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So … What is it?
Well! I suggest you get yourself a cup of tea and settle down to read this page in full.
It’s longer than most other pages on this site and I could split in into shorter pages, but I might lose you at a vital moment, so please persevere!
In around 1980 a famous Chinese doctor, Dr John HF Shen, gave a series of lectures in London which I attended. One lecture was on the causes of disease including this, the remaining pathogenic factor.
To give an idea of what he meant, he suggested we think of a burglar, entering our house at night.
If we hear him entering and decide we don’t want to lose our possessions, we have two choices.
Either
or
Either way is pretty effective: in neither case is he likely to trouble us again.
Shooting him does have a certain finality about it, however!
What shall we do with the body? Shall we keep it, festering in the basement, attracting vermin and disease into our house?
And then there’s the smell!
If we tell the police, there will be questions:
The better way is to make a huge fuss and scare him away in the first place!
That’s the way a healthy body deals with a disease:
That’s the way the body is designed to do it. It exteriorises the symptoms and stops them from penetrating deeper.
But suppose our body fails to dislodge the invader?
As with the burglar, our problems are just beginning. With the burglar living with us, we’ll get a series of disagreements and arguments; we may all get a little heated!
Add the expense of supporting him or living with his body and life becomes a drain.
In terms of Chinese Medicine, this will lead to generation of Heat and exhaustion of our Yin reserves. His presence (ie the remaining pathogenic factor’s presence) will interfere with the movement of energy of the Spleen and Stomach leading to Damp.
Heat will dry the body fluids and create potential for Phlegm.
Damp makes you heavy, achey, tired and slow-witted. (Read more on it by clicking Damp! It’s common among people with post-viral and chronic fatigue syndrome and now Long Covid. Also fibromyalgia.)
(By the way, perhaps you are wondering where the burglar comes from? See our page on the Four Levels, though it can sometimes apply to something else, see Six Stages.)
These ‘syndromes‘, as they are called in Chinese medicine, of Damp, Heat and Phlegm – emerge as conditions we experience after an acute infection or disease has failed to achieve success: we are left with inflammation, rashes, mild fevers, heaviness, tiredness and discharges.
‘Hasn’t achieved success’? – we hear you wonder …
Well, the point of an acute disease and its symptoms is to chase out and destroy the invader.
If your body doesn’t achieve, say, the fever required to do this, all that effort has gone for nothing, and you’re still stuck with the invader.
So, although tired by its efforts, your body keeps trying, hence the mild fever, or feeling of heat, as your body keeps doing what it’s designed to do – one million years of trial and error which has given us the genes to deal with this.
Unfortunately, that continuing effort takes energy. Very tiring!
Alternatively, and this happens more with young people, the effect can lead to hyper-activity as the body’s attempts to produce yang (heat) enter the mental sphere. That means they
They also develop various sensitivities, and often become fussy eaters or can’t digest ‘normal’ foods, needing special diets. Depending on their genes and upbringing and the foods they eat they may put on weight or lose it. (Very difficult for their parents and teachers.) Also, being yin deficient so lacking a solid ‘base’ some become pre-occupied with identity and sexuality issues.
Actually there’s an additional problem nowadays, which takes us into very politically incorrect territory. By using immunisation and antibiotics to prevent acute disease and the death and damage it can do to us, we may have stopped our genes from adapting in such a way that only the healthy genes make it down to future generations.
There’s more on this mechanism below. Or read our page on Suppression.
Hence there is a danger, unless we can find a better way, that we are making our bodies susceptible to more chronic disease: which is exactly what keeping the RPF, the burghlar or his body, in the house, represents.
And – look around! – we DO have a huge increase in chronic diseases like asthma, allergies and skin diseases, controlled with drugs. Also, an increase in hyperactivity amongst younger people – often prescribed ritalin, which is classified as a stimulant, but actually, to me at least, is more like a sedative, steadying their hyperactivity. (Read our page on primary and secondary actions of foods herbs and drugs. Then read our page on Suppression.)
(End of homile.)
Worse, these continuing efforts to produce a fever, to heat us, drain our resources causing Yin deficiency, with poor sleep patterns (bad dreams or frequent waking), sore throat, more tiredness and depression.
This weakens our body and prevents our Lung qi from regulating our defensive energy. (Check our page on Lung Qi deficiency.)In turn that makes us more susceptible to yet more invasions or infections.
This burglar, this remaining pathogenic factor, has a lot to answer for!
Of course this happens when our body lacks the ability to ‘fight’ in the first place; perhaps because of a series of illnesses beforehand from which it has never properly recovered.
