TCM Theory

The Eight Principles

DIFFERENTIATION OF SYNDROMES

Identification of a syndrome entails making further analysis and synthesis of the clinical data obtained by applying the four diagnostic methods in order to determine the stage to which the disease had developed its location, and the degree of opposing force between the body resistance and the pathogenic factors. Thus it can be seen that identification is made not form a simple lost of symptoms and signs but from a reflection of the pathogenesis of the disease. Correct differentiation is requisite to applying correct therapeutic methods and attaining the anticipated clinical results.

There are a number of methods for differentiating syndromes of which three are introduced here briefly:

1.Differentiation of syndromes according to eight principles.

2.Differentiation of syndromes according to the theory of zang-fu.

3.Differentiation of syndromes according to the theory of channels and collaterals.

Each of these three lays stress on a particular aspect, at the same time connecting with and supplementing one another. Differentiation of syndromes as also mentioned in preceding chapters on etiology and methods of diagnosis should be taken into consideration in clinical work.

DIFFERENTIATION OF SYNDROMES ACCORDING TO

EIGHT PRINCIPLES

The eight principles in differentiation of syndromes are yin and yang, exterior and interior, cold and heat, xu (deficiency) and shi (excess). This method is widely applicable clinically. Diversified as clinical manifestations and pathological changes may be, application of this method makes it possible to grasp the key link and solve the complicated problems systematically. The qualifiers exterior and interior relate to the depth of the disease, cold and heat to its mature, xu (deficiency) and shi (excess) to the opposing force in the struggle between the anti-pathogenic and pathogenic factors, and yin and yang relate to the categories of the disease. Yin and yang are the chief principles among the eight. All the exterior syndromes, beat syndromes and syndromes of the shi (excess) type fall into the category of yang, While all the interior syndromes, cold syndromes and syndromes of the xu (deficiency) type fall into the category of yin. There may exist clinically among the syndromes those of exterior and cold, and interior and heat, which classify in the yin and yang complex. Below is given a brief description of the main clinical symptoms and signs on which differentiation of syndromes by the eight principles is based.

Exterior and interior form two principles relating to the depth of the diseased area and generalizing the direction of the development of the disease. Exterior syndromes refer to diseases resulting from invasion of the superficial portion of the body by exogenous pathogenic factors and are marked by sudden onset with short duration. Chief manifestations are intolerance to cold (or wind), fever, headache, nasal obstruction and superficial pulse. Interior syndromes may result from transmission of exogenous pathogenic factors to the interior if these are not eliminated in time, or they may be caused by direct attack on the zang-fu organs by exogenous pathogenic factors. Dysfunction of the zang-fu organs is also among the causes of interior syndromes. Generally speaking, the main sign in identifying exterior and interior syndromes is fever accompanied by intolerance to cold (or wind) in the former, while in the latter fever is not accompanied by intolerance to cold (or wind). Both exterior and interior syndromes may be complicated by cold, heat, xu (deficiency), or shi (excess), and their clinical manifestations vary. Care should be taken to distinguish between them.

Exterior syndromes are usually mild and superficial as they are located on the superficial portion of the body and are the early stage of exogenous diseases. Interior syndromes are mostly severe and deep, as the pathogenic factors are in the interior of the body, damaging the zang-fu organs.

Differentiation of cold, heart, xu (deficiency) and

shi (excess) in exterior and interior syndromes.

	Exterior	Interior Syndrome
Cold	Fever, chills, no sweat, Superficial and forceful pulse, Thin white tongue coating, etc.	Chill, cold limbs, pallor, absence of thirst, loose stools, clear profuse urine, deep and slow pulse, pale tongue, etc.
Heat	Fever with intolerance to wind, there may be sweating, a little thirst, superficial and rapid pulse, thin yellow tongue coating, etc.	High fever, thirst, irritability and restlessness, flushed face, red eyes, constipation deep yellow scanty urine, rapid pulse of the shi type, red tongue with white coating etc.
Xu (Deficiency)	Sweating, intolerance to wind, superficial and slow pulse, etc.	Feeble breathing, apathy, general lassitude, palpitation, dizziness, deep pulse of the xu type, flabby and pale tongue with white coating, etc.
Shi (Excess)	No sweat, general aching, superficial and forceful pulse, white-coated tongue, etc.	Coarse breathing, sonorous voice, irritability fullness of the chest, abdominal distention, constipation, deep pulse of the shi type, rough tongue with thick coating, etc.

2.Cold and heat

Cold and heat relate to two different natures of disease. Diseases caused by pathogenic heat, summer heat or dryness is mostly heat syndromes, and those caused by pathogenic cold are mostly cold syndromes. But the latter may turn into the former. Moreover, xu (deficiency) of yin or yang may respectively lead to heat or cold syndromes of the xu type. These should be distinguished from those of the shi type. Clinical manifestations of heat and cold syndromes of the xu type are to be discussed later.

