IV. EJECUCIÓN DEL CONTRATO 23. RESPONSABLE DEL CONTRATO
24. OBLIGACIONES DEL CONTRATISTA
The “formula of eight words” mentioned in the above verse refers to eight principles used by Chinese physicians to understand illness. These eight words, which work in pairs, are cold, hot, empty, solid, internal, external, yin and yang. The words are meant to summarize syndromes exhibited by the patient, not characteristics of pathogenic agents. We must also bear in mind the linguistic and cultural difference between English and Chinese: as in other medical terms translated from Chinese to English, the words should be interpreted symbolically, not literally.
Whether the disease is classified as cold or hot depends on the nature of the disease. Cold diseases show the following symptoms: deficient in body warmth, afraid of being cold, not feeling thirsty, clear urine, liquid faeces, slow and feeble pulse rate, cold limbs, pale face, and whitish fur on tongue. Cold diseases are related to weakening of physiological functions and low energy level. In other words, when a Chinese physician diagnoses a disease as cold, it suggests that one, some or all of the patient’s internal organs are under-functioning.
The following are the symptoms of hot diseases: feverish, warm limbs, feeling hot and stuffy, thirsty, thick and short urine, solid faeces, red face, dried lips, red or yellowish tongue, and rapid and strong pulse rate. Hot diseases are related to activated physiological functions and increased metabolic processes. They are often found in contagious diseases. “Cold” and “hot” here are different from, but related to, “cold” and “heat” as two of the six evils mentioned in the previous chapter.
Whether the illness is “empty” or “solid” refers to the relationship between the natural physiological functions and body resistance on one hand, and the effects of pathogenic agents on the other. Generally, empty diseases are the result of weakening of body functions, whereas solid diseases are caused by the increasing potency of pathogenic agents. The cause of an empty disease is not obvious, like energy blockage or hormonal imbalance, whereas the cause of a solid disease is obvious, like a viral attack or a structural defect. When a physician diagnoses a patient as having a solid disease, for example, it suggests that he is not reacting effectively to some exo-pathogenic agents.
Common symptoms of empty illness are sweating, slow and feeble pulse rate, shrunk tongue, feeling weak and tired, and failing physiological functions. Common symptoms of solid diseases include strong pulse, swollen tongue, bodily swelling, pus, phlegm and other secretions. When your conventional doctor cannot find any clinical cause of your sickness, though both you and your doctor realize that the ailment is not imaginary, it is likely to be an empty disease.
External or internal diseases refer to the depth or developmental stage of the illness. External diseases are found at the skin and flesh levels, whereas internal diseases occur inside the body or in internal organs. However, the crucial factor in determining whether the disease is external or internal, is not so much the location of the disease, as the state of the patient’s reaction against it. An infection, for example, may be found at
the skin level, but if its effect threatens the internal organs, it can be regarded as at the internal stage.
The main symptoms of external diseases are being afraid of cold or wind, fever, blocked nose, whitish fur on the tongue, “floating” pulse, headache, sour limbs and body pains. The main symptoms of internal diseases are very high fever, solid faeces, thick and yellowish urine, yellowish tongue, “sunken” pulse, congested chest, swollen abdomen, delirious, dejected, and semiconscious.
Yin and yang refer to the two primary guidelines that can summarize the other six factors mentioned above. Diseases that are internal, cold and empty are generally termed as yin illness, whereas diseases that are external, hot and solid are yang illness. Yin illness shows the following main symptoms: pale face, feeble voice, afraid of cold, clear urine, liquid faeces, not thirsty, and weak pulse rate. Yang illness includes the following main symptoms: red and bright face, fever, loud voice, solid faeces, thick and yellowish urine, fast breathing, and strong pulse rate. These eight principles are useful guidelines enabling the physician to understand his patient’s symptoms systematically. These principles, however, must never be taken as rigid rules.
In his diagnosis, the physician must also be aware of “false symptoms”. For example, the patient may be feverish, feel thirsty and have a clear pulse rate, thus giving an appearance of a yang illness. On closer examination, we may find his metabolic processes not functioning properly, and his energy level is low. Although he is feverish, he is afraid of cold; he feels thirsty, but he does not desire to drink; his pulse may be clear, but it lacks strength. Actually his is a yin sickness, commonly found in the advanced stage of a contagious disease when his natural body defence has been worn down. Such is an example of a “solid yin disease manifested as empty yang symptoms.”
On the other hand, a patient may appear to have yin symptoms. He does not sweat, his limbs are cold, he feels bodily pains, and he has “floating” pulse rate. However, his physiological functions are working well, and his energy level high. He does not need extra clothing, his body is warm, his urine yellowish, his faeces hard and smelly, and his pulse rate strong. His case is “solid yang disease manifested as empty yin symptoms”, often found in a strong, healthy person initially attacked by some contagious disease. In his diagnosis, the physician needs to consider the following factors: 1. Location: whether the illness is “internal” or “external”. 2. Body resistance: whether the illness is “empty” or “solid”.
3. Behaviour of illness: whether the illness has the properties of “wind”, “cold”, “dryness”, “dampness”, “heat” or “fire”.
4. Developmental stage: whether the illness is “superficial”, “initial”, “intermediate” or “advanced”. The Chinese terns for these stages are “wei”, “qi”, “ying” and “xue”. In physiological context, these terms have different meanings.