During the Ming and Qing dynasties, some outstanding physicians, such as Zhang Jingyue, Cheng Zhongling, and Jiang Bihua, extracted the two principles of Yin and Yang from the Six Meridians diagnosis to govern the differentiation of exterior and interior, cold and heat, deficiency and excess, which was highly valued and welcomed by practitioners at that time.Later, it was further developed and refined, becoming what we now know as the Eight Principles diagnosis.From Jiang’s article “Differentiation of Exterior and Interior, Deficiency and Excess, Cold and Heat,” it can be seen that the terminology at that time only referred to Yin and Yang as principles, while the differentiation of exterior and interior, deficiency and excess, cold and heat had not yet reached the level of principles.
▢Author/Liu Duzhou
Jiang stated: “All human diseases are fundamentally related to Yin and Yang. The differentiation of Yin and Yang is closely tied to the concepts of exterior and interior, deficiency and excess, and cold and heat. The interior is Yin, the exterior is Yang, deficiency is Yin, excess is Yang, cold is Yin, and heat is Yang. A good physician saves people by distinguishing these Yin and Yang; a mediocre physician harms people by misidentifying these Yin and Yang.” His statement is fundamentally similar to Zhang Jingyue’s concepts of the “Two Principles” and “Six Transformations.” It can be said that this was the embryonic stage of the Eight Principles diagnosis system. Today, revisiting the development and clinical application of the Eight Principles diagnosis system is necessary for our reference and learning.However, it must be pointed out that the thought of the Eight Principles diagnosis originates from the Six Meridians diagnosis in the “Shang Han Lun” (Treatise on Cold Damage). In the “Shang Han Lun,” the Six Meridians and the Eight Principles are closely interconnected and inseparable. This is because the Six Meridians represent the material aspects, summarizing the organs and meridians, and differentiation must be based on this material foundation; thus, diseases cannot exceed the scope of the Six Meridians. However, the symptomatic manifestations of the Six Meridians cannot deviate from the rules of the Eight Principles differentiation, so the two must be combined to be effectively used in clinical differentiation. The specific methods of combining the Eight Principles diagnosis with the Six Meridians diagnosis are introduced as follows:
1. Yin and Yang
The “Nei Jing” (Inner Canon) states: “To treat a disease, one must seek the root; the root lies in Yin and Yang.” Therefore, the two principles of Yin and Yang serve as the foundation for the Six Meridians and also as the foundation for the Eight Principles, governing all symptoms and their developments.
1. Taiyang Disease
Taiyang and Shaoyin are exterior and interior, respectively, and thus have a differentiation of Yin and Yang. If the pulse is floating, with fever and aversion to cold, it indicates a disease occurring in Taiyang, termed Yang syndrome. If the pulse is deep, with no fever but aversion to cold, it indicates a disease occurring in Shaoyin, termed Yin syndrome.
2. Yangming Disease
Yangming and Taiyin are exterior and interior, respectively, and thus have a differentiation of Yin and Yang. If there is body heat with sweating, and aversion to heat rather than cold, it indicates a disease occurring in Yangming, termed Yang syndrome; if there is cold in Yangming, with inability to eat, difficulty in urination, cold sweat on hands and feet, and initially hard but later loose stools, it indicates a disease occurring in Taiyin, termed Yin syndrome.
3. Shaoyang Disease
Shaoyang and Jueyin are exterior and interior, respectively, and thus have a differentiation of Yin and Yang. If a person experiences alternating chills and fever, fullness in the chest and hypochondria, irritability, and nausea, it indicates a disease occurring in Shaoyang, termed Yang syndrome. If there is deafness, contraction of the scrotum, and inability to take in water, with a black and slippery tongue coating, it indicates a disease occurring in Jueyin, termed Yin syndrome.
The Six Meridians diseases all have aspects of Yin and Yang. Viewing the problem from the perspective of opposing developments is called the method of dichotomy. The ability to differentiate allows for clarity in understanding the Six Meridians, and further clarifies the differentiation of exterior and interior, cold and heat, deficiency and excess.
