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All lessons   Module 5: Going deeper   Lesson 1

Module 5   Lesson 1   Liu Jing, Wei Qi Ying Xue

Acute disease: Six Stages and Four Levels

How do you read tongue and pulse in a febrile illness, and which finding shows you that it is going a layer deeper?

After this lesson you ask three questions first in every acute illness (where, what, how deep), you know the tongue and the pulse for each stage and each level, you read the course of a febrile illness on the tongue from white to yellow to Deep-Red and back, and you know which tongue and pulse pictures call first for emergency services (112 in Europe, 999 in the UK, 911 in North America) or for a GP or primary care doctor the same day.

Cold from outside: the Six Stages via the skin, the Yang hit first Taiyang thin white floating, tight or relaxed Shaoyang thin white, edges reddish wiry Yangming red, dry yellow overflowing bowel: deep, full Taiyin pale, white deep, slow, weak Shaoyin pale and wet, or red and bare minute, or thin-rapid Jueyin mixed often wiry Heat from outside: the Four Levels via nose and mouth, the Yin hit first Wei red tip, thin white floating, rapid Qi red, yellow coating, dry rapid, overflowing here the two maps meet Ying deep red, bare thin, rapid 112 Xue deep red to purple, dry rapid; with Wind wiry 112 outside inside The coating says how deep; the body, whether the Yin is hit thin white thicker, yellow thick, dry, brown deep red, bare pale, wet, white Heat going deeper Cold in the Yin
Schematic. Red: the Yang stages and the Heat levels; blue: the Yin stages; outlined and marked 112: the two deepest levels. Shaoyang with a dotted border: the hinge between outside and inside (by depth it lies between Taiyang and Yangming). Tongue and pulse for each box: textbook, after the Chinese standard textbook of diagnostics, Sacred Lotus and Me & Qi; the book in ch. 44 and ch. 45.

Know by heart

  • Three questions in every acute illness. Outside or inside: does the pulse float, is there still aversion to cold? Cold or Heat: tight or rapid, chills or fever predominant, sore throat? How deep: the coating and the body; mnemonic: where, what, how deep.
  • Taiyang and Wei: the exterior. Taiyang: body normal, thin white coating; floating and tight (Cold, no sweating) or floating and relaxed (Wind, slight sweating). Wei: red tip or sides, thin white; floating and rapid; mnemonic: the tongue hardly changes yet, the pulse floats.
  • Yangming and Qi: Heat inside. Red with a dry yellow coating; overflowing and rapid. In the Intestines (Yangming organ): thick, dry, yellow to brown or black coating; deep and full. Shaoyang, the hinge: thin white, edges slightly red; wiry.
  • The Yin stages. Taiyin: Pale, white coating; deep, slow, weak. Shaoyin Cold: Pale, wet, white; deep, minute, thin. Shaoyin Heat: Red, little or no coating; thin and rapid. Jueyin: mixed, often wiry.
  • Ying and Xue: Heat in the depths. Ying: Deep-Red without coating; thin and rapid. Xue: Deep-Red to Purple, dry; rapid, with Wind wiry; mnemonic: the coating disappears, the body burns.
  • The course. Unfavourable: thin to thick, white to yellow to brown or black and dry, Red to Deep-Red, a coating that suddenly disappears, a floating pulse that becomes deep and thin. Favourable: thick to thin, thin white and rooted again, moisture that returns.
  • Red flags. Emergency services (112): neck stiffness on bending forward, drowsiness or confusion, spots that do not fade under pressure, breathlessness at rest, convulsions, an older person who is cold and drowsy. The same day: fever for more than three days, rapid breathing, dehydration, fever in a vulnerable client; straight away: fever in a baby under three months or during chemotherapy.

The rest of this lesson is reference.

Three practice questions from this lesson

Case. Man, 29. Shivery since this morning, 38.0 °C, stiff neck on turning (bending forward is free), occipital headache, aching body; he is not sweating. Tongue Pale-Red, thin white coating. Pulse superficial and tight.
  1. Taiyang, Attack of Cold
  2. Wei, Wind-Heat
  3. Shaoyang, the hinge

Answer: Taiyang, Attack of Cold. Chills predominant, no sweating, a normal tongue and a floating, tight pulse: Cold on the outside. Wind-Heat gives a sore throat, a redder tip and a rapid pulse; Shaoyang a string without floating, with cold and hot in turn.

Case. Woman, 25. 38.6 °C with slight chills, sore throat, slight thirst, some sweating. Tongue Pale-Red with a redder tip and redder sides, thin white coating. Pulse superficial and rapid.
  1. Wei, Wind-Heat
  2. Taiyang, Attack of Cold
  3. Qi level

Answer: Wei, Wind-Heat. The pulse still floats and there is aversion to cold: exterior. The sore throat, the redder tip and the rapid pulse make it Heat. At the Qi level the chills are gone and the coating is yellow.

Case. Man, 41, fourth day of flu. No more chills, 39.4 °C, he feels hot, sweats a lot, great thirst for cold water; the abdomen is soft and the stools normal. Tongue Red with a dry yellow coating. Pulse broad, forceful and rapid.
  1. Yangming channel, the Qi level
  2. Yangming organ, Heat in the Intestines
  3. Shaoyang, the hinge

Answer: Yangming channel, the Qi level. The four greats (fever, sweating, thirst, big pulse) without a full, hard abdomen: Yangming channel, on the Heat map Stomach-Heat at the Qi level. The organ pattern has constipation and a deep, full pulse.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 17 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.

Try two lessons freeSee Tongue and Pulse