Any pattern of greater yáng disease.

The greater yáng (tài yáng) governs the exterior; it is often described as the [protective] fence of all the channels (诸经之藩篱 zhū jīng zhī fán lí). Evils entering the body usually settle in the greater yáng (tài yáng) channel first, giving rise to greater yáng (tài yáng) channel patterns, which are exterior patterns.

The greater yáng (tài yáng) channel traverses the head, nape, and back, so when it is affected by external evils, there may be pain in this area. The greater yáng (tài yáng) also controls defense and provisioning qì, so evils invading the greater yáng (tài yáng) cause disturbances of provisioning and defense. The greater yáng (tài yáng) bowel is the bladder, which in some cases may also be affected.

If greater yáng (tài yáng) channel patterns are unresolved, the evil can move into the greater yáng (tài yáng) bowel (the bladder). This, however, is rare, and the evil more commonly passes to other channels.

Although the Shāng Hán Lùn (伤寒论 On Cold Damage) describes a considerable variety of greater yáng (tài yáng) patterns, these are mostly variations of four basic patterns: wind-strike, cold damage, water amassment, and blood amassment. Variations of these depend on the nature of the evil and the state of right qì.

Greater yáng (tài yáng) Channel Patterns

There are two basic greater yáng (tài yáng) channel patterns: wind strike caused by wind and cold damage caused by cold or wind-cold. In this context, it is first important to note two points: Cold damage is used in the narrow sense of a specific pattern here, in contrast to the wider meaning of externally contracted disease in general; and wind strike must be distinguished from wind stroke (apoplexy), even the though the Chinese terms are identical (中风 zhòng fēng).

The main signs of greater yáng (tài yáng) channel disease stiffness and pain of the head and nape, aversion to cold, and a pulse that is floating. Whatever the disease evil or the duration of the disease, the simultaneous presence of these signs and pulse provides certain indication of greater yáng (tài yáng) channel disease.

A pulse that is floating: A pulse that is felt when light pressure is applied is called floating. In greater yáng (tài yáng) disease, a pulse that is floating usually reflects a condition in which an external evil has invaded the fleshy exterior and right qì is resisting the evil and trying to push it out of the body. In cold damage patterns, the pulse is floating and tight. In wind strike patterns, the pulse is floating and moderate, where moderate means gentle and harmonious, rather than the usual sense of being slightly slow.

Stiffness and pain of the head and nape: The foot greater yáng (tài yáng) channel stretches from head to foot, passing over the nape and back. An external evil invading the greater yáng (tài yáng) channel obstructs the qì of the channel, which is reflected in pain and stiffness. This accords with the axiom when there is stoppage, there is pain. If the offending evil is wind, there may be only pain in the head and nape, while if it is cold, which causes greater obstruction of channel qì, pain may be experienced in the limbs (generalized pain).

Aversion to cold (or wind): Aversion to cold a sensations of cold that cannot be completely relieved by adding extra clothing or bedclothes. Aversion to wind, a sensations of cold felt on exposure to wind or drafts and, is essentially the same, but milder. Aversion to cold arises when yáng qì fails to warm the body, either because it is obstructed by an evil or because it is vacuous. In exterior patterns, both pathomechanisms may be operant. Defense qì is obstructed by the evil and in some cases may be insufficient.

Heat effusion: In externally contracted diseases of the three yáng channels, heat effusion is a manifestation of the struggle between right qì and evil qì. It does not necessarily reflect the presence of evil heat. In the exterior patterns of greater yáng (tài yáng) disease, it can occur even in conditions caused by the contraction of cold, which constitute the majority of greater yáng (tài yáng) patterns. In exterior patterns, evil qì is in the exterior of the body and impairs the normal function of defense qì; hence heat effusion is accompanied by aversion to cold or aversion to wind. Note that heat effusion occurring in yáng brightness (yáng míng) and lesser yáng (shào yáng) disease patterns is explained by other pathomechanisms.

