Headache So Bad You Can’t Get Out of Bed or Sleep at Night? Doctor Zhang Xichun’s Qinggan Zhenni Fang (Clear the Liver and Suppress the Reversal Formula) for Headache from Liver Fire Rising
Patient search terms: headache / headache so bad you can’t get out of bed / headache that keeps you awake at night / headache so bad you roll around in bed / headache with high blood pressure Medical terms: headache from liver fire rising upward (gan huo shang chong) · liver-gallbladder stagnant heat · liver yin insufficiency (hypertensive headache)
The opening: a headache so bad he could not get out of bed for two months
The case we discuss today is about headache (tou tong) — not an ordinary headache, but the kind so bad you cannot get out of bed. The patient’s surname was Li, he lived in Tianjin, and he was a merchant — someone in business. In the old case record the phrase “业商 (ye shang)” simply means doing business — back in the Republican era many patients were merchants, and actually a lot of what happened then looks very much like our lives today.
💬 Note from Doctor Luo: Notice that in Doctor Zhang Xichun’s case records, a great many patients were in business — merchants are especially common. Why? Because in our own time, so many people are also in business. What was this merchant’s distinguishing trait? His constitution had always been weak (素来羸弱) — he was not someone who did physical labor. Running a business is a thinking person’s job. The root of the illness was planted right there.
The cause: business worries — the fire of the heart and liver pressed upward every day
Doctor Zhang Xichun wrote the cause very plainly: because of the strain of business affairs, and because many things went against him (因商务操劳，遇事多有不顺). Right there the cause is named — doing business is exhausting: every day at work there are worries, there is constant busyness, and on top of that things go wrong: an employee quits, a customer complains, a partner backs out… so many unpleasant things waiting for you.
💬 Note from Doctor Luo: When modern readers hear these few lines, they immediately feel the resonance — so many people are in exactly this patient’s situation. What happens when many things go against you? The fire of the heart and liver constantly stirs on its own (心肝之火，常常妄动) — you are frequently “heated up.” What does that mean in Chinese medicine? It means fire arising from emotion: there is heart fire and there is liver fire, and together they are called heart-liver fire. You get to work and hear that a key employee is leaving with no replacement — there it is, the fire flares right up. That is what “the fire of the heart and liver constantly stirs” looks like, and the headache slowly begins.
The symptoms: lighter in the morning, worse in the afternoon, sleepless at night
How bad was this headache? So bad he could not get out of bed — for two months already. And it followed a pattern: each morning the pain seemed lighter; once noon passed it began to build, and by night he could not sleep from the pain — some patients truly feel this way, rolling around in bed, unable to fall asleep; after the rooster crow (near dawn) the pain eased again, and he could doze a little.
💬 Note from Doctor Luo: Besides the headache, what else? From time to time he felt heat in his chest (心中时或觉热) — he often felt hot and restless inside; he had no appetite (饮食懒进) — his stomach was off and he did not want to eat. What is this connected to? Whenever a person’s emotions are disturbed, the appetite goes haywire. This is what Chinese medicine calls liver qi running sideways and attacking the spleen-earth (肝气横逆克脾土): when liver qi becomes depressed and stagnant, it bullies the spleen, and the function of the spleen and stomach suffers — the relationship between the liver and the spleen/stomach is extremely close.
Then the pulse: the pulse beat five times per respiration — slightly fast; the left pulse was wiry and long (xian chang) — especially at the guan (bar) position, and it was hard, showing that the liver fire was considerable; the right pulse was comparatively calm — the spleen and stomach had not been hurt too badly yet.
What did Doctor Zhang Xichun think? A wiry, long left pulse — liver fire, liver-gallbladder heat rushing upward
Doctor Zhang Xichun judged by the pulse and put it bluntly: this is clearly liver-gallbladder heat rushing upward and causing pain in the brain (显然系肝胆之热上冲，脑部作疼也) — the fire of the liver and gallbladder rose upward, reached the head, and there was the pain (with heart fire involved as well, of course).
💬 Note from Doctor Luo: If you took this patient to be examined today, his blood pressure would most likely already be high. Headaches of this kind have many causes: yin deficiency, yang deficiency, qi and blood deficiency can all produce headache; classified by cause, there are qi deficiency, blood deficiency, yin deficiency, yang deficiency, blood stasis, phlegm-dampness, constrained liver qi, liver fire, and so on; there is also migraine. So headache is actually a fairly complex condition that needs careful analysis — and of all its forms, the kind caused by bad emotions and liver fire is quite common. Headaches of this sort often bring changes in blood pressure with them.
