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Chapter 3 of 9
温病条辩
Overall Paraphrase
This chapter is from Wen Bing Tiao Bian: Original Disease Chapter. Wu Jutong excerpts nineteen passages from the Huangdi Neijing, appending his own commentary to each, with the purpose of tracing the origins of warm disease, distinguishing warm disease from cold damage, and clarifying the onset and prognosis of warm disease. The following follows the original order, paraphrasing item by item. Any references to ancient formulas, acupuncture, or prognostic judgments are purely for the study of classical literature and do not constitute diagnosis, medication, or treatment advice.
【I】 Qi Movement and the Onset of Warm Disease
The Six Yuan Zheng Ji Da Lun states: In the years of Chen and Xu, during the first qi-phase, the people are prone to warm disease; in the years of Mao and You, during the second qi-phase, pestilence arrives on a grand scale, and the people are prone to sudden death; during the final qi-phase, they are prone to warm disease. In the years of Yin and Shen, during the first qi-phase, warm disease arises; in the years of Chou and Wei, during the second qi-phase, warm pestilence spreads widely, near and far alike; in the years of Zi and Wu, during the fifth qi-phase, the people are prone to warm disease; in the years of Ji and Hai, during the final qi-phase, the people are prone to warm pestilence.
Wu Jutong explains: This is from the perspective of the Five Movements and Six Qi (the ancient model using Heavenly Stems and Earthly Branches to project climate and disease patterns), narrating the onset of warm disease. The earliness or lateness, and severity or mildness, of warm disease each year results from the interacting influences of the Si Tian, Zai Quan, Zhu Qi, and Ke Qi. Wu Jutong believes that Wu Youke's statement—"Warm disease is not cold damage; warm disease is more common, cold damage is rarer"—is very insightful. However, Wu Youke's claim that "there is qi out of its season" has the flaw of attending to one thing while losing sight of another. When the year is harmonious, harvests are good, and the weather is tranquil, the people's qi and blood are also balanced; even if warm disease should prevail that year, cases will be mild. But after famine or war, even a year that should be mild will see severe cases. This is the principle of nature.
【II】 Latent Qi and the General Cause of Warm Disease
The Yin Yang Ying Xiang Da Lun states: When joy and anger are immoderate, and cold and heat are excessive, life is not robust. Thus, extreme yin necessarily gives rise to yang, and extreme yang necessarily gives rise to yin. Therefore it is said: "If one is injured by cold in winter, one will surely suffer warm disease in spring."
Wu Jutong notes: The preceding item discussed the qi movements of heaven and earth; from this item onward, the focus shifts to why humans fall ill. Since the Song and Yuan dynasties, many famous physicians have failed to distinguish warm disease from cold damage. For example, Pang Anchang, Zhu Gong, Han Zhihe, Wang Shi, Liu Shouzhen, Zhang Zihe, and others either treated warm disease with methods for cold damage, or mistook warm summerheat for cold damage. Suspicious of the acrid-warm methods like Mahuang and Guizhi, they then established formulas such as Fangfeng Tongsheng, Shuangjie Tongsheng, and Jiuwei Qianghuo (these ancient formulas are discussed solely as historical scholarship, not as medication guidance), even adding bitter-cold drugs to acrid-warm formulas. Wang Andao's analysis in the Su Hui Ji is comparatively detailed.
Wu Jutong holds that the most detailed discussions of warm disease are found in the three schools of Zhang Jingyue, Wu Youke, and Yu Jiayan. Zhang Jingyue and Yu Jiayan both fixated solely on the character "cold," failing to notice the preceding clauses "extreme yin necessarily gives rise to yang, extreme yang necessarily gives rise to yin." Zhang Jingyue directly treated warm disease as cold damage, following old theories without substantive insight. Yu Jiayan, while offering some analysis, also mixed cold damage Shaoyin and Jueyin patterns into his middle chapter, with medication still inseparable from acrid-warm release of the exterior and acrid-hot warming of the interior—doing great harm. Wu Youke, though capable of distinguishing cold from warm and unwilling to lightly use acrid-warm, acrid-hot, or sweet-warm medicinals, failed to understand the principle of latent qi causing disease (when external pathogens invade but do not manifest immediately, instead hiding within the body to emerge later), and thus outright denied "injury by cold in winter leading to warm disease in spring."