Sweating/absence of sweating: The two major greater yáng (tài yáng) exterior patterns, wind strike and cold damage, are primarily distinguished by the presence and absence of sweating respectively. The presence and absence of sweating are explained in terms of provisioning-defense disharmony.

Provisioning qì and defense qì pervade the exterior of the body to keep it secured against invading evils and to maintain the normal opening and closing of the interstices (sweat ducts and pores). Provisioning qì provides nourishment. It is yīn, and hence has the qualities of sinking, condensation, and stillness. Defense is yáng, and therefore has the qualities of activity, rising, and expansiveness. When evils invade the body, they upset the normal balance between provisioning and defense, causing either one or the other to increase in strength. Wind is yáng; it damages defense by intensifying its yáng qualities, giving rise to a condition of strong defense and weak provisioning (卫强营弱 wèi qiáng yíng ruò). By contrast, cold is yīn; it damages provisioning by intensifying its yīn qualities, giving rise to a condition of strong provisioning and weak defense (营强卫弱 yíng qiáng wèi ruò). When wind and cold invade the body together, they give rise to dual repletion of provisioning and defense. Note that when we say that provisioning or defense is strong, we mean that its yīn or yáng qualities are pathologically intensified, or made excessive, by a similar-natured disease evil. It does not mean that they are healthily exuberant.

When wind invades, defense is strong and provisioning is weak. Defense yáng is more active, rising, and expansive than normal, so it rises to the body’s surface to fight the evil, giving rise to heat effusion. The sinking, condensing, and quiescent qualities of provisioning yīn become comparatively weak, so it loses its ability to remain contained within, causing spontaneous sweating and a pulse that is floating and moderate. This is traditionally summed up in the phrase floating yáng manifests in spontaneous heat effusion; weak [provisioning-]yīn manifests in spontaneous sweating. Sweating partly disperses defense yáng, leaving the skin and flesh deprived of warmth; hence there is aversion to cold. This condition is described as a greater yáng (tài yáng) exterior vacuity because the sweating gives rise to insufficiency of provisioning yīn, as well as causing defense qì to partly dissipate.

When cold invades, provisioning is strong and defense is weak. The sinking, condensing quiescent qualities of provisioning yīn are greater than the active, rising, and expansive qualities of defense yáng. Defense yáng becomes depressed in the fleshy exterior and cannot spread outward to warm the skin; hence there is aversion to cold. Yáng qì becomes depressed in the inner body and unable to spread outward; hence heat builds up to give rise to heat effusion. Provisioning yīn’s sinking, condensing, and quiescent qualities become relatively more predominant; hence there is absence of sweating and a pulse that, though floating, is also tight. At the same time, qì and blood flow is inhibited, giving rise to headache and pain in the joints. This condition constitutes a greater yáng (tài yáng) repletion pattern.

If both wind and cold invade the body together, they damage defense and provisioning. The cold damages provisioning, making its sinking, condensing, and quiescent qualities strong; hence there is aversion to cold and absence of sweating. At the same time, wind damages defense, intensifying its active, rising, and expansive qualities. However, in the absence of sweating, yáng heat cannot discharge outward, but rather is depressed in the inner body; hence, there is high fever with vexation and agitation. This constitutes a pattern of dual repletion of the exterior and interior, also called exterior cold and interior heat, which falls within the scope of greater yáng (tài yáng) channel patterns.

Greater yáng (tài yáng) Wind Strike Pattern (太阳中风证 tài yáng zhòng fēng zhèng

Also exterior vacuity pattern (表虚证 biǎo xū zhèng)

A disease pattern chiefly characterized by aversion to wind, sweating, a pulse that is floating and moderate.

Description: Aversion to wind, heat effusion, sweating, pain and stiffness in the head and nape, and a pulse that is floating and moderate. In some cases, there is a noisy nose or dry retching.

Pathogenesis: Insecure interstices (sweat glands and pores) allowing wind evil to assail the fleshy exterior, causing provisioning-defense disharmony with strong defense and weak provisioning.

