Health

 

 
-TRADITIONAL CHINESE MEDICINE-
 

Diagnostic Theory

Contents


Introduction

The theories of the six channels, four stages of wei, qi, ying and xue are methods of differentiating syndromes of febrile diseases caused by exogenous pathogenic factors.

By the theory of Six Channels

This method first appeared in the Shang han lun (The Treatise on Febrile Diseases Caused by Exogenous Pathogenic Factors) by Zhang Zhongjing of the eastern Han Dynasty (25 BCE -220 CE). In this book various clinical manifestations of febrile disease caused by exogenous pathogenic factors such as Taiyang syndromes, Yangming syndromes, Shaoyang syndromes, Taiyin syndromes, Shaoyin syndromes, and Jueyin syndromes are used to explain the location and nature of pathological changes, the strength and weakness of anti-pathogenic and pathogenic qi, and the tendency of disease development, as a guide for clinical treatment.

By the theory of Four Stages of Wei, Qi, Ying, and Xue

This method was first put forward by Ye Tianshi, a Qing Dynasty (1644- 1911 CE) physician, in his book "Wan Gan Wen Re Pain" (On Febrile Diseases Caused by Pathogenic Mild Heat). He classified the clinical manifestations of febrile diseases caused by pathogenic mild heat into four stage, wei (outer defensive) stage, qi (inner defensive) stage, yin (nutrient) stage, and xue (blood) stage. These are the four body strata used the explain the location and severity of pathological changes, and which form the basis of clinical treatment.

By the Theory of Sanjiao

This was advocated by Wu Jutong, another Qing Dynasty physician. He summarized clinical manifestations of epidemic febrile diseases as having three areas: the upper, middle, and lower portions of the body cavity. These are also used to guide clinical treatment.

These three methods are not contradictory, rather they supplement each other's deficiencies. They can be used jointly to differentiate febrile diseases caused by exogenous pathogenic factors.


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The Six Levels

The Six Levels (or Six Stages or Six Channels) are first heard of from Zhang Zhong- Jing in the Shang Han Lun from about 220 CE or about 1700 years ago.

The names of the levels are the same as the names of the head and foot pairs of acupuncture meridians. The order is roughly the order that a disease takes as you go from health to death. In some diseases levels are skipped or the order can change.

The six stages are:


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Taiyang Diseases

A taiyang disease is a pathological syndromes caused by exogenous pathogenic factors invading the body surface; it is also known as an exterior syndrome. Taiyang disease can be classified into syndromes of the Taiyang channel and syndromes of the Taiyang fu organ (urinary bladder).

These are common manifestations of Taiyang exterior syndromes. On this basis, if they are accompanied by sweating, aversion to wind, floating and superficial pulse, they are known as wind stroke syndromes of Taiyang or exterior xu syndromes caused when the defensive qi is invaded by exogenous pathogenic wind. This leads to a disharmony between defensive and nutrient qi. If aversion to cold is not accompanied by sweating and a floating tense pulse, this is understood as Taiyang febrile syndrome caused by cold or exterior shi syndromes. In this case, exogenous pathogenic cold has obstructed the body surface and blocked the yang qi flow.

In addition, since the lung dominates the skin and hair, if exogenous pathogenic factors attack the body surface, lung qi will lead to dysfunction causing nasal obstruction, cough, asthma, etc.

These syndromes are due to exogenous pathogenic factors being transmitted from the exterior to the interior, giving rise to qi activity dysfunctions in the urinary bladder. This further affects the body fluid flow leading to fluid retention and its sequence of irritability, thirst with preference for drinks, vomiting after drinking, and dysuria.

Pain and lump in the lower lateral abdomen resulting from pathological heat transmitted along the Taiyang channel and mixing with blood in the lower jiao. Mental mania is caused by an upward disturbance due to blood retention and pathogenic heat. Since the disease location is in the blood of the lower jiao, the urinary bladder is not affected, thus there is normal urination.


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Yangming Diseases

Yangming diseases are usually caused by exogenous pathogenic wind and cold which convert to heat and transmit directly into the interior, attacking the Yangming. They may also be due to delayed treatment causing body fluid consumption, which dries the stomach and intestines, resulting in constipation. yangming diseases exhibit the greatest conflict between pathogenic and anti-pathogenic factors. They are also divided into syndromes of the Yangming channel and Yangming fu organ.

