Putting the Emperor back on his throne expresses the treatment strategy of connecting the person to the heavens, great void and spirit brilliance.

In Chapter 66 of the Yellow Emperor’s Classic states, The ruler fire relies on being honored, the minister fire relies on its position.

The ruler fire is referring to the Emperor. The emperor is associated with the heart. Yet, the heart is the only organ without the flesh radical, all the other organs have one, suggesting that the heart is something without form.

The heart also has form and this form is the yin aspect of storing jing which is its ming men aspect.

So the heart has form and no form at the same time. The ruler fire connects us to the changes of the five elements or five aspects and to yin and yang. Without this connection there would be no transformation and changes.

This ruler fire is an aspect of yang qi called spirit brightness and its location is the great void.

Now, the five periods and yin and yang, they are the way of heaven and earth, the fundamental principals governing the myriad things, father and mother to change and transformation, basis and beginning of generating and killing, they are the palace of spirit brilliance.

The palace brilliance is the five elements and yang and yin. The palace brilliance is the starting place of change and transformation. We need to be connected to this brightness because it is what keeps us healthy.

Wang Bing, That union and dispersion of qi are immeasurable, that generation and transformation of the myriad beings is inexhaustible, all this is possible only because of the movement of the spirit brightness.

The spirit brightness resides in the heavens.

Now, as for the operation of change and transformation, in heaven it is darkness, the darkness generates the spirit.

Wang Bing, Darkness is distance, is hidden and deep, hence it generates the spirit.

The great void spreads the true magic power of qi. The myriad beings depend on the great void to come into existence.

Wang Bing, The true qi of the great void reaches everywhere. The true qi supports generation and existence. Hence anything that depends on qi and contains magic power embraces true qi to be alive.

The great void is to say, the region of emptiness and darkness, that which is filled by the true qi, the palace of spirit brightness. The true qi is infinitesimal, nothing is to far for it to reach.

Cold, dryness, fire, dampness, heat, and wind, these are the yin and yang of heaven. The three yang and three yin act on their behalf.

Tai yang cold, yang ming dryness, shao yang fire, tai yin dampness, shao yin heat, and jue yin wind act on the behalf on the six qi in heaven.

It is the formless heart that connects us to the heavens, and the great void where the spirit palace resides.

We must honor the ruler fire when we treat for this is the source of all change and transformation. When we treat we restore the function of yang qi and nourish the yin qi. This is putting the Emperor back on his throne.

This connects us the great mystery of the Dao stated in Chapter 1 Dao De Ching.

The Way that can be walked is not the eternal Way. The name that can be named is not the eternal name. The nameless is the beginning of Heaven and Earth.

The named is the mother of all things. Therefore: Free from desire you see the mystery.

Full of desire you see the manifestations. These two have the same origin but differ in name.

That is the secret, The secret of secrets, The gate to all mysteries.

Chapter 74 Wang Bing, The ruler fire does not rule a period.

Lin Yi, The ruler fire exists by name, the minister fire exists by position. That is to say the ruler fire does not rule a period.

Zhang Jiebing, The difference between the five periods, or elements, or agents, and the six qi, is that the periods are based on the heavenly stems, and the six qi are based on the earthly branches.

Five elements are based on the 10 heavenly stems.

The six qi are based on the 12 earthly branches.

Ruler fire is found in the six qi on earth, in the shao yin heart. The minister fire is found in the shao yin heart. The ruler fire rules in name only. We give respect to it by calling its name. It is the connection to the Dao and nature. 

In the great void is the grand qi. The grand qi is the qi of creation, it sustains the great void.

Zhang Jiebing, The grand qi is the principal qi of the great void. All the myriad things depend on it. Hence the earth is located in the middle of the great void because it is supported by the principal qi.

The six qi are the transformations of the grand qi. That is, the activities of the six qi between heaven and earth.

Zhang Zhicong, That is to say how the six qi move between heaven above and earth below. Cold, dryness, fire, dampness, heat, and wind are qi without physical appearance in heaven. Hardening, drying, warming, moistening, steaming, and moving are their corporal manifestations on the earth.

The six qi enter the earth. Hence they let the corporal qi receive non-corporal qi of the great void and thereby generate and transform the myriad things.

