Cold and Fever That Won’t Go Away for Days, Sweating at the Slightest Movement, and Feeling Nauseous? The Classic Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction): Pair Xiao Chai Hu Granules with Gui Zhi Granules to Build Up Upright Qi and Push the External Pathogen Out

Patient search terms: cold and fever won’t go away for days / sweating at the slightest movement / feeling nauseous with a cold / fever with chills alternating / what medicine to stock for a cold / Xiao Chai Hu granules with Gui Zhi granules / Chai Hu Gui Zhi Tang

Corresponding medical names: external contraction with superficial deficiency (biao xu) and Lesser Yang (shao yang) disharmony · ying-wei disharmony with spontaneous sweating · alternating chills and fever

Opening: as restrictions lifted, everyone felt a little anxious

Back then, epidemic policies varied from place to place, but gradually opening up was the overall trend. Ordinary people were a bit dazed: oh no, so how do we prepare? What should we stock up on? How do we get ready?

Doctor Luo Dalun first gave everyone a dose of reassurance.

💬 Note from Doctor Luo: Everyone, don’t worry, don’t be afraid. Because this virus really is not as fierce as it used to be. But even if it is not as fierce, it is still an external pathogen (wai xie), so we still need to analyze it carefully. Friends who are close to Chinese medicine, who love Chinese medicine in daily life — this is where your advantage shows: you know what to expect, you hold some knowledge, so you are not especially frightened.

Look at the other side of the internet: people with no Chinese medicine knowledge at all run to the hospital the moment they get a fever. The hospital is packed and they cannot get in, and they wail and cry as if they cannot bear it.

💬 Note from Doctor Luo: This is exactly why it is so good to learn a little Chinese medicine — we have all kinds of methods to help handle these situations. Today I will introduce a formula called Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) — this is Zhang Zhongjing’s formula, and nowadays both of the component formulas are available as ready-made Chinese patent medicines. Combined together, they are especially suited to people whose upright qi (zheng qi) is insufficient right now.

Zhang Zhongjing’s master principle for treating external contraction: Is upright qi sufficient? Is the pathogen winning?

Zhang Zhongjing built an entire system for treating external-contraction illness and epidemics. How do we read this system? Doctor Luo sums it up in one sentence — you must always consider two factors: whether upright qi (zheng qi) is sufficient and whether the pathogen is winning — and above all, whether upright qi is sufficient.

💬 Note from Doctor Luo: When your upright qi is insufficient and an external pathogen arrives, the body’s response will be problematic. That is why there is the Gui Zhi Tang pattern — what does Gui Zhi Tang talk about? It is for people whose upright qi is not especially strong in daily life, who are a little weak. When the external pathogen comes, cold evil invades the body surface, and when you resist, there is a problem, because upright qi is not sufficient. What is this called? Superficial deficiency (biao xu) — the body surface is what contacts external pathogens, and when the upright qi at the body surface is insufficient, that is superficial deficiency.

The superficial deficiency pattern: sweating at the slightest movement — ying and wei are disharmonized

What does superficial deficiency look like? Doctor Luo explains it clearly through the ying (nutritive) and wei (defensive) qi — there are two things at work here: defensive qi (wei qi) and nutritive qi (ying qi).

💬 Note from Doctor Luo: When wei qi (defensive qi) is insufficient, what happens to the ying qi (nutritive qi) inside? It comes out. Ying qi travels inside the vessels — it is the nutritive blood, a yin-type substance; wei qi travels outside the vessels. When wei qi is insufficient, ying qi comes out, and the person sweats. That is why it is called the superficial deficiency pattern (biao xu zheng).

The most prominent manifestation of the superficial deficiency pattern is spontaneous sweating (zi han) — after contracting an external pathogen, touch your forehead or move slightly and you sweat; move slightly and you sweat.

💬 Note from Doctor Luo: Whenever you sweat at the slightest movement, you should strongly suspect the superficial deficiency pattern — what we call ying-wei disharmony: the wei qi can no longer hold the ying qi in place, so the ying qi leaks out from inside. In ordinary times this is not obvious, but once you catch an external pathogen, the body knows it must fight, and both ying and wei speed up their activity: the wei qi is already insufficient — it wants to move but lacks the strength; the ying qi speeds up, and with wei qi insufficient, it runs out, and that is why you sweat.

