of Acupuncture and Chinese Medicine 23
Aust J Acupunct Chin Med 2010;5(2):23–29
* Correspondent author; e-mail: firstname.lastname@example.org
2010 VOLUME 5 ISSUE 2
Andrew Koh* MA, BA(Hons), DipNursing, RN
Sydney Institute of Traditional Chinese Medicine
and the 2009 H1N1 Influenza
wen bing 温病 or warm diseases in Chinese medicine (CM).
Some epidemiological data will be used to underscore the
theoretical foundations and practice of wen bing. It is suggested
that the 2009 H1N1 inﬂuenza can be managed from a wen
bing perspective using a fourfold management approach.
Influenza – warm diseases
Inﬂuenza is categorised in CM as an exogenous warm
disease or wen bing; the 2009 H1N1 virus falls into the same
classiﬁcation.10-12 However, the treatment of such diseases
is based on the pattern differentiation fundamental to the
practice of CM. It involves diagnosing from a presenting set
of signs and symptoms and treating the condition according
to CM principles.
Epidemic diseases have been recognised by CM physicians
since the Han Dynasty, as evidenced in the Shang Han Lun 伤
寒论 of Zhang Zhong Jing 张仲景 (150–219 CE), a text that
predates the biomedical appreciation of epidemic by several
hundred years.11,13 The Chinese medical theory of epidemic
diseases, however, was developed by Wu You Xing 吴有性
(1582–1652), who proposed that such diseases were caused
I had a little bird
And its name was Enza
I opened the window
(An anonymous schoolgirl’s poem from the time of
the 1918 H1N1 Spanish Inﬂuenza)
Epidemiology of the 2009 H1N1
The 2009 H1N1 (swine ﬂu) is the ﬁrst inﬂuenza pandemic of
the twenty-ﬁrst century. Its rapid spread across the globe has
caused considerable panic among health authorities and the
general public worldwide.1 The pandemic raised the spectre
of the 1918 Spanish ﬂu, which killed between 20 and 50
million people.2-5 As of 17 October 2009, the World Health
Organization reported 414 000 laboratory-conﬁrmed cases
of 2009 H1N1 and nearly 5000 deaths.6 The US president
declared a national emergency on 23 October 2009 with
regard to the H1N1 pandemic.7-9 This reﬂects the seriousness
with which various world governments viewed the situation.
This paper will examine some of the epidemiological features
of the 2009 HIN1 inﬂuenza with the main characteristics of
The epidemiological data of inﬂuenza can serve as a basis for the effective use of wen bing 温病
theory in the management of the 2009 H1N1 inﬂuenza. The long history of Chinese medicine in
general and of the wen bing school speciﬁcally holds much evidence on adapting and responding
to changes in the climate, environment and newly emerging diseases. Uncovering and comparing
these data and information from Chinese medicine with modern epidemiological ones can perhaps
offer another legitimate and valid way of understanding and treating contemporary diseases. Such
a methodology may also be another strategy for integrating biomedicine with Chinese medicine.
This paper will examine some of the epidemiological features of the 2009 HIN1 inﬂuenza and
their similarities with the main characteristics of wen bing or warm diseases in Chinese medicine.
It is suggested that the 2009 H1N1 inﬂuenza can be managed from a wen bing perspective using
a four phase approach.
KEYWORDS wen bing, pandemic, H1N1, swine ﬂu, inﬂuenza, lingering pathogens,
of Acupuncture and Chinese Medicine
24 2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
Within clinical settings, CM physicians are likely to note that:
• The onset of the warm disease is acute;
• Heat signs, especially fever, are certainly present at the initial
• Manifestation of the disease changes frequently due to heat
injuring body ﬂuids and yin.11-12,14-15
When inﬂuenza, including the 2009 H1N1, is examined, the
characteristics and features closely resemble those described of
warm-heat pathogenic qi above (see Table 1).
by pestilence qi or li qi 疠气, and expanded by various wen
bing physicians through the centuries.11-12 The development
of various schools of CM practice is a direct recognition that
diseases change over time and space. In the time of Zhang
Zhong Jing and his contemporaries, cold pathogen was the
main theoretical focus in northern China. The major cause of
diseases came to be seen as warm pathogen by the sixteenth
century, an approach that was dominant in central and
southern China. Such a shift in perspective nevertheless makes
use of the same CM principles. While some of the wen bing
physicians seem to distinguish between warm diseases and
pestilence qi, the contemporary CM approach is to treat the
two concepts as equivalent.12 The main reason is that ‘pattern
identiﬁcations and treatment determinations are too similar to
those of the four season warm diseases’.12 Accordingly, in this
paper both terms will be used interchangeably.
