This book is designed for the serious student of Chinese medicine. Both the beginner and advanced practitioner will find this information useful from school to everyday clinical practice. The first section of the book covers a basic history and evolution of the six stages of disease. Chapter Two reviews various theoretical concepts related to the six stages. Symptoms and treatment concepts, according to the Chinese classic Shang Han Lun, are examined in Chapter Three. In Chapter Four complications of combined and overlapping stages of disease show how disease many times will not follow the normal progression of the Six Stage Model. An in- depth study of conformations and the basic treatment concepts for each of the stages are presented in Chapter Five. A quick overview of the twenty-four basic classifications of Chinese herbal formulas will be found in Chapter Six. Primary herbs for each stage and their related formulas are examined in Chapter Seven. Chapter Eight deals with differential diagnosis of syndromes and treatment. Conformations for formulas and a comparison to other formulas from the Classic Shang Han Lun (Treaties on Fever and Chills) and the Jen Kuei Yao Lue (Perceptions from the Golden Chamber) are the main emphasis in Chapter Nine. Practitioners will find Chapter Ten a very useful clinical reference of all ninety herbal formulas (in table form) found in this book. In Chapter Eleven, there are four major lists dealing with the names of individual herbs. The first three lists are a cross reference for herbs listed by the Pin Yin, Pharmaceutical, and Common names. The fourth list gives the classification and function of the 118 herbs used in this work.
Six Strands of the Web
An In-depth Study of the Six Stages of Disease In Traditional Chinese MedicineBy James Michael MooreAuthorHouse
Copyright © 2012 Dr. James Michael Moore
All right reserved.ISBN: 978-1-4772-0874-8Contents
About the Author............................................................................xiiiAbout This Book.............................................................................xvNotice......................................................................................xviiPreface.....................................................................................xixChapter 1: History of Six Stages of Disease Model...........................................1Chapter 2: Basic Theoretical Concepts Related to Six Stages.................................14Chapter 3: Symptoms and Treatment According to the Shang Han Lun............................36Chapter 4: Combined and Overlapping Diseases................................................43Chapter 5: Conformations for the Six Stages.................................................46Chapter 6: Traditional Classification of Formulas...........................................57Chapter 7: Basic Herbs and Formulas for the Six Stages......................................73Chapter 8: Differential Diagnosis for the Six Stages Syndromes..............................80Chapter 9: Shang Han Lun Basic Formulas (Indications and Conformations).....................112Chapter 10: Herbal Formula (Tables).........................................................132Chapter 11: Individual Herb Lists...........................................................226Bibliography................................................................................277
Chapter One
History of Six Stages of Disease Model
Overview
The main emphasis in this section is on the history and development of Chinese medicine and its spread to other countries.
• History and evolution of "six stages of disease model"
• Huangdi's Internal Classic, or Huangdi's Cannon of Medicine
• Shang Han Lun (Treatise on Chills and Fever)
• Jen Kuei Yao Lue (Prescriptions from the Golden Chamber)
• Japanese Kanpo
The Six Stages of Disease (Liu Jing Bian Zheng)
Introduction
The "Six Stages of Disease" is a theoretical concept that can be used as a model to help understand the progression and treatment of disease. The pathology of febrile related disorders according to the_Shang Han Lun (Treatise on Chills and Fever) and Jen Kuei Yao Lue (Prescriptions from the Golden Chamber) show how a disease can move from what is known as the surface" or "external" aspect of the body to the "interior" aspect in six major levels each having its own unique pathology and Treatment Concept. The order of these levels of penetration or stages of disease is classified as taiyang (greater yang), shaoyang (lesser yang), yangming (sunlight yang), taiyin (greater yin), shaoyin (lesser yin), and jueyin (absolute yin). The jueyin stage of disease, as it nears its end, is that stage where the body no longer has enough strength to control the balance of yin and yang. When the body becomes too weak to maintain proper balance of yin and yang, the disease has won the struggle.
The original Chinese model used to describe the progression of fever related disease was first recorded in the medical classic Huangdi Nei Jing (Huangdi's Internal Classic, or Huangdi's Cannon of Medicine). This is the oldest and greatest Chinese medical classic known. Its authorship is ascribed to the Yellow Emperor Huangdi (2698-2589 B.C.). The work was actually written by unknown authors during the Warring States Period (475-221 B.C.).
