High Blood Pressure with Headache and a Sensation of Qi Rushing Up? Doctor Zhang Xichun’s Zhengan Xifeng Tang Case of Cerebral Congestion Headache

Search terms this page answers: high blood pressure / headache / head feels swollen and painful / a sensation of qi rushing upward / headache at night that won’t let you sleep / dizziness / tripping over your words / heart feeling hot

Medical terms: hypertension · cerebral congestion (cerebral infarction / cerebral hemorrhage) · liver yang hyperactivity · liver fire flaring upward

Opening: the 52-year-old bank president with two years of headaches

Today’s patient had some weight behind him — the general manager of the Continental Bank of Beiping, what we would call the president or CEO today, aged 52 at the time. But no matter how mighty the bank president, illness doesn’t care: cerebral congestion and headaches, treated for two years, growing worse all the while, until finally he came to Doctor Zhang Xichun.

What made this illness so dangerous? For two years the headache was so bad at night he couldn’t sleep; and by the end, his speech was starting to slur (the Chinese text says yan yu se se — words coming out stiff and clumsy), and his arms and legs were no longer quite obeying him. Put into today’s language, these symptoms sound like the warning signs of high blood pressure and cerebral infarction — if it hadn’t been treated, the trouble would have been grave indeed.

💬 Note from Doctor Luo: You might wonder — how can Chinese medicine talk about “cerebral congestion”? That’s a Western-medicine term! Correct — ancient Chinese medicine truly had no such phrase. Doctor Zhang Xichun was a famous representative of the school of integrating Chinese and Western medicine (zhong xi yi hui tong pai). He insisted that Chinese medicine should learn from Western medicine and took Western research findings very seriously. He said plainly that the name “cerebral congestion” came over from the West — it is what Western doctors call it.

What exactly is “cerebral congestion”? Doctor Zhang Xichun translates Western medicine for Chinese medicine

Doctor Zhang Xichun explained it clearly: what is called cerebral congestion is actually the “jian jue” (collapse from heat) described in the Huangdi Neijing — the condition that later formularies called “wind stroke” (zhong feng). He even brought in the Western medical account and divided cerebral congestion into three stages:

• Mild: cerebral congestion — blood fills the vessels of the head but has not escaped them. The person just has headache and dizziness, or slight drooping of the mouth and eye, limbs a little unsteady. This level roughly corresponds to today’s cerebral infarction.
• Moderate: cerebral hemorrhage — some small branches of the head’s vessels begin to leak a small amount of blood.
• Severe: major cerebral hemorrhage — this is very serious. In lighter cases the person may regain consciousness on their own; in severe ones, regaining consciousness is hard and medication is essential. Doctor Zhang Xichun stressed: even if cured, some aftereffects will remain; the number of people who fully recover at this stage is very small.

💬 Note from Doctor Luo: You see, Doctor Zhang Xichun had already researched Western knowledge of cerebrovascular disease this thoroughly — in his day that was remarkably forward-looking. His three levels basically track what today’s doctors call “cerebral vasospasm, small hemorrhage, and massive hemorrhage.” This is exactly why his case records are still so valuable today: in integrating Chinese and Western medicine, he genuinely integrated.

Who was the patient? A dozen branch banks, all opened by his own hand

This President Tan, Doctor Zhang Xichun described as “bing xing qiang gan jing ming” — exceptionally capable, exceptionally shrewd. The branch offices of the Continental Bank of Beiping — he personally set up more than a dozen of them.

And the result? Overwork of the mind (lao xin guo du), and down he came with cerebral-congestion headache.

💬 Note from Doctor Luo: From beginning to end, this case has one thread: overwork. Worrying day and night, a dozen ventures to manage — and the liver fire burned up bit by bit. Notice that the illness Doctor Zhang Xichun describes here corresponds closely to today’s high blood pressure and cerebral infarction — and one of the top triggers of exactly these diseases today is, likewise, long-term stress, emotional tension, and excessive overwork.

How sick was he? A constant feeling of qi trying to rush upward

This patient’s own sensation is extremely typical: he always felt a stream of qi inside his chest and abdomen trying to rush upward. And what does qi rushing upward do?

• The head aches, and he was constantly dizzy;
• At night the headache grew worse — how bad? He couldn’t sleep;
• After two years of treatment, not only was there no improvement, but his speech gradually became slurred — tripping over words; his limbs gradually grew less agile — arms and legs not quite obeying;
• Food stagnation — after a meal, the food seemed not to move downward;
• His heart constantly felt hot — a sensation of internal heat;
• Dry stools.

