Nauseated, Dizzy, and Hot One Minute, Cold the Next After a Cold? Doctor Luo Dalun: If Your Tongue Comes Out Pointed, Keep a Box of Xiao Chai Hu Granules (Minor Bupleurum Granules) at Home

Patient search terms: nausea after a cold / dizzy after a cold / alternating chills and fever / hot and cold flashes when sick / pointed tongue / what patent medicine to stock for flu season / Xiao Chai Hu Granules

Corresponding medical names: Shao Yang pattern · constrained liver qi · qi stagnation · disharmony of the liver and gallbladder · alternating chills and fever · heat entering the Blood Chamber · exterior-contraction illness

Opening: with the epidemic still surging, what should you stock at home?

Recently the epidemic has still been unstable, with outbreaks flaring up here and there. Doctor Luo Dalun’s advice is very practical: be prepared before trouble comes (you bei wu huan) — and that especially means ready-made Chinese patent medicines. People constantly ask him — what ready-made Chinese medicines should we stock at home?

💬 Note from Doctor Luo: Everyone keeps asking me what ready-made Chinese patent medicines we should stock right now. I say there are a few that I recommend — you can memorize this list. For example, the Xiao Chai Hu Granules I am talking about today — you can keep a box of these at home; every pharmacy carries them.

Why Xiao Chai Hu Granules? It starts with a very interesting discovery — the shape of the tongue.

The tongue discovery from the Wuhan outbreak

Back when the epidemic first broke out in Wuhan, the professional committee Doctor Luo belongs to collected a large number of tongue photos from patients, and many doctors pored over them, offering advice to the frontline. Doctor Luo kept studying these tongues as well, and roughly divided the tongue pictures into three directions — the first two are what everyone talks about, and the third is one he summarized himself: a great many people have tongues that come out pointed.

💬 Note from Doctor Luo: The first type is cold invasion — the tongue is white and the coating is thick. We call this warming the yang and dispelling cold (wen yang san han). This is because cold blocks the circulation of qi and blood in the body and blocks the movement of the defensive and nutritive qi, so the exterior pathogen gets in. You may already have insufficient yang qi yourself; when the cold pathogen descends, it obstructs the circulation of qi and blood.

💬 Note from Doctor Luo: The second type is heat — normally the body’s fluids (jin ye) are already insufficient, there is yin deficiency, the fluids are deficient. Then the external conditions turn against you: the winter suddenly warms up for a stretch, you sweat, it heats up again — and now the fluids are even more deficient, and the circulation of the defensive and nutritive qi goes wrong again. Because there is not enough water in the river, the boats that ferry the troops cannot move — so the exterior pathogen arrives and breaks in.

The pointed tongue: a huge group of people who are easily overlooked

The third type is the one Doctor Luo really wants to talk about — the tongue whose shape is pointed.

💬 Note from Doctor Luo: We know a normal tongue comes out oval-shaped. So when a tongue comes out pointed, what does it mean? It means constrained liver qi (gan qi bu shu) and stagnation of the qi mechanism. This is the situation of a huge group of people who carry a lot of mental pressure, anxiety, and so on. When the liver qi is constrained, qi and blood cannot flow freely and smoothly — people like this have many nodules on their bodies, all kinds of nodules. In short, the qi and blood are not flowing smoothly enough, because the liver governs free flow (shu xie): if your emotions are usually poor and the liver cannot discharge smoothly, you will find things blocked up inside, and this condition makes the defensive and nutritive qi circulate sluggishly as well.

These three groups are exactly the people most likely to be struck when an exterior pathogen arrives:

💬 Note from Doctor Luo: The cold-invaded, yang-insufficient people get struck; the yin-deficient, fluid-insufficient people get struck when the weather turns hot; and the people with constrained liver qi and a stagnant qi mechanism get struck too when the exterior pathogen comes — because your defense troops cannot move smoothly. So this is a huge group of people.

When a person with constrained liver qi catches a cold, they often go straight into a Shao Yang pattern

Doctor Luo gives a special warning: when people with constrained liver qi catch a cold, what state do they tend to enter afterward? — the Shao Yang pattern of Chinese medicine, and they often enter it rapidly.

