shang han lun 5, 6

5. Shao Yin Diseases

6. Jue Yin Diseases


5. Shao Yin Diseases

Concept:                 

Shaoyin diseases —- yin and yang def of HT/KI,

Pathogenesis: yin and yang def of HT/KI, mainly yang def

Location: HT/KI (internal)

Nature: def SD of the whole body

Causes: from other meridians

  • yang level (over sweating/purging —- deprive KI yang)
  • tai yin (SP → KI by wrong treatment )

by routine transmission (tai yang – shao yang – yang min – tai yin – shao yin)

direct attack (wind cold)

Diagnosis:

Chief symptoms/pulse:  sleepiness + weak/faint/thin pulse

Symptom of meridian: sore throat

patterns:

– cold transformation SD:

Sleepiness, cold sensation, cold limbs, diarrhea, clear urine, faint p

– heat transformation SD:

Irritability, insomnia, red tongue, scanty t c, thin rapid pulse

Treatment principles:

– cold transformation SD: warm meridians and restore yang qi — si ni tang, etc

– heat transformation SD: nourish yin and clear heat — huang lian er jiao tang, etc

Precaution:  

Prohibition: sweating/purging therapy

Prognosis:

– cold transformation SD:  alive, if yang back; die, fi yang gone

– heat transformation SD: tendency — damage yin,  move blood, produce wind

 

A. Principles/Essentials of shao yin disease

281: In disease of the shaoyin, the pulse is faint and fine and (there is) a desire only to sleep.

Symptom: sleepiness – no spirit, sleepiness, low grade consciousness, extreme fatigue

—- HT/KI yang def, HT shen restricted by yin cold

Pulse:  faint:hardly being felt  —- HT/KI yang def

Thin: as thin thread  —– yin blood def

 Key: one symptom + one pulse

B. Patterns of cold

  1. Key manifestations of SD of shao yin def cold SD (282, 283)

282:When in shaoyin disease, (there is) desire but inability to vomit,  heart vexation, and desire only for sleep, and (after) five or six days, spontaneous diarrhea and thirst, this belongs to shaoyin. (There is) vacuity; hence water intake (should) relieve (the thirst). If the urine color is clear, then shaoyin signs are all present. The urine is clear because of vacuity cold in the lower burner and inability to control water; consequently, that makes the color clear.

 shao yin disease:

original symptoms:

– tending to vomit [dry vomit – ST cold and qi rebelling ],

heart vexation [yang def + cold disturbing]

desire only for sleep [sleepiness – HT yang def]

  disease course: (after) five or six days [yang def progresses],

  present symptoms:

 spontaneous diarrhea     [fire can’t produce earth, failure to TNT],

thirst    [yang def in lower jiao, failure to steam water upward]

urine color is clear  [KI yang def, failure to control water]

  pathogenesis:  yang def, “excess” cold

  diagnosis: shao yin bing

 

  1. SD indicated by si ni tang (323, 324)

323: When in shaoyin disease the pulse is sunken, (it is necessary) to warm urgently and (therefore) Si Ni Tang is appropriate.

 

shao yin disease

deep pulse:  shao yin yang def and yin exc

 

treatment: si ni tang

– fu zi (raw)

-gan jiang

– gan cao

 

C. Heat transformation SD:

  1. pattern of huang lian er jiao tang

303: When in shaoyin disease (that has lasted) more than two or three days, (there is) vexation in the heart and inability to sleep, Huang Lian E Jiao Tang governs.
shao yin disease:

course:

symptom: vexation, inability to sleep

parthenogenesis: KI/HT yin def + fire

treatment:   clear heat, nourish yin

huang lian er jiao tang — huang lian, er jiao, huang qin, bai shao, egg yolk

 

E. Sore Throat

Gan cao tang pattern, jie geng tang pattern

When in shaoyin disease (that has lasted for) two or three days, (there is) sore throat, one can give Gan Cao Tang; (if the person) does not recover, give Jie Geng Tang.
– heat epi

Gan cao tang (mild): gan cao

jie geng tang (not mild): jie geng + gan cao

 


6. Jue Yin Diseases

  1. Essentials
  2. Mixed cold and heat
  3. Fluctuation of cold and heat
  4. Jue (cold) syndrome
  5. Diarrhea
  6. Vomiting
  7. Prognosis

————————

1: Essentials

L 326

In disease of the jueyin, (there is) dispersion-thirst (Xiao Ke), qi surging upward to the heart (ST region), pain and heat in the heart, hunger with no desire to eat, vomiting of roundworms after eating, and (if) precipitation (is used), (there will be) incessant diarrhea.

Jue yin;

thirst, qi striking ST —- fire damage body fluid

pain, heat in ST —- ( deficiency ) fire attacking upwards

hanger, appetite loss —– def fire in ST

—– > yin def/body fluid def + ST yin def + def fire

 

if wrong treatment (purging) -à diarrhea

 

Key: heat (ST) in the upper, cold (SP def ) in the lower

 

LV (pathogen à fire) attacks SP

Def + excess

Round worms:

  • prefer warm
  • hate cold

 

  1. Mixed cold and heat

1) wu mei wan

L 338

When in cold damage the pulse is faint and *there is) reversal, and at seven or eight days, (there is) cold skin and the person is agitated without temporary (periods of) quiet, this indicates visceral reversal (zang jue), not roundworm reversal. In roundworm reversal, the person should vomit roundworms. Now, the person is still, and then periodic vexation, which indicates visceral cold. Roundworms ascend and enter the diaphragm; hence (there is) vexation, (but) wait a moment and it will cease. After eating there is retching and again vexation, when the roundworms smell malodor of food. The person only spontaneously vomits roundworms. For roundworm reversal, Wu Mei Wan governs. It also governs enduring diarrhea.
Faint pulse, cold extremities – yang def

(8 days later) cold limbs — yang reduced + cold increased

constant restlessness  — yang def + yang floating

—- > zang jue

vomiting of round worms, nausea —- round worms moving upwards

cold extremities —- qi ji abnormal, disharmony of yin yang

 

treatment p: (regulate cold and heat), regulate qi ji, pacify round worms

wu mei wan:

 

dang gui, ren shen — tonify qi/blood

rice, honey — smell good (attracting round w)

 

wine, wu mei — sour

xi xin, gan jiang, fu zi  — pungent     control round w

huang lian, huang bai — bitter

 

shu jiao (hua jiao) —- kill

pain?

Only for parasite? Beng lou, leucorrhoea, chronic gastritis, GB infection  — heat-cold