Comments on and Excerpt of Translation of a Warm Disease Treatise

By Sara Bayer

 

The Gǔang Wēnyì Lùn is a 17^th century book discussing the clinical appearance of and treatment strategies for a variety of warm disease entities. The date of publication and even the authorship are uncertain though investigation of sources makes it seem likely it was published between 1675 and 1695 A.D. and the author was one Dài Tiān-zhāng 戴天章. It seems most agree that it was a response to the earlier book Discussion of Warm Epidemics, Wēnyì lùn 溫疫論, by Wú Yòu-kě.

Wú Yòu-kě’s and subsequently Dài’s writing took place during a period of population fluctuation in China. These fluctuations coincided with a number of factors including climate change and dynastic instability. Cooling periods contributed to agricultural hardship, food supply problems, epidemics, and natural disasters. In times of population expansion, the increased number of people could not be supported during cooling periods, leading to political instability.¹ The atmosphere was grim at the time of the writing of the Wēnyì lùn during the chaos at the end of the Míng dynasty. From 1626 to 1646 population in China decreased more than eleven percent.² By the time of what may have been the second publication (1722) of Dài’s book, China was well into the subsequent population increase that lasted with fluctuations until the next huge decline in the 1850’s.³ China entered the “High Qing” period of good weather, population expansion, but not the absence of epidemics. According to Qīng dynasty records from the beginning of the Shùnzhì Emperor’s reign in 1643 to the end of the Qiánlóng Emperor’s reign in 1796, there were no fewer than 219 epidemics, population increases notwithstanding.⁴ I speculate that the increase in population density helped make the large numbers of casualties possible.

To place the following litany of epidemics alongside dates of wēnbìng (warm disease) theory authors, Dài was born in 1644 and Wú Táng 吳瑭wrote the Wēnbìng tiáobiàn (Systematic Analysis of Warm Diseases) in 1792⁵ or 1798 ^6,7 though it was not published until 1812. The epidemics were particularly virulent in Jiāngnán where major warm disease physician-theorists operated.⁸ The epidemics on record are all called “big epidemics” dà yì 大疫 and some of the entries include chilling statements. Each epidemic was named for the geopolitical location where it occurred, usually a county name. In the twentieth year of the Shùnzhì reign (1663), “many people and cattle perished.” In the forty-second and forty-third years of the Kāngxī reign (1703-1704) “there were countless dead.” In the autumn of the forty-second year of the Kāngxī reign (1703) in another location “half the people died.” In the first and eleventh years of the Yōngzhēng reign (1722 and 1733) “there were countless dead.” In the fifty-first year of the Qiánlóng reign (1786) “the number of dead could not be calculated.”⁹

Wú is said to have made additions to the theory of contagion, saying epidemic disease comes through the mouth and nose, entering the interior. Warm diseases symptoms thus are said to start in the interior and subsequently appear at the exterior, the opposite of normal transmission in cold injury. Wú certainly wrote about his and thus immortalized the idea within wénbìng theory but I am sure he was not the first to conceive of it. A quote from a Daoist liturgical book of the Sòng dynasty found in the General History of Guǎngxī Province and translated in Leprosy in China constitutes a much earlier mention of contagion coming through the mouth and nose:

“The process by which the poison of one is poured into another is called zhu…he might inhale the filthy qi…the poisonous qi from the patient might force its way into the mouth and nostrils of the healthy person while talking to him and [this qi] will enter the five viscera and develop an illness. Another possibility is that when a weak or hungry person uses a toilet visited by a patient… the filthy and poisonous qi excreted by the latter, not yet dissipated, will force its was up and enter the healthy person’s mouth and nostrils and into his viscera…this belongs to the same kind of transmission by sweat, as in cases of diarrhea epidemics.”¹⁰

Wú Yòu-kě is said to have been in the purgation school (gōng xià pài 攻下派) of Zhāng Cóng-zhèng 張從正.¹¹ Although Dài at times recommends successive courses of purgation, the Gǔang wēnyì lùn gives thorough and specific attention to the various treatment methods of sweating, purging, supplementing, harmonizing and clearing. According to Liu Guo-hui, Dài was the first to “enumerate the different treatment methods and emphasized early purgation in warm epidemics.”¹² In his section on the purgation method, Dài however also clearly states that purgation may not be necessary if sweating and clearing work in the early stages. I think this is an example of the relative sophistication of Dài, standing as he did on Wú’s shoulders. In general, the development of warm disease theory is more subtle and nuanced than indicated in modern textbooks. Modern textbooks refer to various authors as if they single-handedly created the theories.¹³ It is more likely many theorists contributed to the digested material we know regard as doctrine.

