Course: Diagnostics II Date: 12/11/07

Six Channel, Four Level, San Jiao Theories

Six Channel Theory

Cold Injured Diseases

Who extrapolated the Six Channel Theory?

Zhang Zhongzing

What is the order of a disease’s progress per the Six Channel Theory?

1. Taiyang Syndromes ( 2 subcategories of this)

a. Taiyang Zhong Feng Syndrome
b. Taiyang Shang Han Syndrome
2. Yangming Syndrome (2 subcategories of this)
a. Yangming Jing Syndrome
b. Yangming Fu Syndrome
3. Shaoyang Syndrome
4. Taiyin Syndrome
5. Shaoyin Syndrome
a. Shaoyin Cold Syndrome
b. Shaoyin Heat Syndrome
6. Jueyin Syndrome

Taiyang Syndromes
First level of a disease - external. Beginning of a problem.
2 subcategories

Taiyang Zong Feng Syn. Mild fever and chills

Aversion to wind
Wind attack, similar to ,Easily/frequently perspires
ext. def (which is also a Headache
wind heat thang) Tongue: pale or normal, thin white coating
Pulse: Floating, slowed down
Taiyang Shang Han Syn Chills greater than fever
,No sweating
Wind/cold type syn. Headache
Similar to ext.excess Neck and body pain
Tongue: normal body, thin white coat
Pulse: floating and tight

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Yangming Syndromes
2nd stage of a disease progress, already in the interior. Organ related. Yangming is rich in Qi and Blood,
so once a disease gets here it has conquered great resources.
2 subcategories.

Jing or Channel No aversion to cold

Syndrome ,No constipation
Red face
4 greats: Great fever
Great sweating
Great thirst
Great pulse
Tongue: red body with yellow and dry coating
Pulse: rapid
Fu or Organ Constant fever, more pronounced in the afternoon
Syndrome Abdominal distention and pain
Constipation
Tongue: red body with prickles, coating is dry, thick, yellow.
Pulse: deep, excessive

Shaoyang Syndrome
3rd stage of a disease. Very specific: Half interior and half exterior.

Shaoyang Syndrome ,Chills and fever alternate

Bitter taste in the mouth (gb and sj involved, many heat signs)
Dry throat
Dizziness and blurred vision
Poor appetite, nausea, vomiting
Pain in the hypochondriac region
Restlessness and irritability
Tongue: red on sides, white or thin yellow coating
Pulse: Wiry

Taiyin or Greater Yin Syndrome

Related to spleen and MJ. Usually interior, deficient, cold, damp.

Taiyin/Greater Yin Syn Abdominal fullness or pain

Nausea and vomiting
Diarrhea
No thirst
Tongue: pale w/white greasy coating
Pulse: deep, weak, slow

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Shaoyin Syndromes
Usually interior, cold, deficient manifestations.
Shaoyin is kidney and heart in zangfu…so is this.
2 subcategories

Shao Yin Cold Syn. No fever

Aversion to cold, cold limbs (greater than taiyin syndrome)
Tendency to sleep, listlessness
Diarrhea with undigested food bits (cold fx spleen/kidney)
Clear urine with increased volume (kidney yang)
Tongue: pale with white coating
Pulse: deep, minute – or – deep, slow weak if kidney yang deficiency
Looks like Kidney Yang Def. Cold symptoms more severe than Taiyin level, more focused at
lower levels.

Shao Yin Heat Syn Restlessness

Irritability
Insomnia
Dry mouth and throat
Scanty deep-yellow urine
Tongue: red body, red tip, little coating
Pulse: thin + rapid
Looks like Heart/Kidney Disharmony (Ht + Kd Yin Xu) pattern.

Jueyin or Terminal Yin Syndrome

Last stage – problem complicated and severe. Correlates to liver/pericardium in zangfu.

Jueyin Syndrome Upper heat, lower cold

Thirst
Ascending of Qi to chest
Burning sensation in chest
Hungry, no desire to eat
Vomiting of ascarides after meals
Tongue: red/pale
Pulse: varied. Slippery, deep, weak, hidden, wiry.
Different organs involved, many possible pulses

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 Theory of Four Levels
Warm Injured Diseases

Who postulated it?

Ye Tianshi

What are the Four Levels?

A progression of a disease from onset to end. The levels are:

1. Wei (Defensive level)

2. Qi (2nd level)
3. Ying (Nutritive level)
4. Xue (Blood level)

What are the characteristics of a disease that can be classified by the Four Levels theory?

Refers to epidemic diseases.

1. Fast onset
2. Fever, likely very high fever, early in the disease
3. Heat signs/symptoms are the primary manifestation
4. Body fluids and yin easily damaged due to high fever

Disease pattern Manifestations

Wei (Defensive) Fever
,Chills and slight aversion to cold
Slight or absent sweating
Sneezing
Cough
Nasal congestion
Sinus drainage
Sore throat
Headache
Slightly increased thirst
Tongue: red tip, white coating (might be slightly yellow)
Pulse: floating, rapid
Pathology: Stagnation of the protective Qi due to the struggle between the protective Qi and Warm-
Heat Pathogens, leading to the failure of the lung in dispersing the protective Qi to the surface, nose,
throat.
Looks like common cold/external wind-heat attack. Characterized by defensive functions of the body
fighting pathogens.

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Disease pattern Manifestations
Qi ,Four Greats
Vigorous fever
Pay attention to this one! Profuse Sweating
Thirst (pref for cold beverages)
Pulse floating and slippery
Aversion to heat
Urine: scanty, yellow, possibly dark
Tongue: dry yellow coating
Pulse: floating or slippery
Pathology: Heat from excess and injury to fluids, which is a consequence of the severe struggle
between antipathogenic Qi and Warm-Heat pathogen.
Getting deeper into interior. Compare to Yangming in Six Channel Theory
Lung, Stomach, Large Intestine mostly involved in this level.

Disease pattern Manifestations

Ying (Nutritive) Pattern
PC/Ht/Shen signs in yellow…Æ
Pathology: Inward progression of protective or Qi level patterns. Blazing heat damages Yin and
disturbs the Heart Shen.
Fever gets worse at night
Insomnia
Irritability
Restlessness
Occasional delirium or muddled consciousness
Thirst with little desire to drink
,Maculopapular manifestations on skin
Tongue: deeper red than wei or qi patterns
Pulse: thin and rapid

Disease pattern Manifestations

Xue (Blood) Pattern Fever
Restlessness or delirium
Muddled consciousness or coma
Loss of blood
Maculopapular manifestations on entire body
Tongue: very deep red, crimson
Pulse: thin and fast –or- choppy
Pathology: Warm-heat pathogen penetrates deeply, disturbs and exhausts the blood
Look for the blood signs for this pattern. Heart, liver, kidney are organs involved in this pattern.

Excess Heat in Blood Level

Organs involved: heart and liver
♦ Fever
♦ Irritation, mania
♦ Purplish or dark macula
Many skin problems are due to heat inside the blood.
♦ Blood in stools or urine
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 ♦ Tremors to spasms/rigidity in the mouth, neck or even opisthotonos (severe rigidity of the
back muscles…sometimes severe enough that the head will touch the heels…damn!)
Too much heat causes wind, then spasms.
♦ Tongue: deep red or scarlet or purplish
♦ Pulse: wiry and fast

Deficient Heat in the Blood Level (yin defic)

Organs involved: liver and kidney
♦ Constant lower fever
♦ Five palm heat
♦ Dry mouth and throat
♦ Fatigue
♦ Emaciation
♦ Mild tremors in four extremeties
♦ Tongue: red/purple with less coating
♦ Pulse: thin and fast .

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 San Jiao Differentiation
Warm Injured Diseases

Upper jiao
Location: above the diaphragm.
Organs in UJ: lung, heart, pericardium
Middle jiao
Location: between upper and lower jiao.
Organs in MJ: stomach, spleen, large intestine and small intestine
Lower jiao
Location: below the umbilicus.
Organs in LJ: liver, kidney, bladder, uterus

Upper Jiao Pattern

Lung can be Wei and Qi, PC cn be ____...missed that.

