Author: Liu Duzhou
During the Ming and Qing dynasties, some outstanding physicians, such as Zhang Jingyue, Cheng Zhongling, and Jiang Bihua, extracted the two principles of Yin and Yang from the Six Meridians differentiation to govern the differentiation of exterior-interior, cold-heat, and deficiency-excess, which was highly valued and welcomed by practitioners at that time.
Later, this concept was further developed and refined, leading to the current system of Eight Principles differentiation. From Jiang’s “Differentiation of Exterior-Interior, Deficiency-Excess, Cold-Heat,” it can be seen that the terminology at that time only referred to Yin and Yang as principles, while the differentiation of exterior-interior, deficiency-excess, and cold-heat had not yet reached the level of principles.
Jiang stated: “All human diseases are nothing but Yin and Yang. The differentiation of Yin and Yang is inseparable from the six terms of exterior-interior, deficiency-excess, cold-heat. The interior is Yin, the exterior is Yang, deficiency is Yin, excess is Yang, cold is Yin, and heat is Yang. A good physician saves people by differentiating these Yin and Yang; a mediocre physician harms people by misidentifying these Yin and Yang.” His statement is fundamentally similar to Zhang Jingyue’s concepts of “Two Principles” and “Six Transformations.” It can be said that this was the embryonic stage of the Eight Principles differentiation system. Revisiting the development and clinical application of the Eight Principles differentiation system today is necessary for our reference and learning.However, it must be pointed out that the thought of Eight Principles differentiation originates from the Six Meridians differentiation in the “Treatise on Cold Damage.” In the “Treatise on Cold Damage,” the Six Meridians and the Eight Principles are closely linked and inseparable. This is because the Six Meridians are material, summarizing the organs and meridians, and differentiation must be based on this material foundation; thus, diseases cannot exceed the scope of the Six Meridians. However, the symptomatic manifestations of the Six Meridians cannot be separated from the rules of the Eight Principles differentiation, so the two must be combined to be effectively used in clinical differentiation. The specific methods of combining the Eight Principles differentiation with the Six Meridians differentiation are introduced as follows:
1. Yin and YangAccording to the “Inner Canon,” “To treat a disease, one must seek the root,” and “The root of life is based on Yin and Yang.” Therefore, the two principles of Yin and Yang serve as the principles of the Six Meridians and the Eight Principles, governing all symptoms and their development and changes.1. Taiyang DiseaseTaiyang and Shaoyin are exterior and interior, respectively, and have a distinction of Yin and Yang. If the pulse is floating, with fever and aversion to cold, it indicates a disease occurring in Taiyang, known as a Yang syndrome. If the pulse is deep, with no fever and aversion to cold, it indicates a disease occurring in Shaoyin, known as a Yin syndrome.2. Yangming DiseaseYangming and Taiyin are exterior and interior, thus having a distinction of Yin and Yang. If there is body heat with sweating, no aversion to cold, but aversion to heat, it indicates a disease occurring in Yangming, known as a Yang syndrome; if Yangming is cold internally, turning to Taiyin, with inability to eat, difficulty in urination, cold sweating in the hands and feet, and initially hard then loose stools, it indicates a disease occurring in Taiyin, known as a Yin syndrome.3. Shaoyang DiseaseShaoyang and Jueyin are exterior and interior, thus having a change of Yin and Yang. If a person experiences alternating chills and fever, fullness in the chest and hypochondria, irritability, and nausea, it indicates a disease occurring in Shaoyang, known as a Yang syndrome. If there is deafness, contraction of the scrotum, and inability to take in water, with a black and slippery tongue coating, it indicates a disease occurring in Jueyin, known as a Yin syndrome.All diseases of the Six Meridians have both Yin and Yang aspects. Viewing the problem with a perspective of oppositional development is called the method of dichotomy. If one can differentiate, one can discern, thus encompassing the Six Meridians and clarifying the differentiation of exterior-interior, cold-heat, and deficiency-excess.From the above, it can be seen that diseases of the Yang meridians often occur in the six fu organs, as the fu organs are Yang, with abundant Qi and blood, strong resistance to pathogens, thus characterized by various heat manifestations; while diseases of the Yin meridians often occur in the five zang organs, as the zang organs are Yin, with deficient Qi and blood, weak resistance to pathogens, thus characterized by various cold manifestations. Broadly