| Acute viral upper respiratory tract infection is a common disease frequently seen in clinic. It is the general name refers to a series of acute infectious inflammations of virus in nose, pharynx and larynx. It features respiratory tract symptoms or systemic symptoms which mainly manifested with fever. Basically, it equals the concept of Shixingganmao or Sishiganmao in TCM and some cases of it belong to category of febrile diseases, plague and seasonal disorders. The pathogenic factors of this disease invade human body from outside and fight against healthy qi which triggers imbalance of yin and yang and finally leads to lung syndromes whose symptoms mainly are aversion to cold with fever, malaise and so on. Doctors in different dynasties have detailed statements on the etiology and pathogenesis, mechanism, therapeutic methods, prescription, medicine on this kind of illness and eventually formed a developed theoretical system concerning exogenous febrile disease.The study consists of two parts. The first one is review of literature which systematically reviews the traditional understanding and current research progress on Ganmao/Shixingganmao both of Western Medicine and Chinese Medicine. The other is clinical research which mainly focuses on the pathogenic laws of this kind of disease.Approaches:Prospective clinical observation is applied in this study. Prospective observation method of clinical epidemiological investigation is implemented to observe 600 cases of Ganmao and its information on syndrome pattern is collected to establish a database and then modern gene diagnosis techniques are adopted to establish the diagnosis of 200 cases of them. Furthermore, researchers analyze the relationship between different kinds of virus which infect the patients and the traits of syndrome pattern they presents to identify the key pathogenesis.Owing to the fact that 2009 is the year of influenza A H1N1 global pandemic and various sentinel hospitals are of aetiological diagnosis ability, we collect 200 influenza A H1N1 infected cases and 200 non-influenza A H1N1 infected cases from June of 2009 to February of 2011 which contains three season of summer, autumn and winter.We collected additional 200 cases that all accepted virus detection by samples from pharyngeal swab or nasal swab (influenza A virus, influenza B virus, influenza A H1N1 virus, respiratory syncytial virus, adenovirus and rhinovirus) from October of 2010 to February of 2011 (winter). Meanwhile, the information gathered by four diagnostic methods was documented.Site of investigation:Respiratory diseases outpatient clinic in Dongzhimen HospitalSource of studied cases:Cases of outpatient that meet all the inclusion standards Results:The syndrome pattern characteristics differ between cases infected by different virus. Ganmao/Shixingganmao cases caused by same virus manifested with similar symptoms and syndrome patterns regardless of the onset season. Cases caused by various viruses presented with different symptoms even they occurred in same season. The climatic condition affects the symptoms to some extent. However, it will not change the syndrome pattern. The diverse initial symptoms of Ganmao/Shixingganmao usually mean that they belong to distinct syndrome patterns.Conclusion:The occurrence of Ganmao/Shixingganmao is the result of interaction between human body, virus and six evil pathogenic factors. Human body and existence of virus are the two indispensable factors contributing to Ganmao/Shixingganmao. The six evil pathogenic factors, as the element from external environment disturbs the equilibrium of human body, play a vital role in the development of exogenous febrile disease under certain circumstance.The virus has its own characteristic which differs from others especially in inducing diseases. It is the determinant of syndrome pattern presents at the early stage of the disease. And this phenomenon fully illustrates the dogma of "one specific pathogenic factor links to one specific disease".The influenza A H1N1 virus is wind-heat epidemic toxin.The six evil pathogenic factors affect the syndrome pattern presents at the early stage of disease to some extent. However, they will not change the pattern arises from the infected virus.It is rational to notice the initial symptoms of Ganmao/Shixingganmao patients for they are of guiding effects for physicians to judge the nature of evil pathogenic factor, the way by which patients are infected, law of syndrome progress and to establish the therapeutic methods.Whether defensive qi could perform its duty of guarding the body and resisting the evil factors is crucial for occurrence of Ganmao/Shixingganmao. Defensive qi insufficiency means human body is unable to resist the virus or it can not adapt the change of external environment. If the defensive qi is abundant, it can withstand the evasion of virus and the six evil pathogenic factors and thus keeps the body in healthy state. Otherwise, it will not succeed in defending the virus and the six evil pathogenic factors and finally result in infection. To sum up, insufficiency of defensive qi is the key part of development of Ganmao/Shixingganmao.Innovations: Theoretical innovation:On the basis of review and analysis of Chinese medical literature on Ganmao/ShixingGanmao, this study finds out defects in pathogenesis theory of Chinese Medicine. These defects were caused by the low level of science and technology in ancient times. Due to this reason, ancient physicians were unable to realize virus and they had to find reasons from other factors in external environment that can be perceived. And they had to speculate and infer the possible causes of disease. This study suggests that the occurrence of Ganmao/Shixingganmao is the result of combination of human body, virus and the six evil pathogenic factors. Therefore, human body and the existence of virus are the two indispensable factors of Ganmao/Shixingganmao onset. It recognizes effects of the six evil pathogenic factors in development of Ganmo/Shixingganmao is that they disturb the balance of body leading to decrease of evil-resistant ability and thus healthy qi is unable to withstand the combined evasion of virus and six evil pathogenic factors. In this theory, healthy qi refers to defensive qi and defensive qi insufficiency is the key part of Ganmao/Shixingganmao occurrence.Technological innovation:Gene diagnosis technology is introduced in clinical study of TCM. With assistance of clinical epidemiology, it identifies influenza A H1N1 virus as wind-heat epidemic toxin in TCM. Wind-heat means it possesses both traits of heat evil and wind evil. After invades the body, wind-heat syndrome starts to present. Epidemic toxin means influenza A H1N1 virus is of powerful infectivity and toxicity. It changes the present condition of TCM in dealing contagious diseases which is over-independent on experience and opinion of experts. It improves the knowledge level of TCM on influenza A H1N1.
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