Differentiation of Exterior and Interior Syndromes in Rural General Practice: Key points for distinguishing between exterior and interior syndromes, compiled by the Medical Education Network, along with corresponding practice questions, is hoped to assist candidates in preparing for the 2021 Rural General Practitioner Examination.
Differentiation of Exterior and Interior Syndromes
【Frequency Index】★★★
【Key Points Explanation】
1. Concept1. Exterior Syndrome (Biao Zheng) refers to the initial stage of invasion by external pathogens such as the six excesses (liù yín) and epidemics (yì lì), where the defensive (wei) qi resists the pathogen at the superficial level of the skin, primarily manifesting as sudden onset of aversion to cold and fever.2. Interior Syndrome (Li Zheng) refers to symptoms reflecting pathological changes within the internal organs, including the viscera, qi, blood, and bone marrow.3. Half Exterior Half Interior Syndrome (Ban Biao Ban Li Zheng) indicates a condition where the disease is neither completely superficial nor entirely internal, with symptoms fluctuating between the two, primarily characterized by alternating cold and heat.2. Clinical Manifestations1. Exterior SyndromeClinical manifestations include sudden onset of aversion to wind and cold, or aversion to cold with fever, body aches, sneezing, nasal congestion, runny nose, itchy throat, slight cough, shortness of breath, pale red tongue, thin coating, and floating pulse.2. Interior SyndromeThe range of interior syndromes is extensive and varied; generally, any specific symptoms that are not classified as exterior syndrome (or half exterior half interior syndrome) fall under this category, known as “not exterior, then interior.” The characteristic symptoms are the absence of sudden onset aversion to cold and fever, with visceral symptoms as the primary manifestation.3. Half Exterior Half Interior SyndromeClinical manifestations include alternating cold and heat, fullness in the chest and flanks, irritability with a desire to vomit, lack of appetite, bitter mouth, dry throat, dizziness, and wiry pulse.3. Key Points for Differentiation1. In cases of external pathogens, simultaneous presence of fever and aversion to cold indicates exterior syndrome; however, if there is heat without cold or cold without heat, it indicates interior syndrome; alternating cold and heat indicates half exterior half interior syndrome.2. Exterior syndrome commonly presents with symptoms such as body aches, nasal congestion, or sneezing, while visceral symptoms are not prominent; interior syndrome is characterized by visceral symptoms such as cough, palpitations, abdominal pain, and diarrhea, with nasal congestion and body aches being less common; half exterior half interior syndrome has unique manifestations such as fullness in the chest and flanks.3. The tongue coating changes are not significant in exterior and half exterior half interior syndromes, while interior syndromes often show changes in tongue coating; exterior syndrome typically presents with a floating pulse, while interior syndrome often shows a sinking pulse or other varied pulse types.Additionally, differentiation of exterior and interior syndromes should also consider the onset speed, severity of the condition, and duration of the illness.
【Advanced Strategy】
This content is frequently tested and commonly appears in Type A1 questions, requiring focused mastery.【Common Mistakes and Confusions】This knowledge often tests the following content:It is essential to master the key points for differentiating between exterior and interior syndromes, as examinations frequently assess these distinctions. Therefore, it is necessary to remember the specific differentiation content.
【Practice Questions】
Type A1 Multiple Choice Question1. Which of the following is not a characteristic essential for exterior syndrome?A. Caused by external pathogensB. Sudden onsetC. Superficial locationD. Short durationE. Must develop into interior syndrome
【Practice Question Answers and Explanations】
1.E【Answer Explanation】Exterior syndrome is commonly seen in the early stages of external pathogen invasion, characterized by sudden onset, superficial location, and short duration. However, not all exterior syndromes will develop into interior syndromes, making E the best option.