Dizziness, Blackouts and Nausea? Doctor Luo Tianyi’s Deficient-Wind Vertigo Case (Tianma Banxia Tang / Gastrodia-Pinellia Decoction)
Patient search words: dizziness with blackouts / seeing black before the eyes / vertigo with nausea / migraine / heat up top, cold down below ｜ Medical terms: xu feng nei dong (deficient-wind stirring internally) · xuan yun (vertigo) · feng tan nei zuo (wind-phlegm rising internally) · shang re xia han (heat above, cold below)
The opening scene: in spring, a 72-year-old senior official suddenly goes blind
In the spring of 1268 AD (the fifth year of the Zhiyuan era of Emperor Shizu / Kublai Khan of the Yuan dynasty, a wuchen year), a 72-year-old veteran official — Yang Gong, a canzheng (a senior policy adviser in the imperial government) — suddenly fell ill. How ill? Tou xuan yan hei: his head spun with a thud, one dizzy spell after another, until his eyes went black and he could not see at all (mu bu jian wu). Right at the start of the case record, Doctor Luo Tianyi tells us two things about this man: he is a canzheng — a man who holds high office and carries the weight of state affairs — and he is 72 years old.
💬 Note from Doctor Luo: Notice Doctor Luo Tianyi’s habit when he records a case — he writes down the patient’s job and age first. A canzheng, an official: heavy work pressure, endless worry. Seventy-two years old — the ancients said “since antiquity, few men live to seventy”; in those days this was a very great age. Don’t underestimate those two details — everything later in the case leans on them.
Who was the patient? An old minister with a long-standing wind illness, flaring up in spring
Yang Gong’s illness did not begin in a single day. The case record says it plainly: su you feng ji — he had long carried a root of “wind” disease. And why did it erupt so violently in spring of all seasons?
💬 Note from Doctor Luo: Spring corresponds to the liver. When liver yin and liver blood are insufficient, it easily gives rise to deficient-wind stirring internally (xu feng nei dong). That is why wind-stroke and vertigo tend to worsen in spring. By writing down the season, Doctor Luo Tianyi is quietly pointing to the mechanism — that is the knack of reading old medical cases.
How far had the illness gone? Dizziness, blackouts, a churning stomach, a swollen red face — and ice-cold legs
Doctor Luo Tianyi recorded the symptoms in a long string: xin fan shen luan — his mind was restless and agitated; e xin yu tu — he constantly wanted to vomit but nothing would come up; xin zhong ao nao — that vexed, oppressed feeling the classics call “regret and vexation in the heart,” a misery hard to put into words; tou pian tong — not a whole-head headache but pain on the sides, the classic one-sided migraine; and tou wei zhong er se chi — his head was slightly swollen and flushed red; his face, cheeks and jowls all suffused with red — the feeling of qi and blood surging upward. At first glance, it looked for all the world like a heat pattern!
But look further down: zu jing leng — his feet and calves were bitterly cold.
💬 Note from Doctor Luo: Red-hot up above, ice-cold down below — this is a complicated illness, a tangle of cold and heat that no simple “excess fire” explanation can cover. When you read old cases, the worst mistake is to grab a single symptom and jump to a conclusion. You must read the whole pattern.
Where did the illness come from? Wine, damp-heat and wind-phlegm blocked the qi between top and bottom
How did Doctor Luo Tianyi analyze it? He said: in his prime, Yang Gong had been a heavy drinker. Too much wine, and wine accumulated damp-heat internally (jiu ji shi re yu nei) — the body carried a heavy load of damp-heat. Over time, the damp-heat slowly condensed into phlegm; once the phlegm grew abundant, it stirred the deficient wind inside the body, and the result was feng tan nei zuo — wind-phlegm rising internally.
Now, in a healthy body, if qi and blood circulate freely, damp-heat can gradually dissolve. But Yang Gong’s qi and blood could not move — the damp-heat could not dissolve, the blockage grew worse and worse, and it hardened into wind-phlegm stuck inside; the more it blocked, the less the upper and lower qi could communicate — and so it became shang re xia han: heat above, cold below.
