Wen Bing 3

1. Wen Bing 3

2. Wind Warmth

3. Wind warmth (general) – cont’d • Wind Warmth 风温 is a acute exogenous febrile disease caused by invasion of wind heat evils. It more often happens in spring and winter time. That happens in winter time is called winter warmth 冬温. Early symptom includes: fever, slightly aversion to wind cold, cough, mild thirst, etc. • Wind Warmth 风温 disease treatment can be a good reference for treating influenza, acute bronchitis and lobar pneumonia, etc.

4. Wind warmth (general) – cont’d Etiology and Pathology • Wind heat evils invasion • Invading lung and Wei • Transfer to stomach  routine • Invading pericardium  adverse transfer • Invading blood and collaterals  skin eruption  papules 疹 • Impair lung and stomach Yin

5. Wind warmth (dx) – cont’d Key Point for Diagnosis • Season  winter , spring • Progress • Lung Wei syndrome  early stage • Heat retention in the lung  middle stage • Impairs lung and stomach Yin late stage • Differs from Spring Warmth severe influenza, epidemic cerebrospinal meningitis, viral encephalitis

6. Wind warmth (wei invasion) – cont’d Differentional Diagnosis • 1. Evils invading lung and Wei • Symptom • fever, mild aversion to wind cold • no sweating or not noticeable sweat • head ache • cough • slightly thirst • red on the tip and sides of the tongue with thin white coating • floating and rapid pulse • Treatment Principle • Release exterior with acrid and cool nature herb. Disperse and relieve lung heat • Prescription • Honeysuckle and Forsythia Powder 银翘散 yin qiao san p 45-46 • 辛凉平剂 mild acrid cool formula • Mullbery Leaf and Chrysanthemum Decoction 桑菊饮 sang ju yin • 辛凉轻剂 light acrid cool formula

7. Wind warmth (wei invasion) – cont’d • “上shang焦jiao如ru羽yu,非fei轻qing不bu举ju” • Upper Jiao is as light as feather, it can not be lifted unless using the light herbs

8. Wind warmth (qi level) – cont’d • 2. heat invade Qi level • 2-1heat evil entangle in the lung • Symptom • fever with sweat • extreme thirst • cough and wheezing • chest pain • red tongue wit yellow coating • rapid pulse • Treatment Principle • Clear heat, release lung stagnation, stop wheezing • Prescription • Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction 麻杏石甘汤 ma xing shi gan tang p. 88

9. Wind warmth (qi level) – cont’d • 2-2 phlegm heat retain in the lung • Symptom • fever with red face • thirst prefer cold drink, thirst doesn’t relief after drink • press pain over the chest • constipation • yellow and greasy coating • flooding and slippery pulse • Treatment Principle • Clear heat eliminate phlegm, release stagnation • Prescription • 小陷胸加枳实汤 xiao xian xiong jia zhi shi tang • 枳实zhi shi (Fructus Immaturus Aurantii) • Minor Sinking into the Chest Decoction 小陷胸汤 xiao xian xiong tang p. 348 • 栝蔞gua lou (Fructus Trichosanthis) • 黄连huang lian (Rhizoma Coptidis) • 半夏ban xia (Rhizoma Pinelliae Ternatae)

10. Wind warmth (qi level) – cont’d • 2-3 phlegm heat obstruct lung with heat retain in the bowel • Symptom • tidal fever with constipation • copious phlegm • wheezing • greasy yellow coating • big forceful pulse especially right cun • Treatment Principle • Dispersing the lung, eliminating phlegm, purging heat downward • Prescription • 宣白承气汤 xuan bai cheng qi tang • 石膏shi gao (Gypsum) • 杏仁xing ren (Semen Pruni Armeniacae) • 栝蔞皮gua loupi (Pericarpium Trichosanthis) • 大黄da huang (Radix et Rhizoma Rhei)

11. Wind warmth (qi level) – cont’d • 2-4 lung heat with papules 疹 eruption • Symptom • fever • red papules 疹 eruption • cough, chest pain • red tongue with yellow thin coating • rapid pulse • Treatment Principle • Dispersing lung, release heat, cooling Ying (blood) and let out papules 疹 • Prescription • Honeysuckle and Forsythia Powder 银翘散 yin qiao san modified: • Omit淡豆豉dan dou chi(Semen Sojae Praeparatum) • Add: • 生地黄 sheng di huang (Radix Rehmanniae Glutinosae) • 牡丹皮mu dan pi (Cortex Moutan Radicis) • 大青叶da qing ye (Folium Daqingye) • Double dose • 玄参xuan shen (Radix Scrophulariae Ningpoenisis)

