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.
2. the classification of syndromes——Yin or
Yang;
3. the location of disease——exterior or
interior;
4. the nature of disease——cold or heat;
5. 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

 indicatesthe exterior parts of body is

affected by exogenous pathogenic
factors and the disease is in its primary
stage and relatively mild.
Exterior syndrome Battlefield
border
 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.
 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
Battlefield
capital
 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.
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
2. Warm the interior
3. Clear away heat
4. Relieve constipation
5. Promote digestion
6. Reinforce Yang
Identification of exterior and
interior syndrome
Exterior syndrome Interior syndrome

New disease, short duration Old disease, long duration

Fever, aversion to cold, or Fever caused by exogenous

to wind pathogens but without aversion to
cold or to wind; or fever due to
endogenous damages
White thin tongue coat Remarkable change in tongue and
(relatively normal) 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
 Itindicates 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
4. 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
7. 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 Cold
invasion of
pathogenic cold
factor, or depletion
of Yang, or excess
of Yin.
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, Fever, aversion to heat,

preference for warmth 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  Heat syndrome
 Warm to expel cold  Clear away heat and
reduce fire
Main points for distinguishing
between cold and heat syndromes
Manifestation Cold syndrome Heat syndrome

Aversion to cold Aversion to cold, Aversion to heat,

or heat preference for 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 Red tongue, yellow

and moist coating 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 manifestations
1. 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  Deficiency syndrome
 Health Qi is not weak  Health Qi is weak
 Pathogenic factor is
 Pathogenic factor is
strong strong
 pathogenic factors
 Conflict is fierce prevail over health Qi
Main points for distinguishing between
excess and deficiency syndromes
Item Deficiency Excess
Duration of Chronic disease New disease
disease
Constitution Weak Strong, in most
cases
Spirit Listlessness Restlessness
Voice and Low voice, weak Sonorous voice,
breathing breathing coarse breathing
Pain Alleviated by pressure Pain on pressure
Chest and No pain on pressure Aggravated by
abdomen pressure
Distention and Sometimes alleviated Not alleviated
fullness
Fever Burning High fever
sensation in the
chest, palms,
soles, and slight
afternoon fever
Aversion to cold Alleviated by Not alleviated by
warmth warmth
Tongue Flaccid with little Thick coating
or no coating
Pulse Forceless Forceful
Treatment principles
 Deficiency syndrome  Excess syndrome
 replenish  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.
2. Listlessness, lassitude and low voice are the
manifestations of deficiency syndrome.
3. Cold form, chills in the limbs, absence of
thirst, ,foul stools and increased amount of
clear urine are the signs of exterior-cold.
4. 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.
2. Aversion to cold and fever seen at the same
time are characteristics of the exterior
syndrome.
3. Flushed face, restlessness, dry mouth, desire
for drink, short micturition with dark color
urine are the manifestation of heat syndrome.
4. Loud voice, rough breathing, dry stools are
the symptoms of excess syndrome.
5. 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 Malar flushed face,
complexion, feverishness, preference for
heaviness of the body, cold, irritability,
lying in a curled-up restlessness, dry and
posture, lassitude, cracked lips, crimson
listlessness, pale and tongue, yellow or stale-
delicate tongue, moist yellow coating, even dry,
and slippery coating dracked, or dark and thorny
Auscultation Low voice, quietness, tongue
Sonorous voice, irritability,
and olfaction disinclination to talk, polylogia, coarse and
weak breathing, short asthmatic breathing, rattle in
breath the throat, shouting and
yelling
Differentiation between Yin and Yang
syndromes
Yin 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
Palpation Abdominal pain alleviated
by pressure, chills, cold
feet, and deep, faint,
thready, unsmooth, and
forceless pulse
Yang syndrome
Dry or hard stools, or
constipation, stools
with foul smell, no
desire to eat, dry
mouth, irritability,
preference for drinking,
yellow and scanty urine
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 50
disease, Yin and Yang
may be exhausted 40
simultaneously,
 Yin humor is dried up, 30
and Yang is collapsed, Yin
both of them can no 20 Yang
longer support each
other. 10
 Such dissociation of Yin
0
and Yang implies death. normal
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.