Although all of us have some ideas about warm disease theory, it is one of the most complex and misunderstood areas in Chinese medicine. One reason for its complexity is that it was developed during a time period – the Qing dynasty – when Chinese medicine was flourishing on many levels. Consequently, contributions from a multitude of doctors spanning more than 300 years resulted in the large array of books, theories, and case histories that now pepper our modern texts and formula books.
The treatment of warm disease is
complicated and in the clinic one must
grasp the core principles. This is particularly so since warm disease has had contributions from many sources and differing
opinions exist in some areas, even up to
the present. I will put forward what I have
learned from my in-depth study and clinical experience, although there may be minor discrepancies compared to “the books”.
Further study is needed.
Stages of warm disease
Generally speaking, when faced with a warm disease patient there are several important items to consider:
1) Disease cause (etiology): A seasonal warm pathogen belongs to the category of externally contracted disease.
2) Classification: Because there are different seasons, complex factors and peculiar symptoms, we have many disease categories such as spring warmth, summer heat warmth, autumn warmth, winter warmth, wind warmth, damp warmth, warm toxin, and warm epidemic, but fundamentally we have to pay attention to wind warmth.
3) Nature: The nature of warm disease is that it belongs to heat. Hence its characteristic is that it easily transforms to heat, damages the fluids, damages the yin, and stirs the blood.
4) Transformations: One can track the location and transmission of a pathogen in the following parts of the body: three burners (upper, middle, and lower) and the four levels (defensive, qi, nutritive, and blood).
A normal transformation is from the upper burner-Lungs to the Middle burner-Stomach and Intestines and then to the lower burner-Liver and Kidneys. It also follows the sequence of defensive to qi to nutritive, and then to blood. Abnormal transformations go from the Lungs straight into the Pericardium, or from the defensive into the nutritive [skipping the qi aspect]. Signs of abnormal transmission within a pattern of normal transmission can also be seen, and are by no means peculiar. One should first understand a pattern within the constructs of normal transmission, and in learning to treat warm disease, one should focus on grasping the wind warmth onset of disease and the way that it transforms. After understanding the treatment principles of wind warmth, it is fairly easy to understand the different circumstances of other patterns and the methods to deal with those.
Four stages
The diagnosis and treatment of wind warmth can be divided into four stages: aversion to wind, transformation into heat, entering the nutritive [aspect], and damage of yin. These are the four stages of the whole disease course and also are the four key points to understand for treatment. Although there are numerous transformations in warm disease, almost all will be included in these four stages.b Furthermore, these four stages can be understood within the context of the following parameters: eight-principle pattern identification, three burner pattern identification, defensive-qi-nutritive-blood pattern identification, zang-fu pattern identification and chief symptoms, indication of drugs (chief herbs), and key formulas. The chart and tables below help to illustrate.
Stages of warm disease
Generally speaking, when faced with a warm disease patient there are several important items to consider:
1) Disease cause (etiology): A seasonal warm pathogen belongs to the category of externally contracted disease.
2) Classification: Because there are different seasons, complex factors and peculiar symptoms, we have many disease categories such as spring warmth, summer heat warmth, autumn warmth, winter warmth, wind warmth, damp warmth, warm toxin, and warm epidemic, but fundamentally we have to pay attention to wind warmth.
3) Nature: The nature of warm disease is that it belongs to heat. Hence its characteristic is that it easily transforms to heat, damages the fluids, damages the yin, and stirs the blood.
4) Transformations: One can track the location and transmission of a pathogen in the following parts of the body: three burners (upper, middle, and lower) and the four levels (defensive, qi, nutritive, and blood).
A normal transformation is from the upper burner-Lungs to the Middle burner-Stomach and Intestines and then to the lower burner-Liver and Kidneys. It also follows the sequence of defensive to qi to nutritive, and then to blood. Abnormal transformations go from the Lungs straight into the Pericardium, or from the defensive into the nutritive [skipping the qi aspect]. Signs of abnormal transmission within a pattern of normal transmission can also be seen, and are by no means peculiar. One should first understand a pattern within the constructs of normal transmission, and in learning to treat warm disease, one should focus on grasping the wind warmth onset of disease and the way that it transforms. After understanding the treatment principles of wind warmth, it is fairly easy to understand the different circumstances of other patterns and the methods to deal with those.
Four stages
The diagnosis and treatment of wind warmth can be divided into four stages: aversion to wind, transformation into heat, entering the nutritive [aspect], and damage of yin. These are the four stages of the whole disease course and also are the four key points to understand for treatment. Although there are numerous transformations in warm disease, almost all will be included in these four stages.b Furthermore, these four stages can be understood within the context of the following parameters: eight-principle pattern identification, three burner pattern identification, defensive-qi-nutritive-blood pattern identification, zang-fu pattern identification and chief symptoms, indication of drugs (chief herbs), and key formulas. The chart and tables below help to illustrate.