I can agree with Hanson’s assessment that the Gǔang wēnyì lùn was intended to meet clinical needs not served by the Wēnyì lùn.¹⁴ The newer work offered more systematic diagnostic and methodological information. I do not know if this actually made a difference in the success of treating seasonal epidemic diseases. The frustration implied in statements of the era about the failure of treating heat disease with Shānghán lùn methods is obvious – but did the new methods really work better? This is nearly impossible to assess in retrospect, given the scanty epidemiological data. From the Qīng dynasty records of epidemics mentioned above, the advent of new warm disease theories did not appear to diminish the numbers or lethality of the epidemics. This point should not be neglected by students or historians of Chinese herbal medicine.

The new subject matter in the Gǔang wēnyì lùn pertains to detailed clinical diagnosis using the patient’s pulse, tongue, mental state, complexion and odor, systematic discussion of treatment methods, systematic division of exterior symptoms from interior symptoms and miscellaneous topics. It broadens the discussion of “simultaneous” (jiān, 兼) disease processes and newly addresses “intermingled” (jiā, 夾) disease processes. There is one small chapter in the Wēnyì lùn on “simultaneous intermittent fevers” (jiān nüè, 兼瘧) and another on “simultaneous dysentery” (jiān lì, 兼痢). Not only does the Gǔang wēnyì lùn discuss three more simultaneous exogenous disease patterns involving wind, cold, and summer heat, it also includes detailed discussion of ten intermingled patterns in which seasonal epidemic symptoms are complicated by various non-epidemic stagnations of qi, food, and phlegm, deficiencies of the spleen and kidney, patterns of hernia pain, heart and stomach pain, wheezing and hemorrhage. The Gǔang wēnyì lùn also addresses a greater number of specific symptoms and expands upon specific symptoms discussed in the Wēnyì lùn.

What disease entities, defined in modern medicine, did the Gǔang wēnyì lùn address? In Chinese medicine of this period, we have broad categories such as warm disease and epidemics and the narrow category of symptoms.

Sources as early as the Qín dynasty list the incidence of epidemics in China.¹⁵ The occurrences of epidemics listed in referenced Qīng dynasty records of epidemics only name the place and the date within the reign period and the occasional mention of high numbers of dead.¹⁶ Nothing is stated regarding the nature of the disease in this Qīng record. We do have occasional later clues in Chinese history that help narrow down the identity of disease entities.¹⁷ For instance there is evidence that bubonic plague existed in Yúnnán province in 1772.¹⁸ A poem by Shi Daonan (1765-1792), “Death of Rats” says, “A few days following the death of rats,/Men pass away like falling walls.”¹⁹ Clues pertaining to the era that concerns us here, the early Qīng, are likely scattered throughout Chinese literature of all genres, not just Chinese medical literature.

Even if we could extract these clues, they would hardly be sufficient to identify disease entities represented in Dài’s book. Both the perils and the near impossibility of narrowing down the broad old definitions of disease entities are at play here. Even the terminology of the time is fraught with inconsistency with variations from province to province of “the colloquial terms for particular diseases or body parts.”²⁰

The term “epidemics” wēnyì doubtless represents some endemic diseases. In fact, the translation of the term yì 疫as “epidemic” probably represents a narrow understanding of the diseases treated with the methods in the books. True, the Gǔang wēnyì lùn refers frequently to the salvation or loss of percentages of people – one in ten, two in in ten – thus implying large numbers of people and thus epidemics. Yet, even single instances of diseases, such as food poisoning, would occur with similar symptoms and lethality.

