Taiyang Disease PathogenesisTaiyang governs the skin and controls the defensive qi (wei qi), serving as the “barrier of the body”. When external pathogens invade the skin, they obstruct the wei yang, causing the ying yin to stagnate, and the evil heat to flourish at the surface, hence it is termed Taiyang disease.According to the fourth section of the Shang Han Lun, “In the first day of cold damage, the Taiyang is affected,” thus Taiyang disease also signifies the early stage of illness.The fundamental pathogenesis of Taiyang disease is: external invasion of wind-cold, causing the ying and wei to be affected, losing their harmony.The heart governs blood and belongs to the ying, while the organs govern qi and belong to the wei, both residing in the chest.Qing, Ke Yunbo in the Shang Han Lun Yi: Explanation of Taiyang Disease states: “The ying and wei circulate at the surface, originating from the heart and lungs.” Therefore, Taiyang disease is a disease of the ying and wei, and when the ying and wei are affected, it leads to heart and lung diseases.It is believed that “the heart and lungs are the interior of Taiyang.” Thus, although Taiyang disease is caused by the external invasion of wind-cold, it is actually due to the heart’s ying and the lung’s wei being affected, hence the pathogenesis often involves changes in the chest.From the perspective of meridian connections, although the small intestine and bladder belong to Taiyang and often have pathogenesis changes due to meridian evil entering the organs, these are results of the evil of the heart’s ying and the lung’s wei not resolving and transforming.1. Disharmony of Ying and WeiThe ying is yin, and the wei is yang; the yin nature sinks and is still, while the yang nature rises and disperses. Both fill the surface of the body, one rising and one sinking, one moving and one still, maintaining the normal physiological function of solidifying the exterior and opening and closing.The so-called evil affecting the ying and wei, losing their harmony, means that one side of the ying or wei is enhanced by external factors, causing a disordered state of yin and yang rising and falling at the skin surface.Wind injures the wei, and cold injures the ying.Wind is yang in nature, while cold is yin in nature.When the yang (wind) external evil is felt, it naturally enhances the rising and dispersing nature of the yang (wei), leading to a pathogenesis of strong wei and weak ying.When the yin (cold) external evil is felt, it enhances the sinking and still nature of the yin (ying), leading to a pathogenesis of strong ying and weak wei.When both wind and cold are felt, it forms a pathogenesis of both ying and wei being solid.This is the reasoning behind Cheng Wujis saying, “Wind combines with the wei,” and “Cold combines with the ying” (in the Annotations on the Shang Han Lun).When the wei is strong and the ying is weak, the rising and dispersing nature of the wei yang dominates, leading to fever; the weak ying yin cannot maintain its stillness, hence it leads to spontaneous sweating, with a floating and relaxed pulse; after spontaneous sweating, the wei yang partially disperses, and the skin slightly loses warmth, hence aversion to wind, which is termed Taiyang Exterior Deficiency Syndrome.When the ying is strong and the wei is weak, the sinking and still nature of the ying yin exceeds the rising and dispersing nature of the wei yang, causing the wei yang to be trapped within the skin surface and unable to disperse outward to warm the skin, hence aversion to cold; the trapped yang qi, unable to disperse outward, rises, leading to fever.The dominant ying yin’s stillness leads to no sweating, a floating and tight pulse, and causes blood circulation to be obstructed, resulting in pain in the head, body, and joints, which is termed Taiyang Exterior Excess Syndrome.If both wind and cold are felt, with cold combining with the ying, the stillness of the ying yin is enhanced, leading to severe aversion to cold and no sweating; wind combines with the wei, enhancing the rising and dispersing nature of the wei yang, but due to no sweating, the yang heat cannot disperse outward and becomes trapped, leading to high fever and irritability, forming a syndrome of both exterior and interior excess, also known as Exterior Cold and Interior Heat Syndrome.These are all termed Taiyang Meridian Syndromes.The Taiyang Exterior Deficiency Syndrome is treated with Gui Zhi Tang (Cinnamon Twig Decoction), the exterior excess syndrome is treated with Ma Huang Tang (Ephedra Decoction), and the syndrome of both exterior and interior excess is treated with Da Qing Long Tang (Major Bluegreen Dragon Decoction).
2. Exterior Cold and Interior Fluid
This is often due to pre-existing water retention, combined with an external cold evil invasion, trapped at the skin surface, where the external cold and internal fluid clash, obstructing the lung’s wei, causing the lung to lose its ability to diffuse and descend, leading to illness.The lung qi cannot diffuse, hence the exterior is solid with no sweating; the lung loses its ability to descend, hence cough and wheezing occur.Moreover, the water qi flows erratically, obstructing the airways, leading to wheezing and coughing; if it obstructs the stomach, it leads to dry retching; if it is retained below and does not disperse, it leads to difficulty in urination and fullness in the lower abdomen; if the water congeals and does not dissolve, it leads to fluid not being distributed and thirst.If the water qi is trapped for too long, it tends to transform into heat, and once the fluid combines with heat, the heat resides within the fluid, making it most difficult to separate, leading to a recurrent illness.Exterior cold and interior fluid, although both are diseases of the exterior and interior, both caused by external cold binding, this one has tangible water fluid trapped internally, even if it transforms into heat after being trapped for a long time, it must also have fluid; the latter has intangible heat evil trapped, with high heat, and