Is COVID Cold-Dampness or Warm-Dryness? Doctor Luo Dalun: Cold, Damp, Warm, and Dry Are All Environmental Conditions — Not the Pathogen Itself

💬 Note from Doctor Luo: Dear friends, good morning, everyone. Today let’s talk about the COVID pandemic — what kind of pathogen is this virus, really? Why bring this up? Because several big-name Chinese medicine influencers have been debating it online. Some say it’s dryness, some say dampness, some say cold-dampness, some say warm-dryness; sometimes it’s cold, sometimes it’s hot — in short, neither the cold-heat question nor the dryness-dampness question has been settled. The virus has come to seem terribly mysterious — even its fundamental nature is in dispute among these doctors, on two completely opposite axes: one says dry, one says damp; one says cold, one says hot. Even that is being argued about.

Opening: New Year 2023, and the Chinese medicine world is at each other’s throats over one question

At New Year 2023, everyone should have been happily welcoming the new year, but the Chinese medicine community was red in the face arguing — is COVID cold-dampness (han shi) or warm-dryness (wen zao)? One camp says cold, the other says hot; one says dry, the other says damp. Sharp lines, no compromise.

💬 Note from Doctor Luo: The ordinary public is bewildered, right? I’m sure if you saw these well-known Chinese medicine doctors on Weibo debating this, red-faced and shouting at each other, you’d be confused too: then what formula should I use? How should I regulate my body? Who’s right? He says the illness is cold, he says it’s hot, he says it’s dry, he says it’s damp — so what do we do?

Doctor Luo says he now understands why the national Chinese medicine authorities stepped in so late — by the time they issued an official TCM guideline, the pandemic peak had already passed. And seeing this kind of bickering, he feels quite disheartened.

💬 Note from Doctor Luo: On such a fundamental question, people hold such sharply opposed positions — it shows that the profession’s understanding of infectious disease, of external-contraction illness, is still at what stage? — not yet grasping the essence. Some individual methods may be locally correct, but overall we’ll keep making mistakes. Actually, back during the Wuhan outbreak I already gave a talk about this exact point. But I found my influence was limited — I explained it, a few Chinese medicine practitioners heard it, and nobody really digested what it meant or thought it through. So three years passed, and the same question is still being debated. In Wuhan it was the same: one says it’s cold-damp, another says no, it’s damp-heat; another says wrong, damp-heat is this, cold-damp is that… the doctors disagreed across the board. Three years later, still the same.

Doctor Zhu Weiju of Republican-era Shanghai: a master of external-contraction illness who left his peers speechless

To explain this clearly, Doctor Luo first introduces a man — Zhu Weiju of Shanghai in the Republican era. This doctor studied external-contraction illness deeply, wrote a monograph on cold damage (shang han), and treated external-contraction diseases in Shanghai so well that his reputation was extraordinary.

💬 Note from Doctor Luo: He completely baffled the warm-disease (wen bing) specialists of Shanghai at the time — some cases they couldn’t cure, he’d come in and cure them in one visit. There was even a famous pediatric master whose own son couldn’t be saved by anyone; the boy was nearly dead, and a few doses from Doctor Zhu saved him. That pediatric master took down the signboard of his own “pediatric clinic” and said: I’ll bow to you as my teacher! — Gentlemen, you are a leading name of Shanghai, why would you bow to me as teacher? He said: You saved my two sons — let my sons study medicine with you. From then on, those two sons both became celebrated pediatric physicians of Shanghai.

💬 Note from Doctor Luo: That was Zhu Weiju — he was extraordinarily good at external-contraction illness. In his books there is something I think everyone should ponder. He discussed this matter very objectively. He said: when external pathogens attack the human body, they come in two kinds — think about whether this is right: one kind is called organic pathogens (you ji zhi xie), the other inorganic pathogens (wu ji zhi xie). What is organic? Microbes, bacteria, viruses — living things. That’s organic. Inorganic means lifeless, for example arsenic — it’s a poison, a kind of pathogen; eat it and you die, but it has no life. Whereas viruses and bacteria enter your body, multiply, and affect your life — those are organic. That’s the division.

What is a plague? The ancients called it “li qi”

Most of our plagues are organic pathogens.

💬 Note from Doctor Luo: What did the ancients call this? — “Among heaven and earth there exists another kind of li qi (pestilential qi).” When such a pathogen arrives, it may show some tendency in how it causes illness, and may lean one way in different people — but let me tell you, what does the invasion of this pathogen actually depend on? Two factors, internal and external.

