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Translated
and Edited By Z'ev Rosenberg, L.Ac., Dipl. Ac., FNAAOM,
and Dr. Fred Wong Commentary by Z'ev Rosenberg, L.Ac., Dipl. Ac., FNAAOM
Original citation: Si chuan zhong yi/Sichuan Journal of Chinese Medicine,
1996, Vol 14
#2, pg. 2-3. Author: Huang Li-ming, Gueiyang College of Chinese Medicine
Associated Hospital #2
Commentary by Z'ev Rosenberg, L.Ac., Dipl. Ac., FNAAOM
Original citation: Si chuan zhong yi/Sichuan Journal of Chinese Medicine,
1996, Vol
14 #2, pg. 2-3. Author: Huang Li-ming, Gueiyang College of Chinese Medicine
Associated Hospital #2
Abstract:
One can utilize warm medicinals in the treatment of warm disease. This
is possible because the etiology of warm disease often includes a mixture
of cold and damp pathogens (along with warm pathogens).
Using acrid-warm medicinals to relieve muscles and induce mild
sweating to rid the body of evils.
This method of using acrid warm medicinals to release the muscle layer
was originally established in the Shang Han Lun. In our example, Dr. Wu
Ju-tong, author of Wen Bing Tiao Bian/Systematic Classification of Warm
Disease, used Gui zhi tang/Cinnamon Twig Decoction (including
acrid warm muscle relieving medicinals) to treat the early stages of warm
disease. An early-stage warm diseasei often has the accompanying cold
pathogens that often "wrap around the fire." If one uses only acrid cool
medicinals to get rid of warm and heat pathogens, the warm evil will be
expelled, but the associated cold pathogens will become more secured (in
the body).
Commentary:
This is an example of warm disease 1) contracted in the cool or cold
season, or 2) contracted by a patient with a yang vacuity constitution.
In this scenario, the climatic cool or cold pathogen enters the cou li/interstices
along with the predominant warm pathogen, especially with a vacuous patient,
using a prescription such as Gui zhi tang which will expel both warm and
cool/cold pathogens. In the Jin gui yao lue/Prescriptions from the Golden
Cabinet, Zhang Ji remarks that warm/sweet medicinals can expel heat pathogens
from the body in a vacuous patient.
In this situation, one must use Cinnamon Twig Decoction
from the acrid-warm formulary to mildly sweat out the cold evil and to
open up the cou li/interstices to allow the cold pathogens to exit. The
warm pathogens is relieved as soon as sweating occurs. However, if external
or visiting cold pathogens have already been relieved but the warm evils
still linger, then Cinnamon Twig Decoction must be used
again. Yin qiao san/Lonicera and Forsythia Powder should be used instead.
Alternately, Dr. Wu uses Cinnamon Twig Decoction as a
regulatory prescription for those who have constitutional yang vacuity
after warm disease has been expelled. Cinnamon Twig Decoction
for external patterns can relieve the muscle layer and dispel pathogenic
qi. For internal patterns, Cinnamon Twig Decoction can
supplement vacuity and regulate yin and yang.
Commentary:
Cinnamon Twig Decoction is an ideal prescription
in modern practice for patients who are highly susceptible to repeated
colds or influenza, as well as seasonal allergies and epidemics. It builds
up the interior (zhong jiao, central burner), harmonizes constructive
qi and defensive qi, and harmonizes the exterior and interior.
In the beginning stages of warm disease, carefully employ acrid
and warm medicinals to relieve the exterior.
"Warm disease is most averse to warm and pungent medicinals." Acrid,
warm and drying medicinals can not only increase warmth and heat, but
also dry out the yin fluids. In warm disease, "if you use acrid and warm
medicinals, it is like adding oil to fire." The disease is not relieved;
on the contrary, a transmuted pattern is generated. ii Therefore, avoid
using a warm, acrid prescription for warm disease treatment when associated
cold pathogens are absent.
Warm pathogens are often simultaneously mixed with cold and damp
pathogens.
