Back Pain for Three Years, Hundreds of Doses Failed? Doctor Zhang Xichun: Free Flow Means No Pain — Blood Stasis Blocking the Channels
Search terms this page answers: back pain / low back pain / back pain so bad I cannot turn / dull lingering back pain / back pain worse when I work / back pain that will not heal for years / chest feels blocked up / back pain that flares up with anger
Medical terms: blood stasis back pain · qi stagnation and blood stasis · blocked channels and collaterals (free flow means no pain, pain means no free flow)
Opening: the last two days we told flank-pain cases — Doctor Zhang Xichun was making a point about the liver
Over the past two days we have been telling Doctor Zhang Xichun’s stories of treating patients, and two of them were flank pain (xie tong): one was liver qi deficiency — the liver qi was weak; another was liver blood deficiency — deficient liver blood and liver yin had stirred up deficient fire. In fact, Doctor Zhang Xichun recorded three flank-pain cases, and the third is even simpler — pure liver fire: a farm woman with a hot temper flew into a rage and developed flank pain.
💬 Note from Doctor Luo: That third case is so simple — pure liver fire, just drain the liver fire downward, no need to go into detail. But notice Doctor Zhang Xichun’s purpose: with these three flank-pain cases he is demonstrating all the different ways the liver can go wrong — how to treat weak liver qi, how to treat deficient liver blood, how to treat blazing liver fire. This is a classic teaching set.
So what shall we talk about today? Today: back pain. Back pain is everywhere — plenty of people ache in the lower back for no obvious reason. Let’s look at a back-pain case Doctor Zhang Xichun treated.
Who was the patient? A 34-year-old Tianjin security captain — and Doctor Luo’s fellow townsman
The patient was Captain Li Yulin of the Tianjin Security Team, a native of Liaoyang — and here’s a coincidence: Doctor Luo Dalun’s own hometown is Liaoyang, Liaoning Province, which in ancient times was called Xiangping. So this was his fellow townsman. Captain Li was only 34 — in the very prime of life, and as a security captain he should have had a solid constitution.
💬 Note from Doctor Luo: Note the age — the moment you hear it, you know this is a young man. A young man with back pain, and a serious case of it at that — there has to be a story behind this.
The cause: worry, overwork, loss of appetite — then his superior ordered him on a long trip
How did the illness start? Around that time Captain Li was extraordinarily busy — his work wore on his mind, he was exhausted, and for several days he could not eat properly (shu ri lan shi — several days of poor appetite). Already low on energy and not in robust shape, he was then ordered by his superior to travel — an important errand that left him no choice but to set off on a long, demanding journey. That is how the back pain began.
How bad was it? He could not turn his body, work made it worse, and his chest felt blocked up
What did the pain feel like? When it struck, he could not turn his body — his lower back simply would not rotate. When it was milder, it was a faint, lingering, nagging ache — not sharp enough to pin down, but always there underneath; sometimes he would indeed go days without pain, but the moment he got angry, or did physical labor, the pain flared up fiercely. On top of that his chest felt very oppressed, as if something were stuck there. And the pulse: deep (mai chen) — a bit over four beats per breath.
💬 Note from Doctor Luo: A deep pulse — file that word away, because Doctor Zhang Xichun is going to build his whole argument on it.
The most striking part of the history: three years, several hundred doses, not one bit of improvement
This was no overnight illness — he had suffered for three years. In those three years Captain Li had taken several hundred doses of medicine and consulted many physicians, yet the pain had never once lessened.
When Doctor Zhang Xichun arrived, the first thing he did was study the formulas the patient had already taken. He looked through them — they were all tonics for the liver and kidney and strengtheners of sinews and bones, with a little wind-dispelling medicine added here and there.
💬 Note from Doctor Luo: This does match the usual way of thinking about back pain. You go to a Chinese medicine practitioner today and say your back hurts — what does most people’s thinking jump to? First kidney deficiency, second maybe cold-damp — kidney deficiency is the most common guess by far. So most back-pain formulas you see are bone-strengthening, du-channel-tonifying, kidney-tonifying formulas. Doctor Zhang Xichun reasoned: several hundred doses of that and not a bit of effect — that approach has to be wrong.
