bubble_chart Concept

The pattern of wind-heat and epidemic toxin refers to a category of symptoms and signs caused by infection with wind-heat epidemic toxin pathogenic qi, which is characterized by a certain degree of epidemicity, infectivity, similar symptoms among the infected population, and relatively severe conditions. Due to the differences in wind-heat epidemic toxin pathogenic qi and the varying locations it affects in the body, the clinical manifestations differ.

The main clinical manifestations include sudden onset, easy transmission, mild aversion to cold with severe fever, sore throat, swollen gums, headache, and cough.

The pattern of wind-heat and epidemic toxin is commonly seen in diseases such as "swollen-head infection," "epidemic eruptive disease," "whooping cough," "scarlatina," "mumps," and "influenza."

This syndrome should be differentiated from common conditions such as "common cold" and "cough."

bubble_chart Differentiation and Treatment

The pattern of wind-heat and epidemic toxin can appear in various diseases. In cases of swollen-head infection, the mechanism of disease is the accumulation of wind-heat epidemic toxin pathogenic qi in the upper energizer, manifesting on the head and face. Symptoms include aversion to cold with fever, redness and swelling of the head and face, inability to open the eyes, throat discomfort, dry tongue and thirst, red tongue with yellow coating, and a rapid and forceful pulse. Treatment should focus on dispersing external wind, clearing heat, and removing toxins, using the Universal Relief Decoction for Eliminating Toxin (《東垣試效方》).

In cases of epidemic eruptive disease, the mechanism of disease is the internal excess of epidemic toxin pathogenic heat, which manifests externally on the skin. Symptoms include initial aversion to cold with fever, splitting headache, and in severe cases, dysphoria and delirious speech, dry lips, red prickles on the tongue, and a rapid pulse. It may also be accompanied by vomiting and diarrhea. In epidemic eruptive disease, a loose, floating, and red appearance indicates a mild condition, while a tight, rooted, and purple or black appearance indicates severe heat and toxin. Mild cases erupt immediately, while severe cases may delay eruption, sometimes not erupting until four or five days. Treatment should focus on clearing heat, cooling blood, and removing toxins, using the Plague-Clear Toxin-Vanquishing Decoction (Yizhen Yide).

In cases of scarlatina, which often occurs in spring, wind-heat epidemic toxin pathogenic qi enters the lungs and stomach through the mouth and nose, rushing up to the throat. Symptoms include redness, swelling, and pain in the throat, ulceration with a white pseudomembrane, severe pain as if cut by a knife, intense chills and fever, general body aches, faint scarlet spots all over the body, followed by a scarlet rash resembling brocade. The rash first appears on the neck, then the chest, back, abdomen, and limbs, eventually spreading to the whole body, except the face. The tongue is smooth and red with small raised bumps resembling Chinese wax myrtle bark. Initial treatment should focus on dispersing toxins with pungent-cool herbs, using Lonicera and Forsythia Powder (Wenbing Tiaobian), followed by clearing heat and removing toxins, using the Cool-Camp Clearing Qi Decoction (《Scarlatina Treatment Summary》), and finally nourishing yin and fluids, using the Yin-Nourishing and Lung-Clearing Decoction (Zhonglou Yuyao).

In cases of whooping cough, also known as pertussis, which often occurs in young children, symptoms include paroxysmal spasmodic cough, followed by a characteristic inspiratory whoop resembling a rooster's crow. It is caused by wind-heat epidemic toxin pathogenic qi invading the lungs, leading to lung qi failing to disperse, transforming into heat, and forming phlegm that obstructs the airways, causing qi to rise counterflow. Chronic cough damages the lung collaterals, leading to hemoptysis. Initial treatment should focus on resolving phlegm with pungent-warm herbs, moving qi, and downbearing counterflow, using Belamcanda and Ephedra Decoction (Jingui Yaolue). In the intermediate stage, when pathogenic heat lingers in the lungs, treatment should focus on clearing heat and ventilating the lungs, using White-Draining Powder (Xiao'er Yaozheng Zhijue) or modified Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (《Cold-Damage Disease Treatise》). In the advanced stage, when yin is damaged, treatment should focus on enriching yin and clearing the lungs, using the Enriching Yin and Clearing the Lung Decoction (Zhonglou Yuyao).

In cases of influenza, symptoms include aversion to cold with fever, headache, backache, limb soreness, nasal congestion, runny nose, sore throat, and dry cough. It is caused by wind-heat

Pattern of wind-heat and epidemic toxin is caused by wind-heat epidemic toxin pathogenic qi, which is most likely to combine with lung and stomach heat accumulation. Children, being of pure yang constitution, have inherent internal heat, making them prone to this condition. Elderly individuals with lung-defense exterior deficiency are also susceptible to external pathogens, hence they are prone to this syndrome as well. Wind-heat epidemic toxin pathogenic qi tends to deplete fluids and damage yin, potentially transforming into a yin deficiency pattern of warm dryness. Furthermore, heat toxin can further develop into a pattern of intense exuberant heat toxin, and in severe cases, heat toxin can stir the blood, leading to a pattern of dual blaze of qi and blood.

