How it Works: Chinese Medical Diagnosis

Heat, Cold, and Dampness:
The most basic concept in Chinese medicine is the concept of Hot and Cold, and dampness. Excessive consumption of spicy foods, excessive exposure to direct sunlight, and other habits like smoking can lead to heat build up in the body. Consumption of cold foods like ice cream or regular exposure to cold temperatures in the environment can cause cold to build up in the body. For most people the concept of heat and cold is a easy one to grasp, but a slightly more complicated diagnosis is dampness. Dampness can cause lassitude, foggy thinking, and slow digestion. Dampness is usually the result of poor diet consisting of greasy foods, alcohol, and/or raw (cold) foods that have damaged the spleen's ability to perform its digestive functions.

Excess and Deficiency
When we are young our bodies have an excess of qi and blood, but as we get older the excesses fade into deficiency. Along the way we may experience a mixture of excess and deficiency in the body that can become more BALANCED through the practice of Oriental medicine. For instance some people have excessive blood accumulation in the lower body (resulting in varicose veins) while simultaneously presenting with deficiency symptoms in the upper body (such as dry eyes). Some patients presenting with low back pain can have huge bulging muscles in the upper back with almost no muscle tone in the lower back. There are literally endless possibilties here. The key to improving your health is learning to recognize and correct imbalances, thereby restoring your body to a balanced state of well-being.

Other Key Elements of Diagnosis:
No discussion on Traditional Chinese Medicine (TCM) would be complete without exploring the basic concepts of yin, yang, and the five elements. These concepts help to define the very categories which lead to your Chinese medical diagnosis. So let's start with the basics...

The Concept of Yin and Yang
Yin and Yang are ways of describing the universe, and also your body which exists within the universe. Yin is considered to be at rest, while yang is considered to be in motion. Children are considered to be more yang than their elderly counterparts. Winter is more yin than any of the other seasons, while the Summer is the most yang of any season. Yin is considered to be female while yang energy is thought of as male. It may help to start with the analogy of night and day. If yin is night, than yang is day. If yin is the moon, then the sun is yang. Sounds simple, right? And in some ways it is... but if really want to understand Oriental medicine then there a few key concepts about yin and yang that you should understand.

  • Yin and Yang are relative to themselves
  • The concept of inter-dependence
  • The concept of mutual consumption
  • Understanding the Opposition of yin and yang
  • Understanding the Tranformation of yin and yang (into each other)

To first understand that yin and yang are relative to themselves let's start with the day and night example from above. If yin is night then yang is day, correct? Yes, true. But what about early morning compared to high noon... which is more yang? Compared to the morning, high noon would be considered more yang. When the sun reaches its highest point in the sky it would be considered to be the maximum-yang point in time for that day. Similarly midnight would be considered maximum Yin for that night. Likewise 10pm would be less yin than midnight, and so on.

Next let's explore the concept that Yin and Yang are also inter-dependant. At the core of this concept is the principle that one could not exist without the other. Continuing with our example, the night could not exist without the day time. If there were no day then it would always be night. If it were always night then yin and yang would not exist. Without its opposite, the other could not exist.

Yin and yang are also mutually consumptive - that is to say they consume each other as they change. As the sun approaches highest noon, the yin of the morning is decreasing. When the sun hits high noon then yin is at its lowest point. But once the sun passes high noon then night time is once again approaching, and the yin has once again begun to increase just as the yang has begun to decrease.

Similarly Yin and Yang are mutually transformative whilst being in direct opposition to each other. The day transforms into night just as the night transforms into day. Extreme heat will transform into cold, while extreme cold will transform into heat. If you'll notice the Tai Ji symbol (that famous black and white circle you've seen many times that makes you think of China) you'll see that it embodies this principle of mutual consumption. The Tai Ji shows not only black in opposition to white, but also that a white dot exists in the center of black (and vice versa). Oriental medicine teaches that the only thing that is constant is change itself.

How Yin and Yang Relate to Your Health:
Yin and yang are concepts that can be used to describe the functioning of your body, its organs, and its disharmonies. Yin deficiency can affect organs such as your liver, heart, and spleen. While yin deficiency indicates an organ that is not getting enough deep rest, yang deficiency indicates an organ that is not able to get up and go. Someone who has an excess of yin might sleep too much, while a yang excess type of person may find it impossible to relax from their daily activities. Liver yang personalities tend to be compulsive workaholics with short tempers. Yang deficiency symptoms might include lassitude or feelings of coldness in the body, while yin deficiency could manifest as insomnia or hot flashes. Traditional Chinese medicine is very complex, and there are dozens of diagnosis related to either excess or deficiency of yin and yang in the various organs. What you need to understand is that yin and yang represent a way of seeing the world, the universe, your body, and your health. By classifying your body into a category of disharmony, the disharmony can then corrected back into harmony using acupuncture, Chinese herbs, nutrition,Tuina, and practices like Qigong. Like the five elements system described below, yin and yang are like a pair of glasses for your practitioner. They're just a way of understanding the world (so that you can begin to change it!)

The Concept of Five Elements
In addition the yin and yang, Chinese medicine teaches that the body is made up of five elements (Metal, Water, Wood, Fire, and Earth). Organs are also related to each other. Each organ system pair is related to one of the five elements as desribed below.

