ArticlesTheTreatmentofRespiratoryInfections

Acuterespiratoryinfectionscannotbediagnosedandtreatedproperlywithoutathorough
understandingofthetheoryofthe6Stagesandparticularlythatofthe4Levels.Thebeginningstages
ofanacuterespiratoryinfectionusuallymanifestwithsymptomsofinvasionsofWindfromthe
Chinesemedicinepointofview.
The"DiscussionofColdinducedDiseases"byZhangZhongJingprovidedtheearliestframeworkfor
thediagnosisandtreatmentofdiseasesfromexteriorWindCold.Althoughthisfamousclassicdoes
alsodiscussinvasionsofWindHeatandtheirtreatment,acomprehensivetheoryofexteriordiseases
fromWindHeatwasnotdevelopeduntilthelate1600sbytheSchoolofWarmDiseases(WenBing).
Thus,thetwoschoolsofthoughtwhichformthepillarsforthediagnosisandtreatmentofexterior
diseasesinChinesemedicineareseparatedbyabout15centuries:theyaretheSchoolofColdinduced
Diseases(SchoolofShangHan)basedonthe"DiscussionofColdinducedDiseases"("ShangHan
Lun")byZhangZhongJing(c.AD220)andtheSchoolofWarmDiseases(WenBingSchool)which
startedinthelate1600sandearly1700s.ThemainadvocatesofthisschoolwereWuYouKe(1582
1652),YeTianShi(16671746)andWuJuTong(17581836).

ShangHanLunTheSixStages
ThesymptomatologyofWindColdwasdiscussedbyZhangZhongJinginthe"DiscussionofCold
inducedDiseases"(c.AD220)wherehefirstelaboratedthetheoryofthe6Stages.Theseare:
GreaterYang
WindColdwithprevalenceofCold
WindColdwithprevalenceofWind
BrightYang
Channelpattern(StomachHeat)
Organpattern(StomachFire)
LesserYang
GreaterYin
LesserYin
TerminalYin
Thefirststage,GreaterYang,istheonlyExteriorone.AtthisstageWindColdisontheExteriorand
onlytheLung'sDefensiveQiportionisaffected,nottheInterior.TheLung'sdispersingand
descendingofQiisimpairedandtheexternalWindislodgedinthespacebetweenskinandmuscles
impairingthecirculationofDefensiveQi.
TheessentialsymptomsoftheGreaterYangstageare:
aversiontocoldorshivering
occipitalheadacheand/orstiffneck
Floatingpulse
"Aversiontocold"indicatesthetypicalcoldfeelingandshiveringwhichcomesonasawaveinthe
beginningstagesofacoldorinfluenza.Itischaracteristicinsofarasitisnotrelievedbycovering
oneself.Mostpeoplewhoexperienceabadcoldorflushivereveninbedundertheblankets.
TheoccipitalheadacheorstiffnessisduetotheobstructionofDefensiveQicirculationinthe
GreaterYangchannels(SmallIntestineandBladder)whichflowinthatarea.
TheFloatingpulsereflectstherushingofDefensiveQitowardstheExteriortofightthepathogenic

factor.
Besidesthesethreecardinalsymptomstherearemanyotherssuchasarunnynose,sneezing,possibly
afever,acough,bodyaches,itchythroat,etc.Alltheseareduetotheimpairmentofthedispersing
anddescendingofQibytheLungsandbytheobstructiontothecirculationofDefensiveQiinthe
muscles.

