Always Angry and Spitting Up Acid? A Ten-Year Illness, Cured in Under a Month
People search for: always angry / bad temper / spitting up sour fluid / heartburn / chest not feeling right / hot hands and feet / feeling down / burping and belching
The medical terms behind it: liver fire with dried blood · liver-spleen disharmony · acid regurgitation and belching · spleen-stomach deficiency
The opening: husband and wife, both driven into the case records by anger
Today we continue with the case stories of Doctor Xue Lizhai (薛立斋), the Ming-dynasty imperial physician. Last time we told how the prefect Zhu Yangshan flew into a rage, came down with abdominal pain and diarrhea, and was cured by Doctor Xue with Xiao Chai Hu Tang and similar formulas. This time, it is his wife’s turn — the wife of Zhu Yangshan, chronically prone to anger. She had never had a good temper, and she flared up at the slightest thing.
💬 Note from Doctor Luo: Look at this couple — one fell ill with abdominal pain and diarrhea because of anger, the other was chronically prone to anger, and the two of them walked into the same case records one after the other. You could say Prefect Zhu had a demanding job and plenty of reasons to get angry on the road, too — but put the two cases side by side, and it is hard not to suspect that his wife’s temper had something to do with it. When a couple’s temperaments clash and they sulk and feud day after day, it is bad for both of their health — Doctor Luo said this quite bluntly.
This lady’s illness lasted more than a decade
What was this lady like on a normal day? Her chest was oppressed and uncomfortable (xiong ge bu li) — her chest always felt as if something were stuck there, never at ease; she brought up copious phlegm — an enormous amount of phlegm; she regurgitated acid and belched (tun suan ai fu) — sour fluid kept rising into her throat, with burping and belching; her appetite faded (yin shi shao si) — she had no desire to eat, and her appetite got worse and worse; and her hands and feet always felt warm (shou zu fa re).
With this cluster of complaints, she suffered for more than ten years — a thoroughly seasoned patient by the time Doctor Xue saw her.
💬 Note from Doctor Luo: Where did the root of the illness lie? Plainly — in the emotions. Her husband had been provoked by her temper into abdominal pain and diarrhea; she herself had been losing her temper every day for a decade. The relationship between bad emotions and the body could not be demonstrated more vividly than in this husband-and-wife pair.
Why didn’t the earlier doctors’ treatments work?
Of course she had taken plenty of medicine over those ten years. The earlier doctors reasoned: this woman flares up easily, so she must have liver fire — and so they prescribed huang qin (baical skullcap root), huang lian (coptis), and zhi shi (bitter orange) to clear the liver and drain fire. Or they combined that with bing lang (betel nut), su ye (perilla leaf), su geng (perilla stalk), and hou po (magnolia bark) — because she always felt her chest was blocked and her phlegm was heavy, they gave her qi-moving herbs.
And the result? No effect. If it had worked, why would she have come looking for Doctor Xue?
💬 Note from Doctor Luo: My guess is this: Doctor Xue first cured Prefect Zhu. His wife saw that and thought, “Oh, you can actually cure him — then I should be treated too,” and came knocking on his door.
Doctor Xue felt the pulse: liver fire had already bullied its way into spleen earth
Doctor Xue’s diagnosis by pulse: left guan position stringy and surging (xian hong) — a stringy-surging pulse is the pulse of liver fire; right guan position stringy and rapid (xian shu) — “rapid” means it beats fast. The right guan corresponds to the spleen and stomach; a stringy, rapid pulse there means liver wood has already invaded and oppressed spleen earth — liver fire is in the middle of bullying the spleen and stomach.
💬 Note from Doctor Luo: Doctor Xue’s diagnosis was liver fire with dried blood (gan huo xue zao). The “liver fire” part is beyond doubt — this woman clearly had a bad temper. But what does liver fire do next? Liver fire injures yin and consumes liver blood; when liver blood runs low, the blood grows dry and parched — the classical phrase is “the liver withers and the blood is insufficient.” On top of that, wood overacts on the position of earth — liver qi runs sideways and attacks spleen earth, and the spleen and stomach suffer along with it.
The diagnostic highlight: instead of draining fire, he supported the upright
By the usual logic, if there is liver fire you clear liver fire, and if the chest is blocked you move the qi — that is what all the earlier doctors had done. Doctor Xue would not. His method was distinctive: support the upright qi first.
How? In the morning he gave Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish liver wood — taking it in the morning nourishes liver blood and liver yin; in the evening he gave Liu Jun Zi Tang (Six Gentlemen Decoction) plus dang gui (angelica) and shao yao (white peony) to regulate and tonify spleen earth — the evening formula tonifies the spleen, with dang gui nourishing the blood and shao yao constraining the liver.
💬 Note from Doctor Luo: You may ask: since there is liver fire, why not use a patent formula like Xiao Yao Wan (Free and Easy Powder) that soothes the liver and clears fire? Doctor Xue drew the distinction very clearly — this was yin deficiency, not excess fire, and the tongue should have shown the signs of yin deficiency. Xiao Yao Wan does contain blood-nourishing herbs, but it has no yin-nourishing herbs — its power to nourish yin is insufficient. Liu Wei Di Huang Wan specializes in nourishing yin, drawing the deficiency fire back down; paired with Liu Jun Zi Tang to tonify the spleen, the effect is dependable. Doctor Xue was especially skilled at using patent medicines, and he even split them between morning and evening — that was his signature technique.
Why the reversal? Nourishing yin in the morning, tonifying yang in the evening
Here is a major puzzle: Chinese medicine usually holds that you lift yang in the morning and nourish yin in the evening — and Doctor Xue himself usually followed that rule. Why did he turn it upside down this time?
