Chapter 3: Eight Principles
Section 1: Exterior and Interior
1. Exterior Syndrome
2. Interior Syndrome
[Appendix] Half Exterior and Half Interior Syndrome
3. Differentiation between Exterior and Interior Syndromes
4. Relationship between Exterior and Interior Syndromes
Section 2: Cold and Heat
1. Cold Syndrome
2. Heat Syndrome
3. Differentiation between Cold and Heat Syndromes
4. Relationship between Cold and Heat Syndromes
5. Relationship between Cold, Heat, and Exterior/Interior
Section 3: Deficiency and Excess
1. Deficiency Syndrome
2. Excess Syndrome
3. Differentiation between Deficiency and Excess Syndromes
4. Relationship between Deficiency and Excess Syndromes
5. Relationship between Deficiency/Excess and Exterior/Interior Cold/Heat
Section 4: Yin and Yang
1. Yin Syndrome and Yang Syndrome
2. True Yin Deficiency and True Yang Deficiency
3. Loss of Yin and Loss of Yang
Chapter 3: Eight Principles
The Eight Principles refer to Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess. They are one of the theoretical foundations for differentiation and treatment. Through the four examinations, after grasping the diagnostic data, one analyzes and synthesizes based on various factors such as the depth of the disease location, the nature of the pathogenic factor, and the strength of the body’s righteous Qi, categorizing them into eight different types of syndromes, known as the Eight Principles differentiation.
Although the manifestations of diseases are extremely complex, they can generally be summarized using the Eight Principles. For example, diseases can be categorized into Yin and Yang syndromes; the depth of the disease can be divided into Exterior and Interior syndromes; the nature of the disease can be divided into Cold and Heat syndromes; the strength of the pathogenic and righteous Qi can be divided into Excess and Deficiency syndromes. Thus, by using the Eight Principles differentiation, one can summarize the intricate clinical manifestations into four pairs of guiding syndromes: Exterior/Interior, Cold/Heat, Deficiency/Excess, and Yin/Yang, thereby identifying the key aspects of the disease, mastering its essentials, determining its type, predicting its trend, and guiding treatment. Among these, Yin and Yang can also encompass the other six principles, with Exterior, Heat, and Excess belonging to Yang; and Interior, Cold, and Deficiency belonging to Yin, thus Yin and Yang serve as the overarching principle among the Eight Principles.
The Eight Principles are a method for analyzing the common characteristics of diseases and are the general framework for various differentiations. In the diagnostic process, they play a role in simplifying complexity and providing a guiding framework. They are applicable to the differentiation in various clinical departments, including internal medicine, external medicine, gynecology, pediatrics, ophthalmology, otolaryngology, etc., all of which utilize the Eight Principles to summarize and categorize. Based on the Eight Principles, combined with the characteristics of organ and viscera changes, it branches into organ differentiation; combined with the characteristics of Qi, Blood, and Body Fluids changes, it branches into Qi, Blood, and Body Fluids differentiation; combined with the characteristics of warm diseases, it branches into Wei, Qi, Ying, and Blood differentiation, etc. Any differentiation cannot be separated from the Eight Principles, hence it is said that Eight Principles differentiation is the foundation of all differentiations.
Eight Principles differentiation does not mean that various syndromes are strictly divided into eight distinct areas; they are interconnected and inseparable.
For example, Exterior and Interior are related to Cold and Heat, and Deficiency and Excess are related to Exterior and Interior. Due to the changes in diseases, they often do not occur in isolation, and there are often mixed situations where Exterior and Interior, Cold and Heat, and Deficiency and Excess intertwine, such as simultaneous Exterior and Interior diseases, mixed Deficiency and Excess, and mixed Cold and Heat. Under certain conditions, diseases can also exhibit varying degrees of transformation, such as Exterior pathogenic factors entering the Interior, Interior pathogenic factors exiting the Exterior, Cold transforming into Heat, Heat transforming into Cold, Excess transforming into Deficiency, and Deficiency leading to Excess, etc. At certain stages of disease progression, some phenomena that are contrary to the nature of the disease can also appear, such as true Cold appearing as false Heat, true Heat appearing as false Cold, true Deficiency appearing as false Excess, and true Excess appearing as false Deficiency. Yin and Yang are also like this; there is Yin within Yang and Yang within Yin, diseases can transition from Yang to Yin, from Yin to Yang, and can also transform from Yin to Yang and from Yang to Yin. Therefore, when conducting Eight Principles differentiation, one must not only be proficient in the characteristics of various syndromes but also pay attention to their interrelations, transformations, mixtures, and the authenticity of symptoms to correctly and comprehensively understand and diagnose diseases.
Section 1: Exterior and Interior
Exterior and Interior are a pair of principles for distinguishing the location and depth of diseases. It is a relative concept. In terms of the body structure and internal organs, the body structure is the Exterior, and the internal organs are the Interior; in terms of Zang and Fu organs, Fu organs are the Exterior, and Zang organs are the Interior; in terms of meridians and Zang-Fu organs, meridians are the Exterior, and Zang-Fu organs are the Interior, etc. From the perspective of disease depth, in cases of external pathogenic diseases, when the pathogenic factor enters the Interior one layer, the disease is deeper; when it exits the Exterior one layer, the disease is lighter. This understanding of relative concepts is particularly important in the differentiation of the six meridians and the differentiation of Wei, Qi, Ying, and Blood. The above is the broad concept of Exterior and Interior. The narrow concept of Exterior and Interior refers to the skin, muscles, and meridians as the Exterior, where these areas are affected by pathogenic factors, belonging to Exterior syndrome; while the internal organs, Qi, Blood, and bone marrow are the Interior, where these areas become diseased, collectively belonging to Interior syndrome. The differentiation between Exterior and Interior syndromes is of great significance in the differentiation of external pathogenic diseases. It can reveal the severity of the disease, clarify the depth of the pathological changes, and predict the trend of pathological changes. Exterior syndromes are shallow and light, while Interior syndromes are deep and heavy. When the Exterior pathogenic factor enters the Interior, it indicates disease progression, while when the Interior pathogenic factor exits the Exterior, it indicates disease regression. Understanding the severity and progression of the disease allows one to grasp the evolution of the disease and take appropriate treatment measures.
1. Exterior Syndrome
Exterior syndrome refers to the symptoms produced when the six excesses and epidemic pathogenic factors invade the body through the skin and hair, mouth, and nose. It is often seen in the early stages of external pathogenic diseases, generally characterized by sudden onset and a short course of illness.
Exterior syndrome has two obvious characteristics. First, it is caused by the invasion of pathogenic factors from the outside. Second, the pathogenic disease is mild.
The location of Exterior syndrome is in the skin and muscles, and the disease is light and easy to treat.
[Clinical Manifestations] Chills, fever, headache, body aches, thin white tongue coating, floating pulse, along with symptoms such as nasal congestion, runny nose, cough, sneezing, and throat itching and pain.
[Pathological Analysis] Due to the six excesses invading the muscle surface, obstructing the normal dissemination of Wei Qi, it becomes stagnant and causes fever. The obstruction of Wei Qi results in the loss of its function to warm and nourish the muscle surface, hence the chills. The stagnation of pathogenic Qi in the meridians causes the flow of Qi and Blood to be obstructed, leading to headache and body aches. The lungs govern the skin and hair, and the nose is the orifice of the lungs; the pathogenic Qi enters the lungs through the skin and mouth, affecting the lungs, causing the lung Qi to lose its ability to disperse, hence nasal congestion, runny nose, and cough. Symptoms such as sneezing and throat itching and pain often occur together. Since the pathogenic Qi is still in the Exterior and has not harmed the Interior, the tongue coating may show no changes, remaining primarily thin and white. The righteous Qi rises to resist the pathogenic factor, and the pulse is floating due to the Qi being driven outward.
2. Interior Syndrome
Interior syndrome refers to a type of syndrome where the disease is deep within the Interior (Zang-Fu organs, Qi, Blood, bone marrow). It is the opposite of Exterior syndrome. It is often seen in the middle or later stages of external pathogenic diseases or in diseases caused by internal injury. The causes of Interior syndrome can be broadly categorized into three situations: first, the pathogenic factor from the Exterior transmits into the Interior, invading the Zang-Fu organs; second, the external pathogenic factor directly invades the Zang-Fu organs; third, emotional disturbances, irregular diet, excessive labor, and other factors damage the Zang-Fu organs, leading to functional disorders, causing diseases.
The scope of Interior syndrome is very broad; apart from Exterior syndrome, all other diseases can be considered Interior syndromes. The characteristics of Interior syndrome can also be summarized in two points. First, the disease location is deep. Second, the condition of Interior syndrome is generally more severe.
[Clinical Manifestations] The causes of Interior syndrome are complex, the disease location is extensive, and the symptoms are numerous, often appearing in forms of either Cold or Heat, or Deficiency or Excess, hence detailed content can be found in various chapters. Here are a few common symptom-pulse analyses:
High fever with aversion to heat or slight fever with tidal fever, irritability, mental confusion, thirst with a desire to drink, or aversion to cold with cold limbs, fatigue, and a pale tongue with thick coating, pulse deep.
[Syndrome Analysis] The above-listed symptoms are some common symptom-pulse combinations that may appear in various Interior syndromes of Cold, Heat, Deficiency, and Excess. In terms of heat and cold, Interior syndromes can be either purely heat or purely cold; heat can manifest as high fever with aversion to heat. Slight fever with tidal heat is often seen in internal injury with Yin deficiency, leading to virtual fire rising. Cold manifestations include aversion to cold, and the need for clothing and blankets can alleviate this, which is due to the body’s own Yang Qi being insufficient or the cold pathogenic factor invading, damaging Yang Qi, resulting in Yang deficiency leading to cold. Irritability and mental confusion are manifestations of Excess heat disturbing the mind; thirst with a desire to drink and short red urine are due to Excess heat consuming body fluids. Constipation is due to heat obstructing the intestines, leading to the depletion of body fluids and loss of normal function. Those with insufficient Yang Qi often show fatigue and cold limbs, while those with virtual cold may present with a pale tongue and thick white coating. Yang deficiency fails to transform fluids, leading to clear and thin excretions. Yang deficiency leads to a slow pulse; cold constricts, and exposure to cold leads to a tight pulse.
[Appendix] Half Exterior and Half Interior Syndrome
When the external pathogenic factor transmits into the Interior but has not yet fully entered, or when the Interior pathogenic factor penetrates the Exterior but has not yet reached the surface, the pathogenic and righteous Qi are in conflict between the Exterior and Interior, which is termed Half Exterior and Half Interior syndrome. Its manifestations include alternating chills and fever, fullness in the chest and flanks, irritability with a desire to vomit, reluctance to eat, bitter mouth, dry throat, dizziness, and wiry pulse. This understanding of Half Exterior and Half Interior is essentially similar to the Shaoyang disease in the differentiation of the six meridians.
3. Differentiation between Exterior and Interior Syndromes
To differentiate between Exterior and Interior syndromes, one primarily examines the changes in Cold and Heat, tongue appearance, and pulse. Generally speaking, in external pathogenic diseases, the simultaneous presence of fever and aversion to cold belongs to Exterior syndrome, while the presence of heat without cold or cold without heat belongs to Interior syndrome. The tongue coating in Exterior syndrome does not change, while in Interior syndrome, the tongue coating often shows changes; a floating pulse indicates Exterior syndrome, while a deep pulse indicates Interior syndrome.
4. Relationship between Exterior and Interior Syndromes
The skin and muscles of the human body are interconnected with the Zang-Fu organs through the meridians, allowing for communication between the Exterior and Interior. During the progression of a disease, under certain conditions, there can be a mixture and mutual transformation of Exterior and Interior syndromes, such as simultaneous Exterior and Interior diseases, the Exterior pathogenic factor entering the Interior, and the Interior pathogenic factor exiting the Exterior.
(1) Simultaneous Exterior and Interior Diseases
When Exterior and Interior syndromes appear at the same time, it is called simultaneous Exterior and Interior diseases. This situation arises not only when the disease initially presents with both Exterior and Interior syndromes but also when the Exterior syndrome has not resolved and has affected the Interior, or when the original disease has not healed and has added a superficial disease, such as having an internal injury and then being affected by an external pathogenic factor, or having an external pathogenic factor first and then injuring the diet.
The appearance of simultaneous Exterior and Interior diseases is often associated with the mutual presence of Cold and Heat, commonly seen as Exterior Cold with Interior Heat, Exterior Heat with Interior Cold, Exterior Deficiency with Interior Excess, and Exterior Excess with Interior Deficiency, etc., which can be found in detail in the differentiation of Cold and Heat, Deficiency and Excess.
(2) Exterior and Interior Transition
1. Exterior Pathogenic Factor Entering the Interior: Any disease with Exterior syndrome, if the Exterior pathogenic factor does not resolve and transmits into the Interior, is termed Exterior pathogenic factor entering the Interior. This often occurs due to a decrease in the body’s ability to resist pathogenic factors, excessive pathogenic Qi, improper care, or misdiagnosis and mistreatment. For example, in any disease with Exterior syndrome, if the aversion to cold resolves, and instead, there is aversion to heat with thirst, red tongue with yellow coating, and red urine, this indicates the Exterior pathogenic factor has entered the Interior.
2. Interior Pathogenic Factor Exiting the Exterior: Certain Interior syndromes, where the pathogenic factor penetrates from the Interior to the Exterior, are termed Interior pathogenic factor exiting the Exterior. This is the result of proper treatment and care, leading to an increase in the body’s resistance. For example, internal heat with irritability, cough, and chest tightness, followed by fever and sweating, or rashes appearing externally, indicates the pathogenic factor has exited the Exterior.
The entry of the Exterior pathogenic factor into the Interior indicates a worsening of the disease, while the exit of the Interior pathogenic factor from the Exterior reflects a decrease in pathogenic factors, which is significant for predicting the development of the disease.
Section 2: Cold and Heat
Cold and Heat are two principles for distinguishing the nature of diseases. Cold and Heat syndromes reflect the relative excess and deficiency of Yin and Yang in the body. Yin excess or Yang deficiency manifests as Cold syndrome; Yang excess or Yin deficiency manifests as Heat syndrome. The differentiation of Cold and Heat is of great significance in treatment. The “Suwen: The Great Discussion on True” states: “Cold is the opposite of Heat,” and “Heat is the opposite of Cold,” thus the treatment methods for the two are exactly opposite. Therefore, the differentiation of Cold and Heat must be accurate.
1. Cold Syndrome
Cold syndrome refers to a type of syndrome where the essence of the disease is cold in nature. It can be caused by the invasion of cold pathogenic factors or by the body’s own Yang deficiency and Yin excess.
Due to the different causes and locations of Cold syndrome, several different types can be distinguished. For example, the invasion of cold pathogenic factors can affect the muscle surface or directly invade the internal organs, hence the distinction between Exterior Cold and Interior Cold. The causes of Interior Cold can be due to the invasion of cold pathogenic factors or the body’s own Yang deficiency, hence the distinction between Excess Cold and Deficiency Cold. Here, we will first analyze the common characteristics of Cold syndrome.
[Clinical Manifestations] The clinical manifestations of various Cold syndromes are not entirely consistent, but common symptoms include: aversion to cold, preference for warmth, pale complexion, cold limbs, lack of thirst, clear and thin phlegm, clear and long urine, loose stools, pale tongue with white coating, and slow or tight pulse.
