Six Stages of Disease caused by Invasion of Cold

Photo by Andrey Kremkov on Unsplash

“Six Stages of disease caused by penetration of Cold.”   It’s not a description that immediately thrills, is it?

But you’ll know people who have been affected by it. They might have got better faster if they’d known what to do, rather than take painkillers and antibiotics.

In the thousand or more years up to AD220 when this theory was first explained in full, Chinese medicine had been developing along various lines. After Zhang Zhong Jing proposed it, there arose a school of Chinese medicine which based all treatments on it: probably they went a bit overboard on this. (There’s a bit more about Zhang Zhong Jing at the foot of this page.)

But we’re the same. At various times, Western doctors believed in

  • the fluxes;
  • the leeching of blood (now returning to fashion, though not in all countries – see our page on Blood Stasis);
  • the humours;
  • disease caused just by parasites;
  • only medicines can cure infectious diseases (we may still be in this one).


A new theory seizes the high ground for a while.

Usually it doesn’t last more than a century.

Zhang Zhong Jing’s theory lasted 1500 years before someone produced a theory that filled some of the ‘holes’ in his original theory.

Chinese Medicine still uses Zhang Zhong Jing’s Six Stages theory every day.

So this is a theory that stands the test of time.

The Six Stages theory

In our central-heated houses we may think that Cold can’t touch us.

That wasn’t the case 2000 years ago. People got sick from it, and many died. There might have been no infection, they just died from cold; and then only after their bodies had put up a powerful defence.

It would have been common in many parts of Northern China where in winter the temperature was frequently below freezing.

People worked physically outside from dawn to dusk. Not surprisingly then, they got cold.

Physicians would have seen the effect of Cold. They did write about it in books prior to Zhang Zhong Jing, but he was the first to elaborate a full theory of it.

Cold near top of mountain

Nowadays some skiers don’t wear enough, so get caught out when their ski-lift stops working for 30 minutes in a blizzard, and they get cold. Then they may get signs of Cold invasion and the first of the Six Stages, the Greater Yang stage.

The Six Stages theory deals with what happens as an invader enters through the skin or muscles: through flesh. (By the way, the same Six Stages theory was set out to cover not just COLD, but other ‘invaders’ that penetrated the body’s outer or skin defences, like ‘DAMP‘ and ‘WIND‘ (yes, wind!) about both of which we have pages you might like to read: just click the links.)

On other pages you can read about each of the six stages. Below you’ll see links to each of those Six stages.

A Healthy Body resists the Cold invasion through Six Stages

Briefly, Zhong Jing  observed that a healthy body mounts its defences in a particular order.

The battle starts in the most Yang areas – the Greater Yang (Tai Yang) stage. If the invader is strong and forces the defence backwards, the resistance puts up barriers at two further Yang levels, the Lesser Yang (Shao Yang) stage and the Bright Yang (Yang Ming) stage.

After that, the resistance retreats to the vital private inner levels, abandoning the Yang defences for the more vital Yin organs levels.

The outer Yang areas were more lively and energetic, with more restlessness and alternation of symptoms as the battle raged back and forth.

Where Resistance gets Strong and Persistent

When the battleground reaches inwards to the Yin areas, the defence is strong and persistent, at least to start with, but with less room for manoeuvre.


Castle walls, like the first line of defence in the Six Stages
Tower surrounded by outer walls – Photo by Jacek Pobłocki on Unsplash


In effect, it is like a medieval fort with a number of perimeter ramparts which are gradually breached by a strong invader. Eventually the defenders retreat to the inner tower. This is strong but, surrounded by a determined enemy, there is nowhere to go. It becomes a question of endurance.

So if a patient is stuck at these inner levels they will have less Yang energy for  the acupuncturist to call on. It can take a while, even with good treatment, to get them better. This is because the patient’s best Yang energies are low, and the body survives only by persistence. At these levels, the patient has very little bounce left.

This has then reached the stage of Yang Deficiency, about which … ahem … I have written a book …

It’s surprising how many ways Yang Deficiency affects the world. For example, the whole question of Identity, including separate identity, whether of peoples, countries, policies or you and me, comes under Yang and its Deficiency and in relation to Yin. (Yes! Including LGBTQIA.)

