Yin and Yang in Diagnosis

As I pointed out in a previous article, health is a balancing act. So, determining which direction the body is out of balance in any given situation is an important key to determining which remedies will help restore health.

Traditional Chinese Medicine (TCM) uses eight basic diagnostic principles based on the concept of yin and yang as shown in the table. The first two pairs of opposites—hot and cold, and damp and dry—are also used in Western herbalism. Heat and dryness are associated with yang, which is associated with fire in both Eastern and Oriental philosophy. Cold and dampness are with yin, and is associated with water in both traditions.

In Western philosophy, heat and dampness are associated with air, while cold and dryness are associated with earth. There is no corresponding idea in Chinese medicine.

But, in every case, it’s important to look at these basic energetic imbalances whenever we are selecting remedies. Here are just a few examples of how understanding these principles has helped me. 

A Case of Painful, Burning Urination

I had a client once who was having problems with urinary urgency and the desire to urinate frequently. He experienced painful, burning urination, and because of this, he was avoiding drinking water in an attempt to urinate less often. 

He was also taking a urinary formula someone had recommended. The formula was what I call a  “kitchen sink blend." It contained a bunch of different remedies that are good for the urinary system without any thought to how they help the urinary system.

Many of the ingredients in the formula he was taking were stimulating (warming) diuretics such as juniper berry. These warming remedies work by slightly irritating urinary passages to increase the flow of urine. His symptoms suggested urinary inflammation or heat, so heating herbs were exactly opposite of what he needed.

I made two recommendations. First, I told him to drink a lot of water. He needed more water to dilute the irritating substances in his urine. True, this might make him pee a lot for a day or two, but as the urine became more dilute, it would be less irritating.  Second, I gave him some soothing urinary herbs to cool the irritation (heat) in the urinary passages. I don’t remember which herbs I gave him, but they were herbs like marshmallow and cornsilk. He followed my suggestions and experienced some relief.

The Importance of Energetics in Herbal Formulas

I’ve worked with an herb company for many years and have seen them make what I considered poor decisions in reformulations. These reformulations were often necessary because an ingredient became scarce or difficult to source in the quality they wanted. Their science team, none of whom were herbalists or understood herbal energetics, would choose ingredients that unintentionally altered the way the formula worked.  

For example. They had a formula based on John Christopher’s version of Samuel Thomson’s herbal composition formula. The blend, which I have made myself, contained two astringents with aromatic properties—bayberry rootbark and white pine bark. These remedies tone and dry mucus membranes. They loosen phlegm and help expel it. The formula also contained smaller amounts of ginger, capsicum, and cloves.

When they couldn’t source white pine bark, they replaced it with mullein. Mullein is a cooling and moistening herb that has the opposite action of white pine bark. Thus, they unintentionally completely altered the way the blend worked. I would have picked another drying respiratory herb with resinous properties instead, such as yerba santa or gumweed.

Later, after pestering them about these things, they started consulting with me on formulation changes. So, in another instance, where they needed to replace bugleweed in a formula designed to cool and soothe intestinal irritation, they told me they were considering replacing it with ginger. So, they wanted to replace a cooling, slightly drying herb with one that was pungent or heating. I was able to get them to pick peppermint and chamomile instead. 

That’s why these assessment ideas like the eight basic diagnostic criteria in traditional Chinese medicine (TCM) are so important, both in formulation and in application.

More Chinese Yin-Yang Diagnosis

Besides the hot, cold, damp, and dry assessments, TCM uses acute versus chronic and interior versus exterior (or superficial). We readily recognize the difference between acute illness and chronic illness in the West, so I won’t dwell on that one, but we don’t recognize the interior versus exterior categories.

External conditions result from some type of outside influence, such as a pathogen, that enters the body through the mouth, nose, or skin. Symptoms are of sudden onset and typically involve fever or acute inflammatory reactions. So, if you got into a patch of poison ivy and your skin broke out in a rash, that would be an external condition. The common cold would also be considered external in the early stages. Typical clinical symptoms of such conditions include headache, fever, chills, muscle aches, sinus congestion, runny nose, itchy throat, red eyes, and a floating pulse (one that is easily felt on the surface of the skin.

These diseases are supported by helping the body clear away the offending invader to prevent the disease from getting deeper into the system. For example, a cold can move from acute sinus congestion into a deeper respiratory problem like pneumonia.

Internal conditions are ones that cause pathological changes in internal organs, blood, and qi. These diseases may be caused by external pathogens, but often involve stress, poor diet, and other poor lifestyle choices. These conditions are more varied in their treatment, because the appropriate therapy depends on which organs and systems are involved. 

Of course, this is just an introduction to these diagnostic criteria in TCM, but I hope it gives you food for thought and helps you recognize that selecting appropriate herbal remedies depends on more than just saying, “these herbs are good for the [heart, lungs, stomach, etc.].” You need to assess how the body is out of balance before you can figure out what you need to do to bring it back into balance.