Syndrome Differentiation
Outline
Syndrome differentiation in TCM is a method to analyses and recognize the syndrome of disease.
In other words, it is also a process in which the location, nature, occurrence and development of a disease as well as the condition of health Qi and pathogenic factors are identified according to the clinical data obtained from the four diagnostic methods.
From the above it becomes obvious that syndrome differentiation is the premise and foundation of treatment.
Correct differentiation and appropriate treatment are the prerequisite for achieving the hoped-for results.
There are a number of methods to differentiation of syndromes in TCM, such as
differentiation of syndromes according to the eight principle;
differentiation of syndromes according to the theory of Qi, blood and body fluid;
differentiation of syndromes according to the Zang-Fu theory;
differentiation of syndromes according to the theory of six meridians;
differentiation of syndromes according to the theory of three jiao.
Each method, while having its own features and laying stress.
They should be applied flexibly and accurately so as to understand a disease comprehensively,
thereby providing the basis for treatment.
The eight principle syndromes
The eight principle syndromes
refer to Yang and Yin, exterior and interior, cold and heat, deficiency and excess.
Is the most important syndrome in TCM.
Complicated as the clinical manifestations of diseases may be, they are classified under the eight principles.
1. the classification of syndromes——Yin or Yang;
2. the location of disease——exterior or interior;
3. the nature of disease——cold or heat; 4. the states of health Qi and pathogenic
factors——deficiency or excess
Exterior and interior
Are two principles for differentiating the location and severity of diseases.
Exterior: the surface skin and body hair, the muscle, the channels.
Interior: Zang-Fu organs, the blood vessels, the bones marrow.
Exterior syndrome
indicates the exterior parts of body is affected by exogenous pathogenic factors and the disease is in its primary stage and relatively mild.
Exterior syndrome
If the enemy invades our border, our army will go out for fight, and then the border will become the battlefield at this moment.
the exterior parts of body is affected by exogenous pathogenic factors and the disease is in its primary stage and relatively mild.
Battlefield border
Exogenous pathogenic factors intrude human body through body hair and skin, muscle, and channels, or through mouth and nose, characterized by rapid onset and short duration.
Symptom
1. Fever, and superficial pulse, white thin coat——a fright between health Qi and pathogenic factors.
2. Aversion to cold ——the hindrance of the defensive Qi fails to warm the body.
3. Nasal obstruction, nasal congestion, itching and pain in the throat, and cough——lung is impaired by pathogenic factors.
4. Headache——the unsmooth flow of Qi and blood caused by pathogenic factors.
Principle of treatment
Relieve the exterior syndrome with drugs pungent in flavor
ginger
Interior syndrome
indicates the disease is in the interior parts of the body, such as Zang-Fu organs, Qi and blood, and marrow.
It is commonly seen in the intermediate and late stages of diseases caused by exogenous pathogenic factors or diseases which result from internal injury.
Interior syndrome
if our army are unable to resist the enemy's invasion, then the enemy will invade into our city, even the capital, the condition is more serious at this time.
the disease is in the interior parts of the body.
Battlefield capital
Symptom
Is characterized by a wide variety of symptoms and with different disease location.
Such as high fever, disphoria, coma, thirst, abdominal pain, constipation, or diarrhea, vomit, short micturition with dark color urine, yellow or white, thick and greasy tongue coat, deep pulse.
Principle of treatment
Different treatments according to the various causative factors. Such as
1. Warm the interior
2. Clear away heat
3. Relieve constipation
4. Promote digestion
5. Reinforce Yang
Identification of exterior and interior syndromeExterior syndrome Interior syndrome
New disease, short duration Old disease, long duration
Fever, aversion to cold, or to wind
Fever caused by exogenous pathogens but without aversion to cold or to wind; or fever due to endogenous damages
White thin tongue coat (relatively normal)
Remarkable change in tongue and tongue coat, e.g. yellow tongue coat, thick and slimy coat, dark red tongue, pale tongue, etc.
Superficial pulse Deep pulse, or full and rapid pulse, etc.
Half-exterior and half-interior syndrome
It indicates that during the penetration of exogenous pathogenic factor from exterior to interior,
Or the exteriorization of interior syndrome, the pathogenic factors just come to its half way
Disease location is neither exterior nor interior, but in between.
Symptom
Alternating fever and chills, nausea, vomit, distressing fullness in the chest and hypochondriac region, restlessness, bitter taste in the mouth, dry throat, no desire for food and drink, vertigo, wiry pulse.
Main points for distinguishing exterior and interior syndrome1. changes of cold and heat Exterior syndrome——fever accompanied by aversion to cold Interior syndrome——fever without aversion to cold, or
aversion to cold without fever
2. Tongue condition Exterior syndrome——comparatively mild, and tongue coating
remains unchanged Interior syndrome——relatively sever, with changes in the
tongue coating by the dysfunction of some Zang-Fu organs
3. Pulse condition Exterior syndrome——superficial pulse Interior syndrome——deep pulse
Heat and cold syndrome
Are two principles used to differentiate the nature of diseases.
