Sores All Over the Throat That Hurt More With Every Cooling Treatment? Doctor Zhang Jingyue’s Case of Throat Lichen (Hou Xuan) — Stopped Clearing Fire, Replenished Kidney Essence Instead, and the Patient Was Well Within Half a Year
Patient search terms: sores in the throat / sore throat / throat ulcers / recurrent throat inflammation / chronic pharyngitis that won’t heal / more pain the more the fire is cleared / a sore throat that has lasted for years
Medical terms for this condition: throat lichen (hou xuan) · deficiency fire from depleted kidney yin · kidney essence deficiency · repelled yang due to exuberant yin (yin sheng ge yang)
Opening: the young wife of the Lai family had stumped every doctor in town
In the Ming dynasty there lived a great physician named Doctor Zhang Jingyue, a native of Shaoxing in Zhejiang. He wrote Jingyue Quan Shu (The Complete Works of Jingyue) and became the grand master of the warming-and-tonifying school of Chinese medicine. One day, a woman of the Lai family came to see him — nearly thirty years old, right at the prime of life, one would think. But she suffered from a wasting deficiency condition (xu sun) and, on top of that, painful throat lichen (hou xuan). Her constitutional foundation had long since been exhausted.
💬 Note from Doctor Luo: What is “deficiency condition” (xu sun)? It means the upright qi (zheng qi) is insufficient — the whole body is sliding downhill. This woman did not fall ill out of nowhere: first her foundation became weak, and only then did all these troubles come knocking. Doctor Zhang Jingyue wrote his case records with the economy of a poet — those first few characters already hand you the single most important piece of information.
Sores covering the whole throat — the pain was so bad she couldn’t even swallow water
What exactly was this “throat lichen”? Sores covered her entire throat — here a sore, there a sore, sores everywhere, red, swollen and painful. And the throat pain would not heal no matter how long it dragged on — time passed and it simply never got better.
💬 Note from Doctor Luo: “Throat lichen” (hou xuan) is an old disease name. From today’s perspective, this kind of recurrent inflammation and ulceration all over the throat looks very much like the pharyngitis and throat ulcers we see today; it also overlaps with conditions such as Behçet’s disease. Just imagine — sores covering the inside of your throat. How much would that hurt? This is not a trivial illness.
To make matters worse, many doctors had been consulted and none had had any effect (duo yi wang xiao).
Every doctor in town shook their heads: a cartload of heat-clearing, toxin-removing herbs — and the more they took, the more it hurt
How had the earlier doctors treated her? When Doctor Zhang Jingyue asked about the history, it was all “heat-reducing, fire-clearing formulas” — nothing but the clearing-and-detoxifying approach. They saw sores in the throat and assumed there must be real fire (shi huo), so they cleared the fire with all their might. The result: the more the fire was cleared, the more it hurt (yu qing huo er yu tong).
💬 Note from Doctor Luo: Does this scene look familiar? So many people pop niu huang jie du wan (bezoar detoxification pills) the moment their throat hurts. It feels better for a couple of days, and then it comes back worse than before. Why? Because those pills clear real fire — but this patient had deficiency fire (xu huo). When the medicine doesn’t match the condition, of course it gets worse the more you take it.
Doctor Zhang Jingyue’s first move: ask about the stool — that’s where the truth was hiding
Doctor Zhang Jingyue did not rush to write a prescription. First he checked the evidence — “examined until it was certain” (cha zhi ji que), verifying each clue one by one. And the evidence told him something important: this woman had loose stools (da bian tang xie) — her bowel movements were unformed — and she also had no appetite, a belly that refused food (du fu bu shi).
💬 Note from Doctor Luo: Doctor Zhang Jingyue saw it clearly: “I know now that the root was never real fire, and moreover the many cold, cooling medicines had made her belly refuse food.” Her condition was never real fire, yet she had been treated as if it were — and the heat-clearing, toxin-removing herbs are all cold in nature. Take too many cold herbs and you wound the yang of the spleen and stomach; that is why her stools turned loose and she couldn’t eat. This was no longer a simple case of throat lichen — the situation had become complicated.