From the above, it can be seen that diseases of the Yang meridians often occur in the six fu organs, as the fu organs are Yang, with abundant Qi and blood, and strong resistance to pathogens, thus characterized by various heat manifestations; while diseases of the Yin meridians often occur in the five zang organs, as the zang organs are Yin, with deficient Qi and blood, weak resistance to pathogens, thus characterized by various cold manifestations. Broadly speaking, symptoms such as lightness of the body, shortness of breath, heat in the mouth and nose, clear eyes, inability to sleep; or extreme heat with blurred vision; or red eyes with excessive tears; or body heat with a red face and lips; or thirst with red and yellow urine, all reflect Yang syndrome. Conversely, symptoms such as heaviness of the body, cold in the mouth and nose, inability to open the eyes, pale complexion, cold extremities, blue nails, diarrhea, and white urine, all reflect Yin syndrome.
Ancient texts state: “Extreme Yang resembles Yin, and extreme Yin resembles Yang,” thus when distinguishing between Yin and Yang syndromes, one must differentiate their authenticity to avoid being misled by appearances. The “Shang Han Lun” states: “If a patient has a high fever but desires to be close to clothing, the heat is in the skin, and the cold is in the marrow; if the body is very cold but does not desire to be close to clothing, the cold is in the skin, and the heat is in the marrow.” This indicates that the “syndrome” has authenticity, while the “condition” is credible. Therefore, one can observe the truth through “desire” and “non-desire.” In clinical practice, if one follows this method, they will be closer to the truth.
2. Exterior and Interior
The Yin and Yang of the Six Meridians diseases all have a problem of the site of onset. Therefore, recognizing the location of exterior and interior diseases allows for the appropriate use of sweating and purging methods.
1. Taiyang Disease Exterior Syndrome
(1) Taiyang Disease Exterior Syndrome: Among the Six Meridians diseases, only Taiyang disease can represent exterior syndrome, which is inseparable from the physiological characteristics of Taiyang. The Taiyang meridian connects to the Fengfu point, governing all Yang Qi, thus it oversees the Six Meridians and governs the Wei Qi, serving as a barrier outside the body, hence Taiyang governs the exterior. Additionally, each of the Six Meridians has its own meridian and fu organ; when the meridian is affected by pathogens, compared to the fu organ, the meridian is external, thus having the meaning of exterior syndrome.
The “Shang Han Lun” states: “If both pulses are floating, it indicates a disease in Taiyang, which will manifest in one or two days. Because its pulse connects to the Fengfu point, it causes headache and stiffness in the neck and back.” The symptoms in the first section of the “Shang Han Lun” stating, “Taiyang disease is characterized by a floating pulse, headache, stiffness in the neck, and aversion to cold,” all illustrate that the pathogen harms the exterior of the Taiyang meridian, leading to the characteristics of disease in the Taiyang meridian.
(2) Taiyang Disease Interior Syndrome: The fu organ of Taiyang is the bladder, located in the lower jiao. If the pathogen in the Taiyang meridian does not resolve, the pathogenic Qi follows the meridian into the fu organ, leading to changes such as water retention and blood retention. We call this the interior (fu) syndrome of Taiyang disease.
Taiyang Water Retention Syndrome: Characterized by a floating pulse, slight fever, thirst with a desire to drink, and difficulty in urination, even vomiting after drinking, this is termed “water reversal.”
Taiyang Blood Retention Syndrome: In Taiyang disease, a weak and deep pulse reflects the exterior pathogen entering the interior, leading to hardness and fullness in the lower abdomen, and mental agitation; or urgent abdominal distension with a frenzied spirit, yet urination is smooth, indicating heat and blood stasis, unrelated to water.
2. Yangming Disease Exterior and Interior Syndromes
(1) Yangming Disease Exterior Syndrome: The “Shang Han Lun” states: “If both pulses are long, it indicates a disease in Yangming, which will manifest in two or three days. Because its pulse is associated with the nose and connects to the eyes, it causes body heat, eye pain, and nasal dryness, preventing sleep.” Cheng Wujin commented: “The Yangming pulse rises from the nose, connects to the eyes. The Yangming pulse, when it reaches the jaw, exits at the eye system… Eye pain and nasal dryness indicate the presence of pathogens in the meridian.” This syndrome also includes fever, aversion to cold, no sweating, a flushed face, headache, and a long floating pulse.
