Fever, Wasting, Night Sweats, and No Appetite for Six Months?

Opening scene: yesterday, deficiency with cold; today, deficiency with heat

💬 Note from Doctor Luo: Yesterday’s case was deficiency with cold (injured spleen-stomach plus insufficient yang). Today we look at deficiency with heat — a case that developed in the opposite direction. When the spleen-stomach becomes deficient, it can develop in two directions: one is yang deficiency (influenced by cold pathogens), the other is yin deficiency (fluids lost, so external heat affects you more easily). Today’s patient developed toward the heat side.

The patient was Aotun Zhou Qingzi, the deputy surveillance commissioner (an official title), only 23 years old — people in those days entered service young; at 23 he was already an official.

He fell ill in March of the wuyin year of the Zhiyuan reign — note the season: March, nearly spring.

His symptoms:

• Fever — feeling hot in the body
• Muscle wasting — losing weight severely (the spleen governs the four limbs; wasting of the limb muscles is tied to the spleen)
• Limb fatigue — no strength in the four limbs (persistent limb weakness, tied to spleen deficiency)
• Drowsiness and night sweats — always wanting to lie down, no energy; sweating the moment he fell asleep, soaked on waking (night sweats are usually yin deficiency)
• Loose stools — stool not formed (spleen deficiency; yin deficiency would normally dry the stool, but spleen deficiency makes it loose)
• Borborygmus with no appetite — the belly gurgling, no appetite
• Loss of taste — couldn’t taste food (only when spleen qi is sufficient does the tongue taste; when spleen qi is deficient, taste fades)
• Reluctance to speak — didn’t want to talk (insufficient upright qi)
• The symptoms came and went (waxing and waning), dragging on for over half a year

💬 Note from Doctor Luo: After yesterday’s “deficiency with cold,” many people said “that sounds just like me” — people with spleen-stomach deficiency are extremely common today. And spleen-stomach deficiency develops in two directions: yang deficiency (from cold) or yin deficiency (with heat). Some people say “I have spleen deficiency, but at night I have to throw my arms and legs out of the blanket, restless and hot”; others say “I have spleen deficiency, but I want to drink cold water”; still others say “I’m irritable and always want to lose my temper” — all of these are developing toward the heat side.

The diagnosis: floating rapid pulse, weak on deep pressure — insufficient upright qi

Doctor Luo Tianyi was called in. He took the pulse: floating and rapid, weak on deep pressure — floating, beating fast, but no strength when pressed deeply, indicating insufficient upright qi.

💬 Note from Doctor Luo: Doctor Luo quoted Wang Shuhe’s Mai Jue (Pulse Song) : “The belly is extremely cold and the navel hot; one wants to obtain fluid-generating medicines to supplement the deficiency” — this must be treated by supplementing the deficiency. How? The method below is especially worth borrowing — attack on multiple fronts.

Treatment one: moxibustion on three points — Zhongwan, Qihai, Zusanli

Doctor Luo Tianyi began with moxibustion:

💬 Note from Doctor Luo: The layout of these three points is interesting — upper, middle, lower: Zhongwan above, Qihai in the middle, Zusanli below — something rising, something descending, with a pivot in between. Once the spleen-stomach function is strengthened, the spleen rises and the stomach descends: the heat above travels downward (the body operates like a circle — spleen qi rises, stomach qi descends, the upper heat descends, the kidney essence is not overly cold, the kidney water ascends, and the heart is not overly hot).

Why moxibustion first? This is where Doctor Luo was clever — acupuncture-moxibustion and herbal medicine should go together. Doctor Luo Tianyi was an imperial physician of the Academy of Medicine, a colleague of the great acupuncture master Dou Hanqing (whose works survive to this day); he was not ashamed to ask and consulted Dou Hanqing about acupuncture. Doctor Luo’s books are full of examples of him asking others for guidance.

I once met an elder practitioner who said: the modern separation of acupuncture-moxibustion from herbal medicine is wrong — in the past they were combined: first open the channels — acupuncture, bone-setting, sinew-regulating — and once the channels are open, the herbs can reach the whole body and actually work. Today people drink herbs while their channels are blocked; the medicine just flushes down through the stomach and intestines, and the effect is poor. This elder treated patients by first setting bones, regulating sinews, and pressing points, then prescribing — with excellent results. This is the real Chinese medicine: every method is used.

Treatment two: sweet-cold formulas to drain heat + sweet-warm herbs to nourish the middle qi

Alongside the moxibustion, herbs were used. Doctor Luo said “use sweet-cold agents to drain the heat, assisting with sweet-warm ones” — he did not record the exact formula, but the thinking is explicit.

💬 Note from Doctor Luo: Here we must distinguish sweet-cold from bitter-cold (Doctor Zhang Xichun also stressed this repeatedly):

• Bitter-cold: clears heat and resolves toxin, drains damp-heat — huang lian, huang bai, huang qin (resolve toxin, dry dampness)
• Sweet-cold: sweet in flavor, cold in nature — sheng di huang and the like, nourishing yin and clearing heat at the same time

This patient had spleen-stomach qi deficiency plus yin deficiency, so sweet-cold (sheng di and similar) had to be paired with spleen-tonifying herbs — bitter-cold was out (huang lian and the like would injure the spleen-stomach).

Spleen-tonifying herbs + yin-nourishing herbs — this is a strategy we know well: nourishing the spleen yin! In the Ming dynasty Miao Xiyong began teaching spleen yin, using huai shan yao, ren shen, bai zhu, fu ling plus sheng di, sha shen, mai dong; in the Qing dynasty Ye Tianshi had herbs for stomach yin; and Doctor Zhang Xichun, when tonifying qi and spleen, often added cooling yin-nourishing herbs like zhi mu. Chinese medicine develops as one unbroken lineage — here in Luo Tianyi’s work, the “dual supplementation of qi and yin” (tonify the spleen + nourish yin) approach is already clearly visible.