speaking: if the body is light, with shortness of breath, heat in the mouth and nose, clear vision, and inability to sleep; or if there is extreme heat with blurred vision; or if the eyes are red with excessive tears; or if there is body heat with a red face and lips; or if there is thirst with red and yellow urine, these all reflect Yang syndromes. If the body is heavy, with cold in the mouth and nose, unclear vision, a desire to lie down, pale complexion, cold extremities, blue nails, and diarrhea with white urine, these all reflect Yin syndromes.Ancient people said: “Extreme Yang resembles Yin, and extreme Yin resembles Yang,” so when differentiating between Yin and Yang syndromes, one must distinguish their authenticity to avoid being misled by their appearances. The “Treatise on Cold Damage” states: “If a patient has a high fever but desires to be close to clothing, the heat is in the skin, and the cold is in the marrow; if the body is very cold but does not want to be close to clothing, the cold is in the skin, and the heat is in the marrow.” This indicates that the “syndrome” has authenticity, while the “condition” is credible. Therefore, one can observe the truth through “desire” and “non-desire.” In clinical practice, if one follows this method, they will be closer to the truth.2. Exterior and InteriorThe Yin and Yang Six Meridians have a problem of the site of disease. Therefore, recognizing the location of exterior and interior diseases allows for the appropriate use of sweating and purging methods.1. Taiyang Disease Exterior Syndrome(1) Taiyang Disease Exterior Syndrome: Among the Six Meridians, only Taiyang disease can represent the exterior syndrome, which is inseparable from the physiological characteristics of Taiyang. The Taiyang meridian connects to the Wind Palace, being the master of all Yang Qi, thus governing the six meridians and controlling the exterior of the body, hence Taiyang governs the exterior. Additionally, each of the Six Meridians has a distinction between meridians and fu organs; when the meridian suffers from pathogens, compared to the fu organs, the meridian is external, thus having the meaning of exterior syndrome.The “Treatise on Cold Damage” states: “If both pulses are floating, it indicates that Taiyang is affected, and it will manifest in one or two days. Because its pulse connects to the Wind Palace, it causes headache and stiffness in the neck and back.” The symptoms in the first section of the “Treatise on Cold Damage” stating, “Taiyang disease is characterized by a floating pulse, headache, stiffness in the neck, and aversion to cold,” all illustrate that the evil affects the exterior of the Taiyang meridian, and the characteristics of the disease are due to the obstruction of Taiyang Qi.(2) Taiyang Disease Interior Syndrome: The fu organ of Taiyang is the bladder, located in the lower jiao. If the evil in the Taiyang meridian does not resolve, the evil Qi follows the meridian into the fu organ, leading to changes such as water retention and blood retention. We call this the interior (fu) syndrome of Taiyang disease.Taiyang Water Retention Syndrome: Characterized by a floating pulse, slight fever, thirst with a desire to drink, and difficulty in urination, it may even lead to vomiting upon drinking, this is called “water reversal.”Taiyang Blood Retention Syndrome: In Taiyang disease, a weak and deep pulse reflects the exterior evil entering the interior, leading to hardness and fullness in the lower abdomen, and mental agitation; or sudden abdominal pain with a sense of urgency, but with normal urination, indicating heat and blood stasis, unrelated to water.2. Yangming Disease Exterior and Interior Syndromes(1) Yangming Disease Exterior Syndrome: The “Treatise on Cold Damage” states: “If both pulses are long, it indicates that Yangming is affected, and it will manifest in two or three days. Because its pulse connects to the nose and is linked to the eyes, it causes body heat, eye pain, and nasal dryness, making it impossible to sleep.” Cheng Wujis notes: “The Yangming pulse rises from the nose, connects to the eyes. The Yangming pulse, directly above the jaw, exits at the eye system… Eye pain and nasal dryness indicate the presence of evil in the meridian.” This syndrome also includes fever, aversion to cold, no sweating, a flushed face, headache, and a long floating pulse.