DIFFERENTIAL DIAGNOSIS ACCORDING TO EIGHT PRINCIPLES

I. DIAGNOSIS ACCORDING TO EIGHT PRINCIPLES: Fundamental nature and location of Disease

A. YIN AND YANG

Differential Diagnosis according to Eight Principles gives three sets of specific polarities with which to judge the exact nature of the Yin relative to the Yang and vice versa. This implies treatment according to the Doctrine of Heteropathy; that Yin is treated with Yang, and Yang with Yin

B. INTERIOR/EXTERIOR

1) Location: Interior/Exterior-

first priority: where is the disease? If chills and fever, or in muscles the disease is exterior, and is considered wind; if it affects the organs, the disease is considered interior.

a) Exterior
- Nature: Hot or Cold

a) Wind Heat - Quality: always excess
b) Wind Cold- Quantity: Excess or Deficient

a) Interior-
-Nature: Hot or Cold

-Quantity: Excess or Deficient
further location:

  

1) Qi, Blood or Fluids affected

2) Zang Fu affected

3) Five Element differentiation

4) Fever Level ( Six Phases, Four Levels)

C. HOT/COLD ( Nature of Disease)

a) Location

1. Exterior

-Wind Heat

-Wind Cold

-Wind Damp in Channels with Heat or Cold

2. Interior

- reflects accumulation of hot or cold

- Heat Excess/ Heat Deficiency and further location:

1) Vital Substances; nature of pathogen implies threat to substances

2) Zang Fu

3) Fever Level

4) Five Element

D. EXCESS/DEFICIENCY

- Measures the ability of the Qi to respond to the pathogen; the more Qi, the stronger the response. Excess implies acute, shorter term: The Qi is strong, the pathogen is strong- the proper method is attack. Deficiency implies chronic; some damage has already been done to organ function- treatment method must include supplementation ( tonification).

1). Vital Substances: Excess or Deficiency of Vital Substances

1. EXCESS

a) Vital Substances- Reflect stagnation; Always Excess, but may arise from Pathogenic Excess or organ hypofunction (Deficiency)

Sx: Pain of sudden onset, aggravated by pressure, and relative severity of all symptoms- high fever, strong pain, severe nausea, vomiting, etc.

2. DEFICIENCY

a) Vital Substances- Deficiency always reflects

functional deficiency; Vital substances unable to perform their respective functions- e.g. Qi unable to warm, transport, etc.,

Sx: weakness, fatigue, shortness of breath, spontaneous perspiration; chronicity of symptoms

b). Pathogen

Pathogens can accumulate either from exterior invasion, or from organ hyperfunction

1) -Excess heat (RE)-High fever, redness, damage to BF thickening of secretions, putrid smell

-Deficiency heat (YIN XU)- weakness and heat: aggravation of heat symptoms at night

2) Excess Cold ( HAN )- differentiated by pain

-Deficiency Cold (YANG XU)- failure of Yang of Spleen  and Kidney; leads to accumultion of BF
and further location:

1) Zang Fu

2) Five Element disharmony

3) Stage of fever ( Each Phase has a relative excess, relative deficiency)

E. YIN AND YANG

1. Yin Deficiency

a. Symptoms: WEAKNESS, HEAT, HEAT SX WORSE P.M.

Nightsweats, malar flush, "tidal" fever, "Five hearts" heat thirst and dryness, dry throat, fatigue, insomnia nightly disturbances: nocturia insomnia

Heat signs: flushing up, chronic sore throat, irritability pulse: empty: rapid and thready

Tongue: small and red, possibly with geographic peeling, or with small horizontal cracks. Maciocia says No coat is definitive.

b. Etiology

1) Heat pathogen damages yin fluids

Exogenous or Endogenous (Anxiety)

2) Blood loss

3) Loss of Essence
- disease

- childbearing

- excessive life style

4) Constitutional weakness

c. Physiology

1. Kidney is the root of Yin, relies upon the tight storage of Essence, supported by Post Heaven Essence. Fuels

Kidney Yang.

Kidney Essence supports Liver Blood. If Liver generates too much heat (Yang), it can not store blood, and becomes

Blood (Yin) Deficient.

Damage to Fluids in San Jiao can damage YIN. Lung becomes dry through Heat pathogen or Qi deficiency (Failing to "regulate Water metabolism": Pores)

Stomach ("Upper Gate" to Kidney) is the "Source of Fluids"; Stomach becomes dry through Hot diet,

systemic loss of fluids, poor spleen transformation

Kidney Yin deficiency: Deficiency heat ( night time fever, malar flush, sweats, etc.)

