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Chapter Five: Eight Principles Differentiation
Section One: The Concept and Origin of Eight Principles Differentiation
1. The Concept of Eight Principles Differentiation
The Eight Principles: Exterior, Interior, Cold, Heat, Deficiency, Excess, Yin, Yang.
Eight Principles Differentiation: A method that uses the Eight Principles to comprehensively analyze clinical data collected from the four examinations to identify the depth of disease location, the nature of cold and heat, the struggle between pathogenic and righteous qi, and the categories of symptoms based on Yin and Yang.
Classification: Yang: Exterior, Deficiency, Cold
Yin: Interior, Excess, Heat
2. The Origin of Eight Principles Differentiation
Proposed by Zhu Weijiu in “Shang Han Zhi Nan” (Difficulties in Cold Damage).
Section Two: The Basic Content of Eight Principles Differentiation
1. Exterior-Interior Differentiation
Exterior: Body surface, viscera, meridians, three Yang meridians, skin, muscles, and collaterals.
General Concept: Interior: Organs, viscera, three Yin meridians, five organs, six viscera, bone marrow.
The meaning of Exterior-Interior in Eight Principles Differentiation: Skin, collaterals, and meridians are external and belong to the exterior; organs, bone marrow, and blood vessels are internal and belong to the interior.
Function of Exterior-Interior Differentiation: To distinguish the depth of disease location and the trend of disease progression.
Exterior Syndrome: Symptoms caused by the invasion of external pathogenic factors such as six excesses and epidemics through the skin and mouth/nose.
Characteristics: Sudden onset, mild condition, shallow location, short duration (defensive qi resists pathogens at the surface).
Clinical manifestations:
Main symptoms: Chills and fever (aversion to wind), body aches, thin white tongue coating, floating pulse. (Key points for differentiation)
Accompanying symptoms: Nasal congestion, runny nose, itchy or sore throat, cough, etc.
Symptom analysis: Fever: External pathogens invade the surface, obstructing the defensive qi’s ability to disperse, leading to heat.
Aversion to wind and cold: Defensive qi is obstructed, losing its function, resulting in a lack of warmth at the surface.
Body aches: External pathogens obstruct the meridians, causing poor circulation of qi and blood.
Nasal congestion, runny nose, sneezing, itchy or sore throat, cough: Pathogenic qi invades through the skin and mouth/nose, affecting the lungs, leading to loss of dispersing and regulating functions.
Floating pulse: External pathogens invade the surface, righteous qi rises to resist the pathogens, causing the pulse to be active at the surface.
Interior Syndrome: Symptoms caused by pathological changes in the internal organs, qi and blood, and bone marrow.
Causes: External pathogens invade the surface, unresolved exterior syndrome leads to internal invasion; external pathogens directly invade the organs; emotional distress, improper diet, and overwork directly lead to dysfunction of the organs and chaotic qi and blood.
Characteristics: Deep and broad disease location, complex causes, and diverse symptoms.
Clinical manifestations: A wide range of symptoms (see differentiation of cold and heat, deficiency and excess, and organ differentiation). For example: high fever, thirst, irritability, abdominal pain, diarrhea or vomiting, short and red urine, constipation, yellow or thick tongue coating, and deep pulse.
Half exterior, half interior: External pathogens have transmitted from the exterior but have not yet entered the interior, or internal pathogens have penetrated the exterior but have not yet reached the exterior, resulting in a struggle between the exterior and interior.
Clinical manifestations: Alternating chills and fever, chest and rib fullness, irritability with a desire to vomit, lack of appetite, bitter mouth and dry throat, dizziness, and wiry pulse.
Key points for distinguishing exterior and interior syndromes: Mainly observe the manifestations of cold and heat, whether the symptoms of the organs are prominent, and changes in tongue and pulse. Also consider the onset speed, severity of the condition, and duration of the illness.
2. Cold-Heat Differentiation
Cold and heat are the two principles for distinguishing the nature of diseases.
Mechanism: Cold and heat are the results of the body’s Yin and Yang being excessively strong or weak. Excessive Yin or Yang deficiency manifests as cold syndrome, while excessive Yang or Yin deficiency manifests as heat syndrome. The “Su Wen – On the Correspondence of Yin and Yang” states: “When Yang is strong, it is heat; when Yin is strong, it is cold.”
