Arm Aching, Weak and Always Feeling Hot? Doctor Zhang Xichun’s Case of Liver Qi Deficiency
What people search for: arm sore and weak / arm has no strength / arm weakness / left arm feels hot / arm feels hot / one arm sore and weak and without strength Corresponding medical terms: liver qi deficiency · liver deficiency pattern · insufficiency of liver yang · stagnation of the channels
Opening scene: a patient who was fine everywhere — except his left arm
Today’s patient is a curious case: a man in his fifties, healthy in every other part of his body — but this one left arm was wrong. It was sore and weak, couldn’t muster any strength, and it kept feeling hot.
💬 Note from Doctor Luo: Everyone, yesterday we discussed Doctor Zhang Xichun’s first case of treating a liver deficiency pattern (gan xu zheng) with raw astragalus (sheng huang qi) — a gentleman who had great difficulty urinating. Seen through modern eyes, that illness would easily make you think of prostate trouble. But Doctor Luo wants to stress that he is very reluctant to force-fit Chinese medicine patterns onto Western disease names, because sometimes it isn’t the prostate at all — other problems can appear too. Whatever the Western name, if you encounter this kind of liver deficiency pattern, you can use this treatment. That is the Chinese medicine way of thinking. Today we continue with the liver deficiency pattern — this time the arm was the problem.
Who was the patient? Liu Zhongyou of Andong, Fengtian
The patient was named Liu Zhongyou, from Andong, Fengtian — Fengtian is today’s Shenyang, and as for Andong, Doctor Luo admits he isn’t sure exactly where that was. The man was in his fifties, and he made a special trip to the Lida Hospital of Chinese Medicine to see Doctor Zhang Xichun.
💬 Note from Doctor Luo: A huge number of Doctor Zhang Xichun’s cases were accumulated in Fengtian — and Fengtian is my hometown, Shenyang. In his later years he founded the Lida Hospital of Chinese Medicine there, in the Dabei Guan (North Pass) district. Sadly, today you can’t even find the site anymore, and there’s hardly any record of it. We people of Shenyang don’t even know — one of the earliest Chinese medicine hospitals in China was founded right in our Shenyang, and it influenced the entire Chinese medicine world. What a shame. So if any Shenyang friend knows anything about this history, you really should go and ask around — if you find it, that would be a great contribution to Chinese medicine.
What was so strange about the illness? A left arm that was sore, weak — and hot
The strange part of Liu Zhongyou’s illness was this: his left arm frequently felt hot, and there was a sore, weak sensation — aching and soft, no strength in it. Everywhere else was perfectly fine. Just this one arm was off.
The other doctors looked at it: heat? Then there must be heat inside — clear the heat! So they gave him a pile of cold, heat-clearing herbs.
💬 Note from Doctor Luo: Everyone, note that this is the most common mental shortcut — the arm feels hot, so it must be a heat pattern, so clear the heat. And what happened? Let’s keep reading.
The more they cleared heat, the worse it got: cold herbs wounded the spleen and stomach
He took the heat-clearing herbs, and the heat did not improve in the least — the left arm was still hot. Instead he gained a brand-new problem: his spleen and stomach digestion declined. He’d never felt this before — after taking the cold medicine, whatever he ate left him bloated, stuffy and full, clogged up and uncomfortable.
💬 Note from Doctor Luo: You see — the heat never got cleared, and the spleen and stomach got wounded by the cold herbs first. This is the price of not discriminating the pattern and just medicating surface symptoms. The key to treating illness lies in recognizing the mechanism of the disease, not in the surface meaning of the phrase “treat the symptoms.”
Doctor Zhang Xichun takes the pulse: the left hand half as strong as the right
With no other option, the patient came to the Lida Hospital of Chinese Medicine to see Doctor Zhang Xichun. The moment Doctor Zhang Xichun took his pulse, he spotted the big problem immediately: the left pulse was extremely weak — compared with the right pulse, it was only half as strong.
💬 Note from Doctor Luo: Here’s a vivid way to think about it: suppose the strength of the right pulse counts as 100 parts — the left pulse would only be 50 parts. Everyone, that difference is unmistakable. Doctor Zhang Xichun then asked him: apart from the arm, do you feel cold or heat anywhere on your body? He said no — no cold or heat anywhere else. And this is the key point: if there were real heat, a person would feel hot all over. But he didn’t.
What was this illness? Liver qi deficiency — not a heat pattern
A weak pulse, localized heat, no heat signs in the whole body — Doctor Zhang Xichun’s judgment: this was no heat pattern at all, it was liver qi deficiency (gan qi xu ruo)! Both the liver qi and the liver yang were weak.
