External pathogenic diseases have been debated for over 2000 years. One faction believes in cold damage (shanghan), while the other supports warm diseases (wenbing), leading to endless arguments. Now, from a clinical perspective, there is no need for such debates. When encountering cold damage, treat according to the six channels of cold damage; when encountering warm diseases, treat according to warm disease principles, focusing on wei (defensive), qi (vital energy), ying (nutritive), and blood, as well as the three jiao (upper, middle, and lower burners). Everything should be based on clinical practice, and we should avoid unnecessary arguments. The characteristic of Traditional Chinese Medicine (TCM) is that it often gets bogged down in theoretical discussions, resulting in hundreds of books that mislead students. After I expressed this view, an elder asked me: “Old Shen, it’s easy for you to say, but how do you differentiate external pathogenic diseases?” I had long prepared for such questions. I replied: “How do you distinguish external pathogenic diseases?” I said: “It’s simple.” There are four indicators. To differentiate between external pathogenic wind-cold and wind-heat, consider these four indicators:
The first is the tongue and pulse, which are crucial.
If the tongue coating is thin and white, and the pulse is floating and tight, that indicates wind-cold. This is the key indicator. If you see a thin white coating and a floating tight pulse, it is wind-cold; if the coating is thin and yellow, and the pulse is floating and rapid, that indicates wind-heat. This is easy to differentiate. When examining external pathogenic diseases, if the pulse is floating and rapid, and the tongue coating is thin and yellow, it is wind-heat; if the coating is thin and white, and the pulse is floating and tight, it is wind-cold. This is the first indicator.
The second indicator is based on cough and phlegm.
External pathogenic diseases primarily affect the lungs, so patients will definitely exhibit cough and phlegm. Of course, when discussing cough and phlegm, we should not differentiate by color but by quality. If the cough produces thin or foamy phlegm, that indicates wind-cold, regardless of whether it is yellow or white; if the phlegm is thick and sticky, regardless of color, it indicates wind-heat. This is easy to distinguish! When a patient coughs, just ask whether the phlegm is thin or thick; thin indicates wind-cold, thick indicates wind-heat, making it easy to identify.
The third indicator is based on sweating and pain.
Sweating and pain! If there is no sweating, and the patient has a headache or joint pain, that indicates wind-cold; if there is sweating, and the patient has a sore throat, that indicates wind-heat. This is also easy to differentiate! The location of the patient’s pain and whether they are sweating can be easily determined by asking.
The last indicator is based on cold and heat.
Cold and heat: if the patient is very sensitive to cold and has a mild fever (below 38.5 degrees Celsius), that is definitely wind-cold; if they are only slightly sensitive to cold but have a high fever (above 39 degrees Celsius), that indicates wind-heat. These four indicators clearly differentiate between wind-cold and wind-heat. Especially the tongue coating and pulse provide a clear distinction for external pathogenic diseases. If it is wind-cold, treat with warming herbs to release the exterior; if it is wind-heat, treat according to warm disease principles focusing on wei, qi, ying, blood, and the three jiao, using cooling herbs to release the exterior. This treatment principle becomes clear, right?
-
For warming herbs to release the exterior, we currently do not use Ma Huang Tang (Ephedra Decoction). Instead, I recommend using Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder).
-
For cooling herbs to release the exterior, we can use Sang Ju Yin (Mulberry Leaf and Chrysanthemum Drink) or Yin Qiao San (Honeysuckle and Forsythia Powder).
This clearly distinguishes between wind-cold and wind-heat.
However, treating external pathogenic diseases requires three additional approaches:
The first is to release the exterior.
Since external pathogenic diseases enter through the mouth and nose, and invade from the surface, if you do not release the exterior, the external pathogens cannot be expelled. What herbs can be used to release the exterior? Chuan Xiong (Ligusticum), Jie Geng (Platycodon), Bo He (Mint), Chan Yi (Cicada Slough), and Sang Bai Pi (Mulberry Root Bark). These herbs for releasing the exterior should be used according to whether it is wind-cold or wind-heat. For example, use Chuan Xiong for wind-cold and Chan Yi for wind-heat. It is essential to release the exterior! Adding one or two herbs to release the exterior can significantly enhance the efficacy. Fang Feng (Saposhnikovia) can also be used, as it is definitely included in Jing Fang Bai Du San, along with Jing Jie (Schizonepeta). In addition to this, we must consider treating external pathogenic diseases based on wind-cold and wind-heat to release the exterior. The herbs I just mentioned are the first measure to improve efficacy.
The second is to promote diuresis and relieve constipation.
External pathogens need to be expelled. What does it mean to promote diuresis and relieve constipation? This means that external pathogens, whether wind-cold or wind-heat, cannot be easily expelled. After releasing the exterior, we promote diuresis and relieve constipation. What herbs can be used for diuresis? Mainly: Che Qian Cao (Plantago), Ze Lan (Lycopus), Bai Hua She She Cao (Hedyotis), and Sheng Yi Yi Ren (Job’s Tears). These diuretic herbs help expel pathogens through urination. What herbs can be used to relieve constipation? Use: Lai Fu Zi (Radish Seed), Cao Jue Ming (Cassia Seed), Quan Gua Lou (Trichosanthes), and Tao Ren (Peach Kernel). This second method for treating external pathogenic diseases is called promoting diuresis and relieving constipation.