The above four stages are put forward based
on my clinical knowledge, and are sufficient
to outline the whole developmental course
of warm disease.
It should be noted that fatalities from
warm disease usually follow the stage of
damage to yin, but are not impossible in
other stages. This is, of course, dependent
upon whether the patient’s constitution
has some special circumstances or if the
treatment is delayed.
Although we often discuss pattern
differentiation of the above four stages
in terms of the upper, middle, and lower
burners or the defensive, qi, nutritive, and
blood, this is not the only classification
method that should be used. Instead
one must stand back and reflect on the
patient’s condition as a whole, observing
the pathological changes in the physiology
as the warm disease transforms and
develops. Similarly, when classifying the
problem using the three burners (upper,
middle, lower) one cannot forget about
the defensive, qi, nutritive, and the blood
aspects, and vice versa.
A warm pathogen that travels from the
upper burner to the middle burner to the
lower burner becomes deeper and deeper.
A warm pathogen that travels from the
defensive aspect to the qi aspect to the
nutritive aspect and then to the blood
aspect becomes more and more serious.
Because of this, one must at all times
think ahead and prevent the pathogen’s progression. Furthermore, once the pathogen is established, one must get the
pathogen to transfer from the deep back
to the more superficial and transform the
serious into the mild, so as to reduce the
chance of the condition worsening.
Ye Tian-Shi said, “When a pathogen
is in the defence aspect, one may use the
sweating method. Once a pathogen reaches
the qi aspect, only then can one clear the
qi. When the pathogen enters the nutritive
aspect, one can still evict the heat and shift
it back to the qi aspect. Once it enters the
blood, the fear is that the pathogen will
both consume and stir the blood, so one
must immediately both cool the blood and
disperse blood heat.”
Brief and to the point, he explains the
development of the onset of disease, and
puts forth the key points for treatment.
The Wen Bing Tiao Bian (Systematic Differentiation of Warm Pathogen Diseases) identifies diseases and treatments for warm disease, and includes a total of 238 methods and 198 formulas. It includes major categories such as windwarmth, summer-heat, lurking summerheat, winter-warmth, damp-warmth, damp-heat, autumn-dryness, warm-toxin, and warm malaria. Within the text it also discusses aspects of cold damp, dysentery, jaundice, and hernia-like mobile abdominal masses. Yet even the disease patterns that are included within the Wen Bing Tiao Bian do not cover completely the scope of warm disease. For example, within wind-warmth patterns, there are also many concurrent patterns and harmful patterns that must be dealt with and differentiated. By focusing on understanding wind-warmth, however, one can grasp the essence of warm disease, which is by no means that complicated. Hence, I think that in the treatment of warm disease, thoroughly understanding the chief signs and patterns of wind warmth should be fundamental. After one understands the chief patterns, chief signs, and chief formulas of wind warmth then one should combine this knowledge with that of the seasonal aspects of the onset of disease, and other complex factors. Consequently, if one understands all this, even conditions that are complex transformations are not difficult to solve.
The Wen Bing Tiao Bian (Systematic Differentiation of Warm Pathogen Diseases) identifies diseases and treatments for warm disease, and includes a total of 238 methods and 198 formulas. It includes major categories such as windwarmth, summer-heat, lurking summerheat, winter-warmth, damp-warmth, damp-heat, autumn-dryness, warm-toxin, and warm malaria. Within the text it also discusses aspects of cold damp, dysentery, jaundice, and hernia-like mobile abdominal masses. Yet even the disease patterns that are included within the Wen Bing Tiao Bian do not cover completely the scope of warm disease. For example, within wind-warmth patterns, there are also many concurrent patterns and harmful patterns that must be dealt with and differentiated. By focusing on understanding wind-warmth, however, one can grasp the essence of warm disease, which is by no means that complicated. Hence, I think that in the treatment of warm disease, thoroughly understanding the chief signs and patterns of wind warmth should be fundamental. After one understands the chief patterns, chief signs, and chief formulas of wind warmth then one should combine this knowledge with that of the seasonal aspects of the onset of disease, and other complex factors. Consequently, if one understands all this, even conditions that are complex transformations are not difficult to solve.
References:
Wu Tang, 1758-
Qin Bo-Wei. Warm Disease Made Simple. Translation by Jason Blalack.
https://www.chinesemedicinedoc.com/cold-damage-vs-warm-disease-qbw/
