"Wind-Warm" in the Shanghan Lun Should Be a Neurological Disease

In the general outline of Taiyang disease in the Shanghan Lun there is this passage: "In Taiyang disease, if there is fever and thirst, and no aversion to cold, it is a warm disease. If, after promotion of sweating, the body is burning hot, it is called wind-warm. Wind-warm disease has a floating pulse in both the yin and yang positions, spontaneous sweating, heaviness of the body, much sleepiness, noisy snoring in the nose, and difficulty speaking. If purged, there will be difficult urination, staring eyes, and incontinence of urine; if treated with fire, there will be slight yellowing of the body, and in severe cases it resembles fright epilepsy, with occasional convulsions, as if smoked by fire. One reversal may still prolong the days; a second reversal hastens the appointed time of death."

This passage mentions a disease name, "wind-warm." From ancient times to the present, commentators have treated it as a kind of externally-contracted febrile disease and, taking it for granted, have offered all sorts of annotations on "wind-warm." The author believes few of these annotations are credible. To a modern neurologist, the symptoms of "wind-warm" are utterly commonplace; the "wind-warm" symptoms described by Zhang Zhongjing are very similar to those of stroke patients. When patients with cerebral infarction or cerebral hemorrhage develop pulmonary infection, they present with a series of symptoms: profuse sweating, heaviness of the body, somnolence, snoring, aphasia, and convulsions.

The prognosis for such patients is poor; even with timely rescue they may not be saved. The volume and location of the cerebral hemorrhage, and the area and location of the infarction, determine the patient's life or death. In fact, Zhang Zhongjing had already observed the poor prognosis of such patients in clinical practice. Zhang Zhongjing said "one reversal may still prolong the days; a second reversal hastens the appointed time," showing that even then he had found that wind-warm patients die rapidly.

As for how "wind-warm" patients should be treated, the Shanghan Lun does not say. Later commentators on the Shanghan Lun, based on their own understanding, proposed many treatment opinions: some said White Tiger Tang should be used, others said Mahixinggan Shigao Gancao Tang, but when these treatment opinions were tested clinically, the results were not very good; perhaps these formulas are even less effective than Angong Niuhuang Wan.

From Zhang Zhongjing's record, it is clear that past doctors were also at a loss when encountering this disease and did not know how to treat it. Some used the "purging method," some used fire therapy. After using the downward-purging method, the patient developed "staring eyes and incontinence," a very critical sign appearing in the late stage of stroke patients and also common in neurology. The patient no longer responds to light, has urinary incontinence or urinary retention, and may die at any time. Some stroke patients develop these symptoms without being purged. Zhang Zhongjing said that after some patients received fire therapy, their skin turned yellow and they had intermittent palpitations (fright epilepsy) and convulsions (chizong), showing that Han-dynasty doctors' fire therapy worsened the patients' condition.

In fact, on the disease of "wind-warm," Zhang Zhongjing himself was also helpless. That is why, although he mentions treatment methods for many diseases in the Shanghan Lun, he only describes the symptoms of "wind-warm" without mentioning treatment—because he himself had not found a good treatment method in clinical practice.

Later commentators on the Shanghan Lun lacked understanding of this disease and almost all annotated blindly. From this we can see that the TCM saying "medicine is a matter of intuition" becomes extremely harmful when taken to extremes. When doctors overvalue their own subjective thinking and undervalue the objective pathology of disease, they inevitably cause many tragedies.

Stroke damages the human central nervous system and is extremely difficult to treat; patients should be promptly sent to neurology for emergency rescue. For cerebral hemorrhage patients, timely intracranial drainage, and for cerebral infarction patients, timely thrombolytic therapy, followed by mannitol and other drugs to lower intracranial pressure, can save some patients. If wind-warm patients are rescued according to the treatment methods of later commentators on the Shanghan Lun, it may delay the optimal rescue time and cost a life for nothing.