Differentiating the Pulse Syndrome and Treatment of Tai Yang Disease

Course: / Herbal Classics 1 / Date: / November 2, 2010
Class #: / 7 / Prof: / Dr. Wu

First part was Nei Jing. This part is Shang Han Lun, Treatise on Febrile Disease – Cold Injured/Induced Disease written by Zhang, Zhongjin, the Chinese Medical Sage (AD 142-220). He died at the age of 78, not bad in the Han Dynasty!

He wrote 112 herbal prescriptions (compare that to 13 in the Nei Jing which are no longer used), about ½ of which are still in use. 397 paragraphs in the Shang Han Lun regarding treatment strategy and such. When ZZ was 50 years old there was a huge plague in China, which eradicated about 2/3 of his family. At that time he was the governor of his region. He resigned and began to study Chinese Medicine. . . which gives me a lot of hope! I started at 46! Good for me. I’m ahead of the game. 

When ZZ was alive people didn’t go to the doc. He saw all 6 stages of disease and cataloged them. Another section is best know for formulas such as Tang Kuei Shaoyao San. Hurray for that one!

Differentiating the Pulse Syndrome
and Treatment of Tai Yang Disease

Pulse is extremely important to ZZ, but doesn’t mention tongue diagnosis much. ZZ was the first to give sx, pulse, dx, tx prin, and rx.

General Introduction

The stages of disease are given in the SHL by the name of the channels. Does that refer to the foot or the hand channels? Let’s look at the Taiyang channel – 19 hand points, 67 foot points (the longest channel in the body). The taiyang starts at the pinky in the hand, goes to the ear, foot taiyang takes up the slack from the eye down to the foot. Note that the foot channel passes through the trunk. The same is true for the Yangming and Shaoyang channels as well as the yin channels. With all of that in mind, know that Zhang Zhongjing was referring to the foot channels. The Neijing functions the same way, referring to the foot channels, not the hand channels.

Definition of Taiyang Disease

This is the upper jiao area stage of disease. This is a broad definition, referring to a region (UJ), not just a single channel. Superficial area is included also – sweating, no sweating, etc. This is a combination of time (beginning stage) and space (foot taiyang channel and the upper jiao – lungs and superficial area).

The most basic symptoms are below. You should add chills and fever:

Floating pulse
This indicates the superficial area noted above and the invasion by the external invasion.

Headaches
This has to do with blockage in the channel

Stiff neck with aversion to cold
The neck is the bottleneck area of the body. Aversion to cold can also be aversion to wind.

Chills/fever
These should be one or the other, not alternating

Syndromes does not equal symptom. The syndrome is a compilation of all symptoms, location (space) and time. This is why you can’t count on using the same formula the whole time you have a disease.

The classification of Taiyang diseases fall into 2 categories.

1. Wind Attack – Superficial Deficiency
   Why does wind evil cause superficial deficiency? Wind evil is yang and tends to attack upper and cause sweating opening the pores and causing a bit of dehydrating. Qi goes with body fluids, so there is a qi xu, specifically wei qi xu. The sx are not excessive, but deficient.
   
2. Wind attacking syndrome of Taiyang disease characterized by
3. Fever
   Fever with aversion to wind, fever with aversion to cold
4. Sweating
   Pores open due to wind evil.
5. Aversion to wind
6. Soft pulse
   This is a compound pulse and must have the following 3 characteristics
7. Floating
8. Thin
   Body fluid xu, cd be yin, blood, or essence xu, but in this case, just body fluids
9. Weak
   Indicates wei qi xu. How do you re-build? Rehydrate, but also add Xi Yang Shen which tonifies qi and nourishes body fluid.
   
10. Cold attack – superficial excess
    This is a cold attack syndrome of Taiyang disease. Cold evil has 3 characteristics:
    First, it is a Yin pathogen attacking the Yang. When the disease is allowed to progress (Taiyang  Yangming Shaoyang Taiyin Shaoyin Jueyin), Yang becomes less and less because the Cold evil damages it. You will note that as the prescriptions progress they get warmer and warmer – this is the reason. This is also why the prescriptions only apply to the stage that is active in the patient.
    The whole Shang Han Lun is to teach you how to save Yang! This is why 70-80% of the herbs are Yang in nature. Conversely, the warm diseases burn off Yin so the herbs in the Warm Diseases Treatise are about saving yin, conserving body fluids, etc.
    Second, the Cold evil causes coagulation, kind of like a hard freeze causes water to turn to slush then freeze.
    Third, Cold causes obstruction, stagnation, contraction. Pores are blocked, hence, the lack of sweating.
    Cold attack with superficial excess is characterized by:
11. Fever or not fever (yet)
    Why does a yin/cold pathogen cause a yang symptom like fever? Cold causes contracting, blocking the pores. Yang then is blocked and is stagnant – which causes heat that now cannot be drained because of the blockage. That’s why you do a diaphoretic treatment with something like Ma Huang or Gui Zhi. That’s similar to taking Tylenol!
    What if there is no fever? Means there is no fever yet. The blockage will eventually cause it.
    
