Vomiting and Bleeding After a Meal and a Fit of Anger During Pregnancy? Doctor Xue Lizhai Stops a Threatened Miscarriage by Clearing Liver Fire and Strengthening the Spleen (Six Gentlemen Decoction Then Augmented Free and Easy Powder, Cured in Four Doses)
Search terms this page answers: pregnancy vomiting / morning sickness / vomiting during pregnancy / vomiting after a meal / vomiting after getting angry / bleeding during pregnancy / spotting in pregnancy / blood in the urine while pregnant / threatened miscarriage / protecting the pregnancy / quick to anger / alternating chills and fever
Medical terms: morning sickness (ren shen e zu) · threatened miscarriage · liver qi attacking the stomach · liver and spleen disharmony · liver qi stagnation with spleen deficiency
Opening: after a meal and a fit of anger, a pregnant woman is vomiting and bleeding
Today’s case was treated by Doctor Xue Lizhai (Xue Ji), head of the Imperial Academy of Medicine in the Ming dynasty. The case record opens with just a few plain words: “diet hou nu nu” — “after eating, she became angry.” She finished a meal, lost her temper, and trouble began.
💬 Note from Doctor Luo: Do you see it? Doctor Xue Lizhai truly puzzled this patient out. He puts the cause right at the top of the case — so many of his patients’ illnesses were tied to emotion. Look through his records and you keep reading “after eating, anger,” “owing to a fit of rage,” “given to suppressed anger”… Bad mood is the common trigger behind all of these cases. This pregnant woman ate, got angry, and immediately ran into trouble.
What kind of trouble? Alternating chills and fever with vomiting — her body went hot and cold by turns, and she vomited.
💬 Note from Doctor Luo: Vomiting during pregnancy is usually waved off — morning sickness, a normal reaction, only a problem when it turns severe. But this woman was different: she had never vomited before; the vomiting began only after the fit of anger. That one clue is crucial.
Where was the root of the illness? Five words — “after eating, she became angry” — are the master key to the whole case
The rest of the symptoms follow: headache, chills, chest and abdominal distension and pain, loose stools of a greenish, pale color (not formed, not the normal brown-yellow), and frequent urination with blood in the urine.
💬 Note from Doctor Luo: Watch that last item — blood in the urine already smacks of a threatened miscarriage. In treating this case Doctor Xue was, in plain words, protecting the pregnancy. But here is the thing: everyone says “protect the pregnancy”; how you protect it, and from what direction, is where all the real learning sits.
Doctor Xue Lizhai’s verdict came down to four characters: qing gan jian pi — clear the liver and strengthen the spleen: soothe the liver and drain liver fire, while at the same time building up the spleen.
Pattern differentiation like detective work: every symptom has several possible causes, but “stuck liver qi” shows up at every crime scene
Doctor Luo Dalun says TCM pattern differentiation is like solving a crime. Vomiting has many possible causes: cold can make you vomit, heat in the stomach can make you vomit; and liver qi running sideways to bully the spleen and earth can make you vomit too — stomach qi is meant to descend smoothly, but when liver qi gets stuck and comes over to torment the spleen and stomach, the stomach qi can no longer go down, so it is forced upward: vomiting, sour regurgitation, hiccups. Headache also comes in many varieties; one of them is anger sending liver fire rushing up to the head. Chest and abdominal distension and pain has its list as well: food stagnation blocking the middle, cold injuring the qi mechanism… but one of the possibilities is again stuck liver qi — qi pent up inside, the chest feels tight, the ribs ache and swell, some people feel so oppressed they think their heart is failing, go to the hospital, and the tests come back normal.
