Aching Bones, Too Much Phlegm, and Always Craving Cold Water? Doctor Xue Lizhai Tonifies the Spleen and Kidneys for an Imperial Guard Who Looked Strong
Patient search terms: bone pain / aching all over the body / no energy in the body / lots of phlegm / dry mouth / always wanting cold drinks
Medical terms for this condition: deficiency of both spleen and kidney · consumptive fatigue · phlegm-dampness obstructing internally · deficiency fire flaming upward (dragon-thunder fire rushing upward)
Opening: even an imperial guard can fall gravely ill
The man in today’s case had an unusual title — Yang Yongxing, an imperial guard (jin yi wei). What did the imperial guard do? They were the troops responsible for the emperor’s personal safety — a name that sounds every bit as formidable as it was. In the movies, imperial guards are all fierce fighters. And this Officer Yang? Heavy-set and tall — stout, towering, the very picture of a strong man.
💬 Note from Doctor Luo: Everyone, notice that Doctor Xue Lizhai begins his case record by writing out the patient’s body condition — heavy-set build. But Doctor Xue’s experience was that when a record says a man is exceptionally stout and tall, that is not necessarily good news. Looking strong on the outside does not mean the upright qi is sufficient inside — he might be outwardly strong but inwardly hollow.
How sick was he? — aching sinews and bones, phlegm in abundance, and a craving for cold water
So what was wrong with this big strong man? His sinews and bones ached weakly — the bones and tendons all over his body were sore and tired; he had excessive phlegm and thirst — an enormous amount of phlegm, along with a dry mouth; and above all he craved cold water — he wanted cold drinks, the colder the better.
💬 Note from Doctor Luo: Aching sinews and bones have many causes: wind-damp conditions divide into wind-cold-damp and wind-damp-heat, and there are also internal-injury and blood-stasis causes. But phlegm in abundance, thirst, and wanting cold water — put those together and something interesting is going on. Normally, wanting cold drinks suggests heat. There is a hidden secret here; let’s keep reading.
Getting worse and worse: dispelling wind and unblocking channels failed, and clearing heat made it worse
The first doctor took one look: too much phlegm, aching sinews and bones — must be wind-phlegm, right? So he used Yu Feng Tang (Wind-Curing Decoction) and Tian Ma Wan (Gastrodia Pill) — medicines that dispel wind and unblock the channels. The result? The phlegm and heat grew even worse — not only did the patient not improve, his phlegm increased and the heat became more obvious.
So another doctor was called, this time treating it as “phlegm-heat” with Niu Huang Qing Xin Wan (Bezoar Heart-Clearing Pill) to clear and resolve phlegm-heat. And that made things worse still — his limbs went numb. Where he had only had aching sinews and bones before, now his arms and legs were numb and hard to move at all.
💬 Note from Doctor Luo: This is what happens when you fail to see the true root of the illness. The more you dispel wind and unblock channels, the more you consume the upright qi; the more you clear phlegm-heat, the sicker the patient becomes. Neither of the first two doctors understood what was really going on inside this big strong man.
How did Doctor Xue see it? — not excess fire, but deficiency of both spleen and kidney
Doctor Xue Lizhai came, took one look, and settled the case with a single sentence: this is not an excess pattern — it is deficiency, deficiency of both the spleen and the kidney.
💬 Note from Doctor Luo: Doctor Xue’s analysis fit every symptom. The kidneys govern the bones and generate marrow — bone problems are most closely tied to the kidneys, and when the kidneys are deficient the sinews and bones ache weakly. A deficient spleen cannot transport and transform water-dampness — dampness overflows and condenses into phlegm, hence the excessive phlegm. The water never turns into normal body fluids, the fluids cannot be distributed, and the person becomes thirsty. Moreover, kidney yang generates spleen earth — when kidney yang is insufficient, the fire of the life gate cannot generate spleen earth, and the spleen earth fails along with it. The spleen and kidney support each other — that is exactly the principle here.
And what about wanting cold water? Does that mean there really is heat inside? Doctor Xue said: this is deficiency heat!
💬 Note from Doctor Luo: Here is an imperfect analogy: when the lamp oil is nearly gone, the flame suddenly leaps up high. When the body is weakened and kidney essence is deficient, deficiency fire runs upward — in Chinese medicine this is called dragon-thunder fire rushing upward — and the upper body feels hot and fiery. If you respond by clearing the fire, the more you clear it, the worse it gets! The reason the Bezoar Heart-Clearing Pill left him paralyzed is that it injured his yang qi — there was never that much excess heat to begin with, but the bitter-cold medicines damaged both spleen yang and kidney yang, the qi and blood stopped moving, and the limbs went numb.
The prescription: Bu Zhong Yi Qi Tang as the base, plus the Modified Eight-Ingredient Pill to warm the kidneys
With the direction fixed, the formula was simple: Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction) to tonify the spleen qi and lift the yang, together with Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) to warm kidney yang. What exactly is the Modified Eight-Ingredient Pill? It is Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) with niu xi (achyranthes root) and che qian zi (plantago seed) added — on top of warming kidney yang, it gains the functions of promoting urination and strengthening sinews and bones. In ancient times it was also called Ji Sheng Shen Qi Wan (Life-Giving Kidney Qi Pill).
