Disease Progression

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.

Dang gui si ni tang and Dang gui si ni jia wu zhu yu sheng jiang tang

Dang gui si ni tang

dang gui 9 gui zhi 9 bai shao 9 da zao 15 zhi gan cao 6 xi xin 9 tong cao 6

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.

This formula is based on gui zhi tang. The sheng jiang has been removed and xi xin has been added. The reason is due to the lack of internal yang qi.

The fine and verging on expiry pulse indicates a shao yin and jue yin level pattern. Fire fails to warm the interior and transform qi, but there is also a lack of yin to transform.

Dang gui, gui zhi, xi xin, warm and move the yang qi.

Bai shao, da zao, and zhi gan cao nourish yin and blood.

Tong cao is a jue yin herb that moves blood and drains heat that can build up in the pericardium nutritive level. It tonifies wood by tonifying the fresh kidney water. Tong cao is bitter and bitter tonifies the kidneys in the five element correspondences.

All other sources use mu tong. Mu tong is cold, bitter and clears heat from the heart and small intestine. It clears from the heat upper and promotes urination to lead it out the lower.

Zhi gan cao replenishes the nutritive ying layer and clears deficient heat while moistening tendons and connective tissue, and so often combined with bai shao. Strengthens qi and moderates other pungent herbs from being too dispersing. It also moistens to prevent excessive drying from pungent herbs.

Why remove sheng jiang and add xi xin? Xi xin is better at adding yang warmth and function to the body then sheng jiang. Sheng jiang adds warmth and function but mostly to the tai yin spleen and lungs. Xi xin is better than sheng jiang at warming and moving the jue yin liver blood. And reversal cold is exactly that, a deficiency of warm circulating yang qi.

Dang gui si ni jia wu zhu yu sheng jiang tang

dang gui 9 gui zhi 9 bai shao 9 sheng jiang 24 da zao 15 zhi gan cao 6 xi xin 9 tong cao 6 wu zhu yu 48 (18)

Line 352 If the person has enduring internal cold, dang gui si ni jia wu zhu yu sheng jiang tang governs.

This formula treats the same pattern as dang gui si ni tang but is stronger at warming the jue yin blood with wu zhu yu and stronger at dispersing outward with sheng jiang.

A note on the dose of the wu zhu yu. Most sources recommend the lower dose of 18 grams instead of the original 48 grams. Therapists choice.

Xiao ban xia tang

Xiao ban xia tang

ban xia 24 sheng jiang 24

This formula restores the pivot of earth. Earth must pivot for normal function. The separation of pure and impure depends on it. The organs associated with earth are the stomach and spleen. The stomach belongs to yang ming and it functions with the large and small intestine and is called the stomach domain. The mandate associated with yang ming is collecting and descending. The spleen belongs to tai yin and it raises clear qi up to the lungs and the 100 vessels.

Chapter 12 Line 28 Persons who suffer with vomiting are supposed to be thirsty; such thirst indicates that the condition is on the verge of resolution. An absence of thirst is caused by propping rheum below the heart. Xiao ban xia tang is indicated.

Vomiting with thirst indicates that the phlegm is being eliminated through vomiting. If there is no thirst then the condition is continuing.

Chapter 15 Line 20 For jaundice disease with unchanged urine color, a tendency to spontaneous diarrhea, and abdominal fullness with panting, heat-eliminating treatments are prohibited; this will result in retching. For retching, xiao ban xia tang is indicated.

If jaundice manifests with cold, there will be signs such as, unchanged urine color, a tendency to spontaneous diarrhea, and abdominal fullness with panting. The panting is due to a failure of the pivoting of the middle.

Chapter 17 Line 12 For all vomiting with an inability to keep food down, xiao ban xia tang is indicated.

This is due to failure of the pivoting of the middle.

General

The pivoting action of the middle consists of the yang ming descending and the tai yin ascending. Yang ming closes and this collecting action brings the yang qi to the interior. Tai yin opens to receive the yang qi. When warm the normal ascending of clear qi and descending of turbid qi occurs.