12. Wind warmth (qi level) – cont’d • 2-5 lung heat transfer to large intestine • Symptom • fever cough • Hot diarrhea with foul smell • Burning sensation in anus • No hard resistant pain in the abdomen  yet ? peritonitis • Yellow coating • Rapid pulse • Treatment Principle • Clear heat stop diarrhea with bitter cold herb • Prescription • Kudzu, Coptis and Scutellaria Decoction 葛根黄连黄芩汤 ge gen huang lian huang qin tang p. 60 • 黄芩huang qin (Radix Scutellariae Baicalensis) • 黄连huang lian (Rhizoma Coptidis) • 葛根ge gen (Radix Puerariae) • 甘草gan cao (Radix Glycyrrhizae Uralensis)

13. Wind warmth (qi level) – cont’d • 2-6 Yangming excess heat • Symptom • Severe fever • Aversion to heat • Thirst prefer cold drink • Yellow dry coating • Floating flood or slippery rapid pulse • Treatment Principle • Clear heat to reserve body fluid • Prescription • White Tiger Decoction 白虎汤bai hu tang p.70

14. Wind warmth (qi level) – cont’d • 2-7 Yangming heat retention • Symptom • Tidal fever • occasional delirious speech • constipation or pure foul liquid • hot sensation in anus • abdominal hard distention pain • dry yellow or dry grey black coating • deep and forceful pulse • Treatment Principle • Soften the stool , downward purging heat • Prescription • Regulate the Stomach and Order the Qi Decoction 调胃承气汤tiao wei cheng qi tang p. 117

15. Wind warmth (Heat invades PC) – cont’d • 3. heat invade pericardium • 3-1 heat invade pericardium • Symptom • scorching fever • cold limbs • delirious speech • coma • slur tongue • fresh purple tongue • rapid and thready pulse • Treatment Principle • Clear heart fire, open orifice • Prescription • Clear the Pallas Decoction清宫汤qing gong tang • 玄参心xuan shen xin (Radix Scrophulariae Ningpoenisis)  • 莲子心 lian zi xin (Plumula Nelumbinis Nuciferae) • 竹叶卷心zhu ye juan xin (Herba Lophatheri Gracilis) • 连翘心lian qiao xin (Fructus Forsythiae Suspensae) • 犀角尖xi jiao jian (Cornu Rhinoceri) tip part • 连心麦冬lian xinmai dong (Tuber Ophiopogonis Japonici) • Together with one of the following herb • Calm the Palace Pill with Cattle Gallstone 安宫牛黄丸an gong niu huang wanP 416  clear heat and detoxify • Greatest Treasure Special Pill 至宝丹 zhi bao dan p. 417 expel turbidity • Purple Snow Special Pill紫雪丹 zi xue dan p. 419  extinguishing wind

16. Wind warmth (Heat invades PC) – cont’d • 3-2 interior close exterior collapse syndrome • Symptom • fever • Unconsciousness • Curl up sleep • Shortness breath with copious sweat • Thready weak pulse • Pale face • Cold limbs • Treatment Principle • Clear heart fire and open orifice, rescue devastated Yang • Prescription • Calm the Palace Pill with Cattle Gallstone 安宫牛黄丸an gong niu huang wanP 416 • Purple Snow Special Pill紫雪丹 zi xue dan p. 419 • Greatest Treasure Special Pill 至宝丹 zhi bao dan p. 417 • Together with • Generate the Pulse Powder 生脉散sheng mai san p245 • Ginsen and prepared Aconite Decoction 参附汤shen fu tang p.28

17. Wind warmth (Heat invades PC) – cont’d • 3-3 heat invade pericardium with YangmingFu excess • Symptom • scorching fever, • delirious speech, coma • slur tongue • cold limbs • constipation • abdominal hard pressure pain • purple tongue • yellow dry coating • rapid deep forceful pulse • Treatment Principle • Clear heart fire and open orifice, downward purging Fu excess • Prescription • 牛黄承气汤niu huang cheng qi tang • Calm the Palace Pill with Cattle Gallstone 安宫牛黄丸an gong niu huang wanP 416 • With • 大黄da huang (Radix et Rhizoma Rhei)

18. Wind warmth (Residual heat damaging Lu/St yin) – cont’d • 4. residual heat impair lung and stomach Yin • Symptom • Indiscernable or no fever • dry cough or sticky and scanty phlegm • dry mouth and dry lips with thirst • red tongue with little coating • thready pulse • Treatment Principle • Nourish lung and stomach fluid • Prescription • Glehnia and Ophiopogonis Decoction 沙参麦门冬汤sha shen mai men dong tang

19. Autumn Dryness

20. Autumn Dryness – cont’d Autumn Dryness • Dryness pathogenic factor attack in Autum • Starts from LU • Dryness damages body fluid

21. Autumn Dryness – cont’d • Etiology and Pathology • Cool dryness • Warm dryness

22. Autumn Dryness – cont’d • Diagnosis • Seasonal factor: beginning of Autumn • LU Wei-stage symptoms with dry mouth, nose, skin, etc • LU,ST - seldom transmits to Lower Jiao

