1. Concept
1. Eight Principles: Refers to the eight diagnostic categories of Exterior, Interior, Cold, Heat, Deficiency, Excess, Yin, Yang.
2. Eight Principles Diagnosis: This is the process by which a physician utilizes the Eight Principles theory to analyze and synthesize various clinical data obtained through observation, listening, questioning, and pulse diagnosis, thereby distinguishing the depth of the disease location, the nature of the disease as cold or heat, the strength of pathogenic and righteous qi, and the yin-yang classification of the disease.
2. Basic Symptoms of the Eight Principles
1. Exterior-Interior Diagnosis: Exterior and interior are a pair of principles used to distinguish the depth of the disease location and the progression of the disease. Narrowly defined exterior and interior: Refers to the skin, muscles, and meridians as the exterior, while the organs and marrow are considered the interior. Diseases affecting the exterior are classified as exterior, indicating a lighter condition; diseases affecting the interior are classified as interior, indicating a more severe condition. The distinction between exterior and interior is particularly significant for externally contracted diseases.
1) Exterior Syndrome: Refers to the superficial symptoms resulting from the invasion of external pathogens such as the six excesses, epidemics, and insect toxins, where the righteous qi resists the evil, and the defensive qi fails to disperse. Changes in the skin and hair do not necessarily indicate a syndrome, and the location of exterior syndromes is not always in the skin and hair. 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, itchy or sore throat, and slight cough.
2) Interior Syndrome: Refers to symptoms indicating that the disease is located internally, affecting the organs, qi, blood, and marrow. Causes: (1) External pathogens invade the exterior and transmit to the interior, resulting in interior syndrome. (2) External pathogens directly enter the interior, invading the organs, known as “Direct Attack“. (3) Emotional distress, dietary indiscretion, and overexertion can directly damage the organs, or qi, blood, and body fluids may be affected.
Clinical manifestations: Due to the complex causes of interior syndrome and its broad range, symptoms can vary widely. The basic characteristics include absence of new onset chills and fever, or only chills without fever, or only fever without chills, with organ symptoms as the primary manifestation, such as high fever, agitation, delirium, 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 of longer duration.
3) Half-Exterior Half-Interior Syndrome: Refers to the condition where the external pathogenic factors are neither fully in the exterior nor have entered the interior, with the evil and righteous qi contending between the exterior and interior, leading to dysfunction of the Shaoyang. 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 symptoms resulting from 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, with sudden onset in robust individuals. Deficiency Cold Syndrome: Refers to long-standing internal damage leading to depletion of yang qi and the internal generation of cold, 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, no thirst, clear and thin secretions, long clear urine, loose stools, pale or bluish complexion, pale tongue with white coating, and slow or tight pulse.
2) Heat Syndrome: Refers to symptoms resulting from the invasion of heat pathogens or the predominance of yang over yin, with hyperactivity of the body’s functions. Excess Heat Syndrome: Refers to invasion of fire heat pathogens, or excessive consumption of spicy and warming foods, or excessive emotional distress leading to heat, or excessive internal yang heat, with rapid onset in robust individuals. Deficiency Heat Syndrome: Long-standing internal damage, or excessive sexual activity, leading to depletion of yin fluids and relative excess of yang, known as Yin Deficiency Syndrome. Exterior Heat Syndrome: Wind-heat pathogens invading 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 secretions, short and yellow urine, dry and hard stools, red complexion, red eyes, irritability, and in severe cases, hemoptysis, epistaxis, 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 evil qi, primarily reflecting the strength of the body’s righteous qi and the decline of the evil qi during the disease process.
1) Excess Syndrome: Refers to the body’s response to external pathogens, accumulation of pathological products, or excess, stagnation, or hyperactivity of qi and blood. Characteristics: Excessive evil qi with no deficiency of righteous qi, with a more intense struggle between the evil and righteous qi. Clinical manifestations: Due to the different natures of the invading evil and pathological products, the symptoms can vary widely. Common characteristics include: strong pulse, fullness, and tension.
3. Relationship Between the Eight Principles Symptoms
1. Symptom Combination: Refers to the coexistence of various symptoms. Narrowly defined: refers to 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 symptoms with sweating. Its actual meaning has two aspects: External Pathogen Deficiency: Refers to exterior symptoms caused by wind invasion. Clinical manifestations: aversion to wind, fever, spontaneous sweating, headache, stiff neck, floating and weak pulse. Internal Injury Deficiency: Refers to frequent sweating due to spleen and lung qi deficiency, with weak defensive yang, leading to easy susceptibility to colds. Clinical manifestations: Frequent spontaneous sweating, easy susceptibility to 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, with the defensive yang being constrained, and the struggle between the evil and righteous qi in the skin and muscles, leading to 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, with the struggle between the evil and righteous qi in the exterior, leading to stagnation of the defensive qi. 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 body fluids. Clinical manifestations: Due to the broad range of interior syndromes, the symptoms can vary widely. The basic characteristics include aversion to cold, preference for warmth, cold limbs, pale complexion, no thirst, thin white tongue coating, and slow or tight pulse. Interior Excess Heat Syndrome: Refers to the invasion of yang heat pathogens, entering the interior, or cold pathogens transforming into heat, or stagnation of qi and blood leading to heat. Clinical manifestations: Due to the broad range of interior syndromes, the symptoms can vary widely. 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. Diagnosis of the Eight Principles
1) Exterior-Interior Diagnosis: Distinguishing between exterior and interior symptoms is crucial for understanding the disease’s location and severity. Exterior Syndrome: Symptoms include chills, fever, and body aches. Interior Syndrome: Symptoms include abdominal pain, diarrhea, and other internal manifestations.
2) Cold-Heat Diagnosis: Distinguishing between cold and heat syndromes helps identify the nature of the disease. Cold Syndrome: Symptoms include aversion to cold, cold limbs, and pale complexion. Heat Syndrome: Symptoms include fever, preference for cold drinks, and red complexion.
3) Deficiency-Excess Diagnosis: Understanding the balance of righteous and evil qi is essential for treatment. Excess Syndrome: Symptoms include strong pulse and fullness. Deficiency Syndrome: Symptoms include weak pulse and fatigue.
3. Conclusion
1) Diagnosis of External Pathogens: Understanding the nature of external pathogens such as wind, cold, heat, dampness, dryness, and fire is essential for diagnosis.
2) Diagnosis of Qi and Blood Disorders: Includes qi deficiency, qi stagnation, blood deficiency, and blood stasis.
3) Diagnosis of Body Fluids Disorders: Includes fluid deficiency, phlegm, and water retention.
4. Diagnosis of the Heart
Common symptoms include chest pain and palpitations. Basic mechanisms include heart qi deficiency, heart yang deficiency, and blood stasis. Clinical manifestations may include anxiety, insomnia, and forgetfulness.