Colds That Come Back Again and Again and Never Fully Clear? Doctor Miao Xiyong’s Case of Repeated External Contraction in a Qi-Deficient Patient (Baihe Disease) — One Dose Cured

Patient search terms: colds that come back again and again / a cold that never fully clears / better one day, sick the next / never fully recovered after a major illness / something off all over

Opening: better, then sick again — on and on without end

In the Ming dynasty there lived a famous physician named Doctor Miao Xiyong, a native of Changshu in Jiangsu and one of the founding masters of the warm-disease (wen bing) school. He practiced medicine with something of the knight-errant’s flair — he made his house calls on a fast horse, and in a single day and night he could cover enormous distances. A physician carried about in a sedan chair could only reach patients within a few li; Doctor Miao rode, so the circle he could serve was far wider.

💬 Note from Doctor Luo: I have written about Doctor Miao Xiyong before — the name I gave him was “the knight-errant physician” (xia yi): superb skill, and a chivalrous heart to go with it. Physicians like that are rare. Today’s case is exactly worthy of his gallant reputation.

In Changshu there lived a certain Mr. Wujian, who was residing as a guest in the capital region — at that time, the actual capital was Nanjing (the Ming dynasty kept Nanjing as its secondary capital). Someone in his household came down with cold damage (shang han), and the illness was cured — but within a couple of days it relapsed. It was treated again and got better, then two days later it came back. And so it went: better, then sick again; sick, then better — back and forth, no one could count how many times, and the illness simply refused to leave for good.

💬 Note from Doctor Luo: This kind of cold — coming back again and again, lingering without ever fully clearing — is extremely common today. Plenty of people recover from a cold but never quite feel like themselves again; it drags on for two or three months, and something is off all over. This case is about exactly that, so it concerns all of us.

Who was the patient: a Donglin man vouches — only Doctor Miao can save him

The Zhao family of Changshu was one of the great local clans. The head of the family, Lord Zhao Wenyi, belonged to the Donglin faction and was a close friend of Doctor Miao Xiyong. He came to Doctor Miao and said: “This illness, no one but you can save; and the others would not even go.” — Only you can treat this; even if we invited anyone else, they could not cure it.

💬 Note from Doctor Luo: Those Donglin literati respected Doctor Miao Xiyong like an elder brother. Lord Zhao Wenyi was the father of Zhao Kaimei — the man who later printed the Song edition of the Shang Han Lun (Treatise on Cold Damage). The Zhao family of Changshu had deep ties with Doctor Miao that ran through generations.

At once Doctor Miao spurred his horse and rode off — and examined the patient on the spot.

How sick was he: a sallow pale face, a blocked chest, and constipation

The patient’s complexion was yellow-white — almost no color in the face; his six pulses were faint and weak — the pulse was very feeble; his bowels did not move; his chest was not comfortable (xiong zhong bu kuai) — tight and oppressed, as if blocked; and he turned his mind away from food (zhuo yi bu si shi) — he simply did not want to eat, no appetite at all.

💬 Note from Doctor Luo: Every one of these symptoms is a clue. The yellow-white complexion — yellow points to spleen deficiency, white points to qi deficiency — you can see at a glance this is deficiency. The six pulses faint and weak: upright qi is insufficient. As for the tight, oppressed chest — many people assume it means qi is stagnated and blocked, but that is not necessarily so. This is deficiency with qi congestion (xu er qi yong): your qi is deficient, too weak to drive the movement of qi and blood, so the qi stagnates right where it is — and that is why you feel the oppression. It is just as the later Doctor Zhang Xichun taught about great qi sinking downward (da qi xia xian): some people feel the qi in their chest cannot rise freely and it seems stuffy, assume it is blockage, and go for formulas that “free the flow” — and the treatment makes things worse. In truth the qi is genuinely deficient.

And why was his stool not moving? A prolonged illness consumes and damages the body fluids. When the fluids inside the body run short, it is like a river with no water — the boats simply cannot move. Add to that the weakness of qi, with no strength to push, and the stool naturally fails to pass. No water, no power — constipation is the inevitable result.

What Doctor Miao saw: this is a “miscarried lily-disease case after cold damage”

Doctor Miao looked at him and said at once: this is shang han baihe huan zheng — a cold-damage illness that has turned into a miscarried lily-disease case — and the pathogen was about to retreat.

💬 Note from Doctor Luo: “Lily disease” (baihe bing) comes from Zhang Zhongjing’s Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet). What is lily disease? It is the condition that follows a major illness, when upright qi is insufficient and qi and yin are both injured — yin deficiency above all, with deficient heat (xu re) smoldering inside, so that the whole body feels wrong in every way. Its most prominent symptom is mental confusion and restlessness: the heart is unsettled, the spirit is dazed and miserable — it belongs to the emotional-psychological category of disorders.

Zhang Zhongjing summarized lily disease very precisely: “In lily disease, the hundred vessels share one root” (bai mai yi zong) — the lung governs the hundred vessels, and all the vessels spring from one source; when the lung is ill, the hundred vessels suffer along with it. The concrete manifestations: “wanting to eat, yet unable to eat” (yi yu shi fu bu neng shi) — hungry but cannot get food down; “wanting to lie down, yet unable to lie down” (yu wo bu neng wo) — sleepy but cannot sleep; “wanting to walk, yet unable to walk” (yu xing bu neng xing) — wanting to move but the legs will not carry you; feeling as if cold yet not cold, as if hot yet not hot; bitter taste in the mouth and reddish urine (kou ku, xiao bian chi); a faint, rapid pulse (mai wei shu); and vomiting easily after taking medicine (“getting the medicine, then violent vomiting and diarrhea” — de yao ze ju tu li); the whole person miserable as if possessed by spirits (“as if there were a spirit” — ru you shen ling zhe), and yet when you look at the body there is no major lesion to find.

💬 Note from Doctor Luo: Why is it called lily disease? For one thing, “the hundred vessels share one root” supplies the character “bai” (hundred); for another, every treatment formula features the herb bai he (lily bulb) — Baihe Zhimu Tang (Lily and Anemarrhena Decoction), Baihe Jizi Tang (Lily and Egg Yolk Decoction), Baihe Dihuang Tang (Lily and Rehmannia Decoction), Baihe Huashi San (Lily and Talc Powder)… Zhang Zhongjing left behind a whole string of lily formulas. Lily clears heat from the heart and lung and nourishes yin; paired with ji zi huang (egg yolk) it nourishes yin even better: boil the lily, beat in the egg yolk and stir — that is Baihe Jizi Tang.

The prescription: three herbs, just three

By the book, lily disease should be treated according to pattern with one of the lily formulas — for clear deficient heat with marked yin deficiency, the choice would be Baihe Dihuang Tang (Lily and Rehmannia Decoction): lily plus a large amount of sheng di (raw rehmannia), together with sheng mu li (raw oyster shell), hua fen (trichosanthes root) and shi hu (dendrobium) to nourish yin, fu xiao mai (unripe wheat) to settle the spirit, and gan cao (licorice).

But Doctor Miao did not copy the book. The prescription he gave this patient was extraordinarily simple — just three herbs:

• Ren shen (ginseng), 5 qian (about 15 g) — after a major illness the qi is deficient; this supplements qi;
• Mai men dong (ophiopogon), 1 liang (about 30 g) — nourishes yin and generates fluids;
• A small amount of chao zhi ke (stir-fried bitter orange) — regulates the qi and clears out that little bit of congestion stuck in the chest.

💬 Note from Doctor Luo: This is the mark of a master. Doctor Miao studied Zhang Zhongjing superbly, but what he grasped was the way of thinking, not the rote formulas. When a deficient person catches colds over and over, the root of the disease is simply insufficient upright qi: supplement qi when qi is deficient, nourish yin when yin is deficient, and add one qi-regulating herb — the zhi ke — to smooth out the stuffiness. One dose down, and the illness was cured.

