Numb Hands, Twitching Muscles, and Feeling Weak in Your 50s: A Stroke Warning?
Opening: one sentence from Doctor Gong Tingxian terrified both old friends
“Within three years, the two of you will surely be paralyzed.”
If those words had come from anyone else, the friends might have laughed them off as a joke. But the man who said them was Doctor Gong Tingxian — imperial physician of the Ming dynasty’s Tai Hospital, known as the “Number One Scholar of the Medical World” (yi lin zhuang yuan). He himself lived to the age of 97, and was one of the most respected physicians of his era. The moment the words left his mouth, both old friends at the gathering went pale.
💬 Note from Doctor Luo: I particularly admire Doctor Gong Tingxian — and especially, he suits us modern people. He lived in the Ming dynasty, when society was fairly stable and life was comfortable, so there were many people with deficiency conditions and many people who ate richly — a state of affairs very much like today’s. Many of his ideas on nurturing health can be picked up and used directly.
Who were the patients? One was “full of desires,” the other loved his wine
The two friends were Shang Huanchuan and Liu Qianxi. Both were on excellent terms with Doctor Gong Tingxian — when you reach middle age, having a few close friends who truly know you is a happy thing. And both men were approaching fifty, nearly at that milestone birthday.
The two had very different temperaments. Shang Huanchuan was “full of desires” — the ancients meant chiefly sexual desire, though ambition also counted: wanting to be an official, wanting to outshine others. So this fellow was fond of beautiful women. Liu Qianxi, on the other hand, loved alcohol — he drank heavily and happily.
💬 Note from Doctor Luo: Between close friends nothing is hidden, so Doctor Gong knew both men’s secrets completely — one was ruled by desire, the other by drink. By age fifty, those two hobbies had both become debts the body was calling in.
That day the two had finally managed to gather for a big reunion — which was no small feat in those days, when one friend was serving as a county magistrate here and another as a prefect there, and meetings were separated by long stretches of time. During the gathering everyone said: brothers, take our pulses, tell us how our bodies are doing.
The pulse: weak at the wrist, yet full at the renying — and always numb, always twitching
Doctor Gong laid his fingers on the pulse, and his brow furrowed. Both wrist pulses were weak (zuo you liang shou mai ju wei) — faint and feeble on the left and right alike. Then he felt the renying pulse — and it was full (sheng), beating forcefully, a sign of excess pathogen. The right pulse was slippery and large (hua da).
Then he asked about symptoms: frequently numb and sore hands and feet — a constant slight aching, slight numbness; and muscles that kept twitching — a patch of muscle on an arm or leg would go “thump, thump, thump” for no reason, like an insect moving beneath the skin. The patients themselves thought: these are such small complaints, surely nothing serious?
💬 Note from Doctor Luo: In ancient texts the renying pulse has a few interpretations — some say it is the pulse beside the Adam’s apple, others say it is the left-hand pulse (renying) versus the right-hand qi-kou pulse. What Doctor Gong felt here was a full renying pulse, which represents excess pathogen (xie qi sheng). The right pulse was slippery and large — slippery (hua) indicates phlegm-dampness, and large (da) indicates excess pathogen. Put the pulse signs together with the symptoms, and he already had his answer.
The diagnostic highlight: “This is qi and blood deficiency with excess wind-phlegm” — no small matter
Doctor Gong stated it plainly: ci qi xue xu, er feng tan sheng ye — this is deficiency of qi and blood, with wind-phlegm in excess.
💬 Note from Doctor Luo: This judgment is worth its weight in gold. Deficiency of qi and blood is the root. When upright qi (zheng qi) is insufficient, the body cannot transform and move dampness, so dampness stays behind and slowly turns into phlegm — if you can’t dissolve it, dampness lingers and breeds phlegm. And when qi and blood are insufficient, blood deficiency gives rise to wind — internal wind easily stirs. So it is qi and blood deficiency first, wind-phlegm excess second: insufficient upright qi is the root, wind-phlegm is the branch.
Here was a man nearly fifty, upright qi beginning to fail, wind-phlegm beginning to flourish. So Doctor Gong said gravely: this state of affairs is not good — within three years you will have paralysis. “You two brothers must be careful. Right now is the time to regulate and tonify.” He wrote out prescriptions and urged them to take medicine to avoid the calamity that would follow (fu yao, yi mian hou huan).
Shang Huanchuan: he listened — one batch of each pill every year, and nothing ever happened
Most people, hearing such a warning, would nod and then forget it. But Shang Huanchuan was different — when someone tells you you could be paralyzed within three years, how can you not take it seriously? He immediately said: I care! Whatever Doctor Gong says, I will heed!
So Shang Huanchuan made one batch each of Shoufeng Shunqi Wan and Yanling Guben Dan every year (mei nian ge yi liao) — one batch of each formula each year, taken slowly over time.
💬 Note from Doctor Luo: “One batch” (yi liao) means making the formula once in the quantity the prescription specifies. This friend Shang made a batch every single year and took it every year — and the result was nothing at all happened to him, he stayed perfectly safe. Doctor Gong’s formulas are all good formulas, and we’ll introduce these two in a moment.
Liu Qianxi: he didn’t listen — kept drinking, and before three years were up, thud! He hit the floor
And the other friend, Liu? He thought: well, Doctor Gong is famous, but all I have is a twitching muscle and slightly numb hands — what’s that? Nothing! So he refused the advice and drank without restraint (bu ting quan, zong yin wu ji) — he went right on drinking, and drank harder than ever.
💬 Note from Doctor Luo: They say giving up lust is easy — giving up alcohol is the hard one. In the deep northeast winters, you see people who drank themselves senseless lying on the road and freezing their ears off, or losing fingers to frostbite; in Russia, drunks freeze to death every winter — it’s that cold. Some people truly cannot quit the bottle.
And what happened? Before three years were up, Liu Qianxi duly had his stroke — “thud,” he collapsed to the ground, paralyzed, unable to move, unable to speak. Only then did he regret it. He sent urgently for Doctor Gong, and in his garbled speech the meaning was clear: brother, I’m so sorry! I wish I had listened to you! Look how obedient Shang was — he listened to you and nothing happened to him. I didn’t listen, I kept drinking, and look at me now. Yuan xiong jie li jiu wo can chuan — use every skill you have, save this poor breath of mine!
The life-saving formula: modified Yangrong Tang plus Jianbu Huqian Wan, taken for a year and a half
Doctor Gong said: of course I’ll save you, brother. He gave him modified Yangrong Tang (Nourishing the Nutritive-Qi Decoction) together with Jianbu Huqian Wan (Agile-Step Hidden-Tiger Pill) — the two taken together, slowly.
💬 Note from Doctor Luo: This is completely different from the acute cases we’ve discussed where “one dose does it.” This isn’t a matter of a year or two. The deficiency had been building for many years — drinking every day, phlegm-dampness thick inside the body — so recovery had to be gradual. What this friend Liu had, in today’s terms, was almost certainly a cerebral infarction (ischemic stroke). He took the medicine slowly for more than a year, and the paralysis actually gradually healed.
Why is fifty a major threshold in life?
The case is told. Two men, the same starting point — both near fifty, both with qi-blood deficiency and excess wind-phlegm — yet one listened and stayed safe, the other refused and ended paralyzed. Where did the difference lie? Doctor Luo says: it lies precisely in “heeding the warning,” in whether you treat “middle age calls for a major overhaul” as something real.
💬 Note from Doctor Luo: The Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine) says, “After forty, the yin qi is half spent” (ren guo si shi, yin qi zi ban) — every ten years is another threshold. By around fifty, the insufficiency of qi and blood begins to show itself plainly. There are far too many people in their fifties today who need nourishment. Every day we think about how to earn money — busy with social engagements, rushing reports, sitting in meetings, driving kids to school. Who among us lives like the ancients, strumming the guqin in the morning, sipping tea, roaming the hills and admiring flowers in the afternoon? Compared with the ancients we are not merely equal — we are busier than they were, and our consumption of qi and blood is no less.