Treatment three: food therapy — japonica rice and mutton to tonify the stomach qi

Next came food therapy: eating japonica rice (northeastern rice) and mutton (mutton soup) to tonify the stomach qi.

💬 Note from Doctor Luo: Someone will object: this patient already has fever — mutton is sweet-warm (even sweet-hot); won’t eating it feed the heat? Doctor Luo cited the classics to explain:

The Neijing’s “the lord of the fire flavor, drain it with sweet” (in the five-organ preferences of supplementation and drainage, the heart fire is drained with the sweet flavor) — Doctor Li Dongyuan and his school extended this as the basis of the earth-tonifying (spleen) school: when qi is deficient there can be deficiency-heat; use sweet herbs like huang qi to fill the upright qi, and the deficiency-heat withdraws on its own (“drain it with sweet”). So deficiency-heat is treated by supplementing with sweet herbs, not by clearing with bitter-cold.

Specifically, two situations: ① deficiency-heat from qi deficiency alone → use sweet herbs directly (raw huang qi); once the upright qi is full, the deficiency-heat recedes; ② qi deficiency plus yin deficiency → use sweet-cold herbs (sheng di) together with huang qi-type herbs.

Doctor Luo also cited Doctor Li Dongyuan’s experience: “ren shen can supplement qi deficiency; mutton can supplement blood deficiency” — mutton is a “flesh-and-blood sentient” food, rich in substance, and can supplement blood deficiency; moreover, only when spleen qi is sufficient does blood have a source of generation. Doctor Li specifically noted mutton for blood deficiency — this was his personal experience.

Doctor Luo adds: a sheep is precious all over — cow’s milk is on the cool side, goat’s milk is warm. For elderly people with yang deficiency and weak kidney qi who urinate frequently at night, drink a cup of boiled fresh goat’s milk before bed — night urination decreases immediately, with instant results (I have personal experience of this).

Treatment four: regulate the emotions — speak little, eat moderately, forgo anger, control desire

Doctor Luo also instructed: speak little (don’t waste qi on excessive talking), eat moderately (no rich, fatty, sweet food), forgo anger, and control desire (nip desires in the bud).

The result: recovered in months, sturdy within two years

“He let go of his daily burdens, and within months his qi was restored to calm” — the body recovered bit by bit, and after several months he was much better. Another two years passed, and he grew plump and strong — once as thin as a beanpole, two years later he had filled out and was stronger than ever before.

💬 Note from Doctor Luo: Someone asked: ordinary doctors treating consumptive disease, when they see heat, all use bitter-cold (toxin-resolving) herbs; you use sweet-cold to nourish yin, and you even have him eating mutton (sweet-warm, heat-feeding) — why?

Doctor Luo cited the Neijing: “When the form is insufficient, warm it with qi; when the essence is insufficient, supplement it with flavor”:

• Form insufficiency (yang qi / function insufficient) → use sweet-warm herbs to supplement qi (Doctor Li Dongyuan’s Buzhong Yiqi Tang was created precisely under this thinking)
• Essence insufficiency (yin blood) → use rich-flavored substances to supplement (shu di huang, deer antler glue)
• “The exhausted are warmed; the damaged are benefited” — consumptive disease is restored slowly with warm supplementation
• Citing Xu Zhicai’s Yao Dui (Drug Couplets) from the Northern Qi: “supplementation can remove weakness; ren shen and mutton are of this kind”

Everyone marveled: “The learning of the Elder Jiegu (Zhang Yuansu) has an ancient source” — the source is the Huangdi Neijing itself!

Doctor Luo did not record the exact formula, but judging by the symptoms, it was most likely a formula like Renshen Huangqi San (Ginseng and Astragalus Powder) (corresponding to the “deficiency with heat” chapter). Renshen Huangqi San treats consumptive fatigue with guest heat, muscle wasting, limb fatigue, five-center heat, dry throat and flushed face, palpitations, tidal fever and night sweats, reduced food intake — very similar to this patient’s symptoms (he did not have cough with pus-blood or chest-rib discomfort). The formula contains ren shen and huang qi (sweet-warm, supplement qi), and also sheng di huang, tian men dong and other sweet-cold yin-nourishing herbs — the dual supplementation of qi and yin approach. In later times Doctor Zhang Xichun treated consumptive disease (tuberculosis-type) the same way: tonify the spleen and qi + clear a little heat + nourish yin.

Modern takeaway: treat disease on multiple fronts — don’t expect a few doses of herbs to do everything

💬 Note from Doctor Luo: Many patients today, once ill, become impatient: a department head gives five doses with no effect and they stop; they go to Beijing to see a nationally famous specialist; five doses with no effect and they’re even more anxious — “my disease must be a nationally rare complex case” — then they get irritable and quarrel everywhere.

Understand this: lingering, hard-to-cure illness is usually accumulated from long-term poor lifestyle habits and poor self-care; expecting a few doses of herbs to fix it is not realistic. You must:

• Change your lifestyle habits (diet, daily rhythm)
• Regulate your emotions (especially important)
• Learn food therapy (whole grains slowly nourish the spleen-stomach)
• Learn some moxibustion, gua sha, and Baduanjin yourself (you go from doctor to doctor, but know nothing yourself — and you expect a few doses of herbs to do it all?)

A physician as skilled as Luo Tianyi — who treated the emperors, kings, and high officials of the Yuan dynasty — treated disease on multiple fronts and by slow nurture: from diet to emotion to herbs to channels and points. That is the right path, and it is the key lesson for us today.

Case source: Wei Sheng Bao Jian (Precious Mirror of Health) by Doctor Luo Tianyi; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).