Differentiation of Syndromes According to the Six Stages

Differentiation of syndromes according to the 6 channels originally appeared in the Traditional Chinese Medicine classic called the "Shang Han Lun", which can be loosely translated as "On Cold Damage". It was written by Zhang Zhong Jing in the late Han Dynasty, circa 20-200 A.D.

The original text was then divided into two texts, one being the "Shan Han Lun" which focused on external conditions, and the other being the "Jin Kui Yao Lue" which focuses on internal conditions. Many of the herbal formulas from these two texts are not only very elegant, but still useful today.

• Tai Yang (Initial Yang) Syndromes
  Tai Yang Zhong Feng Syndrome - Febrile Disease caused by Wind (External Deficiency)
  Tai Yang Shang Han Syndrome - Febrile Disease caused by Cold (External Excess)
• Yang Ming (Greater Yang) Syndromes
  Yang Ming Jing (Channel) Syndrome
  Yang Ming Fu (Organ) Syndrome
• Shao Yang (Lesser Yang) Syndrome
• Tai Yin (Initial Yin) Syndrome
• Shao Yin (Lesser Yin) Syndrome
  Yang Deficient Shao Yin Syndrome
  Yin Deficient Shao Yin Syndrome
• Jue Yin (Greater Yin) Syndrome

Tai Yang (Initial Yang) Syndromes

The Tai Yang syndrome corresponds to the initial invasion of the external Cold Evil through the pores and interstices of the skin.

General symptoms:

• Headache and Stiff Neck
• Chills and Fever
• Floating Pulse

The stiff neck and headache will be located in the Tai Yang (Bladder and Small Intestine Channel) areas of the body. The floating (superficial) pulse is located in the exterior, and with the finger raised, it has a surplus, when pressing down it is insufficient, weak, or disappears. When pressure is released, it regains full strength.

A fever ensues when the strong Zheng (Upright) Qi of the body engages the Wind-Cold invasion (Cold Evil) at the surface level of the body. Tai Yang syndrome fevers are relatively mild because the invading cold is weak compared to the body's Wei (Defensive) Qi, as it is in the initial stage of entering the body.

If the cold evil becomes stronger because the Wei (Defensive) Qi is weak or easily depleted, the fever will increase as the pathogen penetrates deeper into the Yang Ming or Shao Yang channels. The Tai Yang fever is generally accompanied by chills, at least in the initial stages of the invasion.

Nasal discharge and sneezing are not included in the general symptoms for the Tai Yang syndrome.

A. Tai Yang Zhong Feng Syndrome

Febrile Disease caused by Wind (External Deficiency)

Symptoms:

• Fever
  - From Wei (Defensive) Qi fighting with the Evil Qi
• Easily Perspires
  - From the inability of the body to keep the pores closed due of Lung Qi Deficiency
  - Also the bodys attempt to relieve the fever and heat
• Headache
  - Cold type of headache with muscle tension around the neck.
• Chills
• Aversion to Wind
• Tongue: The tongue body appears deficient (perhaps pale), and the coating is normal: thin, white.
• Pulse: Moderate Floating (superficial) pulse. The pulse is moderate (as opposed to strong) as this is a deficiency condition - the patient perspires easily. Consequently the pulse is not as rapid (as in an excess condition).
• Shen (Spirit): The patient may appear tired and weak.

Treatment

Formula: Gui Zhi Tang (Cinnamon Twig Decoction)

Function: Releases the pathogenic influences from the muscle layer and harmonizes the nutritive (Ying) and defensive (Wei) Qi.

Contents:

• Gui Zhi
• Bai Shao
• Sheng Jiang
• Da Zao
• Gan Cao

B. Tai Yang Shang Han Syndrome

Febrile Disease caused by Cold (External Excess)

Symptoms:

• Fever and Chills with aversion to Cold
• No Perspiration
  - As this is an excess condition, the pores are closed and the skin is dry and tight
• Headache
  - In the Tai Yang Channel area (occipital region)
• Lumbago
• Arthralgia
• General aching
• Tongue: Normal body with thin white coating
• Pulse: Floating and tight pulse.

