Warm disease pattern identification

The process of diagnosing a morbid condition as a warm disease pattern.

Warm disease patterns are externally contracted disease patterns identified in the warm disease school. By contrast to the cold damage school, which focuses primarily on the invasion of cold evil, the warm disease school holds externally contracted disease to be essentially hot in nature.

Warm disease takes assumes diverse forms, such as wind warmth, damp warmth, spring warmth, summerheat warmth, and warm dryness (autumn dryness), which are seasonally related.

Warm diseases are understood to progress through the body stage by stage in two different ways: either through the four aspects, namely defense, qì, provisioning, and blood or through the triple burner (upper, center, and lower). These trajectories of progression provide two systems of pattern identification, which can be applied whatever the nature of the invading of the invading evil.

Warm disease analysis shares considerable common ground with cold damage theory. Like cold damage theory, it understands disease to progress through different stages defined by the body parts or aspects of physiology. Even though the four-aspect and triple-burner pattern identification provide the main framework of analysis, the channels are adduced to explain finer distinctions between patterns. As in cold damage, not all external contractions progress through all stages; most are resolved in the early stages.

Origins

The doctrine of warm diseases arose in the Míng and Qīng dynasties as a new alternative to the doctrine of cold damage. The concept of warmth as a cause of disease appears in the Nèi Jīng. However, the concept was not taken up in the Shāng Hán Lùn, as this text focused on cold damage. It was not until the second millennium that warmth gained in importance as a proposed cause of externally contracted disease. This development may have been related to changes in the nature of externally contracted diseases attributable to the increasing settlement of the warmer, southern parts of China and increasing urban concentrations throughout the country.

Warm Diseases

Warm disease theory recognizes numerous diseases, most of which are seasonally related and named after the evils causing them. They can all be analyzed in terms of the four-aspect pattern identification system. Here are some examples of warm diseases:

Wind warmth (风温 fēng wēn) occurs mostly in winter and spring, in the initial stages of external contraction, when the lung and defense are affected. It manifests in heat effusion, cough, and slight thirst. The tongue fur is white; the tongue is red at the margins and tip. The pulse is floating and rapid.

Summerheat warmth (暑温 shǔ wēn) occurs in the summer and is initially characterized by vigorous heat effusion, vexing thirst, and sweating. The pulse is large and surging. The disease develops swiftly and easily damages liquid and qì.

Damp warmth (湿温 shī wēn) mostly occurs in damp summer weather. In the initial stages, it manifests in generalized heat failing to surface, generalized heaviness and fatigued limbs, oppression in the chest, and glomus in the stomach duct. The tongue fur is slimy. The pulse is moderate. Dampness accounts for the heat that fails to fully reach the surface, which can only be felt on prolonged palpation. It also accounts for the sensations of heaviness and oppression.

Warm dryness (温燥 wēn zào), also called autumn dryness, occurs in dry autumn weather (of China). It is marked by dry pharynx, dry nose, and dry skin.

Massive head scourge (大头瘟 dà tóu wēn) is a disease characterized by hot red swollen face. It occurs mostly in winter and spring and is attributed to wind warmth toxin. It is equivalent to mumps.

Putrefying throat sand (烂喉痧 làn hóu shā) is a disease marked by an ulcerating painful swollen pharynx with heat effusion and a papular eruption described as sand speckles (沙点 shā diǎn) or cinnabar sand (丹痧 dān shā) appear all over the body. It corresponds to scarlatina in biomedicine.

Four-Aspect Pattern Identification

The four-aspect pattern identification system was developed by Yè Guì (叶桂, also called Tiān-Shì 天士) of the Qīng Dynasty. It incorporates the Nèi Jīng’s concepts of defense, qì, provisioning, and blood, but adds a new sense of levels through which externally contracted disease progresses. The notion of different levels of progression was inspired by the six-channel system of cold damage progression found in the Shāng Hán Lùn. So, like cold damage theory, it represents a new development of ancient ideas grounded in clinical observation.

According to four-aspect pattern identification, externally contracted disease evils invading the body normally first settle in the defense aspect. Depending on the nature and strength of the evil and the state of the body’s right qì, the disease can penetrate the qì aspect, the provisioning aspect, and finally the blood aspect. The levels are related to different organs and channels.

