From my perspective, one of the biggest barriers between the general public and widespread acceptance of Oriental Medicine practice is language. There is a language to this healing tradition that sound not only foreign, but downright scary to a western ear. Liver Qi Stagnation? Erupting Blood Toxins? Yin Deficiency? All of these sound like the patient may have serious cause for alarm and should be headed to the ER, not the acupuncturist’s clinic.  Now what if I said “Stress and Anxiety”, Rashes, and normal perimenopausal estrogen loss?  Is this better? 

In many cases these may be eastern and western equivalents. The language of Chinese Medicine has been around for around 4,000 years, while our modern English was developed between the 15th and 17th century AD. In all these millennia, Oriental Medicine (OM) practitioners have been working with patients and documenting, and developing a system of diagnosing and treating patients long before our really cool modern MRI’s, CT Scans and lab work. 

The language barrier was one of the greatest obstacles that I faced in school to become an Oriental Medical practitioner. My first career was as a scientist, and I favor precision in language and meaning. What the hell was Qi? What did it mean for someone to be “deficient”? I couldn’t relate to some of my fellow students were so comfortable in loose concepts and talked in ways that seemed to vague to me. 

So to that end, for the benefit of my own patients, I wanted to create a series of short writings that could help bridge the language gap between east and west, because ultimately I did come to a comfortable place with the OM way of seeing the body in health and disease. 

The Eight Principles

I decided to start with the Eight Principles, which is a basic set of binary filters used for to describe the natures of things for diagnostic purposes. The idea is that if you can apply this eight principle decision tree to a sick person, it will really help you get to a treatment protocol. Now this is somewhat oversimplified, but generally you won’t cause further harm to a patient if you stick to the eight principles and you will be able to make headway with their situation.  No matter the level of sophisticated training, when it’s a complex I often go back to these when determining a treatment pathway. This said, I do not ignore any western diagnostics I am given either, but use it where it’s useful.

What Are The Eight Principles?

These eight principles are “hot/cold”, “interior/exterior”, “yin/yang”, and “excess (full)/ deficient (empty). 

Yin-Yang

Yin-Yang deserves it’s own essay as they are concepts with deep and complex meaning. However, we can start with the others here. 

Hot/cold

Let’s take a person with a upper respiratory cold. We have all been there, and thus can relate.  Hot/cold describes a basic nature of the disease that is easy to understand. If you have a raging fever that has you sweating through your sheets, it’s a hot condition. If you are bone-chilled with teeth chattering no matter how many blankets you have, it’s a cold condition. Again, a bit of a simplification, but you get an idea.  

Interior/exterior

Next is interior/exterior. My favorite way to think of this is depth of disease penetration. For example, most colds start on the outside of the body—you catch a virus or bacteria through your nose. Then your body tries to fight it off, sometimes successfully. This is what an OM practitioner would call an “exterior” condition, and there are many strategies to help purge diseases at this stage. But, weeks later, you still have a lingering cough, it’s going deep in the chest and making you feel totally debilitated..now that disease is “going interior”. Some diseases, like organ pathologies, may start in the interior of the body, and these are generally thought of as more serious than an exterior condition. OM practitioners use different acupuncture, treatment styles and herbal formula based on whether a condition is interior or exterior. 

Full/excess and deficient/empty

Full/excess and deficient/empty are the most complex topics we will address today. These also describe not only the nature of disease but also of its’ presentation in the patient, and the progress of the disease.  Going back to our common cold ideas, a full /excessive condition could be represented by a chest cold that has really made the lungs feel tight, heavy, full of inflammation and phlegm; there is an aggressiveness to the nature of the pathogen and disease presentation. Think that the condition is acute and “strong”.  Now, fast forward six months that that same patient now has weak, damaged lungs, gets easily winded with mild exertion, has a weak, non-productive lingering cough, has lost overall vitality. The virus/bacteria or infectious state may not actually be present; but the body has been left debilitate and is now way more vulnerable to other disease conditions. This is more an idea of a deficient condition- it refers more to the body’s weakness in either (or both) the  ability to defend itself, or to perform it’s usual functions (like breathing easily, digesting efficiently, providing muscles with energy). 

Now disease states can be combined to allow the practitioner to make a more refined diagnosis (and treatment plan). Thus, we can have a patient with an external, full hot condition in the lungs, but we can also have an external, full cold condition. How? This is where signs and symptoms come in. Certain symptoms are thought of as “hot” (yellow phlegm, fever, parched throat) while others are more “cold” (clear thin or white mucus, sense of cold, pale skin). Sounds simple enough, but in reality most patients are a mixed bag of symptoms and the OM practitioner spends a lot of time deducing the true nature of the illness -what is the “root: cause, and what is a “ branch” symptom? And which to treat first? 

This is just a simple overview into some basic differential diagnostics used by OM practitioners and certainly doesn’t cover many advanced diagnostic methods. I plan to cover many more topics in the future, so please subscribe below, or ask a question!