Dr. Liu specializes in treating exogenous febrile diseases, particularly in the management of colds and influenza. His unique insights span diagnosis, treatment principles, prescriptions, and medication.（一）Principles and Methods, Respecting the ClassicsFirstly, Dr. Liu’s understanding of colds and influenza is deeply rooted in classical texts. The “Nanjing – Difficulties 58” states: “There are five types of cold damage: wind stroke, cold damage, febrile diseases, damp-warm diseases, and warm diseases.” This indicates that TCM’s concept of cold damage broadly encompasses all exogenous febrile diseases. Therefore, Dr. Liu believes that colds and influenza also fall under this broad category. Secondly, in diagnosis and treatment, Dr. Liu adheres to Zhang Zhongjing’s six meridian differentiation, particularly focusing on treating Taiyang (Greater Yang) diseases. In his prescriptions, he often selects formulas from the “Shang Han Lun” (Treatise on Cold Damage). In the “Medical Cases of Liu Huimin,” 12 cases of colds and influenza are recorded, with 10 prescriptions derived from Zhang Zhongjing’s formulas such as Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), Da Qing Long Tang (Major Blue Dragon Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Ge Gen Tang (Kudzu Decoction), and Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). This demonstrates Dr. Liu’s emphasis on classical texts and his adept use of classical formulas.（二）Respecting Tradition but Adapting FlexiblyDr. Liu does not rigidly adhere to ancient texts but rather adjusts prescriptions based on symptoms, demonstrating flexibility in treatment. For instance, for patients with severe chills, he combines Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig) and adds Qiang Huo (Notopterygium) to enhance the dispersing effect; for cough with phlegm, he often uses Jie Geng (Platycodon) and Chuan Bei Mu (Fritillaria) combined with Xing Ren (Apricot Kernel) to stop cough and resolve phlegm; for sore throat, he employs Jie Geng and She Gan (Belamcanda) to clear the lungs and benefit the throat; for loss of appetite, he prefers Shen Qu (Massa Fermentata) and Mai Ya (Barley Sprout) to aid digestion and strengthen the stomach; if a child has a high fever that does not subside, fearing that excessive heat may induce convulsions, Dr. Liu often selects Gou Teng (Uncaria) and Bo He (Mint) to clear heat and cool the liver, stopping convulsions, effectively “cutting off” the disease progression.In addition to adjusting prescriptions based on symptoms, Dr. Liu also creates new formulas inspired by classical ones, embodying the concept of “spiritual resemblance.” For example, in the “Medical Cases of Liu Huimin,” he has developed three formulas for treating colds or influenza: Gan Mao Tui Re Tang 1, Gan Mao Tui Re Tang 2, and Wai Gan Ke Sou Fang. For Gan Mao Tui Re Tang 1, the formula includes Ma Huang, Xuan Shen (Scrophularia), Ge Gen, Sheng Shi Gao (Gypsum), Shan Yao (Chinese Yam), Gou Teng, Bo He, Jie Geng, She Gan, Chai Hu (Bupleurum), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube), which has the effects of dispersing the exterior, reducing fever, clearing lung qi, and benefiting the throat, primarily treating colds or influenza with symptoms of persistent fever, stiff neck, body aches, chills without sweating, and sore throat with cough. This illustrates Dr. Liu’s adeptness in using classical formulas, whether in “form resemblance” or “spiritual resemblance.”（三）Effective Use of Strong Sweating AgentsDr. Liu believes that in exogenous febrile diseases, patients have not been afflicted for long, and their righteous qi is generally not deficient. Therefore, the focus should be on dispersing the exterior and expelling pathogens, often adhering to the principle that “treating exogenous diseases is like commanding an army; it is crucial to be decisive and vigorous.” He generally advocates the use of strong sweating agents to expel pathogens. In Dr. Liu’s book “Selected Essentials of TCM for Cold Damage Diseases,” he lists three commonly used representative formulas for treating Taiyang diseases: Modified Gui Zhi Tang, Modified Ma Huang Tang, and Modified Ge Gen Tang.1. Modified Gui Zhi Tang: Gui Zhi 12g, Ma Huang 9g, Bai Shao (White Peony) 18g, Xing Ren 12g, Sheng Shi Gao 24g, Zhi Mu (Anemarrhena) 12g, Shan Yao 30g, Sheng Jiang 9g, Da Zao 5 pieces.2. Modified Ma Huang Tang: Ma Huang 12g, Gui Zhi 9g, Xing Ren 12g, Bai Shao 12g, Ban Xia (Pinellia) 9g, Fang Feng (Siler) 9g, Sheng Shi Gao 30g, Shan Yao 36g, Jie Geng 10g, Sheng Jiang 9g.3. Modified Ge Gen Tang: Ge Gen 15g, Ma Huang 9g, Gui Zhi 9g, Zhi Mu 12g, Sheng Shi Gao 24g, Shan Yao 30g, Bai Shao 12g, Sheng Ma (Cimicifuga) 9g, Gan Cao 3g, Sheng Jiang 9g, Da Zao 5 pieces.In all three formulas, Ma Huang and Gui Zhi are used together. Ma Huang is well-known for its strong sweating power, as noted in the “Shen Nong’s Materia Medica” which states that it is “more potent than those with strong qi.” The “Materia Medica on Harm and Benefit” praises it for being “light and dispersing, with the fastest effect in inducing sweating,” and Zhang Xichun even calls Ma Huang “the chief herb for inducing sweating.” When combined with Gui Zhi, the effect of dispersing and relieving the exterior is enhanced. Moreover, the dosages of these two herbs are relatively large, and they are paired with Sheng Shi Gao to strengthen the effect of dispersing and expelling pathogens, making them indeed strong sweating formulas.Furthermore, Dr. Liu believes that even if children suffer from exogenous diseases, if the condition is severe, adult dosages can be used for treatment. For instance, Dr. Liu once treated an 11-year-old patient with a cold, presenting with chills, fever, body aches, nasal congestion, runny nose, no sweating, cough, bitter mouth, nausea, loss of appetite, yellow urine, dry stool, yellow tongue coating, and a floating rapid pulse. Dr. Liu diagnosed it as exogenous wind-cold with lung and stomach heat accumulation, indicating that the treatment should focus on inducing sweating and relieving the exterior while clearing lung and stomach heat. The prescription included Ma Huang 9g, Qiang Huo 6g, Chai Hu 9g, Gui Zhi 9g, Bai Shao 12g, Shan Yao 30g, Zhi Mu 15g, Sheng Shi Gao 24g, Chao Xing Ren 9g, Zhu Ru (Bamboo Shavings) 9g, Sheng Jiang 6g, Da Zao 4 pieces, and Zhi Gan Cao 6g, decocted in water for oral administration. In this formula, Ma Huang and Gui Zhi work together, with Chai Hu and Qiang Huo assisting in dispersing the exterior and expelling pathogens; Sheng Shi Gao, Zhi Mu, and Zhu Ru are used together to clear lung heat and stop nausea, indicating that all selected herbs are potent. Additionally, the dosages of the herbs are all at the levels commonly used for adults, demonstrating a strong efficacy. After taking one dose, the patient sweated, the fever subsided, and the body temperature returned to normal.However, in treating exogenous febrile diseases, Dr. Liu does not always use strong and harsh formulas; he often adjusts based on the severity of the condition, using heavier herbs for severe cases and lighter herbs for milder cases. He places great emphasis on the influence of seasonal climate on diseases, advocating for timely adjustments. For example, in winter, when the pores are closed, Dr. Liu will heavily use Ma Huang, Gui Zhi, and Qiang Huo to induce sweating; in spring or autumn, he often uses Ge Gen, Bo He, and Su Ye (Perilla Leaf), and even when using Ma Huang, he uses it in smaller amounts; in summer, he commonly uses Xiang Ru (Elsholtzia) and Fu Ping (Duckweed) for gentle sweating.（四）Emphasizing Simultaneous Exterior and Interior Resolution, and the Effective Use of Sheng Shi GaoBased on years of clinical experience, Dr. Liu believes that early-stage exogenous febrile diseases are not limited to exterior symptoms. Particularly for patients whose fever does not subside after taking medication, it is often due to unresolved exterior pathogens that have transformed into interior heat, accompanied by varying degrees of interior heat. If one only focuses on resolving the exterior, the interior heat will remain unresolved; conversely, if one only clears the interior, the exterior pathogens cannot be expelled. Therefore, Dr. Liu emphasizes the need to “clear interior heat while dispersing the exterior” to achieve simultaneous resolution of both. The prescriptions not only use Ma Huang and Gui Zhi to disperse the exterior but often combine Sheng Shi Gao and Zhi Mu to clear the interior. For instance, the commonly used formulas by Dr. Liu, such as Da Qing Long Tang, Ma Huang Xing Ren Gan Cao Shi Gao Tang, and those recorded in “Selected Essentials of TCM for Cold Damage Diseases” like Modified Gui Zhi Tang, Modified Ma Huang Tang, and Modified Ge Gen Tang, are all formulas that achieve simultaneous resolution of both exterior and interior. Dispersing the exterior aids in clearing the interior, and clearing the interior benefits the dispersing of the exterior; the two complement each other. Thus, the simultaneous resolution of both exterior and interior is Dr. Liu’s most frequently used method for treating exogenous febrile diseases and is one of his diagnostic and therapeutic characteristics.From his prescription practices, it is evident that Dr. Liu not only uses herbs that induce sweating and disperse the exterior but also frequently employs Sheng Shi Gao. Sheng Shi Gao is cold in nature, clears heat, and drains fire, making it a key herb for treating intense interior heat. The “Medical Records of Traditional Chinese Medicine and Western Medicine” states that it “cools while dispersing, having the power to penetrate the exterior and resolve muscle heat,” further explaining that “by expelling heat from the exterior, Sheng Shi Gao can help the internal heat to escape through the pores.”Dr. Liu studied and worked at the Lida TCM Hospital founded by Zhang Xichun in his early years, thus his use of Sheng Shi Gao was greatly influenced by Zhang. Sheng Shi Gao, being pungent and cold, helps to disperse heat and clear interior heat. “Its pungent, dispersing, and cooling nature can assist Ma Huang and Gui Zhi in reaching the exterior, while also transforming the heat accumulated in the chest into sweat, allowing it to escape with Ma Huang and Gui Zhi” (as noted in the “Medical Records of Traditional Chinese Medicine and Western Medicine”). When Ma Huang and Gui Zhi are combined with Sheng Shi Gao, they induce sweating without causing excessive heat; conversely, Sheng Shi Gao, when combined with Ma Huang and Gui Zhi, clears interior heat without the risk of excessive cooling. Therefore, the combination of Sheng Shi Gao with Ma Huang and Gui Zhi achieves the goal of simultaneous resolution of both exterior and interior.In the “Medical Cases of Liu Huimin,” a total of 12 cases of “colds and influenza” are recorded, with Sheng Shi Gao used in 11 cases, and the dosage varying between 12-24g based on the severity of the condition. This indicates that the frequent and heavy use of Sheng Shi Gao is another characteristic of Dr. Liu’s treatment of exogenous febrile diseases.（五）Emphasizing the Importance of the Spleen and Stomach, and Constantly Protecting Stomach QiIn treating colds, influenza, and other exogenous diseases, Dr. Liu advocates for expelling pathogens as the primary focus, often using strong medications such as Ma Huang, Gui Zhi, and large doses of Sheng Shi Gao. However, if not careful, this can lead to excessive sweating that harms body fluids or coldness that damages the stomach. TCM believes that the stomach qi is fundamental; with stomach qi, one lives; without it, one dies. Dr. Liu also emphasizes that the spleen and stomach are the foundation of postnatal health and are indeed the source of fluid production. Therefore, in clinical practice, Dr. Liu pays attention to both the compatibility of herbs and the method of administration.While using Ma Huang, Gui Zhi, Sheng Shi Gao, and other herbs that disperse the exterior and clear the interior, he often combines them with Huai Shan Yao (Chinese Yam). This herb is sweet and neutral, and it is recorded in the “Shen Nong’s Materia Medica” as being effective for “injuries to the middle, replenishing deficiency, eliminating cold and heat pathogens, and strengthening qi and muscle.” The “Compendium of Materia Medica” also states that it can “benefit kidney qi and strengthen the spleen and stomach.” Shan Yao nourishes the spleen and stomach, preventing excessive coldness from Sheng Shi Gao from harming stomach qi. Additionally, Dr. Liu often uses Shan Yao in larger quantities than Sheng Shi Gao, reflecting his emphasis on the spleen and stomach.Moreover, Dr. Liu emphasizes protecting stomach qi in the method of administration. He instructs patients to “drink a bowl of hot rice soup after taking the first dose of medicine, and then take the second dose half an hour later to induce sweating,” and he writes this instruction in detail on the prescription. This method imitates Zhang Zhongjing’s practice of using congee after Gui Zhi Tang to induce sweating. The reasons are twofold: first, to use the essence of food to warm the middle burner, ensuring that sweating has a source without harming the spleen, stomach, body fluids, and yang qi; second, to fill the stomach qi, invigorating the stomach qi to assist the defensive yang in expelling pathogens. This demonstrates that in treating colds, influenza, and other exogenous febrile diseases, Dr. Liu uses strong medications while also protecting the righteous qi, expelling pathogens without harming the righteous.Dr. Liu emphasizes treating Taiyang diseases primarily, effectively using strong sweating agents, advocating for early-stage resolution of both exterior and interior, and frequently using and emphasizing the importance of Sheng Shi Gao while also protecting the spleen and stomach. These insights provide valuable experience for our understanding and treatment of exogenous febrile diseases.Source: “Experience Records of Nine Renowned Doctors from Shandong University of Traditional Chinese Medicine,” edited by Liu Yu.
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