Shang Han Lun Is Based on the Progression of Disease

Zhong Feng/Shang Han

Wind Heat/Wind Cold

Shang Han Lun is based on the progression of disease. The Etiology is primary focused on Wind Heat (Zhong Feng) and Wind Cold (Shang Han).

In this progression the body makes adjustments between Wei Qi & Ying Qi; creating Dampness, Heat, & Dryness.

Damp Heat that has not been resolved is the underlying cause of Wind Heat (WH) and Wind Cold (WC).

In order to properly diagnose WH & WC you must look at the body’s response (symptoms) and determine which symptoms are perverse vs. upright.

Diagnosing and treating the origin of the pathology in its’ 1st stage will help deter progression of the pathological factor (PF).

In an attempt to eradicate the PF the body will utilize the mobilization of Yang Qi (DU 16 good pt. to access this) via Wei Qi which emerges at the Jing Well pts.

If the PF is untreated or treated improperly it will move into Yin (beginning at the Yang Ming stage) where it becomes stagnant and trapped, causing difficult eradication. At the Yang Ming stage there is the same amount of Yang, however, the Yang is not moving which causes stagnation.

<sidenote> At the Jue Yin level there is an abundance of saturated Yin causing it to explode out resulting in Leakage

Tai Yang level of disease (Pulse: Exterior & Floating)

Wind = Change in one’s lifeAir + Pressure Qi + Pressure

Skin

Whenever the Air Pressure is higher than Qi Pressure inside the body the barometric presser is changed. We attempt to use the mechanism of sweating to correct exterior/interior AND Qi/Pressure imbalances. Sweat originates from Yang Ming and is considered to be Turbid. If the body has an adequate amount of Yang (Yuan Qi), the body will respond by the process of Tai Yang/Yang Ming to reach homeostasis.

Wei Qi (LU/LV)  comes from spine & chest

Ying Qi (SP/ST/HT)

Yang Qi (KD)  Can be accessed via Yang organs, Du Mai, & Back Shu pts.

Wind

Stiffness at the region of the neck will prevent Wei Qi from moving to the exterior for protection. This will also cause stiffness of the joints. A major pt. for the articulation of Yang Qi in releasing this stiffness is Du 14. The neck is a sensory portal. When the neck becomes stiff this indicates that some type of sensory perception is activated telling the body that something is changing either physically, emotionally, psychologically, or environmentally.

Wind can also cause headache (HA), neck pain, stiff limbs, Wu (aversion), Al (severeness), muscle spasms, tremors, itch and chills. The body will generate a response like fever (upright response) in addition to Heat or Cold symptoms. Fever in turn will provoke body pressure to equalize via sweat.

Wei Qi is responsible for warming & controlling pores. It also goes to the sinews. The body’s natural response to a PF could be inflammation (heat) in the sinews causing swelling. This would be considered an upright response.

To make a proper diagnosis between Wind Heat and Wind Cold the following signs & symptoms should be considered.

Wind Heat (Zhong/Feng) / Vs. / Wind Cold (Shang/Han)
Wind / Cold constricts Qi
Aversion to wind / Aversion to cold
** Fever (subjective not necessarily temperature related) / * Fever or no fever
** Severe chills
* Chills / Physique (tired, heavy, pain, listless, constriction)
Pulse: Slow, Floating / Zong Qi (chest) will have to be utilized to push Wei Qi out because the body cannot access Wei Qi from Yang Qi due to the cold
Vomit, retching, rebellious Qi
Pulse: Tight (can be felt at either superficial or moderate level)

Zhong Feng Wind Heat

Wind Heat Tai Yang Treatment Plan:

1)Emit and scatter Wei Qi

2)Adjust Wei & Ying Qi

3)Adjust balance between Wei & Yang Qi

4)Address clumping factor in chest & abdomen

5)Add to protocol when you see complications

Complications

Stiff Neck
Pain in the 4 limbs
Headache or heavy sensation in the head
Dysurea

Zhong Feng (Wind Heat) Formula:

