Diagnosis and Treatment of Latent Pathogens
© 2000 William Robert Morris
Just as a fish in water, humans live surrounded by influences. If the water is turbid, the fish waste away. If the influences are irregular, the people fall ill. The most severe influence is that of evil which is taken by the transport channels to the Zang Fu. Jing and Shen are present in the body from the very beginning, they are the foundation of the constitution. The penetration into the interior by evil moves through the primary vessels and eventually the divergents causing confusion to the Jing-Shen
Wen Bing
Wen Bing theory is commonly used to describe the location of Latent Heat in the system. The latency typically is identified in the area at the deeper portion of the Qi stage, close to the Ying. The use of Xiao Chai Hu Tang (Minor Bupleurum Combination) often an appropriate choice in these circumstances just as it is in Shao Yang patterns.
The Nei Jing in chapter 3 states: "If Cold enters the body in wintertime, it comes out as Heat in springtime."
When this occurs after damage in the winter, it is sometimes referred to as “Spring Heat”. It is clearly described in the Wen Bing literature for the use of Huo Xiang Zheng Qi Pian (Agastache Formula) when a Summer Heat pathogen remains latent and re-emerges in the Fall. I have seen this in numerous instances and the Li Dong Yuen formulas for summer heat are appropriate for the latent heat that is a product of Summer Heat.
The Nei Jing, chapter four states “the essence is the root of the body, if it is guarded and stored, Latent Heat will not occur in the springtime”. The implications of this are two-fold. One, modifying ones behavior such that the essence is guarded and stored helps to prevent latent heat. Two, deficiency signs in the proximal pulse positions may give an indication of those individuals prone to invasion by evil and corresponding development of Latent Heat patterns.
Shao Yang strategies for management of latent heat pathogens
The Shang Han Lun states that any one symptom from the Shao Yang category is sufficient to render a Shao Yang diagnosis. Loss of appetite is one of the more salient symptoms and is a clinical keynote for progression into the Shao Yang. The next step is making the distinction between a Tai Yin pattern and a Shao Yang pattern. Other Shao Yang symptoms include a bitter taste in the mouth, dry throat, dizzy vision, alternating aversion to cold and flushing of heat, chest and rib fullness, taciturnity, heart vexation, frequent retching, and a pulse that is fine and stringlike.
The meridian systems containing large amounts of Jing and Yuan Qi are the Eight extraordinary vessels and the Divergent vessels. Wei Qi travels outside the primary vessels and Ying Qi travels inside the vessels. Wei Qi tends to travel in the Muscle Vessels, the Divergents, and in some extra vessels such as the Yang Wei. The Ying Qi travels inside the primary vessels.
It is said that unresolved infections cause Yin Xu. Antibiotic therapy may leave residual infection that remains unresolved. An external pathogen may combine with the Wei Qi; The Wei Qi gets trapped and incubates this produces stagnant heat. This state of affairs may burn off Jing in an attempt to clear the stagnation. Examples of this could include degeneration of the spine and joints.
Divergent Vessels
The Divergent Vessels travel from the exterior to the interior, they can divert internal or external pathogens away from primary organs. When the Wei Qi is strong enough to stop a pathogen but not strong enough to expel it entirely, one possibility is the lingering of pathogens in the Divergent Vessels. When the Wei Qi or Yang Qi combine with pathogens, Heat may result. Over time this may result in frank diseases such as heart attack, uterine tumors, and infertility. A prime features of Divergent Meridian involvement include the presence of organic lesions, chronic/ intermittent symptoms, and emotional disturbances.
Pulses related to the Divergent meridian system include the diaphragm pulse [the divergents may be construed to traverse the diaphragm. I have found them to be useful for quickly changing a positive diaphragm finding.] and the neuro-psychological pulse which respond to treatment by the divergents most of the time (Van Nghi considers all divergents to converge at Bai Hui [Du 20]). Also, consider deep or superficial pulses - any pulses that reflect a lack of communication from the interior to the exterior. And, course vibrations at the organ depth - especially the lower third of the organ depth - reflect damage to organ tissue (this is consistent with Van Nghi's notion that organic lesions are a reason to use divergent vessels).
If the pulse is very deep or superficial, then the use of Luo channels in conjunction with divergents is often a useful intervention.