23. Autumn Dryness in the Wei Stage– cont’d • 1. Autumn Dryness in LU Wei-stage • Fever, slight aversion to wind cold, cough with little phlegm, hoarse voice, dry throat, dry nose, slight thirst, red tongue tip and edge with dry thin white coating, rapid large pulse on right • Sang Xing Tang • 桑叶sang ye (Folium Mori Albae) • 杏仁xing ren (Semen Pruni Armeniacae) • 沙参sha shen (Radix Adenophorae seu Glehniae) • 贝母 bei mu (Bulbus Fritillariae)\ • 豆豉dou chi (Semen Sojae Praeparatum) • 栀子zhi zi (Fructus Gardeniae Jasminoidis) skin • Pear skin

24. 2 Autumn dryness in Qi-stage • 2-1 Dryness disturbs orifices • 2-2 Dryness heat injures LU • 2-3 LU dryness and LI heat with bleeding • 2-4 Dryness in LU with constipation • 2-5 LU & ST yin injury

25. Autumn Dryness in the Qi Stage– cont’d • 2-1 Dryness disturbs orifices • Sx: Fever, thirst, tinnitus, red eyes, swollen gums, sore throat, dry yellow tongue coating, rapid pulse • Rx: Qiao He Tang (modified) • 薄荷bo he (Herba Menthae Haplocalycis) • 连翘lian qiao (Fructus Forsythiae Suspensae) • 甘草gan cao (Radix Glycyrrhizae Uralensis) • 栀子zhi zi (Fructus Gardeniae Jasminoidis) skin • 桔梗jie geng (Radix Platycodi Grandiflori) • 绿豆lu dou (Semen Phaseoli Radiati) skin

26. Autumn Dryness in the Qi Stage– cont’d • 2-2 Dryness heat injures LU • Sx: Fever, thirst, restlessness, non-productive cough, fullness in chest, rib pain, dry throat, dry nose, red tongue tip and edge, thin white dry or thin yellow dry coating, rapid pulse • Qing Zao Jiu Fei Tang • 石膏shi gao (Gypsum) • 桑叶sang ye (Folium Mori Albae) • 甘草gan cao (Radix Glycyrrhizae Uralensis) • 人参renshen (Radix Ginseng) • 黑芝麻hei zhi ma (Semen Sesami Indici) • 阿胶e jiao (Gelatinum Corii Asini) • 麦门冬mai men dong (Tuber Ophiopogonis Japonici) • 杏仁xing ren (Semen Pruni Armeniacae) • 枇杷叶蜜炙pi pa ye (Honey –fried Folium Eriobotryae Japonicae)

27. Autumn Dryness in the Qi Stage– cont’d • 2-3 LU dryness and LI heat with bleeding • Sx: Itchy throat and non-productive cough at beginning, followed by severe cough with sticky phlegm with blood, chest pain, burning in abdomen, diarrhea, red tongue with thin yellow dry coating, rapid pulse • Rx: E Jiao Huang Qin Tang (modified) • 阿胶e jiao (Gelatinum Corii Asini) • 黄芩huang qin (Radix Scutellariae Baicalensis) • 杏仁xing ren (Semen Pruni Armeniacae) • 桑白皮sang bai pi (Cortex Mori Albae Radicis) • 白芍bai shao (Radix Paeoniae Lactiflorae) • 甘草gan cao (Radix Glycyrrhizae Uralensis) • 车前草che qian cao (Herba Plantaginis) • Sugar cane

28. Autumn Dryness in the Qi Stage– cont’d • 2-4 Dryness in LU with constipation • Sx: Cough with phlegm, fullness in chest and abdomen, constipation with dry stools, dry red tongue • Rx: Wu Ren Ju Pi Tang • 杏仁xing ren (Semen Pruni Armeniacae) • 郁李仁yu li ren (Semen Pruni) • 桃仁tao ren (Semen Persicae) • 柏子仁bai zi ren (Semen Biotae Orientalis) • Pine nut • 陈皮chen pi (Pericarpium Citri Reticulatae)

29. Autumn Dryness in the Qi Stage– cont’d • 2-5 Lung & Stomach yin injury • Sx: After fever or with slight fever, non-productive cough or cough with scanty phlegm, dry nose, dry throat, thirst, dry tongue body with little coating, thin rapid pulse • Glehnia and Ophiopogonis Decoction 沙参麦门冬汤sha shenmai men dong tang

30. 3. Autumn dryness in Ying or Xue-stage • Sx: Fever, thirst, restlessness, with all kinds of bleeding, deep red tongue body with yellow dry tongue coating, rapid pulse • Rx: Bai Hu Jia Di Huang Tang • Bai Hu Tang • Sheng Di