Stomach Pain, Feeling Blocked, Burping and Acid Reflux? Doctor Zhang Xichun’s Huangqi Jianzhong Tang (Astragalus Fortify the Middle Decoction) Variation for Stomach Pain from Liver Qi Stagnation
Patient search terms: stomach pain / stomach ache / burping / acid reflux / food stuck and not going down / dry stools / getting thinner and thinner / the illness born of homesickness Medical terms: wei wan tong (stomach pain) · liver qi stagnation (gan yu qi jie) · liver wood attacking the spleen (gan mu cheng pi) · loss of the normal rise and fall of the spleen and stomach (functional dyspepsia / chronic gastritis)
The opening: a southern woman married to the north — stomach pain that lingered for three years
The case we discuss today is about stomach pain (wei teng) — not the kind that makes you roll on the floor, but the kind that is dull and stuffy, blocked up in there, a discomfort you cannot quite describe. The patient was a woman surnamed Xu who lived in Baohuali, in the city center of Tianjin. She was nearly thirty (年近三旬) — still fairly young, as you can see.
💬 Note from Doctor Luo: When a young woman has a stomach problem, do not rush to think “did she eat something bad?” — first consider the emotional factor. What was this patient’s background? She had originally been a southerner, who married a northerner and moved north with her husband to settle there — far from her hometown, unable to visit her natal family (远怀乡里，归宁不得): she was too far from home to return even for a visit, and she missed her family and kin every single day. With the phrase “hiding away her worries and longings” (藏起忧思), Doctor Zhang Xichun put his finger straight on the root of this illness.
The cause: an illness born of homesickness — liver qi stagnation, and worry wounding the spleen
How did this illness come about? Doctor Zhang Xichun explained it in just a few strokes: this Madam Xu missed home every day, but could not go back — how could her emotions be well? The first cause is liver qi not moving smoothly — liver qi stagnation (肝气郁结): her emotions were bad. And there is a hidden layer underneath that he did not dwell on: a southerner living in the north — the climate, the water, the food are all a little hard to get used to.
💬 Note from Doctor Luo: You see, this is the hallmark of Doctor Zhang Xichun’s case records — he does not just write prescriptions; he writes the cause of the illness out plainly. Bad emotions, plus excessive worry and brooding, gradually wounded the spleen. Why? The Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine) says “the spleen governs thought” (脾主思) — the emotional activity corresponding to the spleen is thinking and brooding, and excessive brooding wounds the spleen. This woman thought of home every day; over-thinking wounded her spleen. Spleen qi by nature rises upward, but once wounded, it could no longer rise.
The symptoms: food stuck and not going down, burping and acid reflux — three years of growing thinner
How far had the illness progressed? Doctor Zhang Xichun wrote “the qi transformation of the middle burner congealed and stagnated” (中焦气化凝郁) — the qi-transforming function of the spleen and stomach, the middle burner, had grown weak and was no longer moving smoothly. In concrete terms: food stagnated and found it hard to move downward (饮食停滞，艰于下行) — after eating, the food always seemed to stop in the stomach and refuse to go down; constant belching (时时嗝逆) — she kept wanting to burp upward; and sour fluid rising (呕酸水) — acid water kept flipping up.
💬 Note from Doctor Luo: What is a normal person like? Stomach qi descending is the normal, smooth direction (胃气下行为顺), and spleen qi rises from the left side. Stomach qi ought to descend; now it did not descend but instead reversed upward — hence the burping and acid reflux. Yet at the same time it was “hard pressed, unable to rise properly” — she wanted to bring it up but it would not come, and when it got stuck badly there was continuous, dull pain (绵绵作疼). At the very beginning of the illness, the record says she “only felt that her qi was not comfortable” (惟觉气分不舒) — so at that point it was not yet severe. But after three years of taking medicine, the illness had actually grown worse, and her body was daily more frail (身形日渐羸弱) — she was getting thinner and thinner, weaker and weaker.
