Fever, Thirst and Foaming at the Mouth for Over Twenty Days That No Doctor Could Fix? Doctor Miao Xiyong’s Ming Dynasty Epidemic Fever Case — One Dose of Dan Dou Chi, Sheng Shi Gao, Zhi Mu and Mai Men Dong Sweats the Pathogen Out

Patient search terms: fever that won’t break / body heat that won’t subside / thirsty, always wanting water / foaming at the mouth / spring cold that never gets better / constipation / dry stools

Opening: this famous physician’s voice could shake the walls

From today on, we begin telling the stories of how Doctor Miao Xiyong treated his patients. Miao Xiyong was one of the most celebrated physicians of the Ming dynasty — and a genuinely fascinating character, very much like a knight-errant: his voice was so loud it could shake the walls, he flew into a thunderous rage at unreasonable people, he threw himself heart and soul into every case — and toward his patients he was full of warmth and devotion.

💬 Note from Doctor Luo: Miao Xiyong was very close to the friends of the Donglin Party (Dong Lin Dang), the reformist faction of Ming scholar-officials, and his name is recorded in history. From childhood he studied the Shang Han Lun (Treatise on Cold Damage), and later he traveled widely, calling on famous physicians and collecting secret formulas and celebrated prescriptions, which is why his thinking was so broad. Most important of all — it was with him that the warm-disease (wen bing) doctrine began to be applied and to awaken. He should be counted as one of the founders of the warm-disease school; an enormous amount of it starts right here.

Who was the patient? A Grand Historian just dismissed from office

The patient in this case was named Shi Heting, and he held the post of taishi — Grand Historian — serving in the capital. In the year Dinghai (about the 15th year of the Wanli reign, c. 1587), in spring, this Grand Historian had just been dismissed from office, and he returned to his hometown.

💬 Note from Doctor Luo: Take note of this background — an official who had just been removed from his post, with a belly full of suppressed anger. It has a great deal to do with how he fell ill later, and with how he was treated.

A strange illness: headache, fever, thirst — and foaming at the mouth

How did the illness start? At first nobody knew; they only took it for an ordinary external contraction — headache, a severe pounding in the head; body heat, a burning fever; thirst, an intense craving for water; and foaming at the mouth, which went on both day and night without stopping.

💬 Note from Doctor Luo: Fever, thirst, foaming at the mouth, day and night without rest — this no longer looks like an ordinary cold. The heat pathogen is burning fiercely inside, nearly scorching the body fluids dry.

The family hurriedly called in a physician. The first doctor took one look: this Grand Historian had just been dismissed from office — being removed from one’s post is hardly good news; how could a man stripped of his position not feel wronged? So he concluded that the patient had liver qi stagnation (gan qi bu shu) — that it was all caused by bad mood — and gave him herbs to soothe the liver, relieve constraint and move qi.

💬 Note from Doctor Luo: I find this doctor amusing — the man is plainly running a high fever; isn’t this obviously an external contraction? Yet the doctor went off toward “dismissed from office, liver qi stagnation.” To be fair, his judgment was not entirely groundless — we’ll come back to that later.

And the result? No effect. The doctor switched approach and prescribed Si Wu Tang (Four Substances Decoction) to nourish the blood.

💬 Note from Doctor Luo: This shows that many physicians of the time were, frankly, not very skilled. Here you have a patient with fever, thirst and foaming at the mouth — a full picture of heat. If your exterior-releasing herbs don’t work, you might nourish the blood and support the upright qi — that wouldn’t be unreasonable. But after the liver-soothing, constraint-relieving herbs had failed, jumping straight to Si Wu Tang to nourish blood strikes me as not following any proper order of battle — what was your diagnosis based on?

Worse and worse, the doctor gave up, and everyone said “he will surely die”

After taking the medicine, the patient not only failed to improve — he grew worse. The doctor took one look: well, this illness is too severe, I can’t treat it — and he abandoned the case and ran off. Everyone said: “wei gong bi si” — this Grand Historian is surely done for!

