Ba Gang Diagnosis
Identification of Patterns According to the Eight Principles/Patterns
The Eight Principles is an important basic paradigm in TCM, as it shows the Location and Nature of the imbalance. Using Eight Principles we learn the basic characteristics of the presenting imbalance.
Interior/Exterior indicates the location of the disharmony, not the cause. For example: Diseases caused by an exterior pathogen may begin in the exterior, but in time they may affect the interior (such as the internal organs).
Internal Organs are affected, and is usually due to an internal (emotional) or miscellaneous cause. It is occasionally caused by exterior pathogens that have penetrated into the Interior.
It is important to note that once a disease is in the Interior, it is classified and treated as Interior regardless of its etiology. For example: Exterior Wind Cold may penetrate into the Lung Organ and causes cough with Phlegm, which is an Interior condition.
Symptoms and signs extremely varied according to Organ affected and Hot/Cold and Full/Empty nature.
Exogenous Pathogens produce Exterior conditions that can affect the skin, muscles and channels.
The Two types of exterior conditions are:
1. Those disorders affecting skin & muscles, caused by exogenous pathogen, that have acute onset.
Example: Invasion of Wind-Cold or Wind-Heat into Exterior
Chills with low grade fever or no fever
fear of cold
less painful stiff neck
fear of wind
2. Those affecting the channels (can be acute or chronic)
Example: Bi Syndrome (Painful Obstruction Syndrome) which is where exogenous pathogens (Wind, Damp, Cold) penetrate channels and obstruct the circulation of Qi causing pain.
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Describes the basic nature of the imbalance. The Clinical manifestations depends on whether the condition is Full or Empty.
Full Heat - Excess Heat in the Interior
Main Signs: Fever (sometimes), thirst, red face, red eyes, constipation. Urine is scanty and dark.
Pulse: Rapid and Full
Tongue: Red with yellow coating
Following are some very general signs of Full Heat that may also be present. Exact symptoms depend on Organ(s) affected.
- Raised, red skin eruption that feels hot e.g. acute urticaria
- Any burning painful sensation e.g. urine or stomach pain
- Loss of blood with large quantities of bright red blood indicates Heat in the Blood
- Extreme mental restlessness/manic behavior (Heat in the Heart)
- Thick, yellow, sticky, malodorous secretions/excretions
Full Heat is caused by Excess of Yang energy in body.
Common causes of Full Heat are:
- Too much hot-energy food (influences LIV or ST)
- Long term emotional distress (stagnation of Qi causes Liver or Heart Heat)
- Exogenous pathogen invades body and transforms into Heat once inside body. For Example; Exterior Cold or Heat turns into Heat and settles in Stomach, Lung or Intestines: symptoms may include high fever, sweating and thirst.
Empty Heat - Deficient Yin in the Interior
Main Signs: Afternoon fever or feeling of heat in afternoon, dry mouth, dry throat at night, night sweats, fever in 5 hearts, dry stools, scanty-dark urine, mental restlessness and fidgeting, vague anxiety.
More specific signs depend on Organ involved.
Pulse: Floating-Empty and Rapid or Thin and Rapid
Tongue: Red, in severe cases peeled. No Coating.
Common cause of Empty Heat is Kidney Yin Deficiency, as the Kidneys are the foundation of all Yin energies of body.
Kidney Yin Deficiency can lead to:
- Deficiency of Lung Yin - Malar flush, dry cough
- Deficiency of Liver Yin - Headaches, dry eyes, irritability
- Deficient Heart Yin - palpitations, insomnia and feelings of restlessness.
Kidney Yin Deficiency can be caused by many factors, stress being a major one. Excessive sexual indulgence, overwork, smoking, alcohol and drug abuse, all deplete Kidney Yin. Long-standing emotional distress can cause Liver Qi Stagnation and Heat or deplete the Kidney Yin directly.
Full Cold - Excess Cold in the Interior
Main Signs: Chilliness, cold limbs, no thirst, pale face, abdominal pain worse on pressure but improved by heat, desire for warm drinks, loose stools, profuse clear urine.
Pulse: Deep, Full, and Tight
Tongue: Pale with a thick white coating
Other signs of Full Cold:
- Cold causes Pain by contracting and blocking Qi flow.
- Excess Cold often produces pain, especially abdominal pain.
- Pain is relieved by heat/exacerbated by pressure.
