to the invading external Wind. This causes the Wind to penetrate into the Interior without the
person developing exterior symptoms. Once in the Interior, it incubates and turns into Heat to
come out some months later.
The ancient doctors believed in particular that if the Essence is properly guarded and not
dissipated, pathogenic factors will not enter the body and Latent Heat will not develop. The
"Simple Questions" in chapter 4 says: "The Essence is the root of the body, if it is guarded and
stored Latent Heat will not appear in springtime."3(507) This concept is very important in
practice as it implies that resistance to pathogenic factors does not depend only on Lung-Qi
(which influences Defensive Qi), but also on Kidney-Qi and Kidney-Essence. In fact, Defensive
Qi is spread by the Lungs but it has its root in the Kidneys, specifically Kidney-Yang.
Moreover, in chronic, recurrent infections such as ME, Kidney-Qi is very often deficient, leading
to a decreased immune response.
Another possible cause of Latent Heat can be immunizations, when attenuated or inert forms of
certain pathogenic organisms are injected in the body, by-passing the body's first line of
resistance. From a Chinese medical perspective it is as if an external pathogenic factor
penetrated the body's Interior directly, completely by-passing the Exterior levels. This is exactly
what happens with Latent Heat.
To summarize, the two conditions which can lead to ME can be illustrated with a diagram
(Figure 25. 1 Figure 25.1).
In both the above conditions the underlying cause is overexertion and lack of adequate rest as
explained above.
It is important to understand the causes of these conditions so that we can advise patients
accordingly. Most people have no idea that special precautions should be taken during and after
an invasion of an exterior pathogenic factor.
Lesser Yang Pattern
Both residual pathogenic factor and Latent Heat can assume the form of the Lesser Yang pattern
(which is part of both the 6-Stage and 4-Level patterns), and though this is not really a third
separate way in which ME can manifest itself, it has such special and defined characteristics that
it is best discussed separately.
Exterior Wind-Heat (or Wind-Cold) can sometimes lodge itself in an energetic niche which is in
between the Interior and Exterior (called Half-Exterior Half-Interior in Chinese). The main
clinical manifestations of this pattern are: feeling hot and cold in alternation, fullness of the
hypochondriac region, poor appetite, irritability, dry throat, nausea, bitter taste, blurred vision,
white-sticky tongue coating on one side only and a Wiry pulse. These symptoms describe the
Lesser Yang pattern of the 6 Stages. In the context of the 4 Levels, the pattern of Gall-Bladder