Sudden High Fever, Drowsiness and Groaning? Doctor Zhang Xichun Cured Autumn Warm Disease with Latent Heat

Search keywords: fever / sudden high fever / high fever that won’t break / whole body achy and weak / drowsy and foggy / constipation with fever / autumn warm disease

Opening: just before Mid-Autumn Festival, a grandmother in Tianjin suddenly collapsed

This story takes place in early autumn, in the season of the “autumn tiger” — the fiercest lingering heat of the year. Near Gulou East in Tianjin, a 59-year-old grandmother fell ill. She hadn’t fallen sick out of nowhere: right before she got ill, she had just moved house. Moving is real, exhausting labor — all the planning, lifting, and worry that comes before and after. Her body was at its most depleted.

💬 Note from Doctor Luo: Why do we keep talking about external diseases and warm disease? One reason: at this point in Medical Records of Integrating Chinese and Western Medicine, Doctor Zhang Xichun’s text is all about external contraction. The other reason: the epidemic at the time I recorded this was not fully over — cases were still rising worldwide, and there were still asymptomatic carriers at home. Everyone needs to prepare for a long battle: go out less, stay away from crowds. At a time like this, learning about external diseases is especially useful — it can help you protect yourself.

The autumn weather held the key to this illness

The grandmother’s illness is called “autumn warm disease with latent heat transforming into fire” (qiu wen jian fu qi hua re). The name is a mouthful, so Doctor Luo Dalun first explains the trick of autumn weather:

In early autumn, the weather is dry and hot. The sky is clear, the air transparent, sunlight reaches the ground with little obstruction — especially around noon, the heat is fierce. But morning and evening turn cooler; in the shade of a tree or behind a building, away from direct sun, it suddenly feels cold.

💬 Note from Doctor Luo: Think carefully about the character of autumn: when it’s hot and dry, the pores open and you sweat. The moment you step into a cool spot, the cool wind blows, the pores don’t have time to close, and the skin’s temperature control weakens — in people with weak bodies, this opens the door for external pathogens. That is how most warm disease is caught.

The grandmother, exhausted from the move, walked straight into the autumn’s mix of dry heat and cool wind.

How sick was she? A little fever in the morning, a blaze by the afternoon

On the morning she fell ill, the grandmother felt slightly warm all over — a little like a cold coming on. Her muscles ached, and she had no strength.

The family thought that was it. But after noon, the heat suddenly erupted — exterior and interior both burning. The fever climbed and climbed into a high fever, getting worse by the hour.

The family hurried for a doctor. By the time Doctor Zhang Xichun arrived, it was 4 o’clock in the afternoon, and the grandmother already lay in bed with her eyes closed, her spirit drowsy and clouded — barely conscious, groaning and moaning, her whole body miserable.

💬 Note from Doctor Luo: This illness moved too fast. A slight warmth in the morning, and by evening the patient is delirious with fever. In half a day she deteriorated this far — that is not the rhythm of an ordinary external contraction.

One hand on the pulse, Doctor Zhang asked: has anything made her angry lately?

Doctor Zhang felt the pulse and found two crucial pieces of information:

The left pulse was deep and wiry — deep, and taut as a drawn bowstring. The left pulse reflects the heart, liver, and kidneys, so Doctor Zhang judged: liver qi stagnation — the liver’s qi was not flowing smoothly. Look at the old lady groaning — partly she was miserable, but partly groaning itself loosens the qi; each moan made her feel a little better.

The right pulse was surging and forceful — beating fast, nearly six beats to one breath. The right pulse reflects the lungs, spleen, and ming men (life gate); a surging, forceful pulse means intense heat — heat entering the yangming channel.

Having felt the pulse, Doctor Zhang did not rush to write a prescription. Instead he asked the family: has anything upset her lately?

💬 Note from Doctor Luo: Do you see that? That came straight out of the pulse. The old-style physicians had this ability — touch the pulse, and they knew your qi had been blocked lately. When the patient hears it, the tears come: “I’m so angry I could die!” And the family says: “Exactly right! She’s always been quick-tempered, and she carries heavy worries and overthinks everything” — a common trait of grandmothers everywhere. The old doctor was truly brilliant.

The tongue and the bowels: the diagnosis is complete

Doctor Zhang asked to see her tongue. The old lady needed to be called out to several times before she opened her mouth — her tongue seemed to have almost no coating, and it had a swollen look to it.

