Headache with Weak Legs, Always About to Fall? Doctor Zhang Xichun’s Case of Cerebral Congestion with Weakness of Both Legs (Settling Liver-Wind Approach)

Search terms this page answers: headache / dizziness / weak legs / legs giving way / always about to fall when walking / can’t stand when getting out of bed in the morning / heat in the chest / dry stool

Medical terms: cerebral congestion · high blood pressure · cerebrovascular accident · stroke warning signs · weakness of both legs

Opening: the headache was cured — yet a year later, the man was gone

Yesterday we talked about a famous banker of the Republican era — Tan Danya. He was no ordinary man. In the late Qing and early Republic, he founded the Mainland Bank (Dalu Yinhang), opened one branch after another, and built a whole network of sub-branches — a name recorded in financial history. At the age of 52 he fell ill with cerebral congestion headaches — and it was serious: his speech was already slurring, and his arms and limbs were numb and hard to move. Doctor Zhang Xichun treated him and set him right. Back at work, however busy, his head no longer ached and his pulse was calm and even. When he left, Doctor Zhang Xichun gave him aftercare advice: drink some yam powder with a little raw hematite powder stirred in.

💬 Note from Doctor Luo: The case record ends right there. But when we look at history, we find that Tan Danya died the next year, at 53 — of what? Cerebral hemorrhage. You may be thinking: Doctor Zhang Xichun is such a brilliant physician — how could his patient still die a year later? The lesson hidden here is worth discussing carefully today, because it touches on a big question: how far does treatment need to go with this kind of disease? How much can the doctor do — and how much responsibility falls on you yourself?

Why was the disease cured and yet the man died? Two reasons, each more important than the last

Doctor Zhang Xichun’s medical skill was high, but we must not deify him. The patient ultimately died, and Doctor Luo Dalun’s analysis gives two reasons.

Reason number one: the aftercare was not done thoroughly enough. “Cerebral congestion” was the Western-medicine term used in the Republican era; in today’s terms it is closely tied to high blood pressure and cardiovascular/cerebrovascular disease. Understand this: high blood pressure is not just high pressure in the head — the pressure is high throughout the body. Besides the head, organs like the kidneys are also damaged. This is a whole-body disease.

💬 Note from Doctor Luo: Doctor Zhang Xichun’s approach was to guide the qi downward and subdue liver fire — to control the cause of the acute attack. That is the crucial step in treating an emergency. But everyone should understand that the follow-up regulation is a long process. Such people are always deficient in upright qi — upper excess, lower deficiency — which is why deficient fire rushes upward. So after the acute stage is handled, building up the root is very important. There is another layer as well: if the blood pressure is high throughout the body, why is the head the most obvious site of symptoms? Because there is local obstruction (yu zu) — liver fire and blood stasis combine, and that is why the head symptoms are so pronounced. So invigorating blood and resolving stasis should be a very important part of the aftercare. In his formula Doctor Zhang Xichun used sheng ji nei jin (dried chicken gizzard lining) to resolve stasis, but that force is not enough. For a patient like this, if the aftercare can include taking san qi powder (notoginseng) long term, together with American ginseng powder and dan shen (salvia) powder, the protection for the cerebral blood vessels is very effective. Doctor Zhang Xichun was exceptionally skilled with san qi; much of what we know about it today traces back to him.

Reason number two: a doctor can treat the disease, but he cannot always treat the “fate.” This “fate” means destiny. Doctor Zhang Xichun brought every symptom of Tan Danya under control — the pulse was calm, the emergency was lifted. And then what? This man ran a bank with so many branches — he should have stepped back, let others handle the work, and changed his way of life. Look at the photographs: Tan Danya was a full-bodied man, very heavy. If he had exercised, built up his upright qi, and stopped worrying, it is entirely possible he would have escaped the cerebral hemorrhage that killed him a year later.