In other formulas sheng jiang supports the movement of yang on the surface. It does so by supporting the normal function of tai yin in sending clear qi up to the heart and 100 vessels.

This pivoting is important and many complex formulas use ban xia and sheng jiang.

Xiao chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 9 ren shen 9 da zao 9 zhi gan cao 9

Line 96 When in cold damage that has lasted for five or six days or wind strike, there is alternating aversion to cold and heat effusion, the person suffers from fullness in the chest and rib side, taciturnity with no desire for food and drink, heart vexation and frequent retching, or possibly there is vexation in the chest and no retching, or thirst or pain in the abdomen, or a hard glomus under the rib side, or palpitations below the heart with inhibited urination, or absence of thirst with mild generalized heat, or cough, then xiao chai hu tang governs.

Ban xia and sheng jiang restoring the pivoting of the middle. Ban xia is working with huang qin in descending. Sheng jiang is working with ren shen in ascending.

Ban xia hou po tang

ban xia 24 hou po 9 sheng jiang 15 fu ling 9 zi su ye 6

Chapter 22 Line 5 For women as if with a piece of fried meat stuck in the throat, ban xia hou po tang governs.

Zi su ye is used in modern formulas to warm the surface. By increasing the dose of zi su ye it could be effectively used for a tai yang pattern with tai yin congestion.

Da chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 15 da zao 9 bai shao 9 zhi shi 6 da huang 6

Line 165 When in cold damage there is heat effusion and sweating that brings no resolution, hard glomus below the heart, retching, vomiting, and diarrhea, then da chai hu tang governs.

In this formula the pivot of earth is really stuck, due to dryness. Bai shao descends, cools, and moistens yang ming. Da huang opens yang ming, and zhi shi pushes yang ming downward.

Chai hu jia mang xiao tang

chai hu 24 huang qin 9 ban xia 9 ren shen 9 sheng jiang 9 da zao 9 zhi gan cao 9 mang xiao 18

Line 104 Here in cold damage the disease has not resolved in thirteen days, and there is fullness in the chest and rib side, retching, late afternoon tidal heat effusion, and shortly afterward mild diarrhea. This was originally a chai hu tang pattern in which precipitation should not cause diarrhea, yet now there is diarrhea, so one knows that a pill medicine was used to precipitate, and this is not the appropriate treatment. Tidal heat effusion means repletion. It is appropriate to first take xiao chai hu tang in order to resolve the external aspect. Afterwards chai hu jia mang xiao tang governs.

late afternoon tidal heat effusion, tidal heat effusion means repletion. This indicates a yang ming bowel pattern, mang xiao cools and drains the excess heat.

It is appropriate to first take xiao chai hu tang in order to resolve the external aspect. Free the circulation of the ministerial fire so tai yang can open, then clear heat so yang ming can descend.

Chai hu jia long gu mu li tang

chai hu 24 huang qin 9 ban xia 12 ren shen 9 sheng jiang 9 gui zhi 9 fu ling 9 long gu 9 mu li 9

da huang 12 da zao 6 dai zhe shi 9

Line 107 When in cold damage that has lasted for eight or nine days, precipitation is used, and there is fullness in the chest, vexation and fright, inhibited urination, delirious speech, heaviness of the entire body, and inability to turn sides, chai hu jia long gu muli tang governs.

vexation and fright, indicates that heat is harassing the heart, gui zhi, long gu, mu li, and dai zhe shi are tonifying, cooling, and descending yang qi, while the da huang descends yang ming.

Ben tun tang

ge gen 15 sang bai pi 24 huang qin 6 ban xia 12 bai shao 6 chuan xiong 6 dang gui 6 sheng jiang 12 zhi gan cao 6

Chapter 8 Line 2 In running piglet qi surges upwards to strike the chest, with abdominal pain, and alternating hot and cold, ben tun tang governs.