💬 Note from Doctor Luo: Let me sort out the pill names so no one gets confused: the kidney-qi pill from Zhang Zhongjing’s Golden Cabinet is sold in pharmacies today as Gui Fu Di Huang Wan; what Doctor Xue called the Modified Eight-Ingredient Pill — anciently the Ji Sheng Shen Qi Wan — is the pill sold in modern pharmacies as Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill). The core idea is shu di huang (prepared rehmannia) to tonify kidney essence, matched with rou gui (cinnamon bark) and fu zi (aconite) to warm the yang — that classic “prepared rehmannia paired with cinnamon” combination was later beloved by Chen Shiduo and Zhang Jingyue, and its ultimate source is Zhang Zhongjing himself.
After three months, fully recovered — and then seven sons
After taking the medicine for three months, the imperial guard’s illness was completely cured. And the result went beyond all expectation — he went on to father seven sons and lived past seventy! In ancient times “seventy years of age has been rare since antiquity,” so this was a thoroughly respectable old age.
Doctor Xue also quoted a line from the Essentials of External Medicine (《外科枢要》): “Whoever takes the Modified Eight-Ingredient Pill for a long time will surely become stout and healthy and have many children.” Doctor Xue said “truly so” — the ancients were not exaggerating.
💬 Note from Doctor Luo: Why is this generally beneficial for men? Through the ages, men expend a great deal, and by a certain age very many men suffer kidney-qi deficiency. The Modified Eight-Ingredient Pill tonifies kidney qi and helps drain the body’s dampness, so it does most men good. But the precondition is pattern differentiation — if you have damp-heat, it is not right for you, so don’t take it casually.
Why would a man who looks so strong actually be deficient?
What makes this case special is that it is a textbook example of treatment that supports the upright qi and establishes the root. In the movies imperial guards fight fiercely, but this officer was a leader — pampered and sedentary — and by middle age his body had quietly fallen into decline.
💬 Note from Doctor Luo: Doctor Xue Lizhai left behind more than three thousand case records in his lifetime — one of the most prolific case-record writers in all of Chinese medical history. He could read a person at a glance: what stage of life they were in, what state their body was in, how their occupation related to their health — one look and he saw it all. Officer Yang here was deficient in the kidneys first — kidney essence insufficient, yin and yang both depleted, with kidney yang deficiency slightly more pronounced, which is why the Modified Eight-Ingredient Pill was chosen. Once kidney yang was insufficient, the fire of the life gate could not generate spleen earth, and the spleen qi failed too; add in the rich, fatty foods he ate and the rushed, skipped meals of an officer on duty, and the spleen and stomach were injured as well — spleen and kidney both deficient, and the aching sinews and bones, the excess phlegm, and the craving for cold water all came at once.
Doctor Xue’s specialty: which medicine at which hour
This combination of “Bu Zhong Yi Qi Tang matched with the Modified Eight-Ingredient Pill” — Doctor Luo says he learned it from Doctor Xue Lizhai. Doctor Xue wielded the classic patent medicines to perfection: how to modify them, which patterns they fit, and what time of day to take them — all arranged with complete clarity.
💬 Note from Doctor Luo: The daily-care routine I talk about all the time comes straight from Doctor Xue Lizhai — take Bu Zhong Yi Qi Wan (Center-Supplementing Qi-Boosting Pill) after breakfast to lift the yang; in the evening, use Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill, i.e. Gui Fu Di Huang Wan) if yang is deficient or Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) if yin is deficient, to replenish kidney essence; at noon, sometimes add a little Xiao Yao Wan (Free and Easy Wanderer Pill) — so the body establishes a cycle: boost yang in the morning, replenish kidney essence at night, and gradually settle into stillness. Once I gave a lecture in Lanzhou, and a local doctor of Western medicine who later retrained in Chinese medicine became the director of a severe infectious-disease unit. He said he was not much of a prescriber himself, but he had worked out which patent medicine to take at what time, how to combine them, and which formula fits which pattern — he drew up a big chart. The results for his critically ill infectious-disease patients improved dramatically; some patients who should not have survived were saved. He said he learned it from me, Teacher Luo. I told him: I learned it from Doctor Xue Lizhai — from the ancients!
Remember these signs: lots of phlegm, thirst, and a craving for cold water — first ask whether it is deficiency
The clinical indicators this case leaves us are clear: aching weak sinews and bones, excessive phlegm, thirst — even a preference for cold water.
💬 Note from Doctor Luo: Craving cold water is sometimes an illusion! It looks like heat, but it is actually deficiency heat — caused by insufficiency of kidney essence. We see this pattern constantly today: the kidney essence is depleted, deficiency fire rises (the dragon-thunder fire rushing upward), and trigeminal neuralgia, toothache, or eye problems appear. Everyone sees “heat” and reaches for heat-clearing, detoxifying, cold-natured medicines — and the more they use, the worse it gets. The correct approach is shu di huang (prepared rehmannia) to tonify kidney essence, matched with fu zi (aconite) and rou gui (cinnamon bark) to warm the yang, plus a little fluid-nourishing medicine — and the deficiency fire comes down on its own. Never use bitter-cold medicines to clear the heat here. This is also why Doctor Xue placed such emphasis on protecting yang qi: in the Jin-Yuan period before the Ming dynasty, doctors like Liu Hejian used cold-natured medicines heavily, and Chinese medicine is always correcting the excesses of its predecessors. A doctor like Xue Lizhai, who stressed supporting the upright qi and protecting yang, deserves our study. From now on, whenever you meet someone with abundant phlegm, thirst, and a fondness for cold water, add one more question in your mind: could this be the deficiency fire of spleen-kidney deficiency?
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》).