The Yellow Emperor’s Classic of Medicine – Suwen

Chapter 31

Discussion on Heat (Part Four)

The Eight Principles of Differentiation for Exogenous Diseases such as Cold Damage

Exogenous diseases such as Cold Damage can be differentiated using the “Eight Principles” based on pulse and symptoms.

“Exterior and Interior” refers to the areas of struggle between the body’s righteous and evil forces;

“Yin and Yang” refers to the state of struggle between the body’s righteous and evil forces;

“Cold and Heat” refers to the manifestations of the struggle between the body’s righteous and evil forces;

“Deficiency and Excess” refers to the comparative strength of the struggle between the body’s righteous and evil forces.

Regarding “Exterior and Interior”, it is essential to determine whether the disease originates from the “Exterior” or the “Interior”.

The causes of disease in the human body can be broadly divided into exogenous factors (the six evils: Wind, Heat, Summer Heat, Dampness, Dryness, and Cold) and internal injuries (Seven Emotions, Overwork, Diet, and Sexual Activity).

The differentiation of Exterior and Interior has two levels:

The first level is to determine whether the patient has an exogenous or internal injury; if it is an internal injury, then treat the interior directly without considering the exterior symptoms;

The second level is if it is purely exogenous, then determine whether it is an exterior syndrome (evil in the three Yang meridians) or an interior syndrome (evil in the three Yin meridians). Exterior syndromes are treated with sweating methods, while interior syndromes are treated with purging methods to expel the evil.

“Exterior syndrome” typically refers to symptoms arising from the six exogenous evils.

Regarding “Yin and Yang”, when diagnosing and treating diseases, one must first examine Yin and Yang, which is the guiding principle of medicine.

Yin and Yang can be primarily divided into three categories: syndrome, pulse, and medicine.

The Yin and Yang of “syndrome” is a classification of the external characteristics of the disease.

Specifically,

Exterior is Yang, Interior is Yin;

Heat is Yang, Cold is Yin;

Above is Yang, Below is Yin;

Qi is Yang, Blood is Yin;

Movement is Yang, Stillness is Yin;

Those who speak much are Yang, those who are silent are Yin;

Those who prefer brightness are Yang, those who desire darkness are Yin;

Weak Yang cannot exhale, weak Yin cannot inhale;

Yang diseases cannot bend, Yin diseases cannot rise.

The Yin and Yang of “pulse” is a classification of the internal characteristics of the disease, directly reflecting the disease’s impact on the body’s life activities.

When assessing the condition, if the “pulse” and “symptoms” do not match, the pulse condition should be prioritized.

Specifically,

“Floating, Large, Slippery, Rapid” are all Yang;

“Deep, Weak, Thin, Choppy” are all Yin.

The purpose of differentiating Yin and Yang in “syndrome” and “pulse” is to reflect the body’s state of resisting pathogenic factors, thereby establishing the main principles for subsequent treatment.

Generally, “Yang” indicates a stronger struggle between the righteous and evil forces, while “Yin” indicates a weaker struggle.

The Yin and Yang of “medicine” refers to the classification of the effects of drugs on physiological activities in the body.

Specifically,

Those that ascend and disperse are Yang, while those that gather and descend are Yin;

Spicy and hot are Yang, while bitter and cold are Yin;

Those that move Qi are Yang, while those that move Blood are Yin;

Those that are active and mobile are Yang, while those that are static and preserving are Yin.

For example, in cases of exogenous Cold Damage, if the “pulse” and “syndrome” indicate an exterior syndrome, then the evil is in the Yang aspect (three Yang meridians), and sweating methods can be used to resolve the exterior.

Based on the diagnosis of the blood and Qi conditions in specific meridians, for patients with Yang excess and external heat, the “cooling resolution” method is used; for patients with Yin excess and internal cold, the “warming dispersion” method is used; for patients with a balance between Yin and Yang, the “harmonizing resolution” method is used.

Regarding “Cold and Heat”, differentiation can be made from three aspects:

First, the Yin and Yang of Cold and Heat, which refers to the causes of Cold and Heat.

If Yin is strong, it leads to Yang disease, resulting in Cold;

If Yang is strong, it leads to Yin disease, resulting in Heat.

If Yin is insufficient, Yang prevails, resulting in Heat;

If Yang is insufficient, Yin prevails, resulting in Cold.

Extreme Heat leads to the exhaustion of Yin, resulting in Cold;

Extreme Cold leads to the emergence of Yang, resulting in Heat.

Yang deficiency leads to external Cold, which can harm Yang;

Yin deficiency leads to internal Heat, which can harm Yin.

Excess Yang leads to external Heat, returning to the Yang aspect;

Excess Yin leads to internal Cold, returning to the Yin aspect.

When Fire is abundant, there is excess Yang, leading to Heat diseases;

When Water is abundant, there is insufficient Yang, leading to Cold diseases.

Second, the Exterior and Interior of Cold and Heat, which refers to the locations of Cold and Heat.

