Too Exhausted to Get Out of Bed? Doctor Zhang Xichun Treated Exhaustion from Overwork with Ginseng, Chinese Yam and Cornus

Patient search terms: exhausted and bedridden / no strength at all / too tired to talk / weak and run-down body / worn down into a fever / heart racing / constipation Medical terms: consumption (xu lao) · chronic fatigue · deficiency of both qi and blood · yin-deficiency fever

Opening: can a person really be so tired they can’t get out of bed?

Today we continue our series on Doctor Zhang Xichun (张锡纯) with a case of consumption complicated by overwork (xu lao jian lao lu guo du, 虚劳兼劳碌过度) — in plain words, an illness that was literally worked into the patient.

💬 Note from Doctor Luo: You might ask — can a person really get sick to that degree? Yes, truly. When deficiency reaches a certain point, there is no strength left at all; you can’t even get up from bed. I have had patients tell me: “I get up, walk one loop around the yard, come back and lie down — and that’s all I can do for the whole day.” That is not exaggeration. That is what consumption is like.

First, let’s understand the word “lao” — how many kinds of overwork are there?

Before we meet the patient, let’s talk about the term xu lao (虚劳, consumption). In the old days the character “lao” (劳, toil) carried many fine distinctions: excess in the bedchamber was fang lao (room-toil); working every day and wearing the body out was lao (toil); staying up all night and brooding over problems, draining the mind, was also a kind of lao.

💬 Note from Doctor Luo: Pay special attention — this “lao” is easily confused with “fei lao” (肺痨, lung-consumption), written with the illness radical — that is tuberculosis in today’s terms. So when the ancients said xu lao, sometimes they meant tuberculosis, and sometimes they genuinely meant the many kinds of weakness caused by overwork. The two characters xu lao cover a very complex range of meanings.

Who was the patient? A poor household — and then a lawsuit on top of it

The patient was a woman from Tianjin. Her husband’s family name was Fu (傅); her maiden name was Ning (宁). She was nearly forty — in her late thirties. She had carried an old root of consumption for a long time: her circumstances in life had never been good, the household was poor, every household matter fell on her shoulders, and on top of that her appetite had declined — so her body had gradually crumbled into consumption.

And just at that moment, the family became entangled in a lawsuit, and she had to go in person to face the court (appear before the magistrate). After half a day of that hard toil she came home, and her illness suddenly worsened — until at last she was confined to bed, unable even to summon the strength to rise.

💬 Note from Doctor Luo: Look at the causes here: difficult circumstances, a poor household, the worry of housekeeping, diminished appetite — and then the strain of a lawsuit on top of it all. Pile those four together and even the strongest constitution would give way. Doctor Zhang Xichun states the cause plainly from the start: consumption meeting overwork — frost on top of snow.

How bad was it: drowsy, silent, and feverish at 38.8°C

What was she like once bedridden? She lay with her eyes closed, drowsy, half-asleep; when her name was called, she would open her eyes a crack — but could not speak. Not that she couldn’t — she was simply too tired to talk, no strength for it.

Her face seemed a little hot. By Doctor Zhang Xichun’s time, Western medicine had already entered China and thermometers existed, so he took her temperature: 38.8°C. He asked: do you feel heat inside? Is your heart racing and fluttering (zheng chong, 怔忡)? To both she slowly nodded.

He asked about eating and elimination: in two days she had only sipped a little rice gruel, unable to eat solid food; she had not had a bowel movement for several days; and her urine had become scanty and short.

💬 Note from Doctor Luo: This whole string of symptoms — drowsiness, silence, fever, palpitations, no appetite, no bowel movement — is no longer ordinary deficiency. This is deficiency pushed to its absolute limit.

The pulse: left wiry and hard, right floating and hollow — Doctor Zhang understood at once

Now Doctor Zhang Xichun felt the pulse, and here is the key point.

The left pulse was floating, wiry and hard. What does “wiry-hard” mean? Press down and it feels like a taut lute string, stiff and unyielding. Doctor Zhang Xichun had an important experience: a wiry-hard left pulse indicates deficiency of yin in the lower burner — when kidney essence and yin are depleted, kidney water can no longer nourish liver wood, the liver wood turns to fire, liver fire rushes upward, and the pulse turns wiry and hard.

