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Syndrome differentiation according to

the six meridians


Syndrome differentiation according to the six meridians
When a TCM physician consults patients, the first step is to differentiate exogenous
disease (illnesses originating form outside of the body) from endogenous disease s
(illnesses originating form inside the body); because, they have different principles of
diagnosis. There are two common methods for identifying exogenous diseases. These
are "syndrome differentiation according to the six meridians" and "syndrome
differentiation according to defense(wei), vital energy(qi), nutrient(ying) & blood(xue)"
discussed in the next section.

Zhang Zhongjing
(150~219AD)
The six meridian method was developed early in the Eastern Han Dynasty by Zhang
Zhongjing (150-219AD) in the book of Shanghan Zabzabinglun (Discourse on Fevers
and Miscellaneous Illnesses), which is a monograph about many types of external
infectious diseases. Later this book became an important guide for identifying this kind
of diseases. The method investigates the pathological changes over the course of an
exogenous disease, especially for cold induced diseases referred to as "shanghan".
Based on the distribution of the three yang meridians (Tai Yang, Yang Ming, Shao Yang)
and the three yin meridians (Tai Yin, Shao Yin, Jue Yin), symptoms and signs of
exogenous diseases are classified into six stages that correspond to one of these
particular meridians. The three yang meridians are located on the exterior parts of the
body and as a disease or evil progresses the disease's symptoms will progress along the
more interior yin meridians. Therefore, a TCM practitioner is able to identify what stage
of a disease a patient has by the signs and symptoms displayed upon one of these six
meridians. The more interior the disease has progressed the more severe the illness and
damage to the organs.
In cold-induced exogenous diseases (shanghan), the external cold and wind evils enter
the body through the skin and muscular striae. They pass along the meridians and
eventually attack the organs. There are particular pathways of transmission for the evils
that invade the body. They usually pass from the exterior parts of the body to the
interior and in this process gradually deplete the body of its qi (vital energy).

In exogenous disease, the usual progression of disease along the meridians is:
Tai yang disease refers to conditions caused by exogenous evils invading the body
surface; which is also known as exterior syndrome.
Yang Ming disease refers to conditions where exogenous wind and cold evils have
converted into heat evils and transmit directly into the interior, attacking the Yang Ming
meridians, which run through the stomach and intestines. This may also be caused by
delayed treatment leading to body fluid consumption. Yang Ming diseases exhibit the
greatest conflict between evils and the body's disease preventing forces.
Shao Yang disease refers to conditions due to unrelieved exterior syndromes that have
transmitted into the interior. The evils turn toward the interior but have not completely
reached the interior. The pathological changes are neither on the exterior nor in the
interior but stay in between. Areas like the gall bladder and stomach are affected. They
are known as half exterior-half interior syndromes.
Tai Yin disease refers to a cold-deficient(xu) type condition resulting from a deficiency
of spleen qi and retention of cold-dampness in the interior. It is mostly due to cold evils
attacking the middle burner in a constitutionally weak patient, or from delayed
treatment of the three yang meridians diseases.
Shao Yin disease refers to pathological changes in the heart and kidneys, which are
extremely deficient conditions and characterized by systemic weakness.
Jue Yin disease indicates the terminal stage of the six-meridian diseases, in which the
body's disease preventing forces are exhausted. There is a derangement in the yin yang
balance. This condition is complex with syndromes of extreme heat or extreme cold, or
syndromes of alternating cold and heat.
Syndromes of the six-meridians
Diseased
Presentations
meridian
Wind
Fever, aversion to wind, headache and spontaneous sweating. On
invasion examination, the pulse is floating and slow
Tai
Fever, aversion to cold, painful and stiff neck, body aching, unable
Yang Cold
to sweat and asthma. On examination, the pulse is floating and
invasion
tense.
High fever, profuse sweating, extreme thirst, flushed face and chest
Meridian
fullness. On examination, a dry, yellow tongue coating and a
type
floating and forceful pulse are present.
Yang
Feverishness of body, which is more pronounced in the afternoon,
Ming
sweating, constipation, abdominal distention and pain that worsens
Fu-organ
when pressed, restlessness and delirium. On examination, a dry
type
yellow tongue coating or yellow coating with thorns on the tongue
and a deep and forceful pulse is present.
Shao Yang
Bitter taste in mouth, dry throat, blurred version, alternating chills
and fever, fullness in chest and under ribs, poor appetite, chest

fullness and nausea. On examination, a white tongue coating and


taut pulse is present.
Abdominal distension with a preference for warmth and feels better
when pressed, vomiting, anorexia and diarrhea. On examination, a
Tai Yin
pale tongue with a white coating and a slow and weak pulse is
present.
Aversion to cold, spiritual fatigue, cold limbs, diarrhea, stool
containing undigested food, nausea, thirst, preference for hot drinks
Cold type
and profuse and clear urine. On examination there is a pale tongue
Shao
with a white coating and a deep and weak pulse.
Yin
Irritability, insomnia, dry mouth and throat and yellow and scanty
Heat type urine. On examination there is a red tongue tip or a deep red tongue
with little coating and a deep, thready and rapid pulse.
Cold limbs, low body temperature and aversion to cold. On
Extreme
examination, there is a pale tongue and an extremely thready, feeble
cold type
pulse that can hardly be felt.
Jue
Yin
Cold limbs, irritability, feverish sensation, thirst and dark yellow
Extreme
urine. On examination, there is a yellowish tongue coating and
heat type
rolling pulse.
According to the eight principles theory, diseases in the yang meridians belong to the
exterior and are more often seen as heat and excess(shi) syndromes. Diseases in the yin
meridians belong to the interior and are more often seen cold and deficiency(xu)
syndromes. When there are changes in any of these six meridians, symptoms associated
with the malfunctioning of the connected organs or other interrelated meridians will
appear. The six-meridian method is regarded as an incomplete method for identifying all
organs or meridians diseases; because, this method mainly focuses on cold-induced
diseases (shanghan). Although syndromes of the six meridians differ, they are
interrelated due to a constant changing process.