1. Concept
1. Eight Principles: Refers to the eight diagnostic principles: Exterior, Interior, Cold, Heat, Deficiency, Excess, Yin, and Yang. 2. Eight Principles Diagnosis: This is the process by which a physician uses the Eight Principles theory to analyze and synthesize various clinical data obtained through observation, listening, questioning, and pulse diagnosis, in order to discern the depth of the disease location, the nature of the disease as cold or heat, the strength of the pathogenic and righteous qi, and the classification of the disease into Yin or Yang.
2. Basic Syndromes of the Eight Principles 1. Exterior-Interior Diagnosis distinguishes the depth of the disease location and the progression of the disease. Narrowly defined, Exterior and Interior refer to the skin, muscles, and meridians as the exterior, while the organs and marrow are considered the interior. A disease on the exterior is lighter, while a disease on the interior is more severe. Understanding the exterior and interior locations is particularly important for external pathogenic diseases.1) Exterior Syndrome: Refers to the light symptoms caused by external pathogens such as the six excesses, epidemics, and insect toxins invading the body through the skin and mouth, where the righteous qi resists the evil, and the defensive qi fails to disperse. Changes in the skin and hair do not necessarily indicate a syndrome, and the location of the exterior syndrome is not always in the skin and hair.Clinical manifestations: Chills (or aversion to wind), fever (or subjective feeling of no fever), body aches, thin white tongue coating, floating pulse. Symptoms may also include nasal congestion, clear nasal discharge, sneezing, itchy or sore throat, and slight cough, etc. 2) Interior Syndrome: Refers to symptoms indicating that the disease is located internally, affecting the organs, qi, blood, and marrow. Causes: (1) External pathogens invade the exterior and transmit to the interior, forming an interior syndrome. (2) External pathogens directly enter the interior, invading the organs, known as “directly entering the disease.” (3) Emotional injuries, dietary indiscretions, and overexertion can directly damage the organs, or the qi, blood, and body fluids can be affected by the disease.Clinical manifestations: Due to the complex causes of interior syndromes and their wide-ranging locations, symptoms can vary widely. The basic characteristics are the absence of new onset chills and fever, or only chills without fever, or only fever without chills, with organ symptoms as the main manifestation, such as high fever, irritability, confusion, abdominal pain and diarrhea, vomiting and constipation, thick tongue coating, changes in tongue quality, and deep pulse, etc. Generally, the condition is more severe and the course of the disease is longer.3) Half Exterior Half Interior Syndrome: Refers to the symptoms when the external pathogenic factors are neither fully on the exterior nor have completely entered the interior, where the evil and righteous qi are contending between the exterior and interior, and the Shaoyang mechanism is not functioning properly.2. Cold-Heat DiagnosisCold and Heat are a pair of principles used to distinguish the nature of the disease. 1) Cold Syndrome: Refers to symptoms caused by the invasion of cold pathogens or the predominance of Yin over Yang. Excess Cold Syndrome: Refers to symptoms caused by external cold pathogens or excessive consumption of cold foods, with a sudden onset in robust individuals. Deficiency Cold Syndrome: Refers to symptoms caused by internal injuries from prolonged illness, where Yang qi is depleted and internal cold is generated, known as Yang Deficiency Syndrome. Exterior Cold Syndrome: Refers to cold pathogens attacking the skin. Interior Cold Syndrome: Refers to cold pathogens affecting the organs, or due to deficiency of Yang qi in the organs. Clinical manifestations: The manifestations of various cold syndromes are not entirely consistent, but common symptoms include: aversion to cold, preference for warmth, cold pain, preference for warmth, pale complexion, thin white tongue coating, and slow or tight pulse, etc. 2) Heat Syndrome: Refers to symptoms caused by the invasion of heat pathogens or the predominance of Yang over Yin, leading to hyperactivity of the body’s functions. Excess Heat Syndrome: Refers to symptoms caused by the invasion of Yang heat pathogens, excessive consumption of spicy and warm foods, excessive emotional agitation leading to heat, or excessive internal Yang heat. Deficiency Heat Syndrome: Refers to symptoms caused by internal injuries from prolonged illness, or excessive sexual activity leading to Yin deficiency and Yang hyperactivity, known as Yin Deficiency Syndrome. Exterior Heat Syndrome: Refers to symptoms caused by wind-heat invading the skin. Interior Heat Syndrome: Refers to symptoms caused by excessive heat in the organs or due to deficiency of Yin fluids. Clinical manifestations: The manifestations of various heat syndromes are not entirely consistent, but common symptoms include: fever, aversion to heat, preference for cold, thirst for cold drinks, yellow and thick sputum, short yellow urine, dry and hard stools, red complexion, red tongue with yellow coating, and rapid pulse, etc.3. Deficiency-Excess DiagnosisDeficiency and Excess are a pair of principles used to distinguish the strength of the righteous and evil qi, primarily reflecting the strength and weakness of the body’s righteous qi and the rise and fall of the evil qi during the disease process. 1) Excess Syndrome: Refers to various clinical manifestations characterized by the presence of external pathogens, accumulation of pathological products within the body, or imbalances of Yin, Yang, qi, and blood, leading to excess, stagnation, and hyperactivity. Characteristics: The evil qi is abundant while the righteous qi is not deficient, and the struggle between the evil and righteous qi is more intense. Clinical manifestations: Due to the different nature of the invading evil and pathological products, the symptoms can vary widely. The basic characteristics are the presence of new onset chills and fever, or only chills without fever, or only fever without chills, with organ symptoms as the main manifestation, such as high fever, irritability, confusion, abdominal pain and diarrhea, vomiting and constipation, thick tongue coating, changes in tongue quality, and deep pulse, etc. Generally, the condition is more severe and the course of the disease is longer.3. Relationship Between the Eight Principles Syndromes1. Syndromes CoexistingBroadly defined: Refers to the coexistence of various syndromes. Narrowly defined: Refers to the comprehensive judgment of the disease from different perspectives such as exterior-interior location, cold-heat nature, and deficiency-excess nature, to fully reveal the essence of the disease. Exterior Deficiency Syndrome: Refers to exterior syndromes with sweating. Its actual meaning has two aspects: External Pathogenic Deficiency: Refers to exterior syndromes caused by the invasion of wind pathogens. Clinical manifestations: aversion to wind, fever, spontaneous sweating, headache, stiff neck, floating and relaxed pulse. Internal Pathogenic Deficiency: Refers to the condition where the spleen and lung qi are deficient, leading to a loose exterior and frequent sweating, making one prone to colds. Clinical manifestations: Frequent spontaneous sweating, easy to catch colds, pale complexion, shortness of breath upon exertion, loose stools, fatigue, pale tongue with white coating, and weak pulse. Exterior Excess Cold Syndrome: Refers to symptoms caused by external cold pathogens, where the defensive Yang is constrained, and the evil and righteous qi are contending at the skin and muscle level, with the pores tightly closed. Clinical manifestations: Chills and fever, no sweating but wheezing, body aches, thin white tongue coating, and floating tight pulse. Exterior Excess Heat Syndrome: Refers to symptoms caused by external heat pathogens, where the evil and righteous qi are contending at the exterior, and the defensive qi is obstructed. Clinical manifestations: Fever, slight aversion to wind and cold, no sweating or little sweating, slight thirst, red tongue with thin white coating, and floating rapid pulse. Interior Excess Cold Syndrome: Refers to symptoms caused by cold pathogens invading the body, obstructing the Yang qi of the organs, and stagnating qi, blood, and body fluids. Clinical manifestations: Due to the wide range of interior syndromes, the symptoms can vary. The basic characteristics are aversion to cold, preference for warmth, cold limbs, pale complexion, no thirst, white and moist tongue coating, and slow or tight pulse. Interior Excess Heat Syndrome: Refers to symptoms caused by Yang heat invading the body, entering the interior, or cold pathogens transforming into heat in the interior, or stagnation of qi and blood leading to heat. Clinical manifestations: Due to the wide range of interior syndromes, the symptoms can vary. The basic characteristics are fever, aversion to heat, thirst for cold drinks, short yellow urine, dry and hard stools, red complexion, red tongue with yellow coating, and rapid pulse. 4. Transformation of SyndromesMeaning: Refers to the transformation of one syndrome into another opposing syndrome under certain conditions. 1) Exterior-Interior Transition: (1) Exterior syndrome entering the interior: Refers to the initial presence of an exterior syndrome, followed by the emergence of an interior syndrome, with the exterior syndrome subsequently disappearing. This is generally seen in the early to mid-stages of external pathogenic diseases, reflecting the progression of the disease from superficial to deep. (2) Interior Evil Emerging Externally: Refers to certain interior syndromes where the pathogenic evil has a tendency to emerge outward. This does not mean that the interior syndrome transforms into an exterior syndrome. Generally, this indicates a favorable trend for the disease to improve. 2) Cold-Heat Transformation: (1) Cold syndrome transforming into heat: Refers to the original cold syndrome, followed by the emergence of heat syndrome, with the cold syndrome subsequently disappearing. This often occurs due to improper treatment, excessive consumption of warming and drying substances, or failure to treat, where the external cold pathogen has not been dispersed in time, leading to an excess of Yang qi and internal heat. (2) Heat Syndrome Transforming into Cold: Refers to the original heat syndrome, followed by the emergence of cold syndrome, with the heat syndrome subsequently disappearing. This often occurs due to improper treatment, damage to Yang qi, or excessive pathogenic evil leading to the depletion of righteous qi, resulting in functional decline and the loss of Yang qi, transforming into a deficiency cold syndrome, or even manifesting as a Yang collapse syndrome. 3) Deficiency-Excess Transformation: (1) Excess syndrome transforming into deficiency: Refers to the initial manifestation of an excess syndrome, which, due to improper treatment or prolonged illness, leads to the depletion of righteous qi, or the gradual decline of the evil qi, resulting in Yang qi or Yin blood being damaged, transitioning from an excess syndrome to a deficiency syndrome. (2) Deficiency Syndrome Transforming into Excess: Refers to the initial manifestation of a deficiency syndrome, which, due to active treatment, rest, and exercise, gradually restores righteous qi, contending with the evil qi to expel it outward, manifesting as an excess syndrome. Alternatively, a patient with a pre-existing deficiency syndrome may present with excess symptoms due to the invasion of new pathogenic evil, or due to dietary indiscretion or trauma, where the deficiency symptoms are temporarily not prominent. If the original condition was a deficiency syndrome, due to insufficient righteous qi, abnormal qi transformation leads to the accumulation of pathological products, manifesting certain excess symptoms, this should not be understood as a transformation from deficiency to excess, but rather as a mixed deficiency-excess condition. 