Heat in the Exterior manifests as fever and headache, red rashes, and a desire to remove clothing or bedding, as well as various painful sores;

Heat in the Interior manifests as dizziness, fullness, thirst, cough, or wheezing, or agitation and restlessness.

Heat in the Upper part manifests as headache and red eyes, sore throat, toothache, or various upward surges, and a preference for coolness with a dark tongue;

Heat in the Lower part manifests as swelling and pain in the waist and feet, constipation, or painful ejaculation, or turbid urine and red stools.

Cold in the Exterior manifests as aversion to cold, cold body, edema, pale complexion, and cold extremities;

Cold in the Interior manifests as cold throat, rumbling intestines, nausea, vomiting, abdominal pain, and a preference for warmth;

Cold in the Upper part manifests as sour belching, choking, indigestion, and bloating;

Cold in the Lower part manifests as unclear separation of clear and turbid, painful diarrhea, impotence, urinary incontinence, and cold knees and feet.

When a patient feels very hot but wants to add clothing, it indicates Heat in the skin and Cold in the marrow;

When a patient feels very cold but wants to remove clothing, it indicates Cold in the skin and Heat in the marrow.

Third, the true and false aspects of Cold and Heat, which refers to the authenticity of Cold and Heat.

Cold is often associated with deficiency, but true Cold can also be present with excess, where extreme Yin generates Heat, resulting in internal Cold and external Heat, known as true Cold and false Heat;

Heat is often associated with excess, but true Heat can also be present with deficiency, where extreme Yang generates Cold, resulting in internal Heat and external Cold, known as true Heat and false Cold.

False Heat is most harmed by cold, while false Cold is most harmed by warmth.

To distinguish true and false Cold and Heat, one should primarily rely on the strength and weakness of the pulse; a true Cold pulse will be slow, weak, and lack spirit; a true Heat pulse will be slippery, strong, and forceful.

Regarding “Deficiency and Excess”, the focus is on assessing the five key elements of the patient: “Spirit, Qi, Blood, Form, and Will” for excess or deficiency; excess is considered real, while deficiency is considered false.

Additionally, differentiation can be made from the perspectives of the deficiency or excess of the Exterior and Interior, Qi and Blood, and the organs.

Pain that can be pressed is considered deficient, while pain that resists pressure is considered excessive.

Diseases can be classified as organ deficiency or excess, and can be assessed through pulse and symptoms.

Exterior excess is characterized by symptoms such as fever, body aches, aversion to heat, and chills.

Cold trapped in the Exterior results in no sweating, while Fire raging in the Exterior results in sores.

Red and painful conditions indicate heat in the Ying and Wei levels;

Stiffness and soreness indicate cold in the meridians.

Interior excess is characterized by symptoms such as distension, pain, hardness, constipation, wheezing, restlessness, insomnia, Qi and Blood accumulation, and stagnation in the abdomen, with Cold evil and Heat toxins deeply lodged in the organs.

Yang excess is associated with more Heat and aversion to heat;

Yin excess is associated with pain and coldness.

Qi excess is characterized by shortness of breath and a loud voice;

Blood excess is characterized by blood coagulation, pain, and hardness.

Heart excess is associated with more Fire and laughter;

Liver excess is associated with pain in the sides and abdomen, often accompanied by anger;

Spleen excess is characterized by fullness and Qi stagnation, or heaviness;

Lung excess is associated with Qi counterflow in the upper jiao, or cough and wheezing;

Kidney excess is associated with obstruction in the lower jiao, with pain or distension, or Heat in the two excretions.

Exterior deficiency may manifest as excessive sweating, weakness of the flesh, aversion to cold, dim vision, tinnitus, numbness in the limbs, fatigue, or a pale complexion with a lack of spirit.

Interior deficiency is characterized by symptoms such as palpitations, anxiety, restlessness, insufficient fluids, inability to eat when hungry, and a dislike for cold drinks, with wide-open eyes and a startle response to sounds.

Upper deficiency may lead to inability to digest food, or excessive vomiting and fullness due to Qi deficiency;

Lower deficiency may lead to incontinence, prolapse, diarrhea, or in women, issues such as amenorrhea, miscarriage, or abnormal vaginal discharge.

Yang deficiency indicates a lack of Fire, leading to insufficient spirit, dark vision, or excessive cold sensitivity;

Yin deficiency indicates a lack of Water, leading to blood loss, heat sensations, or bone steaming and fatigue.

Qi deficiency is characterized by a weak voice and shortness of breath;

Blood deficiency is characterized by dry skin and muscle cramps.

Heart deficiency is associated with Yang deficiency and excessive sadness;

Liver deficiency is associated with visual disturbances and fearfulness;

Spleen deficiency is characterized by weakness in the limbs, or inability to digest food, with abdominal distension and worry;

Lung deficiency is characterized by shortness of breath and dry skin;

Kidney deficiency may lead to obstruction in the two excretions, incontinence, excessive diarrhea, or inability to bend or straighten the back, with bone pain and weakness.