Feeling Chilly, Running a Fever, Nose Running Clear Then Yellow? External Cold with Internal Heat (the “Cold Wrapping Fire” Pattern) — Try Ganmao Qingre Keli (Cold-Relief Heat-Clearing Granules)

Patient search terms: cold medicine / cold with fever / runny nose clear then yellow / external cold with internal heat / “cold wrapping fire” / Ganmao Qingre Keli / Fang Feng Tong Sheng Wan / Sheng Mai Yin

Corresponding medical names: wind-cold external contraction turning to internal heat · cold-wrapping-fire pattern · mixed cold-heat external contraction

Opening: winter arrives, and external-contraction illnesses love to cluster

When winter comes, common colds, flu and seasonal epidemics easily break out all at once, and the picture gets complicated. Doctor Luo Dalun cuts straight to the point: at times like this you really should learn some of Chinese medicine’s experience for handling external-contraction illness.

💬 Note from Doctor Luo: Right now, epidemics, external-contraction illnesses, colds and flu can easily appear together this winter, making things complicated. So my dear friends, you really should learn some of Chinese medicine’s experience and thinking for preventing and treating external-contraction illness. Today I’m introducing a patent medicine called Ganmao Qingre Keli (Cold-Relief Heat-Clearing Granules) — some of you know it, some have taken it, some don’t know it yet.

First, don’t blow the epidemic out of proportion — Doctor Luo reassures everyone:

💬 Note from Doctor Luo: Even with the current epidemic, don’t treat it as something extraordinary or too serious — it isn’t necessarily so. Right now it’s basically on par with the flu, sometimes even milder. The big pattern is that the north gets more cold exposure, so fever, whole-body aches and headaches are more pronounced; the south tends to be milder. Don’t panic — many of us in Chinese medicine have concluded that if you follow the Chinese-medicine approach to external contraction, the results are quite good. So whether you study the treatment of colds and flu, or the treatment of epidemics and plagues, the general approach is roughly the same.

And the subject of today’s talk, Ganmao Qingre Keli, is a highly representative, clearly reasoned, and extremely commonly used formula — its chief actions are dispersing wind and cold, releasing the exterior and clearing heat.

Why do people catch external pathogens so easily in winter?

Doctor Luo starts from the most fundamental principle: when it’s equally cold, why do some people stay well while others fall ill?

💬 Note from Doctor Luo: It’s winter now, the weather is cold, and people are especially vulnerable to external pathogens. Why? If your yang qi is sufficient and your upright qi is full, then when the temperature drops, your qi and blood still circulate normally and can adjust — then external pathogens cannot invade, because your defense system (the ying wei qi, nutritive and defensive qi) is functioning normally. But many people have insufficient upright qi. When it turns cold, the qi and blood stagnate, circulation develops obstacles, and the defensive function drops — what we call immunity declining — so external pathogens invade easily. When the drop in outside temperature causes this decline in defense and the invasion of pathogens, what do ordinary people call it? They call it catching cold.

The first gate of external contraction: the external-cold stage

After catching cold, the cold pathogen binds the surface, and the body gives its first signal.

💬 Note from Doctor Luo: When cold pathogen binds the surface, what happens? You sneeze, your nose runs clear, you’re averse to wind and cold, you get a headache, and sometimes you even develop a fever. At this point the nasal discharge is clear and the phlegm is clear too. This is external cold arriving at the body surface — the first stage of external contraction caused by wind-cold pathogen — the external-cold stage.

Many people pay no attention at this stage at all: they feel slightly chilled, think it’s nothing, sleep through the night — and the next morning their throat hurts, their phlegm has turned yellow, and it’s external cold with internal heat.

Not sealed off — the pathogen moves inward, and internal heat emerges

If it’s not controlled at this point, the pathogen keeps moving inward, and the body starts reacting along with it. Add to that the fact that many people already have heat stored inside, and a “cooperation between inside and outside” begins.

💬 Note from Doctor Luo: Some people already have latent heat in the body — for example, they eat rich, fatty, sweet food, which creates accumulation inside, producing phlegm-dampness; as the phlegm-dampness stagnates over time it transforms into heat, so they have their own heat. Others have liver fire, or ministerial fire (xiang huo), and so on — there’s heat inside. Then when they struggle against the external pathogen, since the pathogen has penetrated deeper, the struggle produces heat signs — the internal heat “fills the battlefield with smoke.” What happens? For instance, the throat swells and hurts, the phlegm turns yellow, the nasal discharge turns yellow, the fever becomes obvious, the temperature climbs. The tongue body gradually turns red — at the start of catching cold the tongue is white, but now the tongue body slowly reddens, and the coating can even take on a slightly yellow look; the throat is especially dry, you cough, and what you cough up is yellow phlegm. This is what we call internal heat.

