Transcript for:
W3 - 6 conformation - Chinese Medicine: Six Stages of Disease

of the six stages we talked about tyong first tyong being the exterior level when I say tyong you automatically think small intestine and urinary bladder but I'll say that for most of the taong diseases we actually don't need to know much about the organ function of small intestine and urinary bladder there's a couple of UB patterns that we'll get to not today but maybe next week we'll mention that um talk about how a pathogen in the tyong level can interfere with the function of water metabolism which we do associate with the urinary bladder to to a extent in Chinese medicine so we'll get to those um for our purposes now I want us to think about taong as being this most exterior layer of energy that we have um it's related to these interstices that I sort of belabored earlier the opening and closing of the pores how our body directly relates to the external environment um we recognize in Chinese medicine that we're there's not a there's not a hard line between interior and exterior in fact we're playing with that line every time we breathe every time that we eat we're relating to the exterior right every time there's a temperature shift our body automatically calibrates to the exterior so we certainly want to get away from a notion that here's my skin everything on this side of the skin is me everything on that side of the skin is the external environment totally separate and embrace sort of a more Dynamic idea of the human body as being this constantly changing constantly exchanging and interchanging um set of relationships with what we might call the exterior world right the taong is the big gatekeeper between what's outside and what's inside um any kind of exterior pathogen has to go through taong for somebody who's very very weak or compromised there might not be much of a struggle at the taong level and this taong phase may be very quick it could just be 15 minutes of feeling slightly chilled that could be your tyong experience before the pathogen goes in deeper if the Juni is very very compromised um when we talk about Tong patterns we're really talking about the set of signs and symptoms that manifests as our body responds to the pathogen um so as a pathogen's coming in it triggers a response from our body and one of the things we know is that as we start to get sick with a head cold or a flu and these are very common tyong manifestations one of the first things that we often feel is this sensation of fever Andor chills chills and or fever something happening on the surface of the body either emitting heat even if our bodies feel cold or this feeling of sort of like creepy crawlies pricklies on the surface of the skin we may also also notice that there's headache or especially achy neck but sometimes an achy back an achy body this is also this achiness is associated with this distribution of our energy to the exterior level and how a pathogen might interfere with that distribution so when we think about when the body's healthy the job of t is to circulate this vigorous energy at the Sur surface of our body without obstruction um when we're subject to environmental extremes or when our Junia is weakened something from the environment comes in a struggle happens right um and there's two very classic manifestations of this stroke the first one is called taang cold damage or sometimes shangan shangan cold damage the tyong layer has been damaged by the cold trying to come in uh the textbook example of this is that there are chills and these chills are usually more predominant than the fever um and this is a a way that we um Nuance the difference between wind cold and wind heat if we have more fever and less chills maybe this is more wind heat if we have more chills and less fever then maybe more wind cold um in the weeks to come we're going to Nuance this discussion of fever and Nuance this discussion of chills but let's just leave those words as they are for right now because I think we have a general impression one of the characteristics of on cold damage is that this chills and fever together is um happening without the person sweating so the person is not yet sweating um or not sweating in response to this and the the the visual of this is that this cold pathogen has actually gotten stuck in the pores it's gotten stuck in the interstices so the fluids can't leave because the cold is occupying those spaces or the cold pathogen is interfering with the ability of the to the interstice is to open and close and release a sweat the theory being that if we could sweat we could sweat this pathogen out right possible other signs and symptoms are body ache especially nape of the neck headache scratchy throat all these things are kind of showing that a pathogen is knocking on the door trying to get in our textbook pulse is floating and tight floating shows us that our resources have risen to the surface appropriately to fight this pathogen and tight because the cold is contracted and congealed a little bit so our our textbook pulse is floating in tight some people will say textbook tongue is thin white coat I don't even think that's worth mentioning we don't actually expect the tongue to really change in reaction to this pathogen if it's just happening this is typically acute this is something that's come on quickly it's a windy change right the wind has blown this pathogen in so one minute you feel okay the next minute you start to feel this um and let's contrast that with something like congestive heart failure which develops over a long period of time right uh you don't come down with congestive heart failure because you are outside in the wind whereas you very well may come out with tyon cold damage because of that um the treatment principle here is resolve the exterior and parenthetically promote sweating right so we want the exterior to resolve we want to release the exterior it's now stuck in tight because of this cold and if we can find something that makes us sweat and warms us up that's going to be appropriate the textbook formula for this is mahong so herba aedra very effective herb for um resolving the exterior and promoting sweat um it's not really replaceable we can try because mahang is harder and harder to get but really mahang is is the one we want to use because it has this strong diaphoretic and warming sweat promoting property this is sometimes called um uh wind cold exterior excess would be another way to describe this so we have an exterior excess of wind cold this is a straight excess condition if we think about our eight principles exterior not interior cold not hot excess not deficiency and whether it's Yang or Yin depends on whether you want to emphasize the fact that it's an excess in exterior versus cold which is Yin I would probably call this a Yang disease right I probably call this a Yang disease um so um this is one manifestation in the taong and we'll just briefly touch the other one before I let you go which is taang windstrike taang windstrike is similar setup up our body is in a place where there's an exterior pathogen being brought in by the wind into our interstices on the taong level but in this case there's something about the situation where there's a little bit of deficiency there's not quite enough resources in our body to meet this pathogen as strongly as we want to so we have chills and aversion to wind with fever but there's this idea that there's a little bit of sweat happening and the reason there's a sweat happening is because the way she has been compromised and isn't monitoring our resources as well as it should so there's an idea that there's a little bit of deficient Wei here that's allowing things to kind of drip out through these interstices that are not being as tightly regulated as we'd like them to be we still have the body ache the headache and the scratchy throat besides the the fact that we are sweating and it doesn't have to be a strong sweat is really the main indication besides the fact I didn't put this in here I should have um that the the pulses is floating tight and sometimes there's some weakness there as well there's a less Vigor um the important thing here is that we're going to harmonize the Ying in the way the idea is that if we give the ying a little bit more to work with the nutritive chi a little bit more to work with then the way Chi which relates to the Ying will'll have enough energy to push this out so gager Tong is our main formula here and I don't expect for the purpose our purposes I don't want you don't need to memorize any of these formulas or the ingredients of these formulas but it helps illustrate our approach once we have this diagnosis we give them gager which harmonizes the Ying in the way gager tongue also has bow in it and one of the things that bow does is it gives our blood a little bit more to work with because it's a nutritious herb bow nourishes the blood nourishes the Ying which helps the whe have enough oomph to push this wind strike out um for our purposes today taang cold damage taong wind strike tyang cold damage straight excess t on windstrike mixed excess and deficiency okay mixed excess and deficiency for tyong windstrike and the fact that we're sweating a little bit is the indicator of that um deficiency in our treatment we're going to nourish that deficiency a little bit to help resolve the tyion wind strike a little bit today our real hope is to um finish up the background work that we need to do to understand the big categories of different systems of pattern identification that we use and diagnosis um and uh today we're going to cover in a little bit greater depth the um six confirmation six Channel disease model which I understand that you do have some familiarity with so um what what were these just mentioned in your foundations or was this something that you had to kind of memorize the key tongues pulses signs and symptoms for the six levels no okay so you've heard of it but you haven't actually gone into it with any kind of depth great so um I think I prefaced this material last time with a little bit historical information which I think is important to keep in mind that um when we talk about the six levels we're actually talking about um one of the major theoretical underpinnings of all even modern Chinese medicine and it's also a topic where there's been um discussions debate and clinical applications for um 2,000 years this is a Han Dynasty thing a gentleman named Jong Jong Jing wrote the shangan Lun and shangan means um cold strike and Lun means trus or classic um and so you know over 1,00 years ago he put down these words about how um he viewed the progression of disease from the exterior into the interior of the body and like many of the medical Classics from um traditional cultures uh for many many centuries medicine wasn't considered something that people um progressively got better and better at with each generation but rather people aspired to be as good as the classical practitioners were so I think that's an important sort of contrast to our modern medical ideas that every generation we're getting better medicine we're getting better Diagnostics all this all this kind of stuff when really from a most traditional cultures of view is much more of a wow the people in the past did it great how come we can't do it as well maybe