Always Cold No Matter How Warm You Dress?
Patient search terms: fear of cold / always cold / aversion to cold / cold even in thick clothes / thick sweater in summer / cold hands and feet
Medical terms: aversion to cold · true heat with false cold · phlegm-heat obstruction · blood deficiency with liver fire · back boil (fabei)
Opening: feeling cold — does that really mean yang deficiency?
The moment someone says “I’m always cold,” the first word that pops into most people’s heads is yang deficiency (yang qi insufficiency). People with yang deficiency do feel cold — that’s true — so the instinct is to grab warming herbs and start tonifying. But the case Doctor Zhu Danxi tells today throws cold water on that reflex: feeling cold does not necessarily mean a cold pattern; sometimes the patient who feels cold actually needs cooling herbs, even an emetic. And the reverse is also true: feeling hot doesn’t always mean heat — sometimes those patients need tonics.
💬 Note from Doctor Luo: Doctor Zhu Danxi had a famous saying: “Aversion to heat is not heat; aversion to cold is not cold” — just because you feel cold does not mean your body is truly cold, and just because you feel hot does not mean you truly have heat. This case is a perfect demonstration of that idea.
The patient: a jinshi gentleman over thirty
The patient was Zhou Bendao, a jinshi (a holder of the highest imperial examination degree), just past thirty — in the prime of life, by all accounts. A man in his thirties should be burning with vitality, yet this gentleman had a strange complaint: aversion to cold — an unbearable, bone-deep chill.
Everyone around him took one look and said: cold? That’s obviously yang deficiency! So they gave him fu zi (aconite) — the fiercest warming herb in the pharmacopeia. Surely, they reasoned, this will warm him right up.
Worse the more warming herbs he took — what was going on?
The result? After several days of aconite, he was not better — he was worse, colder than ever. The family panicked and rushed to Doctor Zhu Danxi.
Doctor Zhu took his pulse and understood at once — the pulse was wiry and slow (xian er huan).
💬 Note from Doctor Luo: What is a wiry pulse? It feels like pressing on a taut zither string — tight and tense. People with yin deficiency or blazing liver fire often have wiry pulses. And “slow” here often points to phlegm — phlegm blocks the movement of qi and blood, so the pulse feels sluggish and stagnant. Put the two together and the clue jumps out: this man’s problem was never cold at all. The real culprit was phlegm-heat stuck inside his body.
The tongue confirmed it: his tongue body was red. A red tongue means heat inside. When phlegm and heat bind together in the interior, they block the channels, and yang qi cannot be transported to the surface — so the patient feels cold. This was false cold hiding true heat.
The masterstroke: a bowl of ginger juice with sesame oil — vomit!
Doctor Zhu did not write a warming formula. Instead he had the family prepare ginger juice mixed with a little sesame oil and poured it into Zhou Bendao. What for? To induce vomiting — to drive the phlegm clogging his body out through the throat.
Vomit he did — a great deal of thick, sticky phlegm, roughly one sheng (about one liter) of it. And then something remarkable happened: after vomiting, Zhou Bendao took off half his padded coat. The man who had been wrapped up like a dumpling in freezing weather suddenly shed half his layers — he simply didn’t feel so cold anymore. Zhou was delighted: “It works! It works!”
The phlegm is out, half the coat is off — but Doctor Zhu said: don’t celebrate yet
Doctor Zhu held up his hand. Don’t celebrate too soon.
💬 Note from Doctor Luo: Doctor Zhu said: inside you, “dry heat has already accumulated” — the phlegm-heat has been burning for a long time, quietly consuming your yin and blood, and your blood is now depleted. Why is the blood depleted? Excessive worry and excessive desire both secretly drain it. The phlegm was only the branch; blood deficiency and blazing fire are the root.
So what came next? Doctor Zhu gave two principles of daily cultivation: “Bland food to nourish the stomach; inner contemplation to nourish the spirit.”
What does “bland food to nourish the stomach” mean? Where does your qi and blood come from? From the spleen and stomach. Why do you have so much phlegm? Because you eat rich delicacies every day and clog your spleen and stomach. People who feast constantly are not necessarily robust — in fact they are often the most qi- and blood-deficient people of all: the spleen and stomach are blocked, the good food turns into internal garbage, and nothing gets absorbed. So at this stage he needed plain, light food — a bowl of congee, some radish and greens — letting the spleen and stomach slowly recover so qi and blood can return.
