Suddenly Drowsy and About to Faint? Doctor Xue Lizhai First Uses Tongbian (Boy’s Urine) for Emergency, Then Shiquan Dabu Tang to Rebuild Primordial Qi
Patient search terms: suddenly drowsy / about to faint / exhausted beyond words / always “on fire” (deficiency fire) / constant sweating / racing heart
Medical terms for this condition: deficiency of primordial qi · mental clouding (hun kui) · qi-deficiency fever · consumptive exhaustion (xu lao)
Opening: this physician had a special gift — using classical formulas with superb mastery
In the last lecture we met Doctor Xue Lizhai, head of the Imperial Academy of Medicine in the Ming dynasty — personal name Ji, courtesy name Xinfu, style name Lizhai, from a family of imperial physicians, who left behind more than three thousand case records in his lifetime. Doctor Luo Dalun says the greatest benefit of studying with Doctor Xue is that he was especially skilled at using ready-made formulas — taking classical prescriptions and wielding them with superb mastery.
💬 Note from Doctor Luo: When to use a classical formula, and at what stage — Doctor Xue has already summarized it all for us. All we have to do is go and look. He summarized more than three thousand cases — imagine how much there is to learn! Today’s case is about tonifying deficiency — the pattern of damage to yuan qi through food, drink, toil, and fatigue. Why did I pick this one? Because there are so many deficient people around today. I never used to think there were this many, but in recent years I’ve found that people are quietly wearing themselves down — very few people these days have truly abundant yuan qi. And when you feel “I have fire,” let me tell you, your fire may not be what you think: some is genuine liver fire flaring up; but some of that fire is not real fire at all.
Who was the patient? — a scholar who worked himself into a faint
The patient in this case was a jinshi (the highest degree in the imperial examination), by the name of Wang Ruhe. How did he fall ill? The original text says it in six characters: yin lao yi shi yu tiao yang — “through toil and ease he failed to look after himself.”
💬 Note from Doctor Luo: What does that mean? He had work tasks pressing down on him, he worked extremely hard, and he did not take care of himself — he didn’t sleep well, and he didn’t eat well. The result? Hu ran hun kui — suddenly his mind went cloudy and groggy, even approaching the look of fainting. Ordinary people get tired, rest for two days after work, and they’re fine — so why did Wang Ruhe get so exhausted he nearly passed out? Doctor Xue took one look and said: yuan qi xu — his primordial qi was deficient. That is the root. Ordinary people are tired, but tiredness doesn’t turn into this kind of illness; the reason he collapsed from exhaustion is that his yuan qi had problems to begin with.
What did Doctor Xue think? — the fire was deficiency fire, the phlegm clouded the clear orifices, and the root lay in yuan qi
Doctor Xue’s reasoning builds layer by layer. On the surface, fire stirred recklessly, carrying phlegm with it to cloud the clear orifices, causing the sudden near-collapse — that is the branch. But what is the root? The root is yuan qi deficiency.
💬 Note from Doctor Luo: Yuan qi is weak, there is a little deficiency fire, a little phlegm; when they combine, the clear orifices get clouded and the person becomes unconscious. How do you handle this? Doctor Xue’s method is especially interesting — ji ling guan tongbian: he had them immediately pour tongbian into the patient.
The first move: pour in tongbian — a life-saving trick learned on the battlefield
Tongbian is the urine of a healthy young boy — tong zi niao, “child urine.” Doctor Xue was especially good at using tongbian, and this had to do with his own experience.
💬 Note from Doctor Luo: In those days Doctor Xue traveled with the Ming army — he was an imperial physician, and accompanying the troops was one of his important duties. He asked the soldiers: you fall off your horses all the time and get injured daily — how do you treat an injury? The soldiers said: quickly drink boy’s urine — you must find the urine of a young boy and drink it. Boy’s urine quickly dissolves the stagnant blood; once the stasis dissolves, the injury becomes much lighter — otherwise it leaves an old wound that lingers for years. So Doctor Xue was deeply impressed by tongbian. Besides dissolving stasis, what else does it do? It clears deficiency fire, nourishes yin, and brings fire down. On one hand it cools the blood and dissolves stasis; on the other it nourishes yin and lowers fire — it clears the fire away. Doctor Xue immediately had people support Wang Ruhe and pour tongbian into him to bring the fire down. What happened? Shen si jian shuang — his mental state gradually improved, his thinking slowly returned. You see — it worked!
