Is My Cold Wind-Cold or Wind-Heat? Doctor Luo Dalun: The Cold Damage (Shang Han) and Warm Disease (Wen Bing) Schools That Have Argued for a Thousand Years Were Always Meant to Be One
💬 Note from Doctor Luo: Dear friends, good morning, everyone. Today let’s continue talking about the difference between cold damage and warm disease. I used to think this question had already been settled — that everyone should be able to tell the two apart. But after this epidemic broke out, I found the problem in Chinese medicine circles was still unresolved — many Chinese medicine doctors themselves are debating it: is this warm disease or cold damage? The debate is fierce. So I think this question clearly hasn’t been settled, and I want to talk about it again.
Opening: The moment the epidemic arrived, Chinese medicine started arguing with itself
What good does this do ordinary people? Doctor Luo says an epidemic is just a severe external contraction; most of our external contractions in daily life are common colds — once these questions are clarified, handling a cold becomes easier too.
💬 Note from Doctor Luo: Otherwise many people are still confused: is my cold a wind-cold cold or a wind-heat cold? This is a question I’ve talked about before — everyone gets confused by it. If this question is clarified, it will benefit the whole future development of Chinese medicine’s theory of external-contraction disease.
Epidemics are the “exam questions” that force Chinese medicine to advance
Doctor Luo has a judgment: epidemics always push Chinese medicine forward.
💬 Note from Doctor Luo: The Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) appeared in connection with an epidemic, and later the emergence of warm disease theory was also connected with epidemics. Epidemics are so destructive that they force people to concentrate and think, to elevate their theories. So I believe that if cold damage and warm disease eventually merge into one unified system of external illness, it will definitely be triggered by an epidemic — otherwise, in ordinary times, the cold damage school uses cold damage formulas and the warm disease school uses warm disease formulas, and nobody is jolted into that kind of change.
The same cold wind — why did only three children get sick? The internal cause is primary
Leave internal-organ diseases aside for a moment and talk only about external contraction. How does a person actually catch an infectious disease? In normal times, the human body and the outside world are in balance, and everyone lives well. So under what circumstances does illness arise?
💬 Note from Doctor Luo: It happens when both the internal environment and the external environment change. Everyone must remember this: the change in our internal environment is the foundation of our life — this is always the primary cause.
He gives a kindergarten example: ten children all go to kindergarten; a cold wind blows; seven children are perfectly fine, and the other three get sick.
💬 Note from Doctor Luo: Folks, the same wind — why did these three children get sick? It must be that their own internal causes went wrong — for instance, they ate too much and developed food stagnation, their qi and blood stopped moving normally, their zheng qi (upright qi) was insufficient. So the internal cause is the primary one.
So how does Chinese medicine analyze the internal causes in the body? They boil down to six words: diet and overwork-fatigue, and injury from the seven emotions (yin shi lao juan, qi qing nei shang).
What messes up your body? — Diet, overwork and fatigue, and the seven emotions
First, diet — there’s a great deal of learning here. Why are there so many people with heavy dampness and qi deficiency?
💬 Note from Doctor Luo: It’s eaten into being! Cold drinks, uncontrolled eating, rich and greasy food — these consume zheng qi. What the body fails to metabolize piles up inside as garbage. Too much cold fluid is drunk, and icy beverages lie dormant in the interior — so dampness grows heavy, phlegm-dampness grows heavy. This is damage we inflict on ourselves. When the spleen and stomach are burdened like this for a long time, their function declines, they can no longer absorb the jing wei (essential nutrients) of food, and in the end the person becomes qi-deficient.
Overwork and fatigue also include sexual excess and excessive worry:
💬 Note from Doctor Luo: Indulgence drains kidney essence; sometimes it develops toward yang deficiency, sometimes toward yin deficiency — toward yin deficiency means essence and blood become insufficient, deficient fire flares up, fluids begin to dry up, the tongue gets redder and redder and the coating thinner and thinner: this is one kind of over-consumption. Overwork and fatigue also include using your brain too much, not sleeping at night, and working too hard.
Add to this injury from the seven emotions — joy, anger, worry, thought, grief, fear, fright — which throws qi and blood into disorder:
💬 Note from Doctor Luo: Different emotions affect different organs and disturb the movement of the body’s qi mechanism. All kinds of unhealthy emotions are an enormous factor in messing up our bodies — you can listen to my earlier talks; this is very important.
