Missed Periods, Chills and Fever, Pain Under the Ribs? Doctor Zhang Xichun’s Liyu Shengxian Tang for Sinking Qi with Stagnation

The setup: an “upgraded” Shengxian Tang, for qi that is both stuck and sinking

Over the last several episodes, Doctor Luo has been telling us about Doctor Zhang Xichun’s treatment of sinking of the great qi (da qi xia xian) — the great qi of the chest sinks down, and a person loses their strength and cannot catch their breath. What did Doctor Zhang use back then? Shengxian Tang (Raise-the-Sinking Decoction) — one lift, one tonify, and the qi comes back up.

But today’s story is about a more troublesome variant: qi stagnation combined with sinking of the great qi. What does that mean? When a person gets angry or stifled, the movement of qi gets blocked (qi stagnation). On top of that, the body is already weak, and the great qi sinks further down — the qi gets stuck in the channels and becomes a blockage. In this situation, simply lifting with Shengxian Tang is not enough.

💬 Note from Doctor Luo: Notice — the difference between Liyu Shengxian Tang and Shengxian Tang is exactly here. Shengxian Tang treats plain sinking of the great qi: just lift the qi and you’re done. Liyu Shengxian Tang treats the complicated picture of sinking of the great qi combined with qi stagnation and blocked channels. Today Doctor Zhang gives us three cases, all on this path, and all cured in just a few doses — extremely representative.

The first patient: a postpartum chest that felt stuffed, and breath that ran hot

Let’s start with the first case. A woman in her thirties. What was wrong? Chest fullness (xiong zhong man men) — her chest felt stuffed and blocked; after meals she would occasionally get pain. Hot breath (bi xi fa re) — the air she breathed out carried heat. And she was often thirsty, always wanting to drink water.

When did it start? She said it began a few days after childbirth, brought on by overexertion.

Doctor Zhang took her pulse: slow and weak — beating slowly, with no strength. He turned it over in his mind, thought hard, and still could not find the thread of the illness.

💬 Note from Doctor Luo: I judge that this was an early case in Doctor Zhang’s career. With the experience he had later, one look at that pulse and he would have understood immediately — why would he need to think? So you see, even the great physicians developed step by step out of “I can’t figure this out.” That’s perfectly normal.

First he tonified the upright qi — so why did she suddenly run hot and cold?

Unable to find the thread, Doctor Zhang treated it as “deficiency” and tonified the upright qi. The prescription was very simple: sheng huai shan yao (Chinese yam), 1 liang, to tonify upright qi and generate fluids; ji nei jin (chicken gizzard lining), 2 qian, to transform stasis; chen pi (tangerine peel), 1 qian, to regulate the qi — the aim being to regulate that “stuffed, blocked” feeling.

And the result? After taking it, she suddenly developed chills and fever — cold one moment, hot the next. That is the classic alternating chills and fever (wang lai han re). When he took her pulse again, it was even weaker.

That’s when Doctor Zhang understood!

💬 Note from Doctor Luo: Sudden chills and fever often mean the illness has entered the shaoyang level. And when the pulse was taken again, the upright qi was even more depleted — that exposed the truth: this patient wasn’t suffering plain deficiency — it was sinking of the great qi! But hers was different from the others. What was the special feature? Her qi aspect was also stagnant, and the qi stagnation was causing blockage of the channels. So here’s the complexity: the channels are blocked, so you want to invigorate blood and regulate qi, right? But if you invigorate and regulate, she has sinking of the great qi — she’s already qi-deficient, and if you stir her up, she can’t take it. That’s exactly why a brand-new formula had to be created.

The new formula arrives: Liyu Shengxian Tang — seven herbs, each with its own job

So Doctor Zhang created a formula called Liyu Shengxian Tang (Regulate-Stagnation and Raise-the-Sinking Decoction), specifically for sinking of the great qi in the chest combined with qi stagnation causing channel blockage.

How is it put together?

• Sheng huang qi (raw astragalus), 6 qian (about 18 g): the lead herb — tonifies the great qi. As discussed before, the fire of anger can squeeze the great qi of the chest down, so tonifying the great qi comes first.
• Zhi mu (anemarrhena), 3 qian: because astragalus can generate heat, zhi mu’s cool, moistening nature restrains it. This patient always felt her breath hot, so you can’t simply push astragalus in by itself, or she’d get hotter and hotter — astragalus paired with zhi mu is Doctor Zhang’s most frequently used combination.
• Dang gui (Chinese angelica), 3 qian: nourishes the blood — while tonifying qi, nourish the blood as well, so that qi and blood can keep pace with each other.
• Gui zhi jian (the tips of cassia twig), 1.5 qian: two uses — first, it generates the great qi of the chest; second, it relieves liver qi stagnation. Cassia twig warms yang and frees the vessels, and using its “tips” gives the strongest generating, ascending energy.
• Chai hu (bupleurum), 1.5 qian: lifts the qi upward, and also helps soothe liver qi.
• Ru xiang (frankincense), 3 qian, and mo yao (myrrh), 3 qian (not processed to remove the oil): the heavy hitters for transforming stasis and freeing the channels — we’ll talk about them in detail in a moment.

