Liu Jing and Liu Jing Diagnosis System in Classical TCM Discussions of Six Divisions or Six Confirmations Diagnosis System in Classical TCM Texts

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1 Liu Jing and Liu Jing Diagnosis System in Classical TCM Discussions of Six Divisions or Six Confirmations Diagnosis System in Classical TCM Texts Liu Jing Bian Zheng system had developed about 1800 years ago by Zhang Zhong Jing (Han Dynasty) from his work of Shang Han Zai Bing Lun. Today, it is translated into English as Six division diagnosis or six confirmation diagnosis system. Due the complexes and abstraction of Liu Jing Bian Zheng theory, there were numerous of different comments about it from many TCM scholars on TCM history. Most of these classical texts are not available in non-chinese languages, therefore, a lot of unclear and confusions remain in the western TCM educations. Since Liu Jing Bian Zheng system highly includes Ba Gang Bian Zheng, Zang Fu Jing Luo Bian Zheng, the pathological mechanisms of diseases, the transmutations and prognosis of diseases, it has been using as a guideline in TCM clinical practices. It is necessary to make clear and understandings of the concepts and theory of this important TCM diagnosis system. There two parts will be discussed in following lecture: Part I, The concepts of Liu Jing in classical TCM texts; Part II, Liu Jing Bian Zheng system in Shang Han Lun. Part I: The concepts of Liu Jing in classical TCM texts

2 1. The original concepts of Liu Jing : Originally, Liu Jing had not described in Huang Di Nei Jing or Shan Han Lun. It had been described as three yin (Tai yin, Shao yin and Jue yin) and three yang (Tai yang, Shao yang and Yang ming). Later, TCM scholars simplified it as Liu Jing. Zhang Zhong Jing had developed his Liu Jing Bian Zheng system according to the theory of Huang Di Nei Jing. In the preface of his Shang Han Lun, he sated that: I refer to the classics of Su Wen, Jiu Juan (Huang Di Nei Jing), and Nan Jing (81 Difficulties). He further developed the theory of pathological mechanisms of three yin and three yang diseases that are induced by external factors, which it described in Chapter Su Wen, Chapter The mount of yang qi in Liu Jing: In Chapter 66 and 74 of Huang Di Nei Jing, Huang Di asked two time same question to Qi Bo: What is about the tree yin and three yang? Qi Bo answered: The definition of three yin and three yang is according to the mount of qi. Further, Huang Di Nei Jing distinguished that tai yang is the most yang and so is called the three yang, yang ming is called two yang and shao yang is called one yang as the indicating the different mount of qi in these three yang phases. It is same as the three yin phases, tai yin means most qi, is called the three yin, shao yin is called two yin and jue yin is called one yin (Su Wen Chapter 21, 79). 3. The mechanisms and functions of qi in Liu Jing: The qi mechanism of the three yin and three yang phases was described clearly for either heavenly qi or human body qi in Su Wen Chapter 6: Tai yang is outer of yang and in charging of opening yang; yang ming is inner of yang and in charging of closing yang; shao yang is pivot and in charging of pivoting yang. It is same as the three yin phases, tai yin is biao (outer) of yin and in charging of opening yin; jue yin is li (inner) and in charging of closing yin; shao yin is pivot and

3 in charging of pivoting yin. Later, this mechanism of qi motion was called qi gate theory by TCM scholars. As we know that in the book of Yi Jing, there were no the concepts of yang ming and jue yin. It was introduced in Huang Di Nei Jing. Huang Di asked Qi Bo: I would like to hear about yang ming. Qi Bo: The two yang (tai yang and shao yang) interact ing maximally is called yang ming. Huang Di: What is about jue yin? Qi Bo: The two yin interacting into the end is called jue yin. (Su Wen, Chapter 66, 74.) 4. The positions and Biao Li relationship of Liu Jing: It is obviously that Liu Jing includes Jing Luo and Zang Fu. In Ling Shu, Chapter 10, 11 and 13, it states very clear that all the paths of meridians and the associations to zang fu. Further, Su Wen Chapter 56, Pi Bu theory (skin zones) related to Liu Jing demonstrates the completed internal (zang fu) and external (meridian branches) TCM anatomy. Refer to Shang Han Lun Ling Jing system, it is can be shown in Fig.1, we tube theory (Li Jie). 5. The sequence of Shang Han transmutation: Su Wen, Chapter 31 describes the transmutation of Shang Han (aviation of external pathologies). The sequence of this transmutation is: From tai yang to yang ming, to shao yang, to tai yin, to shao yin and in the end to jue yin. This is basically corresponding to Shan Han Lun. Zhang Zhong Jing in his Shan Han Za Bing Lun, further developed this mechanism, theory and clinical applications. Summarizing above related concepts of Liu Jing in Huang Di Nei Jing, it can be seen that Liu Jing Bian Zheng system of Shang Han Lun is based on Huang Di Nei Jing. The importance is that Zhang Zhong Jing had combined all concepts of Liu Jing holistically but not only using one of those. Even though, last decade, Feng Shi Lun et al., in their publishes, such as Shan Han Za Bing Lun Suo Yuan and Zhang