Once the internal layout of the body is disturbed, it settles steadily into several constitutional patterns: qi deficiency, blood deficiency, yin deficiency, yang deficiency, essence deficiency, and also phlegm-dampness (phlegm-heat, cold-phlegm), blood stasis — all of these are abnormal patterns. Broken down by the five organs it becomes finer still: lung qi deficiency, spleen qi deficiency, liver qi deficiency, heart qi deficiency, kidney qi deficiency — each with different concrete manifestations.
How does the outside world “slip in while you’re weak”? — The six qi and the six excesses (liu yin)
When the body itself has entered an abnormal state and the external environment changes as well, external contraction easily follows. The normal external environment has its rhythms: summer is hot, winter is cold, and the body adapts — in winter the skin closes up, sweating decreases, activity drops, and the body resists cold; when spring arrives and the sunlight grows strong, the body begins to change.
💬 Note from Doctor Luo: This has to do with all kinds of sensory organs in the body — it’s extremely subtle, like a seed sprouting on its own once the temperature is right; it’s the product of nature’s billions of years of evolution. A few days ago my elderly mother said, “Why have I started sweating?” The weather had just warmed up a little, and people with yin-deficient constitutions change especially visibly. I adjusted her treatment right away, and her body began to recover.
So under what circumstances does the body fail to adapt? — When things go too far. For this “too far,” the ancients used one character: yin (excess — the character for “excessive,” not the yin of “licentious”).
💬 Note from Doctor Luo: For example, a few days ago it was minus fifteen degrees, then suddenly minus twenty-five — a cold snap arrives, and some people can’t adapt. Or in winter, when it’s normally minus fifteen and suddenly jumps to plus one degree and the snow melts — people can’t adapt to that either. Excessively cold, excessively hot, excessively windy, extremely heavy dampness — people whose bodies were already in disorder run into trouble at times like this.
Why is there so much abnormal weather? What the ancients studied was the five movements and six qi (wu yun liu qi) — the movements of the stars and planets in the cosmos, and the many factors piling up to produce abnormal climate.
💬 Note from Doctor Luo: Too many factors influence our Earth. The moon’s gravitational relationship with us causes the daily tides; women’s menstruation comes once a month, and it’s connected to the gravitational changes between the moon and the earth. A netizen commented that this year falls in an active phase of the sunspot cycle, so locust plagues and fires are especially numerous — I think that makes sense; changes in distant celestial bodies all cause changes in Earth’s climate.
These six natural changes — wind, cold, summer heat, dampness, dryness, fire — the ancients called the six qi; when they go to excess, they become the six excesses (liu yin).
Is cold evil really “evil qi”? — The startling words of Republican-era master Zhu Weiju
Here is the key question: are the six excesses evil qi?
💬 Note from Doctor Luo: The six excesses should be called evil qi, but they are not the whole content of evil qi. Strictly speaking, the six excesses are the external environment that produces change in the body — the changed external environment messes up your body, and on top of that your body was already in disorder, so you lose the ability to resist another pathogen entering. So both the pathogen that enters the body and the change in the external environment — we call them both evil qi.
Why did the ancients call changes in the external environment “evil qi” too? For ease of grasp:
💬 Note from Doctor Luo: The ancient Chinese were clever — dividing things too finely is hard to grasp, so they simply called changes in the external environment evil qi. For example, you suddenly catch cold, your belly turns icy, you start having diarrhea — we say cold evil has entered, and we warm the yang to drive the cold evil out. In fact the body warms up and function recovers, and ordinary people say “the cold evil has been driven away” — you drink ginger soup and the cold evil is expelled — very intuitive. For ordinary diseases, explaining it this way causes no problem.
But during an epidemic, a problem appears: you clearly suffered cold evil — so why does a heat reaction appear on the inside? This is entering the interior and transforming into heat — there are always people who can’t explain “how does cold evil turn into heat.” This forced people to think.
At this point Doctor Luo especially admires a famous Republican-era doctor — Zhu Weiju:
💬 Note from Doctor Luo: Zhu Weiju belonged to the Fire Spirit school (huo shen pai), excelled at using fu zi (aconite), and would treat disease by putting up a military-style guarantee: “You all say this disease can’t be cured — I’ll treat it, and if I fail, you can come smash my clinic’s signboard!” He wrote a book called Difficult Issues in Cold Damage (Shang Han Zhi Nan), and its prefaces were written by the great Shanghai doctors of the day — famous names like Lu Yuanlei and Zhang Cigong. He held a very high position in the Shanghai medical world of that era. He said: Chinese medicine absolutely must get this question straight — if you forever treat the six excesses as evil qi, Chinese medicine will never progress!
