Pattern diagnosis — Six Stages, Four Levels, Triple Burner

Beyond the foundational Eight Principles and Zang-Fu patterns, three specialised diagnostic systems describe how externally contracted disease progresses through the body. Each was developed for a particular class of disease and remains in active clinical use, especially in Chinese herbal medicine. The three systems are: the Six Stages (Liu Jing) from the Shang Han Lun for Cold-induced disease; the Wei Qi Ying Xue or Four Levels system for febrile Warm disease; and the Triple Burner system also used in Warm disease.

Six Stages (Liu Jing Bian Zheng)

Zhang Zhongjing’s Shang Han Lun (c. 220 CE) described how externally contracted Cold pathogens progress through six channel stages, each with characteristic features and corresponding herbal formula. The system remains the framework for Cold-induced disease (modern viral and bacterial infections that fit the picture) and underlies the classical herbal canon.

1. Tai Yang (Greater Yang) — Bladder/Small Intestine. Exterior stage with chills, fever, body ache, headache, floating pulse. Treat: release the exterior (Ma Huang Tang for Cold; Gui Zhi Tang for Wind).
2. Yang Ming (Bright Yang) — Stomach/Large Intestine. High fever without chills, profuse sweating, intense thirst, full pulse (Channel level) or constipation with abdominal fullness (Organ level). Treat: clear Heat (Bai Hu Tang) or purge (Da Cheng Qi Tang).
3. Shao Yang (Lesser Yang) — Gallbladder/Triple Burner. Half-exterior-half-interior; alternating chills and fever, bitter taste, hypochondriac fullness, nausea. Treat: harmonise Shao Yang (Xiao Chai Hu Tang).
4. Tai Yin (Greater Yin) — Spleen/Lung. First Yin stage; cold limbs, abdominal fullness, vomiting, no thirst, watery diarrhoea. Treat: warm the middle (Li Zhong Tang).
5. Shao Yin (Lesser Yin) — Heart/Kidney. Cold transformation (collapse of Yang) or Heat transformation. Cold pattern: severe fatigue, cold limbs, pale tongue, hidden pulse. Treat: rescue Yang (Si Ni Tang).
6. Jue Yin (Reverting Yin) — Liver/Pericardium. Complex mixed Cold-Heat patterns, often with profound exhaustion. Treat: warm and clear simultaneously (Wu Mei Wan).

Wei Qi Ying Xue (Four Levels)

Ye Tianshi (1666–1745) developed this framework in the Qing-dynasty Warm-disease (Wen Bing) school for febrile illness caused by Warm pathogens (modern equivalent: many viral fevers, scarlet fever, severe influenza, dengue, etc.). Disease progresses through four progressively deeper levels:

1. Wei (Defensive level) — superficial; fever, mild chills, sore throat, slight thirst, floating-rapid pulse. Treat: release with cool diaphoretics (Yin Qiao San, Sang Ju Yin).
2. Qi (Qi level) — deeper, true febrile stage; high fever, no chills, profuse sweating, strong thirst, full rapid pulse. Treat: clear Qi-level Heat (Bai Hu Tang).
3. Ying (Nutritive level) — Heat in Blood-Ying with night-fever, mental disturbance, scarlet tongue, faint maculae, restlessness. Treat: cool the Ying, nourish Yin (Qing Ying Tang).
4. Xue (Blood level) — deepest; bleeding (skin haemorrhage, nasal/uterine), confusion, scarlet-purple tongue, weak rapid pulse. Treat: cool Blood and stop bleeding (Xi Jiao Di Huang Tang — rhinoceros horn now substituted with water buffalo horn).

Triple Burner pattern diagnosis (Wu Jutong)

Wu Jutong (1758–1836), the other great Wen Bing physician, developed a parallel framework based on the Triple Burner. Warm disease progresses from Upper to Middle to Lower Burner:

1. Upper Burner — Lung and Pericardium; chest and throat symptoms; superficial febrile stage. Yin Qiao San, Sang Ju Yin.
2. Middle Burner — Stomach, Spleen, Large Intestine; abdominal symptoms, high fever, thirst. Bai Hu Tang family.
3. Lower Burner — Liver and Kidney; deepest stage with severe Yin depletion, tremor, profound exhaustion. Da Ding Feng Zhu, San Jia Fu Mai Tang.

Which framework to use

The frameworks are not mutually exclusive; a single patient may be analysed through several lenses. Broadly:

1. Acute Cold-induced infection → Six Stages
2. Acute Warm-pathogen febrile illness → Wei Qi Ying Xue or Triple Burner
3. Chronic internal disease → Zang-Fu pattern diagnosis within the Eight Principles
4. Channel symptomatology (numbness, weakness, channel pain) → channel theory and the Extraordinary Vessels

Why this matters in modern practice

The pattern-diagnosis frameworks tell the practitioner which formula to prescribe. The entire classical herbal canon — the formulas you can read about in the formula directory — is organised by which pattern each formula treats. Yin Qiao San is for Wei-level Warm disease; Da Cheng Qi Tang is for Yang-Ming Organ-level fullness; Si Ni Tang is for Shao-Yin Cold collapse. Pattern diagnosis is the link between the patient’s symptoms and the right intervention.