Belching, Vomiting, and Qi Rushing Up? Doctor Zhang Xichun’s Case of Liver Qi Stagnation Causing Stomach Qi Counterflow

Search terms this page answers: belching / vomiting / qi rushing upward / a stream of gas pushing up from the belly / stomach feeling blocked / distending pain under the ribs / heat and stuffiness in the chest / stomach trouble when emotions are low / constipation

Medical terms: stomach qi counterflow (wei qi shang ni) · liver qi stagnation with stomach qi counterflow (liver-stomach disharmony) · gastroesophageal reflux · nervous belching

Opening: a 52-year-old businessman bent double by relatives and shops

Today’s patient was named Yao Jingsheng, 52 years old, and he lived east of the Drum Tower in Tianjin. His profession was business — the old records simply say “one who trades.” A man at midlife, he ought to have been slowing down. But the illness that brought him to Doctor Zhang Xichun was precisely the kind you get when you cannot slow down.

What was the diagnosis? In his case record, Doctor Zhang Xichun wrote: liver qi stagnation with stomach qi counterflow (gan yu wei ni zheng) — in plain language, the liver qi was not flowing smoothly, so the stomach qi turned upward.

💬 Note from Doctor Luo: Why devote a whole case to this? Because in modern society this condition is extremely common — when people’s emotions are off, when liver qi is stuck, the spleen-stomach system acts up, and a very large share of those problems involve stomach qi rushing upward. Modern medicine calls the emotion–stomach connection the “brain–gut axis”; Chinese medicine explained it long ago in terms of qi movement. Cases like this deserve several articles.

Who was the patient? Racking his brains every month to support his relatives

Doctor Zhang Xichun wrote his case records in remarkable detail — he even recorded the patient’s occupation, because many diseases are tied to how a person makes a living. Yao Jingsheng’s illness lived in his daily life:

His extended family had many branches, and most of the relatives could not support themselves — life was hard for them, and they depended on his help. So every month he had to rack his brains to figure out how to earn more money in order to support them.

And that was not all — he also ran several shops of his own, one here, one there, and every one of them had to be managed with meticulous care, ceaselessly costing him thought and worry.

The result, in four words: overwork of the mind (lao xin guo du).

💬 Note from Doctor Luo: Look at this man’s situation: relatives to support, businesses to manage, everything demanding attention. And he was a decent, dutiful man, generous to his family — but decency is decency, and the body has its limits. At middle age, zheng qi (upright qi) is already beginning to decline; add this kind of strain, and heart blood and qi become insufficient — deficiency of zheng qi is the first problem. On top of that comes liver qi stagnation, and the illness becomes stubborn.

How sick was he? A stream of qi in the belly, shoving straight upward

What was the most unbearable sensation? He constantly felt a stream of qi rising from his belly — just like the running piglet syndrome (ben tun) we discussed in earlier cases — a surge of qi pushing straight up from below.

Where did it stop along the way?

• Rising into the upper belly, it caused fullness and stuffiness in the stomach region — his stomach felt blocked;
• Higher still, heat and restlessness in the chest — hot and vexed;
• At the same time, distending pain under the ribs — the flanks, the armpit areas, the ribcage all ached and swelled with tension;
• He was constantly belching (eructation), hiccup after hiccup;
• When things went wrong, he would vomit;
• And down below? Dry, bound stools — constipation.

Notice the pattern: this man’s qi was moving entirely upward, and that is exactly why his stools were dry and bound.

💬 Note from Doctor Luo: This cluster of symptoms is very familiar today — people with gastroesophageal reflux and stomach qi counterflow often feel exactly this way: belching, acid rising, a hot chest, distending flanks, and sluggish bowels. The moment they get tense or angry, the symptoms flare. Doctor Zhang Xichun laid out the whole mechanism of this disease with complete clarity.

The pulse told the truth: left wrist deep and fine, right wrist wiry and hard

When Doctor Zhang Xichun took the pulse, he used his “three positions taken together” method — three fingers across the cun, guan, and chi positions, reading all three at once. The left wrist (heart, liver, kidney) was deep and fine — deep and fine usually means liver qi stagnation. The right wrist? Wiry, hard, and long, and its force was several times greater than the left.