Chinese medicine also classifies headache by location, and it is precise about it: forehead pain relates to the yang ming (Stomach/Large Intestine) channel — spleen-stomach disharmony often causes forehead headache; pain on both sides belongs to the shao yang (Gallbladder/San Jiao) channel, usually connected with the liver and gallbladder; pain at the back of the head belongs to the tai yang (Bladder/Small Intestine) channel, often connected with being blown on by cold wind and the like; pain at the very top of the head (vertex) belongs to the jue yin (Liver/Pericardium) channel — it is a jue yin channel problem.
If the hospital measures high blood pressure, do you take blood-pressure pills for life?
💬 Note from Doctor Luo: I have met such patients: they get a headache, go to the hospital for a checkup, the doctor measures the blood pressure — it is high — and prescribes blood-pressure medication. That medication you must take year after year, for the rest of your life. But from the perspective of Chinese medicine, this has not solved the root problem. In an illness like this, you must solve the root — why is there a headache? What has gone wrong among the organs? Put those in order, and that is treating the root.
The treatment principle: clear liver fire, nourish liver yin, suppress the liver’s reversal
What treatment principle did Doctor Zhang Xichun set? Clear the liver fire, nourish the liver yin — you have liver fire, do you not? First, clear the liver fire. Why is there liver fire? Besides depression and stagnation of liver qi, this liver fire will injure the yin, so insufficiency of liver yin can also produce deficiency fire — add bad emotions on top, and the two factors combine into something complicated. So he cleared liver fire and nourished liver yin at the same time, while also suppressing the liver’s reversal (zhen gan ni) — since the liver fire was rushing upward, he used herbs to press that rebellious qi back down. Together with herbs that raise the clear and lower the turbid, he adjusted the qi mechanism (qi ji).
💬 Note from Doctor Luo: Learn this train of thought — when you meet this kind of situation, this is how you should think: clearing the liver, nourishing the liver, suppressing the reversal, and regulating the rise and fall — these four moves combined make a complete formula.
The prescription: white peony eight qian leading, arborvitae seed six qian following — herb by herb
Here is the formula. Sheng hang shao (raw white peony, bai shao), eight qian (about 24 g) — a fairly large dose. What is it for? Restraining yin and softening the liver — white peony is indispensable when softening the liver. Its taste is bitter and slightly sour, and precisely because it is sour it enters the liver channel; it can nourish yin and blood, and retreat heat and remove restlessness.
💬 Note from Doctor Luo: Doctor Zhang Xichun believed that white peony can gather the floating heat of the upper burner and send it downward to be discharged in the urine — so some patients pass more urine after taking white peony: the heat is guided downward and drained out through urination. At the same time it can nourish the liver and generate liver blood — a very important reason liver fire flares so violently is insufficiency of liver yin and liver blood. It is like a tree: when the water is insufficient, the upper part dries out, and wind stirs and fire transforms; give it yin-nourishing and blood-nourishing support, let the liver yin and liver blood be nourished, and the liver wind should draw back and settle.
The second herb, bai zi ren (arborvitae seed), six qian (about 18 g) — also no small dose. What does arborvitae seed do? We usually know that arborvitae seed enters the heart channel and supports heart qi — for palpitations, racing heart, anxiety, and heart deficiency, arborvitae seed is used to nourish the heart and calm the spirit. But what is often forgotten is — arborvitae seed can also nourish the liver, and it does so remarkably well.
💬 Note from Doctor Luo: Why can arborvitae seed nourish the liver? This is the experience of the ancients, and they reasoned it out with theory — and the reasoning is very entertaining: they said the branches of the cypress tree all lean toward the northwest — why northwest? The northwest is the direction where metal and water combine — the west belongs to metal, the north to water, so the cypress absorbs a great deal of the qi of metal and water; and the arborvitae seed itself really is gathered in winter. With abundant water, water can nourish the liver-wood; and metal, metal controls wood (jin ke mu) — it restrains and manages the liver-wood. Doctor Zhang Xichun gave an example: it is like an army — on one side you supply it with grain and fodder (nourishment), and on the other you discipline it with regulations — then your army is certainly a powerful and elite force! So arborvitae seed’s nourishing effect on the liver-wood is especially good — particularly when the liver-wood has lost its nourishment and stirs wind and transforms fire, using it gives excellent results.