we need to dig into these Classics a little bit deeper and try to figure out what's going on so um with that in mind when we look at the history of Chinese medicine and we see that um tremendous amounts of dialogue Tex texts have been written that are all Reflections on this jungong Jing shun where people have taken the theories and principles and Di diagnostic approaches and oh thank you from uh for o message uh and then applied them to the the diseases that they were seeing in the in the modern day um when we look at the title shangan Lun um tretis on cold damage one could think that this uh text only applies or the system of thought only applies to what happens if you get too cold or what happens if this um external evil of cold penetrates your body um so a common misconception is that it's only useful in describing the progress of cold diseases or it's only useful for describing the progress of exterior diseases um so diseases that we get communicable diseases from the external environment um in the 1800 years or so since this text was uh uh first uh first published um it has been applied for all sorts of diseases it's it's actually viewed to be a foundational way of um describing both health and pathology in the body regardless of where the pathology might originate from um this is an area that in um uh recent generations of practitioners have have been um sort of revivifying and bringing back into the medicine because a lot of it was actually stripped out or simplified during the Communist era um and we're still in that process and you as um 21st century TCM students um at some point your education probably be part of that process um not in this course because this course is sort of a General Diagnostic overview but maybe later on in your education or if you decide to do a doctorate um looking back to these classical sources like Jang Jong Jing shangan Lun and saying okay how can we apply this as as a as a comprehensive model of Health and Wellness as well as disease maybe something that you may be taking part of because there's translations that are um around now that weren't around even five or 10 years ago so even if you're not a Chinese language um reader or speaker we have more and more opportunities us to actually get to the original sources and then get to the incredible Rich 18 centuries of Reflections on these original sources um but you know sometimes I take a certain sense of reassurance because when my patients will often come to see me for acupuncture and they'll often you know say oh I'm here for knee pain and okay and then I ask them all these questions about their knee but I ask them about their General Health too and they sometimes they say oh what why why are you asking me these questions or maybe I give them a great treatment for knee pain and they say oh the knee the knee feels great but uh what's really been bugging me is insomnia can Chinese medicine treat that and my short answer is that Chinese medicine can treat all pathologies that East Asian cultures saw in the 3,000 years of medical history that we have recorded for them so it's a comprehensive approach right um so it's important to have that sort of big view of the medicine as we approach any specific diagnostic system that may be applied towards one area of pathology more or less than others um with that in mind our task today is really is is going to be um sort of a fly over of these six levels and we'll talk about the um the four-level model as well but we're going to focus mostly today on the six levels the six confirmations or the six channels and these are all synonymous for our purposes um uh you know if I say six confirmations if I say six levels if I say six stages if I say six channels this all means basically the same thing for our purposes right now you there are Scholars that say that if you translated to six channels you're doing a disservice to the model etc etc I don't want to get into politics we don't need that right now um but just be aware that these are all um synonyms so a great General overview of um you know how we think of the body so you know uh there's we could make jokes about you know the body being represented as just a circle because we have arms legs and heads and we're more complicated but energetically this is actually kind of accurate that there's this idea that there's the exterior the outside world and then Progressive layers inter to the interior to the innermost depths of sort of what creates a human being um and just generally we'll just re observe and and and uh make note and this should start to be sounding familiar to you all that the outermost later is is taong the most young taii means great or most and yang obviously means young and this Yang layer is our exterior this is what separates us from the environment um then we have uh a discussion about what the next layer is but we'll go with this model right now that the shaoang is the pivot between the exterior and the interior sometimes called half half exterior half interior or called neither exterior nor interior or sometimes described as generally as the pivot between exterior and interior but everybody is in agreement that once we get to Yang Ming which is really these big bowels so um you we know from a Zang Fu uh standpoint this is the stomach in the large intestine these big work Workhorse bowels that push food from the external environment from the mouth all the way through the anus um so this is the third layer in is this young Ming layer and then we have the tie-in layer and the tie-in layer is very interesting because if we think about the digestive tract right in a certain sense the digest digestive tract in um our bodies could be con could almost be considered a part of the outside that we're carrying inside our body right so we have our skin which separates all of our muscles and bones and all that stuff from the exterior environment but then we also have this part of our body which is basically a tube from the mouth to the anus right and is covered with all these special cells that are extra res resistant to exter the external environment right um and we put the external environment in one end of the tube and something magical and mysterious happens where by The End by the time that the remnants come out the other end of the tube some aspect of the outside world has been absorbed into the inside so we want to think about the digestive tract mouth throat stomach small intestine large intestine and then anus it's almost being almost like the outside of outside of the body but it's carried on the inside of the body and what the Tha Yin function is is the inside of the body working on what's inside these this digestive tract and extracting and assimilating what we can use from it right um so we know this is a function of digestion this is a function of the spleen in Chinese medicine which is part of tyen right that the spleen job is to kind of look at the stuff that the digestive tract is is holding and say I can take that I can take that I can take that I can take that I can turn this into blood and then distribute it right so that's tiin we could reflect that the lung does a similar kind of job where the lung does the same thing with air so when we inhale air this is the outside of the body and the inside of our lungs maybe that's considered almost like the outside of the body also but then we have this tie-in action of the lungs to take out the tenen chi the Heavenly Chi which if we're being clumsy we could say is oxygen right but really we want to think about it much more this idea of cheni this clear Chi from the heavens that then is brought in by the tiin layers and turned to the inside of the body so we know that the the tieni from the lungs will then embed in the chi extracted from the food and this then becomes this um yingchi this nutritive Chi that circulates throughout our whole body through the action of ta Yin the main point that I'm trying to make here is physiologically Yang Ming is this um this part of our being which is um still kind of on the outside and it is rich in and blood because it still has to interact with the external environment you know when I swallow a piece of ham sandwich or something like that that's still the outside world coming into my body and that's different than blood whereas blood is really a product of the interior of the body right Yang Bing's job is to take that extra ex external part of our of the of the world this Yin of the earth and move it through the body until tyin has absorbed everything it needs out of it and then Yang Ming releases whatever's left as feces right as fertilizer as Yin you know this is now a Yin substance you know it's turbid and we put it back into the Earth right you know the evolutionary biologist will say that you know if we had to um analyze multicellular organisms which we are we're a multicellular organism you know basically we're a tube to digest things and ways to move that around and point it towards food right so this is sort of the Yang Ming idea that where this this sort of tube and all this around the tube that you need to aim the tube where it needs to go and then absorb food right um once we have this Blood circulating and everything the blood is um is considered moving at a deeper level of the body and then we start to talk about shaen and shaen we we can look at heart and kidney function um but one of the things that we're looking at when we get to pathology as we'll see in a second is that shaan is um often about the balance of um water and heat in the body right so we think about this as heart and kidney where heart holds the fire and water holds the water um where kidneys hold the water and Shion activi is often a balance of this and Shion disorders will show us a balance between the heating and the cooling of the body and it's considered a deeper level um and in the very very core we get this idea of the paric cardium and the J in and this is always mysterious um so why do we talk about the pericardium the liver as being the deepest organs in the six stages Theory whereas in Zang we often think about the kidneys as being the deepest layer um and this has to do with Chinese medical history and has to do with us different paradigms kind of intersecting historically where different people describe different functions of the body as belonging to one organ or the another or another but the pericardium has always been related to the activity of the heart and the and sort of the central why are our bodies warm as opposed to cold that separates life from death and the liver has this deep deep organ of storage in our body so we know the liver Treasures the blood and stores the blood um and this Joan level if a disease progresses all this way we find that there's often um psycho emotive issues that will come up as the spirit at a deep level is Disturbed and this is also called terminal Yin sometimes because this is an a layer where we might see actual terminal stage diseases as well so this is a big big overview of the six stages um diseases from the exterior come in through the taong they may not stay there for very long and then they can end up in any one of these um layers and it doesn't have to be strictly sequential so you could have a disease that starts in the taong and it's only like a cough a sneeze and a sniffle and then it lodges in the