Respiratory Diseases - (2nd Edition)

Author: Wu Yanhua, Sun Xiaosheng, Guo Taomei / Country: Mainland China
Publisher:
Publish Date: 2006-06-01
Features:
7. Zhao Chun's Diagnostic and Treatment Experience
Zhao Shi has conducted in-depth research and accumulated extensive clinical experience in treating high fever caused by external pathogens.
(1) Diagnosis Emphasizes the Combination of Disease Differentiation and Syndrome Differentiation:
Zhao Shi emphasizes the use of both Western and Chinese medical methods to collect clinical data during diagnosis, advocating for the combination of disease differentiation and syndrome differentiation. The diagnostic process often begins with disease differentiation before moving to syndrome differentiation. This approach not only broadens the diagnostic perspective and helps select the optimal treatment plan for the patient but also provides significant benefits in understanding the progression of the disease and making prognostic judgments. From a Western medical perspective, Zhao Shi believes that the diagnosis of acute infectious diseases must be comprehensive, incorporating epidemiological data, clinical history, physical examinations, and laboratory test results, all of which hold important diagnostic value. From a Chinese medical perspective, Zhao Shi considers high fever caused by external pathogens to be primarily due to sudden exposure to six pathogenic evils (wind, cold, summer heat, dampness, dryness, and fire) or epidemic toxic Qi. The internal cause of the disease is the weakness of the defensive Qi and its inability to protect the body, known as "where the pathogen invades, the body must be deficient." The etiological and pathogenic characteristics of this condition involve the invasion of external pathogenic toxins, the struggle between the pathogen and the body's resistance, and the imbalance of yin and yang, leading to severe heat. It is prone to injuring yin and consuming qi, resulting in dangerous symptoms such as delirium, convulsions, (obstruction), and depletion (), as well as various forms of bleeding, indicating damage to the body's vital organs. This can lead to complex syndromes such as pathogen excess or both pathogen excess and deficiency. Therefore, during clinical practice, it is essential to carefully observe the type of heat, distinguish symptoms such as thirst, sweating, abdominal fullness, jaundice, macules, and mental state, to identify the nature and location of the pathogen. The primary location of this syndrome is often the three yang meridians, defensive qi, nutritive qi, and blood, as well as related internal organs. In the early stages of the disease, it is typically characterized by heat and excess; in the middle stage, although signs of deficiency may appear, the pathogen remains the primary focus; in the later stage or when the disease transforms, the signs of deficiency become more pronounced, commonly involving qi and yin depletion or yang deficiency. This condition can affect people of all ages and genders, occurring in all four seasons, with a generally short course of illness. The diagnostic methods for high fever caused by external pathogens have varied among medical practitioners throughout history, with some emphasizing the six channels differentiation, while others focus on defensive qi, nutritive qi, and blood, or the three (jiao) differentiation. These diagnostic methods should be applied flexibly based on the patient's condition, with the ultimate goal of accurate syndrome differentiation. Based on the patient's symptoms and tongue and pulse characteristics, high fever caused by external pathogens can be broadly categorized into the following syndromes:
① Defensive Qi Syndrome: Including wind-heat syndrome, wind-cold syndrome, and summer-dampness syndrome;
② Qi Syndrome: Including lung-heat stagnation syndrome, stomach-heat excess syndrome, intestinal heat accumulation syndrome, bladder damp-heat syndrome, and pathogen lurking in the original position syndrome;
③ Dual Qi and Nutritive Qi/Blood Syndrome;
④ Nutritive Qi Syndrome: Including heat injuring nutritive qi syndrome and heat invading the heart (bao) syndrome;
⑤ Blood Syndrome.
(2) Integrated Combination of Western and Chinese Medicine for Mutual Complementarity:
Zhao Shi emphasizes the integrated combination of Western and Chinese medicine in treating high fever caused by external pathogens, fully leveraging the strengths of both to improve cure rates. High fever during external pathogen attacks is necessarily caused by toxic pathogens, so treatment must be timely, accurate, and rapid in eliminating these toxins while preserving the body's vital qi. Once the toxins are removed, the heat will subside, and the disease will be cured. The fundamental principle of treatment is to eliminate the pathogen to drain heat. Treatment should be adjusted based on the location of the pathogen—whether on the surface, internally, in the qi, nutritive qi, or blood—and administered accordingly, including methods such as:
- Pungent and Cold Decoctions for External Release;
- Pungent and Warm Decoctions for External Release;
- Clearing Summer Heat and Eliminating Dampness for External Release;
- Clearing Heat and Calming Asthma;
- Clearing Heat and Generating Fluids;
- Purgative Methods for Draining Heat;
- Clearing Damp-Heat;
- Promoting Diffusion in the Original Position;
- Clearing Qi and Cooling Nutritive Qi;
- Clearing Nutritive Qi and Draining Heat;
- Clearing the Heart and Opening the Orifices;
- Clearing Heat and Cooling Blood;
- Cooling Blood and Dispelling Stasis;
- Quelling Wind and Stopping Convulsions.
However, when treating high fever caused by external pathogens, it is essential to protect body fluids and ensure the proper functioning of the qi system, preventing the disease from progressing and correctly applying methods such as pungent and cold decoctions for external release, clearing heat and draining heat, clearing heat and generating fluids, clearing nutritive qi and cooling blood, and nourishing yin to support the body to prevent dangerous symptoms such as convulsions, collapse, (obstruction), depletion (), and bleeding.
In addition to the above treatments, Zhao Shi believes that emergency measures can also include the following methods:
- For fever reduction, acupuncture can be used on points such as Dazhui, Quchi, Hegu, and Shaoshang;
- Herbal bathing: decocting Schizonepeta 10g, Mentha haplocalyx 15g, or Ephedra 10g for bathing to induce mild sweating and relieve fever, suitable for wind-cold high fever syndrome;
- Gypsum decoction or a 20% gypsum solution for bathing, suitable for high fever with pathogenic heat entering the interior;
- Herbal decoctions for promoting diffusion, such as Mulberry leaf 50g, Imperata cylindrica 25g, Perilla leaf 15g, and Schizonepeta 15g, decocted for bathing.
For delirium with Yangming channel symptoms, Baihu Decoction can be used for enema; for Yangming intestinal symptoms, Chengqi (e.g., Danzhong Longgu Decoction) can be used for enema.
Chinese herbal preparations and injections can also be selected.
P14-15