The doctor who makes an accurate diagnosis is the real hero. In modern, economically advanced countries like the U.S. and the U.K., an accurate Chinese medical diagnosis based on the Eight Principles need not be complicated or convoluted.

There are only six common syndromes to master. The first three are exterior and fairly simple to diagnose:

• Qi and blood stagnation in the channels (exterior excess)
• Wind invasion (exterior excess)
• Wei qi deficiency (exterior deficiency)

The next three are interior excess syndromes that involve zang-fu theory. This is where people get confused:

• Liver qi stagnation (interior excess yang)
• Heart heat (interior excess yang)
• Spleen damp (interior excess yin)

If you are wondering where the primary deficiencies of yin, yang, blood, and kidney are in all this, you need to read my article in the March 2014 issue of Acupuncture Today, "The Deficiency Myth" before you continue. These four syndromes are all life-threatening emergencies that you have never seen and will never see in your clinic, in spite of what you might have been taught.

Liver Qi Stagnation

Liver qi stagnation is a nervous condition with a multitude of signs and symptoms that usually boil down to continual fear and anxiety about the future and/or the past. Reality only exists in the moment, and while analyzing the past and planning for the future are healthy and natural human qualities, fearing phantoms causes pain and disease of mind and body. Liver qi stagnation tightens muscles in a constant state of fight-or-flight. It will inhibit the circulation of yangqi, blood and fluids in any organ or tissue.

In this fast-changing, post-COVID world, liver qi stagnation is ubiquitous. Watch for symptoms of worrying in patients; even in those who deny that they worry. Ultimately, a patient's poor mental health must be addressed to achieve a lasting cure. In addition, any habit that ruins posture will also stagnate liver qi.

Patients who have cold extremities or are cold all the time have poor circulation of yangqi, not "yang deficiency." Patients who complain of numbness and tingling in extremities have blood blockage distal to an area of stagnant qi, not blood deficiency. Activation, not tonification, is called for in these situations.

Heart Heat

The living heart is always moving, always working, always creating friction. Thus, the heart is most easily injured by interior excess yang and a life of hurrying and scurrying. Excessive work, sleep deprivation, an unnatural worship of busyness and speed, multitasking, difficulty paying attention, excessive talking, and of course, an agitated shen are indicative of chronic heart heat.

Occasional eruptions of heart fire are common. The modern epidemic of autoimmune diseases, as well as many inflammatory disorders, indicate heart heat.

Spleen Damp

Spleen damp can be accurately diagnosed from across the street. Excess body fat is a definite tell, and since ninety percent of Yanks and Brits are officially obese or overweight, you can guess how common spleen damp is in those two countries alone.

The other pathognomic indication of spleen damp is the absence of hunger. Not to be confused with appetite (the mental desire for food), hunger is an empty feeling in the belly that motivates and prepares lean, healthy animals and humans to go to work, i.e., to venture into the wilderness to forage and hunt for food. The hunger feeling is spleen yangqi collecting in the middle jiao, preparing to fly to the extremities.

Fatigue, pain, a burning or tight feeling in the belly, boredom, unhappiness, and starvation are often mistaken for hunger. A damp spleen does not want food – any food. In the absence of hunger, there is no such thing as "healthy food," in spite of all the advertising to the contrary.

The secondary pattern of spleen qi deficiency will always accompany spleen damp. Long lists of food intolerances and allergies, stomach and intestinal complaints, excessive phlegm of both substantial and insubstantial varieties, and general fatigue are prominent indications of spleen qi deficiency that all the ginseng in the world will not fix.

In fact, a weak digestion will have trouble digesting orally administered herbs. Only some type of intermittent fasting will remedy this condition of interior excess yin.

When Interior Excess Syndromes Combine: Four Examples

These three interior excess syndromes combine in a hundred different ways. Here are four common examples.

1. Anything that stagnates can cause heat, as qi beats furiously against the barrier. The heat from chronic fear or unwanted food in the gut will often rise up into the throat and head. Esophageal reflux and mental confusion are as common as dirt. Patients will use the heavy yin of food to push the heat back down, thus maintaining an unrelenting and pathological feedback loop.
2. Interior excess yin includes enlarged fat cells, impacted fecal matter, excessive serum cholesterol, and especially unwanted growths like cysts, tumors, and fibroids. Liver dominates the groin region. When sexual energy is constricted due to liver qi  stagnation, circulation is impaired in reproductive organs. Excess yin from overeating can pile up in corners and become health issues for both men and women.
3. Worrying about an economic future that does not exist is a common feature of workaholics. Excessive activity then becomes chronic heart heat, which can rise up into the liver-dominated brain and literally burn brain tissue. The result is severe stagnation, i.e., paralysis, in any part of the body.
4. A stroke, also called a cerebral vascular accident, presents as either internal excess yin or internal excess yang. In the first case, a damp spleen will provide a piece of excess material that enters the bloodstream, lodges in the brain, and blocks tissues downstream from receiving qi and blood. In the second case, liver qi stagnation can transform into liver fire that rises into the brain, bursts a blood vessel, and again prevents tissues downstream from receiving qi and blood.

Clinical Takeaway

Once you become well-versed in the three interior excess syndromes of liver qi stagnation, heart heat and spleen damp, you can figure out any situation without any guesswork and become the hero of the hour.

Dr. E. Douglas Kihn is a retired doctor of Oriental medicine and the author of Chinese Medicine for the Modern World: Ancient Wisdom to Stop Worrying, Hurrying, and Overeating (2019). He received a Master of Arts from Emperor's College of Oriental Medicine and a DOM from Samra University; and has taught at Emperor's College, Samra and Royal University. Learn more at www.gobodytrust.com.