Wu Jutong analyzes the biases of the three schools: Zhang mixes classical passages, using texts that describe cold damage transforming into heat—also termed "heat disease"—to explain warm-heat, mistakenly taking warm disease for cold damage; Yu speaks of spring warmth at every turn, but early spring commonly sees cold patterns, and he mistakes cold damage for warm disease; Wu, living amid the wars and pestilences of the late Ming, saw warm pestilence everywhere and therefore outright denied the classics. Wu Jutong maintains that latent qi causing disease—such as spring warmth, winter cough, and warm malaria—is clearly stated in the Neijing. There are also cases that are not latent qi but arise from the current Si Tian seasonal qi, as described in the Liu Yuan Zheng Ji; this is the norm. Additionally, there is qi out of its season, as Wu Youke called "li qi" (pestilent qi), which occurs occasionally; this is a variation. The key lies in the physician's ability to perceive both the norm and the variation and to apply remedial measures accordingly.
【III】 Storing Essence and Prevention
The Jin Gui Zhen Yan Lun states: Essence is the foundation of the body. Therefore, those who can seal and store their essence will not suffer warm disease in spring.
Wu Jutong cites the I Ching ("Treading on frost, the solid ice will come"), the Li Ji ("In all matters, preparation ensures success"), and the Neijing ("The superior physician does not treat disease already manifest, but disease not yet manifest"), emphasizing that prevention must be early and meticulous. This passage should be read in conjunction with the monthly ordinances and with the preceding item "injury by cold in winter." Those injured by cold in winter are prone to warm disease in spring; only those skilled at storing essence can avoid it. When essence is stored, all diseases can be withstood—not only warm disease. The phrase "not storing essence" should be understood flexibly; it does not refer exclusively to sexual excess. Anything that stirs and depletes the body's essence qualifies—for example, when winter should be cold but is warm instead, when yang qi fails to lie latent and vents outward like in spring, or even when peach and plum trees bloom out of season—all are manifestations of essence not being stored.
【IV】 The Temporal Boundary Between Warmth and Summerheat
The Re Lun Pian states: In all cases where cold damage leads to warm-heat disease, onset before the summer solstice is called warm disease; onset after the summer solstice is called summerheat disease. Summerheat disease should be allowed to sweat; do not check the sweating.
Wu Jutong explains: Warmth is the gradual approach of summerheat. Before the summer solstice is spring; spring qi is warm, yang qi ascends and unfolds, and if yin essence is insufficient to support it, warm disease results. After the summer solstice, warmth intensifies into heat; heat in excess stirs dampness; heat and dampness clash to become summerheat. "Do not" is a prohibition—do not suppress the sweating of summerheat disease; this is the great principle of treating summerheat.
【V】 Distinguishing Cold Damage from Summerheat Injury
The Ci Zhi Lun states: When qi is profuse but the body is cold, this is due to cold damage; when qi is deficient but the body is hot, this is due to summerheat injury.
Wu Jutong emphasizes that this is the differentiation between cold damage and summerheat disease. The classics are this clear—why do people throughout the ages persist in using cold-treatment methods for warmth and summerheat?
【VI】 Characteristics of Summerheat Pathogen
The Sheng Qi Tong Tian Lun states: When affected by summerheat, one sweats; with agitation, one pants and wheezes; when quiet, one talks excessively.
Wu Jutong explains: Summerheat contains fire 🔥. Fire is urgent by nature and governs dispersion, thus causing spontaneous sweating. Fire and the heart resonate with the same qi, thus the heart is prone to agitation. Agitation then causes panting and wheezing—fire overcomes metal (the lungs), producing panting, while the clear, open qi of the chest is constrained, so one wants to groan. If the pathogen does not vent outward but hides within the heart, the person appears quiet; yet the heart governs speech, and with summerheat lodged in the heart, even in stillness the person will mutter ceaselessly.
【VII】 Pulse Diagnosis and Cubit-Skin Diagnosis in Warm Disease
The Lun Ji Chi Pian states: When the skin at the cubit is markedly hot, and the pulse is full and restless, this is warm disease; when the pulse is full and slippery, the pathogen is about to exit.
