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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)
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
A POSITIVE PROCESS: THE FIVE ELEMENTS ARE AN AFFIRMATION OF THE POSITIVE THRUST OF NATURE
FIVE ELEMENTS is the Life Cycle of the creation and control of being- The growth and development of being. ( Hammer)
Being is: the essential qualities of the individual evolved through the conscious process of individuation and differentiation from our common racial unconscious spiritual heritage.
The healthy urge to become something is a positive process:
To live, to expand, combating the restrictive environment.
A POSITIVE PROCESS: THE FIVE ELEMENTS ARE AN AFFIRMATION OF THE POSITIVE THRUST OF NATURE
TOWARDS LIFE AND RENEWAL.
Negative Emotions are Distortions of the process of becoming:
Negative emotions are always the secondary expression of some failure in the realization of a primary positive emotional force or need.
As practitioners, “ we are needed to recognize the positive quest for contact beneath the negative emotion.”
Anger is the emotion of the Soul or spiritual faculties in self urge or birth and growth of ego: The healthy urge to become something
JARRETT:
De ( Virtue): The original endowment of nature prior to moral distinctions and conscious effort
Ming ( Destiny)- Our contract with Heaven, conferred by Heaven upon man; “ Our movement through Life is powered by a wave of destiny that we are given the choice to either fulfill or repudiate with every heart beat.
Jing ( Essence) – Our inherited endowment; the seed of all being, and the wellspring of life’s manifestations. Jing holds the potential for the manifestation of Heaven’s will as it exists uniquely within each human being.
Shen (Spirit); The heavenly brightness emanating from the heart which is the active impulse from heaven to ignite our inborn potential.
Ling ( Spirit)- The substrate of that potential. Pure potential. Together with Shen, it creates a spiritually potent force to live our destiny
FIVE ELEMENTS
WOOD HUN/ ANGER/ BENEVOLENCE
Color is green- Spring, youth, vigor, flexibility
Season is Spring- Beginning of Life. Life begins after dormancy of winter, “ The natural violence of seeds ( Hammer), “ The violence proper to all beginnings,”
( Larre, Seven Emotions)
Hun is Spirit of Liver, “ Ethereal Soul” according to Maciocia, aggressive for experience, amoral, childlike.; moves Mind and vision out into the world and back into self. Eyes create duality. A flexible HUN integrates Inner and Outer Vision. The Qi of the Mind
Boundaries, Flexibility, inner vision, decision-making, judgment (GB)
EMOTION: ANGER- the female slave under the hand of the master
Energy necessary to push through obstruction, frustration.
Aggressive energy, protective: Qualities necessary for a good general: anger, aggression, but flexible and under control
Also: Belligerence, resentment, rigidity, arrogance, determination ( Excess)
Timidity, indecision, flaccidity, humility, impotence,
VIRTUE: BENEVOLENCE; mutual benefit; grow according to your own nature and allow others to grow according to theirs.
Also: Discernment, Flexibility, Esteem, Patience
Wood is the fuel for Heart Fire/ The Liver and the Heart together create the emotional states.
FIRE SHEN/JOY/PROPRIETY- The Emperor/Empress/ Sovereign/ Ruler
Season: Summer, peak of life cycle, yang of Yang
Climate: Heat, warmth; fire made useful by limitations; naturally kinetic, expansive, dynamic. Bonding, passion, desire
Natural tendency for these things to rise; Must be descended to Kidney, bring Fire to Water, Shen to Jing, emotions to wisdom
The Heart must remain open to provide a suitable resting place for Shen;
The original nature of Heart, serene accepting open
EMOTION: JOY- “Joy makes the Heart Larger.” ( Maciocia)
“Appropriate Joy- e.g., contentment, appropriate to Heart, like sweet taste to the spleen; easy to overdo it. Excessive joy and emotionality deplete the heart and lead to sadness.
Speech: “ When you first attain a little insight, if you are delighted and talk too much, your shen leaks out and there is no spiritual refreshment of the light of the body.” ( Taoist Meditation).
VIRTUE: PROPRIETY ( Ceremony/ritual)
Alignment with the Tao allow heavenly spirits to guide from within.
Coming from the Heart.
If you need rules to be kind and just, if you merely act virtuous, this is a sure sign that virtue is missing.
“ He moves in Harmony with the present moment always knowing the truth of just what to do.” Being in the right place at the right time knowing just what to do.
EARTH YI/INTENT / WORRY, OVERTHINKING/ INTEGRITY
Time of Life: Childhood, nourishment
Climate: Earth must be Moist for fruits to ripen
Earth nourishes everyone generously; Earth is what we stand on, our “Bottom Line”, our Integrity
Nourishes Potential into being
Yi procures nourishment for the Mind, just as spleen provides nourishment for the body; This nourishment contains Heart Fire and manages Heart Shen. The Link between Heart and Spleen is the link between inspiration and intention.
Intellect, clarity of thought, concentration, evaluation and storage of data.
Generation of ideas, sustained intention.
Intent, idea, thought, opinion, meaning, intention, taste and tendency
( Larre)
Ability to nurture self and others
POST-Heaven Qi and Blood are the physiological basis for the Intellect
EMOTION: WORRY, OVERTHINKING
Worry creates stagnation, draws too much Qi to the spirit, without intention; worry is part of a self-perpetuating vicious cycle ( just like dampness)
Brooding, obsessive thoughts
VIRTUE: INTEGRITY
Authenticity of Speech ( Spleen governs the mouth); the extent to which our words conform to the truth in our heart.
“ Clever words, an ingratiating demeanor, and excessive respect…I am ashamed of them.” - Confucius
RECIPROCITY
Heaven bestows on great and small alike; reciprocity of nurturance between heaven and earth, meeting the needs of others; symbiosis, nature
METAL PO ( ANIMAL SPIRIT)/ SADNESS/ RIGHTEOUSNESS
Most Yin of the elements, most dense, slowest to change
Po is coming and going of Essences
Hard, permanent; highly-organized, crystalline minerals, can be cast and re-cast, but will maintain molecular identity
Direction- West, setting sun, end of life cycle
Fall- end of growth cycle
Harvest what is valuable, store it, let the rest go fallow during winter
Middle Age, maturity
Metal functions- somatic intelligence; homeostasis, senses, instincts, identity, individuality; Autonomic nervous system; purely somatic
PO is the Animal Spirit/Corporeal Soul
Breathing is the direct manifestation of the corporeal soul
Somatic manifestation of the Soul
EMOTION/ Grief; Sadness
Po reacts to life with sensations and emotions, stores reactions, Hun should raise this information to the Shen, or else it will stay in Po and create disease.
