Headache That Nothing Could Fix? Doctor Luo Tianyi’s Shunqi Hezhong Tang (Decoction to Harmonize the Middle and Smooth the Qi) for Qi-Deficiency Headache

Opening scene: we talked about phlegm headache before — today it is the qi-deficiency kind

💬 Note from Doctor Luo: Earlier we discussed phlegm-accumulation headache (spleen deficiency with flourishing phlegm), which Doctor Li Dongyuan cured with Banxia Baizhu Tianma Tang (Pinellia, Atractylodes and Gastrodia Decoction). Today we talk about qi-deficiency headache — a completely different pattern behind the same symptom.

The patient was a certain Mr. Yang — Staff Officer Yang (name De, style name Zhongshi). “Staff officer” (can mou) is a military staff position — the word is still used in China today. He was 61 years old.

In the second lunar month of the renzi year (springtime), he developed an unbearable headache — the pain was so fierce that he could not sleep day or night. The physician Cao Tongfu invited Doctor Luo Tianyi to see him.

How the illness ran its course: treated as an external cold and sweated — each round made it worse

Staff Officer Yang explained: “I had recently been in Yanjing (present-day Beijing). At first it was only mild dizziness and a dull ache. I consulted a physician, and he treated it as a cold-damage illness (‘you were chilled by the cold wind’) — he gave me sweating herbs to release the exterior. After I sweated, the pain did not improve — it got worse. The physician would not accept that (‘the cold has not been fully cleared’), so he sweated me again — and the illness turned severe (worse and worse).”

At his wit’s end, he headed home. On the road home, at every town he stopped and consulted the local doctor — and they all reasoned the same way: he had been blown by the wind, so scatter the cold and release the exterior. The result: he only got worse, until the pain kept him from sleeping. By now he also had aversion to wind and cold (he dreaded drafts and chill) and no appetite.

The diagnosis: six pulses stringlike, thin and faint — a deficiency pattern!

When Doctor Luo Tianyi took the pulse, he found all six positions stringlike, thin and faint (a deficiency-pattern pulse — the beat has no force) — together with short, hurried breathing (insufficient upright qi, with rapid, oppressed breathing — the same kind of gasping that Doctor Zhang Xichun’s patients with sinking of the great qi showed) — and lazy speech (not wanting to talk, no strength behind the words).

💬 Note from Doctor Luo: Doctor Luo Tianyi’s analysis begins with the Neijing (Inner Canon): "In spring, disease settles in the head" — in spring the qi of heaven and earth rises and all things sprout; illnesses that arise in spring tend to strike the head (the uppermost part). Whether the rising overshoots (fire rushing up — anger, blood pressure spiking in a surge) or fails to rise at all (clear qi unable to ascend), the head gets into trouble.

This patient belonged to the second kind — the clear qi simply could not rise. Look at the symptoms: no appetite = spleen and stomach deficiency; short, hurried breath = qi deficiency; lazy speech = qi deficiency; aversion to wind and cold = only when upright qi is insufficient does one fear external wind and cold. This is the Li Dongyuan school’s contribution to Chinese medicine!

The key theory: wei han versus wu han — the dividing line between external contraction and internal damage

💬 Note from Doctor Luo: Traditional Chinese medicine had long focused on external contraction (everything since the Shang Han Za Bing Lun, the Treatise on Cold Damage, has been about it). But many internal-damage illnesses (those caused by internal weakness) look a great deal like external contraction — take feeling cold, for example:

• Wei han (true fear of cold) in external contraction (genuinely struck by cold wind, or flu with fever): even wrapped in thick clothes you are still cold (bundled under heavy blankets with a high fever, still shivering) — adding layers does not remove the cold — this is called wei han (truly dreading the cold).
• Wu han (dislike of cold) in internal damage (insufficient upright qi, for example kidney-yang deficiency): you feel listless and drowsy, and wear more clothes than everyone else — in the same room, others are fine in T-shirts, but you are not — yet putting on one more layer makes you comfortable. This is insufficiency of the body’s own upright qi (not an invading cold pathogen) — called wu han (you merely dislike the cold; once you add clothes you warm up).

External excess and internal deficiency look remarkably alike, and many doctors of antiquity could not tell them apart — they treated both as external contraction, and that is where trouble begins.

The greatest contribution of the Li Dongyuan school was separating external contraction from internal damage — the book Nei Wai Shang Bian Huo Lun (Distinguishing Internal and External Damage) is devoted to exactly this. When Li Dongyuan was besieged inside Bianliang city (during the Mongol conquest of the Jin dynasty), great numbers of people in the city had injured spleen and stomachs and deficient upright qi, and fell ill after the siege was lifted. Everyone treated it as an epidemic and dispersed and purged — huge numbers died. Li Dongyuan pondered: no — these are internal-damage illnesses. When the spleen and stomach are damaged to a certain point, the whole system is on the verge of collapse; force-feeding or sweating pushes it over the edge, and the patient dies. So he created the Buzhong Yiqi Tang (Decoction to Tonify the Middle and Augment the Qi) approach, devoted to regulating internal damage, and wrote books so that doctors could distinguish external from internal.

Every doctor Staff Officer Yang met failed to make that distinction — from Beijing all the way home, everyone sweated him as if he had an external contraction, and each time he grew worse.

