Introduction:Xiong Zhicheng is a fourth-generation disciple of Master Xiao Xiangru. Today, let us revisit the content related to external pathogenic diseases as recorded by Brother Xiong from the book “Reconstruction”.
Reconstructing the Diagnostic and Treatment System for Early External Pathogenic Diseases
Careful reading of the book “Reconstruction” reveals the immense effort and dedication the master has put into standardizing the diagnosis and treatment of early external pathogenic diseases. Learning this content provides us with a framework to improve the treatment efficacy of external pathogenic diseases and lays a foundation for further exploration in this field by more scholars, pointing out the direction.Currently, the master is constructing the “Study of External Pathogenic Diseases in Traditional Chinese Medicine”, striving to unify the long-debated concepts of cold damage (shanghan) and warm diseases (wenbing) within the system of external pathogenic diseases in TCM. As students and disciples, we are filled with anticipation.What follows is a transcription of the relevant content from the book “Reconstruction” to deepen our understanding:
1. Diagnostic and Treatment Norms for Early Cold Pathogenic Diseases1. Taiyang Cold Damage Syndrome[Clinical Manifestations]Chills, fever, no sweating, headache and body aches, or stiffness in limbs, nasal congestion, clear nasal discharge, pale tongue with thin white coating, and a floating tight pulse.[Syndrome Analysis]Cold pathogens invade the exterior, binding the defensive qi, preventing it from warming and distributing the flesh, leading to chills; when the cold pathogen invades the exterior, the defensive qi rises to resist the pathogen, resulting in fever.The mechanisms of fever caused by external cold and internal heat are different, and the treatments are fundamentally distinct, which requires high attention; cold pathogens bind the exterior, blocking the pores, hence no sweating;when cold pathogens bind the exterior, the meridians are obstructed, leading to headache and body aches or stiffness; the lungs are associated with the skin and hair, and when cold pathogens bind the exterior, lung qi is obstructed, resulting in nasal congestion and clear nasal discharge; a pale tongue with thin white and moist coating indicates a cold tongue pattern; a floating pulse indicates an exterior condition, and a tight pulse indicates cold, thus a floating tight pulse is a sign of cold pathogens binding the exterior.[Treatment Method]Warmly disperse and induce sweating to expel cold.[Formulas]For mild cases: Scallion and Fermented Soybean Decoction (Cong Chi Tang) (scallion white, fermented soybeans) with Jing Jie (Schizonepeta), Fang Feng (Siler), Su Ye (Perilla Leaf), and Xing Ren (Apricot Kernel);For severe cases: Ma Huang Decoction (Ma Huang, Gui Zhi, Xing Ren, Gan Cao).2. Taiyang Wind Stroke Syndrome[Clinical Manifestations]Chills, fever, sweating, headache, nasal sound, dry retching, pale tongue, thin white coating, and a floating slow pulse.[Syndrome Analysis]Taiyang Wind Stroke Syndrome occurs in individuals with a weak spleen and stomach constitution, where the pores are loose, and they are affected by a lighter cold pathogen.When cold pathogens invade the exterior, they bind the defensive qi, preventing it from warming and distributing the flesh, leading to chills; when cold pathogens invade the exterior, the defensive qi rises to resist the pathogen, resulting in fever; in individuals with a weak spleen and stomach constitution, the pores are loose, and the exterior is not solid, leading to sweating;when cold pathogens bind the exterior, the qi is not smooth, resulting in headache; when cold pathogens bind the exterior, lung qi is not disseminated, leading to nasal sound; when cold pathogens bind the exterior, they affect the stomach qi and cause dry retching; a pale tongue with thin white coating indicates a cold tongue pattern; when cold pathogens invade the exterior, the pulse is floating, and sweating leads to a slow pulse.[Treatment Method]Release the muscles, disperse cold, and harmonize the nutritive and defensive qi.