Swine Flu, seasonal influenza and common cold Chinese medicine analysis and treatment strategy Yaron Seidman

n L.Ac. The World Health Organization declared a swine flu pandemic on June 11th 2009 the first global flu epidemic in 41 years In recent weeks I have treated six cases of swine flue with Chinese herbal formulas, all of which recovered quickly. Recovery time from drinking the first dose of herbs ranged between 2 hours of seeing great improvement to one to three days for complete recovery. With this new pandemic in sight I have resolved to write this short essay and circulate it among my peers. If you find this method successful please circulate this note to your colleagues so they can help their patients. 1. Understanding swine flu, influenza and common cold with Chinese medicine. Disregarding the conventional names of influenza is the first step. Focusing on Chinese medicines differentiation of syndromes and application of treatment (bian zheng lun zhi ) is the correct approach and should be done next. Swine flu and other influenza types consist of two main syndromes; cold injuries (shang han ) or warm obstruction (wen bing ). Understanding the difference between shang han and wen bing is the key for success and fast recovery.

www.ChineseClassics.org

It is key to understand that a warm obstruction or wen bing is not fever or febrile disease as some translate it. On the contrary, one of the chief symptoms differentiating shang han syndrome and wen bing syndrome is fever. Wen bing rarely will have fever and if so a low grade fever and not high fever. Cold injury, on the other hand, will often be accompanied by fever, which from time to time may spike to a high temperature. How can we understand this difference? Yang energy opens up from the interior outwards to the skin surface. This is a Tai Yang function of the six spheres described in the Shang Han Lun. The Yang opening action is obstructed by external invading cold. Cold has an inward momentum as we will see next with Wen Bing. When Yangs outward and upward motion is being obstructed by cold it heats up the surface to create fever. The more Yang pushes outwards to the surface and being blocked by the cold injury, the higher the fever. Fever is a sign that our Yang is stronger then the cold pathogen. If the cold injury didnt resolve and yet the fever subsided, it signifies that ones own Yang has weakened. At this time one feels chills as the exterior cold wins over the situation. Thus in the Shang Han Lun Tai Yang chapter- third quote the text explains Tai Yang obstruction, if fever broke in already, or if there is no fever yet, there must be an aversion to cold .. this is called cold injury. For the purpose of treatment the practitioner must differentiate between the patient having fever or not (will be discussed in the treatment section). Cold injury with or without fever requires formula modifications as it signifies our own Yang winning or losing. Wen bing or heat obstruction has a completely different mechanism. In Tai Yang cold injury, the bodys Yang goes out to the skin in spring and summer or east and south or morning and midday (all synonyms). The pervasive cold energy comes from the south to obstruct the skin surface or the most exterior aspect of our body. Cold energy coming from the south is called in the classics evil wind (Zei Feng ). In contrast in fall and winter and west and north, the Yang energy withdraws. The Yang energy withdraws into the interior of the body. This withdrawal takes place thanks to the cooling down of Yang and the metal/dryness force of the lungs and large intestines (Tai Yin lungs and Yang Ming large intestine). However, this cooling down is not an absolute cooling down, but rather a withdrawal of Yang into the bodys core. This means that the body turns warm on the inside while it turns cold on the outside, which is opposite to the Tai Yang process of hot exterior and cold interior. While observing the four seasons we can see that in spring and summer the Yang is expanding to the exterior, and at the same time it is lacking in the interior. This is called in the classics Tai Yang cold water. Water, as we will see next, displays the state of Yang in the interior. When the sages described Tai Yang as having the quality of cold water, it means that while the Yang energy expands outwards it is lacking Yang energy inside or the water is cold. In contrast, in fall and winter the Yang is lacking on the outside, thus it is cold outside, but it is full of Yang on the inside. Thus storage and hibernation of seeds can take place (life force is positioning itself inside). For the modern mind this classical explanation is hard to understand because we are taught that Yang is always on the outside and it has no business coming inside. In reality, Yang goes outside in spring and summer thus the temperature warms up,

