Differentiation of Syndromes According to the 4 Levels

Differentiation of Syndromes According to the 4 Levels

Wei (Defensive) Level

The Wei stage is typically the initial stage of many infectious diseases, or Warm Wind diseases. The Warm evil in combination with Wind attacks the surface or exterior of the body (the skin) where the defensive Qi, or Wei Qi, guards the body like an aura. As the Lungs control the Skin and the Wei Qi goes through the Lungs, the symptoms in this Stage are related to the Lungs.

Symptoms of Wei Level

  • Fever predominant, but there may be chills.
  • Headache due to warm wind evil.
  • Cough with thick and yellow sputum.
  • Sore throat due to warm evil.
  • Little or no sweating.
  • There may be slight thirst
  • Tongue: Red body, tip, and sides; thin white or yellow coating.
  • Pulse: Floating and rapid.

Treatment of Wei Level

Formula: Yin Qiao San (Honeysuckle and Forsythia Powder)

Function: Disperses Wind-Heat, clears Heat and relieves toxicity.


  • Jin Yin Hua
  • Lian Qiao
  • Jie Geng
  • Niu Bang Zi
  • Bo He
  • Dan Dou Chi
  • Jing Jie
  • Dan Zhu Ye
  • Lu Gen
  • Gan Cao


  • Quchi (LI-11)
  • Hegu (LI-4)

Qi Level

At this stage, the Warm Evil has progressed into the interior. With the Warm Evil attacking the Zangfu, excessive type symptoms (internal excess heat) will result as there is a confrontation between the Vital Qi, or Zheng Qi of the human body and the pathogenic Warm Evil. Depending one which Zang Fu is attacked, resulting symptoms will vary.

The most commonly affected organs are the Lungs, Stomach, Large Intestine, Gallbladder and the Spleen.

Symptoms of Qi Level

  • High fever
  • Profuse sweating
  • No Chills with a sensitivity to heat rather than cold
  • Excessive thirst with a preference for cold drinks
  • Cough with yellow and sticky sputum, possible chest pain
  • Asthma due to Lung Qi deficiency
  • Patient will be irritable and uncomfortable in any position,
  • Constipation or apparent diarrhea, the stool will by dry due to the heat and unable to pass. Intestinal fluids appearing to be diarrhea may be passed
  • Stomach ache, with fullness, tenderness, and discomfort with pressure
  • Tongue: Red body with yellow, dry coating. Tongue coating could also be black due to Stomach heat
  • Pulse: Rapid. Excessive and deep indicating interior disease, or rapid and strong indicating a heat diseases.

Notes: If the Lungs are attacked, symptoms such as cough with yellow phlegm asthma; chest pain will be present. With heat in the chest irritability will be present. Heat in the Stomach result in profuse sweating, 4Wh fever as well as a strong thirst for cold drink. Heat in Large Intestines result in constipation, abdominal ache and "diarrhea." Tongue coating could be black due to Stomach heat.

Treatment of Qi Level

Formula: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)

Function: Facilitates the flow of Lung Qi, clears Heat, and calms wheezing by directing rebellious Qi downward.


  • Ma Huang
  • Shi Gao
  • Xing Ren
  • Gan Cao

Ying (Nutritive) Level

When the Warm Evil pathogen have progressed pass the Qi stage, it enters the Nutritional Qi, or Ying Qi stage. At this stage, the disease has nearly reached the Blood (Xue) stage the deepest level. This stage is very similar to the Xue Fen stage but is slightly less serious. Ying is considered the Qi of Blood and is also the precursor of blood. It circulates through the the blood vessels and through the Heart. The this stage of a Warm Evil invasion, the most symptoms affect the Heart, producing Interior Deficient Heat.

Symptoms of Ying Level

  • High fever which is worse at night.
  • Mental restlessness and insomnia, the heat has entered the Ying Level and is progressing to the Xue (Blood) Level. Because Blood belongs to the Heart, the Shen is affected producing mental restlessness and insomnia.
  • Illogical Speech, this indicates a further progression of the disturbance of Shen. As the disease worsens, the Shen dulls and eventually coma may result.
  • Inability to drink more than small sips or a rinsing of mouth. This symptoms is due to Stomach deficiency.
  • Skin Rash - red dots on a portion or all of the body; within the dots there is a small amount of blood. This symptoms is produced by the Blood Heat.
  • Tongue: Deep red body with a peeling yellow coat (the peeling is due to Stomach Qi deficiency).

Treatment of Ying Level

Formula: Qing Ying Tang

Function: Cools Heat, cools Blood, and opens the orifices (clearing the Shen).


  • Xi Jiao
  • Sheng Di Huang
  • Xuan Shen
  • Zhu Ye Xin
  • Yin Hua
  • Lian Qiao
  • Huang Lian
  • Dan Shen
  • Gan Cao

Xue (Blood) Level

At this stage, the Warm Evil has entered into the Blood. As the Heart controls the Blood and the Liver stores the Blood, both organs are affected at this stage. The Kidneys are also involved. A significant symptoms of this stage is bleeding. The bleeding is due to Heat in the Blood; it may occur throughout the body. The skin may bleed, the mouth, nose, anus, etc. This stage is considered the final stage and is usually the terminal stage of a febrile disease. At this stage, people usually die very quickly. Again the symptoms are made up of two types: excess heat symptoms and deficient yin symptoms.

Symptoms of Xue Level

Includes all Ying Level symptoms, plus the following:

  • Spasms and shaking due to internal Liver Wind.
  • Bleeding, The heart cannot control the blood any more resulting in various bleeding symptoms: nose bleeding, vomiting of blood, blood in the stools, irregular uterine bleeding, etc.
  • Tongue: Deep red, or purple body.
  • Pulse: Wiry and small; due to wind and deficiency.

Treatment of Xue Level

Formula: Xi Jiao Di Huang Tang

Function: Clears Heat, cools Blood, extinguishes Internal Wind, and stops the Bleeding.


  • Xi Jiao
  • Sheng Di Huang
  • Bai Shao
  • Mu Dan Pi

References Used

The TCM information presented here has been referenced from numerous sources; including teachers, practitioners, class notes from Five Branches University, the following books, as well as other sources. If you have benefited from this information, please consider supporting the authors and their works by purchasing the books below.

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