasis
Example: tinnitus — constant “seashore” sound, especially at night <- Excess
Example: tinnitus — constant whistling, high-pitched, strong buzzing <- Deficiency
One test to determine which type of tinnitus (Exc vs. Def) is the “clap test”. Clap next to the patient’s ear. If the problem goes away temporarily, it is Deficiency (lacking and likes additional energy); if it is aggravated, it is Excess (too much, dislikes more added energy).
What’s outside amplifies what’s inside. Environmental (external) factors will aggravate any internal Excess.
Example: Shen disturbance aggravated in hot room <- Heat Excess
Example: rheumatoid arthritis aggravated on humid days <- Damp Excess
Pain, with the “what” and the “when”, is an additional tool to help us complete the picture and zoom in on our target, particularly in regards to Deficiency vs. Excess and Cold vs. Heat.
|Description||dull, lingering||sharp, excruciating||cramping, spastic||burning|
|Temperature||-||-||relieved by heat||relieved by cold|
|Rest||better with rest||worse with rest||-||-|
|Activity||worse with activity||better with activity||-||-|
|Position||better lying down||better sitting up||-||-|
|Food||relieved abdominal pain||aggravated abdominal pain||relieved by hot food,
aggravated by cold food
|relieved by cold food,
aggravated by hot food
|Bowel Movement||worse after evacuation||relieved after evacuation||-||-|
Fu Organs in the spotlight!
In last Monday’s class, of the Zang-Fu Organs, we covered the Zang (Yin) Organs. Now we cover the Fu (Yang) Organs. Note that it’s a much smaller spotlight though.
Gallbladder : Minister of Justice
The Gallbladder is categorized as an Extraordinary Organ because it is hollow, like all Yang (Fu) Organs, but also stores pure essence like all Yin (Zang) Organs.
1. Stores and excretes bile.
Bile is considered a surplus of the Liver, a pure essence. The Gallbladder assists in digestion (bile helps digest fats via emulsification). It is mostly regulated by the Liver, but still works quite independently.
In dysfunction, e.g. Damp Heat, there can be a bitter taste in the mouth due to excess bile (accompanied by nausea).
2. Controls courage.
The Gallbladder is crucial in producing courage, particularly the type needed for making hard decisions. Just as its Wood complement, the Liver, is responsible for vision and strategy, the Gallbladder gives one the courage to act on the vision/strategy. In TCM, the Gallbladder is like a judge who needs to make correct choices which the crowds may not like.
Pathology: Gallbladder Qi Deficiency will cause a shrunken ability to act, or timidity.
3. Controls the movement of the sinews.
The sinews are the tendons and ligaments. Note the different roles of the Wood pair:
Liver -> Blood -> lubricates sinews
Gallbladder -> Qi -> creates movement of the sinews
Small Intestine : Minister of Reception
As mentioned in Day 9, the Small Intestine is responsible for separating the pure from the impure. At the time of its activity (1pm-3pm), it is time to start winding down after the peak of day, and to decide what can be done today and what should be left for tomorrow.
The Small Intestine enables us to prioritize, a quality of Fire Element. In dysfunction, e.g. ADHD, one is unable to focus and can’t pick out the needle from the haystack of other distractions.
Stomach : Minister of the Mill
1. Enables rotting and ripening of food.
The Stomach is one big fermentation crock. It contains both Fire/Yang, as well as Water/Yin, needed for fermentation. A common dysfunction of the Stomach is excessive Fire, resulting in: quick hunger (burns food up too much without deriving pure essence), thirst, foul smell (halitosis), bleeding gums (<- Yin Deficiency), and Rebellious Qi symptoms : heartburn / acid reflux, vomiting, nausea.
Typical Stomach dysfunction: Stomach Fire, Stomach Yin Deficiency (both Heat).
The Stomach sends Yang to the Spleen, while the Spleen sends Yin to the Stomach; they energetically balance each other out when healthy.
2. Controls transportation of food essences.
The Stomach works with the Spleen to provide food essences mainly to the muscles and limbs. Chronic fatigue/weakness in the muscles/limbs is the first sign of weakness of the Stomach.
3. Controls the descending of Qi.
See above diagram, blue arrows.
4. Is the origin of Body Fluids.
The Stomach is linked to the Large Intestine via an energetic channel. Imbalance can produce bloating and gas.
The Large Intestine moves impure substances (“dirt”) downward and excretes them as stool. The Large Intestine is associated with “letting go” while its Metal complement, the Lungs, is associated with “taking in”.
As Emotions can affect Organs, someone who is afraid of letting go, will also experience constipation. On the flip side, someone who has been abused will want to let go of the trauma and will tend toward diarrhea.
Bladder (urinary) : Minister of the Reservoir
The Bladder is Qi-powered by the Kidneys. It is also one of the Organs involved in the Qi transformation process (see diagram), separating pure from impure, and removes fluids from the body in the form of urine.
In dysfunction, ischuria (urine retention) can be caused by Bladder Dampness (-> urinary tract infection, UTI) or by Kidney Qi Deficiency (no pushing power).
Most of the pure essence/Qi refined by the Bladder goes upward to the Small Intestine.
San Jiao : Triple Burner/Heater/Warmer
1. Responsible for proper functioning of the 3 Jiaos.
The San Jiao regulates (1) body temperature, (2) movement of Body Fluids, and (3) the passage of Qi among the 3 Jiaos. During its peak time of 9pm-11pm, it is important to be laying horizontal (and asleep) in order for it to work best in cooling down the body (Yang -> Yin) for a good night’s sleep.
If the San Jiao fails to do its job, the body will face a serious, systemic problem (heat buildup in some areas, lack of heat in others).
2. Is an avenue for Original (Yuan) Qi.
There are 3 avenues for the Yuan Qi, one of which is the San Jiao. The other 2 are: the Kidney channels, and the Extraordinary Vessels (e.g. the Du + Ren, which are the reservoirs for surplus Qi and Blood).