  • Stomach and Spleen are Earth
  • Lung and Large Instestine are Metal
  • Kidneys and Urine Bladder are Water
  • Liver and Gallbladder are Wood
  • Heart and Small Intestine are Fire
  • Pericardium and San Jiao are Fire

As you can see there are twelve major organ systems in Chinese medicine, and each organ system pair is related to one of the five elements. Like the concept of yin and yang the five element system is a way of seeing the world - a pair of glasses that your practitioner can use to understand and adjust patterns of disharmony. It is not the purpose of Chinese medicine to be absolute, but to be relative. Five element diagnosis is simply a theory that helps to explain disharmonies in your health. By implementing the five element system of medicine your practitioner can change the way in which your body functions, which in turn can lead to a cure for disease.

The five elements control each other, and generate each other at the same time. They can also insult each other and overact upon each other. Because this guide is meant as a simple introduction, lets just look at the two most simple sequences below: generating and controlling.

The Generating Sequence of Five Element Theory
Remember that this is just a theory that's used to explain patterns of disharmony. The generating sequence explains how increasing (tonifying) one element can lead to an increase in its child element. Just as earth generates metal on our planet, so will tonifying the earth (spleen and stomach) tonify metal (lung and large intestine). And just as water will condense and form droplets on a metal surface, tonifying metal generates water within the body. Trees of course can not grow without water which is why tonifying water (kidney and urine bladder) will generate wood and tonify the liver and gallbladder. Wood (liver and gallbladder) in turn is used to generate fire that can then tonify the heart, small intestine, pericardium, and san jiao. And just as the earth's core is made of fire, fire generates earth to tonify the spleen and stomach.

Controlling Sequence of Five Element Theory
The last sequence we will examine in this article is the controlling sequence of Chinese medicine. While the generating sequence explains how to tonify a given organ system, the controlling sequence explains how to reduce a given organ system. To understand how each element controls its counterpart consider the following analogies. Wood controls earth by covering its surface, while the hot fire of a forge can be used to control (melt) metal. A Metal axe controls trees made of wood by chopping them down, and water controls fire by extinguishing it. Finally earth can control water by soaking it up, just as the great floods will slowly recede as the water sinks into the earth. Therefore if we want to reduce the amount of water in your system we can start by tonifying the Spleen and Stomach (Earth).

The Concepts of Qi and Blood
To conclude our introduction to Chinese medical diagnosis let's examine two final concepts: qi and blood. Keep in mind that this is not an exhaustive discussion of Chinese medical diagnosis, but merely an introduction to several key concepts. Your practitioner may very well have more information for you when you visit his/her office, but its important for you to be armed with some basic knowledge before beginning your healing journey.

The Concept of Qi - Qi is simply a word for energy: the life force that animates all things. The Chinese character for Qi symbolizes the steam that is rising off a bowl of rice. You can't always see it, but you can feel it. Coming from a strictly analytical point of view you could think of qi as electricity within the body, but the Chinese concept of qi is more broad and more advanced. Qi is not only electrical, but could also be magnetic, thermal, gravitational, or chemical. Anything the moves and changes is motivated by qi. Western biology seeks to understand processes at a cellular level by explaining ATP synthesis and the Krebb's cycle, but Chinese medicine is concerned with the person as a whole and so it does not dote on the microscopic details. In Chinese medicine every part of the body is seen as related to, and a reflection of, another part of the body. This is why the whole body can be treated with auricular acupuncture (acupuncture of the ear).

The Concept of Blood - Perhaps more simple to understand from a Westerner's perspective is the concept of blood. Blood is of course, simply speaking, the blood that flows through your veins, nourishes your body, and powers your organ systems. Just as you may have an excess or deficiency of yin and yang, you may also have an excess or deficiency of qi and blood. Blood excess may manifest as stagnaton in the legs, creating edema and unsightly vericose veins. Blood deficiency can lead to dryness, dim vision, heart palpitations, and poor memory. Qi deficiency can lead to fatigue, shortness of breath, or poor intestinal motility. Overall qi excess is generally only seen in young children, and can manifest as wild or reckless behaviour.

Clinically speaking people are rarely simply suffering from "qi deficiency" or "qi excess" but rather they have a relative deficiency in one organ system and an excess in another. Excessive liver qi can manifest as liver qi stagnation which causes symptoms like irritability, moodiness, and PMS. The diagnosis of liver qi stagnation often present alongside spleen qi deficiency which in turn shows up as gas, bloating, foggy thinking, and poor digestion. In the case of liver qi excess alongside spleen qi deficiency the practitioner can diagnose the person as having relatively too much qi in the liver and not enough qi in the spleen. Specific acupuncture points, nutrition advice, and Chinese herbs can then be prescribed to help the whole person return to greater harmony and experience less disease.

This introduction to Chinese medical diagnosis is not intended as a comprehensive guide, but aims to provide you with enough basic information to feel comfortable talking to your acupuncturist. Check out some of our other articles to read more about Manual Therapy, Chinese Nutrition, Chinese Herbs, and other treatments that are available within the scope of Oriental medicine.

The information on the web site does not constitute medical advice, and you should always consult your doctor for medical advice before taking any action to do with your health. By using this web site you agree to our terms and conditions of use.

Justin Hays, LAc, MAOM

JL Hays