(2) Yangming Disease Interior Syndrome: If the stomach and intestines are affected by pathogens, it is termed Yangming Disease Interior Syndrome. The “Shang Han Lun” states: “After four or five days of cold damage, if the pulse is deep and there is shortness of breath, the deep pulse indicates the disease is in the interior, and if sweating is induced, the fluids will be lost, leading to difficulty in defecation…” This refers to the interior syndrome of Yangming affecting the stomach and intestines. Interior syndromes cannot be treated with sweating; inducing sweating will harm the fluids, leading to difficulty in defecation.
3. Shaoyang Disease Exterior and Interior Syndromes
(1) Shaoyang Disease Exterior Syndrome: Shaoyang is half exterior and half interior, located in the two sides of the body, yet it also has exterior and interior syndromes based on the meridian and fu organ.
The “Shang Han Lun” states: “If both pulses are wiry, it indicates a disease in Shaoyang, which will manifest in three or four days. Because its pulse circulates in the hypochondrium and connects to the ears, it causes pain in the hypochondrium and deafness.” Cheng Wujin commented: “Pain in the chest and hypochondrium with deafness indicates obstruction in the meridian, leading to dysfunction.” The “Shang Han Lun” also records that “Shaoyang wind causes deafness in both ears, red eyes, fullness in the chest, and irritability…” indicating Shaoyang meridian syndrome.
(2) Shaoyang Disease Interior Syndrome: This refers to the Shaoyang fu syndrome. The “Shang Han Lun” states: “The disease of Shaoyang is characterized by bitter mouth, dry throat, and dizziness.” This indicates that the pathogenic heat has entered the gallbladder fu, causing bile to overflow, leading to a bitter mouth, hence termed the interior syndrome of Shaoyang disease.
4. Taiyin Disease Exterior and Interior Syndromes
(1) Taiyin Disease Exterior Syndrome: The “Shang Han Lun” states: “If both pulses are deep and thin, it indicates a disease in Taiyin, which will manifest in four or five days. Because its pulse spreads in the stomach and connects to the throat, it causes abdominal fullness and throat dryness.” The “Shang Han Lun” states: “Taiyin wind causes pain in the four limbs…”; and “If Taiyin disease has a floating pulse, sweating can be induced…” all reflect the fact that the exterior of the Taiyin spleen meridian is affected by disease.
(2) Taiyin Disease Interior Syndrome: The “Shang Han Lun” states: “If it is originally a Taiyang disease, and the physician mistakenly purges it, leading to abdominal fullness and pain, it belongs to Taiyin…” This indicates that after a mistaken purging, the exterior pathogen has entered the interior of Taiyin, resulting in abdominal fullness and pain in the Taiyin interior syndrome.
5. Shaoyin Disease Exterior and Interior Syndromes
(1) Shaoyin Disease Exterior Syndrome: The “Shang Han Lun” states: “If both pulses are deep, it indicates a disease in Shaoyin, which will manifest in five or six days. Because its pulse penetrates the kidney and connects to the lung, it causes dry mouth and tongue, and thirst.” This discusses the heat syndrome of the Shaoyin meridian. The “Shang Han Lun” states: “If Shaoyin disease is first contracted, and the pulse is deep, it should be warmed; it is appropriate to use Si Ni San.” This discusses the cold syndrome of Shaoyin disease.
(2) Shaoyin Disease Interior Syndrome: This refers to the diseases of the heart and kidney in Shaoyin. For example, the “Shang Han Lun” states: “In Shaoyin disease, if the pulse is deep, it should be warmed; it is appropriate to use Si Ni San.” Another section states: “In Shaoyin disease, if the pulse is thin and deep, the disease is in the interior…” These two sections indicate that Shaoyin disease can have both cold syndromes due to Yang deficiency and heat syndromes due to Yin deficiency.
