The fourth category of disease classification depends on the patient’s physiological response to the disease, enabling the physician to understand where and what is wrong with the patient. He determines which organ or meridian systems are diseased, and what pathogenic factors are responsible. It does not matter whether he starts with the “where” or the “what” factors; the conclusion is similar.
For example, by examining the patient’s nose, face, pulse and numerous other features of the four diagnostic techniques, the physician may conclude that the disease is located at the lungs, and symptoms like yellowish phlegm, thirst, back pain and a strong pulse rate indicate that the pathogenetic cause is fire. The disease, therefore, is described as excess fire at the lungs. This classification is very popular, as it enables the physician to treat the cause and site of illness directly. In this case, the main therapeutic principle is to dispel fire at the lungs, and it can be realized in many ways to be explained in later chapters. The example here is simplified for readers’ easy understanding; real cases are often more complex, but the underlying principles are the same.
The internal organs and their meridians involved are the heart, small intestine, liver, gall bladder, spleen, stomach, lung, colon, kidney, urinary bladder, pericardium, and triple warmer. They are examined against pathogenetic factors like cold, heat, empty, solid, yin and yang deficiency. It must be pointed out again that pathological terms like “cold” and “heat” should be interpreted symbolically, not literally; this apparent “strangeness” is as much the result of linguistic and cultural discrepancies, as of different medical thinking.
The following is only a brief description of the symptoms and other features that Chinese physicians employ for their classification. Not all disease types are shown.
In Chinese medical philosophy, disease of the heart system concerns the circulatory and the nervous systems. Symptoms of illness due to “cold” at the heart include pain at the heart, cold limbs, and slow pulse. Dry and painful tongue, and feeling of oppression in the chest indicate disease caused by “heart-fire”. Illnesses resulting from “yin-deficiency of the heart” are indicated by being easily frightened, loss of memory, and sleeplessness.
Disease at the small intestine can usually be divided into the “empty, cold” type or the “solid, hot” type. “Empty, cold” illness of the small intestine is indicated by clear urine, purging, stomach pain, weak pulse and whitish fur on tongue; whereas “solid, hot” illness is reflected in reddish urine, swollen abdomen, pain at waist and spine, sore tongue, and yellowish fur on tongue. “Empty” and “solid” here refer to the weakening of physiological functions, and the potency of pathogenic agents respectively.
The common pathogenetic causes of liver diseases are cold, heat, empty or solid conditions. Cold illness of the liver system shows the following symptoms: spasm, pain at the genitals, slow and sunken pulse, and smooth and greenish fur on tongue. Pain at
the ribs, swollen and reddish eyes, sleeplessness, reddish tongue, and frequent pulse show hot illness of the liver. Sound in the ear, blurred eyesight, lacklustre nails, weak pulse, and pale tongue without fur indicate illness caused by deficient liver energy. Pain at the ear, crimson tongue, yellowish fur on tongue, strong pulse, and being easily prone to anger show that the illness is due to excessive liver energy. Hence, if your ears are painful but your ear specialist finds nothing wrong with them, you should start examining your liver system.
Disease at the liver system often affects the gall bladder system; therefore there are many similarities between the two. Headache, vomiting, flatulence, sleeplessness, and weak pulse are common symptoms of energy deficiency of the gall bladder. Excessive gall bladder energy is indicated by bitter taste in the mouth, chill alternating with fever, blurred eyesight, hearing loss, and rapid pulse.
“Dampness” is a very common pathogenetic cause of the spleen system. Insufficient yang resulting from “dampness” and “cold” are manifested as abdominal pain, purging, inability to digest food, slow and sunken pulse. Spleen illness due to “dampness” and “heat” are yellowish fur on tongue, short yellowish urine, solid and rapid pulse, and excessive body fluid. Generally, sweet taste in the mouth is indicative of spleen system problem.
The spleen system and the stomach system are closely related; hence illnesses at one system often affect the other system. Symptoms of stomach illness caused by yang deficiency are abdominal pain, tastelessness, wanting to vomit, cold limbs, slow and sunken pulse. Excessive fire in the stomach is indicated by great thirst, hunger, smelly breath, and bleeding gums.
Illness of the lung system is often manifested in the nose, throat and skin. When “cold” and “wind” attack the lung, the symptoms are blocked nose, cough, thin and whitish phlegm, whitish fur on tongue, and floating and smooth pulse. If the lung is attacked by “fire”, symptoms are reddish face, yellowish phlegm, phlegm with blood, thirst, chest and back pains, whitish spots on throat, yellowish fur on tongue, and strong pulse. Lung illness due to deficiency of yang energy is indicated by shortness of breath, pale face, cold limbs, frequent urine, cough, dry skin, hair dropping, weak and empty pulse.
Symptoms like liquid faeces, clear and long urine, abdominal pain, whitish fur on tongue, and weak pulse indicate cold diseases of the colon. Solid faeces, short urine, pain at the anus, yellowish fur on tongue, and frequent pulse show that the colon illness belongs to the hot type.
Diseases of the kidneys are often manifested in the eyes, ears and genitals, and are more often “empty” rather than “solid” in nature. Nocturnal emission, tinnitus, lumbago, dizziness, blurred eyesight, red tongue without fur, weak and rapid pulse indicate yin deficiency of the kidney system. Its yang deficiency is shown by symptoms like premature ejaculation, impotency, flaccidity of lower limbs, and chilliness at waist and legs. Women who fail to bear children despite trying hard, and despite being repeatedly told by gynaecologists that they are clinically normal, may have amazing
results after consulting Chinese physicians regarding their kidney system.
Sickness concerning the urinary bladder system is often reflected in the urine. Clear, frequent urine shows cold urinary bladder disease, whereas short, painful urine shows the disease is of the hot nature. Uncontrollable urination indicates empty illness; congested, painful urination indicates solid illness. However, although the diseases may be at the urinary bladder system, they are frequently related to the lung and the kidney systems.
In this classification of diseases according to the organ systems, the pericardium and the triple warmer are not mentioned because diseases of the pericardium system are similar to those of the heart system, and since the triple warmer contains all the other internal organs, its diseases are included in these organs.
This classification concerns not only physical but also psychological diseases, as the Chinese have always regarded the soma and the psyche as one unity. Perhaps western doctors and psychiatrists may derive some insight from the Chinese concept that emotional disorders are related to physiological ailments.
A useful approach to this classification is to apply the Eight Principles of cold, hot, empty, solid, internal, external, yin and yang to the organ systems. For example, after knowing that the patient’s problem lies with his liver system, we find out whether the disease is cold or hot, empty or solid, internal or external, yin or yang. Alternatively, having established that the patient’s condition is yang, hot, solid and external, we find out at which organ system the disease is located.
Chinese physicians classify diseases not for academic pleasure, but for practical usefulness. It is therefore a gross mistake to suggest, as some misinformed writers do, that the Chinese are in the habit of classifying factors or processes in medicine and other fields according to philosophical concepts for no better reasons than following convention, such as grouping syndromes into six classes, and not five, seven or any other number because the Yi Jing (I Ching) mentions six divisions of yin-yang, or classifying disease development into three levels so as to conform to the Confucian concept of the three levels of heaven, earth and man. One writer even mentioned that to complete the pairing of yin-yang organs, the Chinese invented the triple warmer concept to match the pericardium!