💬 Note from Doctor Luo: Because you have disharmony between the liver and gallbladder, their functions out of accord, the qi mechanism knotted. What happens then? For example, the mouth tastes bitter, the mouth is dry; you do not want to eat, your appetite is gone; you feel vexed and quick to anger (irritable with a tendency to vomit, xin fan xi ou); you easily feel nauseated and retch; then there is chest oppression or even palpitations; there are distending pains in the ribs; at this point headache or dizziness also appears — some people feel dizzier; and this condition also brings insomnia with many dreams. Once these symptoms appear, you quickly enter the Shao Yang state.

This is a large group of people who are vulnerable during external-contraction illness, and especially during a plague. Back then, when Doctor Luo looked at the tongue photos of Wuhan COVID patients, he found a very large number of tongues came out pointed — and this is fully explainable from medical principle:

💬 Note from Doctor Luo: Why do you catch an exterior illness? Because the defensive and nutritive qi are certainly not circulating smoothly, and cannot defend against the exterior pathogen. What causes the defensive and nutritive qi to circulate poorly? Cold invasion with yang insufficiency; yin deficiency with heat sensation; people with heavy dampness, when the weather is especially humid, whose yang qi is insufficient and lets dampness become a pathogen; and what else? Also people with constrained liver qi and poor emotions. So these people who are habitually knotted up, whose qi mechanism moves sluggishly, form a huge group — they are more likely to contract exterior pathogens.

One bout of anger and you catch a cold?

At this point Doctor Luo gives several very everyday examples — the relationship between emotions and catching cold is closer than he once imagined:

💬 Note from Doctor Luo: I often hear of patients like this — they have one bout of anger and catch a cold, right? Some people say that after catching a cold they just take Niu Huang Jie Du Wan (Bezoar Detoxification Pills) and they get better — why is that? It is all this same reason: a person with constrained liver qi, once their emotions fluctuate, is more likely to contract the exterior pathogen. Then after contracting it, if they can drain liver fire and so on, using some of these methods, they recover and get well. So many examples show: emotions are linked to contracting exterior pathogens — when your emotions are poor, you are more likely to be struck. Your whole immune function declines; in reality that is insufficient upright qi and poor circulation of the defensive and nutritive qi.

How to tell whether Xiao Chai Hu Granules are right for you — four signals

So what can you use at that point? — Xiao Chai Hu Granules. How do you judge whether you should take them? Doctor Luo gives a very concrete set of signals.

💬 Note from Doctor Luo: First, your own mood has not been very good lately — you may have been under pressure, anxious. Also, if the shape of your tongue comes out pointed, you should be highly sensitive and pay close attention. And once you do contract an exterior illness, which symptom stands out? There is a feeling of nausea, of vomiting rising upward — this is different from Huo Xiang Zheng Qi: with Huo Xiang Zheng Qi the head feels muffled and stuffy, and there may be diarrhea; with Xiao Chai Hu, it is that rising, retching sensation. Also dizziness — you always feel a little woozy; and some people have a bitter taste, the mouth feels especially unpleasant and dry. If you have these symptoms, we call this a Shao Yang pattern, and you should be able to take Xiao Chai Hu Granules.

The most important signal: alternating chills and fever

Among all the symptoms, Doctor Luo picks out the most critical, most characteristic one — alternating chills and fever (han re wang lai).

💬 Note from Doctor Luo: The most important symptom here is what we call alternating chills and fever. What does that mean? It means the body’s heat comes and goes in waves — cold for a while, then hot; hot for a while, then cold again. If you notice this kind of pattern — cold, then a while later hot; hot, then after a while cold again — that is called alternating chills and fever. What is this? Disharmony of the liver and gallbladder, with impaired free flow. The body wants to fight for a while, then it wants to fight again — the body’s function is no longer vigorous, so at this point you can take Xiao Chai Hu Granules.

Breaking down the formula: one herb rises, one descends, one cools, one warms — untying the knotted qi

Why can Xiao Chai Hu Tang cure this illness? Break the formula open and you will see at once — it takes care of the ascent, descent, entry, and exit of the qi mechanism all at once.