12. Aversion to cold
    
13. Body aches
    Due to the contraction factor. Note that the wind sx don’t have a lot of pain (except HA), but this one does for the reason just noted .
    
14. Vomiting
    Stomach yang is harassed and affected. This is not a heat related vomit, but cold related – you can use fresh ginger or Huo Xiang … Tang.
    
15. Tight pulse in all (cui, guan, chi) positions
    This is a marker of total excess. Tight pulse vs string/wiry pulse:
16. Wiry pulse is a compound pulse which is straight and long, much like a musical string.
17. Tight is like a twisted cord
    
18. Restrained Wind or Cold Attack
    
19. Time: Taiyang over 8-9 days time.
    Normally Taiyang stage is about a day, then Yangming for 1 day, Shaoyang for 1 day, 3 days for each of the yin stages. When there is no recovery and it lingers, it means the wei/immune is weak and cannot remove the pathogen.
    
20. Fever/aversion to cold
    Still a superficial syndrome!
    
21. More heat than cold
    Cold pathogen is moving from cold to heat
    
22. Vomiting
    MJ is involved.
    
23. Sx come 2 – 3 times per day like malaria!
    This is the key here. Pathogens are staying in the middle part – ½ yin, ½ yang areas of the body. There is a pivot between the two, the MJ/diaphragm, dai meridian area, dividing line between yin and yang. When the wei qi is not strong the disease will move back and forth between yin and yang.
    
24. Urine and bowels are unaffected
    This tells you it’s not moving to Taiyin area.

Pathological Transmission

Normal flow:

Usually the pattern flows from Taiyang  Yangming  ShaoyangTaiyin ShaoyinJueyin. Occasionally goes this way: Taiyang  Shaoyang Yangming Taiyin ShaoyinJueyin.

Note that the Shaoyang and Yangming flip, but the others don’t. Both of these are correct if you are asked on a board! But why is this true? It’s related to body constitution and related to wei qi.

Taiyang to Yangming means Yang is strong and the fight is severe – with the 4 greats. The reaction is strong, the type is excess. This generally applies to young kids, young people, strong body constitution. Weaker people will often flow from taiyang to shaoyang with it’s alternating chills and fever and a less severe reaction overall. Old people, wei qi xu patients, etc will fall into this category.

On the first day of a cold attack, the Taiyang is the location. If the pulse is quiet (or peaceful) it indicates that the disease will not transmit to the next. If, however the pulse gets greater (one of the 4 greats), the patient is moving to Yangming. This comes along with nausea and restlessness in addition to the fast/tight pulse.

If Yangming/Shaoyang sx don’t happen in the 2nd or 3rd day of Cold attack, there is no transmission of the pathogen.

Taiyang stage, if HA lasts 7 days and sx disperse, disease/attack is over. If comes again, likely attacking the next channel (probably Yangming). What points will stop the progression? LI 4, LI 11. LI 11 clears the heat and LI 4 is for….well, everything! Remember that 2nd Metacarpal Bone Therapy from Advanced Techniques? LI 10 and ST 36 are 2 more to use for prevention – this will prevent transmission from any stage to any other. The Yangming channel has the most Qi and Blood when compared to any other channels, hence the ability to prevent.

BioClock Theory with Taiyang Disease

We respond strongly to the external environment. ZZ says follow the natural yin/yang cycles of the day to more effectively treat these disorders.

The symptoms of Taiyang normally are alleviated from 9a – 3p, the shi, Wu and Wei time phases.

Taiyang disease with sx alleviated but not completely gone will be healed in 12 days. This is the 2nd cycle of the whole 6 stages. Allow the body to take 2 cycles to recover.

You need to understand when the energy flows through the channels. When the energy is flowing through the spot you happen to be needling, you get great results. See the Bioclock information given in Advanced Needling

What follows are the rules for each different phase of disease and channel.

And now, the Herbs

Wind Attack with Superficial Deficiency

Gui Zhi Tang Decoction

Wind attack of taiyang ds is due to floating yang with xu yin. When wind invades the superficial area, the wei qi floats. The assumption means that ying and wei qi are harmonized. When wind invades the yang part – wei qi – making the yang part stronger and making yin deficient.

Note that Gui Zhi and Shao Yao should be same amount to maintain balance.

The floating yang causes fever/heat while yin xu = sweating.

The yin xu caused by sweating, aversion to wind, chills, fever, nausea, stuffy nose.

Note that most of the ingredients are from the kitchen.

Gui zhi tastes acrid and sweet. So does rou gui. It is also warm. Goes to Ht, Lu, UB. Yang herb. There are 5 functions:

1. Regulate ying/wei
2. Warm channels and dispel cold
3. Transform qi, unblock yang.
4. Warm/facilitate flow of blood in the vessels
5. Warm and facilitate movement of Yang in chest

Shao yao is bitter and sour and cool – almost opposite of gui zhi! Note doesn’t differentiate between bai shao and chi shao. Dr. Wu says bai shao because this is about tonifying yin in this case. Yin herb. Goes to Lv and Sp. 3 functions:

1. Nourish blood, regulate menstruation
   To regulate menses, use both bai shao and chi shao.
2. Calms and curbs Liver yang and alleviates pain.
3. Preserve Yin and regulate Ying qi and wei qi.