If a warm disease simultaneously is mixed with damp and cold at the time
of diagnosis, it should be appropriately assisted with acrid warm combined
with an acrid cool prescription. This can strengthen its ability to relieve
the exterior and dispel the pathogen. When warm evil visits the exterior,
and defensive qi becomes stagnant, during treatment one should appropriately
course and release the interstices to drive out the evil. At the early
stages of the wind/warm patterns, Dr. Wu uses acrid and cool prescriptions,
such as Yin qiao san/Lonicera and Forsythia Powder. This prescription
includes acrid/cool medicinals such as jin yin hua/fl. lonicera,
lian qiao/fr. forsythia, fl. lopatheri, bo he/fl. Mentha,
niu bang zi/sm. arctium, and jie geng/rx. platycodon
to penetrate and out-thrust warm evils. Dr. Wu was particularly careful
that coursing the exterior did not weaken the qi, so he added acrid warm
medicinals jing jie/fl. schizonepeta and dan dou chi/sm.
soya preparata. This helps relieve and course the exterior, in order to
sweat and out-thrust the pathogen.
Commentary:
Even in standard warm disease prescriptions such as Yin qiao san,
Wu Jutong included warm pungent medicinals to protect the defensive qi.
This seems to be inspired by the example of Gui zhi tang listed above.
Dan dou chi/sm. soya preparata also moistens yin and helps supplement
the kidney qi and jing jie/fl. Schizonepeta is moistening as well
Sang xing tang can also be chosen to treat early-stage autumn
dryness with the pathogen at the wei fen/defensive division of
the lung. This achieves the clinical result of utilizing acrid, cool,
sweet and moistening medicinals to lightly out-thrust the defensive qi
in the exterior. In this prescription (San xing tang), acrid
dispersing medicinals are used to course and out-thrust wind/dry evil,
combined with sweet, moistening medicinals to nourish yin. Together they
achieve the effect of coursing the exterior and moistening the dryness,
driving out the pathogen but not damaging the fluids or binding the exterior.
Acrid dispersing medicinals in this prescription include sang ye/fl.
mori, and dan dou chi/sm. soya preparata. Sm. soya is acrid and
slightly warm. Its ability to disperse the wind/dryness and resolve the
exterior is superior to using sang ye/fl. mori alone. Therefore,
it can be seen that a warm evil visiting the exterior, although using
mainly acrid/cool medicinals, should not neglect the us e of acrid mild
warm medicinals as well. As a matter of principle, use acrid cool as the
main medicinals, assisted by mild acrid warm medicinals. Acrid cool medicinals
can penetrate and diffuse warm evils, but their ability to course the
interstices is weak. Therefore, they need to be assisted by acrid warm
medicinals in order to drive the pathogen outward. Using this combination,
one does not have to worry about warm acrid medicinals aggravating heat
to damage the fluids. Jing jie/fl. schizonopeta and dou chi/sm.
soya preparata dosages can be increased or decreased, according to the
degree of exterior blockage
Summer heat disease patterns are often mixed. For example, "summer heat
is often mixed with dampness." At the peak of the summer season, people
often like to eat raw and cold foods. By sleeping outside, and exposing
oneself to the elements in order to stay cool, one can easily develop
the pattern of summer heat pathogen mixed with cold and damp. For this
we must use acrid warm medicinals. Dr. Wu uses the method of alternating
acrid warm with acrid cool medicinals to penetrate the exterior and clear
summer heat. In Xiang ru tang/Elscholtzia Decoction,
xiang ru/hb. Elscholtzia and hou po/cx. magnolia are
the acrid warm medicinals, for relieving the exterior and dispersing cold,
clearing summer heat and transforming dampness. "In the beginning of warm
disease, damp heat is a great difficulty. Damp is a yin pathogen, and
won't transform if it is cold. Naturally, treatment should not exclude
prescriptions containing acrid warm medicinals," such as San ren tang/Three
Kernel Decoction, including xing ren/sm. armencia, hou
po/cx. magnolia, and ban xia/rz. pinellia.
Damp heat type of warm disease
In a damp heat pattern of warm disease, one should consider warm or hot
medicinals. Dampness is a yin evil, its nature is cloying and stagnant.
