TCM Diagnostics II Final Study Questions

Course:
Diagnostics II
Six Channel, Four Level, San Jiao Theories
Date:
Six Channel Theory

Cold Injured Diseases
Who extrapolated the Six Channel Theory?
Zhang Zhongzing
What is the order of a diseases progress per the Six Channel Theory?
1. Taiyang Syndromes ( 2 subcategories of this)
a. Taiyang Zhong Feng Syndrome
b. Taiyang Shang Han Syndrome
2. Yangming Syndrome (2 subcategories of this)
a. Yangming Jing Syndrome
b. Yangming Fu Syndrome
3. Shaoyang Syndrome
4. Taiyin Syndrome
5. Shaoyin Syndrome
a. Shaoyin Cold Syndrome
b. Shaoyin Heat Syndrome
6. Jueyin Syndrome
Taiyang Syndromes
First level of a disease - external. Beginning of a problem.
2 subcategories
Taiyang Zong Feng Syn.
Wind attack, similar to
ext. def (which is also a
wind heat thang)
Taiyang Shang Han Syn
Wind/cold type syn.
Similar to ext.excess
Mild fever and chills

Aversion to wind
,Easily/frequently perspires
Headache
Tongue: pale or normal, thin white coating
Pulse: Floating, slowed down
Chills greater than fever
,No sweating
Headache
Neck and body pain
Tongue: normal body, thin white coat
Pulse: floating and tight
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12/11/07
Yangming Syndromes
2nd stage of a disease progress, already in the interior. Organ related. Yangming is rich in Qi and Blood,
so once a disease gets here it has conquered great resources.
2 subcategories.
Jing or Channel
Syndrome
4 greats:
Fu or Organ
Syndrome
No aversion to cold
,No constipation
Red face
Great fever
Great sweating
Great thirst
Great pulse
Tongue: red body with yellow and dry coating
Pulse: rapid
Constant fever, more pronounced in the afternoon
Abdominal distention and pain
Constipation
Tongue: red body with prickles, coating is dry, thick, yellow.
Pulse: deep, excessive
Shaoyang Syndrome
3rd stage of a disease. Very specific: Half interior and half exterior.
Shaoyang Syndrome
,Chills and fever alternate

Bitter taste in the mouth (gb and sj involved, many heat signs)
Dry throat
Dizziness and blurred vision
Poor appetite, nausea, vomiting
Pain in the hypochondriac region
Restlessness and irritability
Tongue: red on sides, white or thin yellow coating
Pulse: Wiry
Taiyin or Greater Yin Syndrome

Related to spleen and MJ. Usually interior, deficient, cold, damp.
Taiyin/Greater Yin Syn
Abdominal fullness or pain

Nausea and vomiting
Diarrhea
No thirst
Tongue: pale w/white greasy coating
Pulse: deep, weak, slow
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Shaoyin Syndromes
Usually interior, cold, deficient manifestations.
Shaoyin is kidney and heart in zangfuso is this.
2 subcategories
Shao Yin Cold Syn.
No fever
Aversion to cold, cold limbs (greater than taiyin syndrome)
Tendency to sleep, listlessness
Diarrhea with undigested food bits (cold fx spleen/kidney)
Clear urine with increased volume (kidney yang)
Tongue: pale with white coating
Pulse: deep, minute or deep, slow weak if kidney yang deficiency
Looks like Kidney Yang Def. Cold symptoms more severe than Taiyin level, more focused at
lower levels.
Shao Yin Heat Syn
Restlessness
Irritability
Insomnia
Dry mouth and throat
Scanty deep-yellow urine
Tongue: red body, red tip, little coating
Pulse: thin + rapid
Looks like Heart/Kidney Disharmony (Ht + Kd Yin Xu) pattern.
Jueyin or Terminal Yin Syndrome

Last stage problem complicated and severe. Correlates to liver/pericardium in zangfu.
Jueyin Syndrome
Upper heat, lower cold

Thirst
Ascending of Qi to chest
Burning sensation in chest
Hungry, no desire to eat
Vomiting of ascarides after meals
Tongue: red/pale
Pulse: varied. Slippery, deep, weak, hidden, wiry.
Different organs involved, many possible pulses
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Theory of Four Levels

