All lessons Module 5: Patterns Lesson 15
The Four Levels: Heat from the outer guard into the Blood
How do you read how deep a Heat disease has gone, and where does a TCM label stop and emergency care begin?
After this lesson you know, for each level, the signs, tongue, pulse, principle and classical formula, the usual and the reverse transmission and latent Heat, and you know that the Nutritive Qi and Blood levels mean an emergency in practice. Formulas by name, without dosages.
Know by heart
- Defensive Qi level (Wei). Fever with slight aversion to cold, sore throat, slight thirst; tongue with a red tip or sides, thin white coating; pulse floating, rapid; expel Wind-Heat with cool, pungent herbs; Yin Qiao San, with cough Sang Ju Yin.
- Qi level. High fever without chills, aversion to heat, sweating, thirst; tongue red with a yellow coating; pulse rapid, overflowing; clear Heat; Bai Hu Tang (Stomach), Ma Xing Shi Gan Tang (Lungs). mnemonic: chills gone, coating yellow: the Heat is in.
- Nutritive Qi level (Ying). Fever worse at night, restlessness, insomnia, delirium, faint spots, little thirst; tongue dark red without coating; pulse thin, rapid; clear the Nutritive Qi and push the Heat back to the Qi level; Qing Ying Tang. In the Pericardium: clouded consciousness, An Gong Niu Huang Wan.
- Blood level (Xue). Bleeding, distinct dark spots, mania, convulsions; tongue dark red to purple; pulse rapid; cool and move Blood; Xi Jiao Di Huang Tang. Late: Empty-Wind from Yin deficiency, Da Ding Feng Zhu.
- Ye Tianshi's rule. At the Defensive Qi level you may induce sweating; only at the Qi level do you clear the Qi; at the Nutritive Qi level you can still push the Heat back to the Qi level; at the Blood level you cool and disperse the Blood. mnemonic: Wei sweats, Qi clears, Ying pushes back, Xue cools.
- Transmission. Usual: from the Defensive Qi level inwards. Reverse: from the Lungs straight to the Pericardium, with confusion. Latent Heat: begins inside, at the Qi or Nutritive Qi level, without exterior signs.
- Red flag. In practice the Nutritive Qi and Blood levels are sepsis, meningitis or a coagulation disorder until proven otherwise: emergency services first, a label only after that.
The rest of this lesson is reference.
Three practice questions from this lesson
Case. Man, 25. Since this morning 38.4 °C, slightly shivery, sore throat, headache, slightly sweaty, slight thirst. Tongue with a red tip. Pulse floating and rapid.
- Bai Hu Tang
- Yin Qiao San
- Ma Huang Tang
Answer: Yin Qiao San. Defensive Qi level, Wind-Heat: cool, pungent herbs. Ma Huang Tang is for Greater Yang Cold without sweating; Bai Hu Tang for the Qi level.
Case. Woman, 33. Slightly feverish, mainly a tickly cough, slight thirst, hardly any sore throat. Tongue with a red tip. Pulse floating and rapid.
- Sang Ju Yin
- Qing Ying Tang
- Ma Xing Shi Gan Tang
Answer: Sang Ju Yin. Defensive Qi level with cough in the foreground and little fever: Sang Ju Yin. Ma Xing Shi Gan Tang is for Lung-Heat at the Qi level, with high fever and yellow phlegm.
Case. Man, 58. Day 4 of flu: 39.5 °C without chills, cough with thick yellow phlegm, breathless, thirsty. Tongue red, yellow coating. Pulse rapid and full. Which level and pattern?
- Qi level, Lung-Heat
- Nutritive Qi level, Heat in the Nutritive Qi
- Defensive Qi level, Wind-Heat
Answer: Qi level, Lung-Heat. No more chills, yellow coating, yellow phlegm, breathlessness: Lung-Heat at the Qi level. But first: breathlessness with high fever is pneumonia until proven otherwise, so to the GP or primary care doctor the same day.
The rest of this lesson
In the course you get the step-by-step explanation, 16 case-based practice questions, 21 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.