Chapter 5: The Six Meridian Syndrome Differentiation of Classical Prescriptions

“Teacher Li, may I understand from your perspective that classical prescriptions not only allow for adjustments in dosage and decoction methods according to clinical circumstances but can also have their ingredients increased, decreased, or even substituted?” Zhang Jing pondered for a moment and decided to seek clarification.

Li Yu nodded slightly, then countered, “Why don’t you tell me how later generations, who honor the Treatise on Cold Damage Disorders as the origin of formula books, interpret the word ‘fang’—‘formula’ or ‘prescription’?”

“‘Fang’ can be understood as a classic prescription. The formulas recorded in the Treatise on Cold Damage Disorders are few in number yet refined in essence, almost miraculous in their efficacy, capable of reviving the dying, resonant like drumbeats—hence their reverence as classical prescriptions by later generations.”

“That’s the common understanding, but I believe ‘fang’ should be seen more as a method—the principle of pattern differentiation and treatment,” Li Yu smiled gently.

Zhang Jing thought it over carefully and found the idea quite reasonable. He couldn’t help but admire inwardly: truly worthy of being the academic heir of Master Liu, his insights were profound and unique.

“Teacher Li, so you mean that the ‘Classic of Decoctions’ authored by Yi Yin should be regarded as the true origin of formula books, the source of all prescriptions, correct?”

“Exactly! The greatest contribution of the Medical Sage Zhang Zhongjing lies in his reference to ancient medical texts such as the Suwen, Lingshu, Nanjing, Yin-Yang Treatise, Tailu Materia Medica, and Pingmai Bianzheng. He extensively discussed Yi Yin’s Classic of Decoctions, comprising numerous volumes, and thereby established the very soul of traditional Chinese medicine—pattern differentiation and treatment.”

“Yes, yes, yes!” Zhang Jing nodded repeatedly in full agreement.

Suddenly, Li Yu shifted the topic and asked, “Now, tell me, what is the core of the Six Channels pattern differentiation?”

Zhang Jing thought for a moment and answered solemnly, “The Six Channels pattern differentiation is based on the system of Three Yin and Three Yang, whose core is Yin and Yang.”

Li Yu nodded faintly. “Correct. Zhang Jingyue once said: Though medicine is complex, it can be summed up in one word—Yin and Yang. Thus, syndromes have Yin and Yang, pulses have Yin and Yang, medicines have Yin and Yang. In short, all things in the universe cannot be separated from Yin and Yang. To illustrate this division, why don’t you give two of the simplest examples?”

“Women represent Yin, men represent Yang. Night is Yin, day is Yang,” Zhang Jing promptly replied.

“Very good. Taking day and night as an example, how would you further subdivide Three Yin and Three Yang on the basis of Yin and Yang?”

“… That’s something I’ve never thought about before,” Zhang Jing admitted, unable to answer immediately.

“No worries. Start by telling me, among the Three Yang, which has the greatest Yang Qi, which is second, and which is the least?”

“Taiyang is the Three Yang, with the most Yang Qi; Shaoyang is one Yang, with the least Yang Qi; Yangming is the combination of two Yang, possessing a moderate amount of Yang Qi.”

“And the Three Yin?”

“Taiyin is Three Yin, with the most Yin Qi; Shaoyin is Two Yin, next in intensity; Jueyin is the extreme Yin, where Yin ends and Yang begins, thus counted as One Yin.”

“Excellent, excellent,” Li Yu nodded repeatedly, then turned to the listless and inattentive Li Simeng and said, “You should learn more.”

Li Simeng pouted, hesitant to argue but dared not, silently shooting Zhang Jing a glance.

“Knock, knock, knock!” The sound of knocking came again.

Zhang Jing, eager and ready, prepared to attend to another patient.

Unexpectedly, Li Yu smiled faintly.

“The first patient took quite some time. I’ll see the next one first, or the others waiting for appointments will get anxious. Your experience with the Four Examinations isn’t sufficient yet, especially pulse diagnosis, which is the hallmark of Chinese medicine and requires real skill. When you rest later, have Simeng take you to the pulse diagnosis practice room to train properly.”

“Pulse diagnosis practice room?” Zhang Jing looked puzzled.

“Yes. Didn’t you use the pulse image simulation testing machine during your Traditional Chinese Medicine Diagnostics exam at university?”

“Oh, yes, yes.”

Zhang Jing recalled it now—a device that simulates various pulse waveforms and quizzes examinees accordingly.

He remembered answering only two out of five questions correctly then. Yet, that accuracy rate ranked among the top in his class.

After all, pulse theory is subtle and profound; its essence is hard to discern. It’s easy to grasp in theory but difficult to distinguish under the fingers.

For clinical novices still in school, it’s truly challenging!

“Though the machine simulation can’t fully reflect the real pulse of the human body, the overall feel isn’t far off. Passing the machine test first, then combining it with actual clinical pulse diagnosis, achieves twice the result with half the effort.”

