A Sensation of Qi Rushing Upward, Chest Hot and Tight at 3 a.m.? Doctor Zhang Xichun’s Formula for Ben Tun (Running Piglet Syndrome) After Over-Purging Dysentery
Patient search terms: a sensation of qi rushing upward / qi pushing up from the belly / chest hot and tight at three in the morning / a few burps and it passes Medical terms: ben tun (running piglet syndrome) · qi rushing upward · restless ministerial fire of the kidney (gastrointestinal neurosis)
The opening: at 3 a.m., a current of hot qi rises from the belly on schedule
Zhang Jiwu, a merchant in Tianjin, had recently come down with a strange illness: every night, just before 3 a.m., a current of qi would rise on schedule from his lower belly, carrying heat up along the inside of his body. When the qi reached his chest, he felt hot and tight, restless and agitated; ten-odd minutes later the qi surged to his throat, and with a few “hic, hic” belches the heat gradually dispersed and he could settle down again.
💬 Note from Doctor Luo: Does this sound bizarre? Ancient Chinese physicians gave this illness a name long ago, and from the Huang Di Nei Jing (Yellow Emperor’s Classic of Internal Medicine) and the Nan Jing (Classic of Difficult Issues) to Zhang Zhongjing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet), it is discussed in remarkable detail — it is called ben tun (running piglet syndrome). “Tun” means piglet, “ben” means running — the patient feels as if a little piglet is running up the body along the meridians from the belly, hence the name. Its hallmark is a current of qi rushing upward from the lower abdomen, passing through the middle burner to the throat; during the rush there is abdominal pain, chest tightness, and shortness of breath; in severe attacks the qi reaches the head, causing dizziness and blurred vision, and after the rush the body still trembles — that startled, throbbing sensation is especially prominent.
Who was the patient: a bout of dysentery, “purged” into a strange illness by rhubarb
Zhang Jiwu lived on Ji Family Lane, Hedong District, Tianjin. He was 45, a merchant, in middle age. The illness began in early autumn, when he caught a bout of red-and-white dysentery — his stools carried streaks of red and white, he ran to the toilet many times a day, his belly ached, and he always felt the bowel was not fully emptied — finish one movement and the urge came again: this is what Chinese medicine calls tenesmus (li ji hou zhong) — urgent straining with a feeling of incomplete evacuation. How did this illness gradually turn into ben tun?
💬 Note from Doctor Luo: The pathogenic qi of dysentery lies in the intestines, and the treatment principle is “treating a blockage with purgation (tong yin tong yong)” — you must purge downward and drive out the damp-heat and toxic qi. You cannot clamp down and stop the diarrhea the moment you see loose stools, or you will leave the pathogen trapped inside the body. A good physician would combine purging with herbs that clear damp-heat and resolve toxins. But the doctor treating Zhang Jiwu apparently fixed on the single idea of “purging”: twice he used rhubarb (da huang) alone to purge downward. The purge worked and the pathogenic qi left — but the lower burner took a heavy beating in the process.
Why did it strike precisely at 3 a.m.?
There was another refinement to this qi rushing upward: it attacked every day at the junction of the chou hour and the yin hour — the chou hour runs from 1 a.m. to 3 a.m., the yin hour from 3 a.m. to 5 a.m., so the junction falls around 3 a.m., just before dawn.
💬 Note from Doctor Luo: One touch of the pulse and Doctor Zhang Xichun saw the mechanism: the pulse as a whole was roughly balanced, except that both chi (foot) positions floated (fu) — the chi positions on the wrist govern the kidney; pressed down, they were not solid and had no strength — a hollow, floating sign. Doctor Zhang Xichun’s analysis: the purging had been too violent, wounding the qi transformation of the lower burner, so the ministerial fire (xiang huo) of the kidney could no longer be restrained. Why did it attack specifically at 3 a.m.? Because that is when yang qi first begins to rise; the moment yang qi stirs, the ministerial fire of the lower burner rushes upward with it — so this is a heat condition (re zheng), not a cold one.
The strategy: combine Zhang Zhongjing’s two ben tun formulas
For ben tun, Zhang Zhongjing left two formulas in the Jin Gui Yao Lue: Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon) treats ben tun caused by cold; Ben Tun Tang (Running Piglet Decoction) treats ben tun caused by liver qi rushing upward — that formula contains both cold and heat herbs, mixed and complicated, but weighted toward heat; its ingredients are pueraria root (ge gen), plum root bark (gan li gen bai pi), pinellia (ban xia), fresh ginger, white peony root (bai shao), skullcap (huang qin), Ligusticum (chuan xiong), Chinese angelica (dang gui), and licorice.
💬 Note from Doctor Luo: Where does Doctor Zhang Xichun’s brilliance lie? At a glance he recognized this was a heat condition, so he took the idea of Gui Zhi Jia Gui Tang, combined it with the idea of Ben Tun Tang, and opened the two formulas fused into one — this prescription carries the shadow of both of Zhang Zhongjing’s formulas.
First, about Gui Zhi Jia Gui Tang — it is simply Zhang Zhongjing’s Gui Zhi Tang (Cinnamon Twig Decoction) with a larger dose of cinnamon twig. Gui Zhi Tang is the very first formula in the Shang Han Lun (Treatise on Cold Damage): cinnamon twig warms yang and frees the vessels, peony restrains and harmonizes the nutritive and defensive qi (ying wei), honey-fried licorice harmonizes the middle, and fresh ginger and jujube harmonize the spleen and stomach. Adding more cinnamon twig or cassia bark strengthens the yang-warming effect — the formula warms yang, disperses cold, and settles rebellious qi, and for ben tun caused by cold its effect is immediate.
💬 Note from Doctor Luo: Here lies a famous thousand-year debate: Zhang Zhongjing’s original text says “add two liang of gui,” and later generations argued endlessly — did he mean more cinnamon twig, or additional cassia bark (rou gui)? One school says Gui Zhi Tang with a larger dose of cinnamon twig; the other says Gui Zhi Tang with cassia bark added. Both camps have clinical experience on their side, and the dispute ran for centuries until the practical conclusion emerged: cinnamon twig works, and cassia bark works too — the therapeutic difference is minimal. A fascinating formula indeed.
Breaking down the prescription: tonify and restrain at the same time — and don’t forget to help the spleen and stomach digest
How did Doctor Zhang Xichun construct his formula?
Cinnamon twig tips (gui zhi jian), 4 qian (about 12 g), lead the formula. Some will ask: doesn’t cinnamon twig have an ascending nature? The qi is already rushing upward — wouldn’t more of it make the rush worse? Doctor Zhang Xichun addressed this question later in his writings — cinnamon twig is a truly remarkable herb, capable of both ascending and descending: when qi should rise, it helps it rise; when qi should descend, it presses it downward. In his own words, it is a “medicine of inconceivable wonder.”
💬 Note from Doctor Luo: This is Doctor Zhang Xichun’s skill at reading the classics — others see cinnamon twig only as warming the channels and freeing the network vessels, but he read out its function of ascending and descending to regulate the qi mechanism, then applied that insight to ben tun: qi rushing upward, so use it to press the qi downward. Students in TCM colleges should learn the direction Doctor Zhang Xichun took: read the classics thoroughly, then put the classics to use flexibly.
Next comes raw Huai yam (sheng huai shan yao), 1 liang (about 30 g) — a generous dose, used to tonify the original qi of the lower burner and restrain the kidney qi; raw euryale seed (sheng qian shi), 6 qian (about 18 g), crushed, works along the same lines as the yam — tonifying kidney qi and restraining. Doctor Zhang Xichun then added raw dragon bone (sheng long gu) and raw oyster shell (sheng mu li) — dragon bone and oyster are herbs that restrain and anchor; they can hold the upright qi without trapping the pathogenic qi — so with yam, euryale seed, dragon bone, and oyster shell tonifying on one side and restraining on the other, the qi transformation of the lower burner grows solid, and even if the qi wants to rush upward, it cannot get going.