bubble_chart Differentiation of Similar Patterns

1. The pattern of wind and heat invading the upper and the pattern of wind-heat and epidemic toxin both may present with symptoms such as fever and chills, sore throat, and cough. However, there is a fundamental difference in the disease cause. The latter is caused by wind-heat epidemic toxin pathogenic qi, which is a pestilential qi, leading to an acute onset, severe symptoms, and a certain degree of infectivity. The symptoms among the infected population are similar, and the transmission and change are rapid, with a higher number of deteriorated pattern. The former, on the other hand, is caused by wind pathogenic heat qi, resulting in milder symptoms related to wind-heat disturbing the head and face or upper energizer, which are not contagious and easier to recover from. Therefore, the two are not difficult to differentiate.
2. The pattern of dual exuberance of wind and heat and the pattern of wind-heat and epidemic toxin both may present with symptoms such as fever, thirst with a desire for cold drinks, sore throat, and eruptions. However, there is a fundamental difference in the disease cause. The latter is caused by wind-heat epidemic toxin pathogenic qi, which is a pestilential qi, leading to an acute onset, severe symptoms, and a certain degree of infectivity. The symptoms among the infected population are similar, and the transmission and change are rapid, with a higher number of deteriorated pattern. The former, on the other hand, is characterized by wind pathogenic heat qi stagnating in the skin and muscles, leading to poor circulation of qi and blood, and may also present with symptoms such as boils, sores, redness, swelling, burning, itching, and pain. Therefore, it is easy to differentiate between the two.

bubble_chart Documentation

1. Danxi Xinfa‧Pestilence》: "When everyone suffers from the same illness, it is called a seasonal epidemic. There are three methods of treatment: tonification, dispersion, and descending. For severe heat, add three wine cups of child's urine. ... For the swollen-head seasonal epidemic, which is caused by dampness at the top of the head, do not use descending or dispersing methods. Dongyuan has a prescription: Notopterygium wine, Skullcap Root wine-steamed, Rhubarb Rhizoma."
2. 《Quansheng Ji‧Differentiation of Cold-Damage Disease, Warm Disease, and Heat Pattern》: "Seasonal epidemic is caused by the sudden outbreak of pestilent qi in the heavens, spreading among people. Whenever the seasonal qi is abnormal, this qi will circulate. ... Swollen-head common cold: Swollen-head is sometimes called seasonal toxin or epidemic toxin, as it is caused by the epidemic toxin qi in the heavens, which people contract and develop into swollen-head common cold. ... If the pathogen is expelled from the exterior, with redness and swelling around the ears, front and back of the head, and feet, this belongs to the Shaoyang channel. Or if there is muscle heat, late afternoon tidal fever, alternating chills and fever, bitter taste in the mouth, dry throat, eye pain, and rib fullness, Minor Bupleurum Decoction should be used with Snakegourd Root, Notopterygium, Schizonepeta, Forsythia, Scutellaria, and Coptis. If the three yang channels are all affected, with symptoms in the head, face, ears, and nose, Universal Relief Decoction for Eliminating Toxin should be used, along with external application of Qingliang Jiuku Powder."
3. Yixue Rumen: "Pestilence: Pestilence is like a ghostly affliction, hence it is called pestilence, also known as seasonal epidemic. When spring should be warm but is cold, summer should be hot but is cool, autumn should be cool but is very hot, and winter should be cold but is warm, and the qi is not in its proper season, those who are affected will develop headaches, body pain, and chills and fever. The treatment is slightly different from cold-damage disease: in spring, the liver is responsible, use Cimicifuga and Pueraria Decoction; in summer, the heart is responsible, use Erxiang Powder and Tiaozhong Decoction; in autumn, the lungs are responsible, use White Tiger Decoction Plus Atractylodes, Powder of Capillaris and Five Ingredients with Poria; in winter, the kidneys are responsible, use Polyghace Seche Decoction, Licorice and Platycodon Decoction; for the earth in the four seasons, treat according to the channel. The treatment is the same as cold-damage disease for exterior pattern: use Toxin-Vanquishing Powder; for half-exterior pattern, use Minor Bupleurum Decoction; for interior pattern, use Major Bupleurum Decoction; for cases with internal damage, tonification, dispersion, and descending should be used, such as licorice products pills."
4. Jingyue Quanshu, Cold-Damage Disease: "Treatment of Swollen-Head Infection: Swollen-head infection is caused by the seasonal evil toxin lodging in the three yang channels, resulting in aversion to cold, fever, headache, stiff neck, or swelling of the throat, even redness and swelling of the cheeks and face, and mumps-like swelling of the shoulders and back. This is also called mumps. Most cases are due to wind-heat, but there are also distinctions between exterior and interior deficiency and excess. In surgery, there is also a seasonal toxin syndrome similar to this. Treatment of Swollen-Head Mumps: For cases where the disease is in the head and eyes, and the internal fire is not severe, first disperse the pathogen, using Zheng Bupleurum Drink or Toxin-Vanquishing Powder. For seasonal toxin with throat swelling and pain, mild internal fire, and normal bowel movements, use Pueraria Root and Arctium Decoction. For seasonal toxin with dual exterior and interior heat, heat and swelling in the head and eyes, use Chai Ge Decoction. For toxin in the Yangming channel, dual exterior and interior heat, headache, and dry nose, use Bupleurum and Pueraria Flesh-Releasing Decoction. For seasonal toxin with extreme heat in the three yang channels, mania, throat swelling, and pain, use Gardenia Seed Decoction. For widespread seasonal toxin, pathogenic heat rising, swelling of the head and face, and throat discomfort, use Universal Relief Decoction for Eliminating Toxin."
5. Yizong Jinjian．Waike Xinfa Essentials: "This condition is also called beard hair or mumps. It occurs in the muscles of both cheeks, not attached to the bone, and regardless of the side, it originates from stomach heat in the Yangming channel. Initially, there is throbbing pain and alternating chills and fever. If there is high swelling, redness, and heat, it is caused by wind-heat in the stomach channel. If the swelling is flat and the color is pale, it is caused by dampness-heat in the stomach. At the onset, use Bupleurum and Pueraria Decoction to disperse. If there is thirst and constipation, use Sisun Qingliang Drink to resolve. If both exterior and interior syndromes are resolved but swelling and pain persist, it will likely form pus, and Tuoli Xiaodu Powder should be used to promote suppuration."