Wind-injury is also called Wind-exposure; it is sometimes also known as the common cold. It is an illness with the main symptoms of headache, nasal mucosal congestion and discharge, sneezing, cold-aversion, fever, and a floating pulse. In general, it lasts 3-7 days. Its course seldom varies.
In more severe cases, especially if it spreads widely within a fairly short period of time with similar symptoms in different patients, it is called influenza.
Etiology and Pathology
Although the main cause of Wind-injury is the Wind evil, its development is closely related to the strength or weakness of the body’s genuine Qi. The illness is mainly located in the lung-Defensive Level. Mostly it results from strong exogenous Wind, but if the patient is exposed to Wind while the body is deficient the result may be an illness of root-deficiency and appearance-strength.
Exogenous Wind is the chief of the six climatic pathogenic evils. It is often accompanied by the various seasonal evils when it causes illness, and can even induce epidemic influenza. Clinically, the most common types are Wind-Cold and Wind-Heat. In addition, the Summer Heat, Dampness and Dryness evils can also join Wind to cause illnesses.
Whether or not Wind attacks depends intimately on the strength or weakness of the body’s resistance. Weakness of the body and deficiency of genuine Qi lead to weakening of resistance. An improper lifestyle or excessive fatigue can cause laxity of the interstitial spaces and dissipation of Defensive Qi. In such circumstances an exogenous evil can attack the skin, hair, the lung or the Defensive Level and result in Wind injury. Furthermore, differences in the body’s constitution are associated with different susceptibilities. For example, Wind-Cold can easily exploit Yang deficiency; Wind-Heat or Dryness-Heat can easily exploit Yin deficiency; and exogenous Dampness can easily complicate a body with much Phlegm and endogenous Dampness.
The pathway of Wind attack is the lung system and the Defensive exterior, and the location of the illness is generally also limited to the lung-Defensive Level.
If Defensive Yang is constrained by any factor, there may be disharmony between Nutritive Qi and Defensive Qi. The struggle between evil Qi and genuine Qi can generate such symptoms of the Defensive Level or the exterior as cold-aversion and fever. When an exogenous evil attacks the lung, the air passage becomes blocked. lung-Qi cannot rise and clarify properly, giving rise to cough and nasal mucosal congestion – symptoms of the lung system. Influenza, because it is a more serious attack by the exogenous evil, has more severe symptoms, and can manifest high fever and delirium.
If the patient’s constitution is vigorous the exogenous evil is confined to the lung-Defensive Level and the illness is mild, with mainly symptoms of the exterior. But if the patient is elderly or has a weak constitution then resistance is weak so that the exogenous evil may transmit from the exterior to the interior. This aggravates the illness and may lead to complications.
In general, Wind-injury occurs most frequently in winter and spring and usually begins abruptly. It lasts 3-7 days. The main symptoms are those of the lung and the Defensive Level. Those of the exterior-Defensive Level are cold-aversion, fever, headache, and aching pain of the limbs or body. Those of the lung system are sneezing, nasal mucosal congestion with clear discharge, throat irritation and cough.
Wind-injury is usually localized to the lung-Defensive Level. It rarely extends or transforms. But if it recurs repeatedly lung-Qi may become deficient, and this state may give rise to such symptoms as shortness of breath, coldness of body, and sweating. If the body’s constitution is weak prior to Wind injury, the illness is one of root-deficiency and appearance-strength.
Influenza, on the other hand, tends to be epidemic and is more severe.
Key Points of Analysis
Wind-Cold and Wind-Heat
Cold and Heat have very different nature and require very different treatment. It is therefore important first to determine whether the illness is one of Wind-Cold or of Wind-Heat. In general, injury by Wind-Cold is characterized by stronger cold-aversion than fever, headache and body aches, and nasal mucosal congestion with clear discharge. Injury by Wind-Heat is characterized by fever stronger than cold-aversion, headache, thirst, nasal mucosal congestion with thick yellow discharge, and sore or swollen throat. Among these symptoms, whether the throat is sore and swollen or not is often the key for differentiating Wind-Heat from Wind-Cold.
Sometimes, in the initial stages an illness may be one of injury by Wind-Cold, but a few days later sore throat may develop and the nasal discharge changes from clear to yellow and thick. This reflects gelling of the Cold evil and its transformation into Heat. At this stage the treatment is that for Wind-Heat.
