Hard Lumps in the Belly for Over 20 Years? Doctor Zhang Xichun Dissolved Stubborn Old Abdominal Masses with Li Chong Tang
Opening: two cases, both with names and faces
In the last few episodes we’ve been talking about how Doctor Zhang Xichun used sheng jineijin (raw chicken gizzard lining). Today Doctor Luo Dalun tells two cases with real names attached. The first patient is the wife of Sun Yishan, a provincial assemblyman of Fengtian (at the time “Fengtian” referred to the area of Liaoning and Shenyang). The second is the wife of Sun’s fellow townsman, Wang Zunshan. An assemblyman was a highly respected public position in those days — the kind of man who carried real weight in society.
💬 Note from Doctor Luo: Doctor Zhang Xichun had a particular gift for one kind of illness — abdominal masses in women. These two cases today, one of twenty years, one of nineteen, were both ancient, stubborn illnesses — and he cured them both.
The first lady: hard lumps in the belly for more than twenty years
Madam Sun was in her forties. Ever since her youth she had felt a hard lump below the stomach (in the epigastric and abdominal region), and it had never gone away for over twenty years. The lump multiplied until finally her whole belly was full of them — press on it and it was rock hard.
💬 Note from Doctor Luo: Notice what the lady said: “my belly is full of hard lumps, and pressing on them is hard.” In Chinese medicine this kind of mass is called zheng jia — the product of blood stasis and deficient upright qi entangling each other for years until something solid forms. By today’s standards, many benign tumors and lumps — including uterine fibroids and ovarian cysts — fall into this category.
Besides the lumps, she suffered frequent pain (stomach pain that came and went), and xin zhong zheng chong — that feeling of your heart racing and jumping, restless and unable to sit still. She also could not eat properly — her appetite was poor and she ate very little (not that she couldn’t swallow anything at all).
Doctor Zhang’s first assessment: the illness had dragged on so long that the blood stasis was already severe
Madam Sun came for treatment at Lida Hospital of Chinese Medicine, the hospital Doctor Zhang Xichun himself had founded. Doctor Zhang’s diagnosis: this illness has gone on far too long, the blood stasis is already very heavy, and it should be hard to treat — ordinary medicines would not do.
💬 Note from Doctor Luo: Doctor Zhang wasn’t trying to frighten her. When a mass has been growing for more than twenty years, the qi and blood have been stagnant and blocked for a very long time — deficiency and stasis are tangled together, which is the most intractable combination there is. But then he looked at one more thing, and it gave him confidence.
What was it? The pulse. Doctor Zhang said: fortunately, the pulse still has strength and still holds its root — the upright qi has not been completely damaged, so the illness can still be treated.
The prescription: Li Chong Tang with leech, plus a little “insurance”
Doctor Zhang prescribed his own formula Li Chong Tang (Regulate the Thoroughfare Decoction, which we discussed in earlier episodes), and into it he added shuizhi (leech), 3 qian (about 9 g) — the leech is the leading herb for breaking blood and expelling stasis. But he was also afraid the leech’s blood-breaking power might be too fierce and damage the upright qi, so he made two preparations at once:
💬 Note from Doctor Luo: First, he raised the dose of ren shen (ginseng) and huangqi (astragalus) by 1 qian each (a mere 3 g) — to hold the upright qi secure, so that attacking the pathogen wouldn’t wound the body. Second, he added tiandong (asparagus root), 3 qian — why? To restrain the warming nature of the ginseng and astragalus — in other words, to add a bit of yin-nourishing medicine so the whole formula stays balanced between attack and support and doesn’t create heat. This is the fine craft of Doctor Zhang’s prescribing.
After forty-plus doses, the lumps shrank by more than half
After a few doses, Madam Sun could eat again — her appetite was back. Once the stomach qi opened, there was a turning point. After more than forty doses, a fair amount of stasis came out of her belly, and the lumps shrank by more than half.
The patient and her family were optimistic. But right then something happened at home — the Sun family were from Liuhe, and when a family matter arose there, the assemblyman took his wife back to the countryside, and the medicine was not continued.
A year off the medicine, and the old illness came back
A year later, the accumulation in her belly filled up again — the illness had relapsed! Madam Sun hurried back and returned to Lida Hospital of Chinese Medicine.
Doctor Zhang said: we’ll use the same formula — I’ll keep treating you.
💬 Note from Doctor Luo: This is the lesson of relapse. An illness like zheng jia is not something you can stop treating once a few doses have dissolved most of it — the remaining root of the disease is still there, and the moment you stop, it easily comes back in force. Doctor Zhang’s position: this kind of stasis has to be dissolved out little by little; you can’t rush it.
Seventy-plus more doses: what came out looked like sheets, lumps, and a placenta
This time she again took more than forty doses, and several lumps were passed urgently; then she took thirty more doses — in total more than seventy doses over nearly two months.
