SARS: Warm Pestilential Qi , atypical pneumonia

[Guest guest]

May 8,2003

 

Dear Listmembers,

 

The following article written by Fu Jing Hua was posted in the TCM Forum of the Chinese Medical School of the Hongkong Baptist University. It was in response to an earlier article which I am at present translating, writteng by Prof. Li Zhi Zhong from the Chinese Medical School of the Baptist University. This article is an attempt to give a Traditional Chinese medical conceptual framework to the current SARs epidemic in China. To help readers understand the notion of the Wu Yun Liu Qi 'Five Flows and Six Qi' I have included a table at the end of the translated article. The notion of Wu Yun Liu Qi is a very complex concept, especially as it relates to the the emergence , development and passing away of the Pestilential Qi . I found the reading of the introductory chapter of the book Treatise on the Differentiation of and Treatment of Warm Febrile Diseases With Vernacular Exposition very helpful. In doing this translation, I hope colleagues will give me feedback on the translation of some technical language used.

 

Regards.

 

Rey Tiquia

Phd Candidate

Dept. of History and Philosophy of Science

University of Melbourne

 

The TCM Theory and Practice of Preventing and Treating

Atypical Pneumonia

 

Fu Jing Hua Beijing

 

" Atypical Pneumonia' fei dian xing fei yan is a Western medical disease nomenclature. At present , its etiology and pathology are still not clear. Hence there is no specific method of prevention and treatnent of this disease. As to TCM (traditional Chinese medicine) etiology and pathomechanism bing ji , this disease falls under the category of wen li 'warm pestilential Qi. Wen Li (warm pestilential Qi ) is different from wen bing 'warm febrile diseases'. It is even very different from liu xing xing gan mao 'influenza'. Hence the use of the theory and practice of of wen bing and liu gan in dealing with the treatment and prevention of 'atypical pneumonia' (including the so-called ' tailoring treatment according to the clinical pattern' bian zheng lun zhi ; differentiation in accordance with the Wei Qi Ying and Blood; and the unified use of the methodologies of tonifying the spleen to benefit the Qi, releiving the exterior to dispel the dampness; clearing the heat and detoxification ) are all inappropriate.

 

The Chinese nation has a long and ancient history of preventing and treating warm pestilential Qi. As a result a whole theoretical framework and practice application with several millennia of history and a a perfect preventative and treatment system has been ceated . A rich clinical patterning lin zheng experience has been accumulated as well . These are all kept and preserved in vast volumes of ancient classical books and historical literary works. Hence, the opposing but complementary TCM and Western medicines can prevent and treat this current disease.

 

Not Knowing the 'Flow of Qi ' Yun Qi and Creativity Zao Hua , It is rare to find a doctor without failures

 

Warm pestilential Qi is similar to other seasonal diseases shi ling xing ji bing . It is a normal phenomenon of rhynmical periodic process of flow and change yun bian in the universe. The Chinese people refers to this temporal-spatial periodic process of flow and change as wu yun liu Qi 'The Five Flows and the Six Qi ( the 'five Flows' refers to the flow of the Five Elements of wood,fire, earth,metal and water; while the 'Six Qi' refers to wind, cold, summer heat,dampness,dryness and fire -Trans.) . When the 'universe' rotates in the the complete circle of 360 degrees, the Three Yin , Three Yang and Six Qi emerge. In a year and in the passage of the four seasons, the Earth rotates by itself. As it revolves gong zhuan , the Five flows emerge and the multi-layered temporal-spatial shi kong pattern and rhythm of of the year, month,day and time unfold.

 

Hence, the Five Flows and Six Qi is not what some people refer to as feudal superstition. Neither is it an idealistic theory of circulation xun huan lun. Neither is it a simplistic climatology pu su qi hou xue . Rather it is a temporal-spatial state of natural existence shi kong ceng mian de zi ran cun zai. It is a first rate Tao of the Flow and transformation of the universe, temporal-spatial effects, and numerology and principle of nature. In China, no famous physician scholar is not aware and knowledgeable of the Flow of the Qi. Knowing or not knowing the Flow of Qi deliniates the real and false physicians and their sucess and failures . As Cheng Wu Yi said: "

 

" Not knowing the flow of Qi yun Qi it is rare to find a physician without failings.