Warm Injured Diseases
Who postulated it?
Ye Tianshi
What are the Four Levels?
A progression of a disease from onset to end. The levels are:
1.
2.
3.
4.
Wei (Defensive level)

Qi (2nd level)
Ying (Nutritive level)
Xue (Blood level)
What are the characteristics of a disease that can be classified by the Four Levels theory?
Refers to epidemic diseases.
1.
2.
3.
4.
Fast onset
Fever, likely very high fever, early in the disease
Heat signs/symptoms are the primary manifestation
Body fluids and yin easily damaged due to high fever
Disease pattern
Wei (Defensive)
Manifestations
Fever
,Chills and slight aversion to cold
Slight or absent sweating
Sneezing
Cough
Nasal congestion
Sinus drainage
Sore throat
Headache
Slightly increased thirst
Tongue: red tip, white coating (might be slightly yellow)
Pulse: floating, rapid
Pathology: Stagnation of the protective Qi due to the struggle between the protective Qi and WarmHeat Pathogens, leading to the failure of the lung in dispersing the protective Qi to the surface, nose,
throat.
Looks like common cold/external wind-heat attack. Characterized by defensive functions of the body
fighting pathogens.
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Disease pattern
Qi
Manifestations
,Four Greats
Vigorous fever
Profuse Sweating
Pay attention to this one!
Thirst (pref for cold beverages)
Pulse floating and slippery
Aversion to heat
Urine: scanty, yellow, possibly dark
Tongue: dry yellow coating
Pulse: floating or slippery
Pathology: Heat from excess and injury to fluids, which is a consequence of the severe struggle
between antipathogenic Qi and Warm-Heat pathogen.
Getting deeper into interior. Compare to Yangming in Six Channel Theory
Lung, Stomach, Large Intestine mostly involved in this level.
Disease pattern
Ying (Nutritive) Pattern
Manifestations
Fever gets worse at night
Insomnia
Irritability
PC/Ht/Shen signs in yellow
Restlessness
Occasional delirium or muddled consciousness
Thirst with little desire to drink
,Maculopapular manifestations on skin
Tongue: deeper red than wei or qi patterns
Pulse: thin and rapid
Pathology: Inward progression of protective or Qi level patterns. Blazing heat damages Yin and
disturbs the Heart Shen.
Disease pattern
Xue (Blood) Pattern
Manifestations
Fever
Restlessness or delirium
Muddled consciousness or coma
Loss of blood
Maculopapular manifestations on entire body
Tongue: very deep red, crimson
Pulse: thin and fast or- choppy
Pathology: Warm-heat pathogen penetrates deeply, disturbs and exhausts the blood
Look for the blood signs for this pattern. Heart, liver, kidney are organs involved in this pattern.
Excess Heat in Blood Level
Organs involved: heart and liver
Fever
Irritation, mania
Purplish or dark macula
Many skin problems are due to heat inside the blood.
Blood in stools or urine
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Tremors to spasms/rigidity in the mouth, neck or even opisthotonos (severe rigidity of the
back musclessometimes severe enough that the head will touch the heelsdamn!)
Too much heat causes wind, then spasms.
Tongue: deep red or scarlet or purplish
Pulse: wiry and fast
Deficient Heat in the Blood Level (yin defic)

Organs involved: liver and kidney
Constant lower fever
Five palm heat
Fatigue
Emaciation
Mild tremors in four extremeties
Tongue: red/purple with less coating
Pulse: thin and fast .
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San Jiao Differentiation

Warm Injured Diseases
Upper jiao
Location: above the diaphragm.
Organs in UJ: lung, heart, pericardium
Middle jiao
Location: between upper and lower jiao.
Organs in MJ: stomach, spleen, large intestine and small intestine
Lower jiao
Location: below the umbilicus.
Organs in LJ: liver, kidney, bladder, uterus
Upper Jiao Pattern