The “Su Wen – On Regulating the Menstrual Cycle” states: “When Yang is deficient, there is external cold; when Yin is deficient, there is internal heat.” This is the meaning.
Common confusion: Cold syndrome and heat syndrome are different from aversion to cold and fever. Aversion to cold and fever are common symptoms and phenomena of disease, while cold syndrome and heat syndrome are the conclusions of differentiation, reflecting the essence of the disease.
(1) Cold Syndrome – Symptoms caused by the invasion of cold pathogens or excessive Yin and Yang deficiency.
Characteristics: Excessive Yin leads to cold; Yang deficiency leads to cold.
Clinical manifestations: Main symptoms: Aversion to cold (fear of cold), preference for warmth, pale complexion, cold limbs, preference for curling up, pale tongue with white coating, slow or tight pulse. (Key points for differentiation)
Accompanying symptoms: Clear and thin secretions, preference for warmth in pain, etc.
Pathogenesis: Cold pathogens invade → Yang qi is insufficient → Cold body and limbs, pale complexion, pale tongue with white coating, slow pulse.
Overconsumption of cold and cool foods → Clear and thin secretions and excretions.
Chronic illness injures Yang → Excessive Yin leads to internal cold → Preference for warmth, pale tongue with moist white coating, cold pain with preference for warmth, tight pulse.
Symptom analysis: Insufficient Yang qi or damage from cold pathogens leads to the body’s inability to warm, hence cold body and limbs, preference for warmth, pale complexion. Excessive Yin leads to insufficient fluids, hence preference for warm drinks. Cold pathogens injure Yang, or Yang deficiency fails to warm and transform fluids, leading to clear and cold secretions and excretions. Cold pathogens injure the spleen, or prolonged deficiency of spleen Yang leads to poor transformation and transportation, resulting in loose stools. Internal cold dampness leads to insufficient Yang transformation, hence pale tongue with moist white coating. Weak Yang qi leads to insufficient force to promote blood circulation, hence slow pulse. Cold tends to constrict, and exposure to cold leads to tight pulse.
(2) Heat Syndrome – Symptoms caused by the invasion of heat pathogens or excessive Yang and Yin deficiency.
Characteristics: Excessive Yang leads to heat; Yin deficiency leads to heat.
Clinical manifestations: Main symptoms: Fever or aversion to heat with preference for cold, red face and ears, irritability, thirst, short and red urine, constipation, red tongue with yellow coating, rapid pulse. (Key points for differentiation)
Accompanying symptoms: Yellow and thick secretions, vomiting blood, etc.
Pathogenesis: Heat pathogens invade → Yang heat is excessive → Fever, irritability, red face and ears, vomiting blood, red tongue with yellow coating, rapid pulse.
Other pathogens transform.
Overconsumption of spicy and rich foods → Depletion of Yin fluids → Thirst and excessive drinking, short and red urine, constipation.
Excessive emotional distress leads to thick and yellow secretions and excretions.
Pathogen analysis: Excessive Yang leads to aversion to heat and preference for cold. Fire rises, leading to red face and ears. Heat disturbs the spirit, causing irritability. Excessive heat injures fluids, leading to thirst and preference for cold drinks. Fluids are scorched by heat, leading to thick and yellow secretions. Fire heat injures the meridians, causing blood to flow abnormally, leading to vomiting blood. Heat injures Yin, leading to depletion of fluids, hence short and red urine. Intestinal heat leads to poor transportation, resulting in constipation. Red tongue with yellow coating indicates heat, and dry coating with little fluid indicates Yin injury.
3. Deficiency-Excess Differentiation
Basic Content:
The mechanism of Deficiency-Excess Differentiation: Deficiency and excess are the results of the strength and weakness of righteous qi and the rise and fall of pathogenic qi.
Deficiency and excess are the two principles for distinguishing the rise and fall of pathogenic and righteous qi, and the struggle between them is the fundamental contradiction throughout the disease process.
Deficiency should be tonified, and excess should be drained.
