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1. Course Number: 200B
2. Course Title: PRINCIPLES AND THEORIES OF TCM II
3. David M. Cohen, L. Ac.,
4. PURPOSE
The purpose of this course is to broaden and deepen the student’s understanding of the principle theories of TCM Differential Diagnosis: Differentiation of Syndromes.
5. OBJECTIVES FOR STUDENTS
By the completion of the term, the student will be expected to know how to identify the basic patterns (Bian Zheng) and the basis of treatment according to Pattern Discrimination. These patterns include the following: the Eight Principles, all the syndromes of Vital Substances ( Qi, Blood, BF), Pathogenic factors, as well as some aspects of Five Element differentiation, Jing Luo theory and the Six Phases, Four Levels and Three Jiaos. The student is required to know the symptomotology of each syndrome, as well as appropriate treatment principle and treatment which includes herbal pharmacopoeia and herbal prescriptions, as well as miscellaneous other relevant treatment, most noticeably diet.
6. REQUIRED TEXTS
Maciocia, The Foundations of Chinese Medicine
Class Outline
7. RECOMMENDED TEXTS
Clavey, Steven, Fluid Physiology and Pathology in Traditional Chinese Medicine
Deng, Tietao, Practical Diagnosis in Traditional Chinese Medicine
Wiseman and Ellis, Fundamentals of Traditonal Chineses Medicine
Wiseman and Feng, A Practical Dictionary of Chinese Medicine
8. Recommended Reading
READING LIST: The Required text for this class may be either Wiseman and Ellis, Fundamentals of Chinese Medicine, or Macicoccia, Foundations of Chinese Medicine. It is further recommended that the student read from as many of the following recommended texts as possible.
* indicates strongly recommended)
( Beijing Foreign Press) , Chinese Acupuncture and Moxibustion
* Bensky, Dan, Formulas and Strategies
Dharmananda, Subhuti, Your Nature, Your Health
Flaws, Bob, Statement of Fact in Chinese Medicine,
Flaws, Bob, and Finney, Daniel, A Compendium of TCM Patterns & Treatments
Hammer, Leon, Chinese Pulse Diagnosis: A Contemporary Approach,
Huang Bing-Shan, Syndromes Of Traditinal Chinese Medicine
Jarrett, Lonnie, Nourishing Destiny
Kaptchuk, Ted, The Web That Has No Weaver
* Li Shih Zhen, Pulse Diagnosis
• Liu, Guohui, Warm Pathogen Diseases
•
Maciocia, Giovanni, The Foundations of Chinese Medicine
* Macioccia, Giovanni, Tongue Diagnosis
Porkert, Manfred, The Essentials of Chinese Diagnosis
9. Course Requirements
Attendance and participation are mandatory to obtain a grade of A.
The final and midterm compose two-thirds of the grade and class participation
in quizzes, homework and case studies will comprise the other third.
10. Evaluation Criteria:
Exams 67%
Quizzes and Classwork 33%
- Passing is 70% and is equivalent to a grade of C. Anything below that is not acceptable for credit to this class. Anyone missing more than three classes can not receive a passing grade in this course.
11. Presentation Methods
This class is primarily lecture, but a section of each class is reserved for questions or review in a question and answer format. Students are encouraged
ask questions, but only after reflecting upon the material.
12. Key Knowledge Presented
The emphasis is on developing skill at Pattern Identification. This includes mastery of the Eight Principles, fundamental knowledge of tongue and pulse diagnosis, functional differentiation of syndromes of vital substances. We will also introduce the differentiation for Shang Han Lun and Wen Bing, theories of Fevers.
13. Required Level of Comprehension
While still an introductory level course Students are required to have a working knowledge of Principles and Theories I or the equivalent, as it is expected that fundamental principles must be clearly understood when applying them to diagnosis. While it is not required for this course, it is also strongly recommended that the student be conversant with the principles of Acupuncture and herbal pharmacopoeia as well.
SYLLABUS AND CLASSS OUTLINE
Week 1- General Introduction to Pattern Discrimination
Differentiation, Treatment principles, methods
- Eight principles revisited
READING: Deng, Practical Diagnosis, p 165-185
Macioccia, Foundations, 417-442
Flaws, Compendium, pp 1-7
Wiseman and Ellis, Fundamentals, 127-143
Week 2- Diagnostic Method Overview I
-Four Methods
-Tongue Examination
READING: Deng, Practical Dx, 33-55
Macioccia, Foundations, 310-316
Macioccia, Tongue Dx, 12-35
Wiseman and Ellis, 89-116
Week 3- Diagnostic Method Overview II
-Intro to Pulse Diagnosis
READING: Deng, 83-155
Kaptchuk, 155-177
Macioccia, 353-361
Li Shih Zhen, Pulse Dx, 102-115
Acupuncture and Moxibustion, 267-271
Wiseman and Ellis, 116-126
Week 4- Pattern Discrimination According to Qi, Blood, and Body Fluids I
Introduction to Differentiation of Syndromes according to
Vital Substances
READING:
Deng, 253-267
Macioccia, 445-455
Flaws, 137-152; 153-167
Wiseman, Ellis, 145-152
Week 5- Pattern Discrimnation according to Qi, Blood, and Body Fluids II
Dampness and Phlegm Patterns, etiology and symptomotology.
READING
Clavey, Fluid Physiology and Pathologyin TCM,
1-17; 151-257, 397- 443 ( You don’t have to…but you’ll wish you did!)
Week 6- Pattern Discrimination according to Five Phases
READING: Dharmananda, Your Nature Your Health
Kaptchuk, 343-354
Macioccia, 775-778
Week 7- MIDTERM EXAM/ Review of Exam
Week 8- Pattern Discrimination According To Pathogenic Factors I:Wind
READING:
Deng, 185-210
Maciocia, 681-687; 687-707
Wiseman & Ellis, 187-223
Week 9- Pattern Discrimination According to Pathogen II: Hot and Cold
Week 10- Pattern Discrimination According to Six Phases
Fundamentals of Shang Han Lun; strong and weak presentations
READING:
Deng, 211-229
Maciocia, 709-719
Wiseman and Ellis, 225-248
Abigail Surasky, writing on Ni Yi Tian-handout
Week 11- Pattern Discrimination According Theory of Warm Diseases
Reading: Liu, 5-101
Wiseman and Ellis, 348-370
Maciocia, 721-741
Week 12- Principles and Methods of Treatment
- Summarizing various treatment principles and methods in the context of Differentiation
