Vomiting Everything, Eight Days Without Food, Death Bed Already Prepared? Doctor Gong Tingxian’s Modified Erchen Tang for Qi-Stagnation Phlegm-Heat Vomiting — Calmed in Two Doses

Patient search terms: vomiting whatever is eaten / unrelenting vomiting / eight days without food / vomiting whenever angry / stomach pain / unable to pass stool / irritable and sleepless / heart racing and panting

Medical terms for this condition: vomiting · qi stagnation with phlegm-heat · phlegm-heat blocked internally · liver wood attacking spleen earth · blood deficiency with weak stomach · reflux esophagitis

Opening: he cured the prince’s wife, and the prince gave him a plaque

Today’s physician is the great Ming-dynasty doctor Gong Tingxian (龚廷贤, 1538–1635). He rose to fame by curing an illness no one else could: the wife of the Prince of Lu was ill, and every famous doctor in the land was helpless — until Gong Tingxian cured her. The delighted prince presented him with a plaque reading “Champion of the Medical Grove” (yi lin zhuang yuan) — “You rank first in the world of medicine!” From that day Gong Tingxian’s name spread across the empire, and he later entered the Ming dynasty’s Imperial Medical Academy, becoming a true imperial physician.

💬 Note from Doctor Luo: Gong Tingxian was enormously influential in the Ming dynasty and profoundly influential on later generations as well. His theories were upright, and his prescriptions were upright — he was a very balanced, moderate doctor who emphasized nourishment and rebuilding. I talked about some of his cases before the pandemic and didn’t finish; today we continue.

Who was the patient? The prince’s wife who threw up at the drop of a hat

The patient was the wife of the Prince of Xinling — the consort of a Ming-dynasty prince. Zhu Yuanzhang’s descendants were scattered across the entire country; there were enormous numbers of princes, and each was effectively “the local emperor” — no one dared cross them, and they were spoiled rotten. This lady, Gong Tingxian wrote bluntly: she had a bad temperament and loved to get angry.

💬 Note from Doctor Luo: The Ming dynasty had a huge number of feudal princes — Zhu Yuanzhang’s descendants multiplied across the land, each one a local lord. With great power, no oversight, and the last word on everything, their tempers naturally swelled. Someone like this consort would fall ill the moment her anger flared.

What was her problem? She vomited at every anger — the instant she lost her temper, she threw up on the spot. On top of that, her chest and diaphragm felt blocked and stuffy, and she was so irritable she could not sleep. Her belly ached; she was constipated and could not pass stool. Worst of all: any food she put in her mouth came right back up — whatever she ate, she vomited — and for eight entire days she had taken in nothing at all.

Eight days without a single grain — the deathbed was already prepared

Eight days without eating or sleeping — how long can a body hold out? By the eighth day the situation had turned critical: palpitations, strained breathing, at death’s door. Her heart raced; she could not catch her breath. Why the panting? Because everything below was blocked! The lung and the large intestine are interior-exterior paired organs (fei yu da chang xiang biao li): when the large intestine cannot move, nothing above can be well. She lay on the bed gasping, and the family had already prepared for her funeral. Of course, the prince’s household had summoned physicians — but with the illness this grave, no one dared treat her anymore, and the whole family sat around weeping.

💬 Note from Doctor Luo: Everyone knows what vomiting feels like. When the body falls out of balance, it sometimes uses vomiting to push evil qi out — that’s the body trying to recover. But once vomiting reaches a certain point, the whole person collapses — it’s unbearably miserable. This lady had already gone eight days without food and sleep, her heart racing and breath short, the family weeping around a prepared deathbed — this illness could not have been more dire.

Feeling the pulse: all six faint and weak — blood depleted, stomach weak

At the critical moment, Gong Tingxian was summoned. He laid his fingers on her wrist: all six pulses were faint and weak (liu mai xu wei) — every pulse position extremely deficient, extremely feeble. His judgment: blood is depleted, upright qi is insufficient; the spleen and stomach are also weak, too feeble to transform and transport, so the qi is all jammed up inside. And thinking one layer deeper: qi stagnation with phlegm-heat — the anger had stagnated the qi, and the stagnation had bred phlegm and fire.

💬 Note from Doctor Luo: Let’s draw a clear distinction here: blood deficiency with a weak stomach is insufficiency of upright qi. But where did the insufficiency come from? It is directly connected to her habit of getting angry. We say liver wood attacks spleen earth (gan mu ke pi tu) — bad emotions cause the spleen and stomach to malfunction. People who are quick to anger, whose liver fire blazes, always have poor spleen and stomach function. When spleen earth is attacked, its ability to transform qi and blood weakens — and the source of blood is precisely the spleen and stomach: when the spleen and stomach are weak, the blood runs short.

Why can’t you tonify when you’re more and more deficient? — a classic dilemma of nourishing the blood

Here Doctor Luo Dalun explains a puzzle many people struggle with: “I’m clearly blood deficient — why does every tonic I eat give me ‘heat’?”

