Chinese Medical Great Works (4)

Author: Cao Bingzhang
Editor: Wu Shaozhen
Publisher:
Publishing Date: 1997-10-01
Features: "Summary of the Theory of Pestilence" by Wu Youxi of the Ming Dynasty. Wu Youxi, styled Youke, was from Zhenze. This book was completed in the year Zhengzheng Renwu (1662). It explains that pestilence arises from the irregular qi of the four seasons. The disease resembles typhoid fever but is fundamentally different, and ancient texts failed to distinguish between them. Thus, he wrote this treatise to elucidate the differences.
In general, typhoid fever enters through the orifices of the nose and mouth, affects the meridians, and progresses from the exterior to the interior, hence its transmission follows the six channels. It moves from the Yang to the Yin, gradually deepening. Pestilence enters through the mouth and nose, hiding in the moxa origin, where the pathogen resides neither exterior nor interior. Its transmission involves nine variations: some affect the exterior, some the interior, some only the exterior without reaching the interior, some the exterior twice, some the interior without exterior, some the interior twice, some both exterior and interior, some divide and transmit separately, some divide and transmit again, some are more exterior than interior, some begin exterior then move to interior, and some begin interior then move to exterior. There are eleven aspects where it differs from typhoid fever, and various complications and concomitant symptoms vary greatly. He wrote treatises and prescriptions to distinguish them one by one. The obvious and easily observable signs include a pulse that is neither hidden nor deep, and a tongue covered with fur, initially white, then yellow, and extremely yellow turning black with.
He noted that in hundreds of cases of pestilence, there might be only one case of typhoid fever, and in hundreds of cases of typhoid fever, there might be only one case of a Yin pattern. This may seem overly rigid. However, considered pestilence as a miscellaneous disease, and medical texts often included it without a dedicated section. Some even misinterpreted the passage in the "Suwen" ("Winter injury from cold in the body, it will surely develop into warmth in the spring") and applied treatments inappropriately. Wu Youxi, due to the severe epidemics in the years Xinji (1641) and Zhisui (1642) in northern and southern Zhili, Shandong, Zhejiang, and Jiangnan, found that treating them with typhoid fever methods was ineffective. He then investigated the root cause, reviewed medical cases, and wrote this book. Thus, pestilence gained a framework to follow, and he could be said to have contributed to society.
The book lacks a strict order, being compiled as notes. It retains its original form. The second volume includes the sections on "Recovery after Eating" and "Recovery after Labor," which contain the "Anxiety-Relieving and Blood-Nourishing Decoction" and the "Taiji Pill" for children's epidemics, but with formulas without ingredients. The section on "Combined Symptoms of Pestilence and Dysentery" is recorded but lacks a corresponding text, so it is supplemented at the end. Additionally, there are "On Correcting Names," "On Correcting Errors in Typhoid Fever Cases," "On Correcting Errors in Pestilence Cases by Various Scholars," and other appendices added after the book was completed. These are also included in this volume to form a complete work.
A supplementary appendix is added with the comments of Ouzhai, specifically his treatise on "Distinguishing the Tongue." Ouzhai, surnamed Nian, named Xiyao, published several "Experienced and Effective Formulas." Excerpt: Ouzhai states: "In typhoid fever, the pathogen enters from the exterior, called the 'middle channel.' In pestilence, the pathogen arises from the moxa origin and exits outward, called 'floating and overflowing.' Typhoid fever and pestilence only transmit through the three Yang and three Yin channels of the feet, not the three Yang and three Yin channels of the hands, hence the focus on the feet rather than the hands. The Bladder Channel of the foot is the Bladder Channel, paired with the Kidney (foot). The Stomach Channel of the foot is paired with the Spleen (foot). The Gallbladder Channel of the foot is paired with the Liver (foot)."
At the onset of pestilence, there is first chills followed by fever, later only fever without chills. In the first two or three days, the pulse is neither floating nor deep but rapid, with fever worsening in the afternoon, headache, body pain. At this stage, the pathogen is in the region before the spine and after the intestines. Although there is headache and body pain, the pathogen is floating and overflowing in the channels, so it should not be treated as a typhoid fever exterior pattern, and strong diaphoretic herbs like Ma Huang and Guizhi should not be used. The pathogen is not in the channels, and sweating would harm the exterior qi, and the fever would not subside. Laxatives should also not be used, as the pathogen is not in the interior, and purgatives would harm the stomach qi, worsening thirst. The "Da Yuan Decoction" is appropriate.
Da Yuan Decoction: Binglang 2 qian, Houpu 1 qian, Caoguo Ren 5 fen, Zhimo 1 qian, Shaoyao 1 qian, Huangqin 1 qian, Gancao 5 fen. Boil 1 gong of water to 8 fen, warm and take in the afternoon.
Note: Binglang is effective in dispersing and grinding, expelling hidden pathogens, and is a dispersing and draining herb. It also dispels miasma in the Lingnan region. Houpu breaks stubborn pathogenic qi. Caoguo is pungent and fierce, with strong qi, expelling hidden pathogens and resolving knots. The three herbs work together to reach the nest of the pathogen, causing it to and quickly leave the moxa origin, hence the name "Da Yuan." Zhimo nourishes Yin due to heat injuring fluids. Shaoyao harmonizes blood due to heat injuring the nutritive qi. Huangqin clears dry heat, and Gancao harmonizes the stomach. The last four herbs are merely harmonizing, like drinking water when thirsty, not remedies for the disease. For pathogens overflowing in the channels, use herbs corresponding to the channel to aid dispersal and draining. For (costal pain), (deafness), (chills and fever), (vomiting with bitter mouth), the pathogen is in the Shaoyang channel; add Chaihu 1 qian to the formula. For (lumbar, back, and nape pain), the pathogen is in the Taiyang channel; add Qianghuo 1 qian. For (eye pain), (pain in the supraorbital ridges), (orbital pain), (dry nose and insomnia), the pathogen is in the Yangming channel; add Genggen 1 qian.
Symptoms vary in onset, severity, and progression, and the dosage and urgency of herbs should be adjusted accordingly. For mild cases with thin white fur on the tongue and mild fever, without transmission to the interior, two or three doses will resolve it. For moderate cases, sweating is necessary. If sweating is not possible, the pathogen is entangled in the moxa origin, with the exterior and interior separated, preventing the exterior qi from reaching the interior and vice versa. Strong sweating should not be forced. Patients may demand sweating when (dispersing) herbs are added, mistakenly using heavy quilts or hot steam, which is improper. However, when exterior and interior are separated, there is no overflowing pathogen in the channels, so the "Three Yang Augmentation" method is not needed; follow the original formula. For severe cases with thick white fur on the tongue, covering the entire tongue without gaps, and if the fever does not subside after taking the decoction, it instead invades inward, with the tongue base turning yellow then central. The pathogen gradually enters the stomach, resembling the "Three Consumptions" pattern. If the pulse is long, (hong,,), with much sweating and thirst, the pathogen is just leaving the moxa origin, ready to exteriorize but not yet doing so, resembling the Ba Huang Tang pattern. If the tongue is pure yellow with interior symptoms, the pathogen has entered the stomach, resembling the Chengqi Tang pattern. Some cases deteriorate within two or three days, some take ten or more days to progress, and some, after four or five days of gradual worsening, suddenly worsen after five or six days.
In cases where the vital qi is strong, the pathogen spreads more easily. When the vital qi is weak, the pathogen spreads less and is harder to transmit. If a patient has long-standing weakness and encounters a mild epidemic, they may not be able to transform it, making transmission unlikely. If the pathogen does not spread, it remains, and the disease does not resolve, prolonging the illness and worsening it, often leading to death. Some doctors misdiagnose weak cases, continuously using Ren Shen and Pí Zi, worsening the condition without resolution.
Ouzhai states: "The Shaoyang Gallbladder channel runs along the sides of the body, the half exterior-half interior. Chaihu is the herb of this channel. The Taiyang Bladder channel runs along the back, the exterior. Qianghuo is the herb of this channel. The Yangming Stomach channel runs along the front of the body, the interior. Genggen is the herb of this channel. The transmission varies: some resolve through (zhan, battle sweat), some through (zi, spontaneous sweat), (dai, night sweat), or (kuang,,,,). Some progress without sweat into the stomach. Some sweat profusely with high fever and thirst, resolving only after . Some have obstructed stomach qi, requiring purgatives to induce . Some resolve with exterior sweating but leave residual pathogens, causing symptoms to recur after three or five days. Some develop jaundice that resolves with purgatives, or jaundice that worsens with purgatives, leading to (ban, rash). Some resolve with . Some have urgent interior symptoms, requiring purgatives even with a rash. These variations are also common. Some have external changes, such as men engaging in excessive sexual activity or having weak lower yang, allowing pathogens to descend to the lower burner, causing urinary retention, abdominal distension, fever at night, unresponsive to (dao chi san, guiding red decoction) or (wu ling san, five-ping decoction), but resolving with (da chengqi tang, major Chengqi decoction). Others have concurrent diseases, with localized weaknesses allowing pathogens to spread. Such cases are rare."
