Understanding Warm Diseases and the Four Levels of Traditional Chinese Medicine

Wen Bing Xue – Study of Warm Diseases

Wen Bing Xue is the study of warm diseases and highlights the coveted “Four Levels” being Wei, Qi, Ying, and Blood. This text serves as the sister to Shang Hun Lun, Treatise on Cold Damage, and is held along with Huang Di Nei Jing as the fundamental building blocks of Traditional Chinese Medicine (TCM). The Four Levels describe the depth of pathogenesis and each level’s distinct symptoms. According to TCM, warm diseases typically reflect highly contagious and potentially deadly diseases. A recent example would be the COVID-19 pandemic and, before that, the Spanish flu and the bubonic plague. It’s not that these diseases are “warm” in temperature per se, but their nature can quickly boil over and make people very sick. Fortunately, due to improvements in healthcare and world nutrition, warm diseases are much less common than before.


The Depth of Disease

Before discussing the Four Levels, it’s worth covering the “depth” of disease. In Chinese Medicine each disease and or pattern can be internal or external. This thought process is provoking for western doctors because it’s generally accepted that you are sick or not and there’s no such thing as interior or exterior. Well, in Chinese Medicine, the body is layered and some diseases thrive in the exterior (flesh level) and some, usually chronic diseases linger in the interior. Although western doctors would agree that the depth and or severity of cancer is much greater than that of the common cold it’s not entirely the same. In western medicine the dissociation of disease and pathology is significant. Chinese Medicine Practitioners are not only educated on disease, but how the pathogen travels throughout the body and with this understanding they’re able to treat effectively.  Without understanding HOW and WHY it’s very difficult to cure anything. Wen Bing Xue describes the flow of evil qi from the exterior to the interior and how to stop it from progressing deeper. The deeper the pathogen travels in the body, the more serious and challenging it becomes to treat.


Level 1: Wei

The Wei level is the first and closest to the skin’s surface, also known as the “flesh”. The Wei Qi, also known as Upright Qi, patrols this level and governs the opening and closing of the pores. The pores act as a gate that generally helps us to thermoregulate, but can also serve as entryways for pathogens, also known as evil qi. Illnesses at the Wei level are traditionally acute and most often short-lived. This is where the common cold, seasonal allergies, and headaches can take hold and, with quick treatment, can be gone before you know it—emphasis on “quick” and or immediate treatment. A lot of the time, when people aren’t feeling well, they shelter to protect others from what they potentially have, which is kind. However, this is when they should seek their local acupuncturist for acupuncture treatments to release the exterior and tonify the Wei Qi to prevent the pathogen from going deeper.


Level 2: Qi

If the pathogen gets through the Wei level, it will enter the Qi level and often present with four distinct symptoms known as the “4 bigs” (high fever, high thirst, irritability, and profuse sweating). This is usually where people seek medical attention, even though it should have been treated at the Wei level. As a means to fend off the pathogen as a last-ditch effort, the body cranks up the heat while also inducing sweating to try and release the exterior. Albeit uncomfortable, this is desirable and reaching for acetaminophen too early can prevent the pathogen release from happening and possibly lodge it deeper. A Chinese medicine doctor would prescribe an herbal formula such as Bai Hu Tang, which clears heat while generating fluid. Acupuncture would follow the same principle.


Level 3: Ying

The following two levels aren’t seen very much clinically, but can occur. The Ying level, or third level, is closely related to the heart and yin. As the body fends off the pathogen at the Wei and Qi level, yin is consumed, and if the pathogen is not eliminated by the time it reaches the Ying level, yin will be all but consumed. As a result, signs of deficiency heat will begin to arise, such as five-palm heat, vexation, insomnia, restlessness, and even delirium. Nourishing yin and clearing heat is the solution here.


Level 4: Blood

Last but not least, the Blood or Xue level. Qi, compared to Blood, is very light and moving, whereas Blood is more nourishing, formed, and calm. According to Chinese Medicine, blood is stored in the liver and is closely related to wind. When heat reaches the Blood level, it dries the liver blood making it more prone to yang rising and reckless wind resulting in nosebleeds, convulsions, rashes, and coma. The prognosis is very poor at this point, but still treatable with potent herbal medicinals to stop the internal wind, clear heat, and nourish the blood.


Steps to Avoid Warm Diseases

With traditional Chinese medicine, you can try to prevent warm diseases from occurring and help make them go away as quickly as possible should they occur. Learn more about the various traditional Chinese medicine offerings to see if these items provide you with relief and promote optimal health and well-being.

Contact us at Wu Wei Wellness to see what treatment options may help!


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