WenBingThe4Levels
Whatdoes"Warmdisease"mean?ThisismyowntranslationoftheChinesetermWenBing.The
abovementioneddoctorsfromthisschoolofthoughtintroducedimportantinnovationstothetheory
ofWindinChinesemedicine.TheSchoolofWarmDiseasespostulatesthatsomeexteriorpathogenic
factorsgobeyondthenaturalcharactersof"Wind"theyaresovirulentandstrongthat,nomatterhow
strongaperson'sbody'sQimaybe,men,womenandchildrenfallillbythedozen.Moreimportantly,
forthefirsttimeinthehistoryofChinesemedicine,thesedoctorsrecognizedthatsomeexternal
pathogenicfactorsareinfectious.
AfurtherinnovativeideastemmingfromthisschoolwasthatthepathogenicfactorscausingWarm
diseases,allofthemfallingunderthecategoryofWindHeat,enterviathenoseandmouth,rather
thanviatheskinashappensforWindCold.
TheessentialcharacteristicsofWarmdiseasesthereforeare:
1)TheymanifestwiththegeneralsymptomsandsignsofWindHeatintheearlystages(WindHeatis
intendedhereinabroadsenseasitmayalsomanifestasDampHeat,SummerHeat,WinterHeat,
SpringHeatandDryHeat)
2)Thereisalwaysafever
3)Theyareinfectious
4)TheWindHeatpenetratesviathenoseandmouth
5)Thepathogenicfactorisparticularlystrong.
6)TheWindHeathasastrongtendencytobecomeinteriorHeat.
7)OnceintheInterior,theHeathasastrongtendencytodryupbodyfluids.
Thus,althoughallpathogenicfactorscontemplatedbytheSchoolofWarmDiseasesfallunderthe
broaddefinitionofWindHeat,notalldiseasescausedbyWindHeatareWarmdiseases.Someofthe
exteriordiseasesthatstartwithsymptomsofWindHeatareWarmdiseases(withalltheabove
mentionedcharacteristics)andsomearenot.ExamplesofWarmdiseasesaremeasles,chickenpox,
sometypesofinfluenza,Germanmeasles,poliomyelitis,smallpox,scarletfever,whoopingcoughor
meningitis.ExamplesofWindHeatdiseaseswhicharenotWarmdiseasesarecommoncold(ofthe
WindHeattype),sometypesofinfluenza,glandularfever(mononucleosis)andanynonspecific
upperrespiratoryinfectionmanifestingwithsymptomsofWindHeat.Thepresentinfluenza
epidemicthatissweepingtheworldatthetimeofwriting(January2000)isaWenBingdisease.
ThisisbecauseitisveryvirulentandhasastrongtendencytoentertheQilevel(causingchest
infections)veryquickly.
Thedistinctionbetween"simple"invasionsofWindHeatandinvasionsofWindHeatthatareaWen
Bingdiseaseisaveryimportantconsiderationinpractice:itispossibletostopdiseasesfrom"simple"
WindHeatattheearlystages,butalthoughtrueWarmdiseasesmaybealleviatedintheinitialstages,
theymaynotbeentirelystoppedattheinitialstages.Inparticular,inthecaseofWarmdiseases,even

thoughitmaynotstopthemattheExteriorlevel,Chinesemedicinecancertainlyachievethe
followingaims:
Alleviatethesymptoms
Shortenthecourseofthedisease
PreventtransmissiontotheYingandBloodlevels(seebelow)
Preventcomplications
Preventtheformationofresidualpathogenicfactors
Thetreatmentofexteriorinvasionsisimportantbecausetheycanhaveveryseriousconsequencesin
childrenandtheelderly.Inchildren,manyseriousdiseasesstartwithsymptomsofinvasionofWind
Heat:intheinitialstagesonedoesnotknowwhatdiseaseitmightbeanditisthereforeimportantto
treatthemanifestationsearly.Forexample,measles,diphtheria,whoopingcough,poliomyelitis,acute
nephritis,scarletfeverandmeningitismayallmanifestwithsymptomsofWindHeatinthebeginning
stage.Intheelderly,exteriorWindmayeasilypenetratetheInteriorcausingbronchitisand
pneumoniawhichisoftenfatalinoldage.

