The warm disease school (wenbing xuepai, 溫病學派) is a body of Chinese medical writing on acute fevers and epidemics that formed between the 16th and 19th centuries in Jiangnan, around Suzhou, and set itself against the older doctrine of cold damage. Volker Scheid, in a 2018 study of the physician Ye Tianshi, describes it as a new way of thinking about febrile and epidemic disease that emerged in Jiangnan and was widely viewed as tied to southern climates and constitutions. Its staging methods, Ye Tianshi's four levels and Wu Jutong's three burners, are defined on The six stages and the four levels.

What is warm disease?

Warm disease (wenbing, 溫病) is a Chinese disease category for acute illnesses with fever. Marta Hanson, in Speaking of Epidemics in Chinese Medicine (Routledge 2011), calls it a nosology that bioscience does not recognise and traces it over two thousand years. In her account warm diseases were associated with the geographical south by at least the 12th century, and returned to prominence in the mid-17th century when the late Ming epidemics pushed at least one physician to re-examine conventional medicine. From the second half of the 17th century through the 19th, warm diseases and febrile epidemics (wenyi, 瘟疫) became the centre of a new discourse on epidemics and of a distinct current of medical learning, which Hanson identifies as the foundation of 20th-century Traditional Chinese Medicine's disease categories.

Jean-Claude Dubois, in the first part of a 2020 series on epidemic disease in Chinese medicine, separates two characters read wen: 瘟, written with the sickness radical, means epidemic, and 溫, written with the water radical, means warmth and names warm disease.

Wu Youxing's Treatise on Pestilence

Wu Youxing (1582 to 1652), also known as Wu Youke, published the Wenyi lun, translated by Dubois as the Treatise on Pestilence and by Hanson as the Treatise on Febrile Epidemics, in 1642. In the second part of his series Dubois translates its opening claim: epidemic fevers do not come from wind, cold, summer heat or damp, but from a different qi found in nature. Wu called it pestilential qi (liqi) or impure qi (zaqi), which Hanson renders as heterogeneous qi. Earlier authors, Dubois writes, had tied epidemics to the seasons and the six atmospheric influences.

Dubois lists the properties Wu gave the impure qi:

  • it has no form, smell or sound, so it cannot be perceived, yet it is material;
  • there are many kinds, and each kind produces its own disease, which is why many households fall ill with the same symptoms at once;
  • each kind settles in particular organs and channels;
  • each kind affects particular species, so that when cattle fall ill sheep do not, and when chickens fall ill ducks do not;
  • it enters through the mouth and nose, and the slightest contact makes young and old, strong and weak alike ill;
  • scattered cases in a quiet year are the same impure qi at a lower load.

Wu hoped for a single remedy for each disease, which would end the need to balance the ingredients of a formula. Dubois reads the impure qi as a foresight of microorganisms. Hanson's book sets out to replace that kind of narrative, of progress and linear development, with accounts of geographic, intellectual and cultural diversity, and Scheid cites her term "epidemiological crisis" for the doubt the late Ming epidemics raised about whether existing doctrine was adequate.

How did warm disease differ from cold damage?

Cold damage follows the Shanghan lun of Zhang Zhongjing, which The classical texts places among the classics. Dubois describes an earlier break by Liu Wansu (about 1120 to 1200), one of the four leading physicians of the Jin and Yuan, who held that any of the six atmospheric influences could cause an epidemic only once it had transformed into fire, so that only cooling remedies applied. Wu then moved the cause from the weather to a specific pestilential qi, and Dai Tianzhang, around 1722, set out the diagnostic signs that separate an epidemic disease from a cold attack. Causes of disease describes the six external influences the two schools argued over.

The disagreement was also about place. Hanson's chapters contrast northern purgatives with southern restoratives in Ming medicine, and a 1998 article she drew on for the book is titled "The Nineteenth-Century Invention of a Southern Wenbing Tradition". Scheid reports that Ye Tianshi is remembered both as a founder of the warm disease current and as a leading figure of a Suzhou style of practice that preferred mild medicinals in low doses, and that in the Republican period modernising physicians criticised his innovations and emphasised cold damage therapeutics instead.

