2b. Six Jing diagnosis –Yangming
Xieqi (the disease-causing energy entity) is too strong, or if the
body is too weak, or if the treatment is improper in the early
Taiyang stage, the Shanghan disease would develop into the
deeper stage: the Yangming stage.
phase of the Yangming stage is Yangming meridian phase. It can
further more be separated into Cold-attack meridian phase and
Wind-attack meridian phase.
phase of the Yangming stage is called organ phase. It can also
be separated into Cold-attack organ phase and Wind-attack organ
the Cold-attack and the Wind-attack meridian phase, the patient
feels hot, has fever, thirsty, sweat, and not dislikes cold but
hot. The pulse feels big as wave. The patient has no chilly at
all. The whole body appears as in a fire condition. This
condition can be seen in the acute pneumonia, acute appetites,
or other acute diseases. If a patient has such manifestations,
we will diagnose the condition as the meridian phase of the
difference between the Cold-attack and the Wind-attack meridian
phase are: in the former, the patient has reduced appetite and
in the later, the appetite remains no change.
in the Cold-attack meridian phase has no sweat (but still have
fever), the patient would have frequent urination, or have
itching feeling under the skin that feels as insect moving.
These patients may have cough, nausea, cold hands and feet, and
strong headache. If the patients have no cough, nausea, or cold
hands and feet, they would have no headache.
Cold-attack meridian phase can be developed from Cold-attack
Taiyang stage, when the sweat therapy used for the Taiyang stage
was not thorough.
the Wind-attack meridian phase have no reduced appetite, but
have dizziness. If they have cough, they must have sour throat
(if they have no cough, they would have no sour throat).
the Cold-attack organ phase have difficulty to eat. When eat,
they feel bloating, dizziness, slight annoyed, and sweat in
hands. They have difficulty in urination, and loose bowel
movement. The stool might even contain non-digested food.
Wind-attack organ phase, the patient feels bloating and pain in
the whole belly and is hard to have a bowel movement. This
condition can be seen in acute intestinal obstruction. Patient
in the Wind-attack organ phase has no problem to eat. Their
urination is not affected, but they have constipation or even no
treatment of Cold-attack meridian phase, if the patient has
sweat, use Guizhi-Fuzi series formulae. If there is no sweat but
frequent urination, use Xiao Qinglong Tang. If there is nausea
after eat, use Wuzhuyu Tang. For the treatment of the
Cold-attack organ phase, use Sini Tang for the treatment.
treatment of Wind-attack meridian phase, herbal formula Gegen
Tang or Baihu Tang is used. If the patient has strong desire to
drink water, use formula Baihu plus Rensheng Tang. If the
patient has fever and has too strong sweat, use Da Chengqi Tang.
If the patient has annoyed feeling, use Tiao Wei Chengqi Tang.
treatment of Wind-attack organ phase, herbal formula Cheng Qi
Tang is used.
Qinglong Tang contains herb Mahuang; Sini Tang contains herb
Fuzi; Bai Hu Tang contains herb Shigao and Chengqi Tang contains
herb Dahuang. These herbs are rarely used, and dared not to be
used, by TCM doctor of College style, but frequently and
commonly used by Jing Fang style TCM doctors.
several special conditions in the Yangming stage.
patient has poor memory. The stool is hard and black in color
but the bowel movement is easy. In such case, use Didang Tang
for the treatment.
patient has jaundice in the skin and eyes. The jaundice can be a
Cold-wetness type and a Hot-wetness type. For the treatment of
the Hot-wetness type of the jaundice, the herbal formulae used
are Mahuang Liangqiao Chixiaodou Tang, Yinchengao Tang or Zhizi
Bopi Tang, depending on the amount of the Hot and the wetness in
Notice and explanation:
the Yangming stage, there is no more cold-dislike feeling, but
hot-dislike feeling. The patient has fever, sweat, bloating
and/or pain in the chest or in the whole stomach. All patients
should have difficulty in bowel movement or no bowel movement.
the patient has reduced appetite, or if the sufferings become
worse after eat, the condition belongs more to the Yangming
Cold-attack syndrome. If the appetite is not affected, or if the
syndrome does not become worse after eating, it would be most
possibly due to Yangming Wind-attack.
Yangming Cold-attack syndrome, we use warm herbs for the
treatment, such as Mahuang, Fuzi, Wuzhuyu, so as to expel the
cold. For Yangming Wind-attack syndrome, we use Shigao or
Dahuang to expel Fire through colon.