Treatment

Formula: Ma Huang Tang (Ephedra Decoction)

Function: Releases the Exterior Cold and arrests wheezing. Opens the Lung Qi and induces sweating.

Contents:

• Ma Huang
• Gui Zhi
• Xing Ren
• Gan Cao

Acupuncture Points: (Appropriate for both external deficiency and external excess syndromes) Zhong Feng and Shang Han

• Lieque (LU-7)
• Fengchi (GB-20)
• Jianjing (GB-21)
• Feishu (BL-13)

Yang Ming (Greater Yang) Syndromes

As the pathogenic factor invades the interior of the body in the Yang Ming stage, both the Zheng (Upright) Qi and the Evil (Xie) Qi are strong, turning the excess pathogen in to heat within the body. Yang Ming fevers are therefore more severe than fevers in the Tai Yang stage. In the Yang Ming Syndrome, there are no chills. There are two types of Yang Ming Syndromes, one that involves the channel, and the other involves the related Zang Fu (Stomach and Large Intestine organs). Both of these syndromes can occur at the same time.

A. Yang Ming Jing (Channel) Syndrome

Symptoms (The Four Big's):

• Big fever
  - This indicates Interior Excess Heat
  - This may be accompanied by mental restlessness or irritability if the Heat affects the mind
• Big sweat
  - Interior Excess Heat is evaporating fluids or forcing fluids out
• Big thirst
  - From consumption of body fluids and excess heat.
  - A preference for cold drinks
• Big pulse.
  - Strong pathogenic and anti-pathogenic factors
• Red Face
• No aversion to cold
• Tongue: Red Body with Thick Yellow Coat (or dry coating).
• Pulse: Excess Pulse

Treatment

Formula: Bai Hu Tang (White Tiger Decoction)

Function:Clears Qi Stage and Yang Ming Channel Heat; Drains Stomach Fire, generates body fluids and alleviates thirst.

Contents:

• Shi Gao
• Zhi Mu
• Jing Mi
• Zhi Gan Cao

B. Yang Ming Fu (Organ) Syndrome

Symptoms:

• The Four Big's (As Above)
• Constant Fever, but more pronounced in the afternoon.
• Abdominal distention
  - The Yang Ming Fu (Organ) syndrome will also have abdominal bloating or in more severe cases, abdominal masses. This is due to the heat drying the fluids, causing Qi Stagnation in the organs
• Constipation
  - The main distinguishing symptom of the Organ (Fu) and Channel (Jing) syndrome
  - Due to interior heat consuming fluids
• Tongue: Thick, Dry, Yellow Coat.
• Pulse: Excess Pulse

Treatment

Formula: Da Cheng Qi Tang (Major Order the Qi Decoction)

Function: Vigorously purges the Heat Accumulation (induces defecation).

Contents:

• Da Huang
• Mang Xiao
• Hou Po
• Zhi Shi

Shao Yang (Lesser Yang) Syndrome

The Tai Yang stage involves Evil pathogens (Cold, Wind) on the exterior of the body which need to be released or "sweated out." The Yang Ming stage involves pathogenic Heat in the Interior which need to be purged through the bowels. In between these two stages is the Shao Yang syndrome where the pathogen is between Internal and External.

Although the Shao Yang symptoms include both chills and fever, these symptoms alternate from one to the other. The related channels of the Shao Yang syndrome are the San Jiao, Gallbladder, Pericardium, and Liver.

