Leg Pain So Bad She Couldn’t Walk — And Then Her Back and Shoulders Ached Too? Doctor Zhang Xichun Tonified the Spleen with Bai Zhu (Atractylodes)

The opening: one herb, curing one leg-pain case after another

Today’s leading character is, once again, Bai Zhu (atractylodes) — the “pillar” of spleen tonification in Chinese medicine.

💬 Note from Doctor Luo: The main job of bai zhu is to tonify the spleen — tonify the spleen, everyone, do remember that. In the most basic qi-tonifying formula of Chinese medicine, Si Jun Zi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), and gan cao (licorice) — bai zhu sits right in there, steady and reliable. And notice: Doctor Zhang Xichun’s last several cases, one after another, were all leg problems — and in every one of them he used bai zhu. Today’s story is another one: he tonified the spleen with bai zhu and cured a young woman’s leg pain.

Who was the patient? A girl whose legs hurt so badly she could hardly walk

This patient was a maidservant — an unmarried girl working in a household. Her illness sounded simple but was anything but mild: leg pain — and how bad was it? She could barely walk at all.

💬 Note from Doctor Luo: You see, this leg pain was serious. When it first struck, Doctor Zhang Xichun gave her a single formula — Jian Yun Tang (Health-Moving Decoction) — and it cured her. But that was not the end of the story. The next year, the old illness came back — and this time, not only did her legs hurt again, she had also developed back pain and shoulder pain. Leg pain and back pain together — what do you do then?

The same formula — this time it didn’t work

Doctor Zhang Xichun first tried Jian Yun Tang again, exactly as before. The result? No effect. Then he took her pulse: the right guan position was very soft and weak (ru ruo) — when he laid three fingers on the wrist, it was the middle finger, the one over the guan position, that felt weakest of all.

💬 Note from Doctor Luo: On the right wrist, the cun, guan, and chi positions correspond to the lung, spleen, and ming men (life gate) — the lung, the spleen, and the life gate — and of these, the guan position governs the spleen and stomach. When the right guan pulse is weak, what does that tell you? The spleen and stomach are deficient. He then asked the girl about her eating: she said her appetite was very poor — she couldn’t get food down. A weak pulse, poor appetite — the evidence for spleen deficiency was complete. Same patient, same illness — why did Jian Yun Tang stop working this time? Because the situation had changed. The root of the illness was in the spleen and stomach now, and this time he had to start from the spleen and stomach.

The spleen governs the four limbs: when the legs have no strength, think of spleen deficiency first

Why would spleen deficiency cause leg pain? Doctor Zhang Xichun reached for one of the core theories of Chinese medicine — the spleen governs the four limbs.

💬 Note from Doctor Luo: The muscles of our four limbs are “fed” by the spleen. When the spleen absorbs nourishment well, the limbs are supplied and the muscles have strength; when the spleen is deficient, the limbs start to go wrong. What’s more, when spleen qi is insufficient, dampness builds up, and dampness sinks downward — so pain from spleen deficiency usually shows up not in the arms but in the lower limbs — that is the leg pain of spleen deficiency. Also, the spleen sits in the center of the body, and the center belongs to Earth, which waters and nourishes all four directions — so whenever there is a problem in the limbs, there is one line of thinking you must always consider: spleen deficiency. That is Doctor Zhang Xichun’s experience.

There is a nice echo here. Doctor Zhang Xichun had discussed earlier how leg pain after a fit of anger comes from liver qi stagnation and liver deficiency, which he treated with herbs like shan zhu yu (cornus fruit) — and cured it. Some listeners of that talk treated their own leg pain with the same formula and got better themselves.

💬 Note from Doctor Luo: Same leg pain — but one case is treated through the liver and the other through the spleen. That is the art of pattern differentiation (bian zheng) in Chinese medicine. You see, just the two words “leg pain” can hide completely different roots of illness — never imagine that a single formula works for everything.