💬 Note from Doctor Luo: Run through this whole list of symptoms and you will see they are all classic signs of the shaoyang pattern: bitter taste, dry throat, dizzy eyes, irritability with a tendency to vomit, alternating chills and fever — hot enough to throw off the blanket one minute, cold enough to reach for a coat the next; people with troubled emotions feel this all the time. When the mood breaks down far enough, liver and gallbladder fall out of harmony, liver and spleen fall out of harmony, liver qi runs sideways and bullies the spleen and earth, and the stomach qi is driven upward — every piece fits. Now, each symptom on its own has several possible causes. But lay the “crime scenes” side by side and you will find — “stuck liver qi” appears at every single scene. It is in the list of causes for the first symptom, in the list for the second, and in the list for the third as well. So is it the prime suspect? That is the logic of pattern differentiation: when one possibility keeps recurring across many symptoms, you must strongly suspect it. Doctor Xue Lizhai saw it with perfect clarity: one spleen, one liver — these two were the troublemakers.
The family panics: “She’s spotting — why aren’t you protecting the pregnancy?”
When Doctor Xue said “clear the liver and strengthen the spleen,” the family balked. The pregnant woman was already bleeding, and the household was frantic: this is a threatened miscarriage, and you’re not protecting the pregnancy, you’re talking about soothing the liver and building the spleen? That’s way off target! That’s not how you treat this! So they called in another physician and took the “stop the bleeding, protect the pregnancy” route — blood is showing, so stop the blood at once.
💬 Note from Doctor Luo: I have to say, this family had nerve — you’ve already called in a figure like Doctor Xue Lizhai, and you still don’t trust him? And go find someone else?
How did that turn out? Worse and worse: the blood flowed more heavily, every symptom intensified. With no other option, they came back to Doctor Xue Lizhai.
Doctor Xue Lizhai’s explanation — greenish stools mean the spleen-earth is injured; blood in the urine means liver fire is pouring into the womb
This time the family was humble and asked: why do you say clear the liver and strengthen the spleen? When there’s bleeding, shouldn’t the first priority be protecting the pregnancy?
Doctor Xue explained: “da bian bu shi er se qing, shi yin shi shang pi tu er jian mu” — “the stools are loose and greenish because improper diet injured the spleen-earth, with wood added on top.” What does that mean? This pregnant woman had long eaten carelessly, so her spleen and stomach were already injured and her foundation weak; now a fit of anger sent liver qi running sideways to bully the spleen-earth once more — salt in the wound. So the greenish stools are a signal that the spleen-earth is injured, and the spleen must be strengthened.
And the frequent urination with blood? That is liver fire. The liver channel runs right past the reproductive system and loops around the genitals; in women especially, the entire womb is intimately connected to the liver channel.
💬 Note from Doctor Luo: Think about it — why does a normal menstrual cycle arrive month after month, right on time? Because the liver’s free-flowing function is normal. The moment the liver cannot flow freely — anger, depression — the period immediately goes haywire. I have truly seen this: a young woman in her twenties, one heartbreak, one major emotional blow, and her period simply stops — amenorrhea, nothing for months. That is how tightly the liver channel and the womb are bound. In this case the fetus was fine inside; then after a meal she flew into a rage, the liver fire descended and entered the womb, the womb lost its normal grip, so to speak, and the blood began to leak out. What has to be done? Drain the liver fire and soothe the liver at once, and at the same time strengthen the spleen to hold the womb secure.
First formula: Liu Jun Zi Tang strengthens the spleen and holds the fetus — secure the fortress first
How did Doctor Xue Lizhai treat her? He began with Liu Jun Zi Tang (Six Gentlemen Decoction).
💬 Note from Doctor Luo: Liu Jun Zi Tang, as you know, is Si Jun Zi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), gan cao (licorice) — plus chen pi (aged tangerine peel) and ban xia (pinellia). The Four Gentlemen tonify the upright qi; chen pi and ban xia give the qi a gentle push. Here ban xia must be handled with special care — use only a little — because in this condition the qi must not be driven downward, and ban xia’s descending action is strong; a touch is enough.