Pain of Loss; deepest, most primal yin emotion; This implies lack of understanding and faith in the Tao, because the only constant in life is loss
Grief comes from attachment to loss or gain;
Lack of understanding of inspiration/exhalation of Life ( Righteousness)
VIRTUE/ RIGHTEOUSNESS
Understanding and accepting the righteousness of the Tao: cycles of gain and loss, inspiration and exhalation, growth and harvest.
The rhythym of the Lungs empowers a broader connection to the breath of the Tao
WATER ZHI/FEAR/WISDOM
“For water benefits all things and goes against none of them. It provides for all people and even cleanses the places a man is loath to go. In this way it is just like the Tao.” TTC 8
“ Nothing in this world is as soft and yielding as water, yet for attacking the hard and the strong none can triumph so easily. It is soft, yet none can damage it. It is yielding, yet none can wear it away.” TTC 78
- Surrendering to your destiny is powerful
Water is a subtle, tenacious force which can dissolve any barrier over time
River flowing to the sea is a return to the origin
Destiny/ Birth and death and rebirth; MING
WINTER- Dissolution, decomposition, hibernation, gestation
The moment when Yin reaches its extremity and spontaneously transforms into yang
BLACK.BLUE/ Color of night of death
EMOTION: FEAR
Discomfort with the unknown, Lacking the “healthy sense of awe.”
Not understanding the nature of death
ZHI- WILL Potency in the mental, physical and spiritual spheres.
Potential, ability and power to manifest
When Intent becomes permanent we speak of the will
WISDOM- accrued through the cycles of life and death
- aligning our will with Heaven’s. Knowing our MING ( destiny)
- Integrating experience into consciousness
Being is: the essential qualities of the individual evolved through the conscious process of individuation and differentiation from our common racial unconscious spiritual heritage.
The healthy urge to become something is a positive process:
To live, to expand, combating the restrictive environment.
A POSITIVE PROCESS: THE FIVE ELEMENTS ARE AN AFFIRMATION OF THE POSITIVE THRUST OF NATURE
TOWARDS LIFE AND RENEWAL.
Negative Emotions are Distortions of the process of becoming:
Negative emotions are always the secondary expression of some failure in the realization of a primary positive emotional force or need.
As practitioners, “ we are needed to recognize the positive quest for contact beneath the negative emotion.”
Anger is the emotion of the Soul or spiritual faculties in self urge or birth and growth of ego: The healthy urge to become something
JARRETT:
De ( Virtue): The original endowment of nature prior to moral distinctions and conscious effort
Ming ( Destiny)- Our contract with Heaven, conferred by Heaven upon man; “ Our movement through Life is powered by a wave of destiny that we are given the choice to either fulfill or repudiate with every heart beat.
Jing ( Essence) – Our inherited endowment; the seed of all being, and the wellspring of life’s manifestations. Jing holds the potential for the manifestation of Heaven’s will as it exists uniquely within each human being.
Shen (Spirit); The heavenly brightness emanating from the heart which is the active impulse from heaven to ignite our inborn potential.
Ling ( Spirit)- The substrate of that potential. Pure potential. Together with Shen, it creates a spiritually potent force to live our destiny
FIVE ELEMENTS
WOOD HUN/ ANGER/ BENEVOLENCE
Color is green- Spring, youth, vigor, flexibility
Season is Spring- Beginning of Life. Life begins after dormancy of winter, “ The natural violence of seeds ( Hammer), “ The violence proper to all beginnings,”
( Larre, Seven Emotions)
Hun is Spirit of Liver, “ Ethereal Soul” according to Maciocia, aggressive for experience, amoral, childlike.; moves Mind and vision out into the world and back into self. Eyes create duality. A flexible HUN integrates Inner and Outer Vision. The Qi of the Mind
Boundaries, Flexibility, inner vision, decision-making, judgment (GB)
EMOTION: ANGER- the female slave under the hand of the master
Energy necessary to push through obstruction, frustration.
Aggressive energy, protective: Qualities necessary for a good general: anger, aggression, but flexible and under control
Also: Belligerence, resentment, rigidity, arrogance, determination ( Excess)
Timidity, indecision, flaccidity, humility, impotence,
VIRTUE: BENEVOLENCE; mutual benefit; grow according to your own nature and allow others to grow according to theirs.
Also: Discernment, Flexibility, Esteem, Patience
Wood is the fuel for Heart Fire/ The Liver and the Heart together create the emotional states.
FIRE SHEN/JOY/PROPRIETY- The Emperor/Empress/ Sovereign/ Ruler
Season: Summer, peak of life cycle, yang of Yang
Climate: Heat, warmth; fire made useful by limitations; naturally kinetic, expansive, dynamic. Bonding, passion, desire
Natural tendency for these things to rise; Must be descended to Kidney, bring Fire to Water, Shen to Jing, emotions to wisdom
The Heart must remain open to provide a suitable resting place for Shen;
The original nature of Heart, serene accepting open
EMOTION: JOY- “Joy makes the Heart Larger.” ( Maciocia)
“Appropriate Joy- e.g., contentment, appropriate to Heart, like sweet taste to the spleen; easy to overdo it. Excessive joy and emotionality deplete the heart and lead to sadness.
Speech: “ When you first attain a little insight, if you are delighted and talk too much, your shen leaks out and there is no spiritual refreshment of the light of the body.” ( Taoist Meditation).
VIRTUE: PROPRIETY ( Ceremony/ritual)
Alignment with the Tao allow heavenly spirits to guide from within.
Coming from the Heart.
If you need rules to be kind and just, if you merely act virtuous, this is a sure sign that virtue is missing.