💬 Note from Doctor Luo: Some people’s spleen and stomach are so weak that they cannot even be nourished. Someone says, “Let me take a little Yu Ling Gao (Jade Spirit Paste) to build up my blood” — and the moment they eat it, their stomach protests and they flare up with heat. Why? Look at their tongue: puffy, with scalloped teeth marks, and a thick coating covering the whole surface — that tells you the spleen and stomach are extremely weak, too weak to transform qi and blood. You give them blood tonics, and they simply cannot absorb them. E Jiao (donkey-hide gelatin) is the same — eat it and up comes the heat, because it can’t be absorbed. What to do? First strengthen the spleen and stomach — take things like Xiangsha Liujun Wan (Six Gentlemen Pill with Aucklandia and Amomum) or Guipi Wan (Spleen-Restoring Pill), and slowly build the spleen and stomach back up. Once they are strong, then pair the Yu Ling Gao and Dang Gui (Chinese angelica) with them for blood-nourishing, and no more heat. When the spleen and stomach cannot transform, tonics are very hard to use. That is why blood deficiency and a weak spleen and stomach so often travel together.

Where does the phlegm come from? Qi stagnation breeds phlegm; liver fire forges phlegm

So if blood deficiency and a weak stomach are deficiency — where did the phlegm-fire come from? Gong Tingxian grasped the core: qi stagnation.

💬 Note from Doctor Luo: The liver governs free coursing — it is in charge of keeping the body’s qi and blood moving smoothly. When liver qi becomes depressed and knotted, qi and blood congeal and move sluggishly; the body’s fluids stop where they are, gradually turning from thin to thick and slowly clotting into phlegm — this is called “invisible phlegm” (wu xing zhi tan); the kind you cough up is “visible phlegm” (you xing zhi tan), and the two are actually connected — sometimes through activity, the invisible phlegm inside can be transformed into visible phlegm and coughed out. Qi stagnation breeds phlegm — that’s one road. The other road: this lady’s liver fire was enormous — she vomited with every fit of rage — and liver fire burning fiercely dries up the body fluids, which also forges fluids into phlegm — this is heat phlegm. Phlegm divides into cold and hot; hers was phlegm-heat. That is why we say strange diseases are often born of phlegm (guai bing duo sheng yu tan): when phlegm-heat blocks the middle-upper burner, the spleen and stomach’s qi mechanism cannot run properly, and above there is panting, stuffiness, and vomiting.

Breaking down the prescription: Erchen Tang as the base, resolving phlegm and clearing heat as the main force

What formula did Gong Tingxian write? Modified Erchen Tang (Two-Cured Decoction) — the ancestral formula for transforming phlegm, as the base.

Erchen Tang is the granddaddy of all phlegm-resolving formulas: Fu Ling (Poria) drains dampness — phlegm and water transform into each other, so draining the excess water cuts off the root of phlegm production; Ban Xia (Pinellia) dries dampness and transforms phlegm; Chen Pi (Tangerine Peel) moves qi and transforms phlegm; Gan Cao (Licorice) harmonizes. Countless later formulas — Wendan Tang (Gallbladder-Warming Decoction) among them — grew out of Erchen Tang.

The modifications are where the real art of this battle lies:

• Ginger-juice-fried Huang Lian (Coptis), wine-fried Huang Qin (Scutellaria), and stir-fried Zhi Zi (Gardenia) — clear the phlegm-heat. But this patient’s spleen and stomach were so weak, and her belly ached — you cannot send bitter-cold herbs straight in. So each had to be processed: the Huang Lian was fried with ginger juice so it wouldn’t be too cold; the Huang Qin was wine-fried.
• Dang Gui (Chinese Angelica) and wine-fried Bai Shao (White Peony) — nourish and move the blood. Her blood was weak, yes — but only these two were used;
• Bai Zhu (White Atractylodes) — strengthens the spleen. The spleen was too weak — again, just this single herb;
• Xiang Fu (Cyperus) — moves the qi;
• Zhu Ru (Bamboo Shavings) and Zhu Li (Bamboo Sap) — the main forces for resolving phlegm-heat. Zhu Ru is the soft white layer scraped from the inside of a bamboo stalk, shaved into fine silky threads — bamboo is cool in nature and specializes in resolving heat-phlegm. Zhu Li is the sap pressed from burned bamboo, also a resolver of phlegm-heat;
• Sheng Jiang (fresh ginger juice) — as a counterbalancing measure, because the formula is full of cold herbs and they feared it would be too chilling; and ginger juice also directs rebellious qi downward and stops vomiting — exactly right for this complaint.

💬 Note from Doctor Luo: Why wine-fry the Huang Qin? From the Song dynasty onward, various processing methods became fashionable in Chinese medicine, and wine-processing was one of them. First, wine is warming — it softens the bitter-cold nature of Huang Qin. Second, wine’s nature moves upward and outward; after wine-frying, the clearing action shifts toward the upper burner — the heat of the upper burner, the limbs’ extremities, and the body surface. That’s why the old masters used wine-fried Huang Qin (jiu qin) when clearing upper-burner heat; and if they feared the patient’s belly was cold or aching, they used wine-fried Huang Qin to warm it a little too. The ginger-juice-fried Huang Lian works the same way: Huang Lian is intensely bitter and cold, too much for a patient with weak spleen and stomach — fried with ginger juice it becomes far less chilling, and in passing it also directs qi downward and stops vomiting.

