2c. Six Jing diagnosis –Shaoyang
Xieqi (the disease-causing energy entity) invades deeper than the
Taiyang layer, but not to the Yangming layer, e.g. it stays in
between the Taiyang and the Yangming stage, the disease belongs
to the Shaoyang stage.
indicated in the Shanghan
Lun, the key point to diagnose Shaoyang stage is the bitter
taste in mouth, dryness in throat and eye dizziness. We can
first name this syndrome as Shaoyang type I syndrome. It is for
easier discussion later with other types of Shaoyang stage.
patient has bitter taste in mouth, dryness in throat, dizziness,
we will say that the patient gets into the Shaoyang stage of the
taste in mouth: the taste can be really a bitter, but can also
be some other kinds of taste, such as sweet, puckery,
astringency, salty, or spicy. Doctors in College style may only
remember from their text book that it should be bitter taste
only, because they learned from text book that the sweet taste
belongs to Spleen; the Spicy taste belongs to Lung; the Salty
state belongs to Kidney; and the sour taste belongs to Liver.
However, according to the text book (the theory comes from
Huang Di Nei Jing
actually), the bitter taste should belong to the Heart. Here in
Shanghan Lun, the bitter taste belongs to Shaoyang
stage, e.g. the Liver-gall bladder system. It appears that, the
Shanghan Lun does not follow the
Huang Di Nei Jing
system. In clinic, whenever there is strange state in mouth, we
should consider the possibility of Shaoyang stage, regardless
what kind of taste in mouth.
throat: in the Taiyang stage, the patient has no dryness or
thirsty feeling in mouth or throat. In Yangming stage, the
patient feels thirsty. Here, the patient feels only dryness.
Apparently, whether the patient feels dry or thirsty is very
important in the diagnosis.
dizziness: it should mean that the dizziness happens when the
eye is open. It disappears or stops after close of the eye. It
can also be that the dizziness occurs after close of eye, but be
better after open the eyes. The eye dizziness can be dizziness
but can also be a dislike or fear of light.
If the dizziness is related to the head position and body
position, it suggests that the disease might be due to something
else, such blood deficiency or cervical spondylosis.
Yangming stage, patient can also have dizziness, but it is not
affected by the position of the head or body, or by the open of
close of the eyes. In the Yangming Wind-attack syndrome, the
dizziness is there no matter the patient eats or not. In the
Yangming Cold-attack syndrome, the patient feels dizziness
mostly after eating.
treatment of the Shaoyang type I syndrome, Xiao Chaihu Tang is
used. Xiao here means small; Chaihu is the name of a herb.
Shaoyang type II syndrome
patient feels shift of chilly and hotness, similar to that of
menopause syndrome; feels strong bloating in chest, no appetite
at all, feels irritated, and tends to have nausea. We call these
conditions as “Shaoyang type II syndrome”.
with this syndrome could have much more other symptoms, such as
irritated feeling in chest without nausea, or feels thirsty, or
feels pain in belly, or has sticky bloating and hard feeling in
the upper side of the belly, or feels palpitation in the upper
stomach, and has difficulty in urination, or not thirsty feeling
but has slight hot feeling in the body, or have cough. After
drink of the Chaihu-containing herbal tea and if the patient
feels thirsty, the condition belongs to Yangming stage. Treat
the Yangming stage (refer to the Yangming chapter for solution).
diagnose this syndrome, either one of the symptoms is enough to
set up the diagnosis:
shift of chilly and hotness; strong bloating in chest, no
appetite, irritated and tends to have nausea. Once the diagnosis
is set up, we can consider the use of the Chaihu-containing
herbal formulae for the treatment. Of course if all the three
symptoms exist, the diagnosis of Shaoyang stage is more correct.
patient “tends to have nausea” means the patient wants to have
nausea so as to release the discomfort. This is different from
the nausea in the Cold-attacked Yangming stage, in which the
nausea comes after eat and the nausea makes the patient feel not
Shaoyang stage, the patient has no desire to eat. In the
Yangming stage, the patient has desire to eat, but dares not to
eat, because after eat, the patient will feel pain in stomach
and has nausea.
deafness – red eyes – bloating in Chest and irritated feeling
syndrome of the Shaoyang stage
patient feels reduced hearing ability, has red color in the
eyes, feels bloating in chest and feels irritated, we will say
that the patient also comes into the Shaoyang stage.
deafness: the hearing ability is reduced, or even completely
lost. The patient may feel block feeling in the ears.
one eye or both eyes turns into red color. The eye may also feel
pain or itch, or tearing from the eyes.
treatment of this syndrome, Xiao Chaihu Tang is also the choice.