(1) Deficiency Syndrome
Deficiency syndrome is a type of symptom caused by insufficient righteous qi in the body. In deficiency syndrome, the righteous qi is significantly weak, while the pathogenic qi is not excessive.
Clinical manifestations: ① Qi deficiency syndrome: Pale complexion, shortness of breath, fatigue, spontaneous sweating, symptoms worsen with movement, pale tongue, weak pulse – insufficient energy.
② Yang deficiency syndrome: Cold body and limbs, pale complexion, fatigue, spontaneous sweating, preference for warm drinks, clear urine, loose stools, pale tongue with white coating, weak pulse – insufficient warming (Qi deficiency can lead to Yang deficiency).
③ Blood deficiency syndrome: Pale or sallow complexion, dizziness, palpitations, insomnia, numbness in hands and feet, pale tongue, thin pulse – insufficient nourishment.
④ Yin deficiency syndrome: Afternoon heat, night sweats, red cheeks, dry throat, heat in palms and soles, red tongue with little coating, thin and rapid pulse – insufficient control of Yang (Blood deficiency can lead to Yin deficiency).
(2) Excess Syndrome
Excess syndrome refers to a type of symptom caused by excessive pathogenic qi. In excess syndrome, although the pathogenic qi is excessive, the righteous qi has not declined.
Clinical manifestations:
① Fever, chest tightness, irritability, even delirium (interior heat disturbs the spirit).
② Rough breathing, excessive phlegm (phlegm-heat obstructing the lungs).
③ Abdominal distension and pain with tenderness, constipation or diarrhea, urgency and heaviness in the abdomen (stomach and intestines with excess heat).
④ Difficulty urinating, or painful urination (bladder damp-heat).
⑤ Pale tongue with thick and greasy coating, strong pulse.
Key points for differentiation: Symptoms of internal stagnation + pale tongue with thick and greasy coating, strong pulse.
Distinguishing between deficiency and excess:
Symptoms Deficiency Excess
Body Condition Weak Strong
Mental State Lethargic Excited
Voice Low and weak Loud and coarse
Pain Likes pressure Resists pressure
Pulse Weak Strong
Tongue Pale and tender Pale and old
Less coating or no coating Thick and greasy coating
Duration Long Short
Relationship between symptoms:
(1) Coexisting Symptoms
Includes: Exterior cold syndrome, exterior heat syndrome, exterior excess syndrome, exterior deficiency syndrome, interior excess cold syndrome, interior excess heat syndrome, interior deficiency heat syndrome (Yin deficiency syndrome), interior deficiency sweat syndrome (Yang deficiency syndrome), etc.
(2) Mixed Symptoms – Coexisting exterior and interior diseases, i.e., both exterior and interior syndromes coexist.
Causes: ① Exterior syndrome unresolved, and pathogens have entered the interior.
② External pathogens simultaneously invade both exterior and interior.
③ Old illness not cured, and new external pathogens invade.
Common types (with cold-heat, deficiency-excess coexisting): Both exterior and interior cold, both exterior and interior heat, exterior cold with interior heat, exterior heat with interior cold, both exterior and interior excess, both exterior and interior deficiency, exterior deficiency with interior excess, exterior excess with interior deficiency.
(3) Transformation of Symptoms
Exterior and interior interchange.
① Exterior pathogens enter the interior: Exterior pathogens initially present as exterior syndrome, later manifesting as interior syndrome, while the exterior syndrome disappears, indicating transformation from exterior to interior.
② Interior pathogens emerge to the exterior: Pathogens in the interior have a tendency to penetrate through the skin to the exterior.
4. Yin-Yang Differentiation
1. Concept: Yin and Yang are the two principles for differentiating the attributes of diseases.
(“Two Principles and Six Transformations”, i.e., Yin and Yang principles govern cold-heat, exterior-interior, deficiency-excess six transformations. Cold syndrome, interior syndrome, deficiency syndrome belong to Yin syndrome; heat syndrome, exterior syndrome, excess syndrome belong to Yang syndrome.)
2. Characteristics. Yin: Static, inward, descending, cold, tangible, obscure.
Yang: Dynamic, outward, ascending, warm, intangible, bright.