💬 Note from Doctor Luo: Look at the design of this formula: gui zhi jian paired with chai hu is the “generate the great qi + lift the qi” combination, carrying the qi upward; ru xiang paired with mo yao is the “free the channels + transform stasis” combination, opening up the blocked channels. One lifts, one frees — the qi neither sinks nor stays stuck. That is the true meaning of the “Liyu” (regulate stagnation) in Liyu Shengxian Tang: first free the stagnation, then raise the sinking.

A closer look at frankincense and myrrh: the “imported Western medicine” of their day

Frankincense and myrrh deserve a chapter of their own — today they are the two most critical herbs in this formula.

What are they? They are resins secreted by trees — not produced in China. Where do they come from? Ethiopia, Somalia, and other faraway places in the Middle East.

When did they enter Chinese medicine? Very early. In the famous Song dynasty formularies — Heji Jufang (Formulary of the Bureau of Peace-Blessing Dispensaries), Puji Benshi Fang (Effective Formulae for Universal Relief) and other classics — frankincense and myrrh were already there. What does that show?

💬 Note from Doctor Luo: It shows that Chinese medicine progresses! Back then, foreign medicines were still adopted and used as Chinese medicines — frankincense and myrrh were the “Western medicine” of their era. Chinese medicine took them in and used them, and they’ve been used right up to today, long since becoming routine herbs in the materia medica. Chinese medicine has always absorbed all kinds of useful medicinal materials as it develops — that’s truly remarkable.

How precious were they in ancient times? In antiquity, Africa, the Middle East and Europe all treated them as extremely precious spices. There’s a European legend: when Jesus Christ was born, the Three Wise Men from the East brought him three treasures — gold, frankincense and myrrh. You can see how valuable they were. Even today there’s essential oil made from frankincense, widely used in the West, and it’s everywhere in China too — used as a room fragrance on one hand, and to regulate the body on the other.

How do their actions differ? Both have a very strong fragrance. In the old days that was considered a proper, fine scent; nowadays people smell it and say “good heavens, what is that smell” — but in the past, ordinary people rarely even got to smell it. Specifically:

• Ru xiang (frankincense): its fragrance is sharp and penetrating. It can penetrate the orifices and regulate qi — it works in the qi aspect.
• Mo yao (myrrh): its scent is lighter, pungent and slightly sour. It excels at transforming stasis and regulating blood — it works in the blood aspect.

That is why Chinese medicine so often uses the two together — to free the stagnation of qi and blood behind all kinds of pain and hardened knots. They can be taken internally, or applied externally.

Doctor Zhang’s rule for frankincense and myrrh: they must be raw

Doctor Zhang had a special requirement for these two herbs: they must be used raw (unprocessed). He said that if you use the processed forms, the medicinal power is greatly reduced. But today’s pharmacies rarely carry the raw form — most of what you find is processed, such as vinegar-processed.

Doctor Zhang was especially skilled with these two herbs. He had a famous formula called Huoluo Xiaoling Dan (Activate-the-Channels Marvelous Pill), which we’ve talked about before — it treats chest pain and all kinds of body pain caused by stagnation, with good results.

But there’s a problem here — one that Doctor Luo puzzled over for a long time.

💬 Note from Doctor Luo: Both frankincense and myrrh irritate the stomach and intestines to some degree. The smell of the decoction is more than many people today can bear — one whiff and they want to vomit. After drinking it, people with weak stomach qi will vomit or have diarrhea: either retching, or loose stools. So: first, formulas containing frankincense and myrrh must be taken after meals; second, people with weak spleen and stomach should avoid them as much as possible; third, the dose must not be large — in general, anything over about 3 grams easily provokes noticeable reactions; fourth, the processed forms have milder side effects, while the raw, unprocessed forms have a high rate of reactions. Doctor Zhang himself never wrote about any of this, and I’ve genuinely been puzzled — he used Huoluo Xiaoling Dan for all sorts of pain, often several hundred doses, with excellent results and substantial doses, yet he never once mentioned gastrointestinal reactions.