Wu Jutong holds that from this item onward are the diagnostic methods for warm disease. The classics distinguish warm disease so clearly, yet people all call it cold damage and apply warming methods for the three yin channels of the foot, treating it as cold damage—a grave error. Zhang Jingyue, when composing the Lei Jing, mutilated the classical text and confounded the chapters because he did not read carefully. Cubit-skin heat is fire scorching yin essence; a full and restless pulse shows yin essence being boiled by fire; a full and slippery pulse indicates that the pathogen has an avenue of external escape.
【VIII】 Acupuncture for Heat Disease and Fatal Signs
The Re Bing Pian states: In heat disease of three days, when the qikou pulse is calm but the renying pulse is restless, needle the fifty-nine points of the yang channels to drain the heat and induce sweating, while also strengthening the yin to supplement what is deficient. When the body heat is severe but both yin and yang pulses are calm, do not needle; if needling is appropriate, do it urgently; if sweat does not come, drain. What is meant by "do not needle" is that there are fatal signs. In heat disease of seven or eight days, with moving panting and a wiry pulse, needle urgently; sweat will come of itself; needle shallowly at the space between the thumb and index finger. In heat disease of seven or eight days, when the pulse is faint and small, the patient passes blood in the urine, and the mouth is dry, death comes within a day and a half; when the pulse is intermittent, death comes within one day. In heat disease, when sweat has already come but the pulse remains restless and panting, and heat returns again, do not needle the skin; when panting is severe, death ensues. In heat disease of seven or eight days, when the pulse is not restless, or restless but not scattered or rapid, within the following three days sweating may occur; if no sweat within three days, death on the fourth day; if sweating has not occurred, do not needle the interstices.
When in heat disease the patient does not feel pain, the ears are deaf and cannot draw back, the mouth is dry, yang heat is severe, yet the yin aspect shows cold signs—the heat is in the bone marrow, and it is an incurable death.
In heat disease, when sweat has already come but the pulse remains restless and full, this is the extreme of the yin pulse—death; when sweat comes and the pulse is calm, life. In heat disease, when the pulse remains restless and full and sweat does not come, this is the extreme of the yang pulse—death. When the pulse is full and restless, and sweat comes and then settles, life.
There are nine conditions of heat disease in which needling is prohibited: first, no sweat, the cheekbones flushed red, and hiccups—death; second, diarrhea with pronounced abdominal distension—death; third, blurred vision with persistent heat—death; fourth, in the elderly and infants, heat with abdominal distension—death; fifth, profuse sweating, vomiting, and bleeding from below—death; sixth, erosion of the tongue root with persistent heat—death; seventh, cough with nosebleed, no sweat, or sweating that does not reach the feet—death; eighth, heat in the marrow—death; ninth, heat with convulsions—death, manifested as arching of the back, convulsions, and clenched teeth. In all these nine conditions, needling is prohibited.
When the color of the Taiyang channel suffuses the cheekbones, it is heat disease; if it contends with the Jueyin pulse, death comes within no more than three days.
When the color of the Shaoyang channel suffuses the front of the cheek, it is heat disease; if it contends with the Shaoyin pulse, death comes within no more than three days.
Wu Jutong's commentary explains:
This passage enumerates fatal signs of heat disease to prohibit acupuncture, because needling at such times may hasten death. But when needling is impermissible, there are occasional cases curable by medication. Needling can drain and unblock; it is swiftest for opening heat-pathogen constraint. However, in supplementing yin and retaining yang, needling is deficient, and this is where decoctions excel.
"When in heat disease of three days the qikou is calm but renying is restless" indicates that the pathogen is still superficial, in the upper jiao; one may needle the yang channels to drain the yang pathogen. When yang qi is free, sweat follows. What is meant by "strengthen the yin to supplement what is deficient" is that since yang excess causes yin decline, draining the excess yang is itself supplementing the deficient yin. Wu Jutong considers "strengthen the yin to supplement what is deficient" to be the key principle in treating warm-heat disease: no heat disease fails to consume yin. If yin depletion does not go past the point of no return, life may be preserved; if depleted utterly, yang qi has nothing to cling to, and there will be qingqi exhaustion and death.
