Elderly Leg Swelling, Whole-Body Edema and Scanty Urine? Doctor Zhang Xichun’s Xuanyang and Jiyin Decoctions for Yin-Yang Dual Deficiency Edema

The opening: a woman in her sixties, swollen all over

In Cangzhou there lived an elderly woman surnamed Liu, past sixty, who had come down with the very complaint many older people know all too well — edema with scanty urine, the whole body swollen.

💬 Note from Doctor Luo: This kind of edema is especially common in the elderly. Look at the shin bone — the front of the lower leg: press it and it pits, leaving a hollow that stays for a long time. And in the afternoon the hand feels tight when you make a fist, even though it was fine in the morning. That is edema — scanty urine, with very little coming out each time.

So there she was, swollen day after day, urinating less and less, and life growing harder by the day.

The first doctor’s approach: drain it! Buckets of water out the bottom

What did the doctor do? He prescribed drastic purgatives that forcefully expel water — the herbs were ground into powder and given to the old woman. After taking it, the water came pouring out — bucket after bucket — and the whole-body swelling disappeared completely.

💬 Note from Doctor Luo: The key ingredient in that formula was gan sui (Euphorbia kansui) — a violent hydrogogue that sends water rushing out downward. The doctor also ordered: no salt — for a hundred days, not a single grain of salt.

Looked effective, didn’t it? Unfortunately, the good times did not last.

After three rounds of purging, not a drop of urine

Within days the edema swelled right back up, exactly as before. She took the medicine again, the water poured out again, and the swelling vanished again. A few days later, it came back. Back and forth, round after round.

💬 Note from Doctor Luo: By the third round, something went badly wrong — the old woman passed not a single drop of urine at all. At that point nobody dared give her that medicine again. Other doctors were called in, but after one look they said the prognosis was poor, they couldn’t treat her — go find someone else.

A case nobody would take — and in the end it reached Doctor Zhang Xichun.

Doctor Zhang Xichun takes the pulse: fast, yet utterly without strength

The moment Doctor Zhang Xichun felt her pulse, his brow furrowed: the pulse was racing — a rapid pulse (shu mai); yet press down and it vanished — no strength at all.

💬 Note from Doctor Luo: What does a rapid pulse mean? Yin deficiency. What does a pulse without strength mean? The yang aspect is deficient too. So this was dual deficiency of yin and yang. The root of this woman’s illness was not the water — it was the qi. The qi transformation (qi hua) had lost its power.

So why couldn’t the water get out? Doctor Zhang Xichun laid out a principle that is absolutely key.

Water becomes urine only when the upright qi does the transforming

Why does the water you drink turn into urine and leave the body? What is needed is used, and the waste becomes urine that is excreted — all of it depends on sufficient upright qi (zheng qi) and vigorous qi transformation.

💬 Note from Doctor Luo: When the upright qi is insufficient and qi transformation is weak, the waste cannot be excreted, the surplus water stays in the body, and it becomes edema. So this illness looks like too much water — but the true root is dual deficiency of qi and yin. It is not something you can solve by draining water alone.

With the root understood, Doctor Zhang Xichun wrote two formulas — one to tonify yang, one to nourish yin.

The yang-tonifying formula: ginseng paired with ophiopogon — this is Xuanyang Tang

The first formula leads with ren shen (ginseng), aided by mai dong (ophiopogon root).

💬 Note from Doctor Luo: Ginseng tonifies qi, but it runs slightly warm; ophiopogon nourishes yin and is cooler in nature. Put the two together, and the formula is neither cold nor hot. Doctor Zhang Xichun believed that when ginseng is paired with yin-nourishing herbs, it can tonify not only qi but blood as well.

Ginseng with ophiopogon — this is in fact the thinking behind the famous Sheng Mai Yin (Pulse-Engendering Powder). Doctor Li Dongyuan already put this formula in his Treatise on the Spleen and Stomach (Pi Wei Lun), saying that in summer one may take Sheng Mai Yin — with wu wei zi (schisandra fruit) added, of course. On this foundation Doctor Zhang Xichun added wei ling xian (clematis root) to move the channels and circulate the qi, and a small amount of di fu zi (kochia fruit) as a guide herb to lead the formula where it needs to go. This yang-tonifying formula he named Xuanyang Tang — the Yang-Venting Decoction.

The Qianlong Emperor’s secret to eating ginseng without getting overheated: one qian of ginseng to one qian of ophiopogon

Speaking of ginseng paired with ophiopogon, Doctor Luo told a story from the Qing imperial palace.

💬 Note from Doctor Luo: Sheng Mai Yin is a famous formula, and the Qing emperors took it every day. The Qianlong Emperor lived to 89, and from his forties on he ate ginseng every single day — three grams, which is one qian. Now, how could he eat ginseng year after year and never get overheated? An ordinary person eating that much would have blood pouring from the nose. The secret was the pairing: one qian of ginseng with one qian of ophiopogon — that is called Shen Mai Yin (Ginseng and Ophiopogon Drink). Sheng Mai Yin occasionally adds wu wei zi, but most of the time it does not — just ginseng with ophiopogon, and the ginseng loses its overheating effect.