Processed pinellia (qing ban xia), 4 qian (about 12 g) (washed in water three times) descends qi — this follows the Ben Tun Tang approach for liver qi rushing upward, since that formula contains pinellia; raw Hangzhou peony root (sheng hang shao / bai shao), 4 qian (about 12 g), also from Ben Tun Tang, is used to restrain and soften the liver — when liver qi no longer charges upward, half the root of the illness is gone. Then phellodendron bark (huang bai): white peony drains the fire of the liver, phellodendron drains the ministerial fire of the kidney — if your kidney ministerial fire is rushing upward, use phellodendron to clear the heat of the lower burner. This is Doctor Zhang Xichun modeling himself on Zhang Zhongjing: in Ben Tun Tang, Zhang Zhongjing used skullcap (huang qin) to clear the heat of the upper burner; Doctor Zhang Xichun changed it to phellodendron to clear the heat of the kidney channel.
💬 Note from Doctor Luo: Notice this adaptation — both clear fire, but Zhang Zhongjing cleared the upper burner while Doctor Zhang Xichun cleared the kidney channel. He knew exactly where the disease was located, so the herbs followed. This is the principle: learn from the ancients’ intention, do not cling to their formulas.
The formula also conceals Doctor Zhang Xichun’s customary craft: raw malt (sheng mai ya) paired with raw chicken gizzard lining (sheng ji nei jin) — with so many herbs in the mix, he feared the patient might not digest and transport them all, so these two help the spleen and stomach handle the load. Finally licorice (gan cao), 2 qian (about 6 g), closes the formula: sweet in flavor, it harmonizes the middle and also relaxes the urgency of the liver, keeping liver qi from turning too violent.
The result: mostly cured after two doses, fully cured after three
The medicine was decocted into one large bowl and taken warm. After two doses, most of the illness was gone. Doctor Zhang Xichun then modified the formula slightly: he reduced the cinnamon a little and added dogwood fruit (shan zhu yu) — which nourishes the yin of the liver and kidney, especially the yin and blood of the liver; sour in flavor, it restrains and calms the liver — plus wolfberry (gou qi zi), also nourishing the liver and kidney. With these two herbs the nourishing power for liver and kidney grew stronger, and after three more doses of this formula, Zhang Jiwu was completely cured.
💬 Note from Doctor Luo: What makes this illness difficult? Most cases of ben tun are cold conditions — see cold, use Gui Zhi Jia Gui Tang, and it works every time; but Doctor Zhang Xichun happened to meet a heat condition — and if you have not thoroughly read the Jin Gui Yao Lue, you would not know where this illness comes from. He read the classics well, so when a difficult, complicated case came up he recognized it accurately and resolved it in a few doses, because he had a clear picture in his mind. An ordinary reader meets Gui Zhi Jia Gui Tang and thinks that is all there is — not knowing the Golden Cabinet also holds Ben Tun Tang for the heat type. Doctor Zhang Xichun not only knew it, he fused the two formulas together — a distinctive insight of his own. That is real skill.
What ordinary people can learn: if qi suddenly rushes upward, don’t panic first
After hearing this case, keep one thing in mind: there is an illness called ben tun — suddenly a current of qi rushes upward from the belly, fast and forceful, slamming into the chest and making it hard to bear. If it happens to you, first analyze whether you have been exposed to cold (most cases of ben tun arise from yang-deficient constitutions catching cold); if not cold, then consider whether there is heat, or liver fire. The two formulas Zhang Zhongjing left in the Jin Gui Yao Lue treat exactly these two situations.
💬 Note from Doctor Luo: How does modern medicine view this illness? It roughly falls under gastrointestinal neurosis — gas accumulating in the intestines, hyperactive peristalsis, or spasm can all produce this sensation, and some cardiovascular conditions can cause it too. Knowing that such a thing exists gives you a frame of reference: those who have heard of it don’t panic; those who have never heard of it panic the moment it appears — and the more you panic, the worse it gets. Studying Chinese medicine broadens your knowledge, so you can face these things with a settled mind — and that alone is a good thing.
Based on Doctor Luo Dalun’s narration of Doctor Zhang Xichun’s case records, from Yi Xue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine).