Understanding TCM Terminology and Diagnosis

Traditional Chinese Medicine (TCM) utilizes a unique language and terminology that is difficult for other cultures to understand. Understanding a little of the roots of this medical language helps the patient become more in touch with the TCM physician and the framework for holistic diagnosis. In essence, this unique terminology was created so that complicated issues in disease and physiology could be communicated with few words, or characters in the Chinese language.

The words Qi, Yin and Yang bring to mind ideas of an esoteric and almost spiritual connotation to most Americans, yet these words were created in the Chinese language to express concrete ideas. This confusing situation has led many health professionals over the years to assume that TCM was nothing more than an esoteric quasi-medicine that only dealt with a balancing of some unseen cosmic energy. This is far from the intent of the early physicians in China and the modern Chinese M.D.s that practice this complementary medicine. Instead, these word were created to express fundamental ideas of complex physiology in the body. By using diagnostic terms that bring us back to fundamental concepts, or universal paradigms, the language helps the physician to see the body as an interconnected system, or holistic mechanism. The challenge for the modern medical doctor and the patient is to gain a basic understanding of these conceptual terms.

In China and many other Asian cultures these terms of Traditional Chinese Medicine have concrete meaning to a majority of the population. Indeed, the flag of South Korea uses the ancient symbol for the fluid motion of Yin and Yang, and the words Qi, Yin and Yang are often seen in common use. To better understand these terms outside of Asian culture, one must understand the context of the language itself. The Chinese language is perhaps the oldest original language left on our planet, and is composed of pictorial characters rather than letters. This use of characters allows the Chinese culture to express concrete ideas that are very complicated and dependant on the context of the surrounding characters. Originally, sentences in Chinese script had no punctuation marks, and the reader could infer a separate meaning of a character when it was combined with the preceding character or the following character. Complex ideas could then be notated with minimal use of characters. Of course, this language was created in a time when only scholars knew the written language and before the printing press made a written text accessible to a large number of people. Originally, these symbols would be read by a person that was also familiar with the writer and knew the conceptual context of what was written. The pictorial symnbols for concepts such as Qi, Yin and Yang had specific meanings that were linked to the author. In time, these words eventually assumed cultural significance and were more easily understood in various contexts. Modern use of these terms is still dependant on the context of their use, and the specific meanings can vary widely depending on the context of the subject being discussed. This is some of the historical framework for the reasoning behind the use of key words in TCM diagnosis and terminology.

Examples of the use of TCM terminology in diagnosis

Typical root diagnoses in TCM read like this with American translation: Liver Qi Stagnation, Kidney Qi deficiency, Spleen Qi deficiency, Yin deficiency, Imbalance of the Ying and Wei Qi, Damp Heat invading the channels etc. This terminology expresses ideas that are so broad and dependant upon the condition of the individual patient that even advanced students of the medicine may remain somewhat unclear on the exact meaning when applied to a specific case. Patients would like a simple explanation of why they are diagnosed with Liver Qi stagnation or Kidney Qi deficiency and are often nonplussed with the explanation. Often, explanations in English language texts are far from satisfactory in explaining these typing diagnoses because they start with the assumption that each term means one specific thing. The truth is that each term may express far different meanings depending on the context of the use.

Qi is a word that was created to express a fundamental physical attribute that had no solid form that we could see or grasp. This is somewhat like the word electron, or the word energy, in our language. An electron is a quantifiable particle of energy, yet has no real form, and is in continuous motion from one atom to another. Your electrons move from your body's atom to another person's atoms continuously, yet there is a balanced exchange of electrons that maintains the physical form that your atoms create. In modern terms we express energy with terms like calorie, which actually is not a tangible substance, but a measure of heat energy, yet everyone uses the term and calories are listed on food packaging.

