Six Stages Four Levels San Jiao

1. Six StagesFour LevelsSan Jiao • ACR class 5

2. Identification of PatternsAccording to the Six Stages

3. (TAI YANG STAGE) ATTACK OF WIND • Slight aversion to cold, aversion to wind, slight fever, stiff neck, headache, aches in the body, sweating, sneezing and Floating-Slow pulse.

4. (TAI YANG STAGE) ATTACK OF COLD • Aversion to cold, slight fever, stiff neck, headache, no sweating, aches in the body, shortness of breath, runny nose with white discharge and Floating-Tight pulse.

5. (TAI YANG STAGE) ACCUMULATION OF WATER • Aversion to cold, slight fever, retention of urine, slight thirst, vomiting of fluids soon after drinking, Floating-Rapid pulse

6. (TAIYANG STAGE) ACCUMULATION OF BLOOD • Hypogastric distension, fullness and urgency, blood in urine, mental restlessness, Reddish-Purple tongue without coat, Deep-Fine-Rapid or Deep-Choppy pulse

7. BRIGHT-YANG (YANG MING) CHANNEL PATTERN • High fever, profuse sweating, feeling of heat, intense thirst, red face, irritability, delirium, red tongue with yellow coating and Overflowing-Rapid or Big-Rapid pulse.

8. BRIGHT-YANG (YANG MING) ORGAN PATTERN • High fever which is worse in the afternoon, profuse sweating, sweating on limbs, constipation, dry stools, fullness and pain in the abdomen which becomes worse on pressure, thirst, Red tongue with a thick dry yellow ("old yellow") coating and Deep-Full-Slippery-Rapid pulse.

9. LESSER YANG (SHAO YANG) STAGE • Alternation of chills and fever, fullness and distension of the costal and hypochondriac regions, lack of appetite, irritability, dry throat, nausea, bitter taste, blurred vision, white tongue coating on one side only and Wiry or Wiry-Fine pulse.

10. GREATER YIN (TAI YIN) STAGE • Abdominal fullness, feeling of cold, vomiting, no appetite, diarrhea, absence of thirst, tiredness, Pale tongue and Deep‐Weak-Slow pulse.

11. LESSER YIN (SHAO YIN) COLD PATTERN • Chills, feeling of cold, lying curled up, listlessness, desire to sleep, cold limbs, diarrhea, no thirst, frequent pale urination, Pale wet tongue with white coating and Deep‐Weak-Slow pulse.

12. LESSER YIN (SHAO YIN) HEAT PATTERN • Feeling of heat, irritability, insomnia, dry mouth and throat at night, dark urine, night sweating, Red tongue without coating and Fine-Rapid pulse.

13. TERMINAL YIN (JUE YIN) • Persistent thirst, feeling of energy rising to the chest, pain and feeling of heat in the heart region, feeling of hunger with no desire to eat, cold limbs, diarrhea, vomiting, vomiting roundworms, Wiry pulse.

14. Identification of PatternsAccording to the Four Levels

15. DEFENSE (WEI) LEVEL

16. (Wei Level) Wind Heat • Fever, aversion to cold, headache, slight sweating, runny nose with yellow discharge, slight thirst, sore throat, red and swollen tonsils, Red sides or tip of the tongue, Floating-Rapid pulse.

17. (Wei Level) Summer Heat • Fever, aversion to cold, headache, sweating, feeling of heaviness, uncomfortable sensation in epigastrium, thirst, irritability, Red sides or tip of the tongue with white sticky coating, Soggy-Rapid pulse.

18. (Wei Level) Damp Heat • Fever worse in the afternoon, body hot to touch, aversion to cold, swollen glands, headache, feeling of heaviness, oppression in epigastrium, sticky taste, thirst with no desire to drink, white sticky tongue coating, Soggy pulse.

19. (Wei Level) Dry Heat • Fever, slight aversion to cold, slight sweating, dry skin, nose mouth and throat, dry cough, sore throat, dry tongue with thin white coating, Floating-Rapid pulse.

20. QI LEVEL

21. (Qi Level) Lung Heat • High fever, feeling of heat, no aversion to cold, cough with thin-yellow sputum, shortness of breath, thirst, sweating, Red tongue with yellow coating, Rapid pulse.

22. (Qi Level) Stomach Heat • High fever worse in the afternoon, no aversion to cold, feeling of heat, intense thirst, profuse sweating, Red tongue with yellow coating, Overflowing‐Rapid pulse.