To further complicate matters, the terms in the Wēnyì lùn and the Gǔang wēnyì lùn are not the only terms in Chinese referring to any specific disease entity. Taking nüè “intermittent fevers” as an example, if we translate it as “malaria” we are leaving out another whole body of literature that discusses zhàng bìng 瘴病 or miasmatic disease. We are also leaving out an entire body of knowledge discussing gǔ 蠱syndrome which also overlaps with malaria and many other diseases.²¹ The terms zhàng and gǔ are not anywhere in the Wēnyì lùn or the Gǔang wēnyì lùn. Yet, both nüè and zhàng are translatable and translated as “malaria” in dictionaries of old or old-medical or modern Chinese. Since “malaria” itself means “bad air,” if we had to pick one term, I might pick zhàng with its connotations of bad air coming across a boundary. In dictionaries of modern Chinese, nüè is the entry for “malaria” while zhàng is the entry for “miasma.” “Miasma” in the Oxford English Dictionary originates in the Greek for pollution – “noxious emanations, especially malaria.” However, it is likely that significant percentages of both nüè and zhàng disease actually were cases of malaria, transmitted by mosquitos. The formulas and treatments related to both of these diseases might provide useful information for modern research into malaria. If we leave either one out, we leave useful information out. Further, since nüè can also just mean “intermittent fever,” translating it as “malaria” would leave out investigation into other disease entities such as the relapsing fevers of modern medicine.

The modern diagnosis of contagious epidemic disease depends on laboratory medicine and the identification of the germs – the causative organisms involved. One author recounts perhaps the earliest importation of germ theory into China. This was in 1890, by the nobleman Xue Fu-chang sent to Germany, who recorded in his diary a visit by a medical member of his mission to Koch’s laboratory.²² An important stream of European medical ideas besides that of the missionary doctors, was from Germany via Japan in the late 19th and early 20th centuries.²³ As we can see, Dài and Wú predate the earliest beginning of the integration of laboratory medicine into China by 150 years. We are thus unable to find completely reliable references to modern disease entities in their books. Even after this time, the integration of the two medical cultures suffered from the regional variations in terminology and the isolation of the Western missionary doctors from each other as they gave Chinese names to modern disease entities.²⁴

What is the usefulness of trying to make some modern identification of the symptoms grouped under the large categories of “seasonal epidemics” (shíyì, 時疫), “epidemic evils” (yìxié, 疫邪), and “warm epidemics” (wēnyì, 溫疫) that are the main topics of the Gǔang wēnyì lùn and Wēnyì lùn? Because the Chinese texts match treatment to symptom patterns, not causative organisms, we have to guess what disease entities are represented by the symptom patterns. If we view our guesses as possibilities, not inevitabilities, we might avoid narrowing the meaning of the Chinese terms. The narrowing of older terms into the compartmentalized laboratory-defined constraints of modern medicine means we may miss important clinical identification of diseases that do not fit into the modern compartments, or lose important clinical information about disease entities that do. Nonetheless, to make the undoubtedly valuable study of older Chinese texts part of integrated medicine we must yield to the temptation to seek possible equivalencies. It would be most profitable to seek equivalencies for diseases for which no modern biomedical treatment or cure exists, where current treatments are losing effectiveness due to adaptation of the causative organisms to drugs, or where current treatment involves troublesome side-effects.

Of course, many such possible equivalencies have already been written into the modern applications of herbal formulas. Some of these modern applications are diseases that can become killer epidemics or simply involve fevers or inflammation, while some seem unrelated to warm-disease categories. I imagine that scientific and Chinese medical literature of the time when germ theory made it to China from Germany and Japan possesses valuable points of contact between old disease names and modern disease entities. This is an interesting area for historical research. It has potential to focus scientific research on herbs for laboratory-defined diseases with poor treatment options.