[Syndrome Analysis] Insufficient Yang Qi or injury from external cold fails to exert its warming effect, hence the coldness of the body and limbs, preference for warmth, and pale complexion. Internal cold is excessive, and body fluids are not harmed, hence the lack of thirst. Insufficient Yang fails to transform fluids, leading to clear and thin excretions. Cold pathogenic factors harm the spleen, or prolonged Yang deficiency leads to loss of normal function, resulting in loose stools. Insufficient Yang fails to transform, leading to a pale tongue with white and slippery coating. Weak Yang Qi fails to drive the blood vessels, hence the slow pulse; cold constricts, and exposure to cold leads to a tight pulse.
2. Heat Syndrome
Heat syndrome refers to a type of syndrome where the essence of the disease is heat in nature. It can be caused by the invasion of heat pathogenic factors or by the body’s own Yin deficiency and Yang excess.
Based on the different causes and locations of Heat syndrome, several different types can also be distinguished. For example, external heat invasion or heat entering the Interior can lead to the distinction between Exterior Heat and Interior Heat. Among Interior Heat, there can be Excess Heat invading or self-weakness causing, hence the distinction between Excess Heat and Deficiency Heat. Here, we will analyze the common characteristics of Heat syndrome.
[Clinical Manifestations] The clinical manifestations of various Heat syndromes are also not entirely consistent, but common symptoms include: aversion to heat, preference for coolness, thirst with a desire for cold drinks, red face and eyes, irritability, yellow and thick phlegm, hemoptysis, short and red urine, dry and constipated stools, red tongue with yellow coating, and rapid pulse.
[Syndrome Analysis] Excess Yang leads to aversion to heat and preference for coolness. Fire heat injures Yin, leading to thirst. Fire heat rises, causing a red face and eyes. Heat disturbs the mind, leading to irritability. Body fluids are consumed by Yang heat, leading to yellow and thick secretions. Heat injures blood vessels, causing hemoptysis. Intestinal heat leads to dry stools, and fluid loss leads to constipation. A red tongue with yellow coating indicates Heat syndrome, while a dry tongue with little fluid indicates Yin injury, and rapid pulse indicates accelerated blood flow due to excessive Yang heat.
3. Differentiation between Cold and Heat Syndromes
To differentiate between Cold and Heat syndromes, one cannot rely solely on a single symptom for judgment; rather, one must conduct a comprehensive observation and analysis of the entire disease presentation, especially focusing on the preferences and aversions to Cold and Heat, thirst or lack thereof, facial color, temperature of the limbs, and the characteristics of the two excretions, tongue appearance, and pulse.
4. Relationship between Cold and Heat Syndromes
Although Cold and Heat syndromes have essential differences, they are also interconnected. They can simultaneously appear in the same patient, presenting as mixed Cold and Heat symptoms, and under certain conditions, they can transform into one another, leading to Cold transforming into Heat and Heat transforming into Cold. During the progression of a disease, especially in critical stages, false Cold or false Heat phenomena may also appear.
(1) Mixed Cold and Heat
When Cold and Heat syndromes appear simultaneously in the same patient, presenting as mixed Cold and Heat, it is termed mixed Cold and Heat. There are different types of mixed Cold and Heat, including upper Cold and lower Heat, and upper Heat and lower Cold. Upper and lower are relative concepts; for example, the diaphragm is the boundary, with the chest being upper and the abdomen being lower. The upper abdomen (stomach) is also considered upper, while the lower abdomen (bladder, large intestine) is considered lower.
1. Upper Cold and Lower Heat: The patient presents with Cold in the upper body and Heat in the lower body at the same time. For example, cold pain in the stomach with vomiting of clear fluids, while also experiencing frequent urination, painful urination, and short red urine, indicates Cold in the stomach and Heat in the bladder.
2. Upper Heat and Lower Cold: The patient presents with Heat in the upper body and Cold in the lower body at the same time. For example, the patient has heat in the chest and cold in the intestines, presenting with both upper heat symptoms such as chest heat, sore throat, and dry mouth, and lower cold symptoms such as abdominal pain with a preference for warmth and loose stools.
2. Mixed Cold and Heat in the Exterior and Interior: The patient presents with simultaneous Exterior and Interior diseases with different Cold and Heat properties, termed mixed Cold and Heat in the Exterior and Interior. This includes Exterior Cold with Interior Heat and Exterior Heat with Interior Cold.
In the differentiation of mixed Cold and Heat, it is crucial to distinguish the degree of Cold and Heat. If Cold predominates, treatment should focus on Cold, while if Heat predominates, treatment should focus on Heat.
(2) Transformation of Cold and Heat
1. Cold transforming into Heat: The patient initially has Cold syndrome, and later Heat syndrome appears, gradually resolving the Cold symptoms. This transformation often occurs due to excessive Yang Qi or the Cold pathogenic factor transforming into Heat. For example, a patient with Cold syndrome initially presents with aversion to cold and fever, no sweating, thin white tongue coating, and floating pulse. As the condition progresses, the Cold pathogenic factor enters the Interior and transforms into Heat, leading to the resolution of aversion to cold and the emergence of high fever, irritability, thirst, yellow tongue coating, and rapid pulse, indicating the transformation from Cold syndrome to Heat syndrome.
2. Heat transforming into Cold: The patient initially has Heat syndrome, and later Cold syndrome appears, gradually resolving the Heat symptoms. This transformation often occurs due to excessive pathogenic factors or deficiency of the righteous Qi, leading to a decline in function. For example, a patient with high fever due to excessive heat may experience sudden drops in body temperature, cold limbs, pale complexion, and weak pulse, indicating the transformation from Heat syndrome to Cold syndrome.
The transformation of Cold and Heat syndromes reflects the changes in the strength of the pathogenic and righteous Qi. The transformation from Cold to Heat indicates that the body’s righteous Qi is still strong, while the transformation from Heat to Cold often indicates that the pathogenic factor is strong and the righteous Qi is weak.
(3) True and False Cold and Heat
When Cold or Heat syndromes develop to an extreme, sometimes phenomena that are contrary to the nature of the disease may appear, such as “true Cold appearing as false Heat” and “true Heat appearing as false Cold.” These phenomena are often seen in critical stages of the disease, and if not carefully observed, they can easily lead to misdiagnosis and mistreatment.
1. True Cold appearing as false Heat: This occurs when there is true Cold internally, but the patient appears to have false Heat externally. The mechanism is due to internal Yin Cold overwhelming Yang externally, leading to a false appearance of Heat. Symptoms may include fever, red face, thirst, and a large pulse, but the patient prefers to be covered and has a pale tongue with a white coating. Therefore, the appearance of Heat is false, and the true nature of the disease is Cold.
2. True Heat appearing as false Cold: This occurs when there is true Heat internally, but the patient appears to have false Cold externally. The mechanism is due to internal Yang Heat overwhelming Yin externally, leading to a false appearance of Cold. Symptoms may include cold limbs, a pale complexion, and a weak pulse, but the patient has a red tongue and a yellow coating. Therefore, the appearance of Cold is false, and the true nature of the disease is Heat.
In general, the manifestations of Cold and Heat are superficial, while the internal manifestations of Cold and Heat are the essence of the disease.
To differentiate between Cold and Heat syndromes, one must consider the entire disease presentation, especially focusing on the preferences and aversions to Cold and Heat, thirst or lack thereof, facial color, temperature of the limbs, and the characteristics of the two excretions, tongue appearance, and pulse.
Section 3: Deficiency and Excess
Deficiency and Excess are two principles for distinguishing the strength of the righteous Qi and the severity of the pathogenic Qi. Generally speaking, Deficiency refers to insufficient righteous Qi, while Deficiency syndrome reflects the manifestations of insufficient righteous Qi. Excess refers to the overabundance of pathogenic Qi, while Excess syndrome reflects the manifestations of excessive pathogenic Qi. The “Suwen: General Discussion on Deficiency and Excess” states: “When the pathogenic Qi is strong, it is Excess; when the essence is taken away, it is Deficiency.” From the perspective of the balance of the righteous and pathogenic Qi, although Deficiency syndrome reflects insufficient righteous Qi, the pathogenic Qi is not strong; while Excess syndrome reflects excessive pathogenic Qi, but the righteous Qi has not yet declined, indicating a fierce struggle between the righteous and pathogenic Qi. Differentiating between Deficiency and Excess is the basis for determining whether to tonify or drain, hence the saying “tonify the Deficient, drain the Excess.”