Chai hu gui zhi tang

chai hu 24 huang qin 9 ban xia 12 ren shen 9 gui zhi 9 bai shao 9 sheng jiang 9 da zao 9

zhi gan cao 9

Line 146 When in cold damage that has lasted for six or seven days, there is heat effusion, mild aversion to cold, vexing pain of the limb joints, mild retching, popping bind below the heart, and the exterior pattern is still present chai hu gui zhi tang governs.

Ban xia and sheng jiang are restoring the pivot. Sheng jiang is supporting gui zhi in warming the surface.

Ban xia xie xin tang

ban xia 24 huang qin 9 huang lian 3 ren shen 9 gan jiang 9 da zao 9 zhi gan cao 9

Line 149 If there is fullness, hardness, and pain below the heart, this indicates chest bind, therefore da xian xiong tang governs. If there is fullness only, without pain, this indicates a glomus, and one should not give chai hu tang but ban xia xie xin tang is appropriate.

Gan cao xie xin tang

zhi gan cao 12 huang qin 9 huang lian 3 ban xia 12 ren shen 9 gan jiang 9 da zao 9

Line 158 When in cold damage or wind strike, the physician has used precipitation, the person will have diarrhea about ten times a day containing food that has not been transformed, with thunderous rumbling in the abdomen, fullness and a hard glomus below the heart, dry retching and a vexation that cannot be quieted.

When the physician sees a glomus below the heart, suggesting the illness has not finished, and again uses precipitation, as a result the glomus increases in severity, it is because heat bind is absent, only stomach vacuity is present with counter flow ascent of visiting qi, causing hardness therefore gan cao xie xin tang governs.

Sheng jiang xie xin tang also known as sheng jiang ban xia tang 

sheng jiang 12 ban xia 12  huang qin 9 huang lian 3 ren shen 9 gan jiang 3 da zao 9

zhi gan cao 9

Line 157 When in cold damage after sweating has issued and brought resolution of the exterior, the stomach is in disharmony, there is a hard glomus below the heart, dry belching with no desire of food, water qi under the rib side, thunderous rumbling in the abdomen, and diarrhea, sheng jiang xie xin tang governs.

Yue bi jia ban xia tang

ma huang 18 shi gao 24 sheng jiang 9 da zao 9 zhi gan cao 6 ban xia 9

Chapter 7 Line 13 Coughing with qi ascent indicates lung distention. The patient presents with panting, eyes bursting from their sockets, and floating large pulses yue bi jia ban xia tang is indicated.

Yue bi tang is being modified with ban xia to treat the pivot of earth.

Vomiting patients should normally be thirsty, for thirst is a sign that it is about to resolve, but now there adversely is no thirst, because there is poking rheum under the heart, and xiao ban xia tang governs.

Xuan fu dai zhe tang

xuan fu hua 9 dai zhe shi 3 ban xia 12 ren shen 6 sheng jiang 15 da zao 6 zhi gan cao 9

Line 161 If in cold damage sweating is promoted, if then vomiting is promoted, or if purged, after resolution, there will be hard glomus under the heart, and incessant hiccups, then xuan fu dai zhe tang governs.

She gan ma huang tang

she gan 9 ma huang 12 sheng jiang 12 wu wei zi 12 ban xia 12 xi xin 9 kuan dong hua 9 zi wan 9

da zao 3 (use jie geng for kuan dong hua)

Chapter 7 Line 6 Cough and adverse flow of qi, with the sound of a water bird in the throat, she gan ma huang tang governs.

Huang qin jia ban xia sheng jiang tang

huang qin 9 ban xia 12 bai shao 6  sheng jiang 3 da zao 9 zhi gan cao  6

Line 172 When in tai yang and shao yang combination disease there is spontaneous diarrhea, give huang qin tang, if there is retching, huang qin jia ban xia sheng jiang tang governs.

Hou po sheng jiang ban xia gan cao ren shen tang

hou po 24 sheng jiang 24 ban xia 24 zhi gan cao 6 ren shen 3

Line 66 When, after the promotion of sweating, there is abdominal distension and fullness, hou po sheng jiang ban xia gan cao ren shen tang governs.

