Bright Yang Stage
Also called Yangming stage

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The Bright Yang stage (Yangming stage) of disease is when your body mounts a massive attack on an invader, such as an invasion by Wind-Cold.

In this ancient theory, first set down in AD220, there are Six Stages your body can go through in its defence against Cold. The stage on this page is the third of them. Each stage shows the attacker getting closer to destroying the host, ie your body's health.

But at this stage, your body has a huge ambush up its sleeve.

Another theory, developed to deal with not Wind-Cold but with invasion by Wind-Heat, found your body used this same defence at its Qi level - see Four Levels.

Ideally, your body stops the invasion in its tracks at the outermost, or most Yang, level. Read more about that here.

If the body now manages to stop the disease at this Bright Yang stage - Yangming stage - it does it by producing a high fever, profuse sweat, great thirst and a pulse described as 'overflowing' - see below for more symptoms.

The fever can be so high that it leads to delirium. Worrying though these symptoms are, they are, for your body, highly effective. 

They stop the disease in its tracks. The fever is such that, although unpleasant for you, it's a good deal more unpleasant for the disease process, the 'cold' invasion.

The 'Cold' that was trying to penetrate inwards is, in effect, burned out. Indeed, the fever is such that you may welcome cool things: quite different from your reaction at the Tai Yang stage, the first and outermost level or the alternating states in the second stage, the Lesser Yang stage.

But sometimes, your body hasn't got the wherewithal to ambush the invader at this stage so the invader marches on to the next level, that of the Greater Yin Tai Yin level.

Why might your body skip this Bright Yang stage?

Here are some reasons why your body might allow the attacker past this Bright Yang stage without mounting a defence here:

• Can't muster the energy for it. Producing a high fever uses a lot of energy. If you put a pan of water on a fire, how long does it take before the water boils? While you wait, you can watch the fire burning away underneath as it tries to raise the temperature. Think how much energy is needed to raise your body, all 8 gallons or 30 litres of it, by just a few degrees.
• Doesn't know how to do it. If your body was never allowed to produce a fever in childhood, perhaps to combat a childhood disease, you/it may fear what happens and so you may put a stop to it by taking medicines that prevent fevers, or that can often quickly ameliorate them. The kind of medicines that do this are pain-killers and antibiotics.

• Connected with the reason just given, you may have been vaccinated as a child. Often vaccinations are given before your immune system is thought to have matured around two (2). This may have prevented you developing such illnesses in the first place, but in so doing it prevents your parents and you from learning how to accept and deal with a high fever, confident in its successful outcome.
• Connected with the first reason above, your body might be weakened in some way, or its response might be compromised by the effect of other things going on, such as great stress, or taking other forms of medication eg for asthma.
• You might be taking something, or doing something, that prevents a good response. This could include a host of supplements that, in effect, finesse the situation away. On the face of it, these are great! But, in effect, they may suppress your body's best way of dealing with the attacker. Read Suppression and the many ways there are to block a reaction. If your body is prevented from deploying its best defence, it has to fall back on its next-best defence.
• Connected with the last reason, you might be using cooling ploys so effectively that it prevents the proper fever. 

What might be a COOLING ploy? Cool moist flannels on the brow are very pleasant for most people in a fever, and rarely make much difference to how it proceeds. Chinese medicine noticed some time ago that putting lots of cold or iced water on the back of the knees (the poplitea) had a pronounced cooling effect on the body. Immersing the body in cold or freezing water also reduces the temperature. If you can contain yourself, however, your feverish body will nearly always emerge healthier, with a better circulation and immune function if allowed to proceed through its own system, unpleasant at the time though this is.

Symptoms of Bright Yang stage

There are two types of Bright Yang stage (you can get both at the same time!):

• Channel type
• Organ type

1/ The 'Channel' type of Bright Yang stage

In this Bright Yang stage, the body confronts the attacking Cold with Heat: like bringing an icicle into your house and putting it into a hot oven until it evaporates.

So your body has allowed the invader in, but for a good reason. In a way, it knows it has the upper hand once it gets the Cold inside.