READING: Wiseman and Ellis, 249-292
Bensky, Formulas and Strategies, 9-14
Week 13- Diagnostic Method revisited; organization of patterns
READING: Deng, 325-342
Week 14- Practical Application of Pattern Discrimination
-Unifying the miscellaneous diseases
Week 15 FINAL EXAMINATION
Tuesday, August 24, 2010
TONGUE OBSERVATION WORKSHEET
I. Overall Health and Spirit of Tongue_______________
II. BODY.
a) Size/Shape _______________
b) Color _______________
c) Motility _______________
d) Moisture _______________
e) Shen _______________
III. COATING Yes____ No____
a)Thickness _______________
b) color _______________
c) Texture _______________
d) Distribution _______________
IV. Distribution of Features
a) Large central crack ____
b) teeth marks ____
c) Red spots ( location?) ____
d) peeled coating ____
Other features ____________________________________
V. Diagnosis according to Eight Principles
_____________________________________________
II. BODY.
a) Size/Shape _______________
b) Color _______________
c) Motility _______________
d) Moisture _______________
e) Shen _______________
III. COATING Yes____ No____
a)Thickness _______________
b) color _______________
c) Texture _______________
d) Distribution _______________
IV. Distribution of Features
a) Large central crack ____
b) teeth marks ____
c) Red spots ( location?) ____
d) peeled coating ____
Other features ____________________________________
V. Diagnosis according to Eight Principles
_____________________________________________
PRINCIPLES AND THEORIES II
Differentiation of Patterns
David M. Cohen, L. Ac.
REVIEW OF BASIC PRINCIPLES
I. YIN AND YANG
a) List the four Laws of Yin and Yang and explain them . Use each in an example drawn from TCM physiology.
1.
2.
3.
4.
II. FIVE PHASES
a) Explain, according to Four Needles, which points are used to:
1) Tonify (Earth)
2) Disperse ( Metal)
III. VITAL SUBSTANCES
a) List all the stages of transformation in the transformation of Qi.
Know the role of each of the organs involved in the specific transformations.
Know the specific function of each kind of Qi and where it predominates
b) What is Yuan ( Source ) Qi and how is it related to
Zheng ( Righteous or True) Qi?
c) What is meant by harmonizing Ying and Wei?
d) What are the San Biao (Three Treasures)?
e) What are the functions of Jing? What is Pre-Heaven Jing and what is PostHeaven Jing? How is it stored and how maintained?
What are signs of Jing decline?
f) List the three organ systems most responsible for Qi production.
List the functions of each organ and give examples of symptoms
arising from disfunction.
g) List the three organs crucial to Blood production and explain function and disfunction as above.
h) List the three organs vital to the transformation and circulation of Jin Ye ( Body Fluids).
IV. ZANG FU.
a) List the functions of the Five Zang organs
b) Explain the role of San Jiao in TCM physiology.
c) Explain the relationship betwen Pre-Heaven and Post Heaven Jing.
d) Define what is meant by a Fu organ?
e) List the Extraordinary Organs and explain what makes them extraordinary.
V. CHANNEL THEORY
a) List all twelve channels from Superficial to deep ( According to SIX PHASES)
b) List the Eight Extra Channels. What are the Master/Couple points?
List one major function for each of the Eight.
c) Explain the clinical significance of:
1. Luo vessels
2. Divergent channels
3. Main Channels
4. Muscle Channels
5. Eight Extra Channels
d) List the five Shu and and give chief indication of each.
VI. ETIOLOGY OF DISEASE
a) What are the Six Types of Qi ( Exogenous Pathogenic Factors)
and how are they characterized? What organs do they primarily attack?
b) What are the Seven Endogenous factors? What are their characteristics and which organs do they affect?
c) What are the principle miscellaneous factors? Which organs do they
attack?
VII. PRINCIPLES OF TREATMENT
a) Explain the struggle of pathogen versus anti-pathogenic factor
in terms of:
1) Excess and Deficiency
2) Root and Branch
3. Righteous Qi (Zheng) and Pathogen
b) Explain the principles involved in choosing all of the following:
1) Attack Only
2) Attack followed by Supplementation
3) Supplementation followed by Attack
4) Simultaneous Supplementation and Attack
5) Supplementation Only
c) Define the following methods of treatment
1) Diaphoresis
2) Harmonizing
3) Purging
4) Ejection ( Vomiting)
5) Warming
6) Clearing
7) Reducing
8) Supplementing
VIII. DIAGNOSIS
a) What are the Four Methods of Diagnosis? Describe them
b) What are the five Qualities of Tongue Body, the four qualities
of tongue coating that are evaluated?
c) What are names of the pulse positions and which organs are represented there?
d) What are the Ten ( or Twelve) Questions
IX. PATTERN DISCRIMINATION (DIFFERENTIATION OF SYNDROMES )
a) list the basic symptomotology
1) deficiency
2) excess
3) Qi deficiency
4) Blood Deficiency
5) Yang Deficiency
6) Yin Deficiency
7) Heat
8) Cold
9) Wind
10) Dampness
11) Summer Heat
12) Dryness
b) Explain the symptomotology between
1) Heat and Cold
2) Interior and Exterior
3) Excess and Deficiency
David M. Cohen, L. Ac.
REVIEW OF BASIC PRINCIPLES
I. YIN AND YANG
a) List the four Laws of Yin and Yang and explain them . Use each in an example drawn from TCM physiology.
1.
2.
3.
4.
II. FIVE PHASES
a) Explain, according to Four Needles, which points are used to:
1) Tonify (Earth)
2) Disperse ( Metal)
III. VITAL SUBSTANCES
a) List all the stages of transformation in the transformation of Qi.
Know the role of each of the organs involved in the specific transformations.
Know the specific function of each kind of Qi and where it predominates
b) What is Yuan ( Source ) Qi and how is it related to
Zheng ( Righteous or True) Qi?
c) What is meant by harmonizing Ying and Wei?
d) What are the San Biao (Three Treasures)?
e) What are the functions of Jing? What is Pre-Heaven Jing and what is PostHeaven Jing? How is it stored and how maintained?
What are signs of Jing decline?
f) List the three organ systems most responsible for Qi production.
List the functions of each organ and give examples of symptoms
arising from disfunction.
g) List the three organs crucial to Blood production and explain function and disfunction as above.
h) List the three organs vital to the transformation and circulation of Jin Ye ( Body Fluids).
IV. ZANG FU.
a) List the functions of the Five Zang organs
b) Explain the role of San Jiao in TCM physiology.
c) Explain the relationship betwen Pre-Heaven and Post Heaven Jing.
d) Define what is meant by a Fu organ?
e) List the Extraordinary Organs and explain what makes them extraordinary.