Pathogenic heat retained in the Yangming channel causes hyperactivity of heat in the stomach, manifesting as fever. pathogenic heat forces the body fluid to flow outward, thus sweating occurs. This perspiration consumes fluids, so there is thirst with a preference for drinking. Irritability is due to heat disturbing the hear-mind. A dry yellow tongue coating is a sign of excessive heat injuring the body fluid. A forceful pulse indicates excessive heat and preponderant yang.

Constipation is due to dryness of the intestine. The dysfunction of qi circulation in the fu organ causes a fullness and distending pain in the abdomen which is worse with pressure. Steaming of interior heat is the cause of fever and sweating. The Yangming qi, peaking at dusk, causes tidal fever when it contends with pathogenic factors. Irritability and delirium or even coma are caused by heat disturbing the hear-mind. Deep and shi pulse, and yellow and dry tongue coating with thorns are signs of interior shi heat leading to the insufficiency of body fluid.


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Shaoyang Diseases

Shaoyang diseases are usually due to unrelieved Taiyang exterior syndromes that have been transmitted into the interior. There may be cases which have Taiyang diseases at the onset, so pathological changes are neither on the Taiyang exterior nor in the Yangming interior, but stay in between. They are known as semi-exterior/interior syndromes.

Pathogenic factors invade the Shaoyang and contend with anti-pathogenic qi in the region between the surface and the interior, so there are alternating chills and fever. The foot Shaoyang channel is distributed along the lateral side of the chest and hypochondriac region. Fullness of the chest and epigastric regions results from the obstruction of qi circulation after pathogenic factors invade the Shaoyang channel. Qi stagnation of the gall bladder may also affect the stomach, so poor appetite, irritability and vomiting occur. Fire of the gall bladder flares up to cause a bitter taste, dry throat, and vertigo. Wiry pulse and white slippery tongue coating are due to pathogenic heat hindering the Shaoyang.


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Taiyin Diseases

Taiyin diseases are mostly due to pathogenic cold directly attacking the middle jiao of a constitutionally weak patient, or due to delayed treatment of diseases of the three yang channels thus damaging the yang of the middle jiao.

The nature of Taiyin diseases is xu cold of the middle jiao, and interior retention of cold damp. The spleen is responsible for the elevation of clean qi, while the stomach is responsible for the descent of turbid qi. The spleen also dominates the function of transportation and transformation of food, and the stomach controls the function of receiving food. Thus when the middle jiao is weak and attacked by pathogenic cold, the functions of transportation, transformation, and food reception become abnormal causing interior retention of cold damp manifesting the above symptoms.


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Shaoyin Diseases

Shaoyin diseases may be due to direct attack of the Shaoyin by exogenous pathogenic factors when the body has yang deficiency and cold; or due to the transmission of pathogenic factors from other channels into the Shaoyin; or due to treatment employing a strong diaphoretic action that injures the yang. After invasion of the Shaoyin by pathogenic factors causing yin symptoms, a change into cold may occur. If yang symptoms occur they may transform into heat. Therefore Shaoyin diseases can be divided into Shaoyin syndromes of cold transformation and Shaoyin syndromes of heat transformation.

Shaoyin syndromes of cold transformation are the manifestations of heart and kidney yang deficiencies and interior retention of yin cold. Insufficient yang qi fails to warm and nourish the extremities resulting in cold extremities and sleep with the knees drawn up. Listlessness is due to the inability of yang qi to nourish the mind. Kidney yang deficiency is unable to warm the middle jiao leading to a dysfunction of the ascending and descending functions of middle jiao qi, resulting in loose stool with undigested food and vomiting. Yang deficiency unsuccessfully controls water, so there is profuse and clear urine. Absence of thirst, preference for hot drinks, pale tongue proper with white coating, and deep feeble pulse are all signs of yang deficiency and yin preponderance.

The patient usually has a yin deficiency. After pathogenic factors invade the Shaoyin, they are liable to transform into heat affecting kidney yin. A lessening of kidney yin (body fluid) prevents its upward flow to the heart, and leads to hyperactivity of the heart fire. Symptoms of irritability, insomnia, dryness of the mouth and throat, deep red tongue, deep thready, and rapid pulse occur.


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Jueyin Diseases

Jueyin diseases indicate the last stage of disease transformation of the six channels. This disease condition is complex with syndromes of extreme heat or extreme cold, or syndromes of alternate cold and heat.

This interior accumulation causes a failure of the yang qi to warm and nourish the body surface. The resulting cold extremities are considered "coldness due to extreme yang," or "coldness due to extreme heat." Syndromes of extreme cold are also known as "coldness due to extreme yin."