1. Deficiency Syndrome
Deficiency syndrome is a pathological summary of various clinical manifestations of insufficient righteous Qi in the body. The formation of Deficiency syndrome can be due to congenital insufficiency, postnatal malnutrition, or the consumption of Qi due to illness.
Due to the complexity of clinical manifestations of Deficiency syndrome, only some common and regular manifestations will be introduced here.
[Clinical Manifestations] The manifestations of various Deficiency syndromes are extremely inconsistent and difficult to summarize comprehensively. Common symptoms include: pale or sallow complexion, mental fatigue, physical weakness, palpitations, shortness of breath, cold limbs, spontaneous sweating, loose stools, urinary incontinence, pale and swollen tongue, weak or thin pulse, or five hearts heat, weight loss, red cheeks, dry mouth and throat, night sweats, and red tongue with little coating, rapid pulse.
[Syndrome Analysis] The pathogenesis of Deficiency syndrome primarily manifests in two aspects: injury to Yin or injury to Yang. If Yang is injured, the manifestations of Yang deficiency will be predominant. Due to the loss of Yang’s warming and consolidating functions, symptoms such as pale complexion, cold limbs, fatigue, palpitations, shortness of breath, loose stools, and urinary incontinence will appear. If Yin is injured, the manifestations of Yin deficiency will be predominant. Due to the inability of Yin to restrain Yang, the loss of nourishing and moistening functions will lead to symptoms such as heat in the palms and soles, irritability, sallow or red cheeks, and night sweats. Yang deficiency leads to excess Yin, hence the tongue is pale and swollen, and the pulse is weak and slow; Yin deficiency leads to excess Yang, hence the tongue is red and dry with little coating, and the pulse is thin and rapid.
2. Excess Syndrome
Excess syndrome is a pathological summary of various clinical manifestations caused by the invasion of external pathogenic factors or the accumulation of pathological products within the body. The causes of Excess syndrome can be divided into two aspects: one is the invasion of external pathogenic factors, and the other is the dysfunction of the Zang-Fu organs leading to the accumulation of pathological products such as phlegm, dampness, and blood stasis.
Due to the different causes, the manifestations of Excess syndrome are also extremely diverse, so only some common and general issues will be introduced here.
[Clinical Manifestations] Due to the different causes, the manifestations of Excess syndrome are also extremely inconsistent, but common manifestations include: fever, abdominal distension and pain with tenderness, chest tightness, irritability, even mental confusion, coarse breathing, excessive phlegm, constipation, or diarrhea, urinary difficulties, painful urination, strong pulse, pale tongue, and thick greasy coating.
[Syndrome Analysis] Excess pathogenic Qi is strong, and the righteous Qi struggles against it, leading to excessive Yang heat, hence fever. Excess pathogenic Qi disturbs the mind or obscures the spirit, leading to irritability and even mental confusion; if the pathogenic Qi obstructs the lungs, it leads to abnormal respiration and chest tightness. If phlegm is excessive, it may also lead to a rattling sound.
Excess pathogenic Qi obstructs the intestines, leading to constipation, abdominal distension, and pain with tenderness. Damp heat descending can lead to diarrhea with urgency, while water dampness stagnates, leading to urinary difficulties. The struggle between the righteous and pathogenic Qi manifests in a strong pulse. Damp heat rising can lead to a thick greasy tongue coating.
3. Differentiation between Deficiency and Excess Syndromes
Deficiency and Excess syndromes have been introduced above, but clinically, some symptoms can appear in both Excess and Deficiency syndromes, such as abdominal pain, which can occur in both. Therefore, to differentiate between Deficiency and Excess, one must consider the four examinations comprehensively, including observing the body shape, tongue appearance, listening to the voice, asking about the onset of the disease, palpating the abdomen, and examining the pulse. Generally speaking, Deficiency syndromes are characterized by weakness, while Excess syndromes are often characterized by a robust physique. Deficiency syndromes have low and weak voices, while Excess syndromes have loud and coarse voices. Chronic diseases are often Deficiency, while acute diseases are often Excess. A pale tongue and weak pulse indicate Deficiency; a pale tongue and strong pulse indicate Excess.
4. Relationship between Deficiency and Excess Syndromes
Disease is a complex process of development, and due to factors such as constitution, treatment, and care, Deficiency and Excess syndromes often exhibit mixed, transformed, and false symptoms. If not carefully observed, misdiagnosis can easily occur. The following will be discussed:
(1) Mixed Deficiency and Excess
Any Deficiency syndrome that is mixed with Excess syndrome, or Excess syndrome mixed with Deficiency syndrome, as well as the simultaneous presence of both, are all considered mixed Deficiency and Excess syndromes. For example, Exterior Deficiency with Interior Excess, Exterior Excess with Interior Deficiency, and so on. The treatment for mixed Deficiency and Excess syndromes often requires both tonification and drainage, but in the process of tonification and drainage, it is also necessary to distinguish which is more predominant, leading to a differentiation in the use of herbs.
(2) Transformation of Deficiency and Excess
The development of a disease is often a process of struggle between the righteous and pathogenic Qi, and the reflection of this struggle in symptoms primarily manifests as changes in Deficiency and Excess. During the course of the disease, some conditions that were originally Excess may transform into Deficiency due to prolonged pathogenic factors damaging the righteous Qi; conversely, some conditions that were originally Deficient may lead to the accumulation of phlegm, food, blood, or water, resulting in various Excess syndromes. For example, a patient with high fever, thirst, and a strong pulse due to Excess heat may, due to improper treatment, develop symptoms of muscle wasting, pale complexion, lack of appetite, and weak pulse, indicating a transformation from Excess to Deficiency. Conversely, a patient with a weak constitution may develop symptoms of palpitations and shortness of breath, and if not treated properly, may suddenly experience severe chest pain, indicating a transformation from Deficiency to Excess.
(3) True and False Deficiency and Excess
Deficiency and Excess syndromes can have true and false manifestations. When differentiating, one must discern the true from the false in the mixed symptoms to avoid the “Deficiency and Excess” error. The differentiation of true and false Deficiency and Excess is not the same as mixed Deficiency and Excess syndromes, and careful observation and differentiation are required.
1. True Excess appearing as false Deficiency: This refers to a condition where the disease is fundamentally Excess, but some symptoms appear to be Deficient. For example, in cases of heat obstructing the intestines, phlegm and food stagnation, the patient may appear calm and have cold limbs, a slow pulse, etc. Upon careful differentiation, it can be found that although the patient appears calm, they may speak loudly and energetically; the pulse may be slow but still strong; although the limbs are cold, the chest and abdomen may feel hot to the touch. This appearance of Deficiency is not due to weakness of the body but rather due to the obstruction of the Excess pathogenic Qi, hence it is termed false Deficiency. The treatment should still focus on attacking the pathogenic factor.
2. True Deficiency appearing as false Excess: This refers to a condition where the disease is fundamentally Deficient, but some symptoms appear to be Excess. For example, a patient with a weak spleen may experience abdominal distension and pain, but upon careful differentiation, it can be found that the distension may lessen, and the pain may be relieved by pressure. The pulse may be wiry, but upon deeper pressure, it may be weak. This appearance of Excess is not due to the presence of Excess pathogenic Qi but rather due to the weakness of the body, hence it is termed false Excess. The treatment should focus on tonification.
To summarize, the differentiation of true and false Deficiency and Excess can be categorized into four key points to guide clinical differentiation.
(1) The strength or weakness of the pulse, the presence or absence of spirit, and the characteristics of floating or deep pulses.
(2) The appearance of the tongue, whether it is swollen or pale.
