ISO/TS 17948:2014 health information traditional chinese medicine literature metedata

Courtesy: ISO/TS 17948:2014 health information traditional chinese medicine literature metedata

In TCM, “pattern” (证; zhèng) refers to a “pattern of disharmony” or “functional disturbance” within the functional entities of which the TCM model of the body is composed. There are disharmony patterns of qi, xuě, the body fluids, the zàng-fǔ, and the meridians. They are ultimately defined by their symptoms and signs (i.e., for example, pulse and tongue findings).

In clinical practice, the identified pattern usually involves a combination of affected entities (compare with typical examples of patterns). The concrete pattern identified should account for all the symptoms a person has.

Six Excesses

The Six Excesses (六淫; liù yín,sometimes also translated as “Pathogenic Factors”, or “Six Pernicious Influences”; with the alternative term of 六邪; liù xié, – “Six Evils” or “Six Devils”) are allegorical terms used to describe disharmony patterns displaying certain typical symptoms. These symptoms resemble the effects of six climatic factors. In the allegory, these symptoms can occur because one or more of those climatic factors (called 六气; liù qì, “the six qi”) were able to invade the body surface and to proceed to the interior. This is sometimes used to draw causal relationships (i.e., prior exposure to wind/cold/etc. is identified as the cause of a disease), while other authors explicitly deny a direct cause-effect relationship between weather conditions and disease, pointing out that the Six Excesses are primarily descriptions of a certain combination of symptoms translated into a pattern of disharmony. It is undisputed, though, that the Six Excesses can manifest inside the body without an external cause. In this case, they might be denoted “internal”, e.g., “internal wind” or “internal fire (or heat)”.

The Six Excesses and their characteristic clinical signs are:

1. Wind (风; fēng): rapid onset of symptoms, wandering location of symptoms, itching, nasal congestion, “floating” pulse; tremor, paralysis, convulsion.
2. Cold (寒; hán): cold sensations, aversion to cold, relief of symptoms by warmth, watery/clear excreta, severe pain, abdominal pain, contracture/hypertonicity of muscles, (slimy) white tongue fur, “deep”/”hidden” or “string-like” pulse, or slow pulse.
3. Fire/Heat (火; huǒ): aversion to heat, high fever, thirst, concentrated urine, red face, red tongue, yellow tongue fur, rapid pulse. (Fire and heat are basically seen to be the same)
4. Dampness (湿; shī): sensation of heaviness, sensation of fullness, symptoms of Spleen dysfunction, greasy tongue fur, “slippery” pulse.
5. Dryness (燥; zào): dry cough, dry mouth, dry throat, dry lips, nosebleeds, dry skin, dry stools.
6. Summerheat (暑; shǔ): either heat or mixed damp-heat symptoms.

Six-Excesses-patterns can consist of only one or a combination of Excesses (e.g., wind-cold, wind-damp-heat). They can also transform from one into another.

Typical examples of patterns

For each of the functional entities (qi, xuĕ, zàng-fǔ, meridians etc.), typical disharmony patterns are recognized; for example: qi vacuity and qi stagnation in the case of qi; blood vacuity, blood stasis, and blood heat in the case of xuĕ; Spleen qi vacuity, Spleen yang vacuity, Spleen qi vacuity with down-bearing qi, Spleen qi vacuity with lack of blood containment, cold-damp invasion of the Spleen, damp-heat invasion of Spleen and Stomach in case of the Spleen zàng; wind/cold/damp invasion in the case of the meridians.

TCM gives detailed prescriptions of these patterns regarding their typical symptoms, mostly including characteristic tongue and/or pulse findings. For example:

• “Upflaming Liver fire” (肝火上炎; gānhuǒ shàng yán): Headache, red face, reddened eyes, dry mouth, nosebleeds, constipation, dry or hard stools, profuse menstruation, sudden tinnitus or deafness, vomiting of sour or bitter fluids, expectoration of blood, irascibility, impatience; red tongue with dry yellow fur; slippery and string-like pulse.

Eight principles of diagnosis

The process of determining which actual pattern is on hand is called 辩证 (biàn zhèng, usually translated as “pattern diagnosis”, “pattern identification” or “pattern discrimination”). Generally, the first and most important step in pattern diagnosis is an evaluation of the present signs and symptoms on the basis of the “Eight Principles” (八纲; bā gāng). These eight principles refer to four pairs of fundamental qualities of a disease: exterior/interior, heat/cold, vacuity/repletion, and yin/yang. Out of these, heat/cold and vacuity/repletion have the biggest clinical importance. The yin/yang quality, on the other side, has the smallest importance and is somewhat seen aside from the other three pairs, since it merely presents a general and vague conclusion regarding what other qualities are found. In detail, the Eight Principles refer to the following:

• Yin and yang are universal aspects all things can be classified under, this includes diseases in general as well as the Eight Principles’ first three couples. For example, cold is identified to be a yin aspect, while heat is attributed to yang. Since descriptions of patterns in terms of yin and yang lack complexity and clinical practicality, though, patterns are usually not labeled this way anymore. Exceptions are vacuity-cold and repletion-heat patterns, who are sometimes referred to as “yin patterns” and “yang patterns” respectively.
• Exterior (表; biǎo) refers to a disease manifesting in the superficial layers of the body – skin, hair, flesh, and meridians.It is characterized by aversion to cold and/or wind, headache, muscle ache, mild fever, a “floating” pulse, and a normal tongue appearance.
• Interior (里; lǐ) refers to disease manifestation in the zàng-fǔ, or (in a wider sense) to any disease that can not be counted as exterior. There are no generalized characteristic symptoms of interior patterns, since they’ll be determined by the affected zàng or fǔ entity.
• Cold (寒; hán) is generally characterized by aversion to cold, absence of thirst, and a white tongue fur. More detailed characterization depends on whether cold is coupled with vacuity or repletion.^[
• Heat (热; rè) is characterized by an absence of aversion to cold, a red and painful throat, a dry tongue fur and a rapid and floating pulse if it falls together with an exterior pattern. In all other cases, symptoms depend on whether heat is coupled with vacuity or repletion.
• Deficiency (虚; xū), can be further differentiated into deficiency of qi, xuě, yin and yang, with all their respective characteristic symptoms. Yin deficiency can also cause “empty-heat”.
• Excess (实; shí) generally refers to any disease that can’t be identified as a deficient pattern, and usually indicates the presence of one of the Six Excesses, or a pattern of stagnation (of qi, xuě, etc.). In a concurrent exterior pattern, excess is characterized by the absence of sweating.