4) True-False Syndrome Distinction: Refers to certain diseases in critical stages where some symptoms may appear that are contrary to the essence of the disease, masking the true nature of the condition. The so-called “true” refers to symptoms that align with the internal essence of the disease. The so-called “false” refers to symptoms or signs that do not conform to the internal essence of the disease. 1) True Heat and False Cold: Refers to the presence of true heat internally while exhibiting some false cold symptoms externally. This is known as “deep heat with deep cold.” Also referred to as Yang excess with Yin constraint. Pathogenesis: Internal Yang heat is abundant, constrained by Yin externally, leading to internal Yang qi being closed off and unable to reach the extremities. Clinical manifestations: Externally appearing as Yin cold syndrome—cold limbs, even cold extremities, aversion to cold, mental confusion, dark purple complexion, and deep slow pulse (or thin rapid). The essence is an excess heat syndrome—cold limbs but burning heat in the chest and abdomen, burning sensation in the mouth and nose, foul breath, thirst for drinks, short red urine, dark and dry stools, red tongue with yellow coating, and strong pulse. (2) True Cold and False Heat: Refers to the presence of true cold internally while exhibiting some false heat symptoms externally. This is known as floating Yang syndrome, also referred to as Yin excess with Yang constraint or Yang floating syndrome. Pathogenesis: Prolonged illness leads to Yang qi deficiency, with internal cold predominating, forcing the floating Yang to rise and escape outward. Clinical manifestations: Externally appearing as Yang heat syndrome—feeling hot, or wanting to remove clothing, flushed complexion, restless mind, thirst, sore throat, and floating large pulse. The essence is Yang qi deficiency—no burning sensation in the chest and abdomen, cold limbs, clear long urine (or reduced urination with edema), or diarrhea with clear fluids, pale tongue, etc. 2) True Deficiency and False Excess: Refers to the essence being an excess syndrome while exhibiting some deficiency-like phenomena. This is known as “great excess with deficiency-like appearance.” Pathogenesis: Large accumulation and stagnation obstruct the meridians, preventing the smooth flow of qi and blood, leading to symptoms resembling deficiency syndrome, such as a silent demeanor, fatigue, thin and weak pulse, etc. Distinction: Although silent, when speaking, the voice is loud and strong; although fatigued, there is relief upon movement; although thin, the abdomen is hard and full, resisting pressure; although the pulse is thin, it is strong upon palpation, indicating that the essence of the disease is excess, while the deficiency is merely an appearance. True Deficiency and False Excess: Refers to the essence being a deficiency syndrome while exhibiting some excess-like phenomena. This is known as “extreme deficiency with excess-like appearance.” Pathogenesis: Organ deficiency, insufficient qi and blood, and inability to transform and transport lead to symptoms such as abdominal distension, shortness of breath, and constipation. Distinction: Although the abdomen is distended, there is occasional relief, or no masses are present; although short of breath, the breath is weak; although the stool is constipated, the abdomen is not hard; and the pulse must be weak, with a pale and swollen tongue, along with fatigue, pale or sallow complexion, indicating that the manifestations of excess are merely an appearance.1. Key Points for Differentiating Exterior-Interior Syndromes1. Cold-Heat Symptoms: The simultaneous presence of chills and fever indicates an exterior syndrome; however, fever without chills or chills without fever indicates an interior syndrome; alternating chills and fever indicates a half exterior half interior syndrome. 2. Tongue Appearance: The tongue coating in exterior syndromes does not change significantly, while the tongue coating and quality in interior syndromes often show changes. 3. Pulse Quality: Exterior syndromes often present with a floating pulse, while interior syndromes often present with a deep pulse. 2. Distinguishing Between Chills, Fever, Cold Syndrome, and Heat Syndrome1. Chills and fever are phenomena of the disease, while the cold and heat manifestations of the disease can be true or false. 2. Cold and heat syndromes are judgments of the essence of the disease and cannot be isolated based solely on individual symptoms such as chills, aversion to cold, or fever.3. Key Points for Distinguishing Cold and Heat SyndromesCold-Heat Syndrome Differentiation Table
| Name | Limbs | Thirst | Urination | Complexion | Tongue Appearance | Pulse Quality |
| Cold Syndrome | Aversion to cold, preference for warmth | No thirst | Clear long urine, loose stools | Pale | Pale tongue | Slow or tight |
| Heat Syndrome | Aversion to heat, preference for cold | Thirst, prefers cold drinks | Short yellow urine, dry stools | Red | Red tongue | Yellow or rapid pulse |
4. Key Points for Distinguishing Deficiency and Excess Syndromes
