Ang warm diseases ay isang pangkalahatang tawag sa maraming uri ng heat-related illnesses, kabilang ang maraming acute traditional heat diseases, at mga infectious diseases na may symptoms sa wei, qi, ying, and blood levels, kahit hindi naman acute infectious diseases tulad ng sepsis. Si Zhang Zhongjing ay nagturo ng apat na methods ng elimination ng toxins: sweat, clear, vomit, and purge; si Liu Hejian ay nagturo ng using pungent-cool method sa initial stage ng heat disease para sa dual resolution; si Zhang Ziyuan ay naniniwala na if used properly, purgative drugs can act like tonics; si Wu Youke ay nagsabi na "epidemic diseases must prioritize eliminating pathogens, even if there is no hard stool." Si Dai Beishan ay nagsabi na "regardless of whether exterior symptoms have disappeared or not, if interior symptoms appear, then purge immediately." Ang konsepto ng "early purge in warm diseases" ay nagmula dito, na nagbibigay ng malaking direksyon sa mga doktor sa paggamot ng warm diseases.
Una, Ang Epekto at Prinsipyo ng Promoting Elimination Therapy sa Warm Diseases
Ang promoting elimination therapy sa warm diseases ay pangunahing layunin ay to eliminate heat pathogens, while removing hardened stool and accumulated stagnation is secondary. Si Wu Youke ay nagsabi na "for conditions that require purging, even if there is no hard stool, some people think it's too early to purge, or think it shouldn't be done, but they don't realize that Chengqi decoction was originally meant to eliminate pathogens, not just for hard stool. If you wait until the stool becomes hard, the blood will be agitated by heat, leading to various complications—like feeding a tiger and leaving it behind, a mistake by the doctor. Moreover, many patients have hard stool that never forms, but instead produces extremely foul-smelling, rotten sauce-like or lotus root mud-like excrement, and even at death, no hard stool appears. But once the foul matter is expelled, the pathogenic toxins disappear, the symptoms and pulse improve. Why obsess over hard stool before acting?! The truth is, heat causes dryness, not dryness causing heat. ... In short, the pathogen is the root, heat is the symptom, and hard stool is a symptom among symptoms. If you can eliminate the pathogen early, why worry about dryness?!" This explanation makes the importance and necessity of promoting elimination therapy in warm diseases very clear! However, it should not be abused or misused; it must be applied at the right time and in the right way, adjusted according to urgency and deficiency/excess, so that its unique role can be fully realized.
When the warm pathogen stays in the qi level and does not resolve outward, it inevitably leads to interior blockage in Yangming, where heat accumulates easily turning dry and injuring yin. Therefore, early application of promoting elimination therapy is most appropriate. Purging is not only about removing accumulation, but also crucial for preserving yin and body fluids. Liu Baozhi said: "The stomach is the sea of the five viscera and six bowels, located in the central earth, best at accommodating. When heat pathogens enter the stomach, they do not spread elsewhere, so in warm diseases with heat accumulation in the stomach, recovery through purgation occurs in about six or seven out of ten cases." This fully illustrates the important role of promoting elimination therapy in treating warm diseases.
The therapy can rapidly expel pathogenic heat and toxins, which is a key route for clearing heat and eliminating pathogens. Whether the pathogen is in the qi level or ying level, or between exterior and interior, as long as the body is strong, or there is no sign of spleen deficiency with loose stools, or there are indications for purging, or extreme heat causing wind, agitation, convulsions, etc., one can use purgation to expel toxins, clear heat, and use formulas like Chengqi or Shengjiang San, or add mirabilite and rhubarb to the diagnostic formula. This is not merely boiling water to stop boiling, but rather removing the fire from under the pot. It can eliminate intangible heat and remove tangible stagnation, achieving two goals at once—a true approach to treating the root. However, for pure wei level exterior conditions with prominent chills and mild fever, or for elderly, weak individuals, pregnant women, or those during menstruation, caution is advised.
Ikalawa, Examples of Application
1. Encephalitis (Japanese)
Ang Japanese encephalitis starts abruptly and progresses quickly. Wei level symptoms are difficult to detect, and by the time the patient seeks help, it is often already in the qi-yin mixed stage or even qi-blood roasting. As long as there are no obvious exterior symptoms, and the warm pathogen has already entered the interior, showing high fever, unconsciousness, agitation, wind movement, or abdominal fullness and constipation, the promoting elimination therapy should be used immediately—"urgent purge to preserve yin"—to provide an exit for the pathogen, which is directly related to the prognosis. The purpose of using this therapy is to expel heat pathogens and preserve yin fluid, so it is not necessarily reserved for constipated patients. Any condition with extreme heat resembling fire or heat-induced wind movement can be treated with it. After purging, temperature usually drops gradually, convulsions lessen, consciousness improves, and fewer sequelae occur. This preventive and proactive approach can shorten the course of illness and prevent cerebral edema and herniation. For example, before cerebral edema forms, early signs include mild conjunctival edema and tongue swelling. Immediate administration of Jiaojian Decoction can prevent its occurrence. Professor Jiang Chunhua proposed the concept of "cutting off and reversing," while renowned physician Yan Cangshan advocated the "three protective measures" for warm diseases (protect brain, protect body fluids, protect intestines), advocating "treating both wei and qi simultaneously, and when in qi, guarding against cooling blood to prevent progression to worse stages." Clinical practice proves that most warm diseases can be prevented from progressing, stopped from developing further, and turned toward recovery.
