Wheezing, Racing Heart, on the Brink of Collapse? Doctor Zhang Xichun’s Four Liang of Prepared Rehmannia Brought a Kidney-Deficient Woman Back from the Edge
Opening: another prepared rehmannia special — first, where this herb comes from
Doctor Luo Dalun says: let’s keep going with how Doctor Zhang Xichun used prepared rehmannia (shu di huang). This herb is what Chinese medicine calls an authentic regional product (dao di yao cai) — it comes from a very particular place. Where? The same place as Chinese yam: Wenxian county, Jiaozuo, Henan province. You see — these two herbs really are a perfect pair.
💬 Note from Doctor Luo: What did Wenxian county belong to in ancient times? The old Jiaozuo area was called Huaiqing Prefecture (Huaiqing Fu), so the four authentic regional herbs produced there are known in Chinese medicine as the Four Great Huai Herbs (Si Da Huai Yao) — Chinese yam, rehmannia, chrysanthemum, and achyranthes root (niu xi). All four carry real weight in Chinese medicine, and among them, yam and rehmannia are the two leading generals. Today’s case just happens to be these two generals working together.
Who was the patient? A woman surnamed Gao from Baizhuang village, frail from birth
The story goes back to when Doctor Zhang Xichun was still living in his hometown. In a neighboring village called Baizhuang lived a woman surnamed Gao. Her body was extraordinarily weak — as the case record puts it, zi bing su lei ruo — her natural endowment was poor, her foundation thin from the very start.
💬 Note from Doctor Luo: What does zi bing su lei ruo mean? It means a weak constitutional foundation — the body has been deficient since childhood. This kind of patient usually looks fine on ordinary days, but once illness strikes, it’s precisely these people who run into the biggest trouble — because they have no capital with which to fight the pathogen.
How sick did she get? Five or six days into a febrile disease, she was wheezing so badly she couldn’t breathe
This time, what Gao caught was an externally contracted febrile disease (wen bing) — a heat-type external illness. By the fifth or sixth day, the situation took a sharp turn for the worse: severe phlegm wheezing (tan chuan shen ju). She was coughing up phlegm, wheezing terribly, gasping for air, unable to catch her breath — the coughing and wheezing somewhat resembled an asthma attack. The family hurriedly sent for Doctor Zhang Xichun.
The first formula: Minor Green Dragon Decoction Plus Gypsum — one dose and the wheezing stopped
After examining her, Doctor Zhang Xichun prescribed the Minor Green Dragon Decoction Plus Gypsum (Xiao Qing Long Jia Shi Gao Tang) from the Synopsis of Prescriptions of the Golden Chamber (Jingui Yaolue). One dose went down — and the wheezing stopped at once. The effect was immediate.
💬 Note from Doctor Luo: The reasoning here is crucial. What does Minor Green Dragon Decoction do? It mobilizes the kidney qi (dong shen qi) — it draws up the essence and qi stored in the kidneys to fight the pathogen. In a person with sufficient kidney qi, the moment it’s mobilized it holds the line and the illness resolves. But in a person with insufficient kidney essence, once you call up that qi and spend it, complications follow — the capital gets used up, and the person collapses fast. So whether this formula works depends entirely on the patient’s foundation.
A peaceful night, then a sudden turn at dawn: the wheezing came back, with a racing heart and a clouded mind
Sure enough, the worry became real. That evening, at around eight o’clock, Gao lay down and slept peacefully through the night. But the next morning, the wheezing suddenly erupted again — and this time it was even fiercer. She grew mentally confused (jing shen huang hu) — something felt wrong inside, her heart was in a panic, her mind started to go blank.
💬 Note from Doctor Luo: This is the classic picture of “the external pathogen hasn’t been fully cleared, and the upright qi gives out first.” The night before, she looked fine — but in reality, the kidney essence that Minor Green Dragon Decoction had mobilized to fight the pathogen was nearly spent. At dawn, the moment upright qi relaxed, the pathogen counterattacked, and the patient headed straight toward collapse (xu tuo).
One touch of the pulse, and Doctor Zhang Xichun was alarmed: like hemp seeds floating on water — the upright qi was about to scatter
Doctor Zhang Xichun took her pulse — it was like hemp seeds floating on water (ru shui shang fu ma). What does that mean? The pulse was deficient, floating, drifting upward — and when he pressed down on it… my goodness, the pulse vanished under his fingers. Worse, it couldn’t be counted (bu fen zhi shu) — how fast was it beating? Thump, thump, thump, thump — so fast the beats couldn’t be told apart.
💬 Note from Doctor Luo: This is the pulse of upright qi about to collapse (zheng qi yu tuo). Floating without a root, scattering the moment it’s pressed, beating wildly fast — it tells you the kidney essence has been depleted to the extreme and the very foundation of the person is being pulled up. Any more delay, and she would have been beyond help.