The longest stage arrives: external cold with internal heat — “cold wrapping fire”

The external cold is still there, and the internal heat is now obvious — both existing at once. This is what ordinary people call “cold wrapping fire.”

💬 Note from Doctor Luo: We ordinary people call it “cold wrapping fire.” Many friends say they can’t tell wind-cold colds from wind-heat colds. In reality, a very large number of people’s external-contraction illnesses definitely pass through a stage — which stage? The external cold with internal heat stage, the cold-wrapping-fire stage: the external cold on the surface is still present — you’re still sneezing, still afraid of cold, and the nasal discharge changes back and forth between clear and yellow; but while the external-cold signs remain, the internal heat signs have already risen — the tongue coating turns yellow, the tongue turns red, phlegm turns yellow, high fever starts, the throat swells and hurts, and so on. This is a fairly long stage in many people’s external-contraction illness. Why? Because during the pure external-cold stage, when the cold pathogen first arrived you didn’t notice — you felt slightly chilled, thought it was nothing, slept through the night, and the next day your throat hurt and your phlegm turned yellow: external cold with internal heat.

So there aren’t many formulas that clear external cold alone, but there are very many that clear external cold with internal heat — because after an external contraction, most people stay in this state for a long time.

How does Ganmao Qingre Keli fight this battle? — Two battalions of herbs

Doctor Luo breaks down the strategy: to handle cold wrapping fire, you use two approaches.

💬 Note from Doctor Luo: What do we do at this point? We use two approaches: one is to use warm herbs to clear the external cold, and the other is to use cooling herbs to clear the internal heat. What does the “Qingre” (heat-clearing) in Ganmao Qingre Keli refer to? It refers to clearing the heat inside. And what do the other herbs do? They disperse external cold, dispel wind and scatter cold. These two battalions of herbs put together make up Ganmao Qingre Keli. You must remember: it is not all heat-clearing herbs.

Formula breakdown · the cold-dispersing group: jing jie sui leads the charge, followed by zi su ye, fang feng, chai hu and bai zhi

The battalion that disperses external cold has an impressive lineup.

💬 Note from Doctor Luo: The most famous herb for dispersing external cold is jing jie sui (schizonepeta spike). Jing jie is a pungent-warm exterior-releasing herb that disperses wind and cold; its volatile, dispersing components are extremely strong. Our family used to run a clinic, and we would stir-fry jing jie into jing jie charcoal — I remember it vividly: the moment you started stir-frying it, the fragrance came out, and just by smelling it your body began to warm up and sweat; by the time it was done you were drenched in sweat, because its dispersing power is very strong. That’s jing jie’s wind-cold dispersing action. And jing jie sui — the spike — disperses even more strongly: you see, it grows at the very tip, so its dispersing power is stronger. I remember when I first studied Chinese medicine, an old master taught me that he especially liked jing jie sui for external contraction, saying its force is the strongest. So this formula mainly uses jing jie sui to scatter cold and thoroughly release the cold qi binding the body surface.

Several herbs cooperate with jing jie sui in pushing outward:

💬 Note from Doctor Luo: Zi su ye (perilla leaf) is a cold-dispersing herb with sweat-inducing, exterior-releasing action. I often tell people: when you catch cold, grab a handful of zi su ye and steep it as tea, or use it for a foot bath — either way the cold is quickly resolved. In the past, ma huang (ephedra) was often used to disperse cold, but some people can’t tolerate ma huang, so nowadays we often substitute zi su ye. Then there’s fang feng (saposhnikovia root), which dispels wind and drives out pathogens. And chai hu (bupleurum) — chai hu also disperses wind and cold and has a dispersing effect, so in formulas for cold-damage-type illnesses chai hu occupies a large proportion, like Zhang Zhongjing’s Xiao Chai Hu Tang (Minor Bupleurum Decoction) and so on. It also soothes the liver and relieves depression and lifts yang qi, but its wind-cold dispersing function is outstanding — for instance, Doctor Zhang Jingyue’s Zheng Chai Hu Yin uses chai hu to lead the charge, pushing the pathogen outward. And bai zhi (angelica dahurica root) is also a pungent-warm herb that dispels wind and cold.

