six stages

April 18, 2000

Hi, All

Has anyone some thoughts on the statement in Giovanni's book, the

foundations of Chinese medicine (p.178), which says that 'the patterns of

the six stages (and some others) can only be understood in the context of

Chinese herbal medicine rather than acupuncture'.

If this is so how relevant is it to acupuncture?

Is it some thing that needs to be fully study by acupuncturist if it can

only be fully understood in the context of herbal medicine?

Kevin (Acu. Student).

April 19, 2000

How about telling readers what the 6 stages are. Most of the members are new to

. They're ready for it. I've been slowly laying the preliminary

groundwork.<G> (Hint to readers new to TCM: TaiYang-stage evil (Small Intestine

and Bladder meridians, the horrible headaches I used to have, Exterior often

means attacking at the meridian level while Interior often means attacking the

organs, " allergies " that aren't the classic allergic response (involves IgE

(immunoglobulin E), an increased tendency to sinus and nasal congestion and

headaches during windy weather (Wind Cold or Wind Heat attacking at the Exterior

Level).

**********************

The more advanced stuff: This is what Roger Wicke has to say in his text (vol 1)

in the chapter on Cold-Induced Evils.

" Currently, much confusion has arisen over the nomenclature for these six stages

and their significance in acupuncture theory. Shortly after Zhang Zhong Jing

created his Theory of Cold-induced Evils to aid in designing herbal strategies

to resolve acute febrile disharmonies, Huang Fu Mi used this framework to

develop a theory of acupuncture and oxibustion (application of heat from burning

substances). He used the same six terms to classify the acupuncture Meridians.

Each level consists of two Meridians, one on the arms and hands, the other on

the legs and feet, as shown in table 10.1.... "

" The herbal practitioner shoud recognize that this correspondence between the

six stages of Cold-0induced Evils and the six levels of acupuncture Meridians

has some basis in clinical reality, but the two systems are not exactly

equivalent. For example, the initial onset of a common cold often begins with

the symptoms and signs of the TaiYang stage, as defined by Zhang Zhong Jing.

However, this does not necessarily mean that this disharmony would be

counteracted successfully by needling acupuncture points on the Small Intestine

and Urinary Bladder Meridians. This may actually be the case, since there are a

few points on these Meridians useful in the beginning stages of common cold with

shoulder and neck stiffness, but more frequently, points on the hand Lung and

Large Intestine Meridians (especially point number L.I.4) are needled. From

table 10.1 one notes that these two Meridians are at the TaiYin and YangMing

stages, respectively. Tghis seeming discrepancy has puzzled many theoreticians

of Chinese herbal science; it is merely due to a historical coincidence that the

same set of six terms would be used to label concepts in both an herbal system

and an acupuncture system. While there are indeed similarities, the

correspondences are not exact. In this text, we will focus on the

correspondences between the Organs and each of the six stages, rather than the

above set of Meridian correspondences, because the Organs and their functions

are more relevant to the understanding of herbal strategies. An herbalist should

be aware of this Meridian correspondences, though, because of their importance

in the general theory of traditional Chinese health practices. " (Wicke, vol. 1,

pp. 142-143)

Note that he said their are some similarities between the two though the

correspondences are not exact. The way I look at it (and I could be wrong) is

that the herbalist version of the 6 stages of Cold-induced Evils applies most

closely to certain infectious diseases. It was developed to fight these so the

herbalist would know what to use during which course of the illness. For

example, if its still completely Exterior (TaiYang stage) and is Cold, you use

herbs to make the person sweat. If it's still completely Exterior (TaiYang

stage) and is Wind, you use herbs to harmonize the Protective (Wei) Qi and

Nutritive (Ying) Qi. If it's Wind, you run the risk in this stage of disrupting

and weakening the Protective Qi if you use herbs that make the person sweat. If

it's Cold, the sweating herbs are what are caused for because the pores need to

be opened.

If the illness has progressed to the YangMing stage, this stage is marked by

high fever without chills. The Heat is in the Interior and burning up precious

liquids. You make the person sweat in this stage, and they're going to lose even

more fluids. In this stage you use herbs to clear Heat, sedate Fire, and purge

if it's YangMing-stage Meridian Evil. If it's YangMing-stage Organ Evil, purging

herbs become even more important using Cold, purging herbs.

But sometimes the the External Evil is something that responds better to the

acupuncture definition. Like my headaches that respond so quickly to points on

the Small Intestine and Bladder meridians. There are herbs and herbal formulas

that work for the headaches. A formula for me called Minor Blue Dragon worked

wonders. It wasn't even given to me for the headaches, but it sure knocked them

out. (Keep in mind these were headaches that a shot of demerol in the emergency

room wouldn't knock out.) The thing is, it contains Ma Huang, and I was

restricted to one bag of the tea per month. Acupressure was the best solution

for me. It not only would clear the headaches in minutes or instantly, it

reduced the tendency to the headaches. They're very rare now, and very mild when

they do appear. I'm not sure herbs would have reduced the tendency to the

headaches. They may have, but I know the acupressure did.

I think it's whatever works the best. Use the herbal model of the 6 stages when

it works best; use the acupuncture model when it works best.

***********************

Additional note: The 6 Stages of Cold-induced Evil model only works with *some*

infectious diseases, not all. There are other infections - the Virulent Heat

Evils that necessitated the development of a different treatment model using the

4 main phases of Wei-stage Evil (Protective Qi-stage Evil), Qi-stage Evil,

Ying-stage Evil (Nutritive Qi-stage Evil), and Xue-stage Evil (Blood-stage).

Some use a 5th stage - Pericardium-stage Evil.

Both the 6 stages of Cold-induced Evil and the 4 phases of Virulent Heat Evil

were developed to help herbalists deal with situations where the clinical

picture changes and where the correct treatment in one phase of the illness

could hurt the patient in another phase. Chinese medicine is very, very careful

about using the correct treatment for the individual at the correct moment in

time.

Victoria

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April 19, 2000

Hi Victoria,

Let my get my history right, are you saying that the inclusion of the

meridians into the six stages was introduced after its initially development

(By Huang Fu Mi) for the purpose of making it more relevant to acupuncture?

Kevin

- victoria_dragon

Chinese Traditional Medicine

Wednesday, April 19, 2000 1:10 AM

Re: [Chinese Traditional Medicine] six stages

" Currently, much confusion has arisen over the nomenclature for these six

stages and their significance in acupuncture theory. Shortly after Zhang

Zhong Jing created his Theory of Cold-induced Evils to aid in designing

herbal strategies to resolve acute febrile disharmonies, Huang Fu Mi used

this framework to develop a theory of acupuncture and oxibustion

(application of heat from burning substances). He used the same six terms to

classify the acupuncture Meridians. Each level consists of two Meridians,

one on the arms and hands, the other on the legs and feet, as shown in table

10.1.... "

April 19, 2000

>Let my get my history right, are you saying that the inclusion of the

>meridians into the six stages was introduced after its initially development

>(By Huang Fu Mi) for the purpose of making it more relevant to acupuncture?

No, the basics of already were in place by the time this

terminology was developed. They already knew about the 6 Pernicious Evils,

Diagnosis by the 8 Principal Patterns, herbs, acupunture channels, etc. But

their medical knowledge was incomplete, and they realized it.

What a lot of people don't realize is that medical problems have not remained

the same over the centuries and millennia. Medicine changed and evolved in order

to meet new challenges and to incorporate ideas that were valid from other

cultures. This is true of a great many cultures, including ancient China, modern

China, and medicine in the West today.

Being knowledgeable about Pernicious Evils, the 8 Principal Pattern, etc. is all

that is needed to treat some medical conditions successfully. I mean for example

when one is Yang Deficient and extremely Cold like I am, the treatment is not

going to change all that much over a period of time. It will change some - like

needing more Yang tonic herbs when it's cold than when it's hot, some Yang

tonics being better than others in my individual case, etc. Some conditions can

be treated rather quickly, and some like Kidney Yang Deficiency, Dampness

accumulation, and Phlegm take a long time to treat. But the general basics of

treatment don't change all that much in regard to the condition.

When it comes to febrile (fever) conditions, they do change very rapidly, and

the treatment has to change according to the stage of the condition. By the time

the herbalist has prepared the herbs to encourage sweating, the Evil may have

progressed to a stage where these diaphoresis herbs not only may not do any

good, but will make the person sicker. A way was needed to predict the stages of

these febrile conditions so the herbalist could be ready with the appropriate

herbs at the correct time.

This is why Zhang Zhong Jing developed the Theory of Cold-induced (Feverish)

Evils. So healers could be ready with the correct strategy at the proper point

in time. Otherwise, by the time the herbalist got a formula prepared, the

patient may have moved on to another stage where the formula would be useless or

even hurtful. By using the Theory of Cold-induced Evils, the herbalists could be

ready with the proper formula already mixed by the time the patient entered

another stage.

Zhang Zhong Jing used the terminology TaiYang, ShaoYang, YingMing, TaiYin,

JueYin, and ShaoYin to name these stages. Shortly after Zhang Zhong Jing came up

with the Theory of Cold-induced Evils to enable healers to predict the stages of

febrile conditions so they could be ready with the correct treatments, Huang Fu

Mi was adding to the knowledge of acupuncture. The meridians were known already.

What he did was to classify them in this stage order. He used the same

terminology of TaiYang, ShaoYang, etc. that Zhang Zhong Jing used in describing

the stages of febrile conditions.