Mr. Chen, male, 8 years old. Admitted to hospital with Japanese encephalitis for ten days, high fever, coma, neck stiffness, convulsions, delirium, and twitching worsening over the past four days. No bowel movement for a week, abdomen hard and full, continuous sweating on head only, slightly yellow and thick greasy coating, deep and forceful rapid pulse. Summer pathogen combined with dampness and food stagnation obstructing Yangming stomach, scorching the heart envelope and causing unconsciousness and blocked orifices. Urgently needed to purge heat and stagnation, supplemented with resolving dampness, warding off evil, calming liver and extinguishing wind, hoping for bowel clearance and stagnation removal, heat reduction and orifice opening. Prescription: raw rhubarb 9g (added later), mirabilite 6g (dissolved separately), whole scorpion 1.5g (ground and swallowed), hook vine (added later), and Artemisia annua each 15g, kudzu root, silkworm pupa, fragrant orchid, and calamus each 9g, licorice 3g. Two doses, taken in four portions within one day. Next morning, bowel opened, passed foul, black-brown old residue four times, consciousness gradually improved, all symptoms diminished. Reduced mirabilite and rhubarb continued, to clear residual heat. Three days later, condition stabilized, discharged voluntarily. The patient had previously taken large doses of Baihu Tang and received injections for anticonvulsant and fever reduction, but condition worsened. Later, treatment focused on promoting elimination, allowing pathogen to exit via bowel. This case of coma was due to excessive heat in Yangming, because the stomach network connects to the heart. The disease was in qi level, not ying level, so it should be distinguished.
In the peak phase of Japanese encephalitis, there is often obstruction of phlegm blocking qi, obscuring the mind, prolonged high fever, unconsciousness, convulsions, snoring sounds, thick greasy coating, constipation or bowel movements without diarrhea. In such cases, the "Phlegm-Expelling and Convulsion-Relieving Powder" can be used: whole scorpion 30 pieces, croton seed 0.45g, ox bile 0.6g, borax 1.5g, realgar 2g, gallbladder stone 6g, Sichuan Fritillary Bulb, Tianzhu Huang each 3g, musk 0.3g (added later). Grind into fine powder, store in sealed bottle. After taking, often results in immediate relief, phlegm cleared, consciousness restored, heat subsided.
2. Typhoid and Paratyphoid
Both typhoid and paratyphoid fall under the category of damp-heat. Due to Wu Ju Tong’s statement that “damp-heat… purging causes diarrhea,” some believe that using purgatives may cause intestinal bleeding, leading to ongoing debate on whether to use them. After reviewing literature and clinical practice, I fully agree that “typhoid and paratyphoid not only can be purged, but should primarily use purgation.” These diseases are mainly caused by warm pathogens, often accompanied by food and dampness, so it is essential to promptly clear stagnation, clear heat, and detoxify, preventing the warm pathogen from spreading to Yangming, transforming into fire, and forcing into the intestinal network, thus preventing or reducing intestinal bleeding and shortening the course of illness. Thus, promoting elimination therapy is an active method to reach the nest of pathogens and drive them out, and it should be "early and cool purgation," not waiting for the tongue coating to turn yellow before considering purgation. Of course, typhoid and paratyphoid should use "light purgation frequently," avoiding overly aggressive methods. Doses of rhubarb generally range from 6–15g, mirabilite from 6–12g, and Cool Partition Formula from 30–45g. Usually used for 3 days, then based on constitution strength and severity of pathogen, used daily or every other day. I use Nie's formulation based on Yang Lishan’s "Shengjiang San" (raw rhubarb, silkworm pupa, cicada slough, turmeric) to create "Exterior-Interior Harmonizing Pill" and "Ge Ku San Huang Pill" for treating typhoid, paratyphoid, and influenza, with remarkable results, typically lasting 3–10 days, small doses, easy to take, no side effects.
