This article explores the understudied issue of urban problems in pre-modern China and examines the responses to the negative impact of urban development on life in the populous city of Kaifeng in the Northern Song (960–1127). Although writers, painters, and historians have portrayed the capital city's splendor for centuries, various urban problems emerged as medieval China became a more urbanized society. This article investigates Ouyang Xiu's (1007–1072) accounts of how extreme weather conditions adversely affected the lives of Kaifeng residents. These experiences, which he discussed in letters and poems, are associated with longer trends that result in climatic anomalies and disasters in the city. Ouyang Xiu also complained about living costs and medical services in Kaifeng. These reflect the difficulties in maintaining good urban provisions and services in a city of this scale.