Chest Feels Blocked, Food Sits Undigested, Growing Thin with Fever and Dry Mouth? Doctor Xue Lizhai Treats Mingmen Fire Deficiency That Cannot Generate Earth (Buzhong Yiqi Tang with Dried Ginger and Cinnamon, Then Bawei Wan)
Search terms this page answers: chest feels blocked / indigestion / eat a little and feel stuffed / growing thinner and thinner / fever and dry mouth / afraid of cold / always hungry
Medical terms: mingmen fire deficiency failing to generate earth · deficiency of spleen and kidney yang · spleen-stomach qi deficiency · sinking of the middle qi
Opening: the same spleen-stomach illness — one patient always hungry, one always blocked
When Doctor Luo Dalun tells the case records of Doctor Xue Lizhai, he loves to put two cases side by side and compare them. That is exactly where today’s case shines — both patients had spleen-stomach qi deficiency, yet the previous patient was so hungry he ate five or six meals a day, while this one felt so blocked that even his food would not dissolve. What is even more interesting: Doctor Xue Lizhai cleared up the symptoms in the first two steps, but he still had to add one more layer — a layer of “fire” — before the job was truly finished.
💬 Note from Doctor Luo: Doctor Luo says this is a particularly good case for explaining the relationship between the spleen and the kidneys — how the yang qi of these two organs is connected. Read this case all the way through, and you will understand the whole thing.
Who was the patient? Zhang Ruhan of Ting Ping, chest stuffed as if something were wedged inside
The patient’s surname was Zhang, given name Ruhan, and his official title was “Ting Ping” (a phonetic rendering of a Ming-dynasty office). His chief complaint could be summed up in a single word: blocked. Between his chest and diaphragm he always felt stuffy and oppressed, as if something were wedged in there and the qi could not pass through — what Chinese medicine calls xiong ge zuo pi, “stuffiness and blockage in the chest and diaphragm.” When he ate, the food would sit right there and refuse to dissolve — yin shi nan hua, “food that is hard to digest.”
The previous doctor’s approach: stagnation? Start with Zhizhu Wan
The previous physician looked at him, decided the spleen and stomach were injured and food stagnation was lodged inside, and prescribed Zhizhu Wan (the Aurantium-Atractylodes Pill).
💬 Note from Doctor Luo: Zhizhu Wan is a genuinely good formula. Whose formula is it? Zhang Yuansu — the Jiegu Old Man, the teacher of Li Dongyuan. Zhi shi (bitter orange) presses downward, reducing accumulation and guiding out stagnation; bai zhu (atractylodes) strengthens and tonifies the spleen — one reduces, one tonifies, a beautiful pairing. The most interesting part is the preparation: after the herbs are ground into powder, you steam rice with lotus leaves, mash the rice into a paste, and form the pills — taking the lotus leaf’s meaning of raising the clear (sheng qing). This is a famous formula.
But Zhang Ruhan took it and saw no real effect. A good formula is a good formula, yet it simply did not work for him. Over time he grew thinner and thinner, and new problems appeared: fever all over the body and a dry mouth. When Doctor Xue Lizhai took his pulse — mai fu da er wei: the pulse beat large, yet it had almost no strength, very weak.
Doctor Xue Lizhai’s judgment: this is not stagnation — the spleen and stomach are simply too deficient
Doctor Xue Lizhai took one look and said: this is spleen-stomach deficiency! There is not that much stagnation in you, he told him. The spleen and stomach are so weak that they have no strength to transport and transform food, so whatever you eat gets stuck inside and cannot dissolve.
💬 Note from Doctor Luo: Zhizhu Wan cannot be called a mistake — but its zhi shi is reducing while its bai zhu is tonifying, and the tonifying power is clearly not enough; it still carries a reducing function. This illness was pure deficiency; there was basically nothing to reduce. So Doctor Xue Lizhai changed the formula: Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) — Li Dongyuan’s formula — with gan jiang (dried ginger) and rou gui (cinnamon) added to warm the yang, support the upright qi and drive out the pathogenic qi, and build the qi back up to full.
