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02
In Ye Tianshi’s “Theory of Warm Diseases”
“In the case of sweating at the Wei level, it cannot be self-justified”
I
In the 8th section of “Theory of Warm Diseases”: Generally speaking, after the Wei level, it refers to Qi, and after the Ying level, it refers to blood. In the case of sweating at the Wei level, Qi can be cleared, and entering the Ying level can still disperse heat and transform Qi, such as with Xi Jiao (Rhinoceros Horn), Xuan Shen (Scrophularia), and Ling Yang Jiao (Antelope Horn). However, entering the blood may consume blood and disturb it, thus requiring cooling blood and dispersing blood, such as with Sheng Di (Rehmannia), Dan Pi (Moutan), E Jiao (Donkey-hide Gelatin), and Chi Shao (Red Peony).
If the sweating method is equivalent to releasing the exterior, then Ye Tianshi states that “in the case of sweating at the Wei level,” Wei should refer to exterior syndrome, because the cause of warm diseases is heat evil, thus the exterior syndrome of warm diseases naturally becomes wind-heat exterior syndrome. This provides a strong basis for the establishment of wind-heat exterior syndrome.
However, in fact, Ye Tianshi did not propose specific clinical manifestations of Wei level syndrome; on the contrary, he had discussions that were not entirely consistent with this.
For example, in “Theory of Warm Diseases,” it states, “The lung governs Qi and belongs to Wei, the heart governs blood and belongs to Ying.”
This means that Qi and Wei are both affected by heat evil invading the lung, while blood and Ying are both affected by heat evil entering the heart, because “warm evil first invades the lung and then reversely transmits to the pericardium.” This sentence indicates that the nature of the symptoms of Qi and Wei is the same, and the nature of the symptoms of blood and Ying is the same.
It also states, “The evil of cold damage lingers at the exterior, then transforms into heat and enters the interior; warm evil transforms into heat the fastest, and has not yet transmitted to the pericardium, the evil still resides in the lung. The lung governs Qi, which connects with the skin and hair, hence it is said to be at the exterior. At the exterior, initially use warm and cool light agents; if there is wind, add herbs like Bo He (Mint) and Niu Bang Zi (Burdock Seed); if there is dampness, add Lu Gen (Reed Rhizome) and Hua Shi (Talc). Either disperse wind from the heat exterior or drain dampness from the heat below, without clashing with heat, otherwise, it will be isolated.”
What is referred to here as Wei level syndrome and exterior syndrome is actually lung heat syndrome. It is simply because the lung has the function of governing Qi and connecting with the skin and hair, so it can also be called exterior syndrome.
Exterior syndrome, that is, Wei level syndrome, is treated initially with warm and cool light agents like Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction). From the perspective of the formula, Sang Ju Yin is indeed a remedy for clearing heat and dispersing the lung.
Ye Tianshi then states, “Previously mentioned warm and cool agents disperse wind, sweet and bland agents drive out dampness; if the illness still does not resolve, it is gradually wanting to enter the Ying level. If the Ying level is affected by heat, then the blood will be harmed, the spirit will be unsettled, and at night there will be insomnia, or there may be spots appearing, then remove Qi herbs.”
This clearly indicates that the previously mentioned “initially using warm and cool light agents at the exterior” refers to “Qi herbs,” not exterior-releasing herbs. This point can be further supported by evidence later.
When distinguishing the tongue, Ye Tianshi also states, “If discussing the heat transmission to the Ying level, the tongue color must be deep red. Deep red is a dark red color. Initially transmitted, the deep red color is mixed with yellow and white, indicating that the evil of the Qi level has not yet been eliminated, and the Wei level has leaked into the Ying level, both can be harmonized.”
Since the “evil of the Qi level” has not yet been eliminated, how can the treatment method be said to be “leaking Wei”?
It can be seen here that Ye Tianshi refers to “Wei” and “Qi” as one concept, and the essence of this concept is what we now refer to as the concept of “Qi level syndrome.”
In other words, Ye Tianshi’s concept of Wei level syndrome is contradictory.
Most of the time, it is believed that Wei and Qi are the same, which is lung heat syndrome; only “in the case of sweating at the Wei level,” Wei can be considered as exterior syndrome;
However, according to Ye Tianshi’s own statement that “warm evil first invades the lung,” the early stage of warm disease is actually lung heat syndrome. Is the treatment method for lung heat syndrome sweating? This is difficult to justify.
II
Furthermore, Ye Tianshi did not propose specific clinical manifestations of Wei level syndrome, nor did he provide sufficient basis to determine that Wei level syndrome is exterior syndrome.
Currently, we merely separate “Wei level syndrome” and “Qi level syndrome” based on Ye Tianshi’s “in the case of sweating at the Wei level,” defining “Wei level syndrome” as “exterior syndrome” does not fully align with Ye Tianshi’s original intent and is inconsistent with clinical facts.
The basis for determining the nature of Wei level syndrome is clinical manifestations.
Ye Tianshi did not specifically propose the clinical manifestations of Wei level syndrome, but we can analyze the basic manifestations of Wei level syndrome based on Ye Tianshi’s discussions.
The opening of “Theory of Warm Diseases” clearly states: “Warm evil first invades the lung,” evidently, the nature of the early stage of warm disease, which is Wei level syndrome, is heat evil invading the lung, that is, lung heat syndrome. The manifestations of lung heat syndrome can include: fever, thirst, sore throat, cough, a red tip and edges of the tongue, thin white or thin yellow coating, and a floating rapid pulse.
There should not be chills. Because the mechanism of chills is that cold evil binds the Wei Qi, preventing Wei Qi from warming the flesh, while heat evil does not have the nature of attraction or stagnation, and cannot bind Wei Qi, thus chills cannot occur. Without chills, it is certainly not exterior syndrome.
03
In Wu Jutong’s “Differentiation of Warm Diseases”
“Yin Qiao San” formula does not match
I
In “Differentiation of Warm Diseases, Upper Jiao Chapter”
Section 2: “All warm diseases begin in the upper jiao, in the hand Taiyin.”
Section 3: “Taiyin disease has a pulse that is neither relaxed nor tight but rapid, or the two cun pulse is large, the chi pulse is hot, headache, aversion to wind and cold, body heat with spontaneous sweating, thirst, or no thirst, and cough, especially severe heat in the afternoon, is called warm disease.”
Section 4: “Taiyin wind warmth, warm heat, epidemic, winter warmth, initially having aversion to wind and cold, Gui Zhi Tang (Cinnamon Twig Decoction) is the main treatment; but if there is heat without aversion to cold and thirst, the warm and cool balanced agent Yin Qiao San is the main treatment.”
Wu Jutong explains the first half of this section in his notes: “Although it is called warm disease, since there is aversion to wind and cold, it is clear that the warmth arises from within, and wind and cold attack from outside, forming a syndrome of internal heat and external cold,” hence the use of Gui Zhi Tang (with Gui Zhi being twice the amount of Shao Yao).
Section 5: “In Taiyin warm disease, if there is aversion to wind and cold, after taking Gui Zhi Tang, if the aversion to cold resolves but the remaining illness does not resolve, Yin Qiao San is the main treatment.”
This section’s notes state, “If aversion to cold is resolved, there is no wind and cold at all, only residual warm disease.”
The warm and cool balanced agent Yin Qiao San formula
Jin Qiao (Forsythia) 1 liang, Yin Hua (Honeysuckle) 1 liang, Ku Guo (Bitter Apricot) 6 qian, Bo He (Mint) 6 qian, Zhu Ye (Bamboo Leaf) 4 qian, Sheng Gan Cao (Raw Licorice) 5 qian, Jing Jie (Schizonepeta) 4 qian, Dan Dou Chi (Fermented Soybean) 5 qian, Niu Bang Zi (Burdock Seed) 6 qian, Lu Gen (Reed Rhizome)
Grind into powder, take 6 qian each time, decoct with fresh reed root, when the aroma is strong, take it, do not over-boil, as lung herbs should be light and clear; over-boiling will make the flavor thick and enter the middle jiao.