"When the body heat is severe and both yin and yang pulses are calm"—is a case of pulse and sign not corresponding; a yang pattern with yin pulse—hence, do not needle.
"In heat disease of seven or eight days, with moving panting and a wiry pulse"—panting indicates excess in the lung qi; wiry indicates wind-fire stirring—hence needling shallowly at the Shaoshang point between thumb and index finger to drain lung qi; when the lung heat constraint opens, sweat comes forth.
"In heat disease of seven or eight days with a faint and small pulse"—the pathogen has penetrated deeply into the blood aspect of the lower jiao, forcing blood out through urine—hence hematuria; kidney essence is nearly exhausted, and yin fluid cannot rise to the mouth—hence dry mouth; a faint, small pulse shows not only exhaustion of yin essence but also the yang qi following it toward depletion—death signs are evident. If the pulse is replete, it may be treatable.
"In heat disease, when sweat has already come yet the pulse remains restless and panting"—this indicates that heat will return; heat does not decline despite sweating; fire overcomes metal, causing panting; the lung's source of transformation is about to fail—hence death.
"When in heat disease the patient does not feel pain"—upright qi is too weakened to contend with the pathogen; deafness is yin injury with essence about to desert; inability to draw back is true qi exhaustion; dry mouth with severe heat shows the solitary excess of yang pathogen; "the yin aspect showing cold signs"—the character "cold" should here be read as "deficiency"—indicating that the kidney yin essence of the lower jiao is depleted and true qi has begun to scatter, while pathogenic heat does not abate—hence heat in the bone marrow, an incurable death.
"When sweat has come yet the pulse remains restless and full"—extreme yin deficiency—hence death. But with appropriate medication, there are survivors. "When the pulse is restless and full and sweat does not come"—extreme yang excess, leaving no place for yin to lodge—hence also stated as death, yet with proper medication to open the constraint, life may yet be saved.
Regarding the nine incurable presentations for which needling is forbidden, Wu Jutong explains each mechanism: no sweat with flushed cheekbones—pathogen excess without resolution; hiccups—spleen yin disease. When both yin and yang are diseased, treating yang impedes yin and treating yin impedes yang—hence death. Diarrhea with marked abdominal distension—severe spleen yin disease, likewise a disease of both yin and yang. Blurred vision—essence dispersed and qi deserting. In the elderly and infants—the former with solitary yang already declined, the latter with immature yang insufficient—when they then encounter warm-heat yang disease compounded by abdominal distension, a yin disease—there is a road to death. No sweat indicates pathogenic yang excess; vomiting indicates upright yang decline; bleeding below indicates heat pathogen penetrating deeply, forcing the yin collaterals. Erosion of the tongue root—fire from the kidney, gallbladder, heart, and other channels binding in the blood aspect, with kidney water unable to ascend for support. Cough with nosebleed—the pathogen closing the lung collaterals and rising into the clear passages above; if sweat comes, the pathogen is released and life is possible; otherwise, the source of transformation is severed. Heat in the marrow—the pathogen has penetrated to the deepest level, the kidney; heat with convulsions—the pathogen has entered the deepest level, the liver.
"The Taiyang channel color suffusing the cheekbones"—the hand Taiyang channel runs obliquely across the cheekbones, meeting the foot Taiyang there; Taiyang belongs to water; when water is boiled by fire, the reddening indicates heat disease; "contending with the Jueyin wood qi"—water is overcome by fire in reverse, and metal does not generate water but instead generates fire—hence death comes swiftly. "The Shaoyang channel color suffusing the front of the cheek"—the hand Shaoyang emerges anterior to the ear, passes before Kebinren, joins the cheek, and reaches the outer canthus, where it meets the foot Shaoyang; the front of the cheek is the meeting point of both Shaoyang channels; Shaoyang belongs to ministerial fire, and Shaoyin belongs to sovereign fire; when two fires blaze together, water can hardly bear it—hence death within no more than three days.
(The above content on acupuncture and prognosis is solely for the study of classical principles and does not constitute any treatment advice.)
