Swollen Lips and Fever After Childbirth That Only Got Worse? Doctor Xue Lizhai Cures Postpartum Deficiency-Fire — Strengthen Qi First, with Three Formulas Rotated by Time of Day
Patient search terms: swollen lips / lips swollen after childbirth / postpartum fever / waves of body heat / fever worse in the afternoon / prone to anger / gets sick whenever angry / irregular periods / period stopped / very heavy periods / drooling / no strength / cannot eat / loose stools
Medical terms: injury from the seven emotions · deficiency of the liver and spleen · qi deficiency giving rise to deficiency fire · flooding and spotting · postpartum disorder
Opening scene: an “angry” woman talked her body into collapse
Today’s case is a gynecology case from Doctor Xue Lizhai (Xue Ji), the director of the Imperial Medical Academy in the Ming dynasty. Doctor Luo Dalun often says that Doctor Xue’s cases are especially representative — after hearing them, many listeners exclaim, “Isn’t this describing me?” This case tells the story of a woman who loved to get angry, who step by step talked her body into collapse — and how Doctor Xue Lizhai pulled her back.
💬 Note from Doctor Luo: Doctor Xue Lizhai was the director of the Imperial Medical Academy in the Ming dynasty, from a family of imperial physicians. He left behind more than three thousand recorded cases, and his gynecology cases are especially representative. If you listen carefully, what will you hear? You will hear — how we ourselves fall ill, and how we should regulate ourselves. For today’s case, remember one sentence first: women who are easily angered and emotionally troubled have far too many chances to fall ill.
Who was the patient? — A postpartum woman whose nature was “good at anger”
Doctor Xue Lizhai begins by recording this woman’s temperament: “xing shan nu” — her nature was to flare up easily and get angry. And what was her complaint? After childbirth — that is, after giving birth — she had swollen lips and internal heat: her lips were swollen, and she felt heat inside her body, coming in waves.
💬 Note from Doctor Luo: Notice that Doctor Xue Lizhai opens with her temperament — that is deliberate. The root of this illness was planted in her personality long ago. After childbirth the body is already depleted, and when illness strikes on top of that, it is the sternest test of a physician’s skill.
First mistreatment: clearing heat and expelling toxins — the lips swelled worse and worse
First she called in other doctors. They looked and thought: swollen lips — that must be heat toxins! So they gave heat-clearing, toxin-expelling medicine. The result? The lips and mouth swelled even more — it was not just the lips anymore, the whole mouth was swelling; by afternoon the heat was worse; and her period became irregular — after childbirth her cycle had returned, and now it started going haywire.
💬 Note from Doctor Luo: Why does clearing make the swelling worse? Because cold, bitter herbs injure the spleen with bitter cold. Once spleen qi is wounded, the deficiency fire blazes even higher — so the lips swell more and the afternoon fever intensifies. And as for the irregular period: what does menstruation depend on? The spleen and stomach are the source that transforms qi and blood — the spleen and stomach absorb nutrients from food and turn them into blood. Once the spleen and stomach are depleted, the period is bound to grow scanty and chaotic. By now the root was already wounded.
Second mistreatment: descending fire and resolving phlegm — she could barely eat
The doctor saw heat remaining and switched to fire-descending, phlegm-resolving herbs. The result? She ate less and less and started vomiting — her appetite shrank and she retched; her stools were no longer formed — loose stools; and the inside of her lips began to bleed — the swelling had broken into bleeding.
💬 Note from Doctor Luo: Descending fire and resolving phlegm kept on injuring the spleen and stomach. Eating little and vomiting means the spleen and stomach are increasingly insufficient; loose stools show spleen qi is wounded — a classic sign of damage from cold, bitter herbs; bleeding inside the lips shows the deficiency heat has grown fiercer. Yet even now, nobody recognized that this was a deficiency.
Third mistreatment: moving qi and guiding out stagnation — the chest clogged up harder
The doctor saw she ate little and her belly was distended, so he used qi-moving, digestion-guiding herbs. The result: chest and diaphragm stuffiness — the more he moved the qi, the worse it was, the more it clogged up inside; the head and eyes grew unclear — her mind was foggy and her vision blurred; the lips swelled further; and now her period stopped entirely — amenorrhea.
💬 Note from Doctor Luo: This is the most critical error. The qi was already extremely deficient, and you go on forcefully moving it — then things inside only turn less and less, hence the chest and diaphragm stuffiness. Head and eyes unclear is qi deficiency unable to lift upward — the clear yang cannot rise to the head and face. Amenorrhea means the spleen and stomach were wounded even more severely. Error after error, the spleen qi wounded again and again, the upright qi wounded again and again — to put it frankly: it was already a mercy that she had not come to grief.
Fourth mistreatment: clearing the stomach and moving blood — the woman was utterly depleted
At this point the doctor wondered: could there be stomach heat? So he used stomach-clearing, blood-moving, stasis-resolving herbs. The result: limbs heavy and weary — no strength in the arms and legs; fever and restlessness — waves of heat through the body, with great irritability; and saliva pouring out — mouthful after mouthful of drool flowing from her mouth. Even at this stage, the doctor still wanted to use a menstrual-opening formula to force her period through — thank goodness it was never given! As Doctor Luo says: in the ancient medical world, there were plenty of mediocre physicians too — doctors who prescribed without reading the condition correctly and made things worse and worse; they really were not rare.
💬 Note from Doctor Luo: Remember the principles behind these symptoms: the spleen governs the four limbs — when the spleen is deficient, the limbs are weary and without strength. Fever and restlessness are deficiency heat from spleen-stomach qi deficiency. The spleen manages water — when spleen qi is sufficient it can control the fluids; when spleen qi is deficient, saliva, urine — these fluids just leak out on their own. And they still wanted to open her period? If they had kept on like that, she truly would have been finished. She was fortunate — she met Doctor Xue Lizhai.
What Doctor Xue Lizhai thought: “the disease is rooted in the seven emotions” — the war chest was down to 5 percent
At one glance Doctor Xue Lizhai named it in two words: “bing ben qi qing” — the root of this disease is emotional disturbance. The seven emotions injure the viscera internally; and where did the damage fall hardest? Deficiency of the liver and spleen. Rage injures the liver; when liver fire blazes, whom does it bully? It attacks and overacts on the spleen and stomach — the spleen and stomach grow ever more deficient, and the upright qi is insufficient. Yet all the previous physicians had used nothing but attacking, purging formulas.
💬 Note from Doctor Luo: Let me use a military analogy: when the war chest is 100 percent full, you can go fight and it is fine; at 80 percent, you can still fight, and with a little supplementing on top, that works too. But right now? The war chest is down to 5 percent — barely enough grain for half a day — and you want to march for two months to fight a great battle? Can that battle be fought? So what should be done now? Replenish the war chest, produce grain — once supplies are abundant, then fight. Support the upright first, attack the pathogen later — physicians must get this order straight. Moving qi, regulating qi, resolving stasis, soothing the liver, draining fire — all of it is harassing the body; the more the yuan qi is depleted, the worse the illness grows.
Doctor Xue Lizhai also pointed out one more layer: some people’s lips swell and they feel internal heat because there really is fire; but there is another situation — when the upright qi is insufficient and the spleen-stomach qi is deficient, the same symptoms appear. Liver qi running sideways overacts on spleen earth and wounds the spleen and stomach; when spleen-stomach qi is insufficient and yuan qi is depleted, internal heat appears all the same. At that point, regulate the spleen and stomach, and the fire above comes down on its own.
The prescription: three formulas rotated by the hour, and the yuan qi gradually recovered
How was she treated? The method had to center on supporting the upright qi. Doctor Xue Lizhai prescribed three formulas: the Augmented Spleen-Restoring Decoction (Jiawei Guipi Tang), the Augmented Free and Easy Powder (Jiawei Xiaoyao San), and the Supplement the Middle and Boost Qi Decoction (Buzhong Yiqi Tang).
💬 Note from Doctor Luo: How were these three used? Doctor Xue’s method is wonderfully clever — matched to the hours of the day: in the morning take Buzhong Yiqi Tang to lift the yang qi; at noon take Jiawei Xiaoyao San — noon is when fire is strongest, so use it precisely then to drain the liver fire; in the evening take Jiawei Guipi Tang (or the Six-Ingredient Rehmannia Pill, Liuwei Dihuang Wan) to nourish the kidneys and the spleen. This practice of “rotating three formulas by the hour within one day” is something I learned from Doctor Xue Lizhai, and I have been teaching it for many years — it works very well.
And the result? The yuan qi gradually recovered, and the lip sores gradually healed. Remember, the swollen lips were the earliest symptom of the whole illness — for that to heal too was no small achievement.
Three relapses, three rescues: anger came once, illness came once
But of course, curing an illness is never that easy. This woman got angry again — some family matter, and she was furious. That one burst of rage brought: chills and fever with ear pain (waves of cold and heat through the whole body, plus earache), chest and diaphragm distension — and her lips swelled up again. Doctor Xue Lizhai said: anger stirs liver fire and wounds the blood — he gave the Four Substances Decoction (Siwu Tang) combined with the Minor Bupleurum Decoction (Xiao Chaihu Tang), plus zhi zi (gardenia fruit). She was better at once.
💬 Note from Doctor Luo: The Minor Bupleurum Decoction is a formula Doctor Xue Lizhai used with special skill. It harmonizes the liver and gallbladder and resolves the shaoyang level — the effect is excellent. Why did the ears hurt? The gallbladder channel runs around the ears — when liver fire stirs, the ears are the first to complain. Xiao Chaihu plus gardenia drains the fire, Siwu nourishes the blood — and it was resolved at once.