(3) The loudness or weakness of the voice.
(4) The strength of the patient’s constitution, the cause of the disease, the duration of the disease, and the treatment history.
5. Relationship between Deficiency/Excess and Exterior/Interior Cold/Heat
Deficiency and Excess often reflect through the aspects of Exterior and Interior Cold and Heat, forming various syndromes. Commonly seen in clinical practice are Exterior Deficiency, Exterior Excess, Interior Deficiency, Interior Excess, Deficiency Heat, Excess Heat, Deficiency Cold, and Excess Cold.
(1) Exterior Deficiency Syndrome
Exterior Deficiency syndrome has two types: one refers to the Exterior syndrome caused by the invasion of wind, characterized by aversion to wind and spontaneous sweating; the other refers to the deficiency of Lung and Spleen Qi, where the Wei Qi cannot secure the surface, leading to spontaneous sweating and susceptibility to external pathogenic factors.
[Clinical Manifestations] External Deficiency: headache, stiff neck, fever, sweating, aversion to wind, floating and weak pulse.
Internal Deficiency: often spontaneous sweating, easy to catch a cold, with pale complexion, shortness of breath, fatigue, poor appetite, loose stools, pale tongue, and weak pulse.
[Syndrome Analysis] The Exterior Deficiency syndrome is caused by the invasion of wind, leading to symptoms such as headache and stiff neck due to the wind obstructing the Taiyang meridian. The righteous Qi is weak, leading to spontaneous sweating and aversion to wind. The pulse is floating and weak due to the deficiency of the Wei Qi.
For Internal Deficiency, the primary cause is the deficiency of Lung and Spleen Qi. The lungs govern the skin and hair, and the spleen governs the muscles; if their Qi is deficient, the muscle surface becomes loose, and the Wei Qi cannot secure it, leading to spontaneous sweating. The deficiency of Wei Qi leads to common colds. The deficiency of Lung and Spleen Qi will also present general symptoms of Qi deficiency, such as pale complexion, shortness of breath, fatigue, poor appetite, loose stools, pale tongue, and weak pulse.
(2) Exterior Excess Syndrome
Exterior Excess syndrome is a type of syndrome caused by the invasion of cold pathogenic factors into the muscle surface.
[Clinical Manifestations] Fever, aversion to cold, body aches, no sweating, floating and tight pulse.
[Syndrome Analysis] The invasion of external pathogenic factors leads to the upward and outward resistance of Yang Qi, resulting in fever. The pathogenic factor obstructs the normal dissemination of Wei Qi, leading to the inability to warm the muscle surface, hence the aversion to cold. The obstruction of the meridians leads to the stagnation of Qi and Blood, resulting in body aches. Cold constricts, leading to the inability of the Ying Qi to reach the surface, hence no sweating. The pulse is floating and tight, indicating the presence of cold pathogenic factors.
(3) Interior Deficiency Syndrome
Interior Deficiency syndrome encompasses a wide range of conditions, including deficiencies in various organs and meridians, as well as deficiencies in Yin, Yang, Qi, and Blood. The details will be elaborated in subsequent chapters.
(4) Interior Excess Syndrome
Interior Excess syndrome also includes a wide range of conditions, not only involving various organs and meridians but also different types of pathogenic factors. Many specific syndromes will be introduced in later chapters. Interior Excess syndrome can be categorized into Excess Cold and Excess Heat.
(5) Deficiency Cold Syndrome
Deficiency Cold syndrome is a type of syndrome caused by the deficiency of Yang Qi in the body.
[Clinical Manifestations] Mental fatigue, pale complexion, aversion to cold, abdominal pain with a preference for warmth, loose stools, clear and long urine, low energy, pale and swollen tongue, and weak pulse.
[Syndrome Analysis] The pathogenesis of this syndrome is due to the deficiency of Yang Qi. The Yang Qi fails to promote and transform, leading to symptoms such as mental fatigue, pale complexion, aversion to cold, abdominal pain with a preference for warmth, and clear and long urine.
(6) Deficiency Heat Syndrome
Deficiency Heat syndrome is a type of syndrome caused by the deficiency of Yin fluids in the body.
[Clinical Manifestations] Red cheeks, weight loss, tidal fever, night sweats, five hearts heat, dry mouth and throat, red tongue with little coating, and rapid pulse.
[Syndrome Analysis] The depletion of Yin fluids leads to weight loss; Yin deficiency fails to restrain Yang, leading to internal heat, hence symptoms such as red cheeks, dry mouth, and night sweats.
(7) Excess Cold Syndrome
Excess Cold syndrome is a type of syndrome caused by the invasion of cold pathogenic factors into the body.
[Clinical Manifestations] Aversion to cold, preference for warmth, pale complexion, cold limbs, abdominal pain with tenderness, clear and long urine, pale tongue with white coating, and slow or tight pulse.
[Syndrome Analysis] The invasion of cold pathogenic factors obstructs Yang Qi, leading to symptoms such as aversion to cold, cold limbs, and abdominal pain with tenderness.
(8) Excess Heat Syndrome
Excess Heat syndrome is a type of syndrome caused by the invasion of Yang heat into the body.
[Clinical Manifestations] High fever, aversion to heat, irritability, thirst with a desire for cold drinks, red face and eyes, yellow and thick phlegm, constipation, and rapid pulse.
[Syndrome Analysis] The presence of Excess heat leads to symptoms such as high fever, irritability, and thirst.
Section 4: Yin and Yang
Yin and Yang are the overarching principles for differentiating diseases. In diagnosis, one can categorize all diseases into two main aspects based on the pathological nature of clinical manifestations. Yin and Yang, in fact, serve as the overarching principles of the Eight Principles, encompassing the content of the other six aspects, namely, Exterior, Heat, and Excess belong to Yang; while Interior, Cold, and Deficiency belong to Yin. Therefore, some refer to the Eight Principles as “Two Principles and Six Essentials.”
In clinical practice, since the relationships between Exterior and Interior, Cold and Heat, and Deficiency and Excess are sometimes intertwined, they cannot be strictly divided. Therefore, the differentiation between Yin and Yang is not always clear-cut, and often complex syndromes arise where Yin is present within Yang and vice versa. For example, the previously mentioned simultaneous Exterior and Interior diseases, mixed Cold and Heat, and mixed Deficiency and Excess syndromes belong to this category.
In addition to Yin and Yang, there are also conditions such as True Yin Deficiency, True Yang Deficiency, and Loss of Yin and Loss of Yang, which will be discussed below.
1. Yin Syndrome and Yang Syndrome
(1) Yin Syndrome
Any syndrome that conforms to the general attributes of “Yin” is termed Yin syndrome. For example, Interior syndrome, Cold syndrome, and Deficiency syndrome generally fall under the category of Yin syndrome.
[Clinical Manifestations] Different diseases exhibit different Yin syndromes, but common manifestations include: dull complexion, mental fatigue, cold limbs, preference for warmth, low energy, low voice, poor appetite, pale tongue, and weak pulse.
[Syndrome Analysis] Mental fatigue, low energy, and low voice are manifestations of Deficiency syndrome. Cold limbs, preference for warmth, and pale tongue are manifestations of Interior Cold syndrome. A pale tongue with a swollen appearance and a weak pulse are indicative of Yin deficiency.
(2) Yang Syndrome
Any syndrome that conforms to the general attributes of “Yang” is termed Yang syndrome. For example, Exterior syndrome, Heat syndrome, and Excess syndrome generally fall under the category of Yang syndrome.
[Clinical Manifestations] Different diseases exhibit different Yang syndromes, but common manifestations include: red complexion, aversion to cold, heat in the skin, irritability, restlessness, loud voice, coarse breathing, thirst, constipation, and rapid pulse.
[Syndrome Analysis] Yang syndrome is a summary of Exterior syndrome, Heat syndrome, and Excess syndrome. The simultaneous presence of aversion to cold and fever is characteristic of Exterior syndrome. Red complexion, irritability, and thirst are manifestations of Heat syndrome. Loud voice, coarse breathing, and constipation are manifestations of Excess syndrome.
(3) Differentiation between Yin and Yang Syndromes
To differentiate between Yin and Yang syndromes, one can refer to the four examinations as follows:
1. Yin Syndrome
① Observation: Pale or dull complexion, cold limbs, low energy, low voice, pale tongue with a swollen appearance.
② Listening: Low voice, quiet demeanor, weak breathing, shortness of breath.
③ Inquiry: Foul-smelling stools, reduced appetite, no thirst, or preference for warm drinks, clear and long urine.
④ Palpation: Abdominal pain with tenderness, cold limbs, weak pulse.
2. Yang Syndrome
① Observation: Red or flushed complexion, preference for coolness, restlessness, dry lips, red tongue, yellow or dark yellow coating.
② Listening: Loud voice, irritability, coarse breathing, and restlessness.
③ Inquiry: Hard or constipated stools, foul-smelling, dry mouth, thirst.
④ Palpation: Abdominal pain with tenderness, warm limbs, strong pulse.
The balance of Yin and Yang is relative; when Yang is strong, Yin is weak, and vice versa. For example, if the pulse is strong, the tongue is red and dry, and there are accompanying symptoms of thirst and high fever, it indicates Yang is strong and Yin is weak. Conversely, if the pulse is weak, the tongue is pale and moist, and there are symptoms of abdominal pain and diarrhea, it indicates Yin is strong and Yang is weak. Additionally, the complex changes in Yin and Yang are specifically reflected in the relationships between Exterior and Interior, Cold and Heat, and Deficiency and Excess, as previously discussed.
2. True Yin Deficiency and True Yang Deficiency
Yin deficiency syndrome is also known as Deficiency Heat syndrome, while Yang deficiency syndrome is also known as Deficiency Cold syndrome, as previously detailed. The kidneys are the root of Yin and Yang in the body. When Yin and Yang are deficient for a long time, or due to prolonged illness, it can lead to True Yin Deficiency or True Yang Deficiency.
(1) True Yin Deficiency
[Clinical Manifestations] Internal heat, pale complexion, red cheeks, dry mouth, irritability, heat in the palms and soles, dizziness, tinnitus, weakness in the lower back and legs, night sweats, and constipation.
[Syndrome Analysis] Prolonged illness damages Yin essence, affecting True Yin, leading to symptoms of Yin deficiency, hence the appearance of pale complexion, red cheeks, dry mouth, irritability, night sweats, and constipation. Additionally, the damage to kidney function leads to symptoms such as dizziness, tinnitus, and weakness in the lower back and legs.
(2) True Yang Deficiency (Kidney Yang Deficiency)
[Clinical Manifestations] Pale complexion, cold limbs, pale tongue, preference for warm drinks, fatigue, shortness of breath, abdominal distension, and diarrhea.
[Syndrome Analysis] Prolonged illness damages Yang Qi, affecting True Yang, leading to symptoms of Yang deficiency, hence the appearance of pale complexion, cold limbs, pale tongue, preference for warm drinks, fatigue, and diarrhea.
3. Loss of Yin and Loss of Yang
Loss of Yin and Loss of Yang are dangerous syndromes in the disease process. Misdiagnosis or delayed treatment can lead to immediate death. Loss of Yin and Loss of Yang are two different types of syndromes. Loss of Yin is fundamentally caused by the massive loss of body fluids, leading to Loss of Yin. Loss of Yang is primarily caused by the loss of Yang Qi. Since Qi can be lost with fluids and blood, Loss of Yang is often seen after excessive sweating, vomiting, diarrhea, or significant blood loss. Additionally, many critical stages of diseases can also present Loss of Yang. Since Yin and Yang are interdependent, Loss of Yin can lead to Loss of Yang, and Loss of Yang can also lead to the depletion of body fluids. In clinical practice, it is important to differentiate between Loss of Yin and Loss of Yang and provide timely treatment.
(1) Loss of Yin
[Clinical Manifestations] Body heat, warm limbs, irritability, thirst, dry mouth, dry skin, very little urine, red tongue, and rapid pulse. Typically, excessive sweating is a characteristic of Loss of Yin, with the sweat being warm, salty, and thin (in cases of Loss of Yin due to vomiting or diarrhea, there may be no significant sweating).
[Syndrome Analysis] The depletion of Yin fluids leads to the loss of moistening functions, hence symptoms such as thirst, dry mouth, and dry skin. The depletion of body fluids leads to very little urine. Yin deficiency leads to internal heat, hence symptoms such as body heat and warm limbs. The rapid pulse and red tongue indicate the presence of internal heat.
(2) Loss of Yang
[Clinical Manifestations] Excessive sweating, cold sweat, pale and sticky sweat, cold body, cold limbs, fatigue, preference for warm drinks, pale tongue, and weak pulse.
[Syndrome Analysis] Loss of Yang occurs in various conditions leading to Yang Qi deficiency. Yang deficiency leads to the inability to secure the body, hence the opening of the pores and excessive sweating. Cold body and cold limbs indicate Yang deficiency.
To differentiate between Loss of Yin and Loss of Yang:
1. Loss of Yin: Sweat: warm, salty, not sticky.
Limbs: warm.
Tongue: red and dry.
Pulse: rapid and weak.
Other: body heat, irritability, thirst, preference for cold drinks.
2. Loss of Yang: Sweat: cold, pale, slightly sticky.
Limbs: cold.
Tongue: pale and moist.
Pulse: weak and thin.
Other: cold body, fatigue, preference for warm drinks.
Six Meridians Differentiation
In the Han Dynasty, Zhang Zhongjing wrote the “Treatise on Febrile Diseases,” which comprehensively analyzed the various syndromes during the evolution of external pathogenic diseases, categorizing them based on the location of the disease, the tendency of Cold and Heat, and the strength of the pathogenic and righteous Qi, distinguishing them into the six meridians: Taiyang, Yangming, Shaoyang, Taiyin, Jueyin, and Shaoyin. For thousands of years, this has effectively guided the differentiation and treatment in Traditional Chinese Medicine.
Symptoms and Treatment of Taiyang Disease
1. Clinical Manifestations
The “Treatise on Febrile Diseases” states: “In Taiyang disease, the pulse is floating, and there is stiffness and pain in the head and neck with aversion to cold.” “In Taiyang disease, there may be fever and sweating, aversion to wind, and a slow pulse, which is called wind stroke.” “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, vomiting, and a tight pulse, which is called cold damage.”
In summary, any appearance of fever, aversion to cold, headache, stiffness, and floating pulse is called Taiyang disease. Taiyang disease is divided into two categories: meridian syndrome and organ syndrome. Meridian syndrome refers to changes in the muscle surface; organ syndrome refers to changes in the bladder due to unresolved Taiyang meridian syndrome.
2. Pathological Mechanism
1. Taiyang Meridian Syndrome: Divided into three types
(1) If the person has disharmony between Ying and Wei, and the Wei Qi fails to secure the surface, leading to a loose muscle surface, it is called wind stroke (not a stroke in the brain).
(2) If the Wei Qi is obstructed, leading to stagnation of Ying and Wei, resulting in a dense muscle surface, it is called cold damage.
(3) If the person is exposed to warm pathogenic factors, leading to internal heat damage, it is called warm disease.
Wind Stroke: Fever, sweating, aversion to wind, and a slow pulse (Exterior Deficiency Syndrome).
Cold Damage: Fever, no sweating, aversion to cold, and a tight pulse (Exterior Excess Syndrome).
Warm Disease: Fever, thirst, no aversion to cold (Interior Heat Syndrome).
Wind Stroke, Cold Damage, and Warm Disease are all categorized as Exterior syndromes, hence they all present with “fever, headache, and floating pulse,” but the distinguishing points are:
Wind Stroke: Floating and slow pulse, with sweating and a thin white tongue coating.