Zhu Weiju’s way of breaking the deadlock was to divide evil qi into two kinds — inorganic pathogens and organic pathogens:
💬 Note from Doctor Luo: Changes in the external environment are inorganic pathogens: you catch cold, the cold enters your body, but it does not multiply and does not develop further — what comes in six parts stays six parts, it doesn’t become nine. It is simply an environment that affects the body. Then there is the second kind, organic pathogens: outside microorganisms — bacteria, viruses — enter the body, and once the environment suits them, they multiply. Organic pathogens can only enter the body and stir up trouble when the body has been severely disrupted by the influence of inorganic pathogens. So every external illness we suffer is the combined action of organic and inorganic pathogens — this matches the actual situation in modern medicine.
Doctor Luo also frankly admits that not everything in Zhu Weiju’s Difficult Issues in Cold Damage is correct (books from the Republican era have their limitations), but this formulation is outstanding — it gives the development and breakthrough of Chinese medicine’s theoretical framework a platform, an opportunity.
The truth about external illness: three factors stacked together
Let’s summarize at this point — every external illness is the result of several factors acting together:
💬 Note from Doctor Luo: First, the qi and blood inside the body move in disorder and the person enters one of the constitutional patterns — qi deficiency, blood deficiency, yin deficiency, phlegm-dampness, and so on. Second, while your body is in various states of trouble, the external environment changes — temperature, humidity, cold — beyond what your body can bear; this is the influence of inorganic pathogens. Third, while inorganic pathogens have brought your zheng qi low, organic pathogens take advantage and enter the body to multiply. So external illnesses are all the result of these several factors acting together.
Why did Zhang Zhongjing write the Treatise on Cold Damage and Miscellaneous Diseases? — A cold period in Earth’s history
Why did the history of Chinese medicine’s external illness split into two great schools, cold damage and warm disease? Because inorganic pathogens (the six-excess environment) are tied to time.
💬 Note from Doctor Luo: Zhang Zhongjing lived in the Eastern Han dynasty. His family had more than two hundred members, and many died in an epidemic — what kind of epidemic was that? One dominated by cold. Later research proved that era was a cold period in Earth’s history; the planet’s temperature was much lower than usual, so the six excesses of that time were mainly cold. In a cold environment, people with insufficient yang qi and qi deficiency get sick more easily.
So the framework of Zhang Zhongjing’s Treatise on Cold Damage and Miscellaneous Diseases is: when the body falls ill under the mainly-cold inorganic pathogen, and organic pathogens enter — what do the body’s different layers of resistance look like?
💬 Note from Doctor Luo: What we call the six channels (liu jing) are really six defensive states. Zhang Zhongjing described the body’s defensive states at different levels with great clarity — some are intensely resistant, some have insufficient resistance and low function — all discussed in extraordinary detail.
Excessive immune response: the truth about COVID that an American professor explained — Zhang Zhongjing understood it 1,800 years ago
A few days ago an audio lecture by an American Professor Wu Jun on preventing and treating COVID-19 circulated online. Doctor Luo listened and was deeply moved — what he said was already present in Zhang Zhongjing’s system.
💬 Note from Doctor Luo: Professor Wu Jun asked: why did those several doctors who died — the hospital surely gave them the best possible care — still die? Most people don’t know — they died of excessive immune response: the body senses an external evil has arrived, mobilizes its great army, and countless shells fire all at once — attacking not only the virus but the body’s own organs. In the end the internal organs are damaged, organs fail — heart failure, kidney failure. The way to save life is to suppress this powerful immune response as much as possible, using antioxidant-type components to restrain it — he said the Chinese herbs ban lan gen (isatis root) and huang lian (coptis) both have this effect.
Chinese medicine knew this long ago:
💬 Note from Doctor Luo: Why does Zhang Zhongjing’s system contain Bai Hu Tang and those heat-clearing formulas? It’s for when the body’s reaction is too violent and it’s in a high-fever, hyper-excited state — you cool it down and restore the normal state, because this excited state easily damages your own organs. Why is the death rate so high now? Excessive immune response. The ancients knew how to avoid entering this excited state. That Western-medicine doctor sent me a voice message, and I told him: we in Chinese medicine have many such approaches — not just Xiao Chai Hu plus ban lan gen and huang qin; we have many such ideas. You can’t help but admire the wisdom of the ancients.