Warm diseases are characterised by the following:
1. They are caused by warm-heat pathogenic qi, contracted
externally through the nose and mouth as opposed to
through the skin as taught by Zhang Zhong Jing.
2. They are infectious diseases that can become epidemic
under certain conditions, seasonal and geographical,
though they are not bound by either. Seasonal inﬂuences
do, however, play an important role in the rise, spread,
virulence and mutability of the diseases. Hence, the warm
diseases bear names such as spring warmth 春温, latent
summerheat 伏暑, and autumn dryness 秋燥.11-12
3. They are diseases that penetrate according to a standard
rhythm or levels, i.e. through the wei 卫 (defensive),
qi 气, ying 营 (nutritive), xue 血 (blood). The speed at
which a warm disease progresses from one level to another
is not necessarily constant, gradual or sequential, as it is
predicated on the constitution of the individual and the
virulence of the pathogenic qi.
4. Such diseases have special clinical characteristics, one of
which is the presence of fever throughout all four stages.
Others include cough, sore throat, tiredness, headache,
The three key features of warm-heat pathogenic qi are:
1. Symptoms appear very quickly;
2. Heat signs and symptoms often predominate;
3. The hot nature of the pathogenic qi readily injures body
ﬂuids and yin.11-12,14
TABLE 1 Features of
Wen Bing H1N1 2009 virus
Pathogenic qi enters via nose
and mouth into the lungs
Virus spreads through
coughing or sneezing,
eventually settling into the
lungs causing respiratory
Runny or stuffy nose
Signs and symptoms appear
quickly Acute presentation
Hot nature; yin and body
ﬂuids readily consumed Fever is a key symptom
The Centre for Disease Control and Prevention notes that
inﬂuenza viruses of all known types, including the 2009
H1N1, are ‘spread mainly from person to person through
coughing or sneezing by people with inﬂuenza. Sometimes
people may become infected by touching something – such as
a surface or object – with ﬂu viruses on it and then touching
their mouth or nose.’16 The signs and symptoms of inﬂuenza
are fever, cough, sore throat, runny or stuffy nose, body aches,
headaches, myalgia, chills, fatigue, possibly nausea, vomiting
of Acupuncture and Chinese Medicine 25
2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
Severity depends on how deeply the pathogen has invaded the
body in a given geographical setting and climate. The signs,
symptoms and transmission route ascribed to inﬂuenzas are
strikingly similar to those described by the wen bing school 温
病派. Thus, the condition that biomedicine calls ‘inﬂuenza’ has
been identiﬁed by the wen bing school several hundred years
earlier. The treatment methods and strategies used by the wen
bing school have been and continue to be applied successfully.
On looking at historical evidence, Cheng and Leung observed
that the 1918 H1N1 pandemic had signiﬁcantly less impact in
China than in the rest of the world. They pointed out that early
twentieth-century China was ‘an underdeveloped and closed-
door country at that time, and it is not likely that China’s
general population used western medicine as the main means
of disease treatment. Traditional Chinese medicine would have
been the only form that the public relied on’.10
Cheng and Leung seem to suggest from the epidemiological
data that traditional Chinese medicine is just as effective (if
not more so) as biomedicine, in treating virulent inﬂuenza.10
Although the authors did not mention the wen bing school
speciﬁcally, this paper asserts the likelihood that the school’s
theories and treatment strategies underpinned the CM
approach to the 1918 inﬂuenza.