Copyright Sara J. Bayer 2017

References (see also Bibliography)

1. Lee and Zhang 2012
2. Lee and Zhang 2012
3. Lee and Zhang 2012
4. Soon 1994, charts paginated 4-8
5. Hanson 2011, p. 219
6. Scheid, Bensky, Ellis, Barolet 2009, p. 956
7. Liu 2005, p. 492
8. Soon 1994, abstract (in English)
9. Soon 1994, charts pp. 4-5
10. Leung 2009, p. 43
11. Unschuld 1985, p. 205
12. Liu 2005, p. 16
13. Maciocia 2005, p. 721
14. Hanson 2011, p. 113
15. Summers citing McNeill in Byrne 2008, p. 495
16. Soon 1994, charts p. 4-5
17. Summers citing Benedict in Byrne 2008, p. 495
18. Ibid.
19. Ibid.
20. Andrews 1997, p. 123
21. Fruehauf, p. 126
22. Andrews 1997, p. 134
23. Andrews 1997, pp. 129-132
24. Andrews 1997, p. 123

Bibliography

Andrews, Bridie J. 1997. “Tuberculosis and the Assimilation of Germ Theory in China, 1895-1937.” Journal of the History of Medicine and Allied Sciences 52.1:114-157.

Fruehauf, Heiner. 2014. “Thunder Pearls, An Effective Chinese Herbal Treatment for Chronic Parasitism.” Lecture Transcript. Classical Pearls Clinical Reference Guide. Portland, OR: Classical Pearls Herbal Formulas™.

Hanson, Marta E. 2011. Speaking of Epidemics in Chinese Medicine. London: Routledge.

Lee Harry F. and David D. Zhang. 2012. “A tale of two population crises in recent Chinese history.” Climatic Change, An Interdisciplinary, International Journal Devoted to the Descriptions, Causes and Implications of Climate Change. Published online, May 12, 2012. doi 10.1007/s10584-012-0490-9

Leung, Angela Ki Che. 2009. Leprosy in China: A History. New York: Columbia University Press.

Liu Guohui. 2005. Warm Pathogen Diseases, A Clinical Guide. Revised ed. Seattle, WA: Eastland Press.

Maciocia, Giovanni. 2005. The Foundations of Chinese Medicine. Second ed. London: Churchill Livingstone.

Scheid, Volker, Dan Bensky, Andrew Ellis and Randall Barolet, trans. and eds. 2009. Chinese Herbal Medicine, Formulas and Strategies. Second ed. Seattle, WA: Eastland Press.

Soon, Swee Sung.1994. “A study on background of doctrine for seasonal febrile diseases in Qing dynasty.” Ui Sahak (Korean Journal of Medical History). 3.2:232-251. PMID 11618943 (Charts in Chinese, Korean text, English abstract).

Summers, William C. 2008. “Plague in China,” citing McNeill, William H. Plagues and Peoples. New York, New York: Anchor Books; 1989 in: Byrne, Joseph P., ed. Encyclopedia of Pestilence, Pandemics, and Plagues, Vol. 2, pp, 496-7; Westport, CT: Greenwood Press.

Summers, William C. 2008. “Plague in China,” citing Benedict, Carol Bubonic Plague in Nineteenth Century China. Stanford: Stanford University Press; 1996 in: Byrne, Joseph P., ed. Encyclopedia of Pestilence, Pandemics, and Plagues, Vol. 2, pp. 496-7; Westport CT: Greenwood Press.

Unschuld, Paul. 1985. Medicine in China: A History of Ideas. Berkeley, CA: University of California Press.

Excerpt of the Translation

The Gǔang wēnyì lùn has four chapters covering differential diagnosis of disease appearance and transmission, evidence for and treatment of exteriority, evidence for and treatment of interiority, treatment methods and miscellaneous topics, and the ingredients and preparatory methods for the prescriptions within the text. It comes to about 200 pages with original Chinese, phonetic transliteration, and English. The following is the first third of my translation of the first chapter.

