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Last time, I discussed the TCM nomenclature for COVID-19, which involved many concepts of external pathogenic diseases. Today, I want to explain how to avoid confusion regarding these various concepts.
01
Standard Nomenclature of External Pathogenic Diseases in TCM
Level One: TCM categorizes diseases based on etiology into external pathogenic diseases and internal injury diseases.
Level Two: Diseases caused by external pathogens are classified as external pathogenic diseases; among these, infectious diseases are termed as epidemics.
Level Three: External pathogenic diseases can be further divided based on specific pathogens into external cold pathogens, external heat pathogens, external damp pathogens, and external dry pathogens.
The current textbooks on external pathogenic disease etiology are not standardized; for detailed explanations, please refer to my “Reconstruction of the Differentiation and Treatment System for Early External Pathogenic Diseases.”
Level Four: Each specific external pathogenic disease can be divided into three stages: early, middle, and late. For example, early external cold pathogen, middle external cold pathogen, late external cold pathogen.
The early stage of external pathogenic diseases is a critical phase for treatment and is also the stage most prone to misdiagnosis under the current textbook system, which requires high attention.
The manifestations in the middle and late stages are relatively clear and less prone to misdiagnosis; therefore, efforts should be focused on the differentiation and treatment of early external pathogenic diseases. Moreover, the nature of the pathogenic factors in the middle and late stages does not completely correspond to that of the early stage. For instance, an external cold pathogen can transform into heat, leading to a heat syndrome in the middle and late stages.
In the textbooks of TCM colleges, concepts such as cold damage and heat diseases from the “Huangdi Neijing,” the broad and narrow definitions of cold damage from the “Nanjing,” and the broad definition of cold damage from the “Shanghan Lun” should be removed, as well as the concept of warm diseases and the concept of exterior syndromes from the textbooks.
These concepts arose from their historical context and have inconsistencies, making them unsuitable for inclusion in current textbooks.
These previously existing concepts can be briefly introduced in “Medical History” to help current TCM students understand the meanings when reading ancient medical texts.
It is the responsibility of TCM academic authorities to standardize these basic concepts and compile standardized textbooks so that TCM students can learn correct TCM from the textbooks.
Rather than having textbooks filled with erroneous concepts as they do now, TCM students must have the ability to sort through these disorganized concepts from ancient medical texts; otherwise, they will make mistakes as soon as they start practicing.
02
Standardization of Course Offerings in TCM Colleges
Currently, the course offerings in TCM colleges related to external pathogenic diseases include “Shanghan Lun” and “Wenbing Xue,” and due to the COVID-19 pandemic, a course on “Epidemiology” has been added.This course setup is the root cause of misdiagnosis of external pathogenic diseases among TCM students and should be corrected.
A clinical course titled “External Pathogenic Diseases” should be established, removing “Wenbing Xue” and “Epidemiology.”
“External Pathogenic Diseases” should be standardized according to the nomenclature above, first discussing the differentiation and treatment system for different types of external pathogenic diseases in the early, middle, and late stages based on etiology; then discussing common external pathogenic diseases as units of disease, using Western medical disease names as units.
“Shanghan Lun” should be clearly understood as a classical medical text, focusing on understanding the clinical treatment system established by “Shanghan Lun” for external pathogenic diseases caused by cold pathogens,and not studied as a course on external pathogenic diseases;
correspondingly, a selection of readings from “Wenbing Mingzhu” should be added, selecting works such as Ye Tianshi’s “External Pathogenic Warm Heat Theory,” Xue Shengbai’s “Wet Heat Disease Chapter,” and Wu Jutong’s “Differentiation of Warm Diseases” to understand the treatment experiences of ancient physicians for external pathogenic diseases caused by heat pathogens.
It should not be the case that after studying “Shanghan Lun,” one claims that external pathogenic diseases are cold damage, and after studying “Wenbing Xue,” one claims that external pathogenic diseases are warm diseases, leading to an endless cold-heat debate from generation to generation.
03
As I have not yet had time to compile “External Pathogenic Diseases,” before it is published, everyone can first look at my “Reconstruction of the Differentiation and Treatment System for Early External Pathogenic Diseases.”
I have already mentioned that the early stage of external pathogenic diseases is the key to differentiation and treatment and is the stage most prone to misdiagnosis. If one masters the differentiation and treatment of early external pathogenic diseases, misdiagnosis can generally be avoided;
then refer to my “Xiao Xiangru’s Lecture on Shanghan Lun,” as well as the recommended readings of “External Pathogenic Warm Heat Theory,” “Wet Heat Disease Chapter,” and “Differentiation of Warm Diseases.”
In this way, everyone will have a basic understanding of external pathogenic diseases and should be able to avoid misdiagnosis.
After the relaxation of COVID-19 prevention and control, my disciples have had the opportunity to treat a large number of COVID-19 patients. Following the methods I taught them and referring to my “Reconstruction of the Differentiation and Treatment System for Early External Pathogenic Diseases,” they have become increasingly proficient in treating external pathogenic diseases, with improving efficacy. In our group, there are daily case-sharing sessions, and the enthusiasm for learning is also increasing.
That’s all for today. Next time, I will discuss why the pathogenic qi of epidemics and the term epidemic have no clinical guiding significance.
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