The Importance of Zheng Qi
According to the wen bing school of thought, warm diseases
take the path of least resistance. Individuals with a weak or
weakened zheng qi 正气 (vital qi, also translated as upright qi)
are most likely to be among the casualties.11-12,14,20 Zheng qi can
be damaged and drained away by a poor lifestyle, unbalanced
diet, overwork, and emotional upheavals. Zheng qi can also be
compromised if there is a constitutional weakness, that is, if a
person’s jing was not strong at birth.20 Epidemiological studies
of the 2009 H1N1 appear to support the wen bing school in
this regard. The World Health Organization reports that the
very young, the elderly and the immuno-compromised are
subject to attacks of seasonal inﬂuenza and these groups are
at particular risk of severe development when infected with
the 2009 H1N1 virus.19 In severe cases, most patients needed
immediate respiratory mechanical support upon admission
to a hospital. From the wen bing school’s viewpoint, the
organ system that is most severely affected by inﬂuenza is the
respiratory. Thus, warm pathogen ﬁrst attacks via mouth and
nose, entering into the lungs, causes damage there and then
progresses to the stomach and in some cases directly to the
pericardium.11-12,14,20 The WHO further points out that in
severe cases, co-morbidity is commonly present, whether in
the form of chronic lung disease or neurological disorders. Two
other groups were singled out as at risk, namely, minority and
indigenous groups, where poor nutrition, lifestyle and access
to healthcare are the key factors. From a wen bing perspective,
in all these groups of people, zheng qi is already weak and
therefore, the body is unable to resist any exogenous pathogen.
The wen bing perspective suggests that as members of these
groups are more likely to suffer from deﬁcient zheng qi, they
are often already weak and therefore, unable to resist the attack
of an external pernicious agent.
The 2009 H1N1 inﬂuenza distinguishes itself from seasonal
inﬂuenza in the relatively high number of apparently healthy
and ﬁt young people infected.21 However, the appearance
of health does not in CM’s view necessarily imply health
itself. What dictates health according to CM is the internal
constitution of the individual, the strength of the qi and blood,
and so forth. The wen bing school postulates that previously
healthy young people who are infected with the 2009 H1N1
inﬂuenza virus probably have weak Zheng Qi.
On the other hand, wen bing’s pestilence qi can also be
overwhelmingly powerful so that even individuals with strong
zheng qi can succumb to the disease. In such cases, however,
these individuals are far more likely to recover from the disease
and do so in a shorter time than their weaker counterparts.11-12,14
In applying this approach, the wen bing school can account for
the unusual number of presumably healthy young people who
were infected with the 2009 H1N1. The concept of zheng qi
and its role in resisting exogenous pathogens also explains why
in this pandemic, most people only experienced a mild form of
the disease, lasting three to ﬁve days.1
With these wen bing concepts and epidemiological data in
mind, a four-phase CM wen bing approach to managing 2009
H1N1 is proposed. The strategy will include tools of CM that
are not speciﬁcally related to the wen bing school.
Managing the 2009 H1N1 Influenza
Zheng qi is pivotal in resisting any exogenous disease. There are
several methods for strengthening one’s zheng qi.
(i) Diet: maintain a balance in the various types of food, eat
according to the seasons and one’s constitution, avoid
overeating, eat up to 70–80% of what is needed, and keep
everything in moderation. Cooked food is preferred as it
is easier to digest.22
(ii) Exercise: workouts, brisk walks, taijiquan 太极拳, qigong 气
功, yoga, slow running, gardening, any physical activity that
causes mild sweating and exerts the body’s system will help
improve one’s condition and strengthens one’s zheng qi.20
(iii) Stress management: while a little mental and emotional
stress can be beneﬁcial, too much of either becomes
of Acupuncture and Chinese Medicine
26 2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
detrimental. Over-thinking injures the spleen and
sustained emotional upheaval injures the lungs, heart,
kidneys and liver.
(iv) Acupuncture: it is common knowledge in CM that
stimulation of the acupuncture point ST 36 Zusanli
strengthens one’s constitution.20,23 This can be done daily
or for three consecutive days each week. Stimulation can
take the form of either needles or 100 moxa cones in each
session.23 Other acupuncture points to consider are CV 6
Qihai, CV 4 Guanyuan and KI 1 Yongquan.20
(v) CM herbal decoctions: take herbal formulae appropriate
to one’s constitution for toniﬁcation, such as Bu Zhong
Yi Qi Tang 补中益气汤 (tonify the middle to augment
the qi decoction), Gui Pi Tang* 归脾汤 (restore the
spleen decoction), Si Jun Zi Tang 四君子汤 (four
gentlemen decoction), Ba Zhen Tang 八珍汤 (eight
treasure decoction), and Liu Wei Di Huang Wan 六味地
黄丸 (six ingredient pill with rehmannia). However, tonic
herbs should be avoided at the ﬁrst sign of any illness and
professional CM advice should be sought. It may also
be beneﬁcial to take Yin Qiao San 银翘散 (honeysuckle
and forsythia powder) occasionally to ensure that no
pathogenic qi has a hold in one’s body.20,24 [*See Editor’s
Comments on page 29 regarding endangered species]
(vi) Fumigation: this is a practice that has been used by past
wen bing physicians. One such formula used in ancient
times is called Tai Yi Liu Jin San 太乙流金散 (supreme
unity ﬂowing gold powder).12 These days, however,
vinegar is the favoured product for fumigating one’s abode
rather than a complex formula.20
Biomedical physicians are likely to encourage the uptake of
vaccination as a preventative measure. Since December 2009,
there has been an approved vaccine for adults (single dose) and
children (two doses).25 However, from the wen bing school’s
perspective, modern day vaccination itself can be a cause of
illness.11,26 The intramuscular delivery of the attenuated virus
circumvents the exterior defences of the body and enters
directly into the interior, into the qi level (of the four levels
in Ye Tian Shi’s 叶天士 diagnostic model: wei 卫 defensive,
qi 气, ying 营 nutritive, xue 血 blood), resulting in internal
latent heat.11,26 When faced with an exogenous pathogen later
on, the heat then manifests itself.11-12,26-27 Although inoculation
is not a novel concept in CM, with the practice ﬁrst recorded
in China around the tenth or eleventh century, the way ancient
CM physicians administered it differs signiﬁcantly from the
modern biomedical approach.28 Ancient records show that
pathogenic material was introduced into the patient either
via the nose or via a scratch on the skin.28 In both methods,
the pathogen was not delivered directly into the interior but
on the exterior. This allows the body to respond in a natural
manner and build up its defence. In other words, one’s zheng
qi, in particular, one’s wei qi, must be strengthened as part of
an illness prevention measure. Vaccination as an aspect of that
strategy is not rejected by CM but the biomedical method
of deep intramuscular delivery is questioned by some CM
The wen bing school has more than 1000 formulae for treating
over 60 types of syndrome.11-12,14 The use and modiﬁcation
of formulae for a patient will depend on a CM practitioner’s
pattern differentiation of the individual. Inﬂuenza falls under
the category of wind warmth 风温, based on the signs and
symptoms and natural history of the disease.11,14,20 Sang Ju
Yin 桑菊饮 (mulberry leaf and chrysanthemum drink) is the
preferred formula in the initial stage of wind warmth.11-12,14,29
It is good for ‘coursing wind, dissipating heat, and treating
cough’.29 The other commonly used formula is Yin Qiao San
(honeysuckle and Forsythia powder).11-12,20,29 The latter is better
than Sang Ju Yin in ‘out-thrusting the exterior with acridity and
coolness and for clearing heat and resolving toxins’.29 The key
symptoms in this scenario are fever and aversion to cold.14
If the patient delays seeking treatment, the pathogen may enter
the qi level. Alternatively, the pathogen may penetrate from the
upper jiao to the middle jiao (of the three burner differentiation
system, also part of the wen bing school). The key symptoms in
this stage are fever, constipation and damage to body ﬂuids, i.e.
