Wednesday, January 25, 2012

Colds & Flu: Traditional Chinese Perspective Summarized

Western biomedical perspective on colds and flus

A Western biomedical discussion of common wintertime upper respiratory infections (URIs) usually begins with a differentiation between the “common cold” and the “flu.” According to western medicine, colds and various influenzas are caused by a wide variety of viruses which affect the respiratory tract. Although both categories of viruses can cause similar “flu-like symptoms,” there are differences between the common cold and the flu. The common cold is usually milder than the flu. Its symptoms include runny nose, congestion, cough and sore throat. Symptoms of flu tend to be more severe, and include fever, body aches, extreme tiredness, and a more intense dry cough. Influenza viruses are of greater concern, particularly among elderly, very young and immune-compromised patients, as they are capable of causing lung infection, pneumonia and even respiratory failure.

Classical Chinese perspective on colds & flus

In classical Chinese medicine, both the common cold and influenza correspond to an invasion of the body by “exterior wind.” In the initial stages of an exterior wind invasion, wind is said to have entered the exterior layer of the body – between the skin and the muscles. Here, the wind battles with the body's outermost defenses and interferes with the proper functioning of the lungs. This accounts for symptoms of chills and fever, body aches, sneezing, coughing, nasal congestion and discharge, etc.

Why the term “wind?” In one sense, “wind” best refers to climactic influences, espcially sudden changes of weather, to which the body cannot adapt. “Wind” also characterizes the complex of symptoms we see when someone has early stage cold or flu: rapidly changing, quickly progressing, moving from place to place in the body, chaotic & disorienting: fever, chills, body aches, sneezing, etc.

The treatment strategy for this initial stage of colds and flus, the exterior wind stage, is to provoke a mild sweating in order to push the invading pathogen out of the body. In terms of home remedies, at the very first signs of a fresh cold, patients are recommended to take mildly spicy herbs (the most basic being a hot tea or rice porridge with fresh green onions and ginger) and then to go to bed, cover up warmly enough to cause a mild sweat, and to rest. Patients are also cautioned against eating hard to digest foods as these will simply tax the system and cause a build-up of damp and phlegm in the body which will simply entrap the exterior pathogen more deeply in the body. Obviously, the patient should rest and keep warm, rather than exerting themselves or exposing themselves to the elements.

(For more on what to eat, what not to eat & home remedies, please see my article on Food Therapy for Colds & Flus.)

In the acupuncture clinic, the general treatment for a wind-invasion is to regulate the surface pores of the patient's body in order to release the exterior pathogen and expel wind, and to restore the dispersing and descending function of the Lung-Qi. This is achieved with acupuncture and/or by using mildly pungent herbs. Acupuncture point prescriptions and herbal prescriptions will vary according to specific nature of diagnosis and symptoms (i.e. headache, bodyaches, nasal congestion, sore throat, etc.)

Moving to the next level of complexity, the practitioner of acupuncture or Chinese herbal medicine, in treating a cold or flu in its initial stages, must differentiate whether the illness is a Wind-Heat or Wind-Cold pattern, and treat accordingly. Symptoms of Wind-Cold include aversion to cold, shivering, no fever, no sweating, occipital headache, stiff neck, body-aches, slight cough, runny nose with white discharge and sneezing. Symptoms of Wind-Heat include aversion to cold, shivering, fever, slight sweating, runny nose with yellow discharge, headache, body-aches, cough, sore throat, swollen tonsils, slight thirst and slightly dark urine. The patient's pulse will be slightly rapid, and tongue might be slightly red at the tip or on the edges in Wind-Heat cases.

Why Do People Catch Colds & Flus? – A Chinese Medicine Perspective

Since the discovery of germ theory, Western biomedicine's principal understanding of why people catch colds and flus is that they contract one or more of a variety of viruses in the environment. I believe it's only been somewhat recently, in naturopathic biomedicine, for example, that modern western medicine has begun to place emphasis on the strength of the immune system as an important factor in why people catch colds and flus.

In Traditional Chinese Medicine, an invasion of an exterior factor has long been understood to result from a temporary and relative imbalance between the strength of the body's Qi and the strength of the pathogen.

So, you can either have a really strong infectious pathogen that makes lots of people sick even if they have strong Qi. Or, on the other hand, a weaker pathogen will cause those people whose Qi are weak, in the moment or in the long term, to get sick.

What makes people's Qi weak? Any number of factors, but particularly overwork, poor diet, lack of quality sleep, exposure to stress or harsh climate, etc.

An important job of Chinese medicine and other health practitioners is to strengthen patient's innate Qi so that they are less vulnerable to infectious diseases, as well as chronic diseases. And, as you'll see below, Chinese medicine theory believes that chronic illness is often brought about by external pathogens, i.e. viruses, that have gone untreated or been improperly treated and have penetrated more deeply into the body. These lingering pathogens, in combination with weakness of the innate Qi, is a good setup for chronic, debilitating illness.