(2) Yangming Disease Interior Syndrome: If the stomach and intestines are affected by evil, it is called Yangming Disease Interior Syndrome. The “Treatise on Cold Damage” states: “If the disease lasts four to five days, the pulse is deep and there is shortness of breath. The deep pulse indicates that it is in the interior, and if sweating is induced, the fluids will be lost, leading to difficulty in defecation…” This refers to the interior syndrome of Yangming affecting the stomach and intestines. The interior syndrome cannot induce sweating; if sweating is induced, it will harm the fluids, leading to difficulty in defecation.3. Shaoyang Disease Exterior and Interior Syndromes(1) Shaoyang Disease Exterior Syndrome: Shaoyang is half exterior and half interior, located in the two sides of the body, yet it also has exterior and interior syndromes based on the meridian and fu organ.The “Treatise on Cold Damage” states: “If both pulses are wiry, it indicates that Shaoyang is affected, and it will manifest in three to four days. Because its pulse circulates in the sides and connects to the ears, it causes pain in the sides and deafness.” Cheng Wujis notes: “Pain in the chest and sides with deafness indicates that the meridian is obstructed and not functioning.” The “Treatise on Cold Damage” also records that “Shaoyang wind causes deafness, red eyes, fullness in the chest, and irritability…” indicating the Shaoyang meridian syndrome.(2) Shaoyang Disease Interior Syndrome: Refers to the Shaoyang fu syndrome. The “Treatise on Cold Damage” states: “Shaoyang disease is characterized by bitter taste in the mouth, dry throat, and dizziness.” This indicates that the evil heat enters the gallbladder fu, forcing the bile to overflow, thus causing bitterness in the mouth, hence it is called the interior syndrome of Shaoyang disease.4. Taiyin Disease Exterior and Interior Syndromes(1) Taiyin Disease Exterior Syndrome: The “Treatise on Cold Damage” states: “If both pulses are deep and thin, it indicates that Taiyin is affected, and it will manifest in four to five days. Because its pulse spreads in the stomach and connects to the throat, it causes fullness in the abdomen and dryness in the throat.” The “Treatise on Cold Damage” states: “Taiyin wind causes pain in the limbs…” and “If Taiyin disease has a floating pulse, it can induce sweating…” all reflect the fact that the exterior of the Taiyin spleen meridian is affected by disease.(2) Taiyin Disease Interior Syndrome: The “Treatise on Cold Damage” states: “If it is originally a Taiyang disease, and the physician mistakenly purges it, leading to abdominal fullness and pain, it belongs to Taiyin…” indicating that after a mistaken purge, the exterior evil enters the interior of Taiyin, resulting in abdominal fullness and pain in the Taiyin interior syndrome.5. Shaoyin Disease Exterior and Interior Syndromes(1) Shaoyin Disease Exterior Syndrome: The “Treatise on Cold Damage” states: “If both pulses are deep, it indicates that Shaoyin is affected, and it will manifest in five to six days. Because its pulse penetrates the kidney and connects to the lung, it causes dryness in the mouth and tongue, and thirst.” This discusses the heat syndrome of the Shaoyin meridian. The “Treatise on Cold Damage” states: “If Shaoyin disease is first acquired, and the pulse is deep, it is treated with Ma Huang, Xi Xin, and Fu Zi decoction,” discussing the cold syndrome of Shaoyin due to Yang deficiency and the exterior receiving cold syndrome.(2) Shaoyin Disease Interior Syndrome: Refers to the diseases of the Shaoyin heart and kidney. For example, the “Treatise on Cold Damage” states: “If Shaoyin disease has a deep pulse, it should be urgently warmed, and it is appropriate to use Si Ni Tang.” Another section states: “If Shaoyin disease has a fine, deep, and rapid pulse, the disease is in the interior…” These two sections indicate that Shaoyin disease has both cold syndromes due to Yang deficiency and heat syndromes due to Yin deficiency in the interior.6. Jueyin Disease Exterior and Interior Syndromes(1) Jueyin Disease Exterior Syndrome: The “Treatise on Cold Damage” states: “If both pulses are weak and slow, it indicates that Jueyin is affected, and it will manifest in six to seven days. Because its pulse circulates in the Yin organs and connects to the liver, it causes fullness and contraction of the scrotum.” The “Treatise on Cold Damage” states: “If the hands and feet are cold, and the pulse is fine and about to disappear, it is treated with Dang Gui Si Ni Tang.” The above two sections reflect the characteristics of Jueyin disease with both heat and cold syndromes.(2) Jueyin Disease Interior Syndrome: The “Treatise on Cold Damage” states: “If a person has had prolonged cold internally, it is appropriate to use Dang Gui Si Ni Tang with Wu Zhu Yu and Sheng Jiang.” “Prolonged cold internally” refers to the cold syndrome in the interior of Jueyin.In summary, we use the principles of exterior and interior to reflect the diseases of the Six Meridians, which can embody the system and completeness of TCM differentiation. If we only discuss the interior syndromes of the organs without mentioning the exterior syndromes of the meridians, we lose the purpose of the Six Meridians differentiation. Therefore, the Eight Principles differentiation must be combined with the Six Meridians differentiation to avoid being one-sided.