The right pulse was floating and hollow (kou, 芤). What is a kou pulse? Press it and the surface seems large, but press deeper and it is empty, hollow in the middle — this is the pulse of blood depletion, of lost blood and drained essence.

Why was the pulse floating? Doctor Zhang Xichun said: when qi and blood are depleted to the extreme, yin and yang can no longer hold each other; yang qi floats upward, drifting on top, so the moment the fingers touch, the pulse is already on the surface, and pressing deeper finds nothing. Both hands could not bear deep pressure — press down and both were empty. And the breath: six beats to one respiration — the pulse was racing very fast.

💬 Note from Doctor Luo: When the pulse races, most people’s first thought is “there’s fire.” But Doctor Zhang Xichun said: apart from externally-contracted heat conditions, when the pulse races in an internal-injury illness, it is usually a great collapse of upright qi — the kind of pulse you generally only see in consumption. So Doctor Zhang Xichun judged from the pulse alone: qi and blood are hugely depleted, yin and yang can no longer hold together — this is consumption at a most dangerous extreme.

Why was her body feverish? Yang qi spilling outward produces heat

Here is a point especially worth remembering: ordinarily, a person deficient in both qi and blood grows colder and colder; but if kidney essence is insufficient, leaning toward yin deficiency, the body instead develops fever.

This woman burned at 38.8°C — not from external infection, but yang qi spilling outward to produce heat — the yang could no longer be contained and was escaping.

💬 Note from Doctor Luo: Doctor Zhang Xichun called this one of the most dangerous conditions in consumption; by the time it reaches this stage it is usually hard to treat. But fortunately, although her breathing was hurried, it was not yet wheezing, and her cough was not severe — she could still be treated. What to do? Quickly tonify qi and blood, and add a little medicine to gather and restrain them — tonify on one side, and on the other bind yin and yang back together so they cannot separate. Then there is hope.

Prescription, part one: ye tai shen with Chinese yam and dogwood — Doctor Zhang’s “three great herbs” for deficiency

Doctor Zhang Xichun wrote his formula. Ye tai shen (野台参) 4 qian (12 g) to tonify qi — this is wild Codonopsis (dang shen) grown on Mount Wutai in Shanxi province. Doctor Zhang Xichun believed that the ginseng written of by Zhang Zhongjing was actually this kind of Codonopsis, not the ginseng of northeastern China, and so he especially prized Shanxi Codonopsis — wild-harvested above all.

Sheng Huai shan yao (生怀山药) 8 qian (24 g) — this is the Huai Chinese yam produced in Wen County, Jiaozuo, Henan province — what Chinese medicine calls a genuine regional herb (dao di yao cai, 道地药材) of the first rank.

Jing yu rou (净萸肉) 8 qian (24 g) — this is dogwood fruit (shan zhu yu, 山萸肉) with the pits carefully picked out (Doctor Zhang Xichun hated the practice of leaving the pits in).

💬 Note from Doctor Luo: These three herbs are chosen with real deliberation! Huai shan yao, Huai shu di (cooked Rehmannia), and shan yu rou are the “three great herbs” Doctor Zhang Xichun always used to tonify deficiency, and their origin is the three tonics in Zhang Zhongjing’s Jing Gui Shen Qi Wan (Kidney Qi Pill). In his later years, whenever he tonified deficiency, these three always appeared. Genuine regional herbs are hard to come by — real Huai shan yao grows only on that one patch of land in Wen County, Jiaozuo. In all of China there is only that one patch, and the supply is very limited.

What was shan yu rou doing here? Nourishing the yin of the liver and kidneys, and especially tonifying liver yin, with a warm medicinal nature. It also has two special functions: first, it unblocks the channels — when liver qi is constrained and the channels are blocked, it can open them; second, at the crisis of an illness it gathers qi and blood, gathers yang qi — when a person’s upright qi is about to collapse and they suddenly alternate between chills and fever, this herb holds the yang in.

