Course:
Diagnostics II Six Channel, Four Level, San Jiao Theories
Date:
Six Channel Theory Cold Injured Diseases Who extrapolated the Six Channel Theory? Zhang Zhongzing What is the order of a disease’s progress per the Six Channel Theory? 1. Taiyang Syndromes ( 2 subcategories of this) a. Taiyang Zhong Feng Syndrome b. Taiyang Shang Han Syndrome 2. Yangming Syndrome (2 subcategories of this) a. Yangming Jing Syndrome b. Yangming Fu Syndrome 3. Shaoyang Syndrome 4. Taiyin Syndrome 5. Shaoyin Syndrome a. Shaoyin Cold Syndrome b. Shaoyin Heat Syndrome 6. Jueyin Syndrome
Taiyang Syndromes First level of a disease - external. Beginning of a problem. 2 subcategories Taiyang Zong Feng Syn. Wind attack, similar to ext. def (which is also a wind heat thang) Taiyang Shang Han Syn Wind/cold type syn. Similar to ext.excess
Mild fever and chills Aversion to wind ,Easily/frequently perspires Headache Tongue: pale or normal, thin white coating Pulse: Floating, slowed down Chills greater than fever ,No sweating Headache Neck and body pain Tongue: normal body, thin white coat Pulse: floating and tight
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12/11/07
Yangming Syndromes 2nd stage of a disease progress, already in the interior. Organ related. Yangming is rich in Qi and Blood, so once a disease gets here it has conquered great resources. 2 subcategories. Jing or Channel Syndrome 4 greats:
Fu or Organ Syndrome
No aversion to cold ,No constipation Red face Great fever Great sweating Great thirst Great pulse Tongue: red body with yellow and dry coating Pulse: rapid Constant fever, more pronounced in the afternoon Abdominal distention and pain Constipation Tongue: red body with prickles, coating is dry, thick, yellow. Pulse: deep, excessive
Shaoyang Syndrome 3rd stage of a disease. Very specific: Half interior and half exterior. Shaoyang Syndrome
,Chills and fever alternate Bitter taste in the mouth (gb and sj involved, many heat signs) Dry throat Dizziness and blurred vision Poor appetite, nausea, vomiting Pain in the hypochondriac region Restlessness and irritability Tongue: red on sides, white or thin yellow coating Pulse: Wiry
Taiyin or Greater Yin Syndrome Related to spleen and MJ. Usually interior, deficient, cold, damp. Taiyin/Greater Yin Syn
Abdominal fullness or pain Nausea and vomiting Diarrhea No thirst Tongue: pale w/white greasy coating Pulse: deep, weak, slow
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Shaoyin Syndromes Usually interior, cold, deficient manifestations. Shaoyin is kidney and heart in zangfu…so is this. 2 subcategories Shao Yin Cold Syn.
No fever Aversion to cold, cold limbs (greater than taiyin syndrome) Tendency to sleep, listlessness Diarrhea with undigested food bits (cold fx spleen/kidney) Clear urine with increased volume (kidney yang) Tongue: pale with white coating Pulse: deep, minute – or – deep, slow weak if kidney yang deficiency Looks like Kidney Yang Def. Cold symptoms more severe than Taiyin level, more focused at lower levels.
Shao Yin Heat Syn
Restlessness Irritability Insomnia Dry mouth and throat Scanty deep-yellow urine Tongue: red body, red tip, little coating Pulse: thin + rapid Looks like Heart/Kidney Disharmony (Ht + Kd Yin Xu) pattern.
Jueyin or Terminal Yin Syndrome Last stage – problem complicated and severe. Correlates to liver/pericardium in zangfu. Jueyin Syndrome
Upper heat, lower cold Thirst Ascending of Qi to chest Burning sensation in chest Hungry, no desire to eat Vomiting of ascarides after meals Tongue: red/pale Pulse: varied. Slippery, deep, weak, hidden, wiry. Different organs involved, many possible pulses
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Theory of Four Levels Warm Injured Diseases Who postulated it? Ye Tianshi What are the Four Levels? A progression of a disease from onset to end. The levels are: 1. 2. 3. 4.
Wei (Defensive level) Qi (2nd level) Ying (Nutritive level) Xue (Blood level)
What are the characteristics of a disease that can be classified by the Four Levels theory? Refers to epidemic diseases. 1. 2. 3. 4.
Fast onset Fever, likely very high fever, early in the disease Heat signs/symptoms are the primary manifestation Body fluids and yin easily damaged due to high fever
Disease pattern Wei (Defensive)
Manifestations Fever ,Chills and slight aversion to cold Slight or absent sweating Sneezing Cough Nasal congestion Sinus drainage Sore throat Headache Slightly increased thirst Tongue: red tip, white coating (might be slightly yellow) Pulse: floating, rapid Pathology: Stagnation of the protective Qi due to the struggle between the protective Qi and WarmHeat Pathogens, leading to the failure of the lung in dispersing the protective Qi to the surface, nose, throat. Looks like common cold/external wind-heat attack. Characterized by defensive functions of the body fighting pathogens.
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Disease pattern Qi
Manifestations ,Four Greats Vigorous fever Profuse Sweating Pay attention to this one! Thirst (pref for cold beverages) Pulse floating and slippery Aversion to heat Urine: scanty, yellow, possibly dark Tongue: dry yellow coating Pulse: floating or slippery Pathology: Heat from excess and injury to fluids, which is a consequence of the severe struggle between antipathogenic Qi and Warm-Heat pathogen. Getting deeper into interior. Compare to Yangming in Six Channel Theory Lung, Stomach, Large Intestine mostly involved in this level.
Disease pattern Ying (Nutritive) Pattern
Manifestations Fever gets worse at night Insomnia Irritability PC/Ht/Shen signs in yellow…Æ Restlessness Occasional delirium or muddled consciousness Thirst with little desire to drink ,Maculopapular manifestations on skin Tongue: deeper red than wei or qi patterns Pulse: thin and rapid Pathology: Inward progression of protective or Qi level patterns. Blazing heat damages Yin and disturbs the Heart Shen. Disease pattern Xue (Blood) Pattern
Manifestations Fever Restlessness or delirium Muddled consciousness or coma Loss of blood Maculopapular manifestations on entire body Tongue: very deep red, crimson Pulse: thin and fast –or- choppy Pathology: Warm-heat pathogen penetrates deeply, disturbs and exhausts the blood Look for the blood signs for this pattern. Heart, liver, kidney are organs involved in this pattern. Excess Heat in Blood Level Organs involved: heart and liver ♦ Fever ♦ Irritation, mania ♦ Purplish or dark macula Many skin problems are due to heat inside the blood. ♦ Blood in stools or urine Page 5 of 10
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Tremors to spasms/rigidity in the mouth, neck or even opisthotonos (severe rigidity of the back muscles…sometimes severe enough that the head will touch the heels…damn!) Too much heat causes wind, then spasms. Tongue: deep red or scarlet or purplish Pulse: wiry and fast
Deficient Heat in the Blood Level (yin defic) Organs involved: liver and kidney ♦ Constant lower fever ♦ Five palm heat ♦ Dry mouth and throat ♦ Fatigue ♦ Emaciation ♦ Mild tremors in four extremeties ♦ Tongue: red/purple with less coating ♦ Pulse: thin and fast .