And “inner contemplation to nourish the spirit”? This man’s liver fire was blazing — that’s why his pulse was wiry. Liver yin insufficient, liver qi unexpressed, desires running wild: today he wanted to be a section chief, tomorrow a bureau chief, the day after a promotion and more money. When the mind churns, the liver qi knots up and the spirit scatters. Draw the desires back in, quiet the mind, and nourish the spirit. If you manage these two things, kidney water can be regenerated, yin blood can recover, and the false fire will naturally descend — “water can be generated, and fire can come down.”
The patient would not listen: “I want to be an official!”
The logic was sound, but Zhou Bendao “was fiercely devoted to advancement in office” — he was utterly committed to climbing the official ladder. He thought: what you say makes sense, I understand; but I’m one step away from becoming a department head — I have to keep pushing!
So the gentleman went right back to his busy rounds among high officials and great houses, leaving Doctor Zhu’s advice behind, observing none of the prohibitions.
💬 Note from Doctor Luo: Doctor Zhu predicted it on the spot: if you take good care of yourself, I can give you blood-nourishing, yin-moistening herbs and you’ll be fine. But if you stay restless inside and out — yin blood insufficient inside, false heat stirring, and outside you keep rushing around with blazing liver fire — kidney water will never regenerate, and in the future the “poison of aconite” is bound to erupt.
What is “the poison of aconite”? Aconite itself is toxic. If it isn’t decocted long enough, it causes numb lips, chest tightness, even life-threatening danger — that’s why it must always be boiled thoroughly. But what Doctor Zhu meant here — the ancients also called it “corrupting poison” (fu du) — was something deeper: your body already holds heat and fire; you should never have taken aconite. By wrongly using a warming herb, you fanned the internal heat hotter and hotter, and the poison it produced will sooner or later burst out through the skin — in the form of a boil.
The ending: three words, “hurry home” — and six months later, death from a back boil
Eventually Zhou Bendao’s illness did clear up, and he went off to serve as an official in another region. One bitterly cold day, while patrolling the city, he caught a chill. What do you do for a chill? Warm the yang, of course — and the most effective warming herb was still aconite. But the man had an odd quirk: he could not stand ginger — the way some people cannot stand cilantro, he wouldn’t touch it. So he used aconite alone; someone told him to boil aconite with slices of pork kidney, and after three doses he was well again.
As luck would have it, he ran into Doctor Zhu Danxi again. Doctor Zhu looked at him and said just three words: “Ke ji gui” — “Hurry home.”
💬 Note from Doctor Luo: What did that mean? Trouble was coming. The ancients held that “one should die in one’s hometown,” and Doctor Zhu was telling him to go home at once — he knew that with all the aconite this man kept taking, no yin-nourishing care, and endless travel and exertion, the poison of the aconite was about to erupt. But Zhou Bendao thought Doctor Zhu was being pedantic: “Old man, I don’t like what you’re saying!” Six months later, he died of fabei — a back boil.
What is fabei? A huge toxic boil that erupts on the back — heat and poison, congested qi and blood, swelling up enormously from the spine. In ancient times fabei could kill. Everyone knows that Fan Zeng, the “yafu” (second father) of the warlord Xiang Yu, died of a back boil; many famous figures of antiquity died of exactly this disease.
This is a failed case: Doctor Zhu cured his disease but could not save his life. The root of the illness was not in the body but in the mind — Zhou Bendao prized fame and profit so highly that he considered health something he could simply skip.
Lesson one: every illness is a warning sent to you
After telling this story, Doctor Luo Dalun reflected: I have seen many such patients. Every time you get sick, it means some part of your lifestyle — or your attitude toward life — has gone wrong. So the first thing to do when illness strikes is not to rush for a prescription, but to ask yourself: why did I get this illness? Serious illness, major illness, chronic illness — these are always tied to your eating habits, your sleep and rest, your level of exertion.
💬 Note from Doctor Luo: Every illness is a warning from heaven, asking you to reflect. But some people cling to me and won’t let go: “Doctor Luo, give me another formula — the last one worked wonders!” Then a month later they’re back for another formula, and this goes on for two or three years. Why? Their way of life hasn’t changed one bit. Problems pile up, and medicine can only solve the problem of the moment. If you won’t reflect and adjust, even a great physician like Doctor Zhu Danxi can’t save you. Doctor Zhu warned Zhou Bendao again and again — he even said “hurry home” in the end — and still he wouldn’t listen. He died of a back boil in the end. What a pity!
Lesson two: feeling cold is not always yang deficiency — my mother’s story
The second lesson is how to tell true cold from false cold. Some people who feel cold really do have yang deficiency — white tongue, diarrhea the moment they’re chilled — that’s genuine yang deficiency. But others have phlegm, dampness, or blood stasis clogging the channels, so qi and blood cannot reach the body surface, and they feel cold all the same.
Doctor Luo told his own mother’s story: years ago his mother developed chronic nephritis. Western medicine said it couldn’t be cured — it would progress to kidney failure, with hormone therapy the only path. At the time she feared cold terribly; in summer she wore a thick sweater. If you only looked at how much she wore, you’d say: warm the yang! — and warming the yang would have been wrong.
💬 Note from Doctor Luo: Back then I was in Beijing studying the kidney-disease approach of the old master Zhao Shaoqin — a great specialist in warm-pathogen (wen bing) medicine at Beijing University of Chinese Medicine. Master Zhao’s view: kidney disease is blood stasis and stagnant heat gathering in the kidney channel. Qi and blood are blocked throughout the body, energy cannot reach the surface, so the surface feels cold. This kind of cold is not yang deficiency — it’s stasis. So how did Master Zhao treat it? With cooling herbs to cool the blood — lu gen (reed rhizome) and mao gen (imperata root) — plus blood-activating, channel-opening herbs like dan shen (salvia) and qian cao (madder). A very small formula — just cooling the blood and resolving stasis. My mother drank it for a year. Day by day the layers of clothing came off; when the kidney disease was cured, she dressed exactly like a normal person and was never cold again. The classic mistake of past TCM kidney treatment was seeing a cold patient and assuming kidney-yang deficiency, then warming and tonifying — which left many patients uncured. And women whose hands and feet turn icy in winter are not all yang-deficient either: some have blood deficiency — not enough blood to reach the extremities; some have blood stasis. Each has its own treatment.
Lesson three: aconite is a fierce general — mishandled, it wounds
The third point concerns aconite (fu zi).
Used correctly, aconite warms the yang with excellent results. But even in ancient times a whole school of physicians kept a very cool head about it: not every disease needs warming. I’ve heard of people so fixated on aconite that they believed every illness should be treated with it — and ended up eating themselves to death, vomiting blood. Chinese medicine always works by pattern differentiation (bian zheng): if the pattern truly is cold, yang deficiency, then aconite warming it is fine. If you can nourish the kidney first — think of it as filling the fuel tank before striking the match — the effect is even better. But if the patient has yin deficiency, liver fire, or heat inside, warming is simply wrong.
💬 Note from Doctor Luo: There are techniques for using aconite too. Zhu Weiju, the famous Shanghai physician of the Republican era, always paired aconite with astringent herbs like long gu (dragon bone) and mu li (oyster shell) — restraining the medicine’s power so the fire doesn’t rage out of control. There are Sichuan doctors famous for aconite; look at their prescriptions and you’ll see they don’t start with aconite at all — first come sheng shan zha (raw hawthorn), ban xia (pinellia) and the like. Why? To open the body’s passages first — clear out the phlegm and dampness so the spleen and stomach can absorb, and only then add aconite gradually. If you warm immediately while phlegm and dampness are still clogged everywhere, you’re asking for trouble. I have personally seen someone eat aconite until a huge boil grew on his back — the phlegm-damp hadn’t been cleared, there was some liver fire underneath, and that combination cannot tolerate heavy aconite. So this fierce general can only be deployed after the pattern has been clearly identified.
Case transcribed from Doctor Luo Dalun’s public lectures on the case records of Doctor Zhu Danxi; source: the collected case records of Doctor Zhu Danxi.