Feeling Fat, Cold, Dizzy and Phlegmy — Is It Real Obesity or Deficiency Obesity? Doctor Xue Lizhai Treats Spleen-Kidney Deficiency with Buzhong Yiqi Tang and Jinkui Shenqi Wan
Patient’s search terms: gaining weight / feeling cold / dizziness / too much phlegm / always getting sick / no strength / quick to anger / face flushing red
Medical terms: deficiency of both spleen and kidney · phlegm-dampness obstruction · sinking of middle qi · floating deficiency fire · deficiency of the three yin channels of the foot
Opening: not all weight gain is the same — there is real obesity and there is deficiency obesity, and Doctor Xue Lizhai could tell at a glance
Say the word “overweight” and most people’s first thought is: too much food, too much nutrition. But Doctor Luo Dalun says the Ming-dynasty physician in today’s story — Doctor Xue Lizhai, director of the Imperial Academy of Medicine — is talking about the other kind of fat: deficiency obesity (xu pang). In a person with deficiency obesity, the body is not carrying extra nutrition. It is carrying extra phlegm-dampness (tan shi) — and insufficient upright qi.
💬 Note from Doctor Luo: Xue Lizhai was the director of the Imperial Academy of Medicine in the Ming dynasty, and he left behind more than three thousand case records. He had a habit when seeing a patient: first he would write down what kind of person this was — physical condition, personality, way of life — and only then look at the symptoms. And most of his patients were middle-class or above in the Ming dynasty, whose way of life looks very much like our own today. That is why reading his case records, so many people feel: “this is talking about me, isn’t it?” The formulas he used over and over — Buzhong Yiqi Wan (Tonifying the Middle Pill), Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill), Bawei Wan (Eight-Ingredient Pill) — are classic formulas he deployed again and again with great skill.
Who was the patient: an official named Sun, plump in build
The patient was called Sun Duxian — “Duxian” was his official title; his surname was Sun. The very first thing Doctor Xue Lizhai wrote was: xing ti feng hou — heavyset in build. At a glance, the man was plump.
💬 Note from Doctor Luo: Notice how Doctor Xue Lizhai begins with the physical state. This kind of heavyset build is usually not a sturdy, strong fat but deficiency obesity — why deficiency? Because the spleen is deficient and phlegm-dampness is heavy. The spleen fails to transform and transport water-dampness; the dampness gradually congeals into phlegm, and the phlegm-dampness piles up in the body and becomes fat. So the moment you see a person in this state, a question mark should go up in your mind: this person’s upright qi may well be insufficient.
Overworking the mind and quick to anger: thinking all day and losing your temper easily — temper injures the spleen and the liver at once
The second trait of this Mr. Sun: lao shen shan nu — he overworked his mind and was quick to anger.
Lao shen (overworking the mind) means thinking about problems every day — officials worry a great deal and stay busy. Doctor Luo Dalun says brooding and anxiety injure the spleen; people who overwork their minds day in and day out generally have problems with the spleen and stomach. Shan nu (quick to anger) means losing your temper easily — when the emotions are off, the liver qi is not flowing freely, and it runs sideways to attack spleen earth; the spleen and stomach suffer all the same.
💬 Note from Doctor Luo: In modern society there are too many people like him, overworking the mind and quick to anger — thinking all day about how to earn money, how to hit the next small goal, how to get one more promotion at work. People who cannot control their emotions are everywhere. Someone tells me, “Doctor Luo, I’ll definitely adjust my emotions,” and then walks out the door — and when he sees the parking-lot attendant moving the car too slowly, he flares up on the spot. People ask me: how come everyone who comes out of your clinic has such a temper? I say: it is not that they have big tempers and so came to me — it is that they have big tempers and poor health, and that is exactly why they came. People with wonderful tempers and healthy bodies never show up at all. So don’t let the two words “quick to anger” slip past you — that itself is a signal of spleen-stomach disharmony.
A face with a yang complexion: red and shiny, it looks like fire — but it is deficiency fire
Next: mian dai yang se — his face was somewhat red and shiny, as if he had fire; thirst, as if he were suffering from heat; and spitting phlegm — he kept bringing up phlegm.
💬 Note from Doctor Luo: Why the phlegm? Because there is heavy dampness in the body. Why is the dampness heavy? Because the spleen is deficient. And what is the root of spleen deficiency? Kidney deficiency. People with deficiency of both spleen and kidney spit phlegm — the fluids are excessive, the spleen and kidney lack the power to transform and transport them, and when the fluids accumulate they congeal into phlegm. So people with deficiency of both spleen and kidney are often thirsty and full of phlegm. You see — the face is red as if there were fire, but in fact it is deficiency fire rising from below, not genuine excess heat.