💬 Note from Doctor Luo: Notice this detail — the liver corresponds to the guan position, and with liver qi stagnation that position should feel slightly raised, like a little bean. But this patient’s right wrist was wiry, hard, and long, with force several times the left — wiry, hard, and long represents chong (thrusting) vessel qi rushing upward. When chong qi runs upward, the yangming stomach qi cannot descend; the stomach qi reverses and comes back up, hence the belching and vomiting. And because stomach qi will not go down, the wastes cannot be transported downward — hence the bound stools. This pulse told the whole story.

How Doctor Zhang Xichun thought: the qi mechanism was disordered, ascent and descent had lost their rhythm

The root was found. How to treat it? His approach had three steps: first, soothe the liver; second, lower the stomach and settle the chong; third, tonify the spleen and stomach.

To understand this treatment, you need the basic map of how Chinese medicine views the body’s qi movement — and the Qing-dynasty physician Huang Yuanyu explained it most clearly:

• The spleen and stomach sit in the middle burner: spleen qi rises on the left, stomach qi descends on the right — this is “the spleen rises and the stomach descends”;
• The liver rises with the spleen, the gallbladder descends with the stomach: on the left, liver qi rises along with spleen qi; on the right, gallbladder qi descends along with stomach qi;
• When stomach qi and gallbladder qi descend, the lung qi above also descends, carrying heart fire downward into the kidney — in this way the kidney water is not cold;
• The kidney water then rises along the liver qi and spleen qi on the left, entering the heart to nourish heart fire — in this way the heart fire is not hot.

No heat above, no cold below — this is the state of the “balanced person” (ping ren), the healthy human being. Once the ascent and descent of the qi mechanism fail, disease follows; and the failure has two root causes: one, weakness of the spleen and stomach; two, liver qi stagnation — when the emotions jam up, the entire qi mechanism falls into disorder.

💬 Note from Doctor Luo: This is the Chinese medical principle that “the spleen and stomach are the pivot of the qi mechanism.” When Huang Yuanyu treated disordered qi movement, almost every one of his formulas contained the trio poria (fu ling), pinellia (ban xia), and licorice (gan cao): poria raises spleen qi, pinellia lowers stomach qi, licorice guards the middle — the core combination of nearly all his formulas. Doctor Zhang Xichun’s approach in this case follows the same great law of ascent and descent, but with herbs and insights of his own.

The prescription: one rising, one falling — raw hematite paired with raw malt

Leading the formula was 30 g (one liang) of raw hematite (sheng zhe shi) — a heavy herb. Doctor Zhang Xichun had a habit: whenever the body’s qi mechanism was rebelling upward, or even when a medicinal property threatened to float upward, he would put raw hematite in the formula, ordering it to go down, and further down.

But was pressing downward alone enough? No.

💬 Note from Doctor Luo: Here is the stroke that shows his mastery. Doctor Zhang Xichun said: raw hematite works especially well when paired with raw malt (sheng mai ya). Why? Because the body’s qi mechanism has both ascent and descent — if you only press down, pressing everything to the bottom, then the moment it rebounds, the moment it is choked off, the body will fall into worse chaos. So you must let the right side descend while the left side ascends — and for the ascending side, use raw malt. Doctor Zhang Xichun held that raw malt can soothe the liver and generate liver qi, and that its action is very gentle. Today we mostly use stir-fried malt to resolve food stagnation; Doctor Zhang Xichun said raw malt resolves food stagnation even better, and that its greater function is to generate liver qi. To only rise without falling is wrong, and to only fall without rising is equally wrong — one rising, one falling, and the qi mechanism can circulate.

Joining the raw malt was another herb, yinchen. What is yinchen? It is artemisia (wormwood) in its youth — the young stage of the plant. It generates liver qi, clears the liver and gallbladder, and removes damp-heat, soothing the liver very gently. So Doctor Zhang Xichun used raw malt and yinchen to soothe the liver and let liver qi rise.