Cold Damage: Floating and tight pulse, with no sweating and wheezing, and a thin white tongue coating.
Warm Disease: Floating and rapid pulse, fever, slight thirst, and a red tongue with a red tip.
2. Taiyang Organ Syndrome: Divided into two types
(1) When the pathogenic Qi enters the bladder, affecting the bladder’s Qi transformation function, leading to water retention, it is called water retention syndrome.
(2) When heat accumulates in the lower jiao, leading to blood stasis, it is called blood retention syndrome.
Water Retention Syndrome: Fever, aversion to wind, difficulty urinating, thirst, and a floating and rapid pulse.
Blood Retention Syndrome: Urgent abdominal distension or fullness, with difficulty urinating, and a deep pulse.
The distinguishing point is that water retention is due to the pathogenic Qi entering the bladder’s Qi division, hence there is only difficulty urinating without any mental symptoms. Blood retention is due to the pathogenic Qi entering the bladder’s blood division, hence there are mental symptoms without difficulty urinating.
3. Treatment Principles
1. Treatment of Taiyang Meridian Syndrome
(1) Wind Stroke: This is a Taiyang Exterior Deficiency syndrome, where the treatment should focus on harmonizing Ying and Wei, leading to sweating and resolution of the disease, using Gui Zhi Decoction.
(2) Cold Damage: This is a Taiyang Exterior Excess syndrome, where the muscle surface is dense and sweating cannot occur; thus, opening the surface and inducing sweating is necessary to expel the pathogenic factor, using Ma Huang Decoction.
(3) Warm Disease: This is internal heat damage, and the “Treatise on Febrile Diseases” does not provide a specific formula; in my opinion, it should primarily use warm and cool herbs, using Yin Qiao San.
2. Treatment of Taiyang Organ Syndrome
(1) Water Retention: This is due to the bladder’s Qi transformation dysfunction, leading to water retention. Wu Ling San (Poria, Polyporus, Cinnamon Twig, Alisma, and Atractylodes) has the function of transforming Qi and promoting urination, hence it is the main formula for water retention syndrome.
(2) Blood Retention: This is due to blood stasis, and heat accumulation in the lower jiao should be treated with methods to attack stasis and promote blood flow, using Tao Ren Cheng Qi Decoction based on the severity of the condition.
3. Treatment of Taiyang Disease with Complications
(1) Taiyang Wind Stroke with Qi Reversal causing wheezing, treated with Gui Zhi Decoction plus Hou Po and Xing Ren.
(2) Taiyang Disease with stiffness in the neck and back, with sweating indicating Exterior Deficiency, and no sweating indicating Exterior Excess; for Deficiency, use Gui Zhi plus Ge Gen Decoction, and for Excess, use Ge Gen Decoction.
(3) Taiyang Disease with internal heat (irritability, thirst) with sweating indicating Exterior Deficiency, and no sweating indicating Exterior Excess; for Deficiency, use Gui Zhi plus Er Miao San, and for Excess, use Da Qing Long Decoction.
(4) Taiyang Disease with water retention (dry vomiting, soft phlegm), if there is no sweating and the heart has water retention, presenting with fever, aversion to cold, sweating, headache, and fullness in the heart and flanks, dry vomiting, and shortness of breath, use Shi Zao Tang (Yuan Hua, Gan Sui, Da Ji, and Jujube) to attack.
(5) Taiyang Disease with internal deficiency, if there is Yin and Yang deficiency with palpitations and irritability, use Xiao Jian Zhong Tang. If there is Qi and Blood deficiency, leading to palpitations, use Zhi Gan Cao Tang.
Yangming Disease Symptoms and Treatment
1. Clinical Manifestations
The “Treatise on Febrile Diseases” states: “Yangming disease is characterized by fullness in the stomach.”
“In the third day of cold damage, the pulse of Yangming is large.”
“What are the external symptoms of Yangming disease? The answer is: fever, sweating, aversion to cold, and aversion to heat.”
“If cold damage leads to vomiting or diarrhea, and the patient does not defecate for five to six days, or even up to ten days, with afternoon tidal fever, and does not have aversion to cold, but appears to be in a ghostly state, if severe, the patient may not recognize people, and if they are restless, they may have a floating pulse, while those who are clear may die; if the pulse is weak, they may only have fever and delirium, and Da Cheng Qi Decoction is the main treatment; if one dose is effective, then stop the subsequent doses.”
In summary, any appearance of fever, sweating, aversion to cold, and a large pulse is called Yangming disease. Yangming disease is divided into two categories: meridian syndrome and organ syndrome. Yangming meridian syndrome refers to changes in the stomach; Yangming organ syndrome refers to changes in the large intestine.
2. Pathological Mechanism
1. Yangming Meridian Syndrome: When external pathogenic factors enter the Interior and transform into heat, heat combines with dryness in the stomach, leading to the consumption of body fluids, resulting in symptoms such as fever, sweating, thirst, and a large pulse.
2. Yangming Organ Syndrome: When external pathogenic factors enter the Interior and transform into heat, combined with the dryness and heat of the large intestine, leading to the consumption of body fluids, resulting in symptoms such as tidal fever, delirium, constipation, abdominal distension, and a deep pulse.
3. Treatment Principles
When high fever is present, cold and cool herbs should be used to clear heat, hence Yangming meridian syndrome primarily uses clearing methods, selecting bitter and cold herbs to clear the heat in the Interior; if heat and dryness accumulate in the large intestine, then cold purgatives should be used to quickly clear the heat and preserve Yin, hence Yangming organ syndrome primarily uses purging methods, selecting bitter and cold purgatives.
1. Treatment of Yangming Meridian Syndrome: Yangming meridian syndrome is caused by heat in the Interior, hence both the Exterior and Interior are hot, so the treatment should be Shi Gao Decoction.
2. Treatment of Yangming Organ Syndrome: Yangming organ syndrome is caused by heat and dryness accumulating in the large intestine. The treatment aims to eliminate dryness and clear heat. Due to the varying severity of the condition, the treatment methods for Yangming organ syndrome can be divided into three categories: Tiao Wei Cheng Qi Decoction is a mild purgative for early-stage constipation; Xiao Cheng Qi Decoction is for constipation with fullness; and Da Cheng Qi Decoction is for constipation with fullness and dryness.
“Excess indicates Yangming, Deficiency indicates Taiyin,” is a saying based on practical experience in Traditional Chinese Medicine. Yangming disease can transform into Taiyin disease, indicating a decline in resistance; conversely, Taiyin disease can transform into Yangming disease, indicating an improvement in resistance.
Shaoyang Disease Symptoms and Treatment
1. Clinical Manifestations
The “Treatise on Febrile Diseases” states: “Shaoyang disease is characterized by bitter mouth, dry throat, and dizziness.”
“If cold damage persists for five or six days, the patient may experience alternating chills and fever, fullness in the chest and flanks, reluctance to eat, irritability, and vomiting, or abdominal pain, or fullness in the flanks, or palpitations, or difficulty urinating, or lack of thirst, or mild fever, or cough.”
“If the original Taiyang disease does not resolve and transitions into Shaoyang, the patient may experience fullness in the flanks, dry vomiting, and difficulty eating, with alternating chills and fever, and a tight pulse.”
In summary, any appearance of bitter mouth, dry throat, dizziness, alternating chills and fever, fullness in the chest and flanks, reluctance to eat, irritability, and vomiting, with a wiry and thin pulse, is called Shaoyang disease. Shaoyang syndrome is characterized by the invasion of the liver and gallbladder.
2. Pathological Mechanism
The external pathogenic factor invades the liver and gallbladder, causing the Qi of the liver and gallbladder to rise, leading to symptoms such as bitter mouth, dry throat, and dizziness. The pathogenic factor in the gallbladder reverses (affecting) the stomach, leading to a reluctance to eat and vomiting. The Qi mechanism is obstructed, leading to fullness in the chest and flanks. The struggle between the pathogenic and righteous Qi leads to alternating chills and fever, with the righteous Qi being weak and unable to expel the pathogenic factor.
