DIFFERENTIAL DIAGNOSIS ACCORDING TO THE SIX STAGES OF COLD

INTRO- Theory of Exogenous Cold Disease/ Theory of Pathogens Stage by stage development of Febrile Disease- The struggle between Righteous Qi (Resistance) and Pathogenic Qi ( pathogen )

High Fever: reflects a strong pathogen attacking undamaged Righteous Qi

Remittent Fever- Pathogen not yet fully erased, Righteous Qi is compromised


I. YANG STAGES (Resistance is greater than pathogen)


A. TAI YANG “ GREATER YANG” ( Bladder and Small Intestine)


1. Location: surface

2. Symptoms: “Fever” and chill, aversion to wind ( aversion to cold), headache, stiff neck

Pulse-superficial (floating)



3. Treatment method: Diaphoresis (Shang Han) or Harmonize Ying and Wei (Chong Feng)


DIFFERENTIATION:

1) Chong Feng (Wind Attack) Wind Cold Deficiency

Lung Qi is deficient and patient may already be perspiring from Lung QI Xu, therefore symptoms are generally milder

Diaphoresis is contra-indicated.

Symptoms: Milder fever, mild chills, aversion to wind, nasal congestion, headache, neck and shoulders stiff, Spontaneous perspiration

Pulse: floating (superficial) and weak (full on light palpation but empty on firmer pressure)

Treatment Principle: Harmonize Ying and Wei ( See Gui Zhi Tang)

TaiYang Chong Feng cont.,

Prescription: Gui Zhi Tang (Cinnamon Twig Soup)

- Releases pathogenic influences from the muscle layer and regulates the nutritive and protective Qi

- Gui Zhi, Bai Shao, Sheng Jiang, Da Zao, Gan Cao

Gui Zhi disperses Wind Cold, and promotes Yang in the Channels

Bai Shao- Benefits Yin and contains ( astringes) the weak nutritive (Ying) Qi

Together, they enhance the ability of Wei Qi to expel pathogens while strengthening the Ying Qi

2) Shang Han (Wind Cold Excess)

Symptoms: Fever and chills, Cold predominates, and fever will be stronger as well. Pulse: will be more tense on both superficial and deep palpation. Can also enter Bladder through Bladder Channel and cause edema or urinary retention

Treatment Principle: Release Exterior Cold ( Disperse Wind Cold)

Prescription: Ma Huang Tang (Ephedra Decoction)

- Releases Exterior Cold and stops wheezing

B. SHAO YANG “LESSER YANG”( Gall Bladder and San Jiao)



This stage indicates the weakening of the Righteous Qi allowing the pathogen to

penetrate to the Interior. This progression usually takes about seven or eight days. This Stage is considered to be the pivot as the pathogen moves from Exterior to Interior or Interior to Exterior



1. Location: Half surface/Half Interior



2. Symptoms: alternating chills and fever ( malaria)Chest distress ( fullness or congestion), hypochondrial or flank pain, bitter taste, dry mouth or throat, poor appetite, vomiting, cough.



Pulse: is likely to be wiry

Tongue may have one-sided white coating



Treatment Principle: Harmonize Interior and Exterior ( e.g. Harmonize Xiao Yang)



Prescription: Xiao Chai Hu Tang ( Minor Bupleurum Decoction)



-Harmonizes and releases Xiao Yang Stage disorders

- Chai Hu, Huang Qin, Ban Xia, Sheng Jiang, Da Zao, Gan Cao, Ren Shen

C. YANG MING “ BRIGHT YANG” (Stomach and Large Intestine)

1. Location: Internal

2. Chief symptoms: "Four Bigs"-Fever, sweating, thirst, pulse, constipation, with organ syndrome

Pulse: Full and forceful, rapid, surging


3. Treatment Method: Clearing ( Yang Ming Jing)/ Purging (Yang Ming Fu)


DIFFERENTIATION:

1) Yang Ming Jing “WITHOUT FORM” ( Channel pathology)

NB- In general, this is the more deficient syndrome with lethargy instead of delirium, but there are many possibilities in the overlapping of syndromes Heat is considered to be in Stomach

Principle conformation: The Four Great Things

1) High fever

2) Profuse perspiration

3) Great thirst

4) large surging pulse

Treatment Principle: Clear Heat

Prescription: Bai Hu Tang (White Tiger Decoction)

-Shi Gao, Zhi Mu, Geng Mi

- Clears Heat ( Qi Level), drains stomach fire, generates fluids, alleviates thirst;


2) Yang Ming Fu ( Organ pathology)

- The more excess condition. Heat has penetrated caused more damage to fluids, more discomfort (pain)

Principle conformation: Four Great Things plus CONSTIPATION, There is abdominal fullness and "focal" distention, pain

Fever is usually worse in the A.M., there is usually agitation or mania, delirium or restlessness.

Note- With the complexity of overlapping symptoms, the differentiation is usually based primarily upon restlessness vs. lethargy

KEY RULE: If the body is heavy, do not purge

Treatment Principle: Purge and Clear Heat

Prescriptions:

1) Da Cheng Qi Tang ( Major Order the Qi Decoction)

- Vigorously purges Heat Accumulation; This formula is for

100% Yang Ming Excess

- Da Huang, Mang Xiao, Zhi Shi, Hou Pu



2) Xiao Cheng Qi Tang- remove Mang Xiao if slightly more deficiency KEY is perspiration. More perspiration, less fever and fullness indicates more deficiency

3) Tiao Wei Cheng Qi Tang- Da Huang, Mang Xiao, Gan Cao for less severe constipation




II. YIN STAGES (Pathogen is greater than resistance. e.g., metabolic hypofunction)

A. TAI YIN ( Spleen and Lung)

Note- When improperly treated, Tai Yang can advance to Tai Yin, or cold pathogen can penetrate directly to spleen when spleen is weak.

This stage reflects a condition arising from a cold pathogen invading an inherently deficient interior (spleen), creating Spleen Yang Deficiency

1. Location: Interior

2. General conformation: full abdomen, no thirst, abdominal pain, vomiting, diarrhea, chills, fatigue.

3. Treatment Principles: Supplement and Warm


DIFFERENTIATION:

a) Strong: Abdominal pain predominates, spasms of rectus abdominus with weakness underneath
Prescription: Xiao Jian Zhong Tang ( Minor Construct the Center Decoction)

-Warms and modifies the Middle burner and moderates spasmodic pain

- Yi Tang ( Maltose) Gui Zhi, Bai Shao, Gan Cao, Sheng Jiang, Da Zao


b) Weak: weakness and cold predominates; symptoms of vomiting, diarrhea,profuse urination. Pulse: weak

Prescription: Li Zhong Wan ( Regulate the Center Pill)

- Warms the Middle burner and strengthens stomach and spleen

- Gan Jiang, Ren Shen, Bai Zhu, Gan Cao


2. SHAO YIN ( Heart and Kidney)

Note- Like the above, but a deeper level of illness: Kidney deficiency with either cold or heat (Yin Xu or Yang Xu)

a) Location: Interior

b) General conformations: Like Tai Yin, but keynote is DROWSINESS.

Kidney deficiency is characterized by the need to “lie down” or lie “curled up.”

If Yang Xu, coldness is pronounced, if Yin Xu, Heat is pronounced.

There will also be urinary symptoms including frequent, clear or copious urination



c) Treatment Principle: Supplement and warm ( or clear Deficiency Heat)



d)Prescription: Zhen Wu Tang ( True Warrior Decoction)

- Warms the Yang and promotes urination

- Fu Zi, Bai Zhu, Fu Ling, Sheng Jiang, Bai Shao

3. JUEH YIN ( Liver and Pericardium )



1.) Location: Interior



2.) General Symptoms: True Cold/False Heat; separation of Yin and Yang,

coma, icy coldness, vomiting when attempting to eat; hunger with no

appetite, Fever in the upper Jiao: Heat and pain in the chest, congestion of Qi in

the chest, thirst, vomiting of worms, or just vomiting.



3) Treatment Principle: Restore Collapsed Yang, warm, etc.,



4.) Prescription: Si Ni Tang (Frigid Extremities Decoction)



Note: Do not confuse with Si Ni San ( Chai Hu, Zhi Shi, Bai Shao, Gan Cao)



-Rescues devastated Yang, warms the Middle, stops diarrhea

- Fu Zi, Gan Jiang, Gan Cao