Lung Pattern 1
Definition:
Disorder of ascending and descending of Lung Qi due to external pathogen attacking.
Looks like wind-cold invasion when compared to the Eight Principles. Comparing to 4
levels, compares to Wei Level. Lung relates to both Wei and Qi.

Manifestations:
♦ Fever
♦ Slight aversion to wind-cold
♦ Headache
♦ Slightly thirsty
♦ Cough
♦ Tongue: thin white coating
♦ Pulse: floating and fast

Treatment: Ma Huang Tang, LU 7, cupping

Lung Pattern 2
Definition:
Blockage of Lung Qi due to accumulation of Lung Heat.
More heat signs here. Compare to Qi level in the Four Level Theory.

Manifestations:
♦ Fever
♦ Sweating
♦ Thirsty
♦ Dyspnea
♦ Tongue: red with yellow coating
♦ Pulse: fast

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 Treatment: clear the heat. Can use Ma xing shi gan tang formula. LU 5, LI 11 and
Ren 17. ST 40 for d/h.

Pericardium Pattern
Definition:
Blockage of Pericardium by invasion of heat.
Pericardium/Heart related to Shen, see those signs below.
Compare this to the Jing level in the Four Levels.

Manifestations:
♦ Muddled consciousness
♦ Delirium
♦ Retraction of the tongue
♦ Cold extremeties
♦ Fever
♦ Tongue: deep red
♦ Pulse: thin and rapid

Treatment: use Shen points and clear heat points. Ht 7, PC 8. Du 24. Ren 26.

Middle Jiao Patterns

Relates to Qi level

Stomach patterns
Definition:
Excessive Heat in the Stomach
Compare to Qi level of Four Levels

Manifestations:
♦ Fever w/o aversion to cold
♦ Red face and eyes
♦ Sweating
♦ Thirsty
♦ Rough breathing
♦ Tongue: Yellow/dry coating
♦ Pulse: flooding, large.

Treatment: ST 44

Large Intestine Pattern

Definition:
Heat accumulation in LI

Manifestations:
♦ Fever reaching height in afternoon
♦ Constipation
♦ Concentrated urine
♦ Tongue: yellow, black, dry coating
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 ♦ Pulse: deep, strong

Spleen Pattern
Definition:
Disturbance of Spleen by damp heat

Manifestations:
♦ Contained fever which still exists even after sweating
Cannot disperse due to sticky/damp nature of this damp heat condition.
♦ Distention in chest and epigastrium
♦ Nausea
♦ Tongue: heavy body, greasy coating
♦ Pulse: soggy

Lower Jiao Patterns

Relates to the Ying and/or Xue levels. But liver fire can be only Qi level as well….

Kidney Pattern
Definition:
Consumption of Yin by heat
I.e., Yin deficiency causing heat. Usually this is hypertension (kidney or liver yin def
causing yang rising)

Manifestations:
♦ Fever
♦ Malar flush
♦ Relatively warm palms/soles
♦ Dry mouth and throat
♦ Fatigue
♦ Pulse: deficient

Formula: Liu wei di huang tang.

KD 3, KD 6. Kidney 3 is a creek, Kidney 6 is an ocean of water.

Liver Pattern
Definition:
Malnutrition of Liver and inner wind due to Kidney Yin Xu
Warm disease hurts the Yin. Kidney and Liver have the same source, so kidney
deficiency can directly cause this problem.

Manifestations:
♦ Convulsions and trembling
♦ Listlessness
♦ Palpitation
♦ Tongue: dry, atrophied, deep red tongue
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 ♦ Pulse: weak

Gou Qi Zi wd be a good herb. LV 3, UB 18.

What is the relationship between the San Jiao and Four Level theories? Both try to understand and
explain the progress of a Warm Injure Disease. Four Levels describe progression from superficial to
blood level. San Jiao goes from upper level to lower level though the jiaos.

Final Exam Review:

Before exam, have a good breakfast!

75 questions including 70 MC and 5 case discussions. Comprehensive.

Eight principles
Zang Fu differentiations including single zang fu and combinations
Six Channel
4 level
3 Jiao

Review all cases discussed!!!

Turn in reading log and the zangfu charts.

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