An Epidemic That Swelled People’s Faces Shut

Opening scene: when the plague came, how did the ancients respond?

💬 Note from Doctor Luo: Today we continue the story of Doctor Li Dongyuan — this time, his treatment of an epidemic. Why this topic? Because the pandemic situation remains serious: cases abroad keep climbing, and at home it isn’t completely over. Don’t let your guard down. The more you understand about external-contraction diseases, the better prepared you are — a little extra knowledge never hurts.

The story takes place in April of the second year of Taihe (1202), when Doctor Li Dongyuan was a young man. He had just finished his medical studies under his teacher Zhang Yuansu. His family was the wealthiest in Hebei, so they bought him an official post in the usual way of the time — a tax-collection post in Jiyuan.

💬 Note from Doctor Luo: Note the season: April, the time when cold and heat alternate — and in Jiyuan, “the people were sick in great numbers” — an epidemic had broken out.

How sick were people? Heads swollen like “big-head dolls”

The symptoms of this epidemic:

• At first, chills and a heavy body — fear of cold, the whole body heavy and weak
• Swollen head and face — the external pathogen moved inward, the head and face swelled, the tonsils inflamed, the whole face following suit — swollen until the eyes could not open
• Labored breathing — struggling to catch the breath
• Throat obstruction — the throat swollen and painful, deeply uncomfortable
• Dry tongue and mouth — the mouth so dry there was no saliva (heat inside the body steaming the fluids away)

This was what the old books called “Da Tou Tian Xing” — the “Big-Head Epidemic”; “tian xing” (heavenly epidemic) is the classical term for an infectious disease. It was extremely contagious — one case would spread to a whole region.

💬 Note from Doctor Luo: Don’t imagine the ancients knew nothing about isolation. The records of the time say “relatives did not visit each other” — families were forbidden to exchange visits, people stayed home as much as possible, exactly like our lockdowns today. The ancients were clever. And the disease itself: “those who caught it mostly could not be saved” — the mortality rate was very high.

The wrong treatment: a mediocre doctor purged the patient toward death

A local gentleman named Zhang had a nephew who caught the disease. By the fifth or sixth day, a doctor was called. The doctor gave Chengqi Tang (a purging formula) plus ban lan gen (isatis root) — purging downward to drain heat and resolve toxin.

The patient improved a little, then the next day relapsed to the same state. The doctor purged again; the patient eased again, then promptly worsened — purged repeatedly, treated and treated, getting worse all the while, until finally the patient was near death.

💬 Note from Doctor Luo: At that point someone remembered: the tax official Li Dongyuan (styled Li Mingzhi) had studied medicine and studied it well — ask him to come look. And so Doctor Li was summoned.

Pattern analysis: the evil heat is up above, and you’re bombing your own side below

Doctor Li listened to the whole story and quoted the Neijing:

“Above the midpoint of the body is the qi of Heaven; below the midpoint is the qi of Earth. This evil heat has lodged between the heart and lungs, and attacks upward to the head and eyes, causing the swelling.”

💬 Note from Doctor Luo: This is the hallmark of the Li Dongyuan school — the human body corresponds to Heaven and Earth and the four seasons. The half of the body above corresponds to Heaven, the half below to Earth. Why is this patient’s face and head swollen, the throat obstructed, the breathing labored? Because the evil heat is lodged between the heart and lungs, attacking upward to the head and eyes — the disease is located in the upper burner!

And what did the mediocre doctor do? Purged downward — attacking the lower burner (the spleen-stomach). This is like a battle: the enemy is outside the trenches, and your artillery is shelling your own positions, blowing up your own soldiers. The spleen-stomach had committed no crime (“attacking a place that has done no wrong”), yet he wounded the upright qi — so the illness grew steadily worse.

The correct approach is precise targeting — every shell hits the enemy, and your own side is protected. So Doctor Li wrote one of the most famous formulas in Chinese medicine: Puji Xiaodu Yin (Universal Salvation and Detoxification Drink).

The prescription: Puji Xiaodu Yin — a battle formation with precise divisions of labor

The structure of this formula is remarkably clear — like an army with well-defined units:

Group One: the monarch herbs — drain the heat between heart and lungs (the main force)

Precise targeting: isn’t the heat between the heart and lungs? Scutellaria clears the lung, coptis drains the heart — the two monarch herbs directly extinguish the heat-toxin of the upper burner.

