The Eight Principal Syndromes

The eight principal syndromes refer to yin and yang, exterior and interior, cold and heat, deficient and excessive syndromes.
Complex as they are, all the signs and symptoms of disease can be generalized according to these eight principal syndromes.
For instance, the type of disease may be classified as yin or yang syndrome; the location and severity of disease can be differentiated as exterior or interior syndrome; pathologic conditions or nature of disease can be divided into cold or heat syndrome; morbid condition of disease can be termed either as deficiency or excess syndrome.
Therefore, the eight principal syndromes serve as the compendium in all the methods of differentiation.
Yin syndrome may generalize the interior syndrome, cold syndrome and deficiency syndrome.
Yang syndrome is a generalization of exterior syndrome, heat syndrome and excessive syndrome.
In this sense, the yin and yang syndromes are the compendium of the eight principal syndromes.
Among them, every syndrome has its own specific symptoms, but they are not isolated and static.
Instead, they are often transformed into one another, and sometimes some false manifestations may occur.
In the course of clinical differentiation, we should, therefore, pay attention not only to differentiation of the symptoms and signs of the eight principal syndromes, but also to their coexistence, transformation, true or false condition.
Only in this way can we make accurate judgement about the disease.
Research and theoretical exploration on differentiating pathological conditions in accordance with the eight principal syndromes by applying scientific technology and methods in addition to the traditional macroscopic and microscopic differentiation in combination.
The laboratory study and theoretical investigation of the eight principal syndromes have offered definite proof of the existence of its patho-physiological fundamentals and scientific basis, thus revealing primarily the real nature of the eight principal syndromes.

Exterior and interior refer to the location of pathologic changes.
The former indicates the superficial while the latter, the internal.
They serve as two of the eight principles to spot the location and measure the severity of a disease.
Exterior and interior are comparatively defined, such as the body, and the zang-organs and fu-organs; the former is defined as the exterior while the latter as the interior.
As for the zang-organs and the fu-organs, the former is the interior and the latter the exterior.
The channels and collaterals are termed as the exterior in comparison with the zang-organs and the fu-organs which are then defined as the interior.
When we make analysis and differentiation of the syndromes according to the two principles of exterior and interior, we may consider a disease as exterior syndrome if the skin, muscular striae, channels and collaterals are affected by pathogenic factors.
We may regard a disease as interior syndrome if it is due to pathologic changes in the zang-organs or fu-organs, blood vessels or bone marrow.
Differentiation of syndromes according to the two principles of exterior and interior plays an important role particularly in the treatment of exopathic febrile diseases.
Its significance lies not only in determining the location and severity of a disease, but also in inferring the tendency of pathological changes.
Generally speaking, a disease in the exterior is superficial and mild; a disease in the interior, deep and serious.
It is regarded as an aggravation of a disease if it develops from the exterior to the interior; otherwise, it is considered as a subsidence of a disease.
Accurate differentiation of the exterior and the interior syndromes can help us to keep informed on the development of a disease and find out the proper treatment so as to obtain a satisfactory effect.

Exterior syndrome indicates signs and symptoms of the invasion of the body surface by exopathic factors.
It is usually seen in the initial stage of exopathic febrile diseases, exterior syndrome is characterized by a sudden onset, superficial location, mild symptoms and short course.
The lodging of "six exopathogens" (wind, cold, summer-heat, dampness, dryness and heat) in the body surface will obstruct the normal dispersion of defensive qi.
As a result, the vital qi rises in resisting against pathogenic factors, so a series of clinical manifestations of exterior syndrome will occur.
It is typically manifested as fever and aversion to cold, headache and general aching, thin and white tongue coating, floating pulse, accompanied with stuffy running nose, itching of the throat, cough and so on.

