A 42-year-old woman with a three-year history of severe fatigue, where eating “hot” foods caused acne and cold foods caused diarrhea, was managed using a Spleen-strengthening and Yang-warming herbal strategy.

Case ID: CHC-0042

Case Summary

This case describes a 42-year-old woman who presented with a three-year history of chronic fatigue that worsened after physical exertion. She exhibited a highly sensitive digestive and immune response, breaking out in acne after eating “hot” or spicy foods, and suffering from diarrhea after consuming cold or iced items. The original report documented a conventional diagnosis of chronic fatigue syndrome (CFS) and a TCM assessment of Consumptive Disease (Xu Lao) driven by Spleen deficiency, dampness stagnation, and Yang deficiency. She was managed with a modified Shenling Baizhu San to rebuild her digestive resilience and warm her underlying constitution.

Patient Presentation

• Patient: 42-year-old female (Surname: Li).
• Main Complaint: Chronic fatigue and lack of strength for 3 years, easily fatigued, worsening after exertion.
• History: The patient sought initial consultation on April 24, 2021. For three years, she suffered from low energy levels. Her presentation was uniquely contradictory: consuming “hot” (shang huo) or spicy foods immediately triggered acne breakouts, whereas consuming cold or frozen foods immediately triggered diarrhea. Additionally, she reported experiencing cold hands and feet during the winter, and her menstrual cycle was easily delayed.

Examination and Diagnosis

• Conventional Diagnosis: Chronic Fatigue Syndrome (CFS).
• TCM Tongue and Pulse: The tongue was pale with a thin, yellow, greasy coating. The pulse was stringy, fine, and rapid (脉弦细数).

TCM Assessment

The original practitioner interpreted the presentation as Consumptive Disease driven by Spleen Deficiency, Dampness Stagnation, and Yang Deficiency failing to transform (虚劳 – 脾虚湿滞，阳虚不化).

According to the holistic principles of yin and yang Chinese Medicine the Spleen is the central hub responsible for transforming and transporting both nutrients and fluids. The original report noted that the patient’s paradoxical reaction to foods perfectly illustrated a severely compromised Spleen. Because the Spleen was deficient and weak, it could not handle cold foods, resulting in immediate diarrhea. At the same time, this weakness caused fluids to stagnate and become heavy Dampness; when she ate “hot” foods, this trapped dampness was easily aggravated into localized heat, pushing upward to cause acne.

Furthermore, her cold extremities in the winter and delayed menstruation indicated a deep, underlying Yang deficiency. Without sufficient Yang warmth (the body’s internal fire), blood circulation becomes sluggish and delayed, failing to properly reach the limbs or fill the uterus on time.

Treatment Approach

The primary treatment principle was to strengthen the Spleen, benefit Qi, warm Yang, and dry dampness (健脾益气，温阳燥湿). The strategy aimed to carefully rebuild the digestive system’s tolerance while simultaneously introducing warm, gently moving herbs to restart her blood circulation.

Herbal Formulas and Modifications

• Initial Formula (April 24, 2021): A 15-herb decoction combining the classical Shenling Baizhu San (Ginseng, Poria, and Atractylodes Powder) with elements of San Xian Tang (Three Immortals Decoction) to warm Yang.
  • Strengthening Spleen and Drying Dampness: Fu Ling (15g), Bai Zhu (10g), Shan Yao (20g), Yi Yi Ren (10g), Sha Ren (5g), Jie Geng (10g), Lian Zi (10g), Tai Zi Shen (20g), and Sheng Gan Cao (5g) form the core of Shenling Baizhu San. This combination gently but persistently rebuilds the Spleen’s digestive power while actively draining the heavy dampness out of the body.
  • Warming Yang and Nourishing Blood: Xian Mao (10g), Yin Yang Huo (Epimedium, 10g), and Xian He Cao (Agrimony, 10g) strongly warm the Kidney Yang and dispel cold to address the cold extremities and delayed menses. Dang Gui (6g) and Hong Zao (Red Jujube, 10g) nourish the blood to ensure the warming herbs do not dry out the patient.
  • Aiding Digestion: Shan Zha (Hawthorn, 10g) was included to guide out food stagnation and assist the Spleen in processing the herbal tonics.
• Administration: 7 doses were prescribed, to be boiled in water and taken warm morning and evening. The patient was instructed to strictly avoid spicy foods and drink more water.

Follow-Up

• May 2, 2021 (Second Visit): After consuming the initial 7 doses, the source reported that the patient experienced no further discomfort. The practitioner instructed her to take an additional 7 doses of the exact same formula to consolidate the treatment, after which she could safely stop the medication.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is how perfectly it addresses a highly common modern presentation: the patient who is “too weak to clear heat, but too congested to take tonics.”

The practitioner’s commentary highlights that in regions with hot and humid climates (like northern Guangdong, where the patient resides), people often habitually drink cold herbal teas (liang cha) to “clear heat.” Over time, this chronic exposure to cold damages the Spleen’s Yang energy, leading to a state of internal damp-cold.

When the patient presented with acne, a less experienced practitioner might have mistakenly prescribed heavy heat-clearing herbs, which would have further destroyed her Spleen and worsened the diarrhea. Instead, the original practitioner recognized that the acne was merely a surface symptom of underlying damp-stagnation. By strictly focusing on strengthening the Spleen (with Shenling Baizhu San) and warming the foundational Yang (with Xian Mao and Yin Yang Huo), the treatment successfully resolved both the chronic fatigue and the paradoxical food sensitivities.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Qingyuan Maternal and Child Health Hospital / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】曾宪进：参苓白术散治疗气虚湿滞型疲劳综合征案
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 21, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation