Provisioning-aspect pattern

A warm disease one stage more advanced than a qì-aspect pattern and characterized by heat effusion that worsens at night; heart vexation; clouded spirit; red or crimson tongue; a pulse that is fine and rapid.

Description: Generalized heat effusion that worsens at night; little or no thirst; heart vexation and insomnia; in severe cases, clouded spirit and delirious speech; faintly visible maculopapular eruptions; a red or crimson tongue; a pulse that is fine and rapid.

Pathogenesis: Warm-heat disease evil penetrating inwards, scorching provisioning-yīn and harassing the heart spirit. This happens in one of three possible ways:

• when qì-aspect disease fails to resolve and passes into provisioning;
• when defense-aspect disease abnormally skips the qì aspect and directly enters the provisioning aspect (this is called abnormal passage to the pericardium or heat falling into the pericardium); or
• when evils directly penetrate the provisioning aspect, without passing through defense or qì. This usually happens as a result of provisioning-yīn vacuity.

Analysis of signs

• Evil heat damaging provisioning-yīn: Generalized heat effusion that worsens at night. Worsening at night is attributed to yīn vacuity and yáng hyperactivity that results from the damage to provisioning yīn by the evil.
• Evil heat steaming the fluids upward to the mouth: Little or no thirst.
• Evil heat harassing the spirit: Heart vexation, insomnia, and, in severe cases, clouded spirit and delirious speech.
• Damage to the blood network vessels: Faintly visible maculopapular eruptions.
• Tongue: Red or crimson and dry.
• Pulse: Fine and rapid.

Further developments: The provisioning aspect lies between the qì and the blood aspects. Heat in the provisioning aspect can move into the qì aspect indicating that the condition is improving; it can also move into the blood aspect, which represents a worsening.

Treatment

Medicinal therapy: Clear provisioning, clear the heart, and resolve toxin using Peaceful Palace Bovine Bezoar Pill (安宫牛黄丸 ān gōng niú huáng wán), Spirit-Like Rhinoceros Horn Elixir (神犀丹 shén xī dān), or Purple Snow Elixir (籽雪丹 zǐ xuě dān) .

Acumoxatherapy: General points: LI-4 (hé gǔ), LI-11 (qū chí), GV-14 (dà zhuī), and TB-2 (yè mén), and SI-3 (hòu xī). For heat harassing the heart spirit, use PC‑6 (nèi guān), HT‑7 (shén mén), HT‑6 (yīn xī), and PC‑7 (dà líng). For severe heat, bleed GV‑14 (dà zhuī). For damage to liquid, needle TB‑2 (yè mén). For clouded spirit, needle GV‑26 (shuǐ gōu) and GV‑20 (bǎi huì). For dampness, SP‑9 (yīn líng quán) and CV‑12 (zhōng wǎn).