4 Zhong Jing Yong Fang Jie Xi denied the theory of Shang Han Lun from Huang Di Nei Jing, however, it is lack of strong citations and academic confirmation. It remains doubts and further discussion.part II: Liu Jing Bian Zheng in Shan Han Lun Since Zhang Zhong Jing established the Liu Jing (three yin and three yang) Bian Zheng system according to Yin Yang and Ba Gang theory, on TCM history, it has had more than 500 significant works to contribute this great TCM classical text. This includes the great three leading group of Shang Han Lun research last century, Li Ke Shao (Shang Dong TCM University), Liu Du Zhou (Bei Jing TCM University) and Chen Yi Ren (Nan Jing TCM University). Due to the difficulties for studying of Shang Han Lun text and many different annotations on history, this important TCM diagnosis and differentiation system has been always a leakage in our west TCM education. Summarizing the main different research of Shang Han schools, Liu Jing Bian Zheng system should include following aspects: Meridianolgy theory: Such as Han Zhi He (Song Dynasty), work of Shang Han Wei Zhi Lun. Zang Fu theory: Such as Shang Han Lun text itself, such as yang ming wei jia shi (stomach and large intestine excess); zang jue (five zang failure). Cosmological theory: Such as Zhang Zhi Cong (Qing Dynasty), work of Shang Han Lun Ji Zhu. Division theory: Such as Ke Yun Bo (Qing Dinasty), work of Shang Han Lai Su Ji. Time stage theory: Such as Zhu Wei Ju, work of Shang Han Zhi Yi. It is clear that any one of above could not completely to explain Liu Jing Bian Zheng system. Therefore, it is necessary to clarify Liu Jing Bian Zheng system and make it to guide today s our clinical practices.

5 Tai yang diseases: It includes that Tai Yang Biao syndromes, such as Tai yang zhong feng, Tai yang shang han and Tai yang wen bing. Tai yang jian zheng relates the diseases are Tai yang combines with other syndromes, such as Da Qing Long Tang and Xiao Qing Long Tang syndromes. However, the mistreated and delay treated tai yang diseases are more related to the diseases that occur in Tai yang fu, Xia jiao, chest and Zhong jiao, like blood stasis in xia jiao, water accumulation in chest, or xin xia pi syndromes, these are called Tai yang changed diseases. It is clearly demonstrated that Shang Han Lun is the classics not only guiding to treat EPF (external pathological factors) caused diseases but also for all kinds of chronicle diseases. Yang ming diseases: It is characterized as the combination of heat and dryness related stomach and large intestine fu and meridian syndromes. The excess (wei jia shi) is the guiding line, such as Bai Hu Tang and the three cheng qi tang syndromes. Yang ming cold, like Wu Zhu Yu Tang syndrome, Yang ming changed syndromes, like jaundice are also discussed in this chapter. Shao yang diseases: Shao yang has mild and smooth yang qi. It is in charge of pivoting qi gates of the three yang. It flows yuan qi through all the betweens and spaces of body. Therefore, shao yang eight major syndromes is the guide line for shao yang diseases that mainly caused by the shao yang qi stagnations and shao yang fire accumulation. These are bit in mouth, dryness of throat, dizziness, wiry pulse, alternatively chilly and fever, distension of under ribs area, nausea to vomit and emotional depressed. Xiao Chai Hu Tang is the guiding formula. Tai yin diseases: Tai yin is the Biao of three yin, has more qi, and in charge of opening of three yin. Tai yin zang mainly concerns spleen. Spleen disorders are guiding line of Tai yin diseases. Three aspects as following: Spleen yang deficiency constitutions are affected EPF; Spleen yang deficiency causes

6 internal cold syndromes; Spleen yang deficiency induces spleen blood luo mai obstruction. Spleen deficiency type of jaundice and spleen yang recovering syndromes are also included. Si Ni Tang and Li Zhong Tang category formulas are concerned. Shao yin diseases: Shao yin has lesser qi and is the pivot of three yin. Shao yin zang are heart and kidney. Kidney is the source of yang jing yuan yang. Heart is Shen of life. Both are the roots of the life. Disorders of ming men fire, heart fire and heart-kidney interactions are the main pathology of Shao yin diseases. Mai che wei and fainting of shen are the guiding line of it. Si Ni Tang category and Huang Lian Er Jiao Tang are related to Shao yin diseases. Jue yin diseases: Jue yin has most less qi and in charge of closing three yin. It is the pivot of all three yin and yang. Erupting to yang and brings heat symptoms and returning to yin getting cold symptoms are the main mechanisms of jue jin. Therefore, upper heat and lower cold (Wu Mei Wan syndrome); Jue yin heat aviating xia jiao (Bai Tou Weng Tang syndrome); Jue yin cold aviating syndrome (Wu Zhu Yu Tang syndrome); Yin yang disconnection at ends of meridians on four limbs (Dang Gui Si Ni Tang syndrome) are major syndromes of Jue yin diseases. The seven-jue syndromes (Seven clod of extremities syndromes, such as cold jue, heat jue, worm jue, blood jue, water jue, phlegm jue and zang jue) as differentiation also are listed in this chapter. Liu Jing Bian Zheng is a completed, holistic and systemic TCM differentiation and diagnosis system. It is the important method to master for the one who is willing to be a good practice TCM practitioner. It is the great clinical foundation of TCM.