Pregnant Woman with High Fever and a Black, Thorny Tongue: Doctor Miao Xiyong’s Bold Use of Raw Gypsum to Save Mother and Baby

Patient’s search words: pregnant woman with fever / fever during pregnancy / high fever that won’t go down / high fever, thirsty, craving cold water / black tongue coating Medical terms: external-contraction cold damage · excess heat in the yangming qi level · qi and yin both injured

Opening: this famous physician arrived on horseback, at a gallop

In the late Ming dynasty, in the Changshu area of Jiangsu Province, there lived a famous physician named Doctor Miao Xiyong — a man with the spirit of a knight-errant. Other doctors went to see patients in sedan chairs; he rode a horse. The moment he received word of a critical case, he would whip his horse and race off to save the patient.

What was he best at? Heat diseases. External-contraction warm febrile illness and high fever were his specialty — above all, he dared to use raw gypsum (sheng shi gao) in huge doses. The later master Doctor Zhang Xichun, who became famous for prescribing large amounts of raw gypsum fearlessly, was directly inspired by Miao Xiyong.

💬 Note from Doctor Luo: Remember, Doctor Zhang Xichun read enormously widely, and he studied Miao Xiyong’s writings with particular care. Miao Xiyong used raw gypsum in very large doses — safe, reliable, effective — and Zhang Xichun, deeply inspired, also experimented with gradually increasing the dose. The three small cases in today’s talk are all lessons in clearing excess heat from the yangming qi level with raw gypsum.

Who was the patient? A lady nine months pregnant

The first patient was the wife of Yu Runfu. Who was Yu Runfu? One of Miao Xiyong’s most devoted admirers — a local gentleman and scholar with ties to the Donglin movement, deeply committed to public welfare and medicine. He helped compile Miao Xiyong’s book, Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening), and after Miao died, he helped arrange the burial. And it was this dear friend’s wife — nine months pregnant, nearly ready to give birth — who came down with cold damage (shang han): an external-contraction yangming syndrome.

Her symptoms: headache, blazing fever (a very high fever), extreme thirst — and most alarming of all: a black tongue coating standing up in prickles — dry, black, with what looked like little thorns sprouting from the surface.

💬 Note from Doctor Luo: When people see a black tongue coating, they panic — but don’t. Distinguish three situations. First: the black coating is moist and slippery — that’s cold-dampness, and this is what the vast majority of black tongues actually are. Second: it’s dry, with prickles, like cracked, parched earth — that’s the sign of extreme heat; a true case of heat that severe is extremely rare. Third: it’s simply stained by food or medicine — I once ate pickled vegetables outside and my tongue turned black that evening; it was coloring from food additives. This pregnant woman’s coating was dry and thorny, which told Miao that the heat in her body had reached its absolute peak.

How serious was it? She had a baby in her belly

Nine months pregnant, burning with fever until her tongue turned black — this was no joke; she was truly in danger. Yu Runfu quickly summoned Doctor Miao Xiyong.

One look, and Miao’s diagnosis was clear: excess heat in the yangming qi level, with both qi and yin injured. What to do? He prescribed Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction): raw gypsum leads, clearing heat; ginseng strengthens the qi — for with both qi and yin deficient, you need both; bamboo leaf clears heat; mai dong (dwarf lilyturf root) and the rest nourish the fluids and enrich the yin.

💬 Note from Doctor Luo: Notice that Bamboo Leaf and Gypsum Decoction contains ginseng — and this is the most important lesson of today’s talk: raw gypsum may be used boldly, but it must always be paired with ginseng to support the upright qi. This goes double for “weak” patients — pregnant women, the elderly.

A twist: he wanted one more herb — but the pharmacy didn’t have it

The formula was ready, but Miao Xiyong wanted to add one more herb — bai yao zi (Stephania root). It’s not a commonly used herb; it can resolve toxins, break up stasis, and disperse congestion — but its most remarkable property is this: it protects the fetus (an tai)! Most blood-moving herbs make pregnant women nervous, yet this one can both move stasis and calm the fetus; it is recorded in ancient formulas for exactly this purpose.

But when he asked at the pharmacy: no bai yao zi!

💬 Note from Doctor Luo: One herb was missing — but a high fever will not wait, and if the heat injured the fetus, what then? Miao Xiyong had a trick — mud from the bottom of a well! The mud at the bottom of a village well is the coldest, most yin substance there is — “the yin within yin.” He had it dug up and smeared over the pregnant woman’s navel (Shenque, CV8), replacing it as it dried. What for? To use yin qi to shield the fetus, so the heat pathogen couldn’t harm it — an external cooling measure, in effect. It sounds bizarre, yet it was a technique Miao had learned by traveling widely and seeking out every master he could find — in an age with no antipyretics, well-bottom mud was a genuinely good option.

Fifteen liang of raw gypsum in a single day and night: cured in one day, a daughter six days later

When the medicine went down, Miao Xiyong’s goal was “strive to break the fever immediately.” What dose? In a single day and night he exhausted 15 liang 5 qian of raw gypsum — that works out to over 400 grams, nearly half a kilogram!

💬 Note from Doctor Luo: For a pregnant woman to be given such an enormous amount of raw gypsum truly boggles the mind. Why did he dare? Because he knew exactly what he was doing — the formula contained ginseng to support the upright qi, and his command of the medicine was complete, so he could use it fearlessly. Later, Doctor Zhang Xichun dared to use large doses for the same reason — he had seen Miao Xiyong do it. Even so, Zhang himself built up the dose gradually, testing as he went.