Doctor Luo also told a true story: just a few days ago, a fan — before Doctor Luo had even gotten to this part of the explanation — heard the earlier symptoms and thought they matched his own. He went through Doctor Zhang’s book, combined Shengxian Tang and Liyu Shengxian Tang into his own self-made formula, and poured it down his own throat. The result: vomiting and diarrhea — torrential diarrhea. He left a comment saying, “I’ll never dare to take Chinese medicine again.”

💬 Note from Doctor Luo: I told the editor at the time — this was far too hasty! I hadn’t even gotten to the side effects of these two herbs, and he’d already prescribed for himself and drunk it. How could that be allowed? Never mind anyone else — when I brew this medicine myself and drink it, I find it nauseating. The taste really is strange. So with frankincense and myrrh, you must be careful and use them under a doctor’s guidance — the doctor will judge whether your stomach qi is weak and whether your spleen and stomach are functioning normally. If you genuinely react badly to these two herbs, they can be replaced with others — tao ren (peach kernel) and hong hua (safflower); for severe blood stasis, substitute san leng (bur-reed rhizome) and e zhu (zedoary). Chinese medicine is full of herbs that invigorate blood, transform stasis and free the channels — it’s not only frankincense and myrrh. But conversely, if the task is dissolving a hardened lump, frankincense and myrrh may still be the more suitable choice. Everyone must use them under a doctor’s guidance.

One dose and it worked: the first patient was cured in four doses

Doctor Zhang gave this woman Liyu Shengxian Tang. And the result? One dose — every symptom began to ease; four more doses — completely cured.

💬 Note from Doctor Luo: You see, once Doctor Zhang’s diagnosis was confirmed, the formula worked very quickly. Earlier we said Shengxian Tang is extremely gentle — almost no one has side effects from it. Liyu Shengxian Tang adds frankincense and myrrh, so you need to keep the side-effect issue in mind — but the formula itself genuinely works for this disease.

The second patient: a 15-year-old girl who strained so hard urinating that she squeezed out a lump

Now for another case. A young girl, 15 years old. What was wrong? A lump had formed on the left side under her ribs — in today’s terms, some kind of mass. The lump bore down with layered, dragging pain — it kept pulling downward in the abdomen, connected up to the lower back and spine, dragging the whole waist down with pain, and she groaned constantly. In severe moments, she often felt as if her urine wouldn’t pass — but when she actually went to urinate, she could pass it; she just had that “blocked” sensation.

Doctor Zhang took her pulse: thin, small and deep — the upright qi was insufficient. He asked her how the illness began, and she said: “When I urinate, I never feel it flows smoothly — my urination is difficult — so I strain very hard.” With that straining, she felt her kidneys start to ache, and gradually a lump formed. When it first formed, it was still a little soft to the touch; now, after more than five months, the lump has grown harder and harder. And the pain follows a pattern: every day at four in the afternoon the pain starts to increase, and it lasts until four in the morning, when it gradually eases again.

How is this analyzed?

💬 Note from Doctor Luo: Doctor Zhang said: this is sinking of the great qi. She already had sinking of the great qi, which easily causes pain with urination; then she strained hard, and as a result the qi of the upper burner sank into the lower burner. Once down in the lower burner, the qi movement bound up, and the binding produced blood stasis — and that’s how this lump appeared. Note the pain pattern — worse at four in the evening, easier at four in the morning — that’s a very typical signal of a strange disease. How to treat it? Still Liyu Shengxian Tang.

How do you dissolve the lump? Add dan shen and sheng ma, then bring in xue jie powder

The stasis-transforming power in Liyu Shengxian Tang was already fairly strong, but Doctor Zhang felt it wasn’t enough, so he made two adjustments: he raised the frankincense and myrrh from 3 qian to 4 qian each, added dan shen (salvia), 3 qian, to invigorate blood and transform stasis, and sheng ma (bugbane), 1.5 qian, to lift the qi upward.

And the result? After two doses, both the bearing-down feeling and the pain were gone.

At that point Doctor Zhang removed the sheng ma — no more lifting needed — and added one more herb: xue jie (dragon’s blood resin). He ground it to powder and had her take 1 qian of xue jie powder, sent down with the decoction of Liyu Shengxian Tang.

💬 Note from Doctor Luo: What is xue jie? It’s also the resin of a tree, and its actions are invigorating blood, settling pain, transforming stasis and stopping bleeding. Doctor Zhang used it here to strengthen the stasis-transforming power. After several doses of this formula, the lump was eliminated. There’s a key point here: when blood stasis has congealed into a lump, Doctor Zhang often reaches for frankincense and myrrh — for dissolving this kind of lump, other herbs may not have the power to reach it; frankincense and myrrh are especially good at dissolving hardened lumps. He would often add these two herbs to the formula for that purpose.

