2 Relationship between different pairs of principles
In the eight principles, external and internal, cold and heat as well as asthenia and sthenia generalize the nature of diseases from the aspects of the location and nature of diseases as well as the conditions of the healthy qi and pathogenic factors. However, different aspects of the nature of diseases are inter-related. For example, cold and heat nature of diseases as well as the predominant and deficient states of healthy qi and pathogenic factors cannot exist independent of the external or internal location of diseases; accordingly, external syndrome or internal syndrome cannot exist independent of cold and heat as well as asthenia and sthenia nature of diseases. The inter-relation between the internal and external, cold and heat as well as asthenia and sthenia may bring about various syndromes. The following is a brief discussion of the major ones.
2.1.5.2.1 External cold syndrome
External cold syndrome refers to the symptoms of exogenous disease at the primary stage caused by pathogenic wind and cold attacking the surface of the body.
Clinical manifestations- Severe aversion to cold, light fever, pain of head and body, stuffy and running nose, no sweating, whitish thin and moist tongue fur, floating and tense pulse.
Analysis of symptoms: Aversion to cold is due to pathogenic cold attacking the superficies and stagnating yang in the superficies; fever is due to healthy qi fighting against pathogenic factors; pain of head and body is due to pathogenic cold stagnating the meridians and preventing meridian qi from free flowing;stuffy and running nose is due to failure of the lung to disperse; no sweating is due to obstruction of the muscular interstices by cold which tends to contract; whitish thin and moist tongue fur as well as floating and tense pulse are signs of pathogenic cold encumbering the surface of the body.
2.1.5.2.2 External heat syndrome
External heat syndrome refers to symptoms of exogenous febrile disease at the primary stage caused, by wind and heat attacking the surface of the body.
Clinical manifestations. Fever, slight aversion to wind and cold, headache, or sweating, slight thirst, swelling sore-throat, red margin and tip of tongue, whitish thin tongue fur or yellowish thin and dry tongue fur, floating and fast pulse.
Analysis of symptoms. Slight aversion to cold and fever are due to wind and heat attacking the surface of the body and the fact that heat is a pathogenic factor of yang nature; headache and swelling sore-throat are due to upper disturbance by pathogenic heat;sweating is due to upper floating of pathogenic heat that loosens the muscular interstices; slight thirst is due to mild impairment of body fluid by pathogenic heat; red margin and tip of tongue as well as floating and fast pulse are signs of wind and heat attacking the surface of the body.
2,1,5.2.3 External sthenic syndrome
External sthenic syndrome refers to symptoms of exogenous disease at the primary stage caused by pathogenic cold attacking the surface of the body. This syndrome is marked by severe aversion to cold, no sweating and floating and tense pulse, also known as external sthenic syndrome of cold attack which is discussed in the section of external cold syndrome.
2.1.5.2.4 Extemal asthenia syndrome
External asthenia syndrome usually refers to two kinds of syndromes. One is the external syndrome caused by exogenous wind attack and marked by aversion to wind, spontaneous sweating and floating and moderate pulse. This syndrome is called exogenous external asthenia syndrome as compared with external sthenia syndrome of cold attack marked by severe aversion to cold, no sweating and floating-tense pulse. The other is external asthenia syndrome of internal impairment caused by loose-hess of weiqi resulting from asthenia of pulmonary and splenic qi.
Clinical manifestations: Light fever, aversion to wind, headache, sweating, whitish thin tongue fur, floating and moderate pulse, or frequent spontaneous sweating, susceptibility to common cold, accompanied by pale complexion, lassitude, shortness of breath, asthma right after movement, poor appetite, loose stool, pale tongue with white fur and thin and weak pulse.