The stroke of genius: ren shen with mai dong — the very longevity formula of the Qianlong Emperor

Have you noticed? Ren shen paired with mai dong is exactly the base of Sheng Mai Yin (the Pulse-Engendering Drink — Sheng Mai San plus one more herb, wu wei zi / schisandra). Ren shen supplements qi and is slightly warming; mai dong nourishes yin and generates fluids — one yin, one yang, balanced with perfect gentleness. Want to substitute American ginseng (xi yang shen)? No — American ginseng is cool in nature, and you cannot strike this balance with it.

💬 Note from Doctor Luo: Speaking of Sheng Mai Yin, here is something amusing: the Qianlong Emperor drank this every single day. I have gone through the Qing palace meal records, and every morning Qianlong’s first bowl was bird’s nest soup, and before every meal two dishes always featured bird’s nest — bird’s nest stewed with duck, bird’s nest this, bird’s nest that, as fixed as iron. Besides bird’s nest, from about age forty on, every day he took one qian (3 g) of ginseng with one qian (3 g) of mai dong — that is Sheng Mai Yin — day in, day out; he also ate some Ba Zhen Gao (Eight-Treasure Paste), which likewise contains ginseng. Qianlong lived to 89 — the longest-lived of all Chinese emperors (among ancient rulers, only that Egyptian pharaoh at 90 outlived him by a single year) — and to manage the affairs of an empire all day yet live so long, the four characters “supplement qi, nourish yin” deserve a large share of the credit.

A bonus story: the Song edition of the Shang Han Lun and Zhao Kaimei’s library

Why did Doctor Miao Xiyong understand Zhang Zhongjing so deeply? When he was young, his neighbors — the Zhao family of Changshu — had members who served as high officials at court; after returning home they built a library, stocked with books of every kind, and hidden among them was a Song-dynasty edition of the Shang Han Lun. The master of the house, Zhao Kaimei (the son of Lord Zhao Wenyi), had it printed in facsimile of the original — the Zhong Jing Quan Shu (The Complete Works of Zhongjing).

💬 Note from Doctor Luo: The true Song original vanished long ago, but Zhao Kaimei’s printing was so faithful that later generations simply called it the “Song edition” (Song ben). Today only four or five copies of this “Song edition” survive in the whole world, scattered across different countries — hard even to see. Doctor Miao Xiyong was a friend of Zhao Kaimei and often went to the Zhao house to borrow books; he studied seriously and corrected his texts against the Song edition, and so he did real work on the Shang Han Lun. But when he treated patients he never applied it mechanically — everything rested on pattern differentiation.

Commentator’s note: when a deficient person keeps catching colds — support the upright qi!

The lesson of this case is wonderfully practical: many people who have been through an external contraction or an epidemic never fully recover; they always feel something is off — not that every episode is severe, but the cold sensation never quite leaves: one moment afraid of cold, the next moment vexed; wanting to walk but unable to move; wanting to lie down but unable to rest; miserable enough that their mood begins to suffer.

💬 Note from Doctor Luo: In such an early age, Zhang Zhongjing described the misery of this deficient state in such detail — truly remarkable. What do you do about it? Support the upright qi (fu zheng) — supplement qi where qi is deficient, nourish yin where yin is deficient; once the upright qi is made sufficient, those symptoms dissolve on their own. This patient is a perfect example: Doctor Miao’s single dose cured him, and after the consultation he mounted his horse and rode off — gallant and chivalrous, the very bearing of the “knight-errant physician.”

Based on Doctor Luo Dalun’s narration of Doctor Miao Xiyong’s medical cases; the case comes from Xian Xing Zhai Yi Xue Guang Bi Ji (《先醒斋医学广笔记》 — Notes from the Studio of Fresh Awakening on Broad Medical Learning) by Doctor Miao Xiyong (Ming dynasty).