After three years, what did she look like? Shortness of breath (呼吸短气) — she could not seem to get enough qi; no fluids in the mouth (口无津液) — her mouth was dry, with too little saliva, and she was often thirsty (时常作渴); her stools were usually dry (大便时常干燥). What does this show? The fluids of the body were insufficient — especially when the stomach yin is deficient, this is exactly what happens.
Then the pulse: both pulses were wiry and thin (脉左右皆弦细) — thin and taut (tight), showing the body was weak, especially the spleen and stomach; the right pulse also carried a firm pulse (右脉兼有牢脉) — and this is where it gets interesting.
The pulse: one “firm pulse” on the right wrist — Doctor Zhang Xichun plants a seed
What does the right pulse represent? In Chinese pulse diagnosis, the left side is heart, liver, kidney, and the right side is lung, spleen, ming men (life gate) — so to read the spleen and stomach, you look at the right pulse. And what is this “firm pulse” (牢脉, lao mai)?
💬 Note from Doctor Luo: With a firm pulse, a light touch finds nothing, and even medium pressure may find nothing — you have to press down deep, and only then do you feel it is very firm and somewhat large. Theoretically, the firm pulse is a combination of five pulse qualities — sunken (chen), wiry (xian), large (da), excess (shi), and long (chang) — and the position is especially deep: the more you press, the more strength there is, rooted down there exerting its force. What does that indicate? It indicates accumulations inside the body. The pulse of a tumor, for example, is often exactly this: the deeper you press, the more forceful it becomes. So Doctor Zhang Xichun plants a seed here — he does not say it outright, but of course he will come back to how to treat it later.
What did Doctor Zhang Xichun think? Spleen qi not rising, stomach qi not descending, fluids all stuck in the middle
How did Doctor Zhang Xichun analyze this illness? He said the Neijing teaches that “the spleen governs thought” — excessive brooding wounds the spleen. This woman thought of home every day; over-thinking wounded her spleen; the wounded spleen qi could no longer rise, and the fluids could not be supplied upward — so her mouth was dry, the burping could not even come out, everything was pent up in the middle; and because stomach qi did not descend, food stagnated in the middle burner. What about the dry stools? That was the spleen deficiency affecting the distribution of fluids throughout the whole body — the water was not being sent where it should go, so locally things dried out.
💬 Note from Doctor Luo: There is also a hidden mechanism here that Doctor Zhang Xichun did not spell out — the liver qi had been wounded as well. We say brooding wounds the spleen, but in fact liver qi stagnation also wounds the spleen — it is the same principle, like two sides of the same coin. To regulate the spleen and stomach — when spleen qi rises and stomach qi descends — only then can the person recover. So the formula Doctor Zhang Xichun wrote follows exactly one idea: regulate the spleen and stomach and restore the rise and fall.
The prescription: Huangqi Jianzhong Tang as the base — herb by herb
Here is the formula. The first herb: sheng huai shan yao (raw Huai mountain yam), one liang (about 30 g).
💬 Note from Doctor Luo: This is a herb Doctor Zhang Xichun loved to use, and he used it in fairly large doses — one liang. Why? When the spleen and stomach are sick, they must be deficient — even when there are outside factors like liver wood running sideways and attacking the spleen-earth, the reason it works is that your spleen and stomach are insufficient. That insufficiency is both cause and result: because you are weak, the liver qi dares to come over and bully you; and after the bullying, you are even weaker. So spleen-stomach insufficiency is the root — for any spleen-stomach illness, Doctor Zhang Xichun would often open with Huai shan yao (the famous mountain yam grown around Wenxian county, Jiaozuo, Henan province — the dao di, authentically produced, herb).
