Comprehensive Guide to the Eight Principles of Diagnosis in TCM

Comprehensive Guide to the Eight Principles of Diagnosis
1. Concept
1. Eight Principles: Refers to the eight diagnostic principles: Exterior, Interior, Cold, Heat, Deficiency, Excess, Yin, Yang.
2. Eight Principles Diagnosis: This is the process by which a physician uses the theory of the Eight Principles to analyze and synthesize various clinical data obtained through observation, listening, questioning, and pulse-taking, thereby distinguishing 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 as Yin or Yang.

2. Basic Syndromes of the Eight Principles
1. Exterior-Interior Diagnosis
Exterior-Interior is a pair of principles used to distinguish the depth of the disease location and the progression of the disease. Narrowly defined, the exterior refers to the skin, muscles, and meridians, while the interior refers to the organs and marrow. Diseases affecting the exterior are considered superficial and less severe, while those affecting the interior are deeper and more serious. The distinction between exterior and interior is particularly important for diseases caused by external pathogens.
1) Exterior Syndrome: Refers to pathogenic factors such as the six excesses, epidemics, and insect toxins invading the body through the skin and mouth, leading to superficial symptoms due to the righteous qi resisting the pathogenic factors and the defensive qi failing to disperse. Changes in the skin and hair do not necessarily indicate a syndrome, and the location of an exterior syndrome is not always in the skin. Clinical manifestations: Chills (or aversion to wind), fever (or subjective feeling of no fever), head and body aches, thin white tongue coating, floating pulse. Symptoms may also include nasal congestion, clear nasal discharge, sneezing, throat itching or pain, and slight cough.
2) Interior Syndrome: Refers to symptoms indicating that the disease is located internally, affecting the organs, qi, blood, or marrow. Causes: (1) External pathogens invade the exterior and penetrate to the interior, resulting in an interior syndrome. (2) External pathogens directly invade the interior, affecting the organs, known as “direct invasion”. (3) Emotional distress, dietary indiscretion, or overexertion can directly damage the organs, or qi, blood, and fluids can be affected, leading to disease. Clinical manifestations: Due to the complex causes of interior syndromes and their wide range of locations, symptoms can vary greatly. The basic characteristics include absence of new chills and fever, or only chills without fever, or only fever without chills, with organ symptoms being the primary manifestation, such as high fever, agitation, confusion, abdominal pain and diarrhea, vomiting and constipation, thick tongue coating, significant changes in tongue quality, and deep pulse. Generally, the condition is more severe and prolonged.

3) Half-Exterior Half-Interior Syndrome: Refers to the situation where the external pathogenic factors are neither fully in the exterior nor have they entered the interior, with the pathogenic and righteous qi contending between the exterior and interior, leading to a less favorable condition. This can occur in conditions such as typhoid fever, lesser yang disease, damp-heat obstructing the membranes, or hidden summer heat obstructing the lesser yang.
2. Cold-Heat Diagnosis
Cold and heat are a pair of principles used to distinguish the nature of the disease.
1) Cold Syndrome: Refers to the manifestation of symptoms due to the invasion of cold pathogens or the predominance of Yin over Yang. Excess Cold Syndrome: Refers to the invasion of cold pathogens from the exterior, or excessive consumption of cold foods, leading to a sudden onset of symptoms in individuals with strong constitutions. Deficiency Cold Syndrome: Refers to long-term internal damage leading to deficiency of Yang qi and the internal generation of cold, also known as Yang Deficiency Syndrome. Exterior Cold Syndrome: Cold pathogens attacking the skin. Interior Cold Syndrome: 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: chills, aversion to cold, cold pain relieved by warmth, cold limbs, pale complexion, thin white tongue coating, and slow or tight pulse.
2) Heat Syndrome: Refers to the manifestation of symptoms due to 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 the invasion of Yang heat pathogens, or excessive consumption of spicy and warming foods, or excessive emotional distress leading to heat, or excessive internal Yang heat, resulting in a rapid and strong condition. Deficiency Heat Syndrome: Long-term internal damage, or excessive sexual activity leading to deficiency of Yin fluids, resulting in excess Yang, also known as Yin Deficiency Syndrome. Exterior Heat Syndrome: Wind-heat pathogens attacking the skin. Interior Heat Syndrome: Heat pathogens prevailing 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 drinks, yellow and thick sputum, short and yellow urine, dry and hard stools, red complexion, red eyes, agitation, and in severe cases, hemoptysis, convulsions, red tongue with yellow coating, and rapid pulse.
3. Deficiency-Excess Diagnosis
Deficiency and excess are a pair of principles used to distinguish the strength of the righteous and pathogenic qi, reflecting the changes in the body’s qi during the disease process.
1) Excess Syndrome: Refers to the body’s response to external pathogens, accumulation of pathological products, or imbalances in Yin and Yang, characterized by excess, solidity, stagnation, and hyperactivity. Characteristics: Pathogenic qi is abundant while righteous qi is not deficient, and the struggle between the two is intense. Clinical manifestations: Due to the nature of the pathogenic factors and the accumulation of pathological products, the symptoms can vary widely.

3. Relationship Between the Eight Principles Syndromes
1) Coexisting Syndromes: Broadly refers to the simultaneous existence of various syndromes. Narrowly: 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: Often refers to exterior syndromes with sweating. Its actual meaning has two aspects: Exterior Deficiency due to External Pathogens: Refers to exterior syndromes caused by wind invasion. Clinical manifestations: aversion to wind, fever, spontaneous sweating, headache, stiff neck, floating and relaxed pulse. Interior Deficiency due to Internal Damage: Refers to frequent sweating due to deficiency of spleen and lung qi, leading to weak defensive qi and loose skin, 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 the invasion of cold pathogens, leading to the binding of the defensive Yang, with the struggle between the pathogenic and righteous qi occurring in the skin and muscles, resulting in closed pores. Clinical manifestations: Chills and fever, no sweating but wheezing, head and body aches, thin white tongue coating, and tight floating pulse. Exterior Excess Heat Syndrome: Refers to the invasion of heat pathogens, leading to the struggle between the pathogenic and righteous qi in the exterior, with the defensive qi being 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 the invasion of cold pathogens, obstructing the Yang qi of the organs, leading to stagnation of qi, blood, and fluids. Clinical manifestations: Due to the wide range of interior syndromes, the symptoms can vary. The basic characteristics include 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 the invasion of Yang heat pathogens, entering from the exterior to the interior, or cold pathogens transforming into heat in the interior, or stagnation of qi and blood in the organs leading to heat. Clinical manifestations: Due to the wide range of interior syndromes, the symptoms can vary. The basic characteristics include fever, aversion to heat, preference for cold drinks, short yellow urine, dry and hard stools, red complexion, red tongue with yellow coating, and rapid pulse.

2) Mixed Syndromes: Refers to the simultaneous appearance of opposing syndromes in a certain stage of the disease. Exterior and Interior Coexisting: Refers to the simultaneous appearance of exterior and interior syndromes at a certain stage of the disease. Causes: (1) Initial disease showing both exterior and interior syndromes. (2) Exterior syndrome not resolved, leading to interior involvement. (3) Original disease not cured, with an additional exterior disease. Common types: (1) Coexisting exterior and interior syndromes with no contradiction in cold-heat or deficiency-excess. Exterior Excess Cold Syndrome and Interior Excess Cold Syndrome.
(2) Coexisting exterior and interior syndromes with the same cold-heat nature but opposite deficiency-excess nature. Exterior Excess Cold and Interior Deficiency Cold Syndrome.
(3) Coexisting exterior and interior syndromes with the same deficiency-excess nature but opposite cold-heat nature, Exterior Excess Cold and Interior Excess Heat Syndrome, known as “cold wrapping fire” syndrome.

3) Transformation of Syndromes: Refers to the transformation of one syndrome into another opposing syndrome under certain conditions. 1) Exterior to Interior: (1) Exterior Syndrome Entering Interior: Refers to the initial presence of an exterior syndrome, followed by the appearance of an interior syndrome, with the exterior syndrome subsequently disappearing. This is generally seen in the early to mid-stages of externally contracted diseases, reflecting the progression of the disease from superficial to deep. (2) Interior Pathogen Emerging Externally: Refers to certain interior syndromes where the pathogenic factors have a tendency to emerge externally. 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 later presenting as 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 the internal Yang qi becoming excessive, resulting in the transformation from cold to heat. (2) Heat Syndrome Transforming into Cold: Refers to the original heat syndrome later presenting as cold syndrome, with the heat syndrome subsequently disappearing. This often occurs due to improper treatment, damage to Yang qi, or excessive pathogenic factors consuming righteous qi, leading to the inability of the righteous qi to withstand the pathogenic factors, resulting in functional decline and loss of Yang qi, transforming into deficiency cold syndrome, or even manifesting as Yang collapse syndrome.

3) Deficiency-Excess Transformation: (1) Excess Syndrome Transforming into Deficiency: Refers to the initial presentation of an excess syndrome, which later transforms into a deficiency syndrome due to improper treatment, prolonged retention of pathogenic factors, or damage to righteous qi, leading to the gradual transformation from excess to deficiency. (2) Deficiency Syndrome Transforming into Excess: Refers to the initial presentation of a deficiency syndrome, which later transforms into an excess syndrome due to active treatment, rest, and exercise, leading to the gradual recovery of righteous qi, which then contends with the pathogenic factors to expel them externally, presenting as excess symptoms. Alternatively, a patient with a pre-existing deficiency syndrome may present with excess symptoms due to new external pathogenic factors, dietary indiscretion, or trauma, where the deficiency symptoms are temporarily not prominent. If the original deficiency syndrome leads to the accumulation of pathological products due to insufficient righteous qi, presenting certain excess symptoms, this should not be understood as a transformation from deficiency to excess, but rather as a mixed deficiency-excess syndrome.

4) True-False Syndrome: Refers to the appearance of certain “false” symptoms that contradict the true nature of the disease during critical stages of the disease. 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 false cold symptoms externally. This is known as “deep heat with deep cold” or Yang excess with Yin obstruction. Pathogenesis: Internal Yang heat is excessive, obstructing Yin externally, leading to internal closure of Yang qi and inability to reach the extremities. Clinical manifestations: Externally resembling Yin cold syndrome—cold limbs, even cold extremities, severe chills or shivering, mental confusion, dark purple complexion, and deep or slow pulse (or thin and rapid). The essence is an excess heat syndrome—cold limbs with burning heat in the chest and abdomen, burning sensation in the mouth and nose, foul breath, thirst for cold drinks, short and red urine, black or tarry 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 false heat symptoms externally. This is known as Yang deficiency with floating excess or Yin excess with Yang obstruction. Pathogenesis: Prolonged illness leading to Yang qi deficiency, with internal cold predominating, forcing the floating Yang to rise and obstruct externally. Clinical manifestations: Externally resembling Yang heat syndrome—feeling hot, or wanting to remove clothing, flushed complexion, mental agitation, thirst, and rapid pulse. The essence is Yang qi deficiency—no burning sensation in the chest and abdomen, cold limbs, clear and long urine (or reduced urination with edema), or diarrhea with clear fluids, pale tongue, etc.