Understand the characteristics of the disease. Generally, manifestations characterized by insufficient, declining, or relaxed righteous qi are mostly deficiency syndromes; manifestations characterized by excess, solidity, and strength are mostly excess syndromes. During the four examinations, pay attention to the quality of the tongue, the tone of voice, the duration of the illness, the severity of pain, and the strength of the pulse. A pale tongue indicates excess, while a plump tongue indicates deficiency; a loud voice indicates excess, while a weak voice indicates deficiency; initial external pathogens are often excess, while prolonged illness often leads to deficiency; severe pain that resists pressure indicates excess, while dull pain that is relieved by pressure indicates deficiency; a strong pulse indicates excess, while a weak pulse indicates deficiency.5. Yin and Yang as the Framework for SyndromesYin and Yang represent two opposing aspects of things, and their application is extensive, encompassing the entire disease process as well as the analysis and summary of each symptom. Based on the basic properties of Yin and Yang in TCM, the nature of the disease, clinical syndromes, and specific symptoms and signs can generally be categorized as Yin or Yang. For example, in the Eight Principles, exterior, heat, and excess belong to Yang, while interior, deficiency, and cold belong to Yin. Thus, Yin and Yang serve as the overarching framework for the Eight Principles, providing a fundamental summary and categorization of syndromes.6. Distinguishing Between Loss of Yin and Loss of YangDistinguish based on the quality of sweat (thin and cold like water or sticky and hot like oil), body temperature (cool or hot), complexion (pale or red), pulse (weak or rapid), etc.Distinguishing Table for Loss of Yin and Loss of Yang
| Name | Sweat | Limbs | Other Symptoms | Tongue | Pulse | Treatment Principle |
| Loss of Yin | Hot sweat, salty and sticky | Warm, aversion to heat | Flushed complexion, whole body hot, restlessness, confusion, shortness of breath, thirst for cold drinks | Red and dry | Thin and rapid, weak or floating | Tonify qi and restrain Yin, rescue Yin and generate fluids |
| Loss of Yang | Cold sweat, tasteless and not sticky | Cold limbs, aversion to cold | Pale complexion, whole body cold, indifference, confusion, weak breath, no thirst or preference for warm drinks | Pale and moist | Weak or floating and empty | Tonify qi and stabilize collapse, restore Yang and rescue from reversal |
7. Why There Are Interrelationships Between the Eight Principles SyndromesThe Eight Principles of exterior, interior, cold, heat, deficiency, excess, Yin, and Yang summarize the essence of the disease from various perspectives. However, the various aspects of the pathological essence are interconnected; that is, the nature of cold and heat, the struggle between evil and righteous qi cannot exist independently of the exterior and interior locations, and vice versa, there cannot be exterior or interior syndromes that exist independently of the nature of cold, heat, deficiency, or excess. Therefore, the Eight Principles syndromes cannot be analyzed, judged, or classified in isolation, as they can coexist, be mixed, or exist in intermediate states, and change continuously with the development of the disease. In clinical diagnosis, it is essential to recognize the basic syndromes of the Eight Principles, but also to grasp the interrelationships between them. Only by linking the Eight Principles together for a comprehensive analysis of the disease can one achieve a more complete and accurate understanding of the syndromes.8. The Significance of Cold-Heat TransformationThe transformation between cold and heat reflects the comparison of the strengths of the evil and righteous forces in the disease, with the key being the rise and fall of the body’s Yang qi. The transformation of cold syndrome into heat indicates that the body’s righteous qi is still strong enough to resist the evil qi, and the Yang qi is relatively abundant, leading to the transformation of the evil qi into heat. The transformation of heat syndrome into cold indicates that the evil qi is too strong and the righteous qi is insufficient, suggesting that the righteous qi cannot overcome the evil, and the condition is critical.9. Distinguishing Between True and False Cold and HeatThe appearance of false symptoms often occurs in the limbs, skin, and complexion, while the internal manifestations of the organs, qi, blood, and body fluids, as well as changes in tongue and pulse, are often the true reflection of the essence of the disease and can serve as diagnostic criteria. False symptoms differ from true symptoms and should be carefully distinguished by their characteristics. For example, although thirsty, one may not want to drink; although the throat may hurt, it may not be red or swollen; although restless, one may feel fatigued and weak; although the pulse may be floating or rapid, it may be weak upon palpation; although the complexion may occasionally appear flushed, it may not be fully red, indicating that the “heat” is merely an appearance.10. Distinguishing Between True and False Deficiency and ExcessThe strength or weakness of the pulse, the vitality of the spirit, especially the deep pulse, is the true essence. The quality of the tongue, whether it is tender and plump or old and withered, the tone of voice, and the strength of the breath are also important criteria for differentiation.1. Disease Etiology Diagnosis1) External Wind Syndrome Meaning: (1) External Wind Syndrome: Refers to a type of syndrome caused by external wind evil invading the skin, muscles, meridians, organs, and qi and blood. It is characterized by sudden onset, rapid changes, and erratic symptoms. (2) Internal Wind Syndrome: Refers to symptoms resembling “wind” caused by pathological changes such as excessive heat burning the tendons, blood deficiency, Yin deficiency, or Yang excess, affecting the liver’s function of governing the tendons, leading to symptoms such as dizziness, numbness, itching, tremors, convulsions, etc. Clinical manifestations: (1) Wind evil invading the exterior: aversion to wind and cold, slight fever, spontaneous sweating, nasal congestion or sneezing, cough, itchy or sore throat, thin white tongue coating, and floating pulse. (2) Wind entering the skin: new onset skin itching, possibly with papules or wheals. (3) Wind invading the meridians: sudden facial numbness, crooked mouth, stiff neck, inability to open the mouth, or even convulsions and arching of the back. (4) Wind injuring the joints: joint pain in the limbs, erratic in nature. (5) Wind-water interaction: sudden swelling of the face, eyelids, or limbs. Common external wind syndromes include wind evil invading the exterior (Taiyang Wind), wind affecting the skin, wind invading the lungs, wind-water interaction, wind evil obstructing the meridians, and wind toxin invading the meridians. Concurrent syndromes include wind-cold, wind-heat, wind-fire, wind-damp, wind-phlegm, wind-water, and wind-toxin syndromes. 