[Formulas]Gui Zhi Decoction (Gui Zhi, Bai Shao, Sheng Jiang, Zhi Gan Cao, Da Zao). Clinical use of Gui Zhi Decoction should follow the original decoction and care methods.[Special Reminder]The fever from early Taiyang cold damage is often very high, as stated in the “Huangdi Neijing”: “Due to cold, the body feels like burning charcoal, and sweating disperses it.” Current textbooks differentiate the nature of cold and heat in early external pathogenic diseases based on the severity of fever and chills, which leads to most people being unable to correctly judge the cold and heat attributes of early external pathogenic diseases. In the face of high fever from early cold pathogens, most people will use cold medicines, reasoning that for fever, even if misdiagnosed, using cold medicine is less severe than using heat medicine.Thus, the misuse of cold and cool medicines in the early stages of cold pathogens has become a trend, with no one considering it wrong.If Ma Huang Decoction is not used in time, it may develop into Da Qing Long Decoction; if Da Qing Long Decoction is not used, it may develop into Ma Xing Shi Gan Decoction syndrome. Ma Huang Decoction syndrome is a cold, while Ma Xing Shi Gan Decoction syndrome is pneumonia. Is this not a serious consequence?Therefore, for early cold pathogens, regardless of the height of fever, as long as there are chills, no sweating, headache and body aches, pale tongue, thin white coating, and floating tight pulse, Ma Huang Decoction should be used promptly, often resolving with one sweat. 2. Diagnostic and Treatment Norms for Early Heat Pathogenic Diseases1. Heat Pathogen Invading the Lung Syndrome[Clinical Manifestations]Fever, sweating, no chills or alternating chills and fever, thirst, headache, red and swollen sore throat, cough, red tongue edges and tip, thin white or thin yellow coating, and a floating rapid pulse.[Syndrome Analysis]Ye Tianshi stated: “Warm pathogens first invade the lungs.”The initial location of external heat pathogens is in the lungs, leading to the lung heat syndrome.Heat pathogens in the lungs manifest as fever, even alternating chills and fever; heat pathogens do not have the property of binding and stagnation, so there are no chills;internal heat forces the fluids to leak out, resulting in sweating;heat pathogens invade the clear orifices, leading to headache;the throat is the gateway of the lungs, and lung heat can cause red and swollen sore throat;red tongue edges and tip, thin white or thin yellow coating indicate the tongue pattern of early heat pathogens invading the lungs;a floating pulse indicates the location of the disease in the lungs, and a rapid pulse indicates heat, thus a floating rapid pulse is a sign of heat pathogens in the lungs.[Treatment Method]Clear heat and resolve lung heat.[Formulas]Sang Ju Yin (Sang Ye, Ju Hua, Bo He, Lian Qiao, Ku Jie Geng, Gan Cao, Wei Gen) is for mild fever, mild sore throat, and predominant cough; Yin Qiao San (Lian Qiao, Jin Yin Hua, Ku Jie Geng, Bo He, Niu Bang Zi, Zhu Ye, Jing Jie Sui, Sheng Gan Cao, Dan Dou Chi). For higher fever, predominant sore throat, and mild cough, remove Jing Jie Sui and Dan Dou Chi. The cause of warm diseases is certainly heat pathogens, and the initial stage of external heat pathogens is in the upper jiao Taiyin, which is the lungs. Taiyin warm disease is the lung heat syndrome caused by heat pathogens invading the lungs. Therefore, the effects of Sang Ju Yin and Yin Qiao San are to clear and resolve lung heat.2. Heat Invading Yangming Syndrome[Clinical Manifestations]High fever with profuse sweating, thirst, irritability, headache, flushed face, red tongue, yellow dry coating, and slippery or floating pulse.[Syndrome Analysis]If the external heat is intense, like in summer, or if the stomach yang is vigorous, it can easily lead to heat entering Yangming.Stomach heat is intense, and heat pathogens fill both internally and externally, leading to high fever; intense heat forces fluids to leak out, resulting in profuse sweating; intense heat injures fluids, combined with excessive sweating, leads to thirst; heat disturbs the mind, resulting in irritability; heat rises and attacks the head and face, leading to flushed face and headache; intense heat forces qi and blood to circulate rapidly, resulting in a slippery or floating pulse.