Every time we treat we make sure our patients are connected to this ability to transform and change. That is putting the Emperor back on his throne.

Chapter 49 Explanation of the vessels

The channels are being described with the hexagrams and 12 branches. Fabulous!

Using the Hexagrams from the I Ching gives us a visual image of the relationship between yang and yin. The six divisions used in the Yellow Emperor’s Classic each has its own unique image.  

Tai yang

 Tai hexagram, Yin branch, the first month

The first month is tai yang, is yin. In the first month the yang qi comes out above while the yin qi abounds. The yang has not reached its own turn of domination yet.

Wang Bing, During the first month, the third yang qi is generated. It is responsible for setting up the yin as the first month of the year. The third yang qi is called tai yang. Hence the text states, Yin is major yang.

The first month occurs in the winter which is a yin time period. Yang qi is rising and there is a balance between yang and yin. Three yang lines and three yin broken lines. Notice yang ming contains more yang lines than tai yang. Yang ming is seen as a combining and closing of yang qi.

Shao yang  

Bo Hexagram, Xu branch, the ninth month

In the ninth month the yang qi is exhausted and the yin qi abounds.

The shao yang abounds. As for abounds, that is an external sign of the condition of the heart.

In shao yang the yang qi is being born again after it has been in storage for recovery in the winter. It is exhausted and goes into storage and it is reborn in spring.

Yang ming  

Gou Hexagram, Wu branch, the fifth month

The yang ming is wu. The fifth month is the yin of the abounding yang. When the yang weakens in the fifth month and when the first yin qi rises it starts to struggle with the yang. At this time the yang abounds and yin qi is added to it.

Yang Shangshan, The yang ming is the head of the three yang. Wu is the fifth month, that is the time when the yang abounds and when it is extensive and brilliant.

Wang Bing, The yang qi descends and the yin qi rises. Hence, the text states, the yang abounds and the yin qi is added to it.

Tai yang represents all the yang in the body. The yang channels come together on the surface in the upper back. Tai yang ensures that yang qi opens which supports function on the surface and in the interior. Yang ming represents this yang qi in the interior.

Tai yin  

Fu Hexagram, Zi branch, the eleventh month

The major yin is zi. In the eleventh month the qi of the myriad beings is all stored in the center.

Wu kun, In the eleventh month, the yin qi greatly abounds. Hence the text states tai yin.

Tai yin opens to receive the descending yang qi. It represents earth, and earth is a combination of soil and water. Remember the trigram of water contains a yang line which symbolizes that the original nature of water is yang.  

Shao yin  

Kun Hexagram, Hai branch, the tenth month

The shao yin, that is the kidneys. In the tenth month all the yang qi of the myriad beings is harmed.

Ma Shi, The shao yin is the beginning yin. The tenth month is the second month of winter, it too, is shao yin.  

Yang qi has gone completely into storage in the winter. This is represented by all yin broken lines.

Plain Questions, The kidneys rule hibernation. They are the root of sealing and concealing, the dwelling place of essence.

The kidneys rule storage and concealment, thus they are the root of sealing up and concealing. They seal up and conceal the yang qi. They seal up and conceal the essence.

Plain Questions, Yin stores essence and is compounded into being, yang defends the exterior and acts to consolidate.

Jing is neither yin nor yang. Essence is yang qi in stored form. Or in other words, the stored form of energy is essence.

Jue yin  

Guai Hexagram, Chen branch, the third month

Ceasing yin is chen, the third month is the yin in the yang.

Zhong Zhicong, The third month is a time when yang abounds while jue yin rules the qi. Hence, this is yin in the yang.

Plain Questions, The liver is the root of dismissal of the ultimate, baiji, and the domain of the hun soul.

Jue yin is the root of the baiji, dismissal of the ultimate, and the bai ji brings about the transition from a state of storage to a state of rebirth. It re-initiates the entire cycle of birth, growth, harvesting, and storage.

Ba, means to cease or to end. Ji, means ultimate or extreme. The ultimate, ji, is the maximum or farthest point. The end of a traditional Chinese year, coinciding with the end of winter, is the most extreme point in that year, and corresponds with the chou period.