【IX】 The Yin-Yang Interlocking Fatal Sign
The Ping Re Bing Lun states: The Yellow Emperor asked: When someone has warm disease, after sweating there is renewed fever, the pulse is restless and racing, it does not diminish with sweating, and the person speaks deliriously and cannot eat—what is the name of this disease? Qi Bo said: Its name is yin-yang interlocking, and those with this condition die. The reason why people sweat is that sweat is born from grain qi, and grain qi is born from essence qi. When the pathogen contends with upright qi in the flesh and bones and sweat results, the pathogen has retreated and essence prevails; when essence prevails, one should be able to eat, and fever should not recur. Now fever returns immediately after sweating—this is the pathogen prevailing; inability to eat means essence has no replenishment; when the pathogen lingers and does not leave, the lifespan will topple. The Re Lun further states: "When sweat has come but the pulse remains restless and full—death." Now the pulse does not correspond to the sweating—this is not prevailing over the disease—death signs are clear. Delirious speech is the loss of will; those who lose their will die. Now three death signs are seen and not one sign of life; even if a temporary remission occurs, death is certain.
Wu Jutong says: When the classics clearly say a condition is fatal, who dares declare certain recovery? But with appropriate medication, there is a possibility of recovery—this is exactly what is meant by acupuncture and herbal drugs having their different applications.
【X to XV】 Heat Disease of the Five Zang Organs
The Ci Re Pian separately discusses the symptoms, transmission, days of death, and acupuncture methods for heat disease of the five zang organs.
Liver Heat Disease: First, yellow urine, abdominal pain, and somnolence, then body heat; when heat contends, there is delirious speech and fright, flank fullness and pain, restless hands and feet, and inability to lie peacefully; worse on Gengxin days, profuse sweating on Jiayi days; if qi rebels, death on Gengxin days. Needle foot Jueyin and foot Shaoyang.
Wu Jutong explains: The liver channel circles the genitals and governs free-flow and dispersion; when the liver is diseased, dispersion goes awry—hence urine turns yellow first. Abdominal pain and somnolence are the wood disease overcoming spleen earth. "Heat contends" means pathogenic heat and upright qi are at war. Delirious speech and fright—the hand Jueyin (pericardium) is also diseased; the two Jueyin share the same qi, and when heat contends, the hand Jueyin also falls ill. Flank fullness and pain—the liver channel runs along both sides of the body. Restless hands and feet without peaceful sleep—the liver governs wind, and wind inundates the four limbs; wood disease also overcomes earth, and the spleen governs the four limbs; when wood is ill with heat, it inevitably draws on the true yin of the kidney (Shaoyin), and when yin is injured, restlessness ensues. Gengxin belongs to metal, which overcomes wood—hence worsening; Jiayi belongs to the wood flourish period—hence sweating and recovery.
Heart Heat Disease: First, melancholy without joy for several days, then fever; when heat contends, there is sudden heart pain, vexation and oppression, a tendency to vomit, headache, flushed face, and no sweat; worse on Ren/Guiday*s, profuse sweating on Bing/Ding days; if qi rebels, death on Rengui days. Needle hand Shaoyin and hand Taiyang.
Wu Jutong explains: Heart disease shows melancholy first because the danzhong (pericardium) acts on behalf of the heart; joy and delight issue from the danzhong—hence melancholy in heart disease. Sudden heart pain—pathogen and upright contending. Vexation and oppression—the heart governs fire, hence vexation; the danzhong's qi is constrained, hence oppression. Vomiting—this is liver disease; the two Jueyin share the same qi; when the danzhong is diseased on behalf of the heart, liver disease also appears; when pathogen is above the diaphragm, there is often vomiting. Headache is fire ascending; flushed face is the color of fire. No sweat—because sweat is the fluid of the heart; when the heart is diseased, sweating cannot be unblocked.
Spleen Heat Disease: First, head heaviness, cheek pain, vexation of the heart, greenish complexion, desire to vomit, body heat; when heat contends, there is low back pain preventing bending and straightening, abdominal fullness and diarrhea, and pain in both cheeks; worse on Jiayi days, profuse sweating on Wuji days; if qi rebels, death on Jiayi days. Needle foot Taiyin and foot Yangming.
