Can’t Eat More Than One Small Bowl, with Acid Reflux and Rotten-Smelling Belching? Doctor Xue Lizhai Treats Spleen Deficiency Turning into Cold in the Middle (Liujunzi Tang plus Paojiang, Muxiang and Sharen)
Search terms this page answers: cannot eat / no appetite / do not want to eat / acid reflux / belching with a strange rotten smell / loose stools
Medical terms: spleen-stomach deficiency · cold in the middle · acid regurgitation with rotten-smelling belching (tun suan ai fu) · deficiency heat · sinking of the middle qi
Opening: the same few formulas, used with such mastery
Doctor Xue Lizhai (Xue Ji) was the director of the Imperial Medical College in the Ming dynasty, and he diagnosed illness as if by magic. The thing that strikes Doctor Luo Dalun most when he tells Doctor Xue’s case records is this: Doctor Xue Lizhai went back and forth using just a handful of formulas — Liujunzi Tang (Six Gentlemen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), Bawei Wan (Eight-Ingredient Pill) — and with those few formulas, adjusted this way and that, he cured all kinds of complicated diseases.
💬 Note from Doctor Luo: By the time you finish studying his case records, you will find your understanding of these formulas has deepened a great deal. Today we look at another one — and the most valuable thing in this case is not some rare herb, but the order in which the formulas were used.
Who was the patient? A woman who could not eat more than one small bowl a meal
The patient was a woman. Her problem was very typical: her appetite was terrible — she could not eat more than one small bowl per meal — what the original record calls “yin shi wu guo wan xu,” “her food never passed one small bowl.” And either her stools were loose (da bian bu shi), or she had tun suan ai fu — sour water coming up into the mouth, and belches carrying a rotten, putrid smell.
Can’t eat, acid coming up, belching — most people’s first thought is: fire in the stomach, phlegm-heat! So one doctor gave her Erchen Tang (Two Matured Substances Decoction) to transform phlegm, and added huang lian (coptis) to clear heat.
The result? More internal heat and vomiting — not only did she not improve, she felt hot and restless inside, and began to feel like vomiting.
Li Dongyuan’s one sentence: pathogenic heat does not digest grain
After examining her, Doctor Xue Lizhai quoted a line from Li Dongyuan: “xie re bu sha gu” — “pathogenic heat does not kill (digest) grain.”
💬 Note from Doctor Luo: Normally, when the mingmen fire (the fire of the life gate, i.e. kidney yang) is sufficient, the yang qi of the spleen and stomach is sufficient, and only then can food be ripened and digested. But if it is pathogenic heat — whether it came from outside or is pathological fire generated internally — it will not help you digest food at all; on the contrary, it makes the spleen and stomach function stall right there, and the food cannot be digested. That is what “pathogenic heat does not digest grain” means. So yes, at the very beginning this patient did show signs of heat — but that was an expression of malfunction, not of genuinely excessive fire.
The key judgment: spleen-stomach deficiency — and beware turning it into “cold in the middle”
Doctor Xue Lizhai’s diagnosis: this woman’s spleen and stomach were already far too weak, and when the previous doctor cleared heat with huang lian and other cold, cooling herbs, it turned into “cold in the middle” (han zhong) — the yang qi inside had become insufficient. As for the “internal heat with vomiting,” that was a false sign — deficiency heat. In reality she had been chilled.
💬 Note from Doctor Luo: When the yang qi of the spleen and stomach is insufficient, some people feel very cold inside, but others, on the contrary, feel hot — and this kind of deficiency heat is the easiest to fool people with. Doctor Xue Lizhai’s case records contain a great many examples of deficiency heat; everyone should learn to recognize it. The moment you see a sign of heat and clear it, you often end up injuring the yang qi to the core.
First formula: Liujunzi Tang plus pao jiang, mu xiang and sha ren
Doctor Xue Lizhai did not rush to the Buzhong Yiqi Tang approach. He first used Liujunzi Tang — to tonify the upright qi of the spleen and stomach — adding pao jiang (blast-fried ginger) to warm the middle, and mu xiang (costus root) and sha ren (cardamom seed) to move the qi. After several doses, the stomach qi gradually recovered and the appetite gradually opened — she could eat more and more.
Second formula: Buzhong Yiqi Tang with additions — cured in a few doses
Once her appetite had recovered, he switched to Buzhong Yiqi Tang plus pao jiang, mu xiang, fu ling (poria) and ban xia (pinellia), and after a few more doses the illness was completely cured.
Why treat the same spleen-tonifying idea in two steps — why not use Buzhong Yiqi Tang from the very beginning? That is the essence of this case:
💬 Note from Doctor Luo: This patient was vomiting, belching and regurgitating sour, rotten material — her qi was moving upward. If at that point you immediately used Buzhong Yiqi Tang to lift the qi upward, the whole qi mechanism would become even more chaotic, the lifting would be too forceful, and the lower jiao would be drained and weakened. So Doctor Xue Lizhai first used Liujunzi Tang to build up the spleen and stomach qi, adding a little qi-moving medicine; once the qi was built up, then he used Buzhong Yiqi Tang to lift it — this order of administration is exactly what we should learn.