Same virus, different reactions: the internal factor — your constitution

First, the internal factor: your constitution.

💬 Note from Doctor Luo: How strong is your constitution? Are you yin deficient or yang deficient? Blood deficient or qi deficient? Is your liver qi constrained, your qi movement knotted? Do you carry heavy phlegm-dampness (tan shi)? And so on. With different constitutions, after the pathogen enters and makes you ill, your body’s way of resisting differs. For example, if your upright qi (zheng qi) is ample and you fight back vigorously, you’ll tend to develop toward heat. If your upright qi is normally weak — you’re always cold, listless, lacking energy — when the pathogen attacks, you’ll tend toward cold. You see — this cold or heat depends on your constitution.

People whose yin and blood are chronically insufficient: outside the weather should turn cold but instead turns hot, sweat pours out, body fluids (jin ye) become even more depleted — when the pathogen then enters, the person moves toward dry-heat: dryness, coughing blood, scanty urine, a hot body. Whereas people with heavy dampness — always drinking tea, big belly, dizzy all day — when the outside air is humid and murky and the pathogen arrives, they get diarrhea and stomach pain.

💬 Note from Doctor Luo: See that? With different constitutions, the very same pathogen making you ill produces different states. The internal factors are these: qi deficiency, blood deficiency, yin deficiency, yang deficiency; whether there’s stagnation, whether there’s blood stasis (yu xue), whether there’s constrained liver qi and knotted qi movement, whether there’s phlegm-dampness — these determine how strongly you can resist illness.

The external factor: is Sanya the same as the northeast?

The internal factor isn’t the whole story — there’s also the external factor: different regions, different climates.

💬 Note from Doctor Luo: At the same moment, different regions are different. Can Sanya compare with the northeast? I lived in the northeast; I’m a northeasterner. Old folks up there, in winter, crack a window for a little air — boom, they’re knocked over by the draft, coughing, even pneumonia. That happens a lot. Down in Sanya, yesterday Thailand was still 31°C — low 25, high 31; Sanya’s low is 15, high 25. Thailand is even hotter; everyone wears short sleeves. I’m still in a jacket — in Sanya I wear a jacket; in Bangkok it’s short sleeves. So every place is different.

Region makes climate different, and climate changes with time — winter differs from summer; the north cools down, the south is damp and hot; the coast is humid, the far northwest is dry… Outside there are wind, cold, summer-heat, dampness, dryness, and fire — several kinds of change.

💬 Note from Doctor Luo: These external changes — temperature, wind, cold, summer-heat, dampness, dryness — we call them “pathogens” (xie qi). Why call them pathogens? Because their changes alter the conditions inside your body, lower your function, and then the real external pathogen invades.

What are the six excesses (liu yin)? An ancient shorthand that has lasted thousands of years

The ancients were very clever: they couldn’t see the actual pathogen — something came in and a person started sneezing; in fact the organic pathogen outside had entered, bacteria in, viruses in. But the ancients couldn’t see it.

💬 Note from Doctor Luo: The ancients didn’t know. They only knew that when the temperature dropped, something came in — so they simply called the temperature drop “cold pathogen” (han xie), and lumped the external pathogen together with changes in climate into the “six excesses” (liu yin). The six excesses are climate changes; combined together they are a convenient shorthand, and that shorthand has lasted thousands of years. Today we say “the cold pathogen has come” or “the damp pathogen has come” — in fact, the cold and damp we speak of are all conditions that cause disease. Do you understand what I mean?

💬 Note from Doctor Luo: Let me say it again: changes in external temperature — dropping or rising, becoming dry or humid, windy or still, high or low air pressure — these are all conditions that cause disease. Because the ancients couldn’t see the microbes outside, the organic pathogen, they called the external condition itself a “pathogen.” It’s a very simple, very clever device. So then I just adjust that state — warm the body up, give it real strength, and it destroys and expels the organic pathogen. Treating an ordinary cold, an ordinary external contraction, heals quickly; you can do fine this way. But when treating a plague — where the picture changes constantly — it can cause problems.

Doctor Zhu Weiju’s warning: muddling the six excesses is “the great obstacle of Chinese medicine”

The real key is to keep a clear head: the ancients lumped the pathogen together with the external conditions; you must separate them.