Or instead of eliciting an effective fever/feel-hot reaction and then sweating at the right time (a wind-heat reaction), the invader produces only a mild or negligible fever without feeling hot or sweating (a wind-cold reaction).
Click to see the difference between a strong wind-heat and a weaker wind-cold reaction.
Medicine has given us many ways to prevent our bodies from exteriorising the disease. These include anti-inflammatory painkillers to reduce fever, lengthening the time it takes to kill the invader, and antibiotics.
You can study the ‘energetic’ effect of any Western, orthodox medicine, herb or food by comparing it with the effect of herbs known to Chinese herbalists.
Herbs used in Chinese medicine are described in terms of their effects in the body: whether for example they are said to be hot, cold, bitter, sweet, neutral, acrid, warm, aromatic etc.
For example, a herb with cold quality would be very cooling, even though it were taken cooked and warm. See also Cold Foods.
In particular, Chinese herbs are classified in 18 different categories such as those that release the exterior; clear heat; drain downwards; drain dampness; transform phlegm and so on.
Herbs are also categorized into which channel (acupuncture meridian) they appear to influence most.
They are studied for how they affect the balance of the body between yin and yang, hot and cold, dry and moist, inside and outside symptoms. (This is a bit technical, I’m afraid (!) but you should be able to understand ‘hot and cold’ if you’ve ever had an infection.)
Chinese Medicine has at least 2000 years of experience in observing the energetic effects of foods and herbs on humans.
The effect of antibiotics has been carefully studied. Usually, they are regarded as having energy that is cold and bitter.
Western medicine would probably agree that antibiotics are cold because Western medicine categorises them as anti-inflammatory.
Click here for more on antibiotics.
Click here for more on the bitter taste.
However, that’s where the two systems of medicine part company, because in Chinese medicine, herbs used to treat invasion by heat or wind-heat would be herbs that released the exterior, definitely NOT herbs that cooled!
Antibiotics, on the other hand, are cold in nature and, just as you shiver and hunch up tight in a chilly wind, they CLOSE the exterior, which is the very opposite of ‘releasing the exterior’.
Closing the exterior leads to what is called the ‘remaining pathogenic factor’ – the burglar’s body, festering under the floorboards.
Antibiotics have other functions. They drain fire and toxins downwards (which is why they work for skin eruptions with pus) and clear heat from the organs.
Antibiotics also encourage defecation, drain phlegm, especially from the lungs, and have a calming action. If you have an infection, you might think all this was good news.
The trouble is that being so powerful, if not combined with any herbs or foods that moderate their action, antibiotics drain heat from the body and greatly weaken the Stomach qi and Spleen qi.
Stomach and Spleen qi are central energies in the body, whose function is to turn food and drink into Qi and Blood.
When the Stomach/Spleen function is weakened, Stomach energy rebels upwards leading to nausea or loss of appetite. Then the Spleen Yang function of separating and transforming is depleted, giving poor digestion, bloating, tiredness, diarrhoea and accumulation of dampness, which is experienced as heaviness, weariness and often swelling or oedema.
Of course, do realise that doctors are becoming increasingly aware that the bugs are winning. Soon, probably, antibiotics won’t work because the bacteria will have learned how to resist them.
Research isn’t yet being done fast enough to find new ones to replace old antibiotics, so we may find ourselves back in the situation we were in before World War 2 when surgery, for example, could lead to serious microbial infection.
And of course, the bugs are older and wiser now.
Antibiotics upset the Lung function of regulating the body’s ‘Wei’ or Defensive energy in several ways. One of the Lung’s functions is to manage the way the body sweats; how it opens and closes your sweat pores.
The Lung meridian arises in the Stomach area (before entering the Large Intestine, the Lungs and the Heart).
When Stomach qi is weakened, the Lung function of opening and closing the pores is disturbed.
Because opening the pores at the appropriate time to allow sweating is a vital part of exteriorising a disease, (ie sending it to the exterior) closing the pores – which is what antibiotics do because of their cold nature – has a dramatic and destructive effect on the body’s attempt to exteriorise the invasion.
So … antibiotics trap the invader inside the body. They clear heat and kill the bacteria – yes! – but the disease process remains, like the burglar’s body.
There! … you have your ‘remaining pathogenic factor’.
Antibiotics cool the body at a time when it needs heat to burn out and exteriorize the invader. They weaken digestion just when the body needs to increase its strength.A good digestion breaks down damp and phlegm: a weak digestion can’t.
So damp and phlegm build up, making the body more susceptible to another attack. When it comes, because the remaining pathogenic factor is already using up energy, there isn’t enough to produce a strong Wind-Heat reaction, so now you may acquire another remaining pathogenic factor!
Used for too long, antibiotics have other effects as explained above: they deplete the body’s reserves – its yin qi. Eventually you get signs of yin deficiency.
This leads to inflammation of internal organ tissue and a reddish or peeled tongue, poor sleep and wakefulness at night, often with sweating, which is exhausting.
You probably know people who have been on regular antibiotics for years: generally speaking they have lower levels of energy.
The disastrous effects of antibiotics are more obvious when used for a wind-cold invasion. That’s because here there is little initial heat to clear, but they still close the exterior and drain heat – what little heat there is – and remember – your existing remaining pathogenic factor has been sapping your body’s ability to produce heat all along.
In Wind-cold, the body only succeeds in exteriorising the invasion when it begins to feel hot and to sweat ‘successfully’. Blocking that action by first cooling the body so that it can’t warm up and sweat, and then closing the exterior as well, ensures survival of your remaining pathogenic factor.
Of course, antibiotics are also used in chronic diseases. This also prevents the body from exteriorising its problem, further weakening the body’s energy.
So a remaining pathogenic factor arises when the body can’t exteriorise an invasion of eg wind-heat or wind-cold, or when a disease process is prevented from being exteriorised.
With that remaining pathogenic factor in the interior, the body has ongoing symptoms of mild infection and tiredness, such as sore throat, poor sleep, restlessness, tiredness, heaviness, stiffness and so on.
These often affect outlook, leading to mild depression.
Western, orthodox doctors are divided in their opinion on chronic fatigue syndrome, some attributing it entirely to mental factors, others to an unresolved infection.
In our opinion, treating a remaining pathogenic factor with more antibiotics will be un-conducive to long-term health for the patient, for reasons given above.
Anti-depressants may alleviate depression, but because they only treat one part of the remaining pathogenic factor’s symptom picture they are also potentially suppressive in our opinion and will need to be repeated indefinitely and increased or changed from time to time.
Taking anti-depressants long-term may lead to other more serious conditions later because like any medicine they have to be metabolized: this imposes additional chemical and enzymatic burdens on the body.
Can anything be done to moderate their actions?
They’re certainly not all bad! Though we’ve described their dire consequences above, they have saved millions of lives.
Had Chinese medicine (herbs, for example) been used with them, their very cold and bitter effects might have been moderated by incorporating other herbs or treatments,
That’s what they do in China – where they do know what they’re talking about.
And in fact that’s apparently what Dr Shen (mentioned above) did – for himself.
After treating hundreds of Chinese with TB successfully using herbs, soon after the Second World War, he himself caught TB.
At this point, penicillin became available.
He said that a condition which with just herbs would have taken many weeks to treat successfully, got him better inside 10 days, combining the antibiotic with Chinese medicine.
In the West, health providers tend to view the combination of antibiotics with herbs as cheating, because it makes it seem that the herbs are killing the infection when it’s not the herbs but the antibiotics that do it – in their opinion. It’s often illegal to combine them, too.
But there are plenty of Chinese herbs which act in a similar way to antibiotics, but aren’t so powerful. Chinese doctors were quick to spot the advantages of combining Western and Chinese medicine. Western medicine, so far, hasn’t accepted Chinese medicine. More fool us.
Alternatively or in addition, we can use acupuncture and moxibustion to restrain the unwanted antibiotic actions.
There are precautions you should take.
Unless there are pre-existing reasons not to, you should take probiotics both before, during and after taking antibiotics.
As categorised in Chinese medicine these have a sweet, salty, warming effect and support the Spleen and Stomach function. (However, take probiotics in pill or powder form and with warm water, not in the form of yogurt, which has a cold energy. For more on this, see our page on Cold Foods.)
However, don’t swallow the probiotics at the same time as you take the antibiotic. Take them in between, as far in time away from the antibiotic as you can. So if you take antibiotics twice daily, say on rising and in the evening, take the probiotics about half way in between. Read the instructions but if you aren’t sure, take them with warm water, after a meal.
For more on pro-biotics, anti-biotics, and pre-biotics, click here.
You should avoid cold, iced, raw and sweet foods before, during and after taking antibiotics.
So during the days before, during and after the course of antibiotics, that means NO COLD, No ICED, No CHILLED, No RAW adn No SWEET foods. (Emphasis is in case you overlooked the first sentence there!)
To support your Spleen and Stomach you should add ginger (cut from the root) to warm dishes and in hot drinks.