💬 Note from Doctor Luo: Everyone, this is something I see every single day — you cure a man, he thinks “wonderful!”, and immediately sets a new goal: fifty more branches next year. The usual state of such people is to work themselves to death and never stop, until something finally goes wrong. So don’t blame Doctor Zhang Xichun — “even such a famous doctor couldn’t cure him.” The same thing happens today; no physician, however brilliant, can control it — you cannot control the other person’s ambition. When patients are sick they are disheartened and let everything go; the moment they recover, they put on a different face. The people who can truly put things down before misfortune strikes are very few — and very wise.

Who was the patient? One timber-purchasing trip, and a 38-year-old director collapsed

The stage is set — now today’s new case. Same disease, worth discussing further.

The patient was Cui Hualin, director of the Dexing Ranch beside Jingang Bridge in Tianjin, only 38 years old, very young. His illness: cerebral congestion accompanied by weakness of both legs. What happened? At the time he went out to purchase timber and lumber, busy for many days, overworking both mind and body, exceptionally hard-pressed — and that is how he fell ill.

💬 Note from Doctor Luo: See this? This kind of disease is almost always linked to overwork. Tan Danya was a banker who overworked; Cui Hualin was a timber buyer who overworked. Both were worn down by labor. Middle-aged men, high work pressure, long-term overdrawing of the body — these are exactly the high-risk group for this kind of disease.

How sick was he? One morning he got out of bed — and sat down on the floor

Cui Hualin’s symptoms at first: frequent headaches, sometimes with vertigo and dizziness; his heart often felt hot; food felt stuck after eating, stagnant and not going down; his stool was dry and bound (constipation). He consulted doctors, with no effect.

Then came one day — when he got out of bed that morning, his two feet suddenly felt weak and powerless; his legs had no strength, and he sat straight down on the floor. People around him helped him up; he rested a while on the edge of the bed, felt a little recovered, stood up and could walk a few steps holding a cane — but he was always trembling and swaying, looking as if he would fall at any moment.

💬 Note from Doctor Luo: Look — these symptoms already show the beginnings of a stroke. Headache, dizziness, weak legs — these are typical signals that something is wrong with the cerebral blood vessels. Cui Hualin was lucky: the symptoms stopped at the legs. If it had been more severe, an entire limb would have been paralyzed and disabled.

Doctor Zhang Xichun’s thinking: the most critical stroke of the whole case

When Doctor Zhang Xichun took the pulse: the left pulse was wiry and hard (xian ying). What does that mean? He explained earlier: whichever position shows a pulse as hard as a plucked string, that is liver qi and evil fire rising — the liver fire is too great and rushing upward (the left side governs the heart, liver, and kidneys). What about the right pulse being wiry, hard, and long? The right side governs the lung, spleen, and ming men (life gate) — this is stomach qi rebelling upward, together with chong qi rushing upward.

💬 Note from Doctor Luo: Doctor Zhang Xichun said this man’s qi mechanism only ascended, never descended — it all rushed upward. The liver qi carried the chong qi and stomach qi upward; blood followed the rising qi and congested the brain — hence the headache and dizziness. Even more importantly, there was very likely blood stasis inside: the brain was congested with excess blood, which leaked out of the tiny blood vessels, and the bleeding pressed on the nerves that govern movement — so the two legs failed. That judgment, Doctor Zhang Xichun was right about.

Then why was the heart hot, the food stagnant, and the stool dry and bound? Doctor Zhang Xichun said all of it was tied to the qi mechanism ascending without descending. So the treatment was set: pacify the liver and clear heat, descend the stomach qi and settle the chong channel — press down the liver heat that was rushing upward, bring the stomach qi and chong qi down, so that the qi transformation of the organs is no longer in excess, and the body can gradually recover.

