Respect Life, Uphold Virtue“Diagnosis and Treatment” – Differentiation of Exogenous Diseases According to the Six Meridians
In Traditional Chinese Medicine (TCM), the differentiation methods include the Eight Principles, Six Meridians, Wei-Qi-Ying-Blood, and San Jiao differentiation. The first three methods are primarily used for diagnosing exogenous diseases, while meridian differentiation is more commonly applied in acupuncture and massage. Exogenous diseases are illnesses caused by the invasion of external pathogens. Due to the different properties of these pathogens, the seasonal onset, and the pathways through which they invade the body, the patterns of disease occurrence, transformation, and clinical manifestations vary. In the Han Dynasty, Zhang Zhongjing’s “Treatise on Febrile Diseases” posited that Yin pathogens (such as wind and cold) often enter through the skin and meridians (Taiyang Meridian) into Yangming and Shaoyang, leading to symptoms of Yang deficiency and internal cold in the three Yin (Taiyin, Shaoyin, Jueyin). For thousands of years, the Six Meridian differentiation has effectively guided the diagnosis and treatment in TCM. This method is not limited to exogenous diseases but also provides guidance for tumors and internal injuries. The Wei-Qi-Ying-Blood differentiation was established by Ye Tianshi in the Qing Dynasty in his work “On Exogenous Warm Diseases”. It categorizes the symptoms reflected at different pathological stages of exogenous warm diseases into four types: Wei-level, Qi-level, Ying-level, and Blood-level, to illustrate the depth of the disease, severity, and transformation patterns, guiding clinical treatment. San Jiao differentiation was created by Wu Jutong in his “Differentiation of Warm Diseases”. This method further clarifies the pathological changes of the organs associated with the San Jiao during the course of warm diseases, serving as a method for differentiation and classification. Despite continuous scientific advancements, the fierce prevalence and widespread transmission of epidemics still pose challenges, often leading to situations where the onset is unpredictable and the manifestations are elusive. In cases where the pathogen is unknown and treatment is ineffective, employing TCM differentiation methods can help identify treatment principles and methods, mobilize the body’s resistance, inhibit pathogen development, eliminate toxins, and restore internal environmental balance, thus playing a positive role in “supporting the righteous and expelling the evil”. In our study of TCM diagnosis and treatment, we learn the differentiation methods of Six Meridians, Wei-Qi-Ying-Blood, and San Jiao for exogenous diseases. One goal is to gain a preliminary understanding of exogenous diseases, while also laying a foundation for further study of “Treatise on Febrile Diseases” and “Warm Disease Theory”. Today, we will first study Zhang Zhongjing’s Six Meridian differentiation.
“
Six Meridians and Six Meridian Diseases
”The Six Meridians refer to the abbreviated terms for the Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin meridians. When studying meridians, we systematically learn the twelve meridians, including the hand and foot Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin meridians, each associated with an organ. In the Six Meridian differentiation for febrile diseases, we need to remember a rule – the Six Meridian differentiation “transmits from foot to foot, not from hand to hand,” meaning the transformation of Six Meridian diseases only transmits through the foot meridians, not the hand meridians. The disease of the Taiyang involves the foot Taiyang Bladder Meridian, the bladder organ, and the body surface Wei and Ying. The main symptoms are the invasion of Yang Qi by wind-cold pathogens, where Yang Qi begins to resist the evil, representing Yang syndrome, exterior syndrome, and the initial stage of Yang syndrome. Yangming disease involves the foot Yangming Stomach Meridian and the gastrointestinal organs, where the evil has entered and transformed into heat. Therefore, the main symptoms of Yangming disease are the intense Yang heat evil, leading to high fever and fullness, representing interior syndrome and extreme Yang syndrome. Shaoyang disease involves the foot Shaoyang Gallbladder Meridian, the gallbladder organ, and the San Jiao, where the evil is cold in the meridian and transforms into heat in the organ. As the symptoms develop, the evil can either enter the Yin and transform into Yin syndrome or enter Yangming and further develop into extreme Yang syndrome. Taiyin disease involves the foot Taiyin Spleen Meridian and the spleen organ, with the main