💬 Note from Doctor Luo: Inside the Xiao Chai Hu Granules, Chai Hu (bupleurum) drives the pathogen outward — it pushes the evil qi out; what does Huang Qin (Scutellaria) do? It clears lung heat, clears heat. Huang Qin and Chai Hu — one cold, one warm — the two of them are a two-way regulation. Then add Ban Xia (pinellia): what does Ban Xia do? It regulates the qi of the upper burner, sends lung qi downward, sends the spleen and stomach qi downward — it adjusts the qi mechanism downward. Chai Hu disperses upward, Ban Xia moves downward, letting your qi mechanism scatter from top to bottom. Then it is matched with Ren Shen (ginseng) — to support the upright qi; with honey-fried Gan Cao (licorice) — to regulate the middle and tonify the spleen and stomach; and then ginger and jujube — to regulate the spleen and stomach.

💬 Note from Doctor Luo: So Xiao Chai Hu Tang is one of Doctor Zhang Zhongjing’s famous formulas. In a word, Xiao Chai Hu Tang harmonizes the Shao Yang and the liver and gallbladder, scattering the qi mechanism up, down, left, and right and opening it up. Are you knotted? I help you untie it; constrained liver qi — I help you spread it out. Once the qi mechanism opens up, qi and blood circulate normally again, the body recovers, and it can drive the exterior pathogen out — that is the function of Xiao Chai Hu Tang.

Why did Doctor Zhang Zhongjing rely on this formula so heavily?

Among all of Doctor Zhang Zhongjing’s formulas, Xiao Chai Hu Tang holds an especially special place. Doctor Luo has talked a great deal about it when teaching the Shang Han Lun (Treatise on Cold Damage); here he stresses just one point — Doctor Zhang Zhongjing valued this formula enormously.

💬 Note from Doctor Luo: The treatment of the Shao Yang pattern — the symptoms are bitter taste, dry throat, dizzy vision, quiet and unwilling to speak, no desire for food, alternating chills and fever, irritability with a tendency to vomit, chest and rib-side oppression and distension, and so on. About these symptoms Doctor Zhang Zhongjing said: when you see but a single symptom, it is the pattern (dan jian yi zheng bian shi) — if you meet just one of these symptoms, you should nail it down and highly suspect a Shao Yang pattern, and treat it with Xiao Chai Hu Tang. So you can see Doctor Zhang Zhongjing relied on this formula especially heavily and valued it especially much. So everyone should know: this is a medicine in constant use, and every pharmacy carries Xiao Chai Hu Granules.

How exactly do you use it? Just grasp those few main symptoms:

💬 Note from Doctor Luo: When you contract an exterior illness, if dizziness appears — the head feels a bit woozy; vomiting rising upward — a slight feeling of nausea; the mouth has a bit of a bitter taste; or hot and cold by turns, sometimes cold and sometimes hot — if you grasp these main symptoms, then it should be about right to use it. Also, by my judgment — as long as you see the tongue come out pointed, and especially if you judge that your emotions really have not been good lately and your stress is heavy, then when you contract an exterior illness, you can match it with a little Xiao Chai Hu Granules — it works very well.

Women catching cold during their period: heat entering the Blood Chamber, and Xiao Chai Hu drawing the pathogen out

There is another scenario for which Xiao Chai Hu is especially well suited — catching a cold during menstruation.

💬 Note from Doctor Luo: When women catch a cold during their period, the symptoms tend to become more severe. When we discussed Doctor Xu Shuwei’s case records, we talked about heat entering the Blood Chamber (re ru xue shi) — it can even produce mental disturbances. What do you do then? Use Xiao Chai Hu Tang — it works by driving the pathogen out (qu xie wai chu): drawing the evil qi outward, pulling it out from the blood level. So this is a ready-made patent medicine I am sharing with you that can be used during an exterior-contraction illness.

Using it in combination: Huo Xiang Zheng Qi for heavy dampness, heat-clearing medicines for strong heat

Xiao Chai Hu Granules do not fight alone — combined with others they work even better:

💬 Note from Doctor Luo: If your dampness is on the heavy side, combine Xiao Chai Hu with Huo Xiang Zheng Qi — the effect is better. When you are both damp and liver-qi constrained, and you contract an exterior illness, of course it will be severe — using them together works very well indeed. Sometimes we match it with a little antiviral oral liquid, some Shuang Huang Lian, some Pu Di Lan, and so on — if your heat signs are marked, you can combine it with other ready-made medicines too. But as long as you know you have emotional constraint and these Shao Yang manifestations, and on top of that the tongue comes out pointed — then you can use it.