2) Excess Cold Syndrome 1) Meaning: Excess cold syndrome refers to a type of syndrome caused by exposure to rain, water, wearing thin clothing, sleeping outdoors, consuming raw or cold foods, etc., leading to damage to the body’s Yang qi and obstructing the flow of qi and blood. It is characterized by sudden onset, severe symptoms, and often identifiable causes of cold exposure. Cold damage syndrome: Refers to symptoms caused by cold evil invading the exterior, obstructing the defensive Yang, and the Yang qi resisting the evil externally, manifesting as exterior excess cold syndrome. Also known as external cold syndrome, exterior cold syndrome, cold evil binding the exterior syndrome, Taiyang cold damage syndrome. Interior cold syndrome: Refers to symptoms caused by cold evil directly invading the organs, qi, and blood, damaging or obstructing Yang qi, and obstructing the flow of qi and blood, manifesting as interior excess cold syndrome, also known as internal cold syndrome. 2) Clinical manifestations: (1) Cold damage: sudden onset of severe chills, mild fever, body aches, no sweating, nasal congestion with clear discharge, no thirst, thin white tongue coating, floating tight pulse, or cold limbs, stiffness, and joint pain. (2) Interior cold: sudden onset of aversion to cold, cold pain in the abdomen or lower back, preference for warmth, possible vomiting or diarrhea, possible cough, asthma, and white phlegm, no sweating, no thirst, clear long urine, pale or bluish complexion, white tongue coating, and deep slow pulse, or even a hidden pulse. Common excess cold syndromes include cold evil binding the exterior syndrome (Taiyang cold damage syndrome), cold evil affecting the lungs, cold stagnation in the stomach and intestines, cold stagnation in the liver meridian, cold stagnation in the heart meridian, cold stagnation in the uterus, and cold bi (painful obstruction). Concurrent syndromes include wind-cold, cold-damp, cool dryness, cold phlegm, and cold-drink syndromes. Evolution: Excess cold syndrome—deficiency cold syndrome—loss of Yang syndrome. 3) Heat Syndrome 1) Meaning: Heat syndrome refers to symptoms characterized by the presence of heat, which can be caused by external heat evil or excessive internal Yang heat. 2) Clinical manifestations: fever, aversion to heat, irritability, thirst for cold drinks, profuse sweating, dry stools, short yellow urine, red complexion, red tongue with yellow or gray-black coating, rapid pulse. Severe cases may lead to various bleeding, abscesses, ulcers, or severe conditions such as heat-induced wind, heat obstructing the heart, etc. 3) Common excess heat syndromes include wind-heat invading the exterior syndrome, lung heat excess syndrome, heart fire excess syndrome, stomach heat excess syndrome, heat disturbing the chest, intestinal heat excess syndrome, liver fire rising syndrome, liver fire invading the lungs syndrome, heat obstructing the pericardium syndrome, heat toxin entering the meridians syndrome, heat (fire) toxin accumulating in the skin syndrome, etc. Concurrent syndromes include wind-heat, wind-fire, damp-heat, summer-heat, warm dryness (dry heat), fire (heat) toxin, stasis heat, phlegm heat, and heat-drink syndromes. 4) Toxin Syndrome 1) Refers to certain highly infectious special pathogens, known as epidemic qi, also referred to as toxic qi or epidemic toxin. In pathogenesis and syndrome names, it is often indicated by the word “toxin,” such as toxic obstruction of the lungs syndrome, epidemic toxin attacking the throat syndrome, etc. 2) Refers to certain toxic substances that have toxic effects, often directly named with the word “toxin,” such as insect bites causing insect toxin invading the skin syndrome, wind toxin invading the meridians syndrome, fire toxin entering the meridians syndrome, etc.; food poisoning leading to food toxin stagnating in the stomach syndrome, etc. 3) Refers to severe syndromes caused by excessive evil qi. Such as heat toxin, damp toxin, cold toxin, fire toxin, phlegm toxin, etc., leading to various critical syndromes, such as heat toxin obstructing the lungs syndrome, toxin hidden in the membranes syndrome, etc. 4) Surgical conditions such as abscesses and ulcers, such as carbuncles, boils, and sores, are often represented by the word “toxin” to indicate their pathogenic nature. For example, heat toxin attacking the head and face syndrome, evil toxin flowing through the muscles and bones syndrome, pus toxin obstructing the skin syndrome, etc. 8) Pus Syndrome 1) Meaning: “Pus” refers to a pathological product formed by the stagnation of qi and blood due to fire heat toxins, leading to the accumulation and fermentation of blood, resulting in a foul-smelling, thick liquid. 2) Clinical manifestations: Characterized by the accumulation of pus. For superficial abscesses, they may present as soft, fluctuating lumps before rupture, releasing pus. For internal abscesses, symptoms may include coughing up pus, vomiting pus blood, purulent urine, or purulent stools. Often accompanied by fever, thick and greasy tongue coating, and slippery rapid pulse. 3) Common pus syndromes include pus toxin accumulating in the skin syndrome, pus phlegm accumulating in the lungs syndrome, and pus accumulation in the gastrointestinal tract syndrome. 9) Food Accumulation Syndrome Meaning: Food accumulation syndrome refers to symptoms caused by irregular eating habits, leading to stagnation of food in the stomach and intestines. Clinical manifestations: Abdominal distension, loss of appetite, sour belching, vomiting sour and spoiled food, foul-smelling stools, thick and greasy tongue coating, and slippery strong pulse. Common syndromes include food accumulation in the gastrointestinal tract syndrome and spleen deficiency with food accumulation syndrome. 