Another way of thinking about it is that your immune system and the invader are equally matched, so there is a tremendous struggle between them, generating a lot of heat: in this way of thinking, the invader has indeed pushed his way indoors, but you are putting up a huge fight to push him out. The heat is the sign of the struggle, so is very important.

• Fever, usually high, usually worse in the afternoon. If neither you nor your parents had experience of this, you may worry about it, and admittedly where small children are concerned, they quite often get delirium and occasionally may even pass out or have a fit. This is rare in healthy children, and does not usually prevent a full recovery. So if you are the parent, keep calm! This reaction is fierce but beneficial. Also, if your child sees that you are alarmed, it will make your child more alarmed too, adding to the anxiety all round, each feeding the other. If you have parents or grandparents who were brought up in 'undeveloped' countries, they almost certainly have experience of this condition. So too do people born before the mid-nineteen sixties when, increasingly, vaccination and pharmaceutical suppressive means began to be used.
• Perspiration - eventually, heavy - so make sure you have lots available to drink. Changes of clothes may be necessary.
• Thirst - considerable. Because of the Heat, you will almost certainly prefer cold or iced fluids. Usually Chinese medicine counsels against giving sick people cold drinks but here there is so much heat around that it probably doesn't matter. Exceptions? Small children because their small bodies can 'rev' up very quickly, producing a splendid fever, (they have plenty of Yang, but at that stage of life, not much of a Yin body to counteract it) but can lose it again because they don't have a body big enough to store the Yang heat.
• Emotional disturbance, meaning impatience, anger, agitation, easily annoyed.
• Sometimes delirium.
• Likes cold and cold conditions. This shows the pattern is no longer at the Great Yang stage where you are averse cold.
• Other signs of Heat include the sensation of heat, a red face and the pulse and tongue symptoms below.
• Tongue: colour is red, coating is yellow: these are both signs of heat
• Pulse: fast - rapid; over-flowing or 'big'

Why is it called the Bright Yang stage or Yang Ming stage?

The above symptoms of great thirst, heat and redness, eg on face and tongue, show that the 'disease-process' is in the Stomach.

In Chinese medicine the Stomach and Large Intestine channels are called, as a whole, the Yang Ming or Bright Yang channel.

Very often it is points along the Large Intestine or Stomach channels that are used for treating this Bright Yang stage syndrome.

What does your acupuncturist do for the Bright Yang stage?

If your body has successfully produced the above symptoms, you can be fairly confident that by the time you reach your acupuncturist the Cold will have been vanquished.

In that case, your acupuncturist will use points that help your body to clear Stomach-Heat. Some of these points will be along the Yangming or Bright Yang channels, and might include points like LI 11, St 21, 34, 43 and 44, Du 14, P 3.

He might also prescribe a herbal recipe containing at least one very 'cold' type herb, balanced with other herbs to prevent damage and to provide nutrition.

Examples of traditional recipes that might form the basis of the recipe for you include Bai Hu Tang.

What can YOU do for yourself?

• For your best Bright Yang stage response, don't stop the fever - it is your body's best ploy! Keep going with it for at least a day, if not two. Let it burn out not just the cold but also any other remaining traces of disease you've been harbouring, including phlegm and catarrh. Indeed, if you stop a fever too soon, you may retain the cold in some form, to return another day when least expected. This is more likely to happen if you use Western medicine to stop it because, unlike Chinese herbal recipes which are well-balanced in their action, Western science prides itself on extracting and using 'pure' active ingredients. Consequently the medicine lacks the other nutritive and supportive substances that your body needs to recover healthfully. 
• Once you've allowed your body to deploy the great fever etc, for at least a day, if it continues to the point where you are weakening (yes, yes, I know, you ask, what does this mean, well tough, you'll have to decide yourself or seek advice: can't put everything here, it would take a book!) you could try to reduce the Heat in your Stomach by using herbs such as fresh Aloe Vera juice. You may need quite a lot and don't complain if you don't like the taste. Find a source that is as close to raw as possible. Avoid it if it is contaminated with sweeteners and other things to make it more palatable. It has a very cold energy, so don't use for more than a few days and probably you should also take it with some warm boiled water in which a piece of ginger root has been stewing: this herb counteracts the very cold in Aloe without preventing it from working. (However, if you are pregnant or menstruating, don't take Aloe.)
• Cool yourself with cold water, on the backs of your knees and even by taking cold showers and baths.
• As the fever reduces, don't go so far as to get cold eg walk outside in cool conditions to the point where you start shivering again. You are still fragile! Allow your body to recover its energy over the ensuing days with rest, plenty of sleep and gradually increasing amounts of well-chewed nutritious food; and fluids, of course.

