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Chapter 4 of 9
温病条辩
The first volume of Wenbing Tiaobian (Systematic Differentiation of Warm Diseases), the Upper Burner Chapter, takes Triple Burner Pattern Differentiation as its guiding principle, focusing on the differentiation and treatment of warm diseases in their early stages affecting the Lung system of the Upper Burner. Wu Jutong classifies warm diseases into nine categories: wind-warmth, warm-heat, warm epidemic, warm toxin, summerheat-warmth, dampness-warmth, autumn dryness, winter warmth, and warm malaria. He explicitly states that warm diseases differ from cold damage: warm diseases enter through the mouth and nose, beginning in the Hand Taiyin Lung; treatment cannot mechanically apply the acrid-warm diaphoresis method used for cold damage, but should primarily employ acrid-cool clear-outthrust with protection of fluids.
Early-stage warm disease commonly presents with: pulse that is neither slow nor tense but stirring-rapid, or with both inch positions exclusively large, warm skin over the elbow, headache, mild aversion to wind and cold, body heat with spontaneous sweating, thirst, and heat worsening in the afternoon. Wu Jutong regards this as the manifestation of wind and fire fanning each other, with fire overriding the Metal of the Lung. It resembles Taiyang wind-strike in its headache, aversion to wind and cold, body heat, and spontaneous sweating; the distinguishing features of warm disease are a stirring-rapid pulse, thirst, cough, warm elbow skin, and afternoon exacerbation of heat.
For cases with persistent aversion to wind and cold at onset, the ancients considered this internal heat with external cold, using Guizhi Decoction (Cinnamon Twig Decoction) to mildly harmonize the nutritive and defensive levels. For those with heat but no aversion to cold, with thirst, use Yinqiao Powder (Lonicera-Forsythia Powder) as the acrid-cool neutral formula. For mild cough, use Sangju Decoction (Mulberry Leaf-Chrysanthemum Decoction) as the acrid-cool mild formula. For exuberant heat with severe thirst, profuse sweating, and red face, use Baihu Decoction (White Tiger Decoction) as the acrid-cool heavy formula. For damage to both qi and fluids, use Baihu plus Renshen Decoction. For blaze in both qi and blood, use Yunü Jian (Jade Woman Decoction) minus Niuxi plus Xuanshen. For blood heat with reckless movement, use Xijiao Dihuang Decoction (Rhinoceros Horn-Rehmannia Decoction) combined with Yinqiao Powder. For fluid damage with thirst, use Xueli Paste (Snow Pear Paste) and Wuzhi Beverage (Five-Juice Drink). For heat constraint in the chest and diaphragm, use Zhizi Chi Decoction (Gardenia-Soja Decoction). For profuse phlegm and drool congestion, use Guadi Powder (Melon Stalk Powder). For heat entering the nutritive level, use Qingying Decoction (Clear Nutritive Decoction) minus Huanglian.
This chapter especially emphasizes: Warm disease must not be treated by diaphoresis. Erroneous diaphoresis may produce macules, unconsciousness, and delirious speech. For macules, use Huatan Decoction (Transform Macule Decoction); for papules, use Yinqiao Powder minus Doudou, plus Xi-Shengdi, Danpi, Daqingye, and doubled Xuanshen. For unconsciousness with delirious speech, use Qinggong Decoction, Angong Niuhuang Pills, Zixue Pellet, and Jufang Zhibao Pellet. Warm toxin presenting with redness and swelling of the head and face, sore throat, and laryngeal swelling—termed "Big-head warmth" and "Toad warmth"—is treated with Puji Xiaodu Beverage minus Chaihu and Shengma, with topical application of Shuixian Paste; after yellow sores appear on the skin, switch to Sanhuang Erxiang Powder.
Summerheat-warmth is characterized by right pulse large, surging and rapid; left pulse comparatively smaller; intense thirst; red face; and profuse sweating. For cases with initial absence of sweating, use Xinjia Xiangru Beverage. For sweating with exuberant heat, use Baihu Decoction or Baihu plus Renshen Decoction. For qi and yin on the verge of collapse, use Shengmai Powder. For residual pathogens, use Qingluo Beverage. For summerheat entering the pericardium, use Qingying Decoction, Angong Niuhuang Pills, or Zixue Pellet. For pediatric summerheat seizures and adult summerheat seizures due to internal stirring of liver wind, modifications of Qingying Decoction remain the basis of treatment.
Summer heat contracted during the long summer that manifests in autumn or winter is called latent summerheat. Latent summerheat shares the same pathological origin as summerheat-warmth and dampness-warmth. Clinically, it is differentiated as pathogen in qi level or blood level, and further as exterior excess or exterior deficiency, treated respectively with modified Yinqiao Powder, Baihu methods, Shengmai Powder, etc.
Dampness-warmth presents mainly with headache, aversion to cold, heavy body, painful achy sensation, white tongue coating without thirst, sallow complexion, chest oppression with loss of appetite, and afternoon body heat. Wu Jutong specifically cautions that dampness-warmth prohibits diaphoresis, prohibits purging, and prohibits moistening. Erroneous diaphoresis leads to unconsciousness and deafness; erroneous purging leads to unremitting diarrhea; erroneous moistening deepens the disease and prevents resolution. Treatment employs Sanren Decoction (Three-Seed Decoction) to gently open the Lung qi of the Upper Burner, allowing qi transformation to resolve dampness. For dampness-warmth entering the pericardium, use modified Qinggong Decoction combined with Zhibao Pellet or Zixue Pellet. For throat obstruction with pharyngeal pain, use Yinqiao Mabo Powder. For chest bi-obstruction with hiccups, use Xuanbi Decoction. For wheezing and急促, use Qianjin Weijing Decoction plus Xingren and Huashi. For cold-dampness damaging yang, use Guizhi Jiangfu Decoction.
