IDENTIFICATION OF PATTERNS ACCORDING TO THE EIGHT PRINCIPLES (八鋼辨證)

• The identification of patterns according to the Eight Principles is the foundation for all the other
methods of pattern formulation. It is the theoretical basis for all of them and is applicable in every
case.
• It is the basic groundwork of the 8 principle pattern, allowing the practitioner to identify the
location and nature of the disharmony, as well as establish the principle of treatment.
• The Eight Principles could be characterized by both Hot and Cold patterns, or by both Full and
Deficient patterns, not mutually exclusive.
• The Eight Principles allows us to unravel complicated patterns and identify the basic contradictions
within them, reducing the various disease manifestations to the bare relevant essentials.
• Not every condition need have all four characteristics. For example Deficiency of Blood does not
involve any Hot or Cold symptoms.
• However, in most cases, the 8 principle pattern is implicit to the identification of patterns according
to the Internal Organs or that according to Qi, Blood and Body Fluids.
THE EIGHT PRINCIPLES
Yin Yang
Interior Exterior
Deficiency Excess
Cold Hot
1. EXTERIOR-INTERIOR
• The differentiation of Exterior and Interior is not made on the basis of what caused the disharmony, but on
the basis of the location of the disease.
• A disharmony is defined as interior when the Internal Organs are affected. This may have arisen from an
exterior pathogenic factor, but once the disease is located in the Interior, it is defined as an interior pattern,
and treated as such.
Exterior Interior
Definition 'Exterior' of the body comprises the skin, Internal Organs are affected
muscles and channels. This space is called
the 'Lung's Defensive-Qi portion'.
Clinical 'fever', aversion to cold, aching body, a stiff It is impossible to generalize the clinical
manifestation neck and a Superficial pulse. The onset is manifestations of interior conditions as these will
acute and the treatment will make a swift depend on the organ affected, and whether the
and marked improvement of the condition. condition is Hot or Cold and Full or Deficient.
Etiology Exterior When an interior condition starts from the
external condition, the symptoms are the
disappearance of aversion to cold and the onset
of aversion to heat.
However, most of the etiologies are from internal
or non-internal/non-external causes.
2. HOT-COLD
• Hot and Cold describe the nature of a pattern and their clinical manifestations depend on whether they are
combined with a Full or Deficient condition.
HOT
Full Heat Deficient Heat
Definition • Full-Heat (whether external or • Deficient-Heat arises from Deficiency of Yin, the Yin is
internal) is Excess of Yang consumed and the Yang is relatively in Excess.
Clinical • Thirst, a feeling of heat, mental • a feeling of heat in the afternoon or evening, a dry
manifestation restlessness, a red face, dry stools, mouth with a desire to drink in small sips, a dry throat
scanty dark urine, Rapid-Full pulse, at night, night sweating, 'five-palm heat', dry stools,
Red tongue with yellow coating scanty dark urine, a superficial-Deficient and Rapid
• Any raised, red skin eruption that feels pulse and a Red-Peeled tongue.
hot, any burning sensation, any • A feeling of mental restlessness, fidgeting and vague
condition of extreme restlessness or anxiety. The person feels that something is wrong, but
manic behavior is unable to describe
etiology • Emotional problems • Overwork (working long hours)
• Diet (too much red meat, spices, • Irregular eating
alcohol) • Excessive sexual activity
• An external pathogenic factor that has • Persistent, heavy blood loss (such as in menorrhagia)
penetrated into the Interior and
transformed into Heat
 COLD
Full Cold Deficient Cold
Definition • Full-Cold is a manifestation of Excess of Yin • Deficient-Cold arises from deficiency
of Yang.
Clinical • Feeling cold, cold limbs, absence of thirst, a pale • A feeling of cold, cold limbs, pale face,
manifestation face, abdominal pain that is aggravated on pressure, absence of thirst. listlessness,
a desire to drink warm liquids, loose stools, clear sweating, loose stools, clear
abundant urination, a Deep Full-Tight pulse and a abundant urination, a Deep-Slow or
Pale tongue with thick white coating. Weak pulse and a Pale tongue with
• White or bluish-purple thin white coating.
