Cold With Sweating and Aversion to Wind? Doctor Xu Shuwei Prescribed Guizhi Tang (Cinnamon Twig Decoction) — the First Formula of the Shanghan Lun
Patient search terms: cold / cold with fever / sweats at the slightest movement / afraid of drafts / stuffy nose / slightly nauseous / wind-cold external contraction
Medical terms for this condition: Taiyang zhongfeng (wind strike on the Taiyang channel) · exterior deficiency pattern of cold damage · early stage of an externally-contracted illness
Opening: we begin the first case of the first case-study classic of the Shanghan Lun
Starting today, Doctor Luo Dalun is going to walk us through a remarkable book — the Shanghan Jiushi Lun (Ninety Discussions on Cold Damage) by Doctor Xu Shuwei. This is the first case-study collection in the history of Chinese medicine devoted entirely to treating illness with the formulas of the Shanghan Lun (Treatise on Cold Damage). Doctor Xu recorded ninety cases in which he used Zhang Zhongjing’s classical formulas, one case with one discussion per entry — enormously valuable material. Through this book, Doctor Luo wants to talk properly about the formulas of the Shanghan Lun and show us what Zhang Zhongjing’s way of treating illness actually was.
And when you open the book, the very first entry is — Case One: Distinguishing the Use of Peony in Guizhi Tang.
💬 Note from Doctor Luo: The Shanghan Jiushi Lun is the first case-study collection in Chinese medicine devoted to the Shanghan Lun. As everyone knows, the Shanghan Lun is the clinical foundation of Chinese medicine — the roots of all later pattern-based diagnosis and treatment lie here. We’ll use this book to discuss the thinking behind the cold-damage formulas, and we start with this very first case.
Who was the patient? In the spring of the gengxu year, Ma Hengdao caught a cold
The patient’s surname was Ma, and his name was Ma Hengdao. The year was gengxu, and it was spring. In spring the weather turns warm, then cold again — and Ma Hengdao came down with an externally-contracted illness and began to run a fever. Then his head ached.
The symptoms went on from there: his nose was blocked, and his nose made a sound — in Zhang Zhongjing’s original text this is called “bi ming” (nasal humming); he felt slightly nauseous, discomfort in the stomach with the urge to retch upward — the original calls this “gan ou” (dry retching); and then the two most important signs: spontaneous sweating (zi han) and aversion to wind (e feng).
💬 Note from Doctor Luo: The two characters “bi ming” have been explained differently by later schools. My own experience: when the nose is blocked, if you blow hard, sometimes it opens up a little and makes a whistling sound — that’s the “ming”. Anyone who has had a cold will recognize the feeling. It’s different from plain nasal congestion: congestion means completely blocked; bi ming means you can force it open a little, with a sound.
How sick was he? Sweating at the slightest movement — the most crucial detail of the whole case
The words “zi han” (spontaneous sweating) — everyone must remember them. What does spontaneous sweating mean? You sweat with the slightest movement; the sweat just pours out on its own. Many people are in exactly this state at the very start of a cold: they sweat a lot, one small movement and they’re covered in sweat. This is the central feature of the Guizhi Tang pattern.
And then there’s e feng — aversion to wind, fear of drafts.
💬 Note from Doctor Luo: In the Guizhi Tang pattern, spontaneous sweating is the core point — remember it, and in a moment I’ll explain why. Zhang Zhongjing’s original text puts it beautifully: “In Taiyang zhongfeng, the yang is floating and the yin is weak. When yang floats, heat issues of itself; when yin is weak, sweat comes out of itself.” — one is “heat issues of itself,” the fever; the other is “sweat comes out of itself,” the sweating; and there you have the syndrome. And then “se she e han, xi xi e feng” — that describes the fear of cold and wind you feel when external evil has just attacked. In northeastern dialect you’d say it’s that shivery, draft-fearing, don’t-want-any-air feeling.