The prescription: qi-descending herbs lead the charge — ten ingredients, each with its own job

Here is the formula Doctor Zhang Xichun wrote:

• Sheng zhe shi (raw hematite), one liang (30 g), ground to a fine powder — heavy and settling, it presses down the qi that is rushing upward;
• Huai niu xi (achyranthes root), one liang (30 g) — as we discussed before, this herb guides blood downward, and it also has a nourishing effect; in severe cases it is the key herb for pressing liver qi down and guiding blood down. Paired with hematite, it is a combination Doctor Zhang Xichun used again and again;
• Sheng huai di huang (raw rehmannia), one liang (30 g) — rehmannia from Wen County, Jiaozuo, Henan — nourishes yin;
• Sheng zhen zhu mu (raw mother-of-pearl shell), six qian (18 g), crushed — what is zhen zhu mu? It is the shell of the mussel that produces pearls — river mussels count too, but sea ones are better quality. It enters the heart and liver channels, pacifies the liver and subdues yang, and also has a heavy, spirit-settling effect — another way to press liver fire downward;
• Sheng shi jue ming (raw abalone shell), six qian (18 g) — shi jue ming is the shell of the abalone you eat. How does it differ from mother-of-pearl? Shi jue ming enters only the liver channel and leaves the heart alone; it too pacifies the liver and subdues yang, and additionally clears the liver and brightens the eyes;
• Sheng hang shao (raw peony root, bai shao), five qian (15 g) — softens the liver;
• Dang gui (Chinese angelica root), four qian (12 g) — nourishes liver blood;
• Long dan cao (Chinese gentian), two qian (6 g) — drains liver-gallbladder damp-heat. This man’s fire was extreme — the heart constantly hot, the stool dry — truly caused by liver-gallbladder fire; this herb drains it;
• Yin chen (capillary wormwood), one and a half qian (4.5 g) — soothes and disperses the liver, while draining liver-gallbladder damp-heat;
• Gan cao (licorice), one and a half qian (4.5 g) — harmonizes all the herbs.

💬 Note from Doctor Luo: Look at this formula: something to draw qi down and draw blood down, something to settle the rebellious qi of the liver, something to soothe the liver, soften the liver, drain liver fire, nourish liver yin, and supplement liver blood — every single action lands on the liver. It is much the same thinking as yesterday’s case. This is Doctor Zhang Xichun’s complete playbook for “when you see disease of the liver.”

A twist in the treatment: seven doses brought great improvement — yet the legs were still weak and the heart still hot

He took the decoction for seven doses in a row. What was the result? All the illnesses were greatly reduced — recovery was excellent, most of it restored, and the pulse began to soften. But: he still needed a cane to walk — small steps, very slow, not back to normal; and his heart still often felt hot.

💬 Note from Doctor Luo: Notice this detail — the disease was mostly cured, but the legs had not fully recovered and the heart was still hot. What does that tell us? It tells us the blood stasis factor had not yet been handled. Doctor Zhang Xichun was aware of it; the next step he added herbs to invigorate blood and resolve stasis. In the acute stage you use qi-descending and liver-settling herbs; in the aftercare you must resolve stasis and open the channels — that is the complete rhythm of treating cerebral congestion.

The finishing touch: dan shen, raw malt, and five ground beetles

On the basis of the original formula, Doctor Zhang Xichun made modifications and added herbs to invigorate and free the blood vessels — the blood-invigorating, stasis-resolving herbs arrived:

• Sheng zhe shi one liang (ground fine), huai niu xi one liang, sheng huai di huang one liang — these three remained as before;
• Bai shao (peony root), five qian (15 g) — softens the liver;
• Zhen zhu mu (mother-of-pearl shell) and sheng shi jue ming (raw abalone shell) — pacify the liver and subdue yang, pressing the liver fire down;
• Dan shen (salvia root) — invigorates blood and opens the channels;
• Sheng mai ya (raw malt), three qian (9 g) — takes the place of yin chen to soothe the liver, letting the liver qi flow freely;
• Tu bie chong (ground beetle), five of them — everyone, this addition was wonderful!