Gui Zhi Tang

Gui Zhi (Cinnamon Twigs) 3g.  Adjust balance b/ween Wei/Ying/Yuan

Bai Shao (White Peoni) 3g.  Adjust balance b/ween Wei/Ying/Yuan and converts body fluids to Wei level

Gan Cao (Licurice) 3g.  Protects Shao Yang, relaxes chest, & drains HT Fire

Sheng Jiang (Fresh Ginger) 3g.  Harmonizes MJ & opens throat

Da Zao (Jujube) 12 pcs.  Hydrates body because you are losing BF via sweat

Decoction

- For every 30g. use 2 cups of H2O for every 90g. use 6 cups of H20

Dosage

7 cups(1 cup 3 x day)

Instructions

patient blankets themselves and sweats
if patient does not sweat after they drink the 1st cup, drink another cup after 2 hours rather than 8 hours
2-3 days should be resolved
no meat, noodles, alcohol, spices, fatty foods
eat vegetable in soup and a minimal amount of fruit
Rice Conji soup good to eat as it hydrates
after drinking the 1st cup patient will most likely feel irritable & agitated because qi is coming from a shaoyang level (zhong Qi). If this happens you could use an even technique on GB 20 & DU 16
after acupuncture treatment give the formula again

You want to release the neck, head, spine (Yang Du 14), harmonize chest & abdomen.

<side note> the termination of the root energy of PF wind heat can stagnate/clump Qi

Lingering of a PF is due to the clumping of qi (patient may feel much better but continue to feel residual mild symptoms)

Pattern of Gui Zhi Tang:

Aversion to wind (add Huang Qi, Bai Zhu, or Fang Feng (9g.)
Can have aversion to cold (add Huang Qi, Bai Zhu, or Fang Feng (9g.)
Can have fever
Floating slow pulse
Floating week pulse
Can have dry retching
Can have some type of nasal discharge
Can be used for HA by adding Ma Huang (9g.) (decoct first with 7 cups take out white foam, boil down to 5 cups). This indicates that cold is now beginning to constrict and go inward in area of the head
Can have tension in neck or upper back (add Ge Gen (24-28g.) reduce Gan Cao to (14g.) decoct first with 9 cups of water, boil down to 7 cups, take out white foam and add the other ingredients, cook down until get 3 cups
Four limbs can be affected (add Fu Zi (9g.)
Ascension of SP use Jie Gen to clear suspended phlegm

When you should STOP taking Gui Zhi Tang:

1)Pulse becomes week

2)Fever last longer than chills

3)Wheezing (exuberant yang qi has exceeded its limit & creates leakage of KD qi)

4)Develops into Shanghan

At this point you need to adjust the balance between Wei & Ying Qi by adding SJ 5 to the treatment plan and adjust the formula:

Gui Zhi Er Zhu Tang (Fever longer than chills + weekness)

Gui Zhi (9-12g.)

Bai Shao (9-12g.)

Gan Cao (9-12g.)

Jujube (4 pcs.)

Ma Haung (15g.) – Opens chest

Shi Gao (15g.) - Anchors

Ren Shen (15g.)

Decoct Ma Huang 1st in 5 cups of water, scrape foam, boil down to 3 cups, boil down to 2 cups, take 1 cup 2 x day

Wheezingwith little or no fever (interior heat causing wheezing)

Ma Huang (12 g.) – Stop wheezing

Xing Ren (50 pcs.)

Gan Cao (9-15g.)

Shi Gao (18g.)

7 cups boil down to 5 cups boil down to 2 cups, 1 cup 2 x day

<side note> Soft Pulse may indication leakage of KD Qi

** If still have symptoms after treatment this can indicate stagnation in the Upper, Middle, or Lower Jiao  You need to support post-natal qi (digestion) by adding to Gui Zhi Tang:

Bai Zhu (3g.) - replaces Gui Zhi

Fu Ling (3g.)