廣瘟疫論
guǎng wēnyì lún
Expanded “Treatise on Warm Epidemics”

卷之一
juàn zhī yī
Chapter One

一辨氣
yī biàn qì
First, Differentiation of the Odor

風寒,氣從外收斂入内, 病無臭氣觸人, 間有作臭氣者, 必待數日轉陽明腑證之時, 亦只作腐氣, 不作尸氣. 瘟疫氣從中蒸達於外, 病即有臭氣觸人, 輕則盈於床帳; 重則蒸然一室, 且專作尸氣, 不作腐氣.

fēng hán qì cōng wài shōu liàn rù nèi, bìng wú chòu qì chù rén jiān yǒu zuò chòu qì zhě, bì dài shù rè zhuǎn yáng míng fǔ zhèng zhī shǐ, yì zhǐ zuò fǔ qì, bù zuò shī qì. wēnyì qì cóng zhon̄g zhēng dá yú wài, bìng jí yǒu chòu qì chù rén, qīng zé yíng yú chuáng zhàng; zhòng zé zhēng rán yī shì, qiě zhuān zuò shī qì, bù zuò fǔ qì.

Wind cold influence comes from the outside and disappears into the interior and the disease is without any striking odor. In some cases an odor will be created after a number of days when it changes to the yang ming organ pattern. It will only create a rotten smell, not the smell of decomposition. However warm disease influence steams from the center to reach the exterior and the disease immediately has a striking odor. If it is mild then it fills the bed curtain. If it is severe then it is like steam in a room. Moreover, there is a particular smell of decomposition, not a rotten smell.

以人身臟腑, 氣血, 津液得生氣則香, 得敗氣則臭.瘟疫, 敗氣也, 人受之, 自臟腑蒸出於肌表, 氣血, 津液逢蒸而敗, 因敗而溢, 溢出有盛衰, 充塞有遠近也.

yǐ rén shēn zāng fǔ, qì xuè, jīn yè dé shēng qì zé xiǎng, dé bài qì zé chòu. wēnyì bài qì yě, rén shòu zhī, zì zāng fǔ zhēng chū yú jī biǎo, qì xuè, jīn yè féng zhēng ér bài, yīn bài ér yì, yì chū yǒu shèng shuāi, chōng sè yǒu yuǎn jìn yě.

People’s internal organs, qi, blood and fluids smell fragrant when fresh. If they are spoiled then they stink. Warm pestilence is a spoiling influence. When someone contracts one, it steams into the flesh, qi, blood and fluids and spoils them. Because they are spoiled they overflow. This overflow waxes and wanes and the extent of the obstruction will vary.

五行原各有臭氣- -木臊, 金腥, 心焦, 脾香, 腎腐. 以臭得其正, 皆可指而名之.

wǔ xíng yuán gè yǒu chòu qì – – mù sāo, jīn xīng, xīn jiāo, pí xiǎng, shèn fǔ. yǐ chòu dé qí zhèng, jiē kě zhǐ ér míng zhī.

Each of the five phases basically has an odor: wood – urine smell, metal – fishy smell, heart – burnt smell, spleen – fragrant smell, kidney – rotten smell. When odor matches correctly, all of these (phases) can be identified and named.

若瘟疫, 乃天地之雜氣, 非臊, 非腥, 非焦, 非腐, 其觸人不可名狀, 非鼻觀精者, 不能辨之. 試察廁間糞氣, 與凶地尸氣, 自判然矣.

ròu wēnyì, nǎi tiān dì zhī zá qì, fēi sāo, fēi xīng, fēi jiāo, fēi fǔ, qí, chù rén bù kě míng zhuàng, fēi bí guān jīng zhě, bù néng biàn zhī. shì chá cè jiān fèn qì yǔ xiōng de shī qì, zì pàn rán yǐ.

In warm pestilence, there are miscellaneous odors of nature, not urine, not fishy, not scorched, not rotten. When they strike a person it is hard to describe. Without refined nostrils one cannot identify them. Compare the odor of the excrement in the toilet with a terrible smell of decomposition and then this will become obvious.

辨之既明, 治之毋惑.知為瘟疫而非傷寒, 則凡於頭痛, 發熱諸表證, 不得誤用辛溫發散. 於諸裡證, 當清, 當下者, 亦不得遲回瞻顧矣.

biàn zhī jì míng, zhì zhī wú huò. zhī wèi wēnyì ér fēi shāng hán, zé fán yú tóu tòng, fā rè zhū biǎo zhèng, bù dé wù yòng xīn wēn fā sàn; yú zhū lǐ zhèng, dāng qīng, dāng xià zhě, yì bù dé chí huí zhān gù yǐ.

