Common TCM Patterns Explained: Qi Deficiency, Yin Deficiency, Liver Qi Stagnation and More

Patterns are not diagnoses

In Chinese medicine, a pattern (zheng, often translated "syndrome") is a highly generalized overall judgment drawn from a person's symptoms. [1] It is a traditional framework. It is not a disease and it is not a lab result. The same medical condition can be given different patterns in different people, and the pattern is then used to guide a practitioner's choices (see pattern differentiation).

ICD-11 has an optional traditional medicine chapter so these patterns can be recorded and counted. [2] WHO says the chapter neither judges nor endorses their scientific validity. [2] This page describes the patterns in the way research papers describe them. It does not match any herb or treatment to a pattern.

Common patterns and what research says

Blood deficiency is not the same as anemia. Anemia is found with a blood test that counts red blood cells. [12] Its symptoms, such as tiredness, shortness of breath and noticeable heartbeats, overlap with the fatigue described above. [12] If you are tired, ask your doctor about testing instead of assuming the pattern.

Do practitioners agree?

Agreement depends on the step.

• In 40 people with knee osteoarthritis, two experienced practitioners examined each person separately. Agreement was relatively good for questions and for listening/smelling, but generally low for visual inspection and touch. [13]
• Three practitioners examining 45 adults with mild high cholesterol had reasonably good agreement on the Eight Guiding Principles, but at the organ-pattern level it was very good for one pattern only (spleen qi deficiency). [5]
• Gastroenterologists trained in Western medicine and TCM practitioners agreed on the syndrome type in 86.3% of 160 people with functional dyspepsia, when going by the main symptoms. [14]
• Researchers state that without standard rules, agreement among practitioners is unsatisfactory. [15] Criteria for prediabetes patterns were found not clearly defined or standardized, leading to poor repeatability. [16] Between 52.7% and 59.6% of functional dyspepsia patients were given two or more patterns, and the commonest patterns differed between Hong Kong and Hunan. [10]

Label: mixed. Agreement can be reasonable in some conditions, but it is not guaranteed.

Do patterns have a measurable biology?

Several small studies searched blood, urine or gene activity for markers of a pattern. One cirrhosis study noted that no biological evidence yet supported pattern differentiation before reporting differences in urine metabolites between two patterns. [7] The chronic fatigue study above included only 10 people per group. [11] I found no independent replication in the sources read. Label: preclinical. See Traditional Frameworks vs Biomedical Explanations.

Does matching treatment to a pattern help?

The one direct test I found was an n-of-1 trial service in China: 50 patients with "kidney-yin deficiency" tried Liuwei Dihuang decoction and placebo in blinded crossover periods. [8] Of 47 who completed, 3 were responders and 28 non-responders; as a group there was no difference from placebo. [8] This does not prove the formula never helps, and it is a single small study (see Liu Wei Di Huang Wan). Label: insufficient evidence. For the larger picture see Does TCM Work?.