question on six level diagnosis

Hi Kaleb,

I don't think that there is necessarily a different organization here, especially not in the original Shang Han Lun. The levels are used to differentiate between exterior (tai Yang), the pivot (Shao Yang)(between the exterior and interior) and the interior (Yang Ming).
I believe the difference in order is just considering cases of passage or transmutations. A case of Tai Yang syndrome can easily turn into a Tai Yang-Shao Yang combination syndrome, as well as a Tai Yang-Yang Ming syn. The Shang Han Lun also has a three Yang combination disease. So more importantly than a specific order of diagnosis, is correct pattern identification, and viewing each sign in its wider context and grasping the pathomechanism from a synthesis of all signs and symptoms observed.

Hope this helps,

Eran

Thanks Eran

I get that each level is a pattern of disharmony with a particular symptom grouping. It helps that you mentioned it doesn't matter which order they are in as long as you look at the level of entry of the pathogen and the symptoms to asses which level you are at.

My two cents are that in one perspeciive it makes more sense to have Shao Yang (half interior/exterior) follow Tai Yang with the interior symptoms of Yang Ming so you have the disease progression from exterior to half and half to interior.
On the other hand clinically at least in my non-malarial experience you usually go from the exterior symptoms to the high fever of Yang Ming without going through the Shao Yang stage.
Also if you look at the stages from the perspective of how much body resistance there is it makes sense to have Shao Yang last because Yang Ming is where the body is still strong, and Shao Yang happens after Yang Ming once the body's Zheng Qi has started to weaken.

Kaleb

I agree with your thinking Kaleb. It does make sense for Shao Yang to follow Tai Yang with progression from exterior to interior. I believe that the book is meant to be read that way (somewhat less confusing) , but of course it can go either way. Technically, disease can even bypass the Tai Yang stage altogether depending on your overall Zheng Qi.
Overall there has been debate for many years as to the true order of the Shang Han Lun and realistically we will probably never know. So more importantly (at least for me clinically) is to rely more on the various constellations of signs, symptoms and pulse conditions that truly reflect certain etiologies. While the six stages are a useful way of predicting disease pattern progressions, as you know Kaleb, clinically it would be a dream if our patients displayed predictable symptoms and progressions. Just rarely ever works that way. :)

Eran