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An Acupuncturists Guide to Diagnosis: 8 Syndrome Differentiation

Syndrome Differentiation is the act of gathering a patients entire list of symptoms, checking the tongue and pulses and looking at the collective evidence to conclude what pattern of imbalance is showing in the body.

Syndrome Differentiation is foundational in your Acupuncturists diagnosis.

Four main pillars that your Acupuncturist will study, learn, and implement to come to a diagnosis and treatment plan include:

  • 8 Principles of Syndrome Differentiation

  • Qi and Blood Theory

  • Zang-Fu Theory

  • Meridian and Channel Theory.

Today, we will cover the 8 Principles of Syndrome Differentiation.

Please note, Chinese medicine is an entire system of medicine, each theory is an independent study, but they are also interrelated, intertwined and complementary of each other.

Each theory is extremely intricate, and one single post cannot do it any justice. I will continue sharing this knowledge, so stay tuned for my future diagnostic posts covering Qi and Blood, Zang-Fu, and Meridians/Channels.

The 8 Principles explain the location of a pathogen, and the nature and strength of the pathogen causing the imbalance.

The journey of the pathogen is determined by the strength of the pathogen and the strength of a persons Immune System (Wei Qi).

An individual with low Immunity (Wei Qi) may have a difficult time fighting off a pathogen, and therefore suffer from more severe symptoms during an invasion. While, someone with a stronger Immunity (Wei Qi) may fight off the pathogen with a hot bath and a good sweat, and not feel any additional symptoms at all.

When an Acupuncture treatment is diagnosed and treated correctly, the Immunity (Wei Qi) increases, and resistance to exterior factors and pathogens invading is strengthened.

Your Acupuncturist will ask you a series of questions to determine whether the pathogen is:

(1) Interior or (2) Exterior?

Interior or exterior refers to the depth and development of a disease/pathogen.

In Chinese medicine the body's Qi-System is made of many "layers". Pathogens must pass through these "layers" to invade the deeper body, and the body must push these pathogens back out through the layers to fight off the invasion.

Some people have naturally strong and resilient "layers", while others may have weaker and less resistant layers - leaving them more susceptible to pathogen invasion and less capable of fighting it off quickly.

Assessing the individuals symptoms concludes - if the pathogen is still residing in the exterior "superficial" part of the body, which includes skin, hair, muscles, meridians, channels and collaterals.

Or, if the pathogen travelled to the interior body reaching the Zang-Fu?

Exterior Syndromes

An imbalance caused by an environmental factor or pathogen.

They are said to appear suddenly, are fairly short lived and may be accompanied by 'Intolerance to Cold or Wind' and Fever.

Interior syndromes

Are deeper and more difficult to address and expel from the body.

The exterior pathogen has invaded deeper to affect the interior body, it may now be directly attacking a specific body system OR it could be a literal functional disturbance in that specific persons body, often due to improper diet, lifestyle, over-work, environmental factors, chronic-emotions, etc.

Interior Syndromes tend to be present longer, and can take some time to address since they've had longer to settle deeper in the body's "layers".

It is important to address invasions immediately, if exterior pathogens are not expelled they will transmit into the interior, and vice-versa, as an interior pathogen is expelled it must move back out through the layers of Qi to the superficial portion of the body to be expelled through the Lungs/Pores - Think coughing up/sweating out etc.

Is the conditions characteristic of (3) Heat, or (4) Cold?

This is where Yin-Yang Theory really comes into play, with at the simplest - yang associating with heat, rising, and expansion and cold, associating with downwards motion, implosion and Yin.

Cold Syndromes, can appear as a True-Cold, or False-Cold.

  • Exterior-Cold Syndrome happens when exposed to Exogenous-Cold (wind/snow, too much ice-cream etc) - it is also known as a TRUE cold.

  • Cold symptoms can also appear when there is an interior Yang-Deficiency - also known as a FALSE cold.

Yang in Chinese Medicine is the active, warming, transmuting aspect, so when Yang is deficient, what that means is that your body is lacking the energy (Qi) it needs to break down, assimilate, transform and transport food/energy (Gu Qi) to where it needs to go in the body. When left untreated Yang-Deficiency will result in deficiency of Qi and Blood. This is a critical condition, and is covered in depth in the Qi and Blood Theory post.

Cold Syndromes show in a Pallor complexion (no energy (Yang/Qi) to bring blood flow up). The person will often have an aversion to Cold (they're already cold enough and can't warm). They will often lack thirst (Water solidifying as it gets colder) or prefer hot drinks (Needs heat). Stools will be loose because there is no energy to hold the muscles, and urine will be clear and copious. Tongue will appear pale (due to lack of blood flow), with a white moist coating and the pulse will be slow.

Heat Syndromes, also appear as a True-Heat or False-Heat.

  • Heat happens most often when your body is fighting off an exterior invading factor. This is similar to the body's natural inflammatory response - and is called True-Heat.

  • Heat symptoms also appear when there is an interior Yin-Deficiency - also known as a False-Heat.