For the diagnosis of Yangming Cold-attack syndrome, it is
introduced in scattered manner in the Yangming chapter. No
systematic introduction for its treatment. The herbal formulae
introduced here come from experience and idea of other TCM
experts. It is listed here for reference. For a long time, the
diagnosis and treatment of Yangming stage are limited to the
Yangming Wind-attack syndrome. However, in clinic, there are
also many cases of Yangming Cold-attack syndrome. This has to be
emphasized and reminded.
are many western people who feel hot, dislike hot, and like to
drink cold or even ice drink. Such condition can also be
regarded as Yangming Wind-attack meridian syndrome. For such
cases, we use Baihu Tang, Baihu plus Rensheng Tang, or Zhuye
Shigao Tang for the treatment. If the person feels hot, dislikes
hot, but like to drink warm water, and feels tired, we would use
Bu Zhong Yi Qi Tang for the treatment (This formula does not
belong to Shanghan Lun). If the diagnosis is correct and the herbal formula is
used in a proper way, the healing effect is excellent. It works
to change the body constitution.
One of the main points to diagnose Yangming stage is the
difficulty in bowel movement. Here we emphasize the difficulty,
not once for how many days for the bowel movement. If the person
has bowel movement once several days, but the person does not
feel stomach pain or bloating, and if the stool passes pretty
easy, it should not be regarded as constipation. On the other
side, it should be regarded as constipation, even if the person
has bowel movement every day, but the stool passes very
difficult. This is different from the western medicine in the
concept of constipation.
(5). There are
Taiyang-Yangming, Zhengyang-Yangming and Shaoyang-Yangming
concepts in the book
Shanghan Lun. The Zhengyang-Yangming syndrome should be the
same as the Yangming Wind-attack syndrome above. There are large
difference in the understanding of the Taiyang-Yangming and the
Shaoyang-Yangming syndrome. Especially for the Taiyang-Yangming
syndrome, most doctor or scholars believe that it is a
condition, in which the Spleen is weak, is in insufficient
status, or in a Yin deficiency condition, so that the weak
Spleen fails to move waster material (stool) down to colon to
pass (so causes constipation). The question is: if the Spleen is
weak, it should be diarrhea or a loose bowel movement, rather
We believe and
agree with the idea that the Taiyang-Yangming develops from the
Taiyang stage and the Shaoyang-Yangming from Shaoyang stage (as
most doctors believe so), but the nature of the Taiyang-Yangming
is the block or the stagnation of Spleen by Wetness-Hotness.
Normally, the Spleen likes dryness environment but hates
humidity. Now it is suppressed by Wetness. It fails to move
water material down to colon to move out, so the stool is hard.
This idea is
supported by the herb constitution of the Maziren Wan, which is
suggested in the book
Shanghan Lun to treat the Taiyang-Yangming syndrome. The
Maziren works to wet the intestine and colon to make the stool
move smoothly and easier. Herb Dahuang works to clear fire and
to remove wetness, so to conduct the stool movement in intestine
and colon. Herb Shaoyao works to nourish the Yin part of the
body, to relax muscle to stop pain. Xingren works to conduct
Lung Qi down, so to
improve bowel movement and to remove stool. The herb Zhishi and
Houpu both work to clear fire and make
Qi move smoothly and
easier in the intestine. The herbs are made into pill form with
honey to fold them. The pill form of herbs works slowly but
constantly. All the herbs work together to clear the wetness and
fire, to conduct the Qi,
and to improve the stool movement. Therefore, the Maziren Wang
works to clear the overwhelming condition, not to nourish the
weak condition. This might be one of the reasons that the use of
Maziren Wan fails to solve constipation: it has been used in
constipation condition that is caused by weakness condition
(deficiency condition), such as Kidney Yin deficiency or
Qi deficiency, not the
Shaoyang-Yangming syndrome forms after sweat therapy, or
urination therapy. In this case, the stomach is dry and annoying
overwhelming, so that the stool is hard to pass. Master
Zhongjing did not tell us which herbal formula to use. We feel
that Da Chaihu Tang might be a proper one.
Taiyang-Yangming and Shaoyang-Yangming syndrome can be regarded
as a sub-type of the Yangming Wind-attack organ stage (the
Zhengyang-Yangming syndrome). In the Taiyang-Yangming, the
stomach feels less bloating. In the Zhengyang-Yangming, the
stomach feels very full and bloating (if the stomach also feels
very painful, it is the Da Jiexiong syndrome or Xiao Jiexiong
syndrome). In the Shaoyang-Yangming syndrome, the stomach feels
bloating mostly in the upper and upper-sided stomach area.
The description of Yangming stage in
Shanghan Lun is very
complex. Here we can only make a preliminary summary about its
main idea. Readers need to check the original content of the
book, as well as refer to the explanation of other TCM experts
in the Shanghan Lun. Here readers need only to remember that in the
Yangming stage, there are Wind-attack and Cold-attack, and there
are Yangming meridian phase and Yangming organ phase.
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