3. Yin and Yang are the general principles of differentiation.
1. Yin Syndrome: Refers to symptoms that conform to the general attributes of “Yin”.
[Clinical manifestations] ① (Deficiency syndrome manifestation) Mental lethargy, shortness of breath, fatigue.
② (Interior cold syndrome manifestation) Cold body and limbs, loose stools, clear and long urine.
③ (Tongue and pulse) Pale and plump tongue, deep and slow pulse, thin and weak.
2. Yang Syndrome: Refers to symptoms that conform to the general attributes of “Yang”.
[Clinical manifestations] ① (Excess syndrome manifestation) Loud voice, coarse breathing, wheezing.
② (Heat syndrome manifestation) Red face, high fever, short and red urine, constipation.
③ (Tongue and pulse) Red tongue with prickles, rapid and strong pulse.
Yin syndrome and Yang syndrome
|
Symptoms |
Cold-Heat |
Mental State |
Complexion |
Thirst |
Voice |
Urination |
Tongue |
Pulse |
|
Yin Syndrome |
Cold Cold Limbs |
Mental Lethargy |
Dull |
Pale and Thirsty |
Low and Weak |
Clear and Long Urine Loose Stools |
Pale and Plump Tongue White and Slippery Coating |
Deep and Slow Weak |
|
Yang Syndrome |
High Fever |
Irritable |
Red |
Thirsty for Cold Drinks |
High and Coarse |
Short and Red Urine Constipation |
Red Tongue Yellow and Black with Prickles |
Rapid and Strong Powerful |
4. Specific Content of Yin and Yang
1. Yin deficiency syndrome refers to the deficiency of Yin fluids, which cannot control Yang, leading to symptoms of deficiency heat.
[Causes] Heat diseases injure Yin, excessive emotional distress leads to fire, overconsumption of warming and drying substances, chronic illness leads to depletion, aging, excessive sexual activity, etc.
2. Yang deficiency syndrome refers to the deficiency of Yang qi, which cannot control Yin, leading to symptoms of deficiency cold.
[Causes] Aging, decline of the body, chronic illness, overconsumption of bitter and cold substances, etc.
Yin deficiency syndrome and Yang deficiency syndrome comparison table
|
Symptoms |
Cold-Heat |
Perspiration |
Complexion |
Thirst |
Urination |
Tongue |
Pulse |
|
Yin Deficiency Syndrome |
Five Hearts Heat Afternoon Heat |
Night Sweats |
Red Cheeks |
Thirsty for Cold Drinks |
Dry and Hard Stools |
Red Tongue with Little Coating |
Thin and Rapid |
|
Yang Deficiency Syndrome |
Aversion to Cold and Cold Limbs |
Spontaneous Sweating |
Pale |
Pale and Thirsty |
Loose Stools Clear and Long Urine |
Pale Tongue with White Coating |
Deep and Slow |
Loss of Yin and Yang syndrome comparison table
|
Symptoms |
Perspiration |
Cold-Heat |
Limbs |
Complexion |
Thirst |
Breath |
Tongue |
Pulse |
|
Loss of Yang Syndrome |
Thin and Clear Cold Sweat |
Cold Body and Aversion to Cold |
Cold Limbs |
Pale |
Thirsty for Warm Drinks |
Weak |
Pale and Moist Tongue |
Weak and Almost Absent Pulse |
|
Loss of Yin Syndrome |
Salty and Sticky Hot Sweat |
Hot Body and Aversion to Heat |
Warm Limbs |
Red |
Thirsty for Cold Drinks |
Rough |
Red and Dry Tongue |
Thin and Rapid Pulse Weak |
3. Loss of Yin Syndrome: Refers to severe depletion of Yin fluids, leading to critical symptoms.
[Causes] Develops from chronic Yin deficiency; continuous sweating, severe vomiting, massive bleeding; severe burns, high fever that does not subside, etc.
4. Loss of Yang Syndrome: Refers to severe decline of Yang qi, leading to critical symptoms.
[Causes] Develops from Yang deficiency; continuous sweating, severe vomiting, massive bleeding; extreme Yin cold can lead to sudden loss of Yang; poisoning, phlegm obstructing the heart orifices, etc.