Besides over-enthusiastic resistance, there is the other end — sluggishness:
💬 Note from Doctor Luo: When external evil invades, your body may be in such a low state that it cannot organize resistance. I’ve written before about the Ma Huang Fu Zi Xi Xin Tang pattern (Ephedra-Aconite-Asarum Decoction), Zhang Zhongjing’s formula for shaoyin disease: when you catch external evil and the shaoyin qi (the qi of kidney essence) is insufficient, the external evil invades not only the body surface but also the kidney essence — this is called dual infection of taiyang and shaoyin (tai shao liang gan). In ancient times it was common in people who caught external evil after intercourse, or in those who were sexually active and kidney-deficient — if you test their hormone levels, many are low. The whole person always wants to sleep, is listless, fears cold, and has a pale face. How do you treat this state? You stir up their fighting spirit, rouse the yang qi, and give them the strength to resist the external evil!
The Treatise on Cold Damage also discusses in detail what to do with blood stasis, and what reactions occur when external evil strikes a body heavy with dampness — it’s all about adjusting the various patterns inside the body.
💬 Note from Doctor Luo: The Treatise on Cold Damage is just two words — “cold damage”: when you catch cold, external evil enters the human body and produces all kinds of changes, and we adjust accordingly. Zhang Zhongjing chose his words with extreme care. But as later generations developed it, they emphasized cold more and more — in fact cold is only one link in your treatment. In that cold-dominated era, Zhang Zhongjing focused on describing how people deficient in the two factors of yang and qi easily catch evil and how to adjust, but he also described heat conditions in great detail — many of his formulas were used again and again by the later warm disease school.
Why did warm disease arise precisely in Jiangnan? — Beyond time, there is also region
Warm disease theory already existed in the Jin and Yuan dynasties, and in the Ming and Qing — especially the Qing — it established its framework. The six excesses, as inorganic pathogens, are tied not only to time but also to region:
💬 Note from Doctor Luo: This time Wuhan produced the pneumonia, and it spread to different regions with different reactions — Guangdong has more damp-heat; in the northwest people say it’s clearly dryness evil, tongues so dry there’s not a drop of fluid. Why such a big difference? Actually the organic pathogen is the same everywhere — it’s all this coronavirus; the inorganic pathogens differ — every region is different. Can you say the northeast is the same as Guangdong? The northwest is certainly not the same as Jiangsu, Zhejiang, Shanghai, or Jiangnan.
Why did warm disease develop precisely in Jiangnan? Because it’s hot there, and it’s damp there:
💬 Note from Doctor Luo: Jiangnan is hot, and heat damages fluids and consumes blood — essence, blood and fluids are all easily consumed by heat. What Zhang Zhongjing had discussed before was qi and yang; what gets damaged here is yin and blood. People with yin deficiency and blood deficiency collapse more easily in a heat-dominated environment, and organic pathogens enter more easily. This is another kind of constitution — heat-leaning, deficient-heat-leaning — and for them, the old cold damage approach no longer quite worked. So many Ming-Qing physicians were puzzled: when an epidemic came, the old cold damage formulas seemed insufficient; the transmission of external evil was not like before — so they began to think, and the warm disease doctrine was born.
Jiangnan has another characteristic — extremely heavy dampness:
💬 Note from Doctor Luo: People with heavy internal dampness collapse more easily when the six excesses bring heavy dampness, and organic pathogens enter more easily. So the warm disease school pays special attention to clearing dampness and removing dampness — this is one of its great features. And where does the root of dampness-removal lie? Zhang Zhongjing had it — he had many formulas and ideas for removing dampness, which later generations developed further.
After a thousand years of arguing — look at the formulas and they’re almost the same
Let’s review: when problems arise inside the body, qi deficiency, blood deficiency, yin deficiency, yang deficiency easily appear, plus phlegm-dampness and blood stasis — phlegm-dampness and blood stasis are obstacles to movement inside the body and must be cleared away. Zhang Zhongjing discussed this long ago, and later warm disease scholars could do it too.
💬 Note from Doctor Luo: The most fundamental bodily problems that Zhang Zhongjing discussed are yang and qi — discussed in extraordinary detail; the warm disease school values blood and yin more. Think about it — if these two schools were combined, wouldn’t Chinese medicine’s theory of external illness be complete? Once the internal environment is fixed, how much the outside affects you no longer matters much.
So what exactly stops the two schools from merging?