1. Key Points for Distinguishing Exterior and Interior Syndromes
1. 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 cold and heat indicates a half-exterior half-interior syndrome.
2. Tongue Appearance: The tongue coating in exterior syndromes shows little change, while the tongue coating and quality in interior syndromes often show significant changes.
3. Pulse Characteristics: 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 Syndrome
1. Chills and fever are phenomena of the disease, while the cold and heat manifestations of the disease can be true or false.
2. Cold syndrome and heat syndrome are judgments of the essence of the disease and cannot be determined solely based on individual symptoms such as chills, aversion to cold, or fever.
3. Key Points for Distinguishing Cold and Heat SyndromesCold-Heat Syndrome Distinction Table

Name	Limbs	Thirst	Urination	Complexion	Tongue Appearance	Pulse Characteristics
Cold Syndrome	Aversion to cold, preference for warmth	No thirst	Clear and long urine, loose stools	Pale	Pale tongue	Slow or tight
Heat Syndrome	Aversion to heat, preference for cold	Thirst, prefers cold drinks	Short and yellow urine, dry and hard stools	Red	Red tongue	Rapid or strong

4. Key Points for Distinguishing Deficiency and Excess Syndromes Understand the characteristics of the syndromes. Generally, manifestations characterized by insufficient, declining, or relaxed righteous qi are mostly deficiency syndromes; manifestations characterized by excess, solidity, or strength are mostly excess syndromes. During the four diagnostic methods, pay attention to the observation of the tongue’s age, the sound of the voice, the duration of the illness, the severity of pain, and the strength of the pulse.
The tongue quality is old for excess, and fat and tender for deficiency; a loud voice indicates excess, while a weak voice indicates deficiency; initial onset of external pathogens is 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 Syndromes Yin and Yang represent two opposing aspects of things, and their application is extensive, encompassing both the overall disease condition and the analysis of each symptom. Based on the basic properties of Yin and Yang in the theory, 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 represent Yang, while interior, deficiency, and cold represent Yin. Thus, Yin and Yang serve as the overarching framework for the Eight Principles, summarizing the types of syndromes.
6. Distinguishing Between Yang Collapse and Yin Collapse Based on the characteristics of sweating (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. Distinction Table for Yang Collapse and Yin Collapse

Distinction Table for Yang Collapse and Yin Collapse

Name	Sweat	Limbs	Other Symptoms	Tongue	Pulse	Treatment Principles
Yin Collapse	Hot, salty, and sticky sweat	Warm, aversion to heat	Flushed complexion, burning heat throughout the body, agitation, confusion, shortness of breath, thirst for cold drinks	Red and dry tongue	Thin and rapid pulse, or weak and large	Tonify qi and restrain Yin, rescue Yin and generate fluids
Yang Collapse	Cold, tasteless, and non-sticky sweat	Cold limbs, aversion to cold	Pale complexion, coolness throughout the body, indifference, confusion, weak breathing, no thirst or preference for warm drinks	Pale and moist tongue	Weak or floating and empty pulse	Tonify qi and stabilize collapse, restore Yang and rescue from reversal

7. Why There Are Interrelationships Between the Eight Principles Syndromes The Eight Principles of exterior, interior, cold, heat, deficiency, excess, Yin, and Yang summarize the essence of the disease from various aspects. However, the various aspects of the pathological essence are interconnected; that is, the nature of cold and heat, the struggle between pathogenic and righteous qi cannot exist independently of the exterior and interior disease locations, and vice versa, there cannot be exterior or interior syndromes that exist independently of the cold, heat, deficiency, or excess nature. Therefore, the Eight Principles syndromes should not 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 not only 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 can one achieve a more complete and accurate understanding of the syndromes.

8. The Significance of Cold-Heat Transformation The transformation between cold and heat reflects the comparison of the strengths of the pathogenic and righteous forces, with the key being the fluctuation of the body’s Yang qi. The transformation of cold into heat indicates that the body’s righteous qi is not diminished and can still resist the pathogenic qi, with Yang qi being relatively strong, leading to the transformation of the pathogenic qi into heat. The transformation of heat into cold indicates that the pathogenic qi is excessive and the righteous qi is insufficient, leading to the depletion or even collapse of Yang qi, indicating that the righteous qi cannot withstand the pathogenic qi, and the condition is critical.

9. Distinguishing Between True and False Cold-Heat The appearance of false symptoms often occurs in the limbs, skin, and complexion, while the internal manifestations of the organs, qi, blood, and fluids, as well as changes in tongue and pulse, are often the true reflection of the disease’s essence and can serve as diagnostic criteria. False symptoms differ from true symptoms and should be carefully distinguished. For example, one may feel thirsty but not want to drink, have a sore throat without redness or swelling, feel agitated but fatigued, have a pulse that is floating or rapid but weak upon palpation, and have a complexion that may occasionally appear flushed but is not uniformly red, indicating that the “heat” is a false symptom.

10. Distinguishing Between True and False Deficiency-Excess The strength or weakness of the pulse, the vitality of the spirit, especially the deep pulse, are the true indicators. The quality of the tongue, whether it is tender and plump or old and thin, the tone of voice, whether it is loud and strong or low and weak, the patient’s physical condition, the duration of the illness, and the treatment history are also important for differentiation.