Huangdi Nei Jing has two parts: Su Wen (Plain Questions) and Ling Shu (Spiritual Pivot or Divine Axis). In the Su Wen chapter 31 ["The Fever", the evolution of disease and how it relates to the "Energetic Layers" of the body is discussed], which states:
"The fever generally happens unexpectedly after a shock from Cold. The Taiyang (Small Intestine and Bladder) meridian is attacked first. This meridian of the Taiyang is in connection with the point Fungfu, (Du-16), meeting point of the meridians of the Bladder, the Yang Wei (extra meridian), and the Governor Vessel. This last is so named because it governsthe Yang of all the body. The energy of the Tai Yang meridian begins at the point Jingming (Bl-1). It is the point therefore which commands all of the Yang energy. If the shock from Cold attacks solely the Yang, even if the temperature is very high, the sick person will not be in danger, but if it simultaneously attacks the Yang and the Yin, the sick person will inevitably be in danger of death.
If the shock from Cold attacks only the Yang: The first day it is the meridians of the Taiyang (Small Intestine and Bladder) which are attacked, the sick person presents pains at the head and neck; the lumbar region and the vertebral column are stiff, aching all over.
The second day, it is the meridians of the Yangming which are attacked (Large Intestine and Stomach); these meridians passing near the nose and eyes, the sick person presents fever, with a feeling of pain at the eyes, and of dryness of the nose; he cannot sleep peacefully, he is agitated.
The third day, it is the Shaoyang (Triple Burner and Gall Bladder). These meridians passing on the side of the body and to the ears, the chest, and in addition he does not hear well. At this period of the sickness, all the Yang meridians are attacked, but not yet the internal organs. If one makes the sick person perspire, he will be cured, otherwise:
On the fourth day, the illness attacks the Yin meridians beginning with Taiyin (Lung and Spleen). These meridians passing on the abdomen and toward the upper part of the chest, the sick person presents abdominal swelling and dryness of the upper respiratory tracts.
On the fifth day, the illness passes to the Shaoyin meridians (Heart and Kidneys). These meridians passing on the chest and toward the tongue (the Kidney meridian, through a secondary vessel, reaches the point Lien-Chuan (CV-23), the sick person presents dryness of the mouth and tongue: he will be very thirsty.
On the sixth day, the illness passes to the Jueyin meridians (Pericardium and Liver). These meridians passing near the genital parts and reaching the Liver, the sick person presents malaise, and his scrotum is retracted. At this moment of the evolution of the sickness, the Three Yang meridians, the Three Yin meridians, the Six Bowels and the Five Organs have been attacked; the energy and the blood no longer function, this is death.
If, as we have just seen, the Yang meridians and the Yin meridians have not been attacked at the same time, but one after another, and if one has undertaken the correct treatment, one sees the following symptoms appear:
The seventh day, the Taiyang meridians are appeased, and the sick person have less pain at the head and neck.
The eighth day, the Yangming meridians are appeased, and the fever come down.
The ninth day, the Shaoyang meridians are appeased, and the sick person hearing improves.
The tenth day, the Taiyin meridians are appeased, and the sick person recover his appetite.
The eleventh day, the Shaoyin meridians are appeased, and the sick person have less thirst.
The twelfth day, the Jueyin meridians are appeased, and the scrotum is relaxed and soon the cure will be complete.
In order to bring about this cure, it is necessary to provoke perspiration during the first Three days, and then it is necessary to purge on the fourth.
The Emperor Huangdi (question): If the Yang and the Yin meridians are affected at the same time, what will the symptoms be?
Chi Po (answer):
If the Taiyang and the Shaoyin meridians are attacked at the same time, the sick person, The first day, pains at the head, dryness of the mouth, and fullness in all the body.
If Yangming and the Taiyin meridians are attacked at the same time, he presents the second day, fullness of the abdomen, loss of appetite, delirium.
If the Shaoyang and the Jueyin meridians are attacked at the same time, he presents the third day, auditory disturbances, and retraction of the scrotum. He can no longer swallow anything: He is in a coma. His death will arrive unexpectedly the six day.
The Emperor Huangdi:
Why does he still survive for three days?
