Differentiation of Four-Phase Disharmony
This diagnostic method was first put forward by Ye Gui (1667-1746 AD), a famous physician the Qing Dynasty. He classified the clinical development of febrile diseases caused by exogenous evils into four pathological phases: defense (wei), qi, nutrient (ying) and blood (xue). These are the four body strata used to explain the location and severity of pathological changes, and form the basis of clinical treatment for the acute febrile diseases. This method not only characterizes the four types of febrile disease disharmonies, but it is also a reflection of the four grades of severity of febrile diseases during their development.
- Defensive (wei) phase refers to disor
ders in the outer defensive forces of the body - protective qi. It usually occurs at the onset of a febrile disease due to external contraction, the pathological changes are present in the lungs, skin and hair. - Qi phase refers to disorders in the body's inner defensive forces, which manifests as an interior heat disharmony caused by excessive heat evils. In this phase, both the body's defense forces and pathogenic factors are very strong, resulting in intense struggling. The affected lesions are usually located in the lungs, spleen, stomach, intestines and gall bladder.
- Nutrient (ying) phase occurs when pathogenic heat is transmitted into the qi of the blood. Ying is a component of the blood, so the disease is actually located in the heart and pericardium.
- Blood (xue) phase represents further invasion of the ying system by the evils. It results in excessive heat stirring the blood and further disturbing the spirit. The pathological changes are mainly in the liver and kidneys.
| Disharmonies in the four phases | ||
| Phase | Disharmony | Main features |
| Wei | Heat invading exterior body | Fever, slight aversion to wind and cold, very little or no sweating, cough, runny nose, headache, sore throat, slightly thirsty and body aches. On examination, the tongue tip and margin are red and covered with a thin white or little yellow coating, and the pulse is floating and rapid. |
| Qi | Heat retention in lungs | Fever, sweating, thirst, cough with yellow sticky sputum, asthma, chest pain, chest fullness and sore throat. On examination there is a red tongue with yellow coating, and a rapid pulse. |
| Excess heat in qi system | High fever, irritability, extreme thirst with preference for cold drinks, profuse sweating, flushed face and coarse breathing. On examination there is a dry and yellow tongue coating and surging pulse. | |
| Heat retention in stomach and intestine | Thirst with preference for cold drinks, anxiety, delirium, fever in afternoon, constipation or diarrhea and distention and pain in abdomen, which feels better when pressed. On examination, there is a dry and yellow tongue coating, and a deep and forceful pulse. | |
| Damp heat retention in spleen | Slight fever, thirst but without desire to drink, chest fullness, nausea, heavy sensation in body and limbs, sleepiness, perspiration with sticky sweat, diarrhea and yellow and scanty urine. On examination, the tongue is red with a yellow thick and greasy coating and the pulse is hesitant and rapid. | |
| Ying | Heat damaging nutrient yin | Fever (worse at night), chest fullness, insomnia, or even coma and delirium and transient rashes. On examination, there is a deep red tongue and thready and rapid pulse. |
| Heat attacking pericardium | High fever, irritability or apathy, stupor, delirium, tongue stiffness and cold limbs. On examination there is a deep red tongue and rolling and rapid pulse. | |
| Xue | Blood heat lead to circulation disorder | High fever, irritability, insomnia, mania, transient rashes, feverish sensation of the palms and soles, and bleeding disorders. On examination, the tongue is dry, deep red or purple color and the pulse is rapid. |
| Liver heat stir up winds | High fever, headache, dizziness, stupor or irritability, upward turning of eyes, tightly closed jaw, a stiffly back and neck and agitation or convulsions. On examination, the tongue is deep red and the pulse is taut and rapid. | |
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