6 channels, 4 layers and Triple Heater

The penetration of disease into the body can be described by 3 sytems. In terms of channels- 6 divisions, substances- 4 layers or the triple heater.

6 Channels = Dynamic energy levels in which perverse energy can penetrate.

1. Taiyang Diseases
A taiyang disease is a pathological syndromes caused by exogenous pathogenic factors invading the body surface; it is also known as an exterior syndrome. Taiyang disease can be classified into syndromes of the Taiyang channel and syndromes of the Taiyang fu organ (urinary bladder).
Syndromes of the Taiyang channel
Aversion to cold, fever, pain and rigidity of the neck, thin white tongue coating, floating pulse.
Exogenous pathogenic factors attack the body surface injuring the defensive yang qi causing an aversion to cold. Fever is due to the obstruction of Yang Qi. Since the Qi of the Taiyang channel is also affected, this results in headache, and neck pain and rigidity. A floating pulse indicates that pathological changes are exterior.

These are common manifestations of Taiyang exterior syndromes. On this basis, if they are accompanied by sweating, aversion to wind, floating and superficial pulse, they are known as wind stroke syndromes of Taiyang or exterior xu syndromes caused when the defensive qi is invaded by exogenous pathogenic wind. This leads to a disharmony between defensive and nutrient qi. If aversion to cold is not accompanied by sweating and a floating tense pulse, this is understood as Taiyang febrile syndrome caused by cold or exterior shi syndromes. In this case, exogenous pathogenic cold has obstructed the body surface and blocked the yang qi flow.

In addition, since the lung dominates the skin and hair, if exogenous pathogenic factors attack the body surface, lung qi will lead to dysfunction causing nasal obstruction, cough, asthma, etc.

The fu syndromes of Taiyang
The Taiyang fu organ syndromes are mainly due to a progression of Taiyang channel syndromes which are not cured when they are on the exterior, and then are transmitted along the channel into the urinary bladder. Taiyang fu syndromes are classified into water retention and blood retention syndromes.
Water retention syndromes: Fever, perspiration, irritability, thirst with or without preference for drinks, vomiting after drinking, and dysuria.

These syndromes are due to exogenous pathogenic factors being transmitted from the exterior to the interior, giving rise to qi activity dysfunctions in the urinary bladder. This further affects the body fluid flow leading to fluid retention and its sequence of irritability, thirst with preference for drinks, vomiting after drinking, and dysuria.

Blood retention syndromes: Pain and lump in the lower lateral abdomen, mania, normal urination.

Pain and lump in the lower lateral abdomen resulting from pathological heat transmitted along the Taiyang channel and mixing with blood in the lower jiao. Mental mania is caused by an upward disturbance due to blood retention and pathogenic heat. Since the disease location is in the blood of the lower jiao, the urinary bladder is not affected, thus there is normal urination.

2. Yangming Diseases
Yangming diseases are usually caused by exogenous pathogenic wind and cold which convert to heat and transmit directly into the interior, attacking the Yangming. They may also be due to delayed treatment causing body fluid consumption, which dries the stomach and intestines, resulting in constipation. yangming diseases exhibit the greatest conflict between pathogenic and anti-pathogenic factors. They are also divided into syndromes of the Yangming channel and Yangming fu organ.
Yangming channel syndromes
Fever, perspiration, thirst with preference for drinking, irritability, yellow dry tongue coating, forceful pulse.
Pathogenic heat retained in the Yangming channel causes hyperactivity of heat in the stomach, manifesting as fever. pathogenic heat forces the body fluid to flow outward, thus sweating occurs. This perspiration consumes fluids, so there is thirst with a preference for drinking. Irritability is due to heat disturbing the hear-mind. A dry yellow tongue coating is a sign of excessive heat injuring the body fluid. A forceful pulse indicates excessive heat and preponderant yang.