Plain Questions, The liver holds the office of general, planning and deliberation originate from it.

By getting rid of polarities, the liver also does away with conflicts and chaos. The general and the root of dismissal of the ultimate are referring to the same thing.

Bai hu tang

shi gao 48 zhi mu 18 geng mi 18 zhi gan cao 6

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

Bai hu jia ren shen tang

shi gao 48 zhi mu 18 geng mi 12 zhi gan cao 6 ren shen 9

When after taking gui zhi tang a great sweat has issued, there is great vexation and thirst, and the disease is unresolved and the pulse is surging and large, bai hu jia ren shen tang governs.

When tai yang is struck by heat, it is summer heat. When there is sweating and aversion to cold, with body heat and thirst, bai hu jia ren shen tang governs.

For thirst with a desire to drink, with a dry mouth and tongue, bai hu jia ren shen tang governs.

Bai hu tang and bai hu jia ren shen tang correspond with the west, autumn, yang ming and earth.

Yang ming represents dryness in the body. When pathological heat and dryness cause yang qi to rise the closing mechanism of yang ming fails. When yang ming fails to descend a separation of yang and yin can lead to death.

This line from the Shang Han Lun describes the start of the separation of yin and yang.

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

The heat in the exterior and cold in the interior is the separation and disease. Yang qi must be present on the surface to support function but not excessively. The interior must be warm for normal function, not cold.

The formula bai hu tang and bai hu jia ren shen tang are both used to treat a yang ming channel pattern and a summer heat pattern.

Yet there is a difference between a yang ming channel pattern and summer heat.

How can one formula treat two different patterns of disease?

By looking at the associated lines in the Shang Han Lun and Jin Gui Yao Lue we see the difference between the key symptoms clearly.

182 Question: What are the outward signs of yang ming disease? Answer: there is generalized heat effusion, spontaneous sweating and no aversion to cold, but aversion to heat.

In a yang ming channel pattern there is aversion to heat.

Chapter 2 Line 26 Tai yang disease with heat stroke is known as summer heat stroke. For sweating, aversion to cold, generalized heat, and thirst, bai hu jia ren shen tang is indicated.

In a summer heat pattern there is aversion to cold. 

This illustrates the difference between the two patterns.

In a summer heat pattern tai yang is damaged and yang fails to warm the surface giving rise to an aversion to cold.

In a yang ming channel pattern the heat effusion causes sweating. The excessive loss of fluids causes dryness, which gives rise to more heat. The dryness and heat prevent yang ming from making its physiological descent into the interior. This is dangerous and a high fever can cause death.

One formula to treat them both.

Cooling the heat and replacing the fluids is the key to treatment. Shi gao is pungent cold dispersing of heat. Zhi mu is cool nourishing of fluids. Geng mi replaces fluids of earth. Zhi gan cao is tonifying and nourishing of fluids in earth. The use of ren shen replaces fluids while raising the original qi and gathering qi.

In summer heat patterns earth becomes damp and cold. Which is why there are so many modern formulas that treat summer heat and the pivot of earth.

In herbal medicine we often talk about herbs that harmonize. Harmonize what? The key herb that harmonizes is zhi gan cao. You know, stir fried with honey Glycyrrhizae radix.

Zhi gan cao is often paired with other herbs like, da huang, gan jiang, gui zhi, or bai shao. Why is that?

Zhi gan cao is a sweet, mildly warm herb that nourishes and tonifies. It is an earth herb that nourishes fluids and tonifies function of the stomach and spleen. It tonifies the center.

Plain Questions, The Center generates Dampness, Dampness generates Earth, Earth generates Sweet, Sweet generates the spleen, the spleen generates the flesh.

It transforms, Earth corresponds with transformation and the sweet taste.

The last eighteen days of each season belongs to earth. This implies that without the earth to give birth to the myriad of things there would be death. This also implies that without earth the seasons could not transform from one to the next.  

Plain Questions, The spleen, does not have a season that it governs.

Plain Questions, The spleen is earth, it rules the central region, it holds fast to the four seasons, and extends to the four viscera. Eighteen days from each season are entrusted to it, but it does not have a season all its own.

Dong Zhongshu called the spleen, The lord of the five elements. It is the ruler because all the other elements cannot come into being without earth.

The spleen and earth makes the transition of yang and yin qi possible from season to season.

Because it is the ruler it corresponds to the element earth, and it is used for the same reason in herbal medicine.  

Sweet warm zhi gan cao is the herb that is the most representative for tonifying the earth. The sweet taste tonifies but also nourishes, it allows for the smooth transformation of qi.

Did you ever wonder why there is no zhi gan cao in the formula da chai hu tang?

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

It would hold back the needed descending action of the yang ming stomach family. After the stool has started to move and there is no more heat and vexation, naturally put it back in and remove the zhi zhi, and or the da huang.

Cold bitter da huang belongs to the west, autumn, and dryness.

It strongly cools and descends the yang qi in the stomach domain. Which is why it is used in the Cheng qi family of formulas.

It is used when internal yang ming heat is so great that the normal cooling, drying, and descending function fails.

But there is another use of da huang that is not so well known. And that is in clearing evil qi from the channels.

By descending, cooling, and drying the stomach domain the channels are affected. Which is why da huang can cause problems if used improperly.

Plain Questions Chapter 5

The six channels are streams, the intestines and the stomach are the sea. The nine orifices are where the qi flows like water.

Zhang Jiebing suggests that the last sentence should be; The nine orifices are where water and qi flow.

All rivers flow into the seas.

By descending the yang ming the sea is drained and the channels which are rivers follow.

The most representative formula of this action is tao he cheng qi tang.

Tao he cheng qi tang

tao ren 9 da huang 12 gui zhi 6 mang xiao 6 zhi gan cao 6

When a tai yang disease is unresolved and heat binds in the bladder, the person is as if manic, and spontaneous blood descent will bring recovery. If the exterior has not been resolved, one should not yet attack, but should first resolve the exterior. When the exterior has been resolved and there is only tense bound lesser abdomen, one can attack and therefore tao he cheng qi tang is appropriate.

It treats blood build up in the lower abdomen which is caused by heat. There will be acute lower abdominal pain, incontinence of urine, night fevers, mental vexation, and thirst. The heat can arise from an external tai yang pattern that progresses to the interior and turns into heat. The heat can be in the lower abdomen, body, or bladder.

The internal heat build up in the lower abdomen is cleared by moving the blood with tao ren and gui zhi, and by draining the seas with da huang and mang xiao.

This is also being done in Feng yin tang.

Feng yin tang

da huang 9 gan jiang 9 long gu 9 gui zhi 6 zhi gan cao 3 mu li 3 han shui shi 12 hua shi 12 chi shi zhi 12 bai shi zhi 12 zi shi ying 12 shi gao 12

Chapter 5 Feng yin tang: for heat paralysis and epilepsy.

Feng yin tang eliminates heat that causes paralysis and seizures. It treats seizures due to major wind in adults, and in children treats convulsions or seizures due to fright, occurring multiple times a day, and medicine has not been able to treat, for it is a heat eliminating formula.

It clears excess heat and internal wind in acute patterns.

Da huang belongs to the west, autumn, and dryness. It also drains the seas to drain the rivers.

Huang qi, Astragali radix

Huang qi is a yang herb that tonifies the yang of the surface and interior.

Huang qi is a yin herb that nourishes earth and yin fluids.

Its core use is in raising the clear qi up to the lungs and heart so it can become blood and be transported out to the circulating yang.

It is the core taxation herb. It counters the collapse of yang and blood.

Huang qi tonifies the yang of the surface which is need to control the opening and closing of the pores.

Huang qi replaces the lost fluids due to excessive sweating of taxation.

Huang qi tonifies tai yin spleen and lung. It raises clear qi to the gathering qi of the chest while nourishing the clear qi.

Huang qi is being used to treat the surface in the formula huang qi gui zhi wu wu tang.

Huang qi gui zhi wu wu tang

huang qi 30 gui zhi 9 bai shao 9 sheng jiang 18 da zao 6

For blood impediment with dual debilitation of yin and yang, faint pulses at the inch opening and bar position, small and tight pulses at the cubit position, and the external sign of generalized numbness resembling that of wind impediment, huang qi gui zhi wu wu tang is indicated.

