Heavy Bleeding and Waves of Body Heat That Won’t Clear No Matter How Much You Cool? Doctor Xue Lizhai’s Metrorrhagia Case — True Cold Hiding Behind False Heat

Patient search terms: menstrual flow suddenly very heavy / blood flooding out / menstrual blood pouring out / body fever / waves of heat / pain in the limbs / dizziness / cannot eat / blood in the stool / the more you clear heat the worse it gets

Medical terms: metrorrhagia and metrostaxis (beng lou) · true cold with false heat · kidney essence deficiency · kidney yang deficiency · floating deficiency fire · cold deficiency of the spleen and kidneys

Opening: an imperial physician — twice dragging his cousin’s wife back from the gates of death

Today’s case comes from Doctor Xue Lizhai (Xue Ji), director of the Imperial Medical Academy in the Ming dynasty. What makes this case special? The man who wrote it up is not Doctor Xue himself, but his cousin Fang Qian. The cousin’s wife fell gravely ill twice, each time down to nothing more than “a last breath of air,” and both times Doctor Xue Lizhai pulled her back with a medicine or two. The cousin was so grateful that he kowtowed and wrote down every step of the rescue with his own hand.

💬 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, and he left behind more than three thousand recorded cases. Among his case records, quite a few were written by the people around him — students, family members — people who, after he cured them, wrote the account out of gratitude. This is a classic example: the more harrowing the case, the more it shows the real skill.

Who was the patient? — fifty years old, and first her menses suddenly turned into a flood

The patient was the wife of his cousin Fang Qian, fifty years old. How did the illness begin for this fifty-year-old woman? — In the year Xin Chou she suffered beng (flooding).

💬 Note from Doctor Luo: First, two words — what is beng, and what is lou? Beng is when the menstrual flow suddenly turns very heavy, a major hemorrhage, pouring out beyond control — that is beng (flooding). Lou is when the flow is scanty but trickles on without end, never quite finishing — that is lou (dripping). Together they are called beng lou (metrorrhagia and metrostaxis). She had beng — meaning the blood loss was severe.

Once the flooding began, no medicine helped — she took many remedies, and none of them worked.

The first attack: body heat, aching limbs, dizziness and phlegm — treated as “fire”

By August of the year Ren Yin, the illness had turned serious: the body ran hot, the limbs ached, she was dizzy, with copious nasal discharge and phlegm, a poor appetite, and no ability to eat.

💬 Note from Doctor Luo: Look at this — body heat, aching limbs. What does the average person conclude at first glance? “This is fire!” So the earlier doctors treated it as fire and used cooling medicines. And the result? Zhuan zhi jue li — the more they treated, the worse it got, until in the end she could not swallow even a single grain of rice. For days she lay at death’s door, unable to move, with only enough breath left to gasp — the person was essentially finished.

Just at that moment, Doctor Xue Lizhai happened to return from his inspection tour of Zhejiang, and the cousin hurried to call him in.

The diagnostic highlight: it looks like heat, but it is actually cold — true cold, false heat

Doctor Xue Lizhai took one look and said: this is cold deficiency of the spleen and stomach (more precisely, cold deficiency of the spleen and kidneys) — the heat signs you see are all appearances! The true root of the illness is insufficiency of kidney essence.

💬 Note from Doctor Luo: Why do I say “cold deficiency of the spleen and kidneys” is more precise? In the ancient books the characters for “stomach” (胃) and “kidney” (肾) look very similar, and copyists easily mixed them up. Besides, the man recording the case was his younger cousin, who knew nothing of medicine; writing “cold deficiency of the spleen and stomach” was not a serious error. Now, about the root: when kidney essence is insufficient, the person can develop in one of two directions — the deficiency can lean toward kidney yin deficiency, or toward kidney yang deficiency. This patient developed toward yang deficiency: cold within, kidney essence depleted — and so the little yang that remained fled to the surface and up to the upper body. That is what xu huo (deficiency fire) is.