Energy is a word that may mean many different things in science, depending on context, yet always adheres to fundamental laws of nature. So too, Qi is a word that signifies the energetic function of the body and all life in the universe. Its character is composed of the symbols for aether, or gas, above an alchemical furnace, and hence denotes the basic energy of the animal derived from transforming foodstuffs into oxygen, carbon dioxide and other gaseous and charged molecules. In essence, this is how our body works. Food, water, air, sunlight radiation etc. are taken into our body and utilized in such a complex way that we may never fully understand the complete physiology. Qi is a word that expresses the results of this energetic physiology and keeps us in touch with the fact that we need to restore this basic energetic physiological function whenever we see disease and dysfunction causing problems. It keeps the practice of TCM centered on a medical goal of not only solving the specific health problem, but always maintaining a focus on restoring optimum health and preventing future health problems. TCM is thus not just a preventative medicine, but a medicine that always incorporates preventative medicine into the healing protocol.

Qi is therefore a conceptual word that refers to fundamental energetic function in the body, but is not a static concept. The use of the word is flluid and can be applied to any context in physiology or anatomical location. One good example of the use of this fluid and universal concept of Qi lies in the phrase Liver Qi. In TCM, the word for liver, gan, can be used in context to mean either the organ itself or the physiological system that is rooted in the organ. Since the liver organ is responsible for a great amount of the key metabolic transformations in the body, the liver system refers to the metabolism of lipids (cholesterol), proteins (amino acids and enzymes) and sugars (carbohydrates and glucose). The liver organ is the main catabolic detoxifier in the body, breaking up circulating chemicals into basic components and then reassembling these components into useful chemicals in the body. When chemicals that are foreign to the body metabolism arrive in the blood, the liver may not be able to efficiently recognize these chemicals (pollutants, toxins and drugs) and will try to excrete them via bile or attached to another carrier chemical (such as a low density lipoprotein, or 'cholesterol'). When the process is too unusual for the body the unfamiliar chemical may be stored with the lipoprotein in our fat cells. Accumulation of toxins in the body occurs in this way. This is an example of Liver Qi. Cholesterol imbalances, gallstone formation, cirrhosis, dysfunction of inflammatory mediators due to imbalance of essential fatty acids (omega 3 and 6), triglyceride imbalances, liver enzyme imbalances, etc. are all examples of Liver Qi pathology.

We can see that when one patient is diagnosed with Liver Qi stagnation and another patient is also diagnosed with Liver Qi stagnation that this may mean very different things in the context of the patient and the condition of the patient. When your friend says that his acupuncturist diagnosed him with liver Qi stagnation and explains why, this explanation may or may not have anything to do with your condition, except that you both have a problem with the liver or liver system function, or Qi. Qi is a word or term that completely depends on the intelligent context of its use. This intelligent context is best understood and explored by the diagnosing physician, and hence, if this physician simply writes Liver Qi stagnation as the diagnosis, this lacks enough specific meaning to inform the patient or another physician of what is exactly wrong with the patient. For this reason, a combination of modern terminology combined with the TCM terminology is essential. The physician may state that the patient has essential hypertension related to Liver Qi stagnation. In this way, we know that the specific problem being treated is essential hypertension, and the underlying problem is Liver Qi stagnation. The physician works to correct both the symptom of high blood pressure and the root dysfunction of inadequate liver system function, or metabolic concerns such as high cholesterol.

Yin and Yang are also words that have no specific meaning outside of a context. The simplified characters for these concepts depict the sunny side of a hill and the shady side, implying that the yin, or shady side, will become the sunny side as the earth moves around the sun, transforming yin to yang and yang to yin. In the body physiology this could be seen in hormonal function, with yin being the substance of the hormones and yang being the function of the hormones. The substance, or chemical, transforms into an activity in the body, and that activity then transforms the chemical substance into a different molecule. Hormones are in constant states of change and transformation, conjugating with carrier proteins and uncoupling when specific receptor proteins accumulate around this conjugated hormone. The hormone itself does not cause the specific chemical action at the target cell, but instead acts as a trigger in a situation dependant upon the chemicals and charged molecules around it. A problem with the yin of the hormonal system would imply a problem with deficiency of excess of hormonal substance, and a yang hormonal problem would imply a deficiency or excess of hormonal activity or function. In treating a Yin deficiency pathology, we might stimulate increase in production of progesterone or testosterone, and in treating a Yang excess pathology, we might try to achieve better function of the hypothalamus, or thyroid hormone receptors.