After she recovered, she got angry again! This time: flank and breast distension (distension under the ribs and in the breasts), abdominal pain, vomiting sour fluid, inability to eat (food would not go down), and difficulty urinating (urine not flowing smoothly). Doctor Xue Lizhai said: anger stirs liver wood, which overacts on spleen earth — supplement the spleen qi, nourish the spleen blood, and use Guipi-style formulas. Slowly she recovered again.
💬 Note from Doctor Luo: The breasts lie along the liver channel’s pathway, so flank and breast distension is a liver-channel problem; vomiting sour fluid is stomach qi rebelling upward; inability to eat means the spleen and stomach are wounded. Here liver wood has overacted on spleen earth, and again the main treatment is to supplement the spleen — fill the spleen and stomach back up, and the liver qi will settle on its own. Do I meet women like this? Constantly. Furious over nothing — dying of rage over trifles. It is simply not worth it.
And later? Overwork plus anger — she was tired, she was angry, and on top of that her diet was irregular (eating at odd times). The result: fever, cough and wheezing, exhaustion with no appetite, and blood flooding out like a collapse (her period pouring out in a flood, like beng lou), and the lip swelling returned. Doctor Xue Lizhai said: there is fire in the liver channel and qi deficiency in the spleen channel — he gave the Buzhong Yiqi Tang plus zhi zi, bai shao (white peony) and mu dan pi (moutan bark). She recovered. And with that, this patient’s symptoms were all gone.
Doctor Luo’s extension: two neglected kinds of “deficiency fire,” and “a great physician can only rescue you in emergencies”
Having told the case, Doctor Luo Dalun asks a question: did this patient really get better in the end? Doctor Xue Lizhai’s record stops here. But think about it: if she never changed her temper, the whole process would play out again — and again — for the rest of her life. Until one day it dawned on her: oh, my body is connected to my emotions — and if she never figured that out, the illness would keep worsening until a serious disease took her.
💬 Note from Doctor Luo: This is the deepest lesson of the case: a great physician can only rescue you in emergencies. You get angry once, I cure you once; you get angry again, I cure you again — but I cannot hold you up for a whole lifetime. Doctor Xue Lizhai was director of the Imperial Medical Academy, and treating the emperor was the same: if the emperor wants to rage, no one can stop him; an imperial physician can only rescue him in emergencies. Many patients scour the world for great doctors — “Who is today’s Zhu Danxi? Who is today’s Zhang Xichun? I must have him write me a prescription” — useless! If you do not adjust your own personality, if you agonize and brood and rage every day, even meeting Doctor Xue Lizhai himself would not help. The body has two parts, form (xing) and spirit (shen): form is the physical body, spirit is the mind. Never use the mind to torment the body — yet that is exactly what so many people are doing. I call cases like this “a blow to the head” cases: a big stick comes down on your skull — are you awake yet, or not?
Inside this case there are also two pieces of theory the ancient physicians taught that we no longer pay attention to, and Doctor Luo Dalun singles both out:
💬 Note from Doctor Luo: The first is deficiency fire from depleted kidney essence — when kidney water is insufficient, deficiency fire rushes upward, like dragon-and-thunder fire racing upward (long lei zhi huo shang ben). It is all too often mistaken for real fire and cleared with cold herbs — that is wrong. The second is deficiency fire caused by qi deficiency — when yuan qi is depleted and spleen-stomach qi is deficient, deficiency fire floats on the surface of the body and in the upper burner. Doctor Xue Lizhai’s books are full of this material — among his three thousand cases there are countless examples of “qi-deficiency fire wrongly treated with cold, bitter herbs” — yet nobody has bothered to summarize them. I suggest listing out what forms deficiency fire takes, what causes it, what patterns it follows, and how to regulate it — once it is written down, everyone will know what to do. Today’s case has two study points. First, when the upright qi is extremely deficient, treatment must center on supporting it — you may add a pinch of liver-soothing herbs (the Jiawei Xiaoyao San), a pinch of fire-draining herbs (the Jiawei Guipi Tang also contains chai hu and zhi zi) — but the core is regulating the spleen and stomach and supporting the upright qi. The Buzhong Yiqi Tang and the Guipi Tang are superb and very gentle for women. Second, even in the hands of a master like Doctor Xue Lizhai, if your personality is not regulated, your body will not heal — the illness came from emotion; the upright qi was wounded, the spleen and stomach were wounded; medicine alone can save you for a moment, but it cannot save you for a lifetime.
Compiled from Doctor Luo Dalun’s lecture on Doctor Xue Lizhai’s medical cases; the case comes from the Records of the Xue Family Medical Cases (《薛氏医案》) by Xue Ji (Ming dynasty).