Huang Lian Tang

Huang lian tang

huang lian 9 ban xia 12 gui zhi 9 ren shen 6 gan jiang 9 da zao 9 zhi gan cao 9

Line 173 When in cold damage, there is heat in the chest, evil qi in the stomach, pain in the abdomen, and a desire to vomit, huang lian tang governs.

Huang lian tang connects the upper and lower. It restores the fire and water relationship needed for life. Fire must make its descent into water. Fire is bringing water it to life so it can move, moisten and nourish all living things.

This formula is based on ban xia xie xin tang. Huang qin has been removed and gui zhi added.

Gui zhi is being used to clear the tai yang wind strike pattern. The use of huang qin would cool the ministerial fire which is needed to open the yang qi.

It clears heat and cold at the same time. The heat is in the chest and the cold is in the stomach domain.

This is a complicated pattern. There is heat and dampness in the upper burner and cold and dampness in the middle. Heat is yang and like fire it tends to rise. Cold is yin and like water tends to sink. If this yang rising and yin sinking continues the transformation of qi will fail and lead to death. The treatment strategy is to reconnect the fire and water of the upper and lower.

The use of huang lian to cool the heat indicates the presence of dampness. Huang lian is cold, bitter, and intensely drying. Gan jiang is used to warm and dry the earth and stomach domain.

It is not mentioned in Line 173, but there will be vexation and agitation from the heat, and cramping pain in the abdomen due to cold. There should be a soft, or watery stool.

The desire to vomit can be caused from either cold or heat.

Da huang gan cao tang

da huang 12 gan cao 3

For vomiting immediately after eating, da huang gan cao tang is indicated.

Xiao ban xia tang

ban xia 24 sheng jiang 24

Vomiting patients should normally be thirsty, for thirst is a sign that it is about to resolve, but now there adversely is no thirst, because there is poking rheum under the heart, and xiao ban xia tang governs.

The combination of ban xia and gan jiang is used in the formulas ban xia xie xin tang, gan cao xie xin tang, and sheng jiang xie xin tang.

Ban xia gan jiang san

ban xia 9 gan jiang 9

Chapter 17, Line 20 For dry retching, vomiting with counterflow, and drool foaming at the mouth, ban xia gan jiang san, is indicated. Grind the ingredients and drink with sour rice milk. Dry retching, vomiting with counterflow, and drool foaming at the mouth, indicate the accumulation of cold in the middle burner. The pivot of the earth is impaired.

Li zhong wan modifications

Li zhong wan

ren shen 9 bai zhu 9 gan jiang 9 zhi gan cao 9

386 When in sudden turmoil, there is headache, heat effusion, and generalized pain, if there is more heat and the patient desires to drink water, wu ling san governs; but if there is more cold and the patient does not drink water, li zhong wan governs.

This line discusses two different patterns. A wu ling san pattern and a li zhong wan pattern. Zhang ji wanted to make clear the difference between the two.

In a wu ling san pattern there will be more thirst with a desire to drink water. Wu ling san treats the failure of transformation of fluids due to cold of the tai yang bladder.

Li zhong wan treats the failure of transformation of fluids due to cold in the middle. The middle is earth and this is the area of the stomach and spleen. In this pattern fluids are still being transformed by the tai yang bladder so there is no thirst, or very little.

Li zhong wan brings yang qi to the interior with gan jiang and bai zhu.

Wang Bing, All yang, where magnificent, is tai yang.

Tai yang opens and yang ming closes. This illustrates the normal function of yang qi and how it reaches the interior. If the yang qi fails to open and descend there will be internal cold. It is the yang qi that warms the tai yin so it to can open. Yang must makes its descent into yin for the transformation of yin and yang.

If there is pounding above the umbilicus, the kidney qi has been stirred and one should remove bai zhu and add gui zhi.

The shao yin kidney has been stirred and there is pounding, indicating that yang qi has been weakened.

