Exterior/Interior - Cat's TCM Notes

Course: Diagnostics II Date: Oct 17, 2007
Chart: Eight Principles Charts

Exterior/Interior

Definition Exterior Interior
Group of pathological condits resulting Pathological conditions resulting from:
What it tells from invasion of superficial portion of
you: the body by exogenous pathogens 1. transmission of exogenous
Locations pathogenic factors to the interior of
Natures Location and stage of a disease the body to affect the Zangfu
Causes (depth of a disease and direction the organs
disease is developing toward—out to in,
Chief or in to out.) 2. or from functional disturbances to
Manifestations Superficial portions: the Zangfu organs

Accompanying Skin, hair, muscles, interspaces Location and stage of a disease
sym/signs between, superfic portions of (depth of a disease and direction the
meridians and collaterals disease is developing toward—out to in, or
1. Sudden onset in to out.)
2. short duration Interior:
3. early stage of exogenous disease
1. invasion of exogenous pathogenic Five zang and six fu organs
factors
1. Chronic
1. Fever simultaneous to chill 2. longer duration
2. Aversion and intolerance to cold, 3. middle or late stage of disease
1. transmission of a persistent pathogen
wind, chill
3. Pain in the limbs from exterior to interior to invade
4. Sweating or not, depending on Zangfu organs
2. direct attack on Zangfu organs by
whether heat or cold is coupled with exogenous pathogens
this. 3. Lifestyle factors which affect zangfu
5. Thin white tongue coat organs directly leading to functional
6. Superficial pulse disturbances such as:

Headache, general aching, nasal a. drastic emotional changes
obstrx/dischg, sneezing, coughing b. improper diet
c. overstrain and stress
1. High fever
2. No aversion to cold
3. irritability, delirium, coma
4. vomiting
5. thirst
6. Either constipation or diarrhea
7. Tongue: yellow fur
(may range from yellow to black,
slippery to greasy, body may be purple,
pale, trembling, deviated,etc.
8. Pulse: deep, slippery, wiry, choppy

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Clinical 1. Exterior cold syndrome 1. interior cold syndrome
Manifestations 2. Exterior heat syndrome 2. Interior heat syndrome
3. Exterior excess syndrome 3. Interior excess syndrome
4. exterior deficiency syndrome 4. Interior deficiency syndrome

Differentiation of Exterior/Interior

Exterior Interior
Fever + aversion to cold 1. Fever, no aversion to cold

Thin white tongue coating –or-
Superficial pulse 2. No fever + aversion to cold
Various abnormal tongue coat qualities
Deep pulse

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Cold/Heat

Definition Cold Heat
Pathological conditions resulting from: Pathological conditions resulting from:
What it tells
you: 1. Exposure to exogenous 1. Invasion of exogenous pathogenic
Locations pathogenic cold heat
Natures -or- -or-

2. deficiency of yang in interior of 2. deficiency of Yin in the interior of
body the body

Nature and stage of a disease Nature and stage of a disease

Exterior or interior Exterior or interior
• Belongs to Yin • Belongs to Yang
• Duration: long (int), short (ext) • Acute/urgent nature if caused by

exogenous heat
• Chronic if caused by deficiency (of

yin, yang, qi, blood)
• Duration: long (int), short (ext)

Chief • Aversion to cold, pref for warmth • Fever, pref for coolness
Manifestations • No thirst • Thirst, pref cold drink
(Symptoms) • Pallor • Redness of face/eyes
• Cold limbs • Hot limbs
• Loose stools • Dry stools or constipation
• Clear, profuse urine • Urine: dark yellow, scanty, reddish
• Tongue: pale, white moist or • Tongue: red w/yellow

• greasy coat and/or dry coat
• Pulse: slow or tense • Pulse: rapid
Tasteless/bland taste in mouth • Spirit:

Clinical 1. Exterior cold o Irritability
Manifestations 2. Interior cold o Restlessness
3. Excess cold 1. Exterior heat
4. Eeficient cold 2. Interior heat
3. Excess heat
4. Deficient heat

Symptom comparison

Cold Heat
Aversion to heat, prefer cold
Cold/heat Aversion to cold, prefer heat Yes, wants cold drinks
Red
Thirst No Hot
Dry
Face Pale Scanty, reddish, dark
Red with yellow coat
Limbs Cold Fast

Stools Loose

Urine Profuse, clear

Tongue Pale with white and greasy coat

Pulse Slow and tight

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True/False syndromes

Thirst True Heat + False Cold True Cold + False Heat
Covering Yes, wants cold Yes, wants warm
Face No Yes
Body feels Pale Red
Throat Hot Cold
Limbs Dry Not dry
Stools Cold Hot
Urine Dry Loose
Tongue Scanty, reddish Profuse, clear
Pulse Deep red, dry yellow coating Pale, white moist fur
Forceful, deep Large, weak

Interior Xu (def) and Shi (excess) Cold Syndromes.

