Eight Principles Flashcards
What are the eight principles?
Yin/Yang
Interior/Exterior
Cold/Hot
Deficient/Excess
Which principles belong to yang?
Excess, exterior and heat
What principles belong to yin?
Interior, cold, deficiency
What do yin and yang represent in terms of disease state?
General category of disease
What do exterior and interior represent in terms of disease state?
Depth of disease
What do cold and heat represent in terms of disease state?
Nature of the disease
What do deficiency and excess represent in terms of disease state?
Relative strength of upright and evil qi
What is the first and most important stage of pattern identification?
Eight Principles
- can be applied to all kinds of diseases
What are the three types of relationships between the eight principles?
Combination
Conversion
Complex
What is a combination pattern?
Simultaneous occurence of signs of two or more of the unpaired principles or the principles of interior and exterior
What is a conversion pattern?
The displacement of symptoms of one principle by symptoms of the opposing principle of the pair
What is a complex pattern?
The simultaneous appearance of symptoms of the paired principles cold and heat or deficiency and excess
What does it mean to see a false sign?
As the disease develops through certain stages, some false appearances opposite to its nature will probably appear. Eg. pseudo-heat in cold syndrome, pseudo cold in heat syndrome, pseudo excess in deficiency cases and pseudo-deficiency in excess cases
What parts of the body are considered exterior?
Skin and hair, muscle, channels and collaterals, respiratory tract
What parts of the body are considered interior?
zang fu organs, qi and blood, bone marrow
What is the clinical significance of the exterior/interior classificaiton?
Used to determine the depth of disease. Important in the treatment of exopathic febrile diseases. Helpful in determining the location and severity of disease but also with inferring the tendency of pathological changes
A disease in the exterior would be considered…
superficial and mild
A disease in the interior would be considered…
deep and serious
What is the cause of Exterior syndrome?
The invasion of the six yin via the skin, hair, mouth and nose. It is commonly seen in the early stage of exopathy and is characterized by sudden onset and short duration.
What is the manifestation of an Exterior syndrome?
Fever with aversion to cold, thin and white tongue coating, floating pulse plus headache and general aching, stuffy runnning nose, itching of the throat, sneeze, cough
What is the principle of treatment for Exterior Syndrome?
Relieve the exterior syndrome with drugs pungent in flavour
Expel wind-cold ?
What is the definition of interior syndrome?
Syndromes in which the zang-fu organs, qi and blood and marrow are affected. It is commony seen in the intermediate and late stages of diseases caused by exogenous pathogenic factors or diseases which result from internal injury
What are three causes of Interior Syndrome?
1) The transmission of exogenous pathogenic factors from exterior to interior to affect the zang fu organs
2) Exogenous pathogenic factors directly attacking the zang fu organs
3) The functional disturbance of the zang fu organs by emotional factors, improper diet or overstrain
What is the clinical manifestation of Interior Syndrome?
High fever and aversion to heat
or low fever, hectic fever, irritability, mental confusion and thirst with desire to drink
or cold limb, abdominal pain, constipatoin or diarrhea, vomiting, scanty dark urine, thick tongue coating and deep pulse
*Causative factors are complicated, range of locations is wide and symptoms varied. Basically all syndromes belong to interior syndrome except exterior syndrome
What is the principle of treatment for Interior Syndrome?
Warm the interior
Clear away heat
Nourish Yin or Reinforce Yang accordingly
What is the definition of half interior/half exterior syndrome?
A syndrome in which the exogenouse pathogenic factors stay just between the exterior and interior
What is the cause of interior/exterior syndrome?
The evil qi fails to be transmitted completely to the interior or the right qi is not strong enough to expel the evil qi to the body surface
What is the manifestation of interior/exterior syndrome?
Alternating chills and fever, discomfort and fullness in teh chest and hypochondrium, vexation, nausea, anorexia (not eating enough), bitter taste in mouth, dry throat, blurring of vision, taut pulse
(This will be discussed again in six-channel pattern identification as Shaoyang syndrome)
What are the main tips for distinguishing between exterior and interior syndromes?