Once the differentiation is completely clear, the treatment will be certain. If one knows it is warm pestilence and not cold damage, then in exterior patterns with headache and fever one will not mistakenly use acrid-warm dispersing herbs. In interior patterns one must appropriately clear and purge and not hesitate to attend to this.

二辨色
èr biàn sè
Second, Differentiation of the Complexion

風寒主收斂, 斂則急, 面色多繃急而光潔; 瘟疫主蒸散, 散則緩, 面色多松緩而垢晦.人受蒸氣則津液上溢於面, 頭目之間多垢滯, 或如油膩, 或如煙燻, 望之可憎者, 皆瘟疫之色也.

fēng hán zhǔ shōu lián, liān zé jí, miàn sè duō bēng jí ér guāng jié; wēn yí zhǔ zhéng sǎn, sǎn zé huǎn, miàn sè duō sōng huǎn ér gòu huì. rén shòu zhēng qì zé jīn yè shàng yì yú miàn, tóu mù zhī jiàn duō gòu zhì, huó rú yóu nì, huó rú yān xūn, wàng zhī kě zēng zhě, jiē wēn yí zhī sè yě.

Wind cold mainly contracts. With contraction there is urgency and the face gets more tight and shiny. Warm pestilence mainly steams and disperses. With dispersing there is laxness and the face gets more slack and muddy. When a person suffers steaming then the body fluids overflow to the face. The area between the eyes is more congested as if with grease or smoke. It is disgusting to observe. This is the look of all warm pestilences.

一見此色, 雖頭痛, 發熱, 不宜輕用辛熱發散; 一見舌黃, 煩, 渴諸裡證, 即宜攻下, 不可拘於下不厭遲之説.

yī jiàn cǐ sè, suī tóu tòng, fā rè, bù yí qīng yòng xīn rè fā sàn; yī jiàn shé huáng, fán, kě zhū lǐ zhèng, jí yí gōng xià, bù kě jū yú “xià bù yàn chí” zhī shuō.

Once one sees this complexion, one cannot lightly use acrid warm dispersing even though there is headache and fever. Once one sees the various internal signs of yellow tongue coat, irritation and thirst, it is suitable to use attacking purgatives. One cannot be restricted by the saying “It is better to delay purgation.” [NOTE 1]

三辨舌
sān biàn shé
Third, Differentiation of the Tongue

風寒在表, 舌多無苔, 即有白苔, 亦薄而滑; 漸傳入裡, 方由白而黃, 由黃而燥, 由燥而黑.

fēng hán zài biǎo, shé duō wú tāi, jí yǒu bái tāi, yì báo ér huá; jiàn chuán rù lǐ, fāng yóu bái ér huáng, yóu huáng ér zào, yóu zào ér hēi.

When wind cold is on the exterior, the tongue is usually coatless. If it has a white coat it is also thin and slippery. Gradually as the disease spreads to the interior, areas change from white to yellow, from yellow to dry, and from dry to black.

瘟疫一見頭痛, 發熱, 舌上即有白苔, 且濃而不滑, 或色兼淡黃, 或粗如積粉.若傳經入胃, 則兼二 三色, 又有白苔即燥與至黑不燥者.

wēn yí yī jiàn tóu tòng, fā rè, shé shàng jí yǒu bái tāi, qiě nóng ér bù huá; huò sè jiān dàn huáng; huò cū rú jī fěn. ruò chuán jīng rù wèi, zé jiān èr, sān sè, yòu yǒu bái tāi jí zào yǔ zhì hēi bù zào zhě.

In warm pestilence at first one sees headache and fever. The tongue will already have a white coat that is also thick and not greasy, or maybe both thin and yellow, or maybe rough like accumulated powder. If it passes into the stomach, then two or three colors can combine. There can even be a white coat getting dry and even a black coat that is not dry.

