Experience in Treating Certain Chronic Wasting Diseases as Vacuity-Warmth

By "chronic wasting diseases" here I mean long-course conditions marked by progressive physical depletion—cancer, diabetes, pulmonary tuberculosis, and various chronic inflammations. Many such patients can be treated in TCM from the perspective of vacuity-warmth (xuwen). Applying the combined treatment principles of supplementation, dispersing, clearing and harmonizing often yields good results, though the course is long, usually requiring three or more years of continuous herbs.

"Vacuity" means deficiency of righteous qi; "warmth" refers to the warm diseases of TCM. Together, vacuity-warmth means warm disease in a setting of deficient righteous qi. Though their named illnesses differ, vacuity-warmth patients share common features. The following are the key points of pattern differentiation.

First, most are thirsty and drink a lot. Polydipsia is a very important clinical sign of warm disease; cancer, diabetes, tuberculosis and many chronic inflammations all present with it.

Second, patients often feel internal heat yet are averse to cold on the surface, wearing more clothes than average. This is what TCM calls bone-steaming tidal fever: the patient feels heat steaming out from within the bones, unlike the fever of a cold.

Third, they tire easily, and sleep does not refresh them; after a full night's rest they feel exhausted and listless on rising. A little physical effort brings on drowsiness and a need to lie down.

Fourth, digestion is poor and gastric-emptying is clearly slowed; though they eat little, they often feel stuffed, and prokinetic drugs (Chinese or Western) do not readily relieve it.

Fifth, urine is often scanty, though not necessarily dark. Vacuity-warmth patients urinate more often than average, in small amounts each time; it is not necessarily dark and scanty—some patients pass very clear urine.

Sixth, they are easily sensitive to warm-dry weather and to spicy, raw-cold and overly salty food—i.e., they readily "get inflamed." Spicy foods, from the TCM view, are warm-dry in nature and most readily consume the body's fluids.

In my personal view, from a Western standpoint this cluster of symptoms may reflect excess histamine secretion due to allergy and inflammation.

From the TCM standpoint, such patients are warm-disease sufferers with deficient righteous qi and abundant phlegm. TCM holds that warm disease is linked to "winter damage by cold" and "failure to store essence in winter." The former arises from external contraction in cold seasons; the latter from excessive sexual activity or overexertion in winter without proper nourishment, leading to kidney deficiency. Thus righteous qi is vacuous and an allergic, weak constitution appears.

The basic treatment principle for such patients is the combined use of supplementation, dispersing, clearing and harmonizing. Formulas should combine kidney-tonifying and spleen-strengthening, phlegm-dissipating and mass-softening, heat-clearing and detoxifying, and stomach-harmonizing and qi-relieving. Choose sweet-cold, yin-nourishing, bland, damp-draining and heat-clearing, detoxifying herbs for marked effect. Patients should be told to exercise more, eat less spicy, irritating and raw-cold food, keep the diet light, use less salt, and especially avoid pickled foods. Once a constitution is formed, it is hard to correct quickly, so the medication course should generally be long.

In treating vacuity-warmth, remember: no acrid-drying herbs, and no moxibustion—both rapidly consume the fluids of warm-disease patients. Wu Jutong said: in warm disease, retaining one portion of fluids means retaining one portion of life. Zhang Zhongjing in the Shanghan Lun also warned that warm-disease patients subjected to fire coercion easily suffer irreversible deterioration. The Japanese classic-formula master Dōmoto Kyūshin explicitly noted that patients with conditions like TB, whose yin fluids are already exhausted, are harmed rather than helped by herbs such as Guizhi Tang.

Qigong helps vacuity-warmth patients markedly. The static practices relieve polydipsia, while dynamic ones such as Taijiquan and the Five-Animal Frolics markedly raise strength and reduce allergy. Such patients should keep regular hours, avoid staying up late, take a midday nap if possible, get moderate sun, and do deep-breathing exercises.

Dietarily, protect the stomach qi carefully: raw-cold, slimy, fishy, pungent, rancid and sour foods are unsuitable, and alcohol should be avoided. Eat light, easily digested food; avoid very hot food; drink room-temperature water rather than scalding water or ice water.