1 Wen Bing 3

2 Wind Warmth

3 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. Wind warmth (general) – cont’d

4 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 Wind warmth (general) – cont’d

5 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 Wind warmth (dx) – cont’d

6 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  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 Wind warmth (wei invasion) – cont’d

7 “ 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 Wind warmth (wei invasion) – cont’d

8 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 Wind warmth (qi level) – cont’d

9 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) Wind warmth (qi level) – cont’d

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 lou pi (Pericarpium Trichosanthis) – 大黄 da huang (Radix et Rhizoma Rhei) Wind warmth (qi level) – cont’d

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) Wind warmth (qi level) – cont’d

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) Wind warmth (qi level) – cont’d

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 Wind warmth (qi level) – cont’d

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 Wind warmth (qi level) – cont’d

15 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 xin mai 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 wan P 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 Wind warmth (Heat invades PC) – cont’d

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 wan P 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 Wind warmth (Heat invades PC) – cont’d

heat invade pericardium with Yangming Fu 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 wan P 416 With 大黄 da huang (Radix et Rhizoma Rhei) Wind warmth (Heat invades PC) – cont’d

18 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 Wind warmth (Residual heat damaging Lu/St yin) – cont’d

19 Autumn Dryness

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

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

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

23 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 Autumn Dryness in the Wei Stage– cont’d

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

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 Autumn Dryness in the Qi Stage– cont’d

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 ren shen (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) Autumn Dryness in the Qi Stage– cont’d

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 Autumn Dryness in the Qi Stage– cont’d

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) Autumn Dryness in the Qi Stage– cont’d

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 shen mai men dong tang Autumn Dryness in the Qi Stage– cont’d

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