Chinese Medicine : Differientation according to the Theories of the Six Channels

Differentiating Syndromes According to the Theories of the Six Channels, Four Stages of Wei, Qi, Ying and Xue, and Sanjiao

The theories of the six channels, four stages of wei, qi, ying and xue are methods of differentiating syndromes of febrile diseases caused by exogenous pathogenic factors.

Differentiating syndromes according to the theory of six channels first appeared in the Shang han lun (The Treatise on Febrile Diseases Caused by Exogenous Pathogenic Factors) by Zhang Zhongjing of the eastern Han Dynasty (25-220). In this book various clinical manifestations of febrile disease caused by exogenous pathogenic factors such as Taiyang syndromes, Yangming syndromes, Shaoyang syndromes, Taiyin syndromes, Shaoyin syndromes, and Jueyin syndromes are used to explain the location and nature of pathological changes, the strength and weakness of anti-pathogenic and pathogenic qi, and the tendency of disease development, as a guide for clinical treatment.

Differentiating syndromes according to the theory of four stages of wei, qi, ying, and xue was first put forward by Ye Tianshi, a Qing Dynasty (1644-1911) physician, in his book Wan gan wen re pain (On Febrile Diseases Caused by Pathogenic Mild Heat). He classified the clinical manifestations of febrile diseases caused by pathogenic mild heat into four stage, wei (outer defensive) stage, qi (inner defensive) stage, yin (nutrient) stage, and xue (blood) stage. These are the four body strata used the explain the location and severity of pathological changes, and which form the basis of clinical treatment. Differentiating syndromes according to the theory of sanjiao was advocated by Wu Jutong, another Qing Dynasty physician. He summarized clinical manifestations of epidemic febrile diseases as having three areas: the upper, middle, and lower portions of the body cavity. These are also used to guide clinical treatment.

These three methods are not contradictory, rather they supplement each other's deficiencies. They can be used jointly to differentiate febrile diseases caused by exogenous pathogenic factors.

1. Differentiating Syndromes According to Six Channels Theory

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).

1) 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.

2) 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.

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.

1) 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.

2) 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.

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.

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.

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.

1). 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.

2) 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.

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.

1) 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."

2) 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."

3) 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. This condition is caused by parasitosis accompanied with mixed heat and cold. The symptoms of xiao ke, a feeling of qi striking upward, and pain and feverish sensation of the heart are heat syndromes. Hunger without appetite, vomiting ascariasis after eating, and serious diarrhea are cold syndromes. The mixture of heat and cold and the disharmony of yin and yang causes coldness of the limbs. Ascariasis disturbs the upper part of the body, manifesting irritability, and vomiting ascarids after eating.

2. Differentiating Syndromes According to the Theory of Wei, Qi, Ying, and Xue

This is a method of analyzing and judging the development of febrile diseases caused by exogenous pathogenic factors. Wei (outer defensive), qi (inner defensive), ying (nutrient), and xue (blood) are not only generalizations of the four types of febrile disease syndromes, but also a reflection of the four grades of severity of febrile diseases during their development.

Wei (Outer Defensive) Stage Syndrome

Wei (outer defensive) stage syndromes are seen at the onset of epidemic febrile diseases, the pathological changes occurring in the lung, and on the skin and hair. Clinical manifestations are characterized by the common exterior syndromes of fever and aversion to wind and cold.

Main clinical manifestations: Fever, a slight aversion to wind and cold, very little or no sweating, cough, headache, sore throat, slight thirst, a red tongue tip with thin white or slight yellowish tongue coating, floating and rapid pulse.

An attack of mild pathogenic heat on the body surface blocks the circulation of wei (defensive) qi, thus leading to dysfunction of the opening and closing of the pores and weakness of the defensive function of the body surface. Symptoms of fever, slight aversion to wind and cold, little or no sweating, and headache result. The lung dominates the skin and hair. Since the wei qi is blocked on the body surface, then the lung qi loses its function of spreading and descending qi, thus cough and sore throat result. Thirst is caused by pathogenic heat consuming the body fluid. Red tongue tip with white thin or yellowish tongue coating, floating and rapid pulse are all signs indicating pathogenic mild heat attacking the wei qi of the body.

