Belly Bloated, Can’t Eat, Throwing Up After Every Bite? Doctor Luo Tianyi’s Mu Xiang Shun Qi Tang (Aucklandia Qi-Descending Decoction) Case
Patient search words: bloated stomach / can’t eat / vomiting after eating / loss of appetite / rib pain ｜ Medical terms: pi wei xu ruo (spleen-stomach weakness) · gan qi bu shu (liver qi constraint) · yang xu (yang deficiency) · sheng qing jiang zhuo (raising the clear, lowering the turbid)
The opening scene: an official’s wife arrives, and the root of her illness is written all over her life
On the twentieth day of the eighth month of 1264 AD (the fifth year of the Zhongtong era of the Yuan dynasty), the wife of a man surnamed Fan came to see Doctor Luo Tianyi. One clarification before we begin: in ancient times the word “langzhong” was not a doctor — it was a court official title. Mr. Fan was a ranking official, and his wife was the mistress of an official household.
💬 Note from Doctor Luo: Doctor Luo Tianyi had a signature way of taking a case — at the very top of the record, he did not write the disease first; he wrote the cause first. For this lady, the record says: “xian yin lao yi, yin shi shi jie” — first, exhaustion from labor and duty, then irregular eating and drinking. Lao yi means overwork — too many household affairs, worn down by strain. Yin shi shi jie means her eating had lost its rhythm. Notice that “jie” here means rhythm and restraint, not cleanliness — skipping breakfast, then bolting a huge lunch; starving herself to lose weight one day, overindulging in good food the next; all of this counts as “irregular eating.” And on top of that, one more entry: you si qi jie — worry and brooding, with qi knotted up inside. She worried every day; everything was turned over and over in her mind.
The seven emotions injure the five organs: worry really can ruin the spleen
Why did Doctor Luo Tianyi take her emotions so seriously? In Chinese medicine, there are only three fundamental sources of internal illness: irregular diet and overwork, and injury by the seven emotions (qi qing nei shang). Each of the seven emotions injures one organ: excessive joy injures the heart, excessive grief injures the lungs, worry and brooding injure the spleen, fear injures the kidneys, and fright injures the gallbladder. This lady worried and brooded day and night. Brooding knots the qi (si ze qi jie); with the qi knotted, the spleen’s qi became bound up, and the spleen was wounded.
💬 Note from Doctor Luo: Just yesterday, in an interview on China National Radio, I said the same thing — true medicine is the medicine of body and mind as one. You must place a person back in the background of his own life: family background, workplace, natural environment, region… and ask, against this backdrop, how did his body fall out of balance? If a patient sits down and the doctor asks two questions, then scribbles out lab orders — frankly, he may never figure out how the illness came about, or how to regulate it. Chinese medicine comes from life; it is an art of living. Once you understand the reasoning, you can live your life better.
How bad had it become? Chest and belly both distended, vomiting with every bite, stabbing pain under both ribs
Doctor Luo Tianyi recorded this lady’s symptoms in detail: xin fu zhang man — her chest and abdomen were distended together; dan shi ze ou — in the morning, a single bite of food came right back up; by evening she could not get anything down at all; and on top of that, liang xie ci tong — stabbing pain beneath both ribs. He took her pulse: wiry and thin (xian er xi).
💬 Note from Doctor Luo: The stabbing pain under the ribs and the wiry pulse both point one way — liver qi constraint (gan qi bu shu). The wiry pulse is the pulse of the liver; the thin pulse tells us the upright qi is insufficient. Remember this combination — deficiency plus emotional trouble — because it is the key to everything that follows.
Doctor Luo Tianyi cites the classics: clear qi in the yin, turbid qi in the yang
Doctor Luo Tianyi was a scholar, so he opened the analysis with the Huangdi Neijing (Yellow Emperor’s Inner Classic). The “Wu Luan” (“Five Confusions”) chapter of the Ling Shu (Spiritual Pivot) says: “Qing qi zai yin, zhuo qi zai yang, luan yu xiong zhong” — clear qi dwells in the yin, turbid qi in the yang, and when the two are thrown into confusion, disorder arises in the chest. (The original passage continues “the nutritive qi follows the vessels while the defensive qi runs backward, clear and turbid interfering with each other,” but Doctor Luo Tianyi trimmed it and kept only the essential line.) What does it mean? He wanted to lay out, with perfect clarity, the principle by which the spleen and stomach raise and lower.