💬 Note from Doctor Luo: Xue’s Case Records contains an explanation, and it makes good sense. First, she had liver fire, and the fire was quite pronounced — if you gave her a warming formula like Liu Jun Zi Tang in the morning, the fire would blaze even higher; instead of tonifying the spleen you would add dryness and heat, and it would oppress the spleen further. Second, she had taken far too much bitter-cold medicine — huang qin, huang lian and the like — over the years, and it had damaged the yang of her spleen and stomach. In the evening the yin qi is naturally at its heaviest; if you then nourish yin with Liu Wei Di Huang Wan, yin piled upon yin would injure the spleen yang even more. So he deliberately reversed the convention: nourish yin in the morning (Liu Wei Di Huang Wan — and the morning is precisely the time of the liver meridian), and tonify the spleen in the evening (Liu Jun Zi Tang, which is warming) — striking a balanced, gentle pattern. Incidentally, for the evening he chose Liu Jun Zi Tang and not Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) — because Bu Zhong Yi Qi Tang lifts the qi upward, and at night the qi should not be lifted upward anymore.
In under a month, a ten-year illness was cured
And so she took Liu Wei in the morning and Liu Jun Zi in the evening — and in less than a month, every symptom was gone. Remember: this was a chronic illness of ten years’ standing.
💬 Note from Doctor Luo: Why couldn’t this be treated by the conventional approach? Because this lady had not been ill for a day or two — she had been ill for ten years. The longer an illness has dragged on, the less you can rush it, and the more you must take a gentle, balanced course. That is exactly where Doctor Xue’s genius lay.
What happened later: a back carbuncle, then another fit of anger — and a nearly disastrous treatment
The lady had two more illnesses afterward, and both are recorded in Doctor Xue’s case records.
A year later, she developed a carbuncle on her back (bei ju) — a boil on her back. The moment anyone hears “boil,” their first instinct is again to clear heat and resolve toxins. But when Doctor Xue looked, he saw that the head of the boil was white and its color dull — not red and swollen. The pattern was deficiency-cold (xu han). When the upright qi and yang qi are insufficient, the pathogen cannot be pushed out, and so the boil cannot develop properly. He therefore treated it with strongly warming tonics — and it healed.
Another year passed, and she flew into a great rage once more. Her old illness came roaring back: acid regurgitation and belching, sour fluid rising, burping — plus a new complaint, fullness and distension in the chest and abdomen, her belly swelling up. It so happened that Doctor Xue was away from home for more than ten days, and someone else treated her — with Er Chen Tang (Two Aged Herbs Decoction) plus sheng shi gao (raw gypsum). The result was disastrous: phlegm gushed out like a spring (tu tan xian ru yong), and her body blazed hot as if roasted (wai re ru zhi). Everyone looked at this and said: isn’t this plainly phlegm-heat? Quick, give her Gun Tan Wan (Phlegm-Rolling Pill) to transform the phlegm-heat!
Just then, Doctor Xue returned home.
💬 Note from Doctor Luo: Doctor Xue felt her pulse: surging and large superficially, but empty when pressed deeply — hong da, an-zhi ruo-wu. He said: this is not excess heat. This is the spleen and stomach being deficient, and fever arising from that deficiency — the very same principle as Li Dongyuan’s “sweet and warm herbs dispel great heat” (gan wen chu da re). The spleen is too weak to control water, and that is why the phlegm and fluids gush out in a flood. It looks like a heat pattern, but it is actually the false image of deficiency heat — cold, cooling medicines are all forbidden here, neither Gun Tan Wan nor gypsum will do.
Doctor Xue prescribed Liu Jun Zi Tang plus sheng jiang (fresh ginger) and rou gui (cinnamon bark). After taking it, the lady felt sleepy; she slept a full sleep, woke, and every symptom was gone as if wiped away (zhu zheng ru shi). A few more doses and she had fully recovered.
What to take away: with emotional illness, supporting the upright is the key
Doctor Xue treated this lady several times, and every time the illness dissolved at his hands — you could say he “monopolized” the case.
💬 Note from Doctor Luo: Today, an enormous number of people fall ill because of bad emotions, and Doctor Xue’s approach gives us great guidance. For acute episodes — like Prefect Zhu’s sudden attack — use Xiao Chai Hu Tang to regulate. For chronic conditions — like this lady, who had been angry for ten years — ten years of anger inevitably drain the upright qi: deficient in the liver, as liver yin and liver blood run low; deficient in the spleen, as spleen yang and spleen qi run low. So he nourished liver yin on one side and tonified spleen yang on the other, using separate formulas at separate times of day. Remember this lesson: in people with long-standing emotional problems, the possibility of an excess pattern is already small; most of them have deficiency patterns, and supporting the upright matters more than attacking the pathogen. You have to build them up slowly, bit by bit.
Bonus: the best medicine of all is the atmosphere at home
There is one more layer to this case record, and Doctor Luo’s comment on it was deeply felt:
💬 Note from Doctor Luo: Notice — this husband and wife, one through rage and one through chronic bad moods, both walked into Doctor Xue’s case records. That tells you something profound: when the atmosphere at home is bad, it damages the health of both people. If you have not seen this clearly, then when your body breaks down, no magic elixir in the world will work — even Doctor Xue himself would have to keep treating you forever. So for people like this, the real task is to adjust the emotions. When the emotions are set right, that is treating the root.
Organized from Doctor Luo Dalun’s commentary on Doctor Xue Lizhai’s case records; the original case comes from Xue’s Case Records (《薛氏医案》).