Interior syndrome indicates signs and symptoms of pathological changes in the interior of the body, and dysfunction of qi and blood in the zang-organs and fu-organs.
It is usually seen in the middle or late stage of febrile diseases and miscellaneous diseases due to internal injury, it is characterized by complicated causes, deep location, severe condition and long course.
Interior syndrome covers a wide range of diseases except exterior syndromes.
It is caused by the invasion of the zang organs and fu-organs by exopathogens after they are transmitted into the interior, or by the direct attack of the zang-organs and the fu-organs by exopathogens, or by dysfunction of the zang-organs and fu-organs, and the adverse flow of qi and blood due to stimulation of the seven emotions, irregular diet and overstrain.
The causes of interior syndrome are complex, its locations are not limited and their clinical manifestations are various.
It usually occurs with intermingled cold and heat, deficient and excessive syndromes.
Here we will discuss its specific manifestation in the elaboration of other differentiations.
Few common symptoms and signs, such as high fever, irritability or coma, thirst, abdominal pain, constipation or diarrhoea, vomiting, scanty dark urine, thick tongue coating and deep pulse.

Cold and heat are two of the eight principles in analyzing and differentiating the nature of pathological conditions.
Cold syndrome and heat syndrome reveal the excessive state or the deficient state of yin and yang.
Excess of yin or deficiency of yang will lead to cold syndrome; excess of yang or deficiency of yin to heat syndrome.
Therefore, it is said: "Cold and heat syndromes are manifestations of yin yang changes."
When making analysis and differentiation of cold and heat syndromes, we should draw our conclusions on the basis of analyzing and generalizing all the symptoms and signs acquired from various diagnostic methods, instead of judging merely by particular and isolated symptoms, Cold and heat syndromes reflect the pathologic nature of a disease.
To put it more concretely, cold syndrome generalizes symptoms and signs of cold manifestations, while heat syndrome generalizes those of the heat ones.
However, cold and heat syndromes are different from cold and heat manifestations.
As superficial phenomena, the manifestations are sometimes contrary to the nature of a disease, thus forming pseudo-cold or pseudo-heat manifestations.
For instance, pseudo-heat manifestations may occur in the case of cold syndrome; pseudo-cold ones may occur in the case of heat syndrome.
On the whole, the nature of a disease usually consists with the phenomena manifested in the course of its development, that is, heat syndrome is shown as heat symptoms, and cold syndrome as cold symptoms.
An accurate analysis and differentiation of cold syndrome and heat syndrome provide the basis for establishing the therapeutic principle.

Cold syndrome indicates that the pathogenic conditions of a disease are cold in nature, usually caused by affections of pathogenic cold.
Or by deficiency of yang and excess of yin in body, or impairment of yang due to prolonged illness.
Cold syndrome is further divided in to exterior cold syndrome and interior cold one according to its location,
The former is due to the invasion of the body surface by pathogenic cold and the consequent obstruction of defensive yang, characterized by serious aversion to coldness, mild fever without sweat headache and body ache, thin white coating of the tongue, floating and tense pulse.
The latter is caused by an attack on the internal organs by pathogenic cold, or by loss of warmth due to insufficiency of yang, typically marked by intolerance of cold, cold limbs, pale complexion, tastelessness, profuse salivation, copious clear urine, loose stool, pale tongue with whitish moist coating, deep and slow pulse.

Heat syndrome indicates functional hyperactivity of the body, arising from affection of pathogenic heat, or fire transformation from disorder of the five emotions, and hyperactivity of yang due to deficiency of yin.
Excessive yang-heat, or the failure of yin to counter against yang due to insufficiency of yin-fluid and functional hyper activity of the body can lead to a series of clinical manifestations of heat syndrome.
It is classified as exterior heat syndrome and interior heat syndrome.
Resulting from the invasion of the body surface by pathogenic heat, exterior heat syndrome is typically shown as fever, slight aversion to wind-cold, dryness of the mouth, slight thirst, often sweating, or as cough, sore throat, red tip and borders of the tongue, floating and rapid pulse.
Interior heat syndrome indicates excessive heat in the interior, or internal heat due to deficiency of yin and functional hyperactivity of the body, manifested as flushed face, fever, coma, restlessness, anxiety, thirst, preference for drinking, scanty dark urine, constipation, red tongue with yellowish coating and rapid pulse.