The combination of gui zhi and zhi gan cao makes the formula gui zhi gan cao tang. This formula tonifies the shao yin heart. Gui zhi warms and mildly nourishes the heart. When the yang qi has been tonified it will once again descend into the interior. Zhi gan cao makes the transition of the yang qi into the yin levels happen, just like it does in the seasons. Zhi gan cao represents earth and earth relates to the last period of each season.

For excessive vomiting remove bai zhu and add sheng jiang.

Sheng jiang disperses excess fluids and will work better than bai zhu. Bai zhu dries and warms fluids but does not disperses.

Consider using ban xia and sheng jiang for vomiting. Together they form the formula xiao ban xia tang. They treat a failure of the pivoting of the middle.

Chapter 17 Line 12 For all vomiting with an inability to keep food down, xiao ban xia tang is indicated.

For excessive diarrhea still use bai zhu.

For palpitations add fu ling.

Fu ling frees the middle from excessive dampness by draining it out through the tai yang bladder.

Fu ling restores a normal qi transformation of the shao yin kidneys by promoting urination and opening the waterways, and this stops palpitations by creating yang qi.

Fu ling restores the balance between water and fire.

For thirst with a desire to drink water add extra bai zhu.

Bai zhu restores the control over water and reabsorbs the fluids in the turbid yin of the large intestine to replenish fluids.

For pain in the abdomen add extra ren shen.

Ren shen tonifies the true qi which will strengthen the shao yin heart and kidneys, while it nourishes and blood to stop pain in the abdomen.

For cold add extra gan jiang.

Raising the dose of the gan jiang can help, and consider adding fu zi to warm the true water to create yang qi. This is being done in si ni tang.

For abdominal fullness remove bai zhu and add fu zi.

Fu zi warms the original qi of the kidneys and the gathering qi of the lungs and heart. Fu zi infuses the body with fire and promotes water metabolism through the descent of fire into the water reservoirs of the body to create qi.

Yang Dawn

The beauty of Chinese Herbal Medicine is illustrated in line 30 of the Shang Han Lun.

Line 30 Question: In a pattern similar to yang dawn

Using the concept of xiang, or images, we can refer to something in terms of the Dao. In doing so we can see its manifestation.

Yang dawn is the time of day when the sun starts to rise. A pattern that is similar to yang dawn refers to this time period. It also refers to its treatment method, time of day, time of year, and directions.

This is all possible because Dao takes nature as model.

The four models of Laozi, Humans take the earth as model, the earth takes the heavens as model, the heavens take the Dao as model, the Dao takes nature as model.

In the early morning the yang qi starts to rise. The starting point is the shao yin. In tai yin the yang qi is in storage. When the time of shao yin comes, in the period of zi, we see the return of yang qi, as illustrated in the hexagram fu.

 The yang line in this hexagram illustrates the return of yang qi. This occurs at 23:00 at night.

Shao yin controls the pivot of fire and water, and yang and yin. The yang qi, when strong, starts to grow, and this continues to the jue yin. The jue yin closes the yin levels of tai yin and shao yin, which gives rise to the growth of yang qi.

The growth that started in shao yin and continued in jue yin, then continues in shao yang.

The shao yang period starts at 3:00 in the morning. It corresponds with the hexagram tai.

Tai contains the all yang trigram on the bottom, illustrated by three yang lines. It contains the all yin trigram on the top, illustrated by three yin lines. We see the tai yin on top of tai yang. This illustrates earth on top and the heavens below.

Hexagram 11 is named 泰 (tài), “Pervading”. Other variations include “peace” and “greatness”. Its lower trigram ☰ qian means force, or heaven, and its upper trigram ☷ kun means field, or earth.

Shang Binghe commentary, Yang naturally rises, yin naturally descends. Because yin is above and yang below, their qi transmits and exchanges, becoming tai. Tai means unobstructed passage.

Tai means unobstructed passage, refers to the normal exchange of yang and yin.

The growth of yang continues from the shao yang to the tai yang. Tai yang opens.

When tai yang fails to open we see the pattern called yang dawn. Yang dawn refers to the time when yang qi starts to grow, and to its treatment, when this fails.

