The Interior in Chinese Medicine

Interior syndromes describe conditions affecting Qi, Blood, Internal Organs and bone marrow. These conditions can be Hot, Cold, Excess or Deficient. In general, Interior conditions tend to be more chronic as opposed to more acute for Exterior Conditions.

It is impossible to generalize to give the clinical manifestations of interior conditions as these will depend on the Organ affected, and whether the condition is Hot or Cold and Full or Empty. When an Interior condition starts with the invasion of an external pathogene, the most important symptoms that mark the change from the Exterior to the Interior stage are the disappearance of aversion to Cold and the onset of aversion to Heat.

For example if a patient suffers an invasion of Wind, in the beginning stage the condition is defined as Exterior: the two chief symptoms that denote this are aversion to cold and ‘fever’. At this stage, the pathogenic factor is either expelled completely and the patient recovers or it penetrates in the Interior: when this happens, the condition is Interior. The main change that denotes this progression of the pathogenic factor to the Interior is the disappearance of aversion to cold and the onset of aversion to heat.

Internal diseases are also commonly caused by the Seven Emotions: Joy, Sadness, Anger, Grief, Melancholy, Fright and Fear. There is a physiological relationship between the emotions and the immune system which is of tremendous importance. Negative emotions tend to make us vulnerable to chronic disease and vice versa.

Other important factors that cause Internal diseases include improper diet, trauma, and bites by animals or insects.

Internal Wind

Internal Wind refers to diseases that affect the nervous and circulatory systems with joint or muscle spasms, spasmodic pains, tremors, epilepsy, coma and apoplexy.

Internal Heat

Internal Heat includes symptoms of constipation, acute abdominal pains, abdomen sensitive to deep palpation, internal inflammation, nervousness and restlessness. The pulse is deeper and more rapid. The tongue is scarlet, with a dry, yellow coat.

Some pathological conditions include cholecystitis, hepatitis, urethritis, cystitis and nephritis. Alterative, heat clearing, antibacterial and antiviral herbs with a bitter flavor are used.

Internal Cold

Internal Cold manifests symptoms of Coldness with a preference for warmth, warm food and drinks, pale complexion, loose stool, pale urine, clear mucus discharges, low vitality, apathy and slow speech. The pulse is deep and slow (around 60 or less beats per minute). The tongue is pale with a white coat. 

Internal Deficiency

Internal Deficiency includes symptoms of fatigue, shortness of breath, involuntary sweating, dizziness, poor memory, timidity, soft spoken voice, lack of appetite, loose stools, pallor and palpitations. The pulse is deep, slow, thin and faint. The tongue appears pale with scalloped edges and a thin white coat. Deficiency symptoms involve Deficiency of Qi, Blood, Yin or Yang.

Internal Excess

Internal Excess may exhibit symptoms of edema (Excess Dampness), obesity, fullness of the abdomen, Stagnation of Qi, Blood, Fluids (lymphatic) and Food. The pulse is deep and full and the tongue is enlarged with a thick coat. Excess commonly transforms to Heat, which produces symptoms of constipation, red complexion, bad breath, abdominal pain, yellow coated tongue and a bounding, rapid and/or full pulse.

Half External - Half Internal

Half External - Half Internal refers to conditions that are a mixture of External-Internal, Hot-Cold and Excess-Deficiency. This condition is characteristic of the Xiao Yang Stage of disease (Lesser Yang) which requires harmonizing formulas with opposite properties. Most often these include formulas with Bupleurum because this herb, while classified and used to relieve External Heat, also helps regulate and release Qi Stagnation. Most, if not all, Bupleurum formulas combine treating both Internal and External, Hot and Cold, Excess and Deficient symptoms. Consequently, there are many formulas in this category.