TheFourLevels:
DefensiveQiLevel(WeiLevel)
WindHeat
DampHeat
SummerHeat
WindDryHeat
QiLevel
LungHeat
StomachHeat
StomachandIntestinesDryHeat
GallBladderHeat
StomachandSpleenDampHeat
NutritiveQiLevel
HeatinPericardium
HeatinNutritiveQi
BloodLevel
HeatVictoriousagitatesBlood
HeatVictoriousstirsWind
EmptyWindagitatesintheInterior
CollapseofYin
CollapseofYang
ThefirstLevelconcernstheexteriorstageofaninvasionofWindHeat,theotherthreeLevels
describepathologicalconditionswhicharisewhenthepathogenicfactorpenetratestheInteriorand
turnsintoHeat.ThefourLevelsrepresentdifferentlevelsofenergeticdepth,thefirstbeingthe
ExteriorandtheotherthreebeingtheInterior.Theinterestingpartofthistheoryisthedistinction,
withintheInterior,ofthreedifferentlevels,theQiLevelbeingthemostsuperficial(withinthe
Interior)andtheBloodLevelthedeepest.
TheDefensiveQiLevelofthe4LevelsbroadlycorrespondstotheGreaterYangStageofthe6
Stages.TheformerdealswithWindHeatandthelatterwithWindCold.
ThemainsymptomsofinvasionofWindHeatareaversiontocold,shivering,fever,sorethroat,
swollentonsils,headacheandbodyaches,sneezing,cough,runnynosewithyellowdischarge,
slightlydarkurine,slightlyRedsidesofthetongueandaFloatingRapidpulse.Itisworthnotingthat
inWindHeattoothereisaversiontocoldasthisisduetoWindHeatobstructingtheDefensiveQi
whichthereforefailstowarmthemuscles.

COMMONCOLDANDINFLUENZA
Infectionfromthecommoncoldorinfluenzavirustakesplacethroughtheupperrespiratorytractand
mayoccurinanyseasonbutitismorefrequentinWinterorSpring.FromtheChinesepointofview,
theycanmanifestwithsymptomseitherofWindColdorWindHeat.
Commoncoldandinfluenzaareviralinfectionsoftheupperrespiratorytract.Thecommoncoldmay
becausedbyavarietyofvirusesincludingtheadenovirus,echovirus,parainfluenzavirus,respiratory
syncytialvirusandrhinovirus.InfluenzamaybecausedbytheinfluenzavirusesA,BorC.

AetiologyandPathology
Aninvasionofanexteriorpathogenicfactorisduetoatemporaryandrelativeimbalancebetweenit
andthebody'sQi.Thisimbalancemayoccureitherbecausethebody'sQiistemporarilyand
relativelyweakorbecausethepathogenicfactorisverystrong.Thebody'sQimaybetemporarilyand
relativelyweakduetooverwork,excessivesexualactivity,irregulardietandemotionalstressora
combinationofthese.Whenthebodyisthusweakened,evenamildpathogenicfactormaycausean
externalinvasionofWind.
"Wind"indicatesbothanaetiologicalfactorandapathologicalcondition.Asanaetiologicalfactor,it
literallyreferstoclimaticinfluencesandespeciallysuddenchangesofweathertowhichthebody
cannotadapt.Asapathologicalcondition,"Wind"referstoacomplexofsymptomsandsigns
manifestingasWindColdorWindHeat.Inclinicalpractice,thisisthemostimportantaspectofthe
conceptofWind.Thus,thediagnosisof"Wind"invasionismadenotonthebasisofthehistory(no
needtoaskthepatientwhetherheorshehasbeenexposedtowind),butonthebasisofthesymptoms
andsigns.Ifapersonhasallthesymptomsandsignsof"Wind"(aversiontocold,shivering,fever,
sneezing,runnynose,headacheandaFloatingpulse),thentheconditionisoneofexteriorWind,no
matterwhatclimatethatpersonhasbeenexposedtointhepreviousdaysorhours.Indeed,thereare
alsochronicconditionswhichmanifestwithsymptomsof"Wind"andaretreatedassucheventhough
theyhavenorelationtoclimaticfactors.Forexample,allergicrhinitis(duetohousedustmitesor
pollen)manifestswithsymptomsandsignsof"Wind"andistreatedassuch.
CommoncoldandinfluenzamaymanifestprimarilywithsymptomsofWindColdorWindHeat.
ThesearethetwomajortypesofWindandmostothertypesmaybetreatedbymodifyingbasic
formulaeforWindColdorWindHeat.
Simultaneouscoldfeelingandfever
Thesimultaneousfeverandshiversisthemostcharacteristicsymptomofthebeginningstagesofan
invasionofWind:theyindicatethatthereisaninvasionofanexteriorpathogenicfactorandthatthis
factorisstillattheExteriorlevel.AlongasthereareshiversthepathogenicfactorisontheExterior.
Ishallnowdiscussindetailthepathologyandclinicalsignificanceofthe"aversiontocold"and
"fever"inthebeginningstageofinvasionofexteriorWind.
Aversiontocold
InExteriorpatterns,theaversiontocoldandcoldfeelingisduetothefactthattheexternalWind
obstructsthespacebetweenskinandmuscleswheretheDefensiveQicirculatesasDefensiveQi
warmsthemuscles,itsobstructionbyWindcausesthepatienttofeelcoldandshiver(evenifthe
pathogenicfactorisWindHeat).Thus,DefensiveQiisnotnecessarilyweakbutonlyobstructedin
thespacebetweenskinandmuscles.
Thus,inExteriorpatterns,bothWindColdandWindHeatcauseacoldfeelingandshivering:itisa
commonmisconceptionthatthisisnotthecasewithWindHeat.Sincethecoldfeelingiscausedby

