Three Months Without a Period and a Four-Cun Lump in the Belly? Doctor Xue Lizhai’s Liver-Spleen Stagnation Case
Patient search terms: period three months late / period absent for months / irregular periods / hard lump on the left side of the belly / something growing in the belly / always feeling hot and thirsty / getting thinner and thinner / no appetite
Medical terms: liver-spleen stagnation · amenorrhea (periods once every three months) · zheng jia accumulation · internal heat with thirst
Opening scene: the gynecology master, and a case that is “hard to learn from”
Today’s case comes from Doctor Xue Lizhai (Xue Ji), the director of the Imperial Medical Academy in the Ming dynasty. He was not only a great master of internal medicine, but also a gynecology master — his skill in regulating women’s and children’s conditions was extremely high. Doctor Luo Dalun is very honest about today’s case: he admires the way Doctor Xue treats patients, but it is hard to learn from him — because every detail in this case, pulled apart, could be discussed for a very long time.
💬 Note from Doctor Luo: Doctor Xue Lizhai’s level in gynecological regulation was extremely high. The point of today’s case is not that you will be able to treat patients after listening. It is to see Doctor Xue’s technique — that exquisite arrangement of taking one medicine in the morning and a different one in the afternoon is worth pondering again and again.
Who was the patient? Internal heat, thirst, no appetite, and an “egg” growing on the left side of the belly
The patient was a woman. What were her symptoms? Internal heat with thirst (nei re zuo ke) — she always felt as if there were fire inside her, and she was constantly thirsty; poor appetite (yin shi shao si) — she did not want to eat. Just these two alone — what would most people think? Internal heat with thirst usually means yin deficiency, or liver fire; poor appetite means the spleen and stomach are in trouble.
But that was not all — there was also something growing in her belly: on the left side of the abdomen, a lump that started about the size of an egg gradually enlarged, until it reached four cun across (about 13 centimeters in diameter)!
💬 Note from Doctor Luo: Everyone, notice this combination: internal heat with thirst + not wanting to eat + a hard lump in the belly, plus periods coming only once every three months, extreme thinness, and ulcerated, sore-like gums and cheeks — you can tell at a glance that this is no light illness.
How severe was it? Periods once every three months, and a body worn down to skin and bone
The gynecological problem was even more serious: jing shui san yue yi zhi — her period came only once every three months, once a season. That is clearly wrong. And look at her body: limb wasting (zhi ti xiao shou) — extremely thin; chi jia sheng chuang — her gums and the inside of her cheeks were swollen and ulcerated like sores. As for the pulse: mai hong da er xu — the pulse beat large, but felt empty when pressed, and this was especially obvious at the left guan position.
💬 Note from Doctor Luo: The left guan pulse corresponds to the liver. A large but empty pulse, most pronounced at the left guan, together with this whole picture of symptoms — the root of the disease floats to the surface: the problem is in the liver, and it is liver qi stagnation. This illness was not acquired in a day or two; the body had already become deficient to a serious degree.
What did Doctor Xue think? Four words: liver-spleen stagnation
Doctor Xue Lizhai’s judgment was just four words: liver-spleen stagnation syndrome (gan pi yu jie zhi zheng). Where did this illness come from? It was tied to the emotions.
Why are women especially prone to this disease? Doctor Luo Dalun puts it plainly: women are more sensitive than men. The same remark — other people shrug it off, but she takes it to heart, and gets angry or cries at the drop of a hat. So liver qi stagnation is especially common in women — this woman had liver qi stagnation; and on top of that she brooded and worried every day — excessive thinking injures the spleen, so her spleen qi became stagnant too. Liver stagnation plus spleen stagnation together make liver-spleen stagnation.
💬 Note from Doctor Luo: The liver governs free-flowing and coursing. When the emotions are bad, liver qi cannot flow smoothly, and the qi mechanism is blocked; when thinking is excessive, the spleen and stomach stagnate on their own. The two together are what Doctor Xue Lizhai called “liver-spleen stagnation syndrome.” Remember this: the root of a great many gynecological diseases lies in the emotions.
Attack the mass right away? Not so fast — protecting the person comes first
By ordinary reasoning — a lump in the belly, periods not coming — shouldn’t we transform phlegm, move blood stasis, break accumulations, and regulate the qi? Doctor Xue Lizhai refused to do that. What did he do first? He supported the upright qi.
His arrangement was extremely refined: Awei Gao plaster applied externally — to dissolve the lump inside the body; and the oral medicine was divided into morning and afternoon: in the morning (before noon), Buzhong Yiqi Tang — supplementing the spleen qi and lifting the qi upward; in the afternoon, Jiawei Guipi Tang — the Spleen-Restoring Decoction plus chai hu (bupleurum) and zhi zi (gardenia), to soothe the liver and clear heart fire.