- with fire flaring up: Sore throat, insomnia,

deficient Stomach fire

Stomach Yin Deficiency: Thirst. poor appetite

Lung Yin Deficiency: dry cough, fatigue, sweats, dry sore throat, thirst

Heart Yin Deficiency: flushing, sweating, palpitations,

insomnia, Shen disturbance

Liver Yin Deficiency: Blood deficiency leading to Liver Wind

2. Yang Deficiency

a) Symptoms: WEAKNESS AND COLDNESS, WATER

BUILD-UP
Fatigue, cold limbs, cold abdomen, urinary-genital weakness, abdo pain, low-back pain, chronic diarrhea, edema; the more pain or discomfort, the more "Accumulation" of cold.

Yang Xu, cont.,

tongue: pale, flabby, moist pulse: Deep, slow soft, weak

b) Etiology:

1) Constitutional weakness: Ming Men fails to thrive

a) Poor post-heaven: poor diet leads to spleen Qi deficiency

c) Physiology:

Kidney is the Root of Yang, depends on Essence to fuel Ming Men Fire to produce Warm Transformation in the San Jiao. Fire is unable to govern water and Yin predominates, leading to poor transformation and transportation. Yin dominates Ming Men fire leading to accumulation of cold and fluids.

Upper Jiao: phlegm cough with abundant sputum, fatigue, perspiration, s.o.b., coldness, weak wei qi

•  

• Heart: Chest pain or discomfort, abundant perspiration,s.o.b., cyanosis of fingers, lips, fatigue, worse with excercise
•   
• Lung: Lung has no syndrome of Yang deficiency, but failure of lung Qi leads to cold
• Middle Jiao (Spleen): fatigue, cold limbs, coldness, lack of appetite, lack of thirst, watery diarrhea, digestive weakness, thirst only for warm drinks, 
•  
• Lower Jiao (Kidney): Edema below the waist, abundant urination,weak cold low back, incontinence, impotence, loss of libido, weakness, exhaustion

 II. TREATMENT PRINCIPLES ACCORDING TO EIGHT PRINCIPLES

A. LOCATION

1) Exterior

a) Wind Cold- Release Exterior with warm acrid substances-

- Warm and activate the Yang

b) Wind Heat- Release Exterior with Cooling acrid substances-

  

-Clear Heat and toxin

c) Wind Cold Deficient –Harmonize Ying and Wei B. PATHOGEN (HOT/COLD)

1. Interior

a) Heat

Excess- Clear Heat

• Quell Fire
• Eliminate Toxin
• Clear Damp-Heat ( Clear Heat/Dry Dampness)
• Cool the Blood
• Clear Summer Heat
• Purge and drain downward
• Deficient- Nourish Yin
• Drain Kidney Fire

b) Cold

• Excess- Expel Cold/Warm Interior
• Deficient- Supplement Yang
• Restore Yang

c) Wind

 Excess- Subdue Liver Wind

• Clear Extreme Heat
•  Subdue Liver Yang
•  Restore Consciousness

 Deficient- Nourish Kid and Liv Yin

•  Nourish Liver Blood

  

d) Dampness

Excess- Disperse (Transform) dampness

•  Transform phlegm
• Soften hardness
• Reduce sores and Disperse abcess
• Eliminate food stagnation

Deficiency- Supplement Spleen

•  Strengthen the center
•  Warm the Yang
•  Tonify Kidney
•  Promote urination

  

e) Dryness

•  Excess- Expel Wind
•  Clear Heat
•  Deficiency- Generate Fluids
•  Nourish Yin
•  Nourish Blood

 f) Summer Heat

• Excess- Drain Summerheat
• Clear Heat
• Cool the Blood
• Clear heat/transform damp
• Deficiency- Supplement the Spleen
• Nourish the Yin

 C. EXCESS AND DEFICIENCY

 1. VITAL SUBSTANCES

a) Qi

 Excess- Dissolve Stagnation

•  Redirect Qi
• Unblock Qi
• Harmonize
• Spread Liver Qi
• Deficiency- Tonify Qi
• Supplement the Spleen
• Tonify Kidney
• Tonify Yang
• Restore Yang
• Astringe Body Fluids
• Tonify Yin

b) Blood

Excess-

Dissolve Stagnation:

•  -Invigorate Blood
• -Dispel stasis
• Reduce (Dissolve Masses)
• Relieve Pain
• Promote menstruation
• Cool the Blood

 Deficiency-

•  Nourish the Blood
• Tonify the Heart/ Calm the Spirit
• Nourish Yin
• Tonify Kidney Yin
• Tonify Spleen Qi

 c) Body Fluids

Excess

•  Transform damp
•  Expel Wind Damp
•  Unblock urination
• Promote Diaphoresis
• Clear Heat/Transform Damp 

Deficiency

• Tonify Spleen (Lung or Kidney)
•  Warm the Yang
•  Promote Urination
•  Astringe Body fluids
•  Nourish Yin/ Generate fluids