“Moreover, for beginners in clinical practice, it’s enough to grasp the big picture and key pulse signs. Then, based on tongue diagnosis, inquiry, and other observations, integrating all Four Examinations for careful pattern differentiation and treatment, major errors are unlikely.”

While Li Yu spoke, the second patient had already seated herself across the consultation desk.

This young woman was starkly different from the previous male patient who wore only a shirt. Though it was not yet winter, she was already wearing a thick down jacket.

Despite this, she shivered intermittently and sniffled now and then.

Zhang Jing understood clearly—these were classic signs of chills.

Li Yu handed the medical record to Zhang Jing.

Zhang Jing took it and noticed the body temperature recorded at 39.8°C.

He felt a chill in his heart: such a high fever accompanied by intense chills, and yet no sweat on the forehead—a rare presentation indeed.

Without letting the patient describe her condition, Li Yu immediately felt her pulse.

After a while, he slowly said, “The pulse is floating and rapid.”

Next, he examined the tongue carefully, murmuring, “Tongue pale in color, coating thin and white.”

After finishing, he turned to Zhang Jing and asked, “Based solely on what we know so far, what would be your preliminary diagnosis?”

Zhang Jing answered confidently, “According to the first article in the Treatise on Cold Damage Disorders: ‘When Taiyang is diseased, the pulse is floating, the head and nape are stiff and painful, and there is aversion to cold.’ The patient has a floating pulse and obvious chills; this should be a Taiyang disorder.”

“And what pattern does that correspond to?” Li Yu pressed further.

“…It should be Taiyang Cold Damage pattern,” Zhang Jing thought and replied.

Li Yu withheld comment, then asked Li Simeng, “What do you think?”

“I…I think it’s Taiyang Wind Strike pattern,” Li Simeng said, mainly to contradict Zhang Jing without much thought.

“Simeng, explain your reasoning,” Li Yu frowned slightly.

“The patient is female, tongue pale… also clearly afraid of cold, indicating a weak constitution… Weakness makes the exterior prone to Qi deficiency, which is the Taiyang Exterior Deficiency pattern, that is, Taiyang Wind Strike. The formula should be Guizhi Decoction,” Li Simeng, somewhat nervous due to lack of preparation, gained confidence as she spoke.

“Doctor Zhang, what evidence supports your diagnosis?” Li Yu turned to Zhang Jing.

“Whether there is sweating or not, and the fever’s nature, can help distinguish Taiyang Cold Damage from Taiyang Wind Strike. This patient has severe chills, wears many clothes, yet shows no sweat, and the body temperature is nearly 40°C; this indicates cold pathogen closing the exterior. Therefore, an initial diagnosis of Taiyang Cold Damage pattern is warranted, but final confirmation requires further inquiry.”

“Good. If you were to conduct the inquiry, what would be your first question?”

“About sweating after the onset of illness.”

“And why?”

“Both Taiyang Wind Strike and Taiyang Cold Damage are caused by wind-cold invasion of the exterior with disharmony of Ying and Wei. Both present with fever, headache, aversion to wind and cold, and floating pulse. However, Wind Strike’s basic pathomechanism is weak Wei Yang and unstable Ying Yin, characterized by sweating and moderate pulse; Cold Damage’s pathomechanism is constrained Wei Yang and stagnant Ying Yin, featuring no sweat and tight pulse. Thus, presence or absence of sweat is crucial to differentiate these patterns.”

“Teacher, I have a disagreement,” Li Simeng interjected suddenly.

“If you have doubts, study the Treatise on Cold Damage Disorders carefully,” Li Yu glanced at her, speaking sharply.

Then, shifting tone, “Doctor Zhang, I’ll conduct the inquiry. You keep recording the case. High fever means the patient is very uncomfortable; we must prescribe quickly and not keep her waiting.”

Through the history, it was learned that the woman came from a mining area and had unfortunately contracted influenza days ago, with persistent high fever.

She first took Western antiviral cold medicine with no effect.

Then took Chinese patent medicines such as Yin Qiao San and Sang Ju Yin granules, which not only failed to help but worsened headaches and joint pains.

Zhang Jing carefully recorded in the medical record: Patient, female, 28 years old. Chief complaint: fever, chills, head and body pain for three days. Due to external invasion by epidemic toxin, no effect from Western medicine; symptoms worsened after taking spicy-cool exterior-releasing and heat-clearing detoxifying patent medicines. Current temperature 39.8°C, nasal congestion, slight clear nasal discharge, no sweating, poor appetite, normal urination and defecation. Examination: tongue pale, coating thin white, pulse floating rapid. Diagnosis: Taiyang Cold Damage pattern.

“Alright, prepare the prescription,” Li Yu nodded after reviewing the notes and said to Zhang Jing.