💬 Note from Doctor Luo: Zhu Weiju was perfectly clear on this. He said: if you can’t get the six excesses straight, if you keep muddling them together, this is “the great obstacle of Chinese medicine” — Chinese medicine will never develop. Why stop short at not understanding what an external pathogen is? Can you develop? Can you figure anything out? I think what Zhu Weiju said is eye-opening and ear-splitting — he is absolutely right. In fact, a pathogen is a pathogen — that li qi, that organic pathogen, is simply a pathogen; all external changes — cold, heat, dryness, dampness — are changes in external conditions. Sometimes in our minds we say them together, but in our own thinking we must stay clear.

A yang-deficient person, when the weather outside turns cold, has lowered function — the organic pathogen easily enters. Then you can’t say “the organic pathogen is the cold pathogen.” It is simply an organic pathogen; it’s just that the outside changed and you got hit. A person with internal yin deficiency and dry heat, with insufficient body fluids — when does he have trouble? When the weather outside is especially hot — the weather should be cold but suddenly turns hot, he sweats more, fluids become even scarcer, and then the pathogen enters.

💬 Note from Doctor Luo: We say “a pathogen has come in” — I’m not even saying “a warm pathogen” or “a heat pathogen has come in” — it’s because the hot weather outside made you sweat more, your internal fluids became even more insufficient, and you yourself are a yin-deficient, fluid-scarce person — so a lowered-function environment was created. The pathogen enters — that is, the COVID virus, as we now call it, comes in. The virus is just an attacking microbe, but in people of different constitutions, under different climate changes, it produces all kinds of states. You must never say this pathogen is a cold-damp pathogen or a warm-dry pathogen — cold, damp, warm, and dry are all just the environment. We only adjust that environment; once the environment returns to normal, the body destroys and expels the thing, and the pathogen is gone.

Chinese medicine adjusts the environment — it does not “kill” the virus

So now some Chinese medicine people are still arguing: this pandemic, this COVID virus — is it a cold-damp pathogen or a warm-damp pathogen?

💬 Note from Doctor Luo: Cold-dampness and warm-dampness are only conditions of the external environment — only triggering factors. In the end, because you’re yang deficient, after the pathogen enters and fights you, you weaken further, and dampness pools inside — that is a result of the disease. The external factor plus your constitution together produce this state; we adjust this state — it’s not really “this is a pathogen, I just drive it out and we’re done.” If you think that way, you’re taking Chinese medicine far too simply, and you haven’t penetrated the internal factors.

The cold-damage (shang han) and warm-disease (wen bing) methods are both methods of changing the environment — we replenish body fluids and moisten dryness, using prepared rehmannia (Shu Di Huang), raw rehmannia (Sheng Di Huang), glehnia root (Sha Shen), ophiopogon (Mai Dong) and so on to restore fluids. It is not “this kind of pathogen needs this kind of medicine.”

💬 Note from Doctor Luo: We change the internal environment; we don’t kill the pathogen. Once the environment changes, our qi and blood circulate, body fluids flow, something moves through the meridians again, the defense forces operate normally, and the pathogen is expelled. But you absolutely must not say “this pandemic can only be treated with warm-disease methods” — that would be wrong. Why? Because different people respond differently. Some constitutions, in certain states, present this picture, and warm-disease methods work for them; but others are not like that — different constitutions, different stages, different regions; someone in Sanya differs from someone in the northeast, and in colder northern places it differs again.

Stop carving the boat to find a fallen sword: don’t slap “cold-damp” or “warm-dry” labels on the virus

There are only a handful of viral strains, and the symptoms they produce differ — one attacks here, another there. But Chinese medicine adjusts according to your overall response and the outside situation — it is not that this strain itself carries some fixed nature.

💬 Note from Doctor Luo: Up to now — three years from Wuhan to today — I feel Chinese medicine theory has not advanced one bit; people haven’t seriously thought these things through. They’re still saying “this is a cold-damp epidemic.” Then when it reaches Sanya, is it really still cold-damp? In Bangkok, is it still a cold-damp epidemic? Look at the published protocols: the south uses Yin Qiao San (Honeysuckle and Forsythia Powder) — the warm-disease method; the north uses cold methods — they really are different. Different climates even cultivate different strains. If you don’t understand that Chinese medicine is a flexible, responsive system, and instead insist on anchoring “this virus is cold-damp, this one is warm-dry” — I tell you, this is called carving a mark on the boat to find a fallen sword (ke zhou qiu jian — clinging to a fixed idea while everything moves). What happens then? Local victories: when you happen to meet this damp-warm disease you win, but overall you will lose and miscalculate, because it is constantly changing.

