Eight Principles Differentiation
The Eight Principles: Refers to the eight categories of Exterior (Biao), Interior (Li), Cold (Han), Heat (Re), Deficiency (Xu), Excess (Shi), Yin, and Yang.
Exterior and Interior — Differentiating the depth of the disease location; Cold and Heat — Differentiating the nature of the disease;
Deficiency and Excess — Judging the strength of the pathogenic and righteous Qi; Yin and Yang — Classifying the types of diseases.
Eight Principles Differentiation: Utilizing the Eight Principles to analyze and summarize the clinical data collected from the four examinations, in order to differentiate the current stage of the disease’s location, nature of cold or heat, strength of pathogenic and righteous Qi, and the category of the disease. This serves as the foundation for differentiation methods and is a guiding principle for syndromes.
Historical Development:
1. Neijing: “A good diagnostician observes color and pulses, first distinguishing Yin and Yang.”
2. Shanghan Lun: Differentiation of the six meridians, divided into three Yin and three Yang.
3. Jingyue Quanshu: “Yin and Yang Chapter” and “Six Transformations Chapter”.
4. Shanghan Zhi Nan: Officially proposed the term “Eight Principles”.
Section One: Basic Syndromes of the Eight Principles
1. Exterior and Interior Differentiation
Exterior and Interior: These are two principles for differentiating the depth of the disease location.
Exterior and Interior: A relative concept.
The skin, muscles, and meridians are on the outside, belonging to the Exterior; blood vessels, bone marrow, and internal organs are on the inside, belonging to the Interior.
The relativity of Exterior and Interior: Exterior — body shell, organs, meridians; Interior — internal organs, viscera.
When external pathogens invade the skin, resulting in a shallow disease location, it is termed an Exterior Syndrome; when the disease is in the internal organs, resulting in a deep disease location, it is termed an Interior Syndrome.
The narrow definition of Exterior and Interior: Exterior — skin, muscles, meridians; Interior — internal organs, bone marrow.
Exterior Syndrome: Pathogenic factors are shallow and the disease is mild — Exterior Syndrome entering Interior — the disease progresses.
Interior Syndrome: Pathogenic factors are strong and the disease is severe — Interior Syndrome exiting Exterior — the disease retreats.
Differentiating Exterior and Interior is particularly important for externally contracted diseases.
(1) Exterior Syndrome
Concept: Refers to the initial stage of externally contracted diseases, where six excesses, epidemics, and other pathogenic Qi invade the body through the skin and nose, with the righteous Qi resisting the pathogenic Qi at the skin surface, characterized mainly by new onset of aversion to cold and fever.
[Syndrome Manifestations] Aversion to cold and fever, body aches, sneezing, nasal congestion, runny nose, itchy throat, slight cough and wheezing, pale red tongue with thin coating, floating pulse.
[Syndrome Analysis]
External pathogens invade the exterior, obstructing the normal dissemination and warming of the defensive Qi, hence the aversion to cold and fever;
External pathogens bind the exterior, causing Qi stagnation and obstruction, leading to pain, hence the body aches;
The lungs govern the skin and open to the nose; pathogenic Qi enters through the skin and nose, affecting the lungs, resulting in nasal and pharyngeal discomfort, loss of lung function in dispersing and descending, hence nasal congestion, runny nose, sneezing, itchy throat, slight cough and wheezing;
As the pathogen has not entered the interior, the tongue appearance shows no significant changes, hence pale red tongue with thin coating;
With the righteous and pathogenic Qi contending at the exterior, the pulse is floating.
[Key Points for Differentiation] New illness, aversion to cold and fever, floating pulse.
Supplement:
1. Can be seen in: Exterior Cold Syndrome, Wind Cold Exterior Syndrome, Exterior Heat Syndrome.
2. Two characteristics of Exterior Syndrome: 1) Externally contracted pathogenic factors, 2) Pathogenic factors are shallow and the disease is mild.
(2) Interior Syndrome
Concept: Refers to the disease location being internal, with internal organs, Qi, blood, and bone marrow affected, primarily manifested by symptoms of organ damage or dysfunction.
