TCM Syndrome Differentiation

Syndrome differentiation is the core of traditional Chinese medicine (TCM). It makes TCM different from any other traditional medicine from a different culture. It is a way to dig out the rooting cause of a disease. Herbal medicine and acupuncture should be applied according to syndrome pattern differentiation.


TCM Syndrome Differentiation


A. What is a syndrome?

The word syndrome is translated from the Chinese word zheng (证), meaning proof or evidence. The number of zheng (syndrome) is countless. Fortunately, there are basic syndrome patterns to follow, so a formally trained TCM practitioner knows how to figure out a disorder’s syndrome pattern. Since the syndrome pattern is derived from a group of symptoms, it is translated into English as a syndrome.


Be aware that TCM syndrome defers completely from Western medicine syndrome. It does not refer to a group of symptoms, it is a result of analyzing a group of symptoms, it is the “root” of a disease. What exactly is the syndrome in TCM? The syndrome is a diagnosis generalized from the following four aspects of a disease. 


1) Cause or pathogen of a disease

It is common sense that treats a disease, we must treat its cause. There are different acupoints for different pathogens, as in ancient acupuncture books and in modern acupuncture textbooks. To correctly choose these points, we need to find out what pathogen is involved first. Pathogens or causative factors are classified as:  

  • Climatic factors: wind, cold, heat, dampness, etc
  • Emotional factors: anger, sadness, worry, etc.
  • Imbalanced diet: overeating fat, lack of protein, too much hot pepper, etc
  • Improper mental and physical lifestyle: mentally drained or physically exhausted
  • Secondary pathogenic factors from the body itself: phlegm blockage, blood clots

2) Location – site affected inside the body

Location, location, location! Just like you buy real property. It is important. For heart disease, you should needle the heart channel.  

  • Is it in the internal organs?  Which one?
  • Is it on channels? Which one?
  • Is it in the upper body, middle body or lower body?

Like a headache, if the pain appears on the lateral side where the Shao yang channel passes through, its location is the Shao yang channel, so pierce acupoints on the Shao yang channel. 


3) Heat (hot, warmth) or cold

Diseases can be grouped into two types, heat or cold. Most symptoms in a heat type of disease show signs of “heat.” By digging out these heat signs, a disease is thus diagnosed as “heat.” One symptom is not of heat, then it is of “cold”, e.g., fevers are of heat, while cold sensation is cold; yellow thick nose mucus is of heat, while clear thin nose mucus is cold.


By analyzing all symptoms, we can diagnose a disorder as heat syndrome or cold syndrome. Some acupoints are very effective for clearing heat from the body, some are good for warming up the body. Knowing the heat or cold of a syndrome, we can correctly choose acupoints with confidence. 


4) Excess or Deficiency

Excess is translated from the Chinese word shi (实), deficiency form xu (虚). Shi describes a pathological state, while anti-pathogenic force (zheng qi, 正气) is fighting with pathogenic force (Xie qi, 邪气) “intensively.” Xu denotes a condition while zheng qi (正气, i.e., qi, blood, body fluid or essence, etc.) is deficient. All disorders can be grouped into one of these two: excess or deficiency.  


From the above discussion, we can get this equation:

syndrome equals “cause/pathogen plus location plus heat/cold plus excess/deficiency”


For headaches, there are many different syndrome patterns. 

If a wind-cold pathogen causes it, its syndrome pattern can be written as: Wind cold attack cold type Taeyang channel excess syndrome


It tells that firstly, the pathogens are wind and cold. Secondly, the headache is of cold type, thirdly, the affected part is the Tai yang channel, and fourthly, it belongs to excess. This long phrase is always shortened to wind-cold (headache). 


B. How to identify syndrome patterns?

This is the most difficult part of TCM theory for students to learn. There are several basic modules to follow when a herbalist or acupuncturist starts to differentiate a syndrome. Different modules are applied to different situations.

1) Syndrome differentiation is guided by eight principles (ba gang bian zheng, 八纲辨证)

This is the number one basic module to make a diagnosis of the syndrome. A conclusion is made after analyzing a group of relevant symptoms and signs, This conclusion is a summary of eight aspects of a disease: exterior or interior, heat or cold, yin or yang, excess or deficiency. This module is contained inside any other modules.


2) Syndrome differentiation according to etiology

TCM etiology is grouped into four groups: external, internal, secondary and others.

  • External pathogenic factors refer to six climatic factors;
  • Internal pathogenic factors include abnormal emotions, irregular diet, exertion or lack of physical exercise.
  • Secondary pathogenic factors include blood stasis and phlegm.
  • Others refer to trauma, parasites, toxin and congenital factors and toxins.

Each type of pathogen or cause has its characteristics, as heat damages body fluid, and dampness blocks qi and blood circulation, thus resulting in a group of relatively fixed symptoms. Analyzing a patient’s symptoms, a practitioner may discover which pathogen is evolving.


3) Syndrome differentiation according to qi, blood and body fluid

This module is very basic and very practical. Qi, blood and body fluid are substances essential for human life activities. Each has its special functions, and each will give a special group of symptoms if dysfunctional. Through analyzing a group of relevant symptoms, qi or blood or body fluid disorder could be diagnosed.


4) Syndrome differentiation according to Zang fu organs

This is the most complete and relatively modern module of syndrome differentiation. It uses zang-fu organs as logic lines to organize and differentiate the complicated world of syndrome patterns. It is from summarizing the modules above and below.

Take heart as an example, there is heart yang deficiency (from the eight principles), heart blood stasis (from the etiology theory) and heart blood deficiency (from the qi, blood, body fluid theory).


This method includes syndrome differentiation according to heart and small intestine, according to lung and large intestine, according to spleen and stomach, according to liver and gallbladder, according kidney and urinary bladder.


5) Six meridian syndrome differentiation (liu jing bian zheng, 六经辨证)

This is the first module of syndrome differentiation invented by Dr. Zhang Zhongjing in the Han dynasty (200 AD) in his book Cold Damage (Shang Han Lun, 伤寒论). It is the first TCM clinical textbook that organized separately or randomly recorded clinical experiences into TCM theoretical system. This module was originally used to guide the treatment of diseases initiated by wind-cold attacks and a broad range of diseases transformed from cold-damaging disorders. It is still favoured by many TCM doctors to treat various kinds of diseases, especially complicated conditions.


6) Four-stage syndrome differentiation (wei qi ying xue bian zheng, 卫气营血辨证)

This set of different syndrome methods was invented by a group of doctors about 400 years ago for treating infectious diseases. Many great formulas are effective in killing bacteria and viruses.


7) Triple jiao syndrome differentiation (san jiao bian zheng, 三焦辨证)

The last one was also used by the doctors who invented the above module. One could see the shade of the zang-fu organ module inside this one. Doctors combined sets to guide the treatment of infectious diseases. This one finds out the detailed location of a diseased site in the body, and the above reveals the trend of a rapidly changing disorder.

In summary, each of the above modules is applied to diagnose different disorders. The eight principle syndrome differentiation is now the most popular set, and it may be applied to 80 to 90 % of diseases a practitioner treats. Syndrome differentiation is fundamentally important for a Chinese medicine practitioner to find the right formula and avoid side effects. It is also important for an acupuncture practitioner to understand the disease and to predict its prognosis, thus helping evaluate the treatment’s effectiveness.