The prescription highlight: four liang of prepared rehmannia! A massive replenishment of kidney essence, paired with one liang of dried yam slices
Now Doctor Zhang Xichun himself was alarmed, and he wrote the prescription quickly. He realized where the problem lay — kidney essence was exhausted (shen jing kui jie). What was the formula? Prepared rehmannia, four liang! A powerful replenishment of kidney essence; paired with dried Chinese yam slices, one liang, to tonify the spleen. Look at that — prepared rehmannia and yam, working together again: one replenishes the congenital essence, the other tonifies the acquired spleen.
💬 Note from Doctor Luo: How much is four liang? By today’s reckoning, one liang is about 30 grams, so four liang comes to 120 to 130 grams — to be used within a single day. That sounds alarming by modern standards, but Doctor Zhang Xichun knew exactly what he was doing: this was a life-saving dose.
No codonopsis to be found — so just two herbs decocted as water: three doses in one day, twelve liang of prepared rehmannia in total
Originally, the formula was meant to include one more herb — Tai Dangshen (tai dang shen, wild codonopsis root from the Mount Wutai region, used to tonify qi and support the foundation). But the pharmacy people ran around for half a day and couldn’t buy any ginseng at all. Doctor Zhang Xichun said: fine — use just prepared rehmannia and dried yam these two herbs, and decoct the water right away! That day the patient took three doses in succession, using twelve liang of prepared rehmannia in total.
💬 Note from Doctor Luo: Twelve liang of prepared rehmannia in a single day — close to three hundred-plus grams. That is a very, very large amount. Why pair it with yam? Yam tonifies the spleen — one herb greatly replenishes kidney essence, the other tonifies the spleen; spleen and kidney are tonified together, and the foundation gets filled up all at once. And what was the result? The illness was cured (qi bing jing yu) — after those twelve liang of prepared rehmannia, the patient recovered the very same day! What does that tell you? It tells you that prepared rehmannia’s power to tonify the kidney is extremely strong — once the upright qi is filled up, the person can pull through.
Why did he dare use such a large dose? The experience of the ancients — and the star ingredient of Liu Wei Di Huang Wan
This heavy use of prepared rehmannia was common among the physicians of old. For example, Fu Qingzhu — the great Qing-dynasty gynecologist — regularly used prepared rehmannia in heavy doses; today, using 90 grams or more is routine for us. Why? Because with a large dose, you fill up the kidney essence in one go, and the person comes back.
💬 Note from Doctor Luo: This is our clinical experience: prepared rehmannia used in small amounts has little power — whenever you use it, you basically start at 50 or 60 grams and up. The most familiar example is Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) — its single most important ingredient is prepared rehmannia, paired with Chinese yam and cornus fruit to tonify the liver, spleen and kidney, plus a few draining herbs — six ingredients in all. The dominant one, occupying by far the largest share, is this prepared rehmannia. So in critical moments, people with insufficient kidney essence rely on it to hold the line.
Doctor Zhang Xichun’s own postscript: shouldn’t he have used Lai Fu Tang? Doctor Luo’s view: what exists is reasonable
At the end of this case record, Doctor Zhang Xichun added a note. He wrote that this pattern, strictly speaking, should have been treated with Lai Fu Tang (Restoration Decoction) — a formula led by two liang of cornus fruit (shan yu rou), plus dragon bone (long gu), oyster shell (mu li) and other herbs. It was only that he was still young at the time, and Lai Fu Tang hadn’t been created yet.
💬 Note from Doctor Luo: Even though Doctor Zhang Xichun said that, I think what exists is reasonable (cun zai ji he li). Lai Fu Tang might also have worked — but perhaps not this fast. The patient was cured of such a serious illness in a single day — what does that show? It shows that using prepared rehmannia with dried yam at that moment was exactly right. And there’s another insight hiding behind this: Doctor Zhang Xichun must have read an enormous number of ancient texts. If you don’t read the old books, you’d never know that prepared rehmannia could be used in such a large dose, or used this way at all. He read the ancients’ writings, gained an understanding from them, met this patient while still young — and cured her in one stroke.
Bonus: an everyday use — prepared rehmannia with dried yam slices, decocted as water, to greatly tonify the spleen and kidney
Finally, Doctor Luo Dalun offers everyone an everyday pairing: prepared rehmannia with dried Chinese yam slices, decocted and drunk as water. It can greatly tonify the spleen and kidney and support the body’s upright qi. For people with kidney deficiency, people with insufficient kidney essence, this method works very well.
💬 Note from Doctor Luo: Remember this herb pair — prepared rehmannia with dried yam slices. One nourishes the kidney and fills the essence, the other strengthens the spleen and boosts qi — spleen and kidney tonified together. It’s a pairing Doctor Zhang Xichun particularly loved. Tomorrow we’ll continue: how exactly to use prepared rehmannia with dried yam, and how to nourish our spleen and kidneys with it.
Based on Doctor Luo Dalun’s explanations of Doctor Zhang Xichun’s case records. The case is from Records of Chinese Medicine with Reference to Western Medicine (Yixue Zhongzhong Canxi Lu), published in installments between 1918 and 1934.