V. CHANNEL THEORY
a) List all twelve channels from Superficial to deep ( According to SIX PHASES)
b) List the Eight Extra Channels. What are the Master/Couple points?
List one major function for each of the Eight.
c) Explain the clinical significance of:
1. Luo vessels
2. Divergent channels
3. Main Channels
4. Muscle Channels
5. Eight Extra Channels
d) List the five Shu and and give chief indication of each.
VI. ETIOLOGY OF DISEASE
a) What are the Six Types of Qi ( Exogenous Pathogenic Factors)
and how are they characterized? What organs do they primarily attack?
b) What are the Seven Endogenous factors? What are their characteristics and which organs do they affect?
c) What are the principle miscellaneous factors? Which organs do they
attack?
VII. PRINCIPLES OF TREATMENT
a) Explain the struggle of pathogen versus anti-pathogenic factor
in terms of:
1) Excess and Deficiency
2) Root and Branch
3. Righteous Qi (Zheng) and Pathogen
b) Explain the principles involved in choosing all of the following:
1) Attack Only
2) Attack followed by Supplementation
3) Supplementation followed by Attack
4) Simultaneous Supplementation and Attack
5) Supplementation Only
c) Define the following methods of treatment
1) Diaphoresis
2) Harmonizing
3) Purging
4) Ejection ( Vomiting)
5) Warming
6) Clearing
7) Reducing
8) Supplementing
VIII. DIAGNOSIS
a) What are the Four Methods of Diagnosis? Describe them
b) What are the five Qualities of Tongue Body, the four qualities
of tongue coating that are evaluated?
c) What are names of the pulse positions and which organs are represented there?
d) What are the Ten ( or Twelve) Questions
IX. PATTERN DISCRIMINATION (DIFFERENTIATION OF SYNDROMES )
a) list the basic symptomotology
1) deficiency
2) excess
3) Qi deficiency
4) Blood Deficiency
5) Yang Deficiency
6) Yin Deficiency
7) Heat
8) Cold
9) Wind
10) Dampness
11) Summer Heat
12) Dryness
b) Explain the symptomotology between
1) Heat and Cold
2) Interior and Exterior
3) Excess and Deficiency
FOUR LEVELS OF HEAT DISEASE-WEN BING SUMMARY
I. WEI LEVEL (DEFENSE LEVEL)
(Corresponds To Wind Heat Attack) An early stage of infectious disease.
Symptoms: Fever and chills with fever predominant, aversion to wind, sore throat, perspiration. Cough. Rash, red and itchy eyes. headace
Pathology: Pathogenic heat invades and injures the superficial layer: muscles, skin and channels. Injures Defensive Qi. Stagnation of Qi occurs and Lung Qi is unable to disperse. A rash may occur through the attempt of the Wei Qi to express the pathogen.
Tongue: may be red
Pulse: superficial and rapid
Treatment Principle: Disperse Exterior with cooling diaphoretics/ Clear Heat and resolve toxin ( attack pathogenic influences)
Herbs:
Chan Tui ( Cicada): sore throat, loss of voice, rashes (measles: draws rash to surface), clears the eyes, stops spasm
Ju Hua ( Chrysanthemum): Interior or exterior wind heat, brightens the eyes
Bo He ( Mentha), Clears Head, eyes and throat, brings rash to surface, frees
Liver Qi
Niu Bang Zi (Arctium): benefits the throat, disperses Fire Poison (potent antibiotic)
Prescription: Yin Qiao San ( Lonicera and Forsythia Powder)
-Disperses wind-heat, clears Heat, relieves toxicity
- Jin Yin Hua, Lian Qiao, Jie geng, Niu Bang Zi, Bo He, Dan Dou Chi (Soja)
Jing Jie, Dan Zhu Yu ( Lopatherum), Lu Gen, Gan Cao
II. QI LEVEL
(Corresponds to Heat Excess in Stomach/L.I. and Lung)
Symptoms: High fever with no aversion to cold and thirst; symptoms may also include cough (lung) or constipation, abdo pain ( St/L.I.)
FOUR GREAT THINGS:
- great fever, great thirst, great perspiration, great pulse
Pathology: Pathogenic heat injures the defensive phase and penetrates to the interior. The pathogen is interior, hence no chill.
Tongue: Red with Yellow coat Pulse: rapid, surging
Syndromes:
LUNG
1) Heat accumulation in Lung; fever, perspiration, thirst, cough, difficult breathing, chest congestion, chest pain
Tx Principle: Clear Heat/ Regulate Lung function ( stop cough and wheezing)
Prescription: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum
and Licorice Decoction
- Facilitates the flow of Lung Qi, clears Heat, and calms wheezing by directing Qi downward
2) Phlegm Heat accumulation in Chest; fever, red face, cough with scanty phlegm, chest pressure, thirst for cold drinks, but frequently vomiting with drink.
Tx Principle: Remove Heat, Transform phlegm, regulate
3) Heat in Lung and Heat obstruction in organs: fever, constipation, phlegm accumulation, dyspnea, perspiration, restlessness
Tx Principle; Clear Heat, transform phlegm, regulate the lung, purge
4) Eruption due to Lung Heat: fever, cough, skin eruption, chest fullness
Tx. Principle: Clear Heat, disperse Lung, promote eruption of rash
5) Lung Heat transmitted to Large Intestine: Fever, cough, diarrhea with foul-smelling stool, burning sensation at the anus
Tx. Principle: Clear Heat and relieve diarrhea
III. HEAT IN YING ( NUTRITIVE) LEVEL
(This corresponds to some aspects of Yin Deficiency, but etiology involves pathogenic fire. Also may include some aspects of Heat in the Blood; but please note that "Heat in the Blood" is a syndrome of Excess as distinct from Heat in the Blood Level, which is a type of febrile disease developing from Yin Deficiency)
Symptoms: Severe fever at night, thirst, restlessness or delirium, insomnia, rash ( red spots)
Tongue: Red with no coating, possible peeling, etc.,
Pulse: rapid, thready
Pathology: Heat has penetrated either from the Wei or Qi Level and damaged the Ying ( Yin) or nutrient aspect of the Qi.
Remember the relationship between Ying and Wei and remember it is two halves of the same whole. In its context as Ying QI, the Blood is also affected, hence the rash. Heat pathogen may also affect Heart and produce
Sx of Deficiency Heart Fire and Shen Sx, or may invade Pericardium and produce "delirium".