3. Cold and HeatThe principles of cold and heat are established to reflect the cold and heat conditions of the Six Meridians diseases. They serve as the basis for differentiation in clinical treatment, as they encompass the specific conditions of exterior-interior and Yin-Yang diseases.1. Taiyang Disease Cold and Heat Syndromes(1) Taiyang Disease Cold Syndrome: Taiyang governs the exterior, yet there is a distinction of cold and heat in exterior diseases that cannot be overlooked. For example, the “Treatise on Cold Damage” states: “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, nausea, and both Yin and Yang pulses are tight, which is called cold damage.” This reflects the characteristics of exterior cold as a disease, thus it can be called the exterior cold syndrome of Taiyang disease.(2) Taiyang Disease Heat Syndrome: Where there is cold, there must be heat; this arises relatively. However, the exterior heat syndrome of Taiyang disease can manifest in two forms: one is the reception of warm evil Qi, as stated in the “Treatise on Cold Damage”: “In Taiyang disease, if there is fever and thirst, but no aversion to cold, it is a warm disease.” This indicates that the warm evil is still in Taiyang and has not fully entered the interior, thus it is called the exterior heat syndrome of Taiyang disease. The other is due to wind-cold binding the exterior, which, if unresolved for a long time, leads to cold stagnation transforming into heat, with the pulse changing from tight to relaxed, the body changing from pain to heaviness, and no sweating with mental agitation, which can also be called the exterior heat syndrome of Taiyang disease; additionally, there is the 27th section stating: “In Taiyang disease, if there is fever and aversion to cold, with more heat than cold… it is appropriate to use Gui Zhi Er Yao Bi Tang,” which also belongs to the exterior heat syndrome of Taiyang disease.2. Yangming Disease Cold and Heat Syndromes(1) Yangming Disease Interior Cold Syndrome: Yangming governs the interior, and the interior syndrome has a distinction of cold and heat. The Yangming disease’s interior cold syndrome, as stated in the “Treatise on Cold Damage”: “If there is virtual cold in the stomach, leading to inability to eat, drinking water causes belching.” This section discusses Yangming interior cold causing belching. The 243rd section states: “If there is a desire to vomit after eating grains, it belongs to Yangming, and Wu Zhu Yu Tang is the main treatment.” This section discusses interior cold causing vomiting and proposes a treatment method.(2) Yangming Disease Interior Heat Syndrome: The interior heat syndrome of Yangming disease can be located in the upper, middle, or lower parts. Heat in the upper part leads to obstruction in the diaphragm, causing discomfort in the heart and a coating on the tongue; heat in the middle leads to thirst and a desire to drink water, with a dry mouth; heat in the lower part leads to a floating pulse with fever, a desire to drink water, and difficulty in urination.3. Shaoyang Disease Cold and Heat Syndromes(1) Shaoyang Disease Cold Syndrome: The symptoms include fullness and oppression in the chest, difficulty in urination, thirst without vomiting, but sweating on the head, abdominal distension, and a wiry and slow pulse.(2) Shaoyang Disease Heat Syndrome: The symptoms primarily include bitter taste in the mouth, irritability, dry throat, and dizziness.4. Taiyin Disease Cold and Heat Syndromes(1) Taiyin Disease Cold Syndrome: The “Treatise on Cold Damage” states: “If there is diarrhea without thirst, it belongs to Taiyin, due to cold in the organs…” The phrase “cold in the organs” refers to cold in the spleen, thus the symptoms of diarrhea without thirst are observed.