The formula itself is also interesting — it regulates cold and heat together, but its center of gravity is on dispersing cold and supporting the upright:

💬 Note from Doctor Luo: This is a formula we use extremely commonly now to push the pathogen out. This formula regulates cold and heat together (han re bing tiao), but in fact it is mainly warming the yang, mainly dispersing cold. Inside there is a little Huang Qin to clear heat, but there is ginger, there is Chai Hu, there is Ren Shen — it pushes the evil qi outward from the inside. So this is a very good ready-made patent medicine. I think every home should keep one box of it — when something unexpected really happens, say you contract an exterior pathogen, Xiao Chai Hu Granules can be used.

Who should stock a box? — and the most important reminder of all

Finally, Doctor Luo paints a portrait of “the person who should stock this medicine”:

💬 Note from Doctor Luo: Who can use Xiao Chai Hu? I think it is people with habitually constrained liver qi — you know it yourself: fairly high pressure, fairly anxious, your mouth has a bitter taste for no reason at ordinary times, you sleep badly with many dreams, you easily feel nauseated, dizzy, and light-headed in daily life — all kinds of liver-qi constraint. Then you should keep a box — because such people are also a high-risk group for exterior illness: others may not get struck, but you very well may.

But in the end, medicine is only a standby; the real line of defense is on yourself:

💬 Note from Doctor Luo: In the final analysis, what matters is this — regulate your emotions well and make yourself happier. This increases your upright qi, lets the defensive and nutritive qi circulate normally, reduces your chances of being struck, and reduces your chances of being invaded by exterior pathogens.

What to take away

Three tongue types are most vulnerable to colds: the cold-invaded type (white tongue, thick coating — warm the yang), the yin-deficient type (low fluids — nourish the yin), and the pointed tongue — constrained liver qi and a knotted qi mechanism, a huge, easily overlooked group in the era of stress and anxiety.
A pointed tongue means the liver cannot discharge smoothly; qi and blood are not flowing, and the defense troops cannot move — so the exterior pathogen breaks in.
People with constrained liver qi who catch cold tend to slip rapidly into a Shao Yang pattern: bitter taste and dry mouth, poor appetite, irritability with nausea, chest oppression or palpitations, rib-side pain, headache or dizziness, insomnia with many dreams.
The single most characteristic signal is alternating chills and fever — cold, then hot, then cold again — pointing to liver-gallbladder disharmony.
Four signals for Xiao Chai Hu Granules: poor mood and heavy stress, pointed tongue, upward-rising nausea (unlike Huo Xiang Zheng Qi, where the head is stuffy and there is diarrhea), and dizziness, with a bitter taste in some people.
Formula logic: Chai Hu drives the pathogen outward, Huang Qin clears heat — one cold, one warm; Ban Xia sends the qi down; Ren Shen, honey-fried Gan Cao, and ginger-jujube support the upright and regulate the middle — harmonizing the Shao Yang and scattering the knotted qi until qi and blood flow again.
Doctor Zhang Zhongjing said of this formula: “when you see but a single symptom, it is the pattern” — any one Shao Yang symptom should raise high suspicion.
Women catching cold during menstruation can use it to draw the pathogen out from the Blood Chamber (heat entering the Blood Chamber, as in Doctor Xu Shuwei’s cases).
Combine it when needed: Huo Xiang Zheng Qi for heavy dampness; antiviral oral liquid, Shuang Huang Lian, or Pu Di Lan when heat signs are marked.
At root, medicine is only a backup: regulate your emotions, keep your upright qi sufficient, and let the defensive and nutritive qi circulate normally — that is the true way to reduce the chance of being struck.

Compiled from Doctor Luo Dalun’s health lecture series (external-contraction prevention series: ready-made Chinese patent medicines). Xiao Chai Hu Tang originates from the Shang Han Lun (Treatise on Cold Damage) by Doctor Zhang Zhongjing of the Eastern Han dynasty.