shaoang for a a long time and actually can become a chronic disease or something comes in through the taong it skips XA Yang altogether and ends up as a bowel disease with some sort of crazy constipation and fever Yang Ming disease and we'll talk about that um could be that we get a head cold and most of it is resolved but some of it lodges in the Sha Yong and hangs out as sort of this incipient subclinical illness for a long time and we can find this as well that there's certain disorders that have been around for a long time that might be described as um residual pathogen lodged in a certain layer um once we get to Therapeutics which we're not really talking about there's different methods for releasing each of these layers right so Tang we mentioned you know just as a couple examples Tang we mentioned one of the things we want to do is if we have taong disease and we're not sweating we want to promote sweating right um so this would be a way of releasing the disease through the exterior however if we had a young Ming disease lodged in the bowel sweating is not going to get to it in fact sweating will make things worse because we're depleting the fluids of the body and as we'll see yangming disease sometimes we're constipated so the last thing that we want to do is make us more dry right so if you sweat somebody with young Ming stage disease you could actually make their um their disease worse so often young Ming disease what we need to do is actually Purge and by purging we often mean give somebody a very strong laxative right get the gut to move strongly and then we poop out the disease from The Young Ling level so we're not today going to get into the treatment principles for each of these individual layers we'll mention them in passing but we're going to Nuance out the highest level pattern pathologies that we see in each of these levels this this jue Dre and uh you'll have to forgive me for my tones but um Dre Yan is sometimes described as terminal Yin final Yin or reverting Yin and uh reverting the reason that they might use reverting is if we think about the taii diagram of the yin and the Yang swimming together when the yin is at its most extreme it's about to revert back to yang right so that's that's one of one or terminal Yin the yin is almost used up you know and that's when things go Yang again right so there's a tremendous cosmology behind this and you know these six stages have been related to the environmental factors and the seasons and all sorts of other things um that you'll dig into later on in your education this is important these are actually notes from Dr Emy Jew who taught this course for many many years and then had kind handed it off during the pandemic era um but she quote some of the the classics and we're not going to go into each of these but just to say that the Ning and the Nanjing are are very very old texts within Chinese medicine and back then they were already talking about this and uh you know the the Ning says shangan a cold strike or cold damage rather is a term that includes all the diseases that have fever so that's interesting to us that you know fever is considered one of the main things that's related to shangan and then here we have this progress of disease and you know this is certainly not meant to be rigid but it's supposed to tell us like as you get sicker what might happen in a textbook case um and it gives us some of the Key signs or symptoms in the N Jing about what we might experience during these times um we don't need to memorize this but I'm pointing towards the cultural history here that this has been something that's been reflected on for a long time and also to familiarize ourselves with the idea that um often the way the classics are organized is they'll say um a very broad statement that sounds like it's um the final word on something so for instance if we say um you know the third day xiaoyong is invaded there is chest and hypochondriac pain and hearing loss um so a classical scholar would look at this and then say Well when they say third day what they mean is sometime not immediately at the first day and it could actually be a week later it could be two weeks later the third day here just means at a later point and they say there's chest and H hypochondriac pain and hearing loss well maybe they don't actually lose their hearing maybe their ears are just a tiny bit clogged or maybe they just have a headache and that's also you know hearing loss that's close enough and chest and hypochondria pain well maybe there's not actually pain maybe it's just a little bit of discomfort so um the classics will make a py statement and then the way a lot of traditional culture um will then go about as the exegesis on that py statement will be where all the meat is so they take a little tiny think it's you know if you ever have gone to um like a Tibetan Buddhism class they do the same thing if you ever gone to a Bible study class they do the same thing where they take you know one sentence and then spend you know three pages explaining that one sentence but the short hands are useful you know so here we you know hear about some of the key symptoms for Xiao Yang we hear about um some of the key symptoms for tyin and they they mention abdominal distension and dry throat so it points towards the digestion and also points to fluid physiology um sh when we get here oh dry mouth dry tongue and thirst so we're getting some image of heat here and then D Yen Jan is invaded there's irritability and contraction of the scrotum so um we certainly don't expect everybody who has a dran pathology to have a contracted scrotum but it also does point to this intimate relationship between the reproductive organs the liver and this deep level of pathology that could be happening um and also irritability points to lingering heat right um so we have a couple of big big uh uh broad breaststrokes of describing pathology here shangan which means cold damage um you know the the actual Jong Jong Jing text says it can be with or without fever must be have aversion to cold you have to hate cold for it to be cold damage you have to say I I just want to get warmed up right whereas wind strike we say aversion to wind and maybe cold and so this is where maybe we need to ask ourselves and our patients a little bit more deeply about their experience you know um before I practiced Chinese medicine I didn't think that anybody would um relate to just a verion to win because it wasn't something I had personally experienced although now that I've been practicing for longer I recognize that experience but it turns out if you ask people about the win some people have very strong opinions and say oh I hate to be in the wind you know so sometimes the information is there but you just have to remember to ask for it um and then we'll talk about this other stuff in a little bit so in terms of his history you know we have the treat of some cold damage and uh here do um Dr Jew has uh uh romanticize the order it is um Jong Jong Jing not Jong Jing Jang as the author but he wrote it sometime between 200 and 210 ad in the in the Han Dynasty it was a time of a lot of warfare a lot of disease and The Story Goes that Jang Jong Jing saw half of his clan extended Clan die of epidemic disease and that was what motivated him to become a Healer right and these Clans number in in the hundreds so he had seen you know huge mortality and that's one of the things that motivated him to describe medicine the way that he understood it um we're going to get into each of these individual uh diseases in a second so I don't want to get into them and I'm gonna uh I'm going to show you where this is if you want to review it but most of the content here is actually um in the slides that I have prepared for you so the key key things here that I want us to take from Dr Jew is this sort of sort of historical understanding that this is an old medicine it does come all the way back from 200 to 210 and this idea that the Ning and the suen have also um contributed py insights to this so we can look at these classic texts and find information about um cold damage and also the progress of disease via this the um six confirmations so let's talk about these um this is definitely stuff that if we want to have um diagnostic competence we we need to be familiar with these pattern discrimination right um and they're going to serice in the rest of this um semester very well so this is definitely something that um you will need to internalize all the nitty-gritty details of um so for instance pretty much everything on these slides are things that you will have to memorize one way or another if that's writing a song write a song If that's flashcards write flashcards if it's making some kind of crazy flowchart whatever it is for you if you develop something I encourage you to share it with your peers in the Forum section but the the key for taong cold damage which is shangan cold damage is severe chills or severe feeling of cold in the body accompanied by fever but here we see you know I wrote chills are greater than fever and this is a very um py textbook way of saying that you know the the patient feels more cold than hot right um and for tyion cold damage we say there are no sweats last week I described this because it's visualized that the external cold pathogen is actually jamming up the inters is in the toi and the yongi can't get there the yongi can't push it out um so this will give us a body ache because the yongi can't circulate to the muscles and the space in between the skin they'll give us aching especially in the young part of the body neck and shoulders and head it may gently affect the throat but a key differentiator we want to make is that for cold damaged diseases generally the throat is described as sort of a scratchy irritated throat not that like I have strep and when I swallow it feels like somebody's jabbing a knit knitting needle into my my throat it's not that kind of pain right um so it's not um as intense a sore throat as with um heat as we'll see later interestingly we also have a couple of um respiratory symptoms here we may have wheezing or rapid breathing um and when we look at the formula down at the bottom we'll see that you know mahang Tong is is an herbal formula that addresses wheezing for sure and addresses the breath as well um we already described the pulse as floating and tight um can we have p reasons why it's floating anybody want to take a stab the pulse is floating because the chi is trying to get to the exterior right it's trying we're Mobil mobilizing our resources to kick out the pathogen and it's tight because cold contracts and congeals right this is um this would be described in eight principles as a wind cold exterior excess disease right so wind cold names the pathogen how it's manifesting in our physiology exterior says where it is it's on this surface layer of the interstices of the toi or the taong layer and it's an excess the pulse shows a straight excess image of floating and tight it's considered um an excess disease that's blocking up the exterior our treatment principle is very simple we want to resolve the in exterior and promote sweating there could also be a stop stop coughing if there is coughing or wheezing and uh not that we're talking about Therapeutics here but mahong Tong is the textbook and in fact sometimes people will describe this not as um on coold damage but they'll just say oh this is mahang Tong they'll use the formula name as the diagnosis right so that's interesting for us as well because there are systems out there that just say oh yeah this is a mahwang Tong disease um and if you understand what mahwang Tong does and it tells you the entire disease as well moving on from Tong cold damage we have Tang wind strike or Jung fun fun here is wind Jong is Strike um the image here is very similar to cold damage with a couple very key differences the first one being bolded on the second line is sweating so if we're going to diagnose taong wind strike we still have this chills and aversion to cold or wind and these are generally more pronounced than fever and the fact that the cold Sensations are worse than the fever tells us that this is probably a cold pathogen in the body and now we have sweating and the reason that we have sweating this time is we say that the ying and the way are not harmonious and the the we doesn't quite have what it needs to hold itself together and so then we're sort of Dripping sweat we may have this body ache headache similar to last time a scratchy throat more likely to have dry heaves for our Tong wind strike um I won't say every single Source talks about digestive disorder with Tong but there is a possibility of dry Hees here um and the pulse you know we is is consistent in so far it's floating because it's exterior but it's moderate because we're saying that one of the reasons that we're sweating is there is a little bit of deficiency of Wei going on here and we pick that up in the pulse so in eight principles we call this a wind cold exterior deficient condition as opposed to a wind cold exterior excess condition um if we wanted to be really pricity we'd probably say it's a mix of excess and deficiency so exterior excess and slight interior deficiency and our treatment principle is to harmonize the ying and way and we use wager Tong for that right so we want to get the Ying the nutritive to give a little bit more energy to the defenses um one of the metaphors that has historically been used to describe uh the the reaction of the body to disease in Chinese medicine is this um like a stockade Town Under Siege you know so this is part of Chinese history there's these Stockade towns that were up in the northern part of China that um generally were agriculturalists and um the good thing about agriculturalists is that they're able to um collect grain and store it through the winter the bad thing about agricultural list is that if you collected grain to store through the winter the roving nomadic tribes of um the north north north of China might think it's a good idea to come and take it from you so this model emerged of the you know it's always a barbarian hordes you know these these Riders from the north swooping down towards civilization and big fat quote marks um to try and invade these stade towns and take their grain um here the images basically the Wei is The Stockade walls and the people fighting from the walls as people try to get inside that's your Wei and if we think about taong windstrike and that kind of idea um a formula like gager Tong is actually bringing like food to the people on the walls so they can fight stronger you know so maybe the people on the walls are a little bit weak because they're undernourished so you give the body more yingchi with ingredients like Bell and that allows the defensive Chi the forces on the on the edge of the stock to fight more strongly Against The Invader and keep them outside the walls right so taong disease would always be this sort of like it's a fight Outside The Stockade walls um and as we'll see in a second um the fight can get inside the Stockade as well so before we go on I want to just make sure that everybody has this um this this differentiation in their head between this wind strike and this cold damage pattern presentation the key being really sweating this is really the key thing is that if somebody's sweating or not sweating is going to really strongly inform our diagnosis and it will also strongly inform what kind of herbs and potentially acupuncture treatments that we're going to give this person um if we sweat somebody who's already sweating we're going to weaken them further right because they're going to lose more sweat um whereas if we give them something that's a little bit nutritive this idea of the sweat being a vital substance we're giving more substance to the system and mahang Tong doesn't do a great job doing that it doesn't give a lot of substance to the system it's mostly just pushing right it's like uh handing the defense better weapons not a sandwich right um so guer Tong we need to give the defense a sandwich as well to make them stronger um and we'll see that in the pulse floating in tight versus floating in moderate that's very important to remember and then we'll just also note that for exterior acute conditions once again we don't necessarily expect the tongue to give us very much meaningful information yeah but um in terms of a TCM education I think that the more of the terminology we can mispronounce in Chinese the better I'm kidding about the mispronounce um so the last one that I'll add and not all sources include this but I certainly think that we should is uh sorry I just got something oh okay um is taang one bing and we're gonna talk about one bing in a second and one bing means warm disease and there's a whole school called one bing disease school which is four levels but there's also a one bing which is a specific taong presentation where there's more heat than cold so I I actually don't want to belabor this but I do want to just mention that you could have something that isn't all cold in the taong layer and there we expect there to be more of a sore throat more fever than chills and that's what points towards heat so a sore throat is considered heat swollen glands and if we look down the throat it'll often be red and inflamed so a stronger heat presentation could be a heat pathogen taong one beinging one means warm Bing means disease so we may see that and we also see this theoretically in the pulse and tongue where we have a rapid pulse showing us heat and a tongue that might be showing some redness so just be aware that the one bing is out there as well um and we would have more sore throat more fever and then these other heat signs and symptoms okay all right let's talk about Yang Ming disease so um I'm putting yangming before xiaoyong but um that doesn't mean that it necessarily has to be there we said that the shaoang can go either between the taong and the Yang Ming or it can go between the Yang Ming and the ta ta Yin and either way we can make good arguments to do um we'll remember that young Ming when I see say young Ming your associative Network automatically says large intestin in stomach right which is really a short hand for the entire digestive tract um so we think about this tube in our bodies that's all Yang Ming um because Yang Ming is this Workhorse system that um breaks down food and protects us from anything pernicious in the food and then excretes what we don't need there's a saying that Yang Ming is rich in Chi and blood so the entire yangming system is rich in Chen blood um we find when we get to acupuncture theory that there's a bunch of very very very strong Chi moving points on the young Ming meridian so for instance hugu li4 very very strong moving you know stomach 36 also very strong moving large intestine 11 these are all yangming points and because the yming system is so rich in ch and blood it means that the we can access it fairly readily with our needles and there will be a response this also means that the chi response of the body when there's a pathogen in the Yang Ming will also be strong because it's ready to go right the Yang Ming is rich in Chi and blood so when we get pathology on the Yang Ming level the symptoms are going to be pretty pronounced um so there's two main differentiations we need to make one is Young Ming Channel disease and the short hand for this which we absolutely need to memorize by next week if not by the end of lecture today is the four bigs right the four bigs Big fever big pulse big thirst big sweat so Yang Ming Channel disease because y Ming is rich in ch and blood when the pathogen gets there it's ready to go right it's ready to go guns guns blazing so there's a very strong immune reaction we kick up a high fever the pulse just jumps a huge forceful pulse we get very thirsty because it's hot you know this battle is actually it's it's a young battle between um our system and the and the uh the Shi the evil Chi and we're also going to be sweating buckets right as we try to push push this pathogen out um uh key here is is that once the disease gets to Yang Ming Channel level there's no longer any aversion to cold on the taong level we had fever and cold together or fever and chills together so fever fever and chills in some relationship but usually the chills were slightly predominant that feeling that you know your your skin is really sensitive and you want to get out of the wind get out of the cold warm up once we get to Young Ming Channel disease we're much more likely to have somebody who's like just sweating and hot there's no chills involved anymore they're not going to be asking for blankets anything like that but most people agree that um covid comes on as a a form of cold damage you know um and often with dampness you know so there's this cold damage that turns into dampness for sure and I can tell you um when I got Co for sure I took a herbal formula called gong which is related to mahang Tong and you know I had this I had chills and uh I also had just horrible achiness around the neck and shoulders you know that just felt like somebody kind of sitting there and this big headache you know and all of that stuff is taong stuff and I took herbs and I wasn't sweating I took herbs to help me sweat um there was some mahang in there and it was a miracle how much better I felt in short order you know so yeah I think that there is definitely you know a lot of Tong coold damage with the progress of Co but it gets damp pretty quick a little bit less with Omicron Omron seems to not sink into the lungs and give people this junky kind of damp flam obstructing the lungs as much um and a lot of people thank goodness because that's potentially way more serious right young Ming we said that this is hot right four bigs young Ming is hot so by this time we have this idea that any pathogen that hangs out in the body for any kind of length of time generally is going to run towards the hot right so all transformations in the body or warm Transformations anything stuck tends to get warm in our body be it a pathogen or our emotions or whatever so we're not surprised to hear this um intense fever with profuse sweating extreme thirst wanting cold beverages so it makes sense right we're sweating we're hot we want to drink cold stuff right and then this red face probably irritability as well so hot and bothered right um at this point we actually expect perhaps the tongue to start showing this so at least a red tongue body and maybe a little bit of a yellowish coat and if there's been a lot of sweating the the the system starting to dry out