23. (Qi Level) Intestine Dry Heat • High fever worse in the afternoon, constipation, dry stools, burning in anus, abdominal fullness and pain, irritability, delirium, Red tongue with a thick dry yellow coating and Deep-Full-Rapid pulse.

24. (Qi Level) Gallbladder Heat • Alternation of heat and cold with prevalence of heat, bitter taste, thirst, dry throat, hypochondriac pain, nausea, fullness in epigastrium, red tongue with sticky unilateral coating and Wiry Rapid pulse.

25. (Qi Level) Stomach-Spleen Damp Heat • Continuous fever that decreases after sweating then increases again, feeling of heaviness of head and body, oppression in epigastrium and chest, nausea, loose stools, Red tongue with sticky-yellow coating, Soggy-Rapid pulse.

26. NUTRITIVE (YING) LEVEL

27. Heat in the Nutritive Qi Level • Fever at night, dry mouth with no desire to drink, insomnia, mental restlessness, delirium, incoherent speech or aphasia, spots on skin (macules), Deep-Red (crimson or scarlet) tongue without coating, Fine-Rapid pulse.

28. (Ying Level) Heat in the Pericardium • Fever at night, mental confusion, incoherent speech or aphasia, delirium, body hot, cold hands and feet, macules, Deep-Red tongue without coating, Fine-Rapid pulse.

29. BLOOD (XUE) LEVEL

30. (Xue Level) Heat Victorious Moving Blood • High fever, mental restlessness, manic behavior, dark macules, vomiting of blood, epistaxis, blood in stools, blood in urine, Dark‐Red tongue without coating, Wiry-Rapid pulse.

31. (Xue Level) Heat Victorious Stirring Wind • High fever, fainting, twitching of limbs, convulsions, rigidity of neck, opisthotonos, eyeballs turning up, clenching of teeth, Dark‐Red tongue without coating, Wiry-Rapid pulse.

32. (Xue Level) Empty Wind Agitating Interior • Low-grade fever, tremor of limbs, twitching, loss of weight, malar flush, listlessness, Dark‐Red tongue without coating, Fine-Rapid pulse.

33. (Xue Level) Collapse of Yin • Low-grade fever, night sweating, mental restlessness, dry mouth with desire to sip liquids, 5 palm heat, malar flush, emaciation, Dark‐Red dry tongue without coating, Fine-Rapid pulse.

34. (Xue Level) Collapse of Yang • Feeling of cold, cold limbs, bright white complexion, profuse sweating on forehead, listlessness, Pale-Swollen‐Short tongue, hidden slow scattered pulse.

35. Qi Level Latent Heat • Lesser-Yang Type: same as 6 stages pattern • Bright Yang Channel Type: "4 Bigs", same as 6 stages pattern • Bright Yang Organ Type: same as 6 stages pattern

36. Blood Level Latent Heat • Lesser-Yin Type: • Weary limbs before onset of other symptoms, insomnia, irritability, dry mouth and throat, scanty dark urine, headache, backache, tiredness; Possibly also delirium, blood in urine, epistaxis, macules. • Deep-red tongue without coating and Fine-Rapid pulse.

37. Identification of PatternsAccording to the Three Burners

38. UPPER BURNER

39. WIND-HEAT INVADING THE LUNGS (Wei Level): same as Wind Heat at the Defensive Qi Level of the 4 Level patterns. • HEAT IN THE LUNGS (Qi Level): corresponds to the Qi-Level Lung Heat pattern from the 4-Levels. • HEAT IN THE PERICARDIUM (Ying Level): corresponds to the Ying-Level Heat in the Pericardium pattern from the 4-Levels.

40. MIDDLE BURNER

41. HEAT IN THE BRIGHT YANG: Corresponds to Qi-Level Stomach Heat / Yangming Channel pattern • DAMP-HEAT INVADING THE SPLEEN: Fever, feeling of heaviness of head or of the whole body, epigastric fullness, nausea, vomiting, red tongue with yellow-sticky tongue coating, Soggy and rapid pulse.

42. LOWER BURNER

43. HEAT IN THE KIDNEYS: corresponds to Xue Level Collapse of Yin in 4 Levels or Shao Yin Heat Pattern in 6 Stages • LIVER-HEAT STIRS WIND: corresponds to Xue Level Heat Victorious Stirring Wind in 4 Levels • LIVER EMPTY-WIND: corresponds to Xue Level Empty Wind Agitating Interior in 4 Levels