Why Yin and Yang Are the Guiding Principles of Diagnosis and Treatment in Traditional Chinese Medicine (TCM)

Why Yin and Yang Are the Guiding Principles of Diagnosis and Treatment in Traditional Chinese Medicine (TCM): Examples of TCM Diagnosis and Treatment for Hypertension (Pattern Differentiation and Treatment for Two Patterns: Spleen-Kidney Yang Deficiency and Liver Yang Hyperactivity)

In TCM, Yin and Yang serve as the foundational principles of diagnosis and treatment because they represent the dynamic balance of opposing yet interconnected forces within the body—such as cold/heat, deficiency/excess, and interior/exterior. Disease arises from an imbalance between Yin and Yang, and treatment aims to restore harmony. Whether in the Eight Principles of Pattern Differentiation (Yin/Yang, Interior/Exterior, Cold/Heat, Deficiency/Excess) or in analyzing specific disease mechanisms, all TCM diagnostics and therapeutics revolve around Yin and Yang.

TCM Pattern Differentiation and Treatment for Hypertension

Hypertension in TCM falls under categories such as "dizziness" (眩晕, xuàn yūn) or "headache" (头痛, tóu tòng), with pathological mechanisms linked to dysfunction of the Liver, Kidney, and Spleen. Below are the diagnostic and therapeutic approaches for two common patterns: Spleen-Kidney Yang Deficiency and Liver Yang Hyperactivity.

1. Spleen-Kidney Yang Deficiency Pattern

Pathology: Insufficient Yang energy in the Spleen and Kidneys leads to poor fluid metabolism, causing clear Yang (清阳, qīng yáng) to fail to rise and turbid Yin (浊阴, zhuó yīn) to disturb the head.
Symptoms:

• Dizziness, heavy-headed sensation (as if wrapped in cloth)

• Cold intolerance, cold limbs, sore and weak lower back

• Frequent nighttime urination, leg edema

• Poor appetite, loose stools, pale and swollen tongue with teeth marks, white slippery coating, deep weak pulse

Treatment Principle: Warm and tonify the Spleen and Kidneys, resolve dampness, and lower turbidity.
Representative Formula:

• Zhen Wu Tang (True Warrior Decoction, 真武汤) with modifications
  Ingredients: Prepared aconite (Fu Zi, 附子), white atractylodes (Bai Zhu, 白术), poria (Fu Ling, 茯苓), fresh ginger (Sheng Jiang, 生姜), white peony root (Bai Shao, 白芍)
  Modifications:

  • Severe edema → Add alisma (Ze Xie, 泽泻) and polyporus (Zhu Ling, 猪苓).

  • Severe dizziness → Add gastrodia (Tian Ma, 天麻) and pinellia (Ban Xia, 半夏) to resolve phlegm.

  • Qi deficiency → Add astragalus (Huang Qi, 黄芪) and codonopsis (Dang Shen, 党参).

Patented TCM Formulas:

• Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill, 金匮肾气丸) to warm Kidney Yang.

• Bu Zhong Yi Qi Wan (Tonify the Middle and Augment Qi Pill, 补中益气丸) to strengthen Spleen Qi.

2. Liver Yang Hyperactivity Pattern

Pathology: Liver Yin deficiency leads to excess Liver Yang rising, causing upward rebellion of Qi and blood.
Symptoms:

• Throbbing headache, dizziness, red face, bloodshot eyes

• Tinnitus (like roaring waves), irritability, insomnia, bitter taste in mouth

• Red tongue with scant coating, wiry and rapid pulse

Treatment Principle: Subdue Liver Yang, nourish Yin, and anchor hyperactivity.
Representative Formula:

• Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction, 天麻钩藤饮) with modifications
  Ingredients: Gastrodia (Tian Ma, 天麻), uncaria (Gou Teng, 钩藤), abalone shell (Shi Jue Ming, 石决明), gardenia (Zhi Zi, 栀子), scutellaria (Huang Qin, 黄芩), eucommia (Du Zhong, 杜仲), mulberry mistletoe (Sang Ji Sheng, 桑寄生), cyathula (Niu Xi, 牛膝), motherwort (Yi Mu Cao, 益母草), polygonum (Ye Jiao Teng, 夜交藤), poria (Fu Shen, 茯神)
  Modifications:

  • Severe Yin deficiency → Add rehmannia (Sheng Di Huang, 生地), scrophularia (Xuan Shen, 玄参), and lycium fruit (Gou Qi Zi, 枸杞).

  • Severe headache → Add prunella (Xia Ku Cao, 夏枯草) and chrysanthemum (Ju Hua, 菊花).

  • Constipation → Add cassia seed (Jue Ming Zi, 决明子) and rhubarb (Da Huang, 大黄).

Patented TCM Formulas:

• Zhen Gan Xi Feng Granules (镇肝熄风颗粒) to calm Liver wind.

• Niu Huang Jiang Ya Wan (Cow Bezoar Hypertension Pill, 牛黄降压丸) for heat-clearing and Yang-subduing effects.

Key Comparison of the Two Patterns

Conclusion

TCM treats hypertension by identifying the root imbalance (e.g., Yang deficiency or Yin deficiency with Yang excess) and restoring harmony. Modern TCM practice often integrates Western medicine for better blood pressure control while improving symptoms and reducing side effects. Personalized treatment by a licensed TCM practitioner is essential for optimal results.

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