“ He moves in Harmony with the present moment always knowing the truth of just what to do.” Being in the right place at the right time knowing just what to do.
EARTH YI/INTENT / WORRY, OVERTHINKING/ INTEGRITY
Time of Life: Childhood, nourishment
Climate: Earth must be Moist for fruits to ripen
Earth nourishes everyone generously; Earth is what we stand on, our “Bottom Line”, our Integrity
Nourishes Potential into being
Yi procures nourishment for the Mind, just as spleen provides nourishment for the body; This nourishment contains Heart Fire and manages Heart Shen. The Link between Heart and Spleen is the link between inspiration and intention.
Intellect, clarity of thought, concentration, evaluation and storage of data.
Generation of ideas, sustained intention.
Intent, idea, thought, opinion, meaning, intention, taste and tendency
( Larre)
Ability to nurture self and others
POST-Heaven Qi and Blood are the physiological basis for the Intellect
EMOTION: WORRY, OVERTHINKING
Worry creates stagnation, draws too much Qi to the spirit, without intention; worry is part of a self-perpetuating vicious cycle ( just like dampness)
Brooding, obsessive thoughts
VIRTUE: INTEGRITY
Authenticity of Speech ( Spleen governs the mouth); the extent to which our words conform to the truth in our heart.
“ Clever words, an ingratiating demeanor, and excessive respect…I am ashamed of them.” - Confucius
RECIPROCITY
Heaven bestows on great and small alike; reciprocity of nurturance between heaven and earth, meeting the needs of others; symbiosis, nature
METAL PO ( ANIMAL SPIRIT)/ SADNESS/ RIGHTEOUSNESS
Most Yin of the elements, most dense, slowest to change
Po is coming and going of Essences
Hard, permanent; highly-organized, crystalline minerals, can be cast and re-cast, but will maintain molecular identity
Direction- West, setting sun, end of life cycle
Fall- end of growth cycle
Harvest what is valuable, store it, let the rest go fallow during winter
Middle Age, maturity
Metal functions- somatic intelligence; homeostasis, senses, instincts, identity, individuality; Autonomic nervous system; purely somatic
PO is the Animal Spirit/Corporeal Soul
Breathing is the direct manifestation of the corporeal soul
Somatic manifestation of the Soul
EMOTION/ Grief; Sadness
Po reacts to life with sensations and emotions, stores reactions, Hun should raise this information to the Shen, or else it will stay in Po and create disease.
Pain of Loss; deepest, most primal yin emotion; This implies lack of understanding and faith in the Tao, because the only constant in life is loss
Grief comes from attachment to loss or gain;
Lack of understanding of inspiration/exhalation of Life ( Righteousness)
VIRTUE/ RIGHTEOUSNESS
Understanding and accepting the righteousness of the Tao: cycles of gain and loss, inspiration and exhalation, growth and harvest.
The rhythym of the Lungs empowers a broader connection to the breath of the Tao
WATER ZHI/FEAR/WISDOM
“For water benefits all things and goes against none of them. It provides for all people and even cleanses the places a man is loath to go. In this way it is just like the Tao.” TTC 8
“ Nothing in this world is as soft and yielding as water, yet for attacking the hard and the strong none can triumph so easily. It is soft, yet none can damage it. It is yielding, yet none can wear it away.” TTC 78
- Surrendering to your destiny is powerful
Water is a subtle, tenacious force which can dissolve any barrier over time
River flowing to the sea is a return to the origin
Destiny/ Birth and death and rebirth; MING
WINTER- Dissolution, decomposition, hibernation, gestation
The moment when Yin reaches its extremity and spontaneously transforms into yang
BLACK.BLUE/ Color of night of death
EMOTION: FEAR
Discomfort with the unknown, Lacking the “healthy sense of awe.”
Not understanding the nature of death
ZHI- WILL Potency in the mental, physical and spiritual spheres.
Potential, ability and power to manifest
When Intent becomes permanent we speak of the will
WISDOM- accrued through the cycles of life and death
- aligning our will with Heaven’s. Knowing our MING ( destiny)
- Integrating experience into consciousness
DIFFERENTIATION AND TREATMENT ACCORDING TO PATHOGENS.
PATHOGEN : DETERMINES THE PATHWAY OF DISEASE
GENERALLY REFLECTS THE EXCESS COMPONENT OF A PATTERN PATHOGENS
I. WIND
1.) WIND COLD
a) KEY SYMPTOMS: aversion to Cold/wind (chills and fever),
thin secretions, pain, patient is easily chilled. No perspiration. Chill predominant. Headache and upper back pain.
Method: Diaphoresis
Tx Principle: Release Exterior with acrid and warming herbs
Points: GB 20, UB 12, L.I.4, Lu 7
Herbs: MaHuang ( Ephedra), Gui Zhi (Cinnamon), Fang Feng ( Siler)
Prescription: MaHuang Tang (MaHuang, Gui Zhi, Xing Ren, Gan Cao)
2.) WIND HEAT
KEY SYMPTOMS: Feverish, but sensitive to wind (chills and fever)sore throat, thick secretions, with difficulty expectorating. Perspiration. Attacks front of face and eyes. Can cause or aggravate skin eruptions
Method: Diaphoresis
Tx Principle: Release Exterior with acrid and cool herbs.
Points: L.I. 4,L.I. 11, SJ 5, Lu 10
Herbs: Bo He ( Mentha), Niu Bang Zi ( Arctium), Chan Tui
( Cicada).
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, Jing Jie, Dan Zhu Ye, Lu Gen, Gan Cao
3.) BI SYNDROME: WIND DAMP WITH COLD OR HEAT
KEY SYMPTOMS: Joint pain with swelling, aggravated by changes in weather or exposure to heat, damp, or cold pathogen, stiffness, decreased mobility.