Dizziness: either deficiency fire rushes upward, or the middle qi sinks downward
There was also tou mu xuan yun — dizziness and vertigo — his head constantly felt woozy. Doctor Luo Dalun says dizziness has two main causes: either deficiency fire rushes upward, or it is qi deficiency with sinking — in deficient people the qi goes downward and cannot be lifted, so the clear yang above is insufficient, and dizziness results; in severe cases, even headache.
💬 Note from Doctor Luo: A few days ago I met a relative with a headache. The weather had just turned cold, and his neck and upper back were tight; I assumed he had caught cold and gave him Gegen Tang (Kudzu Decoction). It worked, but it did not fully resolve. Later he happened to mention: “today I ate a very full lunch, but I got hungry early in the afternoon — so hungry I could not stand it, I grabbed a mooncake and ate it just to hold on.” The moment I heard that, I knew: this is da qi xia xian — collapse of the great qi! The qi was running downward! I said: stop everything else, take Buzhong Yiqi Wan. The very night he took it, his headache was gone. Dizziness and headache — when the middle qi sinks, the clear yang above cannot rise, and vertigo and headache follow. So when I explain case records, it is like solving a case: you lay out the possibilities, cross-reference to locate the cause, and finally pin down the nature of the illness.
Heat rising from the abdomen: the water is shallow, and it can no longer hold the dragon
One more key symptom: re cong fu qi — heat rising from the abdomen — heat suddenly rises from below the belly and rushes upward.
💬 Note from Doctor Luo: This is a very typical deficiency fire. Chinese medicine has a saying: “shallow water cannot support the dragon” (shui qian bu yang long). When kidney yin is insufficient and the essence fluids are deficient, yang appears to be in surplus, and deficiency fire rises — like dragon-thunder fire (long lei zhi huo) rushing upward. So heat rising from the abdomen, together with dizziness and vertigo, are both expressions of this deficiency fire surging upward.
The pulse settles the case: left hand surging and forceful, right hand surging but without strength
Doctor Xue Lizhai took the pulse: the three pulses of the left hand were surging and forceful (hong er you li); the three pulses of the right hand were surging but without strength (hong er wu li).
The three left pulses correspond to the heart, liver and kidney; they beat large and seem forceful — that is deficiency fire up above, so they beat hard. The three right pulses correspond to the lung, spleen and life gate; they beat large too, but press down and there is no strength — that is deficiency: spleen-lung qi deficiency with sinking of the middle qi, the body making a last-ditch effort. The pulse looks big, but it is soft the moment you press.
💬 Note from Doctor Luo: See how clearly Doctor Xue Lizhai separated the symptoms and pulses: on the left, kidney yin deficiency with deficiency fire surging upward; on the right, spleen qi insufficiency with sinking of the middle qi. The two causes are interwoven — it looks like a heat pattern, but it is not. So you must never casually clear heat; you must tonify the spleen and the kidney instead. That is the single most important diagnostic discrimination in this case.
The prescription: tonify the spleen on one side, tonify the kidney on the other — Buzhong Yiqi Tang plus mai men dong and wu wei zi, combined with Jiajian Bawei Wan
Doctor Xue Lizhai’s diagnosis: zu san yin kui sun — deficiency of the three yin channels of the foot — the foot jueyin liver channel, the foot taiyin spleen channel and the foot shaoyin kidney channel, all three yin channels depleted. The treatment strategy was set: tonify the spleen on one side, tonify the kidney on the other.
For the spleen, he used Buzhong Yiqi Tang (Tonifying the Middle and Replenishing Qi Decoction), with mai men dong (ophiopogon) and wu wei zi (schisandra) added. Buzhong Yiqi Tang tonifies spleen qi insufficiency and raises the middle qi, treating the sinking of middle qi; adding mai men dong nourishes yin — tonifying spleen yin; adding wu wei zi astringes the essence qi of the five viscera — Sun Simiao said wu wei zi tonifies the five viscera.
For the kidney, he used Jiajian Bawei Wan (Modified Eight-Ingredient Pill) — that is, the Eight-Ingredient Pill (Gui Fu Di Huang Wan, Cinnamon and Aconite Rehmannia Pill) with che qian zi (plantago seed) and niu xi (achyranthes) added to promote water and guide things downward. This is Jisheng Shenqi Wan (Life-Saving Kidney Qi Pill) — the very formula sold in pharmacies today as Jinkui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet).
💬 Note from Doctor Luo: In Jiajian Bawei Wan, a large dose of shu di huang (prepared rehmannia) serves as the sovereign herb to tonify kidney essence, paired with rou gui (cinnamon bark) and fu zi (aconite) to draw the deficiency fire downward — because when kidney yin is insufficient and dragon-thunder fire rushes upward, you must guide fire back to its source (yin huo gui yuan). Why so much phlegm? Because spleen and kidney qi are deficient, with no strength to transform and transport water-dampness; the fluids fail to move normally and congeal locally into phlegm. So if a person in a state of deficiency-damage is constantly full of phlegm, you should consider insufficiency of the spleen and kidney. Buzhong Yiqi Tang paired with Jinkui Shenqi Wan is a genuinely fine treatment method — and when these two medicines were taken, the patient recovered.
