High Fever, Vomiting, Diarrhea and Leg Cramps? Doctor Zhang Xichun’s Two-Decotion Rescue

Patient search terms: high fever / vomiting and diarrhea / vomiting even a sip of water / diarrhea more than ten times a day / no urination for three days / leg cramps Medical terms: febrile disease (wen bing) · wind-warmth (feng wen) · pathogen in the yang ming level · fluid deficiency — treated with Ziyin Xuanjie Tang (Nourish Yin and Unblock Decoction)

Why keep talking about febrile disease?

Doctor Luo Dalun says that lately, because of the pandemic, people have grown tired of hearing the words “febrile disease” (wai gan bing, externally contracted illness) — the audience for these lectures has clearly dropped. But after thinking it over, he decided to keep going anyway. Why?

💬 Note from Doctor Luo: We shouldn’t judge our work only by the effect of the moment. A lot of things don’t look especially valuable right now, but as time passes, some of what’s in them turns out to be exactly what people need. If we explain Doctor Zhang Xichun’s approach to febrile disease thoroughly, when you look back later you’ll say: “Ah, there’s real substance here.”

So today’s case is a very typical febrile-disease case record from Doctor Zhang Xichun — a febrile illness with vomiting and diarrhea, plus leg cramps.

Who was the patient? A 53-year-old Tianjin merchant

The patient was a nephew-generation member of Doctor Zhang Xichun’s own family, 53 years old, doing business in Tianjin.

💬 Note from Doctor Luo: Notice that whenever Doctor Zhang Xichun writes down a patient’s occupation, you can read a great deal from it. What defines a merchant? Worry! Constant worry means liver fire and liver-qi stagnation — you can count on it. When he wrote a patient’s job into a case record, it was never an accident. There is method in it.

This man had long suffered from cramping pain in the sinews of his legs — he got leg cramps all the time, painfully. Sometimes an attack left him bedridden. So these cramps were no ordinary twitch.

Why do legs cramp? When fluids run dry, the channels parch

Doctor Luo Dalun first explained the principle: most leg cramps come from insufficiency of yin blood and body fluids (jin ye).

💬 Note from Doctor Luo: Think of a branch. When there is no water inside it, it dries out, and a dry branch curls and cracks. The human body is the same: when fluids and yin blood are insufficient, the channels have nothing to nourish them, and you get spasms and pain. Cold can also cause cramping — but note: not everyone who catches cold cramps up. Who cramps in the cold? Usually people who are already short of fluids and yin blood. So leg cramps are, in the great majority of cases, a fluid-deficiency problem.

What does this have to do with febrile disease? Everything. Who catches febrile disease easily? People whose fluids and yin blood are insufficient.

💬 Note from Doctor Luo: Compare the channels to a canal. When it has water, the boats carrying your defense troops can reach every post. When the canal dries up, the boats can’t move and the defense can’t get into position. Then if the weather turns hot and you sweat, the channel dries further. Under these conditions an external pathogen can easily invade — that is febrile disease. So people who get wen bing almost always carry some degree of fluid deficiency; when outside heat makes them sweat, fluids are badly damaged, and in walks the pathogen. This patient’s leg cramps were a clue that he already had the foundation for febrile disease.

How did the illness begin? A drafty rickshaw ride home

One day in his shop (he was a merchant, after all) his old complaint flared up — the cramps came back. His legs hurt terribly and he poured sweat. The pain was unbearable, so he hired a carriage home — not a taxi like today, but an open rickshaw (yang che), with the passenger sitting out in the wind on all sides. And what happened? Leg pain, sweating, and wind blowing on him along the way — a febrile disease took hold.

Then came vomiting and diarrhea together: throwing up, purging, high fever. Within no time the illness was severe.

💬 Note from Doctor Luo: There’s a secret here. Someone asks: “Doctor Luo, didn’t you say the problem is fluid deficiency plus outside heat plus sweating — that’s a heat factor? Why does Doctor Zhang Xichun write ‘caught wind’? Doesn’t wind cool you down — how does it cause illness?” Think about it: when your fluids are insufficient and the weather is hot, sweating straight into a febrile disease does happen. But more often the illness arrives with wind — that’s feng wen (wind-warmth). When you sweat, the pores open; wind blows on you and chills the surface just a little. Your upright qi was already weak, and the body’s surface temperature control is fragile — that temperature swing makes it even easier for the pathogen to invade. Wind and warmth mixed together causing illness — that’s wind-warmth.