Shaoyang type IV syndrome: Acute stomach pain syndrome of
patient has any of the symptoms above, which is sufficient to
diagnose Shaoyang stage, and also has acute stomach pain (the
pulse can be either floating-harsh or deep-and-string), use Xiao
Jiang Zhong Tang for the treatment first. If it does not work,
change to use Xiao Chaihu Tang.
type of Shaoyang stage in female:
If a female got the
Shanghan disease and feels chilly and hot, and the same time she
has menstruation comes, her fever is over, but she feels cold in
the body, has slow pulse, bloating feeling in the upper-side of
the belly, and has delirium, this is the condition that we call
it Hotness invasion into uterus. For the treatment, use
acupuncture on Qimen point, to deplete the
Xieqi through the
the female has Shanghan disease when her menstruation comes, she
had delirium at night seeming she see a ghost, but normal during
day time. This is also a kind of hotness invasion in uterus.
This condition will cure by itself, if the
Xieqi does not affect
the stomach and the chest.
When the Hotness invades into
the uterus, seven to eight days after the Shanghan disease, the
Xie Hotness will
entangle in the uterus, which stops the menstruation and makes
the female feel chilly and hot shift, which happens on fixed
time. In this case, use Xiao Chaihu Tang for the treatment.
to entangle; Xiong means chest. It means the
Xieqi is entangled in
the chest cavity. This condition is caused by over sweat due to
sweat therapy (Insufficient sweat therapy makes the disease
falls into the meridian phase of Yangming stage).
patient with the Jie Xiong condition feels shot of breath,
irritated, anxiety, and feels hard and pain in the upper stomach
area. This condition needs Da Xian Xiong Tang for the treatment.
Da here means big. Xian means to shrink in, or to fall down.
Xiong means chest.
patient with the Jie Xiong condition can also feel hard,
fullness, bloating and pain from the upper stomach to the lower
stomach (the whole belly – similar to the organ phase of the
Yangming stage), which is so pain that the patient do not want
the stomach be touched. The patient has no bowel movement for
several days, feels dry and thirsty in the mouth and tongue, and
has fever in the afternoon. The Da Xian Xiong Tang is also used
for the treatment of this type of Jie Xiong condition.
patient feels pain in the upper stomach, which is painful when
touch, with floating-slippery pulse, it is called Small Jie
Xiong condition. This condition needs Xiao Xian Xiong Tang for
the treatment. Xiao here means small.
patient feels hard and pain in the upper stomach, and feels very
tight and stiffness on the neck, we use Da Xian Xiong pill for
There is a
condition or syndrome called Zhizi Chi Tang in
Shanghan Lun. It is
introduced and scattered in different chapters for different
stages (in the Taiyang, Yangming and Jueyin stages), but it is
almost always introduced as a outcome of a improper treatment of
that disease by use of sweat therapy, vomiting therapy, a colon
cleansing therapy, or a hot-needle acupuncture therapy. It is
characterized as irritated without clear reason (no clear
physical reason, such as pain, or emotional reason, such as
angry to someone). The location of the disease is in the chest
(actually it is located in the pleural cavity), not in the lung,
therefore the patient has no cough or phlegm, such respiratory
symptoms, but has emotional symptoms, such as irritated (not
means stress or anxiety). There is no such irritated symptom in
other Shanghan disease stages. Here we should mention that, the
irritated feeling is not the restless feeling. They are
different. For the restless symptom, the patient has restless
arm and/or legs. The arm and/or leg jumps from time to time. It
is a typical symptoms indicating Shaoyin stage.
are the paragraph introducing the Zhizi Chi Tang:
Shanghan Lun – Taiyang disease-middle part: “After sweat therapy, vomiting therapy
or colon-cleansing therapy, if the patient feels no-reason
irritated feeling and hard to fall into sleep, in severe case,
the patient may turn over and over on the bed and feels terrible
irritated. In this case, use Zhizi Chi Tang for the treatment.”
sweat therapy or colon cleansing therapy, if the patient feels
annoying hot, and feel chock and press in chest, use Zhizi Chi
Tang for the treatment.”
Shanghan Lun – Yangming disease: “In the Yangming disease, if the pulse feels
floating and tight, the patient feels dry mouth and bitter taste
in mouth, the stomach feels full and the patient has asthma,
fever and sweat, no chilly feeling, but dislikes hot, and if the
body feels heavy, in such case, the use of sweat therapy would
cause restless and the patient feels frustrated or fluttered
feeling in heart and has delirium. If hot acupuncture needle is
used, the patient will have scare feeling, palpitation and hard
to fall into sleep. If colon-cleansing therapy is used, the
stomach becomes hollow and empty, with a feeling as gas rushes
up the diaphragm, a feeling of irritated, and the tongue is with
heavy tongue covering. In this case, use Zhizi Chi Tang for the
“After use of
colon-cleansing therapy in Yangming stage, if the patient feels
hot, warm in hands, no Jiexiong syndrome, feels irritated, feels
hungry but cannot eat, and has sweat on head, use Zhizi Chi Tang
for the treatment.”