💬 Note from Doctor Luo: The contemporary senior physician Li Ke (李可), when he met patients at the absolute crisis of an illness with yang qi on the verge of escape, would often use shan yu rou in heavy doses to gather the yang — and this approach was inherited directly from Doctor Zhang Xichun.

Prescription, part two: her mood was poor — so why did he use no liver-soothing herbs at all?

This woman’s family was poor and she was in a lawsuit — her mood was certainly bad, her liver qi constrained. An ordinary doctor at this point would add a little herb to soothe the liver and move qi, something like xiang fu (Cyperus) or qing pi (green tangerine peel).

But Doctor Zhang Xichun added not a single one. Why?

💬 Note from Doctor Luo: This is the difference between a master physician and an ordinary doctor! This woman’s yin and yang were on the verge of separating — the illness at its extreme. To use qi-moving herbs at such a moment would scatter the upright qi even further — and once the qi scatters, the person is finished. So at this point you cannot soothe; you can only gather. What Doctor Zhang Xichun used was one single herb, shan yu rou, to nourish liver yin, tonify the liver channel and gather — paired with sheng Hang shao (white peony) 4 qian to soften the liver. Gathering, softening, tonifying — at this juncture it was done with perfect propriety — a master physician prescribes with real insight.

Prescription, part three: long gu anchors the floating yang, goji and Rehmannia replenish essence, hematite guides the medicine downward

Next came sheng long gu (生龙骨, raw fossil bone) — it settles the liver and subdues floating yang, pulling the yang that had drifted upward back down. Long gu is fossilized bone of ancient animals; its nature is exceptionally heavy and sinking, and it has a powerful suppressing action.

💬 Note from Doctor Luo: A word of caution: when you buy long gu these days, try to buy it from a large, established pharmacy (for example, Tongrentang), because these fossils are getting rarer, and on the market some people make fake models out of minerals and pass them off as long gu — and then who knows what effect they have.

Then da gan gou qi (大甘枸杞) 6 qian (18 g) — large, sweet goji berries, which tonify the essence of the liver and kidneys. Gou qi is also warm in nature; although it is usually said to nourish yin, its more important action is to supplement essence — the essence of all five organs.

Sheng Huai di huang (生怀地黄) — Rehmannia from Wen County, Jiaozuo, which nourishes yin and cools the blood, chosen because this woman had deficiency heat; xuan shen (玄参) 5 qian nourishes yin and moistens dryness; sha shen (沙参) 5 qian nourishes yin. On top of supplementing essence, these three yin-nourishing herbs steered the treatment in the direction of nourishing yin — once the yin deficiency is corrected, the fire floating in the upper burner can be drawn back down.

Last came sheng zhe shi (生赭石, raw hematite), ground fine, 5 qian (15 g). Why hematite? First, the formula contained qi-tonifying Codonopsis, and this woman’s upper burner was already hot — her face was burning — so he feared the tonics would push the heat even higher; hematite is heavy and suppressing, it draws the medicinal power downward and keeps it from floating up. Second, hematite makes the qi mechanism descend and opens the bowels — she had not moved her bowels for days, so while tonifying upright qi on one side, it also freed the stool on the other, and the constipation was likely to resolve.

Gan cao (甘草, licorice) 2 qian (6 g) harmonized all the herbs. Decoction was made down to one large bowl, divided into two portions, one in the morning and one in the evening.

Three doses, a turn for the better: she could talk, she could eat, the fever fell

After three doses, the results came: she could speak, she could eat — the body began to recover; the floating heat was gathered back, and her temperature fell to 37.6°C; no more heat and agitation in the chest, only an occasional flutter of palpitation; her bowels moved, and her urine flowed freely.

💬 Note from Doctor Luo: Look — three doses, and she went from bedridden drowsiness to speaking and eating. That is what it means when the direction of tonification is right. In treating consumption, Doctor Zhang Xichun’s first step was always to stabilize the crisis of “yin and yang about to separate,” and only then to adjust slowly.

