Always Feel Like Catching a Cold, Sneezing in the Wind With a Clear Runny Nose?
Patient search terms: always feel like catching a cold / always catching colds / pseudo-cold / fear of wind and cold / sneezing / clear runny nose / sneezing when cold wind blows
Medical terms: spleen-lung qi deficiency · wei qi failing to secure the exterior · deficiency-type external contraction in a weak person (after mistreatment the case briefly resembled an impending stroke)
Opening: there is a kind of “cold” you have never actually caught
Let me ask you a question first: when a cold wind blows, do you sneeze, get a clear runny nose, and shiver all over — thinking to yourself, “oh no, I’m catching a cold again”? But then a couple of warm days pass and you seem fine; you take some random medicine and it clears up. Then the cold wind blows again, and you “catch a cold” once more — over and over, so that in a single month you “catch a cold” several times.
💬 Note from Doctor Luo: Someone told me once, “I catch a cold four times a month.” I honestly didn’t believe he was really catching colds — once a week? How could that be? What he actually had was a state: it looks like a cold, but it isn’t one. The case we tell today, from the Ming-dynasty imperial physician Doctor Xue Lizhai, is exactly about this kind of thing.
Who was the patient? A Confucian scholar who studied himself weary
Doctor Xue Lizhai was the director of the Imperial Academy of Medicine (tai yi yuan yuan zhang) in the Ming dynasty, born into a family of imperial physicians. In his lifetime he left behind more than three thousand case records — one of the most prolific case-record writers in all of Chinese medicine. Today’s case is very short, and very interesting.
The patient was a ru zhe (儒者) — a Confucian scholar, a man of books. The original case record opens with one line: “Yi ru zhe su qin ku — a scholar reported that he had long been diligent and hard-working.” What does that mean? It means the man had spent all his effort, day in and day out, on the imperial examinations and on study, wearing himself down with constant labor of the mind.
💬 Note from Doctor Luo: Doctor Xue Lizhai had a habit when seeing patients — he looked at the person first: what was his way of life, what state was he usually in? This scholar’s daily grinding study consumed his heart blood and also wounded the qi of his spleen and stomach. That had everything to do with the illness that came later.
Three symptoms: fear of wind, clear nasal discharge, chills and sneezing
What were this scholar’s symptoms? First, wei feng han — aversion to wind and cold: he was always afraid of wind and cold; when the cold wind came, he could not bear it. Second, bi liu qing ti — a clear runny nose. Third, han jin pen ti — chills and sneezing: he constantly felt cold, shivered a little, and then the sneezes came one after another.
💬 Note from Doctor Luo: Everyone, take note — there is a rule to a runny nose: if what flows out is clear — thin and transparent, like the white of an egg — then you should know this is a cold pattern; it is only when the discharge is yellow and thick that it is a heat pattern. A person like this today would often be labeled with “allergic rhinitis” at the hospital — sneezing all day, clear snot running, and antihistamines not helping much. Doctor Xue Lizhai did not see it that way at all.
Doctor Xue Lizhai saw it at a glance: spleen-lung qi deficiency, unable to secure the interstices
Doctor Xue Lizhai’s diagnosis was a single sentence: “This is spleen-lung qi deficiency, unable to secure the interstices (ci pi fei qi xu, bu neng shi cou li ye).” — The qi of the spleen and the qi of the lungs are both insufficient; upright qi cannot fill the surface of the body; the interstices (cou li, the spaces of the skin and flesh) are not secure; and the defensive strength is weak.
💬 Note from Doctor Luo: Why do you sneeze and “catch a cold” the moment the wind blows? It is not because the external pathogen is terribly fierce — it is because your own defenses are empty. Upright qi is insufficient, the wei (defensive) qi cannot secure the exterior, and no one is guarding the border, so when the enemy comes even a little close, you react enormously.
The patient did not believe it: it must be wind pathogen — dispel the wind!
By rights, once the imperial physician had seen it so clearly, the patient should simply have taken the prescription. But this scholar did not believe it. He thought: I fear wind and cold, so wind pathogen must have entered — I should dispel the wind and scatter the pathogen (shu feng san xie)! So he took wind-dispelling, pathogen-expelling herbs (qu feng san xie zhi yao) on his own.
And the result was disastrous — zhi ti ma juan: his arms and legs grew more and more weak and numb; tan xian zi chu: phlegm began oozing out of his mouth on its own; and he looked as though he were about to have a stroke.
💬 Note from Doctor Luo: Famous physicians being doubted by their patients — this happened quite a lot in ancient times; Doctor Zhang Xichun ran into it too. Look at this man: the moment he “expelled the pathogen” himself, he nearly collapsed. This is the part of the whole case most worth pondering: why did the wind-dispelling herbs, which looked exactly right for the symptoms, ruin the man?
Doctor Xue Lizhai’s second judgment: the wind herbs dissipated the yuan qi
Doctor Xue Lizhai looked again and broke it down in one phrase: “This is because the wind herbs dissipated the yuan qi (ci yin feng yao hao san yuan qi).” — The wind-dispelling, pathogen-expelling herbs had scattered and wasted his primal qi. He also quoted Doctor Li Dongyuan: “Because fire is exuberant, earth is deficient (yin huo sheng er tu xu).”