Yangming fu organ syndromes
Fever, tidal fever at dusk, sweating, constipation, fullness and pain of the abdomen (worse with pressure), irritability, delirium or even coma, yellow and dry tongue coating, or yellow coating with thorns, deep, forceful shi pulse.
Constipation is due to dryness of the intestine. The dysfunction of qi circulation in the fu organ causes a fullness and distending pain in the abdomen which is worse with pressure. Steaming of interior heat is the cause of fever and sweating. The Yangming qi, peaking at dusk, causes tidal fever when it contends with pathogenic factors. Irritability and delirium or even coma are caused by heat disturbing the hear-mind. Deep and shi pulse, and yellow and dry tongue coating with thorns are signs of interior shi heat leading to the insufficiency of body fluid.

3. Shaoyang Diseases
Shaoyang diseases are usually due to unrelieved Taiyang exterior syndromes that have been transmitted into the interior. There may be cases which have Taiyang diseases at the onset, so pathological changes are neither on the Taiyang exterior nor in the Yangming interior, but stay in between. They are known as semi-exterior/interior syndromes.
Main clinical manifestations: Bitter taste in the mouth, dryness of the throat, vertigo, alternate chills and fever, fullness of the chest and epigastric regions, poor appetite, irritability, vomiting, white slippery tongue coating, wiry pulse.

Pathogenic factors invade the Shaoyang and contend with anti-pathogenic qi in the region between the surface and the interior, so there are alternating chills and fever. The foot Shaoyang channel is distributed along the lateral side of the chest and hypochondriac region. Fullness of the chest and epigastric regions results from the obstruction of qi circulation after pathogenic factors invade the Shaoyang channel. Qi stagnation of the gall bladder may also affect the stomach, so poor appetite, irritability and vomiting occur. Fire of the gall bladder flares up to cause a bitter taste, dry throat, and vertigo. Wiry pulse and white slippery tongue coating are due to pathogenic heat hindering the Shaoyang.

4. Taiyin Diseases
Taiyin diseases are mostly due to pathogenic cold directly attacking the middle jiao of a constitutionally weak patient, or due to delayed treatment of diseases of the three yang channels thus damaging the yang of the middle jiao.
Main clinical manifestations: Abdominal distension, vomiting, anorexia, diarrhea with pain preferring warmth and pressure, thirst, pale tongue proper with white coating, slow or delayed pulse.

The nature of Taiyin diseases is xu cold of the middle jiao, and interior retention of cold damp. The spleen is responsible for the elevation of clean qi, while the stomach is responsible for the descent of turbid qi. The spleen also dominates the function of transportation and transformation of food, and the stomach controls the function of receiving food. Thus when the middle jiao is weak and attacked by pathogenic cold, the functions of transportation, transformation, and food reception become abnormal causing interior retention of cold damp manifesting the above symptoms.

5. Shaoyin Diseases
Shaoyin diseases may be due to direct attack of the Shaoyin by exogenous pathogenic factors when the body has yang deficiency and cold; or due to the transmission of pathogenic factors from other channels into the Shaoyin; or due to treatment employing a strong diaphoretic action that injures the yang. After invasion of the Shaoyin by pathogenic factors causing yin symptoms, a change into cold may occur. If yang symptoms occur they may transform into heat. Therefore Shaoyin diseases can be divided into Shaoyin syndromes of cold transformation and Shaoyin syndromes of heat transformation.

Cold transformation Shaoyin syndromes
Aversion to cold, sleeping with the knees drawn up, listlessness, cold extremities, loose stool with undigested food, vomiting, absence of thirst, preference for hot drinks, profuse and clear urine, pale tongue with white coating, deep and feeble pulse.
Shaoyin syndromes of cold transformation are the manifestations of heart and kidney yang deficiencies and interior retention of yin cold. Insufficient yang qi fails to warm and nourish the extremities resulting in cold extremities and sleep with the knees drawn up. Listlessness is due to the inability of yang qi to nourish the mind. Kidney yang deficiency is unable to warm the middle jiao leading to a dysfunction of the ascending and descending functions of middle jiao qi, resulting in loose stool with undigested food and vomiting. Yang deficiency unsuccessfully controls water, so there is profuse and clear urine. Absence of thirst, preference for hot drinks, pale tongue proper with white coating, and deep feeble pulse are all signs of yang deficiency and yin preponderance.