When tai yang fails we see the tai yang wind strike pattern. We can treat this pattern with the herbal formula of gui zhi tang.

A yang dawn pattern refers to the formula gui zhi tang, because this formula restores the normal manifestations of the Dao.

Ling gui zhu gan tang

Ling gui zhu gan tang

fu ling 12 gui zhi 9 bai zhu 6 zhi gan cao 6

Warms the tai yang channel and organ, promote qi and water transformation, tonifies the spleen and drain dampness. It restores earth’s control over water. It warms a cold center with fluid accumulation, fullness in the chest, dizziness, and palpitations, cough and loose stools.

Jin gui yao lue formula

Line 16 For phlegm-rheum below the heart manifesting with propping fullness in the chest and rib-sides and dizzy vision, ling gui zhu gan tang is indicated.

Line 17 With shortness of breath and mild rheum, rheum should be eliminated by urination, ling gui zhu gan tang is indicated. Shen qi wan is also indicated.

If we combine these two lines we see that ling gui zhu gan tang is used for rheum and dampness causing chest and rib-side fullness, shortness of breath and dizzy vision, and should be eliminated by promoting urination.

What is the difference between dampness and phlegm rheum?

Rheum is an old-fashioned word for the watery discharge that drips from your nose and eyes when you have a cold or allergies.

Phlegm is the thick mucus secreted in the respiratory passages and discharged through the mouth, especially that occurring in the lungs and throat passages, as during a cold.

Phlegm rheum is a slightly thicker fluid than dampness that is accumulating.  

Wiseman and Wilms, Medical literature from the Song period onward uses tan, phlegm to denote a thick turbid substance, and yin, rheum to denote a thinner, clearer form of pathological fluid.

For phlegm-rheum below the heart, refers to the stomach and epigastric region.

Dizzy vision is being caused by the internal wind created by the failure of the yang qi to descend. And by the failure of clear qi to reach the eyes. The phlegm is obstructing the yang qi from ascending.

Fu ling, Poria

Fu ling restores normal qi transformation of the kidneys by disinhibiting urination and opening the waterways.

Bai zhu and fu ling are the core herbs for clearing dampness from earth and draining it out by promoting urination. Bai zhu builds a dyke and fu ling opens the waterways.

Gui zhi, Cinnamomi cassiae ramulus

Gui zhi warms all three burners through the ministerial fire and so tonifies function of the yang and yin organs.

Gui zhi is the main herb to restore the water metabolism of the tai yang bladder. It warms the yang on the bladder channel and promotes the transformation of kidney qi as vapor from the stored fluids of the bladder.

Bai zhu, Atractylodis macrocephalae rhizome

It tonifies tai yin qi of the spleen and lung and strengthens the spleen by drying and draining dampness to allow normal function to return.

Zhi gan cao, Glycyrrhizae radix prep

Zhi gan cao directly enters the heart. It strongly tonifies heart qi and regulates heart rhythm. It also builds spleen qi to strengthen lung and heart qi to revive the pulse beat.

Ling gui zhug an tang contains two pairs of herbs. The first pair of gui zhi and zhi gan cao tonify yang qi. This strengthens the heart yang and fire element. Yang qi when weak fails to transform fluids.

Gui zhi tonifies yang qi and zhi gan cao ensures a smooth transition of the yang qi into the yin divisions.

Gui zhi corresponds with the southern direction and summer season. Zhi gan cao corresponds with the center and the last period of each season.

The second pair of bai zhu and fu ling promote the transformation of fluids, especially in the middle and lower burners. Bai zhu tonifies the fire element in earth. Fu ling promotes the movement of fluids in the middle and lower burners.

Bai zhu corresponds with the southern direction and the summer season. It also corresponds with the center and the last period of each season.

Fu ling corresponds with the center and the last period of each season.

Zhen wu tang

fu zi 9 bai zhu 6 fu ling 9 bai shao 9 sheng jiang 9

The most complex and variable syndromes are those that pertain either to diseases of the pivot, and diseases in which water plays a key role.