6. Jueyin Disease Exterior and Interior Syndromes
(1) Jueyin Disease Exterior Syndrome: The “Shang Han Lun” states: “If both pulses are weak and slow, it indicates a disease in Jueyin, which will manifest in six or seven days. Because its pulse circulates in the Yin organs and connects to the liver, it causes fullness and contraction of the scrotum.” The “Shang Han Lun” states: “If the hands and feet are cold, and the pulse is thin and about to disappear, it is appropriate to use Si Ni San.” The above two sections reflect the characteristics of heat and cold in the Jueyin meridian disease.
(2) Jueyin Disease Interior Syndrome: The “Shang Han Lun” states: “If a person has had prolonged cold internally, it is appropriate to use Si Ni San with Wu Zhu Yu and Sheng Jiang.” “Prolonged cold internally” refers to the cold syndrome in the Jueyin organs.
In summary, we use the principles of exterior and interior to reflect the diseases of the Six Meridians, which can embody the system and completeness of TCM differentiation. If we only discuss the interior syndromes of the organs without addressing the exterior syndromes of the meridians, we lose the essence of the Six Meridians differentiation. Therefore, the Eight Principles diagnosis must be combined with the Six Meridians diagnosis to avoid being one-sided.
3. Cold and Heat
The principles of cold and heat are established to reflect the cold and heat conditions of the Six Meridians diseases. They serve as the basis for differentiation in clinical treatment, as they encompass the specific conditions of exterior and interior, Yin and Yang.
1. Taiyang Disease Cold and Heat Syndromes
(1) Taiyang Disease Cold Syndrome: Taiyang governs the exterior, yet there is a differentiation of cold and heat in exterior diseases that cannot be overlooked. For example, the “Shang Han Lun” states: “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, vomiting, and both Yin and Yang pulses are tight, which is termed cold damage.” This reflects the characteristics of exterior cold as a disease, thus it can be termed Taiyang disease exterior cold syndrome.
(2) Taiyang Disease Heat Syndrome: Where there is cold, there must be heat; this arises in relation. However, the exterior heat syndrome of Taiyang disease can be of two forms: one is due to the invasion of warm pathogens, as stated in the “Shang Han Lun”: “In Taiyang disease, if there is fever and thirst, but no aversion to cold, it is termed warm disease.” This indicates that the warm pathogen is still in Taiyang and has not fully entered the interior, hence it is called Taiyang disease exterior heat syndrome. The other is due to prolonged cold binding the exterior, leading to cold stagnation transforming into heat, where the pulse changes from tight to relaxed, the body changes from pain to heaviness, and there is no sweating but mental agitation; this can also be termed Taiyang disease exterior heat syndrome. Additionally, the 27th section states: “In Taiyang disease, if there is fever with aversion to cold, more heat than cold… it is appropriate to use Gui Zhi Tang with Er Chen Tang,” which also belongs to Taiyang disease exterior heat syndrome.
2. Yangming Disease Cold and Heat Syndromes
(1) Yangming Disease Interior Cold Syndrome: Yangming governs the interior, and the interior syndrome has a differentiation of cold and heat. The interior cold syndrome of Yangming disease is described in the “Shang Han Lun”: “If there is cold in the stomach, leading to inability to eat, drinking water causes belching.” This discusses Yangming interior cold causing belching. The 243rd section states: “If there is a desire to vomit after eating grains, it belongs to Yangming, and Wu Zhu Yu Tang is appropriate.” This discusses interior cold causing vomiting and provides a treatment method.
(2) Yangming Disease Interior Heat Syndrome: The interior heat syndrome of Yangming disease can be located in the upper, middle, or lower parts. Heat in the upper part, stagnating in the diaphragm, leads to heart discomfort and tongue coating; heat in the middle leads to thirst and dry mouth; heat in the lower part leads to a floating pulse with fever, thirst, and difficulty in urination.
