In my practice, nearly all my patients come in with a pre-existing Western Medical diagnosis of a imbalanced/pathological state, such as GERD (acid reflux) or insomnia. I always take this information in, as it’s useful, and as an American who culturally grew up in the western medical system, I can understand quickly what the patient is trying to convey to me about how they feel and why they are there.
However, I then generally proceed with what I fondly call my “TCM Interrogation”, where I will ask all sorts of questions that may or may not seem to be related to their chief complaint. For example, for my “insomnia” patient I will ask many questions about the timing and pattern of their insomnia, how they tend to sweat/not sweat, do they run hot/cold, and examine their tongue. Why do I do this?
One Disease, Many Patterns
In Traditional Chinese Medicine there is a concept of “one disease, many patterns, and it’s opposite- many diseases, one pattern”. What this means is that while western medicine may label the overall chronic tendency to have disturbed sleep cycles as “insomnia”, in TCM we look at this as “one disease (disrupted sleep patterns) with a potential underlying wide variety of patterns that cause it (such as Heart Yin Deficiency, Heart Blood Deficiency, Heart Fire Blazing Upwards, possibly complicated by Liver and Kidney Yin deficiency heat. WHAT?? Heart is on fire? This sounds serious! `At this point the confused patient may reconsider if that person that warned them TCM doctors were all a bunch of quacks were correct! PLEASE- read on!
In the reverse situation, of many diseases, one pattern- a patient comes in complaining of raging diarrhea with some blood, and this can be multiple diseases- for example an infectious type diarrhea caused by a bacteria could present with exact same symptoms as ulcerative colitis, which is not a bacterial infection but an autoimmune disease. In this case, the acupuncture, dietary therapy and herbal formulas to treat and control the acute diarrhea may initially be the same, and later, once the crisis has passed, if needed a more nuanced approach will be taken to address the underlying cause.
Organs in Traditional Chinese Medicine
This brings me to a basic explanation of “organs” in TCM theory. Lets take the liver, for example. In TCM, when a practitioner mentions the liver, they can mean both the literal liver organ tissue that helps with bile and hormone production and detoxification, or they can mean the metaphorical liver, which refers more to emotional and hormonal regulation. Now, there are some overlaps here between TCM and western medicine. We know the liver as an organ is instrumental in sex hormone production, and in TCM, anytime you work to regulate any menstrual cycle issue you will address the liver channel using acupuncture and herbs. In TCM, additionally the liver (along with Heart) are also considered key for emotional regulation. Anyone who has been an emotional teenager can attest that hormones can wreak havoc on the emotions. The “TCM interrogation” will help me sleuth out if the emotional upset is due more to the metaphorical liver imbalance, or more of an emotional heart issue, which will lead to both different acupuncture point prescriptions and different herbal formulas.
Six Pathological Factors of Traditional Chinese Medicine (TCM)
This is where the six pathological factors come in. In TCM there are categories of “pathogenic factors” that can result in disease states. A key thing to note is that TCM practitioners also recognize that the climate/seasonal condition and diet can all strongly influence (both encourage OR discourage) the development of these pathological factors. The factors are: Wind, Dryness, Cold, Hot, Fire, Dampness and Phlegm. These factors can cause imbalanced states in either the physical or metaphorical organ system. Next, I will describe each of these and give examples. Some of the concepts are more unusual than others for a western reader.
Hot vs Cold
Hot vs Cold: These are the two concepts perhaps easiest for a western audience to understand. A hot pathology often refers to a inflammatory state, such an angry swollen toe in gout, or infected sore on the body, a feverish viral infection. Tissue is often red, hot, inflamed, and patients may have a fever, or feel a burning or heat radiating out of their body. In reverse are cold conditions, where an arthritic joint or muscle ache that gets worse when the weather gets cold, a visceral pain in the abdomen that feels better with a heating pad pressed on it and worse with icy drinks.
Fire is a often an acute exacerbation of a hot condition. Think of very high fevers, severe acid reflux that is scorching the esophagus and leading to a constant need for cold drinks or antacids.
Dryness vs Dampness
Dryness vs Dampness: Dryness is rather self explanatory; people experience this when they have a chronic dry mouth and throat, husky dry cough, dry eyes, or skin/hair that stubbornly refuses to be moisturized but is rather dry and flaky.
Dampness is a more difficult concept but a VERY important one. Its manifestations are things like achy muscles, tender spots in muscles, bloating, edema, sluggish digestion, sticky stools, a tendency to have a lot of mucus in the head or lungs, chronic sleepiness, foggy headed thinking.
Thus dampness can present in many body systems and I have come to think of it as a state where overall systems are not running smoothly and there is a backup of circulation, poor fluid metabolism, and an overproduction of thicker body fluids like mucus. I most often see “damp” presentations in my patients who are having some sort of issue metabolically that is manifesting as retaining fluid, bloating or who’s bodies get achy and sore with mild to moderate activity.
For me, damp presentations are like a kitchen sink sponge that is saturated with dirty water- it can kind of clean up a mess, but not very well, and there is a lot of “stagnant” aspects that are breeding grounds for bacteria. So with herbs and acupuncture, I try to stimulate the body’s ability to “wring out its sponge of the lymphatic and metabolic/endocrine system.
Phlegm
Phlegm is an exacerbation of Damp like Fire is an exacerbation of Heat. Think of a pot of sauce left on a stove too long, that becomes, thick and congealed. In TCM, phlegm refers to more than just the stuff you cough up out of your lungs. It’s a bit of a catch-all category for unexplained things in TCM that seemed to be “bothersome accumulations” like lipomas, goiters, stubborn persistent weight gain, and even the troubled, unclear thinking that accompanies many severe mental illnesses.
In my next article I will talk about the organs/meridian systems as understood in TCM.