Ye Tianshi, Wu Jutong and Wang Mengying

Scheid writes that Ye Tianshi, who died in 1746, studied with seventeen masters, that several physicians who shaped his thinking, Wu Youxing among them, worked near Suzhou, and that his four levels grew out of a differentiation by qi and blood that he also used in internal medicine. Scheid describes Wu Jutong's Wenbing tiaobian of 1798, the Systematic Differentiation of Warm Diseases, as an attempt to systematise Ye's innovations; Dubois credits it with the three burners.

In Dubois's account Wang Mengying (1808 to 1866) combined the two schools: his Wenre jingwei takes Zhang Zhongjing's theory as its warp and Ye Tianshi's teaching as its weft, and in 1838 he wrote a treatise on cholera that attributes the disease to a particular foul poison.

How was Chinese medicine used against SARS?

Hanson, in a 2008 Lancet essay, reports that during the 2003 SARS epidemic the Chinese government recommended prevention formulas in newspapers, encouraged doctors of Chinese medicine to work alongside biomedical colleagues, and praised the integrated treatment given at the Guangdong Hospital of Traditional Chinese Medicine, and that physicians treated over 50% of SARS patients with integrated medicine. Her book closes on SARS, which she describes as a southern disease pattern, and argues that the old discourse on disease and geography could still be seen in Chinese medicine's response to it.

Two systematic reviews pooled the trials of herbs used for SARS. Liu J and colleagues, in 2004, included 8 randomised trials with 488 patients, all comparing herbs added to conventional treatment with conventional treatment alone. They reported lower mortality with the combination (relative risk 0.32) but called the evidence insufficient because the trials were of low methodological quality. The 2012 Cochrane review by Liu X and colleagues included 12 randomised trials and one quasi-randomised trial with 640 patients and 12 herbs. It found no difference in mortality. It reported that some herbs may improve symptoms, quality of life and the clearing of lung infiltrates, and may reduce corticosteroid doses, and it rated the evidence weak because of the poor quality of the trials.

Was Chinese medicine in China's COVID-19 treatment plan?

Yes, from the plan's fourth revision. Wang, Greenhalgh, Wardle and the Oxford TCM Rapid Review Team, in a 2022 systematic review, report that China published the first version of its COVID-19 treatment plan on 16 January 2020 and added Chinese herbal medicine from the fourth revision. Six preparations, the "three medicines and three formulations", were selected; the three medicines, Lianhua Qingwen among them, were existing products used for respiratory illnesses, and the three formulations were new preparations developed from existing formulas. Ang and colleagues found 26 government-issued Chinese guidelines by 6 March 2020, which assigned patterns and formulas separately to the mild, moderate, severe and recovery stages, and that liquorice root was the most frequent herb across the Chinese guidelines. Dubois reproduces a Chinese table drawn up during the epidemic that classifies COVID-19 as a pestilence of the damp-heat type affecting the lung.

What did trials of Lianhua Qingwen find?

Lianhua Qingwen draws on both schools. Xiao and colleagues, in a 2026 review, describe it as modified from Maxing Shigan decoction of the Shanghan lun and Yinqiao powder of the warm disease literature, with rhubarb taken from Wu Youxing's treatise.

Hu and colleagues randomised 284 patients at 23 hospitals in China to usual treatment with or without the capsules for 14 days, without blinding. They reported symptom recovery in 91.5% against 82.4%, and a median of 7 days to recovery against 10, but no difference in progression to severe disease or in viral test results. Zheng and colleagues then ran a double-blind, placebo-controlled trial in 2022 with 815 adults with mild to moderate COVID-19 at 17 sites in China, Thailand, Vietnam and the Philippines, against a matching placebo made by the capsules' manufacturer, Yiling Pharmaceutical. The median time to sustained improvement of nine symptoms was 4.0 days against 6.7. Shortness of breath, headache and chills did not differ, the rate at which viral tests turned negative did not differ, and no patient in either group progressed to severe illness.

The Oxford review, searching to September 2020, found 13 studies of the six preparations with 1,467 participants, 6 of them randomised. It reported that no study convincingly showed a change in disease severity, that the symptom findings could reflect bias in how symptoms were scored, and that the findings neither support nor refute the official claims.

What AcuiQ records

AcuiQ's protocol index records published acupuncture prescriptions. It does not list herbal formulas such as Lianhua Qingwen as protocols, and it does not record whether a paper's authors framed an illness as warm disease or cold damage.