Wu Jutong explains: The spleen belongs to damp earth and is heavy by nature; when damp pathogen strikes a person, the head feels as if wrapped—hence head heaviness first in spleen disease. The cheeks belong to Shaoyang; earth and wood mutually conquer; when earth is diseased, wood disease also emerges. The spleen channel connects to the heart—hence vexation of the heart. Greenish complexion and desire to vomit also belong to wood disease. The low back is the residence of the kidney; the spleen governs control over water; when the spleen is diseased, it cannot control water—hence low back pain; when the spleen is diseased, the stomach cannot act alone, and Yangming governs the binding of bones and movement of joints—hence pain preventing bending and stretching. Abdominal fullness and diarrhea are the spleen channel's own disease; cheek pain is also wood disease.
Lung Heat Disease: First, sudden chills with shivering, piloerection, aversion to wind and cold, yellow coating on the tongue, body heat; when heat contends, there is panting and cough, pain running through the chest and upper back, inability to take a full breath, unbearable headache, and sweating with chills; worse on Bing/Ding days, profuse sweating on Gengxin days; if qi rebels, death on Bing/Ding days. Needle hand Taiyin and hand Yangming, letting blood the size of a soybean—immediate relief.
Wu Jutong explains: In lung disease, aversion to wind and cold appears first because the lung governs qi and also governs the skin and body hair; when the lung is diseased, qi becomes congested and cannot defend the skin and hair. Yellow tongue coating—lung qi fails to transform; damp-heat accumulates into a yellow fur. Panting is extreme qi constraint; cough—fire overcomes metal. The chest and upper back serve as the palace of the back; the lung governs heavenly qi; when lung qi is severely constrained, pain runs through the chest and upper back. Inability to take a full breath is extreme qi constraint. Unbearable headache—also extreme congestion of heavenly qi. Sweating with chills—when sweat pores open, sweating occurs; after sweating, defensive qi is depleted, hence chills; moreover, the lung itself dislikes cold.
Kidney Heat Disease: First, low back pain, soreness of the lower legs, bitter thirst with frequent drinking, body heat; when heat contends, there is neck pain and stiffness, coldness and soreness of the lower legs, heat under the feet, and unwillingness to speak; when qi rebels, neck pain with dizzying confusion; worse on Wuji days, profuse sweating on Rengui days; if qi rebels, death on Wuji days. Needle foot Shaoyin and foot Taiyang.
Wu Jutong explains: The low back is the residence of the kidney; the kidney channel penetrates the spine. Soreness of the lower legs—heat scorching the fluids. The kidney governs the five fluids and dislikes dryness; in heat disease, fluids are injured and dryness results—hence bitter thirst as the body seeks water for rescue. The neck is the pathway of the Taiyang channel; when kidney disease with heat contends, the zang organ's disease becomes severe and transfers to the fu organ—hence neck pain and stiffness. Coldness of the lower legs in the face of heat is extreme heat resembling cold; soreness is heat scorching the fluids. Heat under the feet—the kidney channel runs obliquely to the Yongquan point on the sole. Unwillingness to speak—kidney disease with water overcoming fire, and the heart governs speech. "Yuan-yuan dan-dan" describes pain so severe that one is overwhelmed and helpless.
Facial Precursors: In liver heat disease, the left cheek first turns red; in heart heat disease, the forehead first turns red; in spleen heat disease, the nose first turns red; in lung heat disease, the right cheek first turns red; in kidney heat disease, the chin first turns red. Though the disease has not yet manifested, if redness is observed, acupuncture should be administered—this is called "treating before disease onset." Wu Jutong's commentary: When the five viscera are about to become diseased, signs invariably appear first in their corresponding facial regions, alerting one to seek early treatment, so as to avoid severe illness from the clash of heat.
【16】Dietary prohibitions after febrile disease ("food relapse") The "Discussion on Heat" chapter states: The Yellow Emperor asked, "When a febrile illness has already recovered, why is there sometimes something left behind?" Qibo replied: "When one forces oneself to eat during intense heat, residual pathogens remain. When the disease has declined but heat is still harbored, because grain qi combines with residual heat, and the two heats merge, something is left behind." To treat the leftover, one must examine whether it is excess or deficiency, and regulate that which goes against or with the natural order. When a febrile disease has somewhat recovered, eating meat causes relapse; overeating causes retention—these are the prohibitions. Wu Jutong's commentary: The prohibitions for febrile disease are self-evident in meaning. Generally speaking, when pathogenic qi attacks a person, it often relies on tangible substances for attachment. During intense heat, eating is absolutely forbidden; after the heat recedes, one must eat sparingly—just as military strategists fortify positions and clear the fields. Only after the heat pathogen has thoroughly retreated may one resume normal eating.