Analysis of symptoms: Fever, sweating and aversion to cold seen in exogenous external asthenia syndrome are due to disharmony between weiqi and yingqi and looseness of muscular interstices resulting from pathogenic invasion of the surface of the body by wind which tends to open and outburst; headache is due to wind attacking the superfices and inhibited flow of meridian qi; whitish thin tongue fur and floating and moderate pulse are signs of pathogenic wind lingering in the surperficies. In external asthenia syndrome of internal impairment, frequent spontaneous sweating and susceptibility to common cold are due to looseness of muscular interstices and weakness of weiqi and yingqi due to qi asthenia in the lung (which governs skin and hair) and the spleen (which governs muscles). The lung governs qi and manages respiration; while the spleen governs transformation and transportation; both of The which are the production source of qi and blood. Asthenia of pulmonary and splenic qi and hypofunction of the lung
and the spleen lead to such symptoms like pale complexion, lassitude, shortness of breath, asthma right after movement, poor appetite, loose of stool, pale tongue with
white fur as well as thin and weak pulse, etc.
2.1.5.2.5 Internal sthenic cold syndrome
Internal sthenic cold syndrome refers to symptoms of internal exuberance of yin cold frequently caused by invasion of pathogenic yin cold into the viscera, or excessive intake of uncooked and cold food which stagnate yangqi.
Clinical manifestations: Clinical manifestations are various due to difference in causes. The usual ones are cold limbs, pale complexion, moist mouth without thirst, or thirst with preference for hot drinks, unpalpable pain of
abdomen, clear and profuse urine, loose stool, whitish moist tongue fur as well as deep and slow pulse or deep and tense pulse.
Analysis of symptoms: Cold limbs and pale complexion are due to invasion of pathogenic cold into the viscera which stagnates yangqi and deprives the body of warmth; moist mouth without thirst, or thirst with preference for hot drinks and profuse clear urine are due to internal exuberance of yin cold and non-impairment of body fluid; unpalpable pain of abdomen is due to stagnation of yin cold and inhibited movement of qi; loose stool is due to pathogenic cold stagnating gastrosplenic yang and failure of the spleen to transport and transform; whitish moist tongue fur and deep and slow pulse or deep and tense pulse are signs of internal cold.
2.1.5.2.6 Internal asthenia cold syndrome
Internal asthenia cold syndrome refers to symptoms of deficiency of yangqi which is discussed in the section of yang asthenia syndrome.
2.1.5.2.7 Internal sthenic heat syndrome
Internal sthenic heat syndrome refers to symptoms of
internal exuberance of pathogenic yang heat usually caused by internal invasion of pathogenic yang heat, or by pathogenic cold transforming into heat and invading the interhal, or by emotional impairment and emotional transformation of fire, or by improper diet which accumulates into heat.
Clinical manifestations: The clinical manifestations are various due to difference in causes. The usual ones are flushed complexion and somatic fever, aversion to heat and preference for cold, thirst with preference for cold drinks, restlessness, or even coma with delirium, yellowish thick sputum and snivel, vomiting blood and epistaxis, unpalpable pain of abdomen, scanty brownish urine, retention of dry feces, reddish and dry tongue, yellowish tongue fur, full pulse, or slippery pulse, or fast and sthenic pulse.
Analysis of symptoms: Flushed complexion and somatic fever as well as aversion to heat and preference for cold are due to exuberant internal heat fumigating the exterior; thirst with Preference for cold drinks, dry tongue and yellowish urine are due to heat consuming body fluid; heat disturbing heart spirit may lead to restlessness in mild case and coma with delirium in severe case; yellowish thick sputum and snivel is due to heat scorching body fluid; hematemesis and epistaxis are due to heat impairing blood collaterals and driving blood to extravasate; unpalpable abdominal pain and retention of dry feces are due to retention of heat in the intestines and stagnation of intestinal qi; reddish tongue with yellow fur and full, slippery,fast and sthenic pulse conditions are signs of internal heat.
2.1.5.2.8 Internal asthenia heat syndrome
Internal asthenia heat syndrome refers to symptoms of consumption of body fluid which is discussed in the section of yin asthenia syndrome.