theobstructionofDefensiveQibyWind(whetheritisWindColdorWindHeat)inthespace
betweenskinandmuscles,thecoldfeelingandshiveringispresentalsoininvasionsofWindHeat,
albeittoalesserdegreethaninWindCold.
Thus,generallyspeaking,therearethreeaspectstothe"coldfeeling"ininvasionsofexteriorWind:
thepatientsfeelscold,heorshehas"waves"ofshivers,andheorsheisreluctanttogooutandwants
tostayindoors.Exceptinmildcases,thecoldfeelingisnotrelievedbycoveringoneself.
Inconclusion,afeelingofcoldinexteriorinvasionsisduetotheobstructionofDefensiveQiinthe
spacebetweenskinandmusclesanditindicatesthatthepathogenicfactorisontheExterior:assoon
asthefeelingofcoldgoes,thepathogenicfactorisintheInterior.
Fever
Asfor"fever"itisimportanttounderstandthattheChinesetermfashaoorfaredonotnecessarily
indicate"fever"."Fever"isasigninmodernWesternmedicine,notinoldChinesemedicine.Inold
China,therewereobviouslynothermometersandthesymptomfashaoorfaredescribedintheold
textsdonotnecessarilymeanthatthepatienthasanactualfever.Itliterallymeans"emittingburning
heat"anditindicatesthatthepatient'sbodyfeelshot,almostburningtothetouch:theareastouched
wereusuallytheforeheadandespeciallythedorsumofthehands(asopposedtothepalmswhichtend
toreflectmoreEmptyHeat).Infact,itisacharacteristicoffare(socalled"fever")intheexterior
stageofinvasionsofWindthatthedorsumofthehandsfeelhotcomparedtothepalmsandtheupper
backfeelshotcomparedtothechest.Thisobjectivehotfeelingofthepatient'sbodymayormaynot
beaccompaniedbyanactualfever.Whenthesymptomsofshiversandfeelingcoldoccurs
simultaneouslywiththeobjectivesignofthepatient'sbodyfeelinghottothetouch(orhavingan
actualfever),itindicatesanacuteinvasionofexternalWindanditdenotesthatthepathogenicfactor
isstillontheExterior.Inparticular,itisthesymptomsofshiveringandfeelingcoldthatindicatethat
thepathogenicfactorisontheExterior:themomentthepatientdoesnotfeelcoldanylongerbutfeels
hotand,ifinbed,heorshethrowsofftheblankets,itmeansthatthepathogenicfactorisinthe
InteriorandithasturnedintoHeat.
Thefever,orhotfeelingofthebodyinexternalinvasionsofWindisduetothestrugglebetweenthe
body'sQi(UprightQi)andtheexternalpathogenicfactor.Thus,thestrengthofthefever(orhot
feelingofthebody)reflectstheintensityofthisstruggle:thisdependsontherelativestrengthofthe
externalpathogenicfactorandthestrengthoftheUprightQi.Thestrongertheexternalpathogenic
factor,thehigherthefever(orhotfeelingofthebody)likewise,thestrongertheUprightQi,the
higherthefever(orhotfeelingofthebody).Thusthefeverwillbehighestwhenboththeexternal
pathogenicfactorandtheUprightQiarestrong.Thus,therearethreepossiblesituations:
StrongpathogenicfactorandstrongUprightQi:highfever(orhotfeelingofthebody)
StrongpathogenicfactorwithweakUprightQiorviceversa:mediumfever(orhotfeelingof
thebody)
WeakpathogenicfactorandweakUprightQi:lowfever(orhotfeelingofthebody)ornofever
However,therelativestrengthofthepathogenicfactorandtheUprightQiisonlyonefactorwhich
determinestheintensityofthefever(orhotfeelingofthebody).Anotherfactorissimplythe
constitutionofaperson:apersonwithaYangconstitution(i.e.withpredominanceofYang)willbe
morepronetoinvasionsofWindHeatratherthanWindColdandwillbemorepronetohaveahigher
fever(orhotfeelingofthebody).Indeed,itcouldbesaidthattheconstitutionofapersonisthemain
factorwhichdetermineswhetherapersonwhofallspreytoaninvasionofWinddevelopsWindCold
orWindHeat.Wereitnotso,incold,Northerncountriesnobodyshouldfallpreytoinvasionsof
WindHeatwhichisnotthecase.Thisisalsothereasonwhy,inchildren,invasionsofWindHeatare
farmoreprevalentthanWindCold:thisisbecausechildrenarenaturallyYanginnaturecomparedto
adults.Thereare,however,alsonew,artificialfactorswhichmaypredisposeapersontoinvasionsof
WindHeatwhensuccumbingtoWindandtheseareverydry,centrallyheatedplaces,hotworking