www.ChineseClassics.org

at which time it is empty inside. In fall and winter Yang goes inside, thus the outside temperature is cold and the inside is full of life. So what is heat obstruction (wen bing) then? The Yang cannot withdraw inwards. It cannot cool off outside and contract into storage inside. Cooling off comes from the dry metal function of Tai Yin lung and Yang Ming Large Intestine. As Wu Jutong explained in Wen Bing Tiao Bian, when heat invades the body it enters through the nose and mouth (hand Tai Yin and Yang Ming orifices) directly to the lungs metal dryness. Heat cannot attack the Tai Yang or skin/exterior, because the Yang wants to expand in this place and heat helps it expand, thus can there be no obstruction. Instead, heat entering the body prevents the bodys Yang from cooling off in the west/lung/metal energy. Yang energy cannot descend into the water in the north. When water/north does not have enough Yang it becomes ice-dry inside. In mild cases the person will experience flu symptoms, and in severe the person can die. These symptoms are different then Tai Yang symptoms of cold injury. When pathogenic heat enters the body and obstruct the cooling off process, the person cannot feel aversion to cold, his lungs are dry and there is cough with coarse sound. The metal-dryness cooling off function is obstructed. Dryness, generally speaking, has two meanings; taking Yang out of the water and ice-dry it, or adding too much Yang to water and evaporate-dry it. This means that the lung/metal/west function is a delicate one. It needs to remove Yang from the exterior and cool it off. This, in turn, is done to nourish the Yang inside the water so it will not become iced-dry. The lung cools of the outside in order to warm up the inside. Standing almost opposite to the Tai Yang cold water function, the lung-metal-dryness serves the function of warm water. Warm water being a description of Yang energy accumulating in the interior. Heat obstruction (wen bing) attacks in this phase. Heat from the north enters into the lungs/metal (Zei Feng) and doesnt let it cool off the exterior Yang. This gives rise to heat accumulating in the lungs (the reverse of dry-metal cooling function), and thus we see the dry symptoms of the lungs in heat obstruction. Since the evil heat obstruct the cooling off process, this cannot give rise to high fever such as with Tai yang cold injuries. However, low grade fever may be present as the bodys Yang cant cool off. In cold injury cough is possible too, for example when the cold obstructs the Tai Yangs entering-exiting motion in the center of the chest. However, this cough cannot be dry, painful and coarse as with heat obstruction. 2. Treatm ent strategy To elaborate further on the Shang han Lun- Tai Yang chapter quote where it is said if fever broke in already, or if there is no fever yet, there must be an aversion to cold, one can see that it explains the relationship between the expanding Yang (defensive energy) and the incoming cold pathogen. The translation should not mean with or without fever there is aversion to cold, but rather if the fever broke in already (the fever is

www.ChineseClassics.org

finished and the Yang has retreated), or if the fever didnt break in yet (because the Yang didnt advance enough to the exterior), then one must have aversion to cold. If, however, fever is in full force and the Yang is expanding with vigor, the person will feel hot. Now this hot feeling is non-the-less a cold injury and should be treated as such. Now that we have a grip on the mechanism of fever and since we understand that our own Yang expanding struggle with the incoming cold and its contraction, we can start differentiating shang han and wen bing. Many go the mistake and think that if a person feels cold it is a cold injury, but if he feels hot it is a heat injury. This frequently leads to the wrong formulas and worsening of the situation. Some yet believe that cold injuries happen in winter when the weather is cold, while heat obstructions happen in summer. In reality, cold injuries and heat obstructions refers to our own bodys disharmony. For example, in midsummer a light breeze can cause a cold injury. A flu like syndrome with fever and chills. It is also possible to create a cold injury in midwinter by a warm breeze opening the Yang and then the exterior cold coming back to obstruct the Tai Yang. Cold injury is characterized by high fever and feeling hot as the Yang surfaces, then feeling very cold when the Yang retracts/diminishes. As the Yang propels outwards the interior becomes depleted of inner Yang (cold water of Tai Yang). Thus after a certain length of fever time, the outward expansion cant sustain itself and cold takes over. When we recognize this difference we can choose correctly between Ma Huang Tang and Gui Zhi Tang and know how to modify it. The same goes for heat obstructions. They can take place in each season, caused by heat, cold, wind or damp. The syndrome presented at the end of the day, after the pathogen entered the body, determines if it is heat obstruction or cold injury. Helping us decide between cold injury or heat obstruction is never the pathogen itself, i.e. It was hot outside then it is heat obstruction. One must know that cold or hot diseases are the result of ones own energy six spheres (Liu Jing). In winter exterior cold can enter the skin, but if the persons west/metal is weak, this can easily transform into a heat obstruction. The same goes for the summer months, heat can enter the body via the nose and lungs, but if the east/wood and south/ fire are weak, this can transform into a cold injury. So when we talk about swine flue it can go either way, depending on the persons weaknesses (or immunity). The swine flu or any other flu can become a cold injury or a heat obstruction. There can be no one treatment for the flu in Chinese medicine. The plain questions- febrile treatise (Re Lun) states all febrile diseases belong to cold injuries (shang han). However, as previously explained, heat obstruction is different then febrile disease, and thus does not belong to cold injury. It is rather the obstruction of the metal cooling off function. Heat, in this case, is evil energy obstructing the normal and vital cooling of function of the body (west/metal and north/water). The symptoms are: dry cough in the lungs which is painful (obstructed), coarse voice, yellow-brown sticky phlegm, diarrhea, constipation, vomiting etc. Wu Juteng propagated that wen bing enters directly into the lungs and through the skin. Future generations didnt understand his meaning and thought of the San Jiao theory as a new theory. Pathogen enters from the upper Jiao to the middle Jiao and then to the lower Jiao. Following are

www.ChineseClassics.org

several quotes from Wu Jutongs work Curing The Practitioners Disease Yi Yi Bing Shu explaining Wu Jutongs theories as being classical and not modern, and as such must to be studied within a classical frame of knowledge. <Chapter 13> Practitioners today do not read the classics. They reach minor accomplishments and feel fulfilled. They love the superficial and easy to reach and they hate the deep and difficult to attain. This is a big disease. Books like the yellow emperor, Shen Nong materia medica, classic of difficulty, Shang Hanlun, golden chamber, book of changes and book of rites must all be studied. Master Ye Tianshis book is very difficult to understand. His book uses classical views the most, so the reader does not know where Ye is coming from and what are his profound ideas. If you are not well versed with the yellow emperor and the golden chamber (of Zhang Zhongjing) you cannot use this knowledge. <Chapter 22> Under heaven there is no medicine that does not incline off the center. The doctor is seeking this inclination away from the center. (The herbs need to be uneven and not mild, they need to have potency). If you apply them correctly the most toxic herb becomes life elixir. If you apply them incorrectly even the mildest food becomes poison. <Chapter 57> After the Tang dynasty (circa 900 AD) the Dao of medicine became diseased. First, towards the end of the Tang dynasty, doctors have frequently used toxic herbs, yet they couldnt use them in the right way against their appropriate diseases. As a result many patients were harmed and so it gave birth to books like <Lei Gong preparations of herbs > and <Peaceful prescriptions- He Ji Ju Fang >. In these books the usage of toxic herbs was prohibited and inserted into a category of banned prescriptions ... Up until a book named <Collected explanations of medical prescriptions Yi Fang Ji Jie

> by Wang Renan that explained how to practice medicine with

absolutely not killing the patients. Its tonifying prescriptions used the prescription six ingredients Di Huang pills(Liu Wei Di Huang Wan) as a first. On the other hand he took the formula small tonifying the center (Xiao Jian Zhong Tang) and other hot formulas and categorized them under formulas that resolve the exterior (like for cold injury). The Yin and Yang became reversed and there is not more extreme example then this one. His praise for the six ingredients Di Huang pills could not be more exhaustive, while his explanations of small tonifying the center decoction was not even one word. Because of him following generations praised the earth and looked lightly at heaven, as if theres a mother without a father, is if there is fall and winter without spring and summer. What a shame! He didnt know that six ingredients Di Huang pill was created by Qian Zhongyang (1032-1113) for reducing childrens fever and maintaining their Yin. From the time of Zhu Danxi (1281-1358) it turned into a tonifying Yin formula and followed by number of other masters it

www.ChineseClassics.org

turned into the great disaster of the people.. Wang talks in his book about formulas like the five yellow powder that can solve Yin and Yang exterior and interior problems. How can one formula solve the exterior and interior the Yin and the Yang, arent they opposite to each other? Where comes this logic from that one formula can control both Yin and Yang? The ancestor Zhongjing clearly explained that when the exterior is in distress save the exterior, and when the interior is in distress save the interior. His explanations of interior and exterior and Yin and Yang were most profound. If one magic formula can solve it all then the art of medicine is not difficult at all. The explanations in Wangs book are all in this fashion. He didnt know that he doesnt understand the essence, otherwise he wouldnt have written it in a book. Following generations believed him and thus created a terrible tragedy for the people. These kind of books where the content is wrong are not only limited for this one book, however only these kind of books circulate widely in the world. These books hurt my eyes and spirit, I have no option but to open them up to the public. They cannot escape from receiving punishment. Peng Ziyi in The Circular Motion Of Ancient Chinese Medicine explains the student of Chinese medicine must have a trained eye in calling the difference between the good and bad in books. Only then can one study Chinese medicine.. The knowledge of heat obstruction from Ye Tianshi, Wu Jutong and others is based in a classical knowledge of circular motion: east, south- center- west and north. Cold injury belongs to east and south, skin and exterior. Heat obstruction belongs to west and north, lungs and inner organs. We cannot close this discussion without a short clarification of these four stages. The energy we talk about in this essay is life energy. This energy comes out in the east to reach the south, and then it enters in the west to reach the north. Why is this life energy reaches to the south and to the north? Where are the south and north in our body? In modern medicine where the physical realm is everything, these questions cannot find an answer. It is only in the realm of life energy that we can find a clue. The life energy reaches out to the exterior to express itself and it gathers back to the interior to charge itself. The south is where the emperor heat resides and it is where the spirit is clear. The north is where the kidneys are and it is the root of storage.(nei jing- ling lan mi dian lun). Together they are the organs of the Shao Yin. When the life force exits and enters in a flowing and unobstructed way life can flourish. However when obstructed life suffers. Cold injury prevents the exiting, while heat obstruction prevents the entering. Both can lead to death or to the shortening of ones life span. As a result to know when to help the Tai Yang open or when to help the Tai Yin metal descend is of great importance. When we analyze a patients syndrome we should think about the life force entering or exiting and not the organs and tissues. Thus Tai Yang disease is not a problem of the skin and flesh or physical Ying and Wei, but rather a problem of life force obstructed from exiting. At the

www.ChineseClassics.org

same time, heat obstruction is not a problem of the lungs or upper Jiao, but rather a problem of life force being obstructed from entering. 3. Using the formulas. Ma Huang Tang is used when cold prevails, while Gui Zhi Tang is used when fever, why? Both formulas are not about inducing sweat. Solving a cold injury has nothing to do with sweat, but rather with expanding or not expanding the Yang in order to solve the problem. Taking the right action at the right time will bring a patient into an Even State (Ping Ren ), which is a cure. A similar action at the wrong time will offset the patient balance further and the disease will aggravate. Thus understanding why any symptom is coming or going, and what is the right action to enter as a response, will make the difference between a great medicine and an ineffective one. Wu Jutong says The ancestor Zhongjing clearly explained that when the exterior is in distress save the exterior, and when the interior is in distress save the interior. The exterior is cold injury, while the interior is heat obstruction. The focus here is the Yang energy or life force. It is not about the skin versus inner organs. In reality, what is equally important is the Yang energy being outside or inside. Water in the north shows that Yang gathers inward. Fire in the south shows that Yang is expanding outwards. The north is warm inside and cold outside, while the south is warm outside and cold inside. Wen bing is when the interior is in distress save the interior. The Yang doesnt contract inwards due to evil heat and then water suffers. If the heat stays outside the water inside is frozen. Water trigram Kan has two Yin lines at the top and bottom and one Yang line in . When the Yang cant reach into the water, then it stays Kun earth between. trigram of three broken lines. Wu Jutong explains the importance of heaving water in Yi Yi Bing Shu <Chapter 62> Water and fire replace the heaven and earth in assuming control over the situation. A person cannot live without having water and fire. Because of this it is a must for every doctor to research well water and fire. If the water inside is frozen like earth the person cant live. Thus in a heat obstruction/ wen bing when the Yang cannot cool off in the west to come down and gather into the water, the result can be dire. Wu Jutong treasured the Yang and life force, and he created Yin Qiao San to reach the above action. Applying this formula at the right time is life saving, at the wrong time putting the patient under the sword. How to know then when to use it? One must be versed with the classical theory behind it. Plain Question Great Treatise of the Supreme Truth states :When wind perverse on the inside, control it with pungent cool, assist it with bitter. Sweet harmonizes/ softens it, while pungent scatters it. When heat perverse on the inside, control it

