Recently, there has been a significant increase in cases of cold and fever, some due to COVID-19, others due to influenza, and some simply from catching a cold. However, regardless of how Western medicine categorizes these diseases, in Traditional Chinese Medicine (TCM), we refer to them as 外感病 (wàigǎn bìng) (exogenous diseases).Due to drastic changes in weather, with unpredictable conditions, it is often cold in the morning but scorching by noon, or one day it is nearly thirty degrees Celsius, and the next day it is chilly with light rain. I also caught a slight cold in such unpredictable weather, but fortunately, after taking some Chinese medicine for a few days, I recovered.
A few days ago, after finishing my outpatient clinic, I suddenly received a WeChat message from a friend saying her husband was ill and she was unsure how to differentiate his condition. I readily agreed to help.She described her husband’s symptoms: fatigue, sore throat, dizziness, and neck pain. This is a typical case of 外感病 (wàigǎn bìng). In our classic text, 《伤寒论 (Shānghán lùn)》, it describes 太阳病 (tài yáng bìng) (Taiyang disease) as: “太阳之为病，脉浮，头项强痛而恶寒。”Here, it seems to match the symptom of neck pain, although the intensity of the pain is still uncertain. Therefore, it is highly likely to be a Taiyang exterior syndrome, but it may not necessarily be 伤寒 (shānghán) (cold damage). Since it is an exogenous disease, the patient is likely to have a fever, so I asked if he had a fever. She replied that he did not have a fever but felt very hot, with a burning sensation in his throat, and drinking water did not relieve his thirst. Additionally, she mentioned that the local temperature was 33 degrees Celsius. Given such hot weather, could it be heat stroke causing his dizziness, fatigue, and neck pain? It is indeed possible, and the patient specifically mentioned feeling like he had heat stroke. What does heat stroke feel like? Friends who have experienced it know that the main symptoms include dizziness, chest tightness, nausea, vomiting, fatigue, fever, and thirst. Looking at it this way, it does seem to fit.Next, we refer to Zhang Jingyue’s 十问歌 (shí wèn gē) (Ten Questions Song), which states: “The first question is about cold and heat, the second about sweating.” The situation regarding cold and heat is that the patient feels hot, but his body temperature is normal.Then I asked if he was sweating. Normally, one should sweat a little, but the patient reported no sweating. In such hot weather, not sweating suggests he is very hot, thus he is thirsty and prefers cold drinks, his urine is slightly yellow, and he has trouble sleeping with dry stools. I suddenly recalled a line from 《伤寒论 (Shānghán lùn)》: “不汗出而烦躁者” (Those who do not sweat and feel agitated), could this be a case for 大青龙汤 (Dàqīnglóng tāng) (Major Blue Dragon Decoction)?《伤寒论 (Shānghán lùn)》 is a classic text but can be difficult to understand. The prescriptions in 《伤寒论 (Shānghán lùn)》 are effective if used correctly, but if misapplied, they can lead to adverse reactions. For example, the text states that if 大青龙汤 (Dàqīnglóng tāng) is used incorrectly, it can cause “服之则厥逆，筋惕肉瞤” (taking it can lead to counterflow and muscle spasms), which is an adverse reaction. Therefore, one should not attempt to use the prescriptions lightly.Although the patient exhibited “不汗出而烦躁” (not sweating and feeling agitated), overall, it does not fit the criteria for 大青龙汤 (Dàqīnglóng tāng), but rather has some similarities.Looking at the patient’s tongue coating, it does not resemble that of a cold damage tongue; it appears more like a tongue indicative of damp-heat obstruction. From my series of thoughts above, it is evident that TCM’s classification of exogenous diseases is actually more precise and detailed than that of Western medicine, and it is closer to the essence of the disease. Symptoms of cold damage, heat stroke, and damp-heat can all manifest in the patient, so why can’t we clearly differentiate them? The reason is that these categories of diseases all belong to the Taiyang exterior syndrome, which share some common characteristics, leading to similarities and differences among the various types of exterior syndromes.In summary, my diagnosis for the patient is: 暑热犯表 (shǔrè fàn biǎo) (heat invading the exterior). Of course, heat can also fall under the category of warm diseases.The patient wanted to use Chinese patent medicine to resolve the issue, so I recommended some suitable options.The next morning, the patient had a low fever and asked if it could be COVID-19. I said it was possible. The patient went to the hospital for testing to see if it was COVID-19, but the results would not be available until the afternoon, so she decided to continue taking the Chinese medicine I prescribed.By the third day, the patient reported that after taking the Chinese medicine, she felt much better. I then asked if she had received an IV at the hospital. The patient said no, and the test results showed she was not positive for COVID-19. After taking the Chinese medicine, she no longer had a fever, her throat dryness and thirst had improved, and currently, she only had neck pain, slight dizziness, and a cough. I then suggested she adjust her medication.
Although this case does not have anything particularly special, in most cases of exogenous diseases, we often encounter wind-cold or wind-heat colds, while heat-invading exogenous diseases are relatively rare. Heat-invading colds are often seasonal, occurring during the hot summer months, and are similar to heat stroke but not entirely the same. Therefore, this is a relatively typical case of an exogenous heat syndrome.Having discussed a case of heat-invading exogenous disease, does this mean that in such hot weather, all our exogenous diseases must be heat syndromes? Must we always use cooling and detoxifying cold medicines to treat heat syndromes?Of course, if it is indeed an exogenous heat syndrome, we must use cold medicines. 《黄帝内经 (Huángdì nèi jīng)》 states: “热者寒之” (cool the heat with cold). While we do use cold medicines, we must be careful with the dosage; we cannot overuse bitter cold clearing medicines, as it may severely damage the Yang Qi. However, if the dosage is insufficient, it will be difficult to resolve the illness. Thus, the challenge in TCM lies in the “method” and the “degree”; if the method of medication is clear and precise, the therapeutic effect will be excellent.Looking back at exogenous diseases, I have encountered many cases of exogenous diseases even in hot summer weather where people still experience wind-cold.The specific reasons that may lead to wind-cold exterior syndrome include:First, significant local climate changes or temperature differences, such as a cold breeze in the morning followed by scorching heat in the afternoon, can easily lead to insufficient clothing and result in wind-cold exposure.Second, after the weather becomes hot, people often turn on air conditioning, and many times the temperature is set too low. After exercising or sweating, when the pores are open, external wind can easily invade, causing wind-cold exterior syndrome.Third, indulging in cold and raw foods can temporarily relieve discomfort from heat, but for those with weak spleen and stomach, especially children with poor digestion, consuming too many cold foods can cause the skin pores to close, preventing sweating when it should occur. This, combined with a humid and hot climate, can easily lead to fever. This is also a type of fever caused by cold syndrome.
Recently, I encountered a typical case of wind-cold induced exogenous disease. Initially, the patient’s husband fell ill and took medication, and then she suddenly noticed discomfort in her upper palate, feeling dry and painful. I prescribed some gentle dispersing Chinese medicine to eliminate the slight pathogenic influence she had contracted.The next day, the patient reported, “After drinking the Chinese medicine, I actually felt much better; the pain in my upper palate has eased, and I have no other discomfort symptoms. However, due to the hot weather, I sweated a lot, and after going out in the wind, I immediately experienced chills, headache, nasal congestion with yellow discharge, pain around the eyes, and cheekbone pain. I woke up in the middle of the night and took the Chinese medicine I prescribed, which slightly alleviated the symptoms. I asked if I needed to change the prescription or continue with the previous medicine. She said the previous Chinese medicine was quite effective.”I examined the patient’s tongue coating and advised her to add 白芷 (Bái zhǐ) (Angelica Dahurica) 10g to the original formula. However, the patient’s symptoms did not improve significantly; she still felt cold, had a runny nose, eye socket pain, and muscle soreness. I realized that while the direction of the medication was correct, the current situation was that the disease was severe and the medicine was too light, so it could not overcome the invading cold evil. Therefore, I changed the prescription to strengthen the warming and dispersing of cold, and after just one dose (to be taken in one day), the patient replied, “The effect is excellent; yesterday I was wondering if I had COVID-19, but today I feel much better, with symptoms improved by more than half, just a slight pain around the eyes and a bit of a runny nose and sneezing.” I then asked how she should take the medicine today, and I replied to continue taking the Chinese medicine, reducing the amount to two-thirds of the original dose.Of course, the hot weather has an impact, which is that it can transform heat. Even in cases of wind-cold colds, there is a possibility of transforming into wind-heat in hot weather, and this patient is no exception. After taking the warming medicine for wind-cold, many of the wind-cold symptoms improved, but later, signs of heat transformation appeared. This indicates that the disease’s progression is influenced by changes in the weather. As clinical practitioners, we only need to adjust the prescription accordingly upon observing these changes. Subsequently, the patient experienced nasal congestion, yellow discharge, dry and hoarse throat, and slight throat pain. I then advised the patient to stop the Chinese medicine and switch to 玄麦甘桔颗粒 (Xuánmài gān qí kè lì) (Xuanmai Ganqi Granules) combined with 银翘解毒丸 (Yínqiáo jiědú wán) (Yinqiao Jie Du Pills), and after two days of taking the patent medicine, she recovered.This case illustrates that even in hot summer weather, wind-cold colds can occur, but summer wind-cold colds can easily transform into heat and often present with mixed cold and heat syndromes. Regardless of which issue arises, we cannot simply treat cold or heat; we must clearly differentiate the degrees of cold and heat and prescribe medication accordingly. Most TCM enthusiasts or learners who cannot accurately differentiate can use 小柴胡汤 (Xiǎo Chái Hú Tāng) (Minor Bupleurum Decoction) when cold and heat are mixed, which should not pose significant problems, although the efficacy may vary from person to person. If the effect is not obvious, it is advisable to seek treatment from a reliable TCM practitioner.
Therefore, in TCM, regardless of the season, it is essential to differentiate between cold and heat, deficiency and excess, and to accurately diagnose in order to achieve good treatment outcomes. Treatment should not be biased; it is not the case that summer must always be a heat syndrome, nor that summer exogenous fevers must always be heat syndromes. While heat syndromes are more common, cold syndromes also exist. We must grasp the core concept of TCM treatment—辨证论治 (biàn zhèng lùn zhì) (differentiation of syndromes and treatment)—to truly help patients solve their problems.