In general, the pathogen moves like water, affecting only those who are susceptible. Variations are due to individual differences. If the epidemic triggers pre-existing conditions, treat the epidemic, and the old condition will resolve.
Ouzhai states: " is trembling with sweat. is spontaneous sweat. is sweat during sleep. is when a person is (crazy), jumping, shouting, and then suddenly sweats and rests."
For urgent cases, aggressive treatment is needed. If fever starts in two days with white fur on the tongue, take one dose of Da Yuan Decoction in the morning, and by noon, the tongue turns yellow, with chest and abdominal fullness, severe thirst, and restlessness. The pathogen has, spreading to the stomach. Add (da huang, rhubarb) to the formula for purgation. If thirst and restlessness slightly subside, fever reduces by six, but later, fever and restlessness return, the tongue turns black with, and the nose looks like soot. The pathogen is severe, re-entering the stomach. Urgently use . A large purge in the evening leads to fever reduction by midnight, and the next morning, the nose is black and the tongue has, as if gone. In one day, there are three changes, resolving in a few days. Due to the severity of the pathogen, transmission is rapid, requiring urgent medication. If untreated or given slow medication, death is likely within two or three days. Even if surviving, treatment is too late. I have seen cases of death within two or three days of onset."
Ouzhai states: "Three changes in one day indicate a severe pathogen. If treated slowly, survival is rare."
For pestilence with white fur on the tongue, the pathogen is in the moxa origin. If the tongue base turns yellow to the center, the pathogen enters the stomach. If there are Three Yang symptoms, use Da Yuan Decoction with the Three Yang Augmentation method. Due to interior symptoms, add . This is called the "Three Consumptions" formula. "Three consumptions" means consuming the interior, exterior, and both. This is the complete treatment for pestilence, suitable for cases where the pathogen spreads to the exterior and interior with remaining knots in the moxa origin.
Three Consumptions Decoction: Binglang, Caoguo, Houpu, Shaoyao, Gancao, Zhimo, Huangqin, , Genggen, Qianghuo, Chaihu, ginger, dates. Decoct and take.
For scattered heat, if the pulse is long, (hong,,), with much sweating and thirst, and fever all over the body, use Ba Huang Tang.
Ba Huang Tang: Gaoqing 1 liang, Zhimo 5 qian, Gancao 1 qian, Chaihu 1 qian, ginger, dates. Decoct and take.
Note: Ba Huang Tang is a pungent and cooling dispersing formula, clearing the exterior and interior heat. It is a herb for clearing the exterior and draining heat. After the pathogen, the central knot gradually opens, and the pathogen is leaving the moxa origin but not yet exteriorizing. However, exterior and interior qi are connected, so the pulse is often long and (hong,,). Ba Huang Tang disperses and cools, and taking it may lead to or . If pestilence starts with a rapid pulse but not (hong,,), the pathogen is still entangled in the moxa origin. Use Da Yuan Decoction. Misusing Ba Huang Tang lacks the ability to break knots and only seeks to clear heat, like adding water to a boiling pot. If the pathogen has entered the stomach, only is effective. Misusing Ba Huang Tang lacks the ability to expel pathogens and harms the stomach qi with its harshness, suppressing the pathogen and causing the pulse to become (xixiao,). Some mistake a Yang pattern with a Yin pulse and declare it incurable. Doctors, seeing a faint pulse, hesitate to use purgatives, instead continuously giving cold and cooling herbs, which worsens the condition. Urgently use to slowly purge, and the six pulses will return.
Ouzhai states: "Continuously giving cold and cooling herbs is common. Some experienced doctors, seeing a weak pulse, immediately use warming tonics. After misusing cold and cooling herbs, the pulse becomes faint, and after fainting, they use warming tonics. If everyone in the world does this, now that this book exposes it, they should regret it."