The Clinical Reality: Modern TCM Clinical Treatment of Colds & Flus

Some of the practitioners I've worked with say that in the modern clinical setting, the differentiation between wind-heat and wind-cold is difficult to make and somewhat irrelevant for effectively treating early stage colds and flus. Another practitioner I know says that people in American clinical setting rarely contract wind-cold. You'll really only see wind-cold-invasions in people working on fishing boats in Alaska or Northern China, for example. In everyday Americans, we most often see colds and flu that are a pattern of wind-heat or combined wind-cold and wind-heat. Also, when cold pathogens linger in the body for a day or more, they generally produce heat and phlegm. This is particularly true in children, who run warm and produce a lot of phlegm.

So, in early stages of cold and flu we usually prescribe spicy and aromatic herbs that are cooling in nature. We also tend to use a category of herbs used for relieve heat and toxins because these have proven to be extremely anti-viral.

After the initial onset of a cold or flu, as the patient's body battles with the invading pathogen over a series of days, a range of different symptoms develop according to the specific virus and according to the physiological traits and tendencies of the patient. These symptoms can range from wet cough to dry cough, bronchitis, asthma, headaches, nasal congestion, runny nose, ear infections, etc. In treatment, then, the practitioner must select from a broader range of herbs and herbal formulas, or other treatment strategies, to address the symptoms according to each individual presentation.

Historical Perspective on the Classical Chinese theories of Cold and Flu Treatment (and how Chinese physicians understood infectious disease way before biomedicine figured out germ theory):

Over two thousand and more years, Classical Chinese Medicine elaborated a complex understanding of the pathology and treatment of various manifestations colds and flus and their related complications. They also developed a significant understanding of acute infectious diseases other than colds and flus.

Common colds and influenza are generally relatively mild and self-limiting diseases. So why does their diagnosis and treatment hold such a prominent place in Traditional Chinese Medicine? There are various reasons for this. Chinese medical practitioners observed that if an external wind invasion (i.e. a cold or flu) was allowed to penetrate more deeply into the interior of the body, or if it was improperly treated, it could trigger more severe short-term diseases as well as long-term chronic illness. Also, it was recognized that the initial symptoms of many severe, life-threatening infectious diseases were similar to symptoms of common cold or flu. So, in the era before antibiotics and other life-saving measures of western medicine, it was critical to identify and eliminate pathogens as soon as possible once they had entered the body. In other words, in order to really do their jobs and save lives in the face of epidemics and infectious diseases, traditional Chinese physicians had to be really good at differential diagnosis and use really sophisticated acupuncture or herbal strategies.

Two major schools of thought formed the pillars for the diagnosis and treatment of exterior diseases in classical Chinese medicine. These schools were separated in time by about 15 centuries. The Discussion of Cold-Induced Diseases (or Shang Han Lun), written by the physician Zhang Zhong Jing around 220 CE, provided the earliest framework for the diagnosis and treatment of diseases from Exterior Wind-Cold. In the Shang Han Lun, Dr. Zhang further elaborated on the diagnosis and herbal medicine treatment of complications of exterior disease in cases where pathogenic cold was allowed to penetrate more deeply into the body. Dr. Zhang describes six levels of progressive disease, affecting first the lungs and the stomach and then progressively impairing the body as a whole.

Fifteen centuries after Zhang Zhong Jing, the School of Warm Diseases (Wen Bing) emerged in the late 1600s, advancing a comprehensive theory of exterior diseases from Wind-Heat, along with their diagnosis and treatment. Dr. Ye Tian Shi, a physician of the Wen Bing School, formulated a theory of four levels to describe the symptomology and treatment for warm pathogenic factors as they advance more deeply into the patient's body. Dr. Ye's four levels correspond roughly, to a certain limited extent, with the six levels of the Shang Han Lun.

Giovanni Maciocia, a modern western scholar of classical Chinese medicine, explains that in addition to expanding Chinese medical understanding of exterior pathogens, the Wen Bing/Warm Diseases School first introduced the idea of infectious disease, well before the introduction of western medicine in China. That is, the Wen Bing School introduced the idea of the “warm disease,” a virulent infectious disease that afflicts individuals even if their body's Qi is strong. Previous to the Wen Bing School, it was believed that a person fell ill from an exterior disease because of a relative imbalance between an external pathogenic factor and the body's innate Qi. The doctors of the Wen Bing School realized that some diseases, while still falling under the category of “Wind” diseases, and still characterized by early cold or flu-like symptoms, were infectious or even epidemic in quality. A further innovative idea stemming from the Wen Bing School was that the pathogenic factors causing Warm diseases (infectious diseases), enter the body via the nose and mouth, rather than via the skin, as happens for Wind-Cold diseases. So, the Wen Bing School provided a sophisticated understanding and notable system of effective treatments for infectious diseases such as measles, chicken pox, German measles, poliomyelitis, small pox, scarlet fever, whooping cough and meningitis well before the advent of western biomedicine.

Information in this article was drawn largely from:

Giovanni Maciocia's The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. London: Churchill Livingstone, 1994.

with shouts out to:

Andrew Gaeddert, Founder of Health Concerns Herb Company,

Gene London, L.Ac.

Briahn Kelly-Brennan, L.Ac.

who introduced me to some of the ideas mentioned here.