Before you can treat in clinic you have to have a good understanding of why people get sick. That’s more than just understanding the biomedical components of a disease, trauma, or syndrome. A lot of people, for instance, come into contact with cold and flu viruses, but not all of them get ill. What makes one person susceptible and not others? The same is true for some types of trauma. Why is it that some people fall and get back up again but another person in the same fall experiences a bone break?

In TCM the answer is that the balance in the body between Yin and Yang and between the Five Elements has been upset in some way making a person more susceptible to pathogenic influences. Understanding 1) whether a pathogen came from outside the body or from inside, 2) how emotions can generate imbalance, 3) how the body is out of balance, and 4) how that out of balance condition caused a problem can take you a long way toward the next steps in treatment.

Treatment consists of using the information you gather from your patient to make a disease diagnosis and a syndrome differentiation (the specific cause of that disease within the patient’s body). All treatment in Chinese medicine is based on this disease and differentiation.


The cause or origin of the problem.

Pathogenic Influences

Pathogens are normally considered to be the bacteria or virus that caused a disease within a living organism. In Chinese medicine we speak of pathogenic influences. These can come from the outside (external pathogens or evils) or could originate from inside the body (the endogenous pathogens).

External Pathogens (Six External Evils)
In Chinese the phrase for the Six External Evils is “Liu Yin.” Liu translates to six while Yin translates to excesses. (This is a different “Yin” than in Yin and Yang.) The six evils relate to six external pathogenic factors which are the cause of disease. These include wind, cold, damp, summer heat, heat/fire, and dryness. [Read more]

Endogenous Pathogens
Endogenous pathogens refer to illnesses and syndromes that are generated from inside an organism. These are the inner five evils generated by emotion out of balance, phlegm and fluid retention, and blood stagnation/stasis. [Read more]

Mechanisms, Diagnostics, and Treatment Strategies

You need a full understanding not only of organs and pathogens, but also of disease mechanisms and diagnostics (with is disease diagnosis + differentiation) in order to create a great treatment strategy.


What happened within the body as a result of the etiology and pathogenic influences to make the disease or syndrome possible.


The diagnosis is the short synopsis of the patient’s complaint. This can be headache, allergic rhinitis, or back pain.


A single disease diagnosis can have my differentiations – specific reasons that the problem occurred. A headache (the diagnosis) in one patient might have a differentiation of a Qi and Blood blockage in the Bladder meridian, but in another patient the differentiation is an external wind heat invasion, and in a third patient it might be due to Liver yang rising. All three patients have headaches, but each of them has a headache with a different differentiation.

Treatment Principles

Once you understand the diagnosis and differentiations for a patient’s problem you can form a working treatment plan which might include a variety of modalities (acupuncture, tuina, cupping, etc.) targeting the disease, pathogens, and differentiations that made all of this come together into a disease or syndrome for your patient.

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