Traditional Chinese Medicine Case Studies / Medical Discussions / Reference Articles for Clinical Practice in TCM
Colds and influenza are diseases that should not be taken lightly. Throughout history and across cultures, they are common and frequently occurring illnesses that can cause significant harm, especially influenza and its complications such as pneumonia, which have claimed countless lives.Western medicine treats colds primarily with symptomatic treatment, using antibiotics to control complications.In theory, most people can recover in about a week.However, in recent years, many individuals find that once they catch a cold, they remain unwell for months, with coughs lingering for half a year, coming and going, causing great distress.Among the reasons for this are environmental pollution, decreased immunity, and the misuse of antibiotics or the premature use of astringent cough suppressants in traditional Chinese medicine (TCM).The fundamental principle of TCM in treating colds and influenza is to “support the right qi and expel pathogens.” Especially in the early stages of an exterior invasion, regardless of whether there is fever or not, whether it is a wind-cold or wind-heat cold, and regardless of whether the person is weak or robust, as long as there is no sweating or insufficient sweating, the primary approach is to induce sweating and release the exterior. Therefore, scallion and ginger soup can be used, or it can be added to other appropriate formulas.As long as the timing is well grasped, thorough and appropriate sweating can often lead to recovery with one sweat, with heat retreating and the body cooling.On the basis of establishing inducing sweating and releasing the exterior as the first principle, combined with seasonal climate changes, regional differences, and variations in patient constitution, treatment should be differentiated according to different situations and stages, whether to induce or restrain, to disperse or descend, to use warming dispersing or clearing purging methods, following the disease progression, and systematically conducting treatment to shorten the course of illness and achieve early recovery.
Differentiating Cold and Heat in Treatment
Wind-Cold Cold This type of cold often occurs when the weather turns cooler, such as in autumn and winter, with symptoms including fever and chills, headache, coughing with clear thin phlegm, pale tongue, thin white coating, or coughing with thick yellow phlegm, pale tongue, thin yellow coating, suitable for using Shen Su Wan with modifications.If prolonged without transformation to heat, still with a pale tongue, no thirst, and a complaint of severe throat itch, it is advisable to use Jin Fei Cao San.Once the exterior is resolved, if the cough persists, switch to using Zhi Sou San with modifications.In elderly or weak individuals with insufficient yang qi, after catching a wind-cold, they often do not have a fever, only fear of cold, or may have only a low fever, headache, body aches, and especially fear of cold, with cold hands and feet.If the pulse is weak and large, use Bu Zhong Yi Qi Tang with modifications;If the pulse is floating and slow, with cold pain and tightness in the shoulders and back, and body aches, use Gui Zhi Jia Ge Gen Tang with modifications;If there is aversion to cold, cold limbs, joint pain, pale tongue with white coating, and a deep thin pulse, use Fu Zi Tang with modifications.If the cough produces clear thin phlegm, add Ban Xia, Gan Jiang, Wu Wei Zi, and Xi Xin; if there is fever, add Ma Huang, Fu Zi, and Xi Xin.Wind-Heat Cold This type of cold often occurs when the weather turns warm, such as in spring and summer. Symptoms include fever, headache, slight aversion to cold, mild thirst, discomfort in the throat, and slightly thick phlegm, with thin white or thin yellow tongue coating, suitable for using Yin Qiao San with apricot kernel, Zhe Bei Mu, and Huang Qin added;If there is chest fullness and discomfort, add Shi Chang Pu and Huo Xiang.If the cough has not completely stopped and has transformed into heat and dryness, use Ye Tian Shi Sha Shen Lu Bei San.For wind-cold or wind-heat colds, if the exterior is not thoroughly resolved, or if prolonged, leading to heat evil obstructing the lungs, causing cough, wheezing, and thick yellow phlegm, with thirst and yellow tongue coating, and a rapid slippery pulse, use Ma Xing Shi Gan Tang.For wind-cold or wind-heat colds, if the evil qi has departed but a slight cough persists for a long time, use Guan Yin Ying Meng San.
