2. The Lung Governs Qi

The significance of "the lung governs qi" in Traditional Chinese Medicine extends beyond its respiratory function; it also encompasses other functions inherent to the lung itself. Although experimental research in this area is relatively limited, according to a report from the Pulmonary Function Research Laboratory of Zhejiang Provincial Hospital of Traditional Chinese Medicine, they selected pulmonary function tests—direct indicators that best reflect the role of lung qi—and conducted observations and studies focusing on the lung's ventilation function. The results showed that in patients with chronic obstructive pulmonary disease, those with lung qi deficiency exhibited abnormal pulmonary function, whereas those without lung qi deficiency mostly had normal pulmonary function, with only a few showing mild abnormalities. Statistical analysis revealed significant differences between the two groups. Among the abnormal cases, most in the lung qi deficiency group presented moderate to severe ventilatory impairment, and these impairments were predominantly of the mixed type, significantly more prevalent than in the non-deficient group. Currently, many literature reports suggest that closed lung volume, flow-volume curves, and lung compliance are sensitive indicators for early diagnosis of small airway diseases. In clinical practice of TCM, such diseases often lack discernible syndromes in their early stages, making the measurement of these indicators particularly important. As these indicators increase, they correspond directly to the degree of lung qi deficiency. The results obtained from 53 cases of individuals without lung qi deficiency in this study indicate that approximately half of the patients already exhibit microscopic changes indicative of lung qi imbalance. Therefore, it can be concluded that the concept of lung qi and "the lung governs qi" in TCM has a material basis. Although experimental research in this area remains limited, it has already provided preliminary evidence supporting this view. With further in-depth research in the future, the true nature of TCM’s theory regarding the lungs will inevitably be gradually revealed.

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Basic Principles of TCM Syndrome Differentiation and Treatment

Pei Zhengxue

Over nearly 2,000 years of development, Traditional Chinese Medicine has, through methods such as dialectical reasoning and syndrome differentiation based on symptom assessment, created a series of basic principles for syndrome differentiation and treatment, including “Eight Principles of Differentiation,” “Zang-Fu Organ Differentiation,” “Six Meridians Differentiation,” “Wei-Qi-Ying-Xue Differentiation,” “Triple Burner Differentiation,” and “Etiology Differentiation.” These diagnostic categories form the main framework of TCM’s clinical syndrome differentiation and treatment theory, giving TCM its unique characteristics. When integrating Traditional Chinese Medicine with Western medicine and drawing on the strengths of both systems, it is essential to first emphasize the basic principles of TCM syndrome differentiation and treatment in order to fully demonstrate TCM’s unique advantages, such as its “macroscopic,” “holistic,” and “body response-oriented” perspectives.

I. Eight Principles of Differentiation

The Eight Principles of Differentiation summarize the clinical manifestations of diseases into eight aspects: Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess. It is the most fundamental principle of TCM differentiation and serves as the guiding framework for classifying TCM syndromes. When faced with a complex array of symptoms, the key lies in identifying the core elements and organizing them systematically to determine the appropriate treatment method and prescription. To achieve this, one must begin with the Eight Principles of Differentiation. TCM holds that any condition can be categorized using these eight principles. Broadly speaking, if a disease is not Yin, it must be Yang; if the affected area is not Exterior, it must be Interior; if the nature of the disease is not Heat, it must be Cold; and if the balance between pathogenic factors and vital energy is not Deficiency, it must be Excess. Each of the eight principles has its own typical syndromes that can exist independently. At the same time, the four pairs of opposing syndromes within the Eight Principles exhibit an inseparable interrelationship. The phrase “inseparable” means that there can be no Yin syndrome without a corresponding Yang syndrome; likewise, there can be no Exterior syndrome without an Interior syndrome. The concept of Cold syndrome is also defined in opposition to Heat syndrome; similarly, Deficiency and Excess are relative concepts. Clinically, multiple syndromes often coexist, with various attributes overlapping—for example, the Fuzi Lizhong Decoction syndrome characterized by Interior Deficiency-Cold; the Mahuang Decoction syndrome characterized by Exterior Cold-Excess; the Guizhi Decoction syndrome characterized by Exterior Cold-Deficiency; and the Chengqi Decoction syndrome characterized by Interior Excess-Heat. The complex and ever-changing progression of disease mechanisms—such as pathogenic factors moving from Exterior to Interior and then back to Exterior, alternating Cold and Heat, and overlapping Deficiency and Excess—results in highly variable clinical presentations. Only by flexibly and skillfully applying the Eight Principles of Differentiation, accurately grasping the essence of the disease, and making a correct diagnosis can we provide a reliable basis for treatment. Among the eight principles, the Yin-Yang pair is particularly important, as it oversees the other six. Yin can govern Interior, Deficiency, and Cold; Yang can govern Exterior, Excess, and Heat. Any clinical manifestation of disease is ultimately the result of an imbalance between Yin and Yang. Only by grounding our diagnosis in the Yin-Yang pair can we gain a deeper understanding of Cold/Heat, Deficiency/Excess, and Exterior/Interior.