A) Know characteristics
Exterior syndrome - sudden onset, short duration, superficial location
Interior syndrome - chronic onset, long duration, deep location
B) Observe chills and fever as well as urine
C) Observe tongue and pulse
What would be the reasons for exterior and interior being affected simulataneously?
1) Evil qi transmitted to the interior while the exterior syndrome has not been relieved
2) An old disease has not been completley cured while a new disease is coming on
3) Bothe exterior and interior affected simultaneously in initial stage
What are some reaons for transmission of evil qi from exterior to interior?
Weakened body resistance
Hyperactivity of pathogenic factors
Improper care
Incorrect or delayed treatment
Preponderence of yin leads to…
endogenous cold
Deficiency of yin leads to…
endogenous heat
Preponderence of yang leads to…
heat manifestation
Deficiency of yang brings on…
external cold
Definition of Cold Syndrome
Pathological conditions which result from the invasion of exogenous pathogenic cold or from deficiency of yang in the body
What are the causes of Cold Syndrome?
- Invasion of exogenous pathogenic yin cold
- Exhaustion of yang qi after a prolonged disease
- Excessive internal cold caused by eating too much raw and cold food
What is the manifestation of Cold Syndrome?
Aversion to cold, preference for warmth, pallor, cold limbs, lying in a curled up posture, tasteless mouth, absence of thirst, clear sputum, saliva and nasal discharge, an increased amount of clear urine, loose stools, pale tongue, white and moist coating, slow or tense pulse
(Normal pulse rate 60-90 bpm, or 4-5 beats per breath)
What is the principle of treatment for Cold Syndrome?
Warm to expel cold
Definition of Heat Syndrome?
Pathological conditions caused by the invasion of exogenous pathogenic heat or by excessive yang or deficiency of yin in the body
Causes of Heat Syndrome
- Invasion of exogenous pathogenic heat
- Transformation of exogenouse pathogenic cold into heat which goes to the interior
- Seriously depressed emotions turning into heat
- Food retention transforming into heat
- Yin deficiency leading to yang hyperactivity (may be from many things, exhaustion of essence due to overwork, lack of sleep, excessive sexual activities etc.)
What are the different types of Heat Syndrome?
- Exterior Heat Syndrome
- Interior Heat Syndrome
- Excess Heat Syndrome
- Deficiency Heat Syndrome
What are the clinical manifestations of Heat Syndrome?
Aversion to heat, preference for cold, thirst with preference for cold drinks, flushed face, red eyes, irritability, restlessness, yellow and thick sputum and nasal discharge, hematemesis (vomit blood), epistaxis, deep yellow and scanty urine, constipation, red tongue, yellow dry tongue coating, rapid pulse
What are the complex syndromes of cold and heat?
- Heat in the upper and cold in the lower
- Cold in the upper and heat in the lower
- Exterior cold and interior heat
- Exterior heat and interior cold
Clinical manifestations of
Heat in the upper and cold in the lower
Heat in the upper: dysphoria with heat sensation in the chest, halitosis and swelling and pain of the gums
Cold in the lower: Abdominal pain which can be alleviated by warmth
Clinical manifestations of
Cold in the upper and heat in the lower
cold in the upper body: chronic epigastralgia and clear vomitus (cold in stomach)
heat in the lower body: yellow and scanty urine, frequent and painful urination (heat in the bladder)
What would cause “Exterior Cold and Interior Heat”?
Interior heat constitution being attacked by exogenous pathogenic wind-cold exogenous pathogenic factors going inward and turning into heat, while the exterior cold has not yet been dispelled
Clinical manifestation of
Exterior Cold and Interior Heat
Exterior cold: aversion to cold, fever, absence of sweating, asthmatic breathing
Interior heat: irritability, thirst, red tongue, white and yellow coating
What would cause an
Exterior Heat and Interior Cold syndrome?