Accompanying Pathogenic Evils
In attacking the body Wind is frequently accompanied by one or more of the other exogenous pathogenic evils.
Dampness often accompanies Wind during the rainy season of late spring and early summer (“plum-rain season”). Wind-Dampness injury is characterized by low-grade fever, headache as though being squeezed, bone and joint pains, chest tightness and a bland or sweet taste in the mouth.
Heat accompanies Wind mostly during summer. Wind-Heat injury is characterized by fever with sweating, agitation, thirst, decreased and dark urine and a yellow and greasy tongue coating.
Dryness accompanies Wind mostly during autumn. Dryness-Wind injury is characterized by fever, headache, a dry nose and throat, cough with no or slight sputum, thirst and a red tongue.
Indigestion from dietary excesses occurs mostly following festivals or celebrations. Indigestion with Wind injury is characterized by a feverish body, chest and epigastric distention, anorexia with nausea, diarrhea and a greasy tongue coating.
In clinical practice, it is important to determine what pathogenic evils have accompanied Wind. Building on the foundation of releasing the exterior and unblocking the lung the physician applies treatment to dissipate Dampness, expel Heat, moisten Dryness and remove stagnation; only by doing so can the physician obtain excellent response.
Strength and Deficiency
Wind-injury is mostly an illness of strength of pathogenic evils, but not invariably so. In differential diagnosis the physician must first determine whether the illness is due to strength in the exterior or underlying deficiency in the exterior.
In general, fever with sweating and wind-aversion are symptoms of deficiency in the exterior, whereas fever without sweating, cold-aversion and body aches are symptoms of strength in the exterior.
In an illness of deficiency in the exterior the appropriate treatment is to disperse Wind to release the exterior but not to over-use acrid-release. In an illness of strength in the exterior the appropriate treatment is to induce sweating to release the exterior, as fever subsides upon sweating. If a deficient body is attacked by an exogenous evil, there may be repeated episodes of illness. The proper approach to treatment must be principally to support the genuine in order to dispel the evils. Thus, in addition to applying a method of exterior-release in accordance with the specific exogenous evil the physician must always attend to the support of genuine Qi.
Main Symptoms. Nasal mucosal congestion or nasal itch, sneezing, and clear discharge; itchy throat; and cough with thin sputum. In severe cases, there may be fever without sweating, cold-intolerance, headache, aching pain in the body and limbs. The tongue coating is white. When there is fever the pulse is floating and rapid; when there is cold-intolerance it is floating and tight. If Dampness has joined the attack, there may be low-grade fever, headache as though being squeezed, and aching pain and heaviness in the limbs; alternately, there are exterior Wind-Cold symptoms and interior symptoms of chest tightness, nausea, anorexia, a bland taste and a greasy tongue coating.
Therapeutic Principle. Acrid-warm release of the exterior to clear the lung and dispel Cold.
Treatment. Cong Chi Tang (Green Onion and Soybean Decoction) and Jing Fang Bai Du San (Schizonepeta-Saposhnikovia Detoxifying Powder) are commonly used.
The composition of Cong Chi Tang is as follows: congbai (Allium fistolosum) three pieces and dandouchi (Glycine max) 6 g. This formula is especially suitable for mild cases.
The composition of Jing Fang Bai Du San is as follows: Qianghuo (Notopterygium) 6g, duhuo (Angelica pubescens) 10 g, chaihu (Bupleurum) 10 g, Qianhu (Peucedanum) 10 g, zhiqiao (Poncirus trifoliata, Citrus aurantium) 10 g, ful-ing (Poria) 10 g, fangfeng (Saposhnikovia) 10g,jingjie (Schizonepeta) 10g,jiegeng (Platycodon) 6g, chuanxiong (Ligusticum) 6 g and gancao (Glycyrrhiza) 5g. If nasal mucosal congestion is very severe, cangerzi (Xanthium sibiricum) may be added.