When Doctor Zhang Xichun felt the pulse: both wrists were wiry and hard — stiff like a taut zither string; forceful before the guan position (at the cun/inch position) — the qi sitting up high; both chi positions were empty on deep pressure — the chi position corresponds to the lower burner, and emptiness on deep pressure shows the lower burner is deficient.

💬 Note from Doctor Luo: A wiry pulse like a zither string points to liver disease; a large cun pulse means qi is moving upward; an empty chi pulse means the lower burner is deficient. Doctor Zhang Xichun had a distinctive doctrine of pulse diagnosis: some pulse signs need not be tied to a fixed position on the cun-guan-chi scale — once they appear, no matter where they appear, they carry diagnostic meaning. He said: “A wiry, hard, forceful pulse, no matter in which position it is felt, is always a sign of excess liver fire.” That sentence is one of the most important in Doctor Zhang’s pulse teaching.

Doctor Zhang Xichun’s reasoning: the key stroke of the whole case

Where was the root of the illness? Doctor Zhang Xichun was categorical: in the liver.

He laid out the analysis layer by layer, with great clarity:

Excess liver fire → liver fire rises → stirs the qi of the stomach to follow it upward → so the patient constantly feels a stream of qi pushing up from the chest and abdomen — that is the source of “that stream of qi.”

Blood follows qi as it rises; as qi keeps ascending, blood ascends with it → all the blood rushes into the head — this is cerebral congestion → the congested blood presses on the head, hence the headache.

Why is it worse at night? Because this patient had upper excess with lower deficiency (shang sheng xia xu) — his yin deficiency was marked. Yin cannot restrain yang; at night the yang should be withdrawing but cannot, so the attack flares naturally. The dizziness is also caused by the cerebral congestion.

Why does the heart constantly feel hot? When liver fire blazes, heart fire blazes along with it — in the old terminology this was called “wood and fire shining together” (mu huo tong ming): the liver belongs to wood, the heart to fire, and wood generates fire. With the fires of both heart and liver burning together, how could the heart not feel hot?

Why can’t he eat properly and passes dry stools? Normally stomach qi descends smoothly. But his entire qi mechanism was rushing upward, so the stomach qi went up too — naturally after a meal he felt the food wasn’t digesting; and when the qi mechanism cannot descend, the strength to move and digest food is insufficient, so the stools turn dry.

As for slurred speech and clumsy limbs, Doctor Zhang Xichun said: this is the cerebral congestion pressing on the relevant nerves — the motor nerves. You see, he borrowed Western medical knowledge to explain the condition even back then.

💬 Note from Doctor Luo: So remember this chain: overwork → excess liver fire → qi rushes upward → blood rises with qi → cerebral congestion → headache, dizziness, unclear speech, clumsy limbs. Liver fire was the root of every single problem in his body. To treat this illness, everything turns on the liver — regulate the liver, descend the stomach, settle the chong (thrusting) vessel, draw blood downward, and match it with herbs that nourish yin and clear heat. Only then does it work.

The prescription: an opening dose of 30 g raw hematite — heavy enough to shock

When Doctor Zhang Xichun acted, the first herb was 30 g (one liang) of raw hematite (zhe shi, ground fine). What is hematite? A red mineral whose main ingredient is ferric oxide. It has one special talent: suppressing rebellion — when the body’s qi mechanism goes abnormally upward, hematite’s heaviness presses it back down. When qi is rushing upward fiercely, you must smash it down with this mineral — which is why he opened with one liang, a heavy dose.

Then came the supporting cast:

• Sheng huai di huang, 30 g — rehmannia from Wen County, Jiaozuo, Henan (the “sheng di” root); nourishes yin and cools the blood, replenishing the yin of the liver and kidney;
• Huai niu xi, 18 g (six qian) — also a specialty of Jiaozuo, Wen County, Henan. That region produces the four celebrated Huai medicinal herbs: huai yam, huai rehmannia, huai niu xi, and huai chrysanthemum — all genuine geo-authentic herbs (dao di yao cai). Huai niu xi’s job is to tonify the liver and kidney while directing blood downward (there are two kinds of niu xi: huai niu xi mainly tonifies while also drawing blood down; chuan niu xi also draws blood down but adds the extra function of unblocking the channels);
• Da gan gou qi (large sweet wolfberry), 18 g — tonifies the essence of the liver and kidney — this is the liver-tonifying one;
• Sheng long gu and sheng mu li (raw dragon bone and raw oyster), 18 g each (pounded) — settle the liver and subdue yang, pulling the yang that is surging upward back down;
• Jing yu rou (cornus fruit) — sour in taste, with an astringing action — astringing the liver qi;
• Bai shao (white peony), 15 g (five qian) — softens the liver. Cornus astringes liver qi very markedly, and white peony softens the liver; the two together work even better;
• Yin chen, 6 g (two qian) — this is the young sprout of yinchen wormwood; in spring it is called yin chen. It carries the nascent qi of the lesser yang (shao yang), resonates with the wood of the liver — “same qi seeks the same” — and is the best herb for going along with the liver-wood qi: it can disperse the liver and soothe it, and is moreover skilled at draining liver fire and liver heat — this was Doctor Zhang Xichun’s hard-won experience;
• Gan cao (licorice), 6 g — harmonizes the middle and blends all the herbs.

💬 Note from Doctor Luo: Look how refined this combination is: raw hematite lowers the qi, huai niu xi lowers the blood — one works on the qi level, one on the blood level; the two together, one qi and one blood, are exquisitely matched. The wolfberry tonifies the essence of liver and kidney, and pairing it with a yin-nourishing herb like raw rehmannia sends the formula in the direction of nourishing yin — replenishing the yin of liver and kidney. That too is a craft. The approach to the liver — heavy suppression, tonification, astringency, softening-moistening, and dispersion — is complete in every dimension.

The birth of Zhengan Xifeng Tang: if you only suppress the liver, it rebounds

There is a crucial insight hidden here. Doctor Zhang Xichun later distilled from this experience his famous formula for high blood pressure with liver yang hyperactivity — Zhengan Xifeng Tang (Liver-Settling, Wind-Extinguishing Decoction) — and its origin story is right in this case.

At first, Doctor Zhang Xichun simply treated by settling the liver + nourishing yin. The result: the immediate effect was excellent, but some patients rebounded — and after rebounding, they were worse than before.

He pondered: why? Eventually he realized — the liver is the “general official” (jiang jun zhi guan) of the body, housing the ministerial fire, with a violently irascible temperament. If you try to crush it down by force, it pushes back with reaction force, fighting you head-on. So suppression alone won’t do — you must also disperse:

💬 Note from Doctor Luo: That is why Doctor Zhang Xichun’s formulas, while settling the liver, almost always pair in yinchen, raw malt (sheng mai ya), and Sichuan chinaberry (chuan lian zi) — herbs that disperse the liver and drain liver fire — pressing down on one side while giving the liver a way out on the other. With that addition, the results finally held steady. Dispersion within suppression, suppression within dispersion — this is Doctor Zhang Xichun’s method for the liver, and the very soul of Zhengan Xifeng Tang.

Four doses in: headache more than half gone, four or five hours of sleep at night

The formula was set: decoct into one large bowl, take warm.

After four doses, what happened?

• The headache was more than half resolved;
• He could sleep four to five hours at night (before, sleep was impossible);
• Every symptom began gradually improving;
• On the pulse, the wiry-hard quality had eased and both chi positions now had root on deep pressure — proof that tonifying the lower burner was working.

So the original formula was adjusted and he continued. How was it adjusted? This part gets interesting:

• Raw hematite stayed at 30 g, raw rehmannia stayed at 30 g (Doctor Zhang Xichun noted that raw rehmannia also carries some power to tonify the essence of liver and kidney — when raw rehmannia is steamed and sun-dried nine times it becomes prepared rehmannia (shu di), which is the herb that specifically tonifies liver-kidney essence);
• Added sheng huai shan yao, 24 g (eight qian) — why? To tonify the spleen and stomach! And why tonify the spleen and stomach? Because when liver qi runs rampant sideways, it easily attacks the spleen earth — when the spleen and stomach are injured, the middle burner loses its stability. Tonifying the middle burner also restrains the sideways rampage of liver qi and its upward rebellion. So when you truly treat liver disease, in the end you must always tonify the spleen and stomach — one glance at this adjustment tells you Doctor Zhang Xichun was a master;
• Huai niu xi 18 g, raw dragon bone and raw oyster 18 g each, cornus 15 g, white peony 15 g — the same as before: settle, astringe, soften the liver;
• Added sheng ji nei jin (raw chicken gizzard lining — the yellow kind, pounded), 3 g (one qian) — for two purposes: first, to strengthen the digestive and moving power — the formula is full of minerals (hematite, dragon bone, oyster) and he feared the stomach’s digestive power might weaken; second, to invigorate blood and resolve stasis — a very large proportion of today’s cerebral congestion and cerebral infarction cases are tied to blood stasis. Once the big picture was under control, it was time to invigorate blood and resolve stasis;
• With yinchen, 4.5 g (one and a half qian) — to disperse the liver; and licorice 6 g.