Heat transformation Shaoyin syndromes
Irritability, insomnia, dryness of mouth and throat, red tongue tip or deep red tongue proper with scanty tongue coating, deep, thready, and rapid pulse.
The patient usually has a yin deficiency. After pathogenic factors invade the Shaoyin, they are liable to transform into heat affecting kidney yin. A lessening of kidney yin (body fluid) prevents its upward flow to the heart, and leads to hyperactivity of the heart fire. Symptoms of irritability, insomnia, dryness of the mouth and throat, deep red tongue, deep thready, and rapid pulse occur.

6. Jueyin Diseases
Jueyin diseases indicate the last stage of disease transformation of the six channels. This disease condition is complex with syndromes of extreme heat or extreme cold, or syndromes of alternate cold and heat.
Extreme cold syndromes
Cold extremities, absence of fever, aversion to cold, pale tongue, and an extremely thready, feeble pulse that can hardly be felt.
Syndromes of extreme cold result from yang xu (deficiency) and excessive yin. So syndromes of extreme cold are also known as "coldness due to extreme yin."

Extreme Heat syndromes
Coldness of extremities, irritability, feverish sensation, thirst, yellowish urine, yellowish tongue coating and slippery pulse.
Irritability, feverish sensation, thirst, yellowish urine, yellowish tongue coating and slippery pulse are signs of interior accumulation of heat. This interior accumulation causes a failure of the yang qi to warm and nourish the body surface. The resulting cold extremities are considered "coldness due to extreme yang," or "coldness due to extreme heat."

Coldness due to ascariasis syndromes
Cold limbs, xiao ke (general term for diseases with symptoms of frequent drinking, of water, urination and bowel movements), a feeling of qi striking upward, pain and feverish sensation of the heart, hunger without appetite, vomiting ascariasis after eating food and serious diarrhea.

SI Bl	Tai yang (small intestine & bladder meridians)	Tai yang disease refers to conditions caused by exogenous evils invading the body surface; which is also known as exterior syndrome.	Superficial Yang
St LI	Yang Ming(stomach & large intestine meridians)	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.
GB TH	Shao Yang (gall bladder & triple burners meridians)	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.	Deep yang
Sp Lu	Tai Yin (lung & spleen meridians)	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.	Superficial Yin
Ht Ki	Shao Yin (heart & kidney meridians) JUE YIN	Shao Yin disease refers to pathological changes in the heart and kidneys, which are extremely deficient conditions and characterized by systemic weakness.
Liv PC	Jue Yin (liver & pericardium Meridians) SHAO YIN	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.	Deep Yin

6 Channels
TAI YANG
Most superficial of channels. First in line to be attacked by Xie Qi = Perverse external Qi. Particularly Wind and Cold.  Wind and Heat not as important.
S/S- Fever with aversion to Cold. Struggle between body and perverse energy, always causes fever. Averseion to cold because Wei no longer able to properly circulate superficially.  Headache from obstruction of Qi and Blood and Qi circulation to head.  Occiput can be painful and stiff.
Attack of wind Heat talked about in terms of Wei qi.   Attack of Wind Cold talked about in terms of TAI YANG.
Treatment- Diaphoresis.- Sweating because Wei Qi weak. Diaphoresis strengthens the Lung’s dispersing function.  Eg cinnamon- ease the muscles and push more circulation exteriorly.   Points – GB 20, GV 16, Bl 12   Pulse- Superficial.

YANG MING - 3rd level of Yin.  Diseases are internal full and Hot. Marked fever- because the battle between Zhen and Xie is raging.
The fever is much more clearlyt marked than in TAI YANG. With fever in TAI YANG hot ouside but cold inside. YANG MING has many hot signs both inside and out.   S/S Heavy sweating because internal heat, and Wei Qi strong. Red face. Irritability and restlessness- Heat from St can effect the Heart.  T- Coating yellow. Dry- Body fluids are being driven off.   P- Strong-ample due to fever.

