Bloated, No Appetite, Constipated After Getting Angry or Upset?
Patient search terms: bloating after anger / can’t eat when upset / tight chest and bloated belly / constipation / one bowel movement every ten-plus days / heart palpitations
Medical terms for this condition: liver depression with spleen weakness · stagnant liver qi (liver wood attacking spleen earth) · functional dyspepsia
Opening: six months of treatment — and getting worse the whole time
Today’s patient was an elderly woman whose family had been worried sick about her for half a year. She had seen many doctors, one after another, and been treated for a full six months — with no effect at all. No, that’s not quite right: it wasn’t that nothing happened. It was that she got weaker and weaker, and the illness pressed on heavier and heavier. At last, out of options, the family brought her to Doctor Zhang Xichun’s door.
💬 Note from Doctor Luo: Everyone, remember this opening: six months of no progress, getting worse all the while — it tells you every previous approach was wrong. This case is Doctor Zhang Xichun’s lesson on exactly where the problem lies when a condition “won’t respond no matter how it’s treated.”
Who was she? A woman near sixty, a worrier her whole life
The patient was close to sixty years old. Her constitution had never been strong to begin with — a weak foundation. Worse, the housework at home was crushing, and she was the worrying type: this matter, that matter, every single thing had to be fretted over. And so the illness came: her heart fluttered and raced — palpitations, anxiety; her mood sank lower and lower as her liver qi knotted up; then came fullness of the chest and abdomen — a tight chest, a bloated belly, fading appetite until she could barely eat; and most alarming of all, her tongue coating turned black while her stool became bound and dry — so dry that she moved her bowels only once every ten-plus days.
💬 Note from Doctor Luo: Notice, this didn’t happen overnight. First came the bad mood, the gloom and frustration; given time, the spleen and stomach gave way — bloating, loss of appetite, constipation, all of it. This is what Doctor Luo always says: a great many stomach and digestive problems are rooted in emotion.
The root of the illness: liver wood attacking spleen earth
Doctor Zhang Xichun took her pulse: it was as fine as a silk thread — the mark of insufficient upright qi — yet threaded through with a wiry quality, tight as a plucked zither string, the classic pulse of constrained liver qi. Fortunately, the rhythm was still normal — the beats came and went as they should. The qi was weak, but it had not yet fallen into chaos, which meant this illness could still be cured.
💬 Note from Doctor Luo: Traditional Chinese medicine describes this as “liver wood attacking spleen earth” (gan mu heng ni ke pi tu). When you’re upset and gloomy, the liver qi cannot flow freely, and it turns sideways to bully the spleen and stomach — this is what the classics call “liver wood overpowering the spleen.” Let it go on long enough, and the spleen and stomach grow weaker and weaker until you settle into the state of “liver depression with spleen weakness”: distended chest and flanks, a tight chest, a bloated belly, and not a shred of appetite. This woman was a textbook case.
Doctor Zhang Xichun’s reasoning: see liver disease, know the liver will transmit to the spleen — so fortify the spleen first
Most doctors, faced with this picture, would start by soothing the liver. Doctor Zhang Xichun did no such thing. Her upright qi, he reasoned, was already too weak — force the liver qi to move with strong dispersing herbs and you only stir the qi further and make the disorder worse. So what did he do instead? First build the upright qi back up — above all, build up the spleen and stomach’s qi until the spleen energy is strong.
💡 Note from Doctor Luo: This strategy comes from the medical sage Zhang Zhongjing: “When you see liver disease, know that the liver will transmit to the spleen — so you must fortify the spleen first.” Seeing that the liver is in trouble, you know its next step is to attack the spleen, so you shore the spleen-earth up in advance — like building a dam before the flood arrives — so the liver qi cannot get in. When your qi is strong, you may soothe the liver freely; when your qi is deficient and the spleen is weak, you fill the spleen first, and the liver qi settles down on its own. This is the principle “to treat the liver, fortify the spleen first.”