The second move: ren shen and huang qi at five qian each — tonify qi and blood, and while at it soothe the liver and drain fire
Once the fire had gone, Doctor Xue immediately followed with the second step: ren shen and huang qi at five qian each (about 15 g), chuan xiong and dang gui at three qian each (about 9 g) — tonifying qi and nourishing blood, supplementing both qi and blood. This man’s upright qi was indeed insufficient. Then he added xuan shen (figwort root, to clear fire and heat), chai hu (bupleurum, to soothe the liver and disperse stagnation in the liver channel), zhi zi (gardenia fruit, to drain the fire of the heart, liver, and san jiao), and honey-fried licorice (to harmonize all the herbs), one qian each.
💬 Note from Doctor Luo: This line of thinking is very important — why did we mention earlier that some people have chest and breast distension and rib-side pain, and that you should drain the liver fire first? Because before you tonify, you should drain the fire a little and open up the liver fire a little. Only then will what you tonify actually stay in. After taking this, Wang Ruhe gradually settled down — but note the phrase the original text uses: fu zhi shao ding — only “slightly settled.”
The crucial look: inspection reveals “the body weary beyond measure,” and a great deficiency is confirmed
After he was “slightly settled,” Doctor Xue began to cha qi xing juan shen — he observed this man: profoundly tired, exhausted beyond words. What is that? The upright qi is especially insufficient.
💬 Note from Doctor Luo: Chinese medicine excels at inspection — wang wen wen qie, the four examinations, and inspection comes first and matters enormously. An old physician looks at you as you walk in: whether your spirit is full, whether your eyes have light, your complexion, the luster of your skin, your posture — are you standing braced and strong, or slumped at the shoulders? Is the belly puffed out from deficiency, or drawn in? One look at the “xing” — the physical form — and he knows how the upright qi stands. Doctor Xue looked and saw two characters — juan shen: weary beyond measure, exhausted beyond words. What does that tell you? The yuan qi can no longer hold the body up. So Doctor Xue judged it a great deficiency, switched to Shiquan Dabu Tang plus wu wei zi and mai men dong, and treated him with that. The result — er an — he was completely well.
Breaking down the prescription: why can Shiquan Dabu Tang treat deficiency fire?
The core formula of this case is Shiquan Dabu Tang — the Ten Complete Great Tonification Decoction. You have to take it apart layer by layer:
💬 Note from Doctor Luo: Ten Complete Great Tonification = Si Jun Zi Tang (Four Gentlemen Decoction: ren shen, bai zhu, fu ling, gan cao — the main formula for tonifying qi, the “ancestor formula” of qi tonics; almost all later qi-tonifying formulas were built by adding ingredients to Si Jun Zi Tang) + Si Wu Tang (Four Substances Decoction: shu di huang, dang gui, chuan xiong, bai shao — for nourishing blood, a formula Zhu Danxi used constantly; among these, shu di huang tonifies the kidney channel). Si Jun Zi plus Si Wu makes Ba Zhen Tang (Eight Treasures Decoction); add huang qi and rou gui (cinnamon bark) to Ba Zhen Tang, and you have Shiquan Dabu Tang. Huang qi tonifies qi; rou gui is the warm-nourishing one, used to gather deficiency fire and guide fire back to its origin (yin huo gui yuan) — everyone, this is extremely important!
The finishing touch: rou gui guides fire back to its origin — the beauty of shu di huang paired with rou gui
Rou gui (cinnamon bark) is something everyone uses in cooking. Doctor Luo says it is truly magical, and its core function can be summed up in four characters: yin huo gui yuan — guide fire back to its origin.