Bonus: Doctor Gong’s four famous formulas, taken apart for you
Doctor Luo says the most valuable part of this case is the formulas Doctor Gong used — “all good formulas; let me introduce them to you slowly.”
Prevention formula one: Shoufeng Shunqi Wan (Wind-Restraining Qi-Smoothing Pill) — the one Shang Huanchuan took
This formula treats heat accumulation in the stomach and intestines: stuffiness and oppression of the chest and diaphragm, bound and dry stools, reddish and difficult urination, intestinal wind and hemorrhoids, aching loins and knees, numb and stubborn limbs, paralysis of hands and feet, difficulty walking, slurred speech — the formula books say it treats “the thirty-six winds and seventy-two kinds of qi, with none it fails to benefit” (san shi liu zhong feng, qi shi er ban qi, wu bu xiao yan), speaking of its power to unblock and purge outward.
The ingredients: da huang (rhubarb) five liang, nine times steamed and nine times dried (jiu zheng jiu shai), huo ma ren (hemp seed) and yu li ren (bush-cherry kernel) to moisten the intestines, gan cao (licorice), tu si zi (dodder seed) two liang to tonify the kidney, dry shan yao (Chinese yam) two liang, niu xi (achyranthes root) two liang, washed in wine — this is the famous Huai niu xi, a special product of Jiaozuo, Henan — zhi ke (bitter orange) to regulate qi, bing lang (betel nut) to resolve dampness, regulate qi and guide stagnation out through the intestines, che qian zi (plantago seed) to promote urination, and shan zhu yu (cornus fruit) to nourish liver blood and liver yin.
💬 Note from Doctor Luo: This formula both supports the upright and unblocks the intestines — it clears out the stagnation lodged between the intestines. When the qi movement inside your body is not flowing and upright qi is insufficient, you need this kind of clearing. Supporting the upright and dispelling pathogen are about half and half: dispelling pathogen means moving the bowels, with a bit of qi regulation added — the emphasis is on unblocking. It suits people with insufficient upright qi, dry stools and intestinal stagnation. Made into pills the size of parasol-tree seeds, take 30 pills each time, with tea or wine, morning and evening, with no dietary restrictions whatsoever (bai wu suo ji).
Prevention formula two: Yanling Guben Dan (Elixir for Prolonging Years and Securing the Root) — the other pill Shang Huanchuan took
This formula is even more important. It treats the five labors, seven injuries, and all the hundred deficiencies (wu lao qi shang, zhu xu bai sun): a withered, aged complexion; a gaunt, wasted body; in middle age, failure of male vigor; scant spirit and short breath; hair turning white before fifty; paralysis of left and right sides; difficulty walking; aching loins and knees; small-intestine hernia; women with no children for years; cold and weak lower burner — all kinds of deficiency.
The ingredients: tian men dong (asparagus tuber) two liang and mai men dong (ophiopogon tuber) two liang to nourish yin; sheng di huang (raw rehmannia) two liang and shu di huang (cooked rehmannia) two liang, both washed in wine — raw and cooked rehmannia used together; shan yao (Chinese yam) two liang; niu xi (Huai achyranthes) two liang; du zhong (eucommia bark) two liang to strengthen loins and knees; ba ji tian (morinda root) two liang to tonify kidney yang; wu wei zi (schisandra fruit) two liang; gou qi zi (goji berry) two liang to tonify liver and kidney; shan zhu yu (cornus fruit) two liang to tonify liver and kidney; bai fu ling (poria) two liang; ren shen (ginseng) to tonify qi; mu xiang (costus root) to regulate qi; bai zi ren (arborvitae seed) two liang to nourish the heart; old chuan jiao (Sichuan pepper) to warm; and one liang each of shi chang pu (acorus rhizome), yuan zhi (polygala root) and ze xie (alisma) — to open the orifices of the heart and drain dampness; plus one and a half liang each of rou cong rong (cistanche) to tonify kidney yang, fu pen zi (raspberry fruit) to tonify the kidney, nv zhen zi (privet fruit) to tonify kidney yin, che qian zi (plantago seed) to promote urination and drain dampness, tu si zi (dodder seed) to tonify kidney yang, and di gu pi (wolfberry root bark). If the patient is a woman, add dang gui (angelica) and xiang fu (cyperus).