5. Excessive Yin Resisting Yang (including Dai Yang Syndrome)
[Concept] Refers to the excessive internal cold obstructing Yang qi, forcing it to float outward, resulting in pathological changes of true cold inside and false heat outside.
[Causes] Prolonged Yang deficiency with excessive Yin or cold pathogens injuring Yang.
[Manifestations] Mental lethargy, cold limbs, clear diarrhea, weak pulse; body heat with aversion to cold, flushed cheeks.
Dai Yang Syndrome (a severe stage of Excessive Yin Resisting Yang) refers to a pathological state where true cold in the lower body forces true Yang to float upward (true cold below, false heat above), which can manifest as flushed face, sore lower back and knees, etc.
6. Excessive Yang Resisting Yin
[Concept] Refers to the extreme heat of Yang qi, which is obstructed, forcing Yin qi outward, resulting in pathological changes of true heat inside and false cold outside.
[Manifestations] High fever, red eyes, irritability, thirst, red and dry urine; pale complexion, cold limbs, deep pulse.
Chapter Three: The Relationship Between Eight Principles Differentiation
The symptoms of the Eight Principles are closely related, with inevitability and universality. Yin-Yang, exterior-interior, cold-heat, deficiency-excess each summarize the essence of pathological changes from different angles, and none of them are complete symptoms. Differentiation requires a comprehensive understanding of the disease’s location, cause, and nature, as any pathological change must have a certain cause, nature, and location, and the condition is in a state of change. Therefore, there exists a broad and close relationship between the symptoms of the Eight Principles, which can be summarized into four categories: coexisting symptoms, mixed symptoms, true and false symptoms, and transformation of symptoms.
1. Coexisting Symptoms
Coexisting symptoms refer to comprehensive symptoms that arise from the interrelationship between disease location, nature, and the rise and fall of pathogenic and righteous qi. It should be noted that this concept is narrow, meaning that regardless of whether the disease location is in the exterior or interior (same or different), there are no opposing symptoms of cold and heat, deficiency and excess. The broad concept of coexisting symptoms refers to the coexistence of various symptoms.
1. Coexisting Exterior and Interior Diseases
[Mechanism] As shown in Figure 7-16.
When exterior and interior diseases coexist, various conditions such as deficiency, excess, cold, and heat often appear. They can present in eight combinations, as illustrated in the figure.
Note: When exterior and interior diseases coexist, the nature of the exterior syndrome is generally determined by the underlying pathological essence. For example, if there is internal accumulation of heat or excessive Yang qi, the exterior syndrome is often heat; if there is insufficient Yang qi, exterior heat syndrome is rarely seen.
2. Mixed Cold and Heat
Common types include: upper cold and lower heat, upper heat and lower cold, exterior cold with interior heat, exterior heat with interior cold.
[Mechanism] The mixed cold and heat in the exterior and interior is seen in “coexisting exterior and interior diseases”, as shown in Figure 7-17.
Note: When cold and heat coexist, it is important to distinguish between the exterior and interior, as well as the relative predominance of cold and heat and the urgency of the condition.
3. Mixed Deficiency and Excess
Mixed deficiency and excess refer to the presence of deficiency symptoms within excess symptoms, or excess symptoms within deficiency symptoms, as well as the simultaneous presence of deficiency and excess. The clinical practice of combining tonification and draining is designed for such symptoms, requiring a clear distinction between the predominance of deficiency and excess to guide treatment.
Common types include: excess with deficiency, deficiency with excess, and equal deficiency and excess.
2. Transformation of Symptoms
Transformation of symptoms refers to the transformation between opposing symptoms in the Eight Principles under certain conditions, where one symptom transforms into another.
From this, it can be seen that: first, the essence of the symptoms has changed; second, there is a process of quantitative change before qualitative change; third, the transformation of symptoms is different from the concepts of coexisting, mixed, and true and false symptoms. The term “transformation” indicates that both essence and phenomenon have changed from one to another; “mixed” refers to opposing symptoms coexisting without changing from one to another, with no distinction between true and false; “true and false” refers to the appearance of certain phenomena that do not correspond to the essence of the disease, which cannot be explained by conventional theories, and are neither transformations nor true opposing symptoms coexisting.
(1) Exterior and Interior Interchange
As the disease penetrates deeper, each layer represents the interior; as the pathogen emerges, each layer represents the exterior, highlighting the relativity of exterior and interior. Understanding the significance of exterior and interior interchange can predict the development and change of the disease, guiding timely changes in treatment methods.
1. Exterior Syndrome Entering the Interior
Exterior syndrome entering the interior refers to the initial presentation of exterior syndrome, later manifesting as interior syndrome, while the exterior syndrome disappears, indicating transformation from exterior to interior.
[Causes and Mechanism] Seen in the early to mid-stages of external diseases, often due to excessive pathogenic qi and weakened righteous qi, leading to misdiagnosis or mistreatment. The mechanism is the invasion of external pathogens into the interior, characterized by prominent visceral symptoms, with the original symptoms of chills and fever transforming into either only heat or only cold, while symptoms like nasal congestion and floating pulse disappear, as shown in Figure 7-19.
This type is generally seen in the early to mid-stages of external diseases, reflecting the progression of the disease from superficial to deep.
2. Interior Pathogens Emerging to the Exterior
Interior pathogens emerging to the exterior refer to the tendency of pathogens in the interior to penetrate through the skin to the exterior.
[Causes and Mechanism] Righteous qi overcomes the pathogens, and treatment is appropriate. This syndrome is characterized by fever accompanied by sweating, and the appearance of rashes is mild, as shown in Figure 7-20.
Interior pathogens emerging to the exterior indicate a favorable trend for the disease to improve.
It should be noted that the concepts of interior pathogens emerging to the exterior, interior syndrome emerging to the exterior, and interior disease emerging to the exterior are different. Strictly speaking, interior syndrome emerging to the exterior should refer to a situation where the original interior syndrome transforms into exterior syndrome, and the interior syndrome disappears, which is clinically difficult to verify; interior pathogens emerging to the exterior refers to the tendency of pathogens to penetrate outward, which does not equate to the transformation of interior syndrome into exterior syndrome; interior disease emerging to the exterior refers to the pathological process where the disease originally located in the viscera and meridians in the interior later penetrates outward due to the struggle between righteous and pathogenic qi.
(2) Cold-Heat Transformation
Cold syndrome and heat syndrome have essential differences, but under certain conditions, cold syndrome can transform into heat, and heat syndrome can transform into cold, which is commonly seen in clinical practice.
1. Cold Syndrome Transforming into Heat
Cold syndrome transforming into heat refers to the original cold syndrome later presenting as heat syndrome, while the cold syndrome disappears.
[Causes and Mechanism] Often due to unresolved external cold pathogens leading to heat, or cold dampness stagnating, Yang stagnating into heat, or overconsumption of warming and drying substances leading to heat, as shown in Figure 7-21.
Conditions for transformation: Cold syndrome has persisted for a long time; inappropriate treatment, overconsumption of warming and drying substances; failure of treatment, while the body’s Yang qi does not decline, leading to cold pathogens transforming into heat.
2. Heat Syndrome Transforming into Cold
Heat syndrome transforming into cold refers to the original heat syndrome later presenting as cold syndrome, while the heat syndrome disappears.
[Causes and Mechanism] Often due to severe heat toxins, or due to misdiagnosis or mistreatment, leading to excessive pathogenic qi, injuring righteous qi, resulting in the inability of the righteous qi to overcome the pathogens, leading to functional decline, and loss of Yang qi, transforming into cold syndrome, as shown in Figure 7-22.
It must be clear that the key factor promoting the transformation of cold and heat is the rise and fall of Yang qi (or Yin qi). When Yang qi is strong (according to the theory of constitution), cold syndrome is likely to transform into heat syndrome; when Yang qi is weak, heat syndrome is likely to transform into cold syndrome.
(3) Deficiency-Excess Transformation
During the progression of the disease, due to changes in the balance of righteous and pathogenic forces, excess syndrome and deficiency syndrome can transform into each other. The transformation of excess syndrome into deficiency syndrome is a common clinical type, essentially a general rule of disease progression. The transformation of deficiency syndrome into excess syndrome is rare in clinical practice, and is often due to deficiency leading to excess, forming mixed deficiency and excess symptoms.