The second herb: da gan gou qi (large sweet Gansu wolfberry), eight qian (about 24 g). There is a story attached — earlier, when Doctor Luo had lectured on “gan gou qi” and explained it as “big, sweet wolfberry,” a netizen wrote in to correct him:
💬 Note from Doctor Luo: The netizen said, “Doctor Luo, your explanation is not quite right — this ‘gan gou qi’ is just like ‘Huai shan yao’: in the old days the term referred to wolfberry from Gansu province.” I said, that’s right, that is indeed the case. Da gan gou qi = large Gansu wolfberry — this too is a dao di herb (authentically produced regional herb). What is wolfberry for? Nourishing the essence of the liver and kidney — and this is the root from which body fluids are generated: if the essence of the liver and kidney is insufficient, the fluids of the body will certainly be insufficient too. And this patient also had liver qi stagnation — liver fire wounds yin and wounds fluids — so he had to supplement the essence and guide it in the direction of yin. You see, when netizens study Chinese medicine carefully, sometimes their knowledge surpasses even us experts.
Next: sheng huang qi (raw astragalus), three qian (about 9 g) — astragalus supports the upright qi, because this person’s upright qi was insufficient; and sheng ji nei jin (raw chicken gizzard lining), three qian (about 9 g) — notice this is a fairly generous amount. Ji nei jin does two jobs: first it transforms stasis (her pulse still had a firm quality, indicating stagnation and blood stasis inside), and second it aids digestion and guides stagnation downward, helping stomach qi descend. Paired with sheng mai ya (raw malt), three qian (about 9 g):
💬 Note from Doctor Luo: Raw malt is what makes spleen qi rise. This malt is a strange thing — roasted, it aids digestion and guides stagnation downward, sending stomach qi down; raw, its qi moves upward and generates spleen qi. That is why some doctors, when they meet a case where the qi mechanism will neither rise nor fall, use raw malt and roasted malt together — one rising, one descending, and the stagnation opens up. Doctor Zhang Xichun’s pairing here is even more refined: raw malt paired with raw chicken gizzard lining — malt raises spleen qi, ji nei jin lowers stomach qi — again, one rising and one falling. This is the method for opening up stagnation: let the spleen and stomach rise and fall, let the whole body’s qi mechanism return to normal — this is Doctor Zhang Xichun’s core technique.
Then xuan shen (figwort root), three qian (about 9 g), tian hua fen (trichosanthes root), and behind them tian dong (asparagus root) — these are all fine herbs for nourishing yin, moistening dryness, and generating fluids, because this person’s fluids were insufficient and internal fire had wounded them. Then sheng hang shao (raw white peony, bai shao), two qian (about 6 g):
💬 Note from Doctor Luo: White peony softens the liver — and this is the key point of the whole formula. On one side, astragalus and cinnamon twig strengthen the spleen; on the other side, white peony softens the liver: once the liver qi becomes soft and gentle, stops being violent, and stops bullying the spleen and stomach, then the spleen and stomach can recover. Doctor Zhang Xichun looked at this illness and saw at once that it came from emotions (liver qi stagnation) plus spleen-stomach weakness — so the formula had to include a liver-softening herb.
Gui zhi (cinnamon twig), one and a half qian (about 4.5 g) — Doctor Zhang Xichun had a splendid discussion of cinnamon twig: the twigs of the cinnamon tree are of two kinds, some forking like deer antlers, some running up in a single shaft and dividing at the top like crab legs. The deer-antler type mostly belongs to yang (warm in nature); the crab-leg type mostly belongs to yin. Cinnamon twig is the deer-antler type, so it is warm and yang in nature — it warms the yang, disperses cold, and unblocks the channels.
💬 Note from Doctor Luo: Doctor Zhang Xichun said cinnamon twig is a very interesting thing — its nature is warm, and warmth is the qi of wood, because it receives the qi of spring wood most deeply, so it is good at rising; but taste it carefully — it also has a little spiciness — and spiciness (the pungent flavor) belongs to metal, it carries the flavor of autumn, so it is also good at descending. Then you may ask: does cinnamon twig rise or descend? Doctor Zhang Xichun said, from his experience: when it should rise it rises, and when it should descend it helps you descend — today we would call that bidirectional regulation!