Wind-cold colds and wind-heat colds follow exactly the same logic.

💬 Note from Doctor Luo: The old textbooks all taught “wind-heat cold.” In fact, wind-cold and wind-heat are often different stages, and sometimes they mix together. If you insist on naming every cold either wind-cold or wind-heat, I’ll tell you — you won’t even be able to treat a common cold. Why can so many Chinese medicine PhDs fail to cure a simple cold? Because they insist on giving it a name, calling it wind-cold or wind-heat — neither is right. It is different states; different people’s constitutions present different states. Under different external stimuli: if you’re yang deficient, you get seriously ill easily in cold weather; if you’re yin deficient with insufficient fluids, you get seriously ill easily in hot weather where fluids run even shorter. Constitution and environment echo each other and shift together — we must not carve the boat to find the sword.

Closing: win the strategy first, then the tactics

Once you understand this, you see why we can flexibly choose all kinds of formulas — sometimes this one, sometimes that one, sometimes changing course mid-treatment — because the external environment and your body’s changes, its strength and weakness, the attack of the pathogen and the defense of upright qi — two forces shifting constantly — we must adjust at every turn.

💬 Note from Doctor Luo: This kind of argument, I feel, does no good for the development of Chinese medicine. We need to grasp this essence; only then can Chinese medicine unify. Let’s put our minds to the method — once the whole strategy is clear, tactics can win; if the strategy is unclear, no matter how brilliant your tactics, you’ll lose the larger game. I already explained this in Wuhan, in many voice messages — but I found people weren’t listening. So it has to be repeated, over and over, so that everyone can treat external-contraction illness correctly. Otherwise, when the next epidemic comes, two years later people will still be debating whether it’s cold-damp or warm-dry, the two camps will clash, and the followers will be dizzy — the famous doctors are fighting; he says cold, he says hot; so which is it? Whom do we learn from? Whom do we listen to? Whose medicine do we take? — It’s just like now: “at this time you can use ephedra, at that time you can’t; at this time you should moisten dryness, at that time you shouldn’t” — people are confused.

Doctor Luo says that usually everyone plays peacemaker, but he feels this matter is serious — Zhu Weiju called it “the great obstacle of Chinese medicine” back then; if this isn’t clarified, Chinese medicine cannot develop. For the sake of the field’s development, he speaks these unvarnished words.

💬 Note from Doctor Luo: Dear friends, that’s all for today. Thank you very much for listening. Today happens to be New Year’s Day, so I wish you all a very happy 2023! May everything go smoothly in the new year — health, good fortune, and the vigor of a dragon. Let’s welcome the new year together. Dear friends, see you tomorrow!

What to take away

The pathogen and the conditions are two different things. Bacteria and viruses are organic pathogens (you ji zhi xie); poisons like arsenic are inorganic pathogens. A plague is what the ancients called li qi (pestilential qi).
Cold, damp, warm, and dry are environmental conditions, not the pathogen itself. The “six excesses” (liu yin) — wind, cold, summer-heat, dampness, dryness, fire — were the ancients’ clever shorthand for the climate changes that make illness possible, because they couldn’t see microbes.
The same virus produces different illnesses in different people. Ample upright qi tends toward heat; weak upright qi tends toward cold; yin-and-blood deficiency tends toward dry-heat; heavy dampness tends toward diarrhea and bloating.
Region and season matter. Sanya is not the northeast; Bangkok is not Beijing. That is why the south published warm-disease-style protocols and the north used cold methods for the same pandemic.
Chinese medicine adjusts the environment; it does not “kill” the virus. Replenish fluids (prepared rehmannia, raw rehmannia, glehnia root, ophiopogon), move qi and blood, and the body expels the invader itself.
Don’t carve the boat to find a fallen sword. Anchor a virus to “cold-damp” or “warm-dry” and you may win locally but lose overall, because the picture is always changing.
Strategy before tactics. If the big picture of external-contraction disease is understood, every formula choice becomes flexible and correct; if not, no amount of clever tactics saves the whole campaign.
Honor to Doctor Zhu Weiju (and the story of the pediatric master Xu Xiaoqu taking down his signboard to learn from him) for stating plainly that muddling the six excesses is “the great obstacle of Chinese medicine.”

Compiled from Doctor Luo Dalun’s lecture series on traditional Chinese medicine.