These terms denote a sort of quantum physics approach to the problems of pathophysiology and holistic medical approach. Not only the specific dysfunctions are examined, but the underlying diversion from homeostasis, or normal systematic function in a healthy individual, is considered. The goal is always to both relieve the symptoms and to restore homeostasis. In TCM we call this attention to both the root and the branch, and this is a fundamental precept of the science. It has always been written in classic texts of TCM that the superior physician will diagnose and treat according to the principles of Yin and Yang, and that the best practice of medicine will incorporate preventative medicine, diagnosing imbalance of Yin and Yang, and correcting this imbalance, before the health problem arises. The treatments in TCM are not limited to balancing of Yin and Yang, or homeostasis, but also are directed at relief or correction of specific localized problems.

The basics of TCM terminology are rooted in the concepts of Yin and Yang, and these terms do have concrete meanings in terms of signs and symptoms. General signs of Yin deficiency include dryness of the skin, mouth or membranes, poor control of body temperature with sudden heat flush to the head or upper body and unusual sweating, or deficiency in blood quantity or quality. Yin is always seen in relation to Yang. Body fluids, such as blood, joint lubricants, lymph and sweat, are more Yin than Yang, and solids parts of the body, such as bones, tendons, etc. are more Yang. Deficient production of blood cells, proteins or fluids are thus seen as a Yin deficiency. The fatique that results from blood deficiency may be seen as a Yang deficiency. YinQi refers to the functional Yin components and generally refers to the Kidney and Adrenal systems, while YangQi refers to the functional Yang aspects of our physiology. Yin deficiency will usually result in poor control of Yang, and overexuberance of Yang, such as heat flush to the upper body, high blood pressure or anxiety. Consequently, Yang deficiency, often seen in debility or aging, will often result in a poor production and regulation of Yin, such as blood and key metabolites. In this way the TCM physician is always keeping the big picture in mind when looking at your health problems and not overlooking critical components of the condition. We may see this as a practical rather than esoteric reason for TCM terminology.

Integrating TCM Terminology into Modern Medicine

In the modern medical world, the problem of communcation arises in the TCM system. So much attention is paid to TCM classification and terminology in TCM study, that there is often less attention paid to the modern medical terms. Adding to this problem is the concept of 'Alternative Medicine' which has created an idea of choice between TCM and modern medicine. This has further complicated a problem that is intrinsicallly complex. TCM medical schools teach modern medicine and terminology and stress the importance of understanding this system of disease and injury classification and diagnosis. Yet, the problem of thorough integration is still complicated by the language. Fortunately, over time there has been much progress in achieving improved education of the TCM physician, who is called a Licensed Acupuncturist in official designation, and the TCM medical schools are insuring the the graduates can integrate and communicate with modern medical doctors on a much higher level today than in the past.

For the patient and modern physicians to fully understand and communicate with the TCM physician, the TCM physician must speak intelligently using modern and commonly understood terms. For the TCM physician to understand the patient descriptions of their health problems and the diagnoses and findings of modern physicians, that TCM physician must rely on the commonly understood terminology. This is something that has been achieved in TCM care and continues to improve as the science becomes more integrated and complimentary to modern medicine. Everyone, patient, medical doctor and Licensed Acupuncturist can now work together in an effective complementary manner to improve the overall health care and reduce health care costs to the nation with preventative medicine and low cost Complementary Medicine. Everyone must work together to achieve this goal, though, gaining understanding and integrating care.