3. Shaoyang Disease Cold and Heat Syndromes
(1) Shaoyang Disease Cold Syndrome: Symptoms include fullness and discomfort in the chest and hypochondria, difficulty in urination, thirst without vomiting, sweating from the head, abdominal distension, and a wiry and slow pulse.
(2) Shaoyang Disease Heat Syndrome: Symptoms include bitter mouth, irritability, dry throat, and dizziness.
4. Taiyin Disease Cold and Heat Syndromes
(1) Taiyin Disease Cold Syndrome: The “Shang Han Lun” states: “If there is diarrhea without thirst, it belongs to Taiyin, due to cold in the organs…” This indicates that the spleen has cold, hence the symptoms of diarrhea without thirst.
(2) Taiyin Disease Heat Syndrome: The “Shang Han Lun” states: “In cold damage, if the pulse is floating and relaxed, and the hands and feet are warm, it is in Taiyin. Taiyin should cause jaundice, but if urination is smooth, it cannot cause jaundice.”
Taiyin is the damp earth, thus diseases can manifest as damp heat or cold dampness, which must be clearly differentiated and not confused.
5. Shaoyin Disease Cold and Heat Syndromes
(1) Shaoyin Disease Cold Syndrome: The cold syndrome of Shaoyin disease is broad. The “Shang Han Lun” states: “In Shaoyin disease, if there is a desire to vomit but cannot, irritability with a desire to sleep, and after five or six days there is diarrhea and thirst, it belongs to Shaoyin…” The white urine indicates that the lower jiao is deficient and cold, unable to control water, hence the color is white. The phrase “the lower jiao is deficient and cold” reveals the essence of the cold syndrome in Shaoyin disease.
(2) Shaoyin Disease Heat Syndrome: The “Shang Han Lun” states: “In Shaoyin disease, if it has been two or three days, with irritability and inability to sleep…” indicating the irritability of the heat syndrome in Shaoyin disease.
6. Jueyin Disease Cold and Heat Syndromes
(1) Jueyin Disease Cold Syndrome: The “Shang Han Lun” states: “If a person has had prolonged cold internally, it is appropriate to use Si Ni San with Wu Zhu Yu and Sheng Jiang.” This indicates that the liver has had prolonged cold, manifesting as cold accumulation in the lower jiao, causing cold pain in the lower abdomen, or reverse vomiting.
(2) Jueyin Disease Heat Syndrome: The heat syndrome of Jueyin disease can arise from the invasion of heat pathogens; or Yang Qi being obstructed, transforming into heat over time; or excessive Yang in Jueyin leading to excess heat, as illustrated in the example of heat-induced Jueyin: The “Shang Han Lun” states: “If cold damage occurs from one to two days to four to five days, there must be fever; if there was heat before, there will be Jue. The deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat. If Jue should be treated with purging, but sweating is induced instead, the mouth will be injured and ulcerated.” This indicates that internal heat in Jueyin can lead to Jue.
4. Deficiency and Excess
The principles of deficiency and excess often reflect the condition of the Six Meridians diseases, indicating the struggle between the righteous and the evil. Generally speaking, diseases of the three Yang meridians are primarily characterized by excess syndromes, while diseases of the three Yin meridians are primarily characterized by deficiency syndromes.
1. Taiyang Disease Deficiency and Excess
(1) Taiyang Disease Exterior Deficiency Syndrome: Taiyang disease is an exterior syndrome; if there is sweating from the exterior syndrome, it is termed exterior deficiency syndrome. For example, the “Shang Han Lun” states: “In Taiyang wind, if the Yang is floating and the Yin is weak, the Yang floating indicates heat; the Yin weak indicates sweating. If there is aversion to cold, aversion to wind, and a floating pulse, it is appropriate to use Gui Zhi Tang.” This discusses the deficiency syndrome of the exterior pathogen in Taiyang disease.
(2) Taiyang Disease Exterior Excess Syndrome: If there is no sweating but shortness of breath, it is termed exterior excess syndrome. For example, the “Shang Han Lun” states: “In Taiyang disease, if there is headache, fever, body pain, back pain, and joint pain, with aversion to wind, no sweating but shortness of breath, it is appropriate to use Ma Huang Tang,” discussing the excess syndrome of the exterior pathogen in Taiyang disease.
