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Treatment of Malaria-like Disease from Wen bing tiao/Systematized Indentification of Warm Disease

(Part 2, continued from Winter 2004 issue) by Wu Jutong, translated and edited by Fred Wong and Z'ev Rosenberg, L. Ac. Introduction (by Z'ev Rosenberg )

Nue/malaria in Chinese medicine is different from the modern biomedical disease. The Practical Dictionary of Chinese Medicine lists about fifteen types of malaria, of which three are described here in Wu Jutong's original text. Malaria or malaria-like disease was originally described in the Shang han lun/Treatise on Cold Damage in the section on Shao yang/minor yang disease. Its manifestation included bitter taste, alternating heat and chill, rib-side pain, decreased appetite, a wiry pulse, and emotional depression. Later, in the Warm Disease literature, the description of malaria-like diseases was expanded to include those caused by summerheat, damp warmth and spring warmth, with variations in symptom patterns from the original description in the Shang han lun. While the diseases discussed below may be similar to observed infectious illnesses in modern practice, and therefore have clinical importance, they should not be seen to be equivalent to malaria as described by Western medicine or treated as such.

Clause 50/Wen nue: Warm malaria: the patient has bone and joint pain, vexation, and occasional vomiting. The pulse is level, but there is heat effusion without chill. This is called warm malaria, bai hu jia gui zhi tang. White Tiger plus Cinnamon Twig Decoction is the governing prescription.

Commentary: Warm malaria certainly is contracted in winter through contraction of wind and cold. Hidden in the marrow in the summer, it is steamed and effused outwards by the body's repeated exposure to summerheat evil. This stirs the hidden evil (contracted in winter) to be effused outward. Because heat is hidden in the marrow, essence is consumed, and the fluids thicken. The bone marrow is disturbed by the heat, therefore, all the bones and joints are painful. The patient suffers from vexation, and cannot calm down. Heat comes out from the inside. Rising up, the heat harasses the stomach, causing the stomach Qi to counter-flow. As a result, there is often nausea and vomiting. Because it is not a newly contracted evil, the pulse doesn't reflect obvious changes (such as a floating quality), rather it is like a normal person's pulse. Because the evil Qi has been long depressed, the Yin Qi is damaged first. The summer Yang heat is blazing hot, so there is Yin vacuity and Yang repletion. As a consequence, the patient exhibits pure heat effusion without aversion to cold. If you see this symptom pattern, you should identify it as warm malaria. This disease is treated by White Tiger plus Cinnamon Twig Decoction to clear evil heat and protect the fluids. Cinnamon twig acts as a medicinal guide to lead the evil upwards and out of the body. This is a fine example of the extraordinary method of "using warm medicinals to treat warm diseases."

Prescription:

Bai hu jia gui zhi tang/White Tiger plus Cinnamon Twig Decoction

Zhi mu/rz. Anemerrhana 18 gm.

Shi gao/gypsum 30 gm.

Geng mi/rice 30 gm.

Gui zhi/Cinnamon twig 9 gm.

Zhi gan cao/prepared licorice 6 gm.

Use eight cups of water and decoct down to three cups of liquid. Take one cup to produce sweating. Repeat up to one or two more doses if necessary to resolve the condition.

Clause 51/Pure Heat Malaria: A patient has no cold, only heat, or presents with slight cold and predominating heat. The tongue is dry, with thirst. This means that the Yin Qi is damaged at the onset (of the disease). The Yang Qi is replete. This is called "pure-heat malaria;"1 Wu zhi yin/Five Juice Drink governs.2

Commentary: This is a malaria-like disease manifestation with pure heat and no chills. At the beginning, there is a slight aversion to cold, but immediately the patient will develop a high fever, the tongue coat will be dry, and the patient will be thirsty. The patient's Yin Qi source is depleted. Yang Qi is excessively flourishing. This is because the stomach fluid is damaged and exhausted. This condition is called pure-heat malaria. The Stomach is associated with Yang Earth, and when the stomach is given Yin medicinals, it is soothed. Therefore in a pattern of Yin vacuity/Yang repletion, rescuing the Stomach Yin is the principle treatment method, with the Five Juice Drink as governing prescription. Take its sweet, cold, soft, moistening Yin and rescue the fluids.