Sweet-warm clears the great heat: the fever and dry mouth are “burned out” by qi deficiency
Why does Buzhong Yiqi Tang cure fever? Doctor Luo stresses that Doctor Xue Lizhai was especially skilled with Buzhong Yiqi Tang — for spleen-stomach qi deficiency, and especially for the many symptoms caused by sinking qi, it works remarkably well.
💬 Note from Doctor Luo: The main direction Buzhong Yiqi Tang works in is gan wen chu da re — “sweet and warm clears the great heat.” This fever was caused by spleen-stomach qi deficiency; it was not real fire. When Doctor Xue Lizhai used it, the effect was immediate — the symptoms all receded: the fever was gone, and the dry mouth was gone too, because both the dry mouth and the fever were produced by qi deficiency.
Interlude: Doctor Luo’s own case — the patient who was always hungry with a pounding heart
At this point Doctor Luo told a story from his own practice that was the exact mirror image of today’s case:
💬 Note from Doctor Luo: I saw a patient recently who was extremely hungry — how hungry? The family had to make five, six, seven meals a day; the moment it was time to eat, he had to eat immediately, or his heart would pound with hunger. He was also dizzy — standing up, the room would spin around him; and his voice was hoarse, always sounding strained. What was this? Sinking of the middle qi (zhong qi xia xian)! Why does the spleen-stomach keep demanding food? Self-rescue — the ancients called it “self-rescue”: the spleen and stomach are so weak that they keep trying to fill themselves up with food. I gave him Buzhong Yiqi Tang, and he was fine within two days.
So both patients had spleen-stomach qi deficiency — why was one always hungry and the other always blocked? Doctor Luo explained: the earlier patient’s spleen-stomach deficiency carried a little deficiency heat; today’s patient carries a little cold — insufficient yang qi. When deficiency heat rises and drains outward, the person gets hungry; when deficiency cold has no fire, the food sits stuck inside and cannot dissolve.
The finishing move: the symptoms were cured, but Doctor Xue Lizhai still had to tonify the “mingmen fire”
With Buzhong Yiqi Tang plus dried ginger and cinnamon, the symptoms receded — but now the signs of spleen-stomach deficiency-cold became even more obvious: the spleen and stomach still felt cold and weak. At this point Doctor Xue Lizhai switched to Bawei Wan (the Eight-Ingredient Pill) to tonify the mingmen. And the result? Yin shi jin jian — within less than a month the appetite opened up; after three months, the body filled out (xing ti chong sheng) — the man who had been dry and thin gradually put on flesh.
💬 Note from Doctor Luo: Bawei Wan is Guifu Dihuang Wan — the Kidney Qi Pill (Shenqi Wan) that Zhang Zhongjing wrote down long ago. The question is: why did tonifying the spleen-stomach qi, plus a little yang-warming medicine, fail to cure the illness completely — and why did it take tonifying the mingmen fire to finish the job? That is the lesson of today: fire generates earth (huo sheng tu).
Fire generates earth: the spleen’s yang is “burned out” by the mingmen fire
Chinese medicine matches the five elements to the five organs — not because there is literally wood inside the liver or earth inside the spleen, but because the properties of the elements describe the properties of the organ qi and the relationships between the organs. That is the wisdom of ancient China. The spleen belongs to earth. What generates earth? Fire generates earth — when fire burns down, its ashes gradually turn into soil.
💬 Note from Doctor Luo: There are two fires. Above is the heart fire, like the sun in the sky; below there is also a fire — kidney yang, called the mingmen fire, the fire of the life gate, like the magma under the earth. It is the same in a person: above, the heart belongs to fire; below, the kidney is the house of water and fire (shui huo zhi zhai) — it holds both water and fire. Water and fire stand for yin and yang; the two embrace each other, yin and yang nourish each other, and only then is a person calm and balanced. The yang qi inside the kidney is the mingmen fire — the root of life, the source of the body’s yang. When the mingmen fire declines, a person fears cold, reproductive function drops, aging speeds up, and the whole body sinks into a deficiency-cold state.
“Fire generates earth” means that the mingmen fire gives birth to the spleen yang — the spleen’s yang qi comes from the mingmen fire, so the yang qi of the spleen and the kidneys is linked together.
💬 Note from Doctor Luo: What we usually call deficiency of spleen and kidney yang (pi shen yang xu) is exactly this situation: constant cold drinks and diarrhea; sit down on a cold bench in the morning and diarrhea comes at once; a cold wind blows and diarrhea follows — when spleen yang deficiency reaches a certain level, it drags kidney yang down with it. When kidney yang is insufficient, it is like the fire under the stove slowly dying: the steam in the pot (the spleen yang) is no longer enough either, and no matter how you steam the food, it will never cook — this is the root of stuffiness, fullness and food that will not digest: with spleen yang deficiency there is no strength to ripen and transform food and drink; and spleen yang deficiency is usually tied to kidney yang deficiency — insufficient mingmen fire.
Doctor Luo used a homely analogy: a person is like a stove with a pot on top and rice steaming inside. When the mingmen fire is strong, the steam in the pot is strong, the spleen yang is strong, and the food dissolves easily — and once dissolved, it is absorbed and used; when the mingmen fire fails and the flame is nearly out, the pot is cold, the food can never cook, and it can only sit stuck inside.
Doctor Xue Lizhai’s warning: if you do not tonify the mingmen fire, the patient will eventually swell up
Doctor Xue Lizhai stressed afterward: in this illness, if you do not use Bawei Wan to warm and tonify the mingmen fire, and only keep tonifying the yang of the spleen and stomach, the case will most likely end as — abdominal distension with wheezing and shortness of breath, swollen legs and feet, and dribbling urination — kidney yang insufficient, water flooding downward.
💬 Note from Doctor Luo: At this point you can also use Jisheng Shenqi Wan (Kidney Qi Pill for Life Preservation) — that is the “Jinkui Shenqi Wan” sold in today’s pharmacies: Bawei Wan plus niu xi (achyranthes root) and che qian zi (plantago seed), which adds the power to promote urination. Doctor Xue Lizhai wrote “yi you de sheng zhe” — even so, the patient may still survive. The wording is grave, which shows how seriously he viewed it: if you do not build up the mingmen fire, the spleen yang will stay deficient, and in the end something major can go wrong.
The acquired root and the innate root: when the child is sick, treat his mother
Why did Doctor Xue Lizhai value the kidneys so highly? Because the spleen is the acquired root (hou tian zhi ben) — the fine nourishment of food and drink is absorbed and produced by the spleen and stomach; the kidney is the innate root (xian tian zhi ben) — the very foundation of the body.
💬 Note from Doctor Luo: The spleen and stomach can be regulated, and once regulated they help the kidney qi become sufficient. But if you regulate only the spleen and stomach while the kidney is severely depleted — the root is broken — then you will exhaust yourself regulating the spleen and stomach, always falling just short. Today’s case shows exactly this principle: the spleen and stomach were treated, but the deficiency-cold had still not turned around, and at that point you must warm the kidney yang; when the kidney yang is sufficient, the deficiency-cold of the spleen and stomach is finally relieved. This is like when the child is sick, you treat his mother — the kidney is the mother of the spleen and stomach, the source; when the mother is well, she sends nourishment to the child, and the child recovers.
Closing: Buzhong Yiqi Tang in the morning, Bawei Wan at night — treat the spleen and kidney together
Doctor Luo ended with an approach modern people can use:
💬 Note from Doctor Luo: We can use the same pairing today — Buzhong Yiqi Tang in the morning, Bawei Wan (Guifu Dihuang Wan) at night — treating the spleen and kidney together. Because the yang qi of the spleen and kidneys is linked, treating both at once works better. Otherwise, taking only spleen-stomach medicine will never quite fix it — the yang qi is simply insufficient and the spleen-stomach function stays weak, because the kidney yang has not been supplying fire to the spleen yang. You tonify for a while and it gets better; you stop and it turns cold again. The root is in the kidney.
Compiled from the case records of Doctor Xue Lizhai (薛氏医案), as explained by Doctor Luo Dalun.