The third patient: two months with no period, chills and fever, and pain under the ribs

Now one more case. A young married woman — her period hadn’t come for two months, and she had alternating chills and fever (han re wang lai) — put on clothes and she’s hot, take them off and she’s cold, shivering one moment and burning the next; at the same time she had pain under the ribs.

First, where exactly is “under the ribs” (xie xia)? From under the armpits, running down to where the ribs end, that whole area counts — it lies on both sides of the body. What kind of illness tends to cause problems under the ribs? Generally, liver and gallbladder problems.

💬 Note from Doctor Luo: Why does liver-gallbladder stagnation tend to settle under the ribs? Because that area sits between yin and yang — the front of the body is yin, the back is yang, and the sides under the ribs lie right between the two. So when the sides of the body hurt, we generally consider liver-gallbladder problems. This young woman’s pain was concentrated under the ribs, which says her liver qi was bound up.

Doctor Zhang took her pulse: very weak, but beating quickly — a rapid pulse, six beats per respiration. What does that tell us?

💬 Note from Doctor Luo: Many people with sinking of the great qi also have heat. For example, someone with yin deficiency and heat — once the great qi sinks, their pulse beats fast. So not all sinking-of-the-great-qi pulses are slow — you must remember this point. After taking the pulse, Doctor Zhang asked about her symptoms, and she said she was often short of breath — always gasping, as if the breath couldn’t quite get through. Doctor Zhang saw it at once: this was sinking of the great qi, combined with stagnation. So he gave her Liyu Shengxian Tang, with long gu (dragon bone) and mu li (oyster shell), 5 qian each, added in.

Why add dragon bone and oyster shell? Two sentences and it’s clear

Adding long gu and mu li to this formula is Doctor Zhang’s signature thinking, and it can be explained in two sentences:

First, long gu and mu li have a freeing, opening power — they help unblock. When we discussed Doctor Zhang’s lung-disease formulas we mentioned that he often put long gu and mu li in the formula precisely to help you open things up — when a person is deficient to a certain degree, stagnation is surely present, and these herbs help you clear it.

Second, long gu and mu li can restrain and calm liver qi. People whose qi movement is blocked often have bound liver qi, with liver fire surging upward and running wild; long gu and mu li restrain the liver qi. And Doctor Zhang said: astragalus has an expanding, distending force — when you tonify with astragalus, the qi bulges outward; with long gu and mu li holding it in, he could use astragalus boldly and without worry.

💬 Note from Doctor Luo: Also, this patient’s rapid pulse indicated yin deficiency, so Doctor Zhang added xuan shen (scrophularia), sheng di huang (raw rehmannia) and bai shao (white peony) to nourish yin. The result: after four doses, the area under her ribs opened up, the stasis moved downward, and then her period came — the menstrual blood was dark purple. From then on her menses ran smoothly, her periods returned to normal, and all her illnesses were cured — everything was well.

Summary: remember one sentence and you won’t misuse this formula

In this episode, Doctor Zhang used three cases to explain, thoroughly, sinking of the great qi combined with qi stagnation.

Sinking of the great qi actually comes with all kinds of complications: a person already has some qi stagnation; the great qi sinks, and this easily produces channel blockage; channel blockage then produces all kinds of pain, and if the stasis binds for a long time it can even form lumps. Doctor Zhang created Liyu Shengxian Tang for exactly this situation, and the way of thinking behind it deserves our careful study.

💬 Note from Doctor Luo: Finally, you must remember the key point of Liyu Shengxian Tang — its main point is not “regulating stagnation” in the sense of soothing the liver and adjusting the emotions. No! Its emphasis is on channel blockage: qi stagnation causes channel blockage, and then it meets sinking of the great qi — that’s what this formula regulates. Otherwise, some readers see the word “Liyu” (regulate stagnation) and assume it means soothing the liver and regulating qi, plus raising the sinking qi — and that would be off-target; use it that way and you’ll get it wrong. All three cases were remarkably effective, and all were cured in just a few doses — but learning Chinese medicine is not about grabbing a formula and using it the moment you see it. Understand the way of thinking; understand your body better and Chinese medicine better; accumulate day by day — and when problems come up, you won’t panic.

Based on Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s medical cases, originally from Records of Chinese Medicine with Western Reference (《医学衷中参西录》, published serially 1918–1934).