conditions(e.g.cooks,metalworkers),etc.
Thus,whatdetermineswhethertheinvadingexternalWindmanifestswithWindHeatorWindCold
isprimarilytheconstitutionofthepersonand,althoughitistruetosaythatahighorlowfevermay
bepresentinbothWindHeatandWindCold,itisafactthatinpracticeWindHeatischaracterized
bygenerallyahigherfever(orhotfeelingofthebody)thanWindCold.
ThedifferentiationbetweenWindHeatandWindColdisnotmadeonlyonthebasisoftheintensity
ofshiversandfever(orhotfeelingofthebody),althoughitistruetosaythatahighfeverismore
likelytooccurwithinvasionsofWindHeat.Otherfactors,suchastongueandothersymptomshelp
ustodifferentiateWindColdfromWindHeat.ThisisillustratedinTable1.Thepresentinfluenza
epidemicdefinitelymanifestswithsymptomsofWindHeatinallcases.
WINDCOLD
PATHOLOGY
PENETRATIONOF
PATHOGENIC
FACTOR
FEVER
AVERSIONTO
COLD
BODYACHES
THIRST
URINE
HEADACHE
SWEATING

WINDHEAT
WindHeatinjuringDefensiveQi
WindColdobstructingDefensive
andimpairingthedescendingof
Qi
LungQi
Viaskin

Vianoseandmouth

Light

High

Pronounced

Slight

Severe
None
Pale
Occipital
Nosweatingorslightsweating
onhead

Slight
Slight
Slightlydark
Wholehead

TONGUE

Nochange

PULSE

FloatingTight
Pungentwarmherbstocause
sweating

TREATMENT

Slightsweating
SlightlyRedonthesidesand/or
front
FloatingRapid
Pungentcoolherbstoreleasethe
Exterior

