Always Feel Like You Have a Cold That Won’t Go Away? Doctor Gong Tingxian’s Treatment of Deficiency Fever Mistaken for Wind-Cold
Opening: a man of rank, sick as if with a cold
Today’s story features Doctor Gong Tingxian — the imperial physician of the Ming dynasty’s Tai Hospital whom the Prince of Lu honored with the plaque “Number One Scholar of the Medical World” (yi lin zhuang yuan), and who himself lived to the age of 97. What was Doctor Gong best at? Tonification. His signature move was supporting the upright — building the body’s own strength.
The patient was Lord Liu of Lake Tai (Taihu shui xian). What office that title actually denoted, Doctor Luo says even a web search cannot confirm — it was most likely a respectful way of referring to a man of rank and standing in the Lake Tai region, the sort of honorific no ordinary person would receive. And why was he ill? Four words: overwork (lao yi tai guo). He had been extraordinarily busy and hard-pressed lately — simply worn out.
💬 Note from Doctor Luo: An illness brought on by exhaustion and a cold caught from wind are two completely different things. Unfortunately, they look almost identical — and today’s story is about how to tell them apart.
Symptoms like a cold — and the doctors called in treated it as one
Lord Liu’s illness ran like this: fever with chills — the body feels hot as if feverish, and at the same time he dreaded the cold; headache and body ache — pain in the head, pain all over; dry mouth and thirst, plus a touch of nausea and irritability.
Look at that: fever, chills, headache, body ache — isn’t that plainly external wind-cold? That is exactly what the previous physicians thought. The first doctor prescribed Qianghuo Tang (Notopterygium Decoction) to scatter the wind-cold outward. The second, seeing the nausea, prescribed Huoxiang Zhengqi San (Agastache Upright-Qi Powder). And the result? Not only no improvement — the patient only grew weaker.
💬 Note from Doctor Luo: Qianghuo Tang and Huoxiang Zhengqi San are both qi-moving, dispersing formulas. When the body’s upright qi (zheng qi) is already insufficient, using these medicines to scatter the qi outward and waste it only leaves you with even less — that is not treatment, it is adding frost to snow.
The illness then turned sharply for the worse: aching exhaustion — a sour, miserable soreness; hands and feet with nowhere to rest — the limbs felt as if they had no place to put themselves; heart racing and mind confused; sleepless day and night; restless whether sitting or lying; and finally unable to take even soup or water — vomiting at the very smell of medicine. The spleen and stomach had stopped transporting and transforming altogether.
Doctor Gong arrives: one touch of the pulse, and everything was clear
The family hurriedly summoned Doctor Gong Tingxian. He laid his fingers on the pulse: all six positions surging and large (liu mai hong da), beating with abnormal force. Then the right-inch qi-kou pulse — tight and full (qi kou jin sheng).
Doctor Gong declared on the spot: “This is internal injury of the primordial qi” (ci nei shang yuan qi ye). Not external contraction — internal injury. The primordial qi was gravely damaged!
💬 Note from Doctor Luo: With that single sentence, we are squarely on Doctor Li Dongyuan’s path. In his Bian Huo Lun (Treatise on Distinguishing the Delusions of Internal and External Injury), Li Dongyuan drew the line between internal injury and external contraction with absolute clarity, and later physicians were enormously influenced by him. Doctor Gong paid special attention to exactly this pulse technique — he opens his mouth with “what about the qi-kou pulse, the qi-kou is tight and full” — this is the signature skill of the Li Dongyuan school.
Internal injury or external cold? The eight diagnostic methods handed down from Doctor Li Dongyuan
The soul of this article is Li Dongyuan’s method for distinguishing internal injury from external contraction. Doctor Luo has laid out all the key points:
First — the pulse: renying versus qikou. The inch position of the left wrist is called renying (the “man’s greeting” pulse), the right wrist qikou (the “qi gate”). If the left renying pulse is larger than the right (one to two times larger, or even more), it is external contraction. If the right qikou is tight and large (one to two times larger than the left), it is internal injury.
Second — the chills. In external contraction, the cold is so severe that even a fire cannot warm it — set the patient beside a brazier and he still shivers under a quilt. Internal-injury chills are different: go into a shady place, a sunless room, under an air conditioner, and the cold immediately comes; but step into a warm room, put on a coat, pull up a blanket, and the cold is gone at once.
Third — feel the palms and the backs of the hands. In internal injury, the palms are hot and the backs of the hands are not. In external wind-cold, the reverse: the backs of the hands are hot and the palms are not.