Then he asked about her bowels: always dry — even in ordinary times, constipation.

💬 Note from Doctor Luo: A tongue with no coating and a swollen appearance means fluids are insufficient and the yin aspect is deficient. Dry stools are also a sign of insufficient fluids. With that information, Doctor Zhang had his answer.

The diagnostic highlight: liver qi stagnation is the foundation for catching external disease

Here is the diagnosis: left pulse deep and wiry — liver qi not flowing, unable to regulate and smooth itself. This is one of the foundations of the illness. Why? Doctor Zhang hammered home a point he made again and again:

💬 Note from Doctor Luo: Whether the attack is cold or heat, if it makes the qi and blood in the channels move insufficiently or with obstacles, the defense troops cannot reach their posts, and external pathogens get in. Besides cold, heat, dampness, and dryness, there is one more major factor — liver qi stagnation. When liver qi stagnates, the qi mechanism is blocked, the channels cannot circulate, and illness easily follows. So under the influence of the external environment — wind, cold, summer heat, dampness, dryness, fire — if the body’s qi and blood and yin and yang are insufficient, and you add phlegm-dampness and liver qi stagnation on top, the internal and external combine and the pathogen enters. Liver qi stagnation is often the foundation on which external disease develops.

This is not empty talk. Doctor Luo Dalun recalls: during the COVID outbreak in Wuhan, he examined large numbers of tongue photos from patients — many of them had sharply pointed tongues. Not pointed because they had been sick a few days — these patients’ tongues were pointed in ordinary times. Their liver qi was insufficient, their qi and blood did not circulate fully, the defense troops could not get into position, the defense system had holes — so they caught external pathogens more easily than others.

💬 Note from Doctor Luo: So how do you guard against epidemics? First of all — keep your emotions optimistic. Stay cheerful, listen to the Dao De Jing, hold a relaxed and unburdened state of mind, and don’t let your liver qi knot up. That matters enormously.

Why “latent heat transforming into fire”? No ordinary cold gets this bad in half a day

The right pulse was surging and forceful, so Doctor Zhang concluded: there must be latent heat that has transformed into fire and rushed into the yangming channel.

How did he know? He said: if this were a freshly contracted external warm disease, it would not reach this severity within half a day — a little heat in the morning, erupting by afternoon is not the rhythm of an ordinary external contraction.

💬 Note from Doctor Luo: This is what we call latent heat transforming into fire (fu qi hua re) — the pathogen hides itself, and when its chance comes, it erupts. Since the heat has entered yangming, what do you do? Clear and resolve it! Use Baihu Tang (White Tiger Decoction) to clear the yangming heat, and add a little liver-soothing, qi-regulating medicine.

Formula breakdown: Baihu Tang as the base, plus one radish seed and one forsythia

The prescription:

• Raw gypsum (sheng shi gao), ground fine, 2 liang (about 60 g) — the sovereign herb of Baihu Tang, clears the great heat of yangming
• Anemarrhena (zhi mu), 8 qian (about 24 g) — clears heat and nourishes yin, working with the gypsum
• Licorice (gan cao) and rice (jing mi) — the original companion herbs of Baihu Tang, protecting the stomach and harmonizing the middle

That is the Baihu Tang base. The next two herbs are where Doctor Zhang’s genius shows:

Raw radish seed (sheng lai fu zi), crushed, 3 qian (about 9 g) — lai fu zi is simply radish seed.

💬 Note from Doctor Luo: Radish seed comes raw or fried; usually we use the fried form to regulate qi and transform phlegm. But Doctor Zhang was especially good at using it for something else — soothing the liver and regulating qi. He called radish seed “a medicine that disperses and dissolves stagnant qi” — it can open up depressed pathogens. Its nature is good at both rising and descending — the fried seed descends more strongly, the raw seed acts with greater force. When he met liver qi stagnation that needed lifting and dispersing, he used raw radish seed. Learn this from him: most of us don’t pay much attention to radish seed’s liver-soothing power; we just use it for phlegm. Zhu Danxi said radish seed transforms phlegm with “the force of pushing down a wall” — very powerful. Yet it is itself a food, gentle and safe, with few side effects. I treat many elderly people with constipation from qi stagnation using radish seed — it has oils, it regulates qi, and it moves the bowels well. Some of my elderly patients need a fairly large dose.

Green forsythia (qing lian qiao) — forsythia comes in green and yellow grades; the green one has stronger power to clear the heart orifices.

💬 Note from Doctor Luo: Forsythia itself has the power to release the exterior — to push pathogens out and resolve toxins. Doctor Zhang also said forsythia excels at soothing the liver — whenever liver qi is not flowing, forsythia can unblock it. So this herb does double duty here: it assists Baihu Tang in clearing heat and resolving toxins and releasing the pathogen, and it helps the radish seed soothe the liver and dissolve depression. That is how a master chooses herbs — no need for extra tangerine peel or osmanthus; radish seed plus forsythia is enough.

A free bonus story: Xu Lingtai’s “secret formula” was a packet of radish seeds

Speaking of radish seed, Doctor Luo Dalun brings out a famous case story from the Qing dynasty:

💬 Note from Doctor Luo: The famous Qing physician Xu Lingtai once treated the son of a wealthy family. The young man went out carousing; his father found out and beat him severely, and after the beating his body collapsed. The grandmother doted on this only grandson and fed him ginseng every day to build him up — until phlegm nodules grew all over his body, lumps one after another, something like lipomas in modern terms. Xu Lingtai was called in. Wealthy families insist on good medicine, and Xu Lingtai said: “I have a secret formula!” He pulled a small packet of powder from his pocket and told them to give it every day. The young man ate it, and he recovered. The host invited Xu Lingtai to dinner and to admire the flowers, and asked: “What was your secret formula?” Xu Lingtai said: “This formula is very expensive. Time to pay — so much money.” The host gritted his teeth and paid. Xu Lingtai laughed: “Actually it was very cheap — radish seed, today’s lai fu zi.” Radish drains the potency of ginseng; the lumps that ginseng built up were dissolved away by radish seed.

One dose, and the fever dropped seventy or eighty percent

What happened? The medicine was finished in two servings, and she broke into a sweat all over. The fever retreated by seventy to eighty percent — the high fever was mostly gone. Her spirit suddenly cleared — the woman who had been drowsy and foggy began to recover as the heat was cleared.

Now the pulse: the left pulse still had a wiry quality, but no longer deep; the right pulse no longer surged, but was still forceful, and the beat count had come down — it was no longer racing.

The old lady said: she still felt heat in the chest, and her stomach felt hungry, yet she was reluctant to eat.

💬 Note from Doctor Luo: Time to change strategy — the heat pathogen has mostly been cleared; now we must nourish yin. Why? Warm disease typically develops in people whose yin is insufficient and fluids are deficient. The dry autumn heat made her sweat, badly damaging her body fluids — that was the predisposing cause. Then the warm disease erupted, and the high fever went on damaging yin. So treating warm disease means two hands at once: clear heat and nourish yin. Clearing heat removes the actual heat; nourishing yin changes the internal environment and tops up the yin. Do both, and adjust which one leads according to which problem is more severe. Now the heat is mostly cleared, but the yin-deficient environment remains — if you don’t change the environment, the heat pathogen can never be fully cleaned out.

Changing the formula: nourish the fluid to float the boat — once the bowels move, the illness is done

The second formula leads with yin nourishment:

• Figwort root (xuan shen), 1 liang (about 30 g) — nourishes yin and resolves toxins; a full liang is a large dose
• Glehnia root (sha shen), 5 qian (about 15 g) — nourishes yin
• Raw white peony (sheng hang shao), 4 qian (about 12 g) — nourishes yin and constrains the liver
• Raw malt (sheng mai ya), 3 qian (about 9 g) — soothes the liver and regulates the qi mechanism (earlier he used raw radish seed and green forsythia to soothe the liver; here he switches to raw malt)
• Fresh imperata root (xian mao gen) — nourishes yin, clears heat, and can push the heat pathogen out through the urine (Doctor Zhang was especially skilled at using imperata root to clear heat from the organs)
• Talc (hua shi), 3 qian (about 9 g) — clears and promotes urination, again hoping the heat exits through the urine
• Licorice (gan cao), 2 qian (about 6 g) — pairs with the white peony to form Shao Yao Gan Cao Tang (Peony and Licorice Decoction), sour-sweet to engender yin, and it also resolves toxins

The formula was taken warm, in large doses. After two doses, the bowels moved.