dryness.14 The appropriate formulas include Bai Hu Tang 白
虎汤 (white tiger decoction), Zeng Ye Tang 增液汤 (increase
the ﬂuids decoction), Tiao Wei Cheng Qi Tang 调胃承气汤
(regulate the stomach and order the qi decoction), Zeng Ye
Cheng Qi Tang 增液承气汤 (increase the ﬂuids and order the
The wen bing school teaches that if wind warmth disease is
left untreated it will penetrate into the ying (nutritive) and
xue (blood) levels. The patient may experience symptoms
including confusion, delirium, loss of consciousness, macules,
and high fever. These signs and symptoms are similar to those
delineated by biomedicine regarding the more severe cases of
2009 H1N1, which include confusion, sudden dizziness, pain/
pressure on chest/abdomen, severe/persistent vomiting.30 The
wen bing school argues that warm diseases ﬁrst attack the lungs,
then frequently the stomach and intestines which accounts for
the nausea and vomiting and abdominal symptoms.11-12,14,20 In
some instances, the disease proceeds directly from the lungs
into the pericardium, accounting for the delirium, confusion
and loss of consciousness.11-12,14,20 There are several formulae
available for the latter cases and their application depends on
of Acupuncture and Chinese Medicine 27
2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
more precise diagnoses. The commonly used formulae are
Qing Ying Tang* 清营汤 (clear the nutritive level decoction),
An Gong Niu Huang Wan* 安宫牛黄丸 (calm the palace pill
with cattle gallstone), Xi Jiao Di Huang Tang* 犀角地黄丸
(rhinoceros horn and rehmannia decoction), Qing Hao Bie Jia
Tang 青蒿鳖甲汤 (sweet wormwood and soft-shelled turtle
shell decoction) and San Jia Fu Mai Tang 三甲复脉汤 (three-
shell decoction to restore the pulse). These herbal prescriptions
are calculated to restore consciousness, clear heat strongly,
open oriﬁces, extinguish wind, stop bleeding and nourish
yin.11-12,14,20,24 [*See Editor’s Comments on page 29 regarding
FU XIE 伏邪 – LINGERING PATHOGENS
When a warm disease invades a body and it is not cleared
completely, there remains some pathogenic factor. This
pathogenic factor is referred to as lingering pathogens or fu
xie.11-12,14,20,26 Liu states, ‘remnants of heat’ refers to a situation
where heat from excess has been ﬁghting with the body’s
yin.11 In the process both sides are injured and the heat thus
become less forceful due to the yin’s moderating inﬂuence.
Maciocia notes that a pathogenic factor ‘may appear to have
been expelled, and the patient appears to recover, but actually
a residual pathogenic factor has been formed’.31 The Chinese-
English Dictionary of Traditional Chinese Medicine deﬁnes
fu qi/fu xie as:
the syndrome of pathogen incubating in the body for a
long period before the onset of the disease. The affected
regions are deeper or shallower. The more deeply the
pathogen incubates, the more severe the illness will
be. The onset of the illness starts from the interior and
slowly extends to the exterior, usually with long and
After the resolution of the acute symptoms, the patient may
not be conscious of any adverse result of fu xie and be under the
impression that all is well. However, fu xie has consequences
and can manifest itself in common signs and symptoms, from
allergies to persistent intermittent low-grade fevers.31 The
chronic allergies/sensitivities may be dismissed as hay fever.
The persistent intermittent low fever may be ignored or put
down to stress. The constant shortness of breath on exertion
where none existed prior to the disease may be ignored or
regarded as a part of ageing. Fu xie, however, predisposes the
patient to exogenous pathogens causing them to fall ill more
easily. It can act as a Trojan horse and allow warm pathogens to
enter more rapidly than normal into the interior of the body
causing a more severe disease state.11-12,14,20,26,32
It is vitally important in treating warm diseases to ensure that
the pathogens are fully and completely expelled. In this, CM
differs from biomedicine. In the latter, antibiotics and antivirals
are used to kill or inactivate the bacteria and viruses. The
implication is that these dead microbes are still left in the body
and may in time be removed by the body’s system altogether
or they may not be removed at all.26 CM, however, is insistent
that pathogens must also be expelled from the body.11,26 It was
the wen bing school that ﬁrst proposed the concept of fu xie
or fu qi wen bing 伏气温病, variously translated as lingering,
lurking, residual warm pathogen disease.
Thus, in the treatment of someone who presents with ﬂu-
like symptoms, a comprehensive and in-depth history of the
patient is essential in drawing out any previous fu xie. This
suggests that post-resolution treatment strategies are essential
once the acute signs and symptoms are gone.
It can be difﬁcult to convince a patient of the need for
follow-up treatment once their presenting condition has
been rectiﬁed. The above discussion of fu xie underscores the
need to educate patients in the concepts of CM. The follow-
through for the clinician is to ensure that (1) the treatment
prescription was correct and effective in resolving the disease;
(2) the herbal prescription has been taken correctly and
consistently by the patient; (3) the patient has had ample rest,
physically, emotionally, mentally; and (4) the patient has been
eating a proper diet.20,27 If any of these four aspects has been
compromised, the physician should consider that some warm
disease pathogen may still remain. If left untreated, this can
then result in a cycle of illness followed by a short period of
recovery and then illness again, a cycle that will surely drain
the patient’s qi and damage the blood over time. Perhaps this
is what epidemiologists allude to when they ‘long puzzled over
why seasonal infectious disease outbreaks occur when they do.
Perhaps the more important question is why they do not occur
when they do not. Is the human population already relatively
resistant for 6–9 months each year?’33 Dowell, from whom the
previous observation comes, further notes that
pathogens do not physically migrate across the equator
and that nationwide epidemics do not necessarily result
from chains of person-to-person transmission. Rather,
the pathogens may be present in the population year-
round, and epidemics occur when the susceptibility
of the population increases enough to sustain them.
Perhaps the most signiﬁcant prediction is that people
are relatively resistant to disease if exposed in the off-
season and that the speciﬁc physiologic process leading
to seasonal resistance should be identiﬁable and perhaps
The trend that epidemiologists have discerned recently would
appear to ﬁt in neatly with the concept of fu xie proposed
some three hundred years ago, a concept that continues to
be developed by the wen bing school.11 It would seem that
modern epidemiological data supports the theory and clinical
of Acupuncture and Chinese Medicine
28 2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
practice of an ancient school of thought in traditional Chinese
medicine. It would also reinforce to CM physicians the vital
need to follow through the treatment of the acute stage of the
2009 H1N1 inﬂuenza, or for that matter, any disease.
A well-known herbal prescription for expelling fu xie is Xiao
Chai Hu Tang 小柴胡汤 (minor bupleurum decoction).
Herbal formulae used to treat the acute stage of 2009 H1N1
or wind warmth disease at the qi, ying and xue levels can also
be prescribed with modiﬁcations. Herbs such as Chantui 蝉
蜕 (Cicadae periostracum), Dandouchi 淡豆豉 (Sojae semen
praeparatum) Bohe 薄荷 (Menthae haplocalycis herba), Jingjie
荆芥 (Schizonepetae herba) and Niubangzi 牛蒡子 (Arctii
fructus) can be added to guide the fu xie to the exterior for
The last phase of managing someone with the 2009 H1N1
inﬂuenza, or in the language of wen bing, wind warmth, is
reinforcing the constitution of the patient. In any disease
process, qi would be used up in overcoming the pathogen. The
more severe the disease is, the more qi is consumed, the more the
damage needs to be arrested and repaired and the constitution
rebuilt. The attention to repairing damages and building up qi is
of particular need in those with prenatal qi deﬁciency. Where the
disease is not so severe, the measures enunciated in phase one,
prevention, can be applied to restore a patient’s constitution.
Obviously, tonic herbs should only be used if the physician is
satisﬁed that there is no lingering pathogen. Otherwise, the
latter can be strengthened and so embed itself even more deeply
in the body, rendering it harder to expel.
The reinforcing phase may involve an honest discussion
between the physician and the patient on changing lifestyle,
addressing harmful habits and adopting a different outlook on
health. It is also a great opportunity for educating the patient
on the various aspects of Chinese medicine to encourage a
deeper understanding. This extends to what is traditionally
called yang sheng 养生, literally cultivating life. The build-up
phase overlaps with many aspects of the prevention phase.
The epidemiological data for inﬂuenza presented above serve
as a basis for the effectiveness and historical and empirical use
of wen bing theory and treatment methods in the management
of the 2009 H1N1 inﬂuenza. This paper does not offer
‘evidence’ in the same mode as those espoused by biomedical
science. A Cochrane meta-analysis by Chen et al.36 suggests
that the application of that model of evidence to CM is
ﬁlled with difﬁculties due to the different natures of the two
medical systems. Chen et al. conclude that the ‘present existing
evidence is too weak to support or reject the use of any Chinese
Medicinal herbs for preventing or treating uncomplicated
inﬂuenza’.36 However, they recognise that the aim in CM in
treating inﬂuenza is ‘not only to cure the respiratory syndrome,
but also to treat the whole body’.36 Thus, they acknowledged
that the use of standard biomedical trials to assess CM is difﬁcult
due to the differences in herbal prescription, pharmacological
agents used and the diagnostic pattern differentiation. The
same conclusion is applicable to wen bing and its use on the
2009 H1N1 inﬂuenza. Chen et al. assert that one ‘must accept
that the overall treatment concept for TCM is different to that
used in western medicine’. 36
It can be argued that experiential evidence can be offered on
the use of wen bing theory in treating 2009 H1N1 inﬂuenza.