- Anything white, bluish-purple or concave (vs. raised) may be due to Cold.
Example: pale tongue, pale face, white tongue coating, concave v. pale spots on tongue, bluish-purple tongue bluish lips or extremities. Secretions/excretions are thin, clear and watery in Cold conditions.
Excess Cold arises from Excess of Yin.
Common causes of Excess Cold are: Invasion of exterior Cold into Interior
- Stomach: vomiting & epigastric pain
- Intestines: diarrhea/abdominal pain
- Uterus: dysmenorrhea
- Liver channel: swelling/pain in scrotum
All of the above have acute onset
Empty Cold - (Deficiency of Yang)
Main Signs: Chilliness, cold limbs, dull-pale face, no thirst, listlessness, spontaneous sweating, loose stools, profuse clear urination.
Pulse: Deep, Slow, and Weak
Tongue: Pale with thin white coating. May be wet and swollen
Empty (Deficiency) Cold is caused by Deficiency of Yang. This is due to Yang Qi being too weak to warm the body. This is usually related to Deficiency of Yang of Kidney, Spleen, Heart or Deficiency of Lung Qi.
For Example: In Spleen Yang Deficiency, Spleen Yang fails to warm muscles, hence chilliness. Spleen Yang does not transform food, hence diarrhea.
Hot and Cold can exist simultaneously in the body.
For Example: There can be Cold in the Spleen (Deficient Spleen Yang) with Damp Heat in the Bladder (Excess Heat). This pattern may occur because Spleen Yang is insufficient to transform Fluids, which then accumulate, forming Dampness. The Dampness then pervades downward to affect the Lower Burner.
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This is a very important, and distingiushed by:
1. Is a Pathogen Present
2. The Strength of the body's Qi
Full (Excess) Condition:
Pathogen is Present - Interior or Exterior, or stagnation of Qi, Blood or Food.
The Body's Qi is relatively intact.
Empty (Deficient) Condition:
No pathogen is present.
Body's Qi is weak or it is Yin, Yang, or Blood Deficient
Mixed (Deficiency and Excess)
Pathogen is present and body's qi is weak or blood, etc.
Distinguishing Full from Empty:
Full condition produces signs like:
Loud voice, acute disease, restlessness, irritability, severe pain, coarse breathing, pain worse on pressure, high pitch tinnitus, profuse sweating, scanty urination, constipation, whole face red, throwing off bedclothes, Full-type pulse, thick tongue coating
Empty condition produces signs like:
Weak voice, chronic disease, listlessness, lying curled up weak respiration, dull, lingering pain, pain alleviated by pressure, slight sweating, frequent urination, loose stools, low pitched tinnitus, Empty-type pulse, thin tongue coating
NOTE: These signs are too general to be of much use clinically.
Beware of making the distinction of Full/Empty on only one sign. Some signs can be categorized as either Full or Empty depending on their etiology.
- Full: Due to Heat or Stagnation
- Empty: Due to Deficient Blood or Yin
- Empty: Due to Spleen Qi deficiency (not accompanied by heat)
- Full: Urgent/foul with burning
Etiology of Full Conditions
By definition, Full conditions Involve Pathogens
- Exterior Condition: Invasion of pathogenic exterior Cold, Wind, Damp or Heat
- Interior Condition: Cold, Heat, Dampness, Wind Fire or Phlegm
- Interior Pathogen: Also Blood Stasis and Qi Stagnation
Interior pathogens usually arise in the interior, due to malfunction of the internal Organ(s). They can, however, occasionally arise when an exterior pathogen makes its way into the Interior, or when an exterior pathogen weakens the body's Qi so that internal Organs begin to malfunction.
Mixed Full-Empty Conditions
The Full part indicates the presence of a pathogen
The Empty part indicates that the body's Qi is weak and not reacting appropriately to the pathogen.
Examples of Empty conditions complicated with Fullness:
- Kidney Yin Deficiency with Liver Yang Rising
- Kidney Yin Deficiency with Flaring of Deficient Heart Fire
- Spleen Qi Deficiency with retention of Dampness
- Deficiency of Qi with Stasis of Blood
Empty (Deficient) Conditions:
There are four kinds...
- Deficient Qi
- Deficient Yang
- Deficient Blood
- Deficient Yin
Empty (Deficient) Qi: - This is the least severe deficiency.