These symptoms are mainly manifestations of the loss of wei qi's defensive function and also indicate a failure of the spread and descent of qi. If pathogenic factors mainly affect the skin and hair, that is, the body surface, then they are characterized by fever, thirst, and sore throat. If the lung is mainly affected, the chief complaint will be cough and sore throat.

Qi (Inner Defensive) Stage Syndrome
Syndromes of the qi (inner defensive) stage are the syndromes of interior heat due to the inner defense being invaded by pathogenic heat. In this case the anti-pathogenic qi and the pathogenic factor are very strong, resulting in hyperactivity of yang heat. Clinical manifestations are fever and no fear of cold.

Since the affected location alters after pathogenic heat is transmitted into the interior, the syndromes of the qi stage can then be classified into different types as follows:

1) Mild heat in the lung: Fever, perspiration, thirst, cough, asthma, chest pain, red tongue proper with yellow coating, rapid pulse. Preponderance of interior heat causes fever, rapid pulse, and red tongue proper with yellow coating. Interior heat steams the body fluid bringing on perspiration and thirst. Retention of pathogenic heat in the lung leads to the dysfunction of lung qi's spread and descent, so cough, asthma, and chest pain occur.

2) Accumulation of pathogenic heat in the chest and diaphragm: Fever, irritability, depression, restlessness, red tongue proper, slight yellowish tongue coating, thirst, constipation, rapid pulse. Retention of heat inside the body causes fever. Pathogenic heat disturbs the mind, so irritability and restlessness result. Pathogenic heat consumes the body fluid resulting in thirst and constipation. Red tongue proper with a slightly yellowish coating , and rapid pulse are signs of excessive pathogenic heat.

3) Heat transmitted into the stomach: High fever, thirst with preference for cold drinks, profuse sweating, anxiety, dry and yellowish tongue coating, full and forceful pulse. The pathogenesis and differentiation of qi stage syndromes is the same as for the Yangming channel syndromes. The only difference is the slower development of the disease condition after the invasion of pathogenic cold is transmitted from the Taiyang into the Yangming, while the transmission of pathogenic mild heat into heat is faster after it enters into the interior.

4) Retention of pathogenic heat in the liver and gall bladder: Retching, bitter taste in the mouth with thirst, irritability, insomnia, hypochondriac pain, yellowish tongue coating, wiry and rapid pulse. Disharmony of qi circulation in the liver and gall bladder channels is due to interior heat retention in the liver and gall bladder. This causes hypochondriac pain, bitter taste in the mouth and a wiry pulse. Stagnation of heat in the liver and gall bladder affects the stomach, causing retching. Pathogenic heat disturbing the heart and mind brings on irritability and insomnia. A yellowish tongue coating and thirst are signs of excessive pathogenic heat.

5) Retention of pathogenic mild heat in the intestine: There are two different groups of clinical manifestations as follows.

a) Dryness of the intestine causing constipation with manifestations being the same a syndromes of the Yangmin fu organs.

b) Heat in the intestine leading to diarrhea, a burning sensation around the anus, thirst, yellowish and dry tongue coating, rapid pulse. Descending heat in the intestine causes a dysfunction of transportation and transformation, thus diarrhea and a burning sensation around the anus result. Pathogenic heat consuming the body fluid produces thirst. Yellowish tongue coating and rapid pulse are signs of excessive pathogenic heat.

Yin (Nutrient) Stage Syndromes
The syndromes of the yin (nutrient) stage occur when pathogenic mild heat is transmitted into the superficial layer of the blood. Ying is a component of the blood, so the disease location is actually in the heart and pericardium. Pathological characteristics show the injury of nutrient yin and the disturbance of heart-mind.

1) Pathogenic heat injuring nutrient yin: Fever (worse at night), irritability, insomnia, or even coma and delirium, recessive rashes, slight thirst, deep red tongue proper, thready and rapid pulse.

