The Eight Principles—Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess—are the most fundamental aspects of diagnosis in Traditional Chinese Medicine (TCM). Through clinical practice and the application of the four diagnostic methods, we analyze and summarize the disease conditions according to the patterns of disease progression, categorizing the identified syndromes into eight types (the Eight Principles). Each category has its representative characteristics, which are used to determine the nature of the disease, leading to accurate diagnoses and appropriate prescriptions for effective treatment.
In the context of internal injuries and miscellaneous diseases, the differentiation is based on the organs; in cases of external pathogens, the differentiation for cold damage uses the Six Meridians method; while for warm diseases, the differentiation involves the San Jiao (Three Burners) method and the Wei, Qi, Ying, and Xue (Defensive Qi, Nutritive Qi, Blood) differentiation.
The development of a disease generally directly affects changes in the body, so symptoms, tongue coating, and pulse can all be analyzed using the Eight Principles to determine the nature of the pathological changes, the depth of the disease location, and the strength of the pathogenic and righteous Qi, thus inferring prognosis and outcomes. Of course, the application of the Eight Principles is not isolated or static; they are interrelated and mutually causal, summarized based on the interactions of righteous and pathogenic Qi. Below, we will discuss the differentiation of Yin and Yang, Exterior and Interior, Cold and Heat, and Deficiency and Excess:
1. Yin and Yang Differentiation
Yin and Yang represent the two opposing yet unified aspects of all things. In the Eight Principles, Exterior, Heat, and Excess are Yang syndromes; Interior, Cold, and Deficiency are Yin syndromes. Therefore, Yin and Yang essentially serve as the overarching principles within the Eight Principles. Patients with Yang syndromes typically exhibit more heat and excess, while those with Yin syndromes tend to show more deficiency and cold.
1. Yin Syndrome
From observation, a patient with a Yin syndrome may present with a dull complexion, lack of energy, fatigue, sluggish movements, a preference for lying down, a desire for quiet, speaking little, a low voice, fear of cold, a preference for warmth, cold extremities, a pale tongue with a white, greasy coating, and a weak, slow pulse.
2. Yang Syndrome
Patients with Yang syndrome often have a red complexion, bright eyes, high fever, thirst, quick movements, irritability, dry and cracked lips, loud and forceful speech, coarse breathing, dry and foul-smelling stools, red tongue with a yellow, thick coating, and a rapid, strong pulse.
2. Exterior and Interior Differentiation
Exterior and Interior refer to the depth of the disease location. When external pathogens invade the body, the initial stage of the disease, where the external pathogen is still affecting the skin and muscles, is considered an Exterior syndrome; when the external pathogen penetrates inward or when the disease originates internally, it is classified as an Interior syndrome.
1. Exterior Syndrome
When the six excesses harm the skin, patients may experience headaches, chills, nasal congestion with excessive mucus, body aches without sweating (or with sweating), normal bowel movements, a thin white tongue coating, and a floating, tight or rapid pulse.
2. Interior Syndrome
Interior syndromes occur when the disease penetrates inward or originates from within. For example, in cases of cold damage leading to Yangming organ syndrome, symptoms may include fever, sweating, irritability, abdominal distension with tenderness, dry stools, delirium, and a strong pulse; or in warm diseases where heat invades the heart, symptoms may include confusion, thirst, and a large, rapid pulse. Diseases resulting from deficiency of Qi and blood, organ weakness, or emotional injuries are also classified as Interior syndromes.
3. Cold and Heat Differentiation
Cold and Heat represent two distinctly different natures of disease. Cold syndromes arise from exposure to cold, often manifesting as a decline in function; conversely, Heat syndromes typically exhibit excessive functional activity.
1. Cold Syndrome
Symptoms may include a pale complexion, cold extremities, lack of thirst, fatigue, loose stools, clear and frequent urination, a pale tongue with a slippery coating, and a slow, weak pulse.
2. Heat Syndrome
Symptoms may include fever without chills, a preference for heat, irritability, thirst, a desire for cold drinks, red and hot urine, dry and foul-smelling stools, a red face and lips, a red tongue with a yellow coating, and a rapid pulse.
4. Deficiency and Excess Differentiation
Deficiency refers to a deficiency of righteous Qi, while Excess refers to the presence of pathogenic factors. Generally, robust individuals who become ill for the first time tend to exhibit Excess syndromes, while those who are weak and have been ill for a long time often present with Deficiency syndromes.
1. Deficiency Syndrome
Patients may appear weak, with a pale complexion, brittle nails, shortness of breath, fatigue, low voice, a preference for lying down, reduced appetite, lack of energy, timidity, forgetfulness, diarrhea with undigested food, cold extremities, dizziness, palpitations, insomnia, night sweats, a pale, swollen tongue with teeth marks, and a weak pulse.
2. Excess Syndrome
Commonly seen are Exterior Excess and Interior Excess syndromes. (1) Exterior Excess is caused by external pathogens obstructing the skin, preventing the lung Qi from dispersing, presenting with fever, chills, body aches, and a floating pulse. (2) Interior Excess, particularly of Heat, may present with a red complexion, coarse breathing, fever, irritability, delirium, abdominal distension with tenderness, constipation, foul-smelling stools, red and hot urine, a yellow, thick tongue coating, and a rapid, strong pulse. Interior Excess due to Cold may present with abdominal distension with tenderness, cold extremities, a slow pulse, and a white, slippery tongue coating. Warming methods should be applied.
The Eight Principles discussed above are categorized for clarity, but they should not be viewed in isolation; they must be integrated, distinguishing primary from secondary, and carefully analyzed to be effectively applied in clinical practice.
In patients, it is often the case that both Exterior and Interior are deficient or excessive, or both Cold and Heat are present, or there may be Exterior Cold with Interior Heat, Exterior Heat with Interior Cold, or Exterior Deficiency with Interior Excess, and vice versa.
In Heat syndromes, there may also be true Cold presenting as false Heat, such as thirst without a desire to drink, a preference for warmth despite a hot body, a red face with cold feet, agitation with weakness, a pale, greasy tongue, and a weak pulse; or true Heat presenting as false Cold, where the patient feels cold but does not want to wear clothes, has cold extremities but a hot body, and experiences foul-smelling black diarrhea, a dry white tongue coating, and a strong, wiry pulse.
In the differentiation of Deficiency and Excess, attention must be paid to the duration of the illness, the strength of the body, and the age of the patient. Sometimes, Deficiency and Excess may be mixed, where the surface appears to be Deficient but is actually Excess, or vice versa. As the ancients said: “Great Excess may appear as Deficiency, and true Deficiency may have a strong appearance.”
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