Belly Swollen, Wheezing So Loud It’s Heard Outside the Room? Doctor Luo Tianyi’s Pingqi San (Qi-Settling Powder)

Opening scene: an urgent consultation in the rainy season on Mount Liupan

💬 Note from Doctor Luo: Today’s case is about food, about the spleen and stomach — and about coughing and wheezing.

In the early autumn of the yiwei year, Doctor Luo Tianyi was summoned by imperial decree to Mount Liupan — the Yuan rulers loved to vacation there (the scenery is beautiful, the grass and trees are lush, and it doubled as a military garrison base). By the eighth lunar month, the rain had been falling without stop.

💬 Note from Doctor Luo: Notice that Doctor Luo Tianyi points out the climate conditions — season, weather patterns — because they matter enormously in diagnosis. We should ask the same question today: what was the weather like where you live when the illness began? It may be connected to the illness. Medical cases are never written carelessly.

The emperor ordered Doctor Luo Tianyi to treat the wife of Marshal Bulin Jidai. About this lady:

• She was past fifty (in her fifties)
• Her body was fat and heavy (very overweight) — a marshal’s wife could eat whatever she wanted, and she ate herself into obesity

The trigger: excessive drinking and excessive consumption of frozen milk — she loved wine, and she also drank cow’s milk like a beverage (a habit of the nomadic tribes), and she drank a great deal of it.

The result: abdominal distension with wheezing followed — her belly swelled up huge, and she wheezed terribly — the sound was audible outside the room (wheezing inside the tent, and people outside could hear it), she could not lie down to rest (unable to sleep lying flat), and urination and defecation were both difficult (little urine, little stool — everything blocked up inside).

💬 Note from Doctor Luo: Have you ever seen someone wheezing badly? The breathing is suffocating and strained, the sound is very loud, they can’t get air in — people around them get frightened and keep their distance. This lady was in an acute state: wheezing so badly she couldn’t lie flat. Truly serious.

Diagnosis: qi kou twice as large as ren ying — internal injury, the spleen and stomach badly damaged

Doctor Luo Tianyi took the pulse: the qi kou pulse was twice as large as the ren ying pulse; the guan (bar) pulse was deep, slow but forceful (the right guan position corresponds to the spleen and stomach).

💬 Note from Doctor Luo: This is the experience of the school of Doctor Li Dongyuan — using the ren ying and qi kou pulses to tell external contraction from internal injury: the left ren ying (at the cum position) and the right qi kou. If qi kou is much larger than ren ying, it is an internal-injury disease (the spleen and stomach are hurt), not an external contraction. Here it was twice as large, which says the spleen and stomach were hurt very badly; a deep, slow but forceful guan pulse says there is stagnation inside.

Analysis of the pathomechanism:

1. Dampness from the rain — days of rain on Mount Liupan, so dampness had accumulated in the body
2. Heat from food and drink — drinking wine (alcohol is dry and scorching hot) plus drinking too much milk (a rich nutritive substance that the body could not fully transform; the surplus nutrition stagnated for too long and turned into heat)

Damp-heat in great abundance → attacks upward into the lungs (the lungs had both dampness and heat, and the spirit qi grew agitated and disordered) → wheezing and fullness. When the pathogen is vigorous the pattern is excess — this was an excess pattern, and the treatment should drain from above downward.

The prescription: Pingqi San — white pharbitis as sovereign, draining water and opening the bowels

Doctor Luo Tianyi created Pingqi San (Qi-Settling Powder):

Usage: ground into a powder; each dose three qian (about 9 g), stirred into a decoction made by boiling sliced fresh ginger (ginger moves the qi of the spleen and stomach and keeps the medicine from being too bitter-cold).

💬 Note from Doctor Luo: The most fascinating herb in this formula is bai qian niu, and it deserves a proper introduction:

Qian niu zi is the seed of the morning glory (the trumpet flower): the seeds of the white-flowered plant, white or yellow, are called bai qian niu (white chou); the seeds of the purple-flowered plant, black, are called hei qian niu (black chou). TCM practitioners often say “the white and the black chou” — the materia medica is all around us in everyday life: the morning glory is such a pretty flower, yet its seeds have enormous power: they drain water (used when water-dampness is extreme, as in edema and ascites from liver disease), send qi downward, kill parasites, and open the bowels while also promoting urination (this is very special — most herbs that purge the stool make the urine decrease; this one drains both together, because what it actually drains is water, and once the water comes out the stool passes naturally).

When to use it: only when water-dampness in the body is extremely heavy; and it must never be boiled for long (prolonged boiling destroys the active constituents and greatly weakens the purging effect) — which is why in the classical formulas pharbitis seed is almost always ground into powder and taken in water or in pills.

White chou vs black chou (TCM draws the distinction finely):

• Bai qian niu (white): white enters the lung — it drains water and sends qi downward while entering the lung channel to drain the water-dampness out of the lungs; as the pressure on the lungs eases, the wheezing and fullness resolve
• Hei qian niu (black): black enters the kidney — it enters the kidney channel (especially the right kidney, the ming men or life gate). Li Shizhen singled this out for praise: only Doctor Li Dongyuan truly understood it — ordinary physicians mixed the black and white seeds together indiscriminately; only Doctor Li Dongyuan knew that the black seed enters the kidney channel and should be used when you need to guide the medicine into the kidney (especially the right kidney, the ming men), tonifying the kidney and draining water-dampness at the same time. Li Shizhen wrote a special note about this in the Bencao Gangmu (Compendium of Materia Medica).

The subtlety of “half raw, half dry-fried”: the raw seed drains water-dampness violently (driving the stagnation out); after dry-frying it becomes gentler and gains the added function of tonifying the spleen and digesting food stagnation — this lady had eaten too well and was over-nourished, so the treatment combined a violent water-drain with food-digestion: the violent and the gentle together. Today the fried form is generally preferred.