Limb temp Int Xu Cold Int Shi Cold
Face complex Cold Cold, pref warmth
Ab pain Pale Pale
Stool Cold pain, better with pressure Pain, worse with pressure
Urine Loose Loose
Taste? Clr, profuse Clr
Tongue Bland
Pulse Pale Pale w/white coat
Fatigue Deep, slow, weak Deep, slow, tight
s.o.b. Yes ---
Yes ----

Exterior cold, heat, deficiency, excess comparison chart:

Aversions Ext cold Ext heat Ext defic (xu) Ext excess (shi)
Strong, to cold Slight: wind & Wind
Fever cold Mild
Chills Mild Severe Mild Severe
Pain Severe Mild Mild Headache
General aching Headache Headache Body pain
Sweating Stiff neck No
Thirst No Yes Spontaneous No
No Yes No
Tongue Slight + dry Mild red
Coating Light/mild red sensation in mouth Pale Thin and white
Thin white moist Red tip and edges Thin or none
Thin yellow

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Pulse Floating and tight Floating and rapid Floating, thin, Floating, strong
Other (superfic, tense) weak Floating tight
Pale face
SOB
Dyspnea w/Exertn
Catch cold easy
Poor appetite
Loose stool

Interior: cold, heat, deficiency, excess comparison chart

Internal cold Internal Heat Internal Xu Internal Shi
High
Aversions Cold, pref heat Pale, swollen
Deep, weak Yellow, old fur
Fever High Constipation
Lassitude Mental
Chills Dizziness restlessness
Palpitation Hoarse breathing
Pain Abdominal Low voice
Less talking
Sweating Poor appetite

Thirst No Yes

Complexion Red eyes, lips

Tongue Red

Coating White

Pulse Deep, slow Deep, fast

Stool Loose

Urine Clear Yellow, red

Other Cold limbs Irritable

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Deficiency/Excess

Deficiency/Excess refers to the relative strength of the pathogens and the anti-pathogenic Qi.

General Symptoms of Deficiency
Common deficiency syndromes types are: yin, yang, qi, blood. More on those specifics next page

Symptom Category Symptom Probable Cause(s)/ Notes
Body Condition Emaciation
Facial Complexion Pallor Qi Deficiency
Demeanor Blood Deficiency
Level of Energy Listlessness Yang Deficiency
Breathing Lassitude
Speech/voice Feeble Lung Qi Deficiency
Heart Shortness of Breath Zong Qi Deficiency
Dislike of speaking Lung Qi Deficiency
Sweating Palpitations Zong Qi Deficiency
Insomnia Heart Qi Deficiency
Nocturnal… Poor memory Zong Qi Deficiency
Heart Qi Deficiency
Pain Spontaneous Heart Blood Deficiency
Tremors Heart Blood Deficiency
Night Sweating (short term = heart,
Tongue Long term = kidney)
Pulse Emissions Qi Deficiency
Yin Deficiency
Enuresis (bed wetting) Yang Deficiency
Pain alleviated by pressure Qi Deficiency
Yes Yin Deficiency
Yang Deficiency
Dry Yin Deficiency
Little coating Yang Deficiency
No coating Qi Deficiency
Of appropriate deficiency type Kidney Qi Deficiency
Deficiency of x
Liver x deficiency
Can also be excess such as external wind
invasion or internal rising liver yang/fire,
etc.
Yin deficiency
Body fluid deficiency
Blood deficiency

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Yin Deficiency Syndromes
Can be many different types of yin deficient syndromes: liver, heart yin, body fluid, etc.

Symptom Affects: Symptom Probable cause(s) / Notes
Body condition Emaciation Yin deficiency
Eye Dry Liver yin deficiency
Blurry Liver blood deficiency
Fever Afternoon fever Yin deficiency
Heat in palms and soles Yin deficiency
Facial complexion Red in zygomatic/malar area Yin loss and blood loss causing def heat
Sweating Night sweats Yin deficiency
Throat and Mouth Dryness Yin deficiency
Body fluid deficiency
Urine Yellow (darkish) Yin deficiency/yang relatively too much
Stool Dry Yin defic
Tongue Red w/ little coating
Pulse Thready and rapid Thready due to deficiency
Rapid due to deficient heat

Yang Deficiency
Yang defic usually preceded by Qi deficiency

Symptom Affects: Symptom Notes or possible causes
Chills and fever Chills
Limbs Cold Cold brings sluggishness in body and mind
Demeanor Listless Yin (body fluid) + Yang (wei qi) = sweat
Energy level Lassitude Spon sweat = yang qi def (wei) cannot ctrl
Sweat Spontaneous sweating sweat pores, so fluids leak out.
Meaning: body fluid enough or not too much
Thirst None heat

Urine Clear, increase in volume Deep = interior
Stools Loose, often with diarrhea Weak = deficiency
early in the morning around Slow = cold
Tongue 5am
Pulse Pale, white coating
Deep, weak, slow

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Qi Deficiency Syndrome
Usually comes before a yang deficiency

Symptom Affects: Symptom Notes or possible causes
Energy level Fatigue
Lassitude (Wei qi deficiency which can’t control pores)
Breathing Shortness of breath Soft = qi not powering blood
Voice Weakness of voice Weak = deficiency
Sweating Spontaneous
Tongue Swollen, teethmarks, white fur
Pulse Soft, weak

Blood Deficiency Syndromes

Symptom Affects Symptom Notes or possible causes
Vision Blurry Often = liver blood deficiency
Facial complexion Pallor
Pale eyelids, mouth, lips,
Energy level gums, nails
Memory and Fatigue
concentration Poor memory
Menses Poor concentration
Other Irregular menstruation
Tongue Dizziness
Pulse Pale with white coating
Weak and soft

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Excess Syndromes

Syndromes of excess refer to pathological conditions in which:
1. the pathogenic factor is hyperactive
2. the antipathogenic Qi remains strong

Reasons for excess:
1. External evil attacking
2. dysfunction of internal organs

Symptom Affecting Symptom Notes or possible causes
Demeanor Aggitation
Voice Loud or sonorous Straining, urgent, painful. Feels incomplete,
Breathing Coarse often with burning. Damp heat is the
Chest/abdomen Distention and fullness problem. Often seen in IBS.
Pain Pain aggravated by pressure
Bowels Constipation
Tenesmus
Urine
Tongue Dysuria
Pulse Thick and sticky coating
Excess type pulses

Exterior/Interior + Cold/Heat + Deficiency Excess Symptoms

Exterior Cold • Chills greater than fever
Heat • Bland taste in mouth
Deficiency • Thirst: No thirst
• Tongue: thin white coating
• Pulse: superficial and tight
• Fever greater than chills
• Thirst: Slight
• Tongue: red sides and tip with thin yellow coating
• Pulse: floating/superficial and rapid/fast
• Pain/stiffness:

• o Headache
• o Stiff neck
• o Aversion to wind
• Fever: yes
• Sweating: yes
• Pulse: floating, slowed down
• Sweating: Frequently, spontaneous
Immunity: Catches cold easily
Face: pale
Breath:
o Shortness of breath

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Excess • o Dyspnea with exertion
• Energy: fatigued
• Appetite: poor
• Loose stool
• Tongue: pale
Pulse: thin, weak
•
Pain:
• o Headache
• o Body pain
Sweating: none
Pulse: Floating and tight

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Interior Defic (xu) Heat • Facial compl: malar flush
• Body type: thin
• Sweating: night sweat
• Fever: palm and sole fever (5 palm heat)
• Thirst: thirst with dry throat
• Tongue: red with less coating
• Pulse: thin and fast

Cold • Facial compl: pale
• Pain: cold pain, better with pressure
• Stool: loose
• Urine: profuse and clear
• Energy: fatigue
• Breathing: shortness of breath
• Limbs: cold
• Tongue: pale
• Pulse: deep, weak and slow

Excess (shi) Cold • Facial compl: pale
• Pain: abdominal pain, worse with pressure
• Stool: loose
• Urine: clear
• Mouth: bland taste with profuse saliva
• Limbs: cold, preference for warmth
• Tongue: pale with white fur
• Pulse: deep, slow, tight

Heat • Fever: high, preference for cold drink
• Facial complexion: red face and eyes
• Spirit:
o Irritability
o Delirium
• Abdominal distension, worse with pressure
• Stool: constipation
• Urine: scanty, red
• Tongue: red with yellow, dry coating
• Pulse: flooding, slippery, fast

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Yin/Yang

Yin and Yang Collapse Yin collapse Yang collapse
Sticky, hot, salty taste Profuse, cold, no taste
Sweating Fever in body, warm limbs Cold body and limbs
Cold/heat SOB Weak
Breathings Irritable, restless Listless
Spirit Yes, cold drink No, possible want of warm drink
Thirst Red, dry Pale, moist
Tongue Rapid, weak Very weak
Pulse

Yang Exterior Main Symptoms Tongue Pulse
Yin Heat Aversion to cold Thin Floating
Fever White/yellow fur
Excess Aching in head and body
Fever Red Rapid
Interior Thirst with pref for cold drink Yellow fur
Cold Flushed face, red eyes
Urine: scanty, yellow Thick, greasy fur Solid
Xu Stool: constipation
Hyperactive Thick Deep
Breathing: hoarse Slow
Pain: pain, fullness in abdomen/chest Pale
White-moist fur
Worse with touch
Stool: dry Little fur Thin
Urination: difficult
Same as syndromes of excess and
deficiency. (WTF???!!!!)
Aversion to cold, likes warmth
Pale face
Cold limbs
Urine: clear
Stool: loose
Pale face
Lassitude
Pain: dull
Palpitations
Weakness
Spontaneous sweating
Likes touch
Shortness of breath
Thin body

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