Doctor Luo also warned: the causes of disease usually mix together. In spring, when midday suddenly turns hot and you sweat, a fluid-deficient person already has the foundation for febrile disease; then in the evening the sun sets, cool wind blows, and wind-warmth forms. Autumn is the same: blazing sun and sweat during the day, then you step into the shade of a tree and a cool wind blows — wind-warmth again. Don’t assume illness has a single cause; externally contracted disease is far more complicated than the textbooks let on.

How bad was it? High fever, violent vomiting, violent purging, three days without urine

The patient’s symptoms: heat in both exterior and interior — high fever, burning hot; endless vomiting — even a sip of water came right back up; diarrhea more than ten times in a day and night; three days into the illness, not a single drop of urine; and when the leg pain was at its worst, he cried out in pain.

The pulse: left position floating, wiry, forceful, but not solid when pressed deeply; right position wiry, long, forceful, very hard on deep pressure, five beats to one breath.

💬 Note from Doctor Luo: There is a story in this pulse. The left floating pulse means an external pathogen; wiry means the blood is not nourishing the liver; “not solid on deep press” means the upright qi is insufficient. The right pulse corresponds to the spleen and stomach: wiry, long, forceful, very hard on deep pressure — the pathogen has entered the yang ming qi level. Qi in the stomach is rushing upward, which is why the pulse is wiry-hard and long. When the pathogen enters yang ming, the body mobilizes its full energy to fight, producing high fever — and there is a surplus of heat.

Why both vomiting and diarrhea? Because he was yin-deficient; the pathogen and the body’s defenses were both consuming him, and the body was very weak. He was hot, so of course he wanted water — but once he drank, the spleen and stomach were too weak to transform it, and the water ran straight into the large intestine and out — hence the torrential diarrhea. At the same time, heat broke the stomach qi upward — hence the vomiting.

Whatever you do, don’t reach for Huo Xiang Zheng Qi — it would be backwards

At this point someone might say: isn’t this just a stomach flu? Why not use Huo Xiang Zheng Qi San (Agastache Qi-Rectifying Powder)?

💬 Note from Doctor Luo: Let me tell you — no! Huo Xiang Zheng Qi is a warming formula; almost every herb in it is warm. For the high fever, vomiting and diarrhea that come from cold — cold-damp invading the exterior, the classic stomach-flu pattern — Huo Xiang Zheng Qi works beautifully. But this patient’s heat came from yin deficiency; he was hot in both exterior and interior. Using Huo Xiang Zheng Qi here would be pouring oil on the fire — completely backwards!

Doctor Zhang Xichun said that in his own practice he had encountered countless cases of “febrile disease with high fever, vomiting and diarrhea,” and that many doctors simply couldn’t treat them — helpless and regretful. He, on the other hand, cured them all with formulas of this kind.

The first formula: Ziyin Xuanjie Tang — yam, talc, and the peony-licorice pair as the base

Doctor Zhang Xichun used a formula called Ziyin Xuanjie Tang (Nourish Yin and Unblock Decoction). The strategy: clear heat, nourish yin, and restore order to the two excretions — your urination and defecation have gone haywire, not a drop of urine while everything pours out through the stool; that cannot stand. On top of that, stop the vomiting and soothe the sinews.

Here is how the formula was built:

• Sheng huai shan yao 1 liang (raw huai yam slices from Wen County, Jiaozuo, Henan): tonifies the spleen. In this state the spleen and stomach are definitely weak. Yam tonifies the spleen, nourishes yin and the spleen’s essence — and yam also stops diarrhea. For diarrhea caused by spleen weakness, yam is the herb to use.
• Hua shi (talc): clears heat and promotes urination, carrying heat out through the urine.
• Shao yao and gan cao (peony and licorice — the Shao Yao Gan Cao Tang pair): sour and sweet together generate yin (suan gan hua yin), nourishing yin blood and moistening the sinews and bones — the cramping stops. Peony also promotes urination; licorice tonifies the spleen, harmonizes the middle, and regulates the stool.

