High Fever That Would Not Break for Over 40 Days? Doctor Zhang Xichun Treated Febrile Disease with Yin Deficiency and Internal Heat Using the Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction)
Opening: a young man from Shanxi burned with fever for forty days in a friend’s home in Tianjin
In the Republican era, in Tianjin, a twenty-eight-year-old young man from Shanxi — Gao Zhenzhi — had come alone to Tianjin to look for work, temporarily lodging at a friend’s house. Who could have imagined that this trip would land him in the middle of a serious illness: in mid-autumn he caught a febrile disease (wen bing), and from then on the high fever would not break. He burned for more than forty days straight, his temperature staying above 39 degrees every single day. Alone in a strange city, staying in a friend’s home, burning with fever for forty days and showing no improvement — put yourself in his shoes: what a difficult, what an unbearable situation that must have been.
💬 Note from Doctor Luo: Why have I been talking about febrile disease so much lately? First, in Doctor Zhang Xichun’s Records of Chinese Medicine with Western Reference, febrile disease cases make up the largest portion; second, in the special circumstances of the present time, everyone should learn more about how Chinese medicine handles external-contraction illness — this epidemic is not going to pass easily, and we should prepare for a long fight. The more external-disease knowledge you store up, the better it will serve you.
Who was the patient? One drinking party burned out the body’s “foundation”
How did the illness begin? Zhang Xichun explained it in a few spare strokes: friends invited him to a gathering, he drank too much wine; on top of that he drank a great deal of hot tea and sweated all over; then, after sweating, he went outside and was struck by the wind. Just those few sentences — and the whole chain of the illness is in them.
💬 Note from Doctor Luo: Let us analyze this. I have said before: who easily catches febrile disease? People whose body fluids (jin ye) are insufficient — people with yin deficiency and internal heat. When fluids are lacking, the “water” inside the body is already scarce; now add strong liquor — in those days they drank baijiu, hot in nature, which goes on injuring the yin — and then hot tea, which makes the whole body sweat, losing still more fluid. Some friends ask: isn’t tea drinking water? No — sometimes no matter how much water you drink, the body cannot convert it into usable fluids, which is why yin-deficient people can drink a great deal of water and still feel thirsty. And it was autumn, hot to begin with, with a lot of sweating; then at night the wind blew over him — the body’s temperature-control system, its defensive system, developed a leak at the surface, the external pathogen slipped in through the weakness, and that is how the febrile disease began.
So this case tells us: febrile disease is the product of internal and external factors stacked together — an internal environment of yin deficiency and insufficient fluids as the foundation, plus an external environment of heat, sweating, and wind creating a leak in the defensive system — and the external pathogen enters through it.
How does febrile disease arise? A short lesson in how the illness starts
Using this case, Doctor Luo Dalun systematically laid out the several ways febrile disease arises — the most valuable extended knowledge in the whole case:
💬 Note from Doctor Luo: When does febrile disease easily occur? First, in winter: when it should be cold but suddenly turns warm, people get hot and suddenly break out in sweat, losing more fluids; then when the wind blows over them, the defensive system is disturbed — this is called wind warmth (feng wen). Second, in spring: in winter the body was injured by cold, and the pathogen lurks in some part of the body — this is called latent pathogen (fu xie), also called hidden pathogen. When the weather warms and the body’s qi mechanism begins to stir, the lurking pathogen comes out — this is exactly what the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) means by “injured by cold in winter, one is sure to fall ill with warmth in spring (dong shang yu han, chun bi bing wen).” In the present epidemic, the asymptomatic carriers are exactly this: a latent pathogen — the pathogen hides in the body, does not produce illness, and appears to show no symptoms. Third, in summer and autumn: the weather is scorching, people sweat a great deal, and in those with insufficient fluids the loss is even greater; with the slightest change of temperature and a breath of wind, the surface defensive system collapses and loses control, and the external pathogen slips in — this too is wind warmth.
