Differentiation of Yin and Yang
The differentiation of Yin and Yang is one of the specific contents of the Eight Principles differentiation (referring to the eight categories of syndromes: Yin and Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess, which are the fundamental guidelines of TCM syndrome differentiation). The characteristic of the Eight Principles differentiation lies in grasping the overall, certain, and relevant nature of the disease’s occurrence and development. Yin and Yang serve as the general framework for distinguishing disease categories and summarizing syndromes.
Classification
Yang Syndrome: Any syndrome that conforms to the general attributes of “Yang” is termed Yang syndrome, such as: Exterior syndrome, Excess syndrome, Heat syndrome, etc. Symptoms include mental excitement, flushed face, strong fever with aversion to heat, coarse breathing, loud voice, dry stools, red urine, thirst with a preference for cold drinks; tongue is red with yellow coating, pulse is rapid and forceful.
Yin Syndrome: Any syndrome that conforms to the general attributes of “Yin” is termed Yin syndrome, such as: Interior syndrome, Deficiency syndrome, Cold syndrome, etc. Symptoms include mental fatigue, pale face, cold limbs with aversion to cold, shortness of breath with low voice, loose stools with clear urine, no thirst with a preference for hot drinks; tongue is pale with white coating, pulse is weak and slow.
Yin Deficiency Syndrome: A syndrome manifested by insufficient Yin fluids in the body. Symptoms include five hearts heat, tidal fever with night sweats, dry throat and red cheeks, constipation, emaciation, tongue is red with little coating, pulse is thin and rapid.
Yang Deficiency Syndrome: A syndrome manifested by insufficient Yang Qi in the body. Symptoms include aversion to cold with cold limbs, pale tongue with no thirst, fatigue and weakness, clear urine with loose stools, tongue is pale with white coating, pulse is weak.
Yin Collapse Syndrome: Symptoms include hot sweat, salty taste, warm limbs; tongue is red and dry, pulse is rapid and forceful or weak upon palpation. Symptoms include hot body, coarse breathing, thirst with a preference for cold drinks.
Yang Collapse Syndrome: Symptoms include cold sweat, bland taste, cold limbs; tongue is pale and moist, pulse is floating and rapid or thin and weak. Symptoms include cold body, weak breathing, no thirst, preference for hot drinks.
Yin and Yang collapse are dangerous syndromes of disease; if differentiation is incorrect or treatment is delayed, death can occur immediately.
These generally appear in cases of high fever and profuse sweating, excessive sweating, severe vomiting and diarrhea, or excessive blood loss, especially profuse sweating can easily lead to Yin collapse; the appearance of Yang collapse indicates further deterioration of the condition.
Application
The application of the Yin-Yang theory in syndrome differentiation mainly has two aspects:
1. Yin and Yang are the guidelines for differentiation
Since Yin and Yang represent two opposing aspects of things, the nature of the disease and clinical syndromes can generally be categorized as Yin or Yang, thus Yin-Yang differentiation is a fundamental method of differentiation.
According to the basic attributes of Yin and Yang in the Yin-Yang theory, clinical manifestations of excitement, agitation, hyperactivity, brightness, etc., are generally classified as Yang syndrome; symptoms that manifest externally, upward, and are easily detectable; pathogenic nature is Yang evil causing disease, and the condition changes rapidly, etc. Conversely, manifestations of inhibition, tranquility, decline, and darkness are classified as Yin syndrome; symptoms that manifest internally, downward, and are not easily detectable; pathogenic nature is Yin evil causing disease, and the condition changes slowly, etc.
Since Yin and Yang provide the most basic summary of various conditions, the Yin and Yang principles in the Eight Principles can also summarize the other six principles, thus Yin and Yang serve as the general framework for syndrome classification and the most basic guidelines for differentiation.
2. Yin and Yang have specific differentiation content
In TCM, Yin and Yang are not only abstract philosophical concepts but also have many specific medical contents, such as Yang Qi, Yin fluids, Heart Yin, Spleen Yang, etc., which are practical medical concepts. Therefore, Yin-Yang differentiation also includes specific differentiation content, the main ones being Yang deficiency syndrome, Yin deficiency syndrome, Yin excess syndrome, Yang excess syndrome, as well as Yang collapse syndrome and Yin collapse syndrome. Additionally, Yang hyperactivity syndrome, floating Yang syndrome, etc., can also be pathological changes due to Yin-Yang imbalance. The so-called Yin excess syndrome actually refers to Excess Cold syndrome, while Yang excess syndrome actually refers to Excess Heat syndrome.
Yin Deficiency Syndrome
Yin deficiency syndrome refers to a syndrome characterized by insufficient Yin fluids such as body fluids, essence, and blood, leading to an inability to restrain Yang, resulting in reduced nourishing and moistening effects, manifesting as a syndrome of false heat. It belongs to the nature of deficiency syndrome and heat syndrome.
Clinical manifestations of Yin deficiency syndrome include emaciation, dry mouth and throat, tidal fever with red cheeks, five hearts heat, night sweats, short yellow urine, dry stools, tongue is red with little fluid and little coating, pulse is thin and rapid, which are characteristic features of the syndrome. It also has the characteristics of a long course and slow progression typical of deficiency syndromes.
Yin deficiency often arises after febrile diseases, or from chronic diseases that consume Yin fluids, or due to excessive emotional stress, irregular sexual activity, or overconsumption of warming and drying substances, leading to the depletion of Yin fluids. When Yin fluids are insufficient, the body loses its nourishing and moistening ability, and since Yin cannot restrain Yang, the Yang heat becomes relatively excessive, resulting in internal heat, thus manifesting as a syndrome of false heat, dryness, and restlessness.