So the heat on the surface of her body was an illusion; much of the swelling and pain of the head and face is likewise illusion. What should be done then? — Tonify the kidney essence and warm the kidney yang — in other words, the approach of Gui Fu Di Huang Wan (Ba Wei Wan, the Eight-Ingredient Pill).

The prescription: one dose of the Ba Wei Wan formula, simmered and sipped slowly

Doctor Xue Lizhai wrote one dose of the Ba Wei Wan formula — he took the Gui Fu Di Huang Wan formula, but instead of making it into pills, he simmered it into a decoction, hurriedly decocted and drunk. Because the stomach had been weak for so long, the medicine had to be taken one small sip at a time.

💬 Note from Doctor Luo: And the result? The next morning, the patient wanted congee — after days without a single grain of rice, she drank several tenths of a bowl of congee. She took another dose of the decoction, her appetite began to return, the heat lessened and the pain stopped — the body heat diminished, and the joint pain ceased. Then Doctor Xue had her take Ba Wei Wan (the pill form). She kept taking it, and the illness was cured.

The second attack: toil, worry and anger — the flooding returned

She recovered. But in the autumn of the year Gui Mao, because of heavy labor, grief and anger, her body collapsed again. In the spring and summer of Jia Chen, the metrorrhagia returned — the menstrual flow was once again very heavy.

By the twentieth day of the sixth month, the illness had turned fiercer: heat in the chest and diaphragm (the chest felt distended and hot), pain along the spine, a waist that could not turn (yao bu ke zhuan), and failing spirit and qi. This time the earlier doctors were even more at a loss — some treated it as internal injury, some as summerheat stroke. And the result? The flooding blood boiled up, and blood appeared in the stool — the menses were extremely heavy, and there was also rectal bleeding; restless, thirsty, constantly drinking (fan ke yin yin); not a grain of rice would go down.

By the thirteenth day of the seventh month: dazed day and night, conscious one moment and unconscious the next, with no plan left — completely at a loss.

A twist in treatment: this time, do not rush to warm yang — first Shi Quan Da Bu Tang with aconite

There was no choice but to call Doctor Xue Lizhai again. He felt the pulse: the pulse was boundless and surging — beating big and fast, too fast to count; but press down on it, and it was extremely weak.

Doctor Xue Lizhai said: “This is rootless fire — true cold within, false heat without.” Inside, still true cold; outside, heat. But this time was different from the last: her qi and blood had already been enormously depleted, so he could not rush to warm yang. First he gave one dose of Shi Quan Da Bu Tang with added aconite.

💬 Note from Doctor Luo: What is Shi Quan Da Bu Tang? I have explained it many times — the qi-tonifying Si Jun Zi Tang (Four Gentlemen Decoction) combined with the blood-nourishing Si Wu Tang (Four Substances Decoction): tonify qi and nourish blood, both formulas together, plus cinnamon and astragalus, tonifying qi and blood at the same time, with a touch of warmth. This time aconite was added too, tipping it toward warming yang. After one dose, the dizziness stopped — her qi and blood had been depleted to the extreme, and the person was nearly gone; now that qi and blood were replenished, the head stopped reeling. Then she could take three or four tenths of congee, and the flooding gradually lessened. Doctor Xue had her take Ba Wei Wan every day, and in the end she fully recovered.

The cousin’s gratitude: “life hung by a thread — this formula is divinely good; there is nothing better”

At the end of the case record, the cousin Fang Qian wrote: my wife was twice in mortal danger, her life hanging by a thread, and both times it was my elder cousin who saved her — “this formula is divinely good; I know of nothing better” (ci fang shen liang, zhi wu chu ci). And so he kowtowed and wrote this account, recording the entire process with his own hand.

