A Comprehensive Guide to the Eight Principles of TCM Diagnosis

The Eight Principles of Diagnosis is the fundamental framework of TCM diagnosis, aimed at TCM enthusiasts and beginners, and can also help patients understand their conditions. This article contains basic content and is a bit lengthy, so feel free to save it for later reading. Writing takes effort, so your encouragement and support are appreciated.

(1) Overview of the Eight Principles of Diagnosis

The Eight Principles (Ba Gang) refer to Yin and Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess. The term “Gang” means principle. The Eight Principles of Diagnosis uses Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess as the guiding principles for diagnosis, referred to as Ba Gang Bian Zheng.

In the Eight Principles, Yin and Yang are the overarching principles, with Exterior and Heat belonging to Yang, while Cold, Interior, and Deficiency belong to Yin. Exterior and Interior are the two principles used to differentiate the depth of the disease and the severity of the condition. Cold and Heat are the two principles used to differentiate the nature of the disease. Deficiency and Excess are the two principles used to differentiate the strength of the pathogenic factors and the body’s righteous Qi. Therefore, the Eight Principles of Diagnosis includes four pairs of interrelated diagnostic principles. Although the manifestations of diseases are varied and complex, they can all be summarized using the Eight Principles. Based on the categories of disease symptoms, they can be classified into Yin and Yang syndromes; based on the location of the disease, they can be classified into Exterior and Interior syndromes; based on the nature of the disease, they can be classified into Cold and Heat syndromes; and based on the strength of the righteous and pathogenic Qi, they can be classified into Deficiency and Excess syndromes. This helps identify the key aspects of the disease, trace its type, and predict its trend to guide treatment.

When clinically applying the Eight Principles of Diagnosis, the first step is to differentiate between Exterior and Interior to identify the depth and severity of the disease. Next, Cold and Heat, as well as Deficiency and Excess, are differentiated to clarify the nature of the disease and the strength of the righteous and pathogenic Qi. Finally, Yin and Yang are differentiated to summarize the overall nature and developmental trend of the disease. The occurrence, development, and changes of diseases always follow their inherent laws. In clinical practice, the application of the Eight Principles of Diagnosis must consider the different developmental patterns of various diseases, as well as the differences in symptoms at different stages of the same disease.

Exterior Syndrome

1. Exterior Syndrome refers to the symptoms that arise when external pathogens invade the body through the skin or respiratory tract. Therefore, Exterior Syndrome is often seen in the early stages of externally contracted diseases, characterized by sudden onset, superficial location, short duration, and mild severity.

[Clinical Manifestations] Fever, chills, thin white tongue coating, floating pulse. Often accompanied by symptoms such as headache, body aches, nasal congestion, runny nose, and cough.

[Syndrome Analysis] The pathogenesis of Exterior Syndrome is due to external pathogens invading the exterior, obstructing the defensive Qi. Zhang Jiebin stated: “Exterior Syndrome occurs when pathogenic Qi enters from the outside.” The external pathogens invade the body at the skin and muscle level. The “Lingshu” states: “Whenever pathogenic Qi enters the body, it must first settle in the skin and hair.” The skin and muscles, also known as the muscle exterior, rely on the nourishment of the defensive Qi to serve as a barrier against external pathogens. The “Lingshu” also states: “Defensive Qi warms the flesh, fills the skin, nourishes the muscles, and controls the opening and closing of the pores.” When external pathogens invade the exterior, the defensive Qi is obstructed and cannot function normally, leading to a loss of warmth in the muscle exterior, hence the feeling of chills. Chills refer to the clinical symptom where the patient feels cold despite being covered or near a heat source. If the external pathogen is not eliminated, the chills will not diminish, hence the saying: “For every bit of chill, there is a bit of Exterior Syndrome.” The external pathogen obstructs the defensive Qi, causing it to become stagnant. However, the defensive Qi still desires to disperse and resist the external pathogen, resulting in fever, which is characterized by being persistent and continuous. The simultaneous occurrence of chills and fever is an important feature of Exterior Syndrome in the early stages of externally contracted diseases, and thus serves as a key diagnostic criterion.