the nature of the two pathogenesis is entirely different.The treatment for exterior cold and interior fluid is Xiao Qing Long Tang (Minor Bluegreen Dragon Decoction), and for fluid evil transforming into heat, it is Xiao Qing Long Jia Shi Gao Tang (Minor Bluegreen Dragon Decoction with Gypsum).3. Evil Entering the MeridianThe evil of the Taiyang meridian enters the organs, starting from the inner corner of the eye, ascending to the forehead, crossing the vertex, connecting to the brain, descending to the neck, and reaching the waist.The exterior evil of Taiyang enters the meridian, causing the meridian qi to be obstructed, and the tendons and vessels to lose nourishment, leading to symptoms such as stiffness and pain in the neck and back, which is the pathogenesis of evil entering the meridian.If the wind evil enters the meridian, it leads to exterior deficiency and spontaneous sweating; if the cold evil enters the meridian, it leads to exterior excess and no sweating.When the evil enters the meridian and causes exterior deficiency with spontaneous sweating, it resembles the symptoms of Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction with Kudzu Root); if it leads to exterior excess with no sweating, it resembles the symptoms of Ge Gen Tang (Kudzu Decoction).4. Evil Trapped in the ChestKe Yunbo states: “Taiyang takes the chest as the interior… Yangming takes the chest as the exterior” (in the Shang Han Lun Yi), and the chest is indeed where the heart and lungs reside.Therefore, if the Taiyang disease is unresolved, the evil qi transmits internally, often first involving the chest, leading to heart and lung symptoms.The pathogenesis of evil trapped in the chest often varies depending on the individual’s organ strengths and weaknesses, the nature of the evil, and the presence or absence of chronic diseases.Generally speaking, when the exterior evil enters and affects the lung, it leads to the basic pathogenesis of the lung losing its ability to diffuse and descend, manifesting as wheezing, coughing, and expectoration of phlegm. However, there are variations such as cold transformation, heat transformation, and the presence of fluid or phlegm.When the exterior evil enters the interior, it leads to symptoms such as “sweating and wheezing” or “no sweating and irritability,” which are pathogenesis changes due to the evil qi transforming into heat and the lung losing its ability to clear and descend.If the person is prone to wheezing, or if there is pre-existing water qi in the chest, the internal evil can lead to pathogenesis changes of cold qi combined with fluid, causing lung qi obstruction, manifesting as coughing and wheezing.If the exterior evil is mismanaged, or if there is excessive sweating, or if fire attacks are misused, it can damage the heart yang, leading to symptoms such as rapid pulse, chest fullness, irritability, palpitations, and even chaotic thoughts.If the heart yang is damaged, it can lead to cold qi rising from the lower jiao, causing chaotic movements; or if fluid accumulates below the navel, it can lead to palpitations and chaotic movements.5. Excess EvilChest obstruction occurs when there is pre-existing phlegm and water retention, and the exterior evil enters the chest, combining with tangible phlegm and water, leading to the so-called pathogenesis of chest obstruction.If it is due to exterior heat entering, the heat resides within the water, while the water resides outside the heat, obstructing the qi mechanism of rising and descending, leading to illness, which is termed heat excess chest obstruction.If it is due to cold phlegm accumulation, it is termed cold excess chest obstruction.Chest obstruction often manifests as fullness and pain in the chest, and even from the heart down to the lower abdomen, leading to fullness and pain.6. Evil Trapped Below the HeartWhen the exterior evil enters below the heart, it often results from mismanagement, and the pathogenesis changes are diverse, primarily forming a fullness syndrome, manifesting as fullness below the heart, tenderness upon pressure, or belching that does not resolve.If it is due to heat evil obstructing below the heart, it leads to qi obstruction; if it is due to stomach deficiency and qi stagnation, it leads to deficiency fullness or qi fullness.If the exterior syndrome is mismanaged, leading to vomiting and purging, it can damage the spleen yang, causing yang qi to weaken, leading to water and fluid retention below the heart.Fluid retention below the heart primarily manifests as fullness below the heart, but due to the fluid’s erratic nature, there are different pathogenesis evolutions and clinical manifestations.If the water qi rises, it leads to qi rising to the chest; if it obscures the clear yang, the yang qi does not rise, leading to dizziness; if it obstructs the stomach, it leads to vomiting of clear water and phlegm; if it rises to the lungs, it leads to coughing and wheezing.The formation of water qi originates from yang deficiency, and insufficient yang qi can also lead to the tendons and vessels losing warmth, manifesting as tremors and shaking.7. Evil Heat Leading to DiarrheaTaiyang exterior syndrome mismanaged can lead to heat entering the intestines, causing diarrhea, termed evil heat diarrhea, which has several pathogenesis changes.One is that exterior heat enters the interior, the exterior evil is completely resolved, and it is purely interior heat diarrhea, with symptoms of “diarrhea that does not stop… wheezing and sweating,” and the pulse is not rapid, treated with Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction).If the pulse is rapid, it indicates that the exterior is not resolved, and the exterior should continue to be resolved, leading to internal harmony.Two is that the exterior evil transmits to the Yangming, and the interior heat is not solid, forming “Taiyang and Yangming combined disease, must lead to diarrhea from below,” with the exterior not resolved, still having fever, aversion to cold, headache, and no sweating, along with Yangming’s diarrhea, indicating that the Taiyang evil is severe, affecting Yangming, and the Yangming interior syndrome is caused by the exterior syndrome.The treatment should resolve the exterior, using Ge Gen Tang (Kudzu Decoction), resolving the exterior leads to internal harmony.Three is that Taiyang and Shaoyang combined disease, “leading to diarrhea from below,” is caused by evil heat pressing the intestines, leading to pure clear heat diarrhea, treated with Huang Qin Tang (Scutellaria Decoction).Four is that the Taiyang disease “exterior symptoms not resolved, but frequent diarrhea, leading to heat and diarrhea that does not stop.” This is termed “cooperating heat and diarrhea.”Due to repeated mismanagement, it weakens the spleen and stomach, leading to exterior heat and internal deficiency cold, termed “cooperating heat and diarrhea.”In fact, this cooperating heat diarrhea is the Taiyang affecting the Taiyin, which can be termed Taiyang and Taiyin combined disease, resembling the symptoms of Gui Zhi Ren Shen Tang (Cinnamon and Ginseng Decoction).Five is that the exterior evil enters below the heart, leading to a fullness syndrome, and repeated mismanagement, leading to “diarrhea that does not stop,” causing the lower jiao to slip, resembling the symptoms of Chi Shi Zhi Yu Yu Liang Wan (Red Stone Fat and Yu Yu Grain Pill).8. Evil Entering the OrgansThis refers to the Taiyang meridian evil not resolving, transmitting internally to the Taiyang organs’ pathogenesis changes.One is that the evil enters the bladder qi aspect, combining with water, leading to water retention and causing difficulty in urination.Two is that the evil heat enters the bladder blood aspect, combining with blood stasis, leading to urgent fullness in the lower abdomen and self-urination, resembling symptoms of blood retention.The lower abdomen is the chamber of the bladder, and the so-called bladder blood retention refers to blood stasis in the lower abdomen, with some cases showing symptoms of blood in the stool.9. Injury to the Yang of the OrgansThis often arises from improper sweating and purging in Taiyang disease.All five organs have yang qi, and the injuries differ, leading to various pathogenesis changes.If excessive sweating injures the lung’s wei yang, symptoms include aversion to cold, sweating without fever.If sweating and purging injure the heart yang, the pathogenesis changes may manifest as anxiety in the upper jiao, leading to chest fullness, irritability, chaotic thoughts; or in the middle jiao, leading to water retention; or in the lower jiao, leading to cold qi rising, causing chaotic movements, or fluid retention below the navel leading to chaotic movements.If excessive sweating injures the kidney yang, the disease transforms from Taiyang to Shaoyin, leading to symptoms such as “sweating, leading to continuous leakage, the person fears wind, difficulty in urination, and limbs slightly urgent, difficult to bend and stretch,” resembling symptoms of Gui Zhi Jia Fu Zi Tang (Cinnamon Decoction with Aconite).If the yang deficiency is too severe, it can transform into Shaoyin disease.10. Injury to the Yin of the OrgansThe pathogenesis changes of yang disease injuring yin primarily manifest as loss of body fluids, with the disease transforming towards Yangming.The so-called “Taiyang disease, if sweating, purging, or causing diarrhea, this leads to loss of body fluids, dryness in the stomach, hence transforming to Yangming.”This indicates that the disease changes often transform into Yangming heat.The pathogenesis of Yangming disease includes the domains of the hand Yangming large intestine and foot Yangming stomach.Yang represents heat, and ming signifies clarity.The pathological response formed by excessive yang heat in the Yinming position is termed Yangming disease.Thus, Yangming disease often transforms from heat, fundamentally characterized by interior heat and stomach excess.The transmission of Yangming disease has three origins: one is that Taiyang disease is improperly treated, leading to loss of body fluids, dryness in the stomach, and transformation into Yangming, termed Taiyang to Yangming; two is that Shaoyang disease is improperly treated with sweating, purging, or diarrhea, leading to stomach dryness and excess, transforming into Yangming, termed Shaoyang to Yangming; three is that without improper treatment, the evil heat directly attacks Yangming, termed Zhengyang to Yangming.Regardless of the source, it fundamentally involves excessive yang qi and rampant evil heat as the basic pathological changes.When the evil heat first enters the Yangming domain, it becomes trapped in the chest, unable to disperse, leading to the pathological changes of heat trapped in the chest; if the evil heat enters the Yangming meridian, it leads to the pathological changes of Yangming meridian heat; if the evil heat enters the organs, it leads to the pathological changes of Yangming organ excess.Yangming and Taiyin are mutually exterior and interior, their meridians are interconnected, and their qi is interlinked, hence during illness, they can mutually transmit changes.Yangming disease with unresolved evil heat, if combined with Taiyin spleen dampness, can lead to pathological changes of jaundice.Yangming disease improperly attacked or attacked too early and too forcefully can often injure the spleen yang, transforming into Taiyin disease.The Shang Han Lun states, “If the qi does not transform, this is merely the initial stage, later it must lead to diarrhea, and it cannot be attacked, as attacking it will lead to fullness and inability to eat.”This illustrates that improper attacks can transform into Taiyin disease.When Taiyin disease is at its peak, it can also often transform into Yangming disease.Yangming disease belongs to heat excess syndrome, while Taiyin disease belongs to deficiency cold syndrome, and the two have mechanisms of mutual transmission, hence there is the saying, “Yangming deficiency is Taiyin, Taiyin excess is Yangming.”Moreover, all three Yin diseases can transform into Yangming, indicating a favorable prognosis.1. Heat Trapped in the ChestThe chest is the exterior of Yangming, or due to excessive sweating, purging, or vomiting, residual heat remains, and the righteous qi is injured, leading to residual heat trapped in the chest; or due to evil heat transmitting through the meridians, initially entering Yangming, not yet entering the organs, disturbing the chest, all belong to the pathogenesis of heat trapped in the chest.The characteristic manifestation is irritability and insomnia.If the trapped heat is too excessive, it disturbs the yang qi, leading to symptoms such as vexation and restlessness.The nature of the pathogenesis is excess evil and deficiency righteousness, primarily based on excess.This resembles the symptoms of Wei Zi Guo Tang (Elderberry Decoction).2. Yangming Meridian HeatThe intangible evil heat is solely dominant in the Yin and Yang meridians, not yet entering the organs and transforming into dryness: one is that the evil heat is excessive externally, forming both exterior and interior heat, manifesting as high fever, profuse sweating, and intense thirst; two is that the heat evil is deeply hidden internally, the yang qi cannot extend and distribute outward, leading to the phenomenon of cold limbs, which is actually a heat excess syndrome, termed heat excess syndrome, hence the saying, “The deeper the cold, the deeper the heat; the milder the cold, the milder the heat.”Due to the high heat, filling both internally and externally, it is most likely to injure body fluids, exhaust qi, and transform into dryness within the organs.This resembles the symptoms of Bai Hu Tang (White Tiger Decoction).3. Yangming Organ ExcessWhen the evil heat enters the organs, it steams and scorches body fluids, transforming into dryness and forming excess in the stomach, leading to obstruction of the organ qi, stagnation of transmission and transformation, and rapidly exhausting body fluids, leading to various pathogenesis changes.One is that dryness and heat combine, accumulating in the stomach and intestines, obstructing the organ qi from descending, leading to abdominal distension and pain; two is that if the organ qi does not flow, the lung qi does not descend, leading to wheezing and shortness of breath; three is that if the stool becomes dry and hard, body fluids flow down, it can lead to self-urination of clear water, pure green in color; four is that if the internal heat is excessive, it disperses outward, leading to tidal fever and sweating; if it steams upward, disturbing the heart spirit, it leads to irritability, vexation, delirium, and incoherence, resembling symptoms of stomach heat affecting the heart.Five is that if the heat evil is deeply hidden, it exhausts body fluids, leading to symptoms such as unclear vision, uncoordinated eyes, and even rapidly descending into unconsciousness.Yangming organ excess resembles the symptoms of Cheng Qi Tang (Purge Decoction).4. Yangming JaundiceThe Shang Han Lun states: “In Yangming disease, if there is fever and sweating, this is due to heat excess, and it cannot lead to jaundice.”“If there is self-urination, it cannot lead to jaundice.”This indicates that Yangming disease is primarily characterized by excessive sweating and self-urination, as Yangming belongs to heat, and the nature of heat evil is dispersive and outwardly penetrating, hence merely having heat evil will not lead to jaundice.The cause of Yangming jaundice is primarily due to “stagnation of heat internally.”The so-called “stagnation of heat” refers to damp-heat stagnation, which is due to lack of sweating and difficulty in urination, leading to dampness, which is sticky, and when combined with heat, the heat obstructs the dampness, and the dampness steams the heat, leading to jaundice.Pathogenesis of Shaoyang DiseaseThe pathogenesis of Shaoyang is based on the gallbladder and Sanjiao.Shaoyang and Jueyin are mutually exterior and interior, their meridians run along the sides of the body, being half external and half internal, representing the pathological response layers.It is externally adjacent to Taiyang and Yangming, and internally close to the three Yin, indicating that the pathogenic evil enters from the outside to the inside, or from Yang to Yin, or from Yin to Yang.Shaoyang means slight, indicating that the yang heat is not as excessive as Taiyang or Yangming, hence it is termed Shaoyang disease.The evil qi and righteous qi contend between the inside and outside, leading to the basic pathogenesis of Shaoyang disease.The transmission of Shaoyang disease has origins, such as evil entering from the exterior, as stated in the Shang Han Lun section 267: “Originally a Taiyang disease, if unresolved, it transforms into Shaoyang.”There are also cases originating from Shaoyang, as stated in section 266: “Cold damage, with a wiry and thin pulse, headache, and fever, belongs to Shaoyang.”Mismanagement or improper treatment of Shaoyang disease, the key to its transmission lies in the deficiency or excess of the spleen and stomach.The Shang Han Lun section 270 states: “In cold damage for three days, the three Yangs are exhausted, and the three Yins will receive the evil; if the person can still eat without vomiting, this indicates that the three Yins are not affected by the evil.”This ability to eat without vomiting indicates that the spleen and stomach are not deficient, hence not transmitting to the three Yins.Generally speaking, if the spleen and stomach yin is excessive, it is easy to enter the three Yin organs; if the stomach is excessive and yang is strong, it is easy to transmit to the Yangming organs.If the righteous qi is too deficient and the evil qi is too excessive, the disease can reverse from Shaoyang to Jueyin; if the Jueyin yang recovers and the heat is excessive, it can also transform into Shaoyang, indicating a favorable prognosis.Since Shaoyang and Jueyin are mutually exterior and interior, there is the saying, “If Shaoyang is deficient, it is Jueyin; if Jueyin is excessive, it is Shaoyang.”Shaoyang disease belongs to the category of three Yangs, and it also has the evolution of meridian and organ syndromes.The evil qi invades the Shaoyang domain, causing gallbladder fire to rise, gallbladder qi to not descend, and stomach qi to rise, as stated in the Ling Shu: “Evil in the gallbladder, reverse in the stomach,” and the mechanism of contention between the righteous and evil qi leads to various pathogenesis changes.Thus, the pathogenesis of Shaoyang meridian disease is formed.And the Shaoyang organ disease must be in the gallbladder organ.The Shang Han Lun section 106 states: “… if there is persistent vomiting, urgency below the heart, vexation, and slight irritability, this indicates that it is unresolved; if treated with Da Chai Hu Tang (Major Bupleurum Decoction), it will be cured.”Section 170 states: “… if there is fullness below the heart, vomiting, and diarrhea, Da Chai Hu Tang is the main treatment.”This indicates the pathogenesis of heat accumulation in the gallbladder organ.Since the Shaoyang gallbladder meridian runs down the chest, penetrating the diaphragm, and connecting to the liver, the gallbladder organ is located below the heart.The so-called “urgency below the heart” and “fullness below the heart” are evidently related to the stagnation of the gallbladder organ qi, which is actually the Shaoyang organ disease.In the past, some believed that the symptoms of Da Chai Hu Tang belonged to the combined disease of Shaoyang and Yangming, but the three symptoms (106, 140, 170) do not include symptoms of dryness and obstruction in the stomach and intestines, indicating that the disease does not involve Yangming.Since the disease does not involve Yangming, using Da Chai Hu Tang to treat it is to relieve the gallbladder organ heat.Shaoyang meridian disease is prohibited from purging, while organ disease is not prohibited from purging.1. Mechanism of ContentionShaoyang resides between exterior and interior, serving as the pivot for the three Yangs and three Yins to enter and exit.Once the evil enters Shaoyang, causing the pivot to be unfavorable, it leads to various pathogenesis changes.One is that the evil resides in Shaoyang, half exterior and half interior, with the righteous and evil contending, equally matched; if it contends with Yin, it leads to cold; if it contends with Yang, it leads to heat, hence alternating between cold and heat.The evil qi stagnates in the Shaoyang meridian, leading to fullness in the chest and ribs.Stagnation of Shaoyang gallbladder wood invades the stomach organ, leading to loss of appetite and irritability.These are all manifestations of cold and heat stagnation in the Shaoyang position, leading to changes in the qi mechanism.This resembles the symptoms of Xiao Chai Hu Tang (Minor Bupleurum Decoction).Two is that the exterior evil has not yet been resolved, and the disease has already involved Shaoyang, forming a combined disease of Taiyang and Shaoyang, with symptoms such as fever, slight aversion to cold, joint pain, slight vomiting, and fullness below the heart, which is termed Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Decoction).Three is that if the Shaoyang disease is unresolved, the evil heat transmits to the Yangming organ, forming a combined disease of Shaoyang and Yangming, resembling the symptoms of Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Glauber’s Salt).Four is that if the Shaoyang pivot is unfavorable, and the heat stagnates in the upper jiao, while the Sanjiao water pathway is obstructed, leading to difficulty in urination, water retention, and forming a pathogenesis change of water and heat mixed in the Sanjiao, resembling the symptoms of Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum and Cinnamon Decoction with Ginger).2. Heat Accumulation in the Gallbladder OrganThe heat of Shaoyang accumulates in the gallbladder organ, causing gallbladder qi to not descend, hence symptoms such as persistent vomiting, urgency below the heart, irritability, and slight vexation.The gallbladder organ resides below the heart, hence although there is persistent vomiting, it can be purged using Da Chai Hu Tang, resolving the Shaoyang externally and relieving the internal heat.This differs from the pathogenesis stated in the Shang Han Lun section 209: “In cold damage, if there is excessive vomiting, although there are Yangming symptoms, it cannot be purged.”In Yangming vomiting, the evil heat is above the diaphragm and has not yet entered the organs, hence it cannot be purged.3. Heat Entering the Blood ChamberHeat entering the blood chamber is a unique pathogenesis change that occurs in women during the physiological process around menstruation when they contract heat diseases.For details, refer to the chapter on the pathogenesis of blood in the section on Wei, Qi, Ying, and Blood.Pathogenesis of Taiyin DiseaseTaiyin governs the spleen, and its diseases arise from the interior, with deficiency cold initially prevailing in the interior, leading to the onset of the three Yin, hence termed Taiyin disease.The basic pathogenesis of Taiyin disease is spleen and stomach deficiency cold.The transmission of Taiyin disease has three origins: one is that “the organs have cold,” and the evil qi directly enters Taiyin; two is that Taiyang disease is mismanaged, leading to spleen yang being harmed, as stated in the Shang Han Lun section 279: “Originally a Taiyang disease, if the physician purges, it leads to abdominal fullness and pain, belonging to Taiyin.”This indicates that the disease transforms into Taiyin; three is that excessive purging of Yangming injures spleen yang, which can transform into Taiyin.Moreover, excessive use of warming and drying methods in Taiyin can also transform into Yangming, as Taiyin spleen and Yangming stomach are mutually exterior and interior.The Shang Han Lun section 192 states: “In cold damage, if the pulse is floating and relaxed, and the hands and feet are warm, this indicates that it is in Taiyin… After seven or eight days, if there is diarrhea, it indicates Yangming disease.”This illustrates the pathogenesis of mutual transmission between Taiyin and Yangming.Thus, there is the saying, “If there is deficiency, it is Taiyin; if there is excess, it is Yangming.”If Taiyin is not treated, and vomiting and diarrhea do not stop, leading to loss of body fluids, the disease can transmit to Shaoyang and Jueyin, making the condition more severe.1. Taiyin Deficiency ColdThe pathogenesis changes of Taiyin deficiency cold primarily arise from spleen yang deficiency, leading to failure in warming and transporting, causing the clear yang not to rise, leading to cold and dampness prevailing in the stomach, with failure in transformation, qi mechanism stagnation, and reversed rising and descending, leading to symptoms such as vomiting, diarrhea, fullness, pain, and inability to eat, resembling symptoms of Li Zhong Tang (Regulate the Middle Decoction).2. Slippery and UncontrolledTaiyin yang deficiency and internal cold develop severely, leading to an inability to raise body fluids, control blood and fluids, causing intestinal fluids and blood to slip down, leading to persistent diarrhea, possibly with blood and pus, and abdominal pain, resembling symptoms of Tao Hua Tang (Peach Blossom Decoction).3. Cold Dampness JaundiceTaiyin dampness is prone to deficiency, with internal cold dampness prevailing, leading to stagnation and jaundice, termed cold dampness jaundice, also known as yin jaundice.Cold dampness jaundice can transform into damp-heat jaundice through Yangming heat transformation, and Yangming jaundice can also transform into cold dampness jaundice through Taiyin cold transformation.Pathogenesis of Shaoyin DiseaseShaoyin governs the heart and kidneys, controlling the two qi of water and fire, serving as the foundation of the human body.When the disease enters Shaoyin, the heart and kidneys become weak, yang qi is not vigorous, and yin blood is insufficient, leading to a significant decrease in righteous qi, which is a critical change in the disease, with weak yang qi leading to a weak pulse; insufficient yin blood leads to a thin pulse; and insufficient yin and yang qi and blood lead to a state of fatigue and mental dullness, termed “only wanting to sleep.”Thus, “thin pulse, only wanting to sleep” is a common clinical feature of Shaoyin disease.Shaoyin governs water and fire, being primarily yin and representing yang; if the body is yang deficient, the disease evil transforms from water into cold, leading to internal cold predominating, manifesting as no heat, aversion to cold, diarrhea, vomiting, and a weak pulse, resembling a series of cold transformation pathogenesis changes.If the internal cold is extremely severe, the remaining yang qi often floats outward, termed “ge yang”; if it floats upward, it is termed “dai yang,” leading to symptoms such as facial redness, body heat, and restlessness, representing the pathogenesis of true cold and false heat.If the body is yin deficient, the disease evil transforms from fire into heat, leading to symptoms such as irritability, insomnia, sore throat, red tongue, and thin rapid pulse, resembling a series of heat transformation pathogenesis changes.Although Shaoyin disease has both cold transformation and heat transformation pathogenesis changes, it fundamentally emphasizes yang deficiency, with cold transformation being more prevalent, hence cold transformation syndrome is the main aspect of Shaoyin, while heat transformation syndrome is the secondary aspect.Therefore, Shaoyin disease fundamentally involves heart and kidney deficiency, with internal cold predominating as the basic pathogenesis.The prognosis of Shaoyin disease depends on the recovery of yin and yang.If yang recovers, there is life; if yang is lost, there is death; if yin is exhausted, there is also death.If the hands and feet transition from cold to warm, aversion to cold and lying down transforms into restlessness and desire to remove clothing, and diarrhea gradually stops, with the pulse transitioning from yin to yang, this indicates recovery of yang qi, suggesting a favorable prognosis.If the hands and feet remain cold, diarrhea does not stop, aversion to cold increases, and the pulse is thin and about to disappear, this indicates that yang qi is about to be lost; if diarrhea stops but the condition does not improve, the pulse does not reach, and dizziness occurs, this indicates that true yin is exhausted, suggesting a severe prognosis.The origins and transmission of Shaoyin disease have three sources: one is that the body is originally yang deficient, and the disease evil directly enters Shaoyin; two is that it transmits from other meridians due to mismanagement; three is that Shaoyin heat transformation leads to Yangming acute diarrhea, or cold transformation leading to Jueyin.1. Yang Deficiency Exterior ColdThe Shang Han Lun section 301 states: “In Shaoyin disease, if it begins with fever, and the pulse is deep, it is treated with Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction).”This indicates that the evil is externally binding, and the yang qi is internally deficient, leading to the simultaneous presence of Taiyang and Shaoyin, representing the pathogenesis of yang deficiency exterior cold.Since the root of Taiyang is indeed Shaoyin.Ke Yunbo states: “If Taiyang yang is deficient, it cannot govern the exterior, injuring the true yin qi, leading to the exposure of the Shaoyin base.”If Shaoyin is yin deficient, it cannot govern the interior, injuring the yang qi of Taiyang, leading to the false appearance of Taiyang disease, hence the pulse is deep… and the Shaoyin disease presents as exterior heat.”(in the Shang Han Lun Yi: Explanation of Taiyang Disease) This illustrates the mechanism of mutual transmission between Taiyang and Shaoyin.This situation is most likely to occur in individuals with pre-existing yang deficiency when they encounter external evil.2. Yin Excess and Yang DeficiencyYin excess and yang deficiency is the basic pathogenesis of Shaoyin cold transformation, where both are interdependent; if yang qi is deficient, yin cold prevails, and if yin cold prevails, yang qi becomes increasingly deficient, with yang qi deficiency being the primary cause.If yang qi is not deficient, even if yin cold is excessive, it will not transform into Shaoyin.Shaoyin yang qi is weak, and yin cold is excessively strong, representing a systemic deficiency cold change, which includes various different pathogenesis changes.One is that cold prevails and yang is weak, leading to cold limbs and diarrhea.Since the limbs are the foundation of all yang, if yang is weak, it loses warmth, hence the limbs become cold.Excessive internal cold cannot digest food and fluids, leading to undigested food and diarrhea.Shaoyin diarrhea often presents with thirst, indicating that yang qi is weak and cannot transform qi and generate fluids, combined with diarrhea leading to fluid loss.This differs from Taiyin diarrhea, which does not present with thirst, as Taiyin merely has spleen yang deficiency while kidney yang is not deficient, and kidney yang can still rise to generate fluids.Two is that yang deficiency and yin excess lead to water qi not transforming.Since the foot Shaoyin kidney is the organ of cold water, if kidney yang is weak, cold water loses warmth and transformation, leading to stagnation and infiltration, causing illness.Cold water stagnates in the tendons and joints, leading to body pain, joint pain, cold hands and feet.Yang deficiency and cold excess cannot warm the tendons and joints, leading to tremors and shaking.Yang qi is weak, and bladder qi transformation is obstructed, leading to difficulty in urination.Water qi not transforming leads to upward pressure on the heart, causing palpitations; if it infiltrates the limbs, it leads to heaviness and pain in the limbs, even swelling; if water cold stagnates, clear yang does not rise, leading to dizziness.Three is that yin excess leads to yang rejection.Due to extreme yang deficiency, internal organs become excessively cold, and the remaining yang qi cannot hide, being rejected outward, leading to symptoms such as body heat and aversion to cold; if rejected upward, it leads to facial redness and irritability, termed “dai yang.”Both manifestations differ, but the essence is the same.Both represent the tendency of yin and yang to separate, indicating a severe condition and poor prognosis.This resembles the symptoms of Tong Mai Si Ni Tang (Open the Pulse and Four Reversal Decoction) and Bai Tong Tang (White Open Decoction).4. Heat Transformation Injuring YinThe evil enters Shaoyin, transforming from yang into heat, injuring yin fluids.Thus, Shaoyin heat transformation injures yin, with yin deficiency and yang excess as the basic pathogenesis.There are several different evolutions.One is that kidney yin is deficient and cannot nourish heart fire, leading to excessive heart fire, yang excess not entering yin, and yin deficiency not restraining yang, leading to symptoms such as irritability and insomnia, treated with nourishing yin and clearing heat, using Huang Lian Jiao Tang (Coptis and Donkey-hide Gelatin Decoction).Two is that yin deficiency with heat combined with water qi leads to water and heat clashing, with body fluids leaking into the large intestine, leading to diarrhea and difficulty in urination, irritability, insomnia, and thirst.The source of water qi primarily arises from yin deficiency leading to bladder qi transformation failure, treated with nourishing yin and promoting water, using Zhu Ling Tang (Polyporus Decoction).Three is that yin deficiency and yang excess lead to floating fire, leading to diarrhea, sore throat, chest fullness, irritability, etc., with diarrhea due to spleen qi deficiency, not due to excessive water qi.Thus, although yin is deficient and fire is floating, there is no evil heat as a problem.5. Heat Transformation into ExcessSee the section on “Yangming Disease Pathogenesis”.6. Qi Stagnation Leading to ReversalQi stagnation leading to reversal arises from liver qi stagnation, which cannot rise, causing yang to stagnate internally, unable to reach the limbs, leading to cold limbs, which is fundamentally different from Shaoyin yang deficiency and yin excess.This pathogenesis change has historically been included in discussions of Shaoyin disease.In fact, qi stagnation leading to reversal is a manifestation of liver wood harming earth, often accompanied by abdominal pain, diarrhea, and heaviness, while cold limbs are relatively mild, resembling symptoms of Si Ni San (Four Reversal Powder).Pathogenesis of Jueyin DiseaseJueyin includes the pericardium and liver, representing the final pathological response layer among the six meridians, also the final stage of the struggle between evil and righteousness.The origins of its transmission include: one is that cold evil directly enters Jueyin, but this is rare; two is that Taiyin and Shaoyang disease worsen, transmitting to Jueyin; three is that Shaoyang disease transforms into Jueyin due to deficiency.There have been various understandings of the essence of Jueyin disease pathogenesis.Some believe that Jueyin represents the extreme of yin, where wood is cold and leads to reversal; others argue that Jueyin is governed by wind qi, with Shaoyang fire transformation, fundamentally representing heat reversal, while loss of yang and cold reversal is primarily discussed in Shaoyin disease; others believe that Jueyin represents the end of yin and the beginning of yang, with yang qi returning, leading to excessive or insufficient qi, hence the pathogenesis can involve mixed cold and heat, with yin and yang being excessively strong or weak.In fact, within Jueyin disease, there are extreme heat conditions such as Bai Hu Tang, Cheng Qi Tang, and Bai Tou Weng Tang; there are extreme cold conditions such as Wu Zhu Yu Tang and Si Ni Tang; and there are mixed cold and heat conditions such as Gan Jiang Huang Qin Huang Lian Ren Shen Tang and Wu Mei Wan.This is because Jueyin represents the extreme of yin, immediately followed by the initial emergence of yang, being fundamentally yin while representing heat, hence it can transform from extreme cold to heat, or from extreme heat to cold, as the saying goes, “extremes lead to reversals,” hence both types of “extreme transformations” are characteristics of Jueyin.Therefore, it can be concluded that when the disease reaches Jueyin, the two extremes of yin meet, and the initial emergence of yang occurs, leading to extreme imbalance of yin and yang, and the two qi not connecting smoothly, hence leading to the basic pathogenesis of heat excess and cold reversal.Heat reversal is the pathological change of yang heat being excessively strong, rejecting yin outward.The term “reversal” refers to cold limbs, indicating yin excess; “heat” refers to fever, indicating yang excess.In the Shang Han Lun, the number of days of heat and reversal is compared, indicating the relative amounts of heat and reversal in all reversal syndromes.The so-called “reversal” indicates the limbs are cold, indicating that yin is excessive; “heat” indicates fever, indicating that yang is excessive.In the early stages of heat reversal, the fever is due to heat rising, and the reversal is due to heat stagnation; the deeper the heat, the deeper the reversal; the milder the heat, the milder the reversal, termed “reversal and heat alternating.”At this time, the amount of heat and reversal should not be used to judge the progress of the disease, nor should the equal duration of heat and reversal be used to determine that it will “definitely recover.”However, in the later stages, if cold becomes more prevalent than heat, and reversal heat prevails, this indicates the transformation of heat reversal into cold reversal.The “reversal” of cold indicates that yin is excessive, while the “fever” indicates that yang is recovering.When reversal is more than heat, it indicates insufficient yang recovery, with the evil prevailing over the deficiency, indicating that the disease is progressing.When reversal and heat are equal, it indicates appropriate yang recovery, suggesting that the disease will recover.When reversal is less than heat, it indicates excessive yang recovery, still belonging to the righteous overcoming the evil, suggesting a favorable prognosis.However, if there is no heat with reversal, it indicates that yin is long and yang is lost, with the evil prevailing over the deficiency, indicating a severe prognosis, falling within the range of “those with persistent reversal will die.”1. Mixed Cold and HeatJueyin represents the end of yin and the emergence of yang, with disease changes often tending towards extremes, often forming mixed cold and heat pathogenesis changes.There are commonly two situations: one is that evil heat prevails in the chest, while the intestines are filled with cold, leading to heat in the chest not being eliminated, while the cold in the intestines becomes more severe.This can lead to symptoms such as worms avoiding cold and seeking warmth, rising to the chest and forming the so-called reversal syndrome, with symptoms such as pain and heat in the chest, lack of appetite, and vomiting; or leading to prolonged diarrhea.The treatment should involve both cold and warmth, using Wu Mei Wan (Mume Pill) or similar.Two is that cold damage is mismanaged, injuring the middle qi, allowing the exterior evil to enter the interior, while being obstructed by internal cold, leading to pathogenesis changes of heat above and cold below.Excessive internal cold and weak yang qi lead to diarrhea, while heat above obstructs, leading to vomiting.This resembles symptoms of Gan Jiang Huang Qin Huang Lian Ren Shen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction).2. Yin Cold RisingDue to the weakness of spleen and stomach yang qi, excessive cold in the middle jiao leads to phlegm and dampness, with yin cold qi carrying phlegm rising along the Jueyin meridian, leading to symptoms such as headache, vomiting of clear phlegm, etc., resembling symptoms of Wu Zhu Yu Tang (Evodia Decoction).3. Blood Deficiency and Cold StagnationDue to the person’s blood vessels being inherently weak, combined with external cold invasion, leading to qi and blood stagnation, causing obstruction in the meridians, leading to pathogenesis changes.Qi and blood stagnation leads to poor circulation, hence the limbs lose warmth, leading to cold limbs, pain, cyanosis, and a thin pulse.However, this type of cold excess and blood deficiency, leading to symptoms such as cold limbs, is fundamentally different from yang deficiency leading to reversal.This resembles symptoms of Dang Gui Si Ni Tang (Angelica Four Reversal Decoction).4. Deep Reversal and Deep HeatDue to the evil heat penetrating deeply, becoming trapped internally, the yang qi is trapped, unable to extend, leading to pathogenesis changes of deep reversal and deep heat, as stated in the Shang Han Lun section 335: “The deeper the reversal, the deeper the heat; the milder the reversal, the milder the heat.”Deep reversal indicates that the heat is deeply trapped internally and is intense, hence the limbs are extremely cold, while the mouth is dry and thirsty, leading to irritability and heat, indicating heat reversal rather than cold reversal.Cold reversal belongs to yang deficiency and yin excess, hence the mouth will not be dry, the tongue will not be dry, and there will be no thirst or clear urination.Deep heat reversal often involves intangible evil heat as the disease.This resembles symptoms of Bai Hu Tang (White Tiger Decoction).5. Heat DiarrheaDue to damp heat pressing down, leading to obstruction and stagnation in the intestines, causing frequent diarrhea, with qi mechanism not flowing smoothly, prominently manifesting as qi wanting to rise but unable to, and evil wanting to exit but not fully, leading to damp heat and turbid evil steaming and corrupting the intestines, hence symptoms such as urgency and heaviness in the abdomen, abdominal pain, and blood in the stool.This belongs to Jueyin heat diarrhea, fundamentally different from Taiyin and Shaoyin deficiency cold diarrhea, and should be noted for distinction.
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