More about this in the book.

The invasion of cold affects more than just our health.

Some of these inner conditions can be reached other than by Cold invasion!

I have many patients who have conditions very similar to many of the symptoms of, for example, the Greater Yin stage.

They didn’t get there from Cold invasion, at least as far as I know.

For others, it would take very little to push them towards the Greater Yin stage.

The beauty of the Six Stages theory is that Zhang Zhong Jing recommended specific treatments we can still use, because they work.

Even if they don’t immediately work, we can understand what is going on and adapt our treatment.

That later theory? The Four Levels

The Four Levels is another huge theory, dealing with how Heat invades the body, described as a warm disease. Cold invasion requires no bacteria or virus for it to work although it doesn’t absolutely exclude it.

This, the Four Levels theory, deals with the kinds of diseases that modern medicine prides itself on being able to treat successfully with antibiotics or by vaccination.

Here (Four Levels) the invader enters via the mouth or nose, or through a wound or other orifice, like the eyes.

However, these days, antibiotics are being overtaken by the bugs and can no longer be relied on in many serious conditions like TB. In which case modern medicine should perhaps take another look at these old theories.

Together these two theories (the ‘Six Stages’ and the ‘Four Levels’) teach us a lot about health and how to help ill people to get better.

Even today.


What are The Six Stages as Cold penetrates?


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.

Why are the Six Stages in this order?

Simplifying this a bit … in the order from Great Yang to Lesser Yin, you move from acupuncture channels that run up: –

  • the back of the legs and arms, being the Bladder and Small Intestine channels – Greater Yang – to
  • the sides, being the Gallbladder and Three Heater channels – Shao Yang – to
  • the front of the legs, lateral to the shinbone, being the Stomach channel, and on the arm, its equivalent being the Large Intestine channel – Bright Yang – to
  • the front of the leg, medial to the shinbone, being the Spleen channel, with its equivalent on the arm the Lung channel – Greater Yin – to
  • the middle of the leg, medial to the Spleen channel, being the Liver channel, its equivalent on the arm being the Pericardium channel – Jue Yin – to
  • the inner leg most medial to the shinbone, being the Kidney channel, with its equivalent on the arm being the Heart channel – Lesser Yin.

Similarly, on the torso, the channel nearest to the spine on the back is the Bladder channel, and that closest to the midline at the front is the Kidney channel.

So you start with your body defending itself using its most Yang area, your back, and as the disease penetrates your body abandons each of its ‘perimeter ramparts’ in turn, ending up with the innermost, that of the Heart and Kidney.

Often, in my experience, the use of inappropriate treatments prevents your body from maintaining its defence at the outermost levels, allowing the disease to penetrate to inner levels.

Typically, the level where the disease is then held is the Greater Yin stage, that of the Spleen and Lungs. It’s held here by use of medication for digestive problems and for respiratory problems like asthma. However, this is not the end of it. Read ‘remaining pathogenic factor‘.

Complications during the Six Stages

When, above, you read that the invader marched in or trampled over the defences, it makes it seem like a huge bogeyman.

Of course, there is no actual ‘cold’ bogeyman! Modern physics tells us that cold happens when molecules move more slowly whereas heat happens when they have more energy.

So ‘cold’ is more like a lack of ‘heat’.

Nevertheless, when treating it, one can learn what to do by pretending it is a bogeyman and behaving accordingly.

In a way, that’s what your body does, only giving way inch by inch, when forced back inwards against its will. Or, when you help it, forcing the invader back out the way ‘he’ entered.

And as a bogeyman, the invader doesn’t necessarily play by the rules! He can jump from stage to stage, or be in more than one stage of the six stages at a time. So acupuncturists need to be flexible in their treatments, and often somewhat imaginative.

Chronic Disease

Often, nowadays, because usually of modern treatments that prevent (Suppression) the body  doing what it is designed to do, the body reaches a kind of stalemate.

It can’t get better and it doesn’t get worse.

Symptoms become chronic. Helping people out of this can be tricky.