Gui Zhi Tang: a formula that builds up upright qi

What do we use for the superficial deficiency pattern? Gui Zhi Tang (Cinnamon Twig Decoction). This formula has been discussed many times; a couple of days ago Doctor Luo also introduced the patent medicine Gui Zhi granules, which can be bought online.

💬 Note from Doctor Luo: What does gui zhi (cinnamon twig) do? It warms and unblocks, tonifying this wei qi; bai shao (white peony root) restrains the yin, keeping that yang from leaking out; and what does honey-fried gan cao (licorice) do? It harmonizes the spleen and stomach — because the root cause is seen as spleen and stomach weakness: when the spleen and stomach are weak, they cannot absorb the essential nutrients of food and transform them into ying and wei qi, so the ying and wei qi become weak. What do ginger and red dates do? They regulate the spleen and stomach. So Gui Zhi Tang is in fact also a formula that harmonizes the spleen and stomach: gui zhi can warm the spleen, shao yao (peony) can restrain the liver, and so liver and spleen are harmonized; ren shen (ginseng) and red dates in the formula guard the spleen and stomach.

This formula also hides a great secret of transformed formulas — the very same medicinals, with the proportions changed, become a famous formula for tonifying the spleen and stomach.

💬 Note from Doctor Luo: Double the peony, add a little yi tang (malt sugar), and it becomes Xiao Jian Zhong Tang (Minor Strengthen the Middle Decoction), Huang Qi Jian Zhong Tang (Astragalus Strengthen the Middle Decoction) — the jian zhong (strengthen the middle) formulas are for tonifying the spleen and stomach. So you see: the same medicinals, with the amounts slightly increased, become the jian zhong decoctions for tonifying the spleen and stomach. So what kind of formula is Gui Zhi Tang? It is a formula that supports upright qi — once your upright qi is topped up and the ying and wei are harmonized, the external pathogen is driven out.

The first formula in the Shang Han Lun: supporting upright qi is the true way

Why did Zhang Zhongjing place Gui Zhi Tang as the very first formula in the Shang Han Lun (Treatise on Cold Damage)?

💬 Note from Doctor Luo: For what purpose? To support upright qi. This embodies a core idea of treatment: when an external pathogen comes, when an epidemic comes, when it invades your body, what can we do? One is to drive it out — if the body has high fever, clear heat, and so on; the other is to support upright qi — you absolutely must support upright qi. So why does the famous epidemic formula Ren Shen Bai Du San (Ginseng Toxin-Expelling Powder) use ginseng as its sovereign herb (jun yao)? Why not? Because once your upright qi is sufficient, you can push these external pathogens out from the inside — that is the true way.

One level deeper than superficial deficiency: the Lesser Yang pattern, like a lamp with low voltage

If your body continues to be deficient — more severely than the ordinary Gui Zhi Tang pattern — what state does it enter? The Lesser Yang (shao yang) pattern. Doctor Luo gives a wonderfully vivid comparison.

💬 Note from Doctor Luo: What does the Lesser Yang pattern mean? It is like a lamp in the room when the electricity is low — the light flickers on and off: when the current is enough it lights up, when it is not enough it goes out. When the body is deficient, it wants to accumulate a little strength; it finally manages to save up some power to resist, and the body starts to have fever; after resisting for a moment, the energy is immediately insufficient again, and the state sinks low again, so it turns cold again — fever and chills alternating, hot and cold by turns (han re wang lai). This is the Lesser Yang pattern: the body can organize only limited resistance, resisting sometimes and not resisting other times — it has entered a deeper stage of insufficient upright qi.

What are the manifestations of the Lesser Yang pattern? — bitter mouth, nausea, dizziness, chest tightness

What does the Lesser Yang pattern mainly show? Doctor Luo lists a long checklist.

💬 Note from Doctor Luo: A bitter taste in the mouth, dry mouth, then a bit of dizziness, a bit of nausea rising up, acid regurgitation, chest tightness, palpitations, distending pain in the chest and flanks, insomnia with dream-filled sleep, and so on. Bitter mouth and dry throat, not wanting to eat or drink much (mo mo bu yu yin shi), alternating chills and fever, vexation with a tendency to vomit (xin fan xi ou), distending pain in the chest and flanks, plus insomnia and dream-filled sleep — that last one is something we added on later. If you have these symptoms, it means the qi mechanism is somewhat bound up (qi ji yu jie) — upright qi is insufficient and the body is beginning to lack the strength to resist.

Xiao Chai Hu Tang: harmonizing the Lesser Yang, with immediate results

What approach does Zhang Zhongjing give at this point? Xiao Chai Hu Tang (Minor Bupleurum Decoction).

💬 Note from Doctor Luo: In Xiao Chai Hu Tang, what does chai hu (bupleurum) do? It resolves the external pathogen, disperses external cold, and vents the pathogen outward; huang qin (baical skullcap root) clears interior heat; ren shen (ginseng) supports upright qi; ban xia (pinellia) harmonizes the qi mechanism and transforms phlegm, sending the qi downward, the way stomach qi descends; then honey-fried gan cao (licorice), together with ginger and red dates, harmonizes the spleen and stomach. Xiao Chai Hu Tang is able to harmonize the Lesser Yang: build the upright qi up to full, then vent the pathogen outward. Chai hu is an herb with the action of venting the pathogen outward. For treating this kind of condition, Xiao Chai Hu Tang should be said to act with immediate results — it can scatter the bound-up qi, scatter it upward and downward, top up your upright qi, and vent the pathogen outward. This is a very lofty way of treating.

Nowadays there is a patent medicine called Xiao Chai Hu granules, available almost everywhere.

What if both patterns appear at once? — Chai Hu Gui Zhi Tang

But the most common clinical situation is both states appearing together — and this is the key point of today’s lecture.

💬 Note from Doctor Luo: What state is that? Your upright qi is insufficient. If you use Gui Zhi Tang alone — well, the insufficiency is a little more severe, edging into the Lesser Yang pattern; if you say it has fully entered the Lesser Yang — no, not yet, it still carries a bit of the Gui Zhi Tang pattern. So what does it look like? Fever and aversion to cold (fa re, pa leng) — that is the Gui Zhi Tang pattern; then aching in the joints and limbs (zhi jie fan teng), joint pain, the channels not running smoothly; the stomach feels a little nauseous, with a stifling sensation under the heart (xin xia zhi jie), chest tightness — that is the Lesser Yang pattern; the exterior symptoms have not been cleared, the external-contraction symptoms remain. What formula does Zhang Zhongjing give at this point? Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction).

This formula is very interesting — it combines Xiao Chai Hu Tang and Gui Zhi Tang together, with the doses cut in half, but the amount of chai hu is still kept a little larger.

💬 Note from Doctor Luo: This formula is specifically for the state of insufficient upright qi — more severe than the plain Gui Zhi Tang pattern, carrying a bit of the Lesser Yang pattern — a little nausea, sometimes a little dizziness. When you see this, use Chai Hu Gui Zhi Tang: half Xiao Chai Hu Tang, half Gui Zhi Tang. Use this formula to resolve the external pathogen — in effect it helps the body build its upright qi up to full and pushes the pathogen out. This method is extremely effective.

When do you use it? — Four signals

Specifically when should you take it? Doctor Luo gives a set of self-check signals.

💬 Note from Doctor Luo: When you feel an external pathogen, you clearly start to feel fatigued; then aversion to cold, your body feels cold; the joints are a bit achy; fever is especially obvious; and when you move slightly you break out in cold sweat (xu han) — that is the Gui Zhi Tang pattern; and behind that, you also feel a little nauseous — that is the Xiao Chai Hu Tang pattern; a little fuzzy, a little dizzy. If you have these symptoms, you can use this formula.

A key experience in the Chinese medicine community: chai hu must be used generously

Chai Hu Gui Zhi Tang is a commonly used method among many Chinese medicine practitioners for treating external-contraction illness, and the results are excellent — but there is one essential trick: the amount of chai hu must be sufficient.

💬 Note from Doctor Luo: Combine the chai hu decoction with the gui zhi decoction, and it is called the Chai Hu Gui Zhi Tang pattern — a frequently used formula, and it works extremely well. Some Chinese medicine doctors even say: whenever you encounter external-contraction fever that will not resolve after several days, what do you do? Chai Hu Gui Zhi Tang. And what is the trick there? For the other herbs you can use 6 or 9 grams, but chai hu must be used a bit more generously — you can use 20 to 30 grams, and the effect is excellent — this is the experience of many practitioners.