8 cups boil down to 3 cups, 1 cup 3 x day, patient should begin to urinate and feel relief.

Tang Dynasty (added acupuncture prescriptions and standardized protocol)

Yang can be reached via:Jing Well pts. + Shu Stream (exterior)

Or Ying Spring pts. + He Sea (bowels & digestion)

Determine the propensity: Does patient have an adequate amount of Ying Qi and Yuan Qi (Yang Qi)?

Determine the pulse: slow, tight, rapid, slippery

When PF is at the Tai Yang level you have to add something to protect Wei Qi & Yin. Treat Tai Yang + protect Yang Ming. Treat Wei Qi + protect Shao Yang. Add points that will protect Shao Yang & Yang Ming via Yuan Source pts.

Tai Yang

Mild – UB 67, UB 65

Severe – SI 1, SI 3 (lethargy, heaviness)

Add SJ 4, GB 40 (protects Yang Qi)
Add ST 42, LI 4 (protects Ying Qi)
If clumping qi resulting in HA add UB 5
Neck stiffness add UB 58
Four Limbs affected add UB 57
Aversion to Wind add UB 2, UB 9
Aversion to Cold add UB 2, UB 9
Sweat with no aversion add UB 66
Lethargy add SI 8, SI 16
Absence of Sweat add UB 67
Irritability add SI 7, GB 30, DU 16
Regulate LU Qi add LU 7

Four Limbs

When the 4 limbs are affected the Urinary Bladder and Bowels will often times be affected as well causing urinary difficulty. This is because the 3 leg yang sinew meridian leads to SI 18 and the 3 leg yin sinew meridian leads to Ren 3 (benefits the UB, intestines, and hemorrhoids). The 4 limbs also have to go through the neck to get to the head resulting in stiff neck. The 3 arm yin sinew meridian has to go through the chest causing irritability.

Pathological Factor

When the PF moves into Zong Qi the patient will have rebellious qi indicating that the condition is becoming more severe (dry retching, vomiting, counter flow)

During treatment there will be an increase in Yang Qi:

Pulse will feel floating, full, strong, rapid

More sweating will occur (can cause thirst, floating/thready pulse or floating/week pulse). Once the patient begins to feel thirsty this will affect the Shen due to body fluid deficiency; causing irritability. You then need to control sweating and can use KD 7 (if you feel a pulse change), HT 6 (dehydration)

Mild irritability

KD Qi will go up to support LU QI (via chest & diaphragm) (KD grasping LU Qi)

Relationship: Water (KD) supports  LV/GB  Commands LU

LV/GB + LU = responsible for Wei Qi

Wei Qi can be separated into two parts; (1) Ying Qi SP/ST (2) Yang Qi KD/LV

<side note> Jin Ye fluids affect blood

<side note> Add herbs (Rou Gui, Zhi Gan Cao) to nourish fluids, strengthen KD, Calm Shen if the pulse is week, thready, choppy.

If the symptoms do not improve by the 3rd day either have wrong diagnosis/treatment plan OR the patient has malaria (which can show the same signs and symptoms)

Malaria

Alternating chills & fever
Little sweat
No vomiting
Little constipation
Still experience a lot of wind in the form of itching, hives, dermatologic issues, spasms

Gui Zhi Ma Huang Ge Ban Tang (use heat to move heat)

Ma Huang 9g. (induces sweat)

Gui Zhi 9-12g.

Bai Shao 9-12g.

Gan Cao 9-12g.

Da Zao 4 pcs.

Sheng Jiang 9-12g.