💬 Note from Doctor Luo: So you see — jing jie sui leads the charge up front, then comes zi su ye, fang feng, chai hu and bai zhi. What kind of herbs are these? They are all wind-dispersing, cold-scattering herbs. A very large proportion of Ganmao Qingre Keli consists of warm herbs that disperse cold. How does the heat arise? The heat arises because external cold seals the body shut, the body fights against it, and internal heat forms inside. At this point you can’t just clear heat on its own — you have to get rid of the cold: once the cold pathogen binding the body surface is dispersed, the body’s qi becomes free-flowing, and the heat inside is cleared by itself. That’s the mechanism by which it clears heat. So what situations is it suited for? It’s cold outside, you’re blown by cold wind, your body functions decline, external pathogens invade, and there’s a foundation of having caught cold — that’s when Ganmao Qingre Keli is suitable.

Formula breakdown · the heat-clearing group: ge gen is the “stroke of genius” — open the qi mechanism and the heat disperses on its own

The warm herbs disperse the external cold; who clears the heat inside? Doctor Luo says this group of herbs is matched especially ingeniously.

💬 Note from Doctor Luo: What about the heat inside? You match it with herbs that clear heat. One of them is ge gen (kudzu root) — ge gen has the action of relaxing the muscles and reducing fever, and its fever-reducing power is very strong. I think putting ge gen in this formula is a stroke of genius. Ge gen reduces fever almost like raw shi gao (gypsum), but it does so by opening the channels and collaterals, dispersing the qi mechanism and scattering the wind pathogen — its heat-penetrating action is excellent. Then it’s matched with di ding (viola herb), a heat-clearing, toxin-resolving herb; and lu gen (reed rhizome), which clears heat, resolves toxins, cools the blood and generates fluids. These are the cooling herbs.

The even more ingenious part comes next — using cold, cool herbs to clear heat isn’t enough; you also have to regulate the qi mechanism:

💬 Note from Doctor Luo: Here’s something very interesting: notice it adds bo he (mint) — bo he is a pungent-cool exterior-releasing herb that pushes the pathogen outward and the heat outward; it’s a herb that moves outward and upward. It adds jie geng (platycodon root), which also regulates qi and has the action of clearing the throat and benefiting the larynx — jie geng is useful for sore swollen throat, and it also benefits the lung qi, carrying the medicinal power upward and spreading it out. Then it adds xing ren (apricot kernel), which opens the lung qi and moves downward — do you see? To open up the stagnation, there are herbs moving up and herbs moving down — these are all qi-regulating herbs. So it doesn’t disperse heat merely with cold, cool herbs; it opens up the qi mechanism for you: bo he disperses outward, jie geng moves upward, xing ren moves downward, and the lung qi is regulated open. Once the qi mechanism opens, the heat naturally disperses. This method of dispersing heat is more reasonable in this situation than clearing heat with extremely bitter-cold herbs like huang lian (coptis) and huang qin (scutellaria) — because here the pathogen isn’t that deep; it’s fairly shallow, and the qi mechanism is still stuck in stagnation. Open the qi mechanism, and it disperses.

💬 Note from Doctor Luo: So this Ganmao Qingre Keli is excellent. I’ve recommended it often before. The other day I was flipping through videos of myself on television from years ago — at home I always kept the classic Tong Ren Tang version of Ganmao Qingre Keli on hand. Sometimes, especially when a cold snap hits in the north or south, after catching cold you feel the external pathogen arriving: you gradually develop a bit of fever, some chest tightness, chills and aversion to cold, body aches, joint aches — all signs of blocked qi movement; your nose runs, sometimes clear, sometimes with a bit of yellow — that’s mixed cold and heat; the external cold is moving inward and may produce internal heat: the throat starts to feel dry, you cough, it hurts a little, and a fever starts. At this point use this formula — especially when the cold pathogen is still fairly strong and just beginning to turn to internal heat, it’s the most suitable, because this formula contains more warm herbs for dispersing cold and wind; once the wind is scattered, you add a little to clear internal heat and regulate the qi mechanism — clearing internal heat isn’t the main focus.

What if internal heat is severe? — Doctor Liu Hejian’s Fang Feng Tong Sheng Wan

But what if the external cold is no longer obvious and the internal heat is especially severe? Doctor Luo also offers the matching formula.

