In my last post, I expressed why it is so important to know if the exterior still needs resolving and I promised to let you know how I evaluate this.

Since then, a group of us are starting to work collectively sharing and helping each other with our Covid cases and finding our methods to be working very well.  Without exception so far, all cases have turned for the better instead of getting worse.  The principles are sound.  This is very exciting.

I’ll be giving a free lecture on the principles I am referring to on Friday, April 3, at 1 pm EST.  Here is a link to register for this lecture:  A group of us are also planning to follow-up with a series of classes about the formula patterns we are finding especially useful.

When someone comes in with an acute upper respiratory issue that has clearly gotten stuck in their chest and is getting hotter and more stuck every hour, it may be easy to think that you just need to clear heat from the lungs.  However, as I discussed in the last post, it is super important to know if the exterior still needs to be resolved as well, before simply using cooling herbs, especially bitter cold herbs.

There are two important reasons for this:

The first is that the reason why heat is developing quickly may be that the exterior is unresolved or even frozen.  The life force in Tai Yang, which is warm, is moving up and out.  If Tai Yang is closed, i.e. unresolved, the warmth of the life force cannot be released from the exterior and, therefore, heat accumulates.  Warm, pungent herbs are needed to go up and out in order to release the surface so heat can be vented.  The heat is there, not because there is a “hot pathogen” but because there is cold closure on the surface.  This is extremely important to understand.

Secondly, in a case in which the exterior is not resolved, if one sees heat without understanding why the heat is there and gives only cold or cold bitter herbs that go down and in, this will cause heat to get worse and go deeper.  This is why, I find it alarming that so many standard TCM treatment protocols I’ve seen recommended online are bitter cold, anti-viral, fire toxin herbs alone, without an eye to whether or not the exterior is resolved.  These protocols don’t understand the dynamics and pathogenesis of the heat and rather just go after the heat itself. It’s a bit like using a sledgehammer and not aiming at the target.

A premise in what I am talking about here is that the heat we see in people who contract this virus is none other than their own body’s life force that is not able to circulate.  It does not come in from the outside. Pathological dampness occurs when the fluid transformative functions of our body are disabled.  It does not come from a damp pathogen.  For me, it is not helpful to view the virus as a “wind-heat pathogen,” “fire toxin,” “hot pathogen” or a “damp warmth pathogen,” as it is being widely talked about.  How else can we view it so that our perspective is more helpful?  We find it more helpful, because it is more fine-tuned and accurate, to see the symptoms as indicators as to which function needs to be restored.  When we see heat, we don’t simply clear heat, we ask which function is disabled so that the life force is building up into heat.  Then, with the herbs, we can do much more with much less intervention

When symptoms show up that indicate that our exterior is not resolved, this means that our Tai Yang function is being asked to do work.  If our Tai Yang is not up to the task, we get sicker.  If we get help with enhancing our Tai Yang function, we get better and even stronger than we were before.  The same is true for each conformation and often more than one conformation at a time.  The herbs don’t expel pathogens.  The herbs restore function.  Our bodies, when they are functioning well, process a bacteria or virus well.   Our bodies are designed to do this.  This is a foundational principle of classical Chinese herbal medicine, as we practice it.

So, now that we know why it is important to know if the exterior is resolved or not and we know the basic principles we are applying, how do you tell?  Of course, the pulse is very important but pulse diagnosis is unavailable to most of us now.  We have to rely primarily on asking questions of our patients.  Here are the primary indications I use to determine if the exterior needs resolving:

  1. The feeling of coming down with something. This is a vague feeling that can’t be located in the body but that everyone is familiar with.  I ask my patients “do you have the feeling of coming down with something?”  Most people are able to answer this.  If they say yes, the exterior still needs resolving.  However, it is not always easy to get a clear answer.  Someone can feel very ill without experiencing this feeling.  Yesterday a Covid patient answered this question with, “not really, I feel like I’m not coming down with something, I feel like I have it”  She felt quite sick.  I knew from this that the dysfunction had moved to the interior primarily.  But, because this is so important, I didn’t leave it at that.  I had other ways of knowing about the exterior.
  2. Achy body. When someone is acutely ill with an achy body, you know it is, at least in part, on the exterior.  The patient I just referred to was mildly achy but not like she had been before.

Other than a floating pulse on the Cun position, primarily on the left, that’s all I have to go on.  Any other symptom, without one of these two things, can be from other issues.  Fever, chills, not sweating, sweating, panting etc., can come with the exterior not being resolved.

These concepts are very important when considering using a formula like Ma Xing Shi Gan Tang vs. Bai Hu Tang.  If the pattern is a Ma Xing Shi Gan Tang pattern, Bai Hu Tang could make it worse.  If the pattern is a Bai Hu Tang pattern, Ma Xing Shi Gan Tang could make it worse.  When we get it just right, the results are remarkable.

Many people are unable to get Ma Huang.  My suggestion is to use Jing Jie in half again or double the dosage you would have used if you were using Ma Huang.  It is, like Ma Huang light, warm and pungent.

It’s also important to note that one can have a feeling of coming down with something in a Shao Yang Xiao Chai Hu Tang presentation. The feeling of coming down with something is not as systemic.  It will show as one symptom, like a sore throat, rather than being a whole body malaise.  Other signs and symptoms will also help you differentiate these patterns.