1. Etiological Diagnosis
1) Exterior Wind Syndrome:
(1) Exterior Wind Syndrome: Refers to the invasion of external wind pathogens attacking the skin, muscles, meridians, organs, and qi and blood, characterized by acute onset, rapid changes, and erratic symptoms.
(2) Interior Wind Syndrome: Refers to pathological changes such as excessive heat burning the tendons, blood deficiency, or Yin deficiency leading to the loss of nourishment to the tendons, or Yin deficiency with Yang excess, affecting the liver’s function of governing the tendons, resulting in symptoms resembling “wind” such as dizziness, numbness, itching, tremors, convulsions, etc., known as “internal wind” or “liver wind”.
Clinical manifestations: (1) Wind Pathogen Attacking the Exterior: Aversion to wind and cold, slight fever, spontaneous sweating, nasal congestion or sneezing, cough, throat itching or pain, thin white tongue coating, floating pulse. (2) Wind Invading the Skin: New onset skin itching, possibly with papules or wheals. (3) Wind Invading the Meridians: Sudden facial numbness, crooked mouth and eyes, stiff neck, inability to open the mouth, or even convulsions of the limbs, opisthotonos, etc. (4) Wind Harming the Joints: Joint pain in the limbs, erratic in nature. (5) Wind and Water Interacting: Sudden swelling of the face, eyelids, or limbs.
Common exterior wind syndromes include: Wind Pathogen Attacking the Exterior (Taiyang Wind), Wind Invading the Skin, Wind Pathogen Invading the Lung, Wind and Water Interacting, Wind Pathogen Invading the Meridians, Wind Toxin Invading the Meridians, etc. Mixed syndromes include: Wind-Cold, Wind-Heat, Wind-Fire, Wind-Damp, Wind-Phlegm, Wind-Water, Wind-Toxin syndromes, etc.
2) Excess Cold Syndrome
1) Definition: Excess cold syndrome refers to the invasion of cold pathogens due to rain, water exposure, wearing thin clothing, sleeping outdoors, consuming raw foods, or drinking cold beverages, damaging the internal Yang qi and obstructing the circulation of qi and blood. It often presents with sudden onset and severe symptoms, with identifiable causes of cold pathogen exposure.
Cold Damage Syndrome: Refers to the invasion of cold pathogens from the exterior, damaging the skin and obstructing the defensive Yang, with Yang qi resisting the pathogens externally, presenting as an exterior excess cold syndrome. Also known as Exterior Cold Syndrome, Taiyang Cold Damage Syndrome.
Interior Cold Syndrome: Refers to the direct invasion of cold pathogens into the interior, affecting the organs, qi, and blood, damaging or obstructing Yang qi, and obstructing the circulation of qi and blood, presenting as an interior excess cold syndrome. Also known as Interior 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, cough, wheezing, no sweating, no thirst, clear and long urine, pale complexion, white tongue coating, and deep, slow, or tight pulse.
3) Common Excess Cold Syndromes: Cold Damage Syndrome (Taiyang Cold Damage), Cold Invading the Lung Syndrome, Cold Obstructing the Stomach and Intestines Syndrome, Cold Obstructing the Liver Meridian Syndrome, Cold Obstructing the Heart Meridian Syndrome, Cold Congealing the Uterus Syndrome, Cold Bi (Painful Obstruction). Mixed syndromes include: Wind-Cold, Cold-Damp, Cool-Dry, Cold-Phlegm, Cold-Drink syndromes, etc. Evolution: Excess Cold Syndrome—Deficiency Cold Syndrome—Yang Collapse Syndrome.
3) Heat Syndrome
1) Definition: Heat syndrome refers to the manifestation of symptoms due to the invasion of heat pathogens or excessive internal Yang heat. The nature of heat syndrome is similar to that of fire syndrome, but heat syndrome has strict seasonal characteristics, and its pathogenesis and symptoms differ from general fire heat syndromes.
2) Clinical manifestations: (1) Heat Damaging the Fluids: Aversion to heat, sweating, thirst, fatigue, heavy limbs, short yellow urine, red tongue, yellow or white coating, rapid pulse. (2) Heat Obstructing the Qi Mechanism: May present with chest tightness, abdominal pain, nausea, no sweating, etc. (3) Heat Obstructing the Spirit: May present with confusion, convulsions, etc.
3) Common Heat Syndromes: Heat Invading the Exterior Syndrome, Heat Damaging the Fluids Syndrome (Heat Stroke), Heat Obstructing the Qi Mechanism Syndrome, Heat Obstructing the Spirit Syndrome (Heat Stroke), etc.
4) Damp Syndrome
1) Definition: Dampness refers to the invasion of external dampness or the internal dysfunction of water metabolism, leading to a pathological state characterized by a diffuse accumulation of moisture. (2) Symptoms caused by dampness are known as damp syndromes. Clinical manifestations are characterized by heaviness, fullness, soreness, and turbidity, with a tendency to be severe.
External Dampness: Head heaviness, limb joint heaviness, soreness, and itching of the skin, possibly with mild aversion to cold and slight fever. Internal Dampness: Chest tightness, poor appetite, no thirst, nausea, fatigue, or loose stools, possibly with cloudy urine, and women may experience increased vaginal discharge. The complexion may appear dull, with a slippery tongue coating and a soft pulse.
Common Damp Syndromes: Damp Obstructing the Defensive Yang Syndrome (Exterior Damp Syndrome), Cold Damp Obstructing the Muscles and Bones Syndrome (Damp Bi), Damp Obstructing the Spleen Yang Syndrome, Damp-Heat Accumulating in the Spleen Syndrome, Liver and Gallbladder Damp-Heat Syndrome, Intestinal Damp-Heat Syndrome, Bladder Damp-Heat Syndrome, Damp-Heat Descending Syndrome, Damp-Phlegm Invading the Head Syndrome, etc. Mixed syndromes include: Cold-Damp, Damp-Heat, Wind-Damp, Heat-Damp, Water-Damp, Phlegm-Damp, Damp-Toxin syndromes, etc.
5) Dryness Syndrome
1) Definition: External dryness refers to the invasion of dryness that damages the body’s fluids, leading to dry symptoms. (2) Internal dryness refers to the insufficient internal fluids leading to dry symptoms, falling under the category of qi, blood, and fluid differentiation.
2) Clinical manifestations: (1) Dryness Damaging the Clear Orifices: Dry skin, possibly cracking or peeling, dry lips, nasal passages, and throat, dry tongue coating, thirst for water, pulse often shows no specific changes or may be thin and rough. (2) Dryness Damaging the Lungs: May present with dry cough with little sputum, thick sputum that is difficult to expectorate, short urination, and dry stools.
3) Common Dryness Syndromes: Differentiated into cool dryness and warm dryness. Based on the location of the dryness invasion and symptom characteristics, it can be divided into Dryness Invading the Exterior Syndrome, Dryness Invading the Lung Syndrome, Dryness Damaging the Clear Orifices Syndrome, etc.
6) Fire-Heat Syndrome
1) Definition: Fire syndrome and heat syndrome both refer to syndromes with warm and hot properties, and their concepts are basically the same. Fire-heat syndrome is mainly divided into excess heat (excess fire) and deficiency heat (deficiency fire). Excess Heat (Excess Fire) Syndrome: Refers to the invasion of external Yang heat pathogens or excessive internal Yang heat. It often presents with sudden onset and severe symptoms.
Deficiency Heat (Deficiency Fire) Syndrome: Refers to internal heat due to Yin deficiency, leading to excessive internal heat.
2) Clinical manifestations: Fever, aversion to heat, agitation, thirst for cold drinks, excessive sweating, dry and hard stools, short yellow urine, red complexion, red tongue, yellow or gray-black coating, rapid pulse (strong, rapid, or wiry). In severe cases, it may lead to various bleeding, abscesses, ulcers, or the formation of pus; or extreme heat may lead to wind, heat obstructing the spirit, and other critical syndromes.
3) Common Excess Heat (Excess Fire) Syndromes: Wind-Heat Invading the Exterior Syndrome, Lung Heat Excess Syndrome, Heart Fire Excess Syndrome, Stomach Heat Excess Syndrome, Heat Disturbing the Chest Syndrome, Intestinal Heat Excess Syndrome, Liver Fire Rising Syndrome, Liver Fire Invading the Lung Syndrome, Heat Obstructing the Heart Protector Syndrome, Fire-Toxin Entering the Meridians Syndrome, Heat Entering the Nutrient Blood Syndrome, Heat (Fire) Toxin Accumulating in the Skin Syndrome, etc. Mixed syndromes include: Wind-Heat, Wind-Fire, Damp-Heat, Summer Heat, Warm-Dryness (Dry Heat), Fire (Heat) Toxin, Stagnation Heat, Phlegm Heat, Heat-Drink syndromes, etc.
7) Toxin Syndrome
1) Refers to certain highly infectious special pathogens, known as epidemic toxins, also referred to as toxic qi, epidemic toxins, etc. In pathogenesis and syndrome names, the term toxin is often used, such as Toxin Closing the Lung Syndrome, Epidemic Toxin Attacking the Throat Syndrome, etc.
2) Refers to certain special pathogens with toxic effects, often directly named with the term 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 syndromes characterized by severe pathogenicity and serious illness, such as various critical syndromes formed by heat toxin, damp toxin, cold toxin, fire toxin, phlegm toxin, etc.
4) Refers to surgical and ulcerative diseases, such as abscesses, carbuncles, boils, ulcers, etc., often represented by the term toxin in their etiology and pathology, such as 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) Definition: “Pus” is a pathological product formed by the stagnation of qi and blood due to fire, heat, and toxins obstructing the circulation of qi and blood, leading to the accumulation and fermentation of blood, resulting in a foul-smelling, viscous liquid.
2) Clinical manifestations: Characterized by the accumulation of pus. For superficial abscesses, carbuncles, sores, and boils, soft and fluctuating lumps can be felt before they rupture, releasing pus. For internal abscesses, symptoms may include coughing up pus, vomiting pus and blood, purulent urine, or bloody stools. Often accompanied by fever, thick and greasy tongue coating, and slippery rapid pulse.
3) Common Pus Syndromes: Pus Toxin Accumulating in the Skin Syndrome, Pus-Phlegm Accumulating in the Lung Syndrome, Pus Accumulating in the Stomach and Intestines Syndrome, etc.
9) Food Accumulation Syndrome
1) Definition: Food accumulation syndrome refers to the stagnation of food in the stomach and intestines due to irregular eating habits, leading to symptoms.
2) Clinical manifestations: Abdominal fullness, poor appetite, sour belching, vomiting sour and spoiled food, foul-smelling stools, thick and greasy tongue coating, and slippery strong pulse.
Common Types: Food Accumulation in the Stomach and Intestines Syndrome, Spleen Deficiency with Food Accumulation Syndrome, etc.
10) Worm Accumulation Syndrome
1) Definition: Worm accumulation syndrome refers to the invasion of larvae into the body or the ingestion of 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 Types: Intestinal Worm Accumulation Syndrome, Liver and Gallbladder Worm Accumulation Syndrome, Worm-Induced Intestinal Obstruction Syndrome, Worm Disturbing the Gallbladder Syndrome, etc.