“Taking the head powder”: the skin of the seed is removed (the skin is pungent), keeping its bitter-cold nature (“use bitter-cold to drain the damp-heat of the qi level”) — that is how precisely the medicine was handled!

Sovereign white pharbitis + ministers qing pi and chen pi + assistants bing lang and da huang — the structure is beautifully clear.

The result: after the first dose the wheezing was reduced by half; after the second dose the wheezing was cured — completely resolved!

What remained was chest and diaphragm discomfort (a stuffy, obstructed feeling in the chest), restless heat and dry mouth, and frequent coughing — the heat inside had not been fully cleared. Doctor Luo Tianyi prescribed Jiajian Xie Bai San (Modified Drain-the-White Powder).

Aftercare: Jiajian Xie Bai San

Xie Bai San is a formula by Qian Yi (imperial physician of the Song dynasty, one of the founders of TCM pediatrics) — very simple: sang bai pi (mulberry root bark) and di gu pi (wolfberry root bark), with licorice and rice. “White” refers to the color that belongs to the lung — it is a formula that drains the heat of the lung.

Doctor Luo Tianyi’s modifications:

• Sang bai pi (from the original): drains lung heat
• Di gu pi (from the original): clears lung heat + clears the hidden fire of the kidney — di gu pi is the root of the wolfberry plant, and being underground it is cool. The kidney and the lung are in a mother-child relationship (metal generates water), so draining the hidden fire of the kidney indirectly drains the hidden fire of the lung
• Zhi mu (anemarrhena): clears lung heat (Doctor Zhang Xichun also liked to pair huang qi with zhi mu)
• Jie geng (platycodon): regulates the qi of the chest and sends the lung qi upward and outward
• Qing pi: breaks and regulates qi
• Huang qin (baical skullcap): drains lung heat
• Gan cao (licorice): from the original formula

Ground into powder, decocted in two cups of water down to one cup, the dregs strained, taken warm. “Shu fu liang yu” — after taking it for a few doses, the illness was completely well.

Ending: Doctor Luo Tianyi’s theoretical discussion — don’t read books like a robot

💬 Note from Doctor Luo: At the end Doctor Luo Tianyi explained two classical sayings:

• Hua Tuo said: “When it is full, there is wheezing; when it is diminished, there is withering” — when the lung qi is full, wheezing easily occurs; when the upright qi of the lung is insufficient, the lung easily withers and dries
• The Nanyang Huoren Shu (Book for Rescuing the Living, Nanyang edition — a classic-formula school work by Zhu Gong of the Song dynasty): “He who develops wheezing has qi in surplus”

Doctor Luo Tianyi said: when you read a book you must grasp the real meaning and not be fooled by the literal words — “full” does not mean the lung qi is truly abundant; it means lung heat is exuberant, the pathogen is exuberant; “qi in surplus” in fact means heat in surplus — and when heat is in surplus, the upright qi is actually insufficient. So in this situation one must drain the heat from the lungs.

Modern lesson: “A thin old age is worth a thousand in gold” — the worst thing is fat and weak together

💬 Note from Doctor Luo: This case is a particular warning for modern people — life is good now, and plenty of people are just like the marshal’s wife, eating rich, fatty, sweet food with abandon.

When I help people regulate their bodies, who do I fear most? Take a woman in her sixties who is fat and wheezes after two steps of walking — this kind of cough and wheeze heals very slowly even with miracle medicine. Why? The constitution is right there: she eats hard every day and has no intention of changing her habits. When an older person is extremely obese and also showing deficiency signs — the body can no longer control that obese form; the upright qi cannot command the body. At that point, forget the wheezing — blood lipids, cardiovascular and cerebrovascular problems, blood pressure, blood sugar will all go haywire — and you can’t fix them one by one, because meanwhile she’s still eating.

It’s like the wife of the boss of a big company — no one at home can control her; she eats whenever she wants and whatever she wants, driven entirely by desire, and only comes to the doctor when her body is a mess. Who can I possibly control? I write the prescription, turn around — and when she goes home, there’s no one to supervise her.

These days the trendy word is “foodie” — and I think it’s actually an insulting word. Do you really need that much food? I grow a few heads of bok choy myself, and the vegetables from a five-meter patch last me the whole summer — the food a person actually needs to sustain life is very little. A “foodie” goes to restaurants demanding every kind of seasoning and rich, fatty delicacy, consuming enormous resources; most of what goes in is useless, and it all has to come out — if it can’t be expelled, it piles up inside the body.

How many diseases are eaten into existence with rich, fatty food? You must control your diet and keep the body in a healthy, light state — if your upright qi at 50 points has to command a body at 200 points, when form and spirit cannot unite, things go bad. The old saying “a thin old age is worth a thousand in gold” is absolutely true — stay light, and that obese state is never good.

The marshal’s wife ate well all the time (plenty of mutton, plus wine and milk) — that’s why she was so fat and wheezed so loudly that people outside heard it — she was lucky to meet Doctor Luo Tianyi, who dared to drain her with bai qian niu; with any other imperial physician, seeing deficiency signs they’d have tonified her — and one round of tonifying would have finished her off.

What ultimately fixes things is lifestyle — a doctor can help you through the crisis, but the key to staying healthy is in your own hands: be a little more moderate, a little more clear-headed, control your desires, keep your body light, let form and spirit dwell together. Eat some whole grains and greens, keep it simple, less meat, exercise moderately — that is the real way to never get sick.

Case source: Wei Sheng Bao Jian (Precious Mirror of Health) by Doctor Luo Tianyi; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).