When a patient is exposed to cold and rain, Dampness may attack along with Wind-Cold. This may be treated with Qianghuo Sheng Shi Tang (Notoptery-gium Dampness-Defeating Decoction), with the following composition: Qianghuo (Notopterygium) 6 g, duhuo (Angelica pubescens) 9 g, gaoben (Ligusticum sinense) 2g, fangfeng (Saposhnikovia) 6g, fried gancao (Glycyrrhiza) 3g, chuanxiong (Ligusticum) 5 g and manjingzi (Vitex trifolia) 10 g. If Dampness is more severe than Wind-Cold, add cangzhu (Atractylodes), houpo (Magnolia), banxia (Pinellia) and chenpi (Citrus tangerina) to promote spleen functions and to dry Dampness.
Main Symptoms. Fever with mild aversion to wind and cold, sometimes with sweating; headache; nasal mucosal congestion with turbid discharge; and cough productive of thick yellow sputum; dry mouth with thirst; and inflamed and painful throat. The tongue coating is thin and yellow, and the pulse slippery and rapid.
If there is exposure to Summer Heat as well, there may be fever not relieved by sweating, agitation, thirst dark urine and yellow and greasy tongue coating.
Therapeutic Principle. Acrid-cool release of the exterior to dispel Wind and cool Heat.
Treatment. Yin Qiao San (Lonicera and Forsythia Powder) and Sang Ju Yin (Mulberry and Chrysanthemum Drink) are both commonly used. Both are acrid-cooling formulas. Sang Ju Yin is less potent than Yin Qiao San, and is more suitable for treating mild cases.
If Wind-Heat is complicated by much exposure to Summer Heat, there is often Dampness and more Heat. In such cases, in addition to the usual symptoms of Wind-Heat there may be fever not relieved by sweating, agitation, thirst with desire to drink, decreased and dark urine, a yellow and greasy tongue coating and a soft and rapid pulse. This may be treated with Xin Jia Xiangru Yin (Newly Supplemented Elscholtzia Decoction) together with huoxiang (Agastache), peilan (Eupatorium), yiyiren (Coix) and Yi San (Six-One Powder). The composition of Xin Jia Xiangru Yin is as follows: xiangru (Elsholtzia spendens) 6 g (late decocted), jinyinhua (Lonicera) 9 g, biandou blossom (Dolichos lablab) 9 g, houpo (Magnolia) 6g, and lianqiao (Forsythia) 12 g. The composition of Yi San is as follows: huashi (talcum) six parts and gancao (Glycyrrhiza) one part. This combined prescription can release the exterior, cool Heat and dissipate Summer Heat and promote the excretion of Dampness in the urine.
Exterior-Cold and Interior-Heat
Main Symptoms. Fever and chills without sweating; headache; aching pain in body and limbs; nasal mucosal congestion; sore throat; and cough with viscous or mixed yellow and white sputum. The tongue is red along the sides and in the tip, the coating is thin and white or thin and yellow, and the pulse is floating and rapid.
Therapeutic Principle. Dispel Wind, clear the lung, expel Cold and cool Heat.
Treatment. Ma Xing Shi Gan Tang (Ephedra, Almond, Gypsum and Licorice Decoction) with added Qianghuo (Notopterygium) and yuxingcao (Houttuynia).
If exterior Cold is more severe than interior Heat, with cold-intolerance and joint pain, add zisu leaf (Perilla) and guizhi (Cinnamomum) to dispel Wind and Cold. If interior Heat is more severe than exterior Cold, with inflamed and painful throat, add banlangen (Isatis) and huangqin (Scutellaria) to cool Heat and remove poison.
In the case of constipation, persistent fever, greasy tongue coating and slippery but replete pulse, it is an illness of strength in both interior and exterior.
Use Fangfeng Tong Sheng San (Miraculous Saposhnikovia Powder) to release both interior and exterior. It has the following composition: fangfeng (Saposhnikovia) 15 g, chuanxiong (Ligusticum) 6g, danggui (Angelica) 6g, baishaoyao (Paeonia) 15 g, dahuang (Rheum) 10 g, bohe (Mentha) 10 g, mahuang (Ephedra) 9g, lianqiao (Forsythia) 15 g, mangxiao (Mirabilite) 15 g, shigao (gypsum) 30 g, huangqin (Scutellaria) 30 g, jiegeng (Platycodon) 30 g, huashi (talc) 90 g, gancao (Glycyrrhiza) 6 g, jingjie (Schizonepeta) 6 g, baizhu (Atractylodes) 9 g and zhizi (Gardenia) 9g.
