Does disease progress according to a set structure?
In other words, does disease progress from tai yang, to yang ming, to shao yang, to tai yin, to shao yin, and finally jue yin?
The quick and simple answer is no. The reason why this is taught is complicated and interesting.
In my basic TCM acupuncture class I was also taught this progression so I understand the confusion.
The chapters of the Shang Han Lun are structured according to the three yang and three yin levels. This structure seems logical. But remember that Wang Shu He found copies of the text and had to decide on the structure. He, and no one else, knows what the original order is of the text. He choose the format that is still used today, first the three yang and then the three yin levels.
But just because the classic text uses this format does not mean that all disease progress from tai yang to jue yin in any structured way.
I believe that the structure that Wang Shu He choose is the best format. It represents the true nature of yang. The progression of yang qi in year and a day are the same. This progression is based on the seasons.
Yang qi rises, grows, collects and is stored.
Spring corresponds with shao yang, summer corresponds with tai yang, autumn corresponds with yang ming, and winter corresponds with all three yin levels.
Morning corresponds with shao yang, afternoon corresponds with tai yang, evening corresponds with yang ming and night corresponds with all three yin level.
Why is there no standard progression of disease? There are any number of unique ways that disease can manifest. Every person has a precondition that affects this progression.
The yang and yin levels used in the Classic on Cold Damage is where the disease is located.
So why is this standard progression theory taught in basic TCM classes? TCM was born in 1940 right after the cultural revolution in China. This rebirth had to reflect modern medicine to be accepted. In doing so it severed ties with its rich past. This new Chinese Medicine is based mainly on the five element structure, where each element is named after the associated yin organ. This is the birth of TCM and the zang fu school.
But what about the Huang Di Nejing Suwen and the Shang Han Lun? They use the three yang and three yin whendescribing disease. In order to integrate the classics two different diagnostic systems are used. One is based on the five elements zang fu school and the other is the three yang and three yin model found in the Classic’s.
My belief is that only one diagnostic system is needed to understand all diseases and treatments. All of Chinese Medicine can be explained by the yin yang theory. Yin and yang can and should be used to explain every aspect of Chinese Medicine, from herbs, to formulas, to treatment strategies.
How does disease then progress?
The name of the Shang Han Lun implies that all damage to yang qi gives rise to a weakening of yang. Yang when weak, fails to go into storage to recover, which weakens it even further. The Shang Han Lun deals with all possible diseases and gives treatment strategies on how to restore yang function.
The genius of Zhang Ji is reflected in his ability to describe the different patterns of disease, including the different paths of progression. No, disease does not progress in any formal structure.
Patterns of passage
Tai yang to shao yang line 266
Line 266 When originally there was tai yang disease that was unresolved and thereby shifted into the shao yang, there is hardness and fullness under the rib side, dry retching and inability to eat, and alternating aversion to cold and heat effusion. When neither vomiting treatment nor precipitation has yet been used and the pulse is sunken and tight, one should give xiao chai hu tang.
Shao yang fails to pivot and yang fails to makes its descent and warm the interior.
Tai yang to yang ming line 181
Line 181 Question: Why does one get yang ming disease? Answer: In tai yang disease, if sweating is promoted, if precipitation is used, or if urination is disinhibited, this causes liquid and humor collapse and dryness in the stomach; hence there is a shift to the yang ming. No changes of clothes, internal repletion, and difficult defecation; these are signs of yang ming.
Yang ming closes excessively and then excess arises.
Tai yang to tai yin line 279
Line 279 When originally there was tai yang disease, but the physician used precipitation, and consequently there is abdominal fullness with periodic pain, this belongs to tai yin disease. Gui zhi jia shao yao tang governs. If there is great repletion pain gu zhi jia da huang tang governs.
Excessive dryness is causing yang ming to closing excessively. This causes pain and fullness. It is called tai yin because the normal opening function of tai yin is failing and yang is entering the interior to fast.
Tai yang to shao yin line 82
Line 82 When in tai yang disease, sweating has been promoted and sweat issues but the disease does not resolve, the person still has heat effusion, and there are palpitations below the heart, dizzy head, generalized twitching and the person is quivering and about to fall, zhen wu tang governs.
Yang qi has failed to warm the interior and cold water is accumulating. The yang qi is still on the surface and there is cold in the interior.
Tai yang to jue yin line 351
Line 351 When there is reversal cold of the limbs and the pulse is fine and verging on expiry, dang gui si ni tang governs.
Tai yang fails to open and this creates cold in the interior which prevents jue yin form fully giving birth to yang. Jue yin closes the yin levels and gives birth to the rise of yang through shao yang.
Yang ming line 184
Line 184 Question: Why does aversion to cold cease spontaneously? Answer: Yang ming resides in the center and governs earth. All things converge here and nothing passes further. Although at the beginning there is aversion to cold in two days it will spontaneously cease, indicating yang ming disease.
Shao yang to yang ming line 179, 265
Line 179 Question: Yang ming disease includes tai yang yang ming, right yang yang ming, and shao yang yang ming. What does this mean? Answer: In tai yang yang ming, the spleen is straightened. In right yang yang ming, the stomach domain is replete. In shao yang yang ming, when sweating is promoted and urine is disinhibited, there is dry vexing repletion in the stomach and difficult defecation.
Line 265 When in cold damage the pulse is string like and fine and there is headache and heat effusion, this belongs to shao yang. In shao yang one cannot promote sweating, as sweating will lead to delirious speech, which belongs to the stomach. If the stomach is harmonized there will be recovery and if the stomach is not harmonized, there will be vexation and palpitations.
Tai yin to shao yin line 273, 277
Line 273 In tai yin disease, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain, and if precipitation is used, there will be a hard bind below the chest.
Tai yang fails to open and this leads to internal cold which affects tai yin and shao yin.
Line 277 When there is spontaneous diarrhea and thirst is absent, this belongs to tai yin because there is cold in the storehouse, one should use a warming treatment. A counter flow cold decoction type of formula should be used.
The formula si ni tang can be used to clear cold in the storehouse, and this formula warms both tai yin and shao yin.
Shao yin to tai yang line 293
Line 293 When in shao yin disease that has lasted eight or nine days, the body and extremities are completely hot, it is because the heat is in the bladder, and there will be bloody excretions.
The bladder belongs to tai yang and now heat is causing the blood to heat up and yang qi becomes abundant and reckless which leads to bleeding.
Shao yin to jue yin 338
Line 338 When in cold damage, there is a faint pulse and reversal, and at seven or eight days, the skin is cold, and the person does not even have periods of peace, this indicates visceral reversal, not roundworm reversal. In roundworm reversal, the person should vomit roundworms. Now the person is still, and then has periodic vexation, which indicates reversal cold. Roundworms ascend and enter one’s diaphragm, so there is vexation, but wait a moment and it will stop. After receiving food, there is retching and again vexation, because the roundworms smell malodor of food, and the person often spontaneously vomits roundworms. For roundworms reversal, wu mei wan governs. It also governs longstanding diarrhea.
The internal cold is preventing the jue yin from closing, this prevents yang from rising. Heat can accumulate in the upper and cold in the lower burner whch gives rise to internal wind.
Jue yin to shao yang line 379
Line 379 When there is retching and heat effusion, xiao chai hu tang governs.
When jue yin closes excessively then heat can influence the shao yang, giving rise to heat in the stomach and heat effusion.