A Hard Lump Under the Ribs, Neither Red nor Swollen: Doctor Zhang Xichun’s Four-Herb Formula for a Half-Yin Half-Yang Sore

The strange lump that stumped every doctor before him

Today’s patient was a young married woman. Under her left ribs — the region along the side of the body — a large lump had appeared. And it was a strange one: about five cun long (roughly 16 centimeters), its upper end reaching above her breast, sprawling across the whole area beneath her ribs.

Stranger still was how it looked. When a sore grows, doesn’t the skin usually turn red and swollen? Not here. The skin color hadn’t changed at all — it looked exactly like normal skin. Press it, and it was rock hard underneath. Compared with the surrounding flesh, it felt slightly warm, yet it hardly hurt.

💬 Note from Doctor Luo: This is the crux of the whole case — hard to the touch and pale in color: that is the signature of a yin pattern. But the slight warmth says there is a little yang hidden inside the yin. Neither purely yin nor purely yang — yin with yang within it — this is what we call a half-yin half-yang pattern (ban yin ban yang). It is the hardest kind to recognize, and the hardest kind to treat.

Two months of excellent prescriptions — and no result

The young woman had already seen doctors. They treated her for more than two months with no effect at all — and the lump had actually grown larger than before. At their wits’ end, the family finally came to Doctor Zhang Xichun.

When Doctor Zhang arrived, the first thing he did was look at the earlier prescriptions. They were all good formulas. Some cleared heat and resolved toxins for hot patterns; some warmed yang and scattered cold for cold patterns; some treated it as a breast abscess (ru yong 乳痈). Every formula was on the right track — so why did none of them work?

💬 Note from Doctor Luo: Doctor Zhang Xichun understood at once. The previous doctors had all taken either a purely yin approach or a purely yang approach. But this pattern — hard and pale, which belongs to yin, yet slightly warm, which is yang within yin — slips through both nets. It wasn’t that the earlier physicians were incompetent; it’s that the half-yin half-yang disease is genuinely hard to identify.

How Doctor Zhang Xichun thought about it — the key move of the whole case

Doctor Zhang Xichun told the family: this lump is hard and pale in color — that is yin. But it also carries slight warmth — yang hidden inside yin. So it is a half-yin half-yang disease, yin containing yang.

The family was stunned. A half-yin half-yang disease? They had never heard such a thing in their lives.

💬 Note from Doctor Luo: Everyone finds the idea of “half-yin half-yang” novel. But the body is full of such positions. The area under the ribs, for instance, is traversed by the Shaoyang channel — by nature a half-interior, half-exterior region, sitting between yin and yang. When disease grows in a place like that, the pattern it produces often carries that same half-yin half-yang character.

The prescription: Huoluo Xiaoling Dan — just four herbs

Doctor Zhang Xichun wrote out a formula: Huoluo Xiaoling Dan (活络效灵丹, the “Activate the Collaterals and Instantly Efficacious Elixir”). It is a very simple prescription, only four ingredients:

Dang gui (Chinese angelica) 5 qian, dan shen (red sage root) 5 qian, raw ru xiang (frankincense) 5 qian, raw mo yao (myrrh) 5 qian — each about 15 grams.

Four herbs, decocted into a soup — and she drank it.

💬 Note from Doctor Luo: Regular listeners will recognize this formula. Dang gui and dan shen nourish the blood and get it moving; ru xiang and mo yao are two herbs Doctor Zhang Xichun used with particular fondness — they invigorate blood, resolve stasis, open the collaterals, and stop pain. All four herbs are aimed at one thing: opening. The goal was to release the qi and blood that had become stuck.

Interlude: Doctor Luo himself has tasted this medicine

Some friends will say: ru xiang and mo yao are fine herbs, but they taste terrible!

Doctor Luo Dalun agrees: yes, terrible — I tried it myself.

💬 Note from Doctor Luo: When I was a student learning formulas, our teacher made us decoct the prescriptions and drink them ourselves — if you have never tasted a formula, how can you know what it is like, or how strong it is? I remember it clearly: I brewed and drank Huoluo Xiaoling Dan. The taste was so awful I had to pinch my nose to get it down — once was more than enough, and I never wanted a second cup. So the young woman in this case probably didn’t enjoy her soup either.

A few doses brought relief; thirty doses erased every trace

How did it go? After a few doses, her symptoms eased. She kept taking it, and after thirty doses the lump dissolved completely — gone without a trace!

Why? Doctor Zhang Xichun’s judgment was that the lump was caused by qi and blood stagnation — qi and blood had clogged up under her ribs and congealed into a mass. So he didn’t argue with the lump about whether it was yin or yang. He simply used Huoluo Xiaoling Dan to open things up — once qi, blood, and the collaterals were flowing freely, the stagnation dispersed, and the lump naturally disappeared.

💬 Note from Doctor Luo: This is Doctor Zhang Xichun’s signature style: he worked out the medical reasoning with unusual thoroughness, and tested his herbs one by one himself. So when he combined a formula, it hit the mark right away, and patients improved quickly. This case was handled beautifully!

What this case teaches us

First: stagnant qi and blood can produce all kinds of lumps. A lump in the body never appears without a cause — it is almost always the result of qi and blood stagnation. That is why dissolving a lump so often means taking the road of invigorating the blood, resolving stasis, and opening the channels.

Second: there is a kind of lump that is neither red nor swollen but slowly bulges up. It may be a pure yin pattern — or it may be a half-yin half-yang pattern. Keep the idea of “half-yin half-yang” in mind, and the next time you meet a lump like this, you will have some idea what you are looking at.

💬 Note from Doctor Luo: Many listeners of this program are not practitioners of Chinese medicine; some are students at TCM colleges. For everyone, remembering the phrase “half-yin half-yang” is today’s harvest. Tomorrow, we’ll continue with how Doctor Zhang Xichun used ru xiang and mo yao to rescue ordinary people.

What to take away: a lump is not always simply “hot” or simply “cold.” When the picture is mixed — hard and pale, yet slightly warm — the purely cooling and purely warming approaches both fail. Sometimes the wisest move is not to attack the lump at all, but to open the roads: move the qi, invigorate the blood, and let the body clear its own congestion.

Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Zhang Xichun, from Records of Chinese Medicine with Reference to Western Medicine (《医学衷中参西录》), published in installments between 1918 and 1934.