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Traditional Chinese Medicine
Diagnosis in traditional Chinese medicine(TCM) forms a complex interwoven pattern or “clinical landscape” that attempts to understand, “what’s going on” for each patient, in a truly holistic sense. This is not a linear process that sees symptoms in isolation but weaves together an intricate pattern of imbalances that explains the whole problem.
Jing
Jing or ‘Essence’can be described as what we bring into the world. It determines our constitutional make-up and is formed at conception by fusion of the Jing of our parents. In western culture, this could be described as our DNA/genetic make up.
Jing has many functions in the human body
Jing determines our growth, maturation, development, brain function, constitutional strength and resistance to disease. It is said to be fixed in quantity but naturally declines with age. By living a moderate and balanced lifestyle, our Jing is preserved enabling a long healthy life. By living beyond our energy, working too hard, consuming too many stimulants, overloading our digestive system, not balancing our rest and activity, our Jing is depleted and we will age prematurely and our bodies suffer from disharmony. This disharmony leads to disease. Signs of poor Jing may include premature aging, early hair loss/graying, infertility, poor memory and weakening of the bones.
Qi
The concept of qi is complex. If we look at the Chinese character for qi, the upper part represents a vapour, steam or gas, whereas the lower part represents a cooking pot or uncooked rice. It therefore represents something both immaterial and material. The term ‘energy’ is usually used to translate this character and can be acceptable to modern physicists who appreciate the continuum of matter and energy. For diagnostic purposes, qi should be regarded as an physiological abstraction or metaphor and is used to describe the dynamic processes of the body.
Signs of Qi deficiency
Tiredness, weak voice, spontaneous sweating, lack of appetite, loose stools and poor immunity.
Blood
The term ‘blood’ is used in a broader sense in traditional Chinese medicine. It not only refers to the blood in our veins, but also menstrual blood and the deep nutrition of our body. Blood nourishes the tissues and organs especially eyes, hair and skin but also muscles and bones. It moistens the tissues of the body, provides a material foundation for the mind. It also anchors our spirit.
Signs of blood deficiency
There are many signs of blood deficiency including tiredness, anxiety, palpitations, dizziness, dry hair and skin, absent or scanty menstruation, insomnia and floaters in the eyes.
Shen
“It is the ‘spark of our being which shines through our eyes when we are truly awake”. The Shen refers to our consciousness or spirit, specifically the mind. In traditional Chinese medicine, the Shen is said to be housed by the heart. A healthy Shen is said to be evident by the ‘glitter’ or sparkle in a person’s eyes.
The eight principles of traditional Chinese medicine
Yin and Yang
The symbol itself has been adopted by popular Bohemian culture, yet it’s meaning within Chinese traditional medicine is both simple and profound. It represents the opposite yet complementary nature of things. This goes against the Aristotelian logic of western thinking, which is opposed to the idea of contraries. Yin and Yang represent the cyclical and symbiotic nature of things, the interdependence of each. It can be used to express the nature of all things, the universe, cycles of nature and of course the human body.
Yin
Yin is cooling, moistening and represented by quiescence, night-time and nutritive elements of the body.
Yin deficiency symptoms
These include feelings of heat in the palms, soles of feet, chest or face, night sweating, insomnia, nervousness and emaciation.
Yang
This is warming, drying, represented by activity and daytime and dynamic elements of the body.
Yang deficiency symptoms
These include tiredness and feelings of cold, frequent pale urination, lack of motivation and timidity.
Excess (shi) and Deficiency (xu)
It is important when making a diagnosis to determine whether a pattern represents an excess or a deficiency. In practice, the two conditions will often co-exist. This means it’s necessary to clear the excess whilst improving/tonifying the deficiency.
Excess
Not surprisingly, an excess condition refers to too much of something. This is best demonstrated in relation to pain conditions. An acute, stabbing pain relieved by movement would likely indicate an excess.
Deficiency
A deficiency is usually caused by overworking a particular body system or in some cases, by a constitutional weakness. To use the example of pain conditions, a dull, aching pain improved by rest would indicate a deficiency.