Lung can be Wei and Qi, PC cn be ____...missed that.
Lung Pattern 1
Definition:
Disorder of ascending and descending of Lung Qi due to external pathogen attacking.
Looks like wind-cold invasion when compared to the Eight Principles. Comparing to 4
levels, compares to Wei Level. Lung relates to both Wei and Qi.
Manifestations:
Fever
Slight aversion to wind-cold
Headache
Slightly thirsty
Cough
Tongue: thin white coating
Pulse: floating and fast
Treatment: Ma Huang Tang, LU 7, cupping
Lung Pattern 2
Definition:
Blockage of Lung Qi due to accumulation of Lung Heat.
More heat signs here. Compare to Qi level in the Four Level Theory.
Manifestations:
Fever
Sweating
Thirsty
Dyspnea
Tongue: red with yellow coating
Pulse: fast
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Treatment: clear the heat. Can use Ma xing shi gan tang formula. LU 5, LI 11 and
Ren 17. ST 40 for d/h.
Pericardium Pattern
Definition:
Blockage of Pericardium by invasion of heat.
Pericardium/Heart related to Shen, see those signs below.
Compare this to the Jing level in the Four Levels.
Manifestations:
Muddled consciousness
Delirium
Retraction of the tongue
Cold extremeties
Fever
Tongue: deep red
Pulse: thin and rapid
Treatment: use Shen points and clear heat points. Ht 7, PC 8. Du 24. Ren 26.
Middle Jiao Patterns
Relates to Qi level
Stomach patterns
Definition:
Excessive Heat in the Stomach
Compare to Qi level of Four Levels
Manifestations:
Fever w/o aversion to cold
Red face and eyes
Sweating
Thirsty
Rough breathing
Tongue: Yellow/dry coating
Pulse: flooding, large.
Treatment: ST 44
Large Intestine Pattern
Definition:
Heat accumulation in LI
Manifestations:
Fever reaching height in afternoon
Constipation
Concentrated urine
Tongue: yellow, black, dry coating
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Pulse: deep, strong
Spleen Pattern
Definition:
Disturbance of Spleen by damp heat
Manifestations:
Contained fever which still exists even after sweating
Cannot disperse due to sticky/damp nature of this damp heat condition.
Distention in chest and epigastrium
Nausea
Tongue: heavy body, greasy coating
Pulse: soggy
Lower Jiao Patterns

Relates to the Ying and/or Xue levels. But liver fire can be only Qi level as well.
Kidney Pattern
Definition:
Consumption of Yin by heat
I.e., Yin deficiency causing heat. Usually this is hypertension (kidney or liver yin def
causing yang rising)
Manifestations:
Fever
Malar flush
Relatively warm palms/soles
Fatigue
Pulse: deficient
Formula: Liu wei di huang tang.
KD 3, KD 6. Kidney 3 is a creek, Kidney 6 is an ocean of water.
Liver Pattern
Definition:
Malnutrition of Liver and inner wind due to Kidney Yin Xu
Warm disease hurts the Yin. Kidney and Liver have the same source, so kidney
deficiency can directly cause this problem.
Manifestations:
Convulsions and trembling
Listlessness
Palpitation
Tongue: dry, atrophied, deep red tongue
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Pulse: weak
Gou Qi Zi wd be a good herb. LV 3, UB 18.
What is the relationship between the San Jiao and Four Level theories? Both try to understand and
explain the progress of a Warm Injure Disease. Four Levels describe progression from superficial to
blood level. San Jiao goes from upper level to lower level though the jiaos.
Final Exam Review:

Before exam, have a good breakfast!
75 questions including 70 MC and 5 case discussions. Comprehensive.
Eight principles
Zang Fu differentiations including single zang fu and combinations
Six Channel
4 level
3 Jiao
Review all cases discussed!!!
Turn in reading log and the zangfu charts.
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TCM Diagnostics II Final Study Questions

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Course:

Six Channel Theory

Mild fever and chills

,Chills and fever alternate

Taiyin or Greater Yin Syndrome

Abdominal fullness or pain

Shao Yin Heat Syn

Jueyin or Terminal Yin Syndrome

Upper heat, lower cold

Theory of Four Levels

Wei (Defensive level)

Deficient Heat in the Blood Level (yin defic)

San Jiao Differentiation

Upper Jiao Pattern

Pulse: deep, strong

Lower Jiao Patterns

Final Exam Review:

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