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 syndrome

1. 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 congealing

5. 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 heat

2. 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 fire

5. Restless——fire impaired the heart

6. Hemorrheage——fire burn the collateral veins

7. Dry stool——heat in the intestine

8. Dry tongue——Yin fulid is impaired

9. Red tongue with yellow coat, and rapid pulse——indication of heat syndrome

Identification of cold and heat syndrome

Cold 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 heat

2. Dysphoria, coma, delirium——heat impaired the function of the heart

3. Chest distress, abdominal distention pain that aggravated by pressure——stagnation of Qi and blood

4. Coarse breathing, rattling sound in the chest and throat——accumulation of profuse phlegm block the lung

5. Diarrhea or dribbling and pain urination, dry stools, constipation——pathogenic dampness factor in the body

6. repletion, forceful pulse——fierce struggle between health Qi and pathogenic factor

7. 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

Yin

Yang

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.