Toothache Keeping You Awake for Weeks? Doctor Zhang Xichun: When Stomach Qi Fails to Descend, Guide the Qi and Blood Down
Search terms this page answers: toothache / tooth pain / toothache so bad I cannot sleep / pain the moment I chew / toothache lasting more than twenty days / toothache from excess heat (shang huo)
Medical terms: wind-fire toothache (feng huo ya tong) · stomach qi failing to descend (wei qi bu jiang) · stomach fire rebelling upward · swollen, painful gums
Opening: “Toothache is not an illness — but when it hurts, it really kills”
Today we continue telling Doctor Zhang Xichun’s stories of treating patients. What shall we talk about? A toothache case.
Almost everyone has met a toothache at some point. Dental care is a huge problem for ordinary Chinese people — Doctor Luo Dalun’s own childhood friends, for instance, mostly have bad teeth, tied to nutrition and the hygiene habits of their generation. So dental disease is extremely widespread.
💬 Note from Doctor Luo: There’s an old saying — “toothache is not an illness, but when it hurts, it truly kills.” It looks like nothing serious — no broken bone, no torn muscle — yet when it strikes it is pure misery, especially at night: the pain simply will not let you sleep. Today let’s sort out Doctor Zhang Xichun’s method for treating toothache properly.
Who was the patient? A merchant in his 30s, living on Dongmenli Erdao Street in Tianjin
This patient’s surname was Wang, and he was in his 30s — see, right in the prime of life. He lived at Dongmenli Erdao Street in Tianjin, and his occupation? Merchant.
💬 Note from Doctor Luo: Notice that when a Chinese medicine physician sees a patient, he will often chat a little — what business are you in, what kind of work, how have things been lately. Is this useful? Of course it is! The ways of the world always contain the seeds of illness. That is why a genuine physician must understand worldly affairs and human circumstances. If you say, “I don’t care about any of that, I only know medical theory, I just treat the disease” — my friends, you may not be able to cure that disease. Because almost every illness is rooted in the patient’s way of life and work. Only by understanding the ways of the world can you truly heal people.
You see, Doctor Zhang Xichun immediately pinpoints the profession — a merchant. And what is special about being a merchant? We’ll come back to that — there has to be a story in it.
The cause: fretting over business by day, drinking one banquet after another by night
How did this illness come about? The original text states it plainly in two sentences:
First, business worry (shang wu lao xin). Doing business means constant worry — thinking all day about how to make money, how to stock goods, this matter and that matter. What does worry do? It breeds liver fire. Once liver fire appears, liver wood overacts on spleen earth (gan mu heng ni ke pi tu), disturbing the spleen and stomach; and liver fire tends to rise upward.
Second, days of continuous banqueting and drinking (jian lian ri yan yin). A merchant has many friends; people gather, and drink follows drink. After several such feasts, he came down with this toothache.
💬 Note from Doctor Luo: Think about it — what happens when you drink and feast day after day? Today Donglaishun, next week Quanjude — after a few days of this, the spleen and stomach easily accumulate heat and get blocked up. Ordinary people who eat several big meals in a row feel uncomfortable and “heated up” — and so did this gentleman; he got a toothache. So you see, is this illness connected to his profession? Yes. Making money means he could afford to go out and eat, and friends meant worry — in a few strokes, Doctor Zhang Xichun sketched the whole cause of the illness.
How bad was it? Pain on every chew, sleepless nights, no relief in twenty-plus days
What were the symptoms? The toothache was severe and interfered with eating (you ai yin shi) — even meals were affected; the moment he chewed anything, it hurt (yi yi jiu teng) — unbearable; he could not sleep at night (ye bu neng mei), the pain keeping him awake. What’s more, he took every medicine for toothache without any effect, and the condition dragged on for more than twenty days without improving.
💬 Note from Doctor Luo: Here I must make something clear: if your tooth is already seriously damaged — the nerve is dead, the tooth structure is destroyed — then no medicine will do much good. What should you do then? Go to a dental clinic and have it repaired. Modern dentistry is extremely advanced; if decay has eaten deep and there is a deep cavity, follow the dentist’s treatment. But if your teeth are normally fine, and recently you got “heated up” or the pain started suddenly for some reason, that kind of case suits herbal treatment. The cases Doctor Zhang Xichun describes belong to this category too.
Doctor Zhang Xichun takes the pulse: right pulse forceful on pressing — the illness lies in the spleen and stomach
Doctor Zhang Xichun took the pulse: the left pulse was passable, but the right pulse was forceful on pressing (you mai an zhi you li).
💬 Note from Doctor Luo: In Doctor Zhang Xichun’s pulse method, the right hand often corresponds to the spleen and stomach. The left pulse is fine, the right pulse is forceful — so the illness lies in the spleen and stomach.
How did he diagnose it? Doctor Zhang Xichun said: this is yang ming stomach qi failing to descend (yang ming wei qi bu jiang).
Pattern identification: stomach qi fails to descend, stomach fire presses upward, and the gums ache
As you know, stomach qi should normally descend — downward movement is its proper direction. If stomach qi goes upward instead, rebelling for some reason, it causes problems in the upper burner.
💬 Note from Doctor Luo: What do our gums correspond to? They correspond to the stomach channel and the large intestine channel. Doctor Zhang Xichun said: when the qi in the stomach fails to descend, stomach fire rebels upward, and the large intestine’s fire follows it up — that is why the gums ache. That is also why people with toothache usually have swollen, painful gums along with it. And who governs the gum flesh? The spleen governs it — and the spleen and stomach are linked. So it is all connected.
How to treat it? Doctor Zhang Xichun said: lower the stomach qi, and at the same time guide the rebellious blood downward, assisted by herbs that clear heat.
At this point we should organize Doctor Zhang Xichun’s toothache treatments properly — he had three strategies, at three levels.
Strategy one: wind-cold invading the exterior? Use aspirin to disperse it outward
Strategy one, the first level: Doctor Zhang Xichun believed that often the face is invaded by external pathogenic qi (wai xie) — by wind-cold; cold pathogen congeals, qi and blood cannot flow freely, and toothache or cheek pain easily follows. What to do? He thought one should disperse it — use medicine to scatter the cold pathogen and push it out.
What medicine? Doctor Zhang Xichun often used aspirin.
💬 Note from Doctor Luo: Some will say — what kind of Records of Chinese Medicine with Western Reference is this? Doctor Zhang Xichun believed Chinese medicine should not use only Chinese herbs; what is worth borrowing from Western medicine should be borrowed — so he is rightly considered a pioneer of integrated Chinese-Western medicine. In that era he already knew to draw on Western advances. He said aspirin has a dispersing action, and can also induce sweat and scatter pathogenic qi. So his first move was often aspirin — to push the pathogenic qi outward and work up a sweat.
Strategy two: interior heat not cleared? Raw shi gao with a little bo he — clear heat and disperse outward at the same time
If the exterior cold is resolved but the pain and heat inside remain, Doctor Zhang Xichun had a second strategy — clear the interior heat.
How? His approach was usually raw shi gao (gypsum), and in a generous amount — two to three liang (60–90 g) — on the heavy side. Grind the raw gypsum to a fine powder, then pair it with one more herb — bo he (mint).
💬 Note from Doctor Luo: Bo he is an herb we constantly use in treating warm diseases — it releases the exterior with acrid, cool action and disperses outward, yet it is cool in nature. Raw gypsum paired with a little mint (a small dose, often just over one qian, about 3–4.5 g) — clears heat on one side while dispersing outward on the other. Isn’t there heat inside? Then I’ll push the heat out for you too. That is Doctor Zhang Xichun’s second strategy — raw gypsum with a tiny bit of mint to clear interior heat.
Strategy three (today’s star): stomach qi rebelling upward? Sheng zhe shi with huai niu xi, guiding the qi and blood down
Strategy three is the one in today’s case — if the heat comes from stomach qi rebelling upward, what do you do? You press the qi downward, let the qi mechanism descend, and guide the blood down along with it.
What herbs do this? Look at this prescription:
Sheng zhe shi (raw hematite), crushed fine, 30 g (one liang) — we have explained before that whenever Doctor Zhang Xichun met rebellious, non-descending qi, he often used hematite’s heavy, settling power to press the qi downward; that was his signature approach.
Huai niu xi (Huai achyranthes root) 30 g (one liang) — where does Huai achyranthes come from? Wen County, Jiaozuo, Henan — the same region as Huai yam, hence the name “Huai.” It tonifies the liver and kidney and also guides the qi and blood downward.
💬 Note from Doctor Luo: Sheng zhe shi 30 g paired with huai niu xi 30 g — both in generous doses. What for? Exactly this: to guide the qi and blood downward. Once the qi and blood descend, the heat and congestion in the upper burner melt away, and the heat disperses with them. This is Doctor Zhang Xichun’s clever trick for toothache. He said of himself: once when he had a toothache he puzzled over it again and again, and in the end he cured it with exactly these two herbs. So whenever he met toothache caused by stomach qi failing to descend, he used these two; and if there was still some heat, he would add a little raw gypsum — that was his experience.
Breaking down the prescription: four herbs, one dose and the toothache is gone
In this case’s formula he did not add raw gypsum; instead he paired the two leaders with two other herbs:
Hua shi (talcum) 18 g (six qian) — what does talcum do? It conducts heat downward and out through the urine (cong xiao bian er chu).
Gan cao (licorice) 3 g (one qian) — licorice harmonizes all the herbs; at the same time, in surgical-type conditions, boils, swellings and sores, licorice is used constantly, because licorice also resolves toxins.
💬 Note from Doctor Luo: Just these four herbs — sheng zhe shi 30 g, huai niu xi 30 g, hua shi 18 g, gan cao 3 g. The decoction was given to the patient, and after one dose the toothache stopped on the spot — cured immediately! One more dose of the same formula to consolidate. One dose cured it, one more to settle the aftermath — that, my friends, is Doctor Zhang Xichun’s method for this kind of toothache.
What to take away: remember the three strategies — wind-fire toothache can be regulated
Today we covered Doctor Zhang Xichun’s three strategies for toothache: the first disperses exterior cold, the second clears interior heat, the third descends stomach qi. Remember all three. If you meet a toothache later — what we commonly call wind-fire toothache (feng huo ya tong) — meaning it is not a half-rotted tooth, but teeth normally fine that have suddenly started hurting because something has disordered the movement of qi and blood, then we can regulate it with herbs.
💬 Note from Doctor Luo: Doctor Zhang Xichun’s thinking on toothache is well worth studying carefully. And once more: if the tooth itself is truly badly damaged, go to the dental clinic — don’t rely on medicine alone. Chinese and Western medicine each have their own place, and that too was Doctor Zhang Xichun’s attitude.
That is all for today’s story. Tomorrow we will continue sharing Doctor Zhang Xichun’s stories of treating patients. Thank you, and see you tomorrow!
Adapted from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records, from Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published serially 1918–1934.