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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.

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