Heat and cold syndrome reflect the states of Yin and Yang in the body.
Zhang Jingyue held that, “cold and heat are mutations of Yin and Yang”.
Symbol of heat and cold syndrome
Heat syndrome Cold syndrome
Cold syndrome
is attributable to the invasion of pathogenic cold factor, or depletion of Yang, or excess of Yin.
Cold
Symptom
1. Cold form, cold limbs, somber with white complexion, curled-up recumbent posture, desire for warmth——Yang Qi is insufficiency or impaired by exogenous pathogenic factors and fail to warm the organism.
2. Tasteless in the mouth——excess of Yin cold, do not harm to body fluid, so there is not thirst.
3. Phlegm, saliva and nasal discharge, long micturtion with clear urine, thin or watery stools ——Yang being insufficient and incapable of steaming the fluid.
4. Tense pulse——cold is congealing5. Slow pulse——Yang being insufficient, not enough
strength to mobilize the circulation of Qi and blood
Heat syndrome
denotes to symptom complex that is attributed to invasion of pathogenic heat, or excess of Yang, or depletion of Yin, or hyperactivity of the organism .
Symptom 1. Aversion to heat and preference for cold——
exuberance of Yang produce excessive heat2. Thirst, desire for cold drink, short micturition with
dark colored urine——consumption of body fulid by heat
3. Yellow, thick phlegm and nasal discharge——fluid decocted by Yang heat
4. Flushed face——upflaming of fire5. Restless——fire impaired the heart 6. Hemorrheage——fire burn the collateral veins7. Dry stool——heat in the intestine8. Dry tongue——Yin fulid is impaired9. Red tongue with yellow coat, and rapid pulse——
indication of heat syndrome
Identification of cold and heat syndromeCold syndrome Heat syndrome
Aversion to cold, cold limbs, preference for warmth
Fever, aversion to heat, preference for cold
Testlessness, no thirst Dry mouth, thirst, desire for cold fluid
Somber white complexion Flushed complexion, congested eyes
Quiet Restlessness
Long micturition with clear urine Short micturition, with dark coloured urine
Thin or watery stools Dry stools
Pale tongue with white moist coat Red tongue with yellow dry coat
Slow pulse or tense pulse Rapid pulse
Principle of treatment
Cold syndrome Warm to expel cold
Heat syndrome Clear away heat and
reduce fire
Main points for distinguishing between cold and heat syndromesManifestation Cold syndrome Heat syndrome
Aversion to cold or heat
Aversion to cold, preference for heat
Aversion to heat, preference for heat
Thirst Absence of thirst Thirst with preference for cold drinks
Complexions Lightly pale Flushed
Four limbs Cold Warm
Stools Loose Constipation
Urine Clear and profuse Yellow and scanty
Tongue Pale tongue, white and moist coating
Red tongue, yellow coating
Deficiency and excess syndrome
Are two principles for differentiating the states of pathogenic factors and health Qi.
Deficiency syndrome chiefly denotes to insufficiency of health Qi.
Excess syndrome denotes to excess of pathogenic factors.
Deficiency syndromes
Include deficiency of Yin, Yang, Qi, blood, essence and body fluid, Zang-Fu organs.
Caused by congenital insufficiency or postnatal malnutrition. Yellow river
There are two major types of deficiency that are frequently observed in clinical practice.
The etiology of deficiency is mainly the damage of Yang and Yin.
1.Yang deficiency
Impairment of Yang leads to warming, moving, and containing dysfunction:
Manifestation: Pale or withered yellow complexion, spiritlessness, lassitude, palpitation, shortness of breath, cold form, chills in the limbs, spontaneous sweat, urinary and fecal incontinence, pale and enlarged tongue, vacuous, deep, and slow pulse;
Cold syndrome
2.Yin deficiency
Deficiency Yin syndrome in which Yin is damaged and unable to restrict Yang,and that Yin fails to nourish and moisten the organism:
Manifestation: feverish, sensation in palms, soles and chest, emaciation, flushed cheeks, dry mouth, dry throat, night sweat, tidal fever, red tongue with less coat, vacuous, thready and rapid pulse.
Heat syndrome
Principle of treatment
Nourish the deficiency Reinforce Yang in case of Yang
deficiency Reinforce Yin in case of Yin deficiency
Excess syndrome
Is caused by attack of exogenous pathogenic factors or dysfunction of the viscera that leads to interior retention of phlegm, fluid, dampness and blood stasis.
Common manifestations1. High fever——excessive heat2. Dysphoria, coma, delirium——heat impaired the function
of the heart3. Chest distress, abdominal distention pain that
aggravated by pressure——stagnation of Qi and blood4. Coarse breathing, rattling sound in the chest and throat
——accumulation of profuse phlegm block the lung5. Diarrhea or dribbling and pain urination, dry stools,
constipation——pathogenic dampness factor in the body6. repletion, forceful pulse——fierce struggle between
health Qi and pathogenic factor7. Tongue with thick greasy coat——turbid damp steaming
up.
Principle of treatment
Reduce the excess Different methods for reducing the
excess should be used depending on different pathogenic factors.
Identification
Excess syndrome Health Qi is not weak Pathogenic factor is
strong Conflict is fierce
Deficiency syndrome Health Qi is weak Pathogenic factor is strong pathogenic factors prevail
over health Qi
Main points for distinguishing between excess and deficiency syndromesItem Deficiency Excess
Duration of disease
Chronic disease New disease
Constitution Weak Strong, in most cases
Spirit Listlessness Restlessness
Voice and breathing
Low voice, weak breathing
Sonorous voice, coarse breathing
Pain Alleviated by pressure Pain on pressure
Chest and abdomen
No pain on pressure Aggravated by pressure
Distention and fullness
Sometimes alleviated Not alleviated
Fever Burning sensation in the chest, palms, soles, and slight afternoon fever
High fever
Aversion to cold Alleviated by warmth
Not alleviated by warmth
Tongue Flaccid with little or no coating
Thick coating
Pulse Forceless Forceful
Treatment principles
Deficiency syndrome replenish
Excess syndrome purge
Yin and Yang (P82)
Yin and Yang is a pair of principle used to summarize the other three pairs of principle and are also the key principles in the eight principles.
So the other three pairs of principles are classified under either Yin or Yang.
Exterior, heat and excess syndromes are classified into the category of Yang,
Interior, cold and deficiency syndromes fall into the category of Yin.
1.Yin syndrome
is characterized by deficiency of Yang-Qi and excess of Yin in the body.
Different symptoms are show in different Yin syndromes.
Manifestation The Yin syndrome is a generalization of
interior, cold, and deficiency syndromes.1. Listlessness, lassitude and low voice are the
manifestations of deficiency syndrome.2. Cold form, chills in the limbs, absence of
thirst, ,foul stools and increased amount of clear urine are the signs of exterior-cold.
3. Pale and enlarged tongue, deep and slow pulse, or weak, thready and choppy pulse indicate deficiency-cold.
2.Yang syndrome
is characterized by the hyperactivity of Yang-Qi and hyperfunctions of the Zang-Fu organs, resulting from excess of Yang-heat in the body.
Different symptoms are show in different Yang syndromes.
Manifestation The Yang syndrome is a generalization of
exterior, heat, and excess syndromes.1. Aversion to cold and fever seen at the same time
are characteristics of the exterior syndrome.2. Flushed face, restlessness, dry mouth, desire for
drink, short micturition with dark color urine are the manifestation of heat syndrome.
3. Loud voice, rough breathing, dry stools are the symptoms of excess syndrome.
4. Dark red tongue with yellow dry coat, the pulse may be superficial rapid, or full and big, or rolling pulse indicate excess heat.
Differentiation between Yin and Yang syndromes
Yin syndrome Yang syndrome
Inspection Pale or dim complexion, heaviness of the body, lying in a curled-up posture, lassitude, listlessness, pale and delicate tongue, moist and slippery coating
Malar flushed face, feverishness, preference for cold, irritability, restlessness, dry and cracked lips, crimson tongue, yellow or stale-yellow coating, even dry, dracked, or dark and thorny tongue
Auscultation and olfaction
Low voice, quietness, disinclination to talk, weak breathing, short breath
Sonorous voice, irritability, polylogia, coarse and asthmatic breathing, rattle in the throat, shouting and yelling
Differentiation between Yin and Yang syndromes
Yin syndrome Yang syndrome
Interrogation Foul stools, loss of appetite, tastlessness in the mouth, absence of irritability and thirst, or preference for hot drinks, and increased amounts of clear urine or scanty urine
Dry or hard stools, or constipation, stools with foul smell, no desire to eat, dry mouth, irritability, preference for drinking, yellow and scanty urine
Palpation Abdominal pain alleviated by pressure, chills, cold feet, and deep, faint, thready, unsmooth, and forceless pulse
Abdominal pain aggravated by pressure, warm body and feet, superficial, rapid, smooth, and forceful pulse
3.Collapse of Yin and Yang
In a critical stage of disease, Yin and Yang may be exhausted simultaneously,
Yin humor is dried up, and Yang is collapsed, both of them can no longer support each other.
Such dissociation of Yin and Yang implies death. 0
10
20
30
40
50
normal
Yi nYang
Conclusion
The eight principles are the guiding principle for syndrome differentiation and treatment.
Review Exterior syndrome indicates the exterior parts of body is
affected by exogenous pathogenic factors and the disease is in its primary stage and relatively mild.
Interior syndrome indicates the disease is in the interior parts of the body.
Heat and cold syndrome reflect the states of Yin and Yang in the body.
Deficiency syndrome chiefly denotes to insufficiency of health Qi.
Excess syndrome denotes to excess of pathogenic factors.
Yin and Yang is a pair of principle used to summarize the other three pairs of principle and are also the key principles in the eight principles.
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