Chapter44identificationofpatternsaccordingtothesixstages六经辨证
Thefirststage,Greater-Yang,isthebeginningstagesandtheonlyexteriorstage,atthegreat-yangstage,theexteriorwindisstillontheexteriorofthebodyandtheinternalorgansarenotaffected(althoughtheGreater-Yangstagedoeshavetwoorganpatternsaswell).AlltheotherstagesarecharacterizedbypenetrationofthepathogenicfactorintotheinteriorintheBright-Yangstageintheyangandinthethreeyinstagesintheyin.TheLesser-Yangstageissomewhatdifferentasitischaracterizedbytheoscillation摆动ofthepathogenicfactorbetweentheexteriorandtheinterior.
Great-Yangstage
Thefirststage,Greater-Yang,isthebeginningstageandtheonlyexteriorstage,attheGreater-Yangstage,theexteriorwindisstillontheexteriorofthebodyandtheinternalorgansarenotaffected(althoughtheGreater-Yangstagedoeshavetwoorganpattersaswell).
Channelpatterns Invasionofwind-coldwithprevalenceofwind Clinicalmanifestations:
Slightaversiontocold,aversiontowind,slightfever,slightsweating,headache,stiffneck,sneezing,floating-slowpulse Treatment:
Releasetheexterior,expelwindandcold,restorethediffusingoflung-Qi,andharmonizenutritiveanddefensiveQi Invasionofwind-coldwithprevalenceofcold Clinicalmanifestations:
Slightaversiontocold,slightfever,absenceofsweating,headache,stiffneck,sneezing,runnynosewithwhitedischarge,breathlessness,floating-tightpulse Treatment:
Releasetheexterior,expelwindandcold,andrestorethediffusinganddescendingoflung-Qi organpatterns Accumulationofwater Clinicalmanifestations:
aversiontocold,fever,retentionofurine,slightthirst,vomitingoffluidssoonafterdrinking,floating-rapidpulse Treatment:
Releasetheexterior,promotethebladder’sfunctionofQitransformation,andpromotetheexcretionoffluids. Accumulationofblood Clinicalmanifestations:
Hypogastric下腹部distension,fullnessandurgency,bloodinurine,mentalrestlessness,reddishpurpletonguewithoutcoating,deep-fine-rapidordeep-choppypulse. Treatment:
Invigorateblood,eliminatestasisfromthelowerburner,andclearheatfromthebladder Bright-Yangstage
Channelpatterns Clinicalmanifestations:
Highfever,profusesweating,intensethirst,redface,afeelingofheat,irritability,delirium,redtonguewithyellowcoating.Overflowing-rapidorbig-rapidpulse.
AttheBright-Yangstage,thepathogenicfactorhasbecomeinteriorandtransformedintoheat.Therefore,fromtheeight-principlepointofview,thispatternisinteriorfull-hot,thispatterncandevelopfromboththeGreater-YangandtheLesser-Yangstages.
TherearetwotypesofpatternsattheBright-Yangstage:
onecharacterizedbyheat‘withoutform’(wuXing),called‘Bright-Yangchannelpattern’
Theothercharacterizedbyheat‘withform’(youXing),called‘Bright-Yangorganpattern’.
Onecouldalsosaythatthechannelpatternischaracterizedbyheat.Whereastheorganpatternischaracterizedbyfire.
Inthechannelpattern,thereisheatand,althoughthisisinterior,itisintenseandprojectedtowardsthesurfaceofthebody,forthisreason,itisclearedwithpungent-coldherbs,whichpushtheheatoutwards(thepungenttastehasanoutward,floatingmovement).
Thispatternischaracterizedbywhatarecalledthe‘fourbigs’:bigthirst,bigsweating,bigfeverandbigpulse.Intestineheatcausesthethirstandsweating;theheatisinthestomachand,asthisisthesourceoffluids,thereisintensethirst.Contrarytothegreater-yangstage,inthiscase‘fever’doesmeananactualfever,whichiscausedbyinteriorheat;thisisthereforean‘interiorfever’comparedwiththatatthegreater-yangstage,whichisan‘exteriorfever’.Besidesthefever,thereisalsoapronouncedfeelingofheatanddefinitelynoaversiontocold—indeed,thedisappearanceoftheaversiontocoldandtheonsetoftheaversiontoheatheraldsthechangefromthegreater-yangtothebright-yangstage. Treatment:
Clearstomach-heat organpatterns Clinicalmanifestations:
Highfeverthatisworseintheafternoon,profusesweating,sweatingonlimbs,abdominalfullnessandpain,constipation,drystools,thirst,darkurine,redtonguewiththickdryyellowcoating,deep-full-slippery-rapidpulse.
Treatment:
Drainfirefromthestomachandintestines,andmovedownward
Lesser-Yangstage
Lesser-Yangstage Clinicalmanifestations:
Alternationofshivers(orcoldfeeling)andfever(orafeelingofheat).Bittertaste,drythroat,blurredvision,hypochondrialfullnessanddistension,lackofdesiretoeatordrink.Irritability,nausea,vomiting,unilateralthinwhitecoating.Wiry-finepulse. Treatment:
Harmonizethelesseryang.
Greater-Yinstage
Greater-Yinstage Clinicalmanifestations:
Abdominalfullness,afeelingofcold,vomiting,lackofappetite,diarrhoea,absenceofthirst,tiredness,paletonguewithstickywhitecoating,deep-weak-slowpulse.
Thegreater-yinpatternisthefirstoftheyinpatterns.ItischaracterizedbySpleen-YangdeficiencywithcoldtheobstructionofcoldintheabdomencausesabdominalfullnessandvomitingwhereastheothersymptomsarecausedbySpleen-Yangdeficiency.
Fromtheeight-principlepointofview,thepatternisinteriorempty-cold Treatment:
Tonifyspleen-yangandexpelcold.
Lesser-Yinstage
Lesser-Yinstage Coldtransformation Chills,afeelingofcold,lyingwithbodycurled,listlessness,desiretosleep,coldlimbs,diarrhoea,absenceofthirst,frequentpaleurination,paleandwettonguewithwhitecoating,deep-weak-slowpulse.
ThepathologyofthispatternisessentiallyKidney-Yangdeficiencywithcold(interiorempty-cold) Treatment:
TonifyKidney-yangandexpelcold. Heattransformation Afeelingofheat,irritability,insomnia,drymouthandthroatatnight,darkurine,nightsweating,redtonguewithoutcoating,finerapidpulse.
ThepathologyofthispatternisKidney-Yindeficiencywithempty-heat.(interiorempty-heat) Treatment:
TonifyKidney-Yinandclearempty-heat
Terminal-yinstage
Terminal-yinstage Clinicalmanifestations:
Persistentthirst,afeelingofenergyrisingtothechest,painandasensationofheatinheartregion,hungrybutnodesiretoeat,coldlimbs,diarrhoea,vomiting,vomitingofroundworms,wirypulse.
Thispatternischaracterizedbyheatabove(thirst,afeelingofenergyrising,painandasensationofheatintheheartregion,andhunger)andcoldbelow(nodesiretoeat,coldlimbs,andvomiting).
Insomecases,thispatternisseeninroundworminfestation. Treatment:
Clearheatabove,expelcoldbelow,andharmonizetheliverchannel.
1/5Chapter44identificationofpatternsaccordingtothesixstages六经辨证
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