There are three pivots and two sources.
Pivot one is the shao yang, pivot two is the shao yin, and pivot three is the earth. The two sources are the earth as post-heaven and shao yin kidneys as pre-heaven.

In this post I will discuss line 316 from the Shan Han Lun.

Line 316 When shao yin disease has not ceased after two or three days, and at four and five days there is abdominal pain, inhibited urination, heaviness and pain in the limbs, and spontaneous diarrhea, it means there is water qi and the person may cough, or have uninhibited urination, or diarrhea, or retching, therefore zhen wu tang governs.

Tai yang rules water, it is the extreme yang within yang. Shao yin is the storage of water and fire. Water and fire together are referred to as shao yin.

Water and fire must remain co-joined and interdependent in the body. They should never separate from each other. Water and fire together are the yin and yang.

Zhen wu tang is the representative formula of the northern direction. It restores the yang qi so it can once again descend into water, so it can once again rise to the heavens.

When shao yin disease has not ceased after two or three days, and at four and five days there is abdominal pain, inhibited urination, heaviness and pain in the limbs, and spontaneous diarrhea, it means there is water qi and the person may cough,

Cold and fluids have accumulated which gives rise to abdominal pain. The cold has closed off the bladder. Yang qi fails to reach and warm the extremities which belong to earth. Yang fails to warm the interior and fluids drop out the bottom as diarrhea. Fluids can accumulate in the lungs giving rise to cough. This is water qi.
Line 316 modifications, If there is a cough add wu wei zi, xi xin and gan jiang. Wu wei zi, xi xin, and gan jiang are the core trio to treat fluid accumulation is the lungs due to cold.

or have uninhibited urination,

Obviously the bladder is not always closed in this pattern. Line 316 modifications, If the urine is uninhibited remove fu ling.


or diarrhea,

Line 316 modifications, If there is diarrhea remove bai shao and add gan jiang.

Removing the bai shao makes the formula more pungent and dispersing. Its sour collecting nature calms internal movement as wind. Bai shao also nourishes fluids and blood which will make the diarrhea worse. Gan jiang introduces dryness into the yang ming domain.

or retching

Line 316 modifications, If there is retching remove fu zi and add sheng jiang.

This modification is interesting because it illustrates that the yang levels, tai yang, yang ming, and shao yang, need to be functioning first before progressing to the yin levels. Retching indicates the accumulation of cold and fluids in the yang ming stomach organ. This prevents yang ming from descending into tai yin to warm the interior. The cold and fluids prevent the exchange of qi between the upper and lower burners. Sheng jiang restore the pivot of earth.

Comparison
Zhen wu tang, fu zi 9 bai zhu 6 fu ling 9 bai shao 9 sheng jiang 9
Fu zi tang, fu zi 9 bai zhu 12 fu ling 12 bai shao 9 ren shen 6
Si ni tang, fu zi 6 gan jiang 4.5 zhi gan cao 6

These formulas open the southern direction. It is fu zi that brings fire to water.

Si ni tang is treating mostly cold.

Zhen wu tang and fu zi tang are both treating cold and fluid accumulation with the addition of bai zhu and fu ling.

Zhen wu tang is more dispersing with the addition of sheng jiang. Fu zi tang it tonifying and nourishing with the addition of bai shao and ren shen.

Gan jiang huang qin huang lian ren shen tang

Gan jiang huang qin huang lian ren shen tang

gan jiang 9 huang qin 9 huang lian 9 ren shen 9

Line 359 In cold damage originally there was spontaneous cold diarrhea, yet the physician used vomiting and precipitation so there is repelling cold. After further adverse treatment through vomiting and precipitation, if there is immediate vomiting after food enters the mouth, gan jiang huang qin huang lian ren shen tang governs.

In cold damage originally there was spontaneous cold diarrhea,

This must be a tai yang wind cold pattern. Tai yang opens and then yang ming closes. The rising and growing of the yang qi is needed internally to warm the organs such as the spleen.

