RR School Of Nursing

Theory of Traditional Chinese Medicine

he theory of Yin-Yang, Five Phases (Wu Xing), Zang-Fu system and pat-

tern differentiation form the theoretical core of TCM. Chinese herbal theory is closely related to these theories and is one of the components of the complete TCM system. To understand clinical application of the herbal substances, it is necessary to understand these basic theories.

1. Yin-Yang Theory and the Eight Principal Patterns

Yin and Yang are ancient Chinese philosophical concepts. Originally, Yang meant the sunny side of a hill, while Yin meant the shady side of a hill. The concept of Yin and Yang was later extended to any two opposite things or phenomena that nourish each other, supplement each other, and transform to each other. The logic in this theory, called synthetic or dialectic, assumes a part can be understood only in its relation to the whole. This dialectical logic explains relationships, patterns, and changes of the world, and this gradually de-

table 2. Relationship of Yin and Yang

Yang

Earth

Night

Autumn, Winter

Cold

Female

Obscured

Downward, inward Interior, abdomen, lower body bones, sinews Blood

Space

Time

Season

Temperature

Gender

Brightness

Motion

Anatomy

Body Part

Physiology

Activity

Function

Spring, Summer

Heaven

Spring, Summer quietude weakness veloped into the theory of Yin-Yang. The general relationship of Yin and Yang is illustrated in table 2.

Traditional Chinese Medicine recognizes many patterns of disharmony in the human body. All of them, however, can be classified into eight groups, known as the Eight Principal Patterns. The Eight Principal Patterns are composed of four pairs of polar opposites: Yin/Yang, Interior/Exterior, Cold/Hot, and Deficiency/Excess. The Yin/Yang pair is the basis of the Eight Principal Patterns, while the other three pairs are actually a concrete subdivision of Yin and Yang into six sub-categories (table 3). To distinguish the eight patterns based on the signs and symptoms is actually to determine the Yin-Yang imbalance of the body, and therefore, is one of a physician's major tasks. An herbal formula, to balance Yin and Yang of the body, is prescribed according to the pattern differentiation. In general, herbs with pungent, sweet, or neutral taste belong to Yang, while those with sour, bitter, or salty taste belong to Yin.

2. Theory of the Five Phases (Wu Xing) and the Organ System

The Theory of the Five Phases is a universal classification of phenomena using five quintessential processes, represented by Wood, Fire, Earth, Metal, and Water. The Five Phases are not elements that are specific types of matter, but are functional processes (phases). This system of correspondences and patterns table 3. General Signs for the Six Subcategories of the Eight Principal Patterns

Patterns Exterior

Interior

Cold

Yin/Yang Yang

Yin Yin

Yang

Deficiency Yin

Excess

Yang

General Signs

Fever, aversion to cold, headache, general aching, stuffy running nose, cough

High fever, irritability or coma, thirst, abdominal pain, constipation or diarrhea, vomiting

Slow, deliberate movement, withdrawn manner, white face, fear of cold, cold limbs, pain lessened by warmth, watery stool, clear urine, no thirst or a desire for hot liquids Quick, agitated movement, extroverted manner, red face and eyes, high fever, irritability, thirst and desire for cold liquids, constipation, dark urine Frail and weak movement, ashen pale, or sallow face, shallow breathing, pain that is relieved by pressure, spontaneous sweating, copious urination or incontinence

Ponderous, heavy movement, loud and full voice, heavy, coarse respiration, pressure and touch increase discomfort, scanty urination

Tongue

Thin and white tongue coating

Thick tongue coating

Pale and swollen tongue material with white or most moss

Red tongue material with yellow moss

Pale tongue material with little or no moss

Thick tongue moss

Pulse

Floating pulse Deep pulse Slow pulse

Rapid pulse

Empty, thin, or otherwise weak pulse

Strong (wiry, slippery, or full) pulse defines events and things, especially in relationship to their dynamics. More specifically, each phase is an emblem that denotes a category of related functions and qualities. The Wood Phase is a growing phase and is associated with active functions. Fire designates functions that have reached a maximal state of activity and are about to begin to decline or to enter a resting period. Metal represents functions in a declining state. Water represents functions that have reached a maximal state of rest and are about to change the direction of their activity. Finally, Earth designates balance or neutrality. In a sense, Earth is a buffer between the other phases.