Treatment Principle: Clear Heat from Nutritive Level
1. Clear Heat and Cool the Blood
2. Clear Heat and resolve toxin
3. Nourish Yin
4. Calm the Shen
Herbs: ( from Blood Heat Clearing category)
Xu Nui Jiao ( Buffalo horn), Sheng Di Huang (Rehmannia Glut.), Xuan Shen ( Scrophularia)
Prescription: Qing Ying Tang (Clear the Ying Decoction)
-Clears the Nutritive Level, relieves Fire toxin, drains Heat, nourishes the Yin
- Xu Nui Jiao, Xuan Shen, Sheng Di Huang, Mai Men Dong, Jin Yin Hua,
Lian Qiao, Huang Lian, Dan Zhu Ye, Dan Shen
IV. HEAT IN THE BLOOD LEVEL
(Corresponds only partially to Heat In The Blood); Remember, this is strong Heat Toxin injuring a compromised Yin situation). Damage is deeper to Nutritive level, symptoms are stronger and bleeding is present
Symptoms: high fever, skin eruptions, vomiting of blood, mania, delirium, e.g., similar to Heat in Ying, but more severe.
Plus: hemorrhage, hemafecia, hematuria, epistaxis, etc., and possibility of coma or unconsciousness.
Tongue and pulse: similar to Heat in the Ying Pathology: If there is less resistance from Yin, Heat toxin
passes through the Ying Level and causes more damage. Damage to blood, e.g., hemorrhage, is the key.
Treatment Principle: Clear Heat, stop hemorrhage, restore consciousness
Herbs: similar to Heat in the Ying Prescription: An Gong Niu Huang Wan (Calm the Palace with Cattle Gall stone Pill)
- Clears Heat, relieves toxicity, dislodges phlegm, opens orifices, calms the Spirit
- includes Niu Huang and Xi Jiao, She Jiang ( Moschus), Borneol, realgar, plus Zhu Sha (Cinnabar) and Zhen Zhu (Margarita),
Huang Lian, Huang Qin, and Zhi ZI
(Corresponds To Wind Heat Attack) An early stage of infectious disease.
Symptoms: Fever and chills with fever predominant, aversion to wind, sore throat, perspiration. Cough. Rash, red and itchy eyes. headace
Pathology: Pathogenic heat invades and injures the superficial layer: muscles, skin and channels. Injures Defensive Qi. Stagnation of Qi occurs and Lung Qi is unable to disperse. A rash may occur through the attempt of the Wei Qi to express the pathogen.
Tongue: may be red
Pulse: superficial and rapid
Treatment Principle: Disperse Exterior with cooling diaphoretics/ Clear Heat and resolve toxin ( attack pathogenic influences)
Herbs:
Chan Tui ( Cicada): sore throat, loss of voice, rashes (measles: draws rash to surface), clears the eyes, stops spasm
Ju Hua ( Chrysanthemum): Interior or exterior wind heat, brightens the eyes
Bo He ( Mentha), Clears Head, eyes and throat, brings rash to surface, frees
Liver Qi
Niu Bang Zi (Arctium): benefits the throat, disperses Fire Poison (potent antibiotic)
Prescription: Yin Qiao San ( Lonicera and Forsythia Powder)
-Disperses wind-heat, clears Heat, relieves toxicity
- Jin Yin Hua, Lian Qiao, Jie geng, Niu Bang Zi, Bo He, Dan Dou Chi (Soja)
Jing Jie, Dan Zhu Yu ( Lopatherum), Lu Gen, Gan Cao
II. QI LEVEL
(Corresponds to Heat Excess in Stomach/L.I. and Lung)
Symptoms: High fever with no aversion to cold and thirst; symptoms may also include cough (lung) or constipation, abdo pain ( St/L.I.)
FOUR GREAT THINGS:
- great fever, great thirst, great perspiration, great pulse
Pathology: Pathogenic heat injures the defensive phase and penetrates to the interior. The pathogen is interior, hence no chill.
Tongue: Red with Yellow coat Pulse: rapid, surging
Syndromes:
LUNG
1) Heat accumulation in Lung; fever, perspiration, thirst, cough, difficult breathing, chest congestion, chest pain
Tx Principle: Clear Heat/ Regulate Lung function ( stop cough and wheezing)
Prescription: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum
and Licorice Decoction
- Facilitates the flow of Lung Qi, clears Heat, and calms wheezing by directing Qi downward
2) Phlegm Heat accumulation in Chest; fever, red face, cough with scanty phlegm, chest pressure, thirst for cold drinks, but frequently vomiting with drink.
Tx Principle: Remove Heat, Transform phlegm, regulate
3) Heat in Lung and Heat obstruction in organs: fever, constipation, phlegm accumulation, dyspnea, perspiration, restlessness
Tx Principle; Clear Heat, transform phlegm, regulate the lung, purge
4) Eruption due to Lung Heat: fever, cough, skin eruption, chest fullness
Tx. Principle: Clear Heat, disperse Lung, promote eruption of rash
5) Lung Heat transmitted to Large Intestine: Fever, cough, diarrhea with foul-smelling stool, burning sensation at the anus
Tx. Principle: Clear Heat and relieve diarrhea
III. HEAT IN YING ( NUTRITIVE) LEVEL
(This corresponds to some aspects of Yin Deficiency, but etiology involves pathogenic fire. Also may include some aspects of Heat in the Blood; but please note that "Heat in the Blood" is a syndrome of Excess as distinct from Heat in the Blood Level, which is a type of febrile disease developing from Yin Deficiency)
Symptoms: Severe fever at night, thirst, restlessness or delirium, insomnia, rash ( red spots)
Tongue: Red with no coating, possible peeling, etc.,
Pulse: rapid, thready
Pathology: Heat has penetrated either from the Wei or Qi Level and damaged the Ying ( Yin) or nutrient aspect of the Qi.
Remember the relationship between Ying and Wei and remember it is two halves of the same whole. In its context as Ying QI, the Blood is also affected, hence the rash. Heat pathogen may also affect Heart and produce
Sx of Deficiency Heart Fire and Shen Sx, or may invade Pericardium and produce "delirium".
Treatment Principle: Clear Heat from Nutritive Level
1. Clear Heat and Cool the Blood
2. Clear Heat and resolve toxin
3. Nourish Yin
4. Calm the Shen
Herbs: ( from Blood Heat Clearing category)
Xu Nui Jiao ( Buffalo horn), Sheng Di Huang (Rehmannia Glut.), Xuan Shen ( Scrophularia)
Prescription: Qing Ying Tang (Clear the Ying Decoction)
-Clears the Nutritive Level, relieves Fire toxin, drains Heat, nourishes the Yin
- Xu Nui Jiao, Xuan Shen, Sheng Di Huang, Mai Men Dong, Jin Yin Hua,
Lian Qiao, Huang Lian, Dan Zhu Ye, Dan Shen
IV. HEAT IN THE BLOOD LEVEL
(Corresponds only partially to Heat In The Blood); Remember, this is strong Heat Toxin injuring a compromised Yin situation). Damage is deeper to Nutritive level, symptoms are stronger and bleeding is present
Symptoms: high fever, skin eruptions, vomiting of blood, mania, delirium, e.g., similar to Heat in Ying, but more severe.
