Leg Pain, with Arms Afraid of Heat and Legs Afraid of Cold? Doctor Zhang Xichun Treats Upper-Heat Lower-Cold Leg Pain by Tonifying the Liver with Heavy-Dose Shanzhuyu

Search terms this page answers: leg pain / leg ache / pain in all four limbs / arm pain / legs afraid of cold / arms afraid of heat / upper heat lower cold / leg pain after a great fit of anger / pain keeps me awake at night / leg pain so bad I cannot turn over in bed

Medical terms: bi syndrome (arthralgia) · limb pain · upper heat with lower cold · liver deficiency · liver wood attacking spleen earth

Opening: a leg-pain patient who even stumped Doctor Zhang Xichun

In the last few talks we covered leg pain from cold and leg pain from blood stasis, and some listeners said they wanted to hear more. Good — today’s case is even more interesting. The arms were afraid of heat, the legs were afraid of cold — the upper and lower halves did not match at all, and it truly “stumped” Doctor Zhang Xichun, a physician with more than forty years of clinical experience.

💬 Note from Doctor Luo: Doctor Zhang Xichun first stated a rule: people whose legs hurt do not necessarily have arm pain, and people whose arms hurt do not necessarily have leg pain — but when arms and legs hurt together, the cause is usually one thing: exposure to cold. In more than forty years of practice he saw such patients beyond counting. Only the elderly lady in today’s case had different causes above and below, so she was worth recording to open up our thinking.

Who was the patient? The mother of the head of the Xi Ta post office in Shenyang

The patient was the elderly mother of the head of the Xi Ta post office in Fengtian (today’s Shenyang), and she was 57 years old that year. In winter, she began to feel pain in all four limbs. Doctors were called in and medicines prescribed — over thirty doses, with no effect at all — and instead the illness grew worse: gradually she became bedridden, unable to turn over in bed, in pain day and night, and this dragged on until the fifth month of the following year.

💬 Note from Doctor Luo: One side remark — Xi Ta today is a famous food street in Shenyang, a Korean-Chinese neighborhood where many Koreans live. If you visit Shenyang and do not taste the food in Xi Ta, that is a bit of a pity. This story happened right there.

Round one: Doctor Zhang Xichun induces sweating with Western aspirin

Doctor Zhang Xichun took the pulse: floating and forceful on both wrists, with only a white coating on the tongue. He reasoned that the illness had begun as external pathogenic heat lodged in the channels. Since the external pathogen had not been driven out, the first step was to induce sweating. Doctor Zhang Xichun was a master of integrating Chinese and Western medicine, so he used Western aspirin, to be taken with sugar water, to bring out a sweat.

💬 Note from Doctor Luo: Aspirin can disperse the sweat of external-contraction illness and induce sweating, and it is also good at treating limb pain — that is why Doctor Zhang Xichun chose it. The next day, after the sweating, the pain was a little better — she could turn over again — but the pathogen inside had still not fully come out.

Round two: clear heat and unblock the channels — the arms got better, but the legs hurt more

The pathogen had not been cleared, and there was still heat, so Doctor Zhang Xichun wrote a formula: forsythia (lian qiao), trichosanthes root (tian hua fen), Chinese angelica (dang gui), salvia (dan shen), white peony (bai shao), frankincense (ru xiang), myrrh (mo yao). On one side it unblocked the channels, on the other it cleared heat — forsythia clears heat and disperses masses, trichosanthes root nourishes yin and is also good at clearing heat, and the rest nourish blood and unblock the channels. This is broadly the thinking of the Huoluo Xiaoling Dan (the “Vitality-Unblocking Miraculous Elixir”).

💬 Note from Doctor Luo: After this medicine, the pain in both arms improved by