TCM terminology applied to a specific health problem

An example of the integration of TCM terminology into modern medicine would be the diagnosis of high blood pressure due to adrenal stress. In this common form of essential hypertension, modern medicine may use an ACE inhibitor combined with a diuretic. ACE inhibitors are angiotensin converting enzyme inhibitors. This implies that there is a poor regulation in the body of the angiotensin, a protein hormone that is produced in the blood when stimulated by a hormone, renin, produced by the kidney in response to blood pressure. Renin also affects other adrenal hormones (such as diuretic hormone) as well as the nervous system and its control of vascular constriction and relaxation. Angiotensin is converted to an active form by an enzyme in the lung, the angiotensin converting enzyme, and hence the drug strategy to lower blood pressure. The diuretic hormone acts to excrete more fluid from the blood volume, thus also lowering blood pressure. This is an example of Kidney Yin affecting Yang. The chronic deficiency of Kidney Yin, or blood volume, stimulates increased renin, which stimulates angiotensin and increased unwanted blood pressure.

While this explanation is complicated, the real complication is even more elaborate, because the body acts so holistically, and there are a number of systems affecting the renin-angiotensin system. The precursor to angiotensin is a chemical that is produced mainly in the liver, angiotensinogen. Angiotensinogen levels may rise due to a number of factors, including stimulation by corticosteroids, estrogens and thyroid hormones, or treatment with synthetic corticosteroids, estrogens and thyroid hormone. Increased angiootensinogen may result in higher levels of angiotensin and hypertension. Here we see that healthy function of the liver and attention to the side effects of medications may be an effective part of the holistic therapy.

Renin is also stimulated by an adrenal hormone aldosterone, which mainly regulates the sodium and water content in the body. More aldosterone is released in response to water retention and sodium levels in the blood, or outside of the cells. We see that a number of problems with body systems may be part of the problem here. Water retention may occur in hormonal imbalances, especially in women premenstrually or in pregnancy, causing a potential rise in aldosterone and subsequent rise in renin, angiotensin and blood pressure. Antidiuretic hormone, secreted in the brain by the pituitary, may be deficient, thus stimulating more aldosterone release. Pituitary hypothalamic dysfunction may occur due to a number of problems, including a subclinical hypothyroidism or even chronic pain or emotional pathologies with depression and anxiety. Our diets may include a low quality table salt, which increases circulating sodium levels, whereas quality sea salt, with a variety of chemicals more natural too the body, would result in a healthy utilization and excretion of sodium and less aldosterone. The TCM physician sees this whole problem as a complex condition of imbalance of the Yin and Yang, and seeks a variety of ways to correct it.

We see then, that the TCM physician may be taking into consideration a large number of factors when making the diagnosis and forming a treatment protocol. The real choice by patients in these situations is whether to take the simple pill to manage the problem, or to also seek the complementary care to correct the array of potential dysfunctions and contributors in the body. Complementary Medicine with its holistic and conceptual approach can improve the overall outcome of your therapy with an integrated medical approach. In a way, both the modern medical doctor and the TCM physician are useing terminology for the same ultimate purpose, to simplify the treatment strategy. The modern doctor simplifies the situation in his terminology by saying that you have hypertension and we'll try taking a combination of ACE inhibitor and diuretic. The TCM physician tries to simplify the situation by expressing the problem in terms of Yin and Yang and organ systems of the kidney and liver. In this sense we see a similar pattern of trying to expressively simplify a complex physiological dysfunction in the body. The patient, of course, has a difficult time understanding the underlying concepts and terms of both the M.D. and the Complementary physician. The terminologies are not meant to oppose each other, though, but rather to help to quickly elucidate, diagnose and treat, and the patient must place some trust in both the M.D. and the TCM physician.

Hopefully, the patient may gain some understanding of both the modern terminology and diagnosis and the TCM terms. My belief is that with difficult problems, patient education and a pro-active approach is very important. Hopefully, the patient's primary medical doctor will also gain some understanding of TCM terminology and approach and see this as a way to improve outcomes and help their practice.

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.

Above: Acupuncture Points
— Photo by Michele Clement