In the critical stage of certain diseases, some false manifestations contrary to the nature of the disease may occur.
Symptoms and signs of heat type may be present in a certain stage of cold syndrome, and vice versa.
In other words, extreme cold resembles heat, and extreme heat resembles cold known also as cold syndrome with pseudo-heat manifestations, and syndrome with pseudo-cold manifestations.
With real coldness in the interior and pseudo-heat in the exterior, cold syndrome with pseudo-heat manifestations in shown as fever, floating redness on the face, thirst, and large pulse, all of which look like heat syndrome.
However, further observation will reveal that the patient prefers warmth and hot drinks although he runs a fever and feels thirsty, with his face intermittent hectic flush, his pulse large and deep without strength, accompanied with cold limbs, copious clear urine, loose stool, pale tongue proper with whitish coating and other manifestations of excessive yin-coldness in the interior.
In this case, the manifestations of heat type are deceptive because the disease is caused actually by excess of yin due to yang insufficiency.
It is also called yang kept externally by excessive yin-cold in the interior since it is caused by the floating of asthenic yang.
Heat syndrome with pseudo-cold manifestations indicates real heat in the interior and pseudo-cold in the exterior.
It is shown as intolerance of cold, cold limbs, diarrhoea, black coating of the tongue and deep pulse, all of which simulate cold syndrome.
But careful examination will prove that the patient is averse to warmth with burning sensation in the chest and the abdomen, diarrhoea, stool with fetid odour or intermingled with hard fecal mass, dry and black coating of the tongue, deep but forceful pulse, all of which are concomitant with dry throat, foul smell in the mouth, preference for cold drink, deep red tongue proper, scanty dark urine, or delirium and coma in serious cases.
In this case, the cold phenomena are pseudo while heat in the interior is the true nature of the disease.
Heat syndrome with pseudo-cold manifestations is caused mainly by excessive heat in the interior and the failure of yang qi to reach the limbs due to internal stagnation of yang qi, or by excessive yang in the interior which keeps yin externally.
Therefore, this syndrome is also defined as “yin is kept externally by the excessive yang inside the body”.
It is necessary to understand the whole course of a disease when we differentiate cold syndrome with pseudo-heat manifestations from heat syndrome with pseudo-cold manifestations.
The former often occurs to patients with cold syndrome history; in other words, cold syndrome with pseudo-heat manifestations is preceded by cold syndrome with later development of heat phenomena.
The latter usually occurs to patients with heat syndrome history; that is, cold manifestations are preceded by heat syndrome with later development of cold phenomena.
Moreover, while pseudo manifestations are often found in the limbs, skin or complexion, the true nature of a disease is seen in changes of the zang-organs, fu-organs, qi, blood and body fluid.
So interior syndrome, tongue and pulse conditions should be treated as our chief basis for analysis and differentiation of a disease.
As for its manifestations, false ones do have some differences from the real ones.
For example, the patient flushes all over his face in the case of true heat syndrome, but tender pink colour only appears on his cheeks intermittently in the case of pseudo-heat syndrome.
The symptoms of cold limbs accompanied with an inclination to huddle up in bed with a desire to be covered with clothes are found in true syndrome, but in the case of pseudo-cold, the symptoms are burning heat over the skin of the chest and the abdomen, and no desire to the cover of clothes.

Deficiency and excess are two of the eight principles to differentiate the prosperity or decline of pathogens and the vital qi.
Deficiency refers to the deficiency of the vital-qi.
Excess to the excess of pathogenic factors.
In the course of this differentiation, deficiency syndrome refers to symptoms complex indicating weakness of the vital-qi when pathogenic factors are not exuberant; excess syndrome, to symptoms complex indicating a fierce conflict between excessive pathogenic factors and the vital-qi which has not fallen into decline.
The choice between tonification and draining based on the analysis and differentiation of deficiency or excess of a disease, and on the understanding of the state of the vital qi in conflict with pathogenic factors.