1) "Rheumatic" pain ( from blockage of Qi),
2) swelling (damp)
3) weakness (with increasing chronicity)
B. TREATMENT PRINCIPLES
1. Expel Wind Dampness
2. Alleviate Pain
3. Activate the Channels
4. Strengthen sinew and bone
5. Reduce Swelling
C. HERBS:
1. Du Huo ( Angelica ) Expels wind damp and alleviates pain, especially lower body (back and legs)
2. Chiang Huo (Notopterygium) : Releases Exterior and disperses Cold; Penetrates through painful obstruction.
" guides Qi to Greater Yang and Governing Channels"
- especially upper limbs ( neck and shoulders)
3. Qin Jiao (Gentiana)- expels wind damp, cramping of extremities
- Clears Deficiency heat
4. Wei Ling Xian ( Clematis ) Expels Wind damp, activatesChannels, alleviates pain:
-Releases Exterior and moves the Qi of the Channels.
Treatment Method: Diaphoresis- but can be combined with activating substances to remove obstruction in the channels
Treatment Principle: Dispel wind-dampness, Remove obstruction from channels, transform damp, relax sinews
Prescription: Shu Jing Huo Xue Tang ( Relax the Channels and Invigorate Blood Decoction) (Clematis and Stephania)
4). INTERNAL WIND
GENERAL WIND SYMPTOMS: erratic movement or lack of movement: trembling, spasmodic movements, convulsions, seizures, uneven movements, opistothonos, twitches, sudden loss of consciousness or movement, dizziness, numbness or hemiplegia
1. EXTREME HEAT
Key Symptoms: convulsions or seizures accompanied by high fever, delirium, perspiration, etc with possible loss of consciousness or paralysis.
Tongue: Red, stiff, quivering
Pulse: Rapid, taut, superificial, replete
Method: Clearing (combined)
Principle: Clear Heat and Subdue Liver Wind
Points: Du 20, 14, Liv 2, 3,
Herbs: Ling Yang Jiao ( Cornus Antelopis), Gou Teng (Uncaria), Niu Xi ( Acyranthes).
Prescription: Ling Jiao Gou Teng Tang ( Antelope Horn and Uncaria Decoction)
- Cools Liver, Extinguishes Wind, increase fluids, relax sinews
2.) YANG RISING
Key Symptoms: dizziness, headache, irritability, hemiplegia, lesser seizure disorders. Stroke, HBP, tinnitus, plus sx of Liver Blood Xu or Kid Yin Xu
Method: Combined- Supplement ( Yin) and Subdue Wind.
Treatment Principle: Extinguish Liver wind and Subdue Yang. Nourish Yin. Regulate Liver.
YANG RISING
Points: Du 20, GB 20, Liv 3
Herbs: Tian Ma ( Gastrodia), Gou Teng ( Uncaria )
Prescription: Tian Ma Gou Teng Yin ( Gastrodia and Uncaria Decoction)
Calms the Liver, Extinguishes Wind, Clears Heat, invigorates the Blood, Tonifies Liver and kidneys
- Tian Ma, Gou Teng, Shi Jue Ming, Zhi Zi, Huang Qin, Yi Mu Cao, Niu Xi, Du Zhong, Sang Ji Sheng, Fu Shen
3) LIVER BLOOD DEFICIENCY WIND (Like Wind in the Channels, but weaker pattern and more predominantly vacuity)
KEY SYMPTOMS: tics, slight tremors, numbness, itchy rash that changes location.
Treatment Method: Combined- Supplement ( Blood) and Subdue Wind
Treatment Principle: Nourish Blood and Subdue Liver Wind
Points: GB 20, Liv 3, Liv 8, Sp 6, 10, Bl. 17
Herbs: Tian Ma, Gou Teng, plus Liver Blood tonics
5) WIND IN THE CHANNELS ( derived from Blood Deficiency but can have varying degrees of severity depending up strength of Yang) Creates “trembling” in limbs
A. SYMPTOMS
a) seizures, strokes, tremors
b) rash, itchy, usually red
c) cramps, spasms
B. TREATMENT PRINCIPLES
1. Extinguish Wind
2. Expel Wind from Sinews (Tremors seizures and strokes)
3. Expel Wind from skin (rashes ands inflammatory skin probs)
C. HERBS
1. Bai Hua She or Wu Shao She ( Agkistrodon or Zaocys)
-Powerfully activate the channels and extinguish wind
- used for wind-stoke or rashes
2. Sang Ji Sheng (Loranthus)- tonifies Liver and Kidneys (Yin) and expels wind dampness
3. Bai Ji Li ( Tribulus) Extinguishes Wind, alleviates pain, brightens the eyes, Liver Yang or Wind Heat in the Liver Channel
-skin lesions with significant itching.
II. HEAT
General symptoms: redness, burning or heat sensation, thickening of secretions, putrescence of smells, hyperactivity and restlessness, rapid movement, perspiration, thirst (for cold); preference for cold, aggravation from warmth
Method: Clearing
Treatment Principles:
Clear Heat and Quell Fire, Clear Heat and Dispel Toxin, Clear Heat and Cool the Blood, Clear Deficiency Heat and Nourish the Yin or Lower the Kidney Fire. Clear heat and generate Fluids .
Herbs: Shi Gao ( Gypsum), Zhi Mu ( Anemarrhena), Zhi Zi (Gardenia)
Prescription: Bai Hu Tang ( White Tiger Decoction)
Clears Qi Level Heat, drains Stomach Fire, generates fluids, alleviates thirst
- Shi Gao, Zhi Mu, Gan Cao, Geng Mi
III. COLD
KEY SYMPTOMS: Chill or subjective feeling of cold, slowness, thin secretions, increased fluid volumes, contractile pain, improved by Heat, preference for warmth and warm drinks, damage to Yang resulting in imbalance of body fluids ( e.g., abundant urination)
Method: Warming
Treatment Principles: Warm the Center and Expel Cold, Warm the Channels, Restore Yang, Warm Yang and promote urination.
Herbs: Gan Jiang ( Dry Ginger), Rou Gui ( Cinnamon Cortex )
Prescription: Li Zhong Wan ( Regulate the Center Pill )
Warms the Middle Burner and strengthens the Spleen and Stomach
- Gan Jiang, Ren Shen, Bai Zhu, Gan Cao
IV. SUMMER HEAT
A. Etiology-
1) Created by Pathogenic Factor, does not develop internally:
invasion of summerheat disease like sunstroke or heat stroke, or invasion of heat toxin; or co-mingling with extremely Yang climate (hot, humid weather) with the body's existing dampness. Attacks Sp/St
2) Seasonal Pathogen: Related to Late Summer.