When the defensive Qi desires to disperse and resist the external pathogen, the pulse is floating. The “Yimen Banghe” states: “The tongue coating is a manifestation of the Qi generated in the stomach, hence healthy individuals often have a thin coating.” It also states: “When the stomach has Qi, and the pathogen enters, the coating becomes thick.” The pathogenesis of Exterior Syndrome is that the external pathogen invades the exterior without affecting the Qi of the stomach, hence the tongue coating appears normal, thin, and white. The skin and lungs are interconnected, with the nose being the upper orifice of the lungs. When external pathogens invade the exterior, the lungs are affected, leading to abnormal dispersal and descent, resulting in cough, nasal congestion, and in severe cases, wheezing. The invasion of external pathogens obstructs the flow of Qi, leading to headaches and body aches. The six external pathogens include Wind, Cold, Heat, Dampness, Dryness, and Fire, and the body’s constitution varies in strength and weakness, so Exterior Syndrome often coexists with Cold, Heat, Deficiency, and Excess.

Interior Syndrome

2. Interior Syndrome refers to a type of syndrome that arises when the disease penetrates deeply into the interior, presenting pathological changes in the organs, Qi, and blood. It is the opposite of Exterior Syndrome. Zhang Jiebin stated: “Interior Syndrome occurs when the disease is internal, in the organs.” The scope of Interior Syndrome is very broad; in general, all syndromes that are not classified as Exterior or half Exterior and half Interior belong to Interior Syndrome.

[Clinical Manifestations] High fever, delirium, irritability, thirst, abdominal pain with constipation, red tongue with yellow coating, or vomiting, abdominal pain, diarrhea, or pain in the flanks, sighing, insomnia, and vivid dreams.

[Syndrome Analysis] The formation of Interior Syndrome generally occurs in three situations. First, when external pathogens invade the exterior and the Exterior Syndrome is unresolved, the pathogen transmits to the interior. For example, Cold pathogens transforming into Heat in the interior or Heat pathogens directly invading the interior, leading to excessive internal Heat, resulting in high fever without chills. Second, when external pathogens directly invade the organs. At the onset of the disease, it presents as Interior Syndrome. For example, overconsumption of cold foods or exposure to cold in the abdomen can lead to Cold Dampness directly invading the spleen and stomach, causing abdominal pain, and if the spleen’s function is impaired, it can lead to diarrhea. Third, internal injuries from emotional disturbances or excessive labor. For instance, anger injures the liver, leading to liver Qi stagnation, resulting in pain and fullness in the flanks, and prolonged stagnation can transform into Heat, disturbing the spirit and causing insomnia and vivid dreams. For more details, refer to the differentiation of Cold and Heat, Deficiency and Excess, and the differentiation of the organs.

Half Exterior Half Interior Syndrome

3. Half Exterior Half Interior Syndrome occurs when external pathogens invade the exterior and partially penetrate the interior, presenting symptoms that linger between the exterior and interior.

[Clinical Manifestations] Alternating Cold and Heat, fullness in the chest and flanks, quiet demeanor, lack of desire to eat, irritability, preference for vomiting, bitter mouth, dry throat, and wiry pulse.

[Syndrome Analysis] Wind and Cold external pathogens attack the exterior, and if the exterior syndrome is unresolved, they can transmit to the interior. The sequence is: Exterior — Half Exterior Half Interior → Interior. Therefore, Half Exterior Half Interior is neither purely Exterior nor purely Interior, but is in a state between the two. Alternating Cold and Heat means that when one feels Cold, Heat follows, and vice versa. The “Shanghan Lun” states: “When the blood is weak and Qi is exhausted, the pores open, and the pathogenic Qi enters, contending with the righteous Qi.” Due to the contention between the pathogenic and righteous Qi in the space between the exterior and interior, when the Yin contends, it results in Cold, and when the Yang contends, it results in Heat, leading to alternating Cold and Heat. Fullness in the chest and flanks indicates that the chest is connected to the flanks, leading to fullness and pain. The quiet demeanor indicates a lack of desire to speak, and the lack of desire to eat indicates a mild symptom of poor appetite; preference for vomiting indicates frequent nausea. This is due to the stagnation of the pathogenic Qi in the chest and flanks, which affects the gallbladder, heart, and stomach. If the heart is unsettled, it leads to irritability, and if the stomach is unbalanced, it leads to vomiting.

Differentiation between Exterior and Interior Syndromes

The differentiation is primarily based on the characteristics of onset, Cold and Heat, tongue appearance, and pulse. Exterior Syndrome is characterized by new onset, rapid onset, short duration, and superficial location. Interior Syndrome is characterized by prolonged illness, slow onset, long duration, and deep location. In Exterior Syndrome, fever and chills occur simultaneously. In Interior Syndrome, there may be only fever without chills or only chills without fever. In Exterior Syndrome, the tongue coating shows no significant changes, typically thin white coating, or only the edges and tip of the tongue may appear red. In Interior Syndrome, the tongue coating shows abnormal changes. In Exterior Syndrome, the pulse is floating. In Interior Syndrome, the pulse is deep. As Cheng Zhongling stated: “The differentiation between Exterior and Interior lies in the presence of fever and tidal heat, chills and heat, headache and abdominal pain, nasal congestion and dry mouth, the presence or absence of tongue coating, and the floating or deep pulse.”

Coexisting Exterior and Interior Syndromes

Coexisting Exterior and Interior Syndromes refer to the simultaneous presence of both Exterior and Interior Syndromes at a certain stage of the disease in a patient. This is also known as simultaneous Exterior and Interior disease. Common clinical examples include Exterior Cold with Interior Heat, Exterior Heat with Interior Cold, both Exterior and Interior Heat, both Exterior and Interior Cold, Exterior Deficiency with Interior Excess, Exterior Excess with Interior Deficiency, both Exterior and Interior Deficiency, and both Exterior and Interior Excess.

The differentiation of coexisting Exterior and Interior Syndromes requires not only distinguishing which occurred first but also differentiating the nature of Cold and Heat, as well as the severity and urgency of the Exterior and Interior conditions, to determine the order and specific treatment methods.

Cold and Heat

Cold and Heat are the two principles used to differentiate the nature of diseases. The “Neijing” proposes the regulatory nature of Cold and Heat based on the dynamics of Yin and Yang. The “Suwen” states: “When Yang is deficient, there is external Cold; when Yin is excessive, there is internal Cold; when Yang is excessive, there is external Heat; when Yin is deficient, there is internal Heat.” Zhang Jiebin stated: “Cold and Heat are the transformations of Yin and Yang.” Therefore, differentiating Cold and Heat is essentially differentiating the excess and deficiency of Yin and Yang. Pathogens can be classified into Yin pathogens and Yang pathogens, while the righteous Qi can be classified into Yin fluids and Yang Qi. When Yang pathogens cause disease, Yang Qi becomes excessive, leading to the injury of Yin fluids, or Yin fluids become deficient, leading to the excess of Yang Qi, which clinically manifests as Heat syndromes. When Yin pathogens cause disease, Yin Qi becomes excessive, leading to the deficiency of Yang Qi, or Yang Qi becomes weak, leading to the excess of Yin Cold, which clinically manifests as Cold syndromes. Cold syndromes and Cold manifestations, Heat syndromes and Heat manifestations, while distinct, are also related. Cold syndromes reflect the essence of the disease at a certain stage, while Heat syndromes reflect the essence of the disease at another stage. Cold manifestations are the clinical signs of Cold syndromes, while Heat manifestations are the clinical signs of Heat syndromes. However, in true Heat and false Cold syndromes, or true Cold and false Heat syndromes, the clinical signs of Cold and Heat do not reflect the true nature of the disease at that stage and can instead interfere with the true nature of the disease. Therefore, it is essential to carefully distinguish between Cold syndromes and Heat manifestations, as well as Heat syndromes and Cold manifestations.

Deficiency and Excess

Deficiency and Excess are the two principles used to differentiate the strength of pathogenic and righteous Qi. The “Suwen” proposes the regulatory nature of Deficiency and Excess. In the “Suwen Tongping” it states: “When pathogenic Qi is strong, it is Excess; when the essence is depleted, it is Deficiency.” Zhang Jiebin explains: “Excess refers to the strong pathogenic Qi, while Deficiency refers to the weak righteous Qi.” In other words, Excess syndromes are characterized by the predominance of pathogenic Qi, while Deficiency syndromes are characterized by the insufficiency of righteous Qi. Shen Zongming stated that all diseases can be categorized into Deficiency and Excess. Differentiating the Deficiency and Excess of diseases and understanding the strength of the pathogenic and righteous Qi provides a basis for appropriate treatment methods. Therefore, Zhang Jiebin stated: “To observe Deficiency and Excess is to understand the fundamental nature of the disease and whether to tonify or drain.” Diseases can be classified into Deficiency and Excess, and Deficiency and Excess can also differ in terms of Exterior and Interior locations and Cold and Heat nature. In other words, Deficiency syndromes can be classified into Exterior Deficiency and Interior Deficiency, Deficiency Heat and Deficiency Cold, while Excess syndromes can be classified into Exterior Excess and Interior Excess, Excess Heat and Excess Cold. There are also cases where an original Excess syndrome transforms into a Deficiency syndrome, and vice versa. Additionally, the same patient may present with mixed or true and false Deficiency and Excess at the same time, requiring careful differentiation in clinical practice. Zhang Jiebin stated: “This is what is meant by having no true Excess or true Deficiency, harming the insufficient while benefiting the excessive, leading to death.”

