TCM Treatment of Diabetes Based on the Theory of The Trinity System: Identification of constitution, disease and pattern

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By Professor Zhao Jin Xi

It has been a known fact that Western Medicine is focused on the disease whereas Chinese medicine is focused on pattern identification. Western medicine emphasizes on the mass while Chinese medicine emphasizes on the individual constitution. There is an element of truth in this claim albeit not the whole truth. Chinese medicine is focused on pattern with simultaneous emphasis on the disease with special emphasis on the individual constitution. The so-called “zheng hou or pattern” in reality is referring to patients of the same constitution being affected by different pathogenic factors and their associated response. The state ofthis reaction will show a series of specific symptoms, signs, tongue and pulse. Therefore, accurate pattern differentiation should reflect the correct constitution which serves as the basis of disease identification.

Identification of constitution

[Nei Jing] particularly emphasizes the significance of the person’s constitution during the course of disease development. A systematic discussion of disease and constitution in [Lingshu: Wu Bian]. During the course of pathogenic attack the constitution of the patient has a significant bearing on the outcome of disease development. Therefore this factor should not be disregarded. What is the cause of people having different constitution? This is mainly hinged on the imbalance of the zang fu function and the condition yin and yang as well as that of qi and blood.

Some people are characterized by spleen deficiency while others are characterized by stomach heat; some may have intrinsic yang deficiency while others have yin deficiency. Due to the difference of a person’s constitution when dealing with health preservation or prevention of disease or the method of treatment strategy can differ. Thus how do we differentiate the different type of constitution? It is essential to focus on the method of identifying the constitution. Citing from ancient time, there is the method of differentiation by the five elements (metal, fire, earth, wood and water); different classification of the body constitution all of which bear different diagnostic value and meaning. “Nei Jing” classifies the wood, fire, earth, metal and water into five categories based on the theory of the five elements; alternatively the classification of body types can be based on the function of the zang and fu; or yin and yang or qi and blood . The three yin and three yang method of classification is mainly based on the theory discussed in “Shang Han Lun” which stems from the philosophy of “Dao De Jing 道德经” which states: “one engenders two; two engenders three and three engenders a myriad of things”. This is a way to classify the different types of body constitution based on the theory of the physiological function of the three yin and three yang channels.

Identification of Disease

Since ancient times Chinese medicine places great emphasis on disease identification such as that discussed in “Nei Jing” and “Jin Gui Yao Lue”. In “Nei Jing” diseases such as Gu Zhang 鼓胀, Xiao Ke 消渴and Shen Feng 肾风etc. Likewise “Jin Gui Yao Lue” adopts disease name as the chapter headings by giving priority to identify the disease before pulse diagnosis to determine herbal prescription. The philosophy of Chinese medicine disease identification is highly scientific with significant clinical implication.

Xu Ling Tai in his book “Lan Tai Gui Fan: preface” states: “to treat disease one must know the disease name, once established then proceed to find out the aetiology of the disease, once that is understood, one must differentiate the root cause and the corresponding symptoms before consider the appropriate treatment. A specific disease must have a key formula and key herbs”. Apart from this, the correlation between the symptoms associated with a particular pattern and the pathogenesis may not be identical.

This is because the pathogenesis of a disease is internal whereas the pattern reflects the external presentations of a specific disease phase [Suwen:Zhi Zhen Yao Da Lun] states in the discussion of the nineteen pathomechanism with special emphasis on “ focus on the pathogenesis, investigate the cause of the disease whether there is the presence of the expected symptoms or void of the expected symptoms…” In reality the emphasis is on the underlying pathogenesis and clinically one must be mindful at all times to focus on the pathogenesis.

Professor Zhao and his team embarks on long term observation and research of diabetes and results of his research findings unveiled the special pathogenesis of diabetes is tantamount to what Zhang Zi Ke description of the word “Xiao 消which is similar to burning 烧”. The pathogenesis of “heat damaging the yin” constitutes the basic pathogenesis of diabetes. Long term sufferer of Diabetes is characterized by qi and yin deficiency; yin and yang deficiency leading to eventual detriment deficiency which is a passage from excess to deficiency. Deficient zheng qi may lead to exploitation of external pathogen susceptible to all types of infection such as boils, ulcers and tuberculosis etc. Diabetes is a typical chronic disease and can be considered what TCM describes “chronic disease may invade the network vessels” thus overtime diabetes may result in stasis bind in the network vessels with complications such as cardiac cerebral and renal disorders, diabetes retinopathy and diabetes neuropathy.

Trinity System Diagnosis: Identification of constitution, disease and pattern

Zhang Zhong Jing in his book “Shang Han Za Bing Lun” pioneered that treatment according to pattern identification with a creative diagnostic method of three yin and three yang pattern identification which is also known as the “Six Channel Pattern Identification”. What is the definition of the three yin and three yang pattern identification? Is this method of pattern identification merely indicated for externally-contracted diseases? There has been much controversial debate on this issue in the past. It was thought that the concept of the three yin and the three yang as well as the six channel system is a different way to express the human body function versus the conventional zang fu organs pattern identification. Different body types may present a slight discrepancy of the yin and yang and thus categorizing people into the three yin and three yang body constitution. The method of applying this theory is based on the theory of the three yin and three yang with reference to the different body types to determine the use of formula which can also be called “formula pattern identification” with special emphasis on” the use of a specific formula is akin to a specific pattern”. This reflects the individualized treatment strategy of Chinese medicine with outstanding therapeutic results. This methodology literally constitutes the pinnacle of TCM pattern identification or it can be regarded as the short cut to the correct use of herbs.

This article was first published at the Pearls of Wisdom Seminar in 2011


About Professor Zhao Jin Xi

Professor Professor Zhao Jin Xi of Dongzhimen Hospital, Beijing advocates a diagnosis-treatment scheme inspired by Shang Han Lun theory which he calls the Trinity System based on a co-ordinated identification of constitutional type, disease and pattern… Read more »


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