Wind-Injury with Qi Deficiency Condition
Main Symptoms. Fever with cold-aversion, or fever that is not high but accompanied by coldness, spontaneous sweating, headache, nasal mucosal congestion, cough with white sputum, low timorous voice, shortness of breath, lassitude, a white tongue coating and a floating and forceless pulse.
Therapeutic Principle. Augment Qi, release the exterior, and harmonize Nutritive and Defensive Qi.
Treatment. Shen Su Yin (Ginseng and Perilla Drink) and Huangqi Guizhi Wu Wu Tang (Astragalus-Cinnamon Five-Ingredient Decoction) are commonly used.
The composition of Shen Su Yin is as follows: muxiang (Aucklandia) 6g, zisu leaf (Perilla) 10 g, washed gegen (Pueraria) 15 g, processed banxia (Pinellia) 10 g, Qianhu without sprouts (Peucedanum) 9 g, renshen (Panax) 9 g, peeled fuling (Poria cocos) 12 g, zhiqiao (Poncirus trifoliata, Citrus aurantium) 15 g, jiegeng without reeds (Platycodon) 15 g, fried gancao (Glycyrrhiza) 10 g, and juhong (Citrus tangerina, orange scraping from peel) 15 g. The banxia is washed in hot water for several times, roasted with ginger, then parched before use.
The composition of Huangqi Guizhi Wu Wu Tang is as follows: huangqi (Astragalus) 9 g, baishaoyao (Paeonia) 9 g, guizhi (Cinnamomum) 9 g, shengjiang (Zingiber) 9 g, and dazao (Ziziphus) five pieces.
Patients who have Qi deficiency, with spontaneous sweating and cold body, are highly susceptible to Wind attack. They may take Yu Ping Feng San often to augment Qi, strengthen the exterior and enhance resistance against exogenous evils. Doing so may prevent recurrent attacks by Wind.
Wind-Injury with Yang Deficiency Condition
Main Symptoms. Intermittent cold-aversion or in severe cases shaking chills; sometimes mild fever; no sweating or spontaneous sweating, the sweating being accompanied by cold-intolerance; headache; coldness and pain in the joints; pallid complexion; feeble voice; and cold limbs. The tongue is pale and plump with white coating, and the pulse is deep, threadlike and forceless.
Therapeutic Principle. Warm Yang and release the exterior.
Treatment. Guizhi Jia Fuzi Tang (Cinnamon Plus Aconite Decoction). Its composition is as follows: guizhi (Cinnamomum) 9 g, baishaoyao (Paeonia) 9 g, gancao (Glycyrrhiza) 6 g, shengjiang (Zingiber) 9 g, dazao (Ziziphus) four pieces, and prepared fuzi (Aconitum) 3 g.
If there are diarrhea and vague abdominal pain as well, add baked ganjiang (Zingiber) and rougui (Cinnamomum) to warm Yang in the middle-jiao and stop diarrhea.
Wind-Injury with Blood Insufficiency Condition
Main Symptoms. Headache, fever, mild cold-aversion with no or little sweating; lusterless complexion; pale lips; pale fingernails; palpitations of the heart; and dizziness. The tongue is pale, with white coating, and the pulse is threadlike, floating and forceless, or hesitant and intermittent.
Therapeutic Principle. Nourish blood and release the exterior.
Treatment. Congbai Qi Wei Yin (Green Onion Seven-Ingredient Drink) with modifications. The composition is as follows: congbai (Allium fistolosum) 9 g, cut gegen (Pueraria) 9 g, freshly prepared dandouchi (Glycine max) 6 g, shengjiang (Zingiber) 6g, fresh maimendong (Ophiopogon) 9g, and gandihuang (Rehmannia) 16 g.
If cold-intolerance is severe, huangqi (Astragalus), fangfeng (Saposhnikovia) and jingjie (Schizonepeta) may be added.
If fever is high, add jinyinhua (Lonicera) and lianqiao (Forsythia).
If blood circulation is impaired, with obstruction of vessels and a hesitant and intermittent pulse, add guizhi (Cinnamomum), honghua (Carthamus) and danshen (Salvia) to stimulate Yang, mobilize blood and relieve obstruction.