💬 Note from Doctor Luo: Tu bie chong — the name may frighten people when they hear it: a round, black, big bug with a shell. It also has the name tu yuan (the “yuan” written in formulas as “tu yuan one qian, two qian” is exactly this insect). This herb invigorates blood, dispels and breaks up stasis remarkably well, and can even join sinews and bones — in external injuries it appears in formulas all the time. Doctor Zhang Xichun used five of them here, precisely to work with dan shen in invigorating blood and resolving stasis.

What was the effect of adding blood-invigorating herbs? After eight more doses, he walked normally again — this man’s gait returned to normal, and the disease was cured. At that point the illness was finished.

After the cure: the doctor’s work is done — now yours begins

The case record stops there; nothing more is written. But Doctor Luo Dalun specifically urges: a person who has had this disease once must pay great attention to the care that follows.

💬 Note from Doctor Luo: Today, when elderly people in many families have cerebrovascular problems, how should the aftercare actually be done? Doctor Zhang Xichun’s case records give a complete route. First, change the diet: no rich, fatty, sweet food; not too salty or spicy. Second, change the habits of life: mind your rest — this man got sick precisely by exhausting himself that way; keep a regular schedule and exercise. Third, in medication: take something to build upright qi, soothe the liver and regulate qi, and invigorate blood while resolving stasis. Today’s doctors will often write one formula, grind the herbs into powder and make pills, or prescribe a patent medicine, so you can take it slowly — resolving a little stasis, supporting a little upright qi, day by day — and only then can a person truly return to health.

A bonus for orientation: Zhen Gan Xi Feng Tang does not treat the three characters “cerebral hemorrhage”

Finally, Doctor Luo Dalun spells out where this approach of Doctor Zhang Xichun belongs:

💬 Note from Doctor Luo: Doctor Zhang Xichun’s Zhen Gan Xi Feng Tang (Settle the Liver, Expel Wind Decoction) and this whole line of thinking are not specifically for treating cerebral hemorrhage or cerebral infarction. What it specifically treats is — liver fire and liver qi rushing upward, the body’s qi mechanism abnormally surging upward — it treats that one pattern (zheng hou). This pattern is connected to many diseases; whenever you encounter the pattern, you may use the approach. But be very clear: with conditions like high blood pressure, cerebrovascular accident, and cerebral hemorrhage, there are other factors that must be considered — for example the blood stasis and blocked channels Doctor Zhang Xichun talked about. So invigorating blood and resolving stasis, building upright qi, soothing the liver and regulating qi — all of these must be used together. Doctor Zhang Xichun’s cases remove the cause and let the body return to normal by itself; after the removal, the remaining homework is completed through gradual regulation.

What to take away

1. Stroke warnings come early and clearly. Headache, dizziness, and sudden weakness of the legs are classic cerebrovascular alarm signals — treat them seriously rather than waiting for a full stroke.
2. A wiry, hard pulse on the left means liver fire rising; wiry, hard, and long on the right means stomach qi rebelling with chong qi rushing up. When the qi mechanism only ascends and never descends, blood follows qi upward and congests the brain.
3. Acute stage first: press the qi down. Heavy, settling herbs — sheng zhe shi (raw hematite) and huai niu xi (achyranthes) as a pair — guide the rushing qi and blood downward and pacify the liver.
4. Aftercare is where blood stasis is resolved. When the crisis passes but legs stay weak and heat lingers, the stasis factor has not been handled. Dan shen, raw malt, and tu bie chong (ground beetle) to invigorate blood and open channels were Doctor Zhang Xichun’s finishing move.
5. The doctor can control the disease; he cannot control the patient’s fate. After recovery, the patient must change diet, rest, exercise, and stop overworking — otherwise the same underlying cause simply strikes again.
6. Zhen Gan Xi Feng Tang treats a pattern, not a disease name. Use the approach when liver fire and qi rush upward — but always combine it with resolving stasis, building upright qi, and soothing the liver.

Adapted from Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records. Source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments 1918–1934.