💬 Note from Doctor Luo: It’s “what evil qi really is” — one says evil qi is cold, the other says it’s heat. The two sides argue over this, they’ve fought over it for a thousand years, everyone keeps brawling. But when you actually look at the formulas, they’re almost the same! In Zhang Zhongjing’s Treatise on Cold Damage and Miscellaneous Diseases there are many, many heat-clearing formulas and many, many dampness-removing formulas; open the warm disease school’s Wen Bing Tiao Bian (Systematic Differentiation of Warm Diseases) or Wang Mengying’s Wen Re Jing Wei (Warp and Woof of Warm-Heat Diseases) and you’ll find Cheng Qi Tang used constantly, Bai Hu Tang used constantly — the thinking is basically the same. The reason they can’t merge is precisely this question of what evil qi is — so I often say, treating the six excesses as evil qi has blocked the development of later generations’ theory of external-contraction disease.
Doctor Luo’s prediction: cold and warm were always meant to be one family
💬 Note from Doctor Luo: So I think Zhu Weiju was an extraordinary man. When he put forward the concepts of inorganic pathogens and organic pathogens, he gave Chinese medicine an opportunity. If we can all reach a consensus — wind, cold, summer heat, dampness, dryness, fire are inorganic pathogens, the disease-causing environment; they change the internal environment, collapse the system, make zheng qi insufficient; then organic pathogens invade; and every time we fall ill, it’s the internal environment, organic pathogens and inorganic pathogens acting together — then all the problems of external illness are solved.
Chinese medicine theory has always been developing; it must not be trapped by theory:
💬 Note from Doctor Luo: Every epidemic, the two sides fight — I say it’s warm disease, he says it’s cold damage; I treat it well with warm disease formulas, and if the cold damage formula doesn’t work I won’t use it; he treats it well with cold damage formulas, and if the warm disease formula doesn’t work he won’t use it. Folks, can Chinese medicine develop like that? It can’t! There’s no such thing as “one disease called cold damage, another disease called warm disease” — there isn’t. Cold and warm are both merely disease-causing environments; what actually enters is the organic pathogen. Whatever pattern the body enters, we adjust accordingly: if it’s deficient, tonify it; if it’s hyper-excited, suppress it — both schools are good at this, and both sets of formulas can be used.
Finally, Doctor Luo makes a prediction:
💬 Note from Doctor Luo: For Chinese medicine to develop in the future, organic pathogens must be subdivided further — how do organic pathogens combine with the environment? What properties do they have? If one day Chinese medicine can subdivide organic pathogens in detail, Chinese medicine theory will truly advance. Of course I believe that day is far off, because the mainstream of Chinese medicine today still venerates antiquity — the more ancient the better — and if you try to break through theoretically, a whole crowd will come to berate you. But we must develop — every epidemic sees cold and warm fighting each other; that situation must be wrong: the patients are waiting over there, and the two sides of Chinese medicine have started fighting each other first.
How to unify them? The framework must be raised, the theoretical framework must be elevated:
💬 Note from Doctor Luo: Take out the Treatise on Cold Damage and take out the warm disease formulas, and examine each formula against the concepts of organic pathogens and inorganic pathogens — they all make sense; cold and warm can then be unified, and everyone can take them out and treat patients without arguing any further. This is the work for future professionals. The reason I share all this with you is to explain how external evil attacks the human body — once you understand it, when you catch a cold or an external contraction in the future, your thinking will be clear, and that will benefit you.
What to take away
- The internal cause is primary: the same cold wind makes three children in ten sick because their own bodies were already disordered — diet, overwork and fatigue, and the seven emotions push the body into patterns such as qi deficiency, blood deficiency, yin deficiency and phlegm-dampness.
- The six excesses are only the environment: wind, cold, heat, dampness, dryness and fire, when excessive, are “inorganic pathogens” — they change the body but do not multiply. Bacteria and viruses are “organic pathogens”; they can only invade and multiply once the inorganic environment has weakened you.
- Every external illness is three factors combined: internal disorder + environmental change + organic pathogen entry.
- Two schools, one story: Zhang Zhongjing’s cold damage system (focused on yang and qi, born in a cold era) and the warm disease school (focused on blood and yin, born in hot, damp Jiangnan) describe two sides of the same body; their formulas — Bai Hu Tang, Cheng Qi Tang, dampness-removing formulas — overlap constantly.
- Stop fighting over the word “evil qi”: cold and warm are both merely environments; what truly enters is the organic pathogen. Unify the frameworks, and treating colds and epidemics becomes far clearer.
This article is adapted from Doctor Luo Dalun’s special lecture “The ‘Cold Damage’ and ‘Warm Disease’ That Have Argued for a Hundred Years Were Actually Always One Family.”