What Doctor Xu thought: isn’t this exactly the Guizhi Tang pattern? — and what “tang zheng” (decoction pattern) means
Doctor Xu Shuwei looked at the symptoms and strung them together: fever, headache, nasal congestion, dry retching, spontaneous sweating, aversion to wind — wan ran gui zhi zheng ye — it is unmistakably the Guizhi Tang pattern.
Here we should explain what makes the Shanghan Lun so fascinating: Zhang Zhongjing built a system of pattern diagnosis that uses a cluster of symptoms to locate the state of a person’s body and to locate which formula should be used. When the “decoction pattern” (tang zheng) evidence for a formula is complete, using that formula works exceptionally well. For example, the symptoms corresponding to Guizhi Tang — Doctor Xu essentially wrote them all out here.
💬 Note from Doctor Luo: Note that Chinese medicine’s pattern diagnosis distinguishes “zheng” as in evidence (症, the symptoms taken as evidence), not just scattered “symptoms.” These symptoms don’t appear in isolation — they appear together, as a cluster called a “zheng hou” (syndrome). When I was a child I watched my mother take pulses, and she’d rattle off a list: “Is your mouth bitter? Is it dry? Do you feel like retching? Is your head dizzy?” People would marvel: how can you be so accurate? My mother taught me: because these symptoms appear together as a group! You name one, the patient matches; you verify the next, and it’s all there — then you can locate what illness it is.
Formula breakdown: the first formula of the Shanghan Lun, simple enough to be just five ingredients
The prescription was written — Guizhi Tang (Cinnamon Twig Decoction). This is the very first formula in Zhang Zhongjing’s Shanghan Lun, which shows how much importance he attached to it. And how simple is it? Just five ingredients:
Gui zhi (cassia twig) 3 liang, shao yao (peony root) 3 liang, zhi gan cao (honey-fried licorice) 2 liang, sheng jiang (fresh ginger) 3 liang (sliced), da zao (jujube) 12 pieces (broken open).
That’s all. The first formula of the Shanghan Lun.
💬 Note from Doctor Luo: The dosage of Guizhi Tang is a matter of great care. Zhang Zhongjing’s “liang” used the Han dynasty weights and measures. Later, archaeologists dug up actual Han dynasty weighing instruments, and it turns out one liang was equivalent to about 15 grams in today’s terms — so 3 liang per the original would be nearly 50 grams! No later physician dared use that much; the usual conversion is 3 qian, about 9 grams. When I prescribe Guizhi Tang, I generally use about 30 grams of gui zhi, 30 grams of shao yao, and 20 grams of honey-fried licorice, and the key is to drink it in small bowlfuls. The way you drink it is what matters: after one small bowl, you must take a small bowl of warm congee, then watch to see if you sweat. If you sweat, stop taking the rest of the medicine; if you haven’t sweated, continue — the goal is a light sweat, no more. Each person’s constitution differs, so how much you drink varies. Don’t obsess over the dosage — just remember those four characters: “yi han wei du” (stop at sweating).
The twist: in the chaos of war, there was no peony to be bought
The formula was settled — but at exactly that moment, something went wrong: the medicine couldn’t be bought.
Doctor Xu Shuwei was living in Zhenzhou (today’s Yizheng, Jiangsu) at the time. That period happened to coincide with rebel soldiers attacking the city: a cavalry band led by a man named Zhang Yu — a mix of Northern Song deserters and local bandits — was marauding through the region, and they had already breached the city of Yizhen, three days ago. In that chaos, Doctor Xu went to the pharmacy to fetch the herbs — Guizhi Tang has just three principal medicinals, gui zhi, shao yao, and honey-fried licorice — and the peony was nowhere to be found (si wu shao yao, “in all four directions, no peony”)!
What to do? Doctor Xu turned around and walked out to his own garden to pick the peony himself.
💬 Note from Doctor Luo: Doctor Xu Shuwei’s family garden had peony growing in it. Even today, if you go to Yizheng, the peonies there are famous — they cover the hillsides, absolutely gorgeous. Back then Doctor Xu simply went into his own garden and picked fresh peony to complete the prescription — a solution forced on him by the chaos of war.