💬 Note from Doctor Luo: Given Doctor Zhang’s skill, having a patient keep taking medicine for more than seventy doses is no small thing. He was committed to one principle: this kind of illness cannot be dissolved all at once — it has to dissolve slowly.
As she took the medicine, the stasis kept coming out — and what came out was sometimes sheet-like, sometimes lump-like, sometimes like a thick membrane, rather like the afterbirth (placenta) that comes away when a woman gives birth.
At that point Madam Sun began to feel weak — her belly felt especially wide and light, but she was a little depleted. Doctor Zhang, fearing the stasis had not fully cleared, gave her some strengthening-and-stasis-dissolving medicine to regulate and support her, and with that, this patient was cured.
The second lady: nineteen years of stasis — secure the upright qi first, then dissolve the stasis
A few months later, Sun Yishan introduced the wife of his fellow townsman Wang Zunshan. Madam Wang said: I’ve had stasis in my belly for nineteen years, and my whole belly is full of hard lumps — another ancient illness.
Doctor Zhang treated her with Li Chong Tang again, but adjusted it to the person:
💬 Note from Doctor Luo: Madam Wang was deficient in qi by constitution — her qi was insufficient. So Doctor Zhang increased the ren shen and huangqi and cut the sanleng (common burreed rhizome) and ezhu (zedoary) in half — for a person with weak upright qi, you first protect the upright qi; the stasis-dissolving herbs must not be applied too hard.
After a few doses, Madam Wang’s appetite increased — she could eat. Only then did Doctor Zhang restore sanleng and ezhu to their original doses, and after several more doses her strength was robust — the upright qi was growing stronger and stronger.
Then Doctor Zhang added shuizhi (leech), 2 qian (about 6 g), and also ten chuji — also called hongniangzi (red cicada) — an insect medicine that breaks blood and expels stasis, with very strong dissolving power.
💬 Note from Doctor Luo: Step by step, this formula advanced like a careful campaign: first tonify the qi and open the appetite, then restore the blood-breaking doses, and finally add the insect medicine to storm the fortress — only once the upright qi is strong do you dare use heavy medicine against nineteen years of old stasis.
When her period came, the purple-black clots went out with the menses
Madam Wang took more than twenty doses, and it happened to coincide with her menstrual period — a fair amount of purple-black blood clots came down with the flow, and the illness was half cured. Then she took thirty more doses, and again it coincided with her period — the stasis blood poured out with the menses, and the masses in her whole belly were gone!
💬 Note from Doctor Luo: This is the beauty of the Chinese medical principle “give the pathogen a way out” — by borrowing the menstrual period, the body’s natural channel for discharging blood, the stagnant blood in the abdomen was expelled all at once. Doctor Zhang then prescribed blood-generating and stasis-dissolving medicine to restore her, and the case was closed.
The stars of the formula: raw chicken gizzard lining with sanleng and ezhu
In these two cases, what played the leading role in the formula? Sanleng, ezhu, and sheng jineijin.
💬 Note from Doctor Luo: Interestingly, Doctor Zhang placed these cases in the chapter on sheng jineijin rather than in the chapter on sanleng and ezhu — which tells you something: Doctor Zhang placed enormous value on the power of sheng jineijin. Of course, sanleng and ezhu also did very important work inside the formula.
What method was Doctor Zhang actually using? The method of supplementing the upright and dissolving stasis — on one side tonifying the upright qi, on the other dissolving the stagnant blood. If the patient also had constrained liver qi, qi depression, and the like, he would add qi-moving, depression-resolving herbs to go with the sanleng and ezhu.
💬 Note from Doctor Luo: Doctor Zhang used sheng jineijin with sanleng and ezhu, plus tonics like ren shen, huangqi, and baizhu (atractylodes), and cured many women with abdominal masses. What exactly are sanleng and ezhu? Why, combined with sheng jineijin, do they have such strong stasis-dissolving power? Tomorrow we’ll devote a whole episode to them — after you hear that one, you’ll have a clear grasp of how to use herbs to dissolve masses. Students of medicine will certainly benefit; when you write formulas in the future, you’ll have a sense of measure.
Bonus: dissolving stasis is a slow business — don’t expect to get fat in one bite
💬 Note from Doctor Luo: Look at these two cases together, and Doctor Zhang’s treatment of old masses comes down to one character — persistence. Twenty years, nineteen years of stasis cannot be cleared in a few doses, so you dissolve it out little by little, you must not stop the medicine casually along the way, and when the upright qi is insufficient you top it up in time. That is the right posture for dealing with ancient zheng jia.
Compiled from Doctor Luo Dalun’s explanations of Doctor Zhang Xichun’s medical cases; the cases come from Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments between 1918 and 1934.