Interior and exterior
The distinction between interior and exterior conditions is really quite simple. Interior conditions are internal disharmonies rather than via an external influence such as a cold virus (pathogen).
Heat and Cold
Cold may occur due to a deficiency of Yang, the bodies warming energy or it can manifest as a result of an external pathogen or virus. Similarly, heat can occur as a result of excess of yang (full heat) or a deficiency of yin (empty heat) or as a result of an external pathogen.
The Five Zang
The five Zang are the Yin organs of the body, also paired with the Fu or Yang organs. The important distinction here is to understand that when talking about, the ‘liver’ we are not necessarily talking about the organ itself but the systems/functions associated with it. Below is some information on some of the more common patterns we come across in practice. There are many more and usually patients will present with a number of overlapping patterns of disharmony.
Zang Fu
There are complex inter-relationships between the Zang Fu. For example, when the spleen is overloaded or weak and unable to transform food and fluids, phlegm is produced. This can manifest in the lungs as excess mucus. Too much fatty or greasy food and/or stress can stagnate the liver producing excess heat. This heat flares up and injures the heart. When formulating a traditional Chinese medicine diagnosis, the aim is to find the root cause of the patients symptoms.
Liver
“Like a military commander formulating strategy and tactics, the liver exercises authority in collecting and directing the blood. Since blood is never stationary but constantly circulating, and since Qi courses through the body with the blood, the liver equitably distributes all resources, assuring the maintenance of smooth flow”. (ref Beinfield and Korngold, Between Heaven and Earth, Ballantine books, 1991 p105)
Liver and the flow of qi
The liver is associated with the flow of qi and blood around the body and is particularly prone to stagnation. This can occur through feelings of frustration and anger but also through overly stimulating foods as well as coffee and alcohol. The liver is associated with the element of wood that needs a sense of growth and flexibility. This in turn gives rise to a sense of self determination and control.
The liver’s main function is to store blood and in turn regulate hormonal balance. It is responsible for nourishing tendons and muscles and has a close relationship with the eyes. The emotion connected with the liver is anger. The Liver is most susceptible during the spring and is paired with the gall bladder. Liver qi is most commonly affected by stress as this interrupts the ‘smooth flow’ of processes in the body.
Symptoms of liver qi stagnation
This can include tension, irritability, anger, depression, abdominal distension, constipation, Irregular periods, painful periods and PMT/pre-menstrual breast distension.
Symptoms of liver blood stagnation
These may included irregular or late periods, severe menstrual pain and/or dark, clotted menstrual flow, heavy or scant menstrual flow (period not getting going) and fixed abdominal masses. As qi stagnates, so too does blood eventually.
Symptoms of liver blood deficiency
Lack of available nutrients in the blood gives rise to blood deficiency. Vegetarians who are not careful about getting good quality proteins in their diets are prone to this but so too are those who have a poor diet, suffer severe blood loss, for example during childbirth, ongoing heavy periods or who generally ‘work beyond their energy’.
Symptoms can include muscle cramps, spasms, muscle weakness, numbness and tingling in the limbs, dry hair and skin, hair loss, blurred vision, floaters, tired, dry or gritty eyes. Dry brittle or withered nails. Infrequent, scanty or lack of periods (amenorrhea). Dizziness, fainting, poor memory, tiredness, vivid dreams.
Heart
“The Heart is considered the ruler because like a benevolent and enlightened monarch, it is all knowing and ever-present, sharing it’s wisdom unconditionally for the good of the whole. Our fire aspect represents fulfilment: the total expression and integration of our being, the full extent of our expansion, maturation and development”. (ref Beinfield and Korngold, Between Heaven and Earth, Ballantine books, 1991 p109)
The heart governs the circulation of blood and the blood vessels themselves. The heart is said to house the Shen, our conscious mind which is particularly sensitive to emotions. The heart is most susceptible during early Summer and it is paired with the small Intestine.
Symptoms of heart qi deficiency
Heart qi is affected mainly by emotional strain and symptoms can include palpitations, shortness of breath, excessive sweating, general fatigue and weakness, stuffiness/suffocating feeling in the chest.
Heart blood deficiency
Symptoms may include palpitations, insomnia, dream disturbed sleep, anxiety and propensity to be startled and dizziness. Heart blood deficiency is usually seen as a progression of liver blood deficiency.
Spleen
“As a minister of agriculture oversees the production and distribution of farm resources, the spleen supplies the nourishment that sustains the organism. The raw material of food and experience is ingested, digested, and assimilated to fuel the life of the body and mind. This fuel, called nutritive essence, is extracted and converted into an abundance of qi and blood. Gathering and holding together is the dominion of Earth. Like Mother Earth, the spleen is the constant provider, the hearth around which the body gathers to renew itself”. (ref Beinfield and Korngold, Between Heaven and Earth, Ballantine books, 1991 p112)
The spleen is responsible for the transformation and transportation of food and fluids. Whilst it provides the raw materials to produce blood, it is said to also hold the blood and those with weak spleen qi may bruise easily or suffer prolonged uterine bleeding.
The spleen is said to maintain lightness and raises our qi and is most susceptible during late Summer. The emotion associated with the Spleen is worry. It is paired with the stomach.
Spleen qi deficiency
Spleen qi deficiency can be thought of as a general weakness of the digestive system, which can be caused by overeating or overloading ourselves with food. Putting too many demands on our bodies (through overwork both physically and mentally) without time for recuperation taxes the spleen and in time, it becomes weak.
Symptoms
These can included fatigue, anorexia, tired heavy limbs, abdominal distension after eating, loose stools, acid reflux, shortness of breath.
Symptoms of spleen yang deficiency
Spleen yang deficiency can be thought of as a coldness of the digestive system, also caused by overwork, which affects the yang of the body. Symptoms may include early morning diarrhoea, cold limbs, loose watery stools containing undigested food, mental fatigue.
Symptoms of spleen qi deficiency with damp
When the spleen becomes deficient, it becomes unable to process foods and fluids adequately enough, which gives rise to damp. This is most often caused by overeating, or eating too many heavy fatty foods. Symptoms may include oedema in limbs (especially legs) stuffy feeling in the chest, heavy limbs, weight gain.
Lung
“In the Lung, the Qi of Heaven (air) joins with the Qi of Earth (nutrition), forming the qi that vitalises human life. Like a minister who conducts affairs of state and determines territorial borders, the lung governs the relationship between the inside and the outside, setting limits and protecting boundaries. With restraint and delicacy, expanding and contracting, the Lung collects, mixes, and scatters the qi, instilling rhythm and order”. (ref Beinfield and Korngold, Between Heaven and Earth, Ballantine books, 1991 p117)
The lung ‘governs respiration’. The pure qi inhaled by the lungs combines with food qi extracted by the spleen to produce ‘gathering qi’ that provides support for the whole body. The lung supports the descending and dispersing of body fluids. The lung has a close relationship with the skin and body hair as well as the nose and voice. The qi of the lung maintains our connectedness with the real world. The emotion connected with the lung is grief.
The lungs are sometimes called the ‘delicate organs’ because of their susceptibility to invasion of pathogens (i.e. colds and flu). The lung provides our defensive qi likened to our immune system. Mucus in the lungs (other than infection) is caused by the inability of the spleen to transform food and fluids. Sadness, worry and grief weaken the qi of the lung. lung qi can also be weakened by life habits such as: sitting, bent over a desk which impair breathing, smoking and excessive use of the voice (i.e teachers, singers). The lungs are most susceptible during Autumn.
Lung qi deficiency
Symptoms may included shortness of breath, a cough, a weak voice. spontaneous daytime sweating, dislike of cold, bright white complexion and propensity to colds.
Lung yin deficiency
Smoking is probably the most common cause of lung Yin deficiency. Symptoms may included dry cough and heat signs in the late afternoon/evening.
Kidney
“The Kidney consolidates and stores the qi that initiates and keeps life growing. Like a minister of the interior who conserves natural resources, stockpiling essential raw materials for use in times of growth, crises, or transition, the kidney preserves what is essential, the essence, of human life. As well of vitality and endurance, the kidney is the germ of intellect, creativity, and houses our instinct to procreate and survive”. (ref Beinfield and Korngold, Between Heaven