厥阴篇>> : “下利后更烦,
Shanghan Lun – Jueyin disease: “If, after colon-cleansing therapy, the patient feels
more irritated, but the stomach area is soft when press, it is
no-mass irritated (Xu irritated), use Zhizi Chi Tang for the
Shaoyang stage can also be separated into the Cold-attack
Shaoyang stage and the Wind-attacked Shaoyang stage, but the
most of the Shaoyang condition belongs to the Wind-attacked
（Most of the Taiyin
stage comes from Cold-attack. See later chapter）
should be pointed out that in the TCM text book, to diagnosis
the Xiao Chaihu Tang syndrome (condition), the pulse should be
string. This is not indicated in the
Shanghan Lun. In the Jing Fang style of TCM, the pulse in the
shaoyang stage might be largely variable, though certainly it
should not be deep (deep pulse indicates Shaoyin stage, see
bellow). In the first three types of Shaoyang stage, there is no
indication that the string pulse is necessary for the diagnosis.
If we stick to the idea from the TCM textbook that to diagnose
Shaoyang stage, and to decide whether to use Chaihu-containing
herbal formulae, need the string pulse, we will miss a lot of
chance to use the Chaihu Tang series.
Nowadays, once seeing a patient with the hot and chilly shift
feeling, the ordinary doctor will soon consider about the
half-surface-half-inner symptom and consider the use of Xiao
Chaihu Tang for the treatment. In fact, the Xiao Chaihu Tang
condition needs to be distinguished with other conditions in the
book Shanghan Lun, such as Guizhi Two Mahuang One Tang, and Guizhi two
Yuebi One Tang. In addition, in menopause syndrome, the patient
can also feel hot, then followed by sweat and chilly. Such
hot-cold shift symptom needs different herbal therapy.
Guizhi Two Mahuang One Tang condition, the patient feels fever,
dislikes cold, and the pulse feels big-wave like.
Guizhi Half and Mahuang Half Tang, the patient feels fever and
chilly, more fever than chilly, red color on face and itch in
body. For the Guizhi Two Yuebi One Tang, the patient also has
fever and chilly, more fever than chilly, but the pulse feels
weak. For the Xiao Chaihu Tang condition, the patient has
annoying floating feeling in the chest, silent without desire to
eat, annoying and nausea, beside the hot-chilly shift.
we can see that, for Taiyang stage, the disease is located
mostly on the back of the body surface: the back of head, the
back of neck, the back of body, the back of the legs and the
outside of the ankles (Urine bladder is special).
Yangming stage, the disease is located mostly in the stomach
(including the large intestine and colon mostly). The disease
location still connects to the out side of the body (through the
mouth and anus).
for the Shaoyang stage, the disease mostly affects the opening
of the body, such as the eyes, the ears, the mouth and the
throat (uterus is special), as well as the sealed space of the
chest (e.g. the pleural cavity) and the stomach (peritoneal
It is a
question for which stage the nose and the lung should belong to.
An allergic sinusitis needs treatment by use of Xiao Qinglong
Tang, or Guizh Fuzi Tang, or Guizhi plus Fuzi Tang. For chronic
sinusitis or hypertrophic rhinitis, it is needed to use Gegeng
Tang or similar formula, which of the formulae belong to
Yangming stage. All in all, they do no belong to Shaoyang stage
disease. The diagnosis and treatment of the respiratory diseases
has been discussed in a sister book of the
Shanghan Lun: the
Shanghan Za Bing Lun. No clear indication for which stage the
diseases of nose and lung mostly belong to.
We do not
mean that the Shaoyang stage should be considered first if the
disease involves the eyes, the ears or the throat. But if the
course of the diseases in these locations is short, and if the
disease follows a common cold, we consider the Shaoyang disease
and to use the Chaihu-containing herbal formulae is reasonable.
the Shanghan Lun,
compared with the chapters for Taiyang disease and Yangming
disease, the chapter for Shaoyang disease is very short. This
does not mean that there are less kinds of syndromes or
conditions in the Shaoyang stage, or there is no more need to
discuss for the Shaoyang disease. This is because the disease
location of the Shaoyang is between the body surface layer (Taiyang
stage) and the inner layer (Yangming stage). If the disease
energy is stronger, the disease develops deeper into the
Yangming stage, and if the body defense system becomes stronger
or the treatment is proper, the disease could turn back to the
Taiyang stage. Also, when the disease is in the Taiyang stage,
an improper treatment in the Taiyang is easy to push the disease
deeper into the Shaoyang stage, making the patient feel
irritated, stroke feeling, depression, nausea, bloating,
hot-cold shifting feeling, etc. For this reason, we regard most
of the syndromes that happen after improper treatment of Taiyang
stage, into the Shaoyang stage, unless it has been clearly
indicated in the book that the symptoms belong to Yangming
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