In this video on fundamentals, we're going over Eight Principle Pattern Diagnosis. We'll talk about, "What are the eight principles?" "What are the characteristics or signs and symptoms that are associated with each?" We'll talk about the concepts of combinations, conversions, complexes, and false signs. And finally we'll talk about when we would actually use this, as opposed to other forms of diagnosis. The slides are available to download if you want to follow along. The link is below. But let's go ahead and get started. This video is brought to you by students like you. So to everyone who supports this channel whether that's by joining the Patreon, making a one-time donation, or purchasing the review courses, thank you. Do remember that old game Guess Who? This was a game where you tried to guess your opponent's character, and the way you did it was by asking a series of questions. So you might ask things like "Ss he bald? Does he wear glasses? Does he look like a bitch?" And by asking these simple questions, that allows you to hone in on the identity of the card you are trying to guess. Well, Eight Principal Pattern Diagnosis is kind of the same thing. If you have a patient in front of you that you're trying to diagnose, you can begin by asking a series of questions that will help you hone in on the patient's particular pattern of disharmony. So the questions you can ask are: Is it exterior or is it interior? Is it hot or is it cold? Is it excess or is it deficient? and Is it Yang or is it Yin? So these are the eight principles we're talking about that can guide our treatment strategy, or help us hone in on a specific diagnosis. So let's go through each one. So with our eight principles, the first thing we can ask is Is it exterior, or is it interior?" Now when e say exterior, we're talking about the superficial levels of the body, namely the skin, muscles, and channels. Or we could specifically say the space between the skin and the muscles, what we call the cou li spaces. (Please do not say "coo lee.") When we say interior, we're talking about the internal organs. So exterior patterns occur when any of the six exogenous pathogens, or six evils, enter the body from the outside. When we say six evils, we mean heat, cold, dampness, dryness, wind, and summer-heat. So one or more of these pathogens attack the body from the outside, and they are now on the exterior. So how do we know if this is an exterior pattern? Well, the main things we're going to see are: simultaneous fever and chills, stiff neck and body ache, and a floating pulse. So we can say "simultaneous fever and chills" or the Wiseman terminology is "heat effusion and aversion to cold (or aversion to wind)." So what's happening here is we have this pathogen or evil qi attacking from the outside. And so the body's upright qi mounts a defence. So this battle between the good qi and evil qi produces heat, and that's why we have fever or a subjective feeling of warmth that can be felt by the patient or felt by the practitioner upon palpation. And then we say aversion to cold or aversion to wind, and what's happening here is, normally you have this yang qi diffusing over the surface of the body, and that warms and protects us. Well here we have this pathogen at the exterior that's blocking the diffusion of yang qi. So we feel susceptible to cold or to drafts. So basically this is like when you get sick and you feel feverish, but you still want to stay bundled up or under a blanket. And that's simultaneous fever and chills. And then we see stiff neck because the most exterior channel is the Tai Yang channel, and those channels go to the neck. And we have body ache because the pathogen is in the muscle layer, and that's where this battle is occurring. And finally, we see a floating or superficial pulse. This is because we have a pathogen on the surface. So the qi of the body rises to meet it. And because the qi is at the surface, we feel the pulse at the surface. So that's how we know that we're dealing with an exterior pattern. Opposite of that is an interior pattern and again when we say interior, we mean at the level of the organs. So interior patterns describe diseases that occur in the inner body or at the level of the organs. This can happen when an external pathogen attacks the body from the outside and works its way deeper into the organ level. Or this can be due to internal causes like the seven emotions... Emotional Damage! Or from miscellaneous causes like taxation-fatigue or poor diet. These things can affect the organs or the qi, blood, and fluids directly. And I think we talked about this in the chapter on etiology, or the causes of disease. And so the signs and symptoms here are going to vary depending on which systems are affected. So there's not really a concrete way to tell if you're dealing with an interior pattern. Basically if it's not exterior, it's interior. If we wanted to say anything we could