Defense-aspect patterns are usually the first stage of warm-heat disease. The condition is relatively mild and affects the lung, skin, and body hair.

Qì-aspect patterns are interior patterns. They are more severe than defense-aspect patterns. The disease can be focused in various possible locations, including the lung, chest and diaphragm, gallbladder, triple burner, stomach, and intestines.

Provisioning-aspect patterns are the manifestation of evil heat falling inward to affect the heart and pericardium.

Blood-aspect patterns represent the deepest level of penetration, where the evil enters the heart, liver, and kidney, stirring the blood, engendering wind, and damaging yīn-blood.

Sequence of stages

The normal sequence of transmission is defense → qì → provisioning → blood. Depending on seasonal conditions, the nature of the evil, and the strength of the patient’s constitution, different sequences are observed.

• Sometimes qì patterns, provisioning patterns, or blood patterns occur in the initial stage.
• In some cases, evil in the defense aspect may fail to resolve before qì-aspect or provisioning-aspect signs appear. These situations are called dual disease of defense and qì and dual disease of defense and provisioning.
• Sometimes, evil in the qì aspect may fail to resolve before provisioning-aspect or blood aspect signs appear. Such situations are called dual disease of qì and provisioning and qì and blood both ablaze respectively.

Triple-Burner Pattern Identification

Triple-burner pattern identification was developed by Wú Táng (吴瑭, also called Jú-Tōng鞠通) in his Wēn Bìng Tiáo Biàn (温病条辨 Systematized Identification of Warm Disease), which appeared in 1798. It is based on the Nèi Jīng concept of the triple burner and the six-channel and the four-aspect pattern identification systems, combined with the warm heat disease laws of passage and transformation. Triple-burner pattern identification represents an alternative method to four-aspect pattern identification in understanding warm-heat disease.

In triple-burner pattern identification, warm disease is understood to progress through the three burners from the upper burner downwards.

Warm disease is divided into initial, middle, and final stages. It starts in the greater yīn (tài yīn) lung channel in the upper burner, at which stage the disease is shallow and mild. When disease of the upper burner fails to resolve, it passes to the spleen and stomach in the center burner, so affected the spleen, stomach, and large intestine. This represents a deeper stage of penetration, at which the patient’s condition is more severe. When center burner disease fails to resolve, it enters the liver and kidney in the lower burner. At this stage, the disease evil has penetrated the body deeply, and the condition is critical. This is the final stage of the disease.

Depending on the nature of evil and differences in constitution, disease in the upper burner may resolve and not pass any further. Sometimes the disease passes from the upper burner straight to the lower burner. In some cases, a center burner disease pattern may be the first to appear. Sometimes, two or all three burners may be simultaneously affected by disease.

Upper-burner disease: The upper burner includes the hand greater yīn (tài yīn) lung channel and the hand reverting yīn (jué yīn) pericardium channel.

In initial-stage warm disease, warm-heat evils enter the lung channel giving rise to exterior patterns marked by heat effusion and aversion to cold.

When the evil fails to resolve, it can penetrate the interior of the lung, giving rise to a pattern of exuberant interior heat characterized by heat effusion without aversion to cold.

When the evil fails to resolve in the lung channel, it can pass directly to the pericardium giving rise to a pattern of heat blocking the heart spirit which is marked by clouded spirit.

Center-burner disease: The center burner includes the hand and foot yáng míng (yáng míng) large intestine and stomach channels and the foot greater yīn (tài yīn) spleen channel. The spleen and stomach reside in the center and stand in exterior-interior relationship with each other.

Yáng míng (yáng míng) is associated with dryness; when evils enter it, they transform under the influence of dryness into dryness-heat. The greater yīn (tài yīn) is associated with dampness; when evils enter it, they transform into dampness. Hence, in the realm of externally contracted disease, yáng míng (yáng míng) disease largely takes the form of dryness-heat, while greater yīn (tài yīn) disease is largely associated with damp-heat.

Lower-burner disease: The lower burner includes the foot lesser (shào yīn) yīn kidney channel and the foot reverting yīn (jué yīn) liver channel.