Wave form or the arrival and departure
Book Five of the Huang Di Nei Jing On the delicate and refined Fundamental Principles of Pulse Diagnosis states: “A pulse that arrives quickly and departs slowly is symptomatic of excess in the upper and deficiency in the lower which gives rise to symptoms in the head. A pulse that arrives slowly and departs quickly is symptomatic of deficiency in the upper and excess in the lower region which gives rise to fear of cold.” Patterns may include a rapid arrival or departure in the wave form while the rate remains fairly normal, this may be described as a pounding sensation. Or, there may be a suspicious slippery quality in the arrival. There may be a tense surface with a slippery turbulence in the Blood depth and clear signs of heat in the Blood (the pulse gets wider as you lift from the Organ depth towards the Qi depth).
Wang Shuhe states in chapter eleven of the Mai Jing “The classic says that the pulse can be latent or hidden. Then in which viscus is (the evil) hidden when (a pulse) is spoken of as latent? The answer is as follows. (Latency) means that Yin and Yang restrain reciprocally and may have to hide in one another. When the pulse located in the Yin (i.e. The chi) presents contrarily a Yang image, this is Yang restraining Yin. Even though the pulse may be occasionally deep, choppy, and short, this is but yin hidden within Yang. If the pulse in the Yang (i.e. the cun) presents contrarily a Yin image, this is Yin restraining Yang. Even though it is occasionally floating, slippery, and long, this is but Yang hidden within Yin.”
Most important: signs of latent heat are those subtle heat signs existing inside a larger picture of normalcy. This is pointing to the potential of compensation or encapsulation. Latent heat is identified as a pulse of excess nature in the deeper section, the confined pulse fits this picture. Maciocia describes the pulse and tongue as fine and rapid; this is true after damage to Yin by Latent Heat pathogens over a period of time.
A ropy (atherosclerotic) pulse due to heat in the blood stream may be a result of focal infections or chronic bacterial infections such as gum infection or chronic appendicitis (Dr. Stefan Kiechl, University of Innsbruck in Austria, Circulation 2001;103:1064-1070.) Bacteria may enter the blood stream through infected gum tissue damaging the intima of the vessels causing plaque formation in an attempt to repair the damage.
The Special Lung Pulse (see attached diagram) is a record of the history of events taking place in the respiratory system. It can give clues about latent pathology depending on the quality that should reflect qualities described elsewhere in this article such as urgency, slipperiness, or rough sensations in the arrival.
Turbulence, roughness, agitation, and/or vibrations in the arrival of the wave are often more consistent significators of latent heat than the Special Lung Pulse (SLP). In addition, the area between the diaphragm and the plura is very important for evaluating latency. Given the correct quality, a positive "Mo Yuan - membrane source" finding is more consistently indicative of latent dampness and heat bound in that area than the SLP is of latent pathogens in the Lungs.
Latent heat may be a result of the penetration by cold during one season only to arise in another. If this is the case, the pulse descriptions in Zhang Ji's Shang Han Lun may prove useful. Reminder - these pulses take place in the context of a whole pattern.
(1) The pulse of the Tai Yin is moderate or weak (deep without force).
(2) The Shao Yin pulse is faint and fine (feeble/absent) or faint and rough - not Dr. Hammer's definition of Choppy in this instance-.
(3) The Jue Yin pulse is 'faint and there is reversal", and/or slow. The hot above and cold below reversal will present with a fuller Cun position and a weaker Chi position or there may be a floating quality. These are pulses without root when Yang is floating upward.
During penetration of the three Yin channels, the SLP, waveform and/or Mo Yuan pulses may provide the only signals from the pulse regarding latent pathogenic processes. If the attack took place through the lungs, the SLP may have a record.
However, if the Central Qi is damaged or weak, the pathogens may penetrate directly into the Tai Yin, presenting a Spleen/Stomach deficiency picture. If there is an underlying deficiency of Heart and Kidney Yang with impairment of Fire and Water helping each other - then the pathogens move directly to the Shao Yin. If there is an underlying reversal pattern due to deficiencies, the pathogen may penetrate immediately to the Jue Yin. Over time these cold pathogens may transform according to the Qi of the host and become latent heat, or they may transform into heat under the influence of a recent pathogenic invasion.
Note: Zhang Ji's descriptions of evaluating and prognosticating based on the response of the pulse to certain herbal treatments in the Shang Han Lun clearly implies an awareness of pulse balancing methods using herbs.
Wang Shu-he. Translated by Yang Shou-zhang. The Pulse Classic (Mai Jing). Pp. 24. Blue Poppy Press 1997.