2. On TCM’s Heat Disease Syndrome

2. On TCM’s Heat Disease Syndrome

In “Treatise on Cold Damage,” it states: “When the Sun is affected, the pulse is floating, the head and neck are stiff with pain and cold, sometimes with fever, sometimes without fever—but always with chills, body aches, nausea, and vomiting, and the pulse is tight in both yin and yang, this is called cold damage.” “When fever and chills occur, and the pulse is slow, this is called wind damage.” “When fever and thirst occur, but no chills, this is heat disease.” “When the Sun is affected, the Yang is floating while the Yin is weak; when the Yang is floating, heat arises spontaneously, while the Yin is weak, sweat comes out, with slight chills, shivering, and a feeling of heat, nasal congestion, and dry vomiting—this is treated with Gui Zhi Tang.” “When the Sun is affected, the pulse is floating and tight, with fever and chills, body pain, and restlessness—this is treated with Da Qinglong Tang.” “When the Sun is affected, after sweating, do not administer Gui Zhi Tang again; when sweat appears and breathing becomes labored, and there is no high fever, this is treated with Ma Xing Shi Gan Tang.” “When cold damage occurs, the exterior is not resolved, but there is water retention in the heart, with nausea, fever, cough, diarrhea, choking, difficulty urinating, abdominal distension, and wheezing—this is treated with Xiao Qinglong Tang.” “When cold damage occurs, the Sun is affected, with a floating and tight pulse, fever and chills, chest and flank discomfort, restlessness, and a desire to eat but unable to do so, with heartache and nausea, or chest discomfort without nausea, or cough, or abdominal pain, or a hard, swollen area under the ribs, or palpitations, or difficulty urinating, or no thirst, but a slight fever and cough—this is treated with Xiao Chai Hu Tang.” “After the Sun is affected, the chest feels heavy and restless, the whole body is heavy, with difficulty urinating, delirium, and inability to turn over—this is treated with Chai Hu Jia Long Gu Mu Li Tang.” These passages are the primary references in “Treatise on Cold Damage” for Sun and Shaoyang diseases. What is their essence? Without proper Western diagnosis as a basis, it is difficult to accurately identify the formula and medication corresponding to these passages. However, with Western diagnosis, we can more easily grasp the applications of these classic formulas. The “cold damage” described above generally refers to severe colds caused by viruses, as well as asthma and lung infections resulting from severe colds. Mahuang Tang, Da Qinglong, Xiao Qinglong, and Ma Xing Shi Gan Tang are all effective formulas for treating these conditions. Japanese physician Danbo Motoyasu, a master of Japanese traditional medicine, believed that these formulas were the best options for treating lung infections—clearly, those who know the art agree. “Wind damage,” on the other hand, is a common cold, characterized by the symptoms described in Gui Zhi Tang—“slight chills, shivering, a feeling of heat, nasal congestion, and dry vomiting”—which are remarkably similar to common colds in modern medicine. More importantly, the adjustments and additions to Gui Zhi Tang are effective formulas for treating common colds today. Of course, Gui Zhi Tang’s primary use lies in regulating autonomic nervous system dysfunction, which is why Gui Zhi Tang is often referred to as “regulating the outer Qi and Wei, and calming the internal organs.” The term “heat disease” was only mentioned in “Treatise on Cold Damage,” but its content was not fully elaborated until the Ming and Qing dynasties, when the Warm Disease School introduced Sangju Yin and Yinqiao San, effectively treating early-stage heat disease, thus filling the gaps in “Treatise on Cold Damage.” So, from a modern medical perspective, what exactly is “heat disease”? “Heat disease” refers to bacterial infections, while “cold damage” refers to viral infections; “wind damage” also involves viral infection.

One thousand seven hundred years ago, a great plague swept across half of the globe. Zhang Zhongjing wrote, “My clan numbers many, and I have lost two hundred relatives since the Jian’an era—two-thirds of them died, and seven out of ten suffered from cold damage.” This demonstrates just how severe the plague was. According to Japanese researchers, this plague spread throughout Japan, and analyses of ancient remains revealed a filtrating virus, confirming that the plague was caused by a filtrating virus. My own experience shows that Mahuang Tang and Gui Zhi Tang are effective against today’s influenza; the Mai Gui Compound I formulated by me is an effective formula for treating current colds. Ancient physicians used the pulse’s floating or tight nature, along with whether the mouth was thirsty or not, to differentiate between heat disease and cold damage—a concept that is quite vague, because thirst or lack of thirst, a rapid or slow pulse, a tight or loose pulse—all depend on individual differences, environmental factors, and even the patient’s mindset. These variable factors can seriously compromise the accuracy of diagnosis. From a modern medical perspective, heat disease is considered a bacterial infection, while cold damage is a viral infection. The initial symptoms of heat disease often include sore throat and enlarged tonsils, whereas cold damage typically does not present with these symptoms. Once we understand this distinction, differentiating between cold damage and heat disease becomes much easier. For anyone experiencing cold symptoms accompanied by sore throat, Sangju and Yinqiao are suitable; for those without sore throat, Mahuang Gui Zhi Tang is ideal. Applying this understanding in clinical practice often leads to effective treatment of underlying conditions. As for the Xiao Chai Hu Tang formula, from a Western medical perspective, it is actually a subacute or chronic inflammatory syndrome—bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, heartache and nausea, restlessness and unwillingness to eat—these seven symptoms can appear in chronic or subacute inflammation of any organ. In “Treatise on Cold Damage,” it is clearly stated: “If only one symptom appears, there is no need for all symptoms to be present.” This description of the Xiao Chai Hu formula is a significant contribution. A patient with bitter taste in the mouth, after numerous tests, turned out to be suffering from hepatitis; another patient with chest and flank discomfort, after thorough examination, was found to have exudative pleurisy—there are countless examples like this.