💬 Note from Doctor Luo: This is mastery. Every herb stands for one line of thinking — hematite heavily suppresses rebellion, dragon bone and oyster settle the liver and subdue yang, yam tonifies the spleen and restrains the liver, chicken gizzard lining aids digestion and resolves stasis. Looking at the earlier formula, you felt something was missing — what was missing was the stasis-resolving piece. When Doctor Zhang Xichun added raw chicken gizzard lining, the entire therapeutic plan snapped into place.

Third visit, new tactics: yam leads the charge, nourishing yin and clearing heat to finish

He took this formula for five more doses: the headache was gone, he slept through the night, all illnesses were cured — essentially well.

Only: the moment he went to the office, started working, started worrying, his head still ached a little, the pulse still carried a trace of wiry-hard quality, and occasionally his heart felt hot. So Doctor Zhang Xichun prescribed a nourish-yin, clear-heat formula — and switched tactics again:

• Sheng huai shan yao, 30 g — this time the yam took the lead as the monarch herb, settling the middle burner and anchoring the spleen and stomach — that was the top priority; one herb in, and it was already the chief;
• Raw rehmannia — nourishes yin; xuan shen (figwort root) and bei sha shen (glehnia root) — both excellent at nourishing yin and clearing heat; sheng hang shao (white peony) — astringes and softens the liver; jing yu rou, 12 g (four qian) — astringes the liver;
• Sheng zhen zhu mu (raw pearl shell) — like dragon bone and oyster, aimed specifically at the liver channel, settling the liver and subduing yang; sheng shi jue ming (raw abalone shell), 12 g — also heading for the liver channel;
• Sheng zhe shi (raw hematite), 12 g — at this point lowering the rebellion of liver qi was no longer the main contradiction, so it stepped back, dose reduced;
• Huai niu xi 9 g, sheng ji nei jin (pounded, yellow) 4.5 g, licorice 6 g.

💬 Note from Doctor Luo: Watch the shift across these three visits: the spleen-tonifying herb took the front line, yin-nourishing followed, astringing and softening the liver, with a touch of liver-settling and blood-invigorating on the side. Doctor Zhang Xichun adjusted the priority and intensity of the medicines according to how the patient was changing — exactly like deploying troops on a battlefield. Wherever the illness had advanced, there the main attack switched.

Aftercare: yam tea with hematite powder, taken like a snack

He took this formula for six doses: at work handling the president’s affairs, his head no longer ached, and the pulse was calm.

At that point Doctor Zhang Xichun told him to stop the decoction and switch to food-therapy aftercare: every day, cook sheng huai shan yao (dried Chinese yam) powder into a tea, stir in a little sugar, and while drinking it, take 3 g (one qian) of raw hematite powder along with it — like a snack, a little at a time, slowly nursing the body back to full strength.

💬 Note from Doctor Luo: Count it up — in the end he took remarkably few doses: four the first time, five the second, six the third — fifteen doses in all, and the illness was cured. A master is a master; the whole plan is perfectly clear — first visit, heavy suppression of rebellion; second visit, tonify the spleen and resolve stasis; third visit, nourish yin to finish; finally, food-therapy aftercare. Not one step out of order.

What this case teaches us: not every case of high blood pressure can be treated this way

The focus of this case? On the liver. Because emotional distress and day-and-night overwork drove liver fire upward and liver yang hyperactive, this illness took shape.

But Doctor Luo Dalun especially warns everyone — never say: as long as it’s high blood pressure, cerebral congestion, or cerebral infarction, use this formula. That will not do!

You must first determine: is the liver fire genuinely excessive, is the liver yin insufficient, is the qi mechanism moving upward? Only then does this approach apply. High blood pressure has countless causes: some arise from yang deficiency, some from heavy dampness, some from blood stasis — in those situations, the approach is entirely different.

💬 Note from Doctor Luo: So Zhengan Xifeng Tang is not “the formula for high blood pressure” — it is the formula for the “liver yang hyperactivity” pattern of high blood pressure. Conversely: whatever the disease, as long as liver yang is hyperactive, liver yin insufficient, and qi mechanism rebelling upward, this approach can be used — for example, someone who constantly hiccups or belches with qi pushing upward, connected to anger, can also draw on this formula. This is the true meaning of Chinese medicine’s “treatment based on pattern differentiation” (bian zheng lun zhi).

Finally, the most valuable thing we can learn from this case is the method of regulating the liver: heavily suppress the liver, disperse the liver, soften the liver, astringe the liver, and tonify the yin of the liver and kidney — these five paths of Doctor Zhang Xichun’s liver treatment are the real treasure of this case record.

Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s cases; source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published serially 1918–1934.