Plus: hemorrhage, hemafecia, hematuria, epistaxis, etc., and possibility of coma or unconsciousness.
Tongue and pulse: similar to Heat in the Ying Pathology: If there is less resistance from Yin, Heat toxin
passes through the Ying Level and causes more damage. Damage to blood, e.g., hemorrhage, is the key.
Treatment Principle: Clear Heat, stop hemorrhage, restore consciousness
Herbs: similar to Heat in the Ying Prescription: An Gong Niu Huang Wan (Calm the Palace with Cattle Gall stone Pill)
- Clears Heat, relieves toxicity, dislodges phlegm, opens orifices, calms the Spirit
- includes Niu Huang and Xi Jiao, She Jiang ( Moschus), Borneol, realgar, plus Zhu Sha (Cinnabar) and Zhen Zhu (Margarita),
Huang Lian, Huang Qin, and Zhi ZI
Differentiation According to San Jiao-Water Metabolism-Force of Kidney Yang
 |
| San Jiao, Illustrated by J.Akee 2010 |
As an organ system, San Jiao represents the pathways of water metabolism created by the force of Kidney Yang. As a metaphor for physiological relationships, it reflects three distinct areas (san jiao)
on the body's trunk, containing relationships between the viscera contained therein:
A. Upper Jiao- Heart and Lung
1. Lung governs Qi and respiration. Creates Zong ( Gathering or Chest ) Qi through respiration.
2. Heart governs blood and moves it through the vessels.
3. Heart Blood depends upon Lung Qi for transportation, warmth and protection.
4. Lung Qi depends upon Heart Blood for nourishment.
Thus, failure of lung qi function, DESCENDING AND ASCENDING, AFFECTS THE HEART BLOOD MOVING BLOOD THROUGH THE VESSELS, or failure for heart blood to nourish Lung Qi, yeild deficiency in lung qi function. In the upper jiao, exterior pathogens such as wind, heat, cold, or damp pathogens could easily become more sinister ESPECIALLY SINCE THE LUNG AND HEART ARE VITAL ORGANS FOR LIFE.
 |
| San Jiao, Illustrated by J.Akee 2010 |
B. Middle Jiao (Liver and Spleen/Stomach)
1. Spleen makes Qi by transforming food and drink into Gu Qi. Spleen transports Qi to the four limbs. Spleen raises the Qi. Spleen makes blood. Spleen holds blood in vessels.
2. Liver circulates the Qi of the spleen evenly and everywhere. Liver stores the blood and releases it when it is needed.
3. When Liver Qi stagnates, spleen Qi stagnates and becomes hypofunctional. When spleen does not make enough blood, Liver has functional blood storage (and releasing problems).
 |
| San Jiao, Illustrated by J.Akee 2010 |
C. Lower Jiao (Kidneys and Bladder, Large And Small Intestine)
1. The Kidneys govern water metabolism, and underlie the body's metabolic processes.
2. The hollow bowels of the lower burner depend on Kidney Qi to keep their water metabolism processes patent.
 |
| San Jiao, Illustrated by J.Akee 2010 |
3. When Kidney Qi is deficient, water accumulates, toxicity builds uP.
Warm Disease Summary
A. TYPES OF WARM DISEASE:
1) Warm Disease without Dampness
a) Includes seasonal affect ( nature of presentation is determined by “climate” of season
- Wind Warmth (Wind Heat ) Winter or spring
- Spring Warmth ( Lurking Heat or winter cold enters Construction in spring when Liver energy arises)
- Autumn Dryness ( Wei level heat that can acutely damage fluids)
b) Warm Toxin- infectious not seasonal
2) Warm Disease with Dampness
a) Summerheat- Heat combined with dampness ; severe attack, sudden onset
- Attacks Spleen/Stomach,
- Summer Heat Heat has heat predominant and appears as Qi level symptoms. Rapid onset. High fever, profuse perspiration, etc.,
- Summer Heat dampness has either predominant dampness or attacks weak spleen. Progresses more slowly and shows up at Wei Level first
- Summer heat readily injures fluids and source Qi
- Often combines with exogenous dampness- Summerheat descends and dampness steams upward
b) Damp Heat
- Develops slowly and has a prolonged course
- Affects mainly stomach and spleen
- causes stagnation of Qi and blocks the clear Yang from Rising
3) Lurking Heat ( emerges from within Construction
-Arises suddenly with exterior signs like aversion to cold
-Exterior Pathogen can not be driven out by Righteous Qi; arises with Exterior attack in another season
a) Spring warmth ( Heat enters construction through the Liver)
b) Summer Heat-
-Emerges in Autumn or winter
-Can resemble Shao Yang Presentation of alternating chills and fever
-generally serious and protracted
4) Warm Toxin ( “pestilential”)
- Infectious, can occur in any season
- Can affect one part of body creating local redness, swelling or sores
- or entire body including interior and exterior and affects QI and Blood
B. Four Levels
1. Wei level
Treatment: Release Exterior and resolve toxin
2. Qi Level
Treatment: Clear Heat from Qi Level, regulate function, resolve toxin
3. Nutritive Level
Treatment: Clear Heat from the blood, resolve toxin, Nourish Yin, Calm Shen
4. Blood Level
Treatment: Clear Heat from Blood, resolve toxin, nourish Yin, Calm Shen
Restore consciousness, stop bleeding, etc.,
C. Triple Burner
1. Upper Burner
Lungs: Heat in Wei Level or Qi Level
Pericardium: Heat enters construction
2. Middle Burner
Spleen/ Stomach: Qi Level Heat, or lurking heat enters Qi or Construction, Summerheat attacks and presents at Wei or Qi level
Liver: Lurking Spring Warmth enters construction
GB: Damp Warmth disease creates Qi level presentation
3. Lower Burner
Kidney: Nutritive or Blood level
Warm Heat Disease (Wen Bing)
I. History
A. Ye Gui (1666-1745)
Developed basic principles of For Level Differentiation;
Identified Warm Heat and Damp Heat
Differentiated newly-contracted warm pathogen disease from “lurking heat”.
B. Xue Xue (1681-1770)
C. Wu Tang (1758-1836)
Used Three Burners as a Tool to differentiate Onset, progression and treatment of warm disease.