As discussed above, the mild form of 2009 H1N1 did not
require hospitalisation. Most patients either would have sought
assistance from their general practitioners or would have
recovered from the illness on their own, if their constitution
was strong. Others would have been treated by their CM
practitioners for inﬂuenza. In late June 2009 in New South
Wales, routine laboratory testing for the 2009 H1N1 virus
was restricted to those hospitalised with the severe form of the
illness. 37 It would have been difﬁcult to gather evidence for the
CM treatment of the mild form of 2009 H1N1 in that climate.
It is not a matter of subordinating CM to biomedicine but rather
using what is relevant from biomedicine to expand and deepen
CM theory and practice. The long history of Chinese medicine
in general and of the wen bing school speciﬁcally holds much
evidence on adapting and responding to changes in the climate,
environment and newly emerging diseases. Uncovering these
huge bases of data and information from CM and comparing
them with modern epidemiological ones can perhaps offer
another legitimate and valid way of understanding and treating
contemporary diseases. Such a methodology would also provide
another strategy for integrating biomedicine with Chinese
medicine. There is surely no need to reinvent the wheel.
The 2009 H1N1 inuenza is the rst u pandemic of the
twenty-rst century. It has caused considerable panic
and anxiety in the public and medical establishment.
The aetiology and presentation of the inuenza are
remarkably similar to those patterns enunciated by
School of traditional Chinese medicine.
On that basis, TCM practitioners can use
theory as a foundation to manage the 2009 H1N1
inuenza effectively. This paper examines the similar
manifestations of warm diseases and swine u and
offers a working framework covering their prevention
of Acupuncture and Chinese Medicine 29
2010 VOLUME 5 ISSUE 2
Wen Bing Xue and
16. CDC. H1N1 ﬂu (‘swine ﬂu’) and you [online]. 12 Jan 2010 [cited 16
Jan 2010]. Available from: http://www.cdc.gov/h1n1ﬂu/qa.htm.
17. CDC. Caring for someone sick at home: know the symptoms of ﬂu
[online]. ca 2009 [cited 16 Jan 2010]. Available from: http://www.cdc.
18. CDC. Interim recommendations for clinical use of inﬂuenza
diagnostic tests during the 2009-10 inﬂuenza season [online]. ca 2009
[cited 16 Jan 2010]. Available from: http://www.cdc.gov/h1n1ﬂu/
19. World Health Organization. Clinical management of human
infection with pandemic (H1N1) 2009: revised guidance [online].
Nov 2009 [cited 16 Jan 2010]. Available from: http://www.who.int/
20. Zhang, YF. Comprehensive methods for preventing and treating
inﬂuenza. J Chin Med 2001;65:6–10.
21. World Health Organization. Clinical features of severe cases of
pandemic inﬂuenza: pandemic (H1N1) 2009 brieﬁng note 13 [online].
16 Oct 2009 [cited 16 Jan 2010]. Available from: http://www.who.
22. Wang XD, Guo HY, Chen SP. Life cultivation and rehabilitation
of traditional Chinese medicine. Shanghai: Publishing House of
Shanghai University of Traditional Chinese Medicine; 2003.
23. Yu HC, Han FR. Golden needle Wang Le-Ting: a 20th-century
master’s approach to acupuncture. Shuai XZ, translator. Boulder, CO:
Blue Poppy Press; 1997.
24. Scheid V, Ellis A, Bensky D, Barolet R. Chinese herbal medicine:
formulas and strategies. 2nd ed. Seattle: Eastland Press; 2009.
25. CDC. Vaccine against 2009 H1N1 inﬂuenza virus [online]. 22
Dec 2009 [cited 16 Jan 2010]. Available from: http://www.cdc.gov/
26. Maciocia G. Myalgic encephalomyelitis: post-viral syndrome, chronic
Epstein-Barr disease. J Chin Med 1991;35:5–19.
27. Blackwell R. Dormant heat. J Chin Med 1989;31:13–16.
28. Temple R. The genius of China: 3,000 years of science, discovery and
invention. Rochester, VT: Inner Traditions; 2007.