Pathogenic mild heat invades deeply into the ying stage, thus scorching and injuring the nutrient yin and leading to insufficiency of blood, so the fever worsens at night and a rapid thready pulse results. pathogenic heat steams nutrient yin causing a slight thirst. Heat disturbs the mind leading to irritability, insomnia, or even coma and delirium. Pathogenic heat causes a disorderly flow of blood, thus a recessive, deep red tongue proper manifests.

2) Heat attacking the pericardium: Fever, coma, delirium, deep red tongue proper, rapid pulse. After pathogenic heat attacks the pericardium, it disturbs the heart-mind bringing on fever, coma, and delirium. A deep red tongue proper is a sign of heat in the blood. Rapid pulse indicates excessive heat.

Xue Stage Syndromes
Syndromes of the xue (blood) stage denote pathogenic mild heat invading the blood to the deepest stage. The pathological changes are mainly in the liver and kidney. Clinical manifestations are characterized by heat in the blood causing disorderly flow, stirring up of wind and heat, and injury of body yin.

1) Heat in the blood causing disorderly flow: Hemorrhage (including hematemesis, epistaxis, bloody stools, purpura, and vaginal bleeding), blood of a dark red or dark purple color, fever (worse at night), irritability, insomnia, feverish sensation of the palms and soles, deep red tongue proper, and rapid pulse.

Extreme heat in the blood stage forces a disorderly flow of the blood causing hemorrhage. Blood of a dark red or dark purple color indicates heat. Fever, worse at night, and a feverish sensation of the palms and soles are both signs of heat in the blood causing yin deficiency. Irritability and insomnia result from heat disturbing the heart-mind. A deep red tongue proper and a rapid pulse are the manifestations of extreme heat in the blood.

2) Heat in the liver stirring up wind: Headache, dizziness, redness of the eyes, irritability, fever, thirst, stiffness of the neck and back, contracture of the four extremities, deep red tongue proper, wiry and rapid pulse.

Headache, redness of the eyes, dizziness are caused by heat in the liver channel. Irritability and thirst result from pathogenic mild heat consuming the body fluid. Extreme heat exhausts the yin fluid of the body, thus the blood fails to nourish the tendons with resulting stiffness of the neck and back, and contracture of the four limbs. A deep red tongue proper, and a wiry rapid pulse are signs of heat in the blood of the liver channel.

3) Heat in the blood injures yin: Fever, flushed face, heat of the palms and soles, dryness of the mouth, listlessness, deafness, xu and forceless pulse, accompanied by irritability, insomnia, protracted fever at dusk, chilliness in the early morning, no sweating after the fever subsides, red tongue proper with scanty coating, thready and rapid pulse.

Hot palms and soles, flushed face, dryness of the mouth, and deafness are all signs of yin deficiency and yang floating upward. Listlessness and xu pulse are caused by the insufficiency of essence and blood. Irritability and insomnia are due to yin deficiency producing a preponderance of fire which disturbs the hear-mind. No sweating after fever subsides, fever at dusk, and chilliness in the early morning are characteristics of yin deficiency producing heat.

4) Perishing of yin and excessive loss of fluid: Slim limbs, withered lips and shrunk tongue, dryness of gums, depressed eyes, unconsciousness, flushed cheeks, coldness of extremities, squirming fingers, feeble and unfelt pulse, or even convulsion.

Atrophy and dryness of the limbs, lips and tongue, dryness of the gums, and depressed eyes are manifestations of perishing yin and excessive loss of fluid. Unconsciousness, feeble and unfelt pulse are signs showing complete exhaustion of yin fluid. Flushed cheeks, and cold extremities are signs of a heat nature showing the internal draining of yin fluid leading to the upward floating of ying qi, and a failure of yang qi to warm and nourish the four extremities. Squirming fingers indicate malnourishment of the tendons due to the internal draining of yin fluid, thus causing an internal stirring of xu wind.