Focus on saving Yin and Essence in treating warm disease
D. Wang Shi-Xiong (1808-1867)
Author of Wen Re Jing Wei ( “Warp and Woof of Warm Heat Pathogen Diseases”). This is the warm disease classic:
1. Clarified concept of Summer Heat as independent of dampness
2. Summarized comparisons between newly contracted and lurking warm disease
3. Warned against using herbs that were too cold at the onset of treatment for warm disease, which might cause the pathogen to “congeal.”
II. Characteristics
A. HEAT
- primarily characterized by Fever
-readily injures Yin
-Heat Pathogen or “Lurking Heat”
-Symptoms appear quickly: fever, thirst, irritability, restlessness, concentrated, dark urine, red tongue, rapid pulse
- Contagious, seasonal, endemic, or epidemic
B. Differentiation Based on 4 Level or 3 Burner
C. Classification of Warm Heat Diseases
1. With/Without Dampnes
Warm Toxin (Wen Du)
b) With Dampness:
Lurking Summerheat ( Fu Shu)
2. Seasonal
3. Infectious/ Epidemic
1. Warm Heat
Wind Warmth: Fever, aversion to cold, cough, floating Pulse
Spring Warmth: High fever, restlessness, strong thirst, possibly convulsions and coma
Autumn Dryness: Dry cough, dryness of the mouth, nose, throat
Warm-Toxin: Local redness, swelling, heat and pain;
Possibly ulcerations; not seasonal, maybe Contagious.
2. Damp Heat
Summerheat Warmth:
Heat: high fever, strong thirst, profuse sweating, flooding pulse
Damp: chills, no sweating, fever, epigastric fullness, greasy tongue coating
Damp Warmth : Aversion to cold, low-grade fever, heaviness of the head and body, stifling sensation in the chest (chest oppression), and distention (fullness) in the epigastric region; greasy tongue coating; soggy and moderate pulse. (late summer).
Lurking Summerheat:
1. Theories of Exterior Pathogenic Attack that cause Heat and Fever
-Cold disease theory came first; In one sense, refers to any externally contracted pathogen. In another, specific cold pathogen. Hence, at first,
“Warm Pathogen” was a type of “Cold Damage.”
- Ye Gui, Xue Xue and Wu Tang, felt this didn’t cover all the bases, like Yin Xu or Heat in Pericardium. Developed a new theory that was more serviceable.
- Main issue is that Warm Heat pathogens can attack the Wei and Qi directly and cause warm heat disease.
- Warm Heat Theory explains more of etiology and pathogens. Lurking Heat theories and Seasonal Theories are covered.
D. ETIOLOGY
1. Wind Heat
SX: Chills and (high) fever, aversion to wind and cold ( Wei Qi stagnation);
slight” perspiration ( attack on Wei Qi usually results in perspiration being less severe than in Qi Level fever.
Red-tipped tongue with thin white coating; rapid and floating pulse.
b) Wind Heat transforms into Fire and injures Yin- initial damage of attack from any Heat pathogen is damage to fluids, particularly LU and ST Yin.
c) Wind Heat quickly advances to Pericardium (Ying) affecting Shen
a) Attacks ST and Qi Level first, often in combination with Dampness.
- If there is more Heat, Summerheat will attack Stomach; if more dampness, will attack Spleen.
Heat Sx. Four Bigs: Fever, Thirst, Sweat, Pulse
Damp Sx: Summerheat with Dampness predominant moves more slowly and will attack Wei Level first; There will be aversion to cold, chills and fever and heaviness of the body, chest distention, absence of sweating, tongue coating.
Sx: severe SOB, fatigue, strong thirst, large pulse at superficial level and frail pulse at deep level.
When accompanied by ingestion of cold foods or drinks, or other chill factors, damp and Heat can be accompanied by cramps, body aches chills, absence of sweating and other signs of cold.
a) develops slowly and has a prolonged course. The onset is insidious and unlike Summerheat there are no “early signs.”
Sx: When dampness predominated over warmth:
Slight fever or contained fever ( with heat trapped by dampness: this is a low grade fever that lasts a long time, where the skin feels hot even though the temperature may not be elevated and is accompanied by other symptoms of dampness and heaviness.
b) Affects Stomach and spleen:
St/Sp symptoms include epigastric fullness, nausea, loose stools, thirst with little desire or absence of thirst.
c) Damp Heat Stagnates the circulation of Qi and prevents the clear Yang from rising to the head.
Sx: affects liver and causes chest and epigastric fullness and distention, abdominal bloating and depression.
Clear Yang fails to reach head: heaviness of head, as if wrapped in a bandage, nasal congestion, plugged ears, diminished hearing and dull expression. Can descend to lower burner leading to water retention, edema, loose stools, cold extremities and white tongue coat.
d) Combination of dampness and heat is difficult to treat.
4. Dryness causes Autumn Dryness
A “seasonal” disease owing more to the development of the theory than the clinical presentation.
May be “Cold” Dryness instead of Heat Dryness
Sx: dry nose and throat, dry cough with little sputum, hoarse voice
b) Dryness injures Fluid of lungs. Signs of dryness can occur with early stage of attack, whereas with Wind Heat, the sryness comes on in later stage.
5. Pestilential Qi and Warm Toxin cause Warm Pathogen disease
Infectious Disease. Pestilential means epidemic, broad-spread and affecting a large population.
Treat Pestilential Heat by clearing Heat and Resolving toxin from Qi and Nutritive (Ying) Levels:
Warm Toxin can be externally contracted or internally;
External factors are considered Primary Factors; Internal Factors are secondary
E. FOUR LEVEL DIFFERENTIATION
1. WEI LEVEL ( Wind Heat)
Slightly increased thirst (implying little fluid damage at onset of Wind Heat).
Headache, can be at eyes, or cause redness, tearing, itching or burning pain in eyes.
Can progress to a deeper level if:
1. Pathogen is extremely severe
3. There is injury to heart Yin or Qi due to improper treatment
( too acrid and warm or too bitter and cold)
Any of these might lead Heat into Nutritive level.
2. QI LEVEL ( Interior Repletion Heat)
Pathogen affects physiological function and circulation of Qi causing it to stagnate.
Four Great Things:
Vigorous Fever ( including aversion to Heat as opposed to avers. To Cold)
Profuse sweating
Thirst ( with preference for cold)
Big Pulse ( Flooding or slippery)
(Yellow and dry tongue coating is primary manifestation of Inter Heat)
Heat injures Yin and disturbs the Spirit of the Heart (Shen)
(“Veiling of Pericardium by transmission of Heat”)
Fever that worsens ( spikes) at night, with thin rapid pulse
Insomnia, irritability, restlessness; “occasional” delirium or muddled consciousness. Deep red tongue
Thirst with little desire to drink ( “Steaming of Yin” creates some moisture.”)
