Author: Wang Hailong
Institution: Yixian Traditional Chinese Medicine Hospital
The differentiation of diseases based on the Six Meridians is a complete theoretical system, thus all diseases in the world can be diagnosed and treated using the Six Meridians. The Qing Dynasty physician Ke Yunbo also stated: “Zhongjing’s Six Meridians serve as the legal basis for all diseases, not solely for the category of cold damage; both cold damage and miscellaneous diseases follow the same principles, all governed by the Six Meridians.” Yu Genchu said: “Using the Six Meridians to manage all diseases is the definitive key principle.”
Phlegm-dampness is a pathological product resulting from abnormal metabolism of body fluids, originating from a single source. Its occurrence is often due to insufficient righteous qi and weakened bodily functions. “For phlegm-dampness, one should use warming herbs to harmonize it,” is the treatment principle and major method proposed by the medical sage Zhang Zhongjing. By using warming herbs, it can be inferred that the condition belongs to the category of Yin and Cold syndromes; therefore, the simple phlegm-dampness syndrome falls under the category of Taiyin disease.
When phlegm-dampness accumulates for a long time, it can easily become stagnant and transform into heat, leading to phlegm-heat or damp-heat syndromes. At this point, simply using “warming herbs to harmonize” will exacerbate the symptoms of stagnant heat. Thus, while transforming (phlegm) dampness, it is necessary to also clear heat. According to the principle of clearing heat, it can be inferred that the Six Meridians correspond to Yangming; therefore, when phlegm-dampness becomes stagnant and transforms into heat, the differentiation of the Six Meridians should be considered as a combined Taiyin and Yangming disease (damp-heat syndrome).
Below, we will examine a specific case to discuss the treatment of damp-heat syndrome according to the Six Meridians:
Patient: Zhang, Female, 47 years old, Initial Consultation: 2022-01-15
The patient developed nasal congestion and runny nose with a sensation of cold after exposure to cold weather 10 days ago. She self-medicated with “Cold and Heat Relief Granules” but saw no significant improvement. One day later, she developed a fever, with a maximum temperature of 39.5°C, accompanied by cough and shortness of breath, with occasional small amounts of phlegm. She visited the county hospital, underwent epidemiological investigation and nucleic acid testing, and was admitted for “pulmonary infection.” During her 8-day hospitalization, she experienced multiple episodes of recurrent fever. After 8 days, her condition improved, cough lessened, and she was discharged. The day after discharge, she developed a fever again and returned for consultation.
Current Symptoms: Chills and fever, temperature 38.6°C, sensation of heaviness and pain in the body, cough, white sticky phlegm in small amounts, difficult to expectorate, accompanied by chest tightness and shortness of breath, discomfort in the throat. Coughing is more pronounced at night after exposure to cold. No nasal congestion or runny nose, slight sweating from the head, thirst with sticky mouth but not bitter, no desire to drink. Poor appetite, sticky and unsatisfactory stools, slightly reduced and pale yellow urine, tongue pale with a thick white greasy coating slightly yellow, pulse deep, slippery, and slightly rapid.
Prescription:
Stir-fried Bitter Apricot Kernel 10g, White Cardamom Seed 10g, Raw Coix Seed 30g, Talcum 24g
Ginger 15g, Pinellia 10g, Bamboo Leaf 10g, White Tongcao 10g
Lingzhi Seed 10g, Honey-fried Licorice 6g, Honey-fried Loquat Leaf 10g
Granule preparation: 5 doses (total of 10 bags), instructing the patient to take one bag each time, dissolved in hot water. Take three times a day.
Follow-up Consultation: 2022-01-18
The patient reported that after taking the medicine on the night of the initial consultation, urination became smooth, slight sweating occurred, and her temperature returned to normal. For the past two days, there have been no further episodes of fever or chills, cough has significantly reduced, stools are no longer sticky, and she has 1-2 bowel movements daily. Appetite has improved, no body pain, and she feels light. Tongue is pale with a thin white moist coating, pulse is deep and slightly slippery. The original prescription was refilled for 5 more doses for consolidation treatment.
Analysis: The initial onset of the disease was due to external cold exposure, and the patient did not promptly interrupt the disease process, leading to 8 days of “antibiotic” treatment during hospitalization. The condition was still not controlled. Currently: chills and fever, temperature 38.6°C, heaviness and pain in the body, which seems to fit the characteristics of an exterior syndrome, but overall, when combined with tongue and pulse, it does not indicate an exterior syndrome. The tongue is pale with a slightly greasy white coating, pulse is deep, slippery, and slightly rapid, thirst with sticky mouth but not bitter, slightly reduced and pale yellow urine, sticky and unsatisfactory stools all suggest the presence of damp-heat internally, damp-heat obstructing the qi mechanism, leading to chest tightness and shortness of breath; dampness obstructing the qi mechanism results in pain due to obstruction, leading to symptoms like headache and heaviness in the body.
As Xue Shengbai stated in the “Damp-Heat Disease Chapter” [1]: Damp-heat syndrome begins with chills, followed by heat without chills, sweating, chest fullness, white tongue, thirst without desire to drink. Wu Jutong also mentioned in the “Differentiation of Warm Diseases” in the Upper Jiao section [43]: Headache, chills, body heaviness and pain, white tongue without thirst, pulse wiry and thin yet moist, pale yellow complexion, chest tightness without appetite, afternoon fever… Therefore, the differentiation of the Six Meridians in this case should be considered as a combined Taiyin and Yangming disease (damp-heat syndrome).
Since the disease is not in the exterior, sweating methods cannot be used; if sweated, it may lead to confusion and deafness, and in severe cases, closed eyes and unwillingness to speak. The method should be to transform dampness and clear heat, promote the smooth flow of qi, selecting the San Ren Decoction with modifications to transform dampness and clear heat (promoting upward, smoothing the middle, and draining downward), and referring to the “Damp-Heat Disease Chapter” [18] for damp-heat syndrome, where cough is restless day and night, even causing difficulty in breathing and inability to sleep… it is advisable to use Lingzhi, Loquat Leaf, and Liu Yi San, etc. After taking the medicine, urination became smooth, slight sweating occurred, heat subsided, and cough reduced, leading to the resolution of various sufferings.
Although Qing Dynasty physicians divided warm diseases into two major categories, one being purely warm-heat diseases, where Ye proposed differentiation of defensive qi, nutritive qi, and blood; the other being damp-heat (warm) diseases, where Wu Jutong proposed the principle of treating from the Sanjiao perspective. Regardless of whether it is warm-heat disease or damp (heat) warm disease, the location of the disease cannot be separated from the exterior, interior, or half; its nature is either Yin or Yang, thus it can be treated using the differentiation of the Six Meridians. As stated in the “Medical Classic of the Golden Mirror”: The myriad changes are not beyond Yin and Yang, exterior and interior.
Recommendation: If the exterior is not resolved, the disease is difficult to resolve.
Recommendation: Read “Shang Han Lun”, learn from Zhongjing, use classical formulas, and differentiate the Six Meridians.