Background and goal
1.1. Developing standard clinical practice guidelines for eight principles-pattern identification (EPPI)
Pattern identification is an act of determining the pathological essence by dis- tinguishing “symptoms” from the disease manifested in patients. The EPPI is the basic code that constitutes the basis of this pattern identification. However, to establish an evidence-based system for Korean medicine, the first step should be securing the diagnostic basis for EPPI.
The results from the domestic status survey show that 42.4% of 505 respondents claimed not using the EPPI since the EPPI is accessorily used in combina- tion with other pattern identifications, such as viscera and bowels-qi and blood (臟腑氣血), meridians and collaterals (經絡), etiology of diseases (病因), and defense-qi-nutrient-blood (衛氣營血). Nevertheless, 57.6% of 505 Korean medical doctors considered it an essential means for pattern identification and a useful diagnostic tool indicating the probability of disease. 95.9% of the EPPI users used it when prescribing herbal medicines. Additionally, they wanted the “establishment of a clear concept of eight principles,” “proposal of syndrome indicators and diagnostic methods,” and “clinical scientific evidence and recommendation criteria;” hence, we began to develop the clinical practice guidelines for the EPPI.
1.2. Development goal
The EPPI, the basis of all pattern identification methods, constitutes an essential diagnostic component of pattern theories related to specific diseases. Therefore, this study aims to synthesize the evidence and benefits of diagnostic interventions by EPPI, establish evidence for a modern reconstruction of symptom indicators of EPPI, and evaluate the evidence for using diagnostic tools, such as questionnaires and diagnostic devices. Then these results are to provide doctors with a clear diagnosis and selecting treatment methods and provide patients with a reference to evaluate the diagnostic suitability using the EPPI. Additionally, this guideline was created for the application in clinical practice and undergraduate education in the future to improve clinical treatment standards and further function as a basic diagnostic tool for developing clinical practice guidelines for Korean medicine.
Synopsis of EPPI
As a fundamental method of pattern identification and treatment (辨證論治), the EPPI includes eight basic symptoms (yin and yang, exterior and interior, cold and heat, deficiency, and excess) based on the rise and fall of healthy qi (正氣), depth of the disease site, and nature of pathogen (病邪) from the symptoms expressed by patients using the following four examinations: inspection, listening and smelling, inquiry, and palpation.
EPPI had begun in Neijing <內經> 2,000 years ago and outlined the eight symptoms in Shanghanlun <傷寒論> in approximately AD 210. Until the early days of the Qing Dynasty, the eight principles were defined as the “fundamental principles” or “doctrine,” “Key Point,” and “complete guidelines” of treatment method and pattern classification. Hence, it was established as a fixed rule of the East Asian traditional medicine pattern identification.
According to Zhang Jiebin (張介賓), the eight principles are composed of two guiding principles (兩綱) of the yin and yang pattern and six variables (六變): exterior and interior, cold and heat, and deficiency and excess; various patient conditions can be represented by combining these principles. Moreover, due to pathological changes, mutations, conversion between the symptoms, contradictory symptoms can be combined, and even false symptoms can appear from the actual condition. The EPPI is a comprehensive summary of these various pathological changes, and the two guiding principles of yin and yang integrate the six variables. In this respect, each yin and yang, exterior and interior, cold and heat, and deficiency and excess pattern identifications have independent meaning and purpose, and these are used as basic models for clinical practice.
Particularly, the yin and yang pattern identification is used for distinguishing yin and yang tendency in the presymptomatic disease (Mibyeong) stage and diagnosing health status and crisis intervention in the severe and acute stage. The exterior and interior pattern identification is necessary to identify the etiology and pathological changes to derive hints for the treatment method and tools in the early stages of an infectious disease. The cold and heat and the deficiency and excess pattern identifications are widely used to determine pathological mechanisms and prescribing rules of formula, treatment tools, supplementary care, and methods of drainage and moxibustion. For identifying most diseases like external contraction and internal damage and acute or chronic diseases, the patterns are combined with nutrition, protection, qi, blood, Viscera and Bowels, and pathogen pattern identification.