say that a deep pulse indicates an interior pattern. Similar idea to before, if the pathogen is deep in the body the qi will go deep to meet it. So we feel the pulse at a deep level. But this doesn't always happen. For example in cases of Yin deficiency, because the yin is not rooting things downward, the Yang qi may float upwards and outwards giving us a floating pulse. So a deep pulse will usually tell us there's an interior pattern, but every interior pattern doesn't necessarily present with a deep pulse. So maybe that's not super helpful. Next we can ask about temperature. "Is it hot or is it cold?" So heat patterns are the result of either an invasion of a Yang evil, or an insufficiency of Yin substance. That's something I copied out of a book. Basically heat can come about in two ways: either we have too much Yang or not enough Yin. In both cases, there's more Yang than Yin, so that's why the patient feels hot. But in one case there's an excess of Yang (that is there's too much Yang heating up the body) so that's why it's called excess heat, replete heat, or full heat. And in the other case there's a deficiency of Yin. There's not enough Yin cooling us down, and that's called deficiency heat, vacuity heat, or empty Heat. So what does heat look like in the body? Well, the color of heat is red. Just like if you get sunburned you turn red. So we might see red face, red eyes, red joints -- so if you have joint pain due to heat, it's going to be swollen, red and warm to the touch -- reddish urine (here we just sometimes say dark urine, but it means dark reddish) and a red tongue. And here we're talking about the body of the tongue. The color of heat is also yellow, and here we're talking about fluids. When heat gets into the fluids it cooks them down and makes them thicker and yellow in color. So you might see coughing of yellow phlegm, yellow discharge -- this could be like pus that's oozing out of a sore, or yellow vaginal discharge -- and a yellow tongue coating is a sign of heat. Heat will also come with heat, like sensation of heat. So fever, sensation of heat in the body, or desire for cold beverages. Heat can also dry out the fluids, so you might see thirst or dry mouth. With the demeanor of the patient, we might see vexation or irritability, like the person is hot-headed or "hot and bothered." Or they might just be really active, like they move and talk really fast because they have a lot of Yang. When you look at the pulse, the pulse is going to be rapid. Remember, heat causes things to speed up, that's like a thing in physics. So we could say that heat speeds up the pulse, or heat speeds up the movement of the blood, and that gets reflected in a rapid pulse. Another thing I might add here is that heat tends the cause of foul smell. So if you have diarrhea or vaginal discharge with a strong foul odor, that means there's heat. Oozing or puss could have a strong foul smell. Or even bad breath could be a sign of stomach heat. So maybe think about, you leave a piece of meat out in the hot sun, and it's going to start to smell rotten. And that's what the heat is doing to your flesh. So that's what heat looks like. If we wanted to, we could point out some specific symptoms that are associated with excess heat or deficiency heat, but I'll let you read about that yourself in the notes. It's kind of what we just talked about, but combined with the next section: excess versus deficiency. So contrary to heat, we also have cold patterns. Cold patterns are the result of either an invasion of a yin evil or an insufficiency of yang qi. So either we have too much Yin or not enough yang. Either way, there's more yin than yang, so the patient feels cold. Ff there's too much yin we call that excess cold, replete cold, or full cold. If there's not enough yang, we call that deficiency cold, vacuity cold, or empty cold. So here we can kind of go through the same characteristics. The color of cold is pale or blue. So with cold patterns, we might see a pale face, blue lips, clear urine -- as in not dark or not red, but clear -- and a pale tongue. We can actually also see a blue tongue in cases of extreme cold, but I feel like that's pretty rare. More often we're just going to see a pale tongue because there's not enough heat warming it up and making it that nice pinkish color. The color of cold is also going to be white or clear. So here we're talking about the fluids. So we might see coughing of white phlegm, white discharge -- like pus or fluid from abscesses, sores, or boils -- or white vaginal discharge. And the tongue coating will be white. And speaking of fluids, in cold patterns, the fluids not only tend to be white or clear, but they're typically thin and copious. So with heat, the heat is cooking down the fluids making them thick and scanty, as in not much amount. But with cold, the fluids are thin in consistency and copious in amount. So with cold, we could say coughing of