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Yesterday, I discussed the TCM nomenclature for COVID-19, which involved many concepts of exogenous diseases. Today, I want to explain how to avoid confusion regarding these various concepts.
01
Standard Nomenclature for Exogenous Diseases in TCM
Level One: TCM categorizes diseases based on etiology into exogenous diseases and internal injuries.
Level Two: Diseases caused by external pathogens are classified as exogenous diseases; among exogenous diseases, those that are infectious are termed epidemics.
Level Three: Exogenous diseases can be further divided based on specific pathogens into exogenous cold pathogens, exogenous heat pathogens, exogenous damp pathogens, and exogenous dry pathogens.
The current textbooks on exogenous diseases have inconsistent theoretical foundations; for a detailed explanation, please refer to my work “Reconstruction of the Diagnosis and Treatment System for Early Exogenous Diseases”.
Level Four: Each specific exogenous disease can be divided into three stages: early, middle, and late. For example, early exogenous cold pathogens, middle exogenous cold pathogens, and late exogenous cold pathogens.
The early stage of exogenous 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 diagnosis and treatment of early exogenous diseases. Moreover, the nature of the pathogenic factors in the middle and late stages does not completely correspond to those in the early stage. For instance, exogenous cold pathogens can transform into heat, leading to heat syndromes in the middle and late stages.
In the textbooks of TCM colleges, concepts such as cold damage and heat diseases from the “Huangdi Neijing” should be removed, as well as the broad and narrow definitions of cold damage from the “Nanjing”, and the broad definition of cold damage from the “Shanghan Lun”. The concept of warm diseases and the concept of exterior syndromes in textbooks should also be eliminated.
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 learners understand the meanings when reading ancient medical texts.
The academic authorities in TCM should work on standardizing these basic concepts and compiling standardized textbooks so that TCM learners can acquire correct TCM knowledge from their studies.
It is not acceptable for current textbooks to be filled with erroneous concepts. TCM learners 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
In the current curriculum of TCM colleges, courses related to exogenous diseases include “Shanghan Lun” and “Wenbing Xue”. Due to the COVID-19 pandemic, a course on “Epidemiology” has also been added.This course setup is the root cause of misdiagnosis of exogenous diseases among TCM learners and should be revised.
A clinical course titled “Exogenous Diseases” should be established, removing “Wenbing Xue” and “Epidemiology”.
“Exogenous Diseases” should be systematically discussed based on the standardized nomenclature, first addressing the diagnosis and treatment system for different types of exogenous diseases in their early, middle, and late stages based on etiology; then discussing common exogenous diseases as units, using Western medical terminology for diseases.
“Shanghan Lun” should be clearly understood as a classical medical text, focusing on the clinical treatment system established by “Shanghan Lun” and understanding its treatment approach for exogenous diseases caused by cold pathogens, rather than being treated as a course on exogenous diseases.
Correspondingly, a course on “Selected Readings of Classic Works on Warm Diseases” should be added, selecting works such as Ye Tianshi’s “Discussion on Exogenous Warm Diseases”, Xue Shengbai’s “On Damp-Heat Diseases”, and Wu Jutong’s “Differentiation of Warm Diseases” to understand the treatment experiences of ancient physicians for exogenous diseases caused by heat pathogens.
It should not be the case that after studying “Shanghan Lun”, one claims that exogenous diseases are cold damage, and after studying “Wenbing Xue”, one claims that exogenous diseases are warm diseases, leading to an endless cycle of cold-heat disputes across generations.
03
As I have not yet had time to compile “Exogenous Diseases”, before it is published, everyone can refer to my “Reconstruction of the Diagnosis and Treatment System for Early Exogenous Diseases”.
I have already mentioned that the early stage of exogenous diseases is critical for diagnosis and treatment and is the stage most prone to misdiagnosis. If one masters the diagnosis and treatment of early exogenous diseases, misdiagnosis can generally be avoided.
Then, one can also look at my “Xiao Xiangru’s Lecture Notes on Shanghan Lun”, as well as the recommended readings of “Discussion on Exogenous Warm Diseases”, “On Damp-Heat Diseases”, and “Differentiation of Warm Diseases”.
In this way, everyone will have a basic understanding of exogenous diseases and should be able to avoid misdiagnosis.
After the relaxation of COVID-19 prevention and control measures, 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 Diagnosis and Treatment System for Early Exogenous Diseases”, they have become increasingly proficient in treating exogenous diseases, with improving efficacy. In our group, there are daily case-sharing sessions, and the enthusiasm for learning is also growing.
That’s all for today. Tomorrow, I will discuss why the pathogenic qi of epidemics has no clinical guiding significance.
Note: Discussion is welcome!The cover image is sourced from Shetu Network.
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