If you don’t like ginger or it’s not available, try teas made from one of the following, all of which like ginger cause sweating, help to scatter wind-cold and support either or both of the Spleen/Stomach and Lung energies:
(By the way, use ginger root not dried ginger ie ginger powder, because dried ginger is too heating.)
Of course, herbs affect people in different ways, so be careful how much you take. You might find peppermint tea is hugely beneficial and warming but I’m one of the few people who apparently find it rather cooling. We’re all different. Nearly always, however, ginger root is beneficial for your Spleen and Stomach energies.
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You should take only cooked, warm food and drinks.
With an invasion of Wind-Cold, a very warm bath for ten minutes or so is another way of helping your body to warm up and sweat.
Ideally stay in the bath until you start to feel too hot and begin sweating: this is the point when your body can start to exteriorise the pathogen.
However, don’t stay in the bath too long: neither to the point when you get weakened and fall asleep nor, worse still, to when you cool down with the water.
Then dry off quickly, wrap up well, go to bed with a hot-water bottle or heated bean-bag (the hot body of a partner sometimes works too, but avoid sex when you’re ill!) and pile on enough bedclothes to keep you sweating in your sleep. Getting hot and sweating from the heat you generate is vital.
NB. The herbs mentioned above are normally used for Wind-cold conditions because they warm your body and cause sweating. If your body can be made to warm up and then sweat, it will kick-start the healthy process of clearing the invading pathogen.
When someone is taking antibiotics, assume that the antibiotics will have a cooling effect – because they nearly always do. (But if, clearly, the antibiotics are heating, then other measures are called for. These would include, obviously, discussion with whoever prescribed the antibiotics to ensure that they are having the desired effect.)
The herbs listed above help to counter the cold effect of the antibiotics at the same time as causing sweating, enabling the body to exteriorise the pathogen.
Even if you have a wind-heat reaction, if you decide to take antibiotics, take the herbs mentioned above because they’ll counter the cold-inducing and exterior-closing properties of the antibiotics.
However, if you can stand a couple of days of discomfort from the Wind-Heat invasion, please don’t take antibiotics! Let your body do the work! That’s what it’s designed for, and your natural Wind-Heat reaction shows your body is up for it!
Some people don’t have a remaining pathogenic factor. They have something else, called Latent Heat.
I know of only two forms of therapy that both recognise and have theories and treatments for a RPF.
During such treatments it is important to monitor the patient carefully and regularly. Also to reassure the patient, who may be unused to feeling ill, not to abort the process by resorting to painkillers, antibiotics, anti-inflammatory medications etc..
If a careful case history is taken before treatment commences, it should point to the kinds of reactions the patient may expect.
Homoeopathic theory suggests that where there have been multiple suppressions, on its way to the exterior the pathogenic factor may take a number of forms, sometimes repeating old diseases.
Therapists with homoeopathic training will be more alert to these possibilities.
I should also mention Natural Medicine and its methodologies such as Hydrotherapy. This aims to stimulate your body into producing a fighting, exteriorising function. I’m not sure they have a theory to explain the results other than that shared with homoeopathy.
However, in spite of everything you’ve read above, if you have started a course of antibiotics, please finish them as desired by your doctor unless you get some kind of allergic reaction to them.
Not to do so may allow the bacteria to recover, and may even enable them to learn how to overcome the antibiotic, rendering that antibiotic less useful in the future, both for you and others.
The number of effective antibiotics is reducing. We’ve realised indiscriminate or incorrect use of antibiotics makes the bugs more resistant. That may return us to how it was before they discovered antibiotics. That would make us susceptible to many diseases we thought were vanquished.
There is a third way to rid yourself from your remaining pathogenic factor, which patients sometimes encounter by good fortune. It isn’t a therapy, but nature taking its course. It isn’t open to everyone, because it takes a certain amount of energy to work.
And, nowadays, we are often a bit frightened of it, sometimes with good reason. So, as I said, it’s not for all of us.
It happens when a patient, with a pre-existing remaining pathogenic factor which hasn’t yet erupted into long-term chronic fatigue, has an invasion of Wind-Cold or Wind-Heat and doesn’t try to suppress it.
This sometimes happens on the way back from a restful holiday when the patient’s body has recovered good supplies of Yin, Yang, Qi and Blood energy again.
To the patient it feels as if they are catching a dreadful infection – a bug! Often this is blamed on the plane’s air-conditioning or on catching it from another passenger.
They get a fever, feel very hot, feel awful, and would normally reach for the painkillers and phone their doctor for help.
If instead they just let the disease process work its way out, getting a sensation of heat, then sweating as explained, they may also rid themselves of any remaining pathogenic factor they had. They may do this naturally at the same time as they exteriorise the bug they’ve just ‘caught’!