Xing Ren 24 pcs. (opens chest, promote bowel movement, and induce sweat)

Pulse = floating, wiry (could be misconstrued as tight)

Determining Pulse

What is the status of exteriorization? Which direction is the floating pulse moving toward? Is it directed toward the front/thenar eminence OR is it moving toward the back/elbow

If the pulse is moving toward the elbow patient will experience low back pain, stiffness, and the pulse will appear tight. Su Wen (cold) will get trapped in the region of the sacrum at the baliao pts. UB 31,32,33,34 (disinhibits the Lower Jiao). As the cold constricts itself into the sacrum it will have an impact on the UB Shu pts. and Dampness will accumulate. The pathological fluids will affect the body’s ability to stand upright (zhi yin), edema (yi yin), or phlegm fluids (tan yin) will ensue. The patients ability to defecate & urinate my also be diminished.

If the pulse is moving toward the thenar eminence dizziness, vertigo, tinnitus, and convulsions may ensue.

<side note> If patient is experiencing Bi Syndrome STILL use Gui Zhi Tang

Slippery Pulse – As the body is trying to bring fluid from the ST up & out the fluid will get stuck somewhere along the way causing a feeling of fullness & oppression of the chest & epigastria. Slippery pulse is NOT always related to phlegm or damp. In this instance a good formula to use would be Xiao Xian Xion Tang (heavily opens the chest).

Tai Yin

When the Yang Qi is lacking (digestion poor & movement slow) Tai Yin disease will commence. The patient needs to rest due to fatigue. They will display heat signs & symptoms. Because Yang has been exhausted heat will go to the head and will burn everything up, then the patient will feel cold again (UB Shu stream pt. good for this).

Yin Treatment

Ying Qi - Irritability & thirst. Have to give White Tiger & Ginseng decoction

Bai Fu (18g.)

Ren Shen (18g.)

Shi Gao (30g.)

Zhi Ma (21g.)

With Amenorrhea add Geng Mi (6 cups), Gan Cao (12g.)

Complication

Pulse = Tight

PF will move deeper causing irritability, restlessness, insomnia, and body aches. Their will be little sweating.

Fan Zao – Irritability & Restlessness key factors in differentiating diagnosis. If patient feels these 2 symptoms give formula:

Major Blue Dragon (Da Qing Long Tang)

Gui Zhi (12g.)

Ma Huang (30g.)

Xing Ren (40 pcs.)

Shi Gao (30g.)

Shen Jiang (12g.)

Jujube (10 pcs.)

Boil Ma Huang first 7 cups of water, scrape foam, add other herbs, boil down to 3 cups. Patient will feel achy & sore because PF is attempting to eradicate from body and the pulse should no longer feel tight.

Window of the Sky Points

Directly have an affect on sensory orifices. If the patient is having a problems relating to eyes, ears, nose, mouth, this may be due to their unwillingness to accept changes going on internally or externally.

Musculoskeletal alignment

1)Mastoid Process (atlas of skull)

2)Diaphragm

3)Abdominal rectus

4)Iliopsoas

5)Perivetebral muscles

You have to change muscles in order to change skeletal alignment. As you move differently you begin to view the world differently (sensory motor track). This will have an affect on the spine, hence, affecting the 4 limbs and head. Releasing flesh is a way of releasing old bad habits/conditions.

Shang Han (Wind Cold)

Achy joints

Achy physique

Aversion to cold

Aversion to wind

Sever chills

Mild fever

Little or no sweat

Headache

Low back pain (some aspect of Yang Qi is constricted in Lumbar)

Potential Wheezing

Heaviness

Floating & tight pulse

Patient may have spontaneous sweating with mild chills. As Wei Qi is surfacing to fight PF patient will feel less cold. Wind is Yang  yang moves wei qi  wei qi induces sweating

Pulse may feel floating, tight, and slow

Because Yang Qi is going up & out there is not much Yang Qi left in the Lower Jiao. This can cause Bi Syndrome, enuresis, poluyuria. As Yang Qi ascends it will go through the chest affecting Zhong Qi, which creates irritability & restlessness. The 4 limbs may spasm due to coldness (lack of Yang Qi) causing constriction of the muscles.