Next came xuan shen (figwort root), six qian (about 18 g) — it nourishes yin and generates fluids, nourishing yin and clearing deficiency heat; then sheng gui ban (raw tortoise plastron) — nourishing yin and subduing yang. The nourishment of the yin side begins here: the herbs before it softened and nourished the liver; the herbs behind it nourish yin. Then long dan cao (gentian root), three qian (about 9 g) — this herb drains the fire of the liver and gallbladder, especially excess heat and excess fire: the front of the formula softens the liver, nourishes the liver and nourishes yin, but you still have excess fire, so one herb of gentian root drains that excess fire away.
Chuan xiong (ligusticum), one and a half qian (about 4.5 g) — this herb you know from Si Wu Tang (Four Substances Decoction). Its main function is unblocking: in Si Wu Tang, chuan xiong is used because after shu di huang (prepared rehmannia) tonifies, it tends to be greasy and cloying, so chuan xiong unblocks it. Chuan xiong can enter both the blood level and the qi level; it is the qi-moving herb within the blood, and its unblocking power is especially strong — moving upward it can reach the very top of the head, and downward or outward it can unblock as well; it also disperses wind-cold. So chuan xiong activates blood, moves qi, dispels wind and stops pain.
💬 Note from Doctor Luo: Here Doctor Zhang Xichun gives a specific explanation: if the pain is in the head, and you use one herb like chuan xiong, will all the medicinal nature not rush upward? Can the head bear it? He said the qi mechanism has both rising and descending — if everything piled up in the head, that would be bad and problems would begin above; when you make the clear qi rise, the turbid qi naturally descends, and after the clear rises and the turbid falls, the upper orifices are no longer congested. But note that this explanation uses words like “clear qi” and “turbid qi” — because in the Republican era people had come into contact with modern medicine and felt they should integrate it, so such explanations are often a bit strained. Just understand it — in that era, a man who could think this far was already remarkable; we need not demand that Doctor Zhang Xichun knew everything.
Finally gan ju hua (chrysanthemum), one qian (about 3 g) — this is the white chrysanthemum we know (huai ju, chu ju, and Hangzhou white chrysanthemum all belong to the gan ju hua family); its function is clearing the liver and brightening the eyes, clearing heat from the liver channel; and gan cao (licorice), three qian (about 9 g) to harmonize all the herbs.
The result: one dose cured seven or eight tenths, two more doses and it was gone
The formula was decocted into one large bowl, cooled to warm, and taken. What happened? After one dose, seven or eight tenths of the illness was cured (服药一剂，病愈十之七八), and the pulse was calmer than before. So he reduced the gentian root (from three qian down to one qian) — the herb that had been draining liver fire hard was now scaled back — and after two more doses, the illness was completely cured.
💬 Note from Doctor Luo: This is what a famous physician looks like — this man had been bedridden for two months; when he met Doctor Zhang Xichun, one dose cured seven or eight tenths of it. Notice: no single herb in this formula is in a huge dose, but every herb has its own direction — there are herbs that soften the liver, herbs that nourish yin, herbs that drain liver fire, herbs that clear liver wind — combined, they are extremely comprehensive, and the treatment is light and nimble. If this man had gone to a hospital, been found to have high blood pressure, and been put on lifelong medication, he would have suffered terribly; but a physician like Doctor Zhang Xichun, starting from Chinese medical theory, analyzed why the headache occurred and adjusted the relationships among the organs: soften the liver, soothe the liver, nourish yin, clear liver fire, and add a little qi-moving, blood-activating medicine — and the illness was cured.
Note from the commentator: with a headache, first figure out which kind you have
What do we learn from this case? For a headache you must first distinguish the cause — by location there is yang ming, shao yang, tai yang, and jue yin; by cause there is qi deficiency, blood deficiency, yin deficiency, yang deficiency, blood stasis, phlegm-dampness, and liver fire. Liver-fire headache from bad emotions is one of the more common kinds, and it often comes with changes in blood pressure.
💬 Note from Doctor Luo: When we listen to Doctor Zhang Xichun’s stories, what we are learning is his way of thinking about treatment: when a headache comes, think a little more — have I been worrying too much lately, is my liver fire too strong? Am I running low on liver yin? Being able to analyze why your own body has fallen out of balance — that is the reward. Tomorrow we continue with Doctor Zhang Xichun’s cases — see you then!
Based on the lectures of Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine) explaining the medical cases of Doctor Zhang Xichun; the case is from Yi Xue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine).