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Wen Bing 3

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Wind Warmth

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• 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

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Etiology and Pathology

• Wind heat evils invasion – Invading lung and Wei– Transfer to stomach routine – Invading pericardium adverse transfer – Invading blood and collaterals skin eruptio

n papules 疹– Impair lung and stomach Yin

Wind warmth (general) – cont’d

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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

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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 h

eat– 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

Wind warmth (wei invasion) – cont’d

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• “ 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

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• 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

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• 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 tan

g 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

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• 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 downw

ard – 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

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• 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)

Wind warmth (qi level) – cont’d

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• 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)

Wind warmth (qi level) – cont’d

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• 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.7

0

Wind warmth (qi level) – cont’d

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• 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

Wind warmth (qi level) – cont’d

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• 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 41

6 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

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• 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 hua

ng 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

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• 3-3 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

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• 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

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Autumn Dryness

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Autumn Dryness

• Dryness pathogenic factor attack in Autum

• Starts from LU

• Dryness damages body fluid

Autumn Dryness – cont’d

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• Etiology and Pathology– Cool dryness– Warm dryness

Autumn Dryness – cont’d

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• 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

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• 1. Autumn Dryness in LU Wei-stage– Fever, slight aversion to wind cold, cough with little ph

legm, 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

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• 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

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• 2-1 Dryness disturbs orifices– Sx: Fever, thirst, tinnitus, red eyes, swollen gums, sor

e 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

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• 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 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

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• 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

Autumn Dryness in the Qi Stage– cont’d

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• 2-4 Dryness in LU with constipation– Sx: Cough with phlegm, fullness in chest and abdome

n, 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

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• 2-5 Lung & Stomach yin injury– Sx: After fever or with slight fever, non-produc

tive 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

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• 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