(2) Taiyin Disease Heat Syndrome: The “Treatise on Cold Damage” states: “If the pulse is floating and relaxed, and the hands and feet are warm, it is in Taiyin. Taiyin should cause jaundice, but if urination is normal, it cannot cause jaundice.”Taiyin is damp earth, thus when diseases occur, there are differences between damp-heat and cold-damp, which must be clearly distinguished and not confused.5. Shaoyin Disease Cold and Heat Syndromes(1) Shaoyin Disease Cold Syndrome: The cold syndrome of Shaoyin disease is quite broad. The “Treatise on Cold Damage” states: “If Shaoyin disease leads to a desire to vomit but cannot, with irritability and a desire to sleep, and after five to six days there is diarrhea and thirst… it belongs to Shaoyin…” The phrase “cold in the lower jiao” reveals the essence of the cold syndrome in Shaoyin disease.(2) Shaoyin Disease Heat Syndrome: The “Treatise on Cold Damage” states: “If Shaoyin disease lasts for two to three days, with irritability and inability to sleep…” indicating the irritability associated with the heat syndrome of Shaoyin disease.6. Jueyin Disease Cold and Heat Syndromes(1) Jueyin Disease Cold Syndrome: The “Treatise on Cold Damage” states: “If a person has had prolonged cold internally, it is appropriate to use Dang Gui Si Ni Tang with Wu Zhu Yu and Sheng Jiang.” This indicates that the person has prolonged cold in the liver, manifesting as cold accumulation in the lower jiao, with cold pain in the lower abdomen, or reverse vomiting, etc.(2) Jueyin Disease Heat Syndrome: The heat syndrome of Jueyin disease may arise from receiving heat evil as a disease; or from Yang Qi being obstructed, transforming into heat over time; or from excessive Yang in Jueyin, leading to excess heat, etc. For example, the “Treatise on Cold Damage” states: “If a cold occurs on the first or second day, it must lead to fever; if there is heat first, there must be cold later. The deeper the cold, the deeper the heat; the milder the cold, the milder the heat. If the cold should be purged, but sweating is induced instead, the mouth will be injured and become red and sore.” This indicates that internal heat in Jueyin can lead to cold syndromes.4. Deficiency and ExcessThe principles of deficiency and excess often reflect the struggle between the righteous and the evil in the Six Meridians diseases. Generally speaking, diseases of the three Yang meridians are primarily excess syndromes, while diseases of the three Yin meridians are primarily deficiency syndromes.1. Taiyang Disease Deficiency and Excess(1) Taiyang Disease Exterior Deficiency Syndrome: Taiyang disease is an exterior syndrome; if there is sweating from the exterior syndrome, it is called exterior deficiency syndrome. For example, the “Treatise on Cold Damage” states: “In Taiyang wind, if Yang is floating and Yin is weak, Yang floating indicates heat is self-generated; Yin weak indicates sweating occurs. If there is aversion to cold, aversion to wind, and fever, with a tight pulse, Gui Zhi Tang is the main treatment.” This discusses the deficiency syndrome of the exterior evil of Taiyang disease.(2) Taiyang Disease Exterior Excess Syndrome: If there is no sweating but shortness of breath, it is called exterior excess syndrome. For example, the “Treatise on Cold Damage” states: “In Taiyang disease, if there is headache, fever, body pain, back pain, and joint pain, with aversion to wind, no sweating, and shortness of breath, Ma Huang Tang is the main treatment,” discussing the excess syndrome of the exterior evil of Taiyang.2. Yangming Disease Deficiency and Excess(1) Yangming Disease Interior Deficiency Syndrome: Yangming governs the interior, and there is a distinction of deficiency and excess. The Yangming disease’s interior deficiency syndrome, as stated in the “Treatise on Cold Damage”: “In Yangming disease, if there is much sweating but no sweating, and the body feels like insects crawling under the skin, this is due to prolonged deficiency.” Cheng Wujis notes: “The stomach is the reservoir of fluids; if Qi is deficient and fluids are few, the disease will lead to no sweating. The stomach governs the muscles of the body, and if the body feels like insects crawling under the skin, it indicates that the stomach Qi has been deficient for a long time.”Note: Taiyang governs the exterior, thus having sweating as deficiency and no sweating as excess. Yangming governs the interior, thus having sweating as excess and no sweating as deficiency, indicating the differentiation of deficiency and excess between exterior and interior.(2) Yangming Disease Interior Excess Syndrome: The interior excess syndrome of Yangming disease is characterized by “not changing clothes” and “difficulty in defecation” as the main clinical manifestations. The “Treatise on Cold Damage” states: “Yangming disease is characterized by fullness in the stomach,” discussing the characteristics of Yangming as a disease. The specific symptoms of interior excess include: no defecation, abdominal fullness and pain, or pain around the navel; or persistent abdominal fullness, leading to inability to eat, with a deep and tight pulse, or a deep and slow pulse with strength, and a yellow and dry tongue coating.3. Shaoyang Disease Deficiency and Excess(1) Shaoyang Disease Deficiency Syndrome: The deficiency syndrome of Shaoyang disease, as stated in the “Treatise on Cold Damage”: “In cold damage, the Yang pulse is thin, and the Yin pulse is wiry; it should be treated with Xiao Jian Zhong Tang first; if there is no difference, Xiao Chai Hu Tang is the main treatment.” Shaoyang disease has a wiry pulse, but if it is taken as floating, it becomes thin, and if taken as deep, it becomes wiry, reflecting the deficiency of Qi and blood in Shaoyang disease. First, use Xiao Jian Zhong Tang to support the deficiency of righteous Qi, then use Xiao Chai Hu Tang (it seems that Huang Qin should be removed and Shao Yao added) to harmonize the evil of Shaoyang.In today’s hepatitis patients, if they experience persistent pain in the sides and do not respond to medication, with a wiry and thin pulse, I often use Xiao Jian Zhong Tang with good results. This is the method of “the liver suffers from urgency, and sweet food is used to alleviate it,” which has been practiced since ancient times, not just recently.(2) Shaoyang Disease Excess Syndrome: Refers to the symptoms of fullness in the chest and sides, urgency in the heart, irritability, persistent vomiting, constipation, bitter taste in the mouth, irritability, and a wiry and slippery pulse.4. Taiyin Disease Deficiency and Excess(1) Taiyin Disease Deficiency Syndrome: The deficiency syndrome of Taiyin disease often correlates with cold syndrome, as stated in the “Treatise on Cold Damage”: “In Taiyin disease, if there is abdominal fullness and vomiting, with inability to eat, and much diarrhea, the abdomen will hurt at times. If purged, there will be a binding sensation in the chest.” This fully reflects the symptoms of vomiting and diarrhea due to deficiency and cold in the spleen. However, in clinical practice, the cold syndrome of Jueyin disease is primarily characterized by vomiting, while the cold syndrome of Taiyin disease is primarily characterized by diarrhea, with vomiting being secondary; this must be understood.(2) Taiyin Disease Excess Syndrome: The “Treatise on Cold Damage” states: “If it is originally a Taiyang disease, and the physician mistakenly purges it, leading to abdominal fullness and pain, it belongs to Taiyin…”; “If there is severe pain, Gui Zhi Jia Da Huang Tang is the main treatment.” This indicates that the excess of the spleen can be purged. However, the pulse must be deep and strong; if the pulse is weak, it should not be used.5. Shaoyin Disease Deficiency and Excess(1) Shaoyin Disease Deficiency Syndrome: The deficiency syndrome of Shaoyin disease should analyze both Yin deficiency and Yang deficiency, as stated in the “Treatise on Cold Damage”: “In Shaoyin disease, the pulse is fine; sweating should not be induced, as it is due to Yang deficiency.” This section discusses that the fine pulse indicates Yang deficiency, thus prohibiting the use of sweating methods. The 285th section states: “In Shaoyin disease, the pulse is fine, deep, and rapid; the disease is in the interior, and sweating should not be induced.” This section reflects the deficiency syndrome of Shaoyin disease, with distinctions between Yin and Yang.