Dampness and heat combined are like pouring oil into noodles, they mix
together, and it is difficult to separate or release them. When damp heat
is the disease pattern, one must consider treatment using the heat pathogen
and the damp pathogen together. Treatment of heat patterns should employ
cold and cool medicinals while treatment of damp uses warm transforming
medicinals. Dr. Wu is very attentive to the use of acrid warm and acrid
hot medicinals. He said: "in the san jiao bian zheng/triple
burner pattern diagnosis method for damp-heat, one should employ
acrid-hot medicinals.iii" In this situation, the nature of damp evil will
determine the use of warm hot medicinals.
Commentary:
Dampness and heat are mutually exclusive pathogens, and do not combine
together readily. Prescriptions that treat damp-heat patterns are always
either more for dampness or more for heat as the more dominant pathogen,
and their ingredients reflect the bias, favoring either warm pungent medicinals
that disinhibit dampness or cool pungent medicinals to clear heat. The
same is true with summer heat patterns, which are divided into summer
heat heat or summer heat damp patterns
Wen bing tiao bian/Systematic Differentiation of Warm Disease by
Wu Ju-tong has many warm-hot natured prescriptions to treat damp-heat,
such as:
- San ren tang/Three Kernels Decoction
- Xiao xian xiong tang jia zhi shi tang/Minor Chest
Bind plus Zhi Shi Decoction for summer warm with glomus below
the heart
- San shi tang/Three Stones Decoction for
summer warm mixed with dampness extending to the san jiao/triple
burner
- Xing ren hua shi tang/Apricot Kernel and Talcum Decoction:for
summerheat with hidden heat pathogen in the triple burner
- Xiao ban xia jia fu ling tang/Minor Pinellia plus
Poria Decoction: for damp-warm of the yang ming with vomiting
but without thirst
- Ju pi zhu ru tang/Tangerine Peel and Bamboo Shaving
Decoction: for yang-ming type of damp-warm with rebellious
qi. This decoction should be freshly prepared
- Wu ge jia jian zheng qi san/Five Additions and Subtractions
Correct Qi Powder: for damp-heat trapped in the triple burner.
Frequently used medicinals are: ban xia/rz. pinellia, hou
po/rx. magnolia, ju pi/citrus pericarpium, xing ren/sm.
prunus (apricot seed), kou ren/fr. amoni, sheng jiang/rz.
zingiberis (fresh), huo xiang/hb. agastaches, fang ji/rx.
stephania tetranda, ju hong/citrus erythrocarpa, zhi shi/fr.
aurantium (bitter orange).
Additionally, damp-heat evils can cause malaria, dysenteric disorders,
jaundice, and bi zheng/painful obstruction (impediment) patterns.
Warm and hot medicinals can also be used, in such prescriptions as:
- Bai hu jia gui zhi tang/White Tiger plus Cinnamon
Twig Decoction: for warm malaria
- Hou po cao guo tang/Magnolia and Amoni Decoction:for
damp malaria with more dampness and less heat
- Huo ren bai du san/Living Man Overcome Toxin Powder:
for summer damp with mixed attack of wind and cold
- Er jin tang/Two Gold Decoction: for summer
and autumn pox/rash disorders
- Jia jian mu fang ji tang/Modified Aristolochia Fangji
Decoction: for summer damp bi syndrome
Frequently used medicinals are: cao guo/fr. Amoni, hou po/cx.
Magnolia, xing ren/sm. prunus, jiang zhe/zin-giber (ginger
juice), guang pi/, ban xia/rz. Pinellia, sheng jiang/rz.
Zingiberis (fresh ginger), zhi shi./fr. Aurantium (bitter orange),
gui zhi/rm. Cinnamon, fang ji/rx. Stephania tetandra.
REFERENCES
- This is usually classified as wei fen/defensive aspect or
early qi fen/qi aspect, within the first few hours or day of
contraction of a warm disease.
- Transmuted pattern/bian zheng: conversion of a simple pattern into
a complex one because of inappropriate treatment" (Wiseman).
- The san jiao bian zheng/triple burner pattern diagnosis, developed
by Wu Ju-tong, divides damp heat disease patterns into upper, middle
and lower burner patterns. Damp-heat pathogens attack the upper burner
first, then sink to the middle burner, and finally the lower burner.
Each stage has specific prescriptions to match the differentiation of
the symptom patterns. For more information, see the upcoming Warm
Disease Theory (Paradigm Press), translated by Garry Seifert.
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