Differentiates the location and depth of the pathogen
Does not differentiate what caused a disease
Etiology might have involved an external invasion of pathogenic factors
A disease classified as exterior is not due to an invasion of pathogenic factors, but due to the fact that the pathogens is located in the exterior of the body
If the pathogen penetrates into the organs, then it is classified as an interior disorder
Exterior
Clinical manifestations of exterior patterns
Two types
Those that affect the skin and muscles and have an acute onset
Ex) Wind-Cold or Wind-Heat invasion
Fever and aversion to cold (chills) occuring simultaneously indicates a pathogenic factor in the exterior
These are subjective feelings of chill and fever
Other general signs and symptoms
Other signs and symptoms vary according to nature of pathogen
Cold or hot, excess or deficient
Cold/Hot
Cold (Wind-Cold)
Slight fever
Pronounced aversion to cold
Severe body aches and stiff neck
No sweating - cold contracts pores
No thirst
Floating-tight pulse or floating-forceful pulse
Thin white tongue coating
Strength of evil vs right
Those that affect the channels and have a slower onset
Pathogenic factors block the circulation of qi in the channels and joints
Pathogenic factors include
Wind
Wind is migratory in nature so pain moves from joint to joint
Usually combines with another pathogenic factor such as cold, damp, heat
Wind is a yang pathogenic factor and has the characteristic of upward and outward movement, therefore usually affects the upward parts of body (face, head, neck, UE)
Cold
Often only one joint affected
Pain is severe as cold is characterized by stagnation and contraction, also limitation of movement
Pain is relieved by application of heat
Characterized by no sweating, can cause a transition to heat
Dampness
Involves swelling of the joint
Characterized by pain and soreness with a heavy sensation, numbness of the limbs, often affects the lower body
Heat
Pain is severe, joints are swollen and hot
Characterized by pain with a burning sensation and redness
Often affects the upper parts of the body and is often seen in acute inflammation of joints and muscles in the upper body
When combined with damp, can affect the lower body (hip, knee, ankle and foot
More information
POS is acute or chronic pain and stiffness in the musculoskeletal system
POS is located in the musculoskeletal system
POS is primarily an external disorder
Musculoskeletal system is considered external relative to the organ system
Linked through the channels
Integrity of qi and blood flow through the channel network and musculoskeletal system is influenced by the function of the internal organs
Any organ system can influence the volume and quality of qi and blood in the channels and its ability to circulate freely
Organ systems that have a direct effect on the manufacture and distribution of qi and blood are especially relevant
Imbalance in any organ system can also affect the integrity of qi and blood distribution through the related channel and tissues under its control
Traditionally focused on the bones and joints
Similar to Western orthopedic model
Concerned with what would be diagnosed biomedically as inflammatory and degenerative joint disease
Since it deals with pain, there is a tendency to use it with all kinds of musculoskeletal pain
All musculoskeletal pain can be technically classified as painful obstruction, but the painful obstruction model may not be able to effectively treat all musculoskeletal pain
Two ways of seeing pain
Constitutional (Chinese) model
Based on the relationship between pathogenic invasion, organ sytem function and local pathology of the joints and soft tissues
Understands how the interior and exterior, and distant parts of the body are linked through the channel system
More concerned with systemic dysfucntion at the expense of local percision
Areas are treated rather than specific tissues
Anatomical (Western) model
Based on the understanding of the structure, function and biomechanics of the components of the musculoskeletal system
Advantages are precision with which it is possible to identify and treat a pain causing structure
Misses the relationship between the function of the organism as a whole and pathology of a specific part
Combination of the two increased results and facilitates an understanding of when to use which tools
Pathology of POS
POS involves the exterior, interior or both
Purely exterior
Confined to the musculoskeletal system
Internal organ system is not involved
Result of trauma or pathogenic invasion
Treatment is predominantly local, aimed at removing the obstruction and correcting qi and blood flow through the channels and tissues
External condition with internal organ dysfunction
Main symptoms are external, but there is an organ system imbalance or weakness
Can occur two ways
Unresolved pathogen may linger in the tissues, eventually impacting the organs
Ex) persistant damp pathogen may deplete the Spleen
Ex) Chronic cold may drain Kidney yang
Ex) Unresolved heat may damage Kidney and Liver yin
Internal organ system problem can predispose the tissues and regions of the body controlled by it to invasion by pathogenic factors or damage from overuse
Internal organ problem with symptoms externally
Main problem is in the internal organs
Symptoms are reflected in the external pathways and tissues related to the affected system
Ex) Dull lower back pain and aching weak knees of Kidney deficiency
Ex) Hip, shoulder and TMJ pain from Gallbladder dysfunction
Treatment is aimed at the organ system, herbs might be the primary modality.
Interior
Differentiated based on the location of the pathogen or based on deficiency of qi, blood, yin or yang, not on etiology
Disease caused by an invasion of pathogen penetrating into interior
Half interior half exterior
Involves the shaoyang channels and organs (shaoyang pattern wind-heat invasion)
Disease already in the interior
Causes a disruption in function of the zang-fu with complex manifestations
See identification of disease by zang-fu pattern
Heart disease there are palpitations and insomnia
Liver disease there is dissiness and hypochondrial pain
Spleen and Stomach disease there is poor appetite, nausea/vomiting and loose stool
Lung disease there is cough and SOB
Kidney and Urinray Bladder disease there is seminal emission, enuresis, or painful, burning urination