Tang Nai-guang on Hidden Warm Evils & Miscellaneous Diseases

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Almost 10 years ago, beginning with my book, Nine Ounces:A Nine Part Program for the Prevention of AIDS in HIV Positive Persons (Blue Poppy Press, 1992), I suggested that the Chinese medical concept of hidden or deep-lying warm evils (fu wen xie) deserves more consideration than this idea typically receives in contemporary Chinese medicine. According to Wiseman and Feng, something that is deep-lying in Chinese medicine is "present in the inner body, [but] latent, or barely perceptible."[1] Hidden or deep-lying evils describe types of evil qi which enter the body at one time, but do not manifest until some time later when provoked by other factors. In addition, hidden evils are primarily associated with warm diseases. According to Jiang Wen-zhai in his Yi Lue Shi San Pian (Thirteen Sheet Summary of Medicine), "Hidden evils... mostly make heat conditions." The locus classicus of the concept of hidden evils is the Nei Jing (Inner Classic) where it says, "[If in] winter [one] is damaged by cold, in spring [this] must [result in] warm disease." However, most of the premodern writings on hidden evils, such as the Fu Xie Xin Shu (Hidden Evils New Book), stem from the Qing dynasty and are considered part of the wen bing xue or warm disease literature. Recently, a number of Western practitioners of Chinese medicine, such as Z’ev Rosenberg and Heiko Lade, have speculated on the use of the concept of hidden warm evils in terms of viral diseases and their sequelae. Although I am not as enthusiastic about the clinical utility of this concept as I once was, I would like to share the some of the opinions of Tang Nai-guang as they recently appeared in an article titled, "Hidden Qi Warm Diseases & Miscellaneous Diseases."[2]

First of all, Tang Nai-guang feels that this concept may be of use in the treatment of certain "miscellaneous diseases." Miscellaneous diseases (za bing) refer to the indeterminate list of traditional Chinese diseases that comprise the Chinese medical specialty of nei ke or internal medicine. Some of the specific conditions that Tang suggests may often be associated with hidden evils include cholecystitis, laryngitis, gynecological inflammatory diseases, prostatitis, and appendicitis. Tang postulates that, due to lowered immunity, pathological germs or viruses may invade the body and lie hidden or latent until they are provoked and activated by some later occurrence, such as psychological injury, poisoning, surgery, or parturition. These events may further weaken the immune system, thus allowing the hidden evils to become overtly active. In such cases, there are no initial defensive aspect symptoms. In conditions such as sudden onset encephalitis and epidemic hemorrhagic fever, these begin directly as interior heat patterns. Thus Tang thinks that hidden warm evils may play a role in a number serious, sudden onset, acute conditions. However, Tang also thinks fu wen xie may also play a role in other, not so serious conditions, such a herpes zoster. As Tang points out, most herpes zoster patients present few defensive aspect symptoms; whereas, interior heat symptoms are typically marked. Another condition Tang thinks may be associated with hidden warm evils is viral pneumonia, especially the heavy type which initially begins as a qi and yin vacuity pattern.

Secondly, Tang Nai-guang thinks that hidden warm evils are often associated with diseases which Chinese medicine regards as difficult to treat. Here he refers to retained evils as a potential source or species of hidden warm evils. Retained evils (yu xie) refer to disease evils which remain after treatment which was not forceful enough. As Tang says, "If treatment is not forceful [enough], evil qi may fall internally."[3] Explaining this process in greater detail, Tang quotes an unidentified ancient:

[If] treatment has already [been given in order] to cure but [this] was no able to completely eliminate the disease root, these evils may lie deeply [or hide] internally and afterwards break out again. These are also called hidden evils.[4]

These retained evils may become hidden for an indeterminate length of time and then, when other factors comes together, they may result in the onset of some other disease. As examples of this process, Tang says that glomerulonephritis may be associated with retained evils from incompletely treated tonsillitis, scarletina, or erysipelas, and he thinks that most cases of viral myocarditis are due to various types of viral upper respiratory tract infections that have not been effectively treated. Other diseases Tang thinks may be associated with hidden or retained evils include a number of autoimmune disorders, such as scleroderma, systemic lupus erythmatosus (SLE), and rheumatoid arthritis RA), which have periods of remission and recurrence. All these are considered by Chinese medicine as difficult to treat diseases.

Unfortunately, Tang does not give any examples of how such hidden evil theory might be applied to the clinical treatment of the diseases he suggests may be associated with hidden evils. Although he thinks that an investigation of this theory may lead to improved Chinese medical treatment of the difficult to treat diseases he mentions, he fails to present a single case history showing this theory’s applicability in real-life practice or to even suggest a hypothetical treatment strategy for such hidden warm evils.

Since hidden warm evils often lie deeply in the blood aspect, there are at least two treatment strategies which are logical possibilities. These are cooling and clearing the blood and upbearing and out-thrusting evils, as in the treatment of measles. Of these two strategies, I think the first one holds the greatest potential for benefit with the least potential for adverse reactions. This is because, the medicinals used for out-thrusting evils are acrid, windy natured medicinals which can damage yin, and many patients with the kinds of conditions Tang mentions above already manifest yin vacuity patterns, or at least mixed yin vacuity patterns.[5]

Cooling and clearing the blood means to clear heat from the blood using such medicinals as Radix Lithospermi Seu Arnebiae (Zi Cao), Radix Scrophulariae Ningpoensis (Xuan Shen), Cortex Radicis Moutan (Dan Pi), Cortex Radicis Lycii Chinensis (Di Gu Pi), Radix Cynanchi Atrati (Bai Wei), and Radix Stellariae Dichotomae (Yin Chai Hu). Interestingly, Hong Qing-xiang, writing in "A Clinical Survey of the Treatment of 12 Cases of Sjögren’s Syndrome," notes that, although this autoimmune condition mostly manifests as a yin vacuity pattern, "taking clearing heat and resolving toxins as the root and nourishing yin and moistening dryness as the tip [or branch] gets better results in clinical practice" than just nourishing yin and moistening dryness.[6] In fact, Hong says that simply nourishing yin and moistening dryness gets only small results in this condition. In the case of Sjögren’s syndrome, overt symptoms of heat toxins are not usually present, but Hong and his teacher, Dr. Fu, seem to think such heat toxins, or at least heat evils, are present in most, if not all, cases of this particular autoimmune disorder. If hidden warm evils do, in fact, play a role in this and other autoimmune diseases, then this approach might be of benefit in those other conditions. Although heat-clearing, blood-cooling and heat-clearing, toxin-resolving medicinals are contraindicated in spleen-stomach vacuity conditions and most patients with autoimmune and other difficult to treat disease do present spleen vacuity symptoms, when these medicinals are combined in formulas which contain ingredients that supplement the spleen and harmonize the stomach, it is my experience that they do not typically provoke side effects. Therefore, I believe their cautious addition to standard formulas for these conditions warrants further investigation.

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