💬 Note from Doctor Luo: Doctor Zhang Xichun placed enormous importance on the liver qi. The liver governs free coursing (zhu shu xie) — it is responsible for smoothing the movement of qi throughout the whole body. When the liver qi is deficient, it lacks the strength to course through the channels, and the qi easily gets stuck and blocked. The liver qi houses the ministerial fire (xiang huo) — the warming qi — which should travel through the whole body to keep you warm. Now that the liver qi is weak, this qi can’t move, and it gets stuck right there in the left arm — which is why the left arm was hot, sore and weak all at once.
And there’s more: when the liver qi is weak, the problem most easily shows up on the left side.
💬 Note from Doctor Luo: The Huangdi Neijing (Yellow Emperor’s Inner Classic) says, “Left and right are the pathways of yin and yang” (zuo you zhe, yin yang zhi dao lu ye) — the left and right sides of the human body are not the same; don’t assume the two sides are perfectly symmetrical. You can see that in this case the illness appeared on the left side again — exactly matching the rule of the liver deficiency pattern.
The prescription: tonify both yin and yang, and open the channels — one complete formula
With the pattern recognized, the formula followed: raw astragalus (sheng huang qi) and cornus fruit (shan yu rou), eight qian each (about 24 g) — this was the core for tonifying the liver. Raw astragalus tonifies liver yang and liver qi, while cornus fruit nourishes liver yin and liver blood — one yang, one yin, working together on both fronts.
💬 Note from Doctor Luo: This is where Doctor Zhang Xichun’s brilliance shows. Raw astragalus is warm in nature, but paired with cornus fruit — one tonifies yang, one nourishes yin — both the yin and the yang of the liver are built up. Still, astragalus leans toward the warm side, and Doctor Zhang Xichun worried it might be too hot, so he matched it with zhi mu (anemarrhena), five qian (about 15 g), to restrain it — that’s why he always liked large doses of raw astragalus paired with a little zhi mu, to clear away astragalus’s heat.
Next came the channel-opening team: dang gui (Chinese angelica) and dan shen (salvia root) to open the channels, ru xiang (frankincense) and mo yao (myrrh) to regulate the qi and stop pain, plus one more — chi shao (red peony root) to open the channels and invigorate the blood. Yesterday’s case used the first few herbs; today red peony was added. The whole formula tonifies the liver, opens the channels, regulates the qi and invigorates the blood — each ingredient doing its own job.
Two doses and the pulse rose; ten doses and the illness was gone
What was the effect of this formula? After only two doses, the left pulse rose — the pulse grew and began to show strength. After ten more doses, the illness was completely cured, fully recovered.
💬 Note from Doctor Luo: Ordinary doctors can’t cure this kind of illness — they all assume heat and desperately clear the heat. Doctor Zhang Xichun instead tonified the liver, and the patient was well in ten doses — which proves that the liver deficiency pattern he spoke of is real and well-founded. What ordinary doctors couldn’t cure, Doctor Zhang Xichun could cure time and again — in those days, even patients that the Japanese hospitals couldn’t treat were sent to him.
Doctor Luo’s closing note: modern people know far too little about liver deficiency
Doctor Luo says he has spent several days talking with everyone about the liver deficiency pattern, because modern people — including many practitioners of Chinese medicine — don’t know enough about liver qi deficiency. They don’t know what liver deficiency looks like, or how to treat it.
💬 Note from Doctor Luo: People haven’t studied Doctor Zhang Xichun’s experience enough. My advice to people practicing Chinese medicine today: go and study Doctor Zhang Xichun’s case records, his thinking, his methods of using herbs, in depth. This man was remarkable — his prescriptions took effect the moment they were written, an arrow that hits the bullseye every time. As for ordinary people, it’s enough to understand that a liver deficiency pattern exists. Raw astragalus is a very gentle herb — using a bit of astragalus in your daily porridge or soup is completely fine, no different from food therapy.
Bonus story: China’s earliest Chinese medicine hospital opened in Shenyang
To close, a little aside. Doctor Zhang Xichun founded the Lida Hospital of Chinese Medicine in Fengtian, in the Dabei Guan (North Pass) district — one of the earliest Chinese medicine hospitals in China, one that influenced the entire Chinese medicine world. And yet today, the people of Shenyang don’t even know this history, and the site can no longer be verified.
💬 Note from Doctor Luo: A couple of days ago a friend asked me, where exactly in Dabei Guan was the Lida Hospital? It can’t be found now — there are no records. I was thinking: if any Shenyang friend knows something, go and ask around — if you really find it, that’s a contribution to Chinese medicine. All right, tomorrow we’ll continue with how Doctor Zhang Xichun used raw astragalus — let’s try to get to the bottom of raw astragalus once and for all. See you tomorrow!
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the original case comes from Yixue Zhongzhong Canxi Lu (《医学衷中参西录》, published in installments between 1918 and 1934).