Ancient Chinese believed that a micro-system, such as the human body, is part of the macro-system of Heaven and Earth. The theory of the Five Phases was considered to be a general rule for the cosmic system. Thus, it can be applied on many levels—to color, sound, taste, emotions, as well as to the organ system in TCM (table 4). The organ system is the core of physiology in TCM

table 4. The Theory of the Five Phases

Five Phases	Wood	Fire	Earth	Metal	Water
Zang	Liver	Heart	Spleen	Lung	Kidney
Fu	Gallbladder	Small Intestine	Stomach	Large Intestine	Bladder
Sense Organ	Eye	Tongue	Mouth	Nose	Ear
Tissue	Tendon	Vessel	Muscle	Skin and hair	Bone
Emotion	Anger	Joy	Pensiveness	Grief	Fear
Season	Spring	Summer	Late summer	Autumn	Winter
Climate	Windy	Hot	Damp	Dry	Cold
Color	Blue	Red	Yellow	White	Black
Flavor	Sour	Bitter	Sweet	Pungent	Salty
Direction	East	South	Middle	West	North

theories. It includes five Zang organs and six Fu organs. Zang organs are Liver, Heart, Spleen, Lung, and Kidney, while Fu organs are Gallbladder, Small Intestine, Large Intestine, Stomach, Bladder, and Three Heaters. The relationships among Zang and Fu organs can be derived from the theory of the Five Phases. During clinical practice, herbal formulas are prescribed according to the pattern differentiation using Zang-Fu theory and other related diagnostic theories.

3. Pathogenic Factors, the Six Pernicious Influences, and the Seven Emotions

The Six Pernicious Influences are the environmental, or exogenous, factors that play a part in disease. They are phenomena described in climatic terms: Wind, Cold, Summer Heat, Damp, Dryness, and Fire. The healthy body is a balance of Yin and Yang. When the balance is upset, Yin and Yang are unbalanced. The body is then susceptible to the harmful effects of a Pernicious Influence, which becomes harmful when the body has an inappropriate relationship to it. Also, if climatic variations occur too rapidly and violently, these become exogenous factors, which may attack the body and cause disease. Different factors have different characters and may lead to different symptoms (table 5).

The Seven Emotions are endogenous factors that may cause disease. The seven are: joy, anger, sadness, pensiveness, grief, fear, and fright. Chinese physicians have always recognized that emotions play a part in health and illness. The emotional life cannot be separated from the physical. Of course, emotional table 5. The Six Pernicious Influences

Pathogenic	Prevail	Yin/
Factors	Season	Yang	Characteristics	Symptoms
Wind	Spring	Yang	Moving, ascending, dispersing, upward, outward, unsteady and change	Headache, dizziness, facial paralysis, lose consciousness suddenly, skin itching occurs at no fixed places
Cold	Winter	Yin	Easy to damage Yang, coagulateand obstructive, astringent	Aversion to cold, pain and cold feeling in abdomen, various kinds of pain, fever, no sweating, muscular cramp, and difficult joint flexion and extension
Summer-Heat	Summer	Yang	Scorching heat, ascending and dispersing, easy to damage Qi and Fluid, accompanied by dampness	High fever, upset, full rapid pulse, shortness of breath, lassitude, loss of consciousness, thirst, vomiting, and nausea
Damp	Late summer	Yin	Heavy and turbid, viscous and lingering, downward, easy to obstruct Qi and damage Yang	Heavy sensation of the head and body, lassitude, loose stool, turbid urine, excessive leukorrhea, tongue with greasy coating, difficult urination, eczema, chest congestion, diarrhea, vomiting, and nausea
Dryness	Autumn	Yang	Dry and easy to damage Fluid, easy to damage the Lung	Dry mouth and nose, dry throat, dry skin, dry cough, and chest pain
Fire	Summer	Yang	Scorching and burning, ascending, easy to damage body Fluid and Qi, easy to promote Liver-Wind, irritate the Heart and Spirit, accelerate the Blood circulation	High fever, aversion to heat, constipation, red tongue with yellow coating, upper body symptoms such as red tip, toothache, blood-shot eyes, dry mouth and throat, convulsion, stiff neck, various bleeding, mania, insomnia, restlessness, and unconsciousness

qualities are not in themselves pathological, and all of them appear in healthy individuals. It is only when an emotion is either excessive or insufficient over a long period of time, or when it arises very suddenly with great force, that it will generate imbalance of the body and cause disease. The reverse is also true: internal disharmony in the body can generate unbalanced emotional states. Based on the theory of the Five Phases, each emotion is related to a particular

Zang-Fu organ (table 4). By adjusting the Yin-Yang balance of the organ system with a proper herbal formula, emotional problems can be solved.

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