💬 Note from Doctor Luo: Why were the bowels blocked? Because the body was dry — fluids insufficient. The riverbed was dry, so of course the little boat couldn’t move. Nourishing yin to move the bowels is what Chinese medicine calls “increasing the fluid to float the boat” (zeng ye xing zhou). Many elderly people have exactly this fluid-deficient constipation. For them, using rhubarb-type purgatives is wrong — you should increase the fluid and float the boat, replenishing their fluids. Look at this grandmother: two doses of yin nourishment, the bowels moved, the heat vanished, she could eat, her pulse was calm — only the beat count was still a little fast.

Aftercare: xuan shen 1.5 liang (about 45 g) with dang shen (Codonopsis) 3 qian (about 9 g) in decoction, drunk a few more times.

💬 Note from Doctor Luo: Think about it — this patient had been drowsy and clouded, and Doctor Zhang turned the illness around with one dose, then two more doses, and then two more — three doses in total cured her. Patients who met Doctor Zhang were truly lucky: the moment they fell ill, they went straight to him, and the case record came out a classic. It also shows that Chinese medicine, used correctly, genuinely works.

Doctor Zhang’s big reflection: latent qi — how does a pathogen hide inside the body?

In this case record, Doctor Zhang explored a question that is especially meaningful today: latent qi (fu qi).

The Huangdi Neijing (Yellow Emperor’s Inner Classic) says: “Injury by cold in winter, certain to cause warm disease in spring” — most spring warm disease comes from cold caught in winter; the pathogen hides in the body and, when the weather warms in spring, erupts like thawing ice. That is the classic pattern of latent heat transforming into fire.

But this patient fell ill in autumn. That’s strange: latent heat — does it also happen in summer and autumn?

💬 Note from Doctor Luo: Some physicians say it happens in all seasons — it’s not necessarily winter cold erupting in spring; you can receive a pathogen at any time, it hides in the channels and blocks the movement of qi and blood, and when you sweat the pathogen comes out. Doctor Zhang thought this view was only half right: sweating doesn’t have much to do with it — in summer everyone sweats; does that mean everyone’s pathogen comes out? He said a pathogen can be received in any of the four seasons, and for some reason stay latent in the body — we call it latent pathogen, latent qi (fu xie, fu qi). It hides in the fatty membranes of the san jiao (the three burning spaces of the torso), and when the environment suits it, it erupts as heat — in cold weather it erupts slowly; in hot weather it transforms into heat quickly. Sometimes the attack is cold, and within ten days it has already transformed into heat and emerged.

Under what conditions does a pathogen hide, and when does it erupt? Two sides: first, the external environment becomes suitable — the pathogen multiplies and strengthens; second, the body’s righteous qi is deficient — insufficient zheng qi, severe dampness, severe liver qi stagnation, disharmony of qi and blood and yin and yang — all giving the pathogen an opening. So latent-qi disease depends on both the external environment and the internal condition of the body.

💬 Note from Doctor Luo: To grasp the whole picture you must step outside medical prejudice and look from a higher vantage point. Illness from latent qi is not necessarily warm disease. Many people refuse at first to accept the latent-pathogen theory — some Chinese medicine practitioners think it’s nonsense — but it genuinely exists.

Looking at the theory today: asymptomatic carriers are living proof

At this point Doctor Luo Dalun brings the discussion back to the present:

💬 Note from Doctor Luo: Much of what happened with COVID-19 fits this pattern — asymptomatic carriers: no symptoms at all, but the pathogen is hidden inside the body, and they can even be infectious. The theory of latent qi and latent pathogen plays a huge role in epidemic prevention today. In earlier talks about latent qi, I often cited hepatitis B virus carriers and the dormant phase of HIV as examples. But an infectious disease like COVID actually confirms the theory even more directly. Chinese medicine recognized very early that some people don’t fall ill at the time of exposure but only later — and it also has a whole set of theories for treating latent qi and latent pathogen. How to put them into practice is for the physicians to work out. If ordinary people simply understand the theory, we can protect ourselves at critical moments — that alone is a good thing.

Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s cases; the original case is from Medical Records of Integrating Chinese and Western Medicine (《医学衷中参西录》).