Deficiency Syndromes

Deficiency syndromes are characterized by the insufficiency of righteous Qi and the weakness of pathogenic Qi. Righteous Qi includes Qi, blood, essence, fluids, and the physiological functions of the organs. Righteous Qi serves to protect the body from various pathogenic factors, maintain normal metabolism, and promote growth and development. When the body’s righteous Qi is insufficient, a series of pathological phenomena arise, including low resistance and weakened organ function, collectively referred to as Deficiency syndromes.

[Clinical Manifestations] Pale complexion, lack of energy, fatigue, shortness of breath, spontaneous sweating, cold limbs, loose stools, urinary incontinence, or pale yellow complexion, five hearts heat, red cheeks with night sweats, dry mouth and throat, red tongue with little coating, and weak, thin pulse.

[Syndrome Analysis] The formation of Deficiency syndromes can be attributed to both congenital insufficiency and acquired malnutrition, with the latter being the primary cause. For example, irregular diet, failure to establish a solid foundation, emotional distress, excessive labor, internal injury to the organs, excessive sexual activity, prolonged illness, or improper treatment can all lead to Deficiency syndromes, but they generally fall into the categories of Yang injury or Yin injury. Yang injury is primarily characterized by Yang Qi deficiency. When Yang Qi is weak, it cannot warm the body, leading to symptoms such as pale complexion, lack of energy, fatigue, shortness of breath, cold limbs, loose stools, and urinary incontinence. Yin injury is primarily characterized by Yin blood deficiency. When Yin is deficient, it fails to nourish and moisten the body, leading to symptoms such as pale yellow complexion, five hearts heat, red cheeks with night sweats, dry mouth and throat, red tongue with little coating, and thin, rapid pulse.

Excess Syndromes

Excess syndromes are characterized by the predominance of pathogenic Qi and the preservation of righteous Qi. Pathogenic Qi includes the six external pathogens, emotional disturbances, phlegm, dampness, and blood stasis. Therefore, Excess syndromes can be seen as a pathological summary of the body’s response to external pathogens or the accumulation of pathological products within the body.

[Clinical Manifestations] Fever, red face, chest tightness, irritability, and in severe cases, delirium, coarse breathing, excessive phlegm, constipation, and difficulty urinating, or painful urination with a burning sensation, pale tongue, thick, greasy coating, and strong, forceful pulse.

[Syndrome Analysis] The causes of Excess syndromes can be divided into two categories: one is the invasion of external pathogens, and the other is the failure of the organs to function properly, leading to stagnation of Qi and blood. For example, Qi stagnation can lead to Qi reversal; blood stasis can lead to blood stagnation; and unprocessed food can lead to food stagnation. All of these can result in Excess syndromes characterized by strong pathogenic Qi.

Differentiation between Deficiency and Excess

To differentiate between Deficiency and Excess, it is essential to recognize that Deficiency is characterized by insufficiency and decline, while Excess is characterized by abundance and excess. 1. Initial stages of external invasion are often Excess syndromes, while prolonged internal injuries are often Deficiency syndromes. 2. A pale tongue with a thin coating is often indicative of Deficiency syndromes, while a dark tongue with a thick coating is often indicative of Excess syndromes. 3. A weak and thin pulse is often indicative of Deficiency syndromes, while a strong and forceful pulse is often indicative of Excess syndromes. 4. Abdominal tenderness is often indicative of Deficiency syndromes, while abdominal pain with resistance to pressure is often indicative of Excess syndromes. As Cheng Zhongling stated: “The differentiation between Deficiency and Excess lies in the presence of sweating or not, abdominal distension and pain, whether the distension decreases or not, and whether the pain is tender or resistant to pressure. The duration of the disease, the thickness of the constitution, and the pulse’s characteristics can also help in differentiation.”

