etiology and progression of lurking heat

[Guest guest]

One of the main characteristics of spring warmth is that it comes on suddenly

from the interior (though it may be initiated by an exterior attack). If it is

caused to flare up by other interior factors like the emotions or liver qi

depression or dampheat, then it will not have any exterior signs. So what makes

this heat different from a purely internally generated heat? In other words,

how does one know it is lurking and not just a result of zang-fu disharmony. I

think the suddenness is the supposed distinction. Purely internal disorders

develop slowly, but the acute symptoms of a lurking spring-warmth flareup seem

to spring from nowhere. The patient may have been aware of minor sx related to

chronic dampheat, but nothing like the severe symptoms of many of the spring

warmth patterns.

 

Now, there are other situations where internal symptoms might flare up suddenly,

but those others are usually still distinguishable from spring-warmth in various

ways. For example, food accumulation usually involves recent consumption. Many

acute problems have exterior symptoms. This can be tricky when an exterior

invasion precipitates spring-warmth. Exterior damp-warmth often has an

unnoticeable protective phase according to Liu, so it might seem to suddenly

arise internally, but the symptoms are typically not as severe at the onset as

spring-warmth. It's that severity out of nowhere with a tendency to both recur

and remit that characterize spring-warmth. Now damp-warmth is probably a common

initiating factor for lurking spring-warmth. Then I would suspect that the

flaring of spring-warmth would greatly exacerbate the damp-warmth in a vicious

cycle.

 

So if an RA patient has constant joint pain due to dampheat, that pain could be

worsened by a flare of spring-warmth, even though spring-warmth alone is not

associated with joint pain. Stasis of blood leads to flaring of spring-warmth

and then the heat further congeals the blood. Another vicious cycle. And both

lingering dampheat and lurking spring-warmth progress to damage ying, blood and

yin essences. This leads to flaring of ministerial fire and all the yin fire

scenarios that are attributed to that process. According to Li dong yuan,

ministerial fire is the foe of spleen qi, thus any displacement of that fire

will weaken the spleen (is this water insulting earth?). So is the long term

presence of spring-warmth and dampheat another path that leads to yin fire,

perhaps a very important one?

 

I do not think we should underestimate the role of microorganisms in a wide

range of health disorders. Western medicine's great triumph and bane has been

its focus on microbes. As Pasteur is reputed to have admitted on his deathbed,

Bernard was right; it is also the terrain, not the microbe alone. Bernard was

the great physiologist Claude Bernard who fought with the germ establishment of

his day much as others do today. Bernard did not deny the importance of the

microbe in illness. Bernard's chief claim to fame was his emphasis on the

terrain, a concept that continues to influence french medicine today. Bernard

proved that microbes typically only caused disease in certain environments.

They were not all powerful demons, except under the rarest of circumstances.

Pasteur finally came to accept the overwhelming evidence of this truth. Bernard

believed that attending to the terrain was as vital as clearing the microbe.

 

In fact, public health measures, which are attributed with most of the decline

in microbial illness, far more than vaccines or antibiotics, are really an issue

of terrain: clean water, clean food, sanitation, hygiene. While developed from

germ theory, these measures are aimed at promoting life rather than attacking

illness. They really embrace that nei jing dictum about not waitng to dig a

well. Now we have gone way too far in attacking germs rather than altering our

external and internal terrain. This has resulted in superbugs who just adapt to

the disease promoting terrain in quite Nitzchean way. OTOH, many in the CAM

field are obsessed with the terrain and miss the trees for the forest. I think

you need to see both.

 

I am treating a disseminated valley fever patient (aka Progressive

coccidioidomycosis). He seemed terminal at first, but has now shown

improvement. Actually two interns and one other supervisor involved with this

case are also on this list. My prognosis is guarded, but the patient pointed

out that he had been placed on a new antibiotic just prior to seeing us. He is

also diligently taking his chinese herbs to supplement lung qi and yin. It is

unclear whether he had prior yin damage or this was as a result of the pathogen.

Perhaps the docs finally just stumbled on the right antibiotic. Perhaps the

combination of antibiotics and tonic herbs is the key. The condition is thought

to only be progressive in those who are immunocompromised. And antibiotics do

not kill bacteria, they just stop their growth till natural immunity takes over.

Perhaps the tonics are actually helping the antibiotics work.

 

BTW, this valley fever case certainly has a wen bing nature to it. From merck:

 

" Progressive coccidioidomycosis may develop a few weeks, months, or

occasionally years after primary infections, which may occur long after leaving

endemic areas. Progressive disseminated coccidioidomycosis is more common in men

than women and is more likely to occur in association with HIV infection,

immunosuppressive therapy, the second half of pregnancy or postpartum, advanced

age, and certain ethnic backgrounds (Filipino, African-American, native

American, Hispanic, and Oriental in decreasing order of relative risk).

[note that the inborn or acquired immunocompromise plus the flaring of the

infection long after contraction both smack of spring-warmth. SW can present

with severe respiratory complications, so this might not be so far-fetched]

 

Symptoms often are nonspecific, including low-grade fever, anorexia, weight

loss, and weakness.

 

[these so-called nonspecific sx point to qi and maybe yin xu; low grade fever

appears in qi xu alone - this patient was basically put on bu zhong yi qi tang

plus sheng mai san, though there was some concern in the lung wilting literature

about qi tonics, the presentation seemed to call for it]

 

Extensive pulmonary involvement may cause progressive cyanosis, dyspnea, and

discharge of mucopurulent or bloody sputum. "

 

[and that's where we were on visit 1; of note is the patient's vigor. While

still using his Oxygen, he is much more nergetic, noted by himself, his

companion and our observation. He could barely speak on visit 1, but by visit

4, he was blabbing nonstop. That seemed to suggest some recovery of lung qi]