TCM Diagnosis: Eight Principles

There are many different ways to diagnose patterns of disharmony in Traditional Chinese Medicine. One of the simplest diagnostic methods is known as the Eight Principles. It is a method of broadly, yet specifically, categorizing disease patterns that allows practitioners to develop concise and accurate treatments for even the most complex cases.

The Eight Principles consist of four pairs of opposing terms: yin or yang, hot or cold, excess or deficiency, and internal or external. Yin and yang serve to organize the six other principles. Cold, deficiency, and internal all belong to yin, while hot, excess, and external all belong to yang.

So, what exactly do these terms mean when it comes to the human body and the diagnosis of TCM patterns of disharmony?

Hot or Cold

The first set of principles describes the overall temperature of the disorder. For example, if a patient has a fever or feels hot, this is obviously a sign of heat. However, there are many other observable signs and symptoms in the body that are characterized as heat in Chinese medicine theory. In general, things with color (red rashes, flushed cheeks, dark urine, yellow or green mucus, etc) or odor (bad breath, strong smelling urine or stool) are seen as signs of heat in the body.

On the other hand, a patient who presents with a cold pattern might feel chilled or have a slightly lower than normal low body temperature. In addition, they could have a very pale complexion. Their hands, feet, abdomen, or other parts of the body might feel cold to the touch. They might experience large amounts of very light to clear urination, and if they have a cold they might notice that they have clear mucus when they blow their nose.

Excess or Deficiency

The next set of principles, excess and deficiency, describe the state of substances such as qi, blood, yin, and yang in the body. If a person’s pattern of disharmony is one of deficiency, they will most likely experience symptoms that are worse when they are tired or worn down. Pain will feel better when pressure is applied to it, because the pressure fills the lack of substance that causes the pain. If the patient does not have enough blood and yin, which moisten and nourish the body, they might experience dry eyes, dry skin, and brittle hair and nails. If the patient is deficient in qi or yang, they will likely feel very fatigued, as they do not have enough energy to get through the day.

In contrast, when a person has too much qi, blood, yin, or yang in their body — either overall or in a specific place — they will experience symptoms of excess. Painful areas will feel worse with pressure, because there is too much substance in that area. If a person has too much fluid (a yin substance) in their body, they may experience swelling, sensations of heaviness in their body, or have a lot of mucus or phlegm.

Internal or External

The next set of principles describes the location and/or origin of the disease. In TCM theory, disease can be located on the outside (exterior) of the body, or the inside (interior) of the body. Disease can also occur to influences from outside the body or from conditions within the body. Patterns of disharmony that would be likely diagnosed by your doctor as a viral illness like the common cold are seen as exterior disorders in TCM theory, because they involve an outside influence (called “pathogenic qi”) invading the superficial aspects of the body.

In contrast, patterns of disharmony that are classified as internal reside deeper in the body. These patterns of disharmony usually (but not always) arise from long term issues such as a poor diet, lack of exercise, chronic stress, or issues with a person’s constitution. Internal patterns of disharmony tend to be more long term and may manifest with chronic digestive issues, chronic headaches, gynecological issues, and many other troublesome symptoms.

Yin or Yang

This principle serves to describe the overall “flavor” of the disorder. A pattern that is cold, deficient, and interior is considered yin, while a pattern that is hot, excess, and exterior is considered yang. While some disease patterns may be purely yin or yang, it is much more common for a pattern of disharmony to have some elements of both yin and yang. By determining if a disease has more yin or yang elements, a practitioner can decide the best way to treat the pattern of disharmony that a patient presents with.

Combinations

While some patterns of disharmony can be neatly sorted into hot or cold, excess or deficient, internal or external, it is much more common (especially with long term disorders) for there to be mixed symptoms. A person can present with simultaneous symptoms of hot and cold or excess and deficiency. Additionally, an external disorder could be complicated by the fact that the person has a pre-existing internal disorder. This can make treating a pattern of disharmony very complex!

Luckily, there are some general rules about how patterns of disharmony should be addressed in TCM theory. While treatment strategy will vary on a case by case basis, generally, exterior patterns should be treated before internal patterns, as they are more superficial and easier to treat. Excess elements of a presentation should be cleared from the body before attempting to supplement deficiencies, since supplementing an excess symptom like lots of phlegm and mucus would only make the patient feel worse. When it comes to treating combined heat and cold, the practitioner must determine which is more severe, as cooling heat when the predominant symptoms are cold would aggravate the patient’s symptoms, and vice versa.

NOTE: This blog is meant for educational purposes only — please don’t try to diagnose yourself using it! If you have a medical issue, please seek guidance and treatment from a licensed medical professional.

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