Eight Principals

The Eight Principles, or Ba Kang are the classifications of illness according to the following 4 questions:

• Is it Yin or Yang? (overall quality of the disorder)
• Is it Interior or Exterior? (depth of disease)
• Is it Cold or Hot? (nature of disease)
• Is it Deficiency or Excess? (strength of disease verses resistance to it)

The eight principals are divided into two categories, Xu and Shi:

Xu-Yin-Interior-Cold-Deficiency

Shi-Yang-Exterior-Hot-Excess

These four broad polarities give a conceptual picture of the disorder, and suggest a rational basis for treatment.  

Once this basic diagnostic has been applied, other diagnostic methods are applied.  It must always be remembered that diseases are complex and ever changing.  Sometimes, two different or even contradictory symptoms will appear simultaneously.  As the disease progresses, the symptoms may move from one parameter to another.  It is important to monitor the changes and tailor the specific treatment to fit the patient at that time.

The treatment is continually adjusted and modified as the disease evolves.

Interior-Exterior

This is the primary location of the disease.  Diseases evolve in primarily one of two ways.

1. The Yin-Yang balance is disrupted, these are always interior diseases.  Interior in this case is defined as the Internal Organs.
2. Excess enters the body from the outside and the body reacts to it.  These are always exterior diseases.  These diseases can often become interior diseases if left untreated.  Exterior in this case is defined as the skin, flesh and channels.

These two processes are not mutually exclusive.  In fact, if there is no weakness in the body's exterior defenses, no Excess can penetrate.

Exterior symptoms include:

• chills
• fever
• headaches
• sore limbs
• running nose
• coughing
• sore throat
• floating pulse

Exterior diseases tend to attack the skin or nose, which are both related to the lungs.  If the excess succeeds in penetrating these defenses, there must be a weakness in the protective Qi.  Chills can result, which is the definitive symptom of exterior disorders.  Sweating is an important indicator in the strength of the protective Qi.  If the excess is in the outer and head parts of the channels, headaches and soreness will result.  This is also reflected in the floating pulse.

Exterior Cold

• Chills are more pronounced than fever
• Coating on the tongue is white and moist
• Head and body pains are severe
• Mucus is clear or white
• Throat may be inflamed and raspy voice
• Pulse is floating and tight

Exterior Hot

• Fever is high
• Coating on the tongue is yellow or gone
• Throat is painful and inflamed
• Mucus from the nose or lungs is yellow and congealed
• Pulse is floating and rapid

 Exterior Excess

• There is no perspiration.  This occurs with Wind-Cold, and that it is so strong that the pores are blocked

Exterior Deficiency

• There is perspiration without the usual corresponding reduction in fever.  This is due to a weakness in the Protective Qi, which is not able to regulate the skin temperature

Interior Symptoms

These are distinct from Exterior symptoms as they arise from the Organs and deeper tissues of the body.  They may arise from Excesses located in the exterior portions of the body which penetrate the external defenses.  Other frequent causes are emotional imbalance, improper living habits, alcoholism and addiction to drugs.  

Symptoms include:

• Fever without chills
• Feeling of coldness in the body
• Irritability
• Pain in the trunk
• Vomiting
• Changes in the tongue itself
• Changes in stool and urine
• Changes in thirst

Interior Cold

• Pale complexion
• Sensitivity to cold in the extremities
• No thirst, or desire to drink hot liquids
• Pain in the abdomen which diminishes with applying heat
• Copious and clear urine
• Watery stools
• Pale tongue with white coating
• Deep slow pulse

Interior Heat

• Flushed complexion
• Fever
• Irritability
• Thirst for cold beverages
• sweating
• Scanty dark urine
• Diarrhea containing pus or blood
• Dark red tongue with yellow coating
• Quick pulse

There is a point in interior diseases and in diseases from external factors when the disease is only partially interior.  This will present as:

• Alternating chills and fever
• Fullness in the loins and chest
• Irritability and restlessness
• Nausea
• Lack of appetite
• Bitter taste
• Parched, dry mouth
• Vertigo
• Wiry pulse 

At these times treating the channels which run down the middle of the extremities is in order, so treating points along the Sj, Gb, P and Liv will be quick to allay these symptoms.