symptoms being the deficiency-cold syndrome of the Taiyin spleen, representing Yin syndrome and interior syndrome, indicating the initial stage of Yin syndrome. Shaoyin disease involves the hand and foot Shaoyin Heart and Kidney meridians. Since the heart is the master of the five organs and the kidney is the root of Yuan Yin and Yuan Yang, when the disease affects Shaoyin, it involves the fundamental Yang Qi of the body, thus representing Yin syndrome and interior syndrome, indicating a critical stage of Yin syndrome. Jueyin disease involves the foot Jueyin Liver Meridian, the liver, and the pericardium. If the evil transmits from Shaoyin, meaning that on the basis of the decline of true Yang of the heart and kidney, the cold evil further invades Jueyin, it represents Yin syndrome and interior syndrome, indicating the terminal stage of Yin syndrome, ultimately leading to the inevitable appearance of Yin excess and Yang deficiency. However, if the external cold directly invades the Jueyin meridian or organ, it represents a treatable Jueyin cold syndrome. The transmission of Six Meridian diseases: when the evil enters from one meridian to another, it is called transmission. The original text of “Treatise on Febrile Diseases” indicates the transmission situation as follows:
“
Differentiation of Six Meridian Diseases
” 1. Taiyang Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “The disease of Taiyang is characterized by a floating pulse, stiffness and pain in the head and neck, and aversion to cold.” “In Taiyang disease, if there is fever and sweating, aversion to wind, and a slow pulse, it is called wind stroke.” “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, nausea, and a tight pulse, it is called cold damage.”
In summary, any occurrence of fever, aversion to cold, headache, stiffness in the neck, and floating pulse is called Taiyang disease. Taiyang disease is divided into meridian syndrome and organ syndrome. Meridian syndrome is the disease caused by the evil in the muscle surface; organ syndrome is the disease caused by the Taiyang evil not resolving and transmitting to the bladder.
Pathological Mechanism
1. Taiyang Meridian Syndrome: divided into three types
(1) When the Wei and Ying are not harmonized, and the Wei fails to secure the exterior, leading to a loose muscle surface, it is called wind stroke (not a cerebral hemorrhage).
(2) When the Wei Yang is obstructed, and the Wei and Ying are stagnant and not flowing, leading to a dense muscle surface, it is called cold damage.
(3) When the external warm evil invades, damaging the fluids and causing internal heat, it is called warm disease.
Wind Stroke: fever, sweating, aversion to wind, and a slow pulse (exterior deficiency syndrome).
Cold Damage: fever, no sweating, aversion to cold, tight pulse, and body pain (exterior excess syndrome).
Warm Disease: fever, thirst, and no aversion to cold (interior heat syndrome).
Wind stroke, cold damage, and warm disease all belong to exterior syndromes, thus all have “fever, headache, and floating pulse,” but their distinguishing points are:
Wind Stroke: floating and slow pulse, sweating, and thin white tongue coating.
Cold Damage: floating and tight pulse, no sweating, and panting, with thin white tongue coating.
Warm Disease: floating and rapid pulse, fever, slight thirst, slight aversion to cold, and red tongue tip.
2. Taiyang Organ Syndrome: divided into two types
(1) When the evil enters the bladder, affecting the bladder’s Qi transformation function, leading to water retention and difficulty urinating, it is called water retention syndrome.
(2) When heat accumulates in the lower jiao, causing blood stasis, leading to fullness and urgency, and self-urination, it is called blood retention syndrome.
Water Retention Syndrome: fever, aversion to wind, difficulty urinating, thirst, vomiting when drinking, and rapid floating pulse.
Blood Retention Syndrome: urgent fullness in the lower abdomen or fullness like madness, self-urination, yellowing of the body, and deep and tight pulse.
Distinguishing point: water retention is due to the evil entering the bladder Qi level, thus only difficulty urinating without mental symptoms. Blood retention is due to the evil entering the bladder blood level, thus only mental symptoms without difficulty urinating.
Treatment Principles and Formulas
1. Treatment of Taiyang Meridian Syndrome
(1) Wind Stroke: being a Taiyang exterior deficiency syndrome, it is characterized by strong Wei and weak Ying, and the treatment for wind stroke only requires harmonizing Wei and Ying, inducing sweating to resolve the disease, which can be treated with Gui Zhi Tang (Cinnamon Twig Decoction).