Signs and Symptoms: Pallor, weak voice, slight daytime sweating, slight dyspnea, fatigue, lack of appetite, weak pulse.
These are primarily signs of weakness of Lung and Spleen Qi. Other signs & symptoms may be present, depending on which other Organs may be involved, esp. Heart or Kidneys
Fatigue, Lack of appetite, abdominal bloating, borborygmus and loose stools over a long period of time.
Tongue: pale and slightly swollen.
Signs are of Spleen Qi Deficiency (not transforming the digestate)
Empty (Deficient) Yang - This is the next stage on from Deficient Qi.
Qi is an aspect of Yang, so Yang Deficiency is similar to Qi Deficiency. However, in Qi deficiency, the function of Qi in transformation has broken down. Yang has the additional function of warming and protecting, so when Yang becomes Deficient, more Cold signs are produced.
Signs: As above for Deficient Qi, plus chilliness, bright pale face, cold limbs, no thirst, desire for warm drinks, loose stools, frequent pale and copious urination, weak pulse, pale and wet tongue.
Organs most often suffering from Yang Deficiency are: Spleen, Kidneys, Lung, Heart, and the Stomach.
Women of 30 suffering from tiredness, chilliness, chronic weakness and pain in the lower back, frequent and pale urination, loose stools.
Pulse: Weak Especially on Right Rear Deep Position
Tongue: Pale, Wet and Slightly Swollen.
Signs are of Deficient Yang of the Spleen and Kidneys
Empty (Deficient) Blood
This can occur when Qi (especially Spleen Qi) is Deficient for a period of time and Qi does not then produce Blood. It can also occur after childbirth, after hemorrhage, or after an illness that weakens Qi or Yin.
Signs: Dull pale face, pale lips, blurry vision, dry hair or skin, depression, fatigue, poor memory, numbness, insomnia, scanty periods or amenorrhea.
Pulse: Fine or Choppy
These signs point to dysfunction of several Organs. When Blood is Deficient, the Organs most often directly affected are the Heart (which moves and governs the Blood) the Liver (which stores the Blood) and the Spleen (which produces Qi and Blood and keeps the Blood in the vessels)
- Deficient Liver Blood: Blurry vision, depression, fatigue, numbness scanty periods
- Deficient Heart Blood: Insomnia, pale face, pale lips, pale tongue
Woman of 27 suffered from fatigue, poor memory, scanty menstruation, constipation and insomnia.
Pulse: Choppy and Fine
Tongue: Pale and Thin
Signs indicate Deficiency of Blood of Liver (scanty menstruation, fatigue, constipation) and of the Heart (poor memory, insomnia)
Empty (Deficient) Yin
This can begin when Blood is Deficient for a long time, since Blood is part of Yin and has the same source. Deficient Yin can also be caused when an Excess Heat condition damages the Yin of the body, by overworking, by excessive indulgence in stimulants, or sexual excess.
Yin has the function of cooling, therefore when Yin is Deficient there are Heat signs. However, these are Empty Heat (since the condition is one of Deficiency of Yin rather than Excess of Yang). Yin also moistens, hence there are signs of dryness when Yin is Deficient.
Signs: Low grade fever or feeling of heat in the afternoon, "five palm heat", dry throat at night, agitated feeling in the afternoon or evening, night sweats, emaciation, malar flush, floating and empty, rapid pulse, and a red peeled and dry tongue
Other signs depend on which Organ(s) are involved. Organs that are most prone to Yin Deficiency are the Kidneys, Heart, Liver, Lung, and Stomach.
A woman of 45 suffered from dizziness, night sweating, soreness of the lower back and slight tinnitus.
Pulse: Fine, and Slightly Rapid
Tongue: Normal with a Rootless Coating
Signs are of Deficiency of Kidney Yin and Stomach Yin
(rootless tongue coating indicates Deficiency of Stomach Yin)
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- Summary of the other six categories
Interior, Empty, Cold is Yin
Exterior, Full, Heat is Yang
- Special Use
Can define two kinds of Emptiness (Deficiency)
Deficient Yin (see above)
Deficient Yang (see above)
Can define two kinds of Collapse
Collapse of Yin
Collapse of Yang
These are very severe Deficient conditions, implying a complete separation of Yin and Yang. Usually followed by death: rarely to be found in clinic.
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