Differentiating Treatment by Season
Winter-Spring Influenza and Severe Colds Winter and spring are peak seasons for influenza and severe colds, as cold evil is prevalent. Patients often have aversion to cold, high fever, no sweating, and body temperature often reaches above 39°C, with severe headaches and muscle aches, and a tight pulse.If there is no thirst, or if there is thirst but the tongue is pale with a moist coating, use Ren Shen Bai Du San;If the exterior symptoms are the same but there is thirst, throat pain, a red tongue, and slight cough, this indicates internal heat, and Qing Wen Jie Du Wan can be selected;If the exterior has not been resolved, or if prolonged, with persistent external cold and internal heat, presenting with high fever, slight aversion to cold, no sweating or little sweating, headache, muscle aches, dry nose, eye pain, thirst, red tongue, and a rapid pulse, use Chai Ge Jie Ji Tang to resolve the Shao Yang and Yang Ming heat.After the heat retreats and the body cools, if the cough does not stop, and if the cough produces thick yellow phlegm, use Qing Qi Hua Tan Wan; if there is dry cough with little or no phlegm, use Sha Shen Lu Bei San.Summer Heat Stroke Cold In the southern summer, not only is it hot, but it is also often humid. If one indulges in coolness and catches a chill, the exterior qi may become obstructed, leading to symptoms of fever, aversion to cold, no sweating, headache, and body aches, or accompanied by thirst and yellow urine, suitable for using Xiang Ru Yin with modifications.If there is vomiting, abdominal pain, or diarrhea, use Huo Xiang Zheng Qi San with added talcum powder.Long Summer Damp-Warm Cold The long summer is the period between summer and autumn, where heat and dampness are both prevalent. At the onset of illness, patients often present with a series of symptoms of heat wrapped in dampness, such as fever and aversion to cold, head heaviness and dizziness, body heaviness and soreness, pale yellow complexion, chest fullness with no appetite, cool in the morning and fever in the afternoon, white tongue with no thirst, and a wiry thin and moist pulse, suitable for using San Ren Tang.If both dampness and heat are strong, with body heat, sweating, and subsequent heat, body aches, and a slow pulse, use Huang Qin Shi Gao Tang. If high fever persists, with body heat, red face, yellow greasy tongue coating, and a rapid pulse, use San Shi Tang.It is worth noting that in provinces like Guangdong and Hunan, the disease mechanism of heat wrapped in dampness can occur in all four seasons. Whenever there is an unexplained low fever, sweating and heat retreating, followed by a recurrence, lingering symptoms, with no thirst or little thirst, or a preference for hot drinks, red tongue, thick greasy coating, and a white moist tongue in the morning that gradually becomes yellow and dry at noon, these symptoms should be considered from the perspective of damp-heat accumulation.In weak individuals, summer colds often manifest as dizziness, fatigue in the limbs, body soreness, loss of appetite, thirst, yellow short urine, or low fever or no fever, with a weak and soft pulse, suitable for using Qing Shu Yi Qi Tang.Autumn Warm-Dry and Cool-Dry Colds As autumn arrives, most people feel dry skin, dry stools, dry nasal passages, and dry hair, which are different from usual, caused by autumn dryness.At this time, dietary therapy can be used without treating it as a disease, such as regularly consuming TCM products like autumn pear syrup or decocting raw Rehmannia with honey. If there is slight fever, no aversion to cold, throat pain, itchy throat, severe cough, and difficulty expectorating thick phlegm, use Ye Tian Shi Sang Ye Bei Mu Fang.Cool-dry colds at the onset present with headache, nasal congestion, body heat, aversion to cold with no sweating, cough with clear thin phlegm, similar to wind-cold colds, but with dry lips, dry throat, and itchy cough, suitable for using Xing Su San.