After hearing this, you understand that febrile disease is not a matter of “bad luck” — it is internal environment (yin deficiency, fluid insufficiency) plus external environment (heat, sweat, wind) stacking together.
How sick was he? Fever of 39.4°C, with “dryness” everywhere
Zhang Xichun recorded Gao Zhenzhi’s symptoms precisely: pain in the bones and joints all over — after the fever, every joint ached; body heat of 39.4 degrees, a very high temperature; heat in the chest with thirst — desperately thirsty; a thin, slightly yellow tongue coating, showing the heat had begun to transform; dry stools — the fluids were insufficient; scanty dark urine — deep color, small amount; a dry cough; body sore and weak, with dizziness on the slightest movement; and the pulse was fast — five beats to one breath — floating, wiry, and weak (fu xian wu li).
💬 Note from Doctor Luo: Here is a diagnostic point everyone should remember: in febrile disease, once the urine becomes scanty and dark (xiao bian duan chi) — deep color, small volume — you may almost immediately suspect insufficiency of body fluids with a high degree of confidence. Why? If the stools are dry but the urine is plentiful, that means water has shifted from the stool to the urine — a different matter; but dry stools plus scanty dark urine means the water is insufficient at both ends, and that is insufficiency of body fluids. Why do I keep emphasizing “body fluids (jin ye)”? Many listeners are confused and think it means something else — Chinese medicine has no such other term; what we mean is jin ye, fluids — the “jin” of Tianjin and the “ye” of liquid.
What was more distressing: by the time Zhang Xichun saw him, the illness had already lasted more than forty days, with doctors called again and again and medicine taken again and again to no effect. The illness had dragged on so long, the fever would not break — the man was already weak beyond description.
What did Zhang Xichun think? The most crucial stroke of the whole case
Forty days without improvement — was the illness simply too severe? Zhang Xichun’s analysis went straight to the heart: this patient had only been lightly exposed to external contraction — it was not a hard-to-treat illness (ci zheng nai bao shou wai gan, bing fei nan zhi zheng) — the external contraction was not severe; this was not an incurable disease — it was that the medicine had not been used accurately. The external pathogen had not been resolved, so the internal heat naturally could not be cleared; and as the heat consumed the body day after day, the yin deficiency grew worse and worse. His original words pinpoint the nature of febrile disease: “The substantial heat of external contraction brews into the deficient heat of internal injury; when the two heats merge, it becomes all the harder to cure (wai gan zhi shi re, niang cheng nei shang zhi xu re, liang re xiang bing ze yu nan zhi yi).”
💬 Note from Doctor Luo: These words of Zhang Xichun’s speak the essence of febrile disease thoroughly. The internal environment of febrile disease is always yin deficiency with deficient heat, insufficiency of body fluids — in the channels and rivers that carry the defensive troops, the water is shallow, even dry; then the external environment turns hot, and the defensive system develops leaks; the external pathogen enters, and the body begins to resist — but it was already hot, and resistance generates more heat, so febrile disease tends to start with high fever; and the high fever in turn further injures the yin, exhausting the body’s fluids. So in treating febrile disease, you must grasp the root: “the internal environment is yin deficient.”
What made this case special: the external pathogen was mostly gone, but the fever caused by yin deficiency was very prominent. So Zhang Xichun’s strategy was clear — vigorously nourish the true yin (da zi zhen yin), with just a little medicine to release the exterior and drain heat. He would use large doses of yin-nourishing herbs to change the patient’s internal “terrain” of yin deficiency and fluid insufficiency.
Breaking down the prescription: one liang of raw Chinese yam first, to support the upright qi
The first formula Zhang Xichun wrote had a very clear approach — the first herb was his “trump card” — sheng huai shan yao (raw Chinese yam), one liang (about 30 g).