29. Jiao SD. Ten lectures on the use of formulas from the personal
experience of Jiao Shu-De. Damone B, translator. Taos, NM:
Paradigm Publications; 2005.
30. CDC. What to do if you get sick: 2009 H1N1 and seasonal ﬂu
[online]. 10 Nov 2009 [cited 18 Jan 2010]. Available from: http://
31. Maciocia G. Diagnosis in Chinese medicine: a comprehensive guide.
Edinburgh: Elsevier; 2004.
32. Chinese-English Dictionary of Traditional Chinese Medicine. 汉
英双解中国大辞典. 原一样 主编. 北京：人民卫生. Beijing:
People’s Press; 1997.
33. Dowell SF. Seasonal variation in host susceptibility and cycles of
certain infectious diseases. Emerg Infect Dis 2001;7(3):369–74.
34. Bensky D, Clavey S, Stoger E. Chinese herbal medicine: materia
medica. 3rd ed. Seattle: Eastland Press; 2004.
35. Chen JK, Chen TT. Chinese medical herbology and pharmacology.
City of Industry, CA: Art of Medicine Press; 2004.
36. Chen XY, Wu T, Liu GJ, Wang Q, Zheng J, Wei J, et al. Chinese
medical herbs for inﬂuenza. Cochrane Database Syst Rev 2007(4).
37. Chant K. H1N1 inﬂuenza 09 response [memo]. Sydney: NSW
Department of Health; 26 June 2009.
Thanks to Yifan Yang, principal of the Sydney Institute of Traditional
Chinese Medicine, for arousing my interest in the subject.
* These formulas (pages 26 and 27) contain muxiang, xijiao
shexiang and niuhuang, substances that are listed in Appendices
I, II or III of the Convention on the International Trade in
Endangered Species of Wild Fauna and Flora (CITES).
International trade in such substances is banned (Appendix
I) or requires relevant permits from the CITES authorities in
the exporting and importing countries (Appendices II and III).
The use of these traditional names are for academic reference
only and effective substitutes are available. The Australian
Acupuncture and Chinese Medicine Association Ltd and the
AJACM oppose the illegal use of endangered species of wild
ﬂora and fauna. For further information, please refer to http://
www.cites.org/ and http://www.acupuncture.org.au/escs.cfm.
1. World Health Organization. What is pandemic (H1N1) 2009?
[online]. ca Nov 2009 [cited 16 Jan 2010]. Available from: http://
2. CNN. Four 20th-century ﬂu outbreaks [serial online]. 29 Apr 2009
[cited 30 Oct 2009]. Available from: http://edition.cnn.com/2009/
3. Kilbourne ED. Inﬂuenza pandemics of the 20th century. Emerg Infect
4. Palese P. Inﬂuenza: old and new threats. Nat Med 2004;10(12):S82–6.
5. Potter CW. A history of inﬂuenza. J Appl Microbiol 2001;91:572–9.
6. World Health Organization. Weekly epidemiological report. No. 49.
4 Dec 2009; 84:505–16.
7. BBC. US declares swine ﬂu emergency [online]. 24 Oct 2009 [cited 4
Nov 2009]. Available from: http://news.bbc.co.uk/2/hi/8324070.stm.
8. CNN. Obama declares H1N1 emergency [online]. 26 Oct 2009
[cited 4 Nov 2009]. Available from: http://edition.cnn.com/2009/
9. Zengerle P. Obama declares swine ﬂu a national emergency. Reuters
[serial online]. 24 Oct 2009 [cited 26 Oct 2009]. Available from:
10. Cheng KF, Leung PC. What happened in China during the 1918
inﬂuenza pandemic? Int J Infect Dis 2007;11:360–4.
11. Liu GH. Warm pathogen diseases: a clinical guide. Rev ed. Seattle:
Eastland Press; 2005.
12. Wen JM, Seifert G, translators. Warm disease theory: wen bing xue.
Brookline, MA: Paradigm Publications; 2000.
13. Mitchell C, Feng Y, Wiseman N. Shang han lun: on cold damage.
Brookline, MA: Paradigm Publications; 1999.
14. Qin BW. Warm disease made simple. Balack J, translator. Lantern
15. Dent N. Clearing deﬁcient heat: a look at qing hao bei jia tang.