Maculo-papular rashes; extravasation of Blood caused by invasion of channels by Heat
Symptoms similar to YING LEVEL, but deeper, or more severe, including possibility of:
Coma, or loss of consciousness
Bleeding
Maculopapular rashes over entire body.
PROGRESSION OF WARM HEAT DISEASE
Usually from Exterior to Interior
Newly-contracted disease tends to attack WEI or QI level first, but may enter Nutritive Level directly.
Lurking disease usually begins at Nutritive Level
This usually implies an ongoing deficiency, usually Kidney ( for Hot or cold) or Spleen for Damp Heat
F. THREE BURNERS
1. Upper Burner
Lungs
a) Warm Heat pathogen attacks Lungs and protective ( Wei) Qi causing failure of Lungs to disseminate the Qi
b) Blockage of Qi due to accumulation of Heat in Lungs ( Qi level)
c) Stagnation of protective Qi, failure of Lung to disseminate the Qi, and stagnation of the Spleen by damp heat. Damp Heat.
Pericardium
a) Blockage of pericardium by Invasion of Heat. Key to the Ying Level. Invade from any of the above upper burner pathologies
b) Veiling of Pericardium by Phlegm and Damp heat.
A Qi Level pathology.
Constant fever that “improves in the morning and worsens in the evening, yellow and greasy tongue coat, slippery and rapid pulse.
Lear thinking alternates with confusion and delirium
2. Middle Burner
Stomach and large Intestine ( Yang Ming)
a) Heat Excess in Stomach ( Qi level)
b) Obstruction of Qi of L.I. by dry stool and Heat, with severe constipation.
Spleen and Stomach Patterns
Damp Heat Transmission or Summer Heat transmission:
Contained fever
Oppression of chest and epigastrium, nausea, loose stools
Greasy tongue coat
3. Lower Burner
Kidney
Severe injury to fluids and yin in upper and middle burner:
Fever, malar flush, warm palms and soles
Listlessness, dry mouth, diminished hearing, deficient pulse
Liver
Exhaustion of Kidney Yin leads to Liver Yin deficiency
Causing the rising of wind:
Trembling of fingers, tonic-clonic convulsions, convulsions, Violent palpitations with emptiness in chest (Kidney too weak to nourish Heart)
A. Ye Gui (1666-1745)
Developed basic principles of For Level Differentiation;
Identified Warm Heat and Damp Heat
Differentiated newly-contracted warm pathogen disease from “lurking heat”.
B. Xue Xue (1681-1770)
Developed Damp Heat Disease Theory and distinguished Damp Heat from Warm Heat or Cold
Defined treatment for D/H disease via the Sp/St, and progression of Disease from Sp(weak)/St(Strong) to Interior ( Liver) or Exterior (GB)C. Wu Tang (1758-1836)
Used Three Burners as a Tool to differentiate Onset, progression and treatment of warm disease.
Focus on saving Yin and Essence in treating warm disease
D. Wang Shi-Xiong (1808-1867)
Author of Wen Re Jing Wei ( “Warp and Woof of Warm Heat Pathogen Diseases”). This is the warm disease classic:
1. Clarified concept of Summer Heat as independent of dampness
2. Summarized comparisons between newly contracted and lurking warm disease
3. Warned against using herbs that were too cold at the onset of treatment for warm disease, which might cause the pathogen to “congeal.”
II. Characteristics
A. HEAT
- primarily characterized by Fever
-readily injures Yin
-Heat Pathogen or “Lurking Heat”
-Symptoms appear quickly: fever, thirst, irritability, restlessness, concentrated, dark urine, red tongue, rapid pulse
- Contagious, seasonal, endemic, or epidemic
B. Differentiation Based on 4 Level or 3 Burner
C. Classification of Warm Heat Diseases
1. With/Without Dampnes
a) SeasonalWithout dampness:
Wind Warmth (Feng Wen)
Spring Warmth ( Chun Wen)
Autumn Dryness ( Qiu Zao)
Warm Toxin (Wen Du)
b) With Dampness:
Summerheat Warmth (Shu Wen)
Damp Warmth (Shi Wen)Lurking Summerheat ( Fu Shu)
2. Seasonal
3. Infectious/ Epidemic
B. Symptoms
1. Warm Heat
Wind Warmth: Fever, aversion to cold, cough, floating Pulse
Spring Warmth: High fever, restlessness, strong thirst, possibly convulsions and coma
Autumn Dryness: Dry cough, dryness of the mouth, nose, throat
Warm-Toxin: Local redness, swelling, heat and pain;
Possibly ulcerations; not seasonal, maybe Contagious.
2. Damp Heat
Summerheat Warmth:
Heat: high fever, strong thirst, profuse sweating, flooding pulse
Damp: chills, no sweating, fever, epigastric fullness, greasy tongue coating
Damp Warmth : Aversion to cold, low-grade fever, heaviness of the head and body, stifling sensation in the chest (chest oppression), and distention (fullness) in the epigastric region; greasy tongue coating; soggy and moderate pulse. (late summer).
Lurking Summerheat:
Fever, restlessness, thirst, epigastric fullness, greasy tongue coating, Or fever, restlessness, dry mouth, deep red tongue with little coating (autumn or winter)
C. WARM PATHOGEN DISEASE VS. COLD DAMAGE
1. Theories of Exterior Pathogenic Attack that cause Heat and Fever
-Cold disease theory came first; In one sense, refers to any externally contracted pathogen. In another, specific cold pathogen. Hence, at first,
“Warm Pathogen” was a type of “Cold Damage.”
- Ye Gui, Xue Xue and Wu Tang, felt this didn’t cover all the bases, like Yin Xu or Heat in Pericardium. Developed a new theory that was more serviceable.
- Main issue is that Warm Heat pathogens can attack the Wei and Qi directly and cause warm heat disease.
- Warm Heat Theory explains more of etiology and pathogens. Lurking Heat theories and Seasonal Theories are covered.
D. ETIOLOGY
1. Wind Heat
a) Attacks Lungs and Wei Qi first; causing stagnation of Wei Qi and impairing Lung function of D and D.
SX: Chills and (high) fever, aversion to wind and cold ( Wei Qi stagnation);
slight” perspiration ( attack on Wei Qi usually results in perspiration being less severe than in Qi Level fever.
Cough, slight increase in thirst.
Red-tipped tongue with thin white coating; rapid and floating pulse.
b) Wind Heat transforms into Fire and injures Yin- initial damage of attack from any Heat pathogen is damage to fluids, particularly LU and ST Yin.
