Delayed Period with Fever and Fatigue? Doctor Xue Lizhai’s Spleen Deficiency Case (Twice Mistreated, Nearly Blind — a Year of Nourishing the Spleen and Stomach Brought Full Recovery)
Patient search terms: delayed period / period coming later and later / period two months late / always feeling feverish and tired / low-grade fever / blurred vision
Medical terms: delayed menstruation · spleen deficiency with weakened qi · deficiency of qi and blood · vision as if covered with a cloth
Opening scene: two rounds of doctors made her worse — until she could barely see
Today’s case comes from Doctor Xue Lizhai (Xue Ji), the director of the Imperial Medical Academy in the Ming dynasty. The patient was a woman whose illness had started simply enough — her periods were arriving later and later, and she felt feverish and exhausted. Nothing that sounded especially dangerous. But after two successive doctors mistreated her, the illness turned sharply for the worse — her two eyes became as if a cloth had been laid over them; she could hardly see anything; her whole mind wandered and her speech came out stammering and halting. By the time Doctor Xue took over, the situation was extremely difficult.
💬 Note from Doctor Luo: This case moved me deeply. Doctor Xue wrote it up very briefly, as if it were nothing special — but behind those few lines stands a patient who may well have been in despair. To reach the point of “vision as if covered with a cloth” is no small matter.
Who was the patient? A delayed period, constant fever, and a body with no strength at all
The patient was a woman. What were her symptoms? Jing hou guo qi — her menstrual period came later and later, pushed back further each time. At the same time she had fever with fatigue (fa re juan dai) — her body always felt hot, like a low-grade fever, and she was utterly exhausted, with no strength in her arms or legs.
Most people, hearing the word “fever,” immediately think: heat! But Doctor Luo reminds us: fever does not always mean a heat pattern.
💬 Note from Doctor Luo: Li Dongyuan said it long ago: people whose qi is extremely deficient can also run a fever. Watch that word “fatigue” — it carries the cause of the disease. Weak, tired limbs point to qi deficiency. When a person’s qi is deficient, the four limbs grow weary and powerless — this is the signal of insufficient qi and blood.
First mistake: Si Wu Tang plus huang lian — and her period became two months apart
The woman went to see a doctor. The doctor reasoned: you have a fever, so you must have heat — what to do? He prescribed Si Wu Tang (Four Substances Decoction) plus huang lian (coptis, goldthread).
Si Wu Tang is the famous blood-nourishing formula (dang gui, chuan xiong, bai shao, shu di huang), and adding huang lian to clear heat follows the approach of Doctor Zhu Danxi: he loved to nourish the blood and used Si Wu Tang constantly; for someone with blood deficiency and heat, a little huang lian on top of a blood-nourishing base is appropriate. The trouble is that an ordinary doctor is not Zhu Danxi. He copied the shape of the method without its spirit — a one-size-fits-all “clear the heat, nourish the blood.”
The result was a disaster: her period came only once every two months, and it was extremely scanty and clotted.
💬 Note from Doctor Luo: Zhu Danxi used Si Wu Tang plus huang lian for the specific situation of blood deficiency with heat. A mediocre doctor only learns the surface: sees fever, clears heat; sees a woman, nourishes blood — without ever considering the root. Naturally, the more he treats, the worse it gets.
Second mistake: fierce medicines to force the period open — and the eyes went dark
With the period arriving once every two months, scanty and clotted, another doctor took over. His diagnosis: blood stasis must be blocking the womb! So he prescribed violent, drastic blood-moving medicines — shui zhi (leeches), meng chong (gadflies), the line of Di Dang Tang (Resistance Decoction). Straight in with the heavy artillery: “Your period won’t come? I’ll force it open!”
The result: liang mu ru bo meng — her two eyes were as if covered with a cloth, and she could no longer see clearly; her whole mind became confused, her speech stammering, her brain seemed to stop working. The damage was enormous.
💬 Note from Doctor Luo: Do not think Doctor Xue was exaggerating — this is exactly what happens in the clinic. A few days ago I told the story of a woman: after giving birth her period was a little irregular with some blood stasis, which needed only slow, gentle regulation — but the doctor immediately used fierce blood-moving herbs like leeches and gadflies. The patient’s eyes went dark on the spot: she could not see anything, everything was spinning with stars. Doctor Xue’s description is not off by a hair. Use medicines that violent, and this is what you get.