To the formula he added zhi ke (bitter orange), zi su (perilla leaf) and shan zhi zi (gardenia fruit). Zhi ke moves the qi; zi su also moves the qi — Doctor Xue judged that this patient’s qi was rising and scattering outward, and placing qi-moving herbs among the tonics helps the formula circulate and lets the qi spread: she was already pent up with anger; if you only pour tonics in, the fire only grows hotter. And shan zhi zi clears a little liver fire.
💬 Note from Doctor Luo: Watch Doctor Xue’s order of battle: support the upright first. Hold the spleen and stomach firm — when the spleen qi is sufficient and can hold the fetus, miscarriage is no longer on the table. This is what I call “securing the fortress first.” Two doses in, the spleen and stomach woke up, and the appetite began to return.
Second formula: Jia Wei Xiao Yao Wan soothes the liver and nourishes blood — then clear the enemy
Once the spleen and stomach recovered, Doctor Xue switched formulas: Jia Wei Xiao Yao Wan (Augmented Free and Easy Powder), with zi su (perilla leaf) and zhi ke (bitter orange) to move the qi.
💬 Note from Doctor Luo: Jia Wei Xiao Yao Wan soothes the liver and drains fire — but it also contains spleen-strengthening and blood-nourishing ingredients: soothe the liver, strengthen the spleen and nourish blood all at once. That is the genius of the Xiao Yao (Free and Easy) family of formulas.
And the result? “Xiao bian dun qing” — the urination cleared at once — no more frequency, no more blood. The bleeding stopped, the fetus was secured. Then she was told to be careful with her diet — this expectant mother really had been careless about food — and she was quickly well.
💬 Note from Doctor Luo: Count it up — four doses in all, and the illness was cured. Doctor Xue Lizhai was a true master: slight adjustments to classic formulas, a few doses, done. That ability to weigh and measure is exactly what we should study carefully.
Cured in four doses: secure first, clear second — the subtlety of sequence
The most valuable lesson here is the order of treatment. In his routine care of patients, Doctor Xue often had people take Liu Jun Zi Tang in the morning to tonify the qi and Jia Wei Xiao Yao Wan in the evening to soothe the liver and nourish blood — morning and evening, both formulas. But in this case he deliberately gave Liu Jun Zi Tang first and Jia Wei Xiao Yao Wan second. Why?
💬 Note from Doctor Luo: Because this patient’s spleen deficiency was very pronounced — injured by careless eating, then injured again by bad emotions; the spleen and stomach had taken a heavy beating. If you charged in soothing the liver and draining fire from the start, her body was too weak to bear it — and with a pregnant woman already spotting, you could tip her straight into miscarriage. So strengthen the spleen first and hold the spleen qi firm so the bleeding stops — hold the fetus by tonifying the qi; then drain the liver fire gradually — secure the fortress, then clear the enemy. This is the art of distinguishing what is urgent from what is fundamental: different patients, different situations, different order and weight of the medicines. That mastery is Doctor Xue Lizhai’s lofty medical achievement.
Bonus: a single fit of anger can stop a young woman’s period — calming the mind is harder than prescribing the medicine
Doctor Luo Dalun says this case is ostensibly about TCM practice, but it is really about emotion.
💬 Note from Doctor Luo: First, remember: anger, this destructive emotion, can bring serious consequences at any time — every bout of pent-up qi in the body can leave its trace. For a woman carrying a child, the stakes are even higher, so the emotions must be managed: cultivate a generous outlook on life, be able to see things through, let them go, laugh them off — that is the foundation of health. Second, learn the method of pattern differentiation — lay out all the possible causes of each symptom and look for the overlapping clues. Third, learn the order of treatment — secure first, clear second. As for the herbs themselves, look at what Doctor Xue used: simple little formulas, patent medicines with slight adjustments — the medicine is relatively simple; calming the mind and reshaping the temper are what is truly hard. I hope that whatever comes your way, you will not take it to heart — all is well, let it go and go with the flow.
Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Xue Lizhai (Xue Ji); the case is from Xue’s Medical Cases (《薛氏医案》), Ming dynasty.