SHAO YANG – Qi circulation or obstruction in GB channel producing alternating chills and fever. Although is  is less deep than YANG MING it is a further complication of the disease. More complicated but less serious than YANG MING.
Body fluids not drastically injured. Disease can go on for years- eg malaria.
Harder to treat- but not as severe. Struggle between Zheng Qi and Xie ½ way between internal and external. Can go back and forwards.
Also symptoms associated with Liv/GB obstruction; Blurred vision, Dry throat, Irritability, St Qi full- anorexia.
P Wiry aor tight
Treatment- Passify the SHAO YANG strengthen the body energy.

TAI YIN
Internal empty Cold
Spleen cod empty- invaded by Cold. This is treated differently to external Cold- This time need to Warm the interior.
S/S – Vomiting, anorexia, the fire of digestion is low. Stools loose, not much transforming from digestion happening. T White coat- greasy.  P – Slow
One cause could be over use of purgatives.   Paten medicine- Li Zhong Wan. , Ginger.

JUEY YIN Heat retained in the Liver channel and its rising - Cold in intestines- Heat rises effecting upper body.  Complication of disease with Cold.  Cold and Empty in Middle Jiao and full upper Jiao.  S/S Hungry but doesn’t  want to eat. St, Intestines, so person can’t eat.
Cold limbs, Diarrhea. Internal parasites. P- Tense and rapid T- Light yellow.
Treatment- Eliminate Xue and strengthen Zhong Qi   Form- WU  MEI .

SHAO YIN  Deepest level- occurs before Juey Yin in stage of disease.
Internal empty condition- Ki and Spleen Yang - take the brunt of it. Can be complication of TAI YIN – Damaging Ki Yang.  S/S  Cold limbs, Chills, Fear of Cold, Diarrhea- with undigested food. Urine profuse. Wanting to sleep- not enough Yang.  T-pale  P Thready, deep
Treatment- Need to rescue Yang   Herbs- Xi Ni Tong. 

Syndromes of the six-meridians
Diseased meridian Presentations
Tai Yang Wind invasion Fever, aversion to wind, headache and spontaneous sweating. On examination, the pulse is floating and slow
Cold invasion Fever, aversion to cold, painful and stiff neck, body aching, unable to sweat and asthma. On examination, the pulse is floating and tense.
Yang Ming Meridian type High fever, profuse sweating, extreme thirst, flushed face and chest fullness. On examination, a dry, yellow tongue coating and a floating and forceful pulse are present.
Fu-organ type Feverishness of body, which is more pronounced in the afternoon, sweating, constipation, abdominal distention and pain that worsens when pressed, restlessness and delirium. On examination, a dry 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.
Tai Yin Abdominal distension with a preference for warmth and feels better when pressed, vomiting, anorexia and diarrhea. On examination, a pale tongue with a white coating and a slow and weak pulse is present.
Shao Yin Cold type Aversion to cold, spiritual fatigue, cold limbs, diarrhea, stool containing undigested food, nausea, thirst, preference for hot drinks and profuse and clear urine. On examination there is a pale tongue with a white coating and a deep and weak pulse.
Heat type Irritability, insomnia, dry mouth and throat and yellow and scanty urine. On examination there is a red tongue tip or a deep red tongue with little coating and a deep, thready and rapid pulse.
Jue Yin Extreme cold type Cold limbs, low body temperature and aversion to cold. On examination, there is a pale tongue and an extremely thready, feeble pulse that can hardly be felt.
Extreme heat type Cold limbs, irritability, feverish sensation, thirst and dark yellow urine. On examination, there is a yellowish tongue coating and rolling pulse.
 

6 Channels

TAI YANG  = Bl, SI 1. Wind at Shang Jiao  Lung  Pericardium Wind Heat penetrating

SHAOYANG = TH, GB Accumulation in GB  channel ½ Exterior, ½ interior.

YANG MING  = St, LI Internal Heat Channel type Fu affected- St, LI

TAIYIN = Sp, Lu Invasion of Spleen by Cold when Spleen Yang Xu

JUEYIN  PC Liv Heat in Heat in Liv channel when St and Intestine are Cold and Xu

SHAOYIN  = Ki Ht. Internal empty Heat