3. Treatment Principles
1. Treatment of Shaoyang Syndrome
Shaoyang disease does not have the exterior symptoms of Taiyang disease, and the pathogenic factor is not in the exterior, hence sweating is not indicated (if sweating occurs, it may damage body fluids and cause the pathogenic factor to enter the Interior); it does not have the interior symptoms of Yangming disease, hence purging is not indicated (if purging occurs, it may lead to Yin deficiency and cause disturbances); there is no obstruction in the chest, hence vomiting is not indicated (if vomiting occurs, it may harm Yang and lead to palpitations). Therefore, the treatment of Shaoyang disease should primarily focus on harmonizing the Exterior and Interior (i.e., using methods to clear heat without inducing sweating). However, since Shaoyang disease often has both Exterior and Interior symptoms, one can use methods to harmonize the Exterior while also employing Taiyang sweating methods or Yangming purging methods as needed.
Because Shaoyang disease is located between the Exterior and Interior, Xiao Chai Hu Decoction is the primary treatment for Shaoyang disease.
2. Treatment of Shaoyang Disease with Complications
(1) If there is mild fever with aversion to cold, joint pain, and fullness in the chest, use Chai Hu Gui Zhi Decoction.
(2) If Shaoyang syndrome presents with abdominal fullness and pain, mild irritability, and difficulty with bowel movements, use Da Chai Hu Decoction.
(3) If Shaoyang disease presents with abdominal pain and tightness, with a floating and tight pulse, use Xiao Jian Zhong Decoction to tonify, and after treatment, if the Shaoyang disease does not improve, use Xiao Chai Hu Decoction to harmonize.
(4) If there is fullness in the chest and flanks, difficulty urinating, thirst without vomiting, but sweating, alternating chills and fever, and irritability, indicating that the pathogenic heat is trapped in Shaoyang, use Chai Hu Gui Zhi Gan Jiang Decoction to harmonize and promote fluid transformation.
(5) If there is fullness in the chest, difficulty urinating, and delirium, with pain in the body that prevents movement, indicating that the pathogenic factor has entered Shaoyang and is affecting the spirit, use Chai Hu plus Long Gu and Mu Li Decoction.
(6) If there is heat in the stomach leading to vomiting, and cold pathogenic factors invade the stomach causing abdominal pain, indicating upper heat and lower cold, use Huang Lian Decoction to clear the upper and warm the middle.
4. Treatment of Shaoyang Disease with Internal Deficiency
If there is Yin and Yang deficiency with palpitations and irritability, use Xiao Jian Zhong Decoction. If there is Qi and Blood deficiency leading to palpitations, use Zhi Gan Cao Decoction.
Taiyin Disease Symptoms and Treatment
1. Clinical Manifestations
The “Treatise on Febrile Diseases” states: “Taiyin disease is characterized by abdominal fullness and vomiting, lack of appetite, and diarrhea, with abdominal pain that occurs intermittently.”
In summary, any appearance of abdominal fullness and vomiting, lack of appetite, diarrhea, and abdominal pain, with a weak pulse, is called Taiyin disease. This is characterized by spleen deficiency and excessive dampness, affecting the spleen meridian.
2. Pathological Mechanism
Cold dampness obstructs the spleen, damaging its Yang, or cold pathogenic factors directly invade the spleen meridian, leading to symptoms such as abdominal pain and vomiting. The stagnation of cold dampness leads to a lack of appetite and diarrhea.
3. Treatment Principles
1. Treatment of Taiyin Disease
Since Taiyin disease is characterized by internal deficiency and cold syndrome (spleen and stomach deficiency), the treatment principle should primarily focus on warming and tonifying, with an emphasis on warming the interior and dispersing cold. If there is a predominance of exterior symptoms, one should first resolve the exterior; if there is an urgent need to treat the interior, one should first address the interior. The “Treatise on Febrile Diseases” does not provide a specific formula for Taiyin disease, but based on the internal deficiency and cold syndrome, the treatment should primarily focus on warming the interior, using Li Zhong Wan as the main formula for Taiyin disease.
2. Treatment of Taiyin Disease with Complications
(1) If there is both diarrhea and abdominal fullness (Taiyin internal deficiency), along with body pain (Taiyang exterior syndrome), it indicates a combination of internal deficiency and exterior symptoms. In this case, use Li Zhong Wan to warm the interior, followed by Gui Zhi Decoction to treat the exterior.
(2) If the exterior symptoms have not resolved, but there is abdominal fullness and pain, use Gui Zhi plus Shao Yao Decoction (increased dosage of Shao Yao).
Jueyin Disease Symptoms and Treatment
1. Clinical Manifestations
The “Treatise on Febrile Diseases” states: “Jueyin disease is characterized by thirst, Qi rising to the heart, heat in the heart, hunger without desire to eat, and diarrhea that does not stop.”
“In cases of cold damage, the pulse may be weak and the body may feel cold, with the patient being restless and unable to find comfort.”
In summary, Jueyin disease can be categorized into four types:
(1) Upper heat and lower cold syndrome: thirst, Qi rising to the heart, heat in the heart, and hunger without desire to eat.
(2) Jueyin heat and recovery syndrome: characterized by alternating cold and heat in the limbs.
(3) Jueyin reversal syndrome: characterized by cold limbs, which may be mild or severe.
(4) Diarrhea and vomiting: heat leading to diarrhea, delirium, or clear diarrhea, with dry vomiting, indicating cold and dampness.
2. Pathological Mechanism
When the disease reaches the Jueyin stage, the liver wood is out of balance, and the heart is also affected by the pathogenic factor, leading to heat rising and cold descending, hence the symptoms of upper heat and lower cold. In the struggle between the righteous and pathogenic Qi, when Yang is strong and Yin is weak, there is more heat than cold; when Yin is strong and Yang is weak, there is more cold than heat, hence the Jueyin reversal syndrome. The internal heat leads to various symptoms of vomiting and diarrhea.
3. Treatment Principles
Jueyin disease is characterized by internal deficiency and mixed Cold and Heat symptoms. The treatment principle is to use both cold and warm methods. For upper heat, use cooling methods; for lower cold, use warming methods; for excessive heat, use tonifying methods. If there is a predominance of heat, use cooling methods.
1. Treatment of Jueyin Disease
(1) Thirst, Qi rising to the heart, heat in the heart, hunger without desire to eat, and diarrhea that does not stop indicate mixed Cold and Heat syndrome. The treatment should involve both cooling and warming methods, using Wu Mei Wan as the main formula for Jueyin disease, which is also effective for treating worm-related symptoms and chronic diarrhea.
(2) If there is vomiting and diarrhea, with food entering the stomach and then vomiting, indicating upper heat and lower cold, the treatment should involve both cooling and warming methods, using Gan Jiang Huang Qin Huang Lian Ren Shen Decoction.
(3) If there is persistent diarrhea, cold limbs, and difficulty urinating, indicating heat in the lower body, the treatment should involve both warming and cooling methods, using Ma Huang Sheng Ma Decoction.
(4) If there is persistent diarrhea with blood and pus, abdominal pain, and urgency, indicating heat in the intestines, the treatment should involve cooling methods, using Bai Tou Weng Decoction, which is highly effective.
(5) If there is blood deficiency leading to cold limbs, weak pulse, and a desire to sleep, use Si Wu Tang.
(6) If there is dry vomiting, phlegm, and headache, indicating cold and dampness, use Wu Zhu Yu Decoction.
2. Treatment of Jueyin Disease with Complications
(1) If there is vomiting and fever, indicating a transition from Yin to Yang, the treatment should involve Xiao Chai Hu Decoction to harmonize.
(2) If there is diarrhea and delirium, indicating heat in the intestines, the treatment should involve Xiao Cheng Qi Decoction to clear the heat.