If you use Gui Zhi Tang the patient will get constipated & develop dryness in the throat, chest, Lower Jiao constipation, & rebellious Qi.

A better formula to use would be:

Gan Cao Gan Jiang Tang (Licorice & dried Ginger)

Gan Cao (15-21g.) – Tonify Qi, warm & strengthen ST

Gan Jiang (10g.) - Warms LU, disperses cold, warms & strengthen ST

3 cups boil down to 1 ½ cups, drink ¾ cup 2 x day. Stop taking the formula once feet feel warm.

Use hot needles on Jing Well pts.

Improper Diagnosis

If you made an improper diagnosis and prescribed Gui Zhi Tang, patient can also develop Shen disturbances, mania, delirium, etc. because Ying Qi & Yang Qi are ascending.

To Resolve you can give the formula Tiao Wei Cheng Qi Tang:

Mang Xiao (6-9g.) – add last 10 minutes

Gan Cao (6-9g.)

Sheng Jiang (6-9g.)

This formula will harmonize the ST by purging. Boil 3 cups down to 1 cup.

If sweating becomes copious (I prefer the term drencherous myself) use

Si Ni Tang:

Fu Zi (9g.)

Gan Cao (9-12g.)

Shen Jiang (6-9g.)

How do you treat a Shang Han Tai Yang Condition (Wind Cold)?

Ma Huang Tang (3:2)

Ma Huang (15-18g.)

Gui Zhi (9-12g.)

Xing Ren (70 pcs.)

Gan Cao (9g.)

9 cups boil down to 7 cups, boil down to 2 ¼ cup, take ¾ cup 3 x day. Blanket yourself to promote sweating

Ge Gen Tang (good for constricted neck & upper back due to cold)

Gui Zhi (9g.)

Shen Jiang (12g.)

Jujube (12 pcs.)

Ge Gen (18g.)

Ma Huang (12g.)

Decoct Ma Huang 1st by boiling 10 cups, boil down to 8 cups, boil down to 3 cups, take 1 cup 3 x day. Blanket to promote sweat

Shang Han constricts chest & prevents Qi from coming out which stagnates fluids. A good formula for this would be:

Xiao Qing Long Tang (good for opening the chest when there is cold phlegm)

Gui Zhi

Bai Shao

Sheng Jiang

Gan Cao

Ma Huang

Ban Xia (if there is sticky phlegm)

Gan Jiang (if there is watery phlegm)

Xi Xin (if there is thin phlegm)

Wu Wei Zi

Da Qing Long Tang (good for Zong Qi where there is heat, irritability & restlessness due to clumping of Qi)

Minor Xiao Xian Xiong Tang

Gua Lou – hot phlegm

Ban Xia – think phlegm

Huang Lian – damp heat

For abdomen fullness, borborygmus, bloating, distention add:

Xiao Cheng Qi Tang

Zhi Shi (15g.) – heat signs

Hou Po (9-15g.) – cold signs

Da Huang (6-9g.) – damp heat signs

Wrong Treatment!

If Pulse is floating & rapid

Patient is thirsty & sweaty

Shang Han (hot, damp, cold)

Hot needle technique / Moxa can inadvertently cause palpitation & abdominal distention

If there is sweating with no thirst due to the fact that the PF is trapped in the LJ use Gui Zhi, Fu Ling, Zhu Ling, Ze Xie, Bai Zhu

Etiology /  / Stage /  / Progression
 /  / 
Zhong Feng / Tai Yang / Status of Ying Qi & Yang Qi
Shang Han / Yang Ming
Pestilent / Shao Yang
Malaria /  Creates pathology of heat & damp

Tai Yang - Cold (Su Wen Zang), Yin Organs, Essences, Viral infection, Goes to Organs
Yang Ming - Heat moves to bowels & sensory orifices (Jing Ye), Fluids/Yin, Bacterial infection, curious organs
Shao Yang - Chest, neck, limbs, damp, Fungal infection

Progression of Pathological Factor