Deutsche Zeitschrift für
DZA
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German Journal of Acupuncture & Related Techniques
J. Ross
4 Imbalances and 5 Organs A new system for diagnosis and treatment
4 Ungleichgewichte und 5 Organe Ein neues System für Diagnose und Therapie
Abstract
Zusammenfassung
This article describes a new system of diagnosis and treatment termed the 4 Imbalances and 5 Organs. The system can be used for different treatment methods, including Western herbs, Chinese herbs, acupuncture, and Chinese nutrition. Its clear visual presentation is designed for rapid and easy clinical use. The first level, the 4 Imbalances gives a clear simple overview of the patient. It cuts through complexity and focuses on the patient’s basic needs, in terms of just four factors: Deficiency, Stagnation, Disturbance, and Excess. The second level, the 4 Imbalances + 5 Organs, focuses on the parts of the picture in precise detail. This increases the accuracy of diagnosis, which is the key to safe and successful treatment.
Der nachstehende Artikel stellt ein neues System für Diagnose und Therapie vor, das als „4 Ungleichgewichte und 5 Organe“ bezeichnet wird. Dieses System kann unter verschiedenen Behandlungsansätzen Anwendung finden, etwa in der Westlichen Kräuterheilkunde, Chinesischen Kräuterheilkunde, Akupunktur und Chinesischen Ernährungslehre. Dank seiner klaren, visuellen Darstellung ist das System für den raschen klinischen Einsatz gut geeignet. Auf der ersten Ebene vermitteln die 4 Ungleichgewichte einen aussagekräftigen, einfachen Überblick über den Patienten. Das System reduziert komplexe Gegebenheiten und richtet den Fokus auf die Grundbedürfnisse des Patienten im Sinne von nur vier Faktoren: Mangel, Stillstand, Störung und Übermaß. Auf der zweiten Ebene richten die 4 Ungleichgewichte + 5 Organe den Fokus mit großer Präzision auf die Einzelteile des Bildes. Dadurch erhöht sich die Genauigkeit der Diagnose, dem Schlüssel zu einer unbedenklichen und erfolgreichen Behandlung.
Keywords
Schlüsselwörter
4 Imbalances (and 5 Organs), Jeremy Ross, Combining Western herbs (Chinese Medicine, and Phytopharmacology), A new system of Diagnosis (and treatment), Western herbal medicine
4 Ungleichgewichte (und 5 Organe), Jeremy Ross, Verbindung von Westlicher Kräuterheilkunde (Chinesische Medizin, Phytopharmakologie), ein neues System für Diagnose (und Behandlung), Westliche Kräutermedizin
The 4 Imbalances and 5 Organs is a new system for differential diagnosis, which can make treatment easier and more effective, whether the treatment is with Western herbs, Chinese herbs, acupuncture, qi gong, or nutrition.
Four imbalances
Complex patients The problem for practitioners is that modern chronic patients are rarely simple. Many have up to 10 different Chinese syndromes at the same time, and sometimes up to 20. This makes two problems for the beginner, and even for the experienced practitioner.
We can say that there are four main things that go wrong with the energy of the body: • Deficiency • Stagnation • Disturbance • Excess Deficiency
First problem
After the consultation, the practitioner is buried in data, and may lose sight of a clear overall picture of the patient’s needs. Second problem
The practitioner does not know where to focus their attention, so that differential diagnosis lacks precision of the details. Solution
It was to solve these two related problems that the system of 4 Imbalances + 5 Organs was developed. Jeremy Ross 78 Coombe Lane Bristol, BS9 2AS, United Kingdom
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Fig. 1: 4 Imbalances Example
This is not enough energy, for example with symptoms of exhaustion or physical weakness. The principle of treatment is to tonify: that is, to increase the energy of the body of a whole, or of some specific organ system.
Innovationen | Innovations J. Ross 4 Imbalances and 5 Organs
Here, there is energy, but the flow of energy is blocked, for example with symptoms such as obstruction sensations in the chest, or emotional constraint. The principle of treatment is to move: that is, to move obstruction to the flow of energy in the body of a whole, or of a specific organ system.