大抵疫邪入胃, 舌苔頗類風寒, 以兼濕之故而不作燥耳. 惟在表時, 舌苔白濃, 異於傷寒, 能

辨. 於在表時, 不用辛溫發散, 入裡時而用清涼攻下, 斯得矣.

dà dǐ yì xié rù wèi, shé tāi pō lèi fēng hán, yǐ jiān shī zhī gù ér bù zuò zào ěr. wéi zài biǎo shì, shé tāi bái nóng, yì yú shāng hán, néng biàn. yú zài biǎo shì, bù yòng xīn wēn fā sàn, ér yòng qīng liáng gōng xià, sī děi yǐ.

Generally when epidemic evil enters the stomach, the tongue coat is quite like wind cold. Because of the dampness, no dryness occurs. It is only when it is on the exterior and the tongue coat is thick white, that it is different from cold injury and can be differentiated. When the disease is on the exterior, do not not use acrid warm dispersing herbs. When it has entered the interior, clearing, cooling and purging should be done.

四辨神
sì biàn shén
Fourth, Differentiation of the Mental State

風寒之邪傷人, 令人心知所苦而神自清, 如頭痛作寒熱之類, 皆自知之. 至傳裡入胃, 始神昏譫語. 縁風寒為天地正氣, 人氣與之乖忤而後成邪, 故其氣不昏人神情也.

fēng hán zhī xié shāng rén, lìng rén xīn zhī suǒ kǔ. ér shén zì qīng, rú tóu tòng zuò hán rè zhī lèi jiē zì zhī zhī. zhì chuán lǐ rù wèi. shǐ shén hūn zhān yǔ. yuán fēng hán wèi tiān dì zhèng qì. rén qì yǔ zhī guāi wǔ ér hòu chéng xié. gù qí qì bù hūn rén shén qíng yě.

When wind and cold evil damage a person, people are aware of suffering yet the spirit is naturally clear. For example with headache, fever and chills and such, one understands these oneself. When (the disease) passes into the stomach, there may be loss of consciousness and delirium. This is because wind and cold are proper influences in nature. Only when people’s qi resists them does evil arise. The influences (alone) thus do not confuse the human spirit.

瘟疫初起, 令人神情異常而不知作苦.大槩煩燥者居多, 或如癡如醉, 擾亂驚悸. 及問其何所苦, 則不自知. 即間有神情而能自主者, 亦多夢寐不安, 閉目即有所見, 即譫妄之根. 縁瘟疫為天地邪氣, 中人人病, 中物物傷, 故其氣專昏人情也.

wēnyì chù qǐ, lìng rén shén qíng yì cháng. ér bù zhī zuò kǔ. dà gài fán zào zhě jū duō, huò rú chī rú zuì, rǎo luàn jīng jì. pí jiān qí hé suǒ kǔ, zé bù zì zhī. jí jiān yòu shén qíng ér néng zì zhǔ zhě, yì duō mèng mèi bù ān, bì mù jí suǒ jiàn jí zhān wàng zhī gēn. yuán wēnyì wèi tiān dì xié qì, zhōng rén rén bìng, zhōng wù wù shāng, gù qí qì zhuān hūn rén qíng yě.

When warm pestilence arises it causes the human spirit and emotions to be abnormal and one does not know one is suffering. Generally the majority are irritated and parched, or idiotic and acting intoxicated. They are disordered and shake with fear. When asked why they suffer they themselves do not know. Even if at the onset the spirit is clear and they are able to be in command of themselves, there are a lot of dreams with restless sleep. When they close their eyes they immediately hallucinate. This becomes the root of nonsensical raving. This is because warm pestilence is a perverse pathogenic influence in nature. When it targets people, they sicken. When it targets objects, they are injured. Thus it particularly muddles human perception.

五辨脈
wǔ biàn mài
Five, Differentiation of the Pulse

瘟疫之脈, 傳變後與風寒頗同, 初起時與風寒迴別.

wēnyì zhī mài chuán biàn hòu yù fēng hán pò tóng. chū qǐ shí yù fēng hán huí biè.

After evolving, the pulse in warm pestilence is much like in wind and cold. However, at the beginning it is completely different.