Prescription:

Wu zhi yin/Five Juices Drink with additions and subtractions.

Combine the fresh juice of the

following:

Mai men dong/ophiopogon (lush winter wheat)

Lu gen/reed grass (phragmatis)

Li/pear

Bi qi/water chestnut

Ou jie/Lotus rhizome

This is a sweet cold prescription to rescue the Stomach Yin. If you need to clear exterior heat, then add (dan) zhu ye/bamboo leaf and lian qiao/forsythia fruit. If you want to drain Yang ming repletion heat because it doesn't have Yin to restrain it, and to protect the Lung's transformed source Qi, add zhi mu/anemerrhena. If you want to save Yin Blood, then add sheng di huang/dried rehmannia root and xuan shen/scrophularia root. If you want to disperse Lung Qi, then add xing ren/apricot seed.

If you want to course the Triple Burner in order to open a path for the evil to exit, add hua shi/talcum. In pure-heat malaria and warm malaria, there is latent heat toxin that originated from wind cold hidden in the bone marrow. The Yin Qi is damaged, and the Yang Qi is replete. Therefore, the symptom pattern manifests as only heat without cold, or mostly heat with lesser cold. The consequence of this pattern can exhaust the muscles and sinews (leading to wei zheng/wilting) and interfere with the normal Qi transformation of the body. These two conditions are one disease with two stages. We can differentiate the two types as milder or serious. Therefore, you have different names of the (same) disease. Warm malaria belongs to early stage disease, tending more towards the exterior. Pure-heat malaria belongs to the later stage, when the fluids are damaged and exhausted, and tends towards the interior. Therefore treat warm malaria using bai hu jia gui zhi tang/ White Tiger plus Cinnamon Twig Decoction, and treat pure-heat malaria using Five Juice Decoction.

Clause 52/Lung malaria: The patient has a white tongue, thirst, and a lingering, frequent cough.

A sensation of cold started and spread from the back. This is caused by latent summer heat, and is called lung malaria. Use xing ren tang/Apricot Seed Decoction.

Commentary: If malaria is aggravated by contraction of cold, the tongue will have a white coating, and there will be thirst with desire to drink. Concurrently, if there is coughing, chills and cold that begins and spreads from the back, this is called lung malaria. This is caused by summerheat hidden in the lung. Summerheat is mixed with damp, so summerheat and dampness mutually contend and cause this condition. The lung controls the flow of Qi, as well as the exterior associated with the skin and body hair, so the (cold) evil enters superficially. The evil does not affect the shao yang channel, therefore, you shouldn't use xiao chai hu tang/Minor Bupleurum Decoction to avoid guiding the evil into the interior. It is more appropriate to use xing ren tang/Apricot Seed Decoction to mildly disperse the Lung Qi with the cool-bitter-acrid method, venting and relieving the summerheat-damp evil.

Prescription:

Xing ren tang/Apricot Seed Decoction:

Xing ren/apricot seed 9 gm.

huang qin/Baikal skullcap root 4.5 gm.

lian qiao/forsythia fruit 4.5 gm.

hua shi/talcum 9 gm.

sang ye/mulberry leaf 4.5 gm.

fu ling/poria fungus 9 gm.

bai kou pi/cardamom peel 24 gm.

li pi/pear skin 6 gm.

Use three cups of water, cook down to two cups and drink. On the next day, drink another two cups.

Z'ev Rosenberg will be presenting a lecture on "The Treatment of Malaria-Like Disease in Chinese Medicine" during Pacific Symposium 2004. See page 36 for registration information.

1 Fan/vexation: a subjective feeling of heat and disquietude in the chest.

• Dan nue/pure heat malaria: a malaria-like disorder with heat effusion but no chill.