💬 Note from Doctor Luo: Every prescription the earlier doctors had written was off the mark; the illness grew worse with each round of treatment, until finally even the doctor fled in fright. Only then did the family panic and hurry to fetch Doctor Miao Xiyong.

By the time Miao Xiyong was brought in, the illness had already dragged on for more than twenty days. The family showed him all the prescriptions and the reasoning of the previous doctors.

Doctor Miao took one look: the prescription was wrong — this is epidemic fever!

Miao Xiyong examined the earlier prescriptions and said: “The prescription was wrong!” This man has epidemic fever (wen yi).

💬 Note from Doctor Luo: Miao Xiyong classified epidemic fever under cold damage (shang han), saying it is an external contraction — caused by “fei shi bu zheng zhi qi,” the unseasonable qi, qi that does not follow the normal seasonal changes. Contracted in spring, it was therefore called epidemic fever. His phrasing was a little bookish: the ancients said “winter injury by cold, spring certain to bring warmth illness” (dong shang yu han, chun bi bing wen), so he believed epidemics should naturally occur in spring. In fact epidemics can break out at any time of year; we can’t say Miao Xiyong was entirely right — he was speaking according to his own academic framework.

What was Miao Xiyong’s evidence for epidemic fever? This illness had neither released the exterior nor purged the interior — releasing the exterior means driving the pathogen out through the body surface; purging means using a downward-draining method to clear the pathogen out through the bowels. Since neither had been done, the heat pathogen lingered between the stomach and the intestines — it stayed trapped inside the body. Fortunately the original qi (yuan qi) was not yet exhausted — this Grand Historian’s constitutional foundation was still sound and strong, which is why he had survived.

💬 Note from Doctor Luo: There is the crux — the earlier doctors were so busy soothing the liver and nourishing the blood that they neither released the exterior nor cleared the heat; the heat pathogen was smothered inside. It was only thanks to the patient’s robust upright qi that he held out for more than twenty days.

So how to treat it? Miao Xiyong wrote a prescription on the spot.

One dose: dan dou chi vents the heat, shi gao and zhi mu clear it, mai men dong replenishes fluids

Miao Xiyong’s thinking in this formula is perfectly clear — three lines of attack advancing together:

• Dan dou chi (fermented soybean), about two he — acrid and cool, releasing the exterior, venting the warm-heat pathogen outward;
• Mai men dong (ophiopogon root), about one liang (roughly 30 grams) — nourishing yin and generating fluids; the patient’s fluids were badly damaged, so this is the body’s water supply;
• Zhi mu (anemarrhena) — clearing heat, especially lung heat;
• Sheng shi gao (raw gypsum), a little over one liang — the main force for clearing interior heat; paired with zhi mu it forms the foundation of Baihu Tang (White Tiger Decoction).

💬 Note from Doctor Luo: First, about dan dou chi — this is a medicine that is also food, a crystallization of the ancestral wisdom of ordinary Chinese people. It is made from black beans: the beans are soaked in water steeped with mulberry leaves and qing hao (Artemisia annua, sweet wormwood), steamed through, dried, fermented, dried again — and the result is dan dou chi. Soybeans fermented with qing hao and mulberry leaf are cool in nature; they can disperse wind and release the exterior, venting the warm-heat pathogen outward. There are other methods of preparation that lean toward dispersing cold, but the mulberry-leaf-and-qing-hao route is the one most commonly used. Dou chi itself is a fire-lowering substance, mild and balanced in nature; it can release the exterior and resolve vexation, and it works with whatever else you pair it with — with warming herbs it releases the exterior warmly, with acrid-cool herbs it resolves warm-heat pathogen. That is why ordinary people used it so often in treating external-contraction illnesses — it is one of the treasures the ancients left us.