Analysis of signs

• Heat effusion: Yáng qì floats outward to fight the assailing evil, thus giving rise to heat effusion. This is why defense qì is said to be strong.
• Sweating: Wind by nature is opening and discharging. This is why provisioning-yīn is said to be weak.
• Aversion to wind: Wind assailing the exterior causes sweating and loosening of the interstices, rendering yáng qì incapable of warming the exterior. Hence, there is aversion to wind.
• Floating and moderate pulse: Wind assailing the exterior causes yáng qì to float out to fight it. Hence the pulse is floating. At the same time, wind evil loosens the interstices and causes sweating that results in insufficiency of provisioning yīn. Hence, the pulse is also moderate (gentle, harmonious, not tight as in cold damage patterns).
• Other signs: In some cases, there may be noisy nose or dry retching. Noisy nose, referring to nasal congestion, arises when the evil affects the lung, causing non-diffusion of lung qì. Dry retching may occur when the evil affects the stomach, impairing harmony and downbearing of stomach qì.

Treatment

Medicinal therapy: Harmonize provisioning and defense using Cinnamon Twig Decoction (桂枝汤 guì zhī tāng).

Acumoxatherapy: Resolve the exterior using LI‑4 (hé gǔ) and TB‑5 (wài guān). Dispel wind using CV‑16 (zhōng tíng), GB‑20 (fēng chí), and ST‑8 (tóu wéi). For stiff neck and aversion to cold, needle GB‑20 (fēng chí), GV‑12 (shēn zhù), BL‑12 (fēng mén), GV‑16 (fēng fǔ). For headache, needle LI‑4 (hé gǔ), GB‑20 (fēng chí), ST‑8 (tóu wéi), and BL‑62 (shēn mài). For sweating, needle HT‑6 (yīn xī).

Greater yáng (tài yáng) Cold Damage Pattern (太阳伤寒证 tài yáng shāng hán zhèng)

Also exterior repletion pattern (表实证 biǎo shí zhèng).

A disease pattern chiefly characterized by aversion to wind; absence of sweating; headache and generalized pain; a pulse that is floating and tight.

Description: Aversion to cold, heat effusion, pain and stiffness in the head and nape; generalized pain; absence of sweating; a pulse that is floating and tight.

Pathogenesis: Cold evil invading the exterior, obstructing defense yáng, causing depression and stagnation of provisioning, and preventing the interstices from opening.

Analysis of signs

• Aversion to cold is due to obstruction of defensive yáng by the cold evil.
• Heat effusion: Yáng qì floats outward (goes to the exterior) to fight the assailing evil, thus giving rise to heat effusion.
• Pain: Cold by nature causes contraction and tension: This explains the pain and stiffness in the head and nape or generalized pain.
• Absence of sweating. Cold by nature is stagnant and congealing and prevents the movement of fluids. Because it causes contraction and tension, it makes the interstices of the flesh close tightly. Hence, sweating is absent.
• Lung: Panting. This occurs when the exterior evil invades the lung and impairs the diffusion of lung qì.
• Pulse: Floating and tight. Floating reflects disease in exterior; tight reflects cold.

Treatment

Medicinal therapy: Resolve the exterior with warmth and acridity using Ephedra Decoction (麻黄汤 má huáng tāng).

Acumoxatherapy: Resolve the exterior using LI‑4 (hé gǔ) and TB‑5 (wài guān). For stiff neck and aversion to cold, needle GB‑20 (fēng chí), GV‑12 (shēn zhù), BL‑12 (fēng mén), GV‑16 (fēng fǔ). For headache, LI‑4 (hé gǔ), GB‑20 (fēng chí), ST‑8 (tóu wéi), and BL‑62 (shēn mài). For absence of TRT

Comparison: Wind strike and cold damage are both characterized by aversion to cold, pain and stiffness in the head and nape, and a floating pulse. The first line of Greater yáng (tài yáng) Disease in the Shāng Hán Lùn reads: In disease of the greater yáng (tài yáng), the pulse is floating, the head and nape are stiff and painful, and there is aversion to cold. However, there are major differences:

• Wind strike manifests as sweating and a pulse that is floating and moderate (gentle and harmonious). It is an exterior vacuity pattern.
• Cold damage is marked by absence of sweating and a pulse that is floating and tight. It is a repletion pattern.

Further developments: Greater yáng (tài yáng) bowel patterns; lesser yáng (shào yáng) disease patterns; yáng brightness (yáng míng) disease patterns.

Greater yáng (tài yáng) Bowel Patterns

When greater yáng (tài yáng) channel patterns do not resolve, the disease evil can spread from the exterior into the greater yáng (tài yáng) bowel, that is, the bladder. There are two greater yáng (tài yáng) bowel patterns: greater yáng (tài yáng) water amassment and greater yáng (tài yáng) blood amassment.

Greater yáng (tài yáng) Water Amassment Pattern

A disease pattern chiefly characterized by greater yáng (tài yáng) channel signs with inhibited urination and lesser abdominal fullness.

Description: Heat effusion; aversion to wind; spontaneous sweating; inhibited urination; distension and fullness in the smaller abdomen; dispersion-thirst (here meaning severe thirst with intake of fluids); immediate vomiting of ingested fluids; a pulse that is floating or floating and rapid.

Pathogenesis: This pattern arises when greater yáng (tài yáng) channel patterns fail to resolve, and the disease evil transforms into heat and proceeds along the channel to enter the greater yáng (tài yáng) bowel, the bladder. It disrupts bladder qì transformation, so that water qì collects.

Analysis of signs

• Obstruction of defensive yáng: Aversion to cold.
• Struggle between right and evil: Heat effusion.
• Impaired qì transformation: Inhibited urination and smaller abdominal fullness arise when heat binds in the bladder. When water fails to move, it prevents liquid from being produced and borne upward to the mouth, so the patient is thirsty and drinks a lot (dispersion-thirst referring to great thirst, not disease corresponding to diabetes). However, the thirst stems from liquid failing to reach the mouth, rather than from insufficiency. Because qì transformation is impaired, excess water is not eliminated and collects in the stomach, giving rise to water counterflow, which manifests in immediate vomiting of ingested fluids.
• Pulse: Floating or floating and rapid. Floating reflects the unresolved exterior pattern. Rapid reflects the transformation into heat.

Treatment

Medicinal therapy: Freeing yáng and disinhibiting water using wǔ líng sǎn (五苓散 Poria Five Powder).

Acumoxatherapy: BL-2 (zǎn zhú), SP-9 (yīn líng quán), and PC-6 (nèi guān).

Greater yáng (tài yáng) Blood Amassment Pattern (太阳蓄血证 tài yáng xù xuè zhèng)

A disease pattern chiefly characterized by tense bound lesser abdomen, uninhibited urination, and stool black as lacquer.

Description: Tense bound lesser abdomen or hardness and fullness of the lesser abdomen; uninhibited urination; maniacally deranged spirit-mind; forgetfulness; a pulse that is sunken, and rough or bound.

Pathogenesis: This pattern arises when greater yáng (tài yáng) channel evils have failed to resolve and transform into heat, which penetrates via the channel to the lower burner, where it binds with static blood in the lesser abdomen.

Analysis of signs

• Impaired qì transformation: Tense bound lesser abdomen or hardness and fullness of the lesser abdomen.
• Bladder qì transformation unaffected: Because the heat is in the blood aspect, urination is uninhibited.
• Stasis-heat harassing the spirit: Maniacally deranged spirit-mind; forgetfulness.
• Stasis-heat moving downward: Stool black as lacquer.

Treatment

Medicinal therapy: For mild cases, expel stasis and discharge heat, using Peach Kernel Qì-Coordinating Decoction (桃仁承气汤 táo hé chéng qì tāng). For severe cases, break blood and expel stasis, using Dead-On Decoction (抵当汤 dǐ dàng tān).

Acumoxatherapy: ST‑37 (shàng jù xū), SP‑15 (dà héng), ST‑28 (shuǐ dào), Hall of Impression (yìn táng), and (Dǒng’s) Gynecological Point.