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Externally contracted disease pattern identification
外感病辨证 〔外感病辨證〕wài gǎn bìng biàn zhèng
The process of diagnosing a morbid condition as a disease pattern caused by an external evil.
Externally contracted disease is disease caused by evil qì invading the body from outside. It stands in contradistinction to internal damage and miscellaneous diseases, which are diseases arising from within the body. Two major schools of thought concenter externally contracted disease exist: the cold damage school and the warm disease school.
General Features
Despite the differences between cold damage and warm disease theories, some basic features of the understanding of externally contracted disease are common to both. Disease of external origin are usually (but not always) characterized by heat effusion and stage-by-stage development (initial stage, exuberant heat effusion stage, and recovery stage).
Heat effusion results from the fierce struggle between right qì and the evil and is the essential characteristic of externally contracted febrile diseases. Its progress reflects the changing relationship between right qì and evil qì. For example, high fever reflects the strong reaction of an undamaged right qì to a highly toxic evil. The heat effusion will gradually subside as right qì overcomes the evil. A remittent heat effusion or persistent heat effusion sets in when the evil has weakened, but has not been fully eradicated and right qì has suffered damage. Absence of initial-stage heat effusion, or even a sudden drop in body temperature, are signs of yáng collapse resulting from the presence of a highly toxic evil and extreme vacuity of right. Externally contracted febrile diseases usually develop through three stages: the initial stage, the exuberant heat effusion stage, and the recovery stage.
Staged development: These three stages reflect the changing relationship between the evil and right. In the initial stage, the struggle between the evil and right has still not reached its height so that the heat effusion is less severe than in the exuberant heat effusion stage. As the struggle becomes more intense, the disease moves into the exuberant heat effusion stage; signs are most pronounced, indicating that the disease has reached its climax. It is at this crucial stage that deterioration or improvement is decided. If right defeats evil, the disease passes into the recovery stage. If it fails to do so, the patient’s condition deteriorates, possibly leading to death. Of course, recovery may come about at any point during the progression of a disease if evil qì weakens and right qì strengthens, either spontaneously or by appropriate treatment. Similarly, deterioration or relapse may occur at any time if evil qì strengthens and right qì weakens, either spontaneously or by inappropriate treatment. Most incidences of externally contracted febrile disease are characterized by the above-mentioned three stages.
Cold Damage and Warm Disease Schools
There are two schools of thought on externally contracted disease. The first to appear was the cold damage school originated by Zhāng Jī (Zhòng-Jǐng) in the Hàn Dynasty. This took wind and cold as the primary causes. Much later, a theory that externally contracted diseases were mainly caused by warm-heat evils developed. Both theories are still applied to this day and posit that external evils enter the body and, if not expelled by right qì or adequate treatment, can penetrate deeper to cause numerous possibly disturbances in the bowels and viscera.
Cold damage theory posits that external evils can pass through six stages, which are labeled by channel names. The warm disease school has two schemes of penetration, the four aspects and the three burners (upper, middle, and lower).
Cold Damage and Warm Disease Pattern Identification
Cold damage six-channel pattern identification
Greater yáng (tài yáng) disease patterns Greater yáng (tài yáng) disease patterns yáng brightness (yáng míng) disease patterns Lesser yáng (shào yáng) disease patterns Greater yīn (tài yīn) disease patterns Lesser yīn (shào yīn) disease patterns Reverting yīn (jué yīn) disease patterns
Defense-aspect patterns Qì-aspect disease patterns Provisioning-aspect disease patterns Blood-aspect patterns
Upper-burner patterns Center-burner patterns Lower-burner patterns