💬 Note from Doctor Luo: Doctor Xue Lizhai was enormously influenced by Doctor Li Dongyuan, and the formulas he used were often Doctor Li’s. This phrase “because fire is exuberant, earth is deficient” — once the upright qi is dissipated, deficiency fire flares up, and the spleen and stomach (earth) become even more deficient. One tonify or one drain — a hair’s breadth apart, a thousand miles of difference.
A comparison: when provisions run short, soldiers have to fight on grass roots
Why do pathogen-expelling herbs consume the yuan qi? There is a wonderful comparison for this.
💬 Note from Doctor Luo: Think of a country. When its economy is strong and its granaries are full, sending troops out to fight is a pleasure — the soldiers fight splendidly! But now your provisions are short, and the soldiers still have to fight — and fighting consumes provisions. With grain running out, the soldiers can only gnaw grass roots and go to war. Can such a war go well? So dispelling pathogens is absolutely not something that costs nothing — it needs a source of energy. Before you use wind-dispelling, pathogen-expelling herbs, you must first weigh the question: is the upright qi sufficient or not? Some people see only the pathogen — fear of wind and cold, therefore wind pathogen — and write a fierce prescription, and the result is that they wound the upright qi and the disease grew worse.
The prescription: Bu Zhong Yi Qi Tang plus Mai Men Dong and Wu Wei Zi
The formula Doctor Xue Lizhai wrote: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) plus Mai Men Dong and Wu Wei Zi. The thinking is perfectly clear — Bu Zhong Yi Qi Tang tonifies the qi of the spleen and stomach and lifts the clear qi upward; Mai Men Dong (ophiopogon tuber) enriches yin and moistens dryness, moistening the lungs and generating fluids; Wu Wei Zi (schisandra fruit) is sour in nature, and sourness astringes — it draws back the yuan qi that was on the verge of being scattered. Treat it this way, and the patient recovered.
💬 Note from Doctor Luo: You see — one tonify, one moisten, one astringe: three layers. Bu Zhong Yi Qi Tang supports the upright, Mai Men Dong moistens the lungs against dryness, Wu Wei Zi astringes the yuan qi — and, on top of that, Wu Wei Zi can nourish all five viscera (its name means “five flavors”). The prescription was written with effortless mastery — the patient took it and the illness was cured.
What is a “pseudo-cold”? Deficient upright qi is the key
The state Doctor Xue Lizhai described surrounds us everywhere — elderly people, children, weakened middle-aged people who always feel on the verge of catching a cold, who live in a constant “cold state”: no fever, yet always cold-like; the moment the cold wind blows, they feel finished.
💬 Note from Doctor Luo: At times like this, if you keep thinking “I’ve caught a cold, I must expel the pathogen,” and take cold medicines, detoxifying medicines, things that scatter outward — that is wrong! Deficient upright qi is the key. When upright qi is insufficient, the wei qi cannot secure the exterior, and the body surface puts on a show that looks like external pathogen invasion — in reality, you yourself have gone “empty”; the external pathogen only needs to creep in a little, and you react enormously. What you should do at such times is strengthen the upright (fu zheng): once the upright qi is topped up, the wei-protecting qi becomes firmer, the interstices fill up, external pathogens cannot get in, and the cold-like symptoms naturally vanish. When we drink a little Chinese yam powder (shan yao fen) in daily life, or use the Bu Zhong Yi Qi line of thinking, it is the same principle — after strengthening the upright, a light sweat may come: that is a sign the qi and blood are flowing freely, not that the medicine chased the pathogen out, but that your own body has reinforced the defenses along the border.
A misconception: can you take tonics during a cold?
Taking this case as an occasion, there is a widely circulated saying that deserves criticism.
💬 Note from Doctor Luo: A lot of medicine package inserts today say: tonics are forbidden during a cold. I think that is very unscientific and does not accord with the principles of Chinese medicine. Some colds arise precisely because the upright qi is insufficient — it is because the upright qi is insufficient that the external contraction happens — and at that very moment you need to tonify! Ren Shen (ginseng), Shan Yao (Chinese yam), Huang Qi (astragalus) can all be used during a deficiency-type external contraction — you simply pair them with a few pathogen-expelling herbs. Once the upright qi is sufficient, the pathogen can truly be driven out — that is the reasoning of Chinese medicine.
Closing: when the pathogen is exuberant, expel it; when the upright is deficient, support it — three thousand cases from Doctor Xue Lizhai, worth savoring slowly
This case is small, but the principle in it is not. After studying this case, what should we remember? Weigh the relationship between the upright and the pathogen: sometimes the pathogen is truly exuberant, and of course you must dispel wind and scatter the pathogen; but sometimes the case is genuinely one of deficient upright qi, and supporting the upright may be the more crucial move. Doctor Xue Lizhai looked at the person first — his way of life, his usual symptoms — and judged that the root of this man’s illness was not “the pathogen keeps sitting at the surface” but “the upright qi keeps staying weak,” and the supporting-the-upright approach came up immediately.
💬 Note from Doctor Luo: A physician like Doctor Xue Lizhai — an imperial physician, director of the Imperial Academy of Medicine — left more than three thousand case records in his practice, and they could not be written carelessly: every one of them concerns people with faces, names, and titles. Such case records are especially worth researching. When you have a free moment, savor them, mull them over — there is a great deal of flavor in them.
Organized from Doctor Luo Dalun’s lecture on Doctor Xue Lizhai’s case records; the original case is from 《薛氏医案》 (Doctor Xue’s Case Records, by Xue Ji of the Ming dynasty).