regardless of how much water you chck down right so um we're we're not surprised to hear that tongue might be dry as well and this is a textbook excess pulse flooding big and forceful right flooding big and forceful um the formula for this is uh the uh bhuton White Tiger decoction right and it has a couple of very strong heat clearing herbs incl including Shaga um Shaga is a mineral substance that actually moves the bowel to clear heat right um so Yang Ming Channel the keys to remember no more cold pure excess four bigs okay so if you got the four bigs Yang Ming Channel you're you're most of the way there okay okay great so let's move on to Young Ming organ um the idea of younging organ and in general we can think about the organs as being located at a deeper level than the channels right the channel are sort of the the arms and legs of the organs in a certain way that extend throughout our whole body right um if this pathogen has gone through the taang level and theoretically maybe even through the yanging channel system and into the yanging organ or yanging Fu and these are used interchangeable Fu being the bowel and Tong being the viscera and we can think about this either Hollow or solid organs blood filled organs or non-blood filled organs this gets us kind of there but the the bowel Ying bowel disease Ying organ disease younging food diseases are all the same thing um here we have an image that the actual function of the bowel is starting to be compromised and the main one of the main signs or symptoms of this is constipation and abdominal distension and pain um so the image in Chinese medicine that you may may recall of the large intestine job is to sort of float the boat of our feces out through the body right and the balance of water in the large intestine is very important if it's too much water then our boat starts to dissolve and we get loose stools and diarrhea if it's too too little water then our then our stools start to get really really compressed and compacted and gets stuck and we call this constipation or some forms of constipation right um so with young Ming organ disease uh the idea is that the the the patient has this hot disease on the interior of the body they're sweating a lot they're really thirsty and now they're their bowel is starting to dry out because of the heat so this creates a stagnation in the actual F Oran of the large intestin we're still sweating and we can talk a little bit about the difference here that there's um it was observed clinically that The Fever for the bowel disease may be a little bit more tidal fever and a tidal fever is a type of fever that we'll talk about maybe even later this morning or this afternoon rather a fever that kind of comes and then goes and comes and then goes and the textbook pattern is a fever that rises in the afternoon I don't have a good reason for that but there may be something that we could kind of make up from looking at a clock or something like that but uh the Yang Ming bowel disease tidal fever in the afternoon or consistent L consistent fever also um sweating of the hands and feet so we're still sweating but maybe that's changed a little bit but really this abdominal distension and pain and constipation is really really where we want to focus in terms of looking for the symptoms so we have an excess heat presentation we have a complaint that's probably centered around abdominal pain abdominal distension abdominal fullness and maybe constipation right um there's a theme in Chinese medicine which holds true that you know I've talked to um this is actually conversation I have with my sister who was a ICU nurse for many years at SF General and uh there's this idea that if the battle is not moving people go a little crazy right people go a little crazy if we can't um release the the um byproduct of our digestion on a regular basis it starts to back back us up and it starts with irritability but can actually turn into delirium insomnia and Insanity um and I bring up my sister because when she started being a nurse she you know this is before I had ever started practicing medicine and she she was telling me about her day and she said that you know she had an incredibly satisfying patient encounter where there was a patient who was incredibly irritable borderline Delirious who hadn't had a poop in like five or six days and this was a geriatric patient and she did what she called a digital de impaction which means you go with your hand up somebody's anus and you scoop out the poo and it was instantaneous she said she had never had a happier person or a happier like instantaneous change in somebody's disposition after this digital de impaction and I was like I don't know if I want to do that kind of medicine but wow awesome results you know maybe we do that with herbs instead of a gloved up hand I don't know what your practice is going to look like I don't know if that's in our scope but the point here is that if you are backed up and maybe you know people have um their own experiences with that if you're backed up then it it starts to affect not just your digestion but your entire shun you know your shun Ming your spirit brightness is affected also and so we need to move this bowel often um so uh important to highlight that even though this presents as a very excess disease um if this lingers at any for any length of time you know somebody has a fever for a while uh there is damage to the giner body fluids here right there's damage here sweat is not just sweat that we've lost but it's actually vital fluids that we will need to replace so that's important to remember um often the the formulas that we have for young being bowel disease will have certain things to not just Purge the bowel but also to moisten right to moisten the bowel and to replenish the Gin in the year um when we look at the tongue and the pulse we're not really surprised to see that um at this point with this actual physical substance jamming up the bowel we actually have something on the tongue that's showing us this there's actually a thick yellow brown or black coat on the tongue which is this um turbidity within the system drafting up to the tongue Co right we're not able to release this turbid Yin when we have Yang Ming Fu disease and it's starting to show up systemically throughout the the body and this thick yellow brown or black turbid dirty tongue coat is something that is textbook Yang Ming Fu disease and of course we expect it to be dry right um because the fluids are being damaged the pulse is interesting a deep pulse shows us where the disease is it's actually in the organs so the organs are deep in the pulse strong it's an excess disease so we're not um um surprised to see that most sources say this is a rapid pulse because of the heat there are occasional sources say that it's slow because the giner have been damaged and so there's um sort of a systemic lack of uh circulation because the genin and the a are damaged but I would say textbook you're safe or bet saying this is going to be de deep strong and Rapid pulse um oh jeez do you guys still have me here yes okay good sorry I just got a note that I lost my zoom but I think it's not yeah what is a thorn thorny tongue so a thorny tongue is uh that's uh I it's cracks along the edges that make it look like the edge of the tongue has strong ridges um so um we talked about taang and in taang we had two main differentiations we talked about wind strike versus cold damage right so these are really important differentiations to keep in mind we got to Yang Ming and we talked about two Chief um differentiations also we talked about Channel and we talked about organ um channel four bigs four bigs four bigs organ constipation and crazy right or Delirious or insomnia some sort of psycho emotive so um uh this is really key that there's there's actually abdominal issues going on here right with that in mind let's go to Shia young um I want to emphasize once again and you know I repeat myself because uh this is one of the ways that that we just kind of learn is by hearing the same stuff over and over but Shong we can describe it as half interior half exterior or sometimes half half sometimes in notes you'll see HH to describe this disease half half but we could just as easily say that it's neither interior nor exterior with this idea that it's stuck in the pivot right so this would be like The Invader stuck in the gate of The Stockade trying to get in we can't kick them out of the gate and they're not getting all the way into the Stockade they're sort of right in that that middle layer right um and we could say that this is either between Yang Ming or taen or between taang and Yang Ming we don't need to have an argument about that um but we do need to know the symptoms there's a few key key symptoms of shaoyang disease um xiaoyang when I say xiaoyong the associative Network in my brain says gallbladder and Sanel right gallbladder and sanou and then there's another little off leg to that that whenever we say gallbladder we have to think about liver parenthetically because liver and gallbladder Are Yin Andy faces of the same thing and so we'll see some some kind of liverish things poke up their head when we talk about sha xiaoyong disease but most of what we see here if we remember our dang Fu uh disease categories sounds a lot like gallbladder heat so heat in the gallbladder system we have a bitter mouth a bitter taste a dry throat all of these things are things that we see with gallbladder heat blurred vision and maybe this intersects with liver a little bit right liver gallbladder gallbladder Meridian goes to the eyes so does the liver Meridian but blurred vision can be part of it fullness and distension in the chest and hypochondriac region tells us things are not flowing smoothly in our bodies let's just remember that when we say xiaoyong is the pivot and our body shaoang is this weird set of networks that run down the lateral sides of our body um so when you were in um acu1 points and channels do you remember the day that you first laid your eyes on the gallbladder Channel like I remember seeing the gallbladder Channel and being like excuse me where where does this go what like it's this crazy like interpretive dance all the way along the side of the head down the side of the rib cage and it does these weird Jiggy Jags and kind of ties into the belt and change it mind and goes down the side of the legs and does some crazy things down by the ankle I mean it's a very interesting Channel but the interesting thing about xiaoyong and when we get into Meridian Theory um is that it it kind of stitches the front and the back of the body together and when when I heard that it really made something kind of Eureka in my head that um xao Yang is this in our bodies it's this channel system that ties the front of the body and the back of the body together and that it's also in charge of sort of rotation and pivoting in the body you know that this kind of lateral motion that we do um so this fullness and distension in the chest and hypochondriac region when we talk about XA Yang we can think about the sides of the rib cages perhaps being more affected right um uh we we can also see some digestive symptoms and so this is angling towards wood Earth disharmony which we talked about before but we know that when the shaoyong system is disrupted the gallbladder and then parenthetically the liver is interfered with this might beat up on the digestion and give us nausea vomiting low appetite and then irritability is also a very textbook sort of liver chees stagnation sign or symptom um it's also the sign or symptom of any kind of lingering pathogen with a low-grade fever um often often makes us um irritable so talking about temperature with Shong the key here is this first symptom alternating chills and fever and the the the Cadence of the cycling there's a lot of different ways it can cycle but if there's a disease where we're sort of oh I feel really hot and I'm sweaty oh now I feel cold and now I feel hot and now I feel cold it's not the same as like I'm cold but I also have a fever on my forehead you know like that's not it it's not that I have mixed fever and chills at the same time but rather an alternating Cadence and this can rapid cycle so like this happens within 20 minutes I go back and forth and we'll as we'll see later there's certain diseases that describe a longer cycle of this where maybe one day you feel hot one day you feel cold um and when we talk about malarial diseases later on the semester this is um often related to a shaoang presentation right um feeling hot feeling cold in in in some sort of cadence um when we look at the tongue and the pulse uh tongue doesn't give us tons of information it's it's like kind of a normal tongue coating is thin and white maybe a little bit yellow because we are talking about heat and then our pulse really points to it so a wiry pulse and you know we've talked about tyong uh taong and Yang Ming confirmations we didn't see anything that said wiry right we saw floating and tight we saw floating in moderate then for yangming Bal we saw either like a a big pulse an excess forceful pulse if it's in the channel level or if it's in the organ level a deep pulse that's also probably forceful once you get down there but this is the first time we've seen that word wiry and wiry means constraint right that's what wiy really means is that something is constraining the chi here and we know that the gallbladder and the sunow are are major organs for sort of General circulation of energy through the system right so you've got a tayang on the outside we've got our Yang Ming which is um remember no chills then our shaoang alternating chills and fever okay um and when we talk about Channel Theory there's a lot a lot of different ideas about where Channel Theory comes from but when we look at the gallbladder Channel um I I have to believe the theory that you know Channel Theory emerges um from people's direct experience of these channels right from these Dows adaps that were sitting in the mountains and eating strange herbs and roots and getting into very very deep states of contemplation about what the nature of their being was and noticing that there was certain flows within their body that were just a little wacky like it's not like a straight up and down line at all I don't know why you would trace it all the way across the head and then back down zigzagging and everything so I I am definitely of the opinion that um Channel Theory evolved from the experience of um of Mystics and Mystics and meditators um all right so um moving from the yangming bowel to tiin which we know as viscera now we're talking about um you know the tiin channel is the hand lung and the foot spleen Channel both belong to tyin and we talked about how the job of tyin in general is about moving fluids and uh taking all the nutrient that's been absorbed via the Yang Ming and then Distributing it um Tyler was very helpful in saying that you know in in W's applied Channel theory he identifies tyin as as being related to dampness in the movement of fluids and that's very true that's very true for all of us uh for all of our uh understandings of of tyin um we think about the tyin as um uh deeper than Yang Ming and when a disease gets through the Yang Ming bowel or through the Shao depending on which level progression that you're thinking of um it now is actually starting to interfere with the assimilation of nutrition and the movement of fluids throughout the body right so we also have an abdominal fullness complaint here um but if we think about this in terms of eight principles we're going to start to see a little bit more deficiency being marked here than excess so we talked about abdominal distension related to yangming bowel pattern right and here we have an abdominal fullness but it's accompanied by all sorts of indigestion complaints so if it's more the top of the digestive system that's been interrupted then we might have vomiting if it's more of the bottom we could talk about diarrhea but in any case there's some disturbance in the digestion and it's not just elimination it's not blocked up because we've had such a fever that we've kind of cooked down the feces in the digestive tract so it's now not moving this is actually because the tie in function has been damaged we're no longer holding on to things long enough to assimilate them or spleen just can't even take it and we vomit um tyin and spleen are very very very closely related in the way we think about them um when the spleen is messed up we know that we have spleen sheet deficiency right um and just just to to make sure that you're all awake give me just a couple symptoms of spleen sheet deficiency so loose stools and fatigue are really number one and number two you could also have body weakness right because the spleen nourishes the muscle In the Flesh and uh which is why we often recommend for our spleen Chi deficient patients of which you know you may be one or you may know one love one um Regular movement of the tissues of the body is very helpful something to engage the muscles without exhausting them and this is really key when we're counseling our patients that have spleeny deficiency or have tyin disease is that we do want them to move because the movement of the body will actually um help tonify the tie-in system but we don't want them to move too much we don't want them to be too ambitious ious you know um so doing something very gently strenuous every day but regularly so you know two 15 minute walks a day or something like that to get the tiin flesh to activate um what we'll see with tiin disease is that we have um this abdominal fullness the loose stools but then we also have signs that the fluids are not moving quite right and this is where Tyler's commented about dampness really comes into effect and we see this um on the tongue the coating will be not only white but kind of green greasy and when we see this greasy tongue coat we know that there's a problem with fluid metabolism that's what the greasy tongue coat is showing us um greasy also suggests that there there is some uh dampness that's not dried out the tongue coat on our younging bowel pattern was a very dry thorny yellow caked dirty coat but we didn't say greasy because it lacked that kind of damp aspect to it um the other thing that we'll notice here is that um abdominal fullness and pain that feels better when you put warmth or pressure on it and we remember from our a principles discussion that better with warmth and pressure always points to some sort of deficiency right um so if we were translating this into more of a dang Fu di diagnosis this is pretty close to spleen Chi deficiency with dampness you know and maybe we could even say spleen Yang deficiency with dampness and why why would I maybe say Yang deficiency and not just Chi deficiency when we're looking at this list of symptoms basically the same the same thing but young is warmer right and so if it's better with warmth this usually points to some sort of young deficiency right so anytime that you see something where cold is a symptom better with warmth is a symptom this often tells you it's not just a chat deficiency but there there could be a y deficiency as well and when we look at our herbs that we're learning about there's certain herbs that are neutral in temperature that's support the spleen and there's certain herbs that are warm in temperature that support the spleen right so we wouldn't want to just necessarily losing use the neutral and temperature herbs but some of the warming herbs also this is very common it's way more common to have a cold spleen a young division spleen than a warm spleen um especially in modern American culture where we're chucking down things straight out of the fridge into our bodies a lot we like a lot of ice drinks we like our smoothies you know it still you know boggles the mind that you can be in a cold City like New York in the winter and see people walking around with ice lattes you're like what are you what are you doing but we do a lot to beat up our digestive fire right and this is certainly not an observation that's strictly from East Asia we see this in South Asia also anybody familiar with ayurveda you know they're always talking about protecting the digestive fire the digestive agne so um this is traditional Knowledge from pretty much across the globe that our digestion likes to be warm right that our digestion likes to be warm um so our Tian disease our our basic model is if we translate spleen Chi or spleen Yang deficiency with dampness because the spleen is no longer longer metabolizing those fluids it's no longer turning them into good Jer so instead of good Jer that flow with the blood in the Chek we have this dampness accumulated right we see that on the tongue with the white greasy coat we also see that in the pulse so our deep pulse again affecting the organ level like this is what our deep pulse says but instead of going deep into the pulse and finding something vigorous like we might with um Yang Ming bowel disease we go deep and we find out actually it's a pretty weak pulse down there um we're lacking something this is primarily deficiency with a little sidebar of excess dampness because of the deficiency um when we get into Clinic we will find that it's um it's a rare patient that we encounter that just has spleen deficiency without dampness um typically by the time they meet us their their spleen has been um on the ropes for a while and it's stopped really doing what it needs to do with the fluids and started to bog down into dampness as well so um when I'm uh press re time in clinic I I have a lot of diagnoses that just say spleeny deficiency with dampness because it's so it's so common to finded you know and you know these patient presentations are very common somebody will come in and they say oh I feel really fatigued uh you know when I eat I feel full really easily and then they'll say something which is always a hint about the dampness they'll say my body feels heavy you know or you'll ask them you'll say hm so you feel fatigued does it feel like your your physical body actually feels heavy and some people like oh no no no it's just I'm tired and other times you're like oh my God I feel like my legs weigh a th pounds you know and then you might start to look for it so you might actually palpate their legs and see oh what does this tissue feel like I'm going to use my palpation from the four pillars of diagnosis and see does is there a lot of interstitial fluid that's not circulating do they have edema when I press on their tissue does it bounce back do do they just kind of feel wet and swampy