False-Heat, is more difficult to address and is becoming much more common in modern times, as our lifestyles are increasingly burning our Yin factors.

When we exhaust our Yin (fluid, blood, cooling), Yang now has nothing rooting it down, and its natural upwards action will now become hyperactive. Basically, the body's Yang (heat/homeostasis) is out of balance and it is burning up all the Body Fluid.

Heat Syndromes will show signs with the colour red - think the blood is circulating quicker because of heat - allowing it to rush against the skin and cause flushing. The face and tongue will be red, along with the palms. People will often experience a low-grade fever (or 5 palm heat-sensation in your chest, hands and feet.) People will experience thirst (as excess heat is causing all fluids to dry up), and cravings will likely be for cold drinks. Constipation often occurs because of fluids being dried, and dark yellow-scanty urine because the fluid of the body is being dried up by the heat. A persons tongue will have a yellow dry coating, and the pulse will be rapid.

Exterior and Interior syndromes are usually complicated by the presence of of an (5) Excess Syndrome or (6) Deficiency Syndrome?

Excess and Deficiency are terms used in clinic to measure and distinguish the ebb and flow of "Yin and Yang" in the relationship and progress of a disease.

An excess or deficiency describes a combination of three things:

  1. The relative strength of a persons immune system (Wei Qi).

  2. The pathogens resistance/strength.

  3. The overall relationship between the pathogen and Immune system (Wei Qi).

This distinctly guides the practitioner to either 'tonify' the immune system (Wei Qi), to boost it's resilience, or to 'reduce' and 'expel' the pathogenic factor.

Deficiency Syndromes

Develop when a person is lacking that original spark of vital (Yuan-Qi) source energy. This could originate from a number of things including but not limited to a difficult birth, low constitutional essence or "bad genetics", lack of proper lifestyle choices, or chronic conditions that over time slowly drain a persons vital-energy (Qi).

A person can be deficient in either Yin or Yang, which is further determined by their unique collection of symptoms.

Yin Syndrome Deficiency - Remember Yin is the cooling/nourishing aspect in the body.

Person will suffer from "False-Heat" symptoms - afternoon hot flashes, facial flushes, 5 palm sweats, night sweats, dry throat and mouth, and urine will be scanty and yellow with dry stools. Tongue will be red (heat), with no coating (no fluids), and Pulse will be thready (deficient as fluids are drying up) and rapid (heat causing blood to flow quickly).

Yang Syndrome Deficiency - Remember Yang is the warmth and activity in the body.

Person will suffer from "False-Cold" symptoms - chills with cold limbs, spontaneous sweats, lack of thirst, clear copious urine, loose stools. Tongue will be pale due to lack of blood flow (water doesn't flow when it's cold) with a white coating (fluids accumulating) and a weak pulse (no warmth to move the blood along.)

Deficiency syndromes are serious, and when not addressed can become chronic and dangerous.

Symptoms of extreme deficiency syndromes include emaciation, listlessness, feeble breathing, dislike of speaking, nocturnal enuresis, and poor memory.

Symptoms of an Excess Syndrome may include but are not limited to stiffness, agitation, coarse breathing, loud voice, pain that's worse with pressure, dysuria, and distention/fullness in chest.

Excess syndromes are not necessarily the interaction of Yin and Yang, but the hyperactivity of a Pathogen and the fight against a persons vital-energy (Qi) that is causing the influx of symptoms. However, if left in excess, and not addressed, it can turn into a deficiency condition.

So what is the current dynamic between (7) Yin and (8) Yang?

As mentioned above Pathological changes happen as a direct result of

  • A deficiency of yang or retention of pathological cold (yin syndrome).

  • Hyperactivity of yang or Excess pathogenic invasion (yang syndrome).

Since Yin and Yang are interdependent on each other, it is important that both elements are strong to provide a good foundation for each other. If Yin collapses it will leave Yang without a foundation and Yang will become hyperactive. If Yang Collapses, then all energy is exhausted from the body.

Both Yin-Syndromes and Yang-Syndromes can result in collapse.

Yang syndrome causes collapse of internal yin fluids, and Yin syndrome causes collapse due to warmth and energy being depleted.

These are considered critical conditions, and will be accompanied by sudden onset of symptoms:

  • Collapse of Yin: sticky sweat, feverish body, warm hands and feet, shortness of breath, irritability, restlessness, thirst for cold drinks, tongue red and dry, pulse thready rapid and weak.

  • Collapse of Yang: profuse cold sweats, coolness to body, cold hands and feet, feeble breathing, listlessness, thirst for warm drinks, tongue pale and moist, pulse thready and feeble.

Chinese Medicine is a complex system involving numerous micro-subjects and theories. It cannot be explained exactly how it works, or how it was discovered, but thousands of years later it is still one of the most effective medicines on the planet.

Was this all Mandarin to you? Was I able to articulate a clear image of what your Acupuncturist is looking for?

Was there too much Jargon, not enough?

I am looking for honest feedback from my readers

- please leave a comment below to let me know how this read made you feel!


Cheers, xxo.

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