Sx: Dry cough, dry throat and nose, strong thirst, red tongue
c) Wind Heat quickly advances to Pericardium (Ying) affecting Shen
Sx: High fever, muddled consciousness or coma, convulsions and delirium within 24 hrs of attack.
2. Summerheat
a) Attacks ST and Qi Level first, often in combination with Dampness.
- If there is more Heat, Summerheat will attack Stomach; if more dampness, will attack Spleen.
Heat Sx. Four Bigs: Fever, Thirst, Sweat, Pulse
Damp Sx: Summerheat with Dampness predominant moves more slowly and will attack Wei Level first; There will be aversion to cold, chills and fever and heaviness of the body, chest distention, absence of sweating, tongue coating.
b) Summerheat can attack the pericardium directly and block Shen, leading to sunstroke ( loss of consciousness)
c) Summerheat readily injures fluids and Source (Yuan) Qi.
Sx: severe SOB, fatigue, strong thirst, large pulse at superficial level and frail pulse at deep level.
d) External Dampness often accompanies Summerheat when attacking the body. Focuses on stomach and spleen
Sx: poor appetite, abdo fullness, loose stools, greasy tongue coating.
When accompanied by ingestion of cold foods or drinks, or other chill factors, damp and Heat can be accompanied by cramps, body aches chills, absence of sweating and other signs of cold.
1. Damp Heat Causes Damp Warmth
a) develops slowly and has a prolonged course. The onset is insidious and unlike Summerheat there are no “early signs.”
Sx: When dampness predominated over warmth:
Slight fever or contained fever ( with heat trapped by dampness: this is a low grade fever that lasts a long time, where the skin feels hot even though the temperature may not be elevated and is accompanied by other symptoms of dampness and heaviness.
b) Affects Stomach and spleen:
“Exterior signs” are heavy head and body and aversion to cold.
St/Sp symptoms include epigastric fullness, nausea, loose stools, thirst with little desire or absence of thirst.
c) Damp Heat Stagnates the circulation of Qi and prevents the clear Yang from rising to the head.
Sx: affects liver and causes chest and epigastric fullness and distention, abdominal bloating and depression.
Clear Yang fails to reach head: heaviness of head, as if wrapped in a bandage, nasal congestion, plugged ears, diminished hearing and dull expression. Can descend to lower burner leading to water retention, edema, loose stools, cold extremities and white tongue coat.
d) Combination of dampness and heat is difficult to treat.
4. Dryness causes Autumn Dryness
A “seasonal” disease owing more to the development of the theory than the clinical presentation.
May be “Cold” Dryness instead of Heat Dryness
a) Mainly attacks Lungs
Sx: dry nose and throat, dry cough with little sputum, hoarse voice
b) Dryness injures Fluid of lungs. Signs of dryness can occur with early stage of attack, whereas with Wind Heat, the sryness comes on in later stage.
5. Pestilential Qi and Warm Toxin cause Warm Pathogen disease
Infectious Disease. Pestilential means epidemic, broad-spread and affecting a large population.
Treat Pestilential Heat by clearing Heat and Resolving toxin from Qi and Nutritive (Ying) Levels:
Warm Toxin can be externally contracted or internally;
External factors are considered Primary Factors; Internal Factors are secondary
E. FOUR LEVEL DIFFERENTIATION
1. WEI LEVEL ( Wind Heat)
Pathogen affects the distribution of Wei Qi, attacks surface Nose and throat.
SX: Fever, accompanied by chill and slight aversion to cold
Slightly increased thirst (implying little fluid damage at onset of Wind Heat).
Slight or absent sweating, sneezing, nasal congestion, sinus drainage, sore throat, cough.
Headache, can be at eyes, or cause redness, tearing, itching or burning pain in eyes.
Can progress to a deeper level if:
1. Pathogen is extremely severe
2. There is constitutional Yin deficiency
3. There is injury to heart Yin or Qi due to improper treatment
( too acrid and warm or too bitter and cold)
Any of these might lead Heat into Nutritive level.
2. QI LEVEL ( Interior Repletion Heat)
Pathogen affects physiological function and circulation of Qi causing it to stagnate.
Four Great Things:
Vigorous Fever ( including aversion to Heat as opposed to avers. To Cold)
Big Pulse ( Flooding or slippery)
(Yellow and dry tongue coating is primary manifestation of Inter Heat)
3. YING (NUTRITIVE) LEVEL
(“Veiling of Pericardium by transmission of Heat”)
Presents with:
4. XUE (BLOOD ) LEVEL
Symptoms similar to YING LEVEL, but deeper, or more severe, including possibility of:
Coma, or loss of consciousness
Bleeding
Maculopapular rashes over entire body.
PROGRESSION OF WARM HEAT DISEASE
Usually from Exterior to Interior
Newly-contracted disease tends to attack WEI or QI level first, but may enter Nutritive Level directly.
Lurking disease usually begins at Nutritive Level
This usually implies an ongoing deficiency, usually Kidney ( for Hot or cold) or Spleen for Damp Heat
F. THREE BURNERS
1. Upper Burner
Lungs
a) Warm Heat pathogen attacks Lungs and protective ( Wei) Qi causing failure of Lungs to disseminate the Qi
b) Blockage of Qi due to accumulation of Heat in Lungs ( Qi level)
c) Stagnation of protective Qi, failure of Lung to disseminate the Qi, and stagnation of the Spleen by damp heat. Damp Heat.
Pericardium
a) Blockage of pericardium by Invasion of Heat. Key to the Ying Level. Invade from any of the above upper burner pathologies
b) Veiling of Pericardium by Phlegm and Damp heat.
A Qi Level pathology.
Constant fever that “improves in the morning and worsens in the evening, yellow and greasy tongue coat, slippery and rapid pulse.
Lear thinking alternates with confusion and delirium
2. Middle Burner
Stomach and large Intestine ( Yang Ming)
a) Heat Excess in Stomach ( Qi level)
b) Obstruction of Qi of L.I. by dry stool and Heat, with severe constipation.
Spleen and Stomach Patterns
Damp Heat Transmission or Summer Heat transmission:
Contained fever
Oppression of chest and epigastrium, nausea, loose stools
Greasy tongue coat
3. Lower Burner
Kidney
Severe injury to fluids and yin in upper and middle burner:
Fever, malar flush, warm palms and soles
Listlessness, dry mouth, diminished hearing, deficient pulse
Liver
Exhaustion of Kidney Yin leads to Liver Yin deficiency
Causing the rising of wind:
Trembling of fingers, tonic-clonic convulsions, convulsions, Violent palpitations with emptiness in chest (Kidney too weak to nourish Heart)
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