Exterior-Interior Harmonizing Pill: Suitable for typhoid, paratyphoid, and influenza with both exterior and interior symptoms, or for cases starting 3–5 days ago still having exterior symptoms. Can release exterior heat, clear intestinal toxins, harmonize exterior and interior, shorten course. After taking, often one purge brings pulse to calm and body cool, or dramatic improvement, continuing for 2–4 doses can cure. Except for those with weakened vital energy or spleen deficiency with loose stools, or very mild fever with significant chills, adults and children can take. Ingredients: raw rhubarb 135g, stir-fried silkworm pupa 45g, cicada slough, licorice each 30g, soap pod, fresh turmeric, charred plum each 15g, talc 180g. Grind into fine powder, mix with fresh patchouli juice, fresh mint juice each 30g, fresh radish juice 240g, form pills the size of green beans. Adults take 4–6g per dose, women or weak individuals reduce dosage; children aged 10 take 2.0–2.3g, 6–8-year-olds take 1.2–1.5g, 2–5-year-olds take 0.5–0.75g. Once daily, if no bowel movement, can repeat once, continue for 1–3 days until fever subsides.
Ge Ku San Huang Pill: For damp-heat and other warm diseases, if the above pill has been used for 3 days without reducing fever, can continue with this pill. This is a formula combining promoting elimination, clearing heat, detoxifying, drying dampness, and transforming turbidity. Generally effective after 5–10 days of continuous use. Ingredients: talc 600g, raw rhubarb 90g, cicada slough 15g, ground into fine powder; separately, prepare a decoction from sophora 150g, kudzu root, scutellaria each 90g, trichosanthes root, capillaris, artemisia each 60g, coptis, licorice, white cardamom each 30g, cicada slough, turmeric, curcuma, atractylodes each 15g. Extract concentrated decoction. Then blend with fresh lotus leaf, fresh patchouli each 150g, fresh perilla 180g, fresh reed root 240g, fresh radish seed 60g, grind and extract juice twice using the above decoction, add fresh radish 90g, make into decoction juice. Mix the juice with the three powdered ingredients and form pills weighing 6g (if fresh herbs unavailable, use half the dry herb amount, grind finely, soak in cooled decoction juice, squeeze again with cool water to avoid loss of decoction). Take 2 pills per dose, once daily, reduce dosage for weak or children. Even with loose stools, can continue taking. Usually, 1–2 mild bowel movements per day, fever gradually reduces and recovers.
3. Pneumonia
The use of purgation in pneumonia is mainly adding rhubarb to the diagnostic formula. Ancient wisdom says "disease in the organ, treat the腑," meaning that when the intestinal fu is cleared, the heat and phlegm obstructing the upper jiao naturally find an exit. Rhubarb has the functions of clearing heat, resolving dampness, and purging blood heat. Modern pharmacological studies show rhubarb can gently purge, strengthen spleen, promote bile secretion, and has strong antibacterial effects, including inhibition of influenza virus. Therefore, using rhubarb to treat measles pneumonia is worth studying, and it also shows efficacy against viral pneumonia, fully demonstrating the outstanding effectiveness of promoting elimination therapy. Through practice, I personally have the same experience: the ability of rhubarb to clear heat, purge fire, and detoxify is remarkable, and as long as used appropriately, it has no side effects.
4. Bacillary Dysentery
In the initial stage of dysentery, due to pre-existing stagnation and intense interior heat, ancient practitioners already said "no stopping method for dysentery," "dysentery should be treated with immediate purgation." Promoting elimination therapy is most suitable for the initial stage of dysentery. I commonly use "Dixie San" (Purgative Powder) with raw and cooked rhubarb as the main ingredient to treat dysentery and diarrhea. It is convenient to take, inexpensive, and highly effective, making it suitable for widespread use.
Dixie San: Raw and cooked rhubarb (fried) each 30g, Atractylodes (soaked in rice water) 90g, apricot kernel (skin and oil removed), qianghuo (fried) each 60g, processed aconite (peeled, baked thoroughly), licorice (fried) 45g. All ingredients ground into fine powder, stored in a bottle. For red and white dysentery, take 3–4g per dose; for red dysentery, mix with a 1-foot-long lampwick grass decoction; for white dysentery, mix with 3 slices of ginger decoction; for mixed red and white, mix with decoction of lampwick grass and ginger. For diarrhea, take 2g per dose, mix with rice broth. Children's dose halved; for children under 4, use 1/4 dose, adjust for infants. Daily 2 times. This formula has the effect of purging heat and stagnation, strengthening spleen and drying dampness, warming the interior and dispersing cold, relieving pain and stabilizing the center. It is highly effective for bacillary dysentery and acute/chronic diarrhea, mainly for real heat type, but even for mild deficiency-cold types, it can be used. However, for epidemic dysentery, must combine with detoxifying agents or use integrated Chinese-Western medicine approach. Avoid in cases of chronic dysentery with watery bloody stools.
The above briefly lists the efficacy of promoting elimination therapy in four warm diseases, illustrating its important role in treating warm diseases. Of course, promoting elimination therapy is not a universal solution; we must still follow the principle of syndrome differentiation and apply it timely and appropriately.
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