(2) Cold Damage: being a Taiyang exterior excess syndrome, the muscle surface is dense and does not allow sweating; thus, opening the exterior and inducing sweating is necessary to expel the evil, which can be treated with Ma Huang Tang (Ephedra Decoction).
(3) Warm Disease: being internal heat damaging the fluids, “Treatise on Febrile Diseases” does not provide a specific formula for treatment. The causes of internal heat are numerous; any damage to the fluids is often due to excessive Yang generating fire and consuming Yin, coupled with insufficient cooling nature of Yin blood, often starting from the liver and stomach. Therefore, it should not be treated externally; if treated externally, it would be seeking distant remedies for nearby issues. The treatment should focus on replenishing the essence to compensate for what is consumed and cooling the blood to clear heat. If the exterior symptoms are resolved and the internal consumption is replenished, the righteous Qi will not be lost; and the path of the evil should be sought, assisted by attacking and defeating it, achieving internal transformation. The path for the evil to leave should be opened with cold and cool methods to relieve diarrhea, and if relieved, the middle jiao will be lightly cold, allowing the remaining Yang to return through the meridians, thus resolving the heat in the middle jiao, achieving the effect of borrowing arrows with a straw boat, cleverly bringing peace to the world.
2. Treatment of Taiyang Organ Syndrome
(1) Water Retention: due to the bladder Qi transformation not functioning, leading to water retention, Wu Ling San (Five-Ingredient Powder with Poria) has the function of transforming Qi and promoting urination, thus it is the main formula for water retention syndrome.
(2) Blood Retention: due to blood stasis, heat accumulates in the lower jiao, it should be treated by attacking stasis and promoting blood flow, and depending on the severity, Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi) can be selected.
3. Treatment of Taiyang Disease with Complications
(1) Taiyang wind stroke with Qi counterflow causing panting can be treated with Gui Zhi Tang plus Hou Po and Xing Ren.
(2) Taiyang disease with stiffness in the neck and back (i.e., rigidity and discomfort), with sweating indicating exterior deficiency, and without sweating indicating exterior excess, for deficiency use Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction with Kudzu), for excess use Ge Gen Tang (Kudzu Decoction).
(3) Taiyang disease with internal heat stagnation (internal heat, irritability, thirst), with sweating indicating exterior deficiency, and without sweating indicating exterior excess, for deficiency use Gui Zhi Er Yao Bei Yi Tang (Cinnamon Twig Decoction with Two Doses of Ephedra), for excess use Da Qing Long Tang (Major Blue Dragon Decoction).
(4) Taiyang disease with internal water retention (dry vomiting, soft phlegm), if the exterior is solid without sweating, and there is water retention in the heart area, with symptoms of fever, aversion to cold, sweating, headache, fullness and pain in the heart area and ribs, dry vomiting, and shortness of breath, after the exterior symptoms are resolved, use Shi Zao Tang (Ten Jujube Decoction) to attack.
(5) Taiyang disease with internal deficiency, if both Yin and Yang are deficient, leading to palpitations and irritability, the treatment should be Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). If there is deficiency of Qi and blood, leading to palpitations with a tight pulse, use Zhi Gan Cao Tang (Honey-Fried Licorice Decoction).
2. Yangming Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “Yangming disease is characterized by fullness in the stomach.”
“After three days of cold damage, the Yangming pulse is large.”
“What are the external symptoms of Yangming disease? The answer is: fever, sweating, and aversion to heat.”
“If cold damage leads to vomiting or diarrhea and does not resolve, with no bowel movement for five to six days, and up to ten days, with tidal fever in the afternoon, and no aversion to cold, but rather aversion to heat, if severe, the patient may not recognize people, feeling anxious and restless, with a wiry pulse, the clear pulse indicates death, while the weak pulse indicates only fever and delirium, treated with Da Cheng Qi Tang (Major Order the Qi Decoction), if one dose purges, then stop further doses.”
“In Yangming disease, if there is excessive sweating and panting, do not use Zhu Ling Tang (Polyporus Decoction), as excessive sweating will dry the stomach, and Zhu Ling Tang will further promote urination.”
In summary, any occurrence of body heat, sweating, aversion to heat, and a large pulse is called Yangming disease. Yangming disease is divided into meridian syndrome and organ syndrome; Yangming meridian syndrome is the disease caused by the evil in the stomach; Yangming organ syndrome is the disease caused by the evil in the large intestine.