(2) Shaoyin Disease Excess Syndrome: It is commonly said that “the kidney has no excess syndrome, and the liver has no deficiency syndrome,” which is a rough statement and insufficient as a guideline. However, how can the excess syndrome of Shaoyin disease be derived? It often forms through the method of “internal organs leaking into the fu.” For example, the “Treatise on Cold Damage” states: “In Shaoyin disease, if there is clear water diarrhea, pure blue in color, with pain in the heart and dryness in the mouth, it can be purged, and Da Cheng Qi Tang is appropriate.” This indicates that internal dryness and heat lead to excess, forcing Yin down, which ultimately affects the kidney, resulting in the excess syndrome of Shaoyin disease.6. Jueyin Disease Deficiency and Excess(1) Jueyin Disease Deficiency Syndrome: The deficiency syndrome of Jueyin disease has distinctions between Yang Qi deficiency and blood deficiency. For Yang deficiency, the “Treatise on Cold Damage” states: “If there is profuse sweating, heat does not dissipate, internal urgency, pain in the limbs, and diarrhea with cold aversion, Si Ni Tang is the main treatment.” This discusses the cold syndrome of Jueyin due to Yang deficiency. For blood deficiency, the “Treatise on Cold Damage” states: “If the hands and feet are cold, and the pulse is fine and about to disappear, Dang Gui Si Ni Tang is the main treatment.” This discusses the cold syndrome of Jueyin due to blood deficiency.(2) Jueyin Disease Excess Syndrome: The excess syndrome of Jueyin disease may involve phlegm obstruction and water retention, with heat accumulation causing the liver’s drainage to be ineffective, leading to Qi stagnation and resulting in cold syndromes. For example, the “Treatise on Cold Damage” states: “If a patient has cold hands and feet, and the pulse is intermittently tight, the evil is obstructed in the chest, with fullness and irritability, and inability to eat, the disease is in the chest, and it must be purged, using Guo Ti San.” This section discusses the phlegm evil obstructing the chest, leading to cold hands and feet in Jueyin disease. The 356th section states: “If there is cold and palpitations in the heart, it is necessary to treat the water first, using Fu Ling Gan Cao Tang, and then treat the cold. Otherwise, if water enters the stomach, it will lead to diarrhea.” This section discusses water retention in the stomach, with the liver not draining effectively, leading to cold hands and feet due to internal water evil, thus it is called the excess syndrome.Conclusion
Through the above combination of Eight Principles differentiation and Six Meridians differentiation, in each meridian, there are changes in the eight aspects of Yin and Yang, exterior and interior, cold and heat, deficiency and excess, reflecting the symptomatic rules of the Six Meridians diseases. Therefore, it has the significance of differentiation principles. However, the Eight Principles differentiation is also an objective reflection based on the diseases of the Six Meridians. Thus, the Eight Principles and the Six Meridians are a unified organic whole, which cannot be separated. If they are artificially divided, it will inevitably destroy the material spirit of the Eight Principles differentiation and the objective existence of the Six Meridians differentiation.
At the same time, the differentiation theory of TCM is embodied in the physiological and pathological changes of the meridians and organs. Therefore, only by using the Eight Principles differentiation method can we encompass the disease locations of the meridians and organs; the disease nature of Yin and Yang organs; as well as the cold and heat, righteous and evil, deficiency and excess, all of which are interconnected, thus having principles and clarity. For this reason, I humbly present the practical situation of combining the Eight Principles and the Six Meridians, discussing the differentiation and treatment methods of Zhang Zhongjing. If there are any omissions, please provide guidance.