Four Levels Flashcards by Annie Crosby

What is the nature of warm diseases?

Warm diseases are caused by external Wind-Heat.

They all manifest with fever
The pathogenic factor enters through the nose and mouth
They are infectious
The pathological developments are rapid
The pathogenic factor of warm diseases tends to injure yin

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What are the four levels?

Defensive Qi level (Wei)
Qi level
Nutritive Qi level (Ying)
Blood level (Xue)

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What is Wei Qi Level?

Is the beginning stage of invasions of wind heat, it is the only exterior level.

There are four different patterns: Wind-Heat, Summer-Heat, Damp-heat and dry-heat

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What is the Qi Level?

The Qi level is interior, the pathogenic factor has moved into the interior and has transformed into heat.

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What is the Qi level characterised by?

Full interior heat with symptoms of fever, thirst, feeling of heat, mental restlessness, red tongue with thick yellow coating. Rapid full pulse.

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What is the nutritive qi level? Ying level.

Heat has penetrated into a deeper energetic layer and begun to injure the yin.
Heat is obstructing the mind and pericardium.

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What differentiates the Ying and Qi level?

In the Ying level, the tongue is deep-red without coating.

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What are the two patterns at nutritive qi level?

Heat in nutritive qi level

2. Heat in the pericardium

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What is the Xue Level?

Heat is affecting the blood.

Macules are a definite sign that heat has reached the blood level.

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What are the 5 patterns of the blood level?

Heat victorious moving blood
Heat victorious stirring Wind
Empty-Wind agitating in the interior
Collapse of Yin
Collapse of Yang

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What are vesicles?

Blister like spots filled with clear fluid, they always indicate damp.

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What are palpules?

Palpules are red solid spots that indicate heat at the qi level, especially in the lungs and stomach.

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What are malcules?

Malcules are spots under the skin that cannot be felt on palpation. They indicate heat at nutritive qi or blood level.

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What are the S&S of Wei level?

Exterior pattern
Fever: Slight Fever, aversion to cold 
Thirst: Slight 
Sweat: Slight
Mental state: Unchanged 
Tongue: Red sides/front. Thin white coat
Pulse: Floating rapid

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What are the S&S of Qi level?

Interior pattern with strong upright Qi
Fever: High fever with feelings of heat
Thirst: Intense thirst, desires cold drinks
Sweat: Profuse
Mental state: Generally mind is clear
Tongue: Red body, thick yellow coat
Pulse: Big, rapid pulse or slippery rapid pulse

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What are the S&S of Ying / Xue level?

Interior pattern with weak upright Qi
Fever: Fever at night 
Thirst: Dry mouth, desire to sip water 
Sweat: Night sweats
Mental state: Delirium, fainting, confusion 
Tongue: Red body, no coat
Pulse: Fine rapid pulse

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What are the S&S for wind heat at the Wei Level?

Fever
Aversion to cold
Headache

Slight sweat
Sore throat

Runny nose with yellow discharge
Swollen tonsils
Body aches

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What is the tongue, pulse and treatment principle for Wind Heat at Wei Level?

T: Dry with thin white coat
P: Floating rapid
TP: Release exterior, expel wind heat.

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What are the S&S of Dry Heat at Wei Level?

Fever
Aversion to cold
Headache

Slight sweat
Sore throat

Dry – skin, nose, throat, mouth
Dry Cough

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What is the tongue, pulse, and treatment principle of Dry Heat at Wei Level?

T: Dry with thin white coat
P: floating rapid
TP: Release exterior, clear heat, promote fluids

What are the S&S of Damp heat at the Wei Level?

Fever – worse in arvo
Aversion to cold
Headache

Heaviness

Uncomfortable epigastrium
Swollen glands
Thirst, no desire to drink
Hot body

What is the tongue, pulse and treatment principle of Damp Heat at Wei Level?

T: Sticky white or yellowish coat
P: Soggy
TP: Release exterior, resolve damp heat

What are the S&S of Summer Heat at Wei Level?

Fever
Aversion to cold
Headache

Slight sweat
Sore throat

Uncomfortable epigastrium
Irritability
Thirst

What is the tongue, pulse and treatment principle of Summer Heat at Wei Level?

T: Red with sticky white coat
P: Soggy rapid
TP: Release exterior, expel summer heat

What are the S&S of Lung Heat at Qi level?