2/ The Bright Yang 'Organ' stage

In this kind of Bright Yang stage condition, the Heat produced by your body is not confined to the Stomach, but reaches down into the Intestines. Consequently, as well as the symptoms explained above you get extra symptoms as follows:

• Abdominal distension and pain, from build up of dry stools
• Constipation
• Stools are dry, hard to pass, and may smell
• Urine is dark
• Other symptoms are mostly the same as above, but the fever may be unremitting, even worse in the afternoon, and you may sweat more on your arms and legs;
• Thirst - great
• Tongue: red, but the yellow covering is not moist but dry
• Pulse: rapid, full, deep, may be slippery

What is going on here?

You could say that here the body has gone overboard with its Heat, almost got out of control, to the point where its fluids are drying out, hence the dry stools, dry tongue and even greater thirst.

Note: people sometimes go straight to this stage, or something very like it, when on holiday in hot countries, perhaps after eating spicy food and sunburning before they have acclimatised. In this case, their bodies reached this stage from Heat, not cold. 

What is the correct treatment?

What you should not do is to prevent bowel movement. That results in the Heat being retained, only to destroy Yin fluids all the more.

The right treatment, the Chinese classics say, is first to purge, in other words to get the body to pass the stools, taking much of their heat with them.

There are herbs for this Bright Yang stage, but modern medicine has ways of treating it too, and there are many supplements for constipation which can be properly employed here without much danger. Herbs used in Chinese medicine for this include senna and aloe vera.

However, such supplements or medicines should not become habitual. You need, after recovering, to make sure you eat foods that provide natural bowel movements without worry. Also to moderate stress levels so that it does not bind you up. (Read my book on the subject of stress, see below.)

Purging too often has its dangers.

• Purging often prevents the natural flow of food along the alimentary canal from releasing its nutrition, so you eventually weaken, making yourself susceptible to the next invader.
• Frequent use of anti-constipation laxatives can make you dependent on them. Any medicine can compromise your health and immunity, and all have secondary effects that you may not be aware of at the time.

Your acupuncturist will use similar points to the 'Channel' kind of Bright Yang stage, with additional points for constipation. For example: LI 11, St 43 and 44, Du 14, P 3, St21 & 25 and Sp 15, Du 14, St 37,  and Sp 6.

Herbs will also be purging, but the right recipe for you will contain herbs that nourish Yin and so help combat the excess Yang situation your body has been in.  Da Cheng Qi Tang and Tiao Wei Cheng Qi Tang could be recipes on which your recipe might be based.

What is the next stage as the invader penetrates further inwards?

The next stage is called the Greater Yin stage. If someone's body can't produce this Bright Yang stage ambush on the invader, the invader may get past it to the Greater Yin stage.

If you have read this far, you'll realise that to mount a Bright Yang stage you need to be fairly young or fit. It is not so common amongst older people, or people weighed down by chronic conditions. They usually pass straight on to the Greater Yin stage.

What are The Six Stages as Cold penetrates?

• Great Yang (Tai Yang)
• Lesser Yang (Shao Yang)
• Bright Yang (Yang Ming)
• Greater Yin stage
• Terminal Yin Jue Yin stage
• Lesser Yin (Shao Yin) stage

Note that this is not the order mostly used since antiquity, but makes more sense to me. For nerds, I'm with Giovanni Maciocia on this one.

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