💬 Note from Doctor Luo: This is the difference between a veteran hand and an ordinary doctor. This woman was already deficient to a serious degree: a four-cun lump in the belly, periods once every three months, a wasted body — her upright qi was severely insufficient. If you charge in with phlegm-transforming, stasis-moving, accumulation-breaking, qi-regulating herbs, the person may collapse. I have seen examples of exactly this: a woman who had just given birth asked a Chinese medicine practitioner for postpartum care; the practitioner took one look and declared “you have blood stasis,” and without distinguishing the pattern or nourishing the blood, piled on blood-moving, blood-breaking herbs — and the woman’s body collapsed on the spot: stars before her eyes, blurred vision, stammering speech, a mind like a blank sheet — suffering for years. That is seeing the disease but not seeing the person. A veteran like Doctor Xue Lizhai looks at someone this deficient and says: before anything else — support the upright qi.
How was the Awei plaster applied? Heat it with an iron first, then stick it on
What is this Awei Gao? A wei (asafoetida) is the resin of a tree from Xinjiang, and it has the power to dissolve accumulations — it specializes in resolving lumps inside the body. Doctor Xue Lizhai often used this formula to dissolve internal masses. What is in it? Qiang huo (notopterygium) and du huo (angelica pubescens) (which dispel wind and scatter dampness), xuan shen (figwort root), rou gui (cinnamon bark), and also shao yao (peony), chuan shan jia (pangolin scales), di huang (rehmannia), liang tou jian (anemone), da huang (rhubarb), bai zhi (angelica dahurica), tian ma (gastrodia), and hong hua (safflower); plus tao zhi (peach twigs), liu zhi (willow twigs), and huai zhi (pagoda tree twigs) — twigs of several trees, all of which have a free-flowing, unblocking nature — together with mu bie zi (bitter cucumber seed) and human hair (burned into charcoal), made into a paste with a little she xiang (musk) inside.
The interesting part is the method of application: first spread some mang xiao (crude mirabilite, a rough form of Glauber’s salt) over the affected area, then cover it with a layer of paper, then take an iron (in ancient times the iron was heated by putting a little charcoal inside) and press it warm over the spot — and only after it was heated did you apply the plaster. That is how the lump-dissolving plaster was used.
💬 Note from Doctor Luo: Look how refined this technique is: heat first, then apply — helping the medicine’s power penetrate. The external plaster handles the local mass; the oral medicine handles the whole body — resolve stasis locally, support upright qi systemically, two lines advancing at once.
Why Buzhong Yiqi in the morning and Guipi in the afternoon? Two “small cycles”
After the two formulas had been taken for about two months, the liver fire receded a little and the spleen earth strengthened a little — the liver fire slowly calmed, and the spleen earth slowly grew more robust. At this point you may ask: the liver qi was so badly constrained — why not vigorously soothe the liver and regulate the qi? Why start with Buzhong Yiqi and Guipi?
Because when the upright qi is insufficient, you cannot attack the pathogen alone. In the morning, Buzhong Yiqi Tang lifts the qi upward and tonifies spleen yang; in the afternoon, Jiawei Guipi Tang — in the science of formulas, Guipi Tang is classified among the blood-nourishing formulas — is a dual tonification of qi and blood: inside it there is long yan rou (dragon eye fruit, longan) to nourish heart blood and settle the spirit, dang gui (angelica sinensis) to nourish the blood and the liver blood, and yuan zhi (polygala) to calm the spirit and settle the heart. So the morning tonifies qi, the afternoon nourishes blood — tonifying yin and yang on separate schedules.
💬 Note from Doctor Luo: This is an extremely gentle combination. In the morning, tonify qi and lift the yang; in the afternoon, tonify both qi and blood, nourish the heart and settle the spirit — over the course of one day, both qi and blood are taken care of. And this is not all — two months in, the exquisite part was just beginning.
Layer two: Buzhong Yiqi sending Liuwei Dihuang, Xiao Yao San sending Guipi Wan
After the liver fire receded and the spleen earth strengthened, Doctor Xue Lizhai upgraded the plan: in the morning he still used Buzhong Yiqi Tang, but now used it to send down Liuwei Dihuang Wan — now that the qi is built up, let it generate kidney water, tonifying kidney yin and kidney essence (for a woman whose blood and essence are depleted); in the afternoon he switched to Xiao Yao San (Free and Easy Powder) decocted in water, sending down Guipi Wan.