2. Qi Disease Diagnosis
1) Qi Deficiency Syndromes: Includes Qi Deficiency Syndrome, Qi Sinking Syndrome, Qi Not Firm Syndrome, Qi Collapse Syndrome.
1) Qi Deficiency Syndrome: Refers to insufficient original (true) qi, leading to reduced functions of promoting, warming, securing, defending, and transforming, or reduced functional activity of the organs. Causes: (1) Prolonged illness, severe illness, or excessive fatigue leading to depletion of original qi. (2) Congenital deficiency or dietary imbalance leading to insufficient generation of original qi. (3) 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 of symptoms with exertion, pale tongue, and weak pulse.
3) Common Types: 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. Mixed Syndromes: Qi and Blood Deficiency, Qi and Yin Deficiency, Yang Qi Deficiency, Fluid Qi Deficiency, etc.
4) Development and Changes: Qi deficiency leads to insufficient transformation—fluid deficiency, blood deficiency, Yang deficiency; Qi transformation dysfunction leads to water retention, leading to dampness, phlegm, 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, making one susceptible to external pathogens, as well as food accumulation, worm accumulation, etc.
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, sensation of qi sinking, or internal organ prolapse, or symptoms of rectal prolapse, uterine prolapse, etc.
(3) Common Types: Middle Qi Sinking Syndrome or Spleen Qi Sinking Syndrome, characterized by internal organ prolapse.
3) Qi Not Firm Syndrome: Refers to the failure of qi to secure and contain, leading to weak symptoms.
(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 symptoms of shortness of breath, low voice, fatigue, etc.
(3) Common Types: Defensive Qi Not Firm (Spleen-Lung Qi Deficiency Syndrome), Qi Not Securing Blood (Spleen Not Containing Blood Syndrome), Lower Source Not Firm (Kidney Qi Not Firm Syndrome), etc.
4) Qi Collapse Syndrome: Refers to extreme deficiency of original qi, leading to a critical state of breathlessness.
(1) Causes: Generally develops from qi deficiency or qi not firm, or due to significant blood loss, termed “qi lost with blood”.
(2) Clinical manifestations: Weak and irregular breathing, possible confusion or fainting, continuous sweating, pale complexion, open mouth and closed eyes, limp limbs, incontinence, weak pulse, pale tongue, and white moist coating.
2) Qi Stagnation Syndromes: Includes Qi Stagnation Syndrome, Qi Reversal Syndrome, Qi Closure Syndrome.
Qi Stagnation Syndrome: Refers to the stagnation of qi in a certain part of the body or a certain organ or meridian, presenting as symptoms of qi stagnation. Also known as Qi Depression Syndrome or Qi Blockage Syndrome.
(1) Causes: (1) Emotional distress, dietary imbalance, exposure to external pathogens, or trauma. (2) Pathological substances such as phlegm, blood stasis, food stagnation, roundworms, or stones obstructing the flow of qi. (3) Weak Yang qi, leading to stagnation of Yin and cold, causing qi stagnation in the organs and meridians.
2) Clinical manifestations: Chest, hypochondriac, and abdominal distension and pain, varying in intensity, often relieved by belching, bowel sounds, or emotional changes, with a wiry pulse and no significant tongue changes.
(3) Common Types: Liver Qi Stagnation Syndrome, Gastrointestinal Qi Stagnation Syndrome, Liver-Stomach Qi Stagnation Syndrome, etc. Mixed Syndromes: Qi Stagnation with Blood Stasis, Qi Depression Transforming into Heat, Phlegm and Qi Intermingling, Qi Stagnation with Damp Obstruction, Qi Stagnation with Water Retention, etc.
Qi Reversal Syndrome: Refers to the abnormal rise and fall of qi, leading to qi rising and reversing, presenting as symptoms of qi reversal.
(1) Causes: (1) External pathogens, phlegm, etc. invading the lungs. (2) Cold, heat, water, food stagnation, blood stasis, etc. invading the stomach. (3) Emotional distress, anger, fear, etc. damaging the liver.
(2) Clinical manifestations: Lung Qi Reversal Syndrome: Symptoms include cough and wheezing. Stomach Qi Reversal Syndrome: Symptoms include belching, nausea, and vomiting. Liver Qi Reversal Syndrome: Symptoms include headache, dizziness, and qi rising from the lower abdomen to the chest and throat.
Qi Closure Syndrome: (1) Refers to the closure of qi due to extreme anger, shock, or excessive worry, leading to symptoms such as confusion or fainting, cold limbs, etc., also known as “spirit qi closure syndrome”.
(2) Or due to blood stasis, stones, roundworms, phlegm, etc. obstructing the vessels, presenting as severe pain in the obstructed area, possibly leading to fainting, constipation, and coarse breathing with a strong pulse.