The third method is to support the righteous qi.
This is what the ancients taught us. Whether it is an external pathogen or not, to resolve external pathogenic diseases, we must support the righteous qi. The most representative formula is Shen Su Yin (Ginseng and Perilla Drink), although I prefer not to use Dang Shen (Codonopsis). Why? Because Dang Shen only tonifies qi, and it is not as effective as Sheng Huang Qi (Astragalus). Sheng Huang Qi can tonify qi, stabilize the exterior, and expel toxins. It tonifies qi, stabilizes the exterior, and expels toxins, making Sheng Huang Qi more comprehensive than Dang Shen. Just add one herb, do not add too much, or you will weaken the pathogens. Alternatively, you can use Xian He Cao (Agrimonia). Use 15g of Sheng Huang Qi and 10g of Xian He Cao.
This is the general principle for treating external pathogenic diseases. Then, based on whether it is a bacterial or viral infection, adjust the treatment accordingly.
-
If it is a bacterial infection, add Pu Gong Ying (Dandelion);
-
If it is a viral infection, add Ban Lan Gen (Isatis).
The third category is summer dampness.
In this season, colds caused by wind-cold or wind-heat are not obvious; rather, patients with external pathogenic diseases have a greasy tongue coating, whether it is white, thick, or yellow. If the tongue coating is greasy, you should consider dampness as the main factor. Do not simply categorize it as wind-heat or wind-cold. If there is dampness, when expelling pathogens, you should apply the theory of the three jiao.
The first is San Ren Tang (Three Nut Decoction). Use Xing Ren (Apricot Kernel) for the upper jiao, Cao Ren (Cardamom) for the middle jiao, and Sheng Yi Yi Ren (Job’s Tears) for the lower jiao. Xing Ren, Cao Ren, and Sheng Yi Yi Ren promote diuresis across the three jiao.
The second is that you must add herbs to clear summer heat.
Two herbs for clearing summer heat: one is Huo Xiang (Agastache). Huo Xiang is a seasonal herb used only in June, July, and August; it is rarely used at other times, making it a seasonal medication for clearing summer heat. I rarely use Pei Lan (Eupatorium), as it is not as effective as Huo Xiang; just using Huo Xiang is sufficient. The second herb for clearing summer heat is Liu Yi San (Six-One Powder). Do you know Liu Yi San? It consists of Hua Shi (Talc) and Gan Cao (Licorice) in a 6:1 ratio. However, you must wrap Liu Yi San in a lotus leaf. The lotus leaf, which blooms in summer, is used; take 30g of Liu Yi San, wrap it in a lotus leaf, tie it with string, and poke holes in the lotus leaf with a needle. This is also an excellent remedy for clearing summer heat and treating external pathogenic diseases. Therefore, the entire discussion on external pathogenic diseases clarifies the distinction between wind-cold and wind-heat. Adding the principles of releasing the exterior, promoting diuresis, and supporting the righteous qi, while paying attention to summer dampness, will generally suffice for treating external pathogenic diseases.
This is how it is clinically, and it is particularly effective. However, do not simply rely on Western medicine’s antiviral treatments; that approach is ineffective, especially for those with greasy tongues, where antiviral treatments are even less effective. Adding Ban Lan Gen for antiviral treatment is sufficient; absolutely do not use Guan Zhong (Cynanchum), as it is particularly bitter and cold, harming the stomach. Of course, I also mentioned children. For children with colds, regardless of the season, do not forget to use Bao He Wan (Preserve Harmony Pill) to regulate digestion and stomach function; this is the key to improving efficacy. Thus, whether it is an external pathogenic disease, internal injury, deficiency, excess, wind-cold, wind-heat, or summer dampness, it is not difficult to manage. Therefore, TCM is particularly simple when I explain it. The diagnosis is based on the tongue; for a thin coating, tonify the kidney; for a greasy coating, treat phlegm and blood stasis together. Clearly distinguish the four main symptoms of external pathogenic diseases. Release the exterior, promote diuresis, and support the righteous qi. You can say that the efficacy is 70-80%. However, as a doctor, you must pay attention; do not let your head get hot and think your efficacy is perfect; that is a mistake. Patients who return for follow-up visits are effective; those who are ineffective do not return. You should have already considered that those patients who do not return indicate that your skills are not 100%, and you must continue to study. Additionally, do not boast about yourself; be humble.
I Declaration:
This article is selected from:《Shen Shao Gong Experience Collection》. The articles shared by this public account are for reference and learning purposes only. If there are any improper uses of the published content, please feel free to contact us. Please retain copyright information when reprinting.All formulas, herbs, and treatment methods mentioned in the text are for learning reference only; non-professionals should not attempt to use them!