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Basic principles of pattern discrimination

The process of determining which actual pattern is on hand is called 辩证 (pinyin: biàn zhèng, usually translated as "pattern diagnosis", "pattern identification" or "pattern discrimination"). Generally, the first and most important step in pattern diagnosis is an evaluation of the present signs and symptoms on the basis of the "Eight Principles" (八纲, pinyin: bā gāng). These eight principles refer to four pairs of fundamental qualities of a disease: exterior/interior, heat/cold, vacuity/repletion, and yin/yang. Out of these, heat/cold and vacuity/repletion have the biggest clinical importance. The yin/yang quality, on the other side, has the smallest importance and is somewhat seen aside from the other three pairs, since it merely presents a general and vague conclusion regarding what other qualities are found. In detail, the Eight Principles refer to the following:
Exterior (表, pinyin: biaǒ) refers to a disease manifesting in the superficial layers of the body - skin, hair, flesh, and meridians. It is characterized by aversion to cold and/or wind, headache, muscle ache, mild fever, a "floating" pulse, and a normal tongue appearance.
Interior (里, pinyin: lǐ)refers to disease manifestation in the zàng-fǔ, or (in a wider sense) to any disease that can not be counted as exterior.There are no generalized characteristic symptoms of interior patterns, since they'll be determined by the affected zàng or fǔ entity.
Cold (寒, pinyin: hàn) is generally characterized by aversion to cold, absence of thirst, and a white tongue fur. More detailed characterization depends on whether cold is coupled with vacuity or repletion.
Heat (热, pinyin: rè) is characterized by absence of aversion to cold, a red and painful throat, a dry tongue fur and a rapid and floating pulse, if it falls together with an exterior pattern. In all other cases, symptoms depend on whether heat is coupled with vacuity or repletion.
Vacuity (虚, pinyin: xū) often referred to as "deficiency", can be further differentiated into vacuity of qi, xuě, yin and yang, with all their respective characteristic symptoms. Yin vacuity can also be termed "vacuity-heat", while yang vacuity is equivalent to "vacuity-cold".
Repletion (实, pinyin: shí) often called "excess", generally refers to any disease that can't be identified as a vacuity pattern, and usually indicates the presence of one of the Six Excesses,or a pattern of stagnation (of qi, xuě, etc.). In a concurrent exterior pattern, repletion is characterized by the absence of sweating. The signs and symptoms of repletion-cold patterns are equivalent to cold excess patterns, and repletion-heat is similar to heat excess patterns.
Yin and yang are universal aspects all things can be classified under, this includes diseases in general as well as the Eight Principles' first three couples. For example, cold is identified to be a yin aspect, while heat is attributed to yang.Since descriptions of patterns in terms of yin and yang lack complexity and clinical practicality, though, patterns are usually not labelled this way anymore. Exceptions are vacuity-cold and repletion-heat patterns, who are sometimes referred to as "yin patterns" and "yang patterns" respectively.
After the fundamental nature of a disease in terms of the Eight Principles is determined, the investigation focuses on more specific aspects. By evaluating the present signs and symptoms against the background of typical disharmony patterns of the various entities, evidence is collected whether or how specific entities are affected. This evaluation can be done
in respect of the meridians (经络辩证, pinyin: jīng-luò biàn zhèng)
in respect of qi (气血辩证, pinyin: qì xuě biàn zhèng)
in respect of xuě (气血辩证, pinyin: qì xuě biàn zhèng)
in respect of the body fluids (津液辩证, pinyin: jīn-yė biàn zhèng)
in respect of the zàng-fǔ (脏腑辩证, pinyin: zàng-fǔ biàn zhèng) - very similar to this, though less specific, is disharmony pattern description in terms of the Five Elements [五行辩证, pinyin: wǔ xíng biàn zhèng])
There are also three special pattern diagnosis systems used in case of febrile and infectious diseases only ("Six Channel system" or "six division pattern" [六经辩证, pinyin: liù jīng biàn zhèng]; "Wei Qi Ying Xue system" or "four division pattern" [卫气营血辩证, pinyin: weì qì yíng xuě biàn zhèng]; "San Jiao system" or "three burners pattern" [三角辩证, pinyin: sānjiaō biàn zhèng]).


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