B. Differentiation
Although essentially a Yang pathogen, Summerheat usually combines elements of heat and dampness, and must be differentiated according to the preponderance of symptoms. The key here is the presence or absence of HIGH FEVER and the resultant damage to BF
C. Key symptoms
1. Summerheat Heat
High fever, with thirst, sparse urination and restlessness. May be profuse sweating or none. Severe symptoms include "inversion syndrome": tetany, convulsion, loss of consciousness; damage to Yuan QI
causes fatigue, exhaustion, dry tongue coating.
Pulse: Full and surging, rapid; or if deficiency thin, rapid, or large but empty and rapid.
2. Summerheat Damp
persistent low grade fever, thirst with no desire to drink, chest oppression, poor appetite, heavy limbs, nausea and vomiting. Sparse urination which is dark and concentrated. Thin, sticky diarrhea
D. Treatment Principles
1. Clear Summerheat
2. Transform dampness
3. Tonify Yin/ nourish fluids
E. Herbs
Heat: Xi Gua (Citrus Vulgaris), Shi Gao (Gypsum), Qing Hao(Artemesia)
1. Prescription : LIU YI SAN ( Six to One Powder): 6 Hua Shi / 1 Gan Cao
I. WIND
1.) WIND COLD
a) KEY SYMPTOMS: aversion to Cold/wind (chills and fever),
thin secretions, pain, patient is easily chilled. No perspiration. Chill predominant. Headache and upper back pain.
Method: Diaphoresis
Tx Principle: Release Exterior with acrid and warming herbs
Points: GB 20, UB 12, L.I.4, Lu 7
Herbs: MaHuang ( Ephedra), Gui Zhi (Cinnamon), Fang Feng ( Siler)
Prescription: MaHuang Tang (MaHuang, Gui Zhi, Xing Ren, Gan Cao)
2.) WIND HEAT
KEY SYMPTOMS: Feverish, but sensitive to wind (chills and fever)sore throat, thick secretions, with difficulty expectorating. Perspiration. Attacks front of face and eyes. Can cause or aggravate skin eruptions
Method: Diaphoresis
Tx Principle: Release Exterior with acrid and cool herbs.
Points: L.I. 4,L.I. 11, SJ 5, Lu 10
Herbs: Bo He ( Mentha), Niu Bang Zi ( Arctium), Chan Tui
( Cicada).
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, Jing Jie, Dan Zhu Ye, Lu Gen, Gan Cao
3.) BI SYNDROME: WIND DAMP WITH COLD OR HEAT
KEY SYMPTOMS: Joint pain with swelling, aggravated by changes in weather or exposure to heat, damp, or cold pathogen, stiffness, decreased mobility.
1) "Rheumatic" pain ( from blockage of Qi),
2) swelling (damp)
3) weakness (with increasing chronicity)
B. TREATMENT PRINCIPLES
1. Expel Wind Dampness
2. Alleviate Pain
3. Activate the Channels
4. Strengthen sinew and bone
5. Reduce Swelling
C. HERBS:
1. Du Huo ( Angelica ) Expels wind damp and alleviates pain, especially lower body (back and legs)
2. Chiang Huo (Notopterygium) : Releases Exterior and disperses Cold; Penetrates through painful obstruction.
" guides Qi to Greater Yang and Governing Channels"
- especially upper limbs ( neck and shoulders)
3. Qin Jiao (Gentiana)- expels wind damp, cramping of extremities
- Clears Deficiency heat
4. Wei Ling Xian ( Clematis ) Expels Wind damp, activatesChannels, alleviates pain:
-Releases Exterior and moves the Qi of the Channels.
Treatment Method: Diaphoresis- but can be combined with activating substances to remove obstruction in the channels
Treatment Principle: Dispel wind-dampness, Remove obstruction from channels, transform damp, relax sinews
Prescription: Shu Jing Huo Xue Tang ( Relax the Channels and Invigorate Blood Decoction) (Clematis and Stephania)
4). INTERNAL WIND
GENERAL WIND SYMPTOMS: erratic movement or lack of movement: trembling, spasmodic movements, convulsions, seizures, uneven movements, opistothonos, twitches, sudden loss of consciousness or movement, dizziness, numbness or hemiplegia
1. EXTREME HEAT
Key Symptoms: convulsions or seizures accompanied by high fever, delirium, perspiration, etc with possible loss of consciousness or paralysis.
Tongue: Red, stiff, quivering
Pulse: Rapid, taut, superificial, replete
Method: Clearing (combined)
Principle: Clear Heat and Subdue Liver Wind
Points: Du 20, 14, Liv 2, 3,
Herbs: Ling Yang Jiao ( Cornus Antelopis), Gou Teng (Uncaria), Niu Xi ( Acyranthes).
Prescription: Ling Jiao Gou Teng Tang ( Antelope Horn and Uncaria Decoction)
- Cools Liver, Extinguishes Wind, increase fluids, relax sinews
2.) YANG RISING
Key Symptoms: dizziness, headache, irritability, hemiplegia, lesser seizure disorders. Stroke, HBP, tinnitus, plus sx of Liver Blood Xu or Kid Yin Xu
Method: Combined- Supplement ( Yin) and Subdue Wind.
Treatment Principle: Extinguish Liver wind and Subdue Yang. Nourish Yin. Regulate Liver.
YANG RISING
Points: Du 20, GB 20, Liv 3
Herbs: Tian Ma ( Gastrodia), Gou Teng ( Uncaria )
Prescription: Tian Ma Gou Teng Yin ( Gastrodia and Uncaria Decoction)
Calms the Liver, Extinguishes Wind, Clears Heat, invigorates the Blood, Tonifies Liver and kidneys
- Tian Ma, Gou Teng, Shi Jue Ming, Zhi Zi, Huang Qin, Yi Mu Cao, Niu Xi, Du Zhong, Sang Ji Sheng, Fu Shen
3) LIVER BLOOD DEFICIENCY WIND (Like Wind in the Channels, but weaker pattern and more predominantly vacuity)
KEY SYMPTOMS: tics, slight tremors, numbness, itchy rash that changes location.
Treatment Method: Combined- Supplement ( Blood) and Subdue Wind
Treatment Principle: Nourish Blood and Subdue Liver Wind
Points: GB 20, Liv 3, Liv 8, Sp 6, 10, Bl. 17
Herbs: Tian Ma, Gou Teng, plus Liver Blood tonics
5) WIND IN THE CHANNELS ( derived from Blood Deficiency but can have varying degrees of severity depending up strength of Yang) Creates “trembling” in limbs
A. SYMPTOMS
a) seizures, strokes, tremors
b) rash, itchy, usually red
c) cramps, spasms
B. TREATMENT PRINCIPLES
1. Extinguish Wind
2. Expel Wind from Sinews (Tremors seizures and strokes)
3. Expel Wind from skin (rashes ands inflammatory skin probs)
C. HERBS
1. Bai Hua She or Wu Shao She ( Agkistrodon or Zaocys)
-Powerfully activate the channels and extinguish wind
- used for wind-stoke or rashes
2. Sang Ji Sheng (Loranthus)- tonifies Liver and Kidneys (Yin) and expels wind dampness
3. Bai Ji Li ( Tribulus) Extinguishes Wind, alleviates pain, brightens the eyes, Liver Yang or Wind Heat in the Liver Channel
-skin lesions with significant itching.
II. HEAT
General symptoms: redness, burning or heat sensation, thickening of secretions, putrescence of smells, hyperactivity and restlessness, rapid movement, perspiration, thirst (for cold); preference for cold, aggravation from warmth
Method: Clearing
Treatment Principles:
Clear Heat and Quell Fire, Clear Heat and Dispel Toxin, Clear Heat and Cool the Blood, Clear Deficiency Heat and Nourish the Yin or Lower the Kidney Fire. Clear heat and generate Fluids .
Herbs: Shi Gao ( Gypsum), Zhi Mu ( Anemarrhena), Zhi Zi (Gardenia)
Prescription: Bai Hu Tang ( White Tiger Decoction)
Clears Qi Level Heat, drains Stomach Fire, generates fluids, alleviates thirst
- Shi Gao, Zhi Mu, Gan Cao, Geng Mi
III. COLD
KEY SYMPTOMS: Chill or subjective feeling of cold, slowness, thin secretions, increased fluid volumes, contractile pain, improved by Heat, preference for warmth and warm drinks, damage to Yang resulting in imbalance of body fluids ( e.g., abundant urination)
Method: Warming
Treatment Principles: Warm the Center and Expel Cold, Warm the Channels, Restore Yang, Warm Yang and promote urination.
Herbs: Gan Jiang ( Dry Ginger), Rou Gui ( Cinnamon Cortex )
Prescription: Li Zhong Wan ( Regulate the Center Pill )
Warms the Middle Burner and strengthens the Spleen and Stomach
- Gan Jiang, Ren Shen, Bai Zhu, Gan Cao
IV. SUMMER HEAT
A. Etiology-
1) Created by Pathogenic Factor, does not develop internally:
invasion of summerheat disease like sunstroke or heat stroke, or invasion of heat toxin; or co-mingling with extremely Yang climate (hot, humid weather) with the body's existing dampness. Attacks Sp/St
2) Seasonal Pathogen: Related to Late Summer.
B. Differentiation
Although essentially a Yang pathogen, Summerheat usually combines elements of heat and dampness, and must be differentiated according to the preponderance of symptoms. The key here is the presence or absence of HIGH FEVER and the resultant damage to BF
C. Key symptoms
1. Summerheat Heat
High fever, with thirst, sparse urination and restlessness. May be profuse sweating or none. Severe symptoms include "inversion syndrome": tetany, convulsion, loss of consciousness; damage to Yuan QI
causes fatigue, exhaustion, dry tongue coating.
Pulse: Full and surging, rapid; or if deficiency thin, rapid, or large but empty and rapid.
2. Summerheat Damp
persistent low grade fever, thirst with no desire to drink, chest oppression, poor appetite, heavy limbs, nausea and vomiting. Sparse urination which is dark and concentrated. Thin, sticky diarrhea
D. Treatment Principles
1. Clear Summerheat
2. Transform dampness
3. Tonify Yin/ nourish fluids
E. Herbs
Heat: Xi Gua (Citrus Vulgaris), Shi Gao (Gypsum), Qing Hao(Artemesia)
1. Prescription : LIU YI SAN ( Six to One Powder): 6 Hua Shi / 1 Gan Cao
INTRODUCTION TO BODY FLUIDS
I. Body Fluids Physiology reflects the dynamic interplay between JIN YE and YUAN QI
A. Jin Ye ( The pure or normal Physiological Fluids)
1) JIN FLUIDS
a) follow the circulation of Qi and Blood, and assist their smooth flow, spreading through the surface of the body, moistening muscles, flesh and orifices. Thin, clear and watery; flow easily.
2) YE FLUIDS
a) A thick, paste-like substance which can seep into the spaces of the bones, and nourish and strengthen the bones and marrow. Thick and viscous, move slowly, function as a lubricant and supplement to Jing Essence LING SHU, ch. 81
Ying (Nutritive) Qi comes out of the Middle Jiao and secretes Jin and Ye fluids like a life-giving fog
From above it pours into the confluences of the tissues, the seeps into the delicate collaterals (SUN MAI), where, if the Jin and Ye are harmonious, through the Qi transformation of the Lungs and Heart they can become RED BLOOD. If this blood remains harmonious, it will first fill the delicate collaterals, then pour into the collaterals proper ( LUO MAI).
When these are full, the blood will pour into the major channels (JING MAI), Both Yin and Yang, ensuring abundance of the protective nourishing Qi and Blood, flowing through the body with the rhythmic impetus of the Lung's breath, Zhang Jing-Yue, 1624:
Jin is the clear portion of Yin and Ye is the murking portion of Jin
Jin is classed as Yang because it travels to the surface and becomes sweat, and Ye is classed as Yin because it pours into the bones and supplements the brain and marrow.