Group Two: the minister herbs — drain fire and support qi (logistics and support)

💬 Note from Doctor Luo: This group is “drain fire and support qi as the ministers.” When treating an epidemic you cannot only attack the toxin — you must preserve the upright qi. Ginseng at 3 qian, the heaviest dose in the formula, exists precisely to support the upright (the famous Renshen Baidu San, Ginseng Toxin-Dispelling Powder, follows the same logic). But ginseng tonifies and can easily feed fire, so it is paired with ju hong to regulate and disperse the qi, xuan shen to nourish yin, and licorice to harmonize — ginseng + tangerine peel + scrophularia + licorice is itself a gentle, upright-supporting formula in miniature.

Important note: modern textbooks have removed the ginseng from Puji Xiaodu Yin — that is wrong! Doctor Li’s original formula contains ginseng, and the version compiled by his disciple Luo Tianyi also contains ginseng. Remove the ginseng and you lose the core idea of “preserving the upright qi.”

Group Three: the assistant herbs — dissipate swelling, resolve toxin, calm breathing (the assault squad)

💬 Note from Doctor Luo: This group is “dissipate swelling, resolve toxin, calm breathing as the assistants,” working with the monarch herbs to attack the toxin. A few fine points:

• Niu bang zi works best fried and then crushed — Doctor Zhang Xichun always wrote “stir-fry and crush” next to burdock seed, a wonderfully meticulous touch (raw burdock seed won’t crush; once fried to fragrance it crumbles easily).
• Ma bo (puffball) is a fungus. Pharmacies find it troublesome and cheap, so they often don’t stock it — if you ever see a pharmacy selling puffball, buy some to keep at home, because this formula can rarely be filled completely without it. In my experience, without the puffball the effect drops noticeably — puffball is indispensable in this formula.
• Doctor Zhang Xichun often paired Chinese yam with burdock seed for cough after a cold — the same idea of tonifying the spleen plus resolving toxin and benefiting the throat.

Group Four: the envoy herbs — airlifting the troops up high (precision guidance)

💬 Note from Doctor Luo: The disease is located in the upper burner (corresponding to Heaven), so the medicine must be lifted upward. Sheng ma lifts the stomach channel qi, chai hu lifts the gallbladder channel qi, and jie geng is the herb Zhang Yuansu specifically singled out as traveling only upward, never downward — these three are like helicopters or troop transports, ferrying the medicine to the upper burner for battle. The whole formula: monarch herbs lead the charge, minister herbs guard the logistics, assistant herbs storm the strongholds, envoy herbs provide navigation — clean structure, each unit doing its job.

How to take it

Grind into fine powder. Half is taken mixed with hot water; half is made into honey pills held in the mouth to dissolve slowly (the throat is full of heat-toxin — let it dissolve gradually).

The result

The patient recovered. Doctor Li sighed: “The dead cannot be pursued; those who come after can still be saved.” So he had the formula carved onto a stone tablet and set by the roadside, to be handed down forever. At the time, “very many were saved alive,” and everyone said, “this formula is the greatest under Heaven.”

Modifications and aftercare

💬 Note from Doctor Luo: The formula can be adjusted: add fang feng (siler), bo he (mint), chuan xiong (ligusticum), and dang gui (angelica) (to disperse the pathogen and nourish the blood); if the stool is dry, add wine-processed da huang (rhubarb) (its nature is gentler). But for most epidemics, when the formula matches the pattern, the effect is excellent.

Caution: this formula is quite cold in nature (plenty of cooling herbs). After the heat-toxin is cleared away, you can use warm tonics such as Fuzi Lizhong Wan (Aconite Center-Regulating Pill) to regulate the body afterward.

Bonus: Doctor Luo’s personal experience — his trump-card formula

💬 Note from Doctor Luo: I deeply admire this formula — it is my trump card:

• Once, while lecturing in another city — heavy smog, exhausting travel — my throat swelled so badly I lost my voice, and I was due to lecture the next day; people had come from far and wide. I quickly got this formula and drank it. The next day my voice was back and I gave the lecture as planned.
• I keep this formula saved in the notes on my phone. Thousands of people in my social circles ask me questions every day; when someone has heat-toxin congesting, I copy it out, adjust it to the situation, and send it over.
• When should it be used? Not for an ordinary cold (that would be too cold — for ordinary heat symptoms, a little Three-Bean Drink or umeboshi sugar water is enough). Use it when heat-toxin is congesting — the throat badly swollen, high fever, heavy heat-toxin in the head and face. Then one or two doses will turn the situation around immediately.

Today this formula is still used for mumps, tonsillitis, head-and-face heat-toxin, and high fevers. A formula written by a Jin-dynasty doctor, still in use today — that is what a classic is.

Case source: Lan Shi Mi Cang (Secrets from the Orchid Chamber) by Doctor Li Dongyuan (compiled by his disciple Luo Tianyi); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).