Over the last several years, I have taken a heightened interest in Warm Disease (Wēn Bìng) theory, which many people know primarily from the Four Levels/Four Aspects (Sì Fèn) that they were taught in acupuncture school, memory-dumped on the boards and then forgot about. I was much the same for many years; even when I was teaching, warm diseases seemed mostly irrelevant to include in a basic acupuncture or Asian bodywork curriculum. The treatment strategies were all based on herbal medicine, and many of the formulas (except for early-stage remedies like Yín Qiào Sӑn) were not readily available in premade form. Also, much of the pathology seemed more advanced than one might encounter in a contemporary acupuncturist’s office.
A couple of things changed my view. First, I practice in a tropical climate zone. As a son of the Midwest, I never realized why Summerheat is classified as a distinct pathogen until I moved to south Florida. Four weeks a year of muggy weather in Illinois does not equate to the seemingly intractable dampness and heat of the tropics. Second, I had an increasing awareness of the application of warm diseases to chronic viral and autoimmune conditions. To be fair, this was not a new idea to me: I volunteered as an acupuncturist in the 90’s at the Northside HIV Treatment Center in Chicago, a community clinic which was founded by Mary Kay Ryan and the late Arthur Shattuck, who wrote a book based in part on diagnosing and treating HIV according to the Four Levels.
And then, of course, the world was hit with an infectious warm disease pathogen, and the Wēn Bìng school suddenly became relevant to just about everyone in the profession. At the time, with the disruption of the herbal medicine supply and the resulting unavailability of most of the usual cold-and-flu-type remedies, I wrote a little post on social media. It was advice on how to keep patients healthy using still-available patent formulas with a strategy based on my study of the Wēn Bìng school.
Once the lockdown eased, and I reopened my clinic, I began to apply Wēn Bìng principles further, with the intention of integrating them into my existing style of acupuncture. I wrote a short piece for the North American Journal of Oriental Medicine in 2021 detailing some of my experiences. I enrolled in a doctoral program in January of 2022, which I have just completed; the major focus of the case studies and thesis I wrote was based on this same topic.
Enter the lurking pathogens
Warm disease theory was not the work of one single person, and there are several important authors and currents of thought which contributed to it. One of the concepts that grabbed me the most was what is known as fú xié in Chinese. Fú xié is translated various ways in the English language literature: lurking pathogens, latent heat, or deep-lying evils are three commonly encountered renditions (I prefer the term lurking pathogens, for what it’s worth). I did the majority of my doctoral writing on the subject of lurking pathogens and a proposed model of treating them with acupuncture. I’ve decided to share some of that work here on Clinical mulch.
Of course, as is the case with the web of Chinese medicine, exploring one topic inevitably leads us all kinds of places, and can connect things in ways we didn’t previously realize. We’ll start with warm pathogen diseases, but soon enough we’ll be linking this part up with Classic of Difficulties and that part up with Ghost diseases, along with some deeper dives into the five-flavor energetics, the qi dynamic, and the membranes and hidden spaces of the body.
So, what are lurking pathogens?
The basics, which we’ll unpack as we go along, are thus:
Lurking pathogens (LP) are pathogenic factors which enter the body from the exterior, usually without provoking symptoms, and hide deep in the interior, where they weaken the vital substances (notably qi and yin) over time.
Some time later, LP are activated by a separate stimulus, and begin manifesting clinically.
Their most usual characteristic is one of either heat or damp-heat, though some sources state that any of the pathogenic factors (including cold, dryness, wind, etc) can enter and become lurking/latent.
Treatment of LP generally employs a strategy of successive stages of exteriorization (through Four Levels or Three Burners), in order to usher the pathogenic factors toward a natural pathway of elimination.
The contemporary Chinese medicine literature may or may not differentiate LP from more conventional pathogenic factors that have been incompletely resolved, but in general the same or similar treatment principles are used.
In recent times, autoimmune, post-viral, environmental, and iatrogenic disease causes have been linked to the concept of LP.
This last point makes LP theory very timely. As I noted in my thesis paper:
Autoimmune and post-viral conditions are becoming a common presentation in contemporary clinical acupuncture practice. Research confirms the upward trend. Dinse et al. (2020), for example, noted the general increase in anti-nuclear antibodies (ANA), a key marker of autoimmunity, in the United States over the last 25 years. Newer post-viral conditions such as long COVID, which can affect even those who were asymptomatic cases (Doykov et al., 2020; Vance et al., 2021) will be a factor in the years to come. Research data concerning the long-term adverse effects of vaccinations, meanwhile, continues to emerge (Hineno & Ikeda, 2021; Pich, 2009).
Next time, we’ll continue with some review of Wēn Bìng theory and Four Levels.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Dinse, G. E., Parks, C. G., Weinberg, C. R., Co, C. A., Wilkerson, J., Zeldin, D. C., Chan, E., & Miller, F. W. (2020). Increasing prevalence of antinuclear antibodies in the United States. Arthritis & rheumatology (Hoboken, N.J.), 72(6), 1026–1035. https://doi.org/10.1002/art.41214
Doykov, I., Hällqvist, J., Gilmour, K. C., Grandjean, L., Mills, K., & Heywood, W. E. (2020). “The long tail of Covid-19”: The detection of a prolonged inflammatory response after a SARS-CoV-2 infection in asymptomatic and mildly affected patients. F1000Research, 9, 1349. https://doi.org/10.12688/f1000research.27287.2
Hayden, R. (2020). COVID-19 thoughts 3-26-20. Originally posted to Facebook, now archived at https://presencecommunityacupuncture.org/wp-content/uploads/2022/09/COVID-19-thoughts-3-26-20.pdf
Hayden, R. (2021). Five phases, four levels, three burners: Building resistance in the pandemic era. North American Journal of Oriental Medicine. 27(83). 5-6.
Hineno, A., & Ikeda, S.-I. (2021). A long-term observation on the possible adverse effects in Japanese adolescent girls after human papillomavirus vaccination. Vaccines, 9(8). https://doi.org/10.3390/vaccines9080856
Pich, M., Köster, A., & Klement, A. (2009). Long term side effects due to vaccination and pharmacovigilance. Deutsches Arzteblatt international, 106(14), 248–249. https://doi.org/10.3238/arztebl.2009.0248b
Ryan, M.K., & Shattuck, A.D. (1994). Treating AIDS With Chinese Medicine. Pacific View Press.
Vance, H., Maslach, A., Stoneman, E., Harmes, K., Ransom, A., Seagly, K., & Furst, W. (2021). Addressing post-COVID symptoms: A guide for primary care physicians. Journal of the American Board of Family Medicine: JABFM, 34(6), 1229–1242. https://doi.org/10.3122/jabfm.2021.06.210254
This is going to be an excellent series. Thanks for writing and sharing, Robert.