Huang qi is being used to treat taxation in the formula huang qi jian zhong tang, which is causing internal urgency or cramping.

Huang qi jian zhong tang

gui zhi 9 bai shao 18 sheng jiang 9 da zao 9 zhi gan cao 6 yi tang 30 huang qi 30

For deficiency taxation with internal urgency, and all kinds of insufficiency, huang qi jian zhong tang governs.

Huang qi is warm and sweet.

Chao huang qi, Dry fried huang qi is warmer than non-dry fried and therefore tonifies better.

Zhi huang qi, Honey dry fried huang qi is also warmer than non-dry fried and also much sweeter. Therefore it tonifies better and nourishes better.

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

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

They share ban xia, huang qin, ren shen, da zao, zhi gan cao.

Xiao chai hu tang uses chai hu, and sheng jiang.

Ban xia xie xin tang uses huang lian and gan jiang.

Lets ignore gan jiang and sheng jiang for a moment because they both treat the yang ming stomach excess dampness and cold.

The difference then is the huang lian and chai hu.

Chai hu is a shao yang herb and huang lian is a yang ming herb.

There really is not much difference between the formulas. They both treat shao yang and yang ming, but xiao chai hu tang treats shao yang more with chai hu, and ban xia xie xin tang treats yang ming more with huang lian.

So, yes it is reasonable to use the modifications in line 96 for ban xia xie xin tang.

Line 96 Modifications of xiao chai hu tang.

If there is vexation in the chest without retching, remove ban xia and ren shen and add gua lou shi.

If there is thirst remove ban xia and add more ren shen and add gua lou gen.

If there is pain in the abdomen remove huang qin and add bai shao.

If there is a hard glomus under the ribs remove da zao and add muli.

If there are palpitations below the heart with inhibited urination remove huang qin and add fu ling.

If there is no thirst and mild generalized heat remove ren shen and add gui zhi, and take the decoction till a slight sweat occurs.

If there is cough remove ren shen, da zao  and sheng jiang and add wu wei zi and gan jiang.

In seeking to understand Chinese Medicine I am always on the lookout for material that clarifies my thoughts. The concept of mingmen has remained unclear for me, until now.

This text is from the website of http://www.itmonline.org. Hat tip to Subhuti  Dharmananda for his sources of information.

From Chen Shiduo, A Secret Manual from the Stone Chamber (Shishi Milu), ca. 1690:

As has already laid out in detail in the Nanjing, mingmen is the master of the twelve channel networks. But even though many texts have since been written about this subject, the quintessence (most typical example) of mingmen still remains in the dark. Therefore I chose to bring up this topic one more time.

It is always said that mingmen is the master of the twelve channel networks. Now, what kind of master is it exactly and what does it master?

Let me put it this way: if there is no fire inside us, we cannot exist. This fire must be there first so that the twelve channel networks can be imbued with the igniting spark of transformation. mingmen, therefore, is a type of prenatal fire.

So mingmen is a type prenatal, or pre-heaven fire.

Chinese Medicine and the I Ching share the same root.

The eight trigrams can be arranged in two ways: pre-heaven and post-heaven.

Six trigrams are born from the Qian heaven and Kun earth trigrams.    

Qian heaven consists of three solid yang lines. Yang is the principle of light and the heavenly, so it has to be represented in abundance in the trigram of Heaven.

It’s the ultimate yang.

Kun earth consists of three broken yin lines. Yin stands for earth, dark, and cold. The trigram represents the receptive, since that is traditionally seen as the role of earth in relation to heaven. It also represents the field on which is grown what we need to survive. 

It’s the ultimate yin.

The Classic of Changes, Qian heaven trigram and the Kun earth trigram gave birth to six offspring.

The three male offspring, Zhen thunder, Kan water, Gen mountain.

The three female offspring, Sun wind, Li flame, Dui lake.

True Transmission of Medical Principals, Of Qian and Kun’s six children, the youngest and the oldest are all imbued with biases of Qian and Kun. Only the middle male and female have received their natural disposition from Qian and Kun. People receive the cardinal qi of their original nature from heaven and earth and thereby come to life. Kan and Li therefore act as the root of establishing life.

Kan water and Li flame are able to act as the root of establishing life.