The prescription revealed: six qian of bai zhu at the head — Zhen Zhong Tang

This time the formula Doctor Zhang Xichun wrote has a very interesting name: Zhen Zhong Tang (Revitalize-the-Middle Decoction) — “zhen zhong” means to rouse and invigorate the qi of the middle burner, the spleen and stomach. The formula went like this:

• Bai Zhu (atractylodes) 6 qian (about 18 g) — the main herb, tonifying the spleen, given in a heavy dose;
• Dang Gui (Chinese angelica) 2 qian — nourishing the blood;
• Chen Pi (aged tangerine peel) 2 qian and hou po (magnolia bark) 1.5 qian — moving the qi and draining dampness;
• Ru Xiang (frankincense) 1.5 qian and mo yao (myrrh) 1.5 qian — unblocking the channels and invigorating the blood.

💬 Note from Doctor Luo: The main herb in this formula is that six qian of bai zhu. Why emphasize bai zhu for leg pain? Because the root of the illness is in the spleen — when the spleen is deficient, the four limbs lose their nourishment and dampness pours downward, and that is why the legs hurt. Tonifying the spleen is treating the root. Dang gui nourishes the blood; chen pi and hou po move the qi and drain dampness; and ru xiang and mo yao — which we’ve talked about before — are masters at invigorating the blood and unblocking the channels. Tonify, nourish, move, unblock — the formula covers every angle.

About ten days, and the back and leg pain was completely cured

How did it work? After taking this formula, her appetite began to increase and her eating picked up — the spleen’s transport and transformation had started turning again.

💬 Note from Doctor Luo: Bai zhu tonifies the spleen; once the spleen is strong and moving, food goes down properly. She took it for about ten days, and the back and leg pain was completely cured. Notice — no painkillers at all, and the leg pain was cured. Because the root was spleen deficiency; once the spleen recovered, the four limbs naturally got their strength back.

Bonus: the two kinds of bai zhu — don’t mix them up when you buy herbs

Finally, Doctor Luo offers a very practical piece of knowledge — bai zhu comes in two forms at the pharmacy.

💬 Note from Doctor Luo: One is chao bai zhu (stir-fried atractylodes) — bai zhu that has been dry-fried until cooked; it tonifies the spleen and drains dampness. The other is raw bai zhu (sheng bai zhu), whose dampness-draining power is even stronger. When we treat low back pain, we often use raw bai zhu. In today’s formula, Doctor Zhang Xichun used stir-fried bai zhu. When you go to buy herbs, please don’t mix the two up.

And bai zhu is both medicine and food — very gentle and mild, with essentially no side effects — which is why it appears in so many Chinese medicinal formulas. From now on, whenever you see this herb, you’ll know what it’s for.

When your legs hurt, don’t just reach for blood-invigorating painkillers — first ask whether the spleen is deficient. For tonifying the spleen and draining dampness, bai zhu is a fine hand. Tomorrow, we’ll continue with Doctor Zhang Xichun’s stories.

What to take away

• Leg pain can have a spleen root: when the legs are weak and aching, first think of spleen deficiency — the spleen governs the four limbs, and when it weakens, dampness sinks into the lower body.
• The same formula failed the second time: the illness had changed; the right guan pulse was soft and weak and her appetite was gone — the evidence pointed squarely at the spleen and stomach.
• Doctor Zhang Xichun’s move: Zhen Zhong Tang (Revitalize-the-Middle Decoction) — a heavy dose of bai zhu (atractylodes, 18 g) to tonify the spleen, with dang gui to nourish blood, chen pi and hou po to move qi and drain dampness, and ru xiang and mo yao to invigorate blood and unblock the channels. Tonify, nourish, move, unblock — all angles covered.
• The result: appetite returned, and after about ten days the back and leg pain was completely cured — no painkillers involved.
• Liver vs. spleen: Doctor Zhang Xichun had earlier treated leg pain after anger through the liver (with shan zhu yu); this case was treated through the spleen — the same symptom, different roots, which is the essence of pattern differentiation.
• Buying bai zhu: stir-fried bai zhu (chao bai zhu) tonifies the spleen and drains dampness; raw bai zhu (sheng bai zhu) is stronger at draining dampness and is often the choice for low back pain.

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