💬 Note from Doctor Luo: The spleen and stomach are the core of the body — they dwell in the center, and so are called the “middle earth” (zhong tu). Every limb, every organ, qi and blood alike — all of it depends on the spleen and stomach to absorb nutrients from food and transport them through the body for nourishment. The qi mechanism itself rotates around the spleen and stomach: the spleen qi governs ascending, lifting the clear up the left; the stomach qi governs descending, sending the turbid down the right. The clear qi rises to the top, bright and refreshing like the sky; the turbid qi sinks down and leaves through the bowels and bladder, carrying like the earth. Raising the clear and lowering the turbid is chiefly the work of the spleen and stomach.
The circle of the body: Huang Yuanyu explained it most clearly
This “circle of qi movement” received its clearest summary in the Qing dynasty, from Huang Yuanyu: the spleen and stomach sit in the middle; the spleen qi ascends on the left, the stomach qi descends on the right; the liver rises with the spleen — liver qi follows spleen qi up the left side; the gallbladder descends with the stomach — gallbladder qi follows stomach qi down the right. Above sit the heart-fire and the lung-metal: heart-fire is the summer, lung-metal the autumn, and the heart-fire descends along with the lung qi on the right, entering the kidneys — the kidneys are the water organ; when fire enters, the water can never turn too cold. And the kidney-water rises on the left along with the liver qi and spleen qi, entering the heart, moistening the heart-fire so it never blazes alone up top. This is what the classics call shui huo ji ji — water and fire in mutual regulation.
💬 Note from Doctor Luo: When upper and lower communicate, a person is well — not too hot above, not too cold below. Very many illnesses are exactly this: hot above and cold below, because the middle is blocked and the spleen and stomach have stopped turning. Why does the middle get blocked? Two reasons. First, the spleen and stomach are too weak — no strength left to turn. Second, the liver qi runs transversely and attacks the spleen-earth (gan qi heng ni ke pi tu) — when the emotions sour, the liver-wood leans over and bullies the spleen and stomach. Weak spleen and stomach plus bad mood — raising the clear and lowering the turbid fails, and the qi mechanism can no longer move between upper and lower.
Clear qi stuck below makes undigested diarrhea; turbid qi stuck above makes distension
Doctor Luo Tianyi then quoted the Neijing again: “Qing qi zai xia ze sheng sun xie, zhuo qi zai shang ze sheng chen zhang” — when clear qi is trapped below, it produces sun xie; when turbid qi is trapped above, it produces chen zhang. Sun xie is a kind of diarrhea — the stools are loose year-round, carrying undigested food fragments, with a cramp and an urgent dash to the toilet, yet no intestinal infection ever shows up on tests. And when turbid qi is trapped above? The upper body swells up — the throat, ears, nose, all the “clear orifices” of the upper jiao begin to misbehave.
💬 Note from Doctor Luo: That is why the Neijing says “jiu qiao wei bing, jie chang wei zhi suo you sheng” — diseases of the nine orifices all originate in the stomach and intestines. Eye problems, ear problems, nose problems — they all connect back to the spleen and stomach. I treat a great deal of tinnitus, and my method is always this: put the spleen and stomach in order first. Once it can raise the clear and lower the turbid, the tinnitus eases at once. And why was this lady worse at night? At night the yin qi is heavy; the turbid yin should descend but does not, and just spreads through the middle and upper jiao — of course she felt worse. The Neijing also says “han sheng man bing” — cold gives rise to fullness. Yang governs transformation: when the flame burns bright, the water in the pot bubbles and steam rises; when yang qi weakens, the refined substances gather without dispersing, and a person swells up with fullness. So in its essence, this illness is a yang-deficiency pattern.
A decisive observation: constrained liver qi develops in two directions
In the cases he recorded before this one, Doctor Luo Tianyi stressed it again and again: constrained liver qi and bad moods develop in two opposite directions. One direction is toward heat: a person with a yin-deficient foundation and overactive ministerial fire — her constrained liver qi smolders into fire over time; the liver fire flares up, blood pressure climbs, the eyes turn red, the face flushes, and she flares up at the slightest provocation. The other direction is toward yang deficiency: a person who is chronically undernourished, sallow and thin, with weak qi and blood — say, a middle-aged woman who works herself to skin and bone every day, with little energy to begin with. Ask her to slam the table and rage? She has no strength for it. She can only swallow the grievance — and the more she swallows, the weaker her yang qi becomes, until she sinks into a cold, yin state.