What did Doctor Xue see? “The spleen is the head of all yin; the eyes are the ancestral home of the blood vessels”
The woman came to Doctor Xue Lizhai. He spoke two sentences that form the heart of this case:
“Pi wei zhu yin zhi shou, mu wei xue mai zhi zong” — the spleen is the head of all yin, and the eyes are the ancestral home of the blood vessels.
What does this mean? The eyes are intimately connected with blood. The eyes depend on blood for nourishment in order to see (mu de xue er neng shi — the eyes can see when they receive blood). When blood is deficient, it cannot rise to nourish the eyes; the eyes go dry of nourishment and naturally cannot see clearly. And where does blood come from? The spleen and stomach. In Chinese medicine, the blood’s source is the spleen and stomach: they absorb the finest nourishment from food, transform it into blood, and distribute it through the whole body. The spleen is the source that produces blood.
So Doctor Xue’s judgment was: the spleen is injured, and all five organs have lost their foundation.
💬 Note from Doctor Luo: Mind the punctuation here. It is “the spleen is injured; the five organs all lose their foundation” — when the spleen is hurt, every organ loses its footing. Nourishment can no longer reach the whole body and the five organs; the organs are like people turned out of their homes with no roots. Blood can no longer return to nourish the eyes, so of course the eyes receive no supply. Some editions punctuate it wrongly as “the spleen injures the five organs, all lose their foundation” — the meaning becomes quite different.
The prescription: Buzhong Yiqi Tang plus Jisheng Guipi Tang — focus on the spleen and stomach
How did he treat her? Doctor Xue’s prescription was strikingly simple: Buzhong Yiqi Tang (Supplement the Middle and Boost Qi Decoction) together with Jisheng Guipi Tang (Life-Saving Spleen-Restoring Decoction) — in other words, the Guipi Tang family. Forget everything else for now — just regulate the spleen and stomach.
And the way to take it mattered: Buzhong Yiqi Tang in the morning, Guipi Tang in the evening.
💬 Note from Doctor Luo: This is where Doctor Xue shows his mastery. The patient’s symptoms were tangled like a ball of twine; nothing she tried had worked. His instruction: just regulate the spleen and stomach. Spleen and stomach insufficient, qi and blood deficient — take Buzhong Yiqi and Guipi, keep at it, and once the qi and blood are full, the body quietly restores itself.
Buzhong Yiqi Tang: Li Dongyuan’s formula, used by Doctor Xue to supplement the original qi
Buzhong Yiqi Tang is Li Dongyuan’s formula, and Doctor Xue Lizhai used it constantly. Li Dongyuan used it for sinking of the middle qi caused by spleen-stomach weakness; Doctor Xue’s emphasis was different — he cared less about the “sinking middle qi” symptom and instead regarded the formula as one that supplements the original qi (yuan qi), treating the spleen-deficient poor appetite with fatigue, dry mouth and fever, as well as fever from irregular diet and overwork — the body running hot and bone-tired.
Each physician understands the same formula differently. Doctor Xue prized above all the point that “when the original qi is insufficient, the body may paradoxically run a fever.”
The formula’s composition: zhi huang qi (honey-fried astragalus), ren shen (ginseng), dang gui (angelica sinensis), bai zhu (atractylodes), with chen pi (aged tangerine peel) and gan cao (licorice), plus sheng ma (cimicifuga) and chai hu (bupleurum) to lift the qi upward. Because it leans toward supplementing yang and raising the yang qi, it was taken in the morning, riding the morning’s rising yang to build the original qi.
Guipi Tang: the blood-nourishing formula taken at night — every ingredient is a lesson
Guipi Tang (Spleen-Restoring Decoction) is classified among the blood-nourishing formulas in the science of prescriptions, and it was taken in the evening — to nourish and build the qi and blood. How is it composed?
