Today, I encountered two patients who left a deep impression on me.
One was a middle-aged male, forty years old, with water blisters the size of soybeans visible on his waist, clustered together, with tense and shiny blister walls, clear blister fluid, surrounded by a red halo and accompanied by pain; this is herpes zoster. The other was a girl under two years old, who had a fever about two days ago, around 39°C, and after the high fever subsided, several small gray-white blisters appeared on her oral mucosa, surrounded by a red halo; this is herpetic pharyngitis.
These are common and frequently occurring diseases.
What impressed me was the middle-aged man’s mumbling; there were no other people around him with herpes zoster, and he was always wearing a mask; the girl’s grandmother was also very confused, as the girl had not yet entered daycare and spent all day at home, so where could she have contracted herpetic pharyngitis?
The main transmission routes for herpes zoster include direct transmission through contact with blister fluid, and it can also be transmitted indirectly through the air; additionally, it can be spread through saliva, making it pervasive. When a person’s immune system is weakened, they are particularly susceptible to infection; herpetic pharyngitis is mostly caused by Coxsackie virus, which can be transmitted through fecal-oral and oral-oral routes (gastrointestinal transmission), as well as through respiratory transmission and mother-to-child transmission.
Herpes zoster is mostly mild, with very few severe cases that can lead to viral encephalitis and meningitis; herpetic pharyngitis is similar, with very few cases progressing rapidly, potentially leading to severe complications such as encephalitis, pulmonary edema, and pulmonary hemorrhage.
In the real world, there are hundreds of times more asymptomatic carriers of these viruses than symptomatic patients, making them difficult to guard against. As mammals, humans have survived in this virus-laden environment for over a hundred million years, so if a patient asks how they got infected, I truly do not know, unless we conduct large-scale nucleic acid testing related to the ‘varicella-zoster virus’ or ‘Coxsackie virus.’
So, how does Traditional Chinese Medicine (TCM) understand these viruses? Chen Wuze in his “San Yin Ji Yi Bing Zheng Fang Lun, Volume Two” states: “The Six Excesses are cold, heat, dryness, dampness, wind, and heat… However, the Six Excesses are the regular qi of heaven; when they invade, they first flow into the meridians and internally combine with the organs, causing external influences.” TCM believes that the Six Excesses are the regular qi of heaven, representing improper qi, and are a part of nature— I now believe this contains extremely profound insights.