Relationship between Deficiency and Excess with Exterior and Interior, Cold and Heat

Deficiency and Excess can be differentiated based on their location in the Exterior or Interior, as well as their nature of Cold or Heat, leading to the formation of various syndromes such as Exterior Deficiency and Exterior Excess, Interior Deficiency and Interior Excess, Deficiency Cold and Excess Cold, and so on. 1. Exterior Deficiency Syndromes can be classified into external and internal types. 2. Exterior Excess Syndromes are most commonly seen in cases of external Cold invasion. The clinical manifestations include fever and chills, with no sweating, headache, body aches, and a floating, tight pulse. 3. Interior Deficiency Syndromes encompass a wide range of conditions, including deficiencies in various organs and meridians, as well as deficiencies in Yin, Yang, Qi, and blood. When classified by Cold and Heat, there are Deficiency Cold and Deficiency Heat syndromes. Deficiency Cold syndromes are caused by the deficiency of Yang Qi within the body. 4. Deficiency Heat syndromes generally refer to conditions caused by the deficiency of Yin fluids. 5. Interior Excess Syndromes also encompass a wide range of conditions, including various organs and meridians, as well as different pathogenic factors. When classified by Cold and Heat, there are Excess Cold and Excess Heat syndromes. 6. Excess Cold syndromes are caused by excessive Cold pathogens obstructing Yang Qi.

Yin and Yang

Yin and Yang are the two guiding principles of classification. Zhang Jiebin stated: “In diagnosing and treating diseases, one must first examine Yin and Yang, as this is the guiding principle of medicine.” Yin and Yang represent the universal laws of nature, and any opposing yet unified phenomena can be classified and distinguished using Yin and Yang. Zhang Jiebin stated: “In human diseases, they may originate from either Yang or Yin, and although the changes are numerous, their essence is one.” Therefore, Exterior, Heat, and Excess belong to Yang, while Interior, Cold, and Deficiency belong to Yin. Thus, Yin and Yang serve as the two guiding principles for classifying diseases. In this sense, the categories of Yin and Yang syndromes are broad. Any syndrome can be classified as Yin or Yang, and any symptom can be analyzed as belonging to either Yin or Yang.

Yin Deficiency, Yang Deficiency, Yin Loss, and Yang Loss are four syndromes that differ from the classification of Yin and Yang. Firstly, they are all classified as Deficiency syndromes. Secondly, they refer to the deficiency and loss of Yin and Yang themselves, which are also commonly seen in clinical practice.

Yin Syndromes

Yin syndromes include Interior, Cold, and Deficiency syndromes. In general, any syndrome that conforms to the general characteristics of Yin can be referred to as a Yin syndrome. It is common to illustrate Yin syndromes using Deficiency Cold syndromes.

[Clinical Manifestations] Dull or pale complexion, aversion to cold, preference for lying against a wall, reluctance to open the eyes, quiet demeanor, soft voice, shallow breathing, fatigue, and in severe cases, lethargy, lack of thirst, or preference for warm drinks, loose stools, clear and long urination, pale and swollen tongue, white and slippery coating, and deep, slow, and weak pulse.

[Syndrome Analysis] Yin syndromes arise from either Yang deficiency or excessive internal Cold. When Yin is excessive, it leads to internal Cold; when Yang is deficient, it also leads to internal Cold. This can occur due to external invasion of Cold pathogens or internal generation of Cold due to Yin deficiency. When Yang is insufficient, it cannot warm the body, leading to the manifestations of Cold, Deficiency, and stillness.

Yang Syndromes

Yang syndromes include Exterior, Heat, and Excess syndromes. In general, any syndrome that conforms to the general characteristics of Yang can be referred to as a Yang syndrome. It is common to illustrate Yang syndromes using Excess Heat syndromes.

[Clinical Manifestations] Energetic spirit, loud speech, rapid breathing, red face, high fever, yellow urine, dry and hard stools, delirium, irritability, red tongue, yellow and dry coating, and rapid pulse.

[Syndrome Analysis] Yang syndromes reflect the pathological changes associated with hyperfunction. Yang is active and hot, and when it disturbs the spirit, it leads to delirium and irritability. Heat accelerates blood flow, leading to a red face and eyes. Excessive heat damages fluids, leading to yellow and scanty urine and dry, hard stools. The red tongue, yellow and dry coating, and rapid pulse indicate the presence of internal Excess Heat.