On the descending side, besides raw hematite, there were pinellia (qing ban xia) — which dries dampness, transforms phlegm, and lowers qi — and bamboo shavings (zhu ru).

💬 Note from Doctor Luo: What are bamboo shavings? You take a bamboo stalk, scrape off the green outer skin, and the layer of white flesh inside is scraped off in fine, curled strips — bamboo is mostly cool in nature, and the shavings clear heat and transform phlegm. Anything caused by phlegm-heat can be treated with them: phlegm-heat cough with yellow sputum; liver-gallbladder heat with phlegm; phlegm-heat causing palpitations, restlessness, and insomnia; and especially vomiting from stomach heat — when the stomach is hot, stomach qi rebels upward; transform the phlegm-heat and the stomach qi naturally descends. Doctor Zhang Xichun judged that this patient had internal heat and liver-gallbladder fire, so he used bamboo shavings to clear the heat and let the stomach qi descend.

Don’t forget the tonics: yam, asparagus root, ophiopogon root, and dipsacus — not one to spare

The qi-lowering herbs were in place, the liver-raising herbs were in place — but Doctor Zhang Xichun was not finished. He also needed to tonify:

• Dipsacus root (xu duan, also called chuan duan, produced in Sichuan and Yunnan): a herb that tonifies the liver and kidney. The liver governs the sinews and the kidney governs the bones, so it strengthens sinews and bones — if you have liver-kidney deficiency, weak sinews and bones, and constant aching lower back, doctors will often prescribe xu duan. Doctor Zhang Xichun used it here to tonify the liver, in order to help liver qi rise — while soothing the liver, draining liver fire, and regulating the qi mechanism, he was also nourishing the liver and helping it recover its function;
• Dried Chinese yam, 30 g (one liang): a large dose — why? To support zheng qi and tonify the qi of the spleen and stomach;
• Asparagus root (tian dong) and ophiopogon root (mai dong): nourish the yin of the spleen and stomach — where there is heat, yin is easily injured, so the yin-nourishing must keep pace.

Finally, raw chicken gizzard lining (sheng ji nei jin) was added to help the medicine circulate and digest, and licorice to harmonize all the herbs. The formula was complete.

💬 Note from Doctor Luo: See how clear this thinking is: descending on one side (hematite, pinellia, bamboo shavings), ascending on the other (malt, yinchen), and while ascending, giving the liver a tonic as well (dipsacus); with the liver regulated, he turns to the spleen and stomach (yam, asparagus root, ophiopogon root nourishing the spleen-stomach yin), and finally chicken gizzard lining to move the medicinal force through the body. Within a single formula, ascent and descent, tonification and drainage are all arranged — that is Doctor Zhang Xichun.

A warning about bupleurum: a lesson learned in blood

Speaking of raising liver qi, someone will ask: isn’t bupleurum (chai hu) the most appropriate herb for raising liver qi? Why did you use raw malt instead of bupleurum?

Doctor Zhang Xichun explained the reasoning in detail:

• Bupleurum does have the power to generate liver qi, but its liver-qi-raising force is very strong. In large doses it clears and resolves the lesser yang (shao yang) and disperses cold — commonly used for externally contracted cold damage; in small doses — three, five, six grams — it soothes the liver and raises liver qi. Yet even at such small doses, Doctor Zhang Xichun considered the force still so great that it can sometimes pull the stomach qi upward along with it;
• This patient’s stomach qi was already rebelling upward. To use bupleurum and drag the stomach qi up together with it would have been a disaster.

Doctor Zhang Xichun also told a lesson from his own experience: he once met a patient with disease of the yangming stomach channel, qi and blood rebelling upward, vomiting blood — blood pouring out of the stomach. The physician treating him, not understanding, gave bupleurum in a dose of several qian, and the patient began vomiting blood without stopping — blood gushed out in torrents, and within moments his life hung by a thread. When Doctor Zhang Xichun arrived, there was no time to prepare medicine — but luckily he had some raw hematite powder at hand. He had the patient drink it slowly, a little at a time; after more than one liang, the bleeding stopped.