💬 Note from Doctor Luo: This case is truly astonishing — twice she was gravely ill, twice unable to eat, twice on the verge of death. Where was the difficulty? The difficulty is: why did so many physicians fail to see it, and the moment Xue Lizhai arrived it was cured? To be honest, if this patient were brought before a Chinese medicine practitioner today and correctly diagnosed on the first try, I would have my doubts. The reason is four words: zhen han jia re — true cold, false heat. Inside the body is true cold; on the surface is deficiency heat — so easy to misread. Especially with her beng lou: the menstrual flow was very heavy, and the body genuinely ran hot — both attacks had body heat — making it all too natural to think “maybe there really is heat,” and so the doctor opens with cooling medicines. That is the biggest trap in this case.

Why was it so easy to misdiagnose? — two problems the Ming physicians solved

Doctor Luo continues: why could the physicians of Doctor Xue Lizhai’s generation see it correctly? Because the physicians of the Ming dynasty basically solved two problems.

💬 Note from Doctor Luo: The first problem — deficiency heat caused by depletion of kidney essence. When kidney essence is depleted, it may lean toward the yin deficiency direction or toward the yang deficiency direction, but either way, kidney essence deficiency produces deficiency heat above and on the surface. Treatment follows the cold or heat: either add yin-nourishing herbs (the Liu Wei Di Huang Wan — Six-Ingredient Rehmannia Pill approach) or add yang-warming herbs (the Ba Wei Wan approach). Liu Wei Di Huang Wan is chiefly large amounts of prepared rehmannia, matched with cornus fruit and Chinese yam, plus moutan bark, alisma and poria. Ba Wei Wan is the six-ingredient formula plus aconite and cinnamon — and the heart of it is a large amount of prepared rehmannia matched with a tiny bit of cinnamon. The second problem — deficiency heat from insufficiency of original qi and spleen-stomach qi deficiency. Especially when the spleen and stomach are a little cold, the body surface may look like it has fire — that is an illusion — so you must tonify the spleen and qi and pull the fire back in.

💬 Note from Doctor Luo: But by the Qing dynasty, these physicians turned their backs on this teaching and went down a wrong road — because after the rise of the Warm Disease school, the emphasis was on clearing heat and clearing damp-heat; everyone preferred to clear heat, and the methods of nourishing and gathering the fire were neglected. Even today, many people still do not recognize this illness: they see heat signs and want to clear heat, and no matter how they clear it, it will not clear. What a pity — what the Ming dynasty had already explained so clearly, later generations simply forgot.

Breaking down the symptoms: what each sign actually means

Doctor Luo takes the symptoms of this case apart one by one:

• Body heat: deficiency heat on the surface, outside — fill up the essence within, warm the yang to gather it back, and the fire returns home;
• Aching limbs, spine pain, a waist that will not turn: the kidneys govern the bones and generate the marrow — bone problems are tied to the kidneys. When kidney essence is depleted and leaning toward yang deficiency, the bones and joints easily hurt — especially cold-type pain;
• Dizziness: insufficient qi and blood;
• Copious nasal discharge and phlegm: yang deficiency — the body lacks the strength to transform and move dampness;
• Fullness and oppression of the chest and diaphragm: yin cold flourishing within — cold qi entrenched inside;
• Inability to eat: on one hand the illness is severe and the upright qi is insufficient; on the other, with yin cold in excess, the spleen and stomach’s transforming power is limited.

💬 Note from Doctor Luo: If you looked at this woman’s tongue today, you should be able to see it — the tongue is definitely not bright red; it would be pale and puffy, with a touch of old red, and the tongue body particularly dull; saliva would pool on it. That is the sign of depleted kidney essence with yang deficiency. By contrast, if kidney essence deficiency leans toward yin deficiency, the tongue is red — red like a persimmon — with almost no coating. Also, feel her knees and ankles: they should be ice-cold — that is a very clear clinical marker. Let me add a “bone pain” checkpoint for you: in Xue Lizhai’s cases all these symptoms are summarized clearly, and with practice you will learn to judge them yourself. This patient had one thing in common across both attacks: the sicker she got, the less she could eat.

The finishing touch: guiding fire home — the magic of prepared rehmannia with cinnamon

The most memorable idea in this case is yin huo gui yuan — guiding the fire back home.

💬 Note from Doctor Luo: In Ba Wei Wan (Gui Fu Di Huang Wan), prepared rehmannia is the largest ingredient, while cinnamon and aconite are only a tiny bit. This construction comes from Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). The wonder is right here — if you take only prepared rehmannia, it will not work: the fire will flare even hotter and nothing will tonify in. But add a little cinnamon, and immediately the fire on the surface comes back. I have experienced this myself: when simmering the decoction, add a slice of cinnamon the size of a fingernail — or the size of a thumb joint — and the surface fire withdraws at once. Remarkable! How did the ancients figure this out? Prepared rehmannia tonifies the kidney essence; matched with a bit of cinnamon it is called yin huo gui yuan — guiding the fire back to the kidneys. Rehmannia alone cannot tonify in; add a touch of cinnamon, and the fire is led straight home.

💬 Note from Doctor Luo: So remember this pairing: prepared rehmannia tonifies the kidney essence; cinnamon warms the yang and guides the fire home. Once many friends understand this, it all clicks — sometimes a sore throat or angry eyes is really heat in the upper burner with cold below, and one bowl of this soup cures it. Today there are very, very many people with kidney essence deficiency. For the surface heat patterns that come from depleted kidney essence — skin problems, bleeding, sore throat, swollen painful throat, trigeminal neuralgia, toothache, styes, ear pain and so on — all you need is to tonify the kidney essence and add a little yang-warming herb, guide the fire home, and the fire comes back where it belongs.

Closing

In this case, Doctor Xue Lizhai acted with precision, identified the pattern with clarity, and achieved certain results, turning the tide — Ba Wei Wan in his hands was nothing short of miraculous. The cousin’s words of gratitude still move us today.

💬 Note from Doctor Luo: True cold with false heat is an illness that tests a physician’s eyes — those who can recognize, in a sea of heat signs, that “this is true cold with false heat, and the yang inside is deficient,” are masters; those who have the courage to use yang-warming formulas are masters too. Let us keep learning, and may our understanding of Ba Wei Wan and Gui Fu Di Huang Wan grow deeper with time.

What to take away

1. Heavy menstrual bleeding plus body heat does not automatically mean “heat.” If the bleeding came with dull cold-type bone and joint pain, dizziness, thick phlegm and nose discharge, an inability to eat, and a tongue that is pale, puffy and dull with saliva on it — think true cold hiding behind false heat (zhen han jia re).
2. The root was kidney essence deficiency leaning toward yang deficiency — the little yang that remained fled to the surface and read as “fire.” Treat the root: tonify the kidney essence and warm the kidney yang with the Ba Wei Wan / Gui Fu Di Huang Wan approach — a large amount of prepared rehmannia with just a little cinnamon and aconite.
3. When qi and blood are already exhausted, do not rush to warm yang — Doctor Xue first gave Shi Quan Da Bu Tang with aconite (four qi-tonifying herbs + four blood-nourishing herbs + cinnamon, astragalus and aconite) to rebuild the foundation, then settled into daily Ba Wei Wan.
4. Guide the fire home (yin huo gui yuan): for upper-body “fire” complaints — sore throat, toothache, trigeminal neuralgia, styes, ear pain, skin eruptions, bleeding — that come with cold below (cold knees and ankles), a soup of prepared rehmannia with a fingernail-sized slice of cinnamon can lead the deficiency fire back down. If you have such symptoms, please consult a nearby licensed practitioner of Chinese medicine before treating yourself.

Compiled from Doctor Luo Dalun’s lecture on the case records of Doctor Xue Lizhai; the case comes from Records of the Xue Family Medical Cases (《薛氏医案》) by Xue Ji (Ming dynasty), written up in gratitude by Doctor Xue’s cousin Fang Qian.