💬 Note from Doctor Luo: Next, sheng shi gao (raw gypsum) — this is Miao Xiyong’s signature herb. Zhang Zhongjing used raw gypsum in Baihu Tang, but later physicians hardly dared to use it, fearing it was too cold, and would prescribe only a tiny pinch. It was with Miao Xiyong that large doses began. The later physician Doctor Zhang Xichun, in fact, only dared to use it boldly after mastering the experience of these predecessors. Before that, physicians used just 1.1 grams or 2 grams of gypsum for fear of its coldness; in reality it can be used in large amounts.

The single dose was decocted, drunk — and the result: a drenching sweat, and the illness was resolved (da han er jie)! More than twenty days of illness — Miao Xiyong, with one dose, produced a full-body sweat that drove the external pathogen out. The body recovered, and the exterior illness was basically cured.

💬 Note from Doctor Luo: What does sweat mean? It means the channels are open — the “transport boats” inside can move again. Merely clearing heat is not enough; the pathogen needs a way out, and that drenching sweat was precisely the exit opened for it.

One last thing: the bowels still won’t move — Doctor Miao said “this is not pathogen”

But there was still a problem: the stool had not passed. The Grand Historian asked: your treatment is truly remarkable — one dose and the illness is gone — but why hasn’t my bowel movement come?

Miao Xiyong said: yesterday the sweat fell like rain — you sweated through completely, and the fluids all went out with it. Now the stomach and intestines are rather dry — “ci chang wei zao, fei you xie ye” — this is dryness of the stomach and intestines, not the presence of pathogen! It isn’t that evil qi is blocking you; it’s that the interior is short of water.

💬 Note from Doctor Luo: This judgment is crucial — “the stool won’t come” can mean two very different things: sometimes a pathogen is blocking (an excess pattern), sometimes the fluids have dried up (a deficiency pattern). Miao Xiyong saw at a glance: this was too much sweating, the water steamed dry — not blocked, just dry.

What did he do? He wrote a wonderfully down-to-earth prescription: let him eat two or three stalks of sugarcane a day (ling ri shi gan zhe liang san gen) — just chew on two or three stalks of raw sugarcane each day. Why? Because sugarcane replenishes the body fluids.

💬 Note from Doctor Luo: The great Qing-dynasty warm-disease physician Doctor Wang Mengying, in his Suixiju Dietary Manual (随息居饮食谱), called sugarcane what? “Tian sheng fu mai tang” — the heaven-made Fu Mai Tang! Fu Mai Tang is Zhang Zhongjing’s Zhi Gan Cao Tang (Honey-Fried Licorice Decoction), the celebrated formula for tonifying qi, nourishing yin and nourishing blood — the classic for restoring body fluids across a thousand years. Wang Mengying said sugarcane is the heaven-made Zhi Gan Cao Tang: it nourishes blood and generates fluids, and its juice is cool, moist and soothing. See how well the ancients knew how to eat.

At the same time, he had the Grand Historian decoct and drink Maimendong Tang (Ophiopogon Decoction).

💬 Note from Doctor Luo: Maimendong Tang is also a formula of Zhang Zhongjing’s: mai men dong (ophiopogon) as the chief herb, with ren shen (ginseng), ban xia (pinellia), gan cao (licorice), jing mi (rice) and da zao (jujube). Mai men dong nourishes yin; ren shen tonifies qi; ban xia directs counterflow downward; gan cao, jing mi and da zao nourish stomach qi — the whole formula is like slowly watering a parched body.

Increasing fluids to move the boat: a dry riverbed, and the boat simply cannot move

And so, within three days, the stool passed — the feces were dry, but they passed at last, and the illness was completely cured.

💬 Note from Doctor Luo: This method is called in Chinese medicine “zeng ye xing zhou” — increasing the fluids to move the boat. If the intestines have no water, it is like a riverbed with no water: the little boat can’t move. What do you do? Add water — once the water is sufficient, the boat moves on its own. Whenever dryness or constipation is caused by insufficient body fluids, you supply water and oils of the sort the body needs; once replenished, everything flows. This is wisdom handed down from antiquity.