Oswald as an example The star ratings for Oswald’s four Imbalances, and associated disorders, are shown in fig. 1 above. The most important disorder for Oswald is the exhaustion, with four stars, but the Deficiency syndrome is Deficient Yin, with associated restlessness, insomnia, and heat sensations. Oswald is warm in temperature, and therefore requires a cool herb combination to balance him.
Disturbance
Star rating and herbs
The energy is disturbed or unstable, for example with emotional symptoms such as anger or anxiety, or physical symptoms such as vomiting or cough. The principle of treatment is to calm: that is, to calm the disturbance, whether this is physical, emotional, or mental.
The importance of the star ratings is that they determine the relative number of herbs in the combination. The more stars awarded to an Imbalance, the more herbs allocated to that Imbalance in the herb combination. For example, for Oswald, in a 6-herb combination, the relative proportions would be approximately: • 2 tonic herbs • 2 calming herbs • 1 moving herb • 1 draining herb
Stagnation
Excess
Here, there is a temporarily too much energy, as in hyperactivity or fever, or too much material, for example when there is excessive bronchial phlegm. The principle of treatment is to drain: that is, to reduce the amount of energy or material, either in the body of a whole, or in a specific organ system. An example of draining from acupuncture is bleeding, and an example from herbal medicine is the use of purgative herbs.
Importance of 4 Imbalances The 4 Imbalance system gives a simple clear overview of the patient. The practitioner can reduce the complexity of the case history to the basic question: ‘Do I tonify, move, calm, or drain this patient?‘ Potential mistreatment If the practitioner does not understand the 4 Imbalances, and, for example, drains a Deficient patient, then that patient will be more ill than before the treatment.
Patient and practitioner
The practitioner and patient together can prioritize the patient’s different disorders, giving star ratings for each. For example, the practitioner may ask the patient: ‘Oswald, you say that your main illnesses are exhaustion, restlessness, a sensation of chest discomfort, and feeling too hot. How many stars, out of five, would you give to each?’ After some discussion, the Oswald decides four stars for exhaustion, two for restlessness, one for chest discomfort, and one for heat sensations. The practitioner can always alter this rating later, for example in the light of data from pulse and tongue.
4 Imbalances + 5 Organs
Combinations of Imbalances
4 Imbalances: simplify complexity
Often a patient has more than one of the 4 Imbalances at the same time: they may have two, three, or all four Imbalances together.
This first level gives a clear simple overview of the patient. It cuts through complexity and focuses on the patient’s basic needs, in terms of just four factors: Deficiency, Stagnation, Disturbance, and Excess.
Example: Oswald
For example, the patient Oswald has all four Imbalances, but to differing degrees, as shown in fig. 1, and explained in the text below.
Prioritization and the star rating system Relative importance of each Imbalance
Because the patient may have more than one Imbalance, the practitioner must decide the relative importance of each Imbalance. Also, the practitioner must also have some way to record this. Star rating system
The relative importance of each Imbalance is shown by its star rating. Star rating from 0-5
The star rating system awards from 0-5 stars ღ for each of the 4 Imbalances, according to the severity of the main disorder that is associated with that Imbalance.
4 Imbalances + 5 Organs: increase precision
This second level focuses on the parts of the picture in precise detail. This increases the accuracy of diagnosis, which is the key to safe and successful treatment. Each of the five Organ systems of Chinese medicine – Spleen, Lung, Kidney, Liver, and Heart – is considered in terms of Deficiency, Stagnation, Disturbance, and Excess. Example: Oswald and the Heart system
Oswald is now specifically questioned about the Heart Organ system: see fig. 2. The practitioner finds that his chest discomfort is associated with sadness, and diagnoses Heart Stagnant Qi. Oswald’s restlessness is associated with the Heart-specific symptoms of anxiety and insomnia, so the diagnosis is Heart Spirit Disturbance. His heat sensations are worse the more anxious he gets, so the practitioner associates these with Heart Deficiency Heat, based on Deficient Yin.
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German Journal of Acupuncture & Related Techniques
However, Oswald’s exhaustion is not associated with increasing sadness or anxiety, so the practitioner must check the other four Organ systems to identify the system associated with Deficiency. Other Organ systems
Fig. 2: 4 Imbalances + 5 Organs Example: Heart
Fig. 3: 4 Imbalances + 5 Organs Example: Kidney
Fig. 4: 4 Imbalances + 5 Organs: Patient Diagram
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The practitioner questions Oswald about Spleen, Lung, and Liver, but Oswald has none of the symptoms that are specific to these Organ systems, such as digestive weakness for the Spleen, respiratory infections for the Lung, or irritability and anger for the Liver. But Oswald does have weak lower back, urinary frequency, and tinnitus that get worse
with increasing exhaustion. The practitioner diagnoses Kidney Deficient Yin, and gives Kidney Deficiency Heat two stars.