💬 Note from Doctor Luo: This is the fine detail a great physician considers: bupleurum raises liver qi, but sometimes it carries stomach qi up with it, so at delicate moments bupleurum must be used with care. Raw malt, by contrast, can generate liver qi yet does not obstruct the descent of stomach qi — being sprouted grain, it even helps the stomach digest. It both protects stomach qi and generates liver qi — that is what makes it ingenious. To this day, many senior Chinese medicine doctors, when the stomach qi is weak, like to use raw malt to generate it, and quite a few use raw malt and stir-fried malt together — there is a great deal of hard-won experience hidden in that trick.

Twenty doses to improvement: even Doctor Zhang Xichun had to go slowly

Doctor Zhang Xichun had the patient take this formula with adjustments to the pattern, for more than twenty doses — a fairly long course by his standards.

Why so slow? Because spleen-stomach problems caused by liver qi stagnation are inherently very hard to regulate — the relatives’ difficulties were still sitting right there in front of him; the knots in his heart were not going to untie overnight.

Happily, after twenty doses the result came: the liver qi had risen, the stomach qi had descended. The left and right pulses, which had differed by several times, gradually leveled out, and all the illnesses were cured — only some weakness of the limbs (zheng qi still insufficient) and weak digestion of careless eating (the spleen and stomach still a little fragile) remained. So Doctor Zhang Xichun prescribed a tonify-qi, strengthen-the-spleen formula to finish:

Wild codonopsis (ye tai shen — wild Wutai Mountain codonopsis/party root) 12 g (four qian), dried Chinese yam 30 g (one liang), raw hematite reduced this time to 18 g (six qian, ground fine), asparagus root and ophiopogon root, raw chicken gizzard lining 9 g (three qian), raw malt, and licorice.

💬 Note from Doctor Luo: This second formula is a “simplified version” of the first: it adds wild codonopsis to tonify qi, keeps the yam, asparagus root, and ophiopogon root nourishing the yin of the spleen and stomach, reduces the hematite to gently lower the stomach qi, uses chicken gizzard lining to help the medicine circulate, pairs raw malt with hematite for one-rising-one-falling, and harmonizes with licorice. Notice — the dose of dried Chinese yam never dropped; it stayed at one liang throughout. That tells you Doctor Zhang Xichun knew perfectly well: for this patient, supporting zheng qi was the key.

He took this second formula for three doses: his appetite increased, his appetite grew better and better, and his strength gradually returned. Then came a final adjustment: wolfberry 15 g (five qian) was added (tonify the liver and kidney) and atractylodes 9 g (three qian) (tonify the spleen). After a few more doses, the case was closed.

Closing: after the illness is cured, don’t forget to nourish the heart

The single most memorable point of this case: illnesses caused by emotion are the hardest to regulate — even Doctor Zhang Xichun needed more than twenty doses. Because as long as your emotions stay unsettled and the knots remain, the medicine can only regulate on one side while waiting for you to let go on the other.

Modern people may not have so many relatives to support, but the knots and frustrations of life still exist. So Doctor Zhang Xichun’s treatment logic is clear — but Doctor Luo Dalun’s final reminder is this: after the formula has done its work, you still need to nourish the heart — take the chance to listen to the Daodejing, to read the Buddhist sutras, to open the knots in your heart and stop the liver qi from stagnating. That is the fundamental way for this disease to truly, thoroughly improve.

💬 Note from Doctor Luo: From this case we can take away at least three things. First, when the stomach is bad, look at the emotions first — belching, acid reflux, a hot chest are not necessarily problems of the stomach itself. Second, regulating the qi mechanism requires both ascent and descent — lowering rebellion alone is not enough; you must also let qi rise, and only with one rising and one falling can the qi mechanism circulate. Third, bupleurum is not omnipotent — at delicate moments of qi counterflow, choose your herbs carefully; a gentle herb like raw malt is often more suitable than a forceful one. Remember these three points, and this case has not been read in vain.

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.