3. Blood Disease Diagnosis
1) 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, presenting as weakness.
(1) Causes: (1) Excessive blood loss, with insufficient time to replenish new blood. (2) Reduced spleen and stomach function, or insufficient nutrition leading to inadequate blood production. (3) Excessive worry and mental strain, or intestinal parasites consuming nutrients, leading to blood deficiency. (4) Blood stasis obstructing the vessels, hindering blood production, or causing local blood supply insufficiency. (5) Prolonged illness or severe illness, damaging essence and consuming qi, leading to depletion of blood production sources.
(2) Clinical manifestations: Pale or sallow complexion, pale lips, eyelids, and nails, dizziness, palpitations, insomnia, numbness in the hands and feet, women may experience scanty menstrual flow, pale color, or amenorrhea, pale tongue, and weak pulse.
(3) Common Types: Heart Blood Deficiency, Liver Blood Deficiency, Blood Deficiency Leading to Dryness of the Intestines, Blood Deficiency Leading to Skin Dryness and Wind Syndrome, etc. Mixed Syndromes: Yin Blood Deficiency Syndrome, Blood Deficiency with Stasis Syndrome.
2) Blood Loss: Refers to significant blood loss due to vomiting blood, blood in the stool, excessive menstrual bleeding, or external trauma, leading to sudden and large blood loss, or due to prolonged blood loss and blood deficiency, presenting with pale complexion, dizziness, palpitations, pale tongue, weak pulse, or even fainting, also known as “blood loss syndrome”. Often accompanied by qi collapse, Yang collapse, and life-threatening conditions.
2) Blood Stasis Syndrome
1) Definition: Refers to symptoms caused by blood stasis. Blood Stasis: Refers to blood that has not been expelled or dissipated in time, remaining in a certain area; or blood flow is obstructed, leading to stagnation in the meridians or organs, losing its physiological function.
(1) Causes: (1) Internal bleeding due to trauma or falls that have not been expelled or dissipated in time. (2) Qi stagnation leading to poor blood flow, or qi deficiency leading to weak blood circulation, resulting in blood stasis. (3) Cold congealing blood stasis, or heat scorching blood stasis, or damp heat, phlegm fire obstructing the vessels, leading to poor blood flow.
(2) Clinical manifestations: Severe pain resembling stabbing or cutting, fixed pain, worsening at night. Masses: Superficial masses appear as dark purple lumps, while abdominal masses may be hard and immovable. Bleeding: Dark purple blood with clots, or black stools resembling tar. Women may experience amenorrhea, or excessive menstrual bleeding. Facial complexion may appear dark, lips and nails may appear purple, or subcutaneous purpura may appear, or veins may be visible on the abdomen, or skin may show red streaks.
(3) Common Types: 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; Stasis in Muscles and Bones, etc. Mixed Syndromes: Qi Stagnation with Blood Stasis, Blood Stasis with Qi Stagnation, Phlegm Stasis, Heat Stasis, Blood Stasis with Water Retention, etc.
3) Blood Heat Syndrome
1) Definition: Refers to the excessive heat in the organs, forcing the blood to manifest as excess heat syndrome. Commonly seen in the most severe stages of externally contracted warm diseases, known as “blood division syndrome”.
2) Clinical manifestations: Symptoms include coughing blood, vomiting blood, nosebleeds, blood in the stool, excessive menstrual bleeding, or local skin and muscle abscesses, as well as internal organ abscesses, accompanied by agitation, thirst, fever, red tongue, and rapid pulse.
4) Blood Cold Syndrome
1) Definition: Refers to the invasion of cold pathogens into the blood vessels, leading to stagnation of qi and poor blood circulation.
2) Clinical manifestations: Cold pain in the limbs, dark purple skin, or cold pain in the lower abdomen, preference for warmth, aversion to cold, relief from warmth, or menstrual irregularities with dark purple blood and clots, purple tongue, white coating, and deep, slow, or rough pulse.
3) Common Types: Cold Obstructing the Liver Meridian Syndrome, Cold Congealing the Uterus Syndrome, Cold Obstructing the Vessels Syndrome, etc.