💬 Note from Doctor Luo: Shu di huang, shan yao, shan zhu yu — this is the “three tonics” foundation of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Why so many yin-nourishing herbs? Because “after forty, the yin qi is half spent” — yin is beginning to run short, and tian men dong, mai men dong, sheng di, shu di are all yin-nourishing. Grind into fine powder, mix with good wine into a paste and form pills the size of parasol-tree seeds, take 80 pills on an empty stomach, washed down with warm wine. The formula books say: after half a month, male vigor is strong; after a month, the complexion is like a child’s and the eyes can see ten li; after three months, white hair turns black again; taken long-term, the spirit never flags and the body is light and strong. Doctor Gong collected an extraordinary number of famous formulas — the Wuji Baifeng Wan (Black-Boned Chicken and White Phoenix Pill) we still take today is simply Doctor Gong’s Wuji Wan and Baifeng Wan combined into one name! After telling you this formula, I almost want to make a batch myself, grind it into powder and form pills — there’s virtually nothing toxic in it, everything is mild; you could reduce the shi chang pu and ze xie a little and the rest is perfectly safe. Or you don’t even need to roll pills — just grind it into powder and drink it as a powder mixed with a little rice wine. When I visit Tongrentang, I ask them to make it up for me. The Chinese ancients had countless formulas like this; some are made into patent medicines but under changed names, like Guben Yanling Wan and the like — whether the proportions match this original, I couldn’t say.
The emergency formula: Yangrong Tang (Nourishing the Nutritive-Qi Decoction) — what Liu Qianxi took after his stroke
It treats wind striking the blood vessels, inability to raise the four limbs, inability to speak, and phlegm clouding the heart orifices with loss of consciousness — a stiff tongue that cannot speak, copious phlegm, a wry mouth and slanted eyes, hemiplegia: all the transformations of wind-stroke.
The ingredients: dang gui (angelica), chuan xiong (ligusticum), bai shao (white peony), sheng di huang (raw rehmannia) — the Four-Substance Decoction (Siwu Tang) as the base to nourish blood; mai men dong (ophiopogon) to nourish yin; yuan zhi (polygala) and shi chang pu (acorus) to open the heart orifices; chen pi (tangerine peel) to regulate qi; wu yao (lindera root) to warm the liver; bai fu ling (poria) to drain dampness; zhi shi (immature bitter orange) to regulate qi and send it downward; ban xia (pinellia) to transform phlegm; huang lian (coptis) to clear heat; fang feng (siler), qiang huo (notopterygium), qin jiao (large gentian) to dispel wind; and gan cao (licorice).
💬 Note from Doctor Luo: The Four-Substance Decoction base nourishes blood; yuan zhi and shi chang pu open the heart orifices — because phlegm has clouded the heart orifices. When decocting, use three slices of fresh ginger in the water, and mix in a little boy’s urine (tong bian), bamboo juice (zhu li), and ginger juice (jiang zhi) when drinking — the urine and bamboo juice are cooling and transform phlegm; the ginger juice is warming, acting as a counter-guide (fan zuo) while also helping to transform phlegm. This formula supports the upright, opens the orifices, unblocks the collaterals, dispels pathogen and transforms phlegm all at once — and it is fairly balanced and mild.