The logic of yin-yang balance: a hundred points of yin, a hundred points of yang
So what was really going on with this throat lichen? Doctor Zhang Jingyue himself explained it: “Throat lichen is mostly a disease of people with yin deficiency and wasting; it is a condition of deficiency fire arising from depleted kidney water.” The kidney water runs low, deficiency fire rises upward, and when it reaches the throat it becomes throat lichen. This yin-deficient type should be treated the way you treat yin-deficient throat obstruction (yin xu hou bi).
💬 Note from Doctor Luo: What is yin-deficient throat obstruction? The lips are red, the cheeks are red, phlegm is plentiful — but the chi pulse (the deep kidney pulse at the wrist) is always listless, and although all six pulses beat quickly, they are soft and weak. Ask further and you find the person has been overindulging in sex and alcohol, easily tired and low on strength — that is kidney yin depletion, water no longer controlling fire. I often explain it with this model: inside the kidney, yin and yang are supposed to be balanced — a hundred points of yin against a hundred points of yang, perfectly matched. Now the yin becomes deficient: yin drops to fifty points, while yang stays at a hundred — compared to the yin, yang now looks like it has fifty extra points. Those fifty extra points are what we call “fire.” But this is deficiency fire: the yang did not really increase — it only looks like more because the yin shrank. So at this point you must not clear the fire; you need to restore those fifty points of yin. When the two sides are balanced again, the fire naturally withdraws. Keep this model in mind and a great many illnesses become easy to read.
The cold herbs wounded the yang, and the weak yang got shoved upward — this is called “repelled yang” (ge yang)
By the book, deficiency fire from yin depletion should be treated with yin-nourishing formulas like Jiajian Yiyin Jian (Modified First Yin Decoction) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) — simply top up the yin and you’re done. But this woman had taken so many cold, cooling herbs that the situation had changed: her yang had been wounded, her kidney essence was depleted, her kidney yang was now insufficient too, and the whole kidney had slid into a “cold” state.
💬 Note from Doctor Luo: Doctor Zhang Jingyue called this zhong xu ge yang — “middle deficiency repelling yang”, also known as yin sheng ge yang, “repelled yang due to exuberant yin.” The yang qi gets shoved upward by yin-cold and floats outside: some people have warm hands and feet but a cold body; others are cold below and hot above. The yang cannot return to its proper post because cold yin qi is blocking the way. At this point, nourishing yin alone is not enough — you must rebuild kidney essence while adding yang-warming herbs, gently inviting the yang back home.
One formula: Liyin Jian — prepared rehmannia leading, rebuilding the kidney essence that was lost
What formula did Doctor Zhang Jingyue use? Liyin Jian (Regulating Yin Decoction). This is one of his own creations from the “New Eight Formations” (xin fang ba zhen), ranked third in the heat formation (right after Liuwei Huiyang Yin, the Six-Ingredient Yang-Returning Drink).
💬 Note from Doctor Luo: The heart of Liyin Jian is the pair prepared rehmannia (shu di huang) with cinnamon bark (rou gui). Prepared rehmannia is the tonifying force — it replenishes kidney essence, and in large doses: usually ten to fifteen grams, sometimes thirty to sixty grams when things are severe! Around it, angelica root (dang gui) nourishes the blood, honey-fried licorice (zhi gan cao) strengthens the spleen, and dried ginger (gan jiang) and cinnamon are both warming herbs that warm the yang. The logic is: large doses of prepared rehmannia to rebuild kidney essence, matched with yang-warming herbs. When the kidney essence is full, both kidney yin and kidney yang are full, and the yang slowly returns home — it is no longer “repelled” outside. Add a little aconite (fu zi) and it becomes Fuzi Liyin Jian; add ginseng and it approaches Liuwei Huiyang Yin.
Dabuyuan Jian: “the first formula for turning back heaven and rebuilding the root”
Liyin Jian alone was not enough. Doctor Zhang Jingyue went back and forth — he interwove it with another formula: Dabuyuan Jian (Great Tonify the Origin Decoction).