風寒從皮毛而入, 一 二 日脈多浮, 或兼緊,兼緩,兼洪而皆浮. 迨傳入裡, 始不見浮脈, 其至數亦清楚而不模糊.

fēng hán cóng pí máo ér rù, yī èr rè mài duō fú, huò jiān jǐn, jiān huǎn, jiān hóng ér jiē fú. dài chuán rù lǐ, shǐ bù jiàn fú mài, qí zhǐ sù yì qìng chǔ ér bù mó hú.

Wind and cold enter from the skin and hair. For the first and second days the pulse mostly floats. It might combine with a tight, slow or flooding quality but all float. When it spreads to the interior, one begins to no longer see a floating pulse. It becomes quick and clear and not muddled.

瘟疫從中道而變,自裡出表, 一二日脈多沉. 迨自裡出表 脈始不沉, 乃不浮不沉而數. 或兼弦,兼大 而皆不浮, 其至數則模糊而不清楚. 其初起脈沉遲, 勿作陰寒斷. 沉者, 邪在裡也;遲者邪在陰分也. 脈象同於陰寒, 而氣色,舌苔,神情依前諸法辨之, 自不同於陰寒. 或數而無力, 亦勿作虛視, 緣熱蒸氣散, 脈不能鼓指, 但當解熱,不宜補氣. 受病之因有不同, 故同脈而異斷也.

wēnyì cóng zhōng dào ér biàn, zì lǐ chū biǎo, yī èr rì mài duō chén. dài zì lǐ chū biǎo, mài shǐ bù chén, nǎi bù fú bù chén ér shù. huò jiān xuán, jiān dà ér jiē bù fú, qí zhì shù zé má hú ér bù qìng chǔ. qí cū qǐ mài chén chí, wù zuò yīn hán duàn. chén zhě, xié zài lǐ yě; chí zhě xié zài yīn fèn yě. mài xiàng tóng yú yīn hán, ér qì sè, shé tái shén qíng yī qiǎn zhū fǎ biàn zhī, zì bù tóng yú yīn hán. huò shù ér wú lì, yì wù zuò xū shì, yuán rè zhēng qì sǎn, mài bù néng gū zhǐ, dàn dāng jiě rè, bù yí bǔ qì. shòu bìng zhī yīn yǒu bù tóng, gù tóng mài ér yì duàn yě.

Warm pestilence travels from the center and changes from the inside, emerging to the surface. For the first and second days the pulse is sunken. When it begins to emerge from the interior to the exterior the pulse starts to become not sunken. It is not floating, not sunken, but is rapid. It may be concurrently wiry or big but in all of these it is not floating. When it becomes rapid it is muddled and unclear. In the beginning the pulse may be sunken and slow. Do not judge this to be yin cold! The sunken-ness is evil in the interior. The slowness is evil in the yin portion. This pulse resembles that of yin cold. However the influence, complexion, tongue coating, mental state and emotions, in accordance with all the above methods, will distinguish it as different from yin cold. Perhaps the pulse will be rapid and forceless. Likewise, do not view this as deficiency! This is due to heat steaming and dispersing the qi so the pulse cannot beat against the finger. One should only release the heat and it is not fitting to tonify the qi. The causes of the diseases are not the same. Thus there is the same pulse but a different judgement.

Notes on the Translation

NOTE 1. There are many articles in Chinese discussing this aphorism. They attribute it to various texts including the Wēnrè lùn, the Shānghán wēnyì tiáobiàn, etc. Since some of these texts antedate the GWYL, they cannot be the origin of the aphorism.

Copyright Sara J. Bayer 2017

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Many thanks to Sara for offering this portion of the text that she has translated and provided discussion for.  We hope that the full text will find its way to publication so that we can continue to benefit from her work and wisdom in making accessible Dài Tiān-zhāng’s discussion of Wen Bing issues.

Sara Bayer holds a Doctorate in Oriental Medicine (DAOM) from Oregon College of Oriental Medicine, an MA from the University of Michigan, Ann Arbor, in Chinese Language and Literature, and a Certificate in Acupuncture from the California Acupuncture College in San Diego.  She maintains a private practice in Seattle, Washington and on Lopez Island, and teaches at Bastyr University and Middleway Acupuncture Institute.