Warm Heat Disease (Wen Bing)

I. History

A. Ye Gui (1666-1745)

Developed basic principles of For Level Differentiation;
Identified Warm Heat and Damp Heat
Differentiated newly-contracted warm pathogen disease from “lurking heat”.

B. Xue Xue (1681-1770)

Developed Damp Heat Disease Theory and distinguished Damp Heat from Warm Heat or Cold

Defined treatment for D/H disease via the Sp/St, and progression of Disease from Sp(weak)/St(Strong) to Interior ( Liver) or Exterior (GB)

C. Wu Tang (1758-1836)
Used Three Burners as a Tool to differentiate Onset, progression and treatment of warm disease.
Focus on saving Yin and Essence in treating warm disease

D. Wang Shi-Xiong (1808-1867)
Author of Wen Re Jing Wei ( “Warp and Woof of Warm Heat Pathogen Diseases”). This is the warm disease classic:

1. Clarified concept of Summer Heat as independent of dampness
2. Summarized comparisons between newly contracted and lurking warm disease
3. Warned against using herbs that were too cold at the onset of treatment for warm disease, which might cause the pathogen to “congeal.”

II. Characteristics

A. HEAT
- primarily characterized by Fever
-readily injures Yin
-Heat Pathogen or “Lurking Heat”
-Symptoms appear quickly: fever, thirst, irritability, restlessness, concentrated, dark urine, red tongue, rapid pulse
- Contagious, seasonal, endemic, or epidemic

B. Differentiation Based on 4 Level or 3 Burner

C. Classification of Warm Heat Diseases

1. With/Without Dampnes

a) SeasonalWithout dampness:

Wind Warmth (Feng Wen)

Spring Warmth ( Chun Wen)

Autumn Dryness ( Qiu Zao)

Warm Toxin (Wen Du)

b) With Dampness:

Summerheat Warmth (Shu Wen)

Damp Warmth (Shi Wen)
Lurking Summerheat ( Fu Shu)

2. Seasonal

3. Infectious/ Epidemic

B. Symptoms

1. Warm Heat

Wind Warmth: Fever, aversion to cold, cough, floating Pulse

Spring Warmth: High fever, restlessness, strong thirst, possibly convulsions and coma

Autumn Dryness: Dry cough, dryness of the mouth, nose, throat

Warm-Toxin: Local redness, swelling, heat and pain;

Possibly ulcerations; not seasonal, maybe Contagious.

2. Damp Heat

Summerheat Warmth:

Heat: high fever, strong thirst, profuse sweating, flooding pulse

Damp: chills, no sweating, fever, epigastric fullness, greasy tongue coating

Damp Warmth : Aversion to cold, low-grade fever, heaviness of the head and body, stifling sensation in the chest (chest oppression), and distention (fullness) in the epigastric region; greasy tongue coating; soggy and moderate pulse. (late summer).

Lurking Summerheat:

Fever, restlessness, thirst, epigastric fullness, greasy tongue coating, Or fever, restlessness, dry mouth, deep red tongue with little coating (autumn or winter)

C. WARM PATHOGEN DISEASE VS. COLD DAMAGE

1. Theories of Exterior Pathogenic Attack that cause Heat and Fever

-Cold disease theory came first; In one sense, refers to any externally contracted pathogen. In another, specific cold pathogen. Hence, at first,

“Warm Pathogen” was a type of “Cold Damage.”

- Ye Gui, Xue Xue and Wu Tang, felt this didn’t cover all the bases, like Yin Xu or Heat in Pericardium. Developed a new theory that was more serviceable.

- Main issue is that Warm Heat pathogens can attack the Wei and Qi directly and cause warm heat disease.

- Warm Heat Theory explains more of etiology and pathogens. Lurking Heat theories and Seasonal Theories are covered.

D. ETIOLOGY

1. Wind Heat

a) Attacks Lungs and Wei Qi first; causing stagnation of Wei Qi and impairing Lung function of D and D.

SX: Chills and (high) fever, aversion to wind and cold ( Wei Qi stagnation);
slight” perspiration ( attack on Wei Qi usually results in perspiration being less severe than in Qi Level fever.

Cough, slight increase in thirst.

Red-tipped tongue with thin white coating; rapid and floating pulse.

b) Wind Heat transforms into Fire and injures Yin- initial damage of attack from any Heat pathogen is damage to fluids, particularly LU and ST Yin.

Sx: Dry cough, dry throat and nose, strong thirst, red tongue

c) Wind Heat quickly advances to Pericardium (Ying) affecting Shen

Sx: High fever, muddled consciousness or coma, convulsions and delirium within 24 hrs of attack.

2. Summerheat

a) Attacks ST and Qi Level first, often in combination with Dampness.

- If there is more Heat, Summerheat will attack Stomach; if more dampness, will attack Spleen.

Heat Sx. Four Bigs: Fever, Thirst, Sweat, Pulse

Damp Sx: Summerheat with Dampness predominant moves more slowly and will attack Wei Level first; There will be aversion to cold, chills and fever and heaviness of the body, chest distention, absence of sweating, tongue coating.

b) Summerheat can attack the pericardium directly and block Shen, leading to sunstroke ( loss of consciousness)

 c) Summerheat readily injures fluids and Source (Yuan) Qi.

Sx: severe SOB, fatigue, strong thirst, large pulse at superficial level and frail pulse at deep level.

 d) External Dampness often accompanies Summerheat when attacking the body. Focuses on stomach and spleen

Sx: poor appetite, abdo fullness, loose stools, greasy tongue coating.

When accompanied by ingestion of cold foods or drinks, or other chill factors, damp and Heat can be accompanied by cramps, body aches chills, absence of sweating and other signs of cold.