【17】Epidemic disease and upright qi The "Discussion on Acupuncture Methods" chapter states: The Yellow Emperor asked, "When the five epidemics arrive, all are mutually contagious—whether adult or child, the symptoms are similar. How can one avoid being infected?" Qibo replied: "Those who are not infected have upright qi maintained within; evil cannot invade." Wu Jutong says: This speaks of the way to avoid epidemics. What follows includes phrases such as "avoid its poisonous qi," as well as practices of visualizing green qi, white qi, and so on—these border on shamanic incantations and are likely later fabrications, so they have been omitted. The essential meaning is nothing more than the two phrases: "upright qi maintained within; evil cannot invade."
【18】Wen disease with severe deficiency leads to death The "Jade Tablet Discussion of Essentials" states: One who suffers from warm disease with severe deficiency of essence and blood will die. Wu Jutong's commentary: In a person with warm disease, if essence and blood are severely deficient, there is no yin fluid to overcome the warmth and heat—hence death.
【19】Combined assessment of pulse diagnosis and forearm skin examination The "Discussion of Normal and Abnormal Pulses of Healthy People" states: If a person's pulse beats three times per inhalation and three times per exhalation, and is rapid and agitated, and the cubital region is hot—this is warm disease. If the cubital region is not hot but the pulse is slippery, this is wind disease. If the pulse is rough, this is bi (obstructive) disease. Wu Jutong's commentary: Three beats per inhalation and exhalation each represents a rapid pulse of six to seven beats per breath. If the cubital muscles are hot, it is warm disease—for warm disease inevitably injures the fluids of the lungs and kidneys. The cubital pulse pertains to the kidneys, while the cubital acupoint pertains to the lungs. If the cubital region is not hot but the pulse is slippery, it is wind disease—wind injures the yang aspect, and the cubital region is yin, hence not hot. If the pulse is agitated yet also rough, this indicates qi in excess with blood insufficiency, and the disease is bi-obstruction.
Bu Gua believes the core principles of this chapter can be summarized as follows:
Warm disease must be distinguished from cold damage Wu Jutong repeatedly criticizes the Song and Yuan physicians' approach of "treating warm disease with cold damage methods"—this is the theoretical starting point of the warm disease school. Warm disease is not an appendage of cold damage; its pathogenesis centers on warm-heat injuring yin, rather than cold pathogen binding to the exterior.
Essence-yin is the core determinant of warm disease prognosis This chapter repeatedly emphasizes "one who stores essence will not suffer warm disease in spring," "warm disease with severe deficiency leads to death," and "strengthen the yin to supplement what is insufficient." Ancient physicians believed that the occurrence, transmission, and prognosis of warm disease are closely tied to whether essence-yin is sufficient. The febrile process inevitably consumes yin; preserving one measure of yin fluid means preserving one measure of vitality.
Seasonal qi, latent qi, and pestilential qi are the three sources of warm disease Wu Jutong distinguished three scenarios: first, the current season's climatic influences directly causing disease; second, latent qi causing disease—"injury by cold in winter necessarily leads to warm disease in spring"; third, non-seasonal qi or pestilential qi causing disease—what Wu Youke called epidemic pestilence. This reflects the ancients' attempt to use "constant and variable" to encompass the complex manifestations of exogenous febrile illness.
Treating before onset and dietary prohibitions From storing essence, early acupuncture, and facial color indicators, to "eating sparingly and avoiding meat" after febrile illness—all embody the spirit of prevention and post-illness care. In particular, the "food relapse" theory holds that residual heat and grain qi reinforce each other, which resonates with the modern clinical experience of avoiding rich foods too early after fever.
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication prescription, or treatment advice. If you feel unwell, please seek medical attention promptly.