copious, thin, clear phlegm -- as opposed to coughing of thick, yellow, scanty phlegm that we see with heat. Cold will also present with sensations of cold. So a cold body, cold limbs, or desire for warm drinks. And here again, we say the fluids are copious. So we can see copious urination -- as in a large quantity or frequent urination -- or watery diarrhea. In terms of demeanor, the person is not vexed or not even particularly energetic. We might say they have a desire for quiet quietness, or we might use the word "listlessness." Basically the person is cold and withdrawn. And the pulse is going to be slow. Just like in physics, cold causes things to slow down or move more slowly. So cold is going to slow down the pulse, or slow down the movement of blood, resulting in a slow pulse. And again, we can talk about specific symptoms associated with excess cold versus deficiency cold (that's what Maciocia does) but I think it makes more sense to just combine this with the concepts we'll learn in the next section, which is excess versus deficiency. So here we're asking, "Is it excess, or is it deficient?" That is, is there too much of something, or is there not enough of something else? And again, when we say excess, we could say excess, or replete, or full -- these are all just different translations of the Chinese term "shi" -- and with deficiency, we could say deficient, vacuous, or empty, and these are all translations of "xu." So with excess patterns, there's an exuberance of evil qi. That is there's too much of something -- phlegm, dampness, stagnation, food accumulation, invading evils Etc. And like before, there's not a lot of concrete signs and symptoms here just because it's really going to depend on what type of evil is exuberant and what system it's affecting. So excess fire in the liver is going to look different than excess cold in the lower jiao. But we can usually say that excess patterns are usually acute -- they have a recent onset. The symptoms tend to be strong or loud, like a strong voice or a loud cough, because it's excess. If there's pain, it may be pain that's worse with pressure. This is common like with epigastric pain or pain associated with menses. If it's an excess condition, the pain is worse with pressure, or it cannot tolerate touch... because there's already too much of something. And as for the pulse, we tend to see a strong, forceful, excess-type pulse. Basically, we have a strong evil, so the body is going to react to it strongly, and that's reflected in a forceful pulse. Opposite that we have deficiency patterns. Deficiency patterns occur when the upright qi is damaged or insufficient. That is there's not enough of something -- not enough qi, not enough blood, not enough Yin, or not enough Yang. This can happen because the patient has a weak constitution, enduring illness can damage the upright qi, you could have a loss of blood or fluids Etc. And again, the signs and symptoms are going to vary depending on what is deficient and which organ is affected. But some things we can look for are deficiency patterns tend to be associated with long-term illness or chronic conditions. Basically don't just suddenly become deficient. Usually it's like you're gradually worn down by enduring evils or just poor life choices. If we see pain in deficiency patterns, the pain is usually better with pressure. So it's like if I had menstrual cramps, and that cramping pain was better with pressure, that might be a deficiency pattern. And as for the pulse, we tend to see a weak or forceless pulse, again because there's deficiency. There's not enough qi to push the blood through the vessels. So we see a weak or forceless pulse. A thin pulse is also a sign of deficiency and here we mean that the vessel is thin in diameter. So if there's not enough Yin or not enough blood to fill the vessel, the pulse will feel thin in diameter. But again, this is not actually true 100% of the time. We do have some deficiency patterns that present with a large pulse, because the yang qi is floating outwards. And finally we can ask is it Yang or is it Yin? And honestly, this is not super helpful because these are just descriptions of the other six. So exterior patterns, heat patterns, and excess patterns are all Yang. Interior patterns, cold patterns, and deficiency patterns are all Yin. So it's not really adding anything new. Or another way we can look at this is, when we say, "Ss it Yin or is it Yang?" we're talking about yin and yang as if they're substances in the body. So if a person has a heat condition, we can ask is this due to excess Yang or deficient Yin. And if a person has cold, is that excess Yin or deficient Yang? But again, we kind of already talked about that so it's not super helpful. And it seems like the books use this as an excuse to talk about Yin collapse and Yang collapse, but I'm not sure that this is really diagnostically relevant in most cases. And also, earlier in