10) Worm Accumulation Syndrome 1) Meaning: Worm accumulation syndrome refers to symptoms caused by larvae invading the body or ingesting worm eggs that develop and reproduce within the body, leading to obstruction of the organs and consumption of qi and blood. It can also be considered a disease concept. 2) Common syndromes include intestinal worm accumulation syndrome, liver and gallbladder worm accumulation syndrome, intestinal obstruction due to worms, and gallbladder obstruction due to worms, etc.2. Qi Disease Diagnosis1) Qi Deficiency Syndromes: Includes qi deficiency syndrome, qi sinking syndrome, qi not holding syndrome, and qi collapse syndrome. 1) Qi Deficiency Syndrome: Refers to insufficient original (true) qi, leading to reduced functions of promoting, warming, holding, defending, and transforming, or reduced functional activity of the organs and tissues. (1) Causes: (i) Prolonged illness, severe illness, or excessive fatigue leading to depletion of original qi. (ii) Congenital insufficiency or dietary imbalances leading to insufficient generation of original qi. (iii) Aging and weakness, leading to decline in organ function and depletion of original qi. (2) Clinical manifestations: Shortness of breath, low voice, shallow breathing, fatigue, dizziness, spontaneous sweating, worsening symptoms with exertion, pale and tender tongue, and weak pulse. (3) Common syndromes: Heart qi deficiency syndrome, lung qi deficiency syndrome, stomach qi deficiency syndrome, spleen qi deficiency syndrome, liver and gallbladder qi deficiency syndrome, kidney qi deficiency syndrome, heart-lung qi deficiency syndrome, spleen-lung qi deficiency syndrome, spleen-stomach qi deficiency syndrome, lung-kidney qi deficiency syndrome, etc. Concurrent syndromes: Qi and blood deficiency, qi and Yin deficiency, Yang qi deficiency, and fluid deficiency syndromes. (4) Development and Changes: Qi deficiency leads to insufficient transformation—fluid deficiency, blood deficiency, Yang deficiency. Qi transformation dysfunction leads to water retention, phlegm production, and fluid overflow. Qi deficiency leads to poor circulation of qi and blood, resulting in qi stagnation and blood stasis. Qi deficiency leads to weak defense against external pathogens, as well as food accumulation and worm accumulation. 2) Qi Sinking Syndrome: Refers to the inability of qi to rise, leading to the sinking of clear Yang qi and the inability to maintain the position of the internal organs. (1) Causes: Generally develops from qi deficiency or is a special manifestation of qi deficiency. (2) Clinical manifestations: Dizziness, tinnitus, fatigue, shortness of breath, a feeling of qi sinking, or internal organ prolapse, or conditions such as prolapse of the rectum or uterus. (3) Common syndromes: Middle qi sinking syndrome or spleen qi sinking syndrome, characterized by internal organ prolapse. 3) Qi Not Holding Syndrome: Refers to the inability of qi to hold and secure, leading to symptoms of weakness. (1) Causes: Generally develops from qi deficiency. (2) Clinical manifestations: Spontaneous sweating, easy to catch colds; or various bleeding; or incontinence of urine and feces, nocturnal emissions, miscarriage, etc., along with shortness of breath, low voice, fatigue, and weakness, which are general manifestations of qi deficiency syndrome. (3) Common syndromes: Defensive qi not holding (spleen-lung qi deficiency syndrome), qi not holding blood (spleen not governing blood syndrome), lower source not holding (kidney qi not holding syndrome), etc. 4) Qi Collapse Syndrome: Refers to a critical condition where original qi is severely deficient, leading to a faint and weak breath. (1) Causes: Generally develops from qi deficiency or qi not holding, or due to significant blood loss, referred to as “qi following blood loss.” (2) Clinical manifestations: Weak and irregular breathing, possible fainting or collapse, continuous sweating, pale complexion, open mouth and closed eyes, limp limbs, incontinence of urine and feces, weak pulse, pale tongue, and white moist coating. 2) Qi Stagnation Syndromes: Includes qi stagnation syndrome, qi counterflow syndrome, and qi obstruction syndrome. 1) Qi Stagnation Syndrome: Refers to the obstruction of qi flow in a specific part of the body or a specific organ or meridian. Also known as qi depression syndrome or qi blockage syndrome. (1) Causes: (i) Emotional distress, dietary imbalances, exposure to external pathogens, or trauma. (ii) Pathological substances such as phlegm, blood stasis, food stagnation, roundworms, or stones obstructing the flow. (iii) Weak Yang qi or cold stagnation leading to obstruction of qi flow. (2) Clinical manifestations: Distension and pain in the chest, hypochondrium, abdomen, etc., with symptoms varying in intensity, often relieved by belching, bowel sounds, or passing gas, and may worsen or improve with emotional changes. The pulse is often wiry, with no significant changes in tongue appearance. (3) Common syndromes: Liver qi stagnation syndrome, gastrointestinal qi stagnation syndrome, liver-stomach qi stagnation syndrome, etc. Concurrent syndromes: Qi stagnation with blood stasis, qi depression transforming into heat, phlegm-qi blockage, qi stagnation with damp obstruction, and qi stagnation with water retention. 2) Qi Counterflow Syndrome: Refers to abnormal qi flow, where qi rises and counterflows, leading to symptoms. (1) Causes: (i) External pathogens or phlegm invading the lungs. (ii) Cold, heat, water, food stagnation, or blood stasis affecting the stomach. (iii) Emotional distress, anger, or fear affecting the liver. (2) Clinical manifestations: Lung qi counterflow syndrome: cough and wheezing. Stomach qi counterflow syndrome: belching, nausea, vomiting. Liver qi counterflow syndrome: headache, dizziness, qi rising from the lower abdomen to the chest and throat. 