💬 Note from Doctor Luo: Doctor Luo Tianyi said this was yang qi failing to communicate (yang qi bu de jiao tong), “the image of the Pi hexagram” — that is, the Pi (Standstill) hexagram of the I Ching, in which the upper and lower parts cannot connect. He only hints at it, but we should follow the thought further: whenever there is heat above and cold below, most often the middle jiao — the spleen and stomach — is blocked: the spleen cannot send the clear qi upward, and the stomach cannot send the turbid downward. Why is the spleen-stomach blocked? A very large reason is insufficient liver qi: heavy work pressure, endless worry, qi stuck, the liver and gallbladder out of harmony. So you see, when Doctor Luo Tianyi wrote down “canzheng,” he was not writing it for nothing — the occupation explains the cause.
Doctor Luo Tianyi’s reasoning: heat up top — yet he dared not use cold-natured herbs
So how to treat it? Doctor Luo Tianyi always grounded his treatment in classical theory. He said the Neijing teaches “zhi re yi han — treat heat with cold”: with heat above, by rights one should use cold-natured herbs to clear it. But, he said, “bing you yuan jin, zheng you qing zhong — illnesses differ in their nearness and remoteness, patterns in their severity and mildness”; there is an order of precedence among remedies, and you cannot slap cold herbs on every red face.
💬 Note from Doctor Luo: Why not? Because Yang Gong was old and his qi weak (nian gao qi ruo) — at 72, by today’s standards he was like a man in his nineties, and he was still going to work every day; his upright qi (zheng qi) was already insufficient. The upper jiao was congested with qi and blood, true — but how could anyone dare to use cold-natured medicine to wound his spleen and stomach? Injure the spleen and stomach, and the trouble becomes far greater. This is the measure of a great physician: see the mechanism clearly, and hold back where the herbs must be held back.
First move: the three-edged needle — a string of purple-black dewdrops from the top of the head
No cold herbs, then — what to do? Doctor Luo Tianyi began with an external treatment. The Neijing lays down the law of acupuncture: re ze ji zhi — when it is hot, needle it quickly, in fast, out fast, draining the heat out; and gao dian zhi shang, she er qu zhi — when the disease sits at the highest summit of the body, take it as you would shoot an arrow: fast and accurate.
Doctor Luo Tianyi took up a three-edged needle (san leng zhen) and chose more than twenty spots on the top of Yang Gong’s head, needling each one in turn to let blood. What did the blood look like? Purple-black — a sure sign of stasis and blockage inside. And the amount was small: like drops of dew (ru lu zhu zhi zhuang), each spot oozing just a few purple-black beads. Yet from those twenty-odd little beads, within a short while (shao qing) Yang Gong’s head and eyes cleared — his vision brightened, and all his symptoms were relieved.
💬 Note from Doctor Luo: This is a classic bloodletting case, and many ancient case collections included it. Doctor Luo Tianyi treated with every method available, not only herbs. When qi and blood were congested violently up above, he used bloodletting to drain the stagnant blood — the stasis was stuck inside, qi and blood could not pass, and the pressure above kept mounting; once it was released and the qi and blood flowed, the symptoms eased at once. Chinese medicine calls this “yu chen ze chu zhi — remove what has stagnated and accumulated.”
Second move: Tianma Banxia Tang — one formula with two famous prescriptions hidden inside
With the symptoms eased, Doctor Luo Tianyi immediately wrote his prescription. To open the reasoning, he first set down a sentence that later generations would repeat for centuries: “Yan hei tou xuan, xu feng nei zuo, fei tianma bu neng chu.” — “When the eyes go black and the head spins, with deficient wind stirring internally, only tianma can remove it.”