Pathological Mechanism
1. Yangming Meridian Syndrome: external evil enters and transforms into heat, combining with dryness in the stomach, leading to the consumption of fluids, resulting in body heat, sweating, thirst, and a large pulse.
2. Yangming Organ Syndrome: external evil enters and transforms into heat, combining with the dryness and heat of the large intestine, leading to the consumption of fluids, forming a solid mass, causing tidal fever, delirium, constipation, abdominal fullness and pain, and a deep and solid pulse.
Treatment Principles and Formulas
When there is high fever and scattered symptoms, use cold and cool herbs to clear heat; thus, Yangming meridian syndrome primarily uses clearing methods, selecting bitter and cold formulas to clear interior heat; if heat and solid mass are present in the large intestine, use purgative methods to quickly clear the heat and preserve Yin, thus Yangming organ syndrome primarily uses purgative methods, selecting bitter and cold purgative formulas.
1. Treatment of Yangming Meridian Syndrome: Yangming meridian syndrome is caused by interior heat steaming, with both exterior and interior heat, thus treatment should be Shi Gao Tang (Gypsum Decoction).
2. Treatment of Yangming Organ Syndrome: Yangming organ syndrome is characterized by evil heat having formed a solid mass in the large intestine. The goal of treatment is to eliminate dryness and clear interior heat. Due to the varying severity of the disease, there are three formulas for Yangming organ syndrome: Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) is a mild purgative for early-stage solid mass, or when fluids are damaged with dryness as the main symptom; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is for solid mass with fullness as the main symptom; Da Cheng Qi Tang (Major Order the Qi Decoction) is for solid mass with fullness and dryness as the main symptom.
“When there is fullness, it is Yangming; when there is deficiency, it is Taiyin,” is a saying based on practical experience in TCM. Yangming disease can transform into Taiyin disease, indicating a decline in resistance; Taiyin disease can also transform into Yangming disease, indicating an increase in resistance and a favorable prognosis.
3. Shaoyang Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “Shaoyang disease is characterized by bitter mouth, dry throat, and dizziness.”
“After five or six days of cold damage, wind stroke, alternating chills and fever, fullness in the chest and ribs, disinterest in food, irritability, and nausea, or fullness in the chest with nausea, or thirst, or abdominal pain, or fullness in the ribs, or palpitations, difficulty urinating, or no thirst, slight fever, or cough.”
“If the original Taiyang disease does not resolve and transforms into Shaoyang, there will be hardness and fullness under the ribs, dry vomiting, and inability to eat, alternating chills and fever, and a tight pulse.”
In summary, any occurrence of bitter mouth, dry throat, dizziness, alternating chills and fever, fullness in the chest and ribs, disinterest in food, irritability, nausea, and a wiry and thin pulse is called Shaoyang disease. Shaoyang syndrome is the disease caused by the evil in the liver and gallbladder.
Pathological Mechanism
External evil invades the liver and gallbladder, causing the Qi of the liver and gallbladder to rise, leading to symptoms of bitter mouth, dry throat, and dizziness. The evil in the gallbladder reverses (affecting) the stomach, causing nausea and disinterest in food. If the Qi mechanism is not smooth, it leads to fullness in the chest and ribs. The struggle between the evil and the righteous leads to alternating chills and fever when the righteous Qi is weak and cannot expel the evil.
Treatment Principles and Formulas
1. Treatment of Shaoyang Syndrome
Shaoyang disease does not have the exterior symptoms of Taiyang, and the evil is not in the exterior, thus sweating is not allowed (if sweating occurs, it will damage the fluids and cause the evil to transmit inward); it does not have the interior solid symptoms of Yangming, and the evil is not in the interior, thus purging is not allowed (if purging occurs, it will easily lead to fright due to Yin deficiency fire); there is no solid evil in the chest, thus vomiting is not allowed (if vomiting occurs, it will damage Yang and cause palpitations). Therefore, there are three prohibitions in Shaoyang (prohibition of sweating, purging, and vomiting). The treatment principle for Shaoyang disease should focus on harmonizing the exterior and interior (i.e., using non-sweating methods to relieve heat), however, Shaoyang disease often has both exterior and interior symptoms, so on the basis of harmonization, the methods of Taiyang sweating or Yangming purging can be used as needed.
Since Shaoyang disease is half exterior and half interior, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the main formula for treating Shaoyang disease.
2. Treatment of Shaoyang with Complications
(1) If there is slight fever and aversion to cold, joint pain, fullness in the chest, and slight nausea, it is Shaoyang with Taiyang disease, which can be treated with Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction).
(2) If there is Shaoyang syndrome with abdominal fullness and pain, slight irritability, and difficulty with bowel movements, with dry yellow tongue coating, it is Shaoyang with Yangming interior solid syndrome, treated with Da Chai Hu Tang (Major Bupleurum Decoction).
(3) If there is abdominal cramping and pain with a floating and thin pulse, it is Shaoyang with insufficient interior Qi, first use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) to replenish deficiency, and if the Shaoyang disease does not reduce after taking the medicine, then use Xiao Chai Hu Tang to harmonize.
(4) If there is fullness in the chest and ribs, difficulty urinating, thirst without nausea, but sweating, alternating chills and fever, and irritability, it indicates that the evil heat is trapped in Shaoyang, and water retention is not transformed, thus Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) should be used to harmonize and promote the fluid.
(5) If there is fullness and anxiety in the chest, difficulty urinating, delirium, and body pain that prevents turning, it indicates that the evil has entered Shaoyang and the righteous Qi is floating, thus Chai Hu Jia Long Gu Mu Li Tang (Bupleurum with Dragon Bone and Oyster Shell Decoction) should be used.
(6) If there is heat (stomach heat) rising, causing vomiting, and cold evil invading the stomach causing abdominal pain, it indicates upper heat and lower cold, treated with Huang Lian Tang (Coptis Decoction) to clear the upper and warm the middle.
4. Taiyin Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “Taiyin disease is characterized by abdominal fullness and vomiting, inability to eat, and frequent diarrhea, with abdominal pain at times; if purged, there will be fullness under the chest.”
In summary, any occurrence of abdominal fullness and vomiting, inability to eat, frequent diarrhea, and weak pulse is called Taiyin disease. It is characterized by spleen deficiency and excessive dampness, with the disease in the spleen meridian.
Pathological Mechanism
Cold dampness obstructs the interior, damaging the spleen Yang, or cold evil directly invades the spleen meridian, damaging the spleen and stomach, which affects the digestion and excretion of food and fluids, leading to abdominal pain at times. Cold dampness invades the stomach, causing vomiting. Stomach Qi stagnation leads to inability to eat. Cold dampness not transformed leads to diarrhea.
Treatment Principles and Formulas
1. Treatment of Taiyin Disease
Taiyin disease is due to interior deficiency cold syndrome (spleen and stomach deficiency cold), thus the treatment principle should focus on warming and tonifying, with emphasis on warming the interior and dispersing cold. If there is a strong exterior symptom, first resolve the exterior; if the interior symptom is urgent, first treat the interior. “Treatise on Febrile Diseases” does not provide a definitive formula for Taiyin, but based on interior deficiency cold syndrome, the main treatment should be warming the interior, thus Li Zhong Wan (Regulate the Middle Pill) is the main formula for Taiyin disease.
2. Treatment of Taiyin Disease with Complications
(1) If there is both diarrhea and abdominal fullness (Taiyin interior deficiency syndrome), along with body pain (Taiyang exterior syndrome), it indicates interior deficiency with exterior symptoms, thus first use Li Zhong Wan to warm the interior, then use Gui Zhi Tang to treat the exterior.
(2) If the exterior symptoms have not resolved, but there is abdominal fullness and pain, use Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction with Increased Peony) (increased dosage of peony) if the exterior has not resolved and there is retained food causing fullness and pain, use Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction with Rhubarb).
5. Shaoyin Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “Shaoyin disease is characterized by a weak pulse, desiring sleep.”
“In Shaoyin disease, aversion to cold, curled body, and cold hands and feet indicate that it is not treatable.”
In summary, Shaoyin disease is the final and most critical stage among the Six Meridians, often presenting with extreme fatigue, a desire to sleep but unable to, resembling a state of coma. Shaoyin disease is characterized by the evil in the heart and kidney, divided into cold transformation and heat transformation.