3. Differentiating Syndromes According to the Sanjiao Theory

Differentiating syndromes according to the theory of sanjiao is a method of analyzing damp-heat syndromes in febrile diseases caused by exogenous pathogenic factors. Damp-heat syndromes are caused by exogenous pathogenic damp and heat, so the disease duration is long and the condition is complicated. Pathological changes are mainly in the middle jiao, especially concentrated in the spleen and stomach. At the early stage of damp-heat diseases there is no clear margin between wei (outer defensive) stage, and qi (inner defensive) stage. Also, before damp-heat is transformed into dryness, it may be transformed into ying (nutrient) stage, and xue (blood) stage. So it is difficult to differentiate damp-heat diseases by using the theory of wei, qi, ying, and xue. Generally, pathogenic damp and heat spread through all the upper, middle, and lower jiao to obstruct the circulation of qi, and block the smooth transportation and transformation of water and fluid. Thus, the method of differentiating syndromes according to the theory of sanjiao is used to analyze these diseases.

The syndromes of the upper, middle, and lower jiao are generalizations of the three kinds of symptom-complex, and a reflection of disease development from upper to lower, from superficial to deep, and from mildness to severity.

Damp-Heat in the Upper Jiao
Damp-heat in the upper jiao indicates the early stage of pathogenic injury. The main pathological changes are in the lung and body surface.

Main clinical manifestations: Severe aversion to cold, little or no fever, no sweating, heaviness and pain of the body, distending pain of the head, deafness, dullmind, indifferent emotions, hypersomnia, poor appetite, white sticky tongue coating, soft and weak pulse.

Damp is a yin pathogenic factor which attacks yang qi easily, so there is severe aversion to cold and a slight fever. Pathogenic damp obstructing the body surface muscles causes an absence of sweating and pain. Pathogenic damp is characterized by heaviness and turbidity, so the manifestations of heaviness of the body and distending pain of the head occur. Pathogenic damp misting of clear yang results in deafness, dullmind, indifferent emotions and hypersomnia. Poor appetite is caused by the retention of damp in the spleen and stomach. A white sticky tongue coating and a soft weak pulse are signs of excessive damp.

Damp-Heat in the Middle Jiao
Damp-heat in the middle jiao transmits from the upper jiao. the main pathological changes show the disturbance of damp on qi activities, and abnormal ascending and descending of middle jiao qi.

Main clinical manifestations: Fever, stuffiness and distension of the chest and epigastric region, anorexia, loose stools, scanty and yellowish urine, light yellow color of the face and eyes, grayish, pale and slightly yellow tongue coating, dullmind, coldness of the lower legs, and soft pulse.

Damp mixed with heat causes fever. Damp also obstructs the qi activities and disturbs its function of ascending and descending, so stuffiness and distension of the chest and epigastric region, anorexia, and loose stools occur. Steaming of damp and Steaming of damp and heat causes alight yellow face and eyes. yang qi fails to spread over the four extremities due to a blockage of clear yang by damp, so a dull mind, and coldness of the lower legs result. Grayish, pale, and slightly yellow tongue coating, and a soft pulse are signs of excessive damp-heat.

Damp-heat in the Lower Jiao
Damp-heat in the lower jiao arises from the middle jiao. The main pathological changes are characterized by problems of the urinary bladder and large intestine.

Retention of damp in the urinary bladder: Dysuria, distending pain and dizziness of the head, fullness and stuffiness of the epigastric and abdominal regions, grayish-white and yellow-sticky tongue coating, unsmooth bowel movements, and soft pulse.

Retention of dampness deranges the qi activities of the urinary bladder, manifesting as dysuria. Distending pain and dizziness of the head, and fullness and stuffiness of the epigastric and abdominal regions are caused by the failure of yang qi to ascend because of the spreading of damp-heat through the upper, middle, and lower jiao. Unsmooth bowel movements are the result of damp-heat retention in the large intestine. Grayish-white, yellow-sticky tongue coating, and a soft pulse are signs of excessive internal damp-heat.

Retention of damp in the large intestine: Constipated stool, fullness of the lower abdomen, distension of the head, stuffiness of the epigastrium, grayish and yellow-sticky tongue coating, and soft pulse.

Grayish and yellow-sticky tongue coating, and soft pulse indicate interior retention of excessive damp-heat. Distension of the head, and stuffiness of the epigastrium indicate damp-heat remaining in the upper, middle, and lower jiao, in which the qi activities of the sanjiao are blocked. Constipation and fullness of the lower abdomen are due to the stagnation of dampness disturbing the large intestine.