the chapter on etiology, we talked about imbalances of Yin and Yang, and I feel like it makes more sense to talk about it there. But these are situations where the yin and yang are suddenly and drastically depleted. Think about someone going into shock after severe fluid loss or blood loss. So, I'm not sure that's something you'll see in a clinical setting very often, but I'll have a few slides in the notes if you want to look at it. So yin versus yang -- not quite as helpful as the other six in terms of diagnosis. So those are the basics of the eight principles. Those are some simple things we can ask a patient or look for in a case study to begin the process of diagnosis and forming a treatment strategy. If we wanted to get a little more complicated about we can talk about the concepts of combinations, conversions, complexes, and false signs. And this is just going a little bit more in depth into how these eight principles interact with each other. So when we talk about combinations, here we're just combining principles from these different pairs. And this is what we usually do. So you don't just say that someone has a an exterior pattern or someone else has a heat pattern. We would use more than one and say that this person has an exterior-cold pattern or this person has an interior-excess-heat pattern. And what's really convenient here is, we can by and large look at these signs and symptoms separately and then put them together. So if a person is sick -- they have simultaneous fever and chills, a red sore swollen throat, coughing a thick yellow phlegm, and the pulse is floating and rapid -- we can say that this is an exterior heat condition. Simultaneous fever and chills and a floating pulse point to an exterior pattern. A red throat, yellow phlegm, and a rapid pulse all point to heat. So put those together and we have exterior heat. Say a person is complaining of frequent, copious urination. They have to get up five times a night to pee. They have long voidings of clear urine, they feel tired and lethargic, they have cold and weak low back and knees, the tongue is pale and wet, and the pulse is deep, weak, and slow. Well, the deep pulse tells us this is an interior pattern. We don't have fever and chills and a floating pulse, so it's definitely not exterior. The copious, clear urination, coldness, and slow pulse tell us that this is a cold pattern. And the lethargy and weak or forceless pulse tells us that this is a deficiency condition. So we could diagnose this patient with an interior, deficiency, cold pattern. And so here you might be noticing that the pulse is giving us a lot of useful information. So in another video on pulse diagnosis, we talked about evaluating the pulse in terms of rate, depth, strength, and quality. And it turns out that these simple characteristics are giving us basic information about the eight principles. So the rate of the pulse is telling us about temperature -- is it hot or is it cold? A rapid pulse is associated with heat; a slow pulse is associated with cold. The depth of a pulse can tell us, "Ss it exterior or is it interior?" A floating pulse usually indicates a exterior pattern, and a deep pulse usually indicates an interior pattern. Again, there are some exceptions here. We can have a floating pulse in certain interior conditions due to deficiency. And the strength of a pulse will tell us, "Ss it excess or is it deficiency?" A strong, forceful pulse is usually associated with excess; a weak, forceless pulse is associated with deficiency. And like we saw, we can very easily combine these. So a floating, rapid pulse is exterior-heat; and a deep, weak, slow pulse is interior-deficiency- cold. So those are combinations of the eight principles. Another thing we can talk about here is conversion of the eight principles. This is just referring to, in the course of disease, one of the eight principles may transform into its opposite. So an exterior pattern can transform into an interior pattern as the pathogen works its way inward. Or a cold pattern can turn into a heat pattern, and so on. So this is something we would have to look out for in the course of treatment. I think the most interesting one here is complexes. So this is similar to a combination, but here we're specifically talking about the combination of two opposites that are occurring at the same time. So a person could be both hot and cold at the same time, or excess and deficient at the same time. So here when we talk about a complex pattern, we don't just mean that the situation is complicated. We're specifically referring to a case where two opposites are occurring at the same time. So we might have things like heat above and cold below, or cold on the exterior with heat on the interior, or even something as specific as heat in the chest and epigastrium with cold in the intestines which can happen in certain Jue Yin patterns. Or we can see complexes of excess and deficiencies. So