Lurking Pathogens 12
Yíng Level Patterns
Yíng level patterns
The Yíng level represents the Yáng portion of the blood. It is the zone where Lurking Pathogens (LP) are said to reside if the Kidney essence is depleted and there is insufficient Zhèng Qì to confine the pathogen to the Qì level (Wen & Seifert, 2000). In warm disease theory, the primary organ associated with it is the Pericardium. Since the Yíng level is of key importance to LP theory, and its pathology has a distinct psychoemotional emphasis as well as phlegm and blood heat manifestations, it is not well described by the Spleen shō, which Japanese Meridian Therapy (JMT) typically categorizes Heart patterns into. The pathodynamic of Yíng-level heat in warm disease theory leads straight to Liver involvement on the Xuè level. Therefore, a more accurate map of the terrain necessitates the inclusion of the Pericardium shō, which, in accordance with the mother-child principle, would include the Liver.
The textbook hallmark of Yíng level diseases is a crimson tongue, generally without coating. The tip of the tongue may be more red with thorns and possibly dark stasis macules. As the heat cooks off the fluids, the pulse becomes thin and rapid.
Pericardium Shō
The Yíng level follows the Qì level in the four levels model. If the pathogen falls from the Qì into the Yíng, the heat becomes deeper and the phlegm grows more recalcitrant. Fevers become progressively later into the evening, the mental state becomes more altered, bleeding and purplish skin lesions more frequently appear.
There is an alternate route in the three burners system, originating in the upper burner. Warm heat pathogens will typically enter the upper burner at the Wèi level, i.e. the Yáng portion of the Lung. From there the most likely route of interiorization is to descend into the chest and then onto the middle burner and the Qì level. In some cases, however, the warm heat pathogen will transfer into the Pericardium in the upper burner, and thus directly into the Yíng level. In normal seasonally-contracted warm disease, this generally produces symptoms of high fever leading to altered mental status. However, in cases of underlying Kidney essence deficiency, this can lead to direct penetration to the Yíng level without immediate clinical manifestations. In this case there may be no Qì level pathology, but triggers such as emotional stress can provoke increasing symptoms of heat at night, dark skin eruptions, bleeding and psychological symptoms such as agitation, irritability, and even psychosis. The patient may experience hallucinations or engage in self-harm. As the heat edges toward the Xuè level, the Liver becomes affected, leading to wind symptoms such as tics, tremors or seizures.
The imperative at this stage is twofold: vent the pathogen back out to the Qì level and protect the Yīn-blood from the ravages of heat. If there is residual phlegm, it must be transformed and swept from the cardiac orifices. This calls for salty, moistening agents, along with acrid tastes to vent the pathogen and bitter tastes to clear heat and quicken blood.
If there is lingering heat in the Qì level, it is necessary when employing a venting strategy to clear the Qì level heat on the affected Yáng channels with fire (Jīng-river) and water (Yín-spring) points and/or vent outward with metal (Jīng-well) points in order to encourage the outward movement of the pathogen from the Yíng level (Young, 2022).
In the treatment course, it is key to note any changes in the tongue at this stage. If the strategy of pushing the pathogen to the Qì level is successful, the coating will start to reappear, the tongue body will begin to appear more moist and the crimson color will recede. In treating miscellaneous internal disease, the thickening of the tongue coat is a bad sign, but in treating LP in the Yíng level, it is a sign of pathogenic regression. Other Qì level symptoms may follow suit, at which time the pattern should follow the pathogen to chase it out of the body.
Maclean et al. (2018) notes that acupuncture is less reliable in the Yíng level than the Qì level and recommends strong stimulation. Our experience has been that using the JMT method outlined in this series can effectively treat LP presenting in the Yíng level.
PC-3 (qū zé) is a key point here, as it clears the Yíng, cools blood and settles tetany, as a Water point, it also resonates with the salty taste and moistens. PC-4 (xī mén) likewise clears the Yíng and cools blood (Ellis et al., 2004). If there is residual phlegm, PC-5 (jiān shǐ) is used, and as above PC-8 (láo gōng) may be employed as well. LR-2 (xíng jiān) cools blood heat and extinguishes wind (Ellis et al., 2004).
Points: Root treatment: PC-3 (qū zé), PC-4 (xī mén), PC-5 (jiān shǐ) (phlegm), PC-8 (láo gōng), LR-2 (xíng jiān). To aid in venting via Qì level: fire (Jīng-river), water (Yín-spring), and/or metal (Jīng-well) points on Yáng channels relevant to location of pathogen (LI, ST, UB, SI, GB, TB).
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Ellis, A., Wiseman, N., Boss, K., & Cleaver, J. (2004). Fundamentals of Chinese acupuncture (Revised ed). Paradigm Publications.
Liu, G. (2005). Warm pathogen diseases: A clinical guide. Eastland Press.
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Unschuld, P. U. (1986). Nan-ching: The classic of difficult issues: with commentaries by Chinese and Japanese authors from the third through the twentieth century. Berkeley: University of California Press.
Wen, J. M., & Seifert, G. (2000). Warm Disease Theory: Wen Bing Xue. Paradigm Publications.
Young, G. (2022). Pearls of Chinese Medicine Wen Bing Seminar Series, Class 1. Presented online October 8, 2022.