The Physician answers:
The Yangming meridian is the meridian which has the most blood and energy; it is thanks to it that, even in the coma, the sick person's life can yet be prolonged for three days."
Over eighteen hundred years ago, (two hundred years after the Huangdi Nei Jing), a Chinese medical practitioner, Zhang Zhongjing, used the "Six Stages" concept of pathology to explain what he saw as an entire life cycle compressed into a very short span of time. Within this cycle various conformations (syndromes) relating to each stage could be made so that the correct herbal prescription could be used. The conformations for each of the various stages depend not only on the etiology of the disease but also the overall constitution of the individual and how the body is dealing with the disease at the time. After studying and synthesizing the medical writings of his time, Zhang Zhongjing developed his concepts of the Six Stages of Disease. This was an elaborate, logical, and practical model, from which, febrile disease caused by "pernicious influences" entering the body could be mapped out and treated. With this model, disease usually follows an orderly progression from the first stage to the last; however, a disease can go straight to any stage, skip stages, or even move in the reverse.
Chart 1 (Progression of the six stages)
The result of Zhang Zhongjing's studies and observations were recorded in his two books Shang Han Lun (Treatise on Chills and Fever) and Jen KueiYao Lue (Prescriptions from the Golden Chamber). Originally these two were bound together as a single book, but during the Sung dynasty (960-1279) they were separated. Historically, when authors cited passages from the Shang Han Lun, they were referring to both books. For the purpose of this work "Shang Han Lun" will be used to refer to both books. The concepts and approach to dealing with disease found in these two classics are unique.
There is nothing in Western medicine quite like them and yet this form of combating febrile disorders has been used for hundreds of years in the Orient with great success and without the dangerous side effects so common with Western allopathic medicine. With the growing concern about today's super strong medications there is a need for safe alternative medical care that has been proven effective. Traditional Chinese herbal formulas discussed here have been used for centuries without major side effects when properly used.
Development of Chinese Medicine
Prior to Shang Han Lun
Long before recorded Chinese history, the works of the great Emperor Yen (Shen Nung) were preserved and handed down verbally from one generation to the next. It is said that Shen Nung, who was born over 5,400 years ago, taught the people how to raise crops, rear domestic animals, and test and identify various herbs. Archeological evidence has revealed that Shen Nung lived in the regions along the Yellow (Yangzi) and Xiang river basins. He is known as the "God of Husbandry" and his work was recorded in various historical references such as the following:
Si-Ma Jien's The Historical Records: "Shen Nung tasted various herbs and determined their medical property and value."
Hui Nan Zi records: "When Shen Nung taught the people to taste various herbs, seventy species of poisonous ones were encountered in a single day; hence medical science progressed rapidly."
Although Shen Nung's birth and death cannot be accurately verified, legend has it that while living in Yuwang he served eight Lords for 820 years. From this it is believed that 3494 B.C. was the time period of the first truly great pharmacologist of the world.
Approximately 830 years later, another great in Chinese medical history, The Yellow Emperor (Huangdi), became known to the Chinese world. The Yellow Emperor's name was Gong-Sun Xien Yua. He is known by the Chinese as the ancestor of the Chinese race. There are a great number of inventions and discoveries attributed to Huangdi and he is known as the legendary founder of Chinese medical science.
Research has shown that in the time of Huangdi there were only hieroglyphics invented by Sang Ji. This form and style of writing of the Nei Jing could not have been from the same time period. Many historians throughout the centuries relate the wording and sentence structure of the Nei Jing to the time period between that of the Warring States to the beginning of the Han Dynasty (403-206 B.C.). This means that there is a time period of 1,271 years between the writing of the Nei Jing and the Yellow Emperor. This however, does not reduce the importance of this classic on internal medicine whose contents include ancient physiology, pathology, therapeutics, classification of diseases, systems of meridians, as well as Chinese philosophy.