2. Yangming Disease Deficiency and Excess
(1) Yangming Disease Interior Deficiency Syndrome: Yangming governs the interior, and there is a differentiation of deficiency and excess. The interior deficiency syndrome of Yangming disease is described in the “Shang Han Lun”: “In Yangming disease, if there is much sweating but no sweating, and the body feels like insects crawling under the skin, this is due to prolonged deficiency.” Cheng Wujin commented: “The stomach is the reservoir of fluids; if Qi is deficient and fluids are few, the disease will lead to no sweating. The stomach nourishes the muscles of the body; if the body feels like insects crawling under the skin, it indicates that the stomach Qi has been deficient for a long time.”
Note: Taiyang governs the exterior, thus having sweating indicates deficiency, while no sweating indicates excess. Yangming governs the interior, thus having sweating indicates excess, while no sweating indicates deficiency, reflecting the differentiation of deficiency and excess between exterior and interior.
(2) Yangming Disease Interior Excess Syndrome: The interior excess syndrome of Yangming disease is primarily characterized by “not changing clothes” and “difficulty in defecation.” The “Shang Han Lun” states: “The disease of Yangming is characterized by fullness in the stomach,” discussing the characteristics of Yangming disease. Specific symptoms of interior excess include: no defecation, abdominal fullness and pain, or pain around the navel; or persistent abdominal fullness, inability to eat, a deep and tight pulse, or a deep and strong pulse, with a yellow and dry tongue coating.
3. Shaoyang Disease Deficiency and Excess
(1) Shaoyang Disease Deficiency Syndrome: The deficiency syndrome of Shaoyang disease is described in the “Shang Han Lun”: “In cold damage, if the Yang pulse is thin and the Yin pulse is wiry, it is appropriate to use Xiao Jian Zhong Tang first; if there is no difference, it is appropriate to use Xiao Chai Hu Tang.” In Shaoyang disease, the pulse is originally wiry; if it becomes thin and tight, it indicates that Shaoyang disease is accompanied by deficiency and insufficient Qi and blood. First, use Xiao Jian Zhong Tang to support the deficiency of Qi, then use Xiao Chai Hu Tang (it seems that Huang Qin should be removed and Shao Yao added) to harmonize the Shaoyang pathogen.
In today’s hepatitis patients, if they experience persistent hypochondriac pain, and medication is ineffective, I often use Xiao Jian Zhong Tang with good results. This is the method of “the liver suffers from urgency, and sweet food is used to alleviate it,” which has been practiced since ancient times, not a new concept.
(2) Shaoyang Disease Excess Syndrome: This refers to symptoms of fullness and discomfort in the chest and hypochondria, urgent discomfort below the heart, irritability, persistent vomiting, constipation, bitter mouth, irritability, and a wiry and slippery pulse.
4. Taiyin Disease Deficiency and Excess
(1) Taiyin Disease Deficiency Syndrome: The deficiency syndrome of Taiyin disease often correlates with cold syndrome, as described in the “Shang Han Lun”: “In Taiyin disease, if there is abdominal fullness and vomiting, inability to eat, and frequent abdominal pain, if purged, there will be a knot below the chest.” This fully reflects the symptoms of vomiting and diarrhea due to spleen Qi deficiency and cold. However, in clinical practice, the cold syndrome of Jueyin disease is primarily characterized by vomiting, while the cold syndrome of Taiyin disease is primarily characterized by diarrhea, with vomiting being secondary; this must be understood.
(2) Taiyin Disease Excess Syndrome: The “Shang Han Lun” states: “If it is originally a Taiyang disease, and the physician mistakenly purges it, leading to abdominal fullness and pain, it belongs to Taiyin…”; “If there is severe pain, it is appropriate to use Gui Zhi Jia Da Huang Tang.” This indicates that the excess of the spleen can be treated with purging. However, if the pulse is weak, it should not be used.