Finally sheng jiang (fresh ginger), three qian (about 9 g), and da zao (jujube), three pieces, split open. Do you see the pattern now? Hidden inside this formula is the shadow of Huangqi Jianzhong Tang (Astragalus Fortify the Middle Decoction) — astragalus, cinnamon twig, white peony, ginger, jujube — minus one herb, licorice — and Doctor Zhang Xichun added Huai mountain yam and several yin-nourishing herbs. A formula this simple.
The result: five doses brought great improvement — but the stomach pain would not be rooted out, blood stasis was blocking the way
The formula was taken for five doses, and all the various symptoms greatly improved — almost everything was gone. The only thing was, the stomach pain had not completely healed. The pulse was taken again: the right pulse still carried a firm quality — what does that mean? There was still stagnation — blood stasis inside that had not been dissolved.
💬 Note from Doctor Luo: Doctor Zhang Xichun reasoned: where it is blocked, there must be blood stasis stuck inside. So what to do? Into the herbs that raise and lower the qi mechanism, add blood-activating, stasis-dissolving medicines. Remember this train of thought — with a stubborn, chronic stomach illness, in the end there is always a little shadow of blood stasis in there.
The second visit: adding peach kernel and notoginseng — four doses and it was cured
Here is the new formula. The original herbs — sheng huai shan yao one liang, da gan gou qi eight qian, sheng huang qi, xuan shen, tian hua fen, sheng mai ya, ji nei jin, sheng shao yao — all stay the same. What was added? Tao ren (peach kernel), one qian (about 3 g) — peeled, stir-fried, and crushed, decocted together with the rest (crushed peach kernel works better in the decoction); plus guang san qi (notoginseng) ground into a fine powder, two qian (about 6 g).
💬 Note from Doctor Luo: How was the notoginseng powder to be taken? Doctor Zhang Xichun wrote it out carefully: divide the powder into two portions — after the first decoction is done, drink one large cup and wash down half the powder; then decoct the dregs a second time, and with the second batch take the other half. Ten herbs in all, taken twice a day.
And the result? After four doses, the stomach was peaceful and free of pain, and all the illnesses were cured (胃中安然不疼，诸病皆愈) — moreover her body gradually grew stronger, and her pulse was already like a normal person’s! Doctor Zhang Xichun told her: continue the same formula for several more doses, to consolidate the cure. And that was that — the illness was cured.
Note from the commentator: with spleen-stomach illness, remember these three steps
What do we learn from this case? How does spleen-stomach illness come about? Doctor Luo Dalun summarizes it into three categories:
💬 Note from Doctor Luo: First, deficiency-cold (xu han — the first thing to consider); second, spleen-stomach weakness; third, liver wood running sideways and attacking the spleen-earth. With spleen-stomach illness you must understand clearly how it arises — basically it is first, the spleen and stomach are deficient; second, emotions are pent up and liver wood runs sideways bullying the spleen-earth. So what is the treatment approach for spleen-stomach illness? You must have liver-soothing, qi-moving herbs in the formula (softening the liver, soothing the liver), at the same time supplement the upright qi of the spleen and stomach, and add a little blood-activating, stasis-dissolving herb — this is the general treatment approach for ordinary spleen-stomach illness. Doctor Zhang Xichun states it extremely clearly here. One more reminder for everyone: Huangqi Jianzhong Tang is the principal formula for treating stomach ulcers — with stomach ulcer, with pain in the stomach, most cases can be approached starting from this formula; Doctor Zhang Xichun saw the case and wrote out this formula at a glance — you know at once that this man was a master.
Bonus: for people with weak digestion, remember these two rules of daily care
Finally, two words of daily-care advice for all our friends:
💬 Note from Doctor Luo: First, take care of your emotions — most people with weak digestion are carrying something on their minds; when you can, let it go. When the emotions are smooth and the liver qi is soft, the spleen and stomach can recover. Second, attend to the weakness of the spleen and stomach — do not stuff yourself recklessly just because you are young; regulate your life in the direction the spleen and stomach need. When we or our family members have weak digestion, we can think and understand it along Doctor Zhang Xichun’s framework, and generally the spleen and stomach will grow strong again. Tomorrow we continue with Doctor Zhang Xichun’s stories — 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).