Pattern differentiation and the prescription: Shunqi Hezhong Tang — raise the yang and tonify the qi

Doctor Luo Tianyi’s analysis: advanced age with weakened qi (at 61, the upright qi is no longer plentiful) → the clear qi cannot rise to the head and face → the head receives no nourishment of qi and blood → headache. There was never any exterior pathogen to begin with — but the doctors sweated him → the qi escaped along with the sweat (blood and sweat share the same source) → the clear yang qi grew more depleted by the day → it could neither nourish upward (to the head) nor guard the exterior (the Neijing says, "the yang qi guards the exterior and makes it firm") → headache, fear of wind, shortness of breath.

Treatment principle: raise the yang and tonify the qi — hence the formula name Shunqi Hezhong Tang (Decoction to Harmonize the Middle and Smooth the Qi):

How to take it: grind the herbs into a single dose (one day’s quantity), decoct two cups of water down to one cup, strain, and take warm — always after a meal (borrowing the food qi of the stomach to tonify qi, and letting the medicine’s nature travel upward).

💬 Note from Doctor Luo: A word on channel-guiding herbs (yin jing bao shi yao). Ancient physicians taught that different headache locations belong to different channels:

• Pain at the back of the head running into the neck = foot taiyang bladder channel → use qiang huo (notopterygium) and chuan xiong
• Pain on both sides = shaoyang channel → use chai hu, huang qin (scutellaria), chuan xiong
• Pain across the forehead = yangming stomach channel → use ge gen (kudzu root), bai zhi (Dahurian angelica), zhi mu (anemarrhena)
• Pain at the very top of the head = jueyin channel → use wu zhu yu (evodia), gao ben (Chinese lovage)
• Whole-head pain = shaoyin channel → use xi xin (asarum)

Add a little of an herb that enters a particular channel, and it opens that channel’s passage, letting all the other herbs act on that channel more effectively — a precision strike! This formula uses chuan xiong, man jing zi and xi xin — anchored in shaoyin (xi xin), while also keeping an eye on the taiyang bladder channel. Even though he had judged there was no external contraction, Doctor Luo Tianyi was still stabilizing the exterior — by tonifying upright qi and yang qi and unblocking the channels, so the body could resist any outside pathogen.

Look back at the whole formula — the thinking is identical to Buzhong Yiqi Tang: huang qi, ren shen, gan cao and bai zhu tonify qi and the spleen + dang gui nourishes blood + chen pi regulates the qi + bai shao astringes + sheng ma and chai hu drive upward — once the qi is topped up, it ascends (the problem was that qi deficiency meant it could not reach the top of the head, wasn’t it? Tonify, and up it goes), plus channel-guiding herbs for the precision strike. The doses are small (huang qi only 1.5 qian, sheng ma and chai hu 0.3 qian each — about one gram — xi xin and chuan xiong 0.2 qian each) — yet the effect is immediate; the cup is barely set down before the patient is cured.

The result: one dose halved the headache, and the second dose cured it completely!

💬 Note from Doctor Luo: From Beijing all the way home, every doctor had failed — the direction was wrong, they treated an internal deficiency as an external contraction and sweated him. Doctor Luo Tianyi, following Doctor Li Dongyuan’s thinking, cured him in two doses — which shows the importance of correct theory. These are all good herbs; used rightly they are good medicine, used wrongly they cannot cure. With the theory right — knowing that both qi deficiency and blood deficiency can cause headache, and that tonifying the qi and raising it will fix it — the headache clears at once.

Bonus: Physician Cao’s poem — a rare record of Li Dongyuan being slandered

The story does not end with the cure. The following spring, Doctor Luo Tianyi traveled to Liupanshan on business, and Physician Cao composed an ancient-style poem praising Luo Tianyi’s medical skill ("truly worthy of being Doctor Li Dongyuan’s distinguished disciple").

💬 Note from Doctor Luo: The poem holds a remarkable detail — the line "先生饮恨卧黄泉" ("the master drank his grievance and lay beneath the Yellow Spring"). Although Doctor Li Dongyuan bore the title of "national physician" and was famous throughout the land, some people spoke ill of him (perhaps fellow physicians jealous of how brilliantly he treated illness). I have never seen this record in the literature before — ordinary documents never record who slandered Li Dongyuan; this is the only appearance of it anywhere. And his disciple Luo Tianyi won glory for his master — look at these treatment results; what else could anyone say?

What to take away: the importance of theory

💬 Note from Doctor Luo: This case demonstrates the importance of theory. Almost every illness can involve: liver fire, phlegm dampness, qi deficiency, blood deficiency, yin deficiency, yang deficiency… miss even one possibility and the illness may not be cured; but locate the pattern precisely, and Chinese medicine acts with remarkable speed.

The idea that "qi deficiency and blood deficiency can cause headache" was proposed by Doctor Li Dongyuan — and this is how the clinical wisdom of Chinese medicine was refined, bit by bit: great physicians of every dynasty added their piece, and in the end formed the Chinese medicine we have today — truly remarkable.

The original case is from Wei Sheng Bao Jian (Precious Mirror of Health) by Doctor Luo Tianyi; the commentary is based on public lectures by Doctor Luo Dalun (PhD in TCM Diagnostics, Beijing University of Chinese Medicine).