5. Shaoyin Disease Deficiency and Excess
(1) Shaoyin Disease Deficiency Syndrome: The deficiency syndrome of Shaoyin disease should analyze both Yin deficiency and Yang deficiency, as described in the “Shang Han Lun”: “In Shaoyin disease, if the pulse is weak, sweating should not be induced, as it is due to Yang deficiency.” This indicates that the weak pulse indicates Yang deficiency, hence sweating should be avoided. The 285th section states: “In Shaoyin disease, if the pulse is thin and deep, the disease is in the interior, sweating should not be induced.” This reflects the deficiency syndrome of Shaoyin disease, with differentiation between Yin and Yang.
(2) Shaoyin Disease Excess Syndrome: It is commonly said that “the kidney has no excess syndrome, and the liver has no deficiency syndrome,” which is a rough statement and insufficient as a guideline. However, how can the excess syndrome of Shaoyin disease be identified? It often forms through the “middle organ leaking into the fu.” For example, the “Shang Han Lun” states: “In Shaoyin disease, if there is clear water diarrhea, pure green color, pain below the heart, and dry mouth, it can be purged, and Da Cheng Qi Tang is appropriate.” This indicates that internal dryness and heat lead to excess, which can affect the kidney, resulting in the excess syndrome of Shaoyin disease.
6. Jueyin Disease Deficiency and Excess
(1) Jueyin Disease Deficiency Syndrome: The deficiency syndrome of Jueyin disease can be differentiated into Yang deficiency and blood deficiency. For Yang deficiency, the “Shang Han Lun” states: “If there is profuse sweating, heat does not dissipate, internal urgency, pain in the four limbs, and diarrhea with cold aversion, it is appropriate to use Si Ni San.” This discusses the cold syndrome of Jueyin Yang deficiency. For blood deficiency, the “Shang Han Lun” states: “If the hands and feet are cold, and the pulse is thin and about to disappear, it is appropriate to use Si Ni San.” This discusses the cold syndrome of Jueyin blood deficiency.
(2) Jueyin Disease Excess Syndrome: The excess syndrome of Jueyin disease can involve phlegm obstruction and water retention, leading to heat accumulation causing the liver’s function to be impaired, resulting in Qi stagnation and the occurrence of Jue. For example, the “Shang Han Lun” states: “If a patient has cold hands and feet, and the pulse is intermittently tight, the pathogen is obstructed in the chest, causing fullness and irritability, and inability to eat, the disease is in the chest, and it must be purged, it is appropriate to use Guo Ti San.” This discusses the phlegm obstruction in the chest, leading to cold hands and feet in Jueyin disease. The 356th section states: “If there is Jue and palpitations below the heart, it is appropriate to treat the water first, and take Fu Ling Gan Cao Tang to treat the Jue. Otherwise, if water enters the stomach, it will lead to diarrhea.” This indicates that water retention in the stomach leads to liver dysfunction, resulting in cold hands and feet, hence termed excess syndrome.
Conclusion
Through the combination of the Eight Principles diagnosis and the Six Meridians diagnosis, in each meridian, there are changes in the eight aspects of Yin and Yang, exterior and interior, cold and heat, deficiency and excess, reflecting the symptomatic patterns of the Six Meridians diseases. Therefore, it has a guiding significance for differentiation. However, the Eight Principles diagnosis is also an objective reflection based on the diseases of the Six Meridians. Thus, the Eight Principles and the Six Meridians form a unified organic whole that cannot be separated. If they are artificially divided, it will inevitably destroy the material spirit of the Eight Principles diagnosis and the objective existence of the Six Meridians diagnosis.
At the same time, the differentiation theory of TCM is embodied in the physiological and pathological changes of the meridians and organs. Therefore, only by using the Eight Principles diagnosis method can we encompass the diseases of the meridians and organs, the nature of the diseases of the Yin and Yang organs, as well as the cold and heat, deficiency and excess, all of which are interconnected, allowing for clarity and understanding. For this reason, I humbly present the practical situation of combining the Eight Principles and the Six Meridians, discussing the methods of Zhang Zhongjing’s differentiation and treatment. Any omissions, please provide guidance.