Prevention of Colds
Individuals who frequently suffer from colds are often elderly, weak, or have insufficient resistance. TCM attributes this to insufficient yang qi, and it is advisable to regularly take TCM products like Bu Zhong Yi Qi Wan. Modern TCM expert Pu Fuzhou advocates using ginger and jujube decoction with Yu Ping Feng San in small doses for regular consumption. My uncle, renowned TCM physician Peng Chongrang from Hunan, believes: “One should not focus solely on tonifying the deficiency.”In Jiangnan, where the climate is humid and the weather changes frequently, weak individuals are prone to dampness and find it difficult to adapt to weather changes, thus laying the foundation for colds.For such individuals, the best preventive medicine for colds is Huo Xiang Zheng Qi San. Huo Xiang Zheng Qi San was originally designed to treat those affected by improper seasonal qi, with symptoms of headache, fever, aversion to cold, body aches, vomiting, and diarrhea. It has the effects of dispersing cold, transforming dampness, releasing the exterior, and resolving internal issues, being potent yet not drying.My uncle praises it as the “first formula in TCM history,” believing that to date, no Western medicine can match its efficacy in treating gastrointestinal colds. During seasonal transitions and climate changes, individuals prone to colds who feel a lack of appetite, decreased food intake, dizziness, heaviness in the body, and soreness in the limbs can take TCM products like Huo Xiang Zheng Qi Wan or decocting ginger and red dates, taking 2-3 packets daily. If there is internal heat, yellow urine, and thirst, or during hot months, adding TCM products like Liu Yi San or Ren Zhong Huang can often prevent the occurrence of colds.Additionally, individuals prone to colds often have chronic inflammatory conditions in the nasal and throat areas, which can easily be triggered by colds. These individuals often belong to what TCM refers to as “fire body” individuals, meaning they have internal hidden heat, especially common in children. They should not be treated as yang qi deficiency and given warming tonics like Bu Zhong Yi Qi Wan or Yu Ping Feng San, but can regularly use herbs like Xin Yi, Cang Er, Huang Qi, Jin Yin Hua, Ban Lan Gen, Tu Fu Ling, and Gan Cao in decoctions to clear and resolve.
Case Studies
Case 1Liu, a 10-year-old girl, first diagnosed on December 4, 2012. The child had a cold and cough for 1 week, and after taking cold medications like Gan Mao Ling, An Bi Xian, and Hu Tong, she was still coughing, with much yellow phlegm, clear nasal discharge, fear of cold, no sweating, and a temperature of 38°C. The tongue was pale red with a thin yellow coating, and the pulse was floating and slow.The prescription used was Tong Xuan Li Fei Wan with modifications: Xing Ren 9g, Su Ye 10g, Zhi Gan Cao 10g, Jie Geng 10g, Qian Hu 10g, Zhi Ke 6g, Ban Xia 10g, Chen Pi 10g, Fu Ling 10g, Sheng Jiang 10g, Hong Zao 10g, Ma Huang 6g, Huang Qin 10g, Zhe Bei Mu 10g, for 5 doses.After 1 dose, the fever subsided, and after 5 doses, she was cured.Note: Tong Xuan Li Fei Wan can be viewed as a modified version of Xing Su Yin, which is used to treat wind-cold colds belonging to the “cold wrapping fire” syndrome.Because the exterior wind-cold had not yet departed, there was nasal congestion, clear nasal discharge, fear of cold, and no sweating. The prolonged stagnation of wind-cold had a tendency to transform into internal heat, hence the yellow phlegm, pale tongue, and thin yellow coating, all characteristics of “cold wrapping fire.”If there is severe nasal congestion with clear nasal discharge mixed with yellow discharge, it indicates that the cold has triggered rhinitis, and Xin Yi San can be added, i.e., adding Xin Yi 5g, Cang Er Zi 10g, Bai Zhi 5g; if there is much yellow phlegm, Zhe Bei Mu 10g can be added. Children often belong to the “fire body” category, and those who like to sweat can also add Sang Bai Pi 10g and Di Gu Pi 10g to clear lung heat.Case 2Zhou, a 39-year-old male, first diagnosed on April 24, 2001. The patient caught a chill after being caught in the rain 5 days prior, and that night developed a high fever, with a temperature reaching 39.5°C, severe headache, vomiting during severe pain, muscle aches throughout the body, aversion to cold, and no sweating. He was urgently sent to a hospital for treatment, where the high fever persisted, fluctuating between 38.7 and 39.7°C, suspected of having epidemic encephalitis, and a lumbar puncture was requested, but the family refused. Upon examination, the face was red, the expression was painful, and he was moaning continuously, still fearing cold, with no sweating, a red throat, no thirst, a soft abdomen with no pain