The result: the illness was cured in one day. Six days later, Mrs. Yu gave birth naturally to a daughter — mother and child safe.

Why was Yu Runfu so devoted to Miao Xiyong? Because of this very case — it truly saved lives. Fevered to that degree, pregnant, and this man came and settled it with a single course of medicine.

The second patient: all the doctors stumped, one dose of White Tiger Decoction saved him

The second patient, Wen Wenxue, was also a scholar of the Changshu literary circle. He caught a cold with a blazing fever — burning terribly — a black tongue coating, tormenting thirst. He was so ill he lay in bed, family gathered around weeping, every physician at a loss.

Miao Xiyong arrived, took one look: another yangming qi-level heat syndrome. A large dose of White Tiger Decoction (Bai Hu Tang) — with raw gypsum in great quantity — and a single dose cured him! The man woke up!

Everyone pressed him: what is your secret for treating external-contraction illness? Miao answered crisply: “Read the works of Zhang Zhongjing thoroughly — that is the secret!”

💬 Note from Doctor Luo: In the small print after the case, it records that 3 qian of ginseng was added to the White Tiger Decoction — making it Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). When Zhang Zhongjing added ginseng to White Tiger Decoction, he was being extremely thorough: some patients really are weak, their illness truly critical, and they must have something to support the upright qi. So: adding ginseng is the secret.

The third patient: the neighbor of the Donglin leader — an elderly tofu seller

The third patient was the neighbor of Gao Chunzhi — the leader of the Donglin movement — an old man who sold tofu. He’d had cold damage for two days and was unconscious — the fever had burned him into a coma. The old man’s son asked Gao Chunzhi to summon Miao Xiyong.

Miao Xiyong asked: Headache? Body fever? — Yes. Had he taken any sweat-inducing medicine? — No. Had he vomited or purged? — No.

💬 Note from Doctor Luo: The record of this case has a problem — the literatus who wrote it up didn’t really understand medicine. He even wrote that Miao Xiyong “flipped through the Shang Han Lun looking for a formula” and used warm herbs like dried ginger and aconite — which is certainly wrong: how could anyone use warming medicine while the patient is burning with fever? But one line is correct: “Without sweating, vomiting or purging, how could the pathogen have any way out?” — he had not sweated, not vomited, not purged; so how could the evil qi leave?

The old man was old and hard-worked — selling tofu is exhausting labor. Miao Xiyong prescribed: White Tiger Decoction plus 3 qian (about 9 g) of ginseng — two doses cured him.

💬 Note from Doctor Luo: Do you see? Whenever you use raw gypsum for an old person or someone constitutionally weak, you must add ginseng. Three qian is 9 grams, and two doses did the job. This is the accumulated experience of Chinese medicine, and both Miao Xiyong and the later Doctor Zhang Xichun emphasized it repeatedly.

The core lesson: how should raw gypsum actually be used?

Put the three cases together, and Miao Xiyong’s method for using raw gypsum becomes perfectly clear:

When can you use it? When heat is exuberant in the yangming qi level — blazing fever, tormenting thirst, craving cold water, red tongue with a yellow or black coating, a forceful bounding pulse. In this state, raw gypsum works brilliantly.

When must you be cautious? If the tongue coating is white, thick and greasy, the body feels cool to the touch, the complexion is pale, and the pulse is weak — that’s cold-dampness or heavy dampness, and you need dampness-resolving formulas like San Ren Tang (Three Kernels Decoction) or Huo Xiang Zheng Qi San (Agastache Qi-Righting Powder). Gypsum must not be used recklessly.

What about weak patients? Pregnant women, the elderly, and the very frail must take raw gypsum with ginseng (or dang shen, codonopsis) to support the upright qi. Doctor Zhang Xichun’s raw gypsum and rice decoction — gypsum cooked with rice into a thin congee — is fine for robust people; but for the elderly and the weak, add 6–10 g of ginseng (or 10–20 g of codonopsis) plus a little Chinese yam (shan yao), supporting the upright while venting the pathogen. That’s the safe way.

💬 Note from Doctor Luo: In one sentence: raw gypsum may be used boldly, but never forget to support the upright qi. Without that support, a large dose of gypsum carries risk; with it, you can dare to use fifteen liang in a day the way Miao Xiyong did. This is what Doctor Zhang Xichun kept warning about later — it is extremely important.

That was Doctor Miao Xiyong — a physician of tremendous charisma: he saw patients like a thunderbolt, got excellent results, and had an enormous bag of tricks — the methods of every school, and folk secret formulas too, all absorbed into his own practice. If a doctor like him were alive today, facing a pandemic, he would surely distinguish himself.

What to take away

• Raw gypsum is the go-to herb for yangming qi-level heat: blazing fever, strong thirst, craving cold water, red tongue with yellow or black coating, forceful pulse.
• Pregnant, elderly, and frail patients must pair gypsum with ginseng (or codonopsis) to protect the upright qi — this was Miao Xiyong’s iron rule and later Zhang Xichun’s too.
• A dry black tongue with prickles means heat at its extreme; a moist black tongue usually means cold-dampness. Don’t panic at the color — read the texture.
• When the pharmacy lacks a herb, improvise: well-bottom mud smeared on the navel (Shenque, CV8) was Miao’s ingenious external method to shield a fetus from heat.
• Miao Xiyong’s “secret” for febrile illness, in his own words: “Read the works of Zhang Zhongjing thoroughly — that is the secret.”

Arranged from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s case records. Source: Xian Xing Zhai Yi Xue Guang Bi Ji (《先醒斋医学广笔记》).