The prescription: Shengjiang Tang (Rising and Falling Decoction) — tonify the spleen first, soothe the liver second
The formula Doctor Zhang Xichun wrote is his celebrated prescription for liver depression with spleen weakness — Shengjiang Tang, the Rising and Falling Decoction. The ingredients are simple:
- Ye tai shen (the wild codonopsis from Mount Wutai — today we simply call it dang shen / codonopsis) 6 g, raw huang qi (astragalus) 6 g, bai zhu (atractylodes) 6 g — these three are the main spleen-tonifying force
- Chen pi (tangerine peel) 6 g, hou po (magnolia bark) 6 g — move the qi and comb through the stuck, knotted qi
- Raw ji nei jin (chicken gizzard lining) 6 g (ground fine) — clears the channels, digests food, and helps the stomach qi descend
- Zhi mu (anemarrhena) 9 g — to balance the warming tendency of the tonics
- Raw bai shao (white peony) 9 g — softens and restrains the liver, reining in its sideways charge
- Gui zhi jian (cassia twig tips) 3 g, chuan xiong (ligusticum) 3 g — these two are the only liver-regulating herbs in the whole formula
- Sheng jiang (fresh ginger) 6 g
💬 Note from Doctor Luo: Look at the structure: the spleen-tonifying herbs take up the greater part of the formula, and only two — gui zhi jian and chuan xiong — are there to move the liver. Doctor Zhang Xichun did not even use chai hu (bupleurum) — these two were enough, he said. Everything else works on the spleen and stomach, regulating their rising and falling. Why is it called the “Rising and Falling Decoction”? Because when the spleen qi is sufficient it can rise, and only then can the stomach qi descend — one rises, one falls, the spleen-stomach wheel turns again, and the illness is done.
Sheng ji nei jin: clears the channels and pulls the stomach qi down
The most ingenious herb in the formula is sheng ji nei jin — the yellow membrane lining a chicken’s gizzard. Doctor Zhang Xichun used it with complete mastery. It clears the channels, it digests food, and above all it can drive the stomach qi downward. When the spleen and stomach lose their rhythm, the stomach qi fails to descend and blocks up the chest and belly; ji nei jin goes in and helps the stomach qi move down, and the fullness dissolves.
💬 Note from Doctor Luo: Doctor Zhang Xichun was exceptionally fond of raw ji nei jin — it breaks up stasis, digests food, and clears the channels, all in one. In this formula it plays the key role of “lowering the stomach qi.” Spleen rising and stomach falling — it works together with the tonics to get the wheel turning again.
The black tongue coating: add one herb, di gu pi
There was one more complication: her tongue coating had turned black. Doctor Zhang Xichun read this as heat in the body, so he added a full liang — 30 g — of di gu pi (wolfberry root bark). A substantial dose. And indeed, after a few doses, the black tongue and the dry stool gradually both resolved.
💬 Note from Doctor Luo: Watch his method of adjustment: a black coating means heat, so he adds di gu pi to clear it; as the heat recedes and the coating turns, he slowly tapers the di gu pi down. Advancing and retreating with measure — that is the craft of an old hand.
The long road: half cured in ten doses, finished only at a hundred
Once the di gu pi was reduced, the woman took a dozen or so more doses, and more than half the illness was gone. Doctor Zhang Xichun said: keep going, stay the course. And so she did — she kept taking it until she had completed a hundred doses — a full hundred bowls of medicine! By the end, the illness was completely cured, and her body was healthier than it had ever been.
💬 Note from Doctor Luo: Everyone, this is the very first time in Doctor Zhang Xichun’s book that he went past a hundred doses! Why so slow? Because this illness had been years in the making — years of pent-up emotion, years of a weakening spleen and stomach. The old saying goes: “illness leaves as slowly as silk is drawn from a cocoon” — it cannot be rushed. Chronic conditions, emotion-driven conditions, take exactly this kind of patience: bowl by bowl, dose by dose.
Bonus: what can we learn from this today?
What Doctor Luo says is worth remembering most is the strategy Doctor Zhang Xichun spelled out at length: when liver qi is charging sideways against a spleen that has already grown weak, the priority is to tonify the spleen and stomach and restore their rising and falling; soothing the liver is secondary. Plenty of people are often in a bad mood, with their liver qi tied in knots, and little by little their spleen and stomach weaken — they’re always running to the toilet, or always constipated, bloated, and unable to digest a bite of food. What to do? Tonify the spleen and stomach as the main course, with just a small measure of liver-soothing herbs — that’s enough.
💬 Note from Doctor Luo: This thinking is extremely practical today. Modern people carry heavy stress and get angry easily, and digestive complaints pile up — so many of them boil down to those four characters, “liver depression with spleen weakness.” Don’t charge in with heavy liver-soothing herbs anymore. First ask whether the spleen is deficient; if it is, fortify the spleen first. That is the old wisdom Zhang Zhongjing passed down and Doctor Zhang Xichun brought to life.
💬 Note from Doctor Luo: One more reminder: in Doctor Zhang Xichun’s day the doses were all modest, because the herbs were daodi (geo-authentic) herbs — grown without chemical fertilizer, so their potency was full. Today we can appropriately increase the amounts. But the core spirit of this case remains what it has always been — tonify the spleen first, soothe the liver second; once the spleen and stomach’s rising and falling turn again, a hundred ailments dissolve on their own.
Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Zhang Xichun, from Records of Chinese Medicine with Western Reference (《医学衷中参西录》).