Warm disease

Any of various febrile diseases characterized by rapid onset and shifts, pronounced heat signs, and a tendency to form dryness and damage yīn.

History: The concept of warm disease was first mentioned in The Inner Classic (内经 nèi jīng). For example, Plain Questions (素问 sù wèn, shēng qì tōng tiān lùn) states, Damage by cold in winter necessarily engenders warm disease in the spring. Zhāng Jī (Zhòng-Jǐng) of the Hàn Dynasty in On Cold Damage and Miscellaneous Diseases (伤寒杂病论 shāng hán zá bìng lùn) mentions warm disease, stating, for example, greater yáng (tài yáng) disease with heat effusion and cough and without aversion to cold is warm disease. If sweating is applied, and there is generalized heat, this is wind warmth. However, the concept of warm disease was not central to his systematic presentation of externally contracted disease which placed the emphasis on wind and cold as the major causes of these diseases. Zhāng Jī’s theories centuries after in the Sòng Dynasty were to become the focus of the cold damage school, whereas the concept of warm disease was to become the focus of a rival school, the warm disease school. In the Suí-Táng Period, The Origin and Indicators of Disease (诸病源候论 zhū bìng yuán hòu lùn) mentions warm diseases, their causes, patterns, and major principles of treatment.

Successive generations of doctors wrote about warm disease, and in the Míng Dynasty writings on the subject became more prolific. This development is attributable on the one hand to the opening up of the south of China where febrile diseases tended to be of a different nature than in the north, and on the other to pestilences arising as a result of wars. In this period, Wu You-Xing in On Warm Epidemics (Wú Yǒu-Xìng 吴有性 [Yòu-Kě 又可], 温疫论 wēn yì lùn) explained in detail the laws governing the origin, development and pattern identification of warm epidemics. Notably, he posed the etiological notion of a contagious perverse qì (戾气 lì qì). This notion represented a break away from the traditional conception of febrile diseases being caused by climatic influences (e.g., the wind and cold of the cold damage school), and made a great contribution to the foundation of the doctrine of warm diseases that developed later.

In the Qīng Dynasty, a comprehensive doctrine of warm diseases began to emerge. Ye Tian-Shi, in On Warm Heat (温热论 wēn rè lùn), introduced the four-aspect (provisioning, qì, provisioning, and blood) pattern identification system. Xuē Xuě, in Systematized Identification of Damp-Heat (湿热条辨 shī rè tiáo biàn), described in detail damp-externally contracted febrile disease patterns. Wu Ju-Tong, in Systematized Identification of Warm Diseases (Wú Táng 吴瑭 [Jú-Tōng 鞠通], 温病条辨 wēn bìng tiáo biàn), posed the notion of triple-burner pattern identification in the treatment of warm and damp-externally contracted febrile diseases. Finally, Wáng Shì-Xióng (王士雄), in Warp and Weft of Warm Heat (温热经纬 wēn rè jīng wěi), brought together all the theories of his predecessors in a complete doctrine of warm diseases.

Theory: The doctrine of warm diseases considers warm disease to embrace all externally contracted febrile diseases. All such diseases have heat as a common feature and consequently they show a tendency toward dryness formation and a resultant damage to yīn. Although the doctrine identifies many different diseases, the major classifications are wind warmth, damp warmth, and warm heat.

1. Wind warmth is characterized by heat effusion, and signs of exuberant lung or stomach heat such as cough, rapid breathing, flaring nostrils, and thirst.
2. Damp warmth is characterized by persistent heat effusion and signs of obstruction and stagnation caused by dampness, such as oppression in the chest, nausea, diminished appetite, abdominal distension, constipation or diarrhea, and slimy tongue fur.
3. Warm heat is characterized by high fever, red complexion, thirst, maculopapular eruptions, heart vexation and, in severe cases, clouded spirit.

Defense, qì, provisioning, and blood are the four aspects used for identification and treatment of warm disease patterns. They are used to explain the origin and development of externally contracted febrile diseases; like the six channels of the doctrine of cold damage, they explain the degree of penetration, severity, and acuteness of diseases. In On Warm Heat (温热论 wēn rè lùn), Ye Tian-Shi states, The general conception [of the doctrine of warm diseases] is that qì comes after defense and that blood comes after provisioning. When disease affects defense, sweating can be administered. Only when it reaches the qì aspect can qì-clearing treatment be prescribed. When it enters provisioning, treatment involves outthrusting heat to the qì aspect. Finally, when it reaches blood and causes depletion and frenetic movement, treatment involves cooling and dispersing the blood. These lines represent the general outline of the four-aspect pattern identification and treatment system of the doctrine of warm diseases. See entries listed below. See also warm disease pattern identification.