The four basic diagnostic methods of "observation, listening, questioning, and palpation" in Chinese medicine were originated by Bian Que (about 407-310 B.C.). Bian Que, originally named Qin Yueren, was the first noted medical expert in the period of the Warring States (403-221B.C.) to be recorded practicing acupuncture. Historical Records tell about one of his famous cases:
While out walking one day with his disciples Tzu Yang and Tzu Pao, Bian Que noticed that many people were outside the Emperor's gate offering sacrifices for the Emperor's son who had suddenly become unconscious. After inquiring about the cause and symptoms of the Emperor's son's disease, Bian Que sent word to the Emperor "There is still some hope for your son, and I would like to treat him." Examination of the son revealed weak breath and some warmth still inside the legs. Bian Que then administered several needles to the head, chest, and limbs whereupon the patient regained his consciousness. With the aid of herbal soups and warming therapy the Emperor's son gradually sat up in bed and regained his health in about 20 days.
Bian Que is reported to have traveled far and wide treating people and alleviating suffering all his life. He was greatly loved and adored for his willingness to help the sick and was called the "King of Drugs". The birthday of the "King of Drugs" is by legend the 28th day of the fourth lunar month and widely celebrated in memory of this medical genius.
Doctor Zhang Zhongjing and the Shang Han Lun
During the period of the Han Dynasty (circa 220 A.D.), Zhang Zhongjing (born with the name Zhang Qi) practiced medicine. This was some 240 years after the Warring States period (403-221B.C.). Zhang Zhongjing was dealing with a huge and deadly epidemic (believed to be typhoid fever) and he watched masses of people dying all around him. Over two hundred of his own relatives, about two thirds of his relations, had fallen ill and died from a plague in the area of Jinjiou. His determination and drive to understand and overcome disease must have been tremendous.
Doctor Zhang Zhongjing observed that acute disease was similar to an entire life cycle compressed into a very short period. From the onset of the disease to the end of life this life cycle could be divided into six individual stages each with its own unique conformation. The conformations for each of the various stages depend not only of the etiology of the disease but also the overall constitution of the individual and how the body is dealing with the disease at any given time.
When Zhang Zhongjing wrote about his observations of the six stages of disease, an acute disease called "Shang han" (which is believed to be perhaps typhoid fever) was common. Zhang made detailed observations on the progression of the illness and created suitable formulas for each stage. For each of the various stages, the Shang Han Lun provides a group of appropriate formulas, but the conformation determines the choice of the formula. Shang Han Lun applies not only to acute diseases, however, for its principles can be used for almost any disease situation as shown in the Japanese kanpo system used today.
From observation one can recognize and determine the conformation, prescribe a matching formula, and cure the disease. Homeopathy resembles this approach in that the constitution of the patient and the main conformation determine the course of treatment.
From his devotion to combating illness came two of the greatest medical classics in Chinese history, Shang Han Lun and Jen Kuei Yao Lue. The Shang Han Lun (Book of Fever and Chills) deals with infectious, contagious, and epidemic fevers. While the Jen Kuei Yao Lue (Prescriptions from the Golden Chamber) deals with diseases that relate to digestive, respiratory, urological, nervous systems disorders, metabolism, gynecology, and other disorders. It is no wonder that Zhang Zhongjing has been revered as a medical saint.
Shang Han Lun and Japanese Kanpo
A brief history of the spread of Chinese medicine here helps to demonstrate the importance the classical "Old School Formulas" Shang Han Lun and Jen Kuei Yao Lue. According to Dr. Hong-yen Hsu, "No matter how advanced a practitioner becomes in Chinese medicine, there, will always be a need to study the Shang Hun Lun and Jen Kuei Yao Lue and Six Stages relationship to disease." Out of all the herbal information imported into other countries from China, none have been more studied and revered than these two medical classics.
There are 113 herbal formulas recorded in the Shang Han Lun and 110 herbal formulas recorded in the Jen Kuei Yao Lue written by Zhang Zhongjing of the Han Dynasty. The formulas from these two classics are known as "old school" formulas.
During the Tang dynasty over 6,000 herbal formulas were recorded in the Wai tai mi yao (Medical Secrets of an Official), compiled by Wang Tao. During the Sung dynasty over 30,000 herbal formulas were recorded in the Tai Ping Sheng Hui Fang (Taiping Scared Remedies), compiled by Wang Huiyin. The Pu Ji Fang (Prescriptions for Medical Relief) was written by Teng Hong of the Ming dynasty, who recorded over 61,739 herbal formulas. These prescriptions together with formulas from other medical resources now number well over 100,000. It is easy to see that the wealth of herbal knowledge in China goes beyond comprehension.
(Continues...)
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