www.ChineseClassics.org

with salty and cold, assist it with sweet and bitter. Sour gathers it, gather and bitter dismantle it. 1 Wen Bing Tiao Bian Scroll 1- Upper Jiao Chapter states Tai Yin wind warmth, warmth heat, epidemic/pestilence, winter grippe, at their initial stages if there is aversion to wind and cold, Gui Zhi Tang dominates it. However heat (obstruction) without aversion to cold and in addition there is thirst, then pungent cool even formula Yin Qiao San will dominate it. This Year 2009 is Ji Chou. It is where the earth is in a constant deficiency state, and thus the four cardinal energies will have problems anchoring into the body. The body, being earth and connecting to the other four elements, affects the wood, fire, metal and water to revolve in a circular motion. The earth is the axis between the four elements, and thus we can see that the four seasons rotate and change because of their relationship with earth. This means that in such a year as Ji Chou our north, south, east and west are in a weak predicament and cold injuries (east and south) as well as heat obstruction (west and north) are possible. Our differentiation of syndromes is more important then ever. We cool of the exterior Yang in the west in order to warm up the interior north, thus if one makes the mistake of cooling off the Yang overall inside and outside, the persons life will suffer. Heat obstruction doesnt allow the exterior Yang to cool off. The answer is pungent cool herbs. In a sense resolving the exterior is the case in both Shang Han and Wen Bing, however in Shang Han cold injury we resolve the cold obstructing the Yang from expanding (the Yang should be able to expand but it cant), in Wen Bing heat obstruction we resolve the heat from preventing the Yang to cool off (the Yang should be able to cool off but it cant). The Yang is cooling off via the dry metal of Tai Yin and Yang Ming i.e. Lungs and Large Intestines. Thus symptoms of Wen Bing should be looked for in dry metal areas of the body. In the east and south the Yang expands via the Tai Yang channels to the surface, so one must look in the Tai Yang area for symptoms in cold injuries. 4. F ormulas Descriptions of the herbs are from Shen Nong Ben Cao Jing, except for few Yin Qiao San herbs, where reference is made to their origin. Ma Huang Tang Ma Huang- flavour bitter and warm. Dominate wind strike cold injury headache, warm up nue (fever), open the exterior to let sweat out, dispel evil and warm up Qi, stops adverse coughing up of Qi, alleviate cold and hot, breaks accumulation of masses. Its other name is dragon of the sand (dunes). Middle class herb. Gui Zhi flavour pungent and warm. Dominate the hundred diseases, nurture the essence and spirit, harmonize the colours (complexion and five directions), it is

