TCM- Differentiation of Syndroms According to the 8 Principles (Exam 1)

INTERIOR/EXTERIOR

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. For example, a disease may be caused by an exterior pathogenic factor, but if this is affecting the Internal Organs, the condition will be classified as interior. Therefore, a disease is classified as exterior not only because it is derived from an exterior pathogenic factor but because its manifestations are such that they are located on the Exterior of the body.

Exterior:

The Exterior of the body comprises the skin, muscles and channels. More specifically, the Exterior refers to the space between skin and muscles; this is the space where Defensive Qi and sweat are located and it is also the space that is first invaded by external pathogenic factors. The diagnosis of exterior condition is made on the basis of its clinical manifestations.

When we say that an extrior condition affects the skin, muscles and channels, we mean that these areas have been invaded by an exterior pathogenic factor, giving rise to typical exterior clinical manifestations. However, it would be wrong to assume that any problem manifesting on the skin, is an exterior pattern.

2 Types of Exterior Conditions:
1. Exterior conditions affecting the skin and muscles- caused by exterior pathogenic factor (acute onset)
2. Exterior conditions affecting the channels- slower onset, painful obstruction syndrome

Symptoms of Exterior Pattern
Main Symptoms:	Fever Aversion to Cold Aching Body Stiff Neck	Floating Pulse	Thin tongue coating
Cold: Eg. Wind-Cold	Slight or absent fever Pronounced aversion to Cold Severe aches in the body Severe stiff neck No sweating No thirst	Floating-Tight Pulse	Thin white tongue coating
Heat: Eg. Wind-Heat	Fever Aversion to Cold Slight sweating Thirst Body aches not so pronounced	Floating-Rapid Pulse	Thin yellow tongue coating

The main factors differentiating the Hot or Cold character of an exterior pattern are:

	Hot	Cold
Thirst:	Presence of	Absence of
Pulse:	Rapid	Tight
Fever:	Presence	Absence
Tongue Coat:	Yellow	White

Obstruction of:
Cold:	Usually only one joint is affected Pain is severe and is relieved by application of heat
Wind:	Pain moves from joint to joint
Dampness:	Swelling of the joints
Heat:	Joints are swollen and hot

INTERIOR:

An Interior condition affects the Internal Organs and bones.

A disharmony is defined as interior when the Internal Organs are affected. This may or may not 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.

When an Interior condition begins with an invasion of a an exterior pathogenic factor, the most important symptoms that mark the change from exterior to interior stage are the disappearance of aversion to cold and the onset of aversion to heat.

HOT/COLD

Full Heat:

Any raised, red eruption that feels hot indicates Heat. For example, acute urticaria normally takes this form. As for pain, any burning sensation indicates Heat, for example the burning sensation of cystitis, or a burning feeling in the stomach. Any loss of blood with large quantities of dark-red blood indicates Heat in the Blood. As far as the mind is concerned, any condition of extreme restlessness or manic behavior indicates Heat in the Heart.

Empty Heat:

Again, these are only the general symptoms and signs; others depend on which organ is mostly affected. Empty-Heat frequently arises from deficiency of KD-Yin. Because KD-Yin is the foundation for all the Yin energies of the body, when this is deficient it can affect the Yin of the Liver, Heart and Lungs. A long-standing deficiency of Yin in any of these organs can give rise to Empty-Heat manifesting with various symptoms, such as mental restlessness and insomnia when Heart-Yin is deficient, irritability and headaches when Liver Yin is deficient and malar flush and dry cough when Lung Yin is deficient.

Manifestations and Etiology of Full vs. Empty Heat
	Manifestations	Etiology
Full-Heat:	Thirst, feeling of heat, mental restlessness, red face, dry stools, scanty dark urine Rapid-Full pulse Red tongue with yellow tongue coating	· Emotional problems · Diet (too much red meat, spices, alcohol) · External Pathogenic Factor that has penetrated into the Interior and transformed into Heat
Empty-Heat:	Feeling of heat in the afternoon or evening, dry mouth with desire to drink in small sips, dry mouth at night, night sweating, feeling of heat in the chest, palms and soles, dry stools, scanty dark urine Floating-Empty-Rapid pulse Red tongue with no coating	· Overwork · Irregular eating · Excessive sexual activity · Persistent, heavy blood loss

Comparison between Full-Heat and Empty-Heat
	Full Heat	Empty Heat
Face:	Whole face red	Malar flush
Thirst:	Desire to drink cold water	Desire to drink in small sips
Bowels:	Constipation, abdominal pain	Dry stools, no abdominal pain
Sleep:	Dream-disturbed, very restless	Waking up frequently during the night or early morning
Pulse:	Full-Rapid-Overflowing	Floating-Empty, Rapid
Tongue:	Red with yellow coating	Red and peeled

Clinical Note regarding Full-Heat vs. Empty-Heat
Full-Heat:	Causes severe restlessness, agitation, anxiety and insomnia with agitated sleep
Empty-Heat:	Causes a vague mental restlessness that is worse in the evening, an anxiety with fidgeting, and waking up frequently during the night