The turnaround: red peony? “This is exactly the right one to use!”
The peony was gathered — but someone nearby raised an objection. Another physician said:
“That’s red peony (chi shao)! We always use white peony (bai shao) in Guizhi Tang — how can red peony be used?”
White peony and red peony — these are two different medicinals, and Guizhi Tang had always used white peony. How could you use red peony?
Doctor Xu Shuwei answered crisply: “Ci zheng dang yong!” — “This is exactly the right one to use!” — I precisely want to use red peony here!
So the medicine was completed. He drank it. The first time, no sweat came; he drank again, and this time a light sweat broke out over his body. The external evil was released, the exterior pattern resolved, and the illness was cured.
💬 Note from Doctor Luo: Think about it — there’s nothing in Guizhi Tang that clears heat or resolves toxin, so how can it treat a cold so miraculously? My own experience: seize the first moment! When you’ve just caught wind-cold and you’re still in the Guizhi Tang pattern stage, if you use it promptly, it basically solves the problem in one dose. This is no joke. A later physician, Wang Qingren, once said, “I have never seen Guizhi Tang cure a single patient with an external contraction.” I honestly don’t understand why he said that — in my own practice, I’ve really seen it work in essentially one go. The key is timing: at the very onset, with a light sweat, drink it and you’re better.
The finishing touch: Doctor Xu left a question — white peony or red peony in Guizhi Tang?
The illness was cured. But Doctor Xu used this case to raise a question that has echoed for a thousand years.
When Zhang Zhongjing wrote Guizhi Tang, in nine out of ten mentions he simply wrote “shao yao” — peony. White or red? He didn’t say. By Doctor Xu Shuwei’s era, the pharmacies’ peony had already split into white peony (bai shao) and red peony (chi shao): the general view was that red peony leans toward moving and freeing what’s blocked, while white peony leans toward nourishing and supplementing. So which one belongs in Guizhi Tang?
Two official pharmaceutical texts each took a different side: in the Shenghui Fang (the Taiping Shenghui Fang, compiled under the direction of Wang Huaiyin of the Hanlin Academy in Emperor Taizong’s reign), Guizhi Tang is written with red peony; but in the Sun Shangyao Fang it’s written with white peony — its author, Sun Yonghe, was a famous physician of the Song dynasty. Back when the future Empress Guangxian, consort of Emperor Renzong, was still an unmarried girl at home, she fell ill and it was Sun Yonghe who cured her; later, when she became empress and even the imperial physicians were at a loss, it was still Sun Yonghe who was summoned into the palace to cure her, and he stayed on as an imperial physician. Two masters at the level of imperial physician, and their statements are directly opposed.
💬 Note from Doctor Luo: Doctor Xu Shuwei said he often put this question to famous physicians, and everyone was “e ran shi cuo” — stunned, unable to answer. The debate goes back to the Tang dynasty, and even today people still argue about it occasionally. Doctor Xu himself was presumably a champion of “use red peony” — he felt that’s what should be used here. Why? We’ll continue tomorrow!
Closing: one formula, and we can talk about it for a very long time
This entry is finished — but the wonders of Guizhi Tang have only just begun. Why can these three herbs plus ginger and jujube cure illness? Should it be red peony or white peony? Why did Zhang Zhongjing place this formula first — what deep meaning is hidden in that? Doctor Luo says: let’s discuss it carefully, bit by bit.
💬 Note from Doctor Luo: We should attach great importance to this first formula of the Shanghan Lun. Its meaning runs very deep. We’ll talk for a little over ten minutes each time, and take it slowly. Tomorrow, we continue with the mysteries inside Guizhi Tang.
Compiled from Doctor Luo Dalun’s commentary on Doctor Xu Shuwei’s case, from the Shanghan Jiushi Lun (Case One: Distinguishing the Use of Peony in Guizhi Decoction).