This determines success and failures among physicians. However, in categorizing

and inferring the principle of the flow of Qi and creativity, one has has to be clearly

knowledgeable about it. "

 

The year 2003 is the Gui year of the lunar calendar. Within the parameters of the Five Flows this year sui belongs to the Great Flow of Fire da yun wei huo . In the Six Qi parameters, this year falls within the ambit of the 'ministry of Heaven' si tian Great Yin , Damp Earth Tai yin shi tu . However, with the arrival of the second flow of Qi (approximately on April to May) the Small Yin Monarch Fire shao yin jun huo is the is the Host Qi zhu Qi , the Small Yin monarch Fire ' the expected guest' ke lin . Hence it is referred to as the ' Great upright Fire' da huo zheng. It is at this time that the Warm pestilential Qi spreads around liu xing .

 

In the south of China, this season comes earlier. Hence the disease spreads here first. When the third Qi flow arrives zhi san zhi Qi ( approximately from June to July) , The Dampness Qi starts to steam up zheng teng . Heavy rain starts falling. The disease gradually gets into hiding yin ni . The Flow of the Qi in the north of China comes late, or may be delayed.

 

The Yellow Emperor's Classic On Internal Medicine Chapter 71 " On the year when the Great Yin Ministry of Heaven is in in season... when the second Qi flow has arrive, the great fire is in upright position da hou zheng myriad of things starts to flourish, the people are in peace and tranquility, the disease Warm pestilential Qi spreads around. People from distant and neraby places are afflicted with diseases with similar clinical pattern. . " The " people are in peace and tranquility " means that when the cold spring has passed, people feel that the weather is very pleasant. And not what other annotators explained as " people are healthy and not sick " . The term 'wen' warm' refers to the pathomechanism as being wen re 'warm and febrile'. Li is similar to the character with the radical referring to 'illness' li. This refers to the etiology, which is yi li 'epidemic pestilential Qi. Because each onr transmits the disease to each other hence " people from distant and nearby places are afflicated by diseases with similar clinical pattern. " .

 

As the Yellow Emperor said in the Chapter on Acupuncture in the Ling Shu said: ² I heard that when the Five Epidemics occur , everyone becomes infected.. Whether they be adults or the young, the symptoms of the disease are the same. Œ. .Wu You Xing in this book Treatise on Warm Epidemic Disease Chapter on Origins of Disease said: " In this epidemic yi , people are affected by the Pestilential Qi from heaven and Earth..The severity of the epidemic varies in each year, and manifest differently in different localities and in different seasons. . When this Qi has come, old and young, weak and strong who comes in contact with it all gets sick. "

 

There are many similar cases of these periodic Flow of Qi epidemic that has occurred in the past. For example in l956., which is the year of the Bing Jia in the Lunar calendar. This year in the parameters of the Six Qi is categorized as the Qi of Tiny Yang Ministerial fire shao yang xiang huo . On the arrival of the third Qi flow , the Tiny Yang Ministerial Fire is the host Qi. The Tiny Yang Ministerial Fire is the expected Guest. . In fact , it was an Encephalitis B epidemic . Most of the patients had symptoms of high fever, tremors, At this time , the veteran TCM practitioner Pu Pu Zhou used the formula 'White tiger Formula' and treated many patients successfully. When the fourth Qi flow has come, this becomes the season of the Yang Ming Dryness Metal as the 'expected Guest'. The disease then eventually disappears. In addition, influenza, epidemic cerebrospinal meningitis, as well as hepatitis, are all related to the transformation and flow of the Qi. The case of the current atypical pneumonia epidemic is also similar to these. It comes at a definite season. With the migration of the Qi flow, it will eventually dissipate. It's rate of transmission and mortality is much lower that the other epidemics mentioned. Hence, we must be clear in our knowledge of this epidemic. Educational propaganda must also be appropriate.We must absolutely avoid unfounded exagerations which leads to 'atypical pneumonia terror'. This then leads to great loss to the national economy and other things.