www.ChineseClassics.org

the leading guide among the herbs. Lengthy consumption will cause the body to become light and not to age, the facial complexion will show brilliance, the person will feel radiant like a young child. Upper class herb. Xing Ren flavour sweet and warm. Dominate stopping adverse coughing up of Qi, loud sounds of thunder (cough sound with mucus), throat obstruction, Qi descent, lactation, metal inflicted wounds, Han Xin and Ben Zhu (disease names; cold heart and gushing of energy). Middle class herb. Gan Cao- flavour sweet and even. Dominate evil hot and cold Qi in the five Zang and six Fu organs. Strengthen the tendons and bones, grow muscles, double ones strength, swelling from metal injuries, soften toxin. Lengthy consumption will make the body light and lengthen the life span.- Upper class herb. Gui Zhi Tang Gui Zhi see above Shao Yao flavour bitter even. Dominate evil Qi and abdominal pains. Expels blood Bi (stagnation), break masses, hot cold hernia lumps, stops pains, increase urination, benefits Qi. Middle class herb. Gan Cao see above Da Zao- flavour sweet and even, dominate in the centre of the body evil Qi. Calm the center and nourish the spleen, help the twelve meridians, harmonize stomach Qi, clear the nine orifices, tonify shortness of Qi ( Qi too deficient to talk-Zhang Jingyue) and shortness of Jin Ye (dry mouth), the bodys center is deficient, great startle, four limbs are heavy, harmonize the hundred herbs. Lengthy consumption will cause the body to become light and live long. The leaves with Ma Huang can help induce sweat. Middle class herb. Sheng Jiang (Gan Jiang) flavour pungent and warm. Dominates Chest fullness, adverse coughing up of Qi, warms the center, stops bleeding, causes sweat, expels wind and damp obstructions, intestinal diarrhea. Fresh (ginger) is finer. Lengthy consumption will expel stench, will penetrates and prevent obstructions of the clear spirit (shen ming). Middle class herb. Yin Qiao San jian wei Jin Yin Hua- (first mentioned in western Han Bie Lu as Ren Dong, and later in 659 AD Xin Xiu Ben Caoas Ren Dong flower, still later in Southern SongLu Yan Ben Cao for the first time as Jin Yin Hua) . Lu Si vine is nontoxic, warm, cures pains in tendons and bones, it is called Jin Yin Hua. Ming Yi Bie Lu states Ren Dong is harvested in the 12th month and dried in the shade. In the Song time, Sheng Hui Fang states heat toxin and bloody dysentery, use a thick soup of Ren Dong Teng. Lian Qiao- Flavour bitter and even. Dominates chills and fever of scrofula (tuberculosis affecting the lymph nodes, especially of the neck), swelling of scrofula, malignant skin ulcers and goiter, heat congealing from insect poison.

www.ChineseClassics.org

Other names for the herb is Yi Qiao, Lan Hua, Zhe Gen, Zhi, San Lian. Lower class herb. Dan Zhuye Flavour bitter and even. Dominate adverse coughing up of Qi, overflow of varicose veins/tendons (Yi Jinji), malignant skin ulcers, kills little worms. Middle class herb. Jing Jie (Jia Su) flavour pungent warm. Dominates chills and fever scrofula (shu lou), scrofula (luo li) with ulcers, scatter masses of condensed Qi, purge downwards blood stagnation, expels damp Bi (obstruction). Another name for it is Shu Ming. Middle class herb. Jie Geng Flavour pungent slightly warm. Dominates pains as if stabbed by a knife in the chest and ribcage, abdominal fullness and faint sounds in the intestines, as well as fear and terror Lower class herb. Bo He - A record of Chinese Medicine at heart while considering Western states Flavour pungent, Qi fragrant and scurry, temperature even. It can penetrate to the bones and tendons when enters, or reach the exterior flesh, it promotes unimpeded flow, connect the meridians, taking it may induce cold sweat, its the best medicine for heat obstruction that requires sweat for remedy. Qian Jin Fang- diet therapy states Indeed for the kidney Qi, it can cause the mans mouth odor to be pure. It refutes evil toxins and relieve the malady of exhaustion. Materia Medica of the Tang states dominate evil wind and causes sweating. Controls gas and abdominal fullness. Cholera, undigested food with flatulence. Gan Cao see above Cooking instructions: Gui Zhi Tang must be cooked into decoction and rice soup given after the tea- this helps push the Yang from the interior outwards. Yin Qian San- Herbs must be grounded into powder (no decoctions or pills), then stirred into Lu Gen or Ju Hua tea. The powder will sink into the bottom, which will help the cooling herbs sink into the northwest where the heat obstruction is taking place. (decoction will push the herbs energy upwards, pills will sink it into the north) It remains up to each practitioner to explore the possibilities of altering the above herbal formulas according to each swine flu display of syndrome. Chinese medicine attributes its effectiveness to its agility and pliability. Copyright 2009 Yaron Seidman

www.ChineseClassics.org