Doctor Xue Lizhai’s warning: looking old too young, unable to bear heat or cold, unable to bear work or leisure, falling ill with every season
After the case, Doctor Xue Lizhai said something especially important: “If a person looks old too young, cannot tolerate heat or cold, cannot bear work or rest, and falls ill with every change of season (shao you lao tai, bu nai han shu, bu sheng lao yi, si shi die bing)” — some people show signs of age at a young age, looking sixty at forty; the slightest change in temperature and they cannot cope, falling ill whether it is too hot or too cold; a little work and they are exhausted; and they are sick all year round, one illness after another with no end in sight.
💬 Note from Doctor Luo: A great many people can recognize themselves in these four sentences. Why? Doctor Xue Lizhai says: all because in youth the qi and blood were just growing and they overworked them (shao shi qi xue fang zhang er lao) — when you are young, your qi and blood are still developing, and you drain them excessively. Young people today stay up every night — binge-watching shows, dancing, drinking until two or three in the morning; the little bar downstairs in our neighborhood is packed with university students, drinking until midnight and staggering out unable to stand. On top of that, they overwork their minds — thinking all day about making money and fretting over all kinds of chores — and add excessive sexual indulgence (se yu guo du), consuming essence before it is even full. One thing leads to another, and illness piles up. What to do? Put the spleen and stomach in order, and fill up the kidney: Buzhong Yiqi to tonify the spleen, and Gui Fu Di Huang Wan (Eight-Ingredient Pill / Jinkui Shenqi Wan) to tonify the kidney — treat it slowly, and once the upright qi is sufficient, those various ailments gradually resolve on their own.
How to use it: tonify the middle and raise yang in the morning; tonify the kidney and guide fire back to its source at night
So how do these two, morning and evening, work together? Doctor Luo Dalun breaks down Doctor Xue Lizhai’s usage for everyone:
In the morning, take Buzhong Yiqi — lifting the spleen qi and raising yang. At night, tonify the kidney — according to your own situation: if yin-deficient, take Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish yin; if yang-deficient, take Jinkui Shenqi Wan (Gui Fu Di Huang Wan) to warm yang. If your emotions are off at midday, you can add Xiao Yao Wan (Free and Easy Pill) to soothe the liver qi.
💬 Note from Doctor Luo: This alternating usage is something I learned from Doctor Xue Lizhai. At night, use shu di huang to nourish the essence as the base; depending on whether the body leans toward yang or yin, add a little warming-yang or yin-nourishing medicine. Many people find that after taking it this way, the body begins to recover — this is supporting upright qi as the root (fu zheng wei ben), the fundamental way of regulating the body. Even if an external contraction occurs, it is because the upright qi is insufficient and the interior is weak, so external pathogens take advantage and enter (the invasion of the six excesses, liu yin). So the most fundamental approach is still to support upright qi. And within supporting upright qi, special attention must go to protecting stomach qi (wei qi) — the stomach is the root of the five viscera. That is why strongly bitter-cold herbs like huang bai (phellodendron) and zhi mu (anemarrhena) must not be used lightly — they can easily injure stomach qi; when they truly are needed, use them with caution and stop as soon as the goal is reached, then come back and tonify the spleen and stomach.
A bonus tip: don’t underestimate patent medicines — when you are genuinely deficient, you can raise the dose
Finally, Doctor Luo Dalun shares a tip on taking patent medicines: don’t look down on ready-made pills — used properly, they treat illness just as well. For a minor ailment, follow the instructions and take them slowly. But if the body is truly a wreck, don’t follow the label — the label dose is written for the average person.
💬 Note from Doctor Luo: Take Bawei Dihuang Wan (Gui Fu Di Huang Wan): if you prescribed it as a decoction, shu di huang would be at least 30 grams and more; but if you take 8 tiny pills per the label, that is far too little. When I take it myself, I double it — the label says 8 pills, I take a bottle cap’s worth, and the effect is very obvious. When the illness is more acute and the person more deficient, you can raise the dose a little and it works faster. That is a small tip I want to share with everyone.
Tonify the spleen on one side, tonify the kidney on the other — with two classic formulas, Doctor Xue Lizhai cured a plump official who was sick all over, looked like he had fire, and in fact was profoundly deficient. Next time you feel you are “gaining weight and feeling cold, dizzy and phlegmy, always getting sick,” ask yourself: is this real obesity, or deficiency obesity? Once the spleen and kidney are filled up, those ailments may well disappear on their own.
Compiled from Doctor Luo Dalun’s explanation of Doctor Xue Lizhai’s case records; the case comes from Xue’s Case Records (薛氏医案).