The taboo of Buzhong Yiqi Tang: first check whether the lower jiao is deficient
Doctor Luo reminds us: Buzhong Yiqi Tang is used enormously today — because very many people today have sinking of the great qi (da qi xia xian) or sinking of the middle qi (zhong qi xia xian) — their qi is moving downward. But before using it to lift the qi, you must check two things: is the lower jiao (the lower body, especially the kidneys) deficient? Is there any sign of qi moving upward?
💬 Note from Doctor Luo: For example, some people’s kidneys are severely deficient. If you use Buzhong Yiqi Tang to lift the qi upward right away, sometimes you cause ti tuo — “lifting off”: you lift the qi up, and the bottom becomes even emptier, and instead the person feels even more deficient. I have been through that mistake myself.
Doctor Luo’s own mistake: lifting the qi right before her period
Doctor Luo told a mistake he once made. He was treating a woman with very obvious sinking of the great qi and middle qi — her voice was hoarse, the qi would not come up, and she was always hungry; if she went a short while without eating, hunger overwhelmed her. She was about to get her period, but Doctor Luo saw the qi deficiency and sinking so clearly that he urgently gave her Buzhong Yiqi Tang combined with Shengxian Tang (Lift the Sinking Decoction, from Doctor Zhang Xichun).
The result? The qi-deficiency symptoms improved immediately — her voice was strong again, her throat was fine, she stopped being hungry. But her period did not come when it should have!
💬 Note from Doctor Luo: Why? When a period is about to arrive, a woman’s qi and blood need to move downward — blood descends and only then does the period come normally. I lifted the qi with my medicine, and the blood stopped in its tracks — that was the mistake. I should have regulated the qi and blood first, and only lifted the qi after her period was over. That lesson left a deep impression on me: I was only thinking about treating the sinking of the great qi, and forgot that the qi mechanism inside the body has its own rhythm of rising and falling every month.
The same woman’s second crisis: after anger, the two chi pulses almost disappeared
Later, this same woman got very angry and upset, and suddenly her appetite dropped again, her yuan qi (original qi) collapsed, and she developed fever — it looked like “food fire” (shi huo, heat from food stagnation). When Doctor Xue Lizhai took her pulse: the pulse was large yet empty (mai hong da er xu) — and the two chi positions (the kidney pulses) felt as if there were nothing there at all.
💬 Note from Doctor Luo: When a person gets angry, the liver qi attacks sideways and overwhelms the spleen-earth — the spleen and stomach become even more deficient, the source of upright qi is cut off, and in the end even the kidneys are dragged down — when the two chi pulses are almost absent, the kidneys are severely depleted, and the qi is about to collapse. This is very serious. It looks like “food fire,” but actually it is deficiency fire rushing upward — because the yuan qi in the kidneys is insufficient. A false appearance!
This time, Doctor Xue Lizhai used Buzhong Yiqi Tang plus Bawei Wan (the Eight-Ingredient Pill — Guifu Dihuang Wan). She took it for more than two months, and the illness was completely cured.
Why add Bawei Wan this time? — supporting the upright so there is no worry of “lifting off”
Both times the same Buzhong Yiqi Tang was used — why no Bawei Wan the first time, and Bawei Wan the second? Because this time the two chi pulses were almost absent — the kidneys were severely depleted.
💬 Note from Doctor Luo: For a person with depleted kidneys, if you use Buzhong Yiqi Tang alone to lift the qi, the bottom is empty — one lift and you get ti tuo, “lifting off”: the yuan qi scatters in an instant and the condition actually relapses. So he used Bawei Wan below to tonify the kidneys, and Buzhong Yiqi Tang above to tonify and lift the qi — supporting the upright with no worry of “lifting off.” In Doctor Xue Lizhai’s case records, Buzhong Yiqi Tang and Bawei Wan are constantly used together — that is his cleverness.
For modern people who want to use this idea, Doctor Luo gave a concrete method:
💬 Note from Doctor Luo: You can take Buzhong Yiqi Tang in the morning and Guifu Dihuang Wan at night (Doctor Xue Lizhai also sometimes used the Dihuang Wan in the morning and Buzhong Yiqi at night — either order can work); if it is kidney yin deficiency, take Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) at night instead. Tonify the kidney on one side, tonify the spleen qi and lift it on the other — then problems rarely arise.
What to take away: more than three thousand case records, won with a few formulas
Doctor Xue Lizhai was the director of the Imperial Medical College — a cautious man — and he treated all kinds of complicated diseases by adjusting just a few formulas, because he could fix the big direction at a glance: is this spleen deficiency, kidney deficiency, or genuinely pathogenic heat? He left behind more than 3,000 case records — rare in any era, ancient or modern.
💬 Note from Doctor Luo: His skill is right here — when something clearly looks like heat, he dares to conclude it is deficiency. If it were us, we would clear the heat and be done for; the more we cleared, the worse it got, the yang qi was injured to the core, and some patients then ate warming herbs for years without ever warming back up. Doctor Xue Lizhai never made that mistake. If we slowly master the usage, the taboos and the pattern differentiation of these few formulas, we can protect our own health very effectively in the future.
Compiled from the case records of Doctor Xue Lizhai (薛氏医案), as explained by Doctor Luo Dalun.