The importance of the role of pattern differentiation in Chinese medicine cannot be overstated. Some go so far as to say that Classical Chinese Medicine is “pattern medicine.” What on Earth can that mean? I think about it in a few ways. First, Chinese medicine takes patterns very seriously. I don’t think most Chinese medicine physicians have theoretical discussions about what constitutes causality. Nor do they seem to be interested in carrying out complex calculations about the distribution of particular disease states across space or time. Despite this apparent failure, Chinese medicine practitioners through history have been interested in the correlation between disease states and other features of the human environment. They have taken a keen interest in the rise and fall of particular conditions in particular places at particular times. Second, a strong feature of our medicine is the perception of subtle patterns in a seemingly hopelessly complex tangle of symptoms and subjective feelings. Where other medical systems throw out the pieces that don’t fit, good Chinese medicine practitioners are always mindful of the “stray” symptoms. They always seem to come into play at some point. Finally, Chinese medicine relies on patterning to allow relatively quick training of practitioners. This can go too far, as it has in many iterations of contemporary Chinese medicine.
Taking all of this into consideration, I find the idea of patterns to be an interesting one. Recently in a class about pharmacology, we began to discuss the role of the imagination in medicine. All human beings have imagination – though some of us are more skilled in using ours than others seem to be. Our professor began to get us thinking about imagination as being especially useful in becoming aware of patterns. How does that make sense to me? Well, let’s look briefly into the meaning of “imagination”:
imagination |iˌmajəˈnā sh ən|
the faculty or action of forming new ideas, or images or concepts of external objects not present to the senses
ORIGIN Middle English : via Old French from Latin imaginatio(n-), from the verb imaginari ‘picture to oneself,’ from imago, imagin- ‘image.’
Taking this definition at face value, what my professor was saying makes lots of sense. The pattern is not present to the senses. Which is to say that I cannot point to anything that is, for instance, “Yang Ming disease.” I do take in a large amount of data (pulse, tongue, color, sound, odor, presenting emotion, symptoms, lab results, subtle information heretofore undefined) through my various senses, but this thing Yang Ming disease is never taken in. It is a concept, an organizing concept. In some real sense, Yang Ming disease is not there. It is an unbelievably useful structure that I can use to order the data I am taking in and craft a treatment that is a response to the disease state being presented by my patient. My ability to grasp this imaginative construct is crucial in my efficacy.
We can take this further, though I get a little weak in the knees as I depart from that relatively solid conceptual ground. We can use structures like Yang Ming disease in a way that is imaginative, or we can turn them into prisons from which no healing can escape. Let’s take Yang Ming disease as an example. The defining line of Yang Ming disease in the Shang Han Lun states:
In Yang Ming disease, the Stomach family is full.
Boy, talk about a range of possible interpretations. We can look deeply into the characters, we can look at all instances in the history of Chinese medical texts of those characters, we can look at all the Yang Ming formulas and see how they treat this “fullness” of the “Stomach family,” we can do many things in order to understand the statement. But, if we don’t let our imagination run free, our efforts may never bear fruit. Once we have obtained all of that data as I listed above, we must let our minds explore. What would the Stomach family being full do in terms of psycho-emotional disturbance? What images come to mind when we consider the Stomach family being full? What is our subjective experience of this disease state?
I believe this kind of activity, while perhaps not good material for scholarly publication, is crucial to my development as a Chinese medicine practitioner. It helps me to understand the formulas and point protocols more fully, not to mention nourishing me deeply as a human being. I also believe that the use of imaginative faculties is, at least in part, behind the brilliance of ancient Chinese medical theory.
I’m interested in hearing how others think about this issue. It’s a small thing, perhaps, but interesting to consider.
Eric
Related posts:
{ 11 comments… read them below or add one }
Wow! Very thought provoking.
My first thought with stray symptoms in a pattern is that we aren’t looking at a big enough pattern to see where they fit.
I think that the idea of using the imagination to really understand is a wonderful way of thinking. Unfortunately I think many people get so caught up in needing an “explanation” and an assurance that their theory is correct that they loose the value of this wonderful tool.
If practitioners understand Chinese physiology, i.e., sanjiao energetics, as elucidated in the Neijing, they do not need to use TCM pattern differentiation in order to diagnosis.
There is no such thing as “stray” symptoms for practitioners who understand sanjiao energetics.
I agree that there truly are no “stray” symptoms. They simply appear to be stray symptoms from the perspective of strict Zang Fu pattern differentiation (and other systems when strictly interpreted).