[Syndrome Manifestations] Wide range, with various manifestations.
[Syndrome Analysis]
Causes: 1) Exterior Syndrome, the pathogenic factor transmits to the interior, 2) External pathogens directly enter the interior, invading the internal organs, known as “direct invasion”, 3) Internal injury factors.
Characteristics: 1) The disease location is deep, 2) There are functional disorders of various internal organ systems.
(3) Half Exterior Half Interior Syndrome
Concept: The disease location is neither completely in the exterior nor fully in the interior, existing in a state of transition between exterior and interior, primarily manifested by alternating cold and heat.
[Syndrome Manifestations] Alternating cold and heat, fullness in the chest and flanks, irritability with a desire to vomit, lack of appetite, bitter mouth, dry throat, dizziness, wiry pulse.
[Syndrome Analysis] In the differentiation of the six meridians, this is usually referred to as Shaoyang Syndrome, see details in Shaoyang Syndrome.
(4) Differentiation between Exterior and Interior Syndromes
The main focus is on examining changes in cold and heat, tongue appearance, pulse condition, etc.
Explanation:
1) Fever and aversion to cold belong to the exterior, but heat without cold belongs to the interior.
2) Exterior syndrome has clear and smooth urination, and normal appetite.
3) Interior syndrome has functional disorders of the internal organ systems.
4) For every bit of aversion to cold, there is a corresponding exterior syndrome.
2. Cold and Heat Differentiation
Cold and heat are the two principles for differentiating the nature of diseases.
Jingyue Quanshu: “Cold and heat are transformations of Yin and Yang.”
Suwen · Yin Yang Ying Xiang Da Lun: “When Yang is excessive, it is heat; when Yin is excessive, it is cold.”
Su Wen · Tiao Jing Lun: “Yin deficiency leads to external cold, Yang deficiency leads to internal heat.”
Cold syndrome and heat syndrome are specific manifestations of the body’s Yin and Yang being excessively strong or weak.
(1) Cold Syndrome
Concept: Refers to the sensation of cold evil, or Yang deficiency with excessive Yin, leading to suppressed functional activity, characterized by “cold and cool” symptoms.
[Syndrome Manifestations] Aversion to cold (fear of cold), preference for warmth, cold limbs curled up, cold pain relieved by warmth, pale tongue, no thirst, clear and thin phlegm, clear and long urination, loose stools, pale complexion, pale tongue, moist white coating, tight or slow pulse.
[Syndrome Analysis]
Cold evil restrains, Yang Qi is obstructed, hence aversion to cold; or Yang Qi is weak, unable to warm, hence aversion to cold and preference for warmth, cold limbs curled up;
Cold evil stagnates or Yang deficiency fails to warm, leading to local cold pain;
Cold does not dissipate water, and body fluids are not harmed, hence no thirst and moist white coating;
Yang does not transform fluids, leading to clear and cold secretions and excretions such as phlegm, saliva, urine, and stools;
External cold obstructs Yang Qi or Yang Qi is insufficient, causing Qi and blood to fail to circulate to the face, hence pale complexion, pale tongue;
Cold evil binds Yang Qi, hence tight pulse; Yang deficiency leads to slow pulse.
Supplement: External cold — cold evil invading the skin surface leads to Exterior Cold; internal cold — cold evil directly entering the internal organs leads to Excess Cold; self Yang deficiency leads to Deficiency Cold.
(2) Heat Syndrome
Concept: Refers to the sensation of heat evil, excessive Yang Qi in the internal organs, or Yin deficiency with excessive Yang, leading to hyperactivity of the body’s functional activities, characterized by “warm and hot” symptoms.
[Clinical Manifestations] Fever, aversion to heat, preference for cold drinks, yellow and thick phlegm, short yellow urination, dry and hard stools, red face, irritability, red tongue with little fluid, yellow and dry coating, rapid pulse.