💬 Note from Doctor Luo: Mrs. Fan was a textbook case of the second kind — developing toward yang deficiency. The qi gathered and bound in her middle jiao, which is why her belly swelled, she could not eat, and she vomited with every bite. The vomiting itself is the stomach failing to descend: the middle is blocked, food cannot pass downward, so it flips back up.
Step one was not a prescription: moxibustion on Zhongwan (CV12) first
Doctor Luo Tianyi treated this illness in stages. The first step — he did not rush to write a formula; he first applied moxibustion to Zhongwan (CV12), the front-mu point of the stomach. Why? To draw the stomach’s generative qi upward. First, rekindle the spleen and stomach’s vitality; then let the decoction lend a hand — in his own words, “ci yi ci fang zhu zhi” — this formula comes to assist the moxibustion.
💬 Note from Doctor Luo: This is Doctor Luo Tianyi’s most distinctive trait! He was Doctor Li Dongyuan’s disciple, yet he had tricks of his own: he was especially fond of warming-yang herbs — Doctor Li Dongyuan did not use nearly so many, but Doctor Luo Tianyi excelled at treating yang-deficiency states. And second, he loved to combine moxibustion with decoction, often telling patients to moxa Zhongwan (CV12) — this was his signature move, and you should remember it. We covered his moxibustion methods in an earlier case — those three points; if you ever have the chance, do try them. They are remarkably effective.
Mu Xiang Shun Qi Tang: raises the clear, lowers the turbid, warms the yang, and supplements the qi
After the moxibustion, Doctor Luo Tianyi prescribed Mu Xiang Shun Qi Tang (Aucklandia Qi-Descending Decoction). The formula was built on the Neijing principle “liu zhe xing zhi, jie zhe san zhi” — what lingers, move it; what knots, scatter it — the belly was distended because the qi was bound up, so the qi had to be moved and scattered open. The construction is strikingly clear-headed: it raises and lowers, warms and supplements and moves, all at once:
The upward movers — the sovereign herbs: chaihu (bupleurum) and shengma (cimicifuga). Both bitter and neutral, bupleurum travels the lesser yang channel and cimicifuga the yangming channel; they disperse the clear qi and set the yang portion in motion, letting the clear qi rise — the very lesson his teacher Doctor Li Dongyuan had taught him.
The downward movers — the assistants and envoys: wuzhuyu (evodia fruit), fuling (poria), and zexie (alisma). Wuzhuyu is bitter and hot — it drains; being thin in qi it belongs to yang within yin, and its job is to guide the turbid yin qi down from above. Fuling is sweet and neutral and drains water; zexie is salty and neutral, thin in qi. Together the three pull the turbid yin downward.
The yang-warming, cold-dispelling group — the minister herbs: shengjiang (fresh ginger), banxia (pinellia), doukou (cardamom), and yizhiren (Alpinia oxyphylla fruit). All pungent-sweet and greatly warming, they scatter the great cold. This patient’s yang qi was insufficient and cold qi was present — the yang was trapped and could not transform, and that was why she bloated and vomited. These pungent-warm herbs rouse the yang and drive out the cold. Banxia has a descending nature, and being pungent as well, it warms the middle and disperses cold.
The qi-moving, stagnation-freeing group: houpu (magnolia bark), muxiang (aucklandia root), cangzhu (atractylodes), and qingpi (green tangerine peel). Pungent-bitter and greatly warming, they free bound-up qi: cangzhu additionally drains dampness and expels damp, while qingpi moves and breaks qi — you are blocked inside, so I will open you up.
The middle-supplementing group: danggui (angelica root), chenpi (aged tangerine peel), and renshen (ginseng). Sweet and warming, they harmonize and nourish the middle qi. When Doctor Luo Tianyi supplemented the spleen and stomach, his usual team was renshen, baizhu, danggui, and chenpi — when the middle qi is fully replenished, the spleen and stomach gain the strength to raise the clear and lower the turbid.