when we feel their tissue and if they feel wet and swampy you can kind of they probably have some dampness it's pretty likely I think that there's actually a really really um strong correlation um between modern diagnoses and traditional diagnoses so hypothyroid tons and tons of hypothyroid people have spleen Chi spleeny deficiency plus dampness yeah that's tons and tons and um you know there's a there's certain demographics that we see within the clinic within my practice that uh very common to see this so a lot of folks you know there's a large subsection of my of my um practice at octagon Community Acupuncture is um uh middle a middleaged Latinos from East Oakland that you know they love acupuncture because it's it's low cost and a lot of them have a lot of body pain use their body pain a lot but a lot of them have had um very hard high carb high sugar diets for a long time many of them have hypothyroid maybe them many of them are pre-diabetic or diabetic on the edge or sort of in the pool of all these metabolic syndromes that we talk about um and they'll often present as as folks that are carrying on carrying a little bit of extra weight circulation not so good often swollen feet swollen ankles and things like that you know there's there's certain modern disease names that don't map cleanly onto patterns but um hypothyroidism and spleen deficiency and dampness is is is is pretty dang close for a lot of it you know all right so that's our picture of tiin and really the key is just remembering everything you learned in your foundations courses when you talked about Spen sheet deficiency with dampness and realizing that it could be fenyang deficiency also and then noting that you there may be some vomiting here too but it likes warmth and pressure and you know what we're going to do is we're going to try to um resolve the dampness with herbs and also boost the spleen with various herbs and acupuncture also this would also be a great moxa patient right so this would be a great patient to actually put moxa directly on the abdomen for instance or moxa on stomach 36 spleen 9 spleen six these points that really really help us um move energy into the tie-in system and kind of dry that dampness and you know using drying herbs like fooling and um BYU tangu things like that very useful and then if they're more towards the cold we might use more warming herbs and if they're very cold we might use like a futa or something like that but we'll also note that um when we look at the digestive herbs common to most cultures almost all of these digestive herbs are either very or um slightly warming so Ginger turmeric garlic onion um cumin all these herbs they they usually the the herbs that in eastern western South Asian Cuisines that you add to help digestability are almost universally warming because of this yeah you can overdo it though you can certainly overdo it uh especially once we move from like the the warming herbs to the fiery hot herbs you know shallan disease more progress pathology and there's two main categories here that we're to talk about and these are broadly discussed as cold transformation or heat transformation um because we're still in a place where zangfu theory is our primary diagnostic rubric um if we map um the cold transformation to a Yang deficiency and the warm transformation to a Yin deficiency is going to get us pretty close to the understanding we need so shaan hanwa cold transformation the image here is somebody who's cold they have a weak pulse um uh they they are very very tired there's their spirit is not bright they don't have the energy to talk loud often very poor circulation to the extremities and um not just diarrhea but Di diara with untransformed food right um or vomiting right after eating you can't even hold it in um and then we may have a little bit of red cheeks but that's that's actually just a one false heat presentation that we see within this General cold presentation if we think about this as being a mix of spleen and kidney yangong deficiency we're dang close to understanding this Shin cold transformation so we could think about this as um uh a patient that generally doesn't doesn't present as very vital that has digestive problems a very weak pulse and also there's um we're starting to see uh symptomology that's really describing the shun right so a low voice deficient shun there this disease has really got to them it's tap them out where they're no longer connecting in the way that they used to connect to the rest of the world um the tongue shows us this Yang deficiency so a pale wet tongue both of these descriptors Point towards Yang deficiency so the tongue isn't isn't uh red because there's not enough Yang to warm it up and it's wet because the Yang is not transforming the fluids um so we could also assume that this might be um swollen as well right um and our pulse is just a you know it's it's a it it Maps almost exactly to Young deficiency with a deep a weak a slow pulse um the picture is here is somebody with just not much oomph right um they're very tired they want to lie down um so this this pathology once it's got to the Shen heart kidney level it it's really taken a serious toll on their Vitality um and we certainly don't expect this to manifest overnight this is probably something that's been around for a while right um if on the other hand we look at shaa which is heat transformation re means heat h means transformation um this is much more uh maps onto a Yin deficiency right so no longer having the the fluid and material basis to kind of blanket the Y and so you start to get these heat signs like irritability um restlessness they can't they can't lie down they um the Yang uh is is a little bit out of control because there's not enough yin to blanket it so the mouth gets dry the throat gets dry they may be restless at night um and the tongue and the pulse is just textbook Yin deficiency pulse right red with a yellow or scanty coating appealed coating um this is Yin deficiency when there's not enough of the fluids to balance the um activity of the young and certainly our pulse also shows that thin and Rapid pulse the thin shows us there's not much that fluid not that much yen flowing and the rapid shows us that uh the the Yang is moving too much because there's not enough yin to balance it um so when we get to the Shao Yen we also have the luxury of um for our purposes right now just doing sort of a simple transformation uh from our dang Fu thinking to our six channel six confirmation thinking where we say Shen cold transformation okay the the reason it's cold is there's not enough Yang Shan heat transformation the reason it's hot is because there's not enough Yin and then if we Port over all of our understandings of Yin and Yang deficiency then we we kind of get a picture of sha Yin does that make sense sort of the polarity on this and just note that this is deficiency right this is not excess at this point this is somebody who's been struggling with a pathogen for a while and and the pathogen's actually winning right the pathogen is actually getting the upper hand here and um this you know we could even say that um when we look at these two maybe we're more concerned about the Yang deficiency than the yin Yin deficiency here because if your appetite is Disturbed and you can't really eat this is always a bad sign if you're if you have diarrhea with undigested Foods I mean one of the things that makes us human is the is the ability to absorb what we eat and if we can't do that this is this is a fairly serious pathology okay let's move on we're we're just about through this overview we get to Jo in we related J in to the pericardium in the liver we talked about the Joan as being intimately related with this deep deepest Lev level of Y our body which we call the ministerial fire and the way this ministerial fire circulates throughout the body we also talked about um the pericardium is sort of storing the heart and the liver is storing the blood um when we get to the Joan level historically very interestingly um a lot of the pathologies described were around parasitic infection so round worms and Joan disease was all was in the classic described as vomiting of round worms and in ancient I mean we we don't live in a world right now where parasites are nearly as common as they have been throughout all of human history and are still common throughout much of the world um so we don't have as much direct patient Encounters in the modern practice to talk about this but we do understand that parasites are opportunistic and if the if the body is very strong many parasites won't be able to occupy a space within the digestion for instance um when the digestion is weakened when the energy is weakened this opens up the door for parasites to actually thrive in our internal Environ so we we think of the parasites here as probably being a secondary marker rather than a primary cause the reason that there are round worms is because the system is too weak to actually kick them out on its own to take care care of them on its own and obviously there's certain times where parasites are unavoidable I mean I I certainly have uh been in environments where I couldn't avoid parasites and you know I had denter and stuff like that um and my health was pretty good when I had that and I know that's a common experience but I think the reason that they highlight the vomiting of round worms is to to show that this Joan disease it's very progressed we've had this dran for a while and it's actually getting to the core of our being the core facility to store and warm the body um we're going to introduce a vocabulary term here which is one of the the um terms that we is potentially kind of kind of silly and funny but uh in the text they'll often describes uh limb reversal and when I was a student I was like limb reversal so the arms go where the legs are or the hands go where the shoulders are like I didn't understand it but what limber veral describes is reverting cold of the four limbs which means the circulation in our bodies is supposed to push all the Yang all the way out to the extremities and then it turns around and it comes back and limber versal means that all the heat in the body is starting to collect towards the core leaving the limbs cold a normal circulation would be heat in the core flows out to the extremities and then comes back limb reversal this flow of energy to the hands and feet has been impeded or revers because the body is trying to preserve the warmth more towards the core of the body so we have reverting cold of the four limbs J also called limb reversal um uh this isn't just like I get cold hands and feet it's not that complaint you know it's it's not like a regular healthy person that gets cold hands and feet there's lots of reasons why somebody might get cold hands and feet it's a very common complaint um usually in our practice it's related to either Chi stagnation or blood deficiency or both and these often go together so um typical cold hands and cold feet that we see in clinic are you know people that are stressed out and slightly undernourished or trying to live on smoothies and salads where their blood is a little bit deficient and it is more common in biological women than men uh because blood is tougher to make for people that have a regular cycle if you are um losing