Doctor Luo himself does exactly the same thing.

💬 Note from Doctor Luo: I keep it in my own bag at all times — Korean ginseng ground to powder, ophiopogon ground to powder, mixed one to one, carried with me every day. I lecture all day and spend my qi, so I use it to tonify qi: every day I take six grams (three grams of ginseng, three grams of ophiopogon) and steep it in water to drink. It supports the qi.

The yin-nourishing formula: prepared rehmannia with tortoise shell — and peony to keep it moving

The second formula nourishes yin, leading with shu di huang (prepared rehmannia).

💬 Note from Doctor Luo: Prepared rehmannia tonifies the kidney yin and the kidney essence — it is the essential herb for nourishing yin. Paired with gui ban (tortoise shell) to enrich the yin, and then shao yao (white peony root) — which moves the cloying richness of the rehmannia so it does not become sticky and obstructing, and also opens the channels. Again, a small amount of di fu zi is added as the guide. This yin-nourishing formula he named Jiyin Tang — the Yin-Nourishing Decoction.

Xuanyang Tang tonifies yang, Jiyin Tang nourishes yin — one yang, one yin. How were they to be taken?

The most brilliant touch: three days of yin first, then three days of yang

The ordinary way to take them is: Xuanyang Tang during the day (taken after waking in the morning), and Jiyin Tang before sleep at night — matching the yang of day and the yin of night.

💬 Note from Doctor Luo: But Doctor Zhang Xichun had a more unusual idea. He had the old woman take three days of Jiyin Tang first, devoting herself entirely to nourishing yin — once the yin was filled up, her urine began to increase. Only then did she take three doses of Xuanyang Tang — this is what he called “yang born from within yin”. Then came three more doses of Jiyin Tang. Three days of yin, three days of yang, alternating back and forth.

Urine flowing like a spring — and the swelling gone with it

So how did it all turn out after this course of tonification?

💬 Note from Doctor Luo: After three doses of Xuanyang Tang, the urine flowed abundantly — the volume picked up. Then three more doses of Jiyin Tang, and the urine came gushing like a spring, and the edema disappeared all at once — cured! The illness that the purgatives could not drain away was cured instead by tonifying both yin and yang.

Bonus: two rhythms of dual yin-yang tonification you can use today

Finally, Doctor Luo distilled today’s lesson into two takeaway points.

💬 Note from Doctor Luo: The first point: ginseng can be paired with ophiopogon — this keeps the ginseng from running too hot, so you tonify qi without getting overheated. The second point: the rhythm of dual yin-yang tonification can be arranged flexibly — you can tonify yang in the morning and yin at night, or you can tonify yin for a stretch and then yang, cycling like Doctor Zhang Xichun with his three days of yin and three days of yang. These are elegant uses of Chinese medicine, and they work remarkably well. If you take away these ideas, today’s lesson has not been wasted.

Edema is not something you solve by draining water alone — when the upright qi is insufficient and qi transformation is weak, the water simply cannot get out. Doctor Zhang Xichun used ginseng to tonify the qi and prepared rehmannia to nourish the yin — tonifying both yin and yang, until the water found its own way out. Tomorrow, Doctor Luo continues with how Doctor Zhang Xichun treated his patients.

What to take away

• The real root of edema: surplus water is only the surface. When upright qi (zheng qi) is insufficient and qi transformation (qi hua) is weak, waste cannot be excreted and water accumulates — draining alone will not fix it.
• The dangerous detour: drastic hydrogogues like gan sui (Euphorbia kansui) can push out buckets of water, but the edema returns — and after repeated purging, the patient may end up passing no urine at all.
• The yang formula: Xuanyang Tang (Yang-Venting Decoction) — ren shen (ginseng) to tonify qi, mai dong (ophiopogon) to balance its warmth, wei ling xian (clematis) to move the channels, di fu zi (kochia fruit) as guide.
• The yin formula: Jiyin Tang (Yin-Nourishing Decoction) — shu di huang (prepared rehmannia) and gui ban (tortoise shell) to nourish yin, shao yao (white peony) to keep the rehmannia from becoming cloying, di fu zi as guide.
• Ginseng without overheating: pair one qian of ginseng with one qian of ophiopogon (Shen Mai Yin) — the Qianlong Emperor’s daily habit, and Doctor Luo’s own go-to for supporting qi during long days of speaking.
• The flexible rhythm: dual tonification can follow day/night (yang by day, yin by night) or longer alternating blocks — Doctor Zhang Xichun used three days of yin, then three days of yang, then yin again, and the urine flowed like a spring.

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).