Table1ComparisonofWindColdandWindHeat.
Themostimportantthingtoestablishwhenweseeapatientsufferingfromanacuterespiratory
infectioniswhetherthestageoftheconditionisexternalorinternal,i.e.whetherthepathogenicfactor
isstillontheExteriororisintheInterior.Intermsoflevels,thismeansdistinguishingwhetherthe
patientisstillattheWeilevelorattheQilevel.ThedifferentiationbetweentheWeiandtheQilevel
isrelativelyeasy:ifthepatientsuffersfromaversiontocold,heorsheisstillattheWeilevelifheor
shedoesnotsufferfromaversiontocoldbut,onthecontrary,fromaversiontoheat,thepatientisat
theQilevel.
Thus,commoncoldandinfluenzawillalwaysstartwithmanifestationssimilartotheGreaterYang
stageofthe6StagesortheDefensiveQilevelofthe4Levelsdependingonwhetherthepathogenic
factorisWindColdorWindHeat.Ifthepathogenicfactorisnotexpelledatthebeginningstages,it
willchangeintoHeatandpenetrateintotheInterior.
OncethepathogenicfactorpenetratesintotheInterior,thebody'sQicarriesonitsfightagainstitin
theInterior:thiscausesahighfeverandafeelingofheat,inmarkedcontrasttotheaversiontocold

andtheshiveringwhichoccurwhenthebody'sQifightsthepathogenicfactorontheExterior.Atthe
exteriorlevel,theinternalorgansarenotaffectedanditisonlytheLung'sDefensiveQiportionwhich
isinvolved.Whenthepathogenicfactorbecomesinterior,theorgansareaffectedandespeciallythe
Lungsand/orStomach(seebelow).
Thisstageofdevelopmentinthepathologyofthesediseasesiscrucialas,ifthepathogenicfactoris
notcleared,itmayeitherpenetratemoredeeplyandcauseseriousproblems(attheNutritiveQior
BloodLevel)orgiverisetoresidualHeatwhichisoftenthecauseofchronicpostviralfatigue
syndromes.
IntheInterior,themainpatternsappearingwillbeeithertheBrightYangpatternofthe6Stagesor,
morecommonly,oneoftheQiLevelpatternswithinthe4Levels.Ingeneral,attheQiLevel,either
theStomachorLungorbothareaffected.

TreatmentThreeTreasuresRemedies
ExpelWindCold
ThisisofcoursesuitabletoexpelWindColdmanifestingwithsymptomsofchilliness(aversionto
cold),possiblyfever,runnynose,cough,sneezing,headache,stiffneckandFloatingpulse.Thisis
whatiscommonlycalleda"headcold".Atleast9tabletsaday(3tablets3timesadayaftermeals)
shouldbetakenandpossiblyevenmoredependingontheseverityofthesymptoms.Bestresultsare
obtainedifthetabletsaretakenwithaninfusionmadewithfreshgingerroot.
Acupuncture
LU7Lieque,L.I.4Hegu,L.I.20Yingxiang,BL12Fengmenwithcupping,BL13Feishu,S.I.3
Houxi(especiallyincaseofheadache).

ExpelWindHeat
InvasionsofWindHeatmanifestwithaversiontocold,fever,thirst,sorethroat,bodyaches,
headache,tonsillitis,earinfection,cough,FloatingRapidpulseandtongueredonthesides.The
dosageisthesameasforExpelWindCold,i.e.atleast9tabletsaday.Thisistheremedyofchoice
forthepresentinfluenzaepidemic:use12tabletsaday.ExpelWindHeatshouldbeastandby
remedyinanyhouseholdwithchildren.
Acupuncture
LU7Lieque,L.I.4Hegu,T.B.5Waiguan,Du14Dazhui,L.I.11Quchi,LU11Shaoshang(incase
oftonsillitis),BL12Fengmenwithcupping,BL13Feishu.