(1) In individuals with normal constitution, the initial stage of external heat pathogens is in the lungs, leading to lung heat syndrome, as previously mentioned with Sang Ju Yin and Yin Qiao San; (2) If lung heat is not resolved in time, it can progress to Yangming heat syndrome, forming Bai Hu Tang syndrome; if individuals with normal constitution are affected by cold pathogens, the initial stage is in Taiyang, as previously mentioned with Taiyang cold damage. If Taiyang cold damage is not resolved in time, cold pathogens can transform into heat internally, leading to Yangming heat syndrome; individuals with normal constitution can develop Yangming heat syndrome from either cold or heat pathogens, but this is not the initial stage, rather it is a result of progression, representing the second stage of the disease.Individuals with vigorous stomach yang who are affected by cold pathogens will quickly progress to Yangming, forming Bai Hu Tang syndrome, but this is not the initial stage; there will be a brief process of Taiyang disease; individuals with vigorous stomach yang who are affected by heat pathogens, or individuals with normal constitution affected by intense heat pathogens, such as in summer, will have Yangming heat syndrome as the initial stage. The former is “Zheng Yang Yangming” in the “Shang Han Lun”, while the latter is the “heat of summer” described by Ye Tianshi.Vigorous stomach yang is the internal cause, while intense heat pathogens are the external cause.[Treatment Method]Spicy cold to clear heat.[Formulas]Bai Hu Tang (Sheng Shi Gao, Zhi Mu, Jing Mi, Zhi Gan Cao) is also referred to as “Yangming Meridian Syndrome” or “Yangming Heat Syndrome”. In warm disease studies, it is mainly used for warm disease qi level syndrome and summer heat, being a major syndrome of qi level syndrome, also known as “Yangming warm disease” or “Middle Jiao warm disease”.[Special Reminder]In the early stages of external heat pathogens, there are no chills because heat pathogens do not have the property of binding and stagnation, so they do not bind the body’s defensive qi, hence no chills.Chills may be observed in the early stages of external heat pathogens, but chills are not a manifestation of early external heat pathogens themselves, rather they are a concurrent syndrome, indicating lung heat combined with external cold pathogens.Treatment should be based on the severity of external cold pathogens and lung heat; if external cold pathogens are predominant, Gui Zhi Decoction should be used first to disperse cold; if lung heat is predominant with slight external cold pathogens, the original formula of Yin Qiao San should be used, removing the dispersing herbs Jing Jie and Dou Chi if there are no chills.For a lighter approach than Yin Qiao San, Sang Ju Yin can be used, while for a heavier approach, Bai Hu Tang syndrome can be used. This illustrates the concept of light, moderate, and heavy treatments.Current textbooks mistakenly consider chills as an inherent manifestation of external heat pathogens, leading to the classification of early external heat pathogens as “wind-heat exterior syndrome” and the treatment methods as “spicy-cool exterior resolution”, confusing the concepts and causing chaos in the treatment of early external pathogenic diseases.3. Diagnostic and Treatment Norms for Early Dry Pathogenic Diseases[Clinical Manifestations]Dry cough without phlegm, or scanty and sticky phlegm, thirst, dry throat, dry nose, red tongue, thin white and dry coating, and a rapid large right pulse.[Syndrome Analysis]In the early stages of external dry pathogens, the disease is located in the lungs, easily injuring lung fluids. Damage to lung fluids affects the lung’s ability to disseminate and descend, leading to cough; lung fluid damage results in dry cough without phlegm, or scanty and sticky phlegm, thirst, dry throat, and dry nose; fluid damage leads to yin deficiency, which in turn causes lung heat, hence the red tongue, thin white and dry coating, and rapid large right pulse indicating lung heat syndrome.[Treatment Method]Clear and disseminate lung heat, nourish yin and moisten dryness.