[Syndrome Analysis]
Excessive Yang heat, body fluids are consumed, or due to Yin fluid deficiency leading to excessive Yang Qi, hence fever, aversion to heat, red face, irritability, red tongue, yellow coating, rapid pulse, etc. — a series of heat manifestations;
Heat injures Yin fluids, hence thirst and desire to drink, yellow and thick phlegm, short yellow urination, dry and hard stools, red tongue with little fluid, dry yellow coating.
(3) Differentiation between Cold and Heat Syndromes
1) Key points for differentiating between cold and heat syndromes.
2) Differentiating between true and false cold and heat syndromes.
In certain critical stages of diseases, some signs may appear that do not conform to conventional understanding, meaning that when the disease progresses to extreme cold or extreme heat, sometimes some “false signs” may appear, known as “extreme heat resembling cold, extreme cold resembling heat”, thus affecting the accurate judgment of cold and heat syndromes. Specifically, there are true heat and false cold syndromes, and true cold and false heat syndromes.
(1) True Heat and False Cold Syndrome — “Extreme Heat Resembles Cold”
The essence of the disease is heat syndrome, yet certain “cold signs” appear.
Internal heat is intense, with burning sensation in the chest and abdomen, delirium, foul breath, preference for cold drinks, short yellow urination, red tongue with yellow dry coating, strong pulse, etc., while the limbs are cold and the pulse is deep and slow (limbs are cold, but the chest and abdomen are hot, not wanting to be covered; although the pulse is deep and slow, it is strong upon palpation).
Pathogenic heat is internally excessive, Yang Qi is obstructed internally, unable to reach the exterior, hence “heat deep and cold also deep”.
(2) True Cold and False Heat Syndrome — “Extreme Cold Resembles Heat”
The essence of the disease is cold syndrome, yet certain “heat signs” appear.
Yang Qi is weak, excessive internal cold, cold limbs, clear urination, loose stools, pale tongue with white coating, weak pulse, feeling of heat, red face, restlessness, thirst, sore throat, floating or rapid pulse (although feeling hot, the chest and abdomen are not hot, and there is a desire to add clothing; although the face is red, it is intermittently visible; although restless, there is a sense of fatigue; although thirsty, there is a desire for hot drinks and little drinking; although the throat is sore, it is not red or swollen; although the pulse is floating or rapid, it is weak upon palpation).
Yang Qi is weak, excessive internal cold, forcing the deficient Yang to float upwards, resisting the exterior.
Explanation — When differentiating true and false syndromes, attention should be paid to:
1) Understanding the entire process of disease development;
2) Internal symptoms and tongue appearance should be the main basis for judgment, while external and limb symptoms are easily misleading;
3) Carefully differentiate false signs.
3. Deficiency and Excess Differentiation
Deficiency and excess are the two principles for differentiating the strength of pathogenic and righteous Qi (nature of the disease).
Suwen · Tong Ping Xu Shi Lun: “When pathogenic Qi is strong, it is excess; when vital Qi is depleted, it is deficiency.”
Jingyue Quanshu · Zhuan Zhong Lu: “Excess means the pathogenic Qi is strong, thus it should be purged; deficiency means the righteous Qi is weak, thus it should be tonified.”
Tong Su Shanghan Lun: “In discussing Qi and blood, Qi has excess and deficiency; when strong, it is excess, when weak, it is deficiency; blood has deficiency and stasis; when deficient, it is deficiency, when stagnant, it is excess.”
(1) Deficiency Syndrome
Concept: Refers to the deficiency of the body’s Yin and Yang, Qi and blood, body fluids, and essence, with the pathogenic Qi not being present, characterized by “insufficiency, relaxation, and decline”.
[Syndrome Manifestations] Various manifestations.
[Syndrome Analysis]
Causes: 1) Insufficient congenital endowment, 2) Acquired imbalance, 3) Disease consumption.
(2) Excess Syndrome
Concept: Refers to the body experiencing external pathogenic factors, or during the disease process, the imbalance of Yin and Yang Qi and blood, leading to the accumulation of pathological products, with the pathogenic Qi being strong and the righteous Qi not being weak, characterized by “excess, hyperactivity, and accumulation”.
[Syndrome Manifestations] Various manifestations.