💬 Note from Doctor Luo: A special word on wuzhuyu (evodia fruit). Doctor Luo Tianyi says it leads the turbid yin qi downward — but wuzhuyu has another action: warming the liver. People with insufficient yang qi usually have insufficient liver yang as well; adding a little wuzhuyu warms the liver and replenishes liver yang, which is a great help to recovery. One herb, many jobs — it fits here perfectly. Look at the whole formula: there are middle-supplementing herbs, qi-moving herbs, middle-warming herbs, plus bupleurum and cimicifuga rising up and pinellia, poria, and alisma descending down — every link interlocks, and no direction is missing.
How to take it: ground to powder, and forbidden foods and anger
Following the preparation method of the time, the formula was ground into powder and decocted — two cups of water simmered down to one, dregs strained, drunk warm. Why grind it? To stretch the herbs. In wartime, medicinal materials were scarce; with small amounts, you had to get more out of each dose. Once the herbs are ground, every piece has more surface area touching the water, and more of the active components come out. These days people still decoct whole herbs, snap the pieces open afterward and find the white core inside never cooked through — precisely because they were not ground. The doses in this formula — three fen, two fen — were all very small.
There were also two prohibitions while taking the medicine: avoid raw, cold, and hard foods, and avoid anger. Raw, cold, and hard foods injure the spleen and stomach — and this illness began with irregular eating. Anger — and this illness began with bad emotions.
💬 Note from Doctor Luo: Many people forget what caused their illness when they take Chinese medicine. You have to analyze it clearly: how did I get this illness? If it came from anger, then you must think it through — listen to my lectures on the Dao De Jing, for instance; keep listening, let the heart put it down and stop clinging, and only then will the medicine work. Otherwise you take the medicine with one hand while you lock horns with people at the office and brace yourself for battle with the other — then the medicine is wasted. Doctor Luo Tianyi wrote the dietary prohibitions and the prohibition on anger right after the formula, and it was all deliberate — this is how your illness came about, so you must adjust.
Recovered in days: a true master at work
The result? Shu ri liang yu — within a few days, she was well.
💬 Note from Doctor Luo: Watch Doctor Luo Tianyi work, and you see the bearing of a true master: the cause is set down for you in perfect detail — not only the physical cause, but how his patient’s habits and temperament produced the illness. Every prescription and every analysis quotes the Huangdi Neijing, dissecting the condition with total clarity, and the formula interlocks link by link. He was Doctor Li Dongyuan’s finest disciple, and he earned high praise — in many respects he was genuinely innovative, developing his teacher’s doctrine further: he used warming-yang herbs more freely than his master, and he pioneered the combination of moxibustion with decoction. Yet he spent his whole life editing his teacher’s books, and Doctor Li Dongyuan’s brilliance cast him entirely in shadow. Without Doctor Luo Tianyi, Doctor Li Dongyuan’s learning would probably not have survived — he edited so many of Doctor Li Dongyuan’s works, and in the end wrote only one book of his own, the Weisheng Baojian (Precious Mirror of Hygiene). He was an extraordinarily modest man.
What to take away today: if your appetite is tiny and one bite bloats you, this is usually how you got blocked
The lesson of this case is direct: irregular eating wounds the body, and bad emotions wound the body too. If a person’s yang qi was already insufficient, then when she swallows grievance she develops toward cold and yin, and the qi knots in the middle jiao — which is exactly the state so many people live in: a tiny appetite, bloated after one bite. Why? Weak spleen and stomach, bad mood, and a blocked middle. The formula and the whole method Doctor Luo Tianyi used today are the key that undoes that knot. Ask yourself — do you have any of this going on in your own life?
💬 Note from Doctor Luo: To close, let us review today’s core once more: raising the clear and lowering the turbid is the spleen and stomach’s own job; spleen qi rises on the left, stomach qi descends on the right, the liver rises with the spleen, the gallbladder descends with the stomach, the heart-fire descends into the kidney-water, and the kidney-water rises to nourish the heart-fire — when this circle turns, a person is well. Bad emotions plus a weak spleen and stomach stall the circle — moxibustion on Zhongwan (CV12) and Mu Xiang Shun Qi Tang are how you set the circle turning again. Learning a little Chinese medicine genuinely does you good.
Case source: Weisheng Baojian (Precious Mirror of Hygiene), medical case of Doctor Luo Tianyi (case title: Xin Fu Zhang Man Zhi Yan — a Case of Chest and Abdominal Distension); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).