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San Jiao Differentiation Warm Injured Diseases Upper jiao Location: above the diaphragm. Organs in UJ: lung, heart, pericardium Middle jiao Location: between upper and lower jiao. Organs in MJ: stomach, spleen, large intestine and small intestine Lower jiao Location: below the umbilicus. Organs in LJ: liver, kidney, bladder, uterus
Upper Jiao Pattern Lung can be Wei and Qi, PC cn be ____...missed that. Lung Pattern 1 Definition: Disorder of ascending and descending of Lung Qi due to external pathogen attacking. Looks like wind-cold invasion when compared to the Eight Principles. Comparing to 4 levels, compares to Wei Level. Lung relates to both Wei and Qi. Manifestations: ♦ Fever ♦ Slight aversion to wind-cold ♦ Headache ♦ Slightly thirsty ♦ Cough ♦ Tongue: thin white coating ♦ Pulse: floating and fast Treatment: Ma Huang Tang, LU 7, cupping Lung Pattern 2 Definition: Blockage of Lung Qi due to accumulation of Lung Heat. More heat signs here. Compare to Qi level in the Four Level Theory. Manifestations: ♦ Fever ♦ Sweating ♦ Thirsty ♦ Dyspnea ♦ Tongue: red with yellow coating ♦ Pulse: fast
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Treatment: clear the heat. Can use Ma xing shi gan tang formula. LU 5, LI 11 and Ren 17. ST 40 for d/h. Pericardium Pattern Definition: Blockage of Pericardium by invasion of heat. Pericardium/Heart related to Shen, see those signs below. Compare this to the Jing level in the Four Levels. Manifestations: ♦ Muddled consciousness ♦ Delirium ♦ Retraction of the tongue ♦ Cold extremeties ♦ Fever ♦ Tongue: deep red ♦ Pulse: thin and rapid Treatment: use Shen points and clear heat points. Ht 7, PC 8. Du 24. Ren 26. Middle Jiao Patterns Relates to Qi level Stomach patterns Definition: Excessive Heat in the Stomach Compare to Qi level of Four Levels Manifestations: ♦ Fever w/o aversion to cold ♦ Red face and eyes ♦ Sweating ♦ Thirsty ♦ Rough breathing ♦ Tongue: Yellow/dry coating ♦ Pulse: flooding, large. Treatment: ST 44 Large Intestine Pattern Definition: Heat accumulation in LI Manifestations: ♦ Fever reaching height in afternoon ♦ Constipation ♦ Concentrated urine ♦ Tongue: yellow, black, dry coating Page 8 of 10
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Pulse: deep, strong
Spleen Pattern Definition: Disturbance of Spleen by damp heat Manifestations: ♦ Contained fever which still exists even after sweating Cannot disperse due to sticky/damp nature of this damp heat condition. ♦ Distention in chest and epigastrium ♦ Nausea ♦ Tongue: heavy body, greasy coating ♦ Pulse: soggy
Lower Jiao Patterns Relates to the Ying and/or Xue levels. But liver fire can be only Qi level as well…. Kidney Pattern Definition: Consumption of Yin by heat I.e., Yin deficiency causing heat. Usually this is hypertension (kidney or liver yin def causing yang rising) Manifestations: ♦ Fever ♦ Malar flush ♦ Relatively warm palms/soles ♦ Dry mouth and throat ♦ Fatigue ♦ Pulse: deficient Formula: Liu wei di huang tang. KD 3, KD 6. Kidney 3 is a creek, Kidney 6 is an ocean of water.
Liver Pattern Definition: Malnutrition of Liver and inner wind due to Kidney Yin Xu Warm disease hurts the Yin. Kidney and Liver have the same source, so kidney deficiency can directly cause this problem. Manifestations: ♦ Convulsions and trembling ♦ Listlessness ♦ Palpitation ♦ Tongue: dry, atrophied, deep red tongue Page 9 of 10
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Pulse: weak Gou Qi Zi wd be a good herb. LV 3, UB 18.
What is the relationship between the San Jiao and Four Level theories? Both try to understand and explain the progress of a Warm Injure Disease. Four Levels describe progression from superficial to blood level. San Jiao goes from upper level to lower level though the jiaos.
Final Exam Review: Before exam, have a good breakfast! 75 questions including 70 MC and 5 case discussions. Comprehensive. Eight principles Zang Fu differentiations including single zang fu and combinations Six Channel 4 level 3 Jiao Review all cases discussed!!! Turn in reading log and the zangfu charts.
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