1. Excess Syndrome Transforming into Deficiency
Excess syndrome transforming into deficiency refers to the situation where the original excess syndrome later transforms into deficiency syndrome.
[Causes and Mechanism] Often due to misdiagnosis or mistreatment leading to damage to righteous qi, or prolonged illness injuring righteous qi, as shown in Figure 7-23.
Excess syndrome transforming into deficiency is a general rule of disease progression and is extremely common in clinical practice.
2. Deficiency Syndrome Transforming into Excess
Deficiency syndrome transforming into excess refers to the original deficiency syndrome, due to active treatment and nourishment, leading to the recovery of righteous qi, which can contend with the pathogens, manifesting as excess symptoms (such as expelling stones, phlegm, sweating, etc.).
[Causes and Mechanism] Gradual recovery of righteous qi enables it to contend with the pathogens, as shown in Figure 7-24.
Deficiency syndrome transforming into excess is rare in clinical practice; although the symptoms may be more pronounced and intense than before, it reflects the righteous qi rising to expel the pathogens, which is favorable for the condition.
It should also be noted that deficiency syndrome transforming into excess is essentially a mixed deficiency and excess condition, but the meanings are different.
3. True and False Symptoms
True and false symptoms refer to two situations of the unity of pathological phenomena and pathological essence during the progression of the disease. The so-called “true” refers to symptoms that correspond to the internal essence of the disease; the so-called “false” refers to certain manifestations that do not correspond to the essence of the disease, which cannot be explained by conventional theories. Cold syndrome and heat syndrome, deficiency syndrome and excess syndrome have distinctions between true and false, and during differentiation, it is necessary to distinguish true from false to eliminate the false and retain the true, to avoid falling into the trap of “cold-cold heat-heat” and “deficiency-deficiency excess-excess”. The appearance of false symptoms in clinical practice is rare, hence the term “true and false symptoms of exterior and interior” is generally not mentioned.
(1) True Cold and False Heat
True cold and false heat syndrome refers to the presence of true cold internally while exhibiting certain false heat symptoms externally. Also known as “Excessive Yin Resisting Yang Syndrome” or “Dai Yang Syndrome”.
[Causes and Mechanism] Yang qi is weak, excessive internal cold forces the Yang to float outward, leading to false heat symptoms (excessive internal cold obstructs Yang externally).
[Clinical Manifestations] No burning sensation in the chest and abdomen, cold limbs, clear and long urine, pale tongue, weak pulse (true cold); flushed face, irritability, and restlessness (false heat).
(2) True Heat and False Cold
True heat and false cold syndrome refers to the presence of true heat internally while exhibiting false cold symptoms externally. Also known as “Yang Repletion” or “Heat Repletion” or “Excessive Yang Resisting Yin Syndrome”.
[Causes and Mechanism] Excessive Yang internally, obstructing Yin externally.
[Clinical Manifestations] High fever, burning sensation in the mouth and nose, thirst, yellow urine, red tongue (true heat); cold limbs, mental confusion, pale or purplish complexion, slow pulse (false cold).
Comparison of true cold and false heat with true heat and false cold is shown in Table 7-7.
Understanding the true and false nature of cold and heat and differentiating symptoms is a key and challenging aspect of this section of study, as referenced in Table 7-8. The key to differentiation lies in observing the clarity and yellowness of urine, whether the chest and abdomen feel burning, and other internal and central manifestations of cold and heat. Symptoms such as cold limbs and flushed face are generally false manifestations. The following four points summarize the rules (key points for distinguishing true cold and false heat):
① Grasp the entire course of the disease: True cold and false heat syndrome often has a history of cold syndrome.
② Use urination, tongue appearance, and changes in the chest and abdomen as the basis: Internally often true, externally often false.
③ Differentiate the severity of the condition: False manifestations are often localized, while true manifestations affect the whole body.
④ Differentiate preferences for cold and heat: What is preferred indicates deficiency, what is disliked indicates excess. For example, a patient with high fever may prefer to wear clothes; a patient with severe cold may not want to be near clothes.