What to take away: when fluids are deficient, the external pathogen easily gets in

Now that the case is finished, what can we learn? Miao Xiyong’s academic thought placed great weight on the coordination between the pathogen and the body’s response: different people falling ill in different seasons and at different times each have their own characteristics.

Take this Grand Historian — he genuinely did have fire: liver qi stagnation and liver fire that readily damage the body fluids; his internal liquids were never abundant to begin with. Serving at court is fire-provoking enough; being dismissed added another blaze of anger on top. So when the first doctor diagnosed “liver qi stagnation,” it cannot be said he was entirely wrong.

💬 Note from Doctor Luo: But simply soothing the liver and moving qi was wrong. The crux is this: when the body fluids are insufficient, the fluids do not circulate smoothly in the channels, and the ying-wei qi (nutritive and defensive qi) cannot be transported to its assigned posts — the posts at the mouth and nose, the posts around the body’s defenses. Where a hundred units used to be delivered, now only thirty can get through. Why? The riverbed has dried up, and the little boats can’t move. Add spring on top: the liver-wood needs water to sprout, the weather turns hot, sweat pours off, and the body fluids grow even scarcer — the riverbed is nearly dry. That is when the external pathogen easily gets in, because you no longer have enough sentries on the wall.

That is why Miao Xiyong’s treatment of this case was so clearly conceived: acrid-cool release of the exterior (dan dou chi venting the heat) + clearing the interior heat (sheng shi gao, zhi mu) + supplementing the fluids (mai men dong) — three lines of attack, straight at the heart of the matter. One dose, and the sweat came out, and the illness was resolved.

💬 Note from Doctor Luo: A word on the difference between warm disease and cold damage. The ancients summarized it simply: when heat symptoms appear, they said a “warm-heat pathogen” has entered — that is warm disease (wen bing); when cold symptoms appear, a “cold pathogen” has entered — that is cold damage (shang han). People with yang deficiency are afraid of cold by nature, and suffer when cold weather arrives — their defense troops also fail to reach their posts, because cold congeals and freezes everything. So whether it is warm disease or cold damage depends on a combination of the climate and the patient’s constitutional foundation — you cannot apply it mechanically.

💬 Note from Doctor Luo: And about the earlier doctor’s Si Wu Tang — strictly speaking, it cannot be called entirely wrong either. Nourishing yin and blood with Si Wu Tang works quite well; but he used it in the wrong place: when he should have released the exterior he went off to nourish yin instead — the order was reversed. Had he first released the exterior, let the pathogen out, and only then nourished the blood and yin, he would have been right. When we study the case records of the ancient masters, this is exactly the way of thinking we are learning — make the diagnosis clearly at the outset, then strike straight to the heart of the matter.

Epilogue: this “Lu Zhishen” of a physician — more tomorrow

There is one more piece of background worth mentioning: Miao Xiyong moved in very wide circles among the Donglin partisans and the literati of the Jiangnan region; many court officials were his friends. He himself was a Lu Zhishen (Lu Tiha) sort of figure — the roaring, bearded monk-knight of the classic novel Water Margin: beard bristling, voice booming, diagnosing like thunder and lightning, accurate in his judgments, strong in personality — and very lovable.

💬 Note from Doctor Luo: A serious illness that had dragged on for more than twenty days, that the earlier physicians had abandoned, that everyone believed would end in death — Doctor Miao Xiyong reversed the whole situation with a single dose, then spent three days adjusting the constipation, and the patient was well. Over the days ahead we will tell many more of Doctor Miao Xiyong’s stories — and to be able to learn something from the ancient masters, to hear how these great physicians actually treated illness, is itself a kind of happiness.

Based on Doctor Luo Dalun’s narration of Doctor Miao Xiyong’s medical cases; the case comes from Xian Xing Zhai Yi Xue Guang Bi Ji (《先醒斋医学广笔记》 — Notes from the Studio of Fresh Awakening on Broad Medical Learning) by Doctor Miao Xiyong (Ming dynasty).