High Fever Thirst Sweating Feels hot Cough with yellow sputum SOB

What is the tongue, pulse and treatment principle of Lung Heat at Qi level?

T: Red with yellow coat P: Slippery rapid TP: clear lung heat, resolve phlegm, promote D&D of Lung

What are the S&S of Stomach Heat at Qi level?

High fever – worse in arvo Big thirst Big Sweat Feels hot This is Yang Ming Channel Pattern in 6 Division theory

What is the tongue, pulse and treatment principle of Stomach heat at Qi level?

T: Red with yellow coat P: Overflowing rapid TP: Clear stomach heat, clear Qi.

What are the S&S of intestine dry heat at Qi level?

High Fever – worse in arvo Constipation Abdominal pain and fullness Irritability Delirium This is Yang Ming Organ Pattern in 6 division theory

What are is the tongue, pulse and treatment principle of Intestines dry heat?

T: Red with thick yellow dry coat P: Full rapid TP: Drain fire, clear stomach and intestines, move downwards

What are the S&S of Gall Bladder heat at Qi level?

High Fever – worse in arvo Thirst Nausea Oppression of chest and epigastrium Bitter taste Dry throat Pain of hypochondria

What is the tongue, pulse and treatment principle in gall bladder heat at Qi level?

T: Red with unilateral sticky yellow coat P: Wiry rapid TP: Clear GB heat, harmonise Shao Yang.

What are the S&S of Damp Heat in Stomach and Spleen?

Fever – decreases with sweat and returns Nausea Oppression of chest and epigastrium Loose stools Heavy body

What is the tongue, pulse and TP in damp heat in stomach and spleen at Qi level?

T: Red with sticky yellow coat P: Slippery rapid or soggy rapid TP: Clear damp from the Spleen and Stomach.

What are the S&S of Heat in Nutritive Qi level?

``` Fever at night Delirium Incoherent speech or aphasia Mental restlessness Insomnia Macules (usually associated with blood heat) ```

What is the tongue, pulse and treatment principle of Heat in Ying Qi level?

T: Red without coat P: Fine and rapid TP: Clear heat from nutritive qi, promote fluids

What are the S&S of heat in pericardium in Ying Qi level?

``` Fever at night Delirium Incoherent speech or aphasia Mental confusion Hot body with cold hands and feet ```

What is the tongue, pulse, and TP in Heat in Pericardium at Ying Level?

T: Red without coat P: Fine and rapid TP: Clear heat from pericardium, restore consciousness and promote fluids.

What are the S&S of Heat Victories agitates blood in Blood level?

``` High fever Mental restlessness/mania Dark macules Vomiting blood Blood in stools Blood in urine Epistaxis ```

What is the tongue, pulse, and TP in Heat victorious agitates Blood?

T: Dark red, no coat P: Wiry rapid TP: Clear blood heat, stop bleeding

What are the S&S in heat victories stirring wind in Blood level?

``` High fever Twitching of limbs Fainting Convulsions Opisthotonos Neck or jaw rigidity Eyeballs turning up ```

What is the tongue, pulse and TP in Heat victorious stirring Wind?

T: Dark red, no coat P: Wiry rapid TP: Clear blood heat. Extinguish wind

What are the S&S of Empty Wind agitating the interior?

``` Low grade fever Twitching or tremors Weight loss Malar flush Listlessness ```

What is the tongue, pulse and TP of Empty Wind agitating the interior?

T: Dark red, no coat, dry P: Fine rapid TP: Clear blood heat, nourish Liver and Kidney Yin, extinguish wind.

What are the S&S of Collapse of Yin?

Low grade fever Night sweats Mental restlessness Malar flush Fire palm heat Dry mouth with thirst for small sips Emaciation

What is the tongue, pulse and TP in Collapse of Yin?

T: Dark red, dry, no coat P: Fine rapid TP: rescue Yin

What are the S&S in Collapse of Yang?

Feeling cold, cold limbs Profuse sweating on forehead Listlessness White complexion

What is the tongue, pulse and TP in Collapse of Yang?

T: Pale, swollen and short P: Hidden and slow TP: Rescue Yang

What is Latent heat?

Occurs when an external pathogenic factor penetrates the body without causing apparent symptoms at the time.