Distinguishing between a cold and a heat syndrome is not difficult, as the two are opposites in nature and have markedly different manifestations.

Differentiation of cold and heat syndromes of the shi type.

Cold syndrome of the shi type	Heat syndrome of the shi type
Chills, cold limbs. Absence of thirst, pallor, excessive sputum, asthmatic breathing. Abdominal pain aggravated by pressure, loose stools, clear urine of increased volume, etc.	Continuous high fever, thirst, flushed face, red eyes, fullness and distending pain in the abdomen aggravated by pressure, unconsciousness, delirium, constipation, concentrated urine, etc.
Deep slow pulse of the shi type.	Rapid pulse of the shi type.
Pale tongue with white or thick sticky coating.	Red if deep red tongue with dry yellow coating.

3. Xu (deficiency) and shi (excess)

Xu (deficiency) and shi (excess)_ are two principles used to analyze and generalize the opposing force of the anti-pathogenic and pathogenic factors during the course of the disease. Syndromes of the xu (deficiency) type refer to those diseases in which the function of the human body is weak. The anti-pathogenic factor insufficient and the co-ordination of yin and yang impaired, while the influence if the pathogenic factor has already become inconspicuous. Syndromes of the shi (excess) type refer to those diseases in which the body function is not to the point of impairment and the anti-pathogenic factor is still of sufficient strength, while the pathogenic factor is hyperactive and severe struggle proceeds between the anti-pathogenic and pathogenic factors. If the anti-pathogenic factor is weak and fails to contend with the pathogenic factor, there will result a disease complicated between xu (deficiency) and shi (excess). Syndromes of the xu (deficiency) type should be treated by the reinforcing method, and those of the shi (excess) type by the reducing method. If xu and shi contend, both reinforcing and reducing methods should be applied.

Syndromes of the shi (excess) type and of heat mature often intermingle, and a syndrome of the xu (deficiency) type often mingles with that if the cold nature. That is to say, heat syndrome is usually of the shi type and cold syndrome generally relates to the xu type.

The main feature of syndromes of yang xu (deficiency of yang) i.e., cold syndromes of the xu (deficiency) type, and syndromes of yin xu (deficiency of yin) i.e., heat syndromes of the xu (deficiency) type are listed below.

Differentiation of syndromes of the xu (deficiency)

and shi (excess) types.

Syndromes of the xu (deficiency) type	Syndromes of the shi (excess) type
Long-standing disease, listlessness, pallor, apathy, lying with the body curled up, feeble breathing, palpitation, shortness of breath, tinnitus, blurring of vision, insomnia, poor memory spontaneous sweating, night sweating, nocturnal emission, enuresis, pain relieved by pressure, loose stools, clear urine increased in volume, etc.	Recent disease, elation, red face, restlessness, sonorous voice coarse breathing, fullness and distension in the chest and abdomen, abdominal pain aggravated by pressure, constipation or tenesmus, painful of difficult urination, et
Thready pulse of the xu type	Pulse of the shi type
Pale tongue with thin coating.	Red tongue with thick coating.

Differentiation of syndromes of yang xu and syndromes of yin xu

Syndromes of yin xu (Cold syndromes of the xu type)	Syndromes of yang xu (Heat syndromes of the cu type)
Chills, cold limbs, sallow complexion, absence of thirst, listlessness, lassitude, spontaneous sweating, loose stools, clear urine in large amount, etc.	Afternoon fever, flush, dry mouth and throat, insomnia with mental restlessness, feverish sensation in palms and soled, night sweating, constipation, concentrated urine, etc.
Deep slow pulse of the xu type.	Tread rapid pulse of the xu type.
Pale tongue with white coating	Red tongue with little coating.

4. Yin and Yang

As has been mentioned above, yin and yang are two general principles used to generalize the categories of disease. They are also used to explain some of the pathological changes of the zang-fu organs and tissues, e.g. syndromes of yin xu, syndromes of yang xu, syndromes of collapse of yin, syndromes of collapse of yang, etc.

So far as clinical manifestations are concerned, those characterized by hyperactivity, excitation, fidgeting and bright or red complexion come mostly within yang syndromes, while those characterized by hypo activity, inhibition, quiescence and sallow or pale complexion come mainly within the yin, These have been shown in the descriptions of the previous six principles. The following are the main features of syndromes of collapse of yin and those of collapse of yang.

Syndrome of collapse of yin	Syndrome of collapse of yang
Sticky sweating, shortness of breath and rapid breathing, flushed face, thirst and preference of cold drinks, hot shin, warm hands and feet, dislike of heat, restlessness.	Profuse cold sweating, feeble breathing, pallor, preference for hot drinks, cool shin, cold limbs, dislike of cold, listlessness.
Thread rapid pulse of the xu type.	Pulse of the xu type, thread and fading.
Red tongue with little saliva.	Pale and moist tongue.