The recovery formula: Jianbu Huqian Wan (Agile-Step Hidden-Tiger Pill) — also given to Liu Qianxi after the stroke
It treats wind-stroke paralysis, hands and feet unable to move, stiff tongue and slurred speech (she qiang yu jian) — the tongue stiff, words unclear.
The ingredients: huang qi (astragalus), stir-fried in salt water; dang gui (angelica); gou qi zi (goji berry), washed in wine; gui ban (tortoise plastron) to nourish yin and clear deficiency heat; zhi mu (anemarrhena) to clear heat; niu xi (achyranthes), washed in wine, to strengthen sinews and bones; bai zhu (atractylodes) to tonify the spleen; bai shao (white peony) to nourish yin; sheng di huang and shu di huang (raw and cooked rehmannia); hu jing gu (tiger leg bone — unobtainable today; dog bone or pyrite can substitute); du zhong (eucommia) to strengthen loins and bones; ren shen (ginseng) to tonify qi; bu gu zhi (psoralea fruit) to warm kidney qi and the lower burner; mai men dong (ophiopogon) to nourish yin; bai fu ling (poria) to drain dampness; mu gua (papaya) to soften and constrain the liver; shi chang pu (acorus) to open the heart orifices; suan zao ren (sour jujube seed) to nourish blood and liver blood; yuan zhi (polygala) to open the heart orifices; yi ren (coix seed) to drain dampness; qiang huo (notopterygium), du huo (pubescent angelica) and fang feng (siler) to dispel wind; huang bai (phellodendron) to clear heat; wu wei zi (schisandra) to tonify the deficiencies of the five organs; chen xiang (agarwood) to regulate qi; and fu zi (aconite) to warm yang.
💬 Note from Doctor Luo: This formula is ground to powder, mixed with honey and five strips of pig spinal cord (zhu sui), then pounded into pills — Doctor Gong was very particular about what he used as the pill base: for Rui Lian Wan, for example, he stewed a pig’s stomach until it was completely tender, pounded it extremely fine, and used that to form the pills. That takes real craft. The pills are the size of parasol-tree seeds, take 100 pills each time, washed down with warm wine or warm water. Tongrentang used to make a Jianbu Huqian Wan, but it was a simplified version of the original — for weak legs and aching, soft loins and knees, not for treating stroke; don’t confuse the two. And later, because tiger bone fell under wildlife protection, production stopped. These formulas we should regard as part of Chinese medical culture.
Closing: middle age calls for a “major overhaul”
Doctor Luo gathers the theme of this piece — prevention is always worth more than remedy:
💬 Note from Doctor Luo: A man like friend Liu, treated only after he is paralyzed — that is already too late. However useful Yangrong Tang and Jianbu Huqian Wan are, they must be taken for a very long time, and whether he recovers fully or carries after-effects is anyone’s guess. So the earlier you start adjusting, the better: tonify what should be tonified, unblock what should be unblocked, transform the phlegm-dampness in the body, and adjust whatever needs adjusting. It’s like a car that has driven 200,000 kilometers — of course you’ll give it a good, thorough overhaul. In middle age, go to a Chinese medicine practitioner and have yourself analyzed: am I deficient or excess? Most people are on the deficient side — then earnestly take some nourishing medicine to build yourself back up, let the body recover slowly, quit the bad habits, and after that you’re fine.
And if you still refuse to pay attention — I’m an emotional man myself, I drink when I feel like it, I eat fatty meat when I want it, and I look twice at beautiful women — that’s normal. But don’t stare too hard. Don’t burn through everything; if you consume too much, in the end the body breaks down. Middle age needs a major adjustment, a major overhaul, serious nourishment. Keep that awareness, and you won’t be the one running to the hospital at sixty or seventy begging for help — how exhausting that would be.
Compiled from Doctor Luo Dalun’s commentary on Doctor Gong Tingxian’s case records; the case comes from Wan Bing Hui Chun (《万病回春》) and Shou Shi Bao Yuan (《寿世保元》), by Doctor Gong Tingxian, published 1587/1615.