we can have liver excess with spleen deficiency, spleen deficiency with excess of dampness and phlegm, or kidney Yin deficiency with liver Yang rising, and so on. So to treat these complex conditions, we may have to use a treatment strategy of harmonizing -- trying to balance out these opposites. Or we may just direct different treatment principles to different parts of the body. For example, if we have cold on the exterior with heat on the interior, we can use warm, acrid herbs to release the exterior cold, and we can combine that with cold herbs that clear interior heat. An example of this would be the formula Da Qing Long Tang - Major Bluegreen Dragon Decoction. And it's interesting to know that if we have a combination of an exterior pattern and an interior pattern, we technically don't call that a complex -- that's still just a combination. And I don't know why, that's just the way it is. But this is something to watch out for. You may see a case where you see both heat signs and cold signs occurring together, and that may just be a sign that you're dealing with a complex pattern. And the most confusing of these is probably false signs. These are misleading signs that look like one thing but are actually the opposite. So you might have something that looks like heat, but is actually due to cold. Or something that looks like deficiency, but is actually excess. So those are called false signs. So we might say things like false heat with true cold, false cold with true heat, false deficiency with true excess and so on. For example, I remember one of my first acupuncture treatments at school. The intern asked about my body temperature, and I said I'm always warm. I'm just a hot, sweaty person. And at that time I had a lot of acne on my back and shoulders. It was really red and angry and just looked like a lot of heat. So this itern was ready to do a heat clearing treatment and give me cold herbs. But then the supervisor came in and took my pulse, and my pulse was slow, like less than 50 beats per minute. And then he looked at my tongue, and my tongue was pale and swollen with tooth marks. So these are not indications of heat. So the supervisor said it might look like he has heat or too much yang, but really the Yang is deficient and that's causing it to float to the surface. And that's why we see these heat signs on the surface, but based on the tongue pulse and other signs, the true condition is cold. So this would be an example of false heat with true cold. Had the intern tried to clear heat, it would have actually made the condition worse. Another example: maybe a patient comes in with cold hands and feet. So you might initially think, "Oh this patient has a cold pattern." But then, as you investigate further, you might find that even though the hands and feet are cold the trunk or the core is hot. And then you find that they have a red tongue and a rapid wiry pulse. So it turns out that these cold hands and feet are not due to a cold pattern, rather, there's stagnation causing the heat. So because of the stagnation, qi and blood are not reaching the extremities, and that's why they feel cold. But overall, really it's an excess heat condition. So in this situation, when you see cold hands and feet, you could say that these are false signs of cold. Really this is an example of false cold with true heat. And we can have the same thing with excess and deficiency. Maybe a person feels really tired, lethargic, and worn down. So you might be inclined to think that this is a deficiency pattern. But maybe they have excess dampness weighing them down and making them feel sluggish. So this could be false deficiency with true excess. So I'm not sure that these false signs are super common, but it is something you want to watch out for. Because if you misinterpret these false signs, that could give you an incorrect diagnosis, which would lead to an inappropriate treatment, which could actually end up making the patient worse. So that's something to look out for. And that's also why it's important to look at the tongue and pulse, because unless the patient is on certain medications the tongue and pulse usually don't lie. And I also like to point this out just for the sake of terminology. I've seen a lot of students and even some teachers misuse this. It's like they think that false heat is a synonym for deficiency heat, and true heat is a synonym for excess heat, and that's just not right. Like we said, deficiency heat, vacuity heat, and empty heat are all the same thing. They're just different translations of "xu re." But false heat is something totally different. And again, these are misleading signs of heat in a patient where the true condition is a cold pattern. And the same thing about false cold. So don't get those mixed up. And finally, we'll talk about when would we actually use this, and I think this is where a lot of people get confused. Because eight principle