1. Damp Heat Causes Damp Warmth

a) develops slowly and has a prolonged course. The onset is insidious and unlike Summerheat there are no “early signs.”

Sx: When dampness predominated over warmth:

Slight fever or contained fever ( with heat trapped by dampness: this is a low grade fever that lasts a long time, where the skin feels hot even though the temperature may not be elevated and is accompanied by other symptoms of dampness and heaviness.

b) Affects Stomach and spleen:

“Exterior signs” are heavy head and body and aversion to cold.

St/Sp symptoms include epigastric fullness, nausea, loose stools, thirst with little desire or absence of thirst.

c) Damp Heat Stagnates the circulation of Qi and prevents the clear Yang from rising to the head.

Sx: affects liver and causes chest and epigastric fullness and distention, abdominal bloating and depression.

Clear Yang fails to reach head: heaviness of head, as if wrapped in a bandage, nasal congestion, plugged ears, diminished hearing and dull expression. Can descend to lower burner leading to water retention, edema, loose stools, cold extremities and white tongue coat.

d) Combination of dampness and heat is difficult to treat.

4. Dryness causes Autumn Dryness

A “seasonal” disease owing more to the development of the theory than the clinical presentation.

May be “Cold” Dryness instead of Heat Dryness

a) Mainly attacks Lungs

Sx: dry nose and throat, dry cough with little sputum, hoarse voice

b) Dryness injures Fluid of lungs. Signs of dryness can occur with early stage of attack, whereas with Wind Heat, the sryness comes on in later stage.

5. Pestilential Qi and Warm Toxin cause Warm Pathogen disease

Infectious Disease. Pestilential means epidemic, broad-spread and affecting a large population.

Treat Pestilential Heat by clearing Heat and Resolving toxin from Qi and Nutritive (Ying) Levels:

Warm Toxin can be externally contracted or internally;

External factors are considered Primary Factors; Internal Factors are secondary


E. FOUR LEVEL DIFFERENTIATION

1. WEI LEVEL ( Wind Heat)

Pathogen affects the distribution of Wei Qi, attacks surface Nose and throat.

SX: Fever, accompanied by chill and slight aversion to cold

Slightly increased thirst (implying little fluid damage at onset of Wind Heat).

Slight or absent sweating, sneezing, nasal congestion, sinus drainage, sore throat, cough.

Headache, can be at eyes, or cause redness, tearing, itching or burning pain in eyes.

Can progress to a deeper level if:

1. Pathogen is extremely severe

2. There is constitutional Yin deficiency

3. There is injury to heart Yin or Qi due to improper treatment
( too acrid and warm or too bitter and cold)
 Any of these might lead Heat into Nutritive level.

2. QI LEVEL ( Interior Repletion Heat)

Pathogen affects physiological function and circulation of Qi causing it to stagnate.

Four Great Things:

Vigorous Fever ( including aversion to Heat as opposed to avers. To Cold)

  

Profuse sweating

  

Thirst ( with preference for cold)

Big Pulse ( Flooding or slippery)

(Yellow and dry tongue coating is primary manifestation of Inter Heat)

 3. YING (NUTRITIVE) LEVEL

  

Heat injures Yin and disturbs the Spirit of the Heart (Shen)

(“Veiling of Pericardium by transmission of Heat”)

 Presents with:

  

Fever that worsens ( spikes) at night, with thin rapid pulse

  

Insomnia, irritability, restlessness; “occasional” delirium or muddled consciousness. Deep red tongue

  

Thirst with little desire to drink ( “Steaming of Yin” creates some moisture.”)

  

Maculo-papular rashes; extravasation of Blood caused by invasion of channels by Heat

 4. XUE (BLOOD ) LEVEL

Symptoms similar to YING LEVEL, but deeper, or more severe, including possibility of:

Coma, or loss of consciousness

Bleeding

Maculopapular rashes over entire body.

PROGRESSION OF WARM HEAT DISEASE

Usually from Exterior to Interior

Newly-contracted disease tends to attack WEI or QI level first, but may enter Nutritive Level directly.

Lurking disease usually begins at Nutritive Level

This usually implies an ongoing deficiency, usually Kidney ( for Hot or cold) or Spleen for Damp Heat

F. THREE BURNERS
1. Upper Burner
Lungs

a) Warm Heat pathogen attacks Lungs and protective ( Wei) Qi causing failure of Lungs to disseminate the Qi

b) Blockage of Qi due to accumulation of Heat in Lungs ( Qi level)

c) Stagnation of protective Qi, failure of Lung to disseminate the Qi, and stagnation of the Spleen by damp heat. Damp Heat.

Pericardium

a) Blockage of pericardium by Invasion of Heat. Key to the Ying Level. Invade from any of the above upper burner pathologies

b) Veiling of Pericardium by Phlegm and Damp heat.

A Qi Level pathology.

Constant fever that “improves in the morning and worsens in the evening, yellow and greasy tongue coat, slippery and rapid pulse.

Lear thinking alternates with confusion and delirium

2. Middle Burner

Stomach and large Intestine ( Yang Ming)

a) Heat Excess in Stomach ( Qi level)

b) Obstruction of Qi of L.I. by dry stool and Heat, with severe constipation.

Spleen and Stomach Patterns

Damp Heat Transmission or Summer Heat transmission:

Contained fever

Oppression of chest and epigastrium, nausea, loose stools

Greasy tongue coat

3. Lower Burner

Kidney

Severe injury to fluids and yin in upper and middle burner:
Fever, malar flush, warm palms and soles
Listlessness, dry mouth, diminished hearing, deficient pulse

Liver
Exhaustion of Kidney Yin leads to Liver Yin deficiency

Causing the rising of wind:

Trembling of fingers, tonic-clonic convulsions, convulsions, Violent palpitations with emptiness in chest (Kidney too weak to nourish Heart)