3) Qi Obstruction Syndrome: (1) Refers to a syndrome characterized by qi blockage due to extreme anger, shock, or excessive worry, leading to symptoms such as confusion or fainting, and limb coldness. Also known as spirit qi obstruction syndrome. (2) Or due to blood stasis, stones, roundworms, or phlegm obstructing the vessels, leading to severe pain at the obstruction site, possibly resulting in fainting, constipation, and coarse breathing with a strong pulse. 3. Blood Disease Diagnosis1) Blood Deficiency Syndromes: Includes blood deficiency and blood loss. 1) Blood Deficiency Syndrome: Refers to insufficient blood volume, leading to an inability to nourish the organs, meridians, and tissues, resulting in weakness. (1) Causes: (i) Excessive blood loss without timely replenishment. (ii) Reduced digestive function or insufficient nutrition leading to inadequate blood production. (iii) Excessive worry or parasitic infections consuming nutrients, leading to blood deficiency. (iv) Blood stasis obstructing the vessels, preventing new blood production. (v) Prolonged illness or severe illness depleting the essence and qi, leading to blood production failure. (2) Clinical manifestations: Pale or sallow complexion, pale lips, eyelids, and nails, dizziness, palpitations, numbness in the hands and feet, women experiencing light menstrual flow or amenorrhea, pale tongue, and thin weak pulse. (3) Common syndromes: Heart blood deficiency, liver blood deficiency, blood deficiency leading to dry intestines, and blood deficiency leading to skin wind syndrome, etc. Concurrent syndromes: Yin blood deficiency syndrome, blood deficiency with stasis syndrome. 2) Blood Stasis Syndrome: 1) Meaning: Refers to symptoms caused by blood stasis. Blood stasis refers to blood that has not been expelled or dissipated in time, accumulating in certain areas, or blood flow being obstructed in the meridians or organs, leading to stagnation and loss of physiological function. (1) Causes: (i) Trauma or falls causing internal bleeding that has not been expelled or dissipated. (ii) Qi stagnation leading to poor blood flow, or qi deficiency leading to weak blood circulation. (iii) Cold stagnation leading to blood stasis, or heat scorching leading to blood stasis, or damp heat, phlegm heat obstructing the vessels, leading to poor blood flow. (2) Clinical manifestations: (i) Pain: Sharp, stabbing pain, fixed in location, worsening at night. (ii) Masses: Superficial masses appear as purple lumps, while abdominal masses may be hard and immovable. (iii) Bleeding: Dark purple blood with clots, or black stools resembling tar. Women may experience amenorrhea or excessive bleeding. (iv) Dark complexion, or cyanosis of the lips and nails, or subcutaneous purple spots, or visible veins on the abdomen, or skin showing thread-like red lines. (v) Purple or dark tongue, or visible purple spots, or varicose veins under the tongue, or blue-purple lines on the tongue. (vi) The pulse is often thin and choppy, or may be knotted, intermittent, or absent. (3) Common syndromes: Heart vessel obstruction syndrome, brain vessel obstruction syndrome, liver blood stasis syndrome, uterine blood stasis syndrome, lower jiao blood stasis syndrome, skin blood stasis syndrome, etc. Concurrent syndromes: Qi stagnation with blood stasis, blood stasis with qi stagnation, phlegm-stasis mutual blockage, stasis-heat mutual blockage, and blood stasis with water retention. 3) Blood Heat Syndrome: 1) Meaning: Refers to symptoms characterized by excessive heat in the organs, forcing heat into the blood. Commonly seen in the most severe stages of external heat diseases, referred to as “blood division syndrome.” 2) Clinical manifestations: Coughing blood, vomiting blood, nosebleeds, blood in urine, blood in stools, excessive menstrual bleeding, or local skin, muscle, or organ abscesses, accompanied by irritability, thirst, fever, red tongue, and rapid pulse. 4) Blood Cold Syndrome: 1) Meaning: Refers to symptoms caused by cold evil invading the blood vessels, leading to stagnation of qi flow and poor blood circulation. 2) Clinical manifestations: Cold pain in the hands and feet, dark purple skin, or cold pain in the lower abdomen, preference for warmth, relief from warmth, or menstrual irregularities with dark purple blood and clots, purple tongue, white coating, and slow or choppy pulse. 3) Common syndromes: Cold stagnation in the liver vessels, cold stagnation in the uterus, and cold stagnation in the vessels, etc. 4. Fluid Disease Diagnosis: 1) Fluid Deficiency Syndrome: 1) Meaning: Refers to insufficient body fluids, leading to dryness in the organs and tissues. Also known as fluid deficiency syndrome. Fluid loss: Refers to mild fluid loss, primarily due to water loss, also known as fluid deficiency. Fluid exhaustion: Refers to severe fluid loss, where not only water is lost but also some essential nutrients are damaged, also known as fluid collapse. Clinically, it is often referred to as fluid deficiency syndrome without strict differentiation. 2) Causes: (1) High fever, excessive sweating, vomiting, frequent urination, burns, etc., leading to excessive fluid loss. (2) Excessive Yang qi leading to hidden fluid loss. (3) Insufficient water intake, weak organ function, and inadequate fluid production. 3) Clinical manifestations: Dry mouth and throat, cracked or chapped lips, sunken eyes, dry skin, thirst for water, short and difficult urination, dry and hard stools, red tongue with little moisture, and thin or rapid pulse. Common syndromes include lung dryness and fluid injury syndrome, stomach dryness and fluid deficiency syndrome, and intestinal dryness and fluid deficiency syndrome. Concurrent syndromes: Dryness of fluids and blood, fluid deficiency with blood stasis, qi following fluid loss, and fluid and qi deficiency syndromes. 2) Phlegm Syndrome: 1) Meaning: “Phlegm” is a pathological product formed by the stagnation of body fluids, characterized by its viscous nature and low mobility, easily obstructing the organs and tissues or spreading throughout the body, leading to phlegm syndrome. 