💬 Note from Doctor Luo: This sentence became key evidence for later research on tianma (gastrodia). Each ancient physician kept his own hard-won insights into individual herbs and wrote them down, and knowledge accumulated as the generations passed — Doctor Luo Tianyi’s line was later quoted by many physicians studying tianma. This is, in fact, the ancient Chinese spirit of evidence-based medicine: search out the evidence of the past to build the knowledge of the present. It is said that one of the founders of evidence-based medicine drew his inspiration precisely from watching how Chinese scholars of old pursued learning — for instance, how they studied the classics of Confucius — and from that spark created Western evidence-based medicine. The principles of scholarship are the same in every age, East or West.
Why is tianma the specific herb for deficient wind? Because tianma’s sprout is called the “wind-settling herb” (ding feng cao): when the wind blows and every other grass sways, tianma’s sprout alone does not move. When wind is stirring, tianma is the herb that answers. Its actions are two: first, dispel wind and unblock the channels (qu feng tong luo) — it can open channels that have become blocked; second, settle liver wind and stop spasms (xi gan feng, zhi jing luan) — for internal wind from liver deficiency, with dizziness, blurred vision and trembling limbs, its effect is especially good.
With tianma as the sovereign herb, the formula is called Tianma Banxia Tang (Gastrodia-Pinellia Decoction). What else did he pair with it? Doctor Luo Tianyi explained: a one-sided headache is a shaoyang-channel illness (pain on both sides belongs to the liver and gallbladder), and nothing but chaihu (bupleurum) and wine-fried huangqin (skullcap root) can treat it — huangqin is bitter and cold, but once fried with wine it first of all rises upward, and second, it can travel the channels. Now look: chaihu, huangqin, plus banxia (pinellia) and gancao (licorice) — short of a single dose of renshen (ginseng), this is exactly Xiao Chaihu Tang (Minor Bupleurum Decoction)!
💬 Note from Doctor Luo: Do you see the trick? A Minor Bupleurum Decoction is hidden inside this formula. Xiao Chaihu Tang was originally for external pathogenic invasion lodged halfway between the interior and exterior (the shaoyang pattern); it harmonizes shaoyang and soothes the liver and gallbladder. Today we also use it to regulate conditions caused by emotions — liver qi stagnation and disharmony between liver and gallbladder. Because Yang Gong’s illness was bound up with the liver and gallbladder, Doctor Luo Tianyi used the Xiao Chaihu structure to disperse the stagnation and regulate the qi mechanism — that is his hidden thread.
Now look again: banxia, jupi (tangerine peel, chenpi), fuling (poria), gancao (licorice) — this is Er Chen Tang (Two-Cured Decoction)! Er Chen Tang is the ancestral formula for transforming phlegm; almost every later phlegm-resolving formula was derived from it.
💬 Note from Doctor Luo: Inside this one Tianma Banxia Tang, the Xiao Chaihu layer soothes the liver and gallbladder and regulates the qi mechanism, while the Er Chen layer transforms phlegm — dispersing stagnation on one side, transforming phlegm on the other. He also added wine-fried huanglian (coptis) — only three fen (about 1 g), a very small amount — riding the wine upward without being too cold, dedicated to clearing that heat up above; and shengjiang (fresh ginger) matched with banxia — pungent and warm, to treat wind-phlegm — for Chinese medicine holds that “tan fei wen bu hua — phlegm will not transform without warmth”; without some warm-natured herb, the phlegm cannot dissolve. Do you see it? This formula harmonizes cold and heat at once: huanglian clears heat, shengjiang warms and transforms. And there is one more herb — qianhu (hogfennel root) (not mentioned in the formula analysis, but present in the formula) — which opens the lung qi and transforms phlegm, the herb commonly used for coughs with abundant sputum.
A few doses and the illness was gone; the next spring, a poem arrived
How was the formula taken? Ground into a fine powder, simmered in water as a drink, with a few slices of ginger added. And the result? After only a few doses (fu zhi shu fu), the pathogenic qi was settled, vitality was restored (sheng qi fu), and the body was at peace. An old patient so dizzy his eyes would not open, so vexed he wanted to vomit, his face swollen — Doctor Luo Tianyi cured him with internal treatment plus external treatment in just a few doses.
