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– Cough
– Sore throat
– Runny or stuffy nose
– Muscle or body aches
– Headache
– Fatigue
– Vomiting and diarrhea (mostly in children)Pneumonia, bronchitis, and sinus and ear infections are examples of complications from flu. The flu can make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu.In order to treat influenza with Chinese medicine, we must master the theory of the 4 Levels from the Wen Bing school.
WEN BING AND THE FOUR LEVELS
Acute respiratory infections cannot be diagnosed and treated properly without a thorough understanding of the theory of the 4 Levels. From the Chinese medicine point of view, the beginning stages of an acute respiratory infection usually manifest with symptoms of invasion of Wind. These can be interpreted either from the perspective of the 6 Stages from the Shang Han Lun or that of the Four Level from the Wen Bing School. In my experience, the latter is clinically more relevant and it applies more to influenza.
The “Discussion of Cold-induced Diseases” (Shang Han Lun) by Zhang Zhong Jing provided the earliest framework for the diagnosis and treatment of diseases from exterior Wind-Cold. Although this famous classic does also discuss invasions of Wind-Heat and their treatment, a comprehensive theory of exterior diseases from Wind-Heat was not developed until the late 1600s by the School of Warm Diseases (Wen Bing).
Thus, the two schools of thought which form the pillars for the diagnosis and treatment of exterior diseases in Chinese medicine are separated by about 15 centuries: they are the School of Cold-induced Diseases (School of Shang Han) based on the “Discussion of Cold-induced Diseases” (Shang Han Lun by Zhang Zhong Jing, AD 220) and the School of Warm Diseases (Wen Bing School) which started in the late 1600s and early 1700s. The main advocates of this school were Wu You Ke (1582-1652), Ye Tian Shi (1667-1746) and Wu Ju Tong (1758-1836).
WEN BING – THE FOUR LEVELS
What does “Wen Bing” mean? The above-mentioned doctors from this school of thought introduced important innovations to the theory of Wind in Chinese medicine. The School of Wen Bing postulates that some exterior pathogenic factors go beyond the natural characters of “Wind”; they are so virulent and strong that, no matter how strong a person’s body Qi may be, men, women and children fall ill by the dozen and, indeed, huge numbers of people are infected. More importantly, for the first time in the history of Chinese medicine, these doctors recognized that some external pathogenic factors are infectious.
A further innovative idea stemming from this school was that the pathogenic factors causing Wen Bing, all of them falling under the category of Wind-Heat, enter via the nose and mouth, rather than via the skin as happens for Wind-Cold.
The essential characteristics of Wen Bing diseases therefore are:
1) They manifest with the general symptoms and signs of Wind-Heat in the early stages (Wind-Heat is intended here in a broad sense as it may also manifest as Damp-Heat, Summer-Heat, Winter-Heat, Spring-Heat and Dry-Heat);
2) There is always a fever;
3) They are infectious;
4) The Wind-Heat penetrates via the nose and mouth;
5) The pathogenic factor is particularly strong.
6) The Wind-Heat has a strong tendency to become interior Heat.
7) Once in the Interior, the Heat has a strong tendency to dry up body fluids.
It is easy to see how this theory corresponds perfectly to the modern view of infectious viral diseases such as influenza. An influenza epidemic or pandemic is a typical Wen Bing disease which means it is more than just “Wind-Heat”. This is because it is very virulent and has a strong tendency to enter the Qi level (causing chest infections) very quickly.
We may not always be able to stop a Wen Bing disease at the Wei Level: even though we may not stop them at the Exterior level and therefore we must be skilled at treating the patterns presenting at the Qi Level. Chinese medicine can certainly achieve the following aims:
– Alleviate the symptoms
– Shorten the course of the disease
– Prevent transmission to the Ying and Blood levels (see below)
– Prevent complications
– Prevent the formation of residual pathogenic factors
The Four Levels
The 4 Levels are:
Wei Level
Wind-Heat
Damp-Heat
Summer-Heat
Wind-Dry-Heat
Qi Level
Lung-Heat
Stomach-Heat
Stomach and Intestines Dry-Heat
Gall-Bladder Heat
Stomach and Spleen Damp-Heat
Ying Level
Heat in Pericardium
Heat in Nutritive Qi
Blood Level
Heat Victorious agitates Blood
Heat Victorious stirs Wind
Empty-Wind agitates in the Interior
Collapse of Yin
Collapse of Yang
The Wei Level concerns the exterior stage of an invasion of Wind-Heat, the other three Levels describe pathological conditions which arise when the pathogenic factor penetrates the Interior and turns into Heat. The four Levels represent different levels of energetic depth, the first being the Exterior and the other three being the Interior. The interesting part of this theory is the distinction, within the Interior, of three different energetic levels, the Qi Level being the most superficial (within the Interior) and the Blood Level the deepest.
Wei Level
The main symptoms of invasion of Wind-Heat are aversion to cold, shivering, fever, sore throat, swollen tonsils, headache and body-aches, sneezing, cough, runny nose with yellow discharge, slightly dark urine, slightly Red sides of the tongue and a Floating-Rapid pulse.
It is worth noting that in Wind-Heat too there is aversion to cold as this is due to Wind obstructing the Wei Qi which therefore fails to warm the muscles. This corresponds to the beginning stages of influenza when the patient has “aversion to cold”.
With our treatment, we should always aim at expelling the Wind at the Wei Level: even though this may not be entirely possible, it will make the symptoms of the Qi Level milder and it will prevent complications.
Qi Level
At the Qi Level, Wind penetrates into the Interior and it changes into interior Heat or Phlegm-Heat, usually in the Lungs. With influenza, this usually manifests with bronchitis or pneumonia. The Qi Level is a crucial level as the pathogenic factor can be expelled completely or it can get worse by penetrating further into the Interior to the Ying or Blood level.
The Qi Level symptoms are symptoms of Interior Full Heat: high fever, thirst, sweating, feeling of heat, red face.
At the Qi Level, the tongue is Red with a thick-yellow coating and the pulse is Full and Rapid. As long as there is a coating on the tongue, the patient is still at the Qi Level. When the coating falls off, the patient is at the Ying or Blood level.
INFLUENZA
Infection from the influenza virus takes place through the upper respiratory tract and may occur in any season but it is more frequent in Winter or Spring. From the Chinese point of view, they usually manifest with symptoms of Wind-Heat.Influenza is a viral infection of the upper respiratory tract. Influenza may be caused by the influenza viruses A, B or C. The present influenza epidemic is of the A type, H3N2 strain.AETIOLOGY AND PATHOLOGY
An invasion of an exterior pathogenic factor is due to a temporary and relative imbalance between it and the body’s Qi. This imbalance may occur either because the body’s Qi is temporarily and relatively weak or because the pathogenic factor is very strong. The body’s Qi may be temporarily and relatively weak due to overwork, excessive sexual activity, irregular diet and emotional stress or a combination of these. When the body is thus weakened, even a mild pathogenic factor may cause an external invasion of Wind.Simultaneous chills and fever
The simultaneous fever and shivers is the most characteristic symptom of the beginning stages of an invasion of Wind: they indicate that there is an invasion of an exterior pathogenic factor and that this factor is still at the Exterior level. A long as there are shivers the pathogenic factor is on the Exterior.
I shall now discuss in detail the pathology and clinical significance of the “aversion to cold” and “fever” in the beginning stage of invasion of exterior Wind.Aversion to cold
In Exterior patterns, the aversion to cold and cold feeling is due to the fact that the external Wind obstructs the space between skin and muscles where the Wei Qi circulates; as Wei Qi warms the muscles, its obstruction by Wind causes the patient to feel cold and shiver (even if the pathogenic factor is Wind-Heat). Thus, Wei Qi is not necessarily weak but only obstructed in the space between skin and muscles.Thus, in Exterior patterns, both Wind-Cold and Wind-Heat cause a cold feeling and shivering: it is a common misconception that this is not the case with Wind-Heat. Since the cold feeling is caused by the obstruction of Wei Qi by Wind (whether it is Wind-Cold or Wind-Heat) in the space between skin and muscles, the cold feeling and shivering is present also in invasions of Wind-Heat, albeit to a lesser degree than in Wind-Cold.Thus, generally speaking, there are three aspects to the “cold feeling” in invasions of exterior Wind: the patients feels cold, he or she has “waves” of shivers, and he or she is reluctant to go out and wants to stay indoors. Except in mild cases, the cold feeling is not relieved by covering oneself.In conclusion, a feeling of cold in exterior invasions is a subjective feeling of the patient and is due to the obstruction of Wei Qi in the space between skin and muscles and it indicates that the pathogenic factor is on the Exterior: as soon as the feeling of cold goes, the pathogenic factor is in the Interior.Fever
As for “fever” it is important to understand that the Chinese term fa shao or fa re do not necessarily indicate “fever”. “Fever” is a sign in modern Western medicine, not in old Chinese medicine. In old China, there were obviously no thermometers and the symptom fa shao or fa re described in the old texts do not necessarily mean that the patient has an actual fever. It literally means “emitting burning heat” and it indicates that the patient’s body objectively feels hot, almost burning to the touch: the areas touched were usually the forehead and especially the dorsum of the hands (as opposed to the palms which tend to reflect more Empty Heat). So the body is objectively hot and the patient feels subjectively cold.In fact, it is a characteristic of fa re (so-called “fever”) in the exterior stage of invasions of Wind that the dorsum of the hands feels hot compared to the palms and the upper back feels hot compared to the chest. This objective hot feeling of the patient’s body may or may not be accompanied by an actual fever.When the symptoms of shivers and feeling cold occurs simultaneously with the objective sign of the patient’s body feeling hot to the touch (or having an actual fever), it indicates an acute invasion of external Wind and it denotes that the pathogenic factor is still on the Exterior. In particular, it is the symptoms of shivering and feeling cold that indicate that the pathogenic factor is on the Exterior: the moment the patient does not feel cold any longer but feels hot and, if in bed, he or she throws off the blankets, it means that the pathogenic factor is in the Interior and it has turned into Heat.The fever, or hot feeling of the body, in external invasions of Wind is due to the struggle between the body’s Qi (Zheng Qi, Upright Qi) and the external pathogenic factor. Thus, the strength of the fever (or hot feeling of the body) reflects the intensity of this struggle: this depends on the relative strength of the external pathogenic factor and the strength of the Upright Qi. The stronger the external pathogenic factor, the higher the fever (or hot feeling of the body); likewise, the stronger the Upright Qi, the higher the fever (or hot feeling of the body). Thus the fever will be highest when both the external pathogenic factor and the Upright Qi are strong. Thus, there are three possible situations:
– Strong pathogenic factor and strong Upright Qi: high fever (or hot feeling of the body)
– Strong pathogenic factor with weak Upright Qi or vice versa: medium fever (or hot feeling of the
body)
– Weak pathogenic factor and weak Upright Qi: low fever (or hot feeling of the body) or no fever
However, the relative strength of the pathogenic factor and the Upright Qi is only one factor which determines the intensity of the fever (or hot feeling of the body). Another factor is simply the constitution of a person: a person with a Yang constitution (i.e. with predominance of Yang) will be more prone to invasions of Wind-Heat rather than Wind-Cold and will be more prone to have a higher fever (or hot feeling of the body). Indeed, it could be said that the constitution of a person is the main factor which determines whether a person who falls prey to an invasion of Wind develops Wind-Cold or Wind-Heat.
Were it not so, in cold, Northern countries nobody should fall prey to invasions of Wind-Heat which is not the case. This is also the reason why, in children, invasions of Wind-Heat are far more prevalent than Wind-Cold: this is because children are naturally Yang in nature compared to adults. There are, however, also new, artificial factors which may predispose a person to invasions of Wind-Heat when succumbing to Wind and these are very dry, centrally-heated places, hot working conditions (e.g. cooks, metal workers), etc.
An influenza epidemic definitely manifests with symptoms of Wind-Heat in all cases.
The most important thing to establish when we see a patient suffering from an acute respiratory infection is whether the stage of the condition is external or internal, i.e. whether the pathogenic factor is still on the Exterior or is in the Interior. In terms of levels, this means distinguishing whether the patient is still at the Wei level or at the Qi level. The differentiation between the Wei and the Qi level is relatively easy: if the patient suffers from aversion to cold, he or she is still at the Wei level; if he or she does not suffer from aversion to cold but, on the contrary, from aversion to heat, the patient is at the Qi level.
Thus, influenza will always start with manifestations similar to the Wei-Qi level of the 4 Levels. If the pathogenic factor is not expelled at the beginning stages, it will penetrate into the Interior and thus become Interior Heat.
Once the pathogenic factor penetrates into the Interior, the body’s Qi carries on its fight against it in the Interior: this causes a high fever and a feeling of heat, in marked contrast to the aversion to cold and the shivering which occur when the body’s Qi fights the pathogenic factor on the Exterior. At the exterior level, the internal organs are not affected and it is only the Lung’s Wei-Qi portion which is involved. When the pathogenic factor becomes interior, the organs are affected and especially the Lungs and/or Stomach (see below).
This stage of development in the pathology of these diseases is crucial as, if the pathogenic factor is not cleared, it may either penetrate more deeply and cause serious problems (at the Ying-Qi or Blood Level) or give rise to residual Heat which is often the cause of chronic post-viral fatigue syndromes.
In the Interior, the main patterns appearing will be one of the Qi-Level patterns within the 4 Levels. In general, at the Qi Level, either the Stomach or Lung or both are affected.
excerpted from:
The Treatment of Influenza with Chinese Medicine