💬 Note from Doctor Luo: In treating external-contraction disease, you must first support the upright qi (fu zheng qi) — only when the upright qi is sufficient can the external pathogen be cleared out and pushed out. The herb Zhang Xichun was best at using to support the upright qi in external-contraction disease was raw Chinese yam. New friends may not know it yet: sheng huai shan yao is not fresh yam — it is the Chinese yam (huai shan yao) produced in Wen County, Jiaozuo, Henan, and the dried slices are called sheng huai shan yao. Why emphasize “sheng huai” (raw, from Huai)? Because pharmacies also carry a prepared slice called stir-fried yam (chao shan yao), which Zhang Xichun strongly opposed, saying the stir-fried yam had little effect. Chinese yam greatly supplements the essence of the lung, spleen, and kidney (da bu fei pi shen san zang zhi jing), most of all the spleen. When an essence-supplementing herb is paired with yin-nourishing herbs it immediately nourishes yin; paired with yang-supplementing herbs it immediately warms yang — this is the principle that essence transforms into yin and yang.
Next came sheng huai di huang (raw Rehmannia), one liang (about 30 g) — the main force for nourishing yin, also used in a large dose; then xuan shen (Scrophularia), one liang (about 30 g), sha shen (Glehnia), tian hua fen (Trichosanthes root), and tian men dong (Asparagus root) — all yin-nourishing herbs, with xuan shen and raw Rehmannia both at one liang: the yin-nourishing dose was very generous.
Then came bai shao (white peony) paired with gan cao (licorice) — this is the Shao Yao Gan Cao Tang (Peony and Licorice Decoction), which generates yin from sour and sweet (suan gan hua yin): it converts the water you drink into body fluids and makes up the shortage of fluid — used very timely. Then hua shi (talc) — to tip the heat outward and drain the heat pathogen out through the urine. And gou qi zi (wolfberry), supplementing the essence of the liver and kidney, assisting the yin-nourishing work.
💬 Note from Doctor Luo: Notice — within the formula, the four herbs raw Chinese yam, talc, raw white peony, and licorice are exactly the Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction) that Zhang Xichun himself created — a famous formula specifically for febrile disease! What state does it treat? It is used when the exterior pathogen has already been resolved but heat remains inside the body. Looking at the whole formula, it is mostly yin-nourishing, with only a very small amount of heat-clearing medicine — this shows Zhang Xichun’s judgment: this patient now had little external pathogen; the main problem was internal yin deficiency and insufficiency of body fluids — and the yin deficiency was producing deficient heat. Under that bodily terrain, the external pathogen could never be cleared, and that was why the fever climbed to 39.4 degrees. So he had to change the body’s terrain — nourish yin, fill up the internal fluids — and the body would turn itself around.
Chinese-Western integration: a bowl of sugar water to take aspirin
The formula was written. How was it taken? Decoct to one large bowl and drink in three portions. Interestingly: with the first portion, he first took a little aspirin with sugar water — why? To induce sweating and release the exterior, letting the pathogen out.
💬 Note from Doctor Luo: This is the hallmark of Zhang Xichun’s practice — integrating Chinese and Western medicine (zhong xi hui tong). He thought Chinese medicine was excellent, but did Western medicine have anything good? Of course it did. And since Western medicine had good things, use them. So he nourished yin with Chinese herbs and paired them with aspirin to induce sweat and release the exterior — Chinese and Western medicines used together. You see, in the Republican era our Chinese medicine already had this breadth of mind — embracing both Chinese and Western approaches, taking whatever is useful — a very advanced, very forward-looking idea. In contrast, some Chinese medicine practitioners today boast “I am pure Chinese medicine, I reject Western medicine, Western medicine is all bad” — this is very narrow-minded, and I strongly oppose it. After so many years, their breadth of mind has not even reached Doctor Zhang Xichun’s — that is actually a regression.