• Usually affects Spleen and Kidneys
• Exterior Cold can invade the Stomach, the Intestine,
the Uterus.
• Cold can also invade the Liver channel causing
swelling and pain of the scrotum.
etiology • The excessive consumption of cold-energy foods • excessive physical work
(such as salads, fruit and iced drinks. • diet, i.e. inadequate consumption of
• When external Cold invades the body, it will invade hot foods
the channels first and then the organs. • excessive sexual activity
3) COMBINED HOT AND COLD
• A condition can often be characterized by the presence of both Heat and Cold.
i. Cold on the Exterior-Heat in the interior:
• This condition is found when a person has a preexisting condition of interior Heat and is subsequently invaded by
exterior Wind-Cold
• This situation also occurs in attacks of Latent Heat combined with a new invasion of Wind-Cold.
ii. Heat on the Exterior-Cold in the Interior:
• This occurs when a person with a Cold condition is attacked by exterior Wind-Heat. There will therefore be some
symptoms of exterior invasion of Wind-Heat (such as a fever with aversion to cold, a sore throat, thirst, a headache
and a superficial-Rapid pulse) and some symptoms of interior Cold (such as loose stools, chilliness and profuse-pale
urine).
iii. Heat above-Cold below
• In some cases there is Heat above (as Heat tends to rise) and Cold below. The manifestations of this situation might be
thirst, irritability, sour regurgitation, a bitter taste, mouth ulcers (manifestations of Heat above), loose stools,
borborygmi and profuse pale urine (manifestations of Cold below).
iv. A combination of Heat and Cold patterns
• The most common situation is both Heat and Cold is when these patterns simply coexist. This is an extremely
common situation in practice.
• For example, it is common for a person to suffer from Kidney-Yang deficiency and Damp-Heat in the Bladder, or
Spleen-Yang deficiency and Liver-Fire.
v. True Cold-False Heat and True Heat-False Cold
• This usually happens only in extreme conditions and is quite rare. It is important not to confuse when Heat
and Cold are simply combined.
• In cases of False Heat and False Cold, tongue diagnosis shows its most useful aspect as the tongue body
color nearly always reflects the true condition. Also thirsty with desire to drink, and wants to cover up can
be factors to determine the true nature of the diseases.
• Deficient-Heat and Deficient-Cold arise from deficiency of Yin or Yang respectively, but there is Heat or
Cold. In False Heat and False Cold, the appearance is false, that is, there is no Heat or Cold respectively.
True Cold False Heat True Heat False Cold
By observation Red cheeks, but rest of face white; Dark face, bright eyes with 'spirit', red dry
irritability but also listlessness, desire to lie lips, irritability, strong body; tongue-body
with body curled up; Pale wet tongue color Red dry
By hearing Breathing quiet; low voice Breathing noisy; loud voice
By interrogation Thirst but no desire to drink, or desire to Thirst with desire to drink cold fluids; scanty
drink warm fluids; body feels hot but likes dark urine, constipation, burning sensation
to be covered; sore throat but without in anus
redness or swelling; pale urine
By palpation Pulse Rapid, Surging but Deficient Pulse Deep, Full; Cold limbs but chest is hot
3. FULL- Deficient (Excess – Deficiency)
• A Full condition is Upright Qi is relatively intact and actively fighting against the pathogenic factor
• A Deficient condition is Emptiness (Deficiency) of the Upright Qi and the absence of a pathogenic
factor
• A Full-Deficient condition Emptiness of the Upright Qi with the presence of a lingering pathogenic
factor that the Upright Qi is not fighting effectively
a. Full Condition
• Any exterior condition due to invasion of exterior Cold, Wind, Damp or Heat is Full by definition
• Any interior pathogenic factor also gives rise to a Full condition, provided the body's Qi is strong
enough to engage in a struggle against such pathogenic factors. Examples of these are interior Cold,
Heat, Dampness, Wind, Fire and Phlegm. Stagnation of Qi and Blood stasis are also Full conditions.
• Acute onset, restlessness, irritability, a strong voice, coarse breathing, pain aggravated by pressure,
high-pitched tinnitus, scanty urination, constipation. a Full pulse
b. Deficient conditions
• We can distinguish four types of Emptiness:
1) Deficient Qi
• Emptiness of Qi is the first and least severe deficiency from which one can suffer. Most of the above symptoms arise
from weakness of Lung-Qi failing to control breathing, and weakness of Spleen-Qi failing to transform and transport.
• Pale face, weak voice, slight sweating, slight shortness of breath, tiredness, loose stools, a poor appetite, Deficient
pulse
2) Deficient Yang
• The main clinical manifestations of Deficient-Yang are, in addition to those of Emptiness of Qi, chilliness, a bright pale
face, cold limbs, absence of thirst, a desire for hot drinks, loose stools, frequent pale urination, a Weak pulse and a Pale
and wet tongue.
• Qi is part of Yang, and Emptiness of Qi is similar in nature to Emptiness of Yang. In fact, the two are practically the
same, just emphasizing different aspects of the functions of Qi.
• In Emptiness of Qi, it is the Qi's function of transformation that is mostly at fault, whereas in Emptiness of Yang, it is
the Qi's function of warming and protecting that is impaired.
• The organs that are most commonly affected by Yang deficiency are the Spleen, Kidneys, Lungs, Heart and Stomach.
3) Deficient Blood
• The main manifestations of Emptiness of Blood are a dull, pale face, pale lips, blurred vision, dry hair,
tiredness, poor memory, numbness or tingling, insomnia, scanty periods or amenorrhea, a Fine or Choppy
Pulse and a Pale-Thin tongue.
• Emptiness of Liver-Blood causes blurred vision, tiredness, numbness or tingling and scanty periods.
• Emptiness of Heart-Blood causes pale face, pale lips, a Pale tongue and insomnia.
• Blood is part of Yin and a long-standing Emptiness of Blood gives rise to Dryness, causing dry hair and nails.
• The organs that are most likely to be affected by Blood Emptiness are the Heart, Liver and Spleen.
4) Deficient Yin
• The main manifestations of Emptiness of Yin are a feeling of heat in the afternoon or evening, a dry throat
at night, night sweating, a thin body, five-palm heat a superficial-Deficient pulse and a red tongue without
coating.
• The organs most likely to be affected by Yin Emptiness are the Kidneys, Lung, Heart, Liver and Stomach.
c. Mixed Full-Deficient conditions
• It arise when there is a pathogenic factor but its influence is not very strong, while the body's Qi is
weak and not reacting properly against it. The examples are;
i. Kidney-Yin or Liver Blood deficiency with Liver-Yang rising
ii. Kidney-Yin deficiency with flaring up of Heart Deficient-Heat
iii. Spleen-Qi deficiency with retention of Dampness or Phlegm
iv. Deficiency of Qi or Blood with Blood stasis
v. Kidney-Yang deficiency with Dampness
4. YIN-YANG
•The categories of Yin and Yang within the Eight Principles have two meanings: in a general sense, they are a
summarization of the other six; in a specific sense they are used mostly in Emptiness of Yin and Yang and
Collapse of Yin and Yang.
•Yin and Yang are a generalization of the other six Principles since Interior, Emptiness and Cold are Yin and
Exterior, Fullness and Heat are Yang in nature.
•In a specific sense, the categories of Yin and Yang can define two kinds of Emptiness and also two kinds of
Collapse.
•Collapse of Yin or Yang simply indicates an extremely severe and sudden state of Emptiness. It also implies a
complete separation of Yin and Yang from each other. Collapse of Yin or Yang is often, but not necessarily,
followed by death.
COLLAPSE OF YIN AND YANG
Collapse of Yin Collapse of Yang
S&S Abundant perspiration, a skin hot to the chilliness, cold limbs, weak breathing, profuse
touch, hot limbs, a dry mouth with a desire to sweating with an oily sweat, absence of thirst,
drink cold liquids in small sips, retention of frequent profuse urination or incontinence, loose
urine, constipation, stools or incontinence
Pulse Superficial-Deficient and Rapid pulse Minute-Deep pulse
Tongue Red-Peeled, Short and Dry tongue Pale-Wet-Swollen Short tongue