4. Fluid Disease Diagnosis
1) Fluid Deficiency Syndrome
1) Definition: Refers to insufficient body fluids, leading to dryness in the organs and tissues. Also known as fluid deficiency syndrome.
Fluid Damage: Refers to a lighter degree of fluid loss, mainly due to water loss, also known as fluid deficiency. Fluid Exhaustion: Refers to a more severe degree of fluid loss, where not only water is lost but also certain essential nutrients are damaged, also known as fluid collapse. In clinical practice, 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 generation.
3) Clinical manifestations: Dry mouth and throat, cracked or chapped lips, sunken eyes, dry skin, thirst for water, short and scanty urine, dry and hard stools, red tongue with little moisture, and thin or rapid pulse.
4) Common Types: Lung Dryness Fluid Damage Syndrome, Stomach Dryness Fluid Deficiency Syndrome, Intestinal Dryness Fluid Deficiency Syndrome, etc. Mixed Syndromes: Dryness with Blood Deficiency, Fluid Deficiency with Blood Stasis, Qi Loss with Fluid Loss, Fluid and Qi Deficiency Syndrome, etc.
2) Phlegm Syndrome
1) Definition: Phlegm is a pathological product formed by the stagnation of 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, vomiting phlegm, dizziness, and obesity, or mental confusion with phlegm sounds in the throat, or mental disorders leading to mania, insanity, or dementia, or the appearance of soft and movable lumps in certain areas, such as goiter, scrofula, breast lumps, or globus sensation, with a greasy tongue coating and slippery pulse.
3) Common Types: Phlegm Disturbing the Spirit, Phlegm Heat Closing the Spirit, Phlegm Fire Disturbing the Spirit, Phlegm Obstructing the Heart Vessels, Phlegm Obstructing the Chest Yang, Phlegm Turbidity Obstructing the Lung, Phlegm Heat Accumulating in the Lung, Phlegm Heat Blocking the Stomach, Phlegm Heat in the Intestines, Dry Phlegm in the Lung, Phlegm Turbidity Invading the Head, Phlegm Obstructing the Uterus (or Seminal Chamber), Phlegm Dampness Accumulating, Phlegm Obstructing the Meridians, Phlegm Dampness Congealing the Skin, Wind Phlegm Disturbing the Spirit, Wind Phlegm Obstructing the Meridians, Phlegm Stasis, etc. Mixed Syndromes: Cold Phlegm, Heat Phlegm, Damp Phlegm, Dry Phlegm, Wind Phlegm, Phlegm Stasis, Pus Phlegm, etc.
3) Fluid Syndrome
1) Definition: Refers to the accumulation of fluids in the stomach, lungs, chest, and abdomen due to the dysfunction of the organs.
2) Clinical manifestations: Symptoms may include dizziness, pale tongue, white slippery coating, and wiry pulse.
(1) Phlegm Fluid: Refers to fluid accumulation in the stomach—fullness and distension, or a sloshing sound, with possible vomiting of clear fluids or phlegm. (2) Chest Fluid: Refers to fluid accumulation in the heart and lungs—coughing and shortness of breath, possibly leading to difficulty lying flat, with thick and white phlegm, chest tightness, and palpitations, or wheezing sounds in the throat. (3) Side Fluid: Refers to fluid accumulation in the chest and hypochondrium—fullness and distension, with pain during breathing, coughing, or turning. (4) Overflowing Fluid: Refers to fluid overflowing into the limbs—swelling, heaviness, and pain, with possible difficulty urinating.
3) Common Types: Cold Fluid Accumulating in the Lung Syndrome, Fluid Accumulating in the Heart Protector Syndrome, Fluid Accumulating in the Chest and Hypochondrium Syndrome, Fluid Retention in the Stomach and Intestines Syndrome, etc.