💬 Note from Doctor Luo: See how each of these four herbs has its own direction: yam secures the stool, talc frees the urine — with the two excretions back in balance, you’re no longer flooding out the back while passing not a drop in front. These four herbs together are actually another famous Doctor Zhang Xichun formula for febrile disease — Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction).

The formula then added: lian qiao (forsythia) 1.5 qian (clears and vents heat), chan tui (cicada slough) 1.5 qian (vents the pathogen outward), one whole centipede (wu gong) ground to powder and swallowed with the prepared decoction, qing ban xia (processed pinellia, rinsed three times in warm water) (descends rebellious qi and stops vomiting), zhu ru (bamboo shavings) (clears heat and dissolves phlegm; when heat makes stomach qi rush upward and vomit, bamboo shavings clear heat and send qi down), and qing dai (indigo naturalis) 2 qian (clears heat, drains fire, cools the blood and disperses macules — and it drains liver fire; once the liver fire is drained, the liver qi no longer runs rampant sideways, and the force shoving stomach qi upward is gone — that also stops vomiting). A slice of sheng jiang (ginger) was added at the end to guard against nausea.

Two herbs here deserve special attention:

💬 Note from Doctor Luo: First, chan tui — the shell that a cicada sheds. Whenever Doctor Zhang Xichun used cicada slough, he first removed the large bamboo-joint piece at the head (head and legs) — he said that big node has a breaking, opening power, and here we don’t need breaking, only venting. Why cicada slough? The cicada is a delightful creature: it drinks but does not eat — it only sips tree sap, takes nothing solid. So a cicada has urine but no stool. By that logic, cicada slough helps the urine and protects the stool! Besides venting the pathogen outward, it also promotes urination and safeguards defecation — a point most people never notice. And the centipede: a centipede is segmented, and every segment has its own “brain” — its nervous system is highly developed. This man’s cramping leg pain is connected to the nervous system; the centipede gathers wind and unblocks the channels. That’s how Doctor Zhang Xichun reasoned it out, and he was right to use it.

The turning point: diarrhea stopped — now bold enough to clear heat

After taking the medicine, results came: the vomiting did not stop (but the medicine stayed down), urine passed twice, the diarrhea stopped completely, and the leg pain improved by more than half. Heat remained in both exterior and interior, and the pulse was still wiry, hard and forceful.

💬 Note from Doctor Luo: What does this tell us? The relationship between the two excretions has been repaired! Once the diarrhea stopped, he could boldly clear heat — go all out on the yang ming heat. Why was he still vomiting? Because there was still heat in the yang ming stomach, and qi was still rushing upward. Now it was simple: treat that heat.

The second formula: a variation of Bai Hu Tang — gypsum, yam, rehmannia

The second prescription: sheng shi gao (raw gypsum) 3 liang (ground fine), sheng huai shan yao 1.5 liang, sheng huai di huang (raw rehmannia) 1 liang (nourishing yin — this man was yin-deficient), sheng bai shao (raw white peony) 5 qian, gan cao (licorice), hua shi (talc) 5 qian, sheng zhu ru (raw bamboo shavings) 3 qian. Decoct into one large bowl and take warm in four portions.

💬 Note from Doctor Luo: Look at the composition — you can see the shadow of Ziyin Qingzao Tang in it: yam, talc, peony, licorice. And you can see the shadow of Bai Hu Tang (White Tiger Decoction): gypsum, with yam standing in for jing mi (rice), rehmannia standing in for zhi mu (anemarrhena), plus licorice. Doctor Zhang Xichun explained: ordinarily, when Bai Hu Tang is used after sweating, vomiting or purging, one should add ren shen (ginseng). But this man was still hot, and he worried that ginseng would help stomach qi rise; so he varied the formula and simply increased the yam instead. Why also talc and peony in a Bai Hu Tang? Because both promote urination — a safeguard so that when the diuretic action kicks in, the water doesn’t reroute back into the large intestine and restart the diarrhea. And the Shao Yao Gan Cao pair, sour and sweet generating yin: this man’s constitution was yin-deficient with insufficient liver yin, so the liver yin had to be attended to; peony astringes and softens the liver — there genuinely was liver fire, and the whole heat pattern was directly tied to it, so the peony could not be left out.