Doctor Luo’s own experience: combining works better than using either alone

Doctor Luo also shares his personal experience with the medicines — using Gui Zhi Tang alone or Xiao Chai Hu Tang alone is not as good as combining the two.

💬 Note from Doctor Luo: Basically, when I use Gui Zhi Tang alone, unless the case is especially typical — the person just sweats at the slightest movement and really wants to feel better right after drinking it — this usually happens in the very earliest stage of external contraction, and if you catch it at that very earliest stage, one pot of the decoction is enough. But sometimes you don’t catch it in time, and it drags on; you drink a cup or two and it doesn’t seem to do anything. And if you use Xiao Chai Hu Tang alone, the effect may also be poor. Often it is chai hu combined with gui zhi drunk together that works extremely well — it supports upright qi; you can clearly feel your upright qi becoming sufficient, and the pathogen is slowly pushed outward, pushed out. So this is a very classic formula.

A practical trick: Xiao Chai Hu granules paired with Gui Zhi granules

So what do ordinary people do when they don’t have the decoction on hand? Today Doctor Luo teaches a very interesting use — drink two ready-made patent medicines together.

💬 Note from Doctor Luo: Pair Xiao Chai Hu granules with Gui Zhi granules — both are available as patent medicines now; Xiao Chai Hu granules are everywhere; as for Gui Zhi granules, as I told you before, you can buy them online. If you have really caught an external pathogen — and very many people have insufficient upright qi — and you can’t quite tell what’s going on, and using Gui Zhi Tang alone feels like it did neither much good nor much harm, as if it is stuck in a stalemate — that may mean the upright qi deficiency is a level deeper than the Gui Zhi Tang pattern. What to do? Chai hu paired with gui zhi — that is Chai Hu Gui Zhi Tang: take Xiao Chai Hu granules together with Gui Zhi granules, mix the two together; you can even make the Xiao Chai Hu a little more. Generally one sachet of each is enough — a little more Xiao Chai Hu is fine too. Combined, the two can gradually build your upright qi up to full and push the pathogen out — the effect is excellent.

💬 Note from Doctor Luo: Sometimes you can also pair it with something else: if there is still a heat pattern, you can add a little Shuang Huang Lian (honeysuckle, skullcap and forsythia liquid) or a little Pu Di Lan (pugentian oral liquid) — just a little; and sometimes you don’t need to add anything at all — basically once you use this combination, when upright qi becomes sufficient, the external pathogen can be resolved on its own. In clinical practice many Chinese medicine doctors use it for external-contraction fever: for this kind of fever, generally if a few days of other treatment haven’t worked, use this formula, and the effect is excellent.

Brewing the granules with ginger-date water: a small detail, a big difference

There is also a bonus point in how you take it — don’t brew it with plain water.

💬 Note from Doctor Luo: In the very earliest stage of just catching cold, before it has turned much to heat — or even if it has just begun to turn to heat — you may have a fever, may feel cold, may feel a little nauseous, sweat at the slightest movement, feel a little dizzy, and so on; and you feel a little weak, upright qi insufficient. At that point drink these two granules. If possible, cut two slices of ginger, put in one red date, boil them in water, and use that hot water to brew the granules — the effect is even better.

Closing: support upright qi and push the pathogen out

Finally Doctor Luo returns to the fundamental idea — why is it that Chinese medicine enthusiasts don’t panic during an epidemic? Because they know how to help the body.

💬 Note from Doctor Luo: Friends who don’t understand Chinese medicine — when a real external contraction comes, when an external pathogen comes, they have no way to deal with it; they don’t know how to help their body. We Chinese medicine enthusiasts know: analyze the different states of the body — the ancients told you: whatever different state you are in, here is how we help you. Chai Hu Gui Zhi Tang is a formula that has been somewhat overlooked, not used very often by many people, but many Chinese medicine practitioners are especially skilled at using this formula and this approach. What I introduced today is its granule form — through supporting upright qi, in the end you push the pathogen out.

Next, Doctor Luo says he will continue to introduce how to help the body build its upright qi up to full — the external-contraction series is still going on.

Compiled from Doctor Luo Dalun’s lecture on preventing and treating external-contraction illness. Chai Hu Gui Zhi Tang originates from the Shang Han Lun (Treatise on Cold Damage) of Zhang Zhongjing of the Eastern Han dynasty (Xiao Chai Hu Tang combined with Gui Zhi Tang).