[Syndrome Analysis]
Causes: 1) External pathogens invade, 2) Dysfunction of internal organs leading to pathological products.
(3) Differentiation between Deficiency and Excess Syndromes
1) Key points for differentiating between deficiency and excess syndromes.
2) Differentiating between true and false deficiency and excess syndromes.
In more complex diseases or when they develop to severe stages, some signs may appear that do not conform to conventional understanding, meaning that when the patient’s righteous Qi is severely depleted, or the pathogenic Qi is extremely strong, some “false signs” may appear, specifically true excess and false deficiency, and true deficiency and false excess.
(1) True Excess and False Deficiency Syndrome — “Great Excess with Deficiency Appearance”
The essence of the disease is excess syndrome, yet certain “deficiency signs” appear.
Excessive pathogenic Qi internally, with pain that resists pressure, pale and old tongue, thick and greasy coating; silent demeanor, fatigue, reluctance to speak, pulse is deep and thin.
(Although silent, when speaking, the voice is loud and strong; although fatigued, there is a sense of relief when moving; although the pulse is deep and thin, it is strong upon palpation).
Pathogenic Qi accumulates, causing obstruction in the meridians, preventing Qi and blood from flowing smoothly.
(2) True Deficiency and False Excess Syndrome — “Extreme Deficiency with Excess Appearance”
The essence of the disease is deficiency syndrome, yet certain “excess signs” appear.
Severe deficiency of the righteous Qi, with fatigue, pale complexion, tender tongue; abdominal distension and pain, constipation, wiry pulse.
(Although the abdomen is distended, it sometimes relieves; although there is pain, it decreases upon pressure; although the pulse is wiry, it is weak upon deep palpation).
Internal organs are deficient, Qi and blood are insufficient, and transformation is weak.
4. Yin and Yang Differentiation
Yin and Yang are the two principles for classifying disease categories (general principles).
Suwen · Yin Yang Ying Xiang Da Lun: “A good diagnostician observes color and pulses, first distinguishing Yin and Yang.”
Jingyue Quanshu: “Yin and Yang are infallible; is there any error in treatment? Although the medical path is complex, it can be summarized in one phrase: Yin and Yang.”
All syndromes characterized by excitement, agitation, hyperactivity, brightness, and leaning towards the exterior or upper part of the body, such as Exterior, Heat, and Excess Syndromes, belong to the category of Yang Syndromes.
All syndromes characterized by inhibition, tranquility, decline, darkness, and leaning towards the interior or lower part of the body, such as Interior, Cold, and Deficiency Syndromes, belong to the category of Yin Syndromes.
Section Two: Relationships between the Eight Principles Syndromes
1. Coexisting Syndromes
Narrow definition: Two or more syndromes that are not opposing in the Eight Principles exist simultaneously.
Broad definition: Various syndromes exist simultaneously.
Common syndrome types: Exterior Excess Cold Syndrome, Exterior Excess Heat Syndrome, Interior Excess Cold Syndrome, Interior Excess Heat Syndrome, Interior Deficiency Cold Syndrome, Interior Deficiency Heat Syndrome.
2. Mixed Syndromes
In the Eight Principles, opposing syndromes exist simultaneously.
Common syndrome types: Exterior and Interior Cold, Exterior and Interior Heat, Exterior Cold and Interior Heat, Exterior Heat and Interior Cold, Exterior and Interior Excess, Exterior Excess and Interior Deficiency.
Cold and heat mixed: Upper Heat and Lower Cold, Upper Cold and Lower Heat.
Deficiency and excess mixed: Deficiency mixed with Excess, Excess mixed with Deficiency, Deficiency and Excess both prominent.
3. Transformation of Syndromes
In the Eight Principles, opposing syndromes can transform into each other under certain conditions.
Common syndrome types: Exterior Pathogen entering Interior, Interior Pathogen exiting Exterior (development trends of severity); Cold transforming into Heat, Heat transforming into Cold (the rise and fall of Yang Qi); Excess transforming into Deficiency, Deficiency transforming into Excess (results of transformation).