Tai Yang Conditions

In Chinese Meridian Theory, as in the law, certain tests or standards must be met in order for a syndrome to be diagnosed. In the case of Tai Yang conditions, a floating pulse and stiffness of the back of the neck mark the first two standards. The rub is numerous other distinctions must be made based upon the progression of the condition relative the body's strength. This includes preexisting conditions such as age and constitution.

The following discussion on Tai Yang formulas allows for us to refine our diagnostic skills and raise deeper questions about common conditions. Central to any exploration of Tai Yang conditions is excess (yang) and deficiency (yin).

The formulas discussed are listed below:

Ge Gen Tang
Gui Zhi Jia Ge Gen
Gui Zhi Jia Ren Shen Tang
Gui Zhi Jia Hou Pu
Ma Huang Tang
Ge Gen Tang
Ge Gen Jia Ban Xia
Gui Zhi Jia Fu Zi
Da Qing Long
Xiao Qing Long

Excess versus deficient-- the initial stages

Quite simply the difference between a TY excess and deficient presentation is the presence of sweat. This axiomatically designates the condition as deficient. The rationale relates to a stagnation of yang qi that allows for the yin qi to seep through the pores. This is called "disharmony between wei and ying," which are more superficial aspects of the body. Sweat differentiates a TY deficient condition from bi syndrome, which can also present with neck stiffness and deficiencies but at deeper levels than wei and ying. Interestingly, however, most bi formulas contain gui zhi and many contain ma huang, both of which release the exterior/wei level. The chronicity of bi patterns is also a major differentiating factor from TY deficiency patterns. Beyond sweat, other TY deficiency symptoms include a moderate or weak pulse.

The sudden onset of neck stiffness without sweat indicates an excess pattern. In such cases, the body is considered strong enough for robust formulas. Ge Gen Tang is therefore appropriate. If, on the other hand, sweat is present then Gui Zhi Jia Ge Gen Tang is what the doctor should order.

Longstanding body aches that result from improper sweating call for Guizhi Jia Ren Shen Tang. This formula is often used in cases of fibromyalgia and even postpartum pain, so understanding the nature of the deficiency vis-a-vis the individual's constitution will determine the appropriateness of this formula. A practitioner will want to pay special attention to the state of blood, as pain cases are often the result of blood stagnation in combination with deficiency.

Asthmatic presentations follow the same logic. Sudden onset asthma with sweating is best addressed with Gui zhi Ho Pu Tang, whereas non-sweating asthma calls for Ma Huang Tang. There are numerous formulas for asthma and I have my doubts about the functionality of either of these formulas. This because by the time a patient feels the need for a doctor's visit, their condition has advanced beyond the the initial stages. For instance, phlegm indicates an advanced condition that would require some modification to more directly address phlegm, which is almost always present in asthma. In an instance of another asthmatic condition, coughing at night, an entirely different etiology is at play and the above formulas should be altogether avoided.

Just what in the world does "deficiency" mean in Chinese medicine? Just because a person develops really strong symptoms doesn't mean that they are deficient. In fact, it usually means the opposite because the body has more energy with which to mount its attack. This reasoning seems to characterize the formulas that allopathically treat the strong symptoms of diarrhea and vomiting, Ge Gen Tang and Ge Gen Jia Ban Xia respectively. These two patterns represent a combination of TY and Yang Ming conditions that exhibit no weakening of the body's response to the pathogen. The advance of the pathogen nevertheless proceeds afoot.

More insight into the differences between excess and deficiency is gained when considering treatment principles. Releasing exterior occurs in both deficiency and excess patterns, however, deficiency also requires harmonizing ying and wei. Deficiency may also require tonification of yang qi, as in Gui Zhi Jia Fu Zi Tang, for copious sweating, vomiting, and loss of fluids. Similarly, an aspect of yang is boosted in Gui Zhi Jia Ren Shen, which to reiterate is for body aches.

Excess presentations require no supplementation and may include more aggressive forms of clearing, such as in Da Qing Long Tang, a pattern also known as "fire wrapped by ice," characterized by the TY symptoms and the presence of irritability. Clearing is even appropriate in presentations that appear to possess deficiency components, as in the case of Xiao Qing Long Tang, which is often prescribed for cases of pneumonia. The excess in this case is the congested fluids that must be cleared from the lung.

It's important to note that vomiting is neither a sign of excess or deficiency. Ge Gen Jia Ban Xia and Gui Zhi Jia Fu Zi both do this. In the case of the latter, vomiting will not be the primary symptom.

In short, as with all syndromes of Chinese Meridian Theory symptoms may take different forms depending on the particulars of the patient. TY syndromes are early stage conditions that must be treated quickly to prevent the advance of the pathogen. In some cases, these formulas are used to treat conditions that have nothing to do with early onset, but are presumably appropriate because the pathogen has failed to advance beyond the very superficial levels of ying and wei.