COUGHFOLLOWINGUPPERRESPIRATORYINFECTION
IftheexternalWindisnotexpelled,itwillusuallyturnintoHeatandentertheInteriorandmost
frequentlytheLungs.Themainsymptomsatthisstageareaversiontoheat,afeelingofheat,possibly
fever,cough(whichmaybedryorproductive),slightbreathlessness,restlessness,disturbedsleep,
thirst,afeelingofoppressionofthechest,Redtonguewithyellowcoating,DeepFullSlipperypulse.
ThesearemanifestationsoftheQilevel.
ThemainpatternsappearingattheQilevelare:
LungPhlegmHeat
DampPhlegmintheLungs
DryPhlegmintheLungs

ThreeTreasuresRemediesCleartheSoul
CleartheSoulcanbeusedforacutechestinfectionsfollowinganinvasionofWind,i.e.whenthe
pathogenicfactorisPhlegmHeatattheQilevel.Themainmanifestationscallingforthisremedyin
thiscontextare:acoughfollowingacoldorflu,expectorationofprofusestickyyellowsputum,slight
breathlessness,afeelingofoppressionofthechest,possiblyfever,thirst,disturbedsleep,aFull
Slipperypulse,aredtonguewithstickyyellowcoating.Thedosageisatleast9tabletsperday.
CleartheSoulcanbeusedalsoforresidualpathogenicfactorwithPhlegmHeatwhenthepatient
suffersfromachroniccoughwithcatarrhandsomebreathlessness(seebelow).

LimpidSea
LimpidSearesolvesDampPhlegmandcanbeusedforachestinfectionmanifestingwithDamp
PhlegmintheLungsfollowingacoldorflu.Themainmanifestationsare:acoughwithexpectoration
ofprofuse,stickywhitesputum,slightbreathlessness,afeelingofoppressionofthechest,asticky
tonguecoating,aFullSlipperypulse.Thedosageisatleast9tabletsperday.
Acupuncture
LU5Chize,LU7Lieque,Ren12Zhongwan,L.I.11Quchi,BL13Feishu,Du14Dazhui,ST40
Fenglong.
Otherprescriptions
TherearetwoprescriptionsthatIcanhighlyrecommendforacutechestinfectionstobeusedasa
decoction:thefirstisQingQiHuaTanTangClearingQiandResolvingPhlegmDecoction(Bensky
p.437)forPhlegmHeatintheLungsandthesecondisQingZaoJiuFeiTangClearingDrynessand
RescuingtheLungsDecoction(Benskyp.160)forDryPhlegmintheLungs.Botharespecificfor
HeatintheLungsattheQilevelfollowinganinvasionofWind:theformerisforPhlegmHeatand
thelatterforPhlegmHeatcombinedwithdryness.
Theclinicalmanifestationscallingforthefirstformula,QingQiHuaTanTang,are:acoughwith
expectorationofprofuse,stickyyellowsputum,slightbreathlessness,afeelingofoppressionofthe
chest,possiblyfever,thirst,disturbedsleep,aFullSlipperypulse,aredtonguewithstickyyellow
coating.
IfcoughisthemainsymptomaddKuanDongHuaandZiWan.
Theclinicalmanifestationscallingforthesecondformula,QingZaoJiuFeiTang,are:acoughthatis
mainlydrybutthepatientfeelssomephlegminthechestwhichisexpectoratedoccasionallyandwith
difficulty,aslightbreathlessness,arawfeelinginthechestandtrachea,adrymouth.Fromthepoint
ofviewofWesternmedicinethiscancorrespondtotracheitis.

RESIDUALPATHOGENICFACTOR
Residualpathogenicfactorisanextremelycommonpathologyandonethatweseeveryfrequentlyin
ourpractice.Infact,wearemorelikelytoseepatientssufferingfromresidualpathogenicfactorthan
fromacuterespiratoryinfections.
AresidualpathogenicfactordevelopsduringaninvasionofWind,usuallyattheQilevel.When
someonesuffersaninvasionofWind,therearetwopossibleoutcomes:eithertheWindisexpelledat
theWeilevelandthechildrecoverscompletely,orthepathogenicfactorprogressestotheQilevel
andbecomesinternal(usuallyintheformofHeat,PhlegmHeatorDampHeat).Afterthis
progression,therearetwopossibleoutcomes:eitherthepathogenicfactorisclearedandthepatient

recoverswithoutanyresidualeffect,orthepatientappearstorecoverbutthereisleftoverHeat,
PhlegmHeatorDampHeat,allofwhichareexamplesofresidualpathogenicfactors.
Whydoesaresidualpathogenicfactordevelop?Itisduetothreepossiblefactors:aweakconstitution,
overworkduringanacuteillness,orimproperuseofantibiotics.Antibioticsarethemostcommon
causeofresidualpathogenicfactorbecause,althoughtheykillbacteria,theydonotexpelWind,clear
HeatorresolvePhlegmorDampnessmoreover,theyarenoteffectiveagainstvirusesand,inspiteof
this,theyarefrequently(andimproperly)usedinviralinfections.Thusifapatienthasanacute,
febrileillnessfromabacterialinfection,theantibioticswilleliminatethefeverbykillingthebacteria,
butheorshemaybeleftwithHeat,PhlegmHeatorDampHeat.Thepatientappearstorecoverand
goesbacktowork,butoverworkandirregulardietcontinueandtheresidualpathogenicfactorwill
predisposethepatienttoafurtherinfection.Thepatientfallsillagainwithafever,moreantibiotics
areadministeredandtheresidualpathogenicfactorisonlystrengthened:thus,aviciouscircleis
installedandthepatientbecomeschronicallyunwell.
Aresidualpathogenicfactormaymanifestwithanyofthefollowingconditions:
Chroniccough
Chronicearinfections
Chronicsinusitis
Chronictonsillitis
Chroniclymphaticcongestion
Recurrentmouthulcers
Chronicdiarrhoea
Insomnia
Restlessness
Apartfromtheabovesymptomsandsigns,thetongueandthepulsemayalsoshowthepresenceofa
residualpathogenicfactor.WhenthereisLungHeat,thetonguemayberedonthefrontifthereis
LungPhlegmHeat,itmayhaveathinyellowcoatingintheareabetweenthetipandthecentre.Inthe
presenceofHeat,thepulsemaybeslightlyrapidandifthereisalsoPhlegmorDampnessitmaybe
slippery.
Themainpatternsappearingasresidualpathogenicfactorsareasfollows.

LungHeat
Irritability,drycough,slightthirst,restlesssleep,redcheeksoronlytherightcheekred,"floating"red
onwhitecomplexion,tongueredinfrontpart.

LungPhlegmHeat
Coughwithstickyyellowsputum,tightnessorfeelingofoppressionofthechest,irritability,restless
sleep,catarrh,slightwheezing,thinyellowtonguecoatinginLungarea,pulseSlippery.

SpleenDampHeat
Nausea,vomiting,diarrhoea,epigastricpain/fullness,smellystools,badbreath,lassitude,night
sweating,pulseSlippery,stickyyellowtonguecoating.

DampHeatinHead
Sinusitis,blockednoseorconstantlyrunnynose,swollenadenoids,pronetoearinfections,irritability,
restlesssleep,dullfrontalheadache,catarrh,swollenglandsinneck,pronetocolds,stickyyellow
tonguecoating.

LesserYangPattern
Chillsandfever,feelinghotandcoldinalternation,earache,irritability,restlesssleep,pulseWiry.

ThreeTreasuresRemedies
CleartheSoul
CleartheSoulistheremedyofchoiceforresidualPhlegmHeatintheLungs.ItresolvesPhlegmand
clearsLungHeat.

DrainFields
DrainFieldsresolvesDampnessfromtheMiddleBurnerandmaybeusedtoeliminateresidual
DampnessintheStomachandSpleen.ThisremedymaybeusedtoresolveDampnessinpostviral
fatiguesyndrome(whichisoftenduetoresidualpathogenicfactor).

EasetheMuscles
EasetheMusclesresolvesDampHeatfromtheMiddleBurnerandmaybeusedtoeliminateresidual
DampHeatintheStomachandSpleen.ThisremedymaybeusedtoresolveDampHeatinpostviral
fatiguesyndrome(whichisoftenduetoresidualpathogenicfactor).

TonifyQIandEasetheMuscles
TonifyQiandEasetheMusclestonifiesSpleenandLungQiandresolvesDampness.Itisusedto
eliminateresidualDampnesswhenthedeficiencyofQipredominates.

WelcomeFragrance
WelcomeFragranceeliminatesresidualDampHeatintheheadcausingchronicoracutesinus
problems.
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