B. Fluid Physiology
A. Spleen: The Separation of the CLEAR (QING) from the MURKY (ZHUO)
- The Fire of Ming Men provides heat for Spleen transformation: The Spleen absorbs
Food and Drink Essences, and sends them upward; - All of the Zang organs (KIDNEY, LUNG, SPLEEN) involved in BF passageways promote this active transformation and transportation
B. The San Jiao is the path for fluid metabolism
- All fluids, both rarified and heavy, move through the energy of the San Jiao.
The Ming Men presides over the Ministerial Fire, and is Director of the separation of the
Yuan Qi in the Kidneys
- The Energy of the San Jiao is the active circulation of the Kidney Yang manifest
as YUAN QI.
In this manner Source Qi is differentiated into "the Three QI".
ZONG QI
GU QI
YUAN QI of lower Jiao
LING SHU, CH. 36:
Of that Qi emerging from the SAN JIAO:
- that which warms the muscles and the flesh and fills out the skin
is called the JIN-FLUIDS.
- that which flows without moving is called the YE-FLUID
C. Other Zang Fu of Fluids Metabolism
Spleen: RULES THE ACSCENT OF THE CLEAR
- Prime Mover and Transformer of the Middle; Root of Post Heaven
- Works with Kidney and Lung to transform and distribute pure fluids
Transforms the Ying and Wei
Lung:
- Transforms Fluids into a fine mist to warm and nourish the surface;
- Promotes the initial descent of the turbid from the top down, promotes movement of "Stomach House" and descent of the murky.
- Wei Qi regulates the pores, travels with fluids
- Works with heart to separate Blood from Fluids and to circulate all Qi and fluids.
Kidney:
- Root of all BF metabolism; power Source for SAN JIAO, Source of all the body's Yang and Yin.
- Rules over the final transformation and storage of Essences; drains the waste from the lower orifices.
STOMACH: RULES THE DESCENT OF THE MURKY
Gateway to the Inner Duct of the San Jiao;
Receives the fullness of foods and fluids and separates the turbid from the murky
Stomach, Large Intestine and Small Intestine
all work in harmony to purify the body by moving waste material and ensuring the
complete transformation of any waste materials still within.
Small Intestine:
-Steams fluids and absorbs essences
-connects energetically to Heart Fire
Large Intestine:
-Final Essences are extracted from mostly solid wastes to support the SOURCE QI And reinforce the JING
Bladder:
- Stores waste fluids for final steaming from Kidney Yang; and ultimate excretion of waste
D. Relationship of JIN YE to other Vital Substances
1. Qi: depends upon QI to transform and transport it
2. Blood: derived from a part of Fluid essences in Upper Jiao
3. Breast Fluids: transformed from the Qi and Blood of the CHONG AND REN
4. Jing Essence
Fluid transformation is directly dependent upon QI transformation, but also promotes Yuan Qi production in the lower Jiao
Ye Fluids/ Jing Essences very close in nature
5. Shen
Integrity of the Blood is dependent on BF physiology SHEN depends upon rarefied Qi
Connection of SHEN to San Jiao; Heart Connects to L.I.; influences Heat, prevents toxic fire
E. FLUIDS OF THE ZANG FU
1. SWEAT - is the Fluid of the Heart;
- fluids that were once Jin become sweat when "steamed" by Yang heat of the Wei Qi
2. TEARS- Fluid of the Liver
- Yang activation of eye fluids is role of Liver
3. (WATERY) SALIVA (XIAN)-Fluid of The Spleen
-Spleen governs the mouth and tongue
4. MUCOID SALIVA (TUO)- Fluid of the Kidney;
-underside of tongue, digestive enzymes, Stomach fluids, jing essences
5. NASAL MUCUS- Lung
-congestion of fluids in URT due to failure of Lung to descend and disperse fluids.
II. DAMPNESS: PRINCIPLES AND TREATMENT
A. Chief symptoms
- general heaviness, lack of thirst, feelings of fullness and distention,
1. Differentiation according to three Jiaos
Upper Jiao- heavy head, dizziness, stuffiness of chest
and epigastrium
Middle Jiao- Loss of taste and appetite, lack of thirst
abdominal distention and fullness, fullness and stagnation
after eating, nausea, weak-heavy limbs, loose stool and
diarrhea, thick white greasy tongue coating
Lower Jiao- Dampness "pouring down"; edema of feet,
murky, difficult urination, leukorrhea, loose stool
B. Nature
1. Damp is heavy and turbid:
Sinking, heavy, sore sensations
2. Damp Illness tends to be chronic
-Spleen weakness is always root of Dampness
- failure of TRANSFORMATION
transformation implies not only changing but
raising
- dampness obstructs spleen function further,
damaging the energy from which it springs
3. Yin Pathogen
Harms Yang and blocks the flow of Qi
4. Causes wide range of problems
Integrity of Body Fluids protects the Tissues and
the Qi
5. Tends to combine with other pathogens
Wind damp
Damp Heat
Cold Damp
6. Seasonal Pathogen
reflects changes in the weather, and
the transformation of the seasons
C. Treatment Principles
a. Transform the Pathogen
1. Expel with sweet-bland diuretic
- FU LING (PORIA COCOS)
Enters: SPLEEN/STOMACH, HEART,LUNG, KID
Harmonizes Center; Calms the Spirit
- ZHU LING (Polyporous)
More diuretic, less tonifying than Fu Ling
- ZE XIE ( Alisma)
Drains damp heat; Yin deficient Heat
2. Eradicate Damp Heat with cooling diuresis
- MU TONG ( Caulis Akebia)
- Enters Heart, Lung, Small Intestine
Drains Heart and Lung Fire
Promotes BF flow ( Milk, Blood)
- QU MAI (DIANTHUS)
"Slippery, descending nature"
Enters HEART/S.I.: moves blood, cools heat
Damp Heat LIN, and obstructed toxic Heat
- YIN CHEN HAO ( Artemesia Capillaris)
Fragrant, only slightly cold