How did Doctor Zhang Xichun think? The most crucial stroke of the whole case — a deep pulse means blood stasis!
If several hundred doses achieved nothing, what else could it be? Doctor Zhang Xichun pulled out the pulse he had just taken: deep (chen). What does a deep pulse indicate? — Blood stasis!
💬 Note from Doctor Luo: Doctor Zhang Xichun reminds us: don’t forget this saying — “free flow means no pain, pain means no free flow” (tong ze bu tong, tong ze bu tong). Pain that has not healed for three years is very likely blood stasis sitting right there blocking the way. Now think it through in reverse: if this were truly liver-kidney deficiency, what should the pulse be? It should be thin and rapid (xi shu). But this pulse is deep — which strongly suggests blood stasis. So how should it be treated? With the approach of lubricating the joints and unblocking the channels. Reading this I was delighted — in Doctor Zhang Xichun’s case records, every line is practical substance.
Doctor Luo’s aside: why are so many modern back-pain cases “blocked channels”?
At this point Doctor Luo cannot resist adding a few words: in the back pain he encounters, cold-damp and kidney deficiency certainly exist — but very many cases are blocked channels. People ask: how can the lower back get its channels blocked?
💬 Note from Doctor Luo: Modern life offers an enormous number of ways to block the channels of the lower back. First: sitting posture. The ancients sat straight; today people slump, cross their legs, twist their bodies into every contorted position — the lower back takes uneven strain, and blood stasis forms easily. Second: sleeping posture — dozing off on the sofa at midday with your body twisted, pressing on your back the same way. Third: exposure to cold — dressing too lightly and letting the lower back get chilled. But there’s something more complicated in there: if you eat ice-cold food every day, your abdomen’s temperature drops — and the lower back sits right behind the abdomen. The front is frozen cold; can the blood circulation in the back stay normal? The two influence each other. Fourth: rich, heavy food. Overweight people carry a big belly hanging out front — how much strain does that put on the lumbar spine out back? Of course it does. So in modern society the opportunities for lower-back blood stasis are everywhere.
So when you meet back pain, consider it from many angles: should we tonify the liver and kidney? Yes, if needed. Should we dispel cold-damp? Yes, if yang qi is insufficient. But one more important approach must never be forgotten — move blood and unblock the channels. Many people fall ill precisely because qi and blood cannot flow and the lower back is obstructed. This is clinical experience.
The prescription: 11 herbs, opening with huai shan yao 30 g — Doctor Zhang Xichun’s signature move
With the plan set, Doctor Zhang Xichun wrote the formula. The first herb: huai shan yao (Huai yam) 30 g (one liang) — as you can see, this is Doctor Zhang Xichun’s signature technique; he was a master of Huai yam. What is it for here? Supporting upright qi (zheng qi).
💬 Note from Doctor Luo: Why can’t qi and blood flow freely? Stasis forms because your upright qi is insufficient and has no strength to push. How do you build upright qi? First fill up the spleen-stomach qi. Look at this patient — at the start he could not eat, he worried and wore himself out, then forced himself on a long journey — deficiency came first. So the very first herb tonifies the spleen-stomach and lifts upright qi, and in a generous dose: 30 g.
Next in line: gou qi (goji berry) 24 g (eight qian) — tonifies the liver and kidney. Is that tonification needed? It can’t hurt — once you’ve tonified, the unblocking has more strength. Then dang gui (Chinese angelica) 12 g (four qian) — what is it for? Nourishing blood and moving blood.
💬 Note from Doctor Luo: Here is a big principle: at a moment like this unblocking alone will not work. You think — there’s blood stasis, so I’ll just push it through hard? No! You must nourish blood in order to move it. If the blood is not first filled up and you go charging through, the unblocking has no strength behind it — and it will wound upright qi. So dang gui nourishes blood as the base, paired with dan shen (salvia root) 12 g to move blood and unblock the channels.
