Who Was Doctor Xue Lizhai, Head of the Ming-Dynasty Imperial Academy of Medicine? Three Thousand Case Records, and the Tonifying Master Who Specialized in the Diseases of the Rich and Powerful
Opening: after Doctor Zhu Danxi, who comes next?
Having just finished telling the case records of Doctor Zhu Danxi, Doctor Luo Dalun says: Doctor Zhu Danxi is done — so who should we talk about next? Today I want to introduce you to a physician of the Ming Dynasty — Doctor Xue Lizhai.
💬 Note from Doctor Luo: Xue Lizhai was one of the most famous physicians of ancient China. Why do we devote a whole series to him? Because his life story is rather special — he was the head of the Imperial Academy of Medicine (Tai Yi Yuan) at the time. What was the Tai Yi Yuan? It was the hospital of the Ming imperial palace. The director of that institution — that is no small rank.
Following in his father’s footsteps: his father was a famous doctor, and he started in external medicine
Xue Lizhai’s father was already a renowned physician — a very accomplished one. Xue Lizhai studied under his father and grew steadily: he began with external medicine (surgery), then gradually developed into internal medicine, pediatrics and gynecology, achieving success in every field, and the books he wrote covered every field as well.
💬 Note from Doctor Luo: Do not underestimate external medicine — in ancient China, external medicine was a huge part of medicine. People developed all kinds of external diseases, suffered injuries, and so on, and all of it was handled by TCM external medicine. Xue Lizhai started in external medicine, and he wrote especially many books in this branch.
Three thousand case records: the physician with the most case records in ancient China
Xue Lizhai left behind an extraordinary number of case records — more than three thousand in total. That should make him the ancient Chinese physician with the most case records of any.
💬 Note from Doctor Luo: Three thousand case records — of course we cannot tell all of them; we can only select a small portion to discuss. But this number alone shows how deep his clinical experience ran.
Who were his patients? — royalty, grand secretaries, high ministers, and the imperial guard
As the head of the Imperial Academy of Medicine, Xue Lizhai treated almost exclusively people of wealth and rank: members of the royal family, grand secretaries, high ministers — the equivalent of today’s premiers and cabinet ministers — as well as people inside the palace; even the commanders of the imperial guard (Jinyiwei) came to see him.
💬 Note from Doctor Luo: What did these people have in common? They ate well and lived privileged lives, but at the same time they burned a great deal of heart-spirit and had many worries — when the emperor issued an order, they had to fret over it. Some were also heavy in desire, which drained them as well. So when he diagnosed and prescribed, he centered on tonification and soothing the liver.
How do you treat the diseases of the rich and powerful? — a few formulas wielded with uncanny mastery
What formulas did Xue Lizhai commonly use? Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) — which he called Shen Qi Wan — and Ba Wei Wan (Eight-Ingredient Pill), which is what we today call Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet); for soothing the liver he used Xiao Yao Wan (Free and Easy Pill), and for tonifying qi, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction).
💬 Note from Doctor Luo: Xue Lizhai applied these formulas with uncanny mastery, making just the right adjustments for each patient. That is what a master looks like — in the end it is not about dazzling complexity; it is these few moves, but with free variation and adjustment they can dissolve countless diseases. He treated so many people — including the ministers at the emperor’s side. Would he dare to write down false case records? No. So his case records are all genuinely real, and the people he treated were cured very effectively.
Why is it especially applicable today? — modern people are the rich and powerful of his day
Xue Lizhai’s experience carries particular inspiration for today: the environment and lifestyle we live in today resemble those of the people in his case records remarkably — privileged living, good food, enormous stress every day, plenty of worries, overthinking, exhausted heart-spirit, and all kinds of excessive consumption.
💬 Note from Doctor Luo: So Xue Lizhai’s experience is something we can use especially well today. What is worth studying in his academic thought: how he adjusted his formulas, how he applied them flexibly; what patterns and what symptoms these formulas correspond to, and how to recognize them. For example, if someone says they have a great deal of phlegm, how would you ever think of treating it with Jin Gui Shen Qi Wan? — Xue Lizhai has many experiences of exactly this kind. Today, when we study Chinese patent medicines, if we truly know how to differentiate patterns and master this information, many diseases can actually be treated with patent medicines alone.
Valuing the spleen and kidney, soothing the liver and regulating qi: his prescribing philosophy
What was the core of Xue Lizhai’s prescribing philosophy? He placed special weight on tonifying the spleen and kidney — people with spleen-kidney deficiency are extremely numerous. Tonifying the spleen: he took the spleen very seriously — once the spleen and stomach weaken, the whole body weakens; when kidney qi is insufficient, the body runs into trouble.
💬 Note from Doctor Luo: When it came to tonifying the kidney, he distinguished very clearly among kidney yin, kidney yang, and true yin (zhen yin) — true yin is essentially the kidney essence — and he kept all of them clear. Then for soothing the liver and regulating qi he used Xiao Yao Wan, and for people with qi deficiency, Bu Zhong Yi Qi Tang — all explained with great clarity. Valuing the spleen and kidney, and valuing soothing and regulating the liver — that is the core of his academic thought.
Master of every branch: gynecology, pediatrics, external medicine
Where was this philosophy applied? Internal medicine, gynecology — he was especially accomplished in gynecology and wrote a dedicated monograph on it; he was also excellent in pediatrics — because Xue Lizhai came down through the lineage of Doctor Qian Yi and placed particular weight on Qian Yi’s thought.
💬 Note from Doctor Luo: Qian Yi was a great pediatric master of the Song Dynasty. Xue Lizhai inherited this lineage, so naturally his pediatrics was outstanding. Add to that his start in external medicine, on which he wrote a great deal — every field is worth studying.
Starting tomorrow: the case records of Xue Lizhai
Today’s piece opens the series and introduces the man himself.
💬 Note from Doctor Luo: Starting tomorrow, we will tell Xue Lizhai’s case records — they should be absolutely fascinating. His case records really are wonderful. I am still learning them myself; we are all learning together. I hope Xue Lizhai’s academic thought can inspire us, and that the methods we learn from him can help us protect ourselves. Tomorrow we set out on a new journey — through the stories of Xue Lizhai, we will master more knowledge of Chinese medicine.
What to take away
- Xue Lizhai was the head of the Ming Imperial Academy of Medicine — the top hospital director of the imperial palace, a rank few physicians ever reached.
- His father was already a famous doctor, and Xue himself started in external medicine before mastering internal medicine, pediatrics and gynecology — a genuinely all-round physician.
- He left more than three thousand case records, the largest collection of any ancient Chinese physician — a mountain of clinical experience.
- His patients were the rich and powerful: royalty, grand secretaries, high ministers and the imperial guard — people who ate well, lived privileged lives, and burned up their heart-spirit on worry and desire.
- Because of his clientele, he prescribed mainly gentle tonification and liver-soothing: Liu Wei Di Huang Wan, Jin Gui Shen Qi Wan, Xiao Yao Wan and Bu Zhong Yi Qi Tang, varied with masterly adjustments.
- He valued the spleen and kidney above all — once the spleen and stomach weaken, the whole body weakens — and in kidney work he clearly separated kidney yin, kidney yang and true yin (kidney essence).
- In pediatrics he carried on the lineage of the Song master Doctor Qian Yi, and he wrote dedicated works on gynecology and surgery.
- His experience maps directly onto modern life: privileged living, constant stress, overthinking and overconsumption — which is exactly why his methods are so usable for us today.
Compiled from Doctor Luo Dalun’s lecture series on Doctor Xue Lizhai’s case records. The case records come from the Xue Family Case Records (Xue Shi Yi An).