Heavy Bleeding with Low-Grade Fever That Gets Worse the More You Clear Fire: Doctor Xue Lizhai’s Spleen Deficiency Metrorrhagia Case
Patient search terms: beng lou / flooding and dripping uterine bleeding / very heavy periods / blood flooding out / low-grade fever / dazed and groggy / insomnia / heart racing / the more you clear “fire” the worse it gets
Medical terms: metrorrhagia and metrostaxis (beng lou) · spleen failing to command the blood · spleen qi deficiency · qi deficiency fever · deficiency of both heart and spleen
Opening: a junior relative, writing a case record to “clear the name” of his teacher
Among the case records of Doctor Xue Lizhai (Xue Ji), imperial physician of the Ming dynasty, there is one that stands out — the man who wrote it up is not Doctor Xue himself, but a younger relative named Gui Dahua.
💬 Note from Doctor Luo: Doctor Xue Lizhai left behind more than three thousand case records, and quite a few were written by the people around him — students, family members, patients — people who, after he cured them, wrote the account down in gratitude and placed it in his books to prove how skilled their teacher was. This case is typical: Gui Dahua wrote down, stroke by stroke, the process by which his own family member was cured, hoping that later patients could “take something from it” — learn something useful.
Who was the patient? — first her menses turned erratic, then they suddenly “flooded”
Gui Dahua wrote it honestly: the patient was his own wife. At first she only had irregular periods — qian qi, meaning her menses never came on time.
But then things suddenly turned serious: beng xue — flooding uterine bleeding.
💬 Note from Doctor Luo: First, let’s explain two words — what is beng and what is lou? Beng is when the flow is very heavy and comes on suddenly — blood rushing out like a burst dam. Lou is when the flow is scanty but trickles on endlessly, never quite finishing. Together they are called beng lou, but strictly speaking the two are different. Gui Dahua’s wife had beng — the blood loss was extremely heavy.
How sick was she? — flooding, dazed confusion, fever, and no sleep
The husband’s list of symptoms is alarming, word for word:
- Beng xue — extremely heavy bleeding;
- Hun kui — dazed and groggy, almost fainting;
- Fa re — the body ran hot, almost like a fever;
- Bu mei — unable to sleep, insomnia.
💬 Note from Doctor Luo: The husband was not a doctor; he simply recorded the most obvious symptoms of the time. Let’s analyze them: bleeding this heavy means the upright qi is insufficient; insomnia means the blood is depleted and cannot nourish the heart — when the heart loses its nourishment, you can’t sleep. Of these four symptoms, the first three are easy to understand — only the “fever” is a trap: it looks far too much like fire.
How the earlier doctors got it wrong — one cooled the blood, one stopped the bleeding, neither worked
The first doctor who came took one look and thought: “Ah, this is blood heat with reckless movement — heat forces the blood to run wild, so we must cool the blood!” He gave cold, cooling formulas.
And the result? The illness only got worse.
💬 Note from Doctor Luo: This is the seductive power of fever — when a doctor sees a fever, the first instinct is “there is heat, clear it and cool the blood.” When the direction is wrong, the more you treat, the worse it gets.
Another doctor said: “This is probably injury from childbirth, isn’t it? Then let’s stop the bleeding — stop the blood first.” He gave hemostatic formulas. They had no effect either.
Only then was Doctor Xue Lizhai called in.
The diagnostic highlight: the fever was an illusion — the root was “the spleen failing to command the blood”
The moment Doctor Xue Lizhai arrived, his diagnosis was one sentence: spleen qi is weak, and it can no longer command and restrain the blood — the method is to tonify the spleen.
💬 Note from Doctor Luo: This is one of the most important principles in Chinese gynecology — pi bu tong xue, the spleen failing to command the blood. Spleen qi is responsible for commanding the blood and keeping it obediently inside the blood vessels; when spleen qi becomes weak, qi can no longer restrain the blood, and the blood runs out. I have explained this principle many times, and everyone should remember it. What to do? Tonify the spleen and qi quickly — the blood will stop by itself.
So he used Bu Zhong Yi Qi Tang with added charred ginger — a few doses, and the flooding stopped — yan, it was cured.
Now here’s the interesting part: the patient clearly had a fever — why did Doctor Xue Lizhai dare to add charred ginger, a warming herb?
💬 Note from Doctor Luo: Because Doctor Xue saw it precisely — this patient’s qi deficiency was severe, and her qi was still draining downward, which is why the blood loss was so heavy. The beauty of Bu Zhong Yi Qi Tang is that it tonifies spleen qi and at the same time lifts the qi upward. In this situation most people would think of Gui Pi Tang, but Doctor Xue judged that her qi deficiency was too severe — the qi had to be lifted first — so he led with Bu Zhong Yi Qi Tang. When the formula is right, a few doses show results.
The patient “adds her own plot twist”: Ba Wu Tang goes wrong
Although the flooding had stopped, one symptom remained: waking in the middle of the night with palpitations — sleeping poorly, heart jumping with alarm, waking with a start in the dead of night.
The couple discussed it: “This must be deficiency of qi and blood, right?” They took Ba Wu Tang on their own.
💬 Note from Doctor Luo: What is Ba Wu Tang? There are many versions of this ancient formula, but roughly it is Si Wu Tang (dang gui, chuan xiong, bai shao, prepared rehmannia) plus Si Jun Zi Tang (ren shen, bai zhu, fu ling, gan cao), sometimes with a little chen pi and ban xia — a formula for tonifying qi and blood. They thought they’d tonify their qi and blood themselves. And the result? Bu xiao — no effect.
No choice — they went back to ask Doctor Xue. Doctor Xue heard them out and returned two characters: “Za yi!” — “Muddled! The thinking is mixed, the medicine has gone astray!”
💬 Note from Doctor Luo: Doctor Xue’s meaning was: after Bu Zhong Yi Qi Tang, the correct next step was Gui Pi Tang with added charred ginger — why? To tonify the heart and spleen. The patient was still deficient in qi and blood, but the focus now was the heart and spleen: the palpitations showed that the blood failing to nourish the heart had become obvious. Gui Pi Tang tonifies qi and blood together and calms the spirit — it is the classic formula for palpitations and heart racing. This is what is so interesting about Doctor Xue’s prescribing — it is extraordinarily pure: Bu Zhong Yi Qi, Gui Pi — all dignified classical formulas; others patch together miscellaneous formulas to tonify qi and blood, and once the direction gets muddled, the illness can’t be cured.
So he gave Gui Pi Tang with added charred ginger to tonify the heart and spleen. And the result: “sui ru chu” — the illness was cured, and she was exactly as she had been before she fell ill.
Going deeper: how many types of beng lou are there? — distinguish deficiency/excess and cold/heat first
Why is this case worth returning to again and again? Because the first two doctors both made mistakes, and Doctor Xue Lizhai saw the direction at a glance. To learn this skill, you first have to understand the classification of beng lou. Doctor Luo divides beng lou roughly into these types:
Type one: blood heat. Heat forces the blood to run faster, and bleeding easily occurs. Blood heat itself splits into two:
- Deficiency heat (yin deficiency): people with liver-kidney yin deficiency tend to have flushed cheekbones, hot palms and soles, a very bright red tongue with little coating, and a thin rapid pulse; they easily get afternoon tidal heat, night sweats, sore weak lower back and knees;
- Excess heat (damp-heat, liver fire): people with damp-heat inside have a yellow greasy tongue coating and a red tongue; people with strong liver fire are prone to explosive anger, irritability, and breast distension and pain.
💬 Note from Doctor Luo: Whether yin deficiency or damp-heat, the menstrual blood in this type of bleeding is bright red, deep red, or purple with clots — not the pale, thin kind. So just by looking at the color, you can sort out one big category.
Type two: yang deficiency (from cold). Yang qi is insufficient and the whole body’s function declines: the menses are thin and pale in color, heavy and trickling endlessly; the lower back aches badly, the person fears cold, hands and feet are icy, and a little cold easily brings on diarrhea; the complexion is pale and dusky, even slightly dark; the tongue is puffy, pale, dull.
Type three: spleen deficiency. That is today’s case: the spleen failing to restrain the blood — the qi deficiency is so severe that the blood simply escapes.
Type four: blood stasis. When the blood vessels do not move properly and stasis builds up, bleeding paradoxically becomes easier — that calls for the activating blood and dissolving stasis approach.
💬 Note from Doctor Luo: Today we focus on the spleen deficiency type. This patient’s actual state at the time would have been: pale, thin menstrual blood, limbs weak and body exhausted (that’s the feeling behind hun kui), scanty speech and weak breath — not wanting to talk, poor appetite, and since the spleen governs the four limbs the limbs had no strength and no warmth; with so much blood lost the face easily puffed and was pale with a yellowish cast; and the tongue must have been puffy, with teeth marks — not bright red but pale, with lots of fluid and saliva on it, and a weak pulse — this is the qi deficiency, spleen qi insufficiency that you can see at a glance.
The most valuable lesson: qi deficiency can also cause fever
The most important thing to remember from this case is the principle of qi deficiency fever.
💬 Note from Doctor Luo: People always assume “yin deficiency has heat, qi deficiency has cold” — but there are exceptions to both! A yin-deficient person does not necessarily run hot: when yin blood is insufficient and the power to nourish the four limbs is weak, a yin-deficient person’s hands and feet are actually colder in winter — ice cold to the touch. Conversely, qi deficiency to a certain degree can also cause fever: when the original qi is depleted to a certain point, yang qi can no longer be held in, and instead flees to the surface — cold on the inside, heat on the outside. Yang qi cannot gather within, so it floats on the surface, and then the body surface feels hot and burning — the temperature may even register a real low-grade fever. This is an illusion!
This principle was one that Li Dongyuan spent enormous effort explaining — many people are chronically weak and always feel like they have a cold, like a fever, when in fact there is no external pathogen at all; it is qi deficiency fever. And Doctor Xue Lizhai, with a huge number of cases, proved that Li Dongyuan was right.
💬 Note from Doctor Luo: The hardest part of this case is the fever. The rest — even a mediocre physician can look at it and think of tonifying the spleen and qi. But the moment there is a fever, everyone panics: “This must be fire, right? Quickly clear heat and cool the blood!” And that is wrong — the more you treat, the worse it gets. So remember: when you see beng lou (or any deficient person) with fever, don’t rush to clear heat — look at the tongue first. If the tongue is puffy, pale, with teeth marks and lots of saliva, it is spleen deficiency — the direction is to tonify, not to clear.
The finishing touch: charred ginger — black enters the blood aspect, warming yang and stopping bleeding
There is one herb in this case that deserves special attention: pao jiang — charred ginger. Doctor Xue used it in both of his formulas — why?
💬 Note from Doctor Luo: What is charred ginger? It is ginger roasted in fire until it is black, like charcoal. This kind of charred ginger is black, so it enters the blood aspect — it can warm yang and disperse cold, and at the same time its ability to stop bleeding is especially good. In gynecology, when treating bleeding that comes from yang deficiency, we often use charred ginger — Doctor Xue’s use of this herb is extremely refined.
There is also a hidden detail in this case: on top of her spleen and qi deficiency, over time a bit of yang deficiency had developed, which is why Doctor Xue added charred ginger to both formulas — warming yang and stopping the bleeding. The whole treatment was, in fact, Doctor Xue working through the case step by step — and in the middle, the patient took Ba Wu Tang on her own initiative and nearly derailed the medicine. Normally, for a patient who is not that deficient, you could start straight away with Gui Pi Tang; but Doctor Xue could see her qi deficiency was extreme, so he first used Bu Zhong Yi Qi Tang to lift the spleen qi, let her function recover a little, then used Gui Pi Tang to tonify qi and blood together and strengthen the ability to command (restrain) the blood — two clear steps, with distinct layers.
💬 Note from Doctor Luo: Notice that Doctor Xue used not a single dedicated hemostatic herb — charred ginger barely counts as half of one. That is how he practiced: when the diagnosis is certain, a simple formula goes straight in and solves the root problem at once. He was a master of gynecology, surgery and internal medicine, and yet look at his formulas — nothing flashy at all. That is real skill.
Closing: how should women with heavy periods take care of themselves?
Doctor Luo says this case teaches two things: first, qi deficiency can cause fever — yin deficiency doesn’t always mean heat, and qi deficiency doesn’t always mean cold; take this exception seriously. Second, beng lou must be sorted into deficiency/excess and cold/heat — yin deficiency, damp-heat and liver fire, yang deficiency, deficiency of both qi and blood, blood stasis, spleen deficiency — each category clearly distinguished. And among them, the spleen failing to command the blood is a pattern we see especially often today.
💬 Note from Doctor Luo: Today many women have very heavy periods that last a long time — some even become anemic, and it interferes with normal life; no matter how they adjust, it doesn’t get better. Very often this is spleen deficiency. I have seen women like this, and I simply had them take Gui Pi Wan (Restore the Spleen Pill). As they kept taking it, their period volume gradually returned to normal and the duration normalized — that is the body beginning to recover. Remember the diagnostic points: heavy periods, but the blood color is not bright red — it is pale; plus all the spleen deficiency symptoms — weak limbs, scanty speech and weak breath, a puffy tongue with teeth marks and lots of saliva, frequent drowsiness, and a heart that races and pounds (palpitations and heart agitation). When all these symptoms are present, you can take Gui Pi Wan, and the overall direction will certainly be right.
For many women whose periods are irregular, overly heavy, or too long, the approach is broadly the same as in this case — tonify the spleen first, and the blood will return to its proper channels by itself.
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), personally recorded in gratitude by Doctor Xue’s junior contemporary Gui Dahua.
What to take away
- Qi deficiency can cause fever. Yin deficiency does not always mean heat (a yin-deficient person’s hands and feet may actually be colder in winter), and qi deficiency does not always mean cold — when original qi is depleted to a certain point, yang qi flees to the surface and the body reads as hot. Before you clear heat on a bleeding, deficient patient, look at the tongue: puffy, pale, teeth marks, lots of saliva — that is spleen deficiency, and the direction is tonify, not clear.
- Sort beng lou into deficiency/excess and cold/heat first. Blood heat (bright, deep red or purple clotted blood, hot palms and soles or yellow greasy tongue), yang deficiency from cold (thin pale blood, cold limbs, pale puffy tongue), blood stasis (activate blood), and — very common today — spleen deficiency, the spleen failing to command the blood.
- Tonify the spleen and the blood returns to its channels. Doctor Xue first lifted the qi with Bu Zhong Yi Qi Tang plus charred ginger, then consolidated the heart and spleen with Gui Pi Tang plus charred ginger — two clear steps, and not one dedicated hemostatic herb. For women today with heavy, long periods that are pale rather than bright red, accompanied by weak limbs, scanty speech, a puffy tongue with teeth marks, drowsiness and heart palpitations, Gui Pi Wan (Restore the Spleen Pill) follows the same direction. If you have such symptoms, please consult a licensed practitioner of Chinese medicine before taking anything.