This condition is caused by parasitosis accompanied with mixed heat and cold. The symptoms of xiao ke, a feeling of qi striking upward, and pain and feverish sensation of the heart are heat syndromes. Hunger without appetite, vomiting ascariasis after eating, and serious diarrhea are cold syndromes. The mixture of heat and cold and the disharmony of yin and yang causes coldness of the limbs. Ascariasis disturbs the upper part of the body, manifesting irritability, and vomiting ascarids after eating.


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The Four Stages

This is a method of analyzing and judging the development of febrile diseases caused by exogenous pathogenic factors. These stages are not only generalizations of the four types of febrile disease syndromes, but also a reflection of the four grades of severity of febrile diseases during their development.

The Four Stages:


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Wei (Outer Defensive) Stage Syndrome

Wei (outer defensive) stage syndromes are seen at the onset of epidemic febrile diseases, the pathological changes occurring in the lung, and on the skin and hair. Clinical manifestations are characterized by the common exterior syndromes of fever and aversion to wind and cold.

Main clinical manifestations:

Fever, a slight aversion to wind and cold, very little or no sweating, cough, headache, sore throat, slight thirst, a red tongue tip with thin white or slight yellowish tongue coating, floating and rapid pulse.

An attack of mild pathogenic heat on the body surface blocks the circulation of wei (defensive) qi, thus leading to dysfunction of the opening and closing of the pores and weakness of the defensive function of the body surface. Symptoms of fever, slight aversion to wind and cold, little or no sweating, and headache result. The lung dominates the skin and hair. Since the wei qi is blocked on the body surface, then the lung qi loses its function of spreading and descending qi, thus cough and sore throat result. Thirst is caused by pathogenic heat consuming the body fluid. Red tongue tip with white thin or yellowish tongue coating, floating and rapid pulse are all signs indicating pathogenic mild heat attacking the wei qi of the body.

These symptoms are mainly manifestations of the loss of wei qi's defensive function and also indicate a failure of the spread and descent of qi. If pathogenic factors mainly affect the skin and hair, that is, the body surface, then they are characterized by fever, thirst, and sore throat. If the lung is mainly affected, the chief complaint will be cough and sore throat.


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Qi (Inner Defensive) Stage Syndrome

Syndromes of the qi (inner defensive) stage are the syndromes of interior heat due to the inner defense being invaded by pathogenic heat. In this case the anti-pathogenic qi and the pathogenic factor are very strong, resulting in hyperactivity of yang heat. Clinical manifestations are fever and no fear of cold.

Since the affected location alters after pathogenic heat is transmitted into the interior, the syndromes of the qi stage can then be classified into different types as follows:


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Yin (Nutrient) Stage Syndromes

The syndromes of the yin (nutrient) stage occur when pathogenic mild heat is transmitted into the superficial layer of the blood. Ying is a component of the blood, so the disease location is actually in the heart and pericardium. Pathological characteristics show the injury of nutrient yin and the disturbance of heart-mind.


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Xue (Blood) Stage Syndromes

Syndromes of the xue (blood) stage denote pathogenic mild heat invading the blood to the deepest stage. The pathological changes are mainly in the liver and kidney. Clinical manifestations are characterized by heat in the blood causing disorderly flow, stirring up of wind and heat, and injury of body yin.


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Three Jiao

The identification of disease according to the Three Burners (San Jiao) was first described by Wu Ju Tong (1758-1836) in his book "A Systematic Identification of Febrile Diseases". The system is often combined with Four Stages theory when diagnosing and treating an externally contracted disease caused by a wind-heat pathogen. The disease will be diagnosed and understood according to its location within the three burners. This system is used within the practice of Chinese herbal medicine, rather than acupuncture or other Chinese medicine modalities. Note that San Jiao theory differs slightly from the San Jiao organ, which is described by Chinese Medicine as the passage of heat and fluid throughout the body.

The three burners are most commonly referred to by their respective names:


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Upper Jiao

The Upper Jiao refers to the upper part of the body, and includes the Heart, Lung, and Pericardium organs. Patterns that affect the upper burner include:


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Middle Jiao

The middle jiao refers to the midsection of the body and includes the Spleen, Stomach, Gall Bladder and Liver organs.

The yang ming pattern is often referred to as the Four Bigs- big fever, big sweat, big thirst, big pulse.


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Lower Jiao

The lower jiao refers to the lower section of the body and includes the Small and Large Intestines, the Kidneys and the Urinary Bladder.


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Sources


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Health :: Traditional Chinese Medicine

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