The trump card: raw hematite to send qi down and stop the vomiting

After all four portions were taken, the exterior-interior heat fell by more than half, the leg pain was cured, and the pulse became softer than before. Only the vomiting lingered — some nausea, no appetite, though the diarrhea had not returned.

At this point Doctor Zhang Xichun played his special move for rebellious qi and vomiting: sheng zhe shi (raw hematite) fine powder 1.5 liang, decocted into one and a half bowls, taken warm in three portions.

💬 Note from Doctor Luo: What happened? By the second portion, he felt his stomach open and the nausea vanish — the force pushing upward was gone, and stomach qi was moving down again. Just those two doses, and the hematite was stopped — no need for more; he switched to rice congee to settle the stomach.

The final blow: a formula that kept getting simpler

He then wrote one more prescription, simpler each time: sheng shi gao 1 liang (clears heat), sheng huai shan yao 1 liang (tonifies yuan qi and the spleen), sheng huai di huang 1 liang (nourishes yin — again a heavy dose), sheng bai shao and gan cao (the Shao Yao Gan Cao pair — sour and sweet generating yin, nourishing yin blood). Decocted into two bowls, taken warm in two portions.

Afterward: the heat in both exterior and interior was completely gone, the bowels moved once, and the illness was cured. His pulse was still a touch fast — five beats to one breath, just slightly quick.

Aftercare: yam powder porridge as a snack

Doctor Zhang Xichun said the upright qi — the true yin and essence — had not yet fully recovered. What to do? He reached for one more of his famous moves, one everyone should know:

💬 Note from Doctor Luo: Take raw huai yam, ground to a fine powder and sifted. Each time use 7–8 qian (about 20–30 g), or up to 1 liang (30+ g), cook it into porridge, add a little cane sugar, and eat it as a snack. If you eat too much of it for too long and feel a bit stuffy, what then? Take a stomach-motility medicine; where no Western medicine is available, use sheng ji nei jin (raw chicken gizzard lining) powder, 3 fen — a very small amount, about one-third of a gram, just a tiny pinch — ground fine and swallowed with a mouthful of the yam gruel to help the spleen and stomach transform. Regulate it slowly like this, and the body recovers.

Doctor Luo’s reflection: Zhang Xichun treated febrile disease with just a handful of formulas

💬 Note from Doctor Luo: When this case is finished, you’ll see that Doctor Zhang Xichun’s approach to febrile disease is very distinctive — and he used just a few formulas. Many people, when they meet a high fever from febrile disease, immediately think of an IV drip; if there’s no drip, they don’t know what to do. But Doctor Zhang Xichun laid the whole strategy out. Once you learn it, you know how to handle such a situation and can protect yourself; students in TCM colleges and practicing clinicians gain one more approach. His formulas were never thrown together randomly — we use them, and they genuinely work beautifully.

What to take away

1. Leg cramps are usually a fluid-and-yin-blood problem. When the channels have nothing to moisten them, the sinews cramp — and the same underlying dryness makes a person vulnerable to febrile disease. If you cramp easily and then catch wind while sweating, febrile disease can follow fast.
2. “Stomach flu” is not always cold-damp. Huo Xiang Zheng Qi works for cold-damp GI illness. When the heat comes from yin deficiency — high fever, vomiting, diarrhea, no urine — warming herbs pour oil on the fire.
3. Restore the two excretions first. Yam secures the stool; talc frees the urine. Once the diarrhea stops, you can boldly clear yang ming heat — Doctor Zhang Xichun’s Ziyin Qingzao Tang / Ziyin Xuanjie Tang base (yam, talc, peony, licorice) does exactly this.
4. Bai Hu Tang can be varied to fit the patient. Yam replaces rice, rehmannia replaces anemarrhena, talc and peony guard the urine — and ginseng is skipped while heat still rages.
5. Raw hematite is the quiet trump card for rebellious stomach qi. Two small doses stopped vomiting that nothing else would touch.
6. Recovery is finished with food. Yam powder porridge with a little cane sugar, eaten as a snack, slowly rebuilds true yin and essence — the gentlest aftercare a great doctor ever prescribed.

Arranged from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the original case appears in Medical Records from the Shichen Xilu (《医学衷中参西录》).