I find that using the six conformation system allows me the correct perspective to understand all symptoms. Anonymous, I’m glad to know that Sanjiao energetics provides you with that kind of perspective. Bonnie – what system do you find helps you in this way?
Eric
I don’t have a particular system. I think I would probably say I use my imagination! :).
Of course also being familiar with a lot of different types of patterning–6 stages, TCM, Five Element and being willing to look at things from the different perspective helps. Sometimes it’s also a matter of getting to the know the patient better–there are times when they leave things out, and will mention something as they get to know you and that can totally change your perspective.
For me, it’s always realizing that when I have something that doesn’t fit that I’m missing something and trying to be mindful that I don’t have the whole picture. When you really focus on the patient, you can still do a great deal of good even if you don’t have the “perfect” diagnosis–and very often that mindfulness will get you to the diagnosis that is “perfect”.
I am reminded of a statement attributed to Picasso:”I don’t seek, I find.”
I feel the pulse. That allows me to approach the miraculous as Thoreau describes it:
“Could a greater miracle take place than for us to look through each other’s eyes for an instant?”
Hi Bonnie,
I am curious to find out what you mean by imagination. Does that include intuition and using your senses to interpret non-verbal information or information given on a subconscious level?
Also, I am wondering if you or any Chinese medicine practitioners reading this would like to comment about the benefits and the drawbacks to using multiple differentiation systems simultaneously in a clinical setting. I bring this up because it is something that I would like to understand more. I feel that maybe some good could come if I were to know and be able to use yin/yang, 4 layer, 5 element, 6 conformation, and 12 zang-fu. Is it good practice to just pick and choose depending on the client in front of us and how we see the disease process manifest? Ideally, I think we could use all these simultaneously if we know and understand them well.
I bring this up because in class last week one of my teachers mentioned that it throws off the treatment and progress of patient if you switch in the middle of a treatment. She was referring to a case study we were discussing in which the practitioner seemed to do 1 or 2 5 element treatments and then switched to TCM style treatment for the next several visits. Have other people out there observed or experienced the advantages or disadvantages of proceeding in this way with treatment methods? I know many practitioners use TCM, 5 element, and Japanese style, so maybe some of these people can speak from experience.
Blessings,
Delli
Hi Delli,
Great questions!
In my opinion, Chinese medicine places no special preponderance on emotions or mental states, specific methods of diagnosis or treatment, pattern fitting or stereotyping. It is the study of what causes health. Furthermore, each person is unique and specific pathological processes may only occur once in any given patient and may require that ANY OR ALL of the following systems be examined and used in order to arrive at a correct diagnosis and treatment: yin and yang; the wuxing (the five movements or phases); the jingluo (the principal channels and their collaterals and their internal and external trajectories as well as the longitudinal, muscle, capillary channels); the distinct channels; the baqimai (the eight curious vessels); the liuqi (the six energies, i.e., taiyang, shaoyang, yangming, taiyin, jueyin and shaoyin); the zangxiang (the organs and their associations); and sanjiao energetics (the production of ying, wei, jing and jingshen; the production of blood and organic liquids; thermogenesis and hydrogenesis).
There really is no such thing as TCM, Five Element Acupuncture, or Japanese Acupuncture per say because they’re all based on Chinese medical concepts. It’s all Chinese medicine. In other words, it’s not like TCM, Five Element Acupuncture, or Japanese Acupuncture treatments play by different macrocosmic and microcosmic rules. Does that make sense?
Hi Eric,
Why did you delete my post?
Delli,
I’d say yes it is intuitive in the direction I go. I know that I pick up things that I can’t verbalize at any time and so if I’m moved to do a point, I usually will.
I will also clarify in using different systems–I try not to change in the middle of a course of treatment–unless someone develops say a wind cold or wind heat and I might look at that as separate from main issue that brought them to me. Also, if they’ve had an emotional upset and are really ungrounded I might go towards a 5 element type treatment rather than my more usual treatment style, which is that I was went to a TCM school and the one practitioner I ALWAYS go to see if he’s in town is Dr. Tran.
I’ve been thinking about this post a lot and the “stray symptoms”. I think that for me very often only through treatment do we peel back enough layers to see the underlying cause of the problem and only then can we really treat. Once I have that–I tend to treat based on that diagnosis–unless I have a branch treatment that must take precedence (ala the wind cold or emotional upset)–and use points that I have learned to help that.
Eric,
Why did you delete my post?
Hey Grasshopper,
Relax! Noone deleted any posts. Comments have to be moderated the first time. Sometimes even later posts get put in the moderation queue. I’m in finals and haven’t had time to approve all the comments that have come in. Take a deep breath. :)
Eric