(2) True Deficiency and False Excess
True deficiency and false excess refer to situations where due to abnormal movement of qi and blood, deficiency syndrome or excess syndrome presents false manifestations that are contrary to their own pathological nature, manifesting as deficiency symptoms resembling excess symptoms or excess symptoms resembling deficiency symptoms.
1. True Deficiency and False Excess refers to the essence of deficiency syndrome, where due to the internal stagnation of pathological products, qi and blood cannot circulate, leading to physiological dysfunction, resulting in certain excess manifestations, i.e., “extreme deficiency with excess symptoms”.
[Causes and Mechanism] Organ failure, qi deficiency, inability to transform, qi stagnation and obstruction.
[Clinical Manifestations] Preference for pressure, shortness of breath, pale tongue, weak pulse (true deficiency); abdominal fullness, shortness of breath, constipation, etc. (false excess).
2. True Excess and False Deficiency refers to the essence of excess syndrome, where due to stagnation of qi and blood in the organs, the movement and transformation are obstructed, leading to certain deficiency manifestations, i.e., “extreme excess with deficiency symptoms”.
[Causes and Mechanism] Internal accumulation of excess, obstruction of meridians, qi and blood not flowing, leading to loss of nourishment to the exterior.
[Clinical Manifestations] Loud voice, fullness and hardness in the chest and abdomen, strong pulse (true excess); lethargy, reluctance to speak, thin body, weak pulse (false deficiency).
Comparison of true deficiency and false excess with true excess and false deficiency is shown in Table 7-9.
It is worth mentioning that true excess and false deficiency arise from excess leading to “deficiency”, while true deficiency and false excess arise from “deficiency” leading to “excess”, thus during differentiation, it is crucial to distinguish the causal and primary relationships between deficiency and excess. Familiarity with the following points is essential for distinguishing true and false deficiency and excess:
① The presence or absence of strength in the pulse, the presence or absence of spirit, especially the deep pulse is true;
② The plumpness and tenderness of the tongue versus the old and thin appearance;
③ The loudness and coarseness of speech and breath versus the low and weak;
④ The strength or weakness of the patient’s constitution, the duration of the illness, the cause of onset, and the treatment process.
Additionally, attention should be paid to “hidden treachery” and “suspicious symptoms”.
Section Three: The Significance of Eight Principles Differentiation
The Eight Principles are concepts abstracted from specific phenomena. Using the Eight Principles to differentiate and summarize symptoms is a method for analyzing the commonality of diseases, representing one aspect of the application of the Eight Principles concept in Traditional Chinese Medicine.
1. Strongly Programmatic and Broadly Applicable Characteristics
The Eight Principles are the most general summary of the body’s response state during the disease process, representing the most basic principled requirements for differentiation and diagnosis. Through the Eight Principles, one can identify the key aspects of the disease, grasp its essentials, determine its type, and foresee its trends, providing direction for treatment.
2. Can Summarize Other Differentiation Methods
Eight Principles Differentiation is the foundation of differentiation. In the process of diagnosing diseases, it serves to simplify complexity and is applicable to the differentiation of various diseases across clinical departments, while other differentiation classification methods are specific deepening of Eight Principles Differentiation.
3. Increases the Complexity, Feasibility, and Practicality of Differentiation
Eight Principles Differentiation provides programmatic differentiation of the essence of diseases from eight different aspects. However, the Eight Principles are not absolutely distinct; they are closely related. Due to the close connections between the Eight Principles (coexisting, transforming, true and false), the complexity of Eight Principles Differentiation is greatly increased, allowing for the combination of more specific symptoms, thus expanding the feasibility and practicality of differentiation. Although the symptoms in clinical practice are complex and variable, they can all be summarized using Eight Principles Differentiation.
4. Reflects the Dialectical Thought of Traditional Chinese Medicine
Eight Principles Differentiation is not a simple categorization of several relatively vague symptoms, but should be understood as reflecting the dialectical thought through their interrelationships. Many differentiation viewpoints in Traditional Chinese Medicine are embodied through the relationships of the Eight Principles, recognizing the basic laws of disease occurrence and development. This has significant guiding implications for correctly understanding the disease process in clinical practice.
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