 

The Pestilential Qi Closes the Openings and brings Disconnection , Three Yin Are Affected and Dryness and Heat Emerge

 

As to the etiology bing yin of the illness, Western medicine strives to seek it's material pathogen. All attention is focused upon the virus.. However, the specific pathogen has not been pinpointed. Moreover, no spefific drug has been found to deal with the illness. Although great human and material resources have been poured into research, the quest for the prevention and cure is still very far. Much less, this pathogenic microorganism is just a secondary etiological factor. . What is more important is the human being's state of life. and his adaptation to the changes of the natural and societal environment. The most limited bio-psycho-social medical model up to now still just have symbolic meaning. It has not entered the so-called " modern medicine's " theory and practice.

 

The Tao of China's medicine is established upon life processes and a plurality of other types of life motion and their mutual interactions with nature and social processes. Its philosophy holds that the causes of diseases is the loss of harmony shi he between the various life motions and it's relationship with nature and society. Hence it is said: " When harmony is attained, there is Zheng Qi (medicatrix naturae) . When disharmony happens heteropathy xie Qi emerges " This year, during late Spring and early summer , the season of Fire has come. Young people due to the irregular eating patterns, irregular sleeping and waking up patterns, over fatigue, mental pressure etc.all led to the build of fire and heat within their bodies. Body fluids were consumed . They are in an unhealthy state and thus became ' cohorts predisposed or susceptible to atypical pneumonia. This is because of the fact that the disharmoniy between their life motion state and nature's Qi flow changes becomes a favourable condition for the multiplication and spread of the virus.

 

The external heteropathy , the Warm Pestilential Q , is what Wu You Xing refers to as " the pestilential Qi betweeen heaven and Earth " , They are different from the 'Six Climactic Condition which are in Excess " liu yin of the wind feng , cold han , summer heat shu , dampness (humdity) shi ,dryness cao .Hence , it is also different from Warm febrile heteropathy wen xie which brings about Wen diseases wen bing .It is similar to wen yi zhang 'febrile epidemic miasma' It is also different from febrile miasmatic pestilential Qi wen yi zhang li . Miasmatic Qi zhang Qi is categorized as Yin heteropathy yin xie while pestilential Qi li Qi is classed as a yang heteropathy. The Yin heteropathy damages shang the yang heteropathy; while the yang heteropathy damages the Yin heteropathy. Their respective pathomechanism bing ji as well as prevention and treatment are different . The pestilential Qi that I refer to are not limited to virus bing du . Instead they are referred to as abnormal yi chang mode of temporal-spatial flow transformation and change yun bian . In nature, this encompasses a multi-layered and muli-lateral interactions including multi-dimensional temporal-spatial mode duo wei shi kong xing shi ; multi-dimensional temporal-spatial states duo wei shi kong zhuang tai ; multi-dimensional temporal-spatial effects duo wei shi kong xiao ying ; and material , energy and information systems etc.

 

TCM pathomechanism does not fix localization ding wei; fix qualitativeness ding xing and fix quantitativeness ding liang . Rather it emphasizes seeking the etiology yin , categorizations shu and force tranectory shi . Warm Pestilential Qi seeks the etiology of the li Qi Pestilential Qi which closes the openings and brings about disconnection li bi qiao suo zhi shi tong . Because the Warm pestilential Qi wen li is dffferent from the transmission and transformation chuan bian of the Warm Heteropathy wen xie which direcly hit the three Yin's ( the three Yin and the three yang refers to the shen spirit shen , Qi physical body xing which are categories of life inner mode of motion zai nei de sheng ming yun dong fang shi . They do not refer to the tissues and organs zu zhi qi guan ).

 

In seeking categorizations shu , this disease is in the Great Yin Lungs tai yin fei . Then it rapidly makes inroads downwards towards the Small Yin Kidneys Shao Yin shen while at the same time making a surprise attack upon the Terminal Yin Pericardium jue yin xin bao .

 

In seeking it's force trajectory tai shi it is heat re and with an inclination towards 'dryness' cao . Its temporal force trajectory shi shi may be subdivided into the initial , middle and later stages. The prevention and treatment of this disease has to be made on the basis of the above etiology and pathomechanism. This is the Tao of 'differentiating the disease and seeking the etiology, investigating the pathomechanism and on this basis executing the treatment ' bian bing qiu yin shen ji lun zhi .

 

Life Hinges on Balancing , Centering and Harmonizing the Zheng Qi

sheng ming zai yu tiao li zheng Qi zai yu zhong he

 

As for preventing being afflicted by this illness, aside from fostering hygienic habits such as quarantining patients, disinfecting hospital wards,as well as avoiding crowds, the more critical aspect is 'harmony ' he xie between life processes itself and the natural and societal environment. What TCM refers to as " when the Zheng Qi is retained within, the heteropathy would not dare invade " (originally from the Chapter on Acupuncture of the Nie Jing ) which actually refers to the spread and infection by the epidemic Warm Pestilential Qi.

 

The basic purpose and aim of the regulation tiao li of diet, rhythm of sleep and waking up; breathing, physical activities etc. in 'Nutruring Life ' she sheng is to maintain a 'centered and harmonious' zhong he state of condition. Everyone is familiar with the concrete methods of going with the flow of nature shun ying zi ran ; balancing the Yin and yang tiao li yin yang ; regulated diet yin shiu you jie ; normal rhythm of sleep and waking up qi ju you chang ; tranquility ,. vacuity and emptiness tian dan xu wu ; Guarding the quintissential and the Spirit within jing shen nei shou ; regulating the breathing tiao li hu xi , Daoist Breathing Excercises dao yin . But the only problem is that people are frightened of death but not afraid to take the route of rushing towards death bu wei qu si zhi tu . People loves life , but are unwilling to take the Tao of nurturing life. she sheng zhi dao . At this point in time, digging the well while thirsty or forging weapons when engaged in battle ke er chuan jing, dou er zhu zhui ( This is a quote from the Neijing Suwen . I now include the complete quote from chapter 2 " In the old days, the sages treated diseases by preventing illness before it began, just as a good government or emperor was able to take the necessary steps to avert war. Treating an illness after it had began is like suppressing revolt after it has broken out. If someone digs a well when thirsty, or forges weapons after becoming engaged in battle, one cannot help but ask:: Are not these actions too late. " .This is from the English translation of the Suwen by Maoshing Ni l995,The Yellow Emperor's Classic of Medicine Shambala , p..7) is far better than being scared and terrified the whole day huang kong zhong ri and blindly taking medicines .

 

Wo/man by him/herself grasp in his/her hands all the weapons needed to overcome all diseases.. Life is capable of self-stability, self regulation, self-control, self harmonization and self organization . TCM's aim is to promote the self realization, self development and self harmonization of human life processes . In the use of preventative medicines yu fang yao wu , they must be administered on the basis of different body state and constitution . This will promote the body's seff harmonization and thus achieve the aim of " preserving the Zheng Qi from within " zheng qi cun nei. For example, if there is accumulation of inner body heat , then the method of clearing heat and moving down fire qing re jiang huo must be used. When body fluids jin ye has been consumed and being exhausted, then body fluids must be generated sheng jin and moisten the dryness run cao . Yin vacuity must be nourished with Yin; when the blood is heated up, then the blood must be cooled down. However, as for the current epidemic of Warm pestilential Qi wen li liu xing zhi ji , cases of cold vacuity must not be tonified with warm tonics xu han zhe bu yi wen bu . Phlegm or dampness ( both thick and sticky as well as the ) must not be transformed through warm materia medica.

 

As for the use of TCM materia medica zhong yao in the prevention of being affected by the warm pestilential Qi , historically, TCM classical texts have very detailed records of all of these. For example in preventing being affected by zhang Qi 'miasmatic Qi' materia medica formula and methods to 'avoid the miasma ' bi zhang fa like xiong huang ( Realgar) powder may be used. In preventing being affected by warm pestilential Qi one can take 'red bean pills' chi xiao dou wan , antelope horn powder ling yang jiao fen. . However, in the related ancient literature which featured these prevention and treatment of disease caused by the warm pestilential Qi, we did not see any evidence of large scale use of sheng Qi, bai zhu, huo xiang, chai hu, fang feng, cao guo, yi ren etc. which are materia medica used to tonify the Qi, dry the dampness cao shi , as well as those pungent and warm materia medica that can relieve the exteriior xin wen fa biao yao . We also saw very little entry on the use of materia medica which are punent and cold and thus can relieve the exterior as well as mateiral medica which can clear heat and detoxify like yin hua, lian qiao, guan zhong, ban lan gen, da qing ye etc. As for the contemporary usage of the word du 'toxic' in the word jie du detoxify, perhaps we can say that the word 'du' 'toxic' in jie du can be similar to bing du 'toxic disease' i.e. virus. Or possible due to the influence of the use of research into Western botanical medicines, and the attempt to use these medicines to inhibit the virus. However, if TCM raises the banner of using TCM materia medica for it's anti-viral effects, once, these medicines have been proven through experimental studies to be ineffective against the corona virus, how can we live up to the trust of our native elders jia xiang fu lao ?

 

For those with accumulated inner heat, preparations that can tonify the Qi and dry the dampness bu Qi cao shi zhi ji , this is like assisting the heteropathy and nurturing the 'invader'. The use of materia medica which can clear heat and detoxify on those patients with a cold vacuity constitution can only damage the Zheng and the person. It is not impossible to use specific materia medica to those cohorts susceptible to the disease for purposes of prevention. The problem is the suitability of target patient and materia medica to the pathomechanism . Otherwise, this will be blindly using materia medica. Not only will it be a case of tonifying something that needs no tonifying , more importantly, this can lead to adverse reactions.

 

Due to the fact that the constitution of the cohorts susceptible to the disease are inclined to be 'hot' , on the basis of synthesizing zong he the ancient formulae, we can use 'red beans' chi xiao dou , jin hao mai, yu xing cao, bai hua she she cao , si cao, gong ying, di ding, (each 12 grams), as well as ru xiang, jiang xiang, (each 6 grams), etc. which are materia medica which can bring down the fire and avoid the heteropathy jiang huo bi xie ; this will regulate and harmonize the state of the human life activities ,

 

Healthy people jian kang ren who have not come in contact with atypical pneumonia patients, must take precautions against fan bei the disease. They must regulate their diet, balance work with play lao yi shi du , relax their minds fang song xing qing , and there is no need to blindly take medicines yao wu . At this period of time, pay attention to eating and drinking light and bland foods, while having less of fatty , sweet and rich foods, have plenty of vegetables, fruits, edible fungi ( mu er yin er ) as well as gou ji walnuts, black beans, lotus seeds, carp li yu , etc.

 

Preserving a bit of Yin fluids Extends A Bit of Life

 

As to the treatment of this disease, because its pathomechanism and force tranectory tai shi is categorized as fire heat with inclinations towards dryness, at the initial stage of 'clinical patterning' lin zheng , there is high fever, dry cough etc. The formula White Tiger Formula bai hu tang must be used immediately and add Ginseng Decoction ren shen tang ( Shi Gao 60 gm, zhi mu 30 gm, ren shen 10 gm) . This formula will bring down the fire and keep the Yin (fluids) jiang re jiu yin .

 

When the trajectory of the fever is getting higher , then use more Shi Gao 100-200 gm, and then add Han Shui Shi 30-60 gm. , Niu Huang (chong) , 1-3 gm, Ling Yang jiao fen (chong) 1-3 gm., Lu Gen 15 gm., Mao Gen 15 gm, Generally, after 2-3 preparations, the fever can subside.

 

When this illness leads to the Pestilential Qi li Qi suffocating the lungs bi fei , clinical pattern lin zheng

of difficulty in breathing, can occur. If too much bitter and cold materia medica are used this can aggravat e the suffocation of the lungs. Hence materia medica which are pungent cooling xin liang , pungent moistening xin run , sweet cooling gan liang , sweet moistening gan run must be used instead. . When the Bitter Qi in the lungs reverses upwards shang ni , the Qi will be under pressure( in the cellular level, it belongs to damage to the respiratory muscles ) then it will be appropriate to add Ting Li Zi (which can bring down the reversing Qi and open the lungs kai fei) , Su Zi, Gua Lou Zi, Niu Bang Zi, Lia Fu Zi etc.. The dose of the preparation should be around 10-16 gm. When the heat heteropathy congests the lungs yong fei add Jin Hao Mai , Yu xing Cao, Bai Hua She She Cao, etc. and the dose should be from 15-30 gm. In this ways, the disease condition can be quickly put under control.

 

When the heteropathy affects the kidneys and heart ( in the cellular level this belongs to the category of damage to respiratory muscles, tearing of glandular bodies xian li ti duan lie, mutating necrosis zhi bian xing huai si ) . In the level of modes of motion , this belongs to the category of 'incapacity to generate' fa bu neng , TCM categorizes these as " the Qi stored in the kidneys Qi zang zhi shen .

 

Damage to the heart muscular tissues can lead to heart failure xin li shuai jie, a life threatening condition which can affect the mode of life motion. TCM categorizes this condition as " the Qi stored in the Heart' Qi zang zhi xin . This should be treated immediately.

 

When the clinical pattern lin zheng of exhaling more and inhaling less hu duo xi shao this is a case of the kidney failing to take in the Qi shen bu na Qi . The kidney must be tonified and the Yin nourished bu shen yu yin . Use the materia medica shu di, shan yu, dong chong, xia cao, gui ban etc.When the Heart Qi is starting to dissipate xin Qi yu tuo , the use the formula shen mai yin as well as huge dose of Ginseng to immediately revive the patient and preserve his yin ji jiu cun yin

 

Diarrhoeia caused by antibiotics and bitter and cold materia medica can be dealt with the use of materia medica such as bai zhu, bai sdhao, chen pi etc. Other variations of the clinical pattern bian zheng may be dealt with in accordance with this type of approach which can bring people on the brink of dying back to life. . In addition, simple but effective therapies like bleeding punctured acupuncttre points (Da zhui , Fei Shu, Shao Shang ) , massage and acupressure dian xue , using materia medica to give a wash yu yao , gua sha etc.

 

Summing up, TCM's knowlege of the etiology, pathomechanism , epidemiology liu xing and prognosis yu hou of Warm pestilential Qi is very clear. It has a whole system of theory and methodology in dealing with this disease. The Chinese people can certainly prevent and cure this disease of atypical pneumonia that is now spreading. Currently the most important thing to do is to quickly apply the TCM thinking , theory and methodology in the practice of preventing and treatment of atypical pneumonia In this struggle which touches with the people's lives and security, we can certainly achieve quick, all-round victory. Not only can we prevent a calamity befalling the world community but also we can make contributions to humanity.

 

 

Six steps Initial Qi Second Qi Third Qi Fourth Qi Fifth Qi Final Qi

 

Six Qi Jue Yin Shao Yin Shao Yin Tai Yin Yang Ming Tai yang

wind wood monarch fire Ministerial fire Damp Earth Dryness metal Cold water

 

24 Solar Terms great cold Spring Equinox Forming Grain Great heat Autumn equinox Slight snow

jie Qi rain water Pure Brightness Grain in Ear Autumn starts Cold Dew Great snow

Spring begins Great Rain Summer solstice limit of heat Frost descent winter solstice

waking of Beggining of Slight heat white dew Winter begins slight cold

insects summer

 

Time Jan,21 Mar.6 Mar.21-May 6 May 21-Ju.7 Jul.23-Sept.8 Sept.23-Nov.8 Nov.23-Jan.6

period

 

This table was not part of the above article. It was translated from the book Wen Bing Tiao Bian Bai Hua Jie Treatise on the Differentiation of and Treatment of Warm Febrile Diseases With Vernacular Exposition which was compiled and annotated by the Zhe Jiang TCM College l978. The Wen bing classic Treatise on the Differentiation and Treatment of Warm Febrile Diseases was originally written by the Qing Chinese medical scholar Wu Tang in 1788.

The English translation of the 24 solar terms were from the book Ancient China's Technology and Science which was compiled by the Institute of Natrual Sciences, Chinese Academy of Sciences, Foreign Languages Press, Beijing, p. 47.