Always Craving Cold Water, Soles Burning Like Irons, Thorns on the Tongue — Then Chills and Two Weeks of Constipation? Doctor Xue Lizhai’s Case of Kidney-Essence Deficiency Treated in Three Twists (Jiajian Bawei Wan, Bawei Wan, and Shiquan Dabu Tang)

Search terms this page answers: craving cold water / burning hot soles of the feet / thorns on the tongue / can’t have a bowel movement / chills after feeling hot / kidney deficiency / always thirsty for cold drinks / feet cold to the knee

Medical terms: kidney-essence deficiency · deficiency of both yin and yang · yin deficiency with blazing fire · yang deficiency · deficiency of both qi and blood · floating deficiency fire

Opening: one illness, three twists — Doctor Xue Lizhai changes his strategy three times

In the stories we have told so far, Doctor Xue Lizhai usually wraps up a kidney-essence deficiency case in one or two doses. Today’s patient is different — one illness, full of twists and turns, and the doctor had to switch his whole approach three times: first tonify the yin, then warm the yang, and finally give a great tonic of qi and blood. Doctor Luo Dalun says that this patient’s foundation was so poor, and his condition changed so fast, that you rarely see anything like it in the case records.

💬 Note from Doctor Luo: Why do we keep telling case after case about kidney deficiency? Because kidney-essence deficiency is extremely common in modern people, yet most people do not really understand what the kidney essence means in Chinese medical theory — so all the disorders that grow out of kidney-essence deficiency get overlooked. It is exactly like the great qi sinking (da qi xia xian) we discussed before: many people have the problem, but they do not know how to fix it. Today’s case lets you see in one sitting all the chaos that a deficient kidney essence can stir up.

Who was the patient? Han Yongzhi, assistant prefect, forty-six years old, seeking help in midsummer

The patient was named Han Yongzhi, and he served as zhou tong — the deputy of a prefect (zhou). He was 46 years old — just past middle age, at an age when a man should still be sturdy and strong. The season was midsummer, the height of summer heat. When Doctor Xue Lizhai wrote down the cause of illness in the record, he did not mince words: excess of sexual desire.

💬 Note from Doctor Luo: Everyone, take note — who would dare write that on a medical record today? The patient would sue you. But look at Doctor Xue Lizhai — and Doctor Zhu Danxi before him — they wrote it right out, without the least hesitation, and they even gave the patient’s full name and official title. Their attitude was: you are making a contribution to medicine, so write the record completely. Doctor Luo says that our modern taboo about this is probably not a good thing. Once the cause is written down, the judgment follows naturally; if you leave it out and look only at the symptoms, sometimes the case is genuinely hard to analyze — because the symptoms of this illness were frighteningly chaotic.

First wave of symptoms: a full display of heat, so hot he could not sit still

Excess of sexual desire, kidney-essence deficiency — which way does the body tip first? This man tipped toward yin deficiency, and so great internal heat blazed up, symptom after symptom:

• Restless heat and thirst: restless inside, feverish, thirsty, and he specifically wanted cold drinks — he drank water without stopping;
• Dribbling urination: urine would not flow freely, just dripped out drop by drop;
• Constipation with dry stool: the stool was dry and would not pass — the body’s fluids were insufficient;
• Gushing sputum: mouthful after mouthful of phlegm surged up — deficiency fire climbing upward carried the phlegm out with it;
• Red face and red eyes: both eyes and the whole face were flushed bright red;
• Thorns all over the tongue: the entire tongue was so parched it stood up in prickles — just like the 79-year-old gentleman in the earlier case — heat at the extreme;
• Cracked, parched lips: the lips had split open;
• Heat all over the body: feverish from head to toe;
• Body prickling like needles: as if something were stabbing him, here and there, unpredictably;
• Soles burning like branding irons: both soles were hot as irons — and if you pressed ice against them, they hurt even more.

And when the doctor took the pulse: mai hong da wu lun — the pulse beat enormously large, without any proper order.

💬 Note from Doctor Luo: Read that list and it looks for all the world like genuine excess heat. But Doctor Xue Lizhai’s diagnosis was: kidney yin insufficient, so the yang has nothing to cling to and flares outward. In fact both yin and yang were deficient — only the yin was the more depleted of the two, which is why the yang looked as if it had multiplied and rushed upward and outward. The doctor said “fei huo ye” — it is not really that much fire; it is deficiency heat. This is the sentence from the Inner Canon (Huang Di Nei Jing): han zhi bu han, shi wu shui ye — when you attack with heavy cold herbs and the heat will not come down, it is not because there is too much fire, but because there is not enough water (yin).

First move: one jin of Jiajian Bawei Wan material, plus one liang of rou gui

What to do? Doctor Xue Lizhai said: dang jun bu qi yin — tonify the yin vigorously, at once. But the prescription he wrote was oddly telling: Jiajian Bawei Wan (Modified Eight-Ingredient Pill) material, one jin (about 600 g), and inside it he added one liang (about 30 g) of rou gui (cinnamon bark). Is this purely nourishing yin? No, it is not.

Doctor Luo unpacked it layer by layer: Jiajian Bawei Wan is simply Bawei Wan (the Eight-Ingredient Pill — Guifu Dihuang Wan, that is, the Jinkui Shenqi Wan approach) with two extra herbs, che qian zi (plantago seed) and huai niu xi (achyranthes root) — which turns it into the formula sold in today’s pharmacies under the name “Jinkui Shenqi Wan” (the Jisheng Shenqi Wan version), with a strengthened ability to promote urination. The pill material alone weighed one jin — an extremely heavy dose. And the largest single ingredient in that jin was shu di huang (prepared rehmannia) — the secret of Liuwei Dihuang Wan and Jinkui Shenqi Wan is the same: shu di huang makes up the biggest share; everything else is there to support it.

💬 Note from Doctor Luo: Here is a subtle point that needs to be made clear. The ancients said “tonify the yin vigorously,” but by “yin” they meant true yin — that is, essence (jing). Where they should have said “essence,” they sometimes said “yin,” and later generations got confused: isn’t nourishing yin about sheng di (raw rehmannia), sha shen (glehnia), mai dong (ophiopogon)? Why is he adding cinnamon to warm the yang? In fact this is tonifying the essence, and then drawing the fire back down. The formula contains shan yao (Chinese yam) and shan zhu yu (cornus fruit), matched with mu dan pi to drain liver fire, ze xie to percolate water, fu ling to clear spleen dampness, and then rou gui and fu zi (aconite) — tonify the essence and gather the fire — that is the whole idea.

Guiding fire back to its origin: the “shu di huang with rou gui” combination Doctor Luo has tested himself

Why does tonifying the essence call for rou gui? This is the most ingenious stroke of the whole case.

💬 Note from Doctor Luo: If you use prepared rehmannia alone to tonify kidney essence, the deficiency fire will sometimes run upward; add a little rou gui, and the fire comes right down — this is yin huo gui yuan, guiding fire back to its origin: drawing the floating deficiency fire back down to its root. Doctor Luo says he tried it himself: taking rehmannia alone feels completely different from taking it with cinnamon — sometimes rehmannia alone even brings the fire out; add a little cinnamon and the fire immediately settles. The ancients combined personal experience and theory this beautifully — truly remarkable.

How the medicine was taken: six bowls decocted at once, drunk cool

How was the medicine taken? “Yi shui dun jian liu wan” — decoct the whole batch at once into six bowls, then let it cool before drinking (because the internal heat was so dry, a cooler drink felt better). The patient drank a bit more than half a bowl within half a day, then slept; when he woke he ate a bowl of warm porridge; that evening he warmed up the remaining medicine and drank another bowl; he slept again, and by dawn ate two bowls of hot porridge. The next morning — zhu zheng xi tui — that entire parade of heat symptoms had all receded.

💬 Note from Doctor Luo: Notice the method: a large dose of medicine, taken frequently in divided portions, with porridge to protect the stomach qi — this is the proper protocol for an acute flare. Overnight, the deficiency fire was gathered back in.

Second twist: the heat is gone, and the cold arrives — feet cold to the knees

But the next day something strange happened: he began to feel cold — his feet were cold all the way up to the knees — and all those symptoms came back. Was this a cold injury, a new attack of “shang han”? Doctor Xue Lizhai said no — re zhi bu re, shi wu huo ye: if it were true great cold, you would use warming herbs to disperse it outward, and it would disperse; if it stays cold no matter what, then it is not external cold pathogen but no fire — yang deficiency. So he switched to Bawei Wan, one dose; the patient slowly recovered, and then took four more doses, after which all the symptoms receded again.

💬 Note from Doctor Luo: This is the secret of kidney-essence deficiency: when the fundamental substance is depleted, the body can tip either toward yin deficiency with deficiency heat, or toward yang deficiency without fire; when the depletion is severe — deficiency of both yin and yang — the symptoms swing rapidly between the two. You gather the fire back in, and immediately the cold of yang deficiency shows its face. It is not that the doctor misjudged; the disease itself was shifting. And the formula all along stayed on the tonify-kidney-essence track — the Jinkui Shenqi Wan / Guifu Dihuang Wan / Bawei Wan line of thinking.

Third twist: thirteen days without a bowel movement, and the pig-bile enema undid everything

Just as recovery was in sight, a new problem appeared: no bowel movement for thirteen days. What to do? Doctor Xue Lizhai used zhu dan dao — the pig-bile enema: take pig bile, pour it into the anus through a bamboo tube (sometimes with a little honey added), and the stool comes out. But here is the problem: pig bile is cold in nature — excellent for constipation from heat binding, but this patient had just had his deficiency fire gathered back in and his yang deficiency was still obvious. The moment the pig-bile enema was used, all the symptoms came back again — back to square one.

💬 Note from Doctor Luo: What does this tell us? It tells us that this man’s upright qi was far too weak — deficiency of both qi and blood. His stool had been blocked for more than ten days; the enema released it and drained his qi along with it. The blockage had actually been protecting him — once it was released, his body could not take it, and every symptom returned. So what to do then? Greatly tonify qi and blood: he was hurriedly put on Shiquan Dabu Tang for several doses, and only after this tonic did the illness finally get better.

A disease of three twists, hiding the great lessons of the kidney essence

The comment appended to the case record says just four characters: yi bo san zhe — “a wave rises, three times it turns.” Doctor Luo traced the whole chain:

Kidney essence depleted → yin deficiency with blazing fire → tonify the essence, gather the fire → yang deficiency surfaces → warm the yang to fill it in → qi and blood still depleted → enema releases the stool and drains the qi → all symptoms relapse → Shiquan Dabu Tang greatly tonifies qi and blood → recovery.

💬 Note from Doctor Luo: Let me repeat what Shiquan Dabu Tang is: Si Jun Zi Tang + Si Wu Tang + huang qi + rou gui — Si Jun Zi Tang tonifies qi, Si Wu Tang tonifies blood, huang qi adds more qi, and rou gui warms the yang. Does it contain shu di huang? Yes — it tonifies kidney essence too. Does it contain rou gui? Yes. As long as you have shu di huang and rou gui in there, the whole strategy never changes — tonify essence, gather fire, warm yang — carried through from beginning to end.

What is the kidney essence, and why does its depletion “swing both ways”?

Using this case as a springboard, Doctor Luo explained the logic of the kidney essence thoroughly:

The kidney essence is the fundamental substance of life. Where does it come from? Innate essence (xian tian zhi jing) is inherited from the parents; acquired essence (hou tian zhi jing) comes from the fine nutrients of food (absorbed by the spleen and stomach) and from the clear qi of breathing, and is stored in the five organs; a part of the finest essence of the five organs combines with the innate essence to become our kidney essence. The kidney essence governs growth, development and reproduction — it is the motive power of the whole of life. Within itself it already contains yin and yang — essence transforms into qi, and qi divides into yin and yang — and that is where kidney yin and kidney yang come from. So when the kidney essence is depleted, some people develop toward kidney yin deficiency, others toward kidney yang deficiency — but the fundamental substance is the same one; loss of yin and loss of yang are both losses, the only question is which way it swings.

💬 Note from Doctor Luo: The later physicians who inherited this approach best were from the Ming dynasty — Chen Shigong and Zhang Jingyue both worked this path, and they got excellent results with deficiency fire, yang deficiency and kidney-essence deficiency. By the end of the Ming dynasty the problem had basically been solved, and solved very well. Then in the Qing dynasty, everyone made a fuss and objected — saying this kind of tonifying is bad, you should clear outward instead — and treatment actually went backwards.

Closing: prevention comes first — you may never meet a Doctor Xue Lizhai

Doctor Luo ended with a blunt truth: this patient’s body was already running on a low-level balance; the slightest breeze of trouble and everything fell apart at once. He was lucky enough to meet Doctor Xue Lizhai — a doctor who followed the symptoms wherever they went: whatever you bring me, I adjust to it — and settled it in three moves.

💬 Note from Doctor Luo: But can you guarantee that you will meet a doctor like Xue Lizhai? Physicians who can explain the kidney essence clearly and know how to regulate it are genuinely rare today. If this patient had run into a mediocre doctor, he would have been ruined in two prescriptions. So defense comes first — take care of yourself first, and never let your body be driven to such a state. Cherish the kidney essence; do not burn it up. Excessive sexual desire was the root of this man’s illness, and it produced a cascade of problems — everyone should treat it with care.

Compiled from the case records of Doctor Xue Lizhai (薛氏医案), as explained by Doctor Luo Dalun.