[Formulas]Sang Ju Yin (Sang Ye, Ju Hua, Bo He, Lian Qiao, Ku Jie Geng, Gan Cao, Wei Gen) with Sha Shen and Pear Skin; or use Sang Xing Tang (Sang Ye, Xiang Bei, Xiang Chi, Zhi Pi, Pear Skin, Xing Ren, Sha Shen).[Special Reminder]The cough from external heat pathogens is primarily due to lung heat, with a tendency and manifestation of fluid damage, but lung heat is the main aspect of the contradiction; when lung heat is cleared, fluids will naturally be preserved;the early stages of external dry pathogens primarily involve fluid damage, with a tendency and manifestation of lung heat, but lung heat is caused by fluid damage leading to yin deficiency, which in turn leads to lung heat. Fluid damage is the main aspect of the contradiction, and treatment should focus on generating fluids and moistening dryness, while also clearing lung heat.In the early stages of external dry pathogens, current textbooks refer to it as “autumn dryness exterior syndrome”; the reason for this is that early external dry pathogens may sometimes show “slight aversion to wind and cold”.It is important to note that dry pathogens do not have the property of binding and stagnation, and cannot bind the body’s defensive qi, thus cannot lead to “chills”.Therefore, “chills” are not an inherent manifestation of early external dry pathogens, but rather a concurrent syndrome, indicating fluid damage in the lungs combined with external cold pathogens. Treatment varies based on the presence of “chills”.(1) If there are no “slight aversion to wind and cold”, then clear and disseminate lung heat, nourish yin and moisten dryness, using Sang Ju Yin with Sha Shen, Mai Dong, Pear Skin, and Pollen, or use Sang Xing Tang; (2) If there is “slight aversion to wind and cold”, then it is advisable to also disperse cold, adding Jing Jie and Fang Feng to the previous formula.4. Diagnostic and Treatment Norms for Early Damp Pathogenic Diseases[Clinical Manifestations]Headache and heaviness in the body, shoulder and back pain that is difficult to turn, or heavy pain in the lower back and spine; white slippery coating, and a soft pulse are also signs of dampness; since dampness is a yin pathogen, heavy and turbid, it can bind the defensive qi, hence chills may also be present.[Treatment Method]Disperse dampness and expel cold.[Formulas]Qiang Huo Sheng Shi Tang (Qiang Huo, Du Huo, Gao Ben, Fang Feng, Gan Cao, Man Jing Zi, Chuan Xiong).[Special Reminder]Because dampness is heavy, turbid, and sticky, it can bind the defensive qi, preventing it from warming and distributing the flesh, hence chills are an inherent manifestation of early damp pathogenic diseases.The deeper theoretical basis is that dampness is similar to water, and water is inherently cold, so dampness shares many characteristics with cold. Additionally, the treatment methods for dispersing cold and dampness are similar; for example, Cang Zhu and Bai Zhi can disperse both dampness and cold.5. Concurrent Pathogenic Syndromes(1) When heat and cold pathogens are concurrent, if heat is predominant and cold is mild, use Yin Qiao San with modifications; if cold is predominant and heat is mild, use Da Qing Long Tang or Jiu Wei Qiang Huo Wan with modifications;(2) When cold and dry pathogens are concurrent, use Sha Shen Mai Dong Tang combined with Cong Chi Tang with modifications;(3) When heat and dry pathogens are concurrent, use Sang Ju Yin or Sang Xing Yin with modifications;(4) When cold and damp pathogens are concurrent, use Qiang Huo Sheng Shi Tang with modifications, adding Xiang Ru and Huo Xiang;(5) When heat and damp pathogens are concurrent, if heat is predominant and dampness is mild, use Bai Hu Tang with Cang Zhu; if dampness is predominant and heat is mild, use Xin Jia Xiang Ru Yin with modifications.Click to view: Xiong Zhicheng: Insights on Learning the “Reconstruction of the Diagnostic and Treatment System for Early External Pathogenic Diseases”
Note:Please follow medical advice for specific treatment and medication!
This article is excerpted from: Master Xiao’s Lecture Hall, Author: Xiong Zhicheng. Cover image sourced from Shetu Network.
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