But the story does not end there. The next spring, Yang Gong was leaving to take up a new official post, and before he departed he wrote Doctor Luo Tianyi a classical poem of thanks. The gist of it: the old master Li Dongyuan was “the immortal among physicians,” and you are his single true heir, receiving the old master’s entire learning; now your fame has reached the imperial court (even the emperor knows of you); you cured my illness — what a bond of fate; I pray I may enjoy the middle span of heaven’s years (zhong tian nian), and live to be a hundred and more.
💬 Note from Doctor Luo: I especially love details like this in old cases — a single poem brings the whole scene and the feelings of the age to life: a 72-year-old minister, cured and heading off to his post, taking the trouble to write a poem thanking the man who saved his life. Reading it moves me. It is a rare warmth in the historical record.
Doctor Luo Dalun’s summary: what is “deficient-wind stirring internally”? With every deficiency, there is an excess
This case is one of the earliest in Chinese medicine to treat deficient-wind stirring internally. Before this, such cases were rare; it was from Doctor Li Dongyuan and Doctor Luo Tianyi onward that classic cases of treating deficient-wind vertigo appeared — recorded in detail, with names and faces, absolutely genuine. From this case we should remember one term — xu feng nei dong: deficient-wind stirring internally.
💬 Note from Doctor Luo: Chinese medicine divides wind into two kinds: external wind is a pathogenic qi that comes from outside; internal wind arises when the upright qi is insufficient and the body is weak within itself — producing vertigo, tremor, and other “wind-like” movements. Deficient-wind stirring internally has nothing to do with external pathogens; it is entirely the result of internal deficiency. Much of what we today call insufficient blood supply to the brain, Meniere’s syndrome, the vertigo and blackouts of various cerebrovascular disorders, and even the limb tremor of Parkinson’s disease, can be classed under the heading of deficient-wind stirring internally.
To regulate deficient-wind vertigo, remember two principles. First: deficiency comes first (xu wei xian) — deficiency of liver and kidney yin, loss of blood, insufficient upright qi: that is the root, and the root must be tonified. Second: with every deficiency there is an excess (you xu bi you shi) — you cannot simply tonify.
💬 Note from Doctor Luo: Why “with every deficiency there is an excess”? Watch an irrigation ditch when you water a field: wherever a stone blocks the channel, when you pour water in at one end, the water on the blocked side rises higher and higher — that is the excess pattern; on the far side of the stone the ditch is dry — that is the deficiency pattern. Whenever there is a blockage, one side is bound to become excess and the other deficiency. So treatment cannot stare only at the deficiency — you must also open the stagnation: regulate the qi mechanism and transform phlegm, as Doctor Luo Tianyi did, opening the blockage, and only then use tianma to nourish yin and settle the wind — deficiency and excess both addressed. That is the true path for regulating deficient-wind stirring internally.
Bonus: a food therapy recipe — the Yunnan tianma egg cake
This case also carries a useful piece of knowledge: tianma (gastrodia) is both medicine and food, and today people in Yunnan and elsewhere eat it regularly. Doctor Luo Dalun learned a trick from the locals in Yunnan — slice tianma, or grind it into powder, and steam it together with eggs into an egg cake, eating a little bit every day.
💬 Note from Doctor Luo: Eggs themselves nourish yin, and tianma settles liver wind and unblocks the channels; the two together make an excellent food therapy. Many elderly friends today have dizziness, limb tremor, or blocked channels from insufficient blood supply to the brain — they may use tianma as appropriate — but remember: use tianma on the foundation of regulating qi and blood, and only then does it work well. Follow Doctor Luo Tianyi’s order: first regulate the qi mechanism and transform the phlegm turbidity, then use tianma to settle the wind — and a few doses finished the job.
Case source: Weisheng Baojian (Precious Mirror of Hygiene), medical case of Doctor Luo Tianyi (case title: a successful treatment of vertigo from deficient-wind stirring internally); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).