Day 58: What happens when an EPI (External/Evil Pernicious Influence) enters your body…

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because it’s watching you… Assuming your Wei (Protective) Qi wasn’t strong enough to win the battle, what happens when the EPI gets past? Where does it actually enter?

In Chinese Medicine, there are classic books written in different time periods. The books will speak of how they looked and treated diseases of that time, but another Doctor later on will come through and take those writings and expound on them. It is no different in Western medicine in that the more we see and learn the more is understood and treatments then are based on the new understanding. The Nei Jing (The Inner Classic of the Yellow Emperor) was written approximately 100 A.D. and was highly regarded by the physicians. About 220 A.D. a Dr. Zhang Zhong-jing wrote another classic called the Shang-han Lun, which was of his discussions of Cold Induced Disorders injuring Yang. (He seemed to ignore Heat Induced Disorders which injure the Yin.) In his studies, he looked at all the writings of his time and developed what is referred to as the Six Stages of Disease (it has other names, too, but the Six is what describes it). While it was mentioned in the Nei Jing, Dr. Zhong-jing took those ideas and elaborated on them and created a sequence of how disease can enter, and it’s pathway through the body. The trouble is, though, that it can skip stages, and even go backwards. It is based on Cold injuring the body from exposure to cold or other cold type of influences. The common cold and flus can fall under this (why you get chills).

The Six Stages are called, in order;

1. Tai Yang or Greater Yang and it involves the Bladder and Small Intestine meridians, and this is the initial stage and of no real concerns. It will show up as pain and stiffness in the neck and head, and the tongue may have a thin, white coat. This is where you will feel a floating pulse because it is still at the surface. It is a Wind-Cold condition. That is why it is a good idea to keep your head and neck (and mouth) covered if you have to go outside on a cold and windy day. It could be damp, also.
2. Shao Yang* or Lesser Yang involves the Triple Burner and Gall Bladder meridians. If Wei Qi isn’t able to stop it at the initial stage, it will go deeper and the patient might feel chills and fever type symptoms. Here it is in between the two stages of external and internal. When the person is experiencing chills, that means the pathogen dominates. When the person is experiencing heat/fever, then the anti-pathogen dominates. Yes, it is a battle. The pain may go further down the body into the ribs and there will also be fullness. The tongue is changing from a white coat to a yellow coat because now there is heat involved, and there may be a bitter taste in the mouth.
3. The Yang Ming* or Bright Ming involves the Large Intestine and Stomach meridians.* Now the patient doesn’t have an aversion to Cold, but more to Heat as fevers are beginning to develop. The Cold (Yin) is turning into Heat (Yang). As heat begins to break down the body (fire burning things up), it will enter the Yin stages, going from the exterior to the interior. Sweating will occur because the pores are not able to control it. Signs of heat will manifest, red face, irritability, etc. The tongue will have a dry yellow coat and the patient will be thirsty. The next two stages are deficiency patterns.
4. Tai Yin or Greater Yin involves the Lung and Spleen meridians. Here there is a deficiency of Spleen (Yang) Qi and Ying (Nutritive) Qi. There will be little appetite, and because the Spleen Qi holds things in place (i.e. no prolapsing or bruising when it is strong) and here it is weakened, there will probably be diarrhea with abdominal pain. As this is a deficiency, warmth and pressure may make the abdomen feel better. There could be vomiting. The tongue coating will be white again because there is no heat in the middle, but it will be sticky.
5. Shao Yin or Lesser Yin involves the Heart and Kidney meridians. In this stage the patient is pretty sick and may even curl up and have a desire to just sleep. They will feel cold in their arms and legs, and if they want to drink, they will prefer warm drinks. It is said that the Fire of the Heart warms the Water of the Kidneys, and that the Water from the Kidneys cools the Fire of the Heart. Therefore, there can be a transformation to cold and/or to heat. Here the tongue is pale, white coat, and because the illness has gone deeper into the body, the pulses will be deep, too.
6. Jue Yin or Absolute Yin involves the Pericardium and the Liver meridians. This is the most severe level. Due to the complications between the Cold and Heat, internally, several of the organs may be exhausted and there is a severe imbalance between Yin and Yang. Here there will be pain and heat in the chest (the Pericardium is the protector of the Heart, so Heart is involved). This is a stage that is considered a miscellaneous pattern, and it is said that worms (round) could be involved. Round worms cannot live in the Cold of the Stomach and Intestines so the patient may begin vomiting them up. The tongue will have a slippery, white coat with red papillae showing through. Not a fun night for anyone involved.

• Note: Some will put the Yang Ming stage before the Shao Yang stage but it is probably moving a bit back and forth. The first three stages are excess patterns, and at entry level, Wei Qi is battling to expel the pathogen. But, if someone has underlying conditions that have weakened their system, the disease will continue to go deeper, entering the next stage, #4 Tai Yin.

As Dynasties changed, so did how the patterns were looked at. They became known as the Four Stages, but, that’s tomorrow’s lesson.