In a tai yang wind cold pattern the yang fails to descend then cold diarrhea occurs.

In tai yang and yang ming combined disease, there will be spontaneous diarrhea, and therefore ge gen tang governs.

If the wind cold tai yang pattern is unresolved, the pattern can change to yang ming and gives rise to diarrhea, dual tai yang and yang ming.

yet the physician used vomiting and precipitation so there is repelling cold.

Vomiting causes a loss of fluids and this weakens the shao yin heart yang and the jue yin blood level. The shao yin then fails to pivot and the exchange between fire and water fails. Yin and yang separate. With yang in the upper and yin below. Yang will continue to rise and yin will continue to sink.

Precipitation, a downward purging of the yang ming bowel causes the fluids on the surface to be pulled inwards. These fluids can be warm because in a tai yang cold strike pattern there can be a high fever. These warm fluids accumulate in the stomach.

After further adverse treatment through vomiting and precipitation, if there is immediate vomiting after food enters the mouth, gan jiang huang qin huang lian ren shen tang governs.

Vomiting after eating indicates heat in the stomach.

Gan jiang warms the cold and dries damp in the yang ming intestines. Gan jiang brings yang to the earth to warm the fluids. It also prevents excessive cooling from huang qin aand huang lian.

Huang qin is a shao yang herb. It clears liver and gall bladder damp and heat that flares up to the upper burner. It also clears san jiao damp heat through its bitter drying taste and cold cooling nature. It also cools the jue yin blood level.

Huang lian is bitter and cold to clear yang ming heat, it clears excessive damp heat in the intestines, resolves toxins, and dries damp.

Ren shen tonifies but also moistens. The tonifying restores normal function while the moistening prevents excessive drying from huang qin and huang lian.

The yin fluids from ren shen moderate excessive movement by anchoring yang within yin. It raises the original qi and gathering qi. It strengthens righteous qi, righteous qi is also called true qi and is a combination of original qi and gathering qi. All are dependent on the qi of shao yin and tai yin. Which in turn are dependent on the jue yin and shao yang for the ministerial fire in all three burners.

Bai hu tang

Line 176 When in cold damage the pulse is floating and slippery, this means there is heat in the exterior and cold in the interior, bai hu tang governs.

Editors of the Song version believe this to be an error. According to Wiseman and the editors of the Song version it should read. There is heat in the exterior, and heat in the interior.

This makes no sense according to the theory of opening, closing and pivoting.

Tai yang opens, yang ming closes, and shao yang pivots.

The slippery pulse indicates heat. The yang qi has been damaged and the yang is on the exterior. The pulse follows the yang. But now the yang is becoming excessive. The tai yang pattern is turning into a yang ming channel pattern.

The tai yang opens. But now it is opening excessively. If left unchecked it continues and fails to make its descent into the yang ming. Yang ming closes and this ensures that the yang qi descends into the interior. When yang fails to descend the interior will not be warmed. This gives rise to coldness and dampness.

Tai yang is summer and yang ming is fall. The yang ming qi is one of coolness and collecting. The yang ming ensures that the yang qi goes into storage for the winter.

The formula Bai hu tang is ensuring that the yang qi is collected and cooled. Bai hu tang brings the autumn to the excessive summer. It represents the west and the qi of the west is descending.

Liu Lihong, After tai yang begins the process of opening the yang door, the yang qi gradually begins to rise as it is released and emerges from storage. The aspect that carries out the closing of the yang qi is the yang ming. The transition between opening and closing depends on the pivoting function of shao yang.

Once tai yin initiates the process of opening the door of gathering and storage, the yang qi enters into the state of gathering and storage in earnest. The door that opened by tai yin is closed by jue yin. Shao yin acts as the pivot between opening and closing.

The white tiger, bai hu, is used to clear yang ming channel heat. This is the spirit of the western direction, and it dominates the changes and transformations associated with that particular cardinal direction. These changes are the collecting and descending, and using bai hu tang is saying that there is a problem in the collecting and descending of the yang qi.