What is Xiao Yao San? It is today’s Xiao Yao Wan, sold in pharmacies. One formula, three jobs: soothe the liver (when the emotions are bad, it soothes the liver qi), nourish the blood (women easily become blood-deficient, so it nourishes the blood), and tonify the spleen (constrained liver qi bullies the spleen and stomach, so it tonifies the spleen). This was taken for another month or so.
💬 Note from Doctor Luo: Do you see it? Doctor Xue Lizhai built two “small cycles”: the morning cycle is Buzhong Yiqi Tang sending Liuwei Dihuang Wan — tonifying qi plus tonifying kidney yin; the afternoon cycle is Xiao Yao San sending Guipi Wan — soothing the liver, strengthening the spleen, and regulating qi and blood. One set in the morning, one in the afternoon — the logic is exceptionally clear.
Layer three: draining the liver fire — Luhui Wan sent down with Xiao Yao San at dawn, and with Guipi Tang in the afternoon
After about three months of regulation, with the upright qi held firm, only then did it become time to drain the liver fire — she began taking Luhui Wan (Aloe Pill). The Aloe Pill treats the mouth and tongue sores, swollen painful gums, and skin sores caused by liver fire; it clears liver fire and removes heat, and contains da zao jiao (large honey locust fruit), qing dai (indigo), lu hui (aloe), zhu sha (cinnabar), she xiang (musk) and so on — its main work is draining liver fire.
But it was not taken dry, either — in the morning, fasting, she took Luhui Wan sent down with Xiao Yao San decocted in water: in the morning yang qi rises, and she borrowed that rising yang to disperse the liver fire; in the afternoon she took Luhui Wan sent down with Guipi Tang: the afternoon is for nourishing the blood, so she nourished the blood while draining the liver fire at the same time.
💬 Note from Doctor Luo: Notice the sequence: support the upright qi for two months first, then regulate qi and blood for a month, and only then dare to drain the liver fire — extraordinary caution. Liver-fire-draining herbs injure the upright qi, so they may only be used once the upright qi is sufficient; and they were always sent down with Xiao Yao San or Guipi Tang — draining and supplementing at the same time, never fighting alone. As for this woman — she knew her body was unwell, and she took it very seriously: she carefully observed the taboos and took her medicine faithfully.
One year later: the lump was gone, and her periods were normal
In this way she was regulated for about a year, and the illness was completely cured: the lump was gone, and her periods were normal.
Someone may say: a whole year just to regulate that? Isn’t that too slow? Doctor Luo Dalun addressed this question directly:
💬 Note from Doctor Luo: Many young people today have seen too little and talk very arrogantly — “our methods are fast, we can regulate this quickly.” But in reality some patients are extremely weak, and gynecological conditions in particular are very hard to regulate. To dissolve a four-cun lump and bring the periods back to normal within a year — that is actually a remarkable achievement. I have seen so many patients who wander from clinic to clinic, in and out of hospitals, through countless doctors — far too many of them end up with bodies that are worse than before. Doctor Xue’s method, though it looks slow, regulates the person — and once the person is regulated, that body will be very well indeed.
Bonus: how did the periods recover? And how did the lump disappear?
Let me explain both questions thoroughly.
Why could the periods recover? This woman’s spleen and stomach were extremely weak — her source of transformation was exhausted (hua yuan kui fa): the source that produces qi and blood had dried up. So her periods became scant and then stopped. The core of Doctor Xue Lizhai’s whole plan was strengthening the spleen and stomach — as the spleen qi slowly recovered, the qi and blood gained a source, and the periods naturally returned; and once the liver fire was removed, the spleen and stomach recovered even better.
Why could the lump disappear? The lump was in the left lower abdomen — the liver channel passes through the sides of the lower abdomen. Liver qi stagnation plus stagnant qi and blood congealed into a mass. The treatment was not to attack the stasis and break the accumulation blindly — that actually makes it impossible to dissolve — but rather to support the upright qi as the main strategy, with a little liver-qi soothing added — and the lump slowly dissolved on its own; the local stagnation was left to the externally applied Awei Gao plaster.
💬 Note from Doctor Luo: Doctor Xue Lizhai’s core idea in treating gynecological disease is supporting the upright qi — the oral medicine mainly supports upright qi and regulates qi and blood, while dissolving stasis is done externally, with local application. This is an extremely steady, extremely patient-friendly method. Everyone, remember: the more deficient the patient, the more you must support the upright qi first — never charge in with attacks. This is exactly what makes Doctor Xue Lizhai great, and it is the most important thing we should learn from him.
Adapted from Doctor Luo Dalun’s lecture on the medical cases of Doctor Xue Lizhai. The case is recorded in Records of the Xue Family Medical Cases (《薛氏医案》) by Xue Ji (Ming dynasty).