Pathological Mechanism
Insufficient Yin Qi leads to a weak pulse. Insufficient Yin blood leads to a thin pulse. Weakness and lethargy lead to a desire to sleep. The heart and kidney water and fire are not in harmony, with the evil transforming into cold, leading to symptoms of cold transformation. If the evil transforms into heat, harming Yin and causing Yang to rise, it leads to symptoms of heat transformation.
Treatment Principles and Formulas
The treatment principle for Shaoyin disease focuses on supporting Yang and nourishing Yin. If there is cold transformation, support Yang with warming methods; if there is heat transformation, nourish Yin with cooling methods. For Shaoyin with exterior symptoms, use warming and sweating methods; for solid heat inside, use urgent purging methods to preserve Yin.
1. Cold Transformation Syndrome
This syndrome is more common in the process of Shaoyin disease, with symptoms including: no heat, aversion to cold, weak pulse, desire to sleep, cold hands and feet, diarrhea with clear fluids, inability to eat, thus treatment should focus on reviving Yang and rescuing the reverse, using Si Ni Tang (Frigid Extremities Decoction).
2. Heat Transformation Syndrome
Characterized by Yin deficiency and Yang excess, and Yin deficiency with heat:
① Irritability, inability to lie down, dry mouth and throat, red tongue tip, thin and rapid pulse, indicating Yin deficiency and Yang excess, treated with Huang Lian E Jiao Tang (Coptis and Donkey-hide Gelatin Decoction) to clear heat and nourish Yin.
② Diarrhea, difficulty urinating, cough, vomiting, thirst, irritability, and inability to sleep, treated with Zhu Ling Tang (Polyporus Decoction) to nourish Yin and clear heat, and promote urination.
3. Shaoyin with Taiyang Exterior Excess Syndrome
Fever, aversion to cold, no sweating, cold feet, and a deep pulse indicate that Yang is weak, treated with Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) or Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) (medicinal ingredients as per formula name).
4. Shaoyin with Yangming Interior Excess Syndrome
Dry mouth and throat, abdominal fullness and pain, constipation or diarrhea with clear fluids, treated with Da Cheng Qi Tang (Major Order the Qi Decoction) for urgent purging to preserve Yin.
One of the methods of TCM differentiation. It uses the Six Meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) to classify the depth of diseases and the differentiation of the strength of the evil and the righteous. This was summarized by Zhang Zhongjing in the Han Dynasty based on the characteristics of the transmission of febrile diseases in the “Suwen: Discussion on Heat” and other texts. It is applicable for the differentiation of exogenous diseases.
6. Jueyin Disease Differentiation
Clinical Manifestations
“Treatise on Febrile Diseases” states: “Jueyin disease is characterized by thirst, Qi rising to the heart, heat in the heart, hunger without desire to eat, vomiting of roundworms, and persistent diarrhea.”
“In febrile diseases, the pulse is weak and cold, and after seven or eight days, the skin is cold, and the person is restless without a moment of peace; this is called hidden Jue.”
“In febrile diseases, if there is fever for four days, and Jue for three days, and fever for four days, and Jue is less heat, the disease will recover; if the fever does not resolve from four to seven days, it must be pus and blood in the stool.”
“In febrile diseases, if there is Jue for four days, and heat for three days, and then Jue for five days, the disease is progressing, with more cold and less heat, indicating a retreat of Yang Qi.”
In summary, Jueyin disease can be classified into four categories:
(1) Upper heat and lower cold syndrome: thirst, Qi rising to the heart, heat in the heart indicates upper heat; hunger without desire to eat, vomiting of roundworms, and persistent diarrhea indicate lower cold syndrome.
(2) Jue heat and recovery syndrome: characterized by alternating cold extremities and fever.
(3) Jue reversal syndrome: characterized by cold extremities, with mild cases only at the wrists and ankles, and severe cases extending beyond the elbows and knees.
(4) Persistent diarrhea and vomiting: heat diarrhea indicates damp-heat diarrhea; delirium indicates solid heat diarrhea; clear diarrhea indicates deficiency-cold diarrhea; dry vomiting, vomiting of saliva, and headache indicate cold drink vomiting; vomiting with fever indicates febrile vomiting; and vomiting with fullness indicates solid vomiting.
Pathological Mechanism
When the disease reaches Jueyin, the liver wood is out of balance, and the pericardium is also invaded by the evil, with the fire of the heart rising, and the heart fire cannot descend, leading to heat above and cold below; in the struggle between the righteous and the evil, if Yang prevails and Yin declines, there will be more heat and less cold; if Yin prevails and Yang declines, there will be more cold and less heat, leading to Jue reversal. When the evil sinks, Qi and blood become chaotic, and Yin and Yang cannot connect, leading to various Jue reversal syndromes. The liver and stomach Qi may reverse, or damp-heat may descend, or solid heat may obstruct, or spleen and stomach may be deficient and cold, leading to vomiting and diarrhea.
Treatment Principles and Formulas
Jueyin disease is characterized by interior deficiency with mixed cold and heat symptoms; thus, the treatment methods should include both cold and heat. For upper heat and lower cold, use both cold and warm methods; for Jueyin cold syndrome, use warming methods; for Jueyin heat syndrome, use cooling methods; for more heat and less cold, use warming methods. Less heat and more cold will self-resolve.
1. Treatment of Jueyin Disease
(1) Thirst, Qi rising to the heart, heat in the heart, hunger without desire to eat, vomiting of roundworms, and persistent diarrhea indicate mixed cold and heat syndrome; treatment should include both cold and warm methods, with Wu Mei Wan (Mume Pill) as the main formula for Jueyin disease with mixed cold and heat syndrome, also effective for roundworm Jue and prolonged diarrhea.
(2) Vomiting and persistent diarrhea, with food entering and immediately vomiting, with sour and foul-smelling, indicates upper heat and lower cold, thus treatment should include both cold and warm methods; upper heat should be cleared, lower cold should be warmed, and deficiency should be supplemented, using Gan Jiang Huang Qin Huang Lian Ren Shen Tang (Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction) for treatment.
(3) Persistent diarrhea, cold extremities, sore throat, and blood in the saliva indicate heat syndrome; thus, the heat should be cleared, the cold should be warmed, and the deficiency should be supplemented, using Ma Huang Sheng Ma Tang (Ephedra and Cimicifuga Decoction).
(4) Diarrhea with sticky pus and blood, abdominal pain, urgency, burning sensation in the anus, thirst, and rapid pulse indicate heat diarrhea; thus, use Bai Tou Weng Tang (Pulsatilla Decoction) for treatment, which is highly effective.
(5) Blood deficiency with cold, righteous Qi being obstructed, cold extremities, thin pulse, and impending collapse indicate that Dang Gui Si Ni Tang (Angelica Decoction for Frigid Extremities) is most suitable.
(6) Dry vomiting, vomiting of saliva, and headache indicate cold drink vomiting, treated with Wu Zhu Yu Tang (Evodia Decoction).
2. Treatment of Jueyin Disease with Complications
(1) Vomiting with fever indicates that the disease has transitioned from Yin to Yang; thus, treatment should follow the trend, using Xiao Chai Hu Tang (Minor Bupleurum Decoction) to harmonize.
(2) Persistent diarrhea with delirium indicates solid heat diarrhea; the Jueyin evil heat is external, combining with the heat of the stomach and intestines, and since the dryness has not yet formed a solid mass, it is only appropriate to use Xiao Cheng Qi Tang (Minor Order the Qi Decoction) for gentle purging.
3. Treatment of Jue Reversal Syndrome
(1) Persistent diarrhea with Jue reversal, profuse sweating, slight fever, aversion to cold, and a weak pulse indicate cold Jue syndrome; thus, it is urgent to support Yang and suppress Yin, using Si Ni Tang (Frigid Extremities Decoction).
(2) Dry mouth, dry tongue, and thirst indicate heat Jue syndrome, treated with Shi Gao Tang (Gypsum Decoction).
(3) Cold skin, alternating between calm and agitation, with food causing vomiting, often vomiting roundworms, indicates roundworm Jue, treated with Wu Mei Wan (Mume Pill).
Thank you for your choice and persistence in Traditional Chinese Medicine!
[TCM Diagnosis] Eight Principles Differentiation of Yin and Yang
[TCM Diagnosis] Eight Principles Differentiation of Cold and Heat
