Lurking Pathogens 4
Treatment Principles
We’re going to continue with a couple of important topics before we pivot to bringing in the Five-Phase acupuncture component. So let’s go back to discussing the ideas of the Warm Disease school. We’re going to look at the questions of 1) where exactly do the Lurking Pathogens (LP) lurk, and 2) how do we get them out?
Location of latency
The location where the LP hide out in the body has been a subject of long discussion with no single answer. Some candidates include: skin, muscle layer, channels and collaterals, bones, blood, lesser yang (Shào Yáng), membrane source (mó yuán), lesser yin (Shào Yīn), Kidneys. Some authors contend that the where the LP will lurk depends on the physical makeup of the patient. The characteristics of an individual LP may also influence its target zone; LP of a damp nature will be particularly drawn to the middle jiao and will readily disrupt the qi dynamic of the Spleen and Stomach (Bevin, 2013; Liu, 2005; Scheid, 2022; Wen & Seifert, 2000).
With regard to the membrane source, Scheid (2022) cites Míng-era physician Wú Yòukě’s conception of it as a zone where pathogenic factors can sequester and evade the defensive qì. The Qīng-era physician Zhōu Xuéhǎi, Scheid notes, saw the membrane source as areas between bodily structures where the LP presence does not disrupt the normal organ and channel functions, allowing it to remain in latency for an extended period. Even following the pathogen manifesting itself, it is a challenge for the body to hunt down and evict the offender from all the myriad locations where it may be, thus taxing and gradually wearing down the Zhèng Qì. Scheid (2022) sees a connection between pathogens lodged in the membrane source and the destruction of the endothelium by viral disorders like Covid-19.
Treatment of LP
A key concept in Warm Disease theory is the principle of venting or outthrusting (透 tòu). Where the four levels represent functional-energetic depth of the body, the direction of pathogen penetration is from superficial to deep, and thus the basic idea in therapy is to get the pathogen to reverse course and move back toward the surface. Venting can be applied at each level, though at the deeper levels (i.e. the blood) the pathogen becomes more difficult to expel.
There are, of course many different treatment strategies in treating Warm Diseases – the Qì level in particular is a complicated affair – but the underlying idea is to move the pathogen to a natural place of exit. The general Four Level principles are shown in Table 1.
The Three Burners model has a somewhat different set of strategies, as shown in Table 2. We will circle back to these later.
LP as a treatment strategy
To summarize, an important aspect of treating LP is a process of displacing and expelling the pathogen in an outward direction and in a staged manner. An important marker of clinical progress is the shift from a deeper level to a more superficial one. The disappearance of Yíng level symptoms and appearance of Qì level symptoms indicates that the LP has been effectively vented. Exterior symptoms may or may not appear, as the pathogen may be eliminated at the qi level and not need venting from the surface at the Wèi level.
This process can be considered an essential defining feature of LP. Chace et al (2007) note the ambiguity and myriad definitions of LP but determine the most salient characteristics as 1) latency, 2) outward expression, and 3) the necessity of staging treatment to expel the pathogen in a successive manner until it is eliminated. Thus, it may be more useful to consider LP as a treatment strategy than as a discrete etiology.
In addition, clinical experience has often shown that LP do not necessarily appear as singular pathogenic factors, but may manifest as “LP complexes”, revealed over the course of treatment as progressively deeper layers of pathogenicity, especially in cases that involve patients with constitutional deficiencies (Chace et al., 2007).
In the next post, we’ll look at a possible convergence of Five-Phase acupuncture with the Four Levels. Stay tuned.
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
Bevin, M.-J. (2013). Lurking pathogens in springtime: Adventures in translation. The Lantern, 10(3), 22-27.
Chace, C., Blalack, J., & Schaefer, J. (2007). Lurking pathogens: Three modern approaches. The Lantern, 4(2), 17-27.
Liu, G. (2005). Warm pathogen diseases: A clinical guide. Eastland Press.
Scheid, V. (2022). Covid from the bottom up: Lessons of the pandemic. The Lantern, 19(2), 2-19.
Wen, J. M., & Seifert, G. (2000). Warm Disease Theory: Wen Bing Xue. Paradigm Publications.