Treat the branch urgently: with pulses this weak, why not tonify heavily?

Here is a seeming contradiction: the patient’s six pulses were faint and weak, she looked like she was on her last legs — why not rush in with heavy tonics? Gong Tingxian’s decision is the most brilliant stroke of the whole case: he judged that phlegm-heat was pressing against them from inside. She looked deficient, yes — but the main contradiction was excess evil, not deficient upright qi.

💬 Note from Doctor Luo: Look at his formula: blood-nourishing herbs — only Dang Gui and Bai Shao, two of them; spleen-strengthening — a single Bai Zhu; while the phlegm-resolving, heat-clearing herbs are many — this is treating the branch urgently (ji ze zhi qi biao). He believed this patient was not about to die: if the deficiency had reached that point, you would tonify. But now, it was external evil — phlegm-heat — making mischief inside. Phlegm genuinely has to be cleared; when it blocks the body, qi and blood cannot run normally. Clear away the phlegm-heat, and the body will gradually recover on its own. Severity and urgency: treat the branch when urgent, treat the root when slow — that is the accumulated wisdom of Chinese medicine.

Calmed in two doses: a woman who hadn’t eaten in eight days recovered after two bowls of medicine

What happened? Two doses, and she was calm (liang fu er an) — after just two bowls of medicine, this patient whose deathbed was prepared, who had not eaten for eight days, could eat again. No more vomiting. Healed!

💬 Note from Doctor Luo: Two doses and done — what does that tell us? It tells us there really was a lump of phlegm-heat squatting in her middle-upper burner, scrambling the movement of qi and blood and wrecking the spleen and stomach’s function, so that anything she ate rebounded right back out. Liver fire kept burning inside, generating more and more phlegm, and it all piled up inside. Gong Tingxian’s grasp of this disease mechanism was extremely precise. How do you tell whether someone has phlegm-heat? Look at the tongue — the coating should be yellowish and greasy. Think about today: since the pandemic, a great many of us carry phlegm in our bodies — upright qi insufficient, qi and blood moving with obstruction. Some have phlegm-heat, some cold phlegm — people who overindulge in rich, sweet, fatty food and run hot liver fire are prone to generating phlegm-heat. What this case teaches us is how to resolve phlegm: Erchen Tang as the base, add heat-clearing herbs, add blood-nourishing and spleen-strengthening herbs, and use Zhu Ru and Zhu Li to clear the phlegm-heat. Once the obstruction is removed, the body bounces back right away.

Aftercare: you can cure the moment — you can’t cure a lifetime

The illness was cured, but Gong Tingxian reminded: aftercare is the longer road.

💬 Note from Doctor Luo: What do you do once this illness is cured? Sooth the liver, move the qi, and strengthen the spleen and stomach — soothe the liver on one side, fortify the spleen on the other. Why? Because this person’s emotions are the problem. Bad emotions are the source of ten thousand diseases: they weaken the spleen and stomach, deplete the blood, cripple transformation and transport, and let dampness stagnate; liver fire then scorches the fluids and turns them into phlegm-heat. So for patients like this, you can cure the moment — you can’t cure a lifetime — their character itself must change. If the temperament doesn’t change, the phlegm will always come back. Phlegm caused by external contraction or by diet is easy to remove; phlegm-heat caused by personality is clearable in the short term, but the road of slow, steady regulation afterward is long.

Finally, Doctor Luo Dalun makes the overarching principle explicit:

💬 Note from Doctor Luo: Cases like this deserve to be savored slowly. In clinical practice, depending on whether the person is strong or weak, and how weak, you decide whether to make supporting the upright qi primary or resolving phlegm primary. For this patient, phlegm-heat was primary, so she cleared the phlegm-heat first — just as with people whose dominant problem is dampness: you try to tonify them and nothing goes in. What to do? Clear first, then tonify — alternate clearing and tonifying, or do both at once, and the body gradually recovers. This is the method for people whose evil qi is overwhelming and phlegm-heat extremely heavy. Gong Tingxian was truly formidable — a patient whose funeral was already prepared, cured with two bowls of medicine. Let’s learn it step by step: when phlegm is overwhelming, resolve the phlegm first; once it’s cleared, then tonify slowly — that way the tonics actually go in. While phlegm evil is raging, whatever tonic you stuff in won’t be absorbed — it comes right back up with the vomiting. That simply doesn’t work.

Compiled from Doctor Luo Dalun’s (PhD, Beijing University of Chinese Medicine) public commentary on the case of Doctor Gong Tingxian; case source: Wan Bing Hui Chun (《万病回春》 — Return of Spring for All Diseases), published 1587, Ming dynasty.