Symptoms:

• Alternating chills and fever
  - It was believed that fevers corresponded to the body's Zheng (Upright or Good) Qi fighting and winning against the pathogenic Evil Qi, and that Chills indicated that the body's Zheng Qi was losing the fight against the pathogenic Evil Qi.
• Bitter taste in mouth
  - Indicates an excess Gall Bladder condition, heat disrupting the flow of bile.
• Blurred vision
  - The Liver, which opens to the eyes, is affected.
• Nausea, vomiting, bloating, poor appetite, and stomach ache.
  - An excess Liver condition can easily affect (attack) the Spleen and Stomach, which govern the digestive system.
• Pain in the costal (hypochondriac) region
  - The costal region is the region of the Liver so as the Meridian flow is disturbed, so is this area.
• Irritability, Heart Vexation, and irregular heart beat.
  - This corresponds to the Pericardium channel being affected. The Pericardium is closely related to the Heart which controls the Shen (Mind).
  - As the Heat disturbs the Pericardium, the Heart and thus the Mind is also affected producing irritability (or even insomnia).
• Tongue: Sides of the tongue are more red, mixed yellow and white coating (again reflecting the halfway characteristic of the Shao Yang syndrome).
• Pulse: Wiry pulse.

Treatment

Formula: Xiao Chai Hu Tang (Minor Bupleurum Decoction)

Function: Harmonizes and releases Shao Yang (lesser yang) channel disorders.

Contents:

• Chai Hu
• Huang Qin
• Ren Shen
• Ban Xia
• Sheng Jiang
• Da Zao
• Zhi Gan Cao

Acupuncture Points:

• Waiguan (SJ-5)
• Yifeng (SJ-17)
• Yanglingquan (GB-34)

Tai Yin (Initial Yin) Syndrome

The invasion into the Tai Yin can occur from a chronic Tai Yang syndrome progressing into the Tai Yin, inappropriate treatment of a Tai Yang disease whcih forces it into the Tai Yin, or if the pathogen is strong enough, it can bypass the exterior and immediately invade the Tai Yin stage. Food poisoning, for example, can cause sudden diarrhea and Cold-Damp in the body (symptoms of Tai Yin syndrome). In all cases, the Spleen and Stomach Zang Fu will be deficient and there will be Internal Cold and Dampness present.

Symptoms:

• Abdominal Fullness
  - From the Spleen not being able to transform and transport.
• Abdominal Pain
  - As this is a deficient pain, it will be alleviated by warmth and pressure.
• Diarrhea, nausea, vomiting.
  - Dampness affects nausea and diarrhea.
  - Also due to the Dampness, the Stomach Qi may be obstructed from descending and may rebel producing vomiting.
• No Thirst
  - No interior Heat
• Tongue: Pale with a white sticky coat.
• Pulse: Slow and weak pulse.
• Shen/Spirit: Low energy, fatigued.

Treatment

Formula: Li Zhong Wan (Regulate the Middle Pill)

Function: Warms the Middle Jiao and strengthens the Spleen and Stomach.

Contents:

• Ren Shen
• Gan Jiang
• Bai Zhu
• Zhi Gan Cao

Acupuncture Points:

• Zusanli (St-36)
• Yinlingquan (Sp-9)

Note: Comparison of Tai Yin and Yang Ming Abdominal Pain

In Tai Yin syndromes, the diarrhea and lack of thirst are both a product of Cold-Damp inside the body. In Yang Ming syndromes, the constipation and strong thirst are both products of the Internal Heat. In the Yang Ming syndrome, the abdominal pain is aggravated by pressure and heat because it is an excess condition. In the Tai Yin syndrome, the abdominal pain is alleviated by pressure and heat because it is a deficiency syndrome.

Starting with a common cold (Tai Yang syndrome), invasions can progress into more complicated internal/external Shao Yang conditions, as well as expressing into full Heat conditions as the body mounts all it's defenses against the invading Cold. If the pathogenic factor is too strong, the fever will subside, and this is an ominous sign (accompanied by cold digestive problems) that the situation is getting worse. This is already a serious situation, if allowed to progress further, the condition may be life threatening.