Wind-Injury with Yin Deficiency Condition
Main Symptoms. Fever with mild aversion to wind or cold; little or no sweat, or night sweats; headache; agitation; dry mouth and throat; hotness in the palms and soles; and dry cough with scant sputum, or blood-streaked sputum. The tongue is red, and the pulse is threadlike and rapid.
Therapeutic Principle. Nourish Yin and release the exterior.
Treament. Jia Jian Weirui Tang (Modified Polygonatum Decoction). Its composition is as follows: raw yuzhu 9 g, raw congbai (Allium fistolosum) 9 g, jiegeng (Platycodon) 5 g, baiwei (Cynanchum atratum) 3 g, dandouchi (Glycine max) 9 g, bohe (Mentha) 5 g, fried gancao (Glycyrrhiza) 5 g, and dazao (Ziziphus) two pieces. (Weirui is an alternate name for yuzhu, Polygonatum odoratum.)
If agitation and thirst are severe, add huanglian (Coptis), zhuye (Phyllostachys nigra) and tianhuafen (Trichosanthes) to cool Heat, generate fluids and tranquilize.
For cough with sputum that is difficult to expectorate and dry throat add ni-ubangzi (Arctium), shegan (Belamcanda) and gualou peel (Trichosanthes) to soothe the throat and dissolve the sputum.
For cough with chest pain and blood-streaked sputum, add fresh baimaogen (Imperata), raw puhuang (Typha angustifolia) and oujie (Nelumbo nucifera, nodes) to clear the lung, cool blood and remove blood stasis.
For Wind-Cold injury select principally the acupoints on the Lung Meridian of Hand-Taiyin, the Large Intestine Meridian of Hand-Yangming and the Bladder Meridian of Foot-Taiyang, such as Lieque (LU-7), Fengmen (BL-12), Fengchi (GB-20) and Hegu (LI-4). Use filiform needles with the reducing method. For patients with a weak constitution, use the mild reinforcing and reducing method; moxibustion may be applied in addition.
For Wind-Heat injury select acupoints on the Small Intestine Meridian of Hand-Taiyang, the Large Intestine Meridian of Hand-Yangming and the Sanjiao Meridian of Hand-Shaoyang, such as Dazhui (GV-4), Quchi (LI-11), Hegu (LI-4), Yuji (LU-10) and Waiguan (SJ-5). Use filiform needles by shallow insertion and the reducing method.
The patient was a 29-year old male. He became ill with abrupt onset the day before consultation. He had cold-aversion, fever without sweat, headache, joint pains, cough with itchy throat and white sputum, and a dry mouth but no desire to drink.
His tongue coating was white and smooth, and his pulse floating, tight and rapid. His temperature was 37.9°C (100.2°F), and pulse rate 92 beats per minute. His white blood cell count was 7,200, with 78% neutrophils and 22% lymphocytes. X-ray and fluoroscopic studies of the chest were normal.
Diagnosis. Wind-Cold joined by Dampness, all lodged in the exterior-Defensive Level and causing impaired flow of lung-Qi.
Therapeutic Principle. Acrid-warm release of the exterior.
Treatment and Course. Modified Jing Fang Bai Du San (Schizonepeta-Saposhnikovia Detoxifying Powder). The modified composition is as follows: jingjie (Schizonepeta) 5g, fangfeng (Saposhnikovia) 6g, Qianghuo (Notoptery-gium) 5 g, duhuo (Angelica pubescens) 5 g, bohe (Mentha) 3 g, xingren (Prunus armeniaca) 10 g, Qianhu (Peucedanum) 6 g, jiegeng (Platycodon) 5g, stirfried zhiqiao (Poncirus trifoliata, Citrus aurantium) 5 g, prepared banxia (Pinellia) 6 g, chenpi (Citrus tangerina) 6 g, shengjiang (Zingiber) three pieces, and congbai (Allium fistolosum) three pieces.
After one dose (a package of herbs), the patient sweated and the cold-aversion and fever subsided. The headache and body aches improved, and the pulse calmed. Only cough remained. He was further treated by the method of unblocking the lung and dissolving sputum. This was accomplished by further modifying Jing Fang Bai Du San – removing jingjie, fangfeng, Qianghuo, duhuo and bohe and adding zisu root (Perilla) 10 g, beimu (Fritillaria) 10 g and gancao (Glycyrrhiza) 3 g. After two successive doses the patient recovered completely and left the hospital.