Most practitioners and students of Chinese medicine are aware of the 5 Phases and the usefulness of this diagnostic approach in their clinical practice. However, knowledge of the 5 is only part of the story when it comes to diagnosing and treating patients. There are a variety of different numerically labelled ways to look at the universe, including human physiology and pathology. Remember: when numbers are used in Chinese Medicine they are used for a specific reason.
Remembering this can help us unlock all kinds of clinically useful information.
For instance, as the article linked above teaches us, when we see the number 5 – we can think of Earth. On the other hand, when we see the number 6 – we think first of Heaven. The number 6 is used in the context of Chinese medicine study when we are considering the 6 Qi & 6 Conformations. It’s easiest to think of the 6 Qi as a Heavenly weather (or climactic) influences on the Earth. These weather influences are microcosmically represented in the body as the 6 conformations. These conformations, of course, have qualities that resonate with the 6 Qi. It’s complicated – in many ways – but the basics are easy to absorb.
This system of six is incredibly powerful, clinically.
In fact, one of our best existing classical clinical manuals – the Shanghan lun – is structured around this system. The entire text uses the 6 Conformations as its premise in diagnosis, explaining how each layer has distinct but sometimes interacting symptoms. What is made clear as you read the text is that the six conformations are not independent, but rather part of a system that is constantly transforming. The key to using the 6 Conformations in clinic is understanding them in this way – not as static layers or, even worse, just pairs of channels.
In many ways, this is the most essential topic for students wishing to enrich their understanding of classical formula prescribing and the biggest gap in most modern TCM education. Even the later Warm Disease theorists (in the Ming Dysnasty) state plainly that knowledge of Cold Damage (and thus the theories of the Shang Han Lun) are the most important to know and understand – this of course includes the 6 conformations!
In my opinion, this theory is the most engaging and interesting of them all. Once you see these different layers in the body, it really informs your practice of internal medicine. It’s one of those things you cannot “unsee.” You wouldn’t want to! Symptoms that seemed disparate and confusing suddenly seem clear and connected. Treatment philosophies that, previously, wouldn’t be considered are suddenly the obvious way forward.
Eric provides this example from his own clinical practice:
I had a patient come in on a referral from another practitioner, a friend, who does not use the 6 conformations in her practice of Chinese medicine. The patient, a woman in late middle age, was presenting with a fairly standard peri-menopausal pattern, with particular emphasis on unrelenting hot flashes that would be accompanied with intensely red and itchy eyes. She also had a tendency to have serious emotional outbursts, and had a feeling of having no “barrier” between herself and other people, especially emotionally.
The practitioner, feeling a quite weak, deep pulse and a pale, flabby tongue had started to use formulas that enriched the kidney yin, also incorporating a formula to treat simultaneous high blood pressure. But she found it difficult to find a formula that would incorporate the menopausal symptoms, the red eyes (which she identified as being chiefly a liver wind problem), the blood pressure, the emotional problems and various other, smaller, symptoms the patient was experiencing.
When I felt the pulse, I did sense the “weakness” that the practitioner described, but the pulse was what I have learned to describe as “verging on expiry” as is discussed in the Shanghan lun, associated with the formula Danggui Sini Tang. Thus, I started thinking about the patient’s case as a Jueyin disease. This perspective allowed me to look at the pericardium, liver, blood and other associated tissues and layers, which brought all of the symptoms together in a way that made sense to me. I proceeded with treatment along those lines, and the patient had no hot flashes within 5 weeks of taking her formula regularly. Thanks, Zhang Zhongjing!
Interested in learning more about this important theory? Want to learn how to put it in practice?