1. Relationship Between Qi Collapse and Yang Collapse Qi collapse and Yang collapse often occur simultaneously, with similar clinical manifestations. The main feature of Yang collapse is cold limbs and body, while the main feature of Qi collapse is weak and faint breathing, often referred to as Yang qi deficiency collapse in clinical practice.
2. Distinguishing Water Retention Water is a tangible evil that overflows the skin, leading to facial and body swelling. Water retention can be classified into two major categories based on the nature of the disease: 1. Yang Water: The nature of the disease is excess. The onset is acute, starting with swelling of 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 invading the lung and obstructing the defensive qi.
2. Yin Water: The nature of the disease is deficiency. The onset is slower, starting with swelling of the feet, gradually spreading throughout the body, with unchanged skin color, and more swelling in the lower body. Often accompanied by symptoms of spleen and kidney Yang deficiency.

3. Distinguishing Between Bleeding

Syndrome Name	Nature of Disease	Severity of Disease	Blood Color, Quality, and Volume	Accompanying Symptoms
Qi Deficiency	Deficiency	Slow	Pale color, thin quality, variable volume	Fatigue, low energy, pale complexion, spontaneous sweating, worsening with exertion, pale tongue, weak pulse, etc.
Blood Heat	Excess	Acute	Red color, thick quality, large volume	Fever, red face, thirst, short yellow urine, dry stools, red tongue, yellow coating, rapid pulse, etc.
Blood Stasis	Excess	IntermittentRecurrent	Purple color, possibly with clots, variable volume	Localized pain, masses, cyanosis of the face and lips, purple tongue, or purpura, or visible veins on the abdomen, or skin showing red streaks.

Summary
1. Etiological Diagnosis:
1) The concept and key points of the six excesses: wind, cold, heat, dampness, dryness, and fire syndromes.
2) The meaning of toxins and key points for distinguishing pus syndrome, food accumulation, worm accumulation, etc.
2. Qi and Blood Diagnosis:
1) Qi Disease Diagnosis: Qi Deficiency Syndrome, Qi Sinking Syndrome, Qi Stagnation Syndrome, Qi Reversal 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.

2. Organ Diagnosis
1. Heart Disease Diagnosis Common Symptoms Symptoms related to the heart itself and its anatomical locations: chest pain, chest tightness, etc. Abnormalities in blood vessel function: palpitations, changes in complexion and tongue, pulse irregularities, etc. Abnormalities in the heart’s function of housing the spirit: agitation, insomnia, vivid dreams, forgetfulness, confusion, delirium, etc. Basic Pathogenesis Deficiency Syndromes Heart Qi Deficiency, Heart Yang Deficiency, Heart Yang Collapse, Blood Vessel Insufficient Nourishment, Blood Circulation Weakness, Heart Blood Deficiency, Heart Yin Deficiency, Spirit Loss.
1) Often due to excessive worry and mental strain.
2) Congenital deficiency, weak organ function.
3) Prolonged illness damaging the heart.Excess Syndromes Often due to phlegm obstruction, fire disturbance, cold congealing, qi stagnation, blood stasis, etc. Heart Fire Excess, Heart Vessel Obstruction, Blood Circulation Impairment, Phlegm Obstructing the Heart Orifice, Phlegm Fire Disturbing the Heart, Spirit Closure or Disturbance.

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