Yin Deficiency Syndromes

Yin Deficiency syndromes arise from the depletion of Yin essence, leading to a lack of control over Yang, resulting in Deficiency Heat syndromes.

[Clinical Manifestations] Weight loss, red cheeks with night sweats, tidal fever, dry mouth and throat, five hearts heat, red tongue with little coating, and thin, rapid pulse.

[Syndrome Analysis] The pathogenesis of Yin Deficiency syndromes is characterized by insufficient Yin essence, leading to a lack of nourishment and tranquility, resulting in relative excess of Yang and the generation of Deficiency Heat. When Yin is deficient, it cannot control Yang, leading to internal disturbance and heat, resulting in symptoms such as red cheeks, tidal fever, night sweats, and dry mouth and throat. The kidney Yin is the foundation of all Yin, so kidney Yin deficiency plays a significant role in the pathogenesis of Yin Deficiency syndromes. Zhang Jiebin stated: “Yin deficiency is due to fluid depletion.” Shen Jinao stated: “Yin deficiency is due to true Yin deficiency in the kidneys.”

Yang Deficiency Syndromes

Yang Deficiency syndromes are characterized by insufficient Yang Qi, leading to a cold Deficiency syndrome.

[Clinical Manifestations] Pale complexion, cold limbs, abdominal pain with a preference for pressure, loose stools, clear and long urination, shortness of breath, fatigue, lack of energy, pale and tender tongue, and weak or deep, slow pulse.

[Syndrome Analysis] The pathogenesis of Yang Deficiency syndromes is characterized by insufficient Yang Qi, leading to an inability to warm the body, resulting in internal Cold. This leads to reduced function of the meridians and organs, causing slow circulation of Qi, blood, and fluids, and the generation of internal Cold. The clinical manifestations include cold limbs, abdominal pain with a preference for pressure, loose stools, clear and long urination, pale complexion, fatigue, and weak or deep, slow pulse. Kidney Yang is the foundation of all Yang, so kidney Yang deficiency plays a significant role in the pathogenesis of Yang Deficiency syndromes. Zhang Jiebin stated: “Yang deficiency is due to fire deficiency.” Shen Jinao stated: “Yang deficiency is due to true Yang deficiency in the kidneys.”

Yin Loss Syndromes

Yin Loss syndromes occur when the body’s Yin essence is severely depleted, leading to exhaustion.

[Clinical Manifestations] Salty sweat, warm hands and feet, fever, coarse breathing, thirst with a preference for cool drinks, dry tongue without moisture, and thin, rapid pulse.

[Syndrome Analysis] Due to excessive depletion of Yin essence, the body experiences heat manifestations, leading to symptoms such as fever, warm hands and feet, coarse breathing, and thirst. The pulse is thin and rapid due to extreme depletion of Yin.

Yin Loss can vary in severity; generally, acute Yin Loss is considered critical and is often caused by external heat diseases. Chronic Yin Loss is less severe and is often caused by prolonged illness.

Yang Loss Syndromes

Yang Loss syndromes occur when Yang Qi is weakened to the point of collapse.

[Clinical Manifestations] Profuse cold sweat, pale and sticky skin, aversion to cold, cold hands and feet, weak breathing, lack of thirst or preference for warm drinks, and floating, rapid, or weak pulse.

[Syndrome Analysis] Yang Qi is severely damaged, leading to floating and weak Yang, resulting in profuse cold sweat and pale, sticky skin. Yang Qi is weak, leading to cold hands and feet, lack of thirst or preference for warm drinks, and the pulse may be floating and rapid or weak and nearly absent. Yang Loss is often caused by excessive pathogenic factors overwhelming the righteous Qi, leading to sudden loss of Yang Qi, or by pre-existing Yang deficiency, where the righteous Qi cannot support the body. Excessive sweating can also lead to the loss of Yang Qi. Although both Yang Deficiency and Yang Loss are characterized by insufficient Yang Qi, Yang Deficiency is a cold Deficiency syndrome, while Yang Loss represents a critical state of Yang Qi collapse.

Yin and Yang must be balanced for health. When Yin and Yang are out of balance, it can lead to severe health issues. Understanding the differentiation of Yin and Yang is crucial for effective diagnosis and treatment in TCM.

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