The base is Si Jun Zi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), zhi gan cao (honey-fried licorice) — which supplements qi: only when qi is sufficient can it produce blood. On top of that, huang qi (astragalus) — more qi supplementation; dang gui to nourish the blood; then long yan rou (dragon eye fruit, longan) — the herb Doctor Luo especially recommends: dried longan is reddish in color, enters the heart channel, nourishes heart blood and settles the spirit, and those who take it sleep extremely well; its flavor is sweet, and sweetness enters the spleen, so it also builds spleen qi — it supplements both qi and blood. Doctor Luo has spoken about it at length before — Yu Ling Gao (Jade Spirit Paste, longan simmered with American ginseng) is excellent for nourishing blood, and longan is exactly the star ingredient. Then yuan zhi (polygala) to nourish the heart and settle the spirit — a person like this broods and worries day and night, draining heart blood, so the spirit must be settled to stop the drain; then chao suan zao ren (fried sour jujube seed) — nourishing the blood of the heart and liver; when the blood is well nourished, sleep comes easily. Finally a little mu xiang (aucklandia) to move the qi — tonics tend to clog; if they sit stuck in one place they can even generate heat, so mu xiang keeps the qi flowing. It is decocted with sheng jiang (fresh ginger) and da zao (jujube) — ginger and jujube harmonize the stomach and regulate the spleen and stomach.
💬 Note from Doctor Luo: Excessive thinking injures the spleen and drains heart blood. Nowadays many people are busy all day and lie awake at night turning over the company’s problems — day after day they drain their heart blood. In Guipi Tang, long yan rou and fried sour jujube seed nourish the blood and settle the spirit, precisely so that a person can sleep well. For insomnia, longan with fried sour jujube seed is exactly this logic: nourish the blood, and sleep follows. One more point — Doctor Xue’s Jiawei Guipi Tang (Modified Spleen-Restoring Decoction) adds zhi zi (gardenia) and chai hu (bupleurum) to the base Guipi Tang — another of his signature moves.
After a year of treatment, the illness was cured — and how to take the pills
And so it went: Buzhong Yiqi Tang in the morning, Guipi Tang at night, devoted entirely to the spleen and stomach. The woman persisted for about a year, and the illness was completely cured.
Doctor Luo gave specific advice about how to take the medicines: people regulating their bodies today can take the patent pills — Buzhong Yiqi Wan and Guipi Wan are both available as ready-made pills, and pills are easy to keep up with, far less troublesome than boiling a fresh decoction every day.
💬 Note from Doctor Luo: If you take the pills, I generally recommend increasing the dose — by half, or even double. A decoction yields a big bowl drunk twice a day; how much strength can seven or eight pills carry? When the formula and the thinking are right, a slightly larger dose works faster and hits harder.
Bonus: why did regulating the spleen and stomach save her? — the one lesson women should never forget
Let us finish by explaining the reasoning fully. Why was this woman saved? Because the true root of the disease was found: the earlier doctors saw “heat” and “blood stasis”; Doctor Xue saw insufficient spleen and stomach — the blood deficient, the qi insufficient, all of it stemming from the spleen and stomach, the “source of transformation,” being out of order. Strengthen the spleen and stomach, and they can transform the essence of food into blood; the blood is no longer deficient, the qi is full again, and the body restores itself — the eyes see again, and the periods return to normal.
And the reverse: what if she had met another reckless doctor? Here she was already depleted to the bone, and they would “soothe the liver” — soothing makes it worse; then they would move blood and force the period — but there is no period to force. The riverbed has run dry; what you must do is fill it with water, not scrape the dry channel with a knife.
💬 Note from Doctor Luo: I admire Doctor Xue enormously for this case. Before I met women like this, I truly could not imagine how badly medicine can injure a person, or how deeply a woman’s body can be depleted. But once you meet one, you understand: the symptoms are tangled like a ball of twine, and Doctor Xue tells you — just regulate the spleen and stomach. Spleen and stomach insufficient: Buzhong Yiqi plus Guipi, keep at it, and when the qi and blood are sufficient, every symptom slowly heals. And remember: women’s bodies are especially easily hurt. When the woman of a household collapses, the household itself mostly stops running. Nourish the spleen and stomach well, keep the qi and blood full — and a person has roots again.
Compiled from Doctor Luo Dalun’s commentary on Doctor Xue Lizhai’s case; the case is from Records of the Xue Family Medical Cases (《薛氏医案》, Ming dynasty, by Xue Ji).