Fourth — the mouth and the nose. Internal injury is damage to the spleen and stomach, so the problems show in the mouth: saliva is copious, the voice is weak and low, speech is an effort — the patient does not want to talk. A little clear nasal discharge may or may not be present; it is not the main issue. External contraction injures the lung and the skin — it must show in the nose: a thick nasal tone, a blocked nose, clear or yellow discharge.
Fifth — the headache. The internal-injury headache comes and goes — it hurts for a while, eases, then hurts again. The external-contraction headache is continuous — a real, unrelenting ache. The location of the headache also fixes the location of the disease: pain on both sides is shaoyang, pain at the crown is jueyin, pain at the forehead is yangming, pain at the back of the head is taiyang — and the back of the head, the taiyang, usually means external cold.
Sixth — the body ache. In internal injury it is weakness and slackness of the four limbs — that sour, heavy, aching tiredness. The spleen qi is insufficient to fill the limbs, which is why “the hands and feet have nowhere to rest.” In external contraction it is joint and muscle pain — it hurts to move at all, far more severe.
Seventh — the appetite. The internally injured patient has no appetite at all and detests food — he cannot taste anything, nothing looks appetizing, he simply does not want to eat. Lord Liu, unable to take soup or water and vomiting at the smell of medicine, was at the stage where the body could no longer transform anything and was refusing food outright. The externally contracted patient, though unable to eat, does not detest food — the moment the body recovers a little, he hungers ravenously. After a cold has eased slightly, some people suddenly crave something sour or spicy; there is desire. The internally injured have no such desire.
Eighth — ask about thirst. Fresh external wind-cold does not cause thirst; after about three days, when the pathogen enters the interior (for instance into the yangming), great thirst begins — a strong desire to drink. Internal injury in most cases does not thirst — the exhaustion has gone on so long that dampness in the body cannot be transformed and carried away; offer him soup and it will not even go down, and one sip of medicine makes him retch.
💬 Note from Doctor Luo: There is one exception — if an internally injured person’s heart fire is especially strong, with yin fire riding upward and fire toxin blazing, then he will thirst and want to drink, and letting him sip some water slowly is good for him. Apart from that, internal injury is basically thirst-free.
Why did he only grow weaker with treatment? — that “deficiency fire” at work
Where did Lord Liu’s restlessness, racing heart, confusion and sleepless nights come from? Li Dongyuan explained it thoroughly: when the spleen and stomach weaken, primordial qi becomes insufficient, and heart fire alone blazes; yin fire rises from the lower burner, and the minister fire (the fire of the lower burner’s pericardium) rides up with it. This kind of “deficiency fire” rushing upward is what makes a person hot, vexed, and utterly unsettled. That is why the case records of Doctor Xue Lizhai are full of patients exactly like this — treated by tonifying yang and tonifying the spleen, gradually bringing the deficiency fire back down.
💬 Note from Doctor Luo: This deficiency fire is a master of disguise — it presents like external contraction, complete with mental agitation and palpitations, but the truth is the body’s fire has simply not returned to its proper place. Tonify the spleen and stomach, and the fire goes home by itself.
The prescription: Buzhong Yiqi Tang as the base, four herbs each doing its job
Doctor Gong prescribed Buzhong Yiqi Tang (Tonifying the Middle and Replenishing Qi Decoction) — Li Dongyuan’s immortal formula, treasured by every physician who came after him. Doctor Gong included it in his own medical writings, recorded all of Li Dongyuan’s modifications in full, and added his own experience on top — which shows how thoroughly he had mastered it.
The formula itself tonifies qi and lifts the yang. On top of that, he added four herbs:
- yuanzhi (polygala root) — settles the spirit and stills the mind. Lord Liu’s heart was racing; this is the herb that calms the heart and fixes the spirit;
- suanzaoren (sour jujube seed) — nourishes liver blood, nourishes the blood and calms the spirit;
- zhuru (bamboo shavings) — clears deficiency heat, clears heat and transforms phlegm;
- maimendong (ophiopogon tuber) — nourishes yin.
💬 Note from Doctor Luo: Look at the composition — Buzhong Yiqi Tang tonifies qi and yang as the base, paired with yuanzhi to settle the spirit, suanzaoren to nourish liver blood, zhuru to clear deficiency heat, and maimendong to nourish yin. Tonifying with clearing, yang carrying a thread of yin — it targets precisely the complicated situation of “dual deficiency of qi and yin with lurking deficiency fire.”
One dose, deep sleep; waking at midnight: “Yunlin, how marvelous!”
The medicine went down, and a miracle happened. Lord Liu, who had not slept for days, fell into a deep sleep on the first dose. Waking in the middle of the night, he spoke a sentence that would live forever: “Yunlin miao zai! Yao yong dang ru tong shen, bu zhi bing zhi he suo qu ye” — “Yunlin, how marvelous! The medicine works as if touched by the gods — I do not even know where the illness has gone!”
Who was “Yunlin”? That was Doctor Gong’s own style name — Yunlin Shanren (the Hermit of Cloud Forest). Put plainly, Lord Liu was saying: Doctor Gong, you are too brilliant! This medicine is miraculous — I have no idea how the illness disappeared!
The next morning he took a second dose, and he was cured.
💬 Note from Doctor Luo: Most of the illness gone the first night, completely gone the next morning — it looks miraculous, but the reasoning is simple: the deficiency fire was drawn back, the upright qi was restored, the qi mechanism resumed its work, the spirit was no longer disturbed — and the disease simply left. When Chinese medicine matches the pattern, it works like this.
What this teaches us: people who always feel they have a cold may well have internal injury
The greatest value of this story is one reminder: some people feel they have a cold all the time — especially the elderly — but it is not a cold, it is internal injury. Internal injury wears the mask of external contraction: fever, chills, headache, body ache. At such a moment the right move is to support the upright; using exterior-dispelling medicines instead only wounds the upright qi further. People say “my cold has not cleared up in two months” — think about it: since when does a cold drag on for two months? That is a deficiency disease, a wasting disease!
💬 Note from Doctor Luo: If the main complaint is a pronounced sensitivity to cold on the body surface, in most cases it is spleen qi deficiency with sinking of middle qi — the spleen earth generates the lung metal, so when spleen qi is deficient the lung defensive qi (wei qi) is deficient, and the body surface breaks down. The root may lie in kidney qi, but treatment must start by switching on the spleen: once the spleen starts working, nutrients can be absorbed, the upright qi has a source — and only then will things slowly improve. So tonifying the spleen is the priority.
What do you use to tonify the spleen? Buzhong Yiqi Tang is the single most important approach — it lifts the qi upward. There is also its streamlined cousin — Shengxian Tang (Lift the Sunken Qi Decoction), the formula of Doctor Zhang Xichun: it focuses more tightly on the heart and lung function, and for many people whose qi sinks and whose heart-lung function falters, it works immediately.
💬 Note from Doctor Luo: In some people the signs are subtler — just assorted spleen-qi deficiencies. For instance, as mealtime approaches you get palpitations, cold sweat, and hunger so fierce you are about to collapse — we call it low blood sugar, but actually it is spleen deficiency with sinking of middle qi. Western medicine says blood sugar is low or the pancreatic islets are dysregulated — but in fact the pancreas overlaps considerably with the Chinese “spleen.” Such people, given a little Buzhong Yiqi (in pill form), stop having these episodes. The same goes for people whose voice gives out when they speak, or who feel dizzy the moment they stand up — the medicine restores them remarkably fast.
How should you take Buzhong Yiqi Wan? Doctor Luo’s own experience: the label says eight pills — you can take more; even a whole bottle cap’s worth is fine — because the amount you drink in a decocted soup is far larger than eight pills, and the tiny pill dose simply does not reach effective strength. Take it once, and the symptoms often vanish at once.
What does a qi-deficient person look like? Heavy tooth marks (scalloping) along the edges of the tongue, a swollen, puffy tongue, copious saliva on it, a pale tongue color; a hoarse voice; frequent hunger; dizziness on standing up; a flustered heart and unsettled mind; a constant feeling that you cannot sit still; breath that leaks away as you talk; walking along and suddenly the breath will not come up — these are, by and large, insufficiency of primordial qi, injured spleen and stomach, sinking of middle qi.
Bonus: why are so many people qi-deficient these days?
Doctor Luo closes with a sigh: qi-deficient people are everywhere now. Stress and anxiety make the liver qi run rampant across the spleen earth, and the spleen and stomach are wounded; indiscriminate feasting wrecks the spleen and stomach; overwork injures them too. Once the spleen and stomach are hurt, the primordial qi is hurt, the middle qi sinks — people like Lord Liu are, in fact, extremely common: worn out, then fever, chills, headache, dry mouth, irritability — all the deficiency symptoms come pouring out.
💬 Note from Doctor Luo: For such people, Buzhong Yiqi Tang is a magic weapon, a talisman. When I get the chance I will summarize the symptoms of Buzhong Yiqi Tang the way I did for Shengxian Tang, so everyone can check themselves against it. One sentence to sum up: if you feel your upright qi is insufficient, you are qi-deficient and exhausted, your voice gives out when you speak, and your tongue has heavy tooth marks on the edges — learning about Buzhong Yiqi can only do you good, never harm.
Compiled from Doctor Luo Dalun’s commentary on Doctor Gong Tingxian’s case records; the case comes from Doctor Gong Tingxian’s medical writings.