💬 Note from Doctor Luo: Some friends ask: what if the external cold is no longer obvious and the internal heat is especially prominent — the bowels start to bind, you run a high fever, the edges of the tongue are all red with a yellow coating, the pulse bounces along strongly and fast, obviously very hot, without that feeling of being afraid of cold, the whole body hot — this is internal heat dominating, external cold slightly lighter. What medicine do you use then? You can go to Tong Ren Tang and buy Fang Feng Tong Sheng Wan (Saposhnikovia Purging-Sagely Pill). Fang Feng Tong Sheng was created by Doctor Liu Hejian (Liu Wansu), a famous physician of the Jin-Yuan era (Jin dynasty), and it’s called resolving both exterior and interior. Its origin is the thinking of Zhang Zhongjing’s Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction) — Zhang Zhongjing created Ma Xing Shi Gan Tang to resolve external cold and disperse internal heat, and Liu Hejian built Fang Feng Tong Sheng on that foundation. This formula uses ma huang, jing jie and so on to resolve external cold, much like what I described before, but its internal-heat-clearing herbs are clearly increased: shi gao (gypsum), zhi zi (gardenia), lian qiao (forsythia), huang qin (scutellaria), and then da huang (rhubarb) and mang xiao (mirabilite) for purging downward — so its ability to clear internal heat is clearly stronger. When interior excess heat is very obvious and there’s still a little cold on the outside — external cold light, internal heat heavy — Fang Feng Tong Sheng Wan is an especially good choice.

But this medicine has an iron rule of use — stop as soon as it works:

💬 Note from Doctor Luo: Fang Feng Tong Sheng Wan used to be called Fang Feng Tong Sheng San, and the rule is generally stop as soon as the disease is resolved: for a severe patient, once you’ve cleared the heat and the body has recovered, that’s enough. You can’t drink it for two weeks — no way; the yang qi would definitely be injured. This medicine purges hard, so it’s a regulating formula aimed at heavy internal heat. Its influence is enormous — many of our current formulas are influenced by it.

Recovery matters a lot: once you’re better, drink some Sheng Mai Yin

After the external pathogen is cleared, what then? Many people ask how to recuperate after illness, and some ask how to boost upright qi when they’re not sick. Doctor Luo’s answer — Sheng Mai Yin (Pulse-Engendering Drink).

💬 Note from Doctor Luo: Many friends ask: what should I do after I recover? Some friends say: before the illness comes, what can I use to lift my upright qi? I think everyone can get some Sheng Mai Yin. After you recover from illness, the fluids are greatly damaged and the upright qi is greatly damaged — qi and yin are both injured. At that point, once the external contraction is better, you should drink Sheng Mai Yin for a few days — a week or two is fine. Tong Ren Tang’s Sheng Mai Yin comes in a ginseng version and a codonopsis version. I think in a season like this epidemic season, you should use the ginseng version — you could even drink the ginseng version preventively. It combines ren shen (Asian ginseng), mai dong (ophiopogon root) and wu wei zi (schisandra berry) — not dang shen (codonopsis), it’s the Northeast ginseng. Ginseng plays a big role in treating plagues and lifting upright qi — in the past there was Ren Shen Bai Du San (Ginseng Toxin-Resolving Powder), which used ginseng to lead the charge against plagues; ginseng’s power to lift upright qi is irreplaceable.

💬 Note from Doctor Luo: For prevention: if you feel your upright qi is usually insufficient — always lacking strength, dry mouth, insufficient fluids — you can also drink the ginseng version of Sheng Mai Yin. Ginseng paired with mai dong is neither cold nor hot — ginseng tonifies qi, mai dong nourishes yin, and the two together are neither cold nor hot; wu wei zi is astringent and contractive, tonifying the essence of the five viscera, and it can also hold the medicinal power in — it’s sour and astringent. Combined, this is like the Qianlong Emperor of the Qing court, who ate it every day all the way to age eighty-nine — he started in his forties, eating ginseng every day, never ginseng alone, always ginseng with mai dong and wu wei zi. So you can take it preventively, but the most important use is for recovery: when you’ve really had an external contraction and recovered, you should eat a bit of Sheng Mai Yin to replenish energy, upright qi and yin fluids — this is the way of protection.

Wrapping up: keep a box of Ganmao Qingre Keli at home

💬 Note from Doctor Luo: Dear friends, that’s today’s formula. Ganmao Qingre Keli is an excellent formula for dispersing wind and pathogens when external cold is especially heavy. If this situation arises at home, you can buy some and keep it on hand. Tomorrow I’ll continue with patent-medicine approaches to external-contraction illness — see you then!

Based on Doctor Luo Dalun’s health lecture (External Contraction Prevention · Chinese Patent Medicine Special).