upon pressure, and had only defecated twice in 5 days with little volume, and yellow urine. The tongue was red with a thick greasy coating, yellow and white mixed, and the pulse was tight and rapid.Diagnosis: Cold dampness binding the exterior, heat stagnating internally.The prescription used was Qing Wen Jie Du Wan:Sheng Di Huang 10g, Xuan Shen 15g, Tian Hua Fen 10g, Chi Shao 10g, Huang Qin 10g, Shan Dou Gen 10g, Yin Hua 10g, Lian Qiao 10g, Zhu Ye 10g, Chai Hu 15g, Ge Gen 15g, Qiang Huo 10g, Fang Feng 10g, Bai Zhi 10g, Chuan Xiong 6g, Gan Cao 5g.2 doses, take 3 bowls of water, decoct for 10 minutes, and take one bowl warm, sweating out the heat as the goal; if sweating does not occur, take another bowl after 2 hours.On April 26, during the second diagnosis: when taking the first bowl of the first dose, he felt bitter and hard to swallow, and after the medicine entered the stomach, he vomited it all out in less than 5 minutes. He was advised to continue taking the medicine, and after finishing, to suck on a plum or sugar cube to prevent further vomiting.After finishing the second bowl, he did not vomit, but his temperature rose by 0.2°C, reaching 39.6°C, with increased headache and body swelling, and a redder face. He was advised not to panic, as this was a medicinal reaction, and to keep warm. Half an hour later, he began to sweat all over, lasting for more than 10 minutes, and the high fever retreated to 38.2°C. The patient felt much better and wanted to eat, and was advised not to take any more medicine and to wait until the next day. The next morning at 8 am, his temperature was 37.8°C, and he was advised to take medicine at 10 am and 4 pm. By 9 pm that evening, he no longer had a fever.On the third day, he did not have a fever all day, and all symptoms of headache and body aches had disappeared, only feeling fatigued, weak, and sleepy. The thick greasy tongue coating had decreased but was still yellow and white mixed, and he was advised to continue taking the third dose of medicine to consolidate the effect. Additionally, Bu Zhong Yi Qi Tang was prescribed with Zhi Zi, Huo Xiang, and Shen Qu, for 7 doses.Note: This case belongs to a severe cold. In the southern spring, when the weather is fluctuating between warm and cold, many people suffer from influenza and severe colds, with the disease being dangerous and symptoms severe, with body temperature often above 39°C.Western medicine employs physical cooling and other symptomatic treatments, which sometimes fail to reduce fever, and lumbar punctures are often proposed to determine if it is encephalitis, but families often refuse to cooperate. This disease, when treated with Chinese medicine, can often be resolved with just one or two doses if appropriate.From a seasonal perspective, this should belong to the warm diseases of “wind warmth” or “spring warmth,” but using cooling dispersing methods like Yin Qiao San or Sang Ju Yin is almost ineffective, and using warming dispersing methods like Gui Zhi Tang, Ma Huang Tang, or Da Qing Long Tang cannot resolve the issue either. This is because the air is mixed with cold dampness, and these two treatment methods and their formulas do not match the syndrome.In the past, I often used “This Matter is Difficult to Know” Nine Flavor Qiang Huo Tang, and with one or two more doses, sweating would occur, and symptoms like headache, aversion to cold, and body aches would all be eliminated. Although reducing high fever is an important part of treatment, some patients may develop a cough that is difficult to resolve for a long time.This may be because these patients have internal hidden heat, and the warming herbs in the formula, such as Qiang Huo, Cang Zhu, Xin Yi, and Bai Zhi, may assist in generating heat and dryness, leading to the upward movement of lung qi. From a Western medicine perspective, this may be due to secondary infections like acute pharyngitis or acute bronchitis, and I have long been unable to find a matching formula for treatment.More than a decade ago, while organizing precious medical texts from the Forbidden City, I discovered this formula from handwritten records of the Qing Dynasty Imperial Pharmacy, and I felt it matched the disease mechanism of severe colds and influenza caused by wind-cold dampness externally and internal hidden heat. When applied clinically, the efficacy was remarkable. This case used the original formula, only changing the pills to decoction.In the formula, Xuan Shen and Shan Dou Gen have a bitter taste that is difficult to swallow, and some patients may react strongly after taking it, so it is important to inform patients to prepare mentally and take necessary measures, such as sucking on a piece of candy after taking the medicine.