diagnosis is actually pretty simple, and it's almost like it's too simple. It's like when would we use this? Or why would we use this as opposed to other forms of diagnosis? Like channel diagnosis, zangfu pattern diagnosis, Shang Han Lun six levels, and so on. Well a few things here. First of all eight principle diagnosis is not meant to be the end-all be-all of diagnosis. This can just give you a starting point to get you going in the right direction and it can also give you an idea of the strategy or methods you might use during treatment. So if you have a patient with a cold condition, you might want to use warming methods like moxa or warming herbs. If the patient has a heat condition you might want to use cooling techniques or cooling herbs. If the patient is deficient. You would probably use tonifying techniques with your needling or tonifying herbs. If the patient has an excess condition, you might use draining techniques, like prick-to-bleed, or draining herbs. If a person has an exterior condition, you might use techniques that release the exterior like cupping or gouache or Plumb Blossom, or you might use acrid herbs that vent the pathogen outward. Whereas if you had an interior condition, you might use deeper needling or bitter herbs that drain the interior and so on. The other thing to realize is, all of our other methods of diagnosis can be thought of or framed in terms of these eight principles. So if you're studying Chinese medicine in the west at some point, you'll probably have to go through and learn all of Maciocia's organ patterns. So for each of the 12 organs, he lists all of the patterns of disharmony that could possibly occur. So here we have an example of lung patterns, but you can see that he even organizes these patterns in terms of the eight principles. So we have deficiency patterns, excess patterns, exterior patterns, and interior patterns. So when we see something like lung yin deficiency, you can say that this is a pattern of interior deficiency heat. And when we see invasion of the lungs by wind- cold, that's an exterior excess cold pattern. Coming at it from another direction. We can also look at patterns associated with specific diseases. So here we have all of the patterns associated with headache. So for wind-cold we could say this is headache due to an exterior excess cold pattern. For liver fire, we could say this is an interior excess heat condition. So if you have a headache patient and you're looking at all the patterns and thinking, "How do I know which one to choose?" or at least "How can I narrow it down?" Well, we can start out with the eight principle pattern diagnosis, and by asking some simple questions -- like, "Is it hot or is it cold? Is it excess or is it deficiency?" -- you can kind of go through a process of elimination to help narrow down your choices. Again, it's kind of like we're playing a game of Guess Who. And even when we get to Shang Han Lun Six-Channel diagnosis, we can frame this in terms of our eight principles. So Tai Yang is exterior cold, and it turns out we have both excess in deficiency patterns at this level; Yang Ming is interior excess heat, and Shao Yang is actually half interior half exterior. So that's why this is so useful. Even if you're using other forms of diagnosis, we can still look at a case in terms of the eight principles to either narrow down our diagnosis or guide our treatment strategy. We can also use this as a test taking strategy. So here we have an example of cough. If we go through our eight principles, we can ask, "Is it exterior, or is it interior?" Well, there's no fever and chills and no floating pulse, so it's probably interior. "Is it hot or is it cold?" Well, there's a red tongue, a rapid pulse, red face and dryness, and scanty phlegm. This is probably a heat condition. "Is it excess or is it deficiency?" Well, the pulse is forceful, the cough is loud, the condition is acute. So this is probably an excess pattern. So we're dealing with internal excess heat. That means we can immediately cross out the "external invasion of wind-cold" and "Lung yin deficiency" because those don't match in terms of the eight principles. So this doesn't get us all the way there, but it gets us close. After this, we would have to look further to know that stress, bitter taste in the mouth, and a tongue that's red around the sides, and a wiry pulse are all associated with the liver. So this would be a liver pattern. So that's a very thorough look at eight principle pattern diagnosis. Again, thank-you to everyone who supports this channel. If you got value of this video and would like to give something back, there are several ways you can do it. You can join the Patreon. This is like a monthly membership. You can give a one-time donation through Buy Me a Coffee. Or you can just share this video and the website with your friends, classmates, and study group. Thanks again, and we'll see you in the next one.