Chen Shiduo calls mingmen a type of prenatal fire. He is referring to the Qian heaven and Li flame types of yang qi.

This fire is immaterial and dwells in water.

The yang line in the trigram Kan water is yang. Yang dwells in water.

On earth, material fire is being quenched by water. Immaterial water, on the contrary, has the ability to generate fire. Therefore, when we say that “fire is being quenched by water” we refer to material water; when we say that “fire is being fueled by water” we refer to immaterial water. And it so happens that immaterial fire can generate immaterial water, meaning that fire is not contained within fire, but within water.

Tai yang is all the yang in the body. Wang Bing, All yang, where magnificent, is tai yang.

Shao yin represents the fire and water of the body and it contains the organs heart and kidneys.

Plain Questions, Heart is the root of life and the seat of shen. It manifests its prosperity on the face, because of its function of keeping blood vessels full. It is located above the diaphragm and is considered yang. Its element is fire. Therefore it is called the tai yang of the yang. In the universal pattern of flow it corresponds to summer.

The kidneys are the storage place of the true yang and the root of all storage in the body. They store jing essence qi of the five zang and six fu organs. They manifest their abundance and health in the head hair. Its effect is to fill the bones and marrow. Being a water element in the lower trunk, the kidneys are considered yin. They are called the shao yin and correspond to the winter energy.

The heart is the element fire and it corresponds to summer.

The kidneys are the element water and it corresponds to winter.

Mingmen fire, is yang fire-a yang that is embedded within two yin. In the microcosmic context of the human body, mingmen is generated first, and only then the heart. Does this fact not illuminate the importance of mingmen? When the heart procures the power of mingmen, consciousness is in command, and we can relate to the outside world. When the liver procures the power of mingmen, it can plan. When the gallbladder procures the power of mingmen, it can make decisions. When the stomach procures the power of mingmen, it can absorb food. When the spleen procures the power of mingmen, it can transport. When the lung procures the power of mingmen, it can fulfill its administrating and regulating functions. When the large intestine procures the power of mingmen, it can pass on the waste. When the small intestine procures the power of mingmen, it can disseminate. When the kidney procures the power of mingmen, it can bring about physical vigor. When the triple burner procures the power of mingmen, it can keep the body’s water pathways unobstructed. When the bladder procures the power of mingmen, it can store. In other words, there is not a single one among the organ networks that does not rely on the mingmen fire for warmth and nourishment.

Mingmen is synonymous with the mandate of each organ. This is illustrated in Chapter 8 of the Yellow Emperor’s Classic.

The heart holds the office of the sovereign and ruler.

The lungs hold the office of chancellor and mentor.

The liver holds the office of general.

The gall bladder holds the office of centered righteousness.

The pericardium holds the office of minister and envoy.

The spleen and stomach holds the office of the granaries.

The large intestine holds the office of transmitting along the way.

The small intestine holds the office of receiving sacrifices.

The kidneys holds the office of making strong.

The san jiao holds the office of clearing the canals.

The urinary bladder holds the office of regional rectifier. 

This type of fire should be tonified rather than purged. This is done by tonifying fire within water, and especially by tonifying water within fire. In this fashion, fire can be fueled by water and at the same time be stored within water. If we just use cold or cool herbs to attack the mingmen fire, it will become weak, and how could it then nourish the twelve channel networks? This is what is really meant by the Neijing statement ‘when the master is dim, the twelve officials are all in a state of crisis.’ Doesn’t that strongly emphasize the importance of mingmen?

Chapter 8 Yellow Emperor’s Classic

However, the decision making is the kings job. If the spirit is clear, all functions of the other organs will be normal. It is in this way that one’s life is preserved and perpetuated, just as a country becomes prosperous when all its people are fulfilling their duties.

If the spirit is disturbed and unclear, the other organs will not function properly. This creates damage. The pathways and roads along which the qi flows will become blocked and health will suffer. The citizens of the kingdom will also suffer.

Mingmen is the prenatal yang of heaven, the postnatal fire, the yang spirit brightness, the spirit of each individual organ. Mingmen is all the yang qi in the body. It is the heart fire and kidney water interacting that produce the rising and falling, entering and exiting of the body’s transformation of qi.

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

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.