After the first dose: the fever dropped by more than half, and the urine flowed freely
The effect of the first dose was immediate: the heat retreated by more than half (re tui qiang ban) — the high fever fell by more than half; the urine became free-flowing — the fluids were beginning to recover; and the pulse beat with strength. So Zhang Xichun made small adjustments to the original formula and gave one more dose (sui yuan fang lue wei jia jian, zai he yi ji).
The second formula again began with raw Chinese yam, one liang (about 30 g) — this was the secret of Zhang Xichun’s practice; raw Rehmannia eight qian (about 24 g) and xuan shen six qian (about 18 g) — both reduced, because the yin-nourishing force was now sufficient; sha shen, gou qi zi, and tian men dong, six qian (about 18 g) each; hua shi three qian (about 9 g), working with the yam to supplement on one side and drain the heat outward on the other; gan cao two qian (about 6 g) — to resolve toxins and harmonize the herbs; and he added e jiao (ass-hide gelatin), crushed, three qian (about 9 g).
💬 Note from Doctor Luo: E jiao has two functions here: first, nourishing yin and moistening dryness (zi yin run zao); second, moistening the bowels — because this patient’s stools had still not moved, and e jiao nourishes the blood and moistens dryness, precisely for softening that dry, bound stool. How was this dose taken? After decocting, strain out the dregs, then dissolve the e jiao into the hot liquid (yang hua) and take it warm in two portions; with the first portion, as before, a little aspirin with sugar water — still to release the exterior and induce sweat, because he felt there was still a little pathogen at the surface.
Two doses — and forty days of high fever were gone
Zhang Xichun recorded the effect of the second dose in detail: after the first portion, he sweated all over again; after the second portion, his mouth was no longer thirsty — before, the fluid insufficiency and yin deficiency with heat had caused the thirst; now the fluids had been replenished; the urine also returned to normal, no longer scanty and dark; and that same day the bowels moved — the fluids in the intestines had recovered. Once the bowels moved, he suddenly felt clear-headed and refreshed, all burning heat gone (dun jue jing shen qing shuang, zhuo re quan wu) — the heat in his body vanished completely, and the illness was cured.
💬 Note from Doctor Luo: You see — only two doses in total. An illness that others had treated for over forty days, burning above 39 degrees every day — two doses from Zhang Xichun, and it was done, no more trouble. Why was Zhang Xichun a master physician? You have to admire him — his skills were genuinely extraordinary. This case shows an extreme situation very clearly: when external contraction comes, what does Zhang Xichun usually use? Raw gypsum (sheng shi gao) — when the external heat is extremely severe, raw gypsum clears the substantial heat, clearing the state of fierce resistance; and on the other hand, when the body itself is yin deficient and short of fluids, he used every method to replenish the fluids and change the internal state of yin deficiency. Today’s case displays this latter aspect with particular clarity.
A bonus diagnostic detail: a red tongue body is the “iron proof” of yin deficiency
In this case Zhang Xichun described the tongue coating — very thin, slightly yellow — but he did not describe the tongue body. Doctor Luo Dalun reminds us especially: at that point the patient’s tongue body must have been red — very red — absolutely not pale and bloodless.
💬 Note from Doctor Luo: A red tongue body with no coating or a thin coating is the sign of yin deficiency. So when looking at febrile disease, do not fixate only on clearing heat and resolving toxins — look at this formula: there is basically no medicine for clearing heat, resolving toxins, or killing viruses and bacteria, right? There is none. Zhang Xichun instead adjusted the terrain of the external contraction by changing the constitution: he corrected the internal state of fluid insufficiency and yin deficiency, added a little medicine to release the pathogen at the surface, and the external pathogen was cleared at once. This is a very high-level approach. What I hope everyone learns is precisely this way of thinking — the principles of Chinese medicine are the principles of life itself: tend your fluids and your upright qi day to day, and when the external pathogen arrives, the body itself will have the strength to push the illness out.
Based on Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s medical case; the case is from the Records of Chinese Medicine with Western Reference (《医学衷中参西录》).