Shao Yin (Lesser Yin) Syndromes

Shao Yin syndrome affects the Kidneys and the Heart. There are two types of Shao Yin syndromes: One involves a deficiency of Yang Qi and Cold, and the other involves a deficiency of Yin and Heat. Both involve a serious disruption of the body's basic Yin and Yang balance.

A. Yang Deficient Shao Yin Syndrome

Symptoms:

• Aversion to Cold, Cold Limbs.
  - The Shao Yin feeling of cold is colder than that of the Tai Yin syndrome.
  - The patient may lie curled up or prefer many blankets.
  - There is little thirst and the patient may prefer warm drinks.
• Tendency to sleep and Listlessness.
  - From Yang Deficiency.
• Diarrhea with undigested food
  - Cold affecting the Spleen and Kidney
• Clear Urine with Increased Volume
  - Yang deficiency leading to excess Yin
• No Fever
• Tongue: Pale (Very Deficient) with a thin white coat.
• Pulse: Deep, minute (very weak) pulse.

Treatment

Formula: Si Ni Tang (Frigid Extremities Decoction)

Function: Rescues devastated Yang, warms the Middle Jiao, and stops the diarrhea.

Contents:

• Fu Zi
• Gan Jiang
• Zhi Gan Cao

Acupuncture Points:

• Zusanli (ST-36)
• Qihai (Ren-6)
• Baihui (Du-20) to hold the Yang

B. Yin Deficient Shao Yin Syndrome

Symptoms:

• Insomnia, irritability.
  - From Fire Flaring up from Deficiency. The Yin is Deficient so the Yang can not be subdued at night.
• Dry mouth and throat.
  - Yin Deficiency implies deficiency of body fluids producing dry mouth and throat (or even skin and eyes).
• Scanty dark yellow urination.
  - From consumption of Yin from Heat
• No Desire to Drink Fluids
  
• Tongue: Dark Red body, Red Tip with little or no coating.
• Pulse: Thin and rapid pulse.

Treatment

Formula: Huang Lian E Jiao Tang (Coptis and Ass-Hide Gelatine Decoction)

Function: Nourishes the Yin, causes the Deficient Fire to descend, eliminates irritability and calms the Shen (Spirit).

Contents:

• Huang Lian
• Huang Qin
• E Jiao
• Shao Yao
• Ji Zi Huang (egg yolk)

Jue Yin (Greater Yin) Syndrome

Jue Yin is the last yin stage. Starting with the initial Tai Yang stage, we progress through the stages until the Jue Yin Stage. This syndrome is the last stage of disease caused by Cold Evil. It chief attribute is the weakness of the Zheng Qi.

Symptoms:

• Alternating sensations of cold and heat.
• Appetite and thirst.
  - The patient will have hunger but will not be able to eat. Once the food is ingested, the patient will vomit it up.
  - If a purgative is inappropriately prescribed, there will be continuous diarrhea.
• Frequent Urination.
• Uncomfortable sensation as if air were ascending upwards from below the epigastrium or Hot and painful feeling in the chest.
  - This sensation is described as Yang separating from Yin.
• Roundworms.
  - The Shang Han Lun also describes this condition where parasites (roundworms) may be vomited.
• Tongue: Red Papillae with Slippery and White Coat.
• Pulse: Deep, Hidden, Wiry

Treatment

Formula: Wu Mei Wan (Mume Pill)

Function: Warms the organs (intestines), calms worms and stops chronic diarrhea.

Contents:

• Chuan Jiao
• Xi Xin
• Gui Zhi
• Fu Zi
• Gan Jiang
• Huang Lian
• Huang Bai
• Ren Shen
• Dang Gui
• Wu Mei

At this stage of disease, the patient may be in shock. The Yang Qi needs to be revitalized or the patient may die. Roundworms may migrate to another part of the GI tract that is more suitable if the gastrointestinal tract environment is altered from illness. They may move into and lodge themselves in the hepato-pancreatic ampulla, producing extreme colicky pain. In this situation, the ingestion of a sour solution such as vinegar or Wu Mei Wan, may alleviate the pain.