Warm malaria typically results from pre-existing yin injury with yang independently hyperactive, manifesting as heat without chills, bone and joint vexation and pain, and episodic vomiting, treated with Baihu plus Guizhi Decoction. Dan malaria, characterized by heat without chills, dry tongue, and thirst, is treated with Wuzhi Beverage. Lung malaria presents with frequent coughing and chills rising from the back, treated with Xingren Decoction. Heart malaria, with predominant heat, clouding, mania, delirious speech, vexation, and thirst, is treated with modified Yinqiao Powder, or in severe cases, Angong Niuhuang Pills.
For autumn dryness initially damaging the qi level of Hand Taiyin, use Sangxing Decoction. For dry cough, use Sangju Decoction. For dryness damaging the yin of the lungs and stomach, use Shashen Maidong Decoction. For dryness transforming into fire with obstruction of the clear orifices, use Qiaohe Decoction. For lung dryness with wheezing and vomiting, use Qingzao Jiufei Decoction (Clear Dryness and Rescue Lung Decoction). A supplementary section on the "Overabundant qi of autumn dryness" divides dryness into overabundant qi (victorious qi) and recovering qi: warm dryness belongs to recovering qi, whereas cool dryness belongs to overabundant qi. For cool dryness with cough, use Xingsu Powder. For dryness penetrating deeply into the blood level forming masses, the ancients used formulas such as Huazheng Huisheng Dan and Fufeng Dan, but these complex prescriptions should be regarded as historical scholarly discourse given their intricate logic.
1. Triple Burner Differentiation and "Treating the Upper Burner Like a Feather"
This chapter locates early warm disease in the Upper Burner, Hand Taiyin Lung, establishing the principle that "treating the Upper Burner is like a feather—what is not light will not rise." Accordingly, medications are chosen for their light, clear, diffuse, and outthrust properties, such as Jinyinhua, Lianqiao, Sangye, Juhua, Bohe, and Zhuye, avoiding heavy, thick, bitter-cold, direct-suppressing agents.
2. The Cold-Warm Divide: Warm Disease Enters via Mouth and Nose
Wu Jutong repeatedly analyzes: cold damage enters through the skin and hair, beginning in the Foot Taiyang Bladder, with cold as a yin pathogen damaging yang; warm disease enters through the mouth and nose, beginning in the Hand Taiyin Lung, with warmth as a yang pathogen damaging yin. Therapeutically, acrid-warm diaphoresis must not be used; instead, the approach should be acrid-cool release of the muscles and clear outthrust of heat. This constitutes the core distinction between warm disease theory and cold damage theory.
3. The Three Acrid-Cool Formulas
Yinqiao Powder is the acrid-cool neutral formula, used for early warm disease with heat but no aversion to cold, accompanied by thirst. Sangju Decoction is the acrid-cool mild formula, used for mild cough. Baihu Decoction is the acrid-cool heavy formula, used for exuberant heat with severe thirst, profuse sweating, and a surging pulse. The three formulas are clearly tiered, embodying the nascent framework of "in the defensive level, diaphoresis is permissible; only when the pathogen reaches the qi level may one clear qi."
4. Diaphoresis Prohibition and Macule/Papule Differentiation in Warm Disease
Acrid-warm diaphoresis is contraindicated in early warm disease. Erroneous diaphoresis readily produces macules, papules, unconsciousness, and delirious speech. This chapter carefully distinguishes macules as belonging to the muscles and papules as belonging to the blood vessels: macules are treated with Huatan Decoction, papules with modified Yinqiao Powder. It emphasizes that ascending, dispersing, warm, and drying medicinals such as Shengma, Chaihu, and Qianghuo must not be used, as they would aggravate heat and injure fluids.
5. The Three Prohibitions in Dampness-Warmth
Dampness-warmth involves the union of dampness and heat. Dampness is sticky and turbid, leading to prolonged disease courses. Wu Jutong sets forth three major prohibitions: diaphoresis leads to unconsciousness and deafness; purging leads to unremitting diarrhea; moistening deepens the disease and prevents resolution. The therapeutic key is diffusing qi to transform dampness, using Sanren Decoction to gently open Lung qi and mobilize the entire body's qi mechanism.
6. Autumn Dryness: Overabundant vs. Recovering Qi
Wu Jutong inherits and develops the dryness theories of Yu Jiayan and Ye Gui, differentiating warm dryness from cool dryness. Warm dryness belongs to recovering qi, treated with acrid-cool, sweet-moistening methods; cool dryness belongs to overabundant qi, treated with bitter-warm, sweet-acrid methods. His supplementary discussion corrects earlier claims that "dryness is a lesser cold" or that "dryness does not cause disease."
✅ Valid Value
⚠️ Historical Limitations
Notice: This content is based on classical Chinese medicine texts and is provided solely for traditional culture learning and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.