It covers pathologically all the clinical manifestations of insufficiency of the vital-qi.
It usually arises from impairment of yin, yang, qi, blood, body fluid, essence, marrow and the zang-organs and fu-organs caused by congenital insufficiency, malnutrition after birth and impairment of diseases.
It has been proved by modern research that deficiency syndrome occurs as a morbid state due to hypo function of cardiac muscle, slow heart rate, insufficient circulation volume, a drop in blood pressure and hypo metabolism which results from the hypo function of the nerve, or nerve depression, and abnormally increased tension of the parasympathetic nerves.
This syndrome, according to the recent discovery, is also closely associated with the function of thyroid and abnormal level of trace element in blood serum.
Deficiency syndrome covers a wide range of deficiency of qi, deficiency of blood, asthenia of yang, yin and the five zang-organs.
With a variety of clinical manifestations, it commonly characterized by a weak constitution, lassitude, feeble voice, pain relieved by pressure, tender tongue proper with thin or little coating and feeble pulse.
In clinical practice, it is often classified as exterior syndrome of deficiency, and interior syndrome of deficiency.
The former refers not only to exterior syndrome of deficiency in exopathy caused by affection of pathogens wind and marked by aversion to wind, perspiration, floating and relaxed pulse, but also to exterior syndrome of deficiency caused by deficiency of the lung-qi and spleen-qi, the failure of defensive qi to protect the body against diseases on account of the loosened integument and musculature, and marked by frequent spontaneous perspiration.
This syndrome is characterized by frequent attack of cold and manifestations of exterior syndrome, accompanied with malaise, dyspnoea on exercise, poor appetite, loose stool, thready and feeble pulse.
Deficiency of the zang-organs and fu-organs, yin and yang, qi and blood all pertains to the deficiency syndrome of interior which is really rich in content.
If differentiated in accordance with the property of cold and heat, deficiency syndrome of interior is classified as asthenic cold and asthenic, heat.
Asthenic cold is also termed insufficiency of yang as it arises from deficiency of yang qi and the consequent development of coldness in the interior.
Asthenic heat is also defined as deficiency of yin because it indicates fever of deficiency type due to insufficiency of yin-blood and the consequent failure of yin to keep yang well.
The clinical manifestations of these two syndromes may also be referred to in the introduction of "deficiency of yin and deficiency of yang" given in differentiating syndromes according to the state of yin in and yang.

It generalizes various syndromes due to exopathic affection or due to accumulation of pathogenic factors inside the body.
Usually short in its course, this syndrome is often seen in the initial stage or middle stage of the disease
Its manifestations vary greatly with different pathologic factors and pathological products.
Generally speaking, the patient with excess syndrome often looks well developed with strong constitution, full of vigour, speaking in a loud voice, and pains with tenderness, shrivelled tongue with thick coating, and forceful pulse.
Common types of excess syndrome are exterior syndrome of excess, cold syndrome of excess, and heat syndrome of excess.
Exterior syndrome of excess arises from a struggle between the vital-qi and pathogenic factors, the obstruction of the body surface due to invasion of exopathic factors, and accumulation of yang qi on the body surface.
In addition to symptoms and signs of exterior syndrome, it is also manifested as no sweating, headache, body ache, floating and tight pulse.
Most of its symptoms are similar to those of exterior syndrome of cold due to exopathic cold.
Cold syndrome of excess (or sthenic cold) arises from affection of pathogenic cold.
The obstruction of yang-qi resulting from excessive pathogenic coldness leads to aversion to cold, cold limbs, pale complexion, abdominal pain and tenderness, constipation, or diarrhoea, profuse sputum, cough and dyspnoea, tastelessness, profuse spittle, copious clear urine, whitish and moist fur or thick and greasy fur, slow or tense pulse.
Heat syndrome of excess (or sthenic heat) occurs as a result of the invasion of the interior of the body by yang-heat.
Consumption of the body fluid by excessive pathogenic heat causes high fever, fidgets, thirst, flushed face, congested eyes, unconsciousness, delirium, abdominal distension, pain and tenderness, dry stool, dark urine, yellow thick or greasy coating of the tongue, full and rapid pulse or slippery and rapid pulse.

As the guideline of the eight principal syndromes, yin and yang serve as the general principle to classify all the syndromes.
This differentiation includes yin syndrome, yang syndrome.
Deficiency of yin and insufficiency of yang, yin depletion and yang depletion.
They are explained respectively as follows.

Symptoms conforming to the general attribute of yin are called yin syndrome, such as, interior syndrome, deficiency syndrome and cold syndrome according to the diagnostic principle of the eight principal syndromes.
There are many manifestations in yin syndrome, and the common ones are: dull complexion, listlessness, heavy sensation of the body, an inclination to huddle up in bed, intolerance of cold, cold limbs, weariness, low and timid voice, anorexia, loose stool, copious clear urine, thick, tender and pale tongue, deep slow or feeble or uneven and thready pulse.
Symptoms conforming to the general attribute of yang are defined as yang syndrome, such as exterior syndrome, excess syndrome and heat syndrome according to the diagnostic principle of the eight principal syndromes.
With a variety of clinical manifestations, it is commonly characterized by flushed face and congested eyes, chills and fever, fidgets, dyspnoea, loud voice, dry stool, dark urine, deep red tongue with dry and yellow fur, floating and rapid pulse, full or slippery and replete pulse.

Deficiency of yin indicates fever of deficiency type due to insufficiency of yin essence and the consequent failure of yin to suppress yang.
The relative excessiveness of yang-qi and the flaring-up of asthenic fire result in emaciation, dry throat, vertigo, blurred vision, palpitation, insomnia with feverish sensation in the chest, palms and soles, hectic fever, night sweating, flushing of zygomatic region, red tongue with little fur, thready and rapid pulse.
Insufficiency of yang indicates the failure of yang to suppress yin due to exhaustion of yang.
Dysfunction of transforming and warming up on account of yang deficiency leads to relative excess of yin and cold of deficiency type in the interior.
Such symptoms as listlessness, fatigue, short breath, disinclination to talk, inclination to huddle up in bed, sleepiness, intolerance of cold, cold limbs, tastelessness, not thirsty, or preference for hot drinks, clear urine, loose stool, pale complexion, plump pale tongue, deep, slow and feeble pulse.

Both syndromes indicate a danger of extreme exhaustion of yin essence or yang-qi.
In such cases, delayed treatment may cause death.
As yin and yang are related to each other, depletion of the former may give rise to that of the latter.
Depletion of yang can also consume yin-fluid.
Modern research holds that depletion of yin and yang will finally turn into reduction of effective circulation blood volume, hypoxia, and acidosis, thus endangering life.
Depletion of yin shows severe consumption of yin-fluid, and its impending exhaustion caused by metabolic disorder of the body fluid resulting from high fever, profuse sweating, severe vomiting and severe haemorrhage.
Depletion of yin is present in the case of domination of heat or in the case of deficiency of yin.
Internal disturbance by heat of deficiency type due to exhaustion of yin in brings about sweating of hot and sticky perspiration, fever, hot limbs, fidgets, short breath, desire for cold drinks, dry lips and tongue, wrinkled skin, scanty urine, dry tongue with little saliva, thready, feeble and rapid pulse and other signs and symptoms of heat of deficiency type due to exhaustion of the body fluid.
Depletion of yang indicates impending exhaustion of yang inside the body.
Since exhaustion of qi results from exhaustion of the body fluid, depletion of yang often occurs after profuse sweating, vomiting, diarrhoea and heavy haemorrhage.,
A constitution with insufficient yang or excessive cold may also lead easily to depletion of yang.
As yang-qi is feeble, unable to consolidate, the following symptoms will show up: profuse cold sweating of tasteless, sticky sweat, cold body, chills, weariness, weak breathing, and tastelessness in the mouth, no thirst, pale complexion, moist and pale tongue, and barely palpable pulse.

Login In