When you're talking about the stages of a feverish conditions, the acupuncture

meridians do not match up exactly to the stage name. Wicke used the example that

when the febrile condition is in the TaiYang-stage of feverish condidions, there

are very few points on the Small Intestine or Bladder meridian (the TaiYang

meridians) that will help. When the feverish condition is in the TaiYang stage,

most of the the points that do the most good are on the hand Lung (TaiYin

meridian) and the Large Intestine (YangMing) meridians. So there's not a

correspondence between the stages of a Cold-induced feverish condition and the

meridians grouped according to these names. When it comes to the stages of

*feverish* conditions, it's not a matter of needling the corresponding meridian

that bears the same name as the the stage of the Cold-induced febrile condition.

Needling the TaiYang meridians (Small Intestine and Bladder) do not equate to

treating TaiYang stage feverish evil. Neither does needling the ShaoYang Triple

Heater and Gallbladder meridians equate to treating the ShaoYang stage of a

feverish condition.

But, infection is NOT the only Evil that can cause illness, and it is not the

only Evil that goes through stages. Nor is it the only Evil that can cause Heat.

In the West, we've grown to think of bacteria and viruses as being the only

things that produce fever. Bacterial- or viral-induced fever is not necessarily

the same thing as Heat. Many Western doctors will say that if the patient is not

running a temperature, there is no infection. (Not strictly true, but it's what

many of them believe and practice.) These same doctors will then turn around and

assume that if the thermometer reading is above 98.6 F, there is a bacterial or

viral infection in the body. Again, not necessarily true.

The concept of fever as defined in the West is NOT necessarily the same thing as

the concept of Heat in . In TCM, if the patient is experiencing

heat sensations and complains of feeling too hot, this may be a Heat condition

as defined by TCM regardless if the thermonmeter says 98.6 F or even lower.

I'm digressing some here so let me get back to other Evils that can go through

stages. Some of these will match up with the acupuncture meridians that bear the

same name. A good example is the headaches I used to have a lot which were

caused by Wind Chill. In the early stages of those headaches, if I use

acupressure on points on the Small Intestine and Bladder meridians, I can knock

the headache out. The symptoms I have during these headaches matches the

symptoms of TaiYang-stage Exterior Chill - just like it was an infection. It's

not, but it has many of the same symptoms. There are aversion to cold and wind,

feeling hot (even though my body temperature is below normal), sinus congestion

and discharge, muscles aches, etc. But unlike infectious diseases, this TaiYang

stage Evil does respond to points on the Small Intestine and Bladder meridians.

In the past, these headaches did progress to what is analogous to a

ShaoYang-stage infectious evil. I did start to feel nauseous, and vomiting would

help me feel better. I did get a bitter taste in the mouth. I did feel

alternately chilled and hot. Etc. And points on the Triple Heater and

Gallbladder meridians (which are classified as the ShaoYang meridians) did help.

Back then I didn't know anything about acupuncture/ acupressure meridians or

TCM. It's only looking back and remembering how I used to rub certain areas to

get some relief that I now realize that these were areas on the Gallbladder and

Triple Heater meridians. (BTW, acupuncture first evolved from humans

instinctively rubbing or applying pressure to parts of the body because it gave

them some relief from the suffering.)

If it is an infectious illness (and some other conditions), there won't

necessarily be a correspondence between the Cold-induced febrile stages and the

acupuncture channels which bear the same names. But, in the case of other Evils,

there may be a correspondence. It depends on the individual and the condition.

One thing that I believe Wicke mentions is that if there is a preexisting Cold

in the body - like in my case of Deficiency Cold due to Kidney Yang Deficiency -

the person is going to be more sensitive to Exterior attack by Cold. That's very

true for me. I got and kept these headaches all year round. Even the cooling

caused by sweating in the summer was enough to cause one to flare up. But I

always had a particularly hard time in the fall when it started to turn cold. I

had a particularly hard time in the spring when one day it would be warm and the

next chilly. As much improvement as I have made, I still have a tendency for

headaches to threaten during these times of the year. I've warned up internally

a lot more than I used to be thanks to the Yang and warming herbs. As this

happened, I lost some of the sensivity to outside cold. But this is not the only

thing I did to help myself. I also found that astragalus helps a lot of things.

Astragalus is one of the herbs that increases Protective Qi (Wei Qi), and this

is part of becoming less weather sensitive. And, I regularly work the

appropriate points on the Small Intestine and Bladder meridians, and this cut

down on the tendency to the headaches. Plus, they can be used when one first

begins to knock it out.

Later in China's medical history, the theory of Virulent Heat Evils was

developed to help healers deal with new challenges. During this period there was

increased international travel and trading around the world. Chinese healers

began to encounter epidemics that were so virulent that they quickly overwhelmed

healthy people. The Cold-induced Evil treatment plan was not adequate for these

new epidemics. There were more signs of Heat in these new epidemics than in what

healers had encountered previously. So Chinese healing evolved to meet new

challenges and incorporate new information that was valid.

Victoria

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April 19, 2000