Second visit: long gu removed, one herb added — people with consumption all carry blood stasis inside

After three doses Doctor Zhang Xichun revised the formula: ye tai shen, sheng Huai shan yao (raised to 1 liang, the dose increased), da gan gou qi, jing yu rou, sheng Huai di huang, xuan shen, sha shen, and zhe shi — with long gu removed, because the signs of yin and yang about to separate had gradually disappeared.

At the same time he added one crucial herb: sheng ji nei jin (生鸡内金, raw chicken gizzard lining, the yellow kind) 1.5 qian.

💬 Note from Doctor Luo: Here Doctor Zhang Xichun set down an important piece of experience: patients with consumption almost always have blood stasis inside the body. Why? Qi is the power that pushes blood along; when upright qi is sufficient, the blood travels without obstruction; but in consumption the driving force is insufficient and the blood is scanty, so the blood easily comes to a halt somewhere and forms stasis. So while tonifying deficiency, you must always add a little herb to invigorate blood and dissolve stasis — but it cannot be fierce. Raw ji nei jin can invigorate blood and dissolve stasis; but if you stir-fry it, it becomes a food-digesting herb, especially for meat. One single herb, and raw versus cooked use changes its action completely.

Four more doses cured it — and aftercare was a bowl of yam paste

This revised formula was taken for four doses, and the newly contracted illness (the illness worked into her this time) was completely cured; only her long-standing consumption was not yet fully resolved. But Doctor Zhang Xichun said: no more decoctions are needed.

What was the aftercare? Every day, cook porridge from sheng Huai shan yao fine powder (Huai yam powder) — simmer it into a paste, add a little white sugar, and eat it as a snack, every single day.

💬 Note from Doctor Luo: Do not underestimate this method! Many people assume Doctor Zhang Xichun wrote this as a casual “psychological comfort” — absolutely not — this yam powder alone can treat many serious illnesses. Huai shan yao greatly tonifies the lungs, spleen and kidneys — three organs at once. After Doctor Zhang Xichun finished treating consumption, he very often used yam powder for the aftercare phase, and many of his case records end with the line “use Chinese yam powder with a little sugar, cook into a paste for aftercare.” In a master’s case records, every sentence may hide a very deep meaning. Just from this one sentence, we can grasp an important method of regulating the body.

Bonus: a true story — yam powder saved an elder who was skin and bones

Doctor Luo has genuinely treated a patient along exactly this line of thinking — a relative of his, an elderly person worn down by consumption, who could no longer take food, and had also developed a mental-emotional disorder: he constantly suspected he had a tumor. He grew more and more frightened, could not sleep at night, was anxious and terrified by day, and grew thin until he was nothing but skin and bones.

💬 Note from Doctor Luo: This kind of illness is extremely hard to treat: he would go for a check-up, and they would say nothing is wrong; a few days at home and he would suspect the tumor again, go back to the hospital — and once admitted, he could sleep fine. Western medicine had no treatment plan at all; Chinese medicine was also difficult, because the elder would not even eat, and any herbal decoction brought all sorts of strange reactions all over his body. My approach was: first, nourish the blood and settle the spirit — herbs that nourish yin and blood like stir-fried suan zao ren (sour jujube seed) and longan flesh, taken at night to settle the spirit; second, at midday, two tablespoons of Huai yam powder stirred into water and drunk — every day without fail. And as he drank it, the elder gradually recovered — now his complexion is rosy, he eats normally, he goes out walking every day, everything has recovered — better than I ever imagined.

This line of thinking was learned from Doctor Zhang Xichun: when deficiency reaches a certain point, first use a formula to reverse the crisis, then use Chinese yam to regulate and finish the job.

What to take away

From this case we take away two great lessons. First: when consumption reaches its extreme, how to replenish a person’s essence and qi — use Huai shan yao, cooked Rehmannia, and shan yu rou to tonify the essence of the liver and kidneys and the qi of the lungs and spleen. Second: the wisdom of finishing care with a bowl of yam powder. The more case records we explore, the closer we come to the master physicians’ way of thinking — and the more we understand about our own bodies.

Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s case records, from Medical Records Integrated Chinese and Western Medicine (《医学衷中参西录》).