blood every month than keeping keeping up with the blood supply is tougher it's easier to get cold limbs from blood deficiency when we talk about Jan disease we're not really talking about just that we're not talking about a super superficial a little bit undernourished and a little bit stressed so things don't circulate this is more serious this means that the young energy in the body the ministerial fire has been compromised and the body's doing whatever it can to preserve it what we end up with is with is erratic movements of energy um and this is key once the body's Energy and Metabolism has been disrupted at the D Yin level the Energy starts to get um uh really disorganized um so sometimes they this is described as running piglet which is an internal Sensation that there's energy Rippling up through the chest um this is sometimes called heat rising and dashing to the heart so physical sensations of heat moving in strange areas of the body there may be pain and heat in the chest and then everything else is kind of disrupted so often there's a hunger with no desire to eat and this is described as a stomach heat so this um irregular energy in the body has hit the stomach and may the stomach want something because the stomach is warming up but you don't really want to put anything in your belly because you're not confident in the be the ability of the body to actually eat and transform it um and we already described cold Limbs and then diarrhea so are you guys familiar with the phrase heat above cold below it's a pretty descriptive pattern it basically means that there's certain signs of heat and certain signs of cold and these are the heat signs have a tropism for the upper body and the cold signs of a tropism for the lower body so in this particular P pattern the heat manifests as this heat in the chest um it could also be heat in the in the digestive system leading to the the craving to eat but then cold below the feet are cold the legs are cold and then maybe diarrhea right and so there's this cold in the digestive system where spleeny yang deficien could be involved here too right and then um our textbook is vomiting of round worms um and interestingly some of the herbal formulas that we might give for Joan stage disease do have toxic substances in them that would potentially kill parasitic roundworms but they also have very warming properties that get in there and kind of stoke the Min ministerial fire and try to bring the heat back to where it's supposed to be the image in Jo yen is the body is now so weak that the Heat's moving all switch of um strange places in the body and so we might need to use herbs to say hey no we want the heat to be in the kidneys we want the heat to be in the core we want the heat to be in the center and then ways to distribute it out so um there are warming uh wangang would be a formula potentially for this where you have some very cooling herbs plus some very warming herbs together as well as some um nutrient herbs as well um we will note here that Joan stage disease the pulse does something interesting which is um textbook pulse goes back to wiry right what was the other stage where we saw a wiy pulse in our associative body and our head why might we have a wiry puls and j in and xia yang what what you know when we think wry what systems do we start to think of exactly so we're deing dealing here sort of with the with the wood phase and the wood phase pokes its head up and shaoyong via the gallbladder and the wood phase pokes his head up and Jo in via the liver right there's a lot of information a lot of associations and honestly uh you know when I give a little like Q&A quiz like that I I don't I don't necessarily need anybody to answer it but I need you to start to think about it and that starts the growing in your brain to put pull these things together so um you know some people are really good at this kind of response and other people are like ah I can't get the short quiz and it's actually not important that you get it the important thing is you start to kind of look through the file cabinet of knowledge in your head yeah okay so let's just review really Qui quickly because this was actually a lot of review but a lot of um uh a lot of information as well so we'll just go through it really quickly together again and then we'll do a little um little quiz activity um so we talked about tyion cold damage cold damage the key markers being no sweats excess and floating in tight pulse tyang wind strike chills and fever mixed chills worse than fever sweating though wind cold exterior deficient condition floating in moderate pulse when we get the tayang one bing I just mentioned that hey you may see heat on the taong level two not just cold and taong one bing one means warm Bing means disease taang warm disease is marked by this really strong sore throat and a pulse and tongue to tell you heat this is also an exterior condition and then I said as as a sidebar there's a couple other tyang diseases that we're not going to talk about now but we may um touch on later this semester Yang Ming disease um Yang Ming is rich in Chi and blood anything that hits the yangming level we expect to have a little bit of drama because there's so much Chen blood there that we expect the disease reaction to be strong um so the pathogen has gone inside become vigorous heat tyang channel four bigs four bigs four bigs what are the four bigs fever pulse thirst sweat um this is memori memorizing stuff pulse is flooding big and forceful and we started to get this yellow dry coat um but it's really the four bigs Tong fu disas or bowel disease or organ disease is all about stuff stuck in the large intestin young Ying organ disease yes uh we have this distension in fullness uh we have the tongue coat and then our pulse is now deep because that's where the pathogen is it's got to the organ level so we have to push down but once we hit that pulse it's forceful whether it's Rapid or slow we can have a discussion is there more damage to the Gen then it's be more slow if it's more heat stage then it's going to be more rapid right um pass pass ing the Yang Ming and moving into xao Yang we talked about this as half half neither exterior nor interior really the trademark here is alternating chills and fever and this is actually kind of important um we're gon to uh talk about malarial diseases later but for shaoang disease this should be not a super fixed pattern the hot and cold shouldn't alternate at a given time of day necessarily it should be sort of a little bit indefinite um I'll also remind you that for this young Ming organ disease we had the same tidal fever where a tidal fever Rises and Peaks maybe in the afternoon for young Ming disease and then recedes again whereas our shaoyong disease we're so talking about less fixed pattern hot and cold random times 20 minutes hot 20 minutes cold maybe hot you know for half a day cold half a day a little bit indefinite there um we have this y repuls that we already discussed and then some of these gallbladder heat signs so bitter bitter taste in the mouth is a textbook gallbladder Heat sign that maybe um biologically we associate with an over secretion of bile and an upsurgence of bile gives you a bitter taste in the mouth that's possible um or a little bit of stomach acid um blurred vision talk you know the liver gallbladder reaction and then um maybe dry throat maybe hypochondriac complaints reduced appetite maybe nausea vomiting and then irritability so this combination sort of liver gallbladder signs and symptoms for our sha young but the main thing alternating chills and fever is alternating chills and fever this is really the key sign maybe bitter taste in the mouth moving into the yin stages our Thai Yin disease we'll just Shand and say spleen Chi deficiency with damp or spleen Yang deficiency with damp that's that's almost the entire idea and everything else Maps pretty cleanly on the greasy tongue coating shows us the dampness right um the pulse is deep moderate and weak which highlights since we haven't said slippery and slippery is really our main sign of dampness in a pulse typically um it tells us that the Yang deficiency or the chi deficiency is predominant with dampness sort of in the background um in the clinic we may see variations on this theme so don't attach too closely to these sort of textbook um pulse and tongues uh we may see a slippery pulse here shaan disease we short-handed and say said okay there's one transformation that sure as heck looks like mostly kidney Yang deficiency or Yang deficiency with a kidney maybe a spleen aspect and then heat transformation is a kidney Yin deficiency um or maybe a generalized Yin deficiency with like irritability insomnia can't lie down restlessness and then the the pulses map really cleanly with that and lastly we got the J in disease ministerial fire deep storage um so limb reversal and we we absolutely have to know this vocabulary word J knee limb reversal or reverting Co of the limbs it's going to come up a number of times in dung um heat signs above cold signs below erratic movements of energy so running Piggies uh heat rising and dashing into the heart maybe some mixed hunger but with diarrhea not wanting to eat and then Jan is also the stage where the classics talk about round worms a lot so this idea of a parasit an opportunistic parasitic infe infection that's able to flourish because the system is weak and then Jan disease the textbook um plus we have here is wiry but we may think that there's also going to be some signs of deficiency because is a long-standing disease so wiry and forceless wiy and thin wiry and deep wiry and floating all of these are possibilities depending on the degree of deficiency but there will be that kind of zing in the pulse right that's the winess that's the constraint um wry kind of describes more the texture of the artery you're feeling right um the textbooks say that wiry feels like a zither string or a guitar string so there's a little bit of tension in the vessel itself that uh is accentuated when the pulse moves through it that's what our wiry means so you could have deficiency or excess in that as well so I I crib this really quickly from Giovani it's a short hand about the um from shaoyong inwards so uh you know his lesser lesser Yang his shaoyong is alternating of Shivers and fevers um greater Yin is spleen deficiency with cold we talked about that uh sha Yin cold transformation kidney deficiency with cold shyang heat transformation kidney Yin deficiency with empty heat and then uh J in heat above cold below and erratic movements of energy okay let's take a breath that's a lot of information um in terms of contextualizing the six stages we're going to take these as pattern descriptions when we get into um symptoms U maybe either later today or next week um but uh for our purpos is right now having this high level understanding of the Key signs or symptoms the progress of disease from superficial to deep and then sort of the key pieces of information the Key signs or symptoms dang Fu equivalents if we have dang Fu equivalents um are also very useful here um and then later on in your education you're going to have lots and lots of opportunity to build out this understanding in a very comprehensive way but for our purposes um together this is really really the key points um