💬 Note from Doctor Luo: What is Dabuyuan Jian? Ginseng (ren shen) leads — three to six grams at the least, thirty to sixty at the most — restoring the original qi (yuan qi) first. Then come Chinese yam (shan yao), prepared rehmannia, and cornus fruit (shan yu rou) — the moment you see these three you recognize the path: it is the lineage of Zhang Zhongjing’s Jinkui Shenqi Wan (Golden Cabinet Kidney-Qi Pill). The Zhangs — Doctor Zhang Jingyue, and later Doctor Zhang Xichun — both walked down the road Zhang Zhongjing built: prepared rehmannia replenishes kidney essence, Chinese yam nourishes lung, spleen and kidney, cornus nourishes liver and kidney. Then eucommia bark (du zhong), angelica, wolfberry (gou qi zi) and honey-fried licorice complete it. Doctor Zhang Jingyue said this formula treats men and women whose qi and blood are wrecked, whose spirit is failing, in critical conditions verging on collapse — he called it “the first medicine for turning back heaven, assisting transformation, and saving the root to cultivate the origin.” When your original qi is nearly gone, this formula can pull you back.
Half a month later the throat pain eased; half a year later the illness was gone
This woman was treated with just those two formulas, going back and forth: when her deficiency grew severe, Dabuyuan Jian stepped in for another round of reinforcement. The result? Within half a month the throat pain diminished (bu ban yue hou tong jian); within less than half a year the illness was completely cured (bu ban nian er bing quan yu).
💬 Note from Doctor Luo: Think about what she ate every day for those six months — a root-saving, origin-tonifying formula, day after day. The throat getting better was only a signal — her whole body was recovering: complexion rosy, energy abundant, voice clear and full. This is where Doctor Zhang Jingyue’s genius lies: he wasn’t treating the throat at all, he was restoring the body’s upright qi. The throat looked like the disease, but it was really just an alarm bell for a depleted body.
Bonus: “Dragon and thunder fire” and repelled yang — when kidney essence runs low, fire runs wild
With this case as the backdrop, Doctor Luo would like to explain one more principle fully: deficiency fire caused by depleted kidney essence comes in two varieties. The first is “dragon-and-thunder fire rushing upward” (long lei zhi huo shang ben) — kidney essence depleted, kidney yin insufficient, deficiency fire rising. Here you use prepared rehmannia paired with asparagus root (tian dong), ophiopogon (mai dong) and other yin-nourishing herbs, plus a small touch of cinnamon bark or morinda root (ba ji tian) to draw the fire downward — this is the relatively simple yin-deficiency-with-fire pattern. The second variety is exactly this case: repelled yang due to exuberant yin. Cold herbs were taken, or the person’s yang was insufficient to begin with — kidney yin and kidney yang are both depleted at a low level, the kidney yang noticeably more so, so the kidney turns “cold,” the yang can’t stay put, and yin-cold shoves it outward. That is ge yang. The treatment is to rebuild kidney essence together with yang-warming herbs.
💬 Note from Doctor Luo: Why is kidney essence so important? “The Dao gives birth to One; One gives birth to Two; Two gives birth to Three; Three gives birth to the ten thousand things.” Kidney essence is the fundamental substance of the body. The prenatal essence (xian tian zhi jing) is what our parents gave us; the postnatal essence (hou tian zhi jing) forms from the nutrients we eat and the clean qi we breathe, and is stored in the kidney. Kidney essence generates kidney qi, and kidney qi then generates kidney yin and kidney yang. So kidney essence is the root of both yin and yang — once the essence is depleted, both yin and yang suffer; it’s just that some people lean toward yin deficiency and others toward yang deficiency. Explaining illnesses caused by depleted kidney essence is a signature theme of my lectures: modern people stay up late, overwork, and chew on worries all day — all of it drains kidney essence. Chronic pharyngitis, fires in the upper burner, fires of the ears, nose and facial orifices — a great many of them are actually deficiency fire. These Ming-dynasty ideas could not be more useful today. When you truly find the right path, these illnesses can actually be regulated surprisingly quickly.
*Compiled from Doctor Luo Dalun’s explanation of Doctor Zhang Jingyue’s case records; the case comes from Jingyue Quan Shu (The Complete Works of Jingyue).