Homoeopathy and the Six Stages


Photo by Zdeněk Macháček on Unsplash


Homoeopathy also has very deep theories about this, with ways to prompt the body to move in the right direction, and rightly done, improvement can be huge.

But it can take time, and most of us are too impatient to wait.

Also, we’ve become used to painless results of treatment, and homoeopaths doing their treatment often get complaints – but the complaints are usually mild, because the patient is feeling so much better and more energetic overall, and the pain felt is mild.

Chinese medicine, rightly done, can do this, but for deep cure – meaning at the deeper of the six stages, I have sometimes found homoeopathy to be better. But it is not necessarily easy, or possible for everyone to go along that route. AND, it requires a good homoeopath.

Any Other Theories in Chinese Medicine – you ask?

Of course! After 3000 years, TCM has lots! They all inter-relate to some extent, and acupuncturists use whichever is most appropriate to the condition being treated.

They include:


And there’s more! In some cases, substantial papers have been written about the use of just one acupuncture point.

Jonathan Brand colours

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More about Zhang Zhong Jing (AD 150 – AD 219)

I came across a cutting from the China Daily which I kept from my time in China 1982-83. It described the life and work of this great, indeed seminal, doctor and author.

Six stages author

A symposium on his ‘Treatise on Febrile Diseases Caused by Cold’ was held in Beijing by Chinese and Japanese medical scholars and experts in October 1981. (The Japanese delegation alone had 43 members.)

Quite apart from his major role in examining and studying Chinese medicine and its classics, and practising as a doctor, then writing his treatise, he was also Governor of Changsha Prefecture for some time, as recorded in different editions of medical works and local chronicles. Apparently he served as doctor on the first and 15th days of each month when he treated patients in his courtroom!

His work, lost soon after he wrote it, possibly because of the wars then ongoing, was reassembled and re-edited in the Jin and Song dynasties into two treatises, the ‘Treatise on Febrile Diseases Caused by Cold’ (Shanghan lun) and the ‘Synopsis of Prescriptions of the Golden Chamber’ (Jinkui Yaolue). Both works are important classics in Chinese medicine, studied and used to this day. Over the centuries several hundred books of notes and explanations of his work have been written.

In 1632, a gardener digging a well in the eastern suburb of Nanyang excavated a tombstone on which was carved the inscription “Tomb of Zhang Zhongjing, Governor of Changsha Prefecture, Saint of Medicine”. On its back was carved “The Fifth Year of Xianhe” which put it at AD330, some 100 years of more after his death. Experts confirmed the identity and the age of the tombstone.

Other pages to read!


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2 Responses

  1. I’ve been diabetic for half my life, but wasn’t aware until far into it. I was recently (within the last year) diagnosed w diverticulitis. I stay exhausted and feel run-down, 24/7. Losing faith in current treatments. Can you help me?

    1. Hi Cindy, Sorry to hear about your woes. Usually diabetes involves your Spleen qi, which is also ‘responsible’ for keeping things in place, so when you have bulges anywhere, whether on your bowels or in the form of a hernia for example, usually your Spleen energy is under par. Also, your Spleen (and Stomach) energy is deeply involved in transforming food into Qi and Blood so a deficient Spleen also leads to Qi deficiency – ‘rundown’.

      There may be other factors weakening your Spleen, the most common being Qi stagnation and interference from your Liver or Wood energies. In treating you it would be important to deal with these too, if present.

      Anyway, probably your Spleen and Stomach energies could be improved, using acupuncture, and/or herbs too. Whether the treatment would quickly clear the diverticules is another matter. With diverticulitis there is inflammation and this brings other issues into play so again would need treatment. Often doctors prescribe antibiotics but these eventually weaken your Spleen energy too. There may be foods to avoid too, depending on your symptoms.

      So you may need treatment to clear heat, even ‘toxic heat’, to ease Qi stagnation, to ‘stimulate’ your Spleen and Stomach energies alongside advice about food. Certainly Chinese medicine can do this, but probably the effects would come gradually, needing persistence.

      If your question is could I personally help, well, you’d need to be living near where I work, which is not far from Edinburgh in Scotland UK.

      Hope this helps!

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