Gan Cao is sweet, can be neutral or warm. Warm is zhi gan cao which is honey cooked giving it more warming function. Gan cao affects all 12 channels! Six functions:

1. Tonify spleen, augment qi.
2. Moistens the Lu and stop cough
3. Clears fire/heat and toxicity
   Use internally or topically.
4. Moderate spasms/eliminate pain
   Shaoyao gan cao tang, for instance.
5. Moderates and reduce harsh property of other ingredients.
   Hence the common use within formulas.
6. Antidote to reduce toxicity
   Commonly with mung beans also which reduce toxicity – especially for food poisoning for instance. Also works for HIV/AIDS (30g + for this purpose).

Sheng Jiang

1. Release exterior w/c
2. Moderate/reduce harshness of other ingredients
3. Warm the MJ, stop vomiting
4. Regulates the Wei/ying qi.

Da Zao is neutral, sweet, goes to Sp/St

1. Tonifies spleen and augment qi.
2. Nourishes blood – also calms spirit
3. Reduces/moderates harshness of other ingredients.

Gui zhi and bai shao yao work together at superficial area, adjusting functions of Wei and Ying qi respectively

Gui zhi / Bai shao yao / Works on the superficial level
Wei qi / Ying qi
Shang jiang / Da zao / Works on the middle, the source of wei ying
Wei qi / Ying qi
Gan cao / Gan Cao / Works on both wei and ying qi.
Wei qi / Ying Qi

Look at the balance here. This is why so many scripts are based upon it.

How to cook:

This is very important.

Break it up and soak it in water. In ZZ’s time, a bamboo knife was used. You should never make metal to break up herbs – will reduce the effectiveness. You add up to 7 cups of water, cook it down to 300ml. Wait for a while and drink the warm porridge to support the herbs – this boost stomach to give more ying and wei qi. Then nap! This will relax you. Cover up with a blanket for a mild sweat. Gui zhi gives a mild sweat. (No ma huang because the person is already slightly dehydrated.) Profuse sweating is not allowed as it will make the ying qi weaker.

Once the sx disappear, stop taking the formula! If no sweating, take it again. Still no sweating? Take it more frequently and finish one decoction in ½ day. Severe cases can take 2 decoctions in 24 hours.

What you shouldn’t do during tx:

No cold, sticky, slippery foods, no meat/wheat, none of the 5 pungent veggies, no alcohol or cheese. All of these will weaken the spleen and damp will increase. Sticky/slippery foods will block the wei qi. No strong smells or foods with strong smells which move the qi too much. This applies to strong perfumes, cosmetics with strong smells, incense, etc.

Indications of Gui zhi Tang

Taiyang ds with HA, fever, sweating, aversion to wind, soft pulse (this is not included in ZZ’s writeup – will have to do this for the test – Wu will give us ZZ’s and ask what’s missing. MC). Taiyang ds with fever/sweating is due to Ying xu with Wei xcs.

After initially taking and sx not go away, but restlessness occurs, then needle GB 20 and Du 16 followed by more Gui Zhi Tang.

Gui Zhi Tang is also used for

1. Cardiovascular disorders as it facilitates the flow of blood in the vessels and moves yang qi in the chest. Also treats Raynaud’s syndrome which is caused by a spasm of the capillaries.
2. OBGYN post partum fever.
3. Dermatitis
   Hives, urticaria
4. Allergies + superficial xu
5. Local sweating due to disharmony of Ying/Wei. Usually neck and above, only on one side. Typical Ying/Wei disorder.
6. Liver Qi Deficiency
   What? No such thing? Turns out there is. Fatigue, weakness caused by stress/depression. Depression gets worse in fall/winter, worse in Oregon/Washington states where there is less Yang.

If Gui Zhi is used incorrectly, you cause some interesting bad sx we will talk about later. You can reverse that with Ren Shen Bai Hu Tang (Bai Hu Tang is too strong on it’s own).

Other complications of Wind Attack

Stiff neck and back, sweating and aversion to wind added to Taiyang disease symptoms. Use Gui Zhi Tang and add 12g of Ge Gen. Doses of Gui zhi and Shao Yao have decreased but are still balanced. Gui Zhi Ge Gen Tang

Ge Gen is sweet, cool, goes to SP, St.

1. Release muscles, dispel heat
2. Nourish body fluid, stop thirst
3. Vents measles (winds missles)
4. Stop diarrhea
5. Hypertension

Another complication: Wheezing. Use Gui Zhi Jia Hou Po Xin Zi Tang

Hou po is acrid, bitter, warm, strong smell. Lu, Li, Sp, St.

1. Facilitates movement of Qi, trx dampness, guide out stagnation
2. Warm/transform phlegm. Descend rebelling qi.

Xing Ren is bitter, sl warm, sl toxic. Goes to

1. –cough/wheeze
2. moist LI, + bm

Good to clean the lungs and interestingly enough, externally to clean metal – antiques like copper.

Contraindications:

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