Then raw mo yao (myrrh) — frankincense (ru xiang) and myrrh both move blood, unblock channels, regulate qi and relieve pain; since the patient hurts, use myrrh. Next raw wu ling zhi (trogopterus dung) 12 g (four qian). Then one controversial herb: chuan shan jia (pangolin scales), dry-fried and ground fine, 6 g (two qian); tao ren (peach kernel), skinned and crushed, 6 g; hong hua (safflower), 4.5 g (one and a half qian); tu bie chong (ground beetle), crushed, five of them; and last san qi (notoginseng), ground fine, 6 g. Eleven herbs in all.
The “scary” herbs in this formula: trogopterus dung, pangolin scales, ground beetle — are they really usable?
A few herbs in this formula have stirred big debate lately, and Doctor Luo wants to talk about them properly.
First, wu ling zhi. What is wu ling zhi? It is the droppings of the flying squirrel. The flying squirrel is also called the “wu” rat (wu shu) — a rodent that can glide through the air, leaping from tree to tree in the forest. Its droppings are called wu ling zhi.
💬 Note from Doctor Luo: Lately people keep arguing: do animal droppings really have medicinal value? Of course they do! Can sha (silkworm droppings) — a medicine we use all the time — is exactly the droppings of silkworms. Wu ling zhi is likewise a very common medicine. Analyzed chemically, it genuinely contains many medicinal compounds — the composition is complex. First point: animal droppings can absolutely be used; the Chinese ancients drew on countless things from nature. Second, some people worry such droppings could transmit viruses — but these medicines are always decocted, and boiling thoroughly removes any such concern. Also, wu ling zhi used raw moves blood, resolves stasis, regulates qi and relieves pain; dry-fried it gains a blood-stopping action — the properties differ by preparation. Here the formula takes its qi-regulating, pain-relieving, channel-unblocking action. And this herb is not indispensable — it can be adjusted or swapped out.
Next, chuan shan jia (pangolin scales). The pangolin is a protected species today; Chinese medicine uses its scales. What really drove pangolin numbers into freefall is that many people eat its meat. In Chinese medicine formulas, which prescription uses pangolin scales? In vanishingly small amounts. So the gourmets who eat pangolin meat are the real culprits — Chinese medicine does not carry that blame first.
💬 Note from Doctor Luo: Pangolin scales do genuinely move blood and unblock channels — but can this herb be left out? Absolutely. Skip it and substitute another herb with the same action. That is why we try to avoid animal medicines. Here 6 g were used — we are only introducing it.
Tao ren (peach kernel) and hong hua (safflower) — these two are often paired, as in Tao Hong Si Wu Tang, where “tao hong” means peach kernel and safflower. Peach kernel resolves formed, tangible blood stasis; safflower resolves the fine, diffuse blood stasis. Together they work beautifully. One detail matters here: peach kernel absolutely must be crushed — if the pharmacy is careless and doesn’t crush it, decocting whole kernels extracts how much of the active constituents? Crushed, the decoction works far better. Two qian of peach kernel is 6 g.
Tu bie chong (ground beetle) — people who grew up in the countryside know it, also called tu yuan (“earth round”): a beetle that lives in the soil. Its power to move and break blood stasis is exceptionally strong, superb for scattering stasis — it is widely used in Chinese medicine and today is almost entirely farm-raised.
💬 Note from Doctor Luo: The ground beetle is not a pretty creature; some patients are startled when they see it in their herbs. But its blood-breaking action is genuinely irreplaceable, very powerful. For blood-stasis back pain like this, Doctor Zhang Xichun used it.
Finally, “guang” san qi (notoginseng) — why “guang” (Canton)? Because in Doctor Zhang Xichun’s day, notoginseng’s main producing region was not Yunnan but the Tianzhou area of Guangxi — hence “Guang” san qi. As time went on, Guangxi’s notoginseng cultivation declined and Yunnan’s rose, so today most notoginseng comes from Yunnan.
💬 Note from Doctor Luo: Look at this formula as a whole and it’s immediately clear: spleen tonics, liver-kidney tonics, blood nourishers, plus blood movers and channel unblockers. The wu ling zhi and pangolin scales can both be swapped — I often use mulberry twig (sang zhi) and loofah vein (si gua luo) and similar channel-unblocking herbs, and the effect is excellent. Master the principle — moving blood and unblocking the channels is the great method.
How to take it? The notoginseng powder is sent down in two divided doses
With the formula set, the taking method also has its rules: decoct the first ten herbs; with the first decoction, send down half the notoginseng powder; then re-decoct the dregs, and with the second cup, send down the remaining half of the powder.
💬 Note from Doctor Luo: Note carefully — the decocted liquid carries the notoginseng powder, finished in two divided doses. That way the blood-moving power of notoginseng acts evenly throughout.
The twist in treatment: after three doses the back stopped hurting, but the pulse was not yet level — remove the pangolin scales, add Dipsacus and white peony
The medicine took effect: after three doses the back no longer hurt, and the chest no longer felt oppressed. The pulse had improved — but had not yet fully returned to normal. What to do? Doctor Zhang Xichun revised the formula: removed the pangolin scales (roasted chuan shan jia) and added two herbs — chuan xu duan (Dipsacus root) and sheng hang shao (white peony root).
💬 Note from Doctor Luo: Chuan xu duan tonifies the liver and kidney, strengthens sinews and bones, and unblocks the channels — for back pain and back soreness we use it all the time; sheng bai shao has a relaxing, pain-relieving action. With these two added, after several more doses the pulse returned to normal, and the illness was rooted out for good.
A disease treated for three years — with Doctor Zhang Xichun it took just a few doses, and the patient was well. That is a master physician: when the formula comes out it aims directly at the cause, so the results are outstanding.
Doctor Zhang Xichun’s appended note: the physician’s worst enemy is a preconceived idea
After recording this case, Doctor Zhang Xichun wrote a passage that Doctor Luo feels is well worth passing on:
💬 Note from Doctor Luo: Doctor Zhang Xichun said: a physician treating illness must not hold a fixed preconception in his heart. If you set up a prejudice in advance — whenever back pain walks in, it must be kidney deficiency, liver-kidney insufficiency, give them tonics — then you are ruined: the patient arrives, you don’t ask a single question about the cause, you start writing the prescription, and you hand out medicine before you even understand the case. That way of practicing is deeply flawed. The causes of back pain are many — you must analyze carefully, case by case.
Bonus: three short case studies — back pain is far more than “kidney deficiency”
Afraid his readers might not remember, Doctor Zhang Xichun gave several more examples showing how varied the causes of back pain are:
First example: a man hurt his back carrying a very heavy load — and then had back pain. How was it treated? Doctor Zhang Xichun used san qi (notoginseng) powder mixed with equal parts tu bie chong (ground beetle) powder, 6 g per dose, twice a day; after three days of the powder, the back pain was gone. Why? Carrying a heavy load injures the sinews and bones — that too is blood stasis, and moving blood and resolving stasis resolves it.
Second example: a woman had back pain every time her period came. Her pulse showed qi and blood both deficient. So on the blood-nourishing base of Si Wu Tang (Four Substances Decoction) he added huang qi (astragalus) 24 g (eight qian); after a few doses the back pain was cured — this was qi-blood deficiency back pain.
Third example: another woman had nagging, unrelenting back pain — not severe, but constant. Her pulse showed cold deficiency of the lower burner, so he warmly tonified the lower burner with a decoction, and additionally gave raw sulfur powder (sheng liu huang) to take a little at a time.
💬 Note from Doctor Luo: Doctor Zhang Xichun regarded raw sulfur as a hot medicine that warms the lower burner — but whatever you do, do not imitate this! Raw sulfur is toxic. We won’t go into it; that particular usage belonged to a specific context in Doctor Zhang Xichun’s world. Ordinary people should never copy it.
Closing: today’s story was worth hearing
💬 Note from Doctor Luo: Doctor Zhang Xichun was right — you think back pain means liver-kidney deficiency, means kidney deficiency? In fact the causes of back pain are very numerous. What we learned today is one big category: channels and collaterals where qi and blood do not flow — blood-stasis back pain. How do you treat this kind? Move blood and unblock the channels. If you can take away this one lesson today, this story was not told in vain.
In this unusual period, we can all learn a little more. Tomorrow we continue with Doctor Zhang Xichun’s stories of treating patients. Thank you, and see you tomorrow!
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.