SP/ST LIV/GB: JAUNDICE
3. Transformation of thick and turbid
with fragrant aromatics
-HOU PO ( CX MAGNOLIA)
Parches the Spleen Qi and
moves the Qi
Promote Descent of Lung Qi by
removing fullness
- SHA REN (AMOMI)
Warm and strongly fragrant:
Parches the Spleen and moves the middle Qi
-HUO XIANG (AGASTACHE/POGOSTEMON)
Lung, Spleen/Stomach
promotes perspiration, relieves summerheat
transform middle jiao, move Qi, piercing fragrance
4. Parch the Spleen with warm-bitter
substances to restore T and T
Pungent warm:
CANG ZHU ( Rhiz Atractylodes)
strengthens spleen, expels wind damp
BAN XIA ( PINELLIA)
strong descending nature
Moves Qi downward: breaks up phlegm
stops NAUSEA
for thin, clear phlegm damp
Bitter Cold :
HUANG QIN (SCUTELLARIA)
- LUNG AND LARGE INTESTINE
Clears Fire and Toxic Heat and damp
HUANG LIAN (COPTIS)
HEART AND MIDDLE JIAO
Clears Damp Heat, obstructed fire
HUANG BAI (PHELLODENDRON)
drain kidney fire, eliminate
lower jiao damp heat
Yin deficiency with Fire flaring
5. Expel Wind-Damp in the surface Tissues
with Wind-dispersing herbs, promote
Spleen transportation of fluids
DU HUO (Rx. Duhuo)
Kidney, Bladder channels
Stops pain of wind-cold-damp in lower body
QIN JIAO ( GENTIANA MACROPHYLLA)
Dispels wind damp in Liver Channel
Cools Yin deficient Heat
SANG JI SHENG (LORANTHUS)
Tonifies Liver and Kidneys;expels wind damp
6. Strengthen Yang to Transform Damp:
PROMOTE WARMTH AND MOVEMENT
REMOVE ACCUMULATED BODY FLUIDS
GAN JIANG ( ZINGIBERIS SICCATUM)
Warms middle and expels cold; warm St and Spleen
ROU GUI (CORTEX CINNAMOMI)
Warms Kidneys and fortifies Yang
III- DAMP HEAT
A. GENERAL SYMPTOMS:
-low grade or afternoon fever, fullness (oppression), obstruction
chest or abdomen, thirst without desire to drink,
heaviness of head and body, lack of appetite,
scanty, dark, difficult urination, loose, explosive stools,
nausea and vomiting
tongue: Thick, greasy yellow tongue coating
pulse: varies according to pathogen
B. ETIOLOGY
1. Invasion of damp pathogen causes Qi and heat to accumulate and combine with dampness
2. Pathogenic fire can cause damage to fluid metabolism leading to damp-heat accumulation
3. Failure of Yang Qi to transform and raise; heat becomes pent-up and combines with BF
C. PATHOLOGY
1. Enter body usually through the Mouth: connection to Stomach
2. Frequently toxic; the fire of damp heat quickly becomes "toxic" fire
3. Easily damages the Sp/St
4. Easily blocks QI mechanism: Ascent and descent of QI movement is regulated by San Jiao.
Damp Heat is sticky by nature
5. Upsets Fluid Metabolism:
Upper Jiao: can not open and regulate fluid passageways; unable to send downward.
Middle Jiao: Yang is blocked and spleen's power of digestion is lost.
Lower Jiao: Kidneys lose the strength to vaporize:uncontrolled or frequent urination or fluid
retention and scanty urination, kidneys unable to control opening and closing
D. Treatment Principles
1. Differentiate which pathogen is mild and which is serious, then expel damp and cool heat
a) if damp predominates: disinhibit the heat by transforming the damp
b) if heat predominates: clear heat, promote diuresis
2. Differentiate area:
a) damp heat on surface utilize fragrant to release the surface
b) Damp Heat Blocking Upper Jiao, obstructing Lung
Promote Qi flow to move the damp
Fragrant transformation of source
c) Damp Heat Blocking Middle Jiao
Bitter cold herbs to drain heat and parch damp
d) Damp Heat in Lower Jiao, obstructing Kidney Yang
Drain the turbid damp though the urine
3. Treatment Principles
DAMPNESS:
1. Promote Lung Flow to transform damp
a) Open lungs to assist pathogenic influence to reach the surface
b) Open Lungs to transform damp and allow Heat to escape through the surface
c) Open lungs to promote fluid metabolism
2. Combining pungent and Bitter flavors to warm the Yang and disperse obstruction
3.Use Bland flavors to promote urination and leach out damp
4. Using Fragrance to transform damp
5. Strengthening Spleen to parch damp
6. Opening the flow of Yang Qi to transform damp
a) use spreading, dispersing herbs to promote the flow of Yang
b) Warm pungent and warm bitter to restore San Jiao Qi movement
c) use bland herbs to promote urination
HEAT:
7. Use of Bitter-Cold to clear Heat and dry damp
- use sparingly when damp exceeds heat
-also drain toxicity ( anti-bacterial )
8. Clear Heat and relieve toxicity
-exogenous epidemic toxic dampness
- endogenous damp heat producing fire
9. Cool and move the Blood
- Pathogen moves easily to Ying (Nutritive)
Level
- Leads to Blood stagnation
10. Nourish Yin, Cool Heat, Promote urination
- Fragrant herbs damage Yin by Yang nature
- Bitter herbs are too draining in
some cases of Yin deficiency Damp Heat;
- Use herbs that preserve Yin by lightly
spreading and opening, or mild diuretic:
Fu Ling (Poria), Shan Yao ( Dioscorea)
Lian Qiao (Forsythia), Hua Shi (Talc)
E. Contraindications
1. Pungent Warm diaphoresis:
avoid using strong, warm and pungent herbs
( Ma Huang, Gui Zhi)
2. Bitter Cold purging:
purgatives are not effective in treating damp's "sticky" nature; only manage to further weaken and
bring down Spleen Yang
3. Moist greasy (Yin) tonics
aggravate damp obstruction
4. Sweet, warm, obstructing tonics
-tonifying without dispersing only aggravates
damp accumulation
5. Dietary Contraindications
-Heavy greasy foods produce dampness
-Sweet, cold foods promote dampness
-Spicy foods promote heat
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