FOUR LEVELS OF HEAT DISEASE-WEN BING SUMMARY

I. WEI LEVEL (DEFENSE LEVEL)

(Corresponds To Wind Heat Attack) An early stage of infectious disease.


Symptoms: Fever and chills with fever predominant, aversion to wind, sore throat, perspiration. Cough. Rash, red and itchy eyes. headace

Pathology: Pathogenic heat invades and injures the superficial layer: muscles, skin and channels. Injures Defensive Qi. Stagnation of Qi occurs and Lung Qi is unable to disperse. A rash may occur through the attempt of the Wei Qi to express the pathogen.

Tongue: may be red
Pulse: superficial and rapid

Treatment Principle: Disperse Exterior with cooling diaphoretics/ Clear Heat and resolve toxin ( attack pathogenic influences)



Herbs:

Chan Tui ( Cicada): sore throat, loss of voice, rashes (measles: draws rash to surface), clears the eyes, stops spasm

Ju Hua ( Chrysanthemum): Interior or exterior wind heat, brightens the eyes

Bo He ( Mentha), Clears Head, eyes and throat, brings rash to surface, frees

Liver Qi

Niu Bang Zi (Arctium): benefits the throat, disperses Fire Poison (potent antibiotic)

Prescription: Yin Qiao San ( Lonicera and Forsythia Powder)



-Disperses wind-heat, clears Heat, relieves toxicity

- Jin Yin Hua, Lian Qiao, Jie geng, Niu Bang Zi, Bo He, Dan Dou Chi (Soja)

Jing Jie, Dan Zhu Yu ( Lopatherum), Lu Gen, Gan Cao

II. QI LEVEL
(Corresponds to Heat Excess in Stomach/L.I. and Lung)

Symptoms: High fever with no aversion to cold and thirst; symptoms may also include cough (lung) or constipation, abdo pain ( St/L.I.)

FOUR GREAT THINGS:

- great fever, great thirst, great perspiration, great pulse

Pathology: Pathogenic heat injures the defensive phase and penetrates to the interior. The pathogen is interior, hence no chill.

Tongue: Red with Yellow coat Pulse: rapid, surging

Syndromes:

LUNG

1) Heat accumulation in Lung; fever, perspiration, thirst, cough, difficult breathing, chest congestion, chest pain

Tx Principle: Clear Heat/ Regulate Lung function ( stop cough and wheezing)

Prescription: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum

and Licorice Decoction

- Facilitates the flow of Lung Qi, clears Heat, and calms wheezing by directing Qi downward


2) Phlegm Heat accumulation in Chest; fever, red face, cough with scanty phlegm, chest pressure, thirst for cold drinks, but frequently vomiting with drink.

Tx Principle: Remove Heat, Transform phlegm, regulate

3) Heat in Lung and Heat obstruction in organs: fever, constipation, phlegm accumulation, dyspnea, perspiration, restlessness

Tx Principle; Clear Heat, transform phlegm, regulate the lung, purge

4) Eruption due to Lung Heat: fever, cough, skin eruption, chest fullness

Tx. Principle: Clear Heat, disperse Lung, promote eruption of rash

5) Lung Heat transmitted to Large Intestine: Fever, cough, diarrhea with foul-smelling stool, burning sensation at the anus

Tx. Principle: Clear Heat and relieve diarrhea

III. HEAT IN YING ( NUTRITIVE) LEVEL

(This corresponds to some aspects of Yin Deficiency, but etiology involves pathogenic fire. Also may include some aspects of Heat in the Blood; but please note that "Heat in the Blood" is a syndrome of Excess as distinct from Heat in the Blood Level, which is a type of febrile disease developing from Yin Deficiency)

Symptoms: Severe fever at night, thirst, restlessness or delirium, insomnia, rash ( red spots)

Tongue: Red with no coating, possible peeling, etc.,

Pulse: rapid, thready

Pathology: Heat has penetrated either from the Wei or Qi Level and damaged the Ying ( Yin) or nutrient aspect of the Qi.

Remember the relationship between Ying and Wei and remember it is  two halves of the same whole. In its context as Ying QI, the Blood is also affected, hence the rash. Heat pathogen may also affect Heart and produce

Sx of Deficiency Heart Fire and Shen Sx, or may invade Pericardium and produce "delirium".


Treatment Principle: Clear Heat from Nutritive Level

1. Clear Heat and Cool the Blood

2. Clear Heat and resolve toxin

3. Nourish Yin

4. Calm the Shen

Herbs: ( from Blood Heat Clearing category)

Xu Nui Jiao ( Buffalo horn), Sheng Di Huang (Rehmannia Glut.), Xuan Shen ( Scrophularia)

Prescription: Qing Ying Tang (Clear the Ying Decoction)

-Clears the Nutritive Level, relieves Fire toxin, drains Heat, nourishes the Yin

- Xu Nui Jiao, Xuan Shen, Sheng Di Huang, Mai Men Dong, Jin Yin Hua,

Lian Qiao, Huang Lian, Dan Zhu Ye, Dan Shen

IV. HEAT IN THE BLOOD LEVEL

(Corresponds only partially to Heat In The Blood); Remember, this is strong Heat Toxin injuring a compromised Yin situation). Damage is deeper to Nutritive level, symptoms are stronger and bleeding is present


Symptoms: high fever, skin eruptions, vomiting of blood, mania, delirium, e.g., similar to Heat in Ying, but more severe.

Plus: hemorrhage, hemafecia, hematuria, epistaxis, etc., and possibility of coma or unconsciousness.

Tongue and pulse: similar to Heat in the Ying Pathology: If there is less resistance from Yin, Heat toxin

passes through the Ying Level and causes more damage. Damage to blood, e.g., hemorrhage, is the key.


Treatment Principle: Clear Heat, stop hemorrhage, restore consciousness


Herbs: similar to Heat in the Ying Prescription: An Gong Niu Huang Wan (Calm the Palace with Cattle Gall stone Pill)

- Clears Heat, relieves toxicity, dislodges phlegm, opens orifices, calms the Spirit

- includes Niu Huang and Xi Jiao, She Jiang ( Moschus), Borneol, realgar, plus Zhu Sha (Cinnabar) and Zhen Zhu (Margarita),

Huang Lian, Huang Qin, and Zhi ZI