II
The above is Wu Jutong’s discussion related to Yin Qiao San in “Differentiation of Warm Diseases.” There are several issues that need to be explored.
First, the location of the disease in the early stage of warm disease is in the lung, which is consistent with Ye Tianshi’s statement that “warm evil first invades the lung.”
Second, the clinical manifestations in the early stage of warm disease include: the pulse is neither relaxed nor tight but rapid, or the two cun pulse is large, the chi pulse is hot, headache, aversion to wind and cold, body heat with spontaneous sweating, thirst, or no thirst, and cough, especially severe heat in the afternoon.
Notably, “aversion to wind and cold” is significant. Here, Wu Jutong believes that “aversion to wind and cold” is an inherent manifestation of warm disease. His notes state: “The aversion to cold in warm disease is because the lung connects with the skin and hair and also governs the exterior, hence it also has aversion to wind and cold.”
Third, the treatment in the early stage of warm disease, if there is aversion to wind and cold, is Gui Zhi Tang; if there is no aversion to wind and cold, it is Yin Qiao San.
According to Wu Jutong’s notes: “Although it is called warm disease, since there is aversion to wind and cold, it is clear that the warmth arises from within, and wind and cold attack from outside, forming a syndrome of internal heat and external cold, hence still using Gui Zhi (with Gui Zhi being twice the amount of Shao Yao) to release the exterior with a warm method, allowing for slight sweating, thus resolving both cold and heat evils.”
Warm heat evil is the qi of spring and summer, and if there is no aversion to wind and cold, it is clear that there is no external cold, which is not the qi of warm and cool autumn metal, insufficient to resolve it. Gui Zhi is warm and spicy, thus treating warmth with warmth, hence it is said to use fire to assist fire, thus changing from the “Inner Canon” that states ‘wind invades within, treat with warm and cool, assisted by bitter and sweet’ method.”
Here, Wu Jutong believes that aversion to wind and cold indicates the presence of external cold, that is, the presence of exterior syndrome, thus requiring exterior release with Gui Zhi Tang; if there is no aversion to wind and cold, it indicates no external cold, thus Yin Qiao San should be used instead of Gui Zhi Tang for exterior release.
What is the purpose of using Yin Qiao San?
In his notes on Yin Qiao San, he believes it is “purely to clear and purify the upper jiao,” evidently not for exterior release, but to clear lung heat. Because “warm evil first invades the lung,” “all warm diseases begin in the upper jiao, in the hand Taiyin.”
Fourth, through the above analysis, it can be seen that Wu Jutong’s understanding of the “aversion to cold” appearing in the early stage of warm disease is contradictory.
In his notes on section 3, he believes that warm disease itself can also present “aversion to cold,” while in his notes on section 4, he believes that “aversion to cold” has external cold.
However, in his subconscious, he ultimately regards “aversion to cold” as an inherent manifestation of the early stage of warm disease, thus he simultaneously states that the main symptom of Yin Qiao San is “only heat, without aversion to cold and thirst,” while also including in the formula herbs that are clearly warm and spicy for exterior release, such as Jing Jie (Schizonepeta) and Dan Dou Chi (Fermented Soybean).
It is precisely this self-contradiction that has allowed the erroneous theory that the early stage of warm disease is wind-heat exterior syndrome and that Yin Qiao San is a warm and cool exterior-releasing agent to become widely accepted.
Fifth, from Wu Jutong’s original intent, the purpose of using Yin Qiao San is undoubtedly to clear lung heat.
From the use of Yin Hua (Honeysuckle) and Lian Qiao (Forsythia) as the name of the formula, as well as being the main herbs with the largest dosage in the formula, this emphasizes the heat-clearing effect of Yin Qiao San, as Yin Hua and Lian Qiao are well-known herbs for clearing heat and detoxifying. The other herbs in the formula, aside from Jing Jie and Dan Dou Chi, are also heat-clearing herbs.
For this reason, I believe that Yin Qiao San should remove Jing Jie and Dan Dou Chi when used for warm disease in the early stage without aversion to cold.
Note: Cover image source from Shetu Network.
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