2) Clinical manifestations: Coughing with phlegm, thick and sticky phlegm, chest tightness, nausea, poor appetite, vomiting phlegm, dizziness, obesity, or confusion with phlegm sounds in the throat, or mental disorders leading to mania, insanity, or seizures, or the appearance of soft, smooth lumps in certain areas, such as goiter, lymphadenopathy, breast lumps, or globus sensation. The tongue coating is greasy, and the pulse is slippery. 3) Common syndromes include phlegm obstructing the heart spirit, phlegm heat obstructing the spirit, phlegm fire disturbing the spirit, phlegm obstructing the heart vessels, phlegm obstructing the chest Yang, phlegm damp obstructing the lungs, phlegm heat obstructing the lungs, phlegm heat in the intestines, dry phlegm obstructing the lungs, phlegm obstructing the uterus (or seminal chamber), phlegm dampness, phlegm obstructing the meridians, phlegm dampness in the skin, wind phlegm obstructing the spirit, wind phlegm obstructing the meridians, phlegm stasis obstructing the meridians, phlegm qi stagnation, and pus phlegm obstructing the lungs, etc. Concurrent syndromes: Cold phlegm, heat phlegm, damp phlegm, dry phlegm, wind phlegm, phlegm stasis, and pus phlegm. 3) Drink Syndrome: 1) Meaning: Refers to symptoms caused by the accumulation of fluid in the stomach, lungs, chest, and abdomen. 2) Clinical manifestations: Symptoms may include dizziness, pale and tender tongue, white slippery coating, and wiry pulse. (1) Phlegm drink: Refers to fluid accumulation in the stomach—distension and fullness, or a sloshing sound, with possible vomiting of clear fluids or phlegm. (2) Supporting drink: Refers to fluid accumulation in the heart and lungs—coughing and wheezing, possibly unable to lie flat, with thick and clear phlegm, chest tightness, and possible wheezing sounds. (3) Suspended drink: Refers to fluid accumulation in the chest and hypochondrium—fullness and pain in the chest and hypochondrium, with pain during breathing, coughing, or turning. (4) Overflowing drink: Refers to fluid overflowing into the limbs—swelling, heaviness, and pain in the limbs, with poor urination. 3) Common syndromes include cold drink in the lungs syndrome, drink accumulation in the pericardium syndrome, drink accumulation in the chest and hypochondrium syndrome, and drink retention in the gastrointestinal tract syndrome. 4) Water Retention Syndrome: 1) Meaning: Refers to symptoms caused by dysfunction of the lungs, spleen, and kidneys, leading to water retention in the skin or accumulation in the chest and abdomen, which may fluctuate with body position. 2) Causes: (1) External wind evil invading, leading to lung dysfunction and obstruction of the water pathways. (2) Internal water invasion, leading to spleen dysfunction and water retention. (3) Internal injury from overwork, irregular sexual activity, prolonged illness, or excessive treatment, leading to spleen and kidney Yang deficiency, which cannot transform water, resulting in water retention. (4) Blood stasis, stones, etc., obstructing the meridians, affecting the normal flow of water, leading to accumulation in the chest and abdomen. 3) Clinical manifestations: Edema, which may appear in the lower limbs, face, or even the entire body, with pitting edema; or water retention in the chest and abdomen, leading to chest tightness and abdominal fullness, with a dull sound upon percussion; and changes in body position may lead to movement, with short and difficult urination, moist tongue coating, and slippery pulse. 4) Common syndromes include wind-water interaction syndrome, spleen deficiency with water retention syndrome, kidney deficiency with water retention syndrome, and water qi obstructing the heart syndrome. 1. Relationship Between Qi Collapse and Loss of Yang: Qi collapse and loss of Yang often occur simultaneously, with similar clinical manifestations. The main feature of loss of Yang is cold limbs and body, while the main feature of qi collapse is weak and faint breath, often referred to clinically as Yang qi collapse. 2. Distinguishing Water Retention: Water is a tangible evil that overflows the skin, leading to facial and body swelling. The nature of the disease can be classified as deficiency or excess, divided into Yin water and Yang water: 1) Yang Water: The nature of the disease is excess. Sudden onset, starting from the eyelids and face, rapidly spreading throughout the body, with thin and shiny skin, and more swelling in the upper body. Often accompanied by symptoms of wind evil invading the lung defense. 2) Yin Water: The nature of the disease is deficiency. Gradual onset, starting from the feet and gradually spreading throughout the body, with unchanged skin color, and more swelling below the waist. Often accompanied by symptoms of spleen and kidney Yang deficiency. 3. Distinguishing Between Bleeding: 1) Qi Deficiency: Refers to a deficiency syndrome characterized by pale and thin blood, with varying amounts of bleeding. 2) Blood Heat: Refers to an excess syndrome characterized by red and thick blood, with large amounts of bleeding. 3) Blood Stasis: Refers to an excess syndrome characterized by dark purple blood with clots, with varying amounts of bleeding. Summary 1. Disease Etiology Diagnosis: 1) The concept and key points of distinguishing the six excesses: wind, cold, summer heat, dampness, dryness, and fire. 2) The meaning of toxins and key points for distinguishing pus syndrome, food accumulation, and worm accumulation. 2. Qi and Blood Diagnosis: 1) Qi Disease Diagnosis: Qi deficiency syndrome, qi sinking syndrome, qi stagnation syndrome, qi counterflow syndrome. 2) Blood Disease Diagnosis: Blood deficiency syndrome, blood stasis syndrome, blood heat syndrome, blood cold syndrome. 3. Fluid Disease Diagnosis: Fluid deficiency syndrome, water retention syndrome, phlegm syndrome, drink syndrome.
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