Yin deficiency can be seen in various organ systems, commonly including Lung Yin deficiency, Heart Yin deficiency, Stomach Yin deficiency, Spleen Yin deficiency, Liver Yin deficiency, Kidney Yin deficiency, etc., with the diagnosis based on the symptoms of each organ.
Yin deficiency can coexist with Qi deficiency, Blood deficiency, Yang deficiency, Yang hyperactivity, essence deficiency, fluid deficiency, and dryness evil, or they can be interrelated, manifesting as Qi and Yin deficiency syndrome, Yin and Blood deficiency syndrome, both Yin and Yang deficiency syndrome, Yin deficiency with Yang hyperactivity syndrome, Yin essence deficiency syndrome, Yin fluid deficiency syndrome, and Yin deficiency with internal dryness syndrome. Yin deficiency can further develop into Yang deficiency or Yin collapse, and Yin deficiency can lead to pathological changes such as wind movement, Qi stagnation, blood stasis, and water retention.
Yang Deficiency Syndrome
Yang deficiency syndrome refers to a syndrome characterized by the depletion of Yang Qi in the body, leading to a loss of warmth, propulsion, and vaporization, manifesting as a syndrome of false cold. It belongs to the nature of deficiency syndrome and cold syndrome.
Clinical manifestations of Yang deficiency syndrome include frequent aversion to cold, cold limbs, bland taste with no thirst, or thirst with a preference for hot drinks, possible spontaneous sweating, clear and long urine or scanty urine with edema, loose stools, pale complexion, tongue is pale and swollen, white slippery coating, pulse is deep and slow (or thin and rapid) and weak, often accompanied by symptoms of fatigue, weakness, and shortness of breath typical of Qi deficiency. Yang deficiency syndrome is often seen in patients with prolonged illness and generally has a slower progression.
Yang deficiency often arises from prolonged illness, or from living in cold environments, leading to gradual depletion of Yang heat, or it may further develop from Qi deficiency, or due to aging leading to insufficient fire at the Mingmen (Gate of Life), or from excessive consumption of bitter, cold, and cooling substances, resulting in reduced organ function and loss of Yang Qi’s warmth, making it unable to resist Yin cold, thus leading to symptoms of aversion to cold and cold limbs. When Yang Qi cannot vaporize and transform fluids, symptoms such as loose stools, clear urine, or scanty urine with edema, and pale swollen tongue may appear.
Yang deficiency can be seen in many organ systems, commonly including Heart Yang deficiency, Spleen Yang deficiency, Stomach Yang deficiency, Kidney Yang deficiency, and Uterine (Essence Chamber) cold deficiency syndrome, each exhibiting their respective organ symptom characteristics.
Yang deficiency can easily coexist with Qi deficiency, i.e., Yang Qi deficiency syndrome; Yang deficiency leads to cold, and there will be cold signs and susceptibility to cold evils; Yang deficiency can develop into Yin deficiency (i.e., both Yin and Yang deficiency) and Yang collapse; Yang deficiency can lead to Qi stagnation, blood stasis, and phlegm retention, resulting in pathological changes.
Yin Collapse Syndrome
Yin collapse syndrome refers to a critical syndrome characterized by significant loss of body fluids and severe deficiency of Yin fluids.
Manifestations of Yin collapse syndrome include hot sweat with a salty and sticky quality, burning body with warm limbs, irritability, aversion to heat, thirst, desire to drink, wrinkled skin, very little urine, flushed face, dry lips and tongue, pulse is thin and rapid, etc.
Yin collapse can develop from a long-standing deficiency of Yin fluids or can occur due to persistent high fever, severe vomiting and diarrhea, continuous sweating, or severe burns leading to rapid loss of Yin fluids. Due to the extreme depletion of Yin fluids, or the presence of internal heat from Yang evils, symptoms such as oily sweating, thin and rapid pulse, burning body, thirst, and flushed face may appear, indicating a state of Yin exhaustion and Yang heat hyperactivity.
Yin collapse often involves the Heart, Liver, and Kidney, and clinically, it is generally not differentiated further. If Yin collapse is not treated promptly, Yang Qi will also decline. Both Yang collapse and Yin collapse occur in critical stages of disease, thus timely and accurate differentiation is essential; if diagnosis and treatment are delayed, it can easily lead to death. In critical conditions, if sudden sweating occurs, it often indicates Yin collapse or Yang collapse, and based on the quality of sweat being thin and cold like water or sticky and hot like oil, combined with the condition, whether the body is cool or hot, face is pale or flushed, pulse is weak or rapid, it is generally not difficult to differentiate between Yang collapse and Yin collapse.
Yang Collapse Syndrome
Yang collapse syndrome refers to a critical syndrome characterized by extreme weakness of Yang Qi, indicating a desire for Yang Qi to escape.
Manifestations of Yang collapse syndrome include profuse cold sweat, thin and pale sweat, dull expression, cold skin, cold hands and feet, weak breathing, pale complexion, tongue is pale and moist, pulse is weak and nearly absent, etc.
Yang collapse generally develops from a foundation of Yang Qi deficiency, but it can also occur due to extreme Yin cold evils causing severe damage to Yang Qi, or from excessive sweating, loss of essence, or significant blood loss leading to the escape of Yang with Yin, or due to severe toxic stimulation, serious injury, or phlegm obstructing the heart orifices, leading to the sudden escape of Yang Qi. Due to the extreme weakness of Yang Qi, it loses its ability to warm, secure, and propel, thus presenting symptoms such as cold sweat, cold limbs, pale complexion, dull expression, weak breathing, and weak pulse, indicating a critical condition.
Clinically, Yang collapse syndrome generally refers to the deficiency of Heart and Kidney Yang Qi. Due to the interdependence of Yin and Yang, the weakness of Yang Qi can also lead to the depletion of Yin fluids.
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