💬 Note from Doctor Luo: I often use shu di huang paired with rou gui — a generous amount of prepared rehmannia with just a tiny bit of cinnamon bark can gather down the deficiency fire that rushes upward from kidney-essence deficiency. I’ve tested it myself: take prepared rehmannia alone, and in some people deficiency fire really does flare up — you tonify and the fire doesn’t know where to go, the energy moves upward, and people say “I drank a little shu di huang and now I’m on fire — my tooth hurts more, why is it swollen and hot?” At that point add a little rou gui — a piece the size of a fingernail is enough — and you’ll find the fire comes right down. Truly remarkable. Look at Yin Huo Tang (Fire-Guiding Decoction) and many other formulas — they all follow the same pattern of shu di huang paired with rou gui; Zhang Zhongjing’s Jin Gui Shen Qi Wan (Kidney Qi Pill) also pairs a large amount of shu di huang with rou gui — rou gui is there to guide fire back to its origin. In Shiquan Dabu Tang, wu wei zi (schisandra) is added because it is sour and astringent — it also has a gathering function: the qi you tonify in shouldn’t scatter as soon as it goes in; wu wei zi gathers it and holds it. And mai men dong (dwarf lilyturf) is added because the earlier herbs risk being a bit warm; mai men dong nourishes yin and moistens dryness. Shiquan Dabu Tang plus wu wei zi and mai men dong — secure the upright qi, and the deficiency fire naturally withdraws.
Doctor Xue’s great summary: how does a person with weak yuan qi gradually drain away?
The case record itself is quite brief, but Doctor Luo says the words Doctor Xue wrote afterward are extremely important: fan ren yuan qi su ruo — “for all people whose yuan qi is originally weak” — yuan qi is the fundamental qi of the body, and people with insufficient upright qi are everywhere today; they are draining themselves badly.
💬 Note from Doctor Luo: Doctor Xue summarized three causes. First, or qi ju shi yi — poor living habits: staying up late, consuming yourself excessively day after day. Second, or yin shi lao juan — not eating properly: skipping meals or going hungry, or eating rich, greasy food, while also being frequently fatigued and overusing yourself. Third, or yong xin tai guo — overthinking day after day: worry injures the spleen and drains the heart-blood. This last one, I think, applies to far more modern people than ancient ones: every day we think about how to get promoted, how to hit some little goal… In today’s world, people who exhaust their spirit outnumber the ancients countless times over. In ancient times life was simple — either you sat the imperial examinations, or you worked at home; and the harvest at home was mostly decided by heaven, so there wasn’t that much to worry about. Today, with the internet, you can see everything — even “set a small goal of one hundred million.” So Doctor Xue’s framework applies perfectly today. This Wang Ruhe was a jinshi — no doubt he too was consuming himself a great deal.
Deficiency of yuan qi: the full list of “fake fire” symptoms
Doctor Xue then listed the various symptoms that can appear when yuan qi is weak. Doctor Luo says if you truly expanded this passage, it could fill a very large lecture:
💬 Note from Doctor Luo: Yi jing bai zhuo — seminal emission and turbid white discharge: kidney qi is insufficient, too weak to hold and astringe. Zi han dao han — spontaneous sweating and night sweats: the fluids can no longer be guarded within. Nei re bu re — internal heat and afternoon tidal fever: between 3 and 5 pm you suddenly feel hot, a tidal fever. Kou gan zuo ke — dry mouth and thirst: qi and blood cannot supply the whole body, and the throat feels especially dry. Hou tong she lie — sore throat and cracked tongue: the throat hurts and the tongue is covered with many cracks. Xiong ru peng zhang, xie lei zuo tong — chest and breast distension, rib-side pain: some liver-qi stagnation and liver fire, but they show up more prominently when yuan qi is insufficient, because the body can no longer adjust itself. Tou jing shi tong, xuan yun yan hua — recurrent headache and neck pain, dizziness and blurred vision: deficient-type headaches from insufficient qi and blood. I have seen people with headaches whose blood pressure measured very high; I looked at the tongue — red tongue body — and the pulse was racing, so I treated them by nourishing yin with Liuwei Dihuang Wan. They took it and got better; the blood pressure came down, the headache vanished. That was a headache from insomnia — actually a manifestation of yin deficiency. Xin shen bu ning, ti er bu mei — restlessness and anxiety, insomnia with easy startling: the heart channel is depleted, qi and blood insufficient — someone bangs the table and you jump out of your skin; when blood fails to nourish the heart, you cannot sleep. Xiao bian chi se, jing zhong zuo tong — scanty, dark, painful urination: the urine is reddish, scanty, and painful to pass. Usually we’d call this damp-heat pouring downward, an excess pattern — but some people are not like that: when qi and blood are depleted to a certain degree, even the fluids are insufficient, the vehicle for excretion is very little, and problems arise when the body tries to push out waste. So not all urinary pain is damp-heat excess — deficient people can have it too, because deficiency fire wanders everywhere. Bian niao yu li — dribbling after urination: always a little urine left dripping out. Qi fu leng tong — cold pain in the navel and abdomen. Xing rong bu chong — a wan complexion and listless bearing. Zhi ti wei han — the limbs fear cold: you are always colder than other people — in the same weather everyone else wears a T-shirt and you need long sleeves. Bi xi ji cu — rapid breathing, which means a racing heart: when yuan qi is insufficient, the heart has to double its effort to pump qi and blood around the body, and still there isn’t enough, so it pumps faster and faster. I see many people with very fast heartbeats these days, especially those in management — the more they manage, the faster their hearts beat. That is overconsumption, qi and blood deficiency — you can see their breathing is urgent too. All of these are signs of deficiency.
Rootless deficiency fire: attacking fire wherever you see it is a serious mistake
With all these “heat” symptoms on the table, Doctor Xue delivered one final, crucial conclusion: geng you yi qie re zheng, xi shi wu gen xu huo — “and as for all the heat symptoms besides — they are all rootless deficiency fire.” They are all fake fire.
💬 Note from Doctor Luo: What is rootless deficiency fire? The yuan qi below is gone, so the deficiency fire runs out. This fire is an illusion — it is caused by yuan qi deficiency. So what do you do? Dan fu qian tang, gu qi gen ben, zhu zheng zi yu — “simply take the previous decoction, secure the root, and all the symptoms will heal by themselves.” Ruo gong qi feng re, ze wu yi — “but if you attack wind-heat, you will be wrong.” At this point, if you see heat and drain the fire, disperse wind and clear heat, you have made a mistake. The “previous decoction” here has three layers: first, tongbian — that was just a guide medicine, a way to control the acute crisis at that moment; second, ren shen, huang qi, chuan xiong, dang gui — this is the simplified Shiquan Dabu Tang idea: tonify qi and blood while soothing the liver and draining fire; third, Shiquan Dabu Tang plus wu wei zi and mai men dong — this is the final formula that secures the root.
How can modern people use this? — Shiquan Dabu Wan with wu wei zi and mai men dong; soothe the liver first, then tonify
How does this formula translate into everyday practice today? Doctor Luo always likes to add a modern application note to Doctor Xue’s cases:
💬 Note from Doctor Luo: Today there is a Shiquan Dabu Wan — the patent medicine exists. You can take one or two grams of wu wei zi and about three grams of mai men dong, decoct them in water, and use the water to wash down Shiquan Dabu Wan. If you have liver fire, first take Jiawei Xiaoyao Wan to soothe and clear the liver fire, and only then Shiquan Dabu Wan with wu wei zi and mai men dong — in this way you gradually build the upright qi back up and the deficiency fire comes down. Remember this lesson: when yuan qi is insufficient, all sorts of symptoms appear that are easily mistaken for “heat” — but they are not real fire, they are deficiency fire. Tonify the yuan qi until it is full, let the upright qi gather and withdraw, and these deficiency fires disappear. It is like our study of Yin Huo Tang (Fire-Guiding Decoction) — once you understand the deficiency fire that arises from kidney-essence deficiency, you can treat many diseases; once you also understand the deficiency fire that arises from yuan qi deficiency — the kind Shiquan Dabu Tang addresses — then indeed even more diseases can be treated. No need to drain fire — use tonification: once the essence gathers, the fire withdraws on its own.
Organized from Doctor Luo Dalun’s lecture explaining the case records of Doctor Xue Lizhai; the case comes from Records of Cases by Doctor Xue (《薛氏医案》).