4 Imbalances + 5 Organs: patient diagram The full Patient Diagram, shown in fig. 4, includes the central 4 Imbalance box, which gives the clear simple overview of the patient’s needs, and the five Organ boxes, which give precise details of each Organ system in terms of the 4 Imbalances.
Free interactive Pdf and videos The 4 Imbalances + 5 Organs system is available as a free download, which uses the free version of Adobe Acrobat. This is available for all practitioners on the DÄGfA website, together with free explanatory videos. Herb diagrams
The description above shows how the Patient Diagram of the 4 Imbalances + 5 Organs system can be used for patient diagnosis. The following description shows how the Herb Diagrams can be used to select the best herbs for a patient.
Problems of herb choice Overlapping actions
One of the biggest problems for students and practitioners of herbal medicine is that related herbs can have many overlapping actions and uses.
Innovationen | Innovations J. Ross 4 Imbalances and 5 Organs
Fig. 5: Comparison of Rosmarinus and Lavandula
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Difficult herb choice
This can make it difficult to differentiate between them, and to choose the right herb for the patient’s needs. What makes a herb special
A practitioner wants to know what makes a particular herb special, and what makes it different from similar herbs.
Lavandula, and the differences between these two herbs become very clear in this diagramatic representation. It can be seen that Rosmarinus is primarily a moving and tonifying herb, whilst Lavandula is primarily calming. It can also be seen that neither of these herbs has either primary or secondary draining action. The star ratings for these and other herbs are based on a careful study of both traditional texts and recent research.
Solution
The Herb Diagrams in the 4 Imbalances and 5 Organs system, and in the interactive pdf download, can be used to solve this problem. The Herb Diagrams are organized in a similar way to the Patient Diagram described above, and use the same 0-5 star rating system.
Quick clear visual picture It is sometimes said that a picture is worth a thousand words, and, as can be seen below, the Herb Diagram can give a quick clear visual impression of what makes a herb special.
Herb diagram: 4 Imbalances Rosmarinus
The 4 Imbalances + 5 Organs diagrams that are used above to compare Western herbs can also be used to compare acupuncture points, Chinese herbs, or the Chinese nutritional characteristics of different foods. The 4 Imbalances and 5 Organs system is very flexible and can be used for both patient diagnosis and different forms of treatment. Financial disclosure
The material in this article is taken from a forthcoming book by Jeremy Ross to be published by Verlag Systemische Medizin (Bad Koetzting, Germany). DÄGfA Congress 2016 Jeremy Ross will be giving two full day courses on how to use the 4 Imbalance interactive system in clinical practice at the DÄGfA Congress in May 2016, in Bad Nauheim. One course focuses on the treament of headache, and the other on the treatment of cognitive disorders.
Figure 6 gives a very clear simple overview of the herb Rosmarinus, and shows that it is primarily to tonify Deficiency and move Stagnation, and secondarily for calming Disturbance.
Comparing Rosmarinus and Lavandula
Acupuncture point comparisons
Fig. 6: Herb Diagram 4 Imbalances Example: Rosmarinus
The herb Diagrams can be used to compare and contrast similar herbs. Figure 5 above shows the Herb Diagrams for Rosmarinus and
Author information Jeremy Ross has a BSc in biology from the University of Birmingham, specializing in plant physiology and biochemistry. He graduated from the National Institute of Medical Herbalists UK in 1982, and gained a doctorate in acupuncture from the British College of Acupuncture in 1985. In 1988 he completed a two-year training in Chinese herbal medicine with Ted Kaptchuk, followed by further training at the International College in Nanjing, China. After 17 years of clinical practice in Bristol, England, he practiced for 10 years in Seattle, USA, and in 2004 returned back to Bristol. For 25 years, Jeremy Ross has specialized on the integration of Western Herbs, Chinese Medicine, and Phytopharmacology. He is the author of three textbooks on this topic.