Then both are gone, and they’ll find they enjoy a much better level of energy and health.
In children, early diseases like chicken pox, mumps and measles often have a similar effect. Preventing them from occurring, either via immunisation or by suppression, may stop their bodies learning and then producing this burning-out, exteriorising, reaction so useful against future diseases.
That may lead, in some children, to retention of a remaining pathogenic factor. (Actually, recent research suggests it is best to get Measles first, because it tends to disrupt or destroy benefits acquired – including antibodies – from other previous diseases.) Read more about this under suppression.
Q/ What if someone catches a bug and doesn’t manage to produce the ‘fever/feel hot and sweat’ reaction of their own accord?
A/ Get treatment from a practitioner who understands and can monitor and treat the condition properly.
Why You get Nervous Stomach Anxiety and How to Handle It. Acupuncture has great ways to help.
Subscribe to the Newsletter
If you are interested in understanding how Traditional Chinese Medicine can improve your life sign up to my newsletter for the latest updates.
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If you are interested in understanding how Traditional Chinese Medicine can improve your life sign up to my newsletter for the latest updates.
4 Responses
thank you Jonathan,
very thought provoking and helps to understand pathophysiology
with history of fungal pna in 2019 treated with anti fungal medicine x 3 months….. cough never got resolved. was treated with INH meds due to hx of positive quantiferon….story goes on to nowadays with asthma.
per western mds, the nodule in lungs is calcified now… is this still considered RPF?
my kids get ‘regular’ colds and I get internal heat in lungs from being around the kids.
lung yin deficient
I am considered immuno competentent, although my immune system doesn’t mount robust response of antibodies to pneumovax 23 and prenvar 13. I understand for asthma, its multi dimensional, but would you start by treating kidney?
Dear Lena, Treating Kidney might or might not be priority: it depends on symptoms. Probably the lung nodule would be considered as ‘phlegm’. If you get internal Lung Heat (which would have dried out the fungal phlegm into a calcified nodule) arising with or causing Lung Yin deficiency, that might be more important. TB-like diseases produce Fire and exhaust yin. If the Fire remains, even in a lesser form, that might be your Remaining Pathogenic Factor. Jonathan
Hi Jonathan,
Thank you so much for this insightful article it really helped to solidify some of my basic TCM knowledge. I’ve been exploring TCM explanations for pathologies since a pulmonary hypertension diagnosis in Dec 2021. I fell ill with phlegm cold illness in October 2021 and never recovered, ending up in hospital in December. I treated with homeopathy and vitamins but my breathlessness was debilitating and oxygen levels very low. I see an acupuncturist and have a weak stomach/spleen and frequently get phlegm which affects my lungs. I am working on heating the body with warm foods, using fresh ginger and easy to digest foods like soups/stews/porridge but wonder if there is anything else I can focus on to help the breathlessness? I feel a lot of stagnation in my body which I would love to shift to get more energy and vitality.
Hi Nicola,
If you still have Stomach/Spleen deficiency with phlegm, that alone would be enough to cause loss of vitality. In effect, your deficient Spleen finds itself unable to stand up to your Liver energy, leading to Qi stagnation. Also, the phlegm itself provides an impediment to the free flow of Qi, like carrying a heavy sack on your back. When you get rid of the phlegm, suddenly you’ll feel lighter and vitality will return.
Of course, quite apart from the phlegm you may also have issues (mental/emotional) leading to Qi stagnation, so could have both, one compounding the other, and worrying about it makes it worse. So you’re in a bind.
If there are no emotional/stress factors leading to Qi stagnation – or you’ve sorted them out, then I would continue with acupuncture, probably taking herbs to back it up.
Ideally you’d get these from someone experienced in Chinese herbal medicine, but there are various formulae in tablet form that work well for many people, the problem being that since they aren’t exactly right for you, you have to know when to stop, or when to add additional formulae to deal with side-issues, or your acupuncturist needs to be able to provide treatment that compensates for the herbal formula’s ‘deficiencies’. In my book on phlegm there is more about several of the classical herbal prescriptions for this and the tablets that some acupuncturists know about are derived from those original Chinese formulae.
But you’re right to continue to avoid foods that may worsen any remaining phlegm. Time spent in a warm dry place – somewhere South of the UK! – and away from worries – may help.
Sometimes, Ive found that doing the above gets you to a position where the correct homoeopathic remedy does the rest, not least because it becomes easier to diagnose, and there are less impediments to it working. But … tricky! And it takes patience.