Interior cold complicated by invasion of pathogenic wind heat; exterior heat which are affected by cold after taking too much medicine of cold nature that damages the spleen and stomach
What are the causes of a transformation of cold in heat syndrome?
Example?
- Excessive yang in the body
- Improper treatment with large doses of drugs of a warm and dry nature
Example: Exterior Wind-Cold turns into fever without chills, irritability, thirst, yellow tongue coating and rapid pulse
What would cause the conversion of a heat syndrome into a cold syndrome?
Example?
- Excessive yin in the body
- Delayed or improper treatment that damages yang qi
Example: a prolonged heat dysentery turning into a deficiency cold dysentery
What are the clinical manifestations of
True Heat with False Cold?
False cold: cold limbs, deep pulse - excessive internal heat hinders the yang qi from reaching the exterior, which is also called “excessive yang manifesting as yin”
True heat: Fever, feverish sensation in the chest, absence of aversion to cold but aversion to heat, thirst with preference for cold drinks, yellow and scanty urine, constipation, deep, rapid and forceful pulse, red tongue with yellow coating
What are the clinical manifestations of
True Cold with False Heat?
False Heat: Fever, thirst, flushed face and full pulse - the excessive yin cold forces yang to the exterior
True Cold: wants to cover up his/her body, prefers warm drinks, full but feeble pulse, cold limbs, clear urine, loose stools, pale tongue with white coating
What are the main points for distinguishing true or false cold and heat?
- False phenomena usually appear on the four limbs, skin and hair, or complexion. The nature of a disease is usually manifested in the zang-fu organs, qi and blood, and body fluids. The tongue and pulse are most important for differentiation.
- The flushed face of false heat only occurse in the cheeks, it is light pink in color, appearing superficially and intermittently, whilte that of true heat is red all over the face
- The cold limbs in the false cold syndrome are accompanied by the absence of a desire for warmth and a heat sensation in the chest and abdomen, while a patient with true cold prefers to lie in a curled up position and craves warmth.
What are the causes of deficiency syndrome?
Congenital deficiency
or
Acquired derangment
leading to
damage of essence, qi, blood, yin, yang in zang-fu organs
What are the manifestations of yang and qi deficiency?
Pallor or sallow complexion, listlessness, lassitude, palpitaitons, short breath, chills, cold limbs, sponatneous sweating, incontinence of stools and urine, pale, puffy, flaccid tongue, slow and feeble pulse
What are the manifestations of yin and blood deficiency?
Burning sensation in the chest, palms, and soles, emaciation, malar flush, dryness of throat and mouth, night sweating, afternoon fever, red tongue with little coating, thready, rapid and feeble pulse
What are the general causes of Excess Syndrome?
Invasion of EPF
or Dysfunction of Zang Fu Organ
leading to
exuberant evil qi
What are the general manifestations of Excess Syndrome?
Fever, abdominal distention and painful areas that the patient is reluctant to have pressed, constipation, irritability, coma, delirium, fullness in chest, coarse breathing, profuse sputum and rattling in throat, dysentery, tenesmus, dysuria, dripping of urine, difficult and painful urination, forceful pulse, rigid tongue and thick, greasy tongue coating
What is the difference between excess and deficiency syndromes when it comes to “aversion to cold”?
In the deficient syndrome the aversion to cold can be alleviated by warmth (therefore it is not true aversion, it is intolerance to cold).
In the excess syndrome the aversion to cold is not alleviated by warmth.
What are the complex (complications) of deficiency and excess syndromes?
1) Excess syndrome complicated by deficiency - Excessive pathogenic factors are predominant, while deficient antipathogenic qi is secondrary
2) Deficiency syndrome complicated by excess - deficiency of antipathogenic qi is predominant and excess of pathogenic factors is secondary.
3) Same severity of deficiency and excess
Talk about the transformation (conversion) of excess into deficiency and vice versa.
Transformation of excess into deficiency: the antipathogenic qi is injuredy by the prolonged stay of excess pathogenic factors
Transformation of deficiency into excess: Insufficiency of the antipathogenic qi and dysfunction of certain zang fu organs in distributing and transforming qi and blood produces endogenous pathogenic factors such as phlegm, retained food, blood stasis and harmful water
What are the key points to distinguish true and false phenomena in deficiency and excess syndromes?
- Is the pulse forceful or forceless? How does it feel with superficial, moderate and deep palpation?
- Is the tongue puffy (?), flaccid (xu) or rigid (excess)? Is there thin coating or thick?
- Is the voice sonorous (excess) or low (xu)?
- Is the constitution strong or weak?
- What is teh causative factor of the disease?
- Is the disease a recent one (excess) or chronic one (xu)?
- What course of treatment has already been taken?
- Symptoms of Exterior Deficiency Syndrome
(caused by invasion of exogenous pathogenic wind)
- POT
SX: Aversion to cold, spontaneous sweating, plus exterior syndrome signs (fever with aversion to cold, thin and white tongue coating, floating pulse, plus headache and general aching, stuffy running nose, itching of throat, sneeze, cough)
POT - Regulate Ying and Wei systems
What are the causes of Exterior Deficiency Syndrome caused by endogenous factors?
Deficiency of qi in the lung and spleen, leading to failure of defensive qi to protect the superficial portion of the body
SX of Endogenous Exterior Deficiency Syndrome?
POT?
Spontaneous sweating, likely to be attacked by EPFs along with qi xu sx (pale or sallow complexion, fatigue, weakness, loose stools, SOB, spontaneous sweating, palpitations, cold limbs (poor circulation), pale puffy and flaccid tongue, slow and feeble pulse
POT: Reinforce the deficiency
What is an Exterior-excess syndrome?
Syndrome in which the superricial portion of the body is invaded by exogenous pathogenic wind-cold
Symptoms of Exterior-excess syndrome?
POT?
Fever, aversion to cold, headache, general pain, absence of sweating, superficial and tight pulse
POT: Relieve the exterrior syndrome with drugs pungent in flavour and warm in property
Definition of Interior-Deficiency Syndrome?
Deficiency of zang-fu organs, yin and yang, qi and blood fall in the category of deficiency syndrome, which will be dealt with in each related section of the manual
Definition of Interior-Excess Syndrome?
Invasion of pathogenic factors into interior… mostly discussed in corresponding section
Deficiency-Cold Syndrome SX
POT
Listlessness, pallor, intolerance of cold, cold limbs, abdominal pain which can be alleviated by pressure, loose stools, increased amoutn of clear urine, lassitude, pale tongue, faint or deep, slow and forceless pulse
POT: Warm and reinforce yang
Deficiency-Heat Syndrome SX
Malar flush, emaciation, afternoon fever, night sweating, 5 centre heat (chest, palms, soles), dry throat and mouth, red tongue with little coating and thready, rapid pulse
POT: Nourish yin to reduce heat
Excess-Cold Syndrome SX
Intolerance to cold, preference for warmth, pallor, cold limbs, abdominal pain which is aggravated by pressure, borborygmus, diarrhea, or rattle in the throat, asthmatic breathing, cough, tastelessness in the mouth, profuse saliva, increased amount of clear urine, white and moist tongue coating, slow or tight pulse
POT: Warm and dispel the cold
Excess-Heat Syndrome SX
Aversion to heat, preference for cold, thirst with desire to have cold drinks, flushed face, red eyes, irritability, or coma and delirium, distention, fullness and pain in teh abdomen with reluctance to be pressed, constipatino, deep-yellow and scanty urine, red tongue with yellow and dry coating, flooding, slippery and rapid pulse
POT: Clear heat and reduce fire
Yin Syndrome
POT
Interior, cold, deficiency
POT: Warm yang to dispel cold
Yang Syndrome
Exterior, heat, excess
POT: Clear away heat and reduce fire
Pale or dim complexion, heaviness of the body, lying in a curled up posture, lassitude, listlessness, pale and tender tongue, moist or slippery coating
Yin or Yang
Type of examination
Yin Syndrome
Inspection
Abdominal pain aggravated by pressure, warm body and feet, superficial, flooding, rapid, slippery and forceful pulse
Yin or Yang
Type of exam
Yang
Palpation
Foul stools, loss of appetite, tastelessness in the mouth, absence of irritability and thirst or preference for hot drinks and increased amounts of clear urine or scanty urine
Yin or Yang
Type of Exam
Yin Syndrome
Interrogation
Sonorous voice, irritability, polylogia (continuous and often incoherent speech), coarse and asthmatic breathing, rattle in teh throat, shouting and yelling
Yin or Yang
Type of Exam
Yang Syndrome
Listening and Smelling
Dry or hard stools, or constipation, stools with foul smell, no desire to eat, dry mouth, irritability, preference for drinking (thirst), yellow and scanty urine
Yang Syndrome
Interrogation
Malar flush or flushed face, feverishness, preference for cold, irritability, restlessness, dry and cracked lips, dep red tongue, yellow coating or dry, cracked, dark and thorny tongue
Yin or Yang
Type of Exam
Yang Syndrome
Inspection
Low voice, quietness, disinclination to speak, weak breathing, short breath
Yin or Yang
Type of Exam
Yin Syndrome
Listening and Smelling
Abdominal pain alleviated by pressure, chills, cold feet, and deep, faint, thready, unsmooth and forceless pulse
Yin or Yang
Type of Exam
Yin Syndrome
Palpation
Causes of Yin Deficiency
Prolonged diseases
Congenital deficiency
Invasion of Yang Evil —->
all 3 of these leading to consumption of yin fluids
—-> yin deficiency —-> flaring up of deficiency fire
Yin Deficiency SX
POT
Emaciation, dry throat, dizziness, blurred vision, palpitation, insomnia, dysphoria with feverish sensation in the chest, palms, soles, hectic (afternoon) fever, night sweating, malar flush, red tongue with little coating, thready and rapid pulse
POT: Nourish yin
Yang Deficiency Causes
Prolonged diseases
Congenital deficiency
Invasion of Yin Evils (eg. cold, damp)
—> all leading to consumption of yang
—> yang deficiency
—-> deficiency cold in the interior
What is the cause of spontaneous sweating?
Yang qi fails to consolidate water
Yang Deficiency SX
POT
Listlessness, fatigue, pallor, short breath, disinclination to talk, lying in a curled up position, sleepiness, intolerance of cold, cold limbs, tastlessness, no thirst or preference for hot drinks, clear urine, loose stools, puffy and pale tongue with white and slippery coating, deep, slow and feeble pulse
POT: Tonify Yang
Causes for Collapse of Yin
- High fever
- Profuse sweating
- Severe vomiting
- Severe hemorrhage
All 4 leading to massive consumption of yin —> Collapse of Yin
Collapse of Yin SX
POT
Profuse, warm, dilute and salty sweating, feverishness, warm limbs, irritability, restlessness, thirst, dry throat, lips and tongue, dry and shriveled skin, scanty urine, red and dry tongue, thready, rapid and faint pulse
POT: Save yin to treat collapse
Causes for Collapse of Yang
- Profuse sweating
- Severe vomiting
- Severe diarrhea
- Severe hemorrhage
All leading to exhaustion of body fluid
—> Collapse of Yang
Collapse of Yang SX
POT
Profuse, cold and sticky sweating, chills, aversion to cold, cold limbs, lying in a curled up position, listlessness, tastelessness in the mouth, absence of thirst or preference for hot drinks, pale and moist tongue, thready and fading pulse
POT: Restore yang and promote resuscitation
DU26, or tips of each finger
Mountain Moxa on umbilicus or moxa with salt
RN4, RN6, DU20