At times, an excess will attack the exterior at the same time an interior disease arises.  It's at times like these when you have to carefully consider all of the symptoms and treat the symptoms with the greatest relevancy.

Is it Hot or is it Cold?

When the body is attacked by Yang excess, or when the Yin substances are depleted, Hot symptoms develop.

When the body is attacked by Yin excess or the Yang activities are weak, Cold symptoms develop.

Hot

• Flushed face
• Red eyes
• Heat in any part of the body
• Fever
• Irritability
• Thirst for cold liquids
• Constipation
• Scanty, dark urine
• Dark red tongue
• Rapid pulse
• Dark, putrid or thick secretions may occur

Cold

• Pale complexion
• Quiet patient
• Tendency to curl up
• Feeling of cold in many parts of the body, or general cold
• Lack of thirst or desire hot liquids
• Severe localized pain
• Diarrhea
• Copious clear urine
• Slow pulse
• Clear white phlegm

When hot or cold is severe, sometimes "false" symptoms appear.  In a hot disease, this appears as cold limbs because the heat is trapped inside the trunk and cannot escape to warm the limbs.  Or, in intense cold diseases, a flushed face, sore throat and irritability my appear due to rising of weak yang.

In such cases, the appearance of the tongue and thirst factors will more accurately reflect the nature of the disease.

Is it Excessive or Deficient?

This classification describes the degree of the body's resistance (Normal Qi) in response to the virulence of the disease.

If the disease occurs because the normal qi is weak rather than the strength of the excess, the disease is called an excessive disease.

If the condition of the body is very weak, and that of the disease process is not necessarily strong, or if the disease is caused by internal disharmony or weakness, then it is called deficient.

In general, acute disorders tend to be excessive, and chronic disorders tend to be deficient.

Excessive symptoms vary widely depending on the type and location of the disease, but the following is important when compared to deficient disease:

• Voice is normal or louder than normal
• Breathing is heavy
• If Ah-Shi  points exist in the chest or abdomen, they are felt as hard or elastic lumps, which react painfully to pressure
• Tongue coating is thick 
• Pulse has great force

Deficient symptoms vary depending on whether it is the Qi, Blood, Yin or Yang of a particular organ that is affected.  In contrast to excess diseases, the following is observed:

• Quiet or withdrawn patient
• Voice is soft or low
• Complexion is from sickly yellow to ghastly pale
• Breathing is light
• Pain is diminished when massage or pressure is used
• Scanty coating on the tongue
• Pulse is weak and/or imperceptible

Is it Yin or is it Yang?

Yin and Yang are the larger features in which the rest of the disease is subsumed.

Yang:

• Exterior
• Hot
• Excessive
• Shi, or hyperactivity
• Use Xie, reducing techniques
• Usually Acute

Yin

• Interior
• Cold
• Deficient
• Xu, or hypoactivity
• Use Bu, reinforcing techniques
• Usually Chronic

It is important to remember that the principles of TCM diagnosis have been the result of the clinical observations of billions of people over thousands of years of clinical practice!  While some of these observations over generations of physicians were written down in the symbolic language of the time, it would be an error to dismiss them as unscientific!  It would be the same as rejecting the data from an electrocardiogram because the data was expressed in alphabetical symbols.

Some of these ancient observations ranged over a wide field of study and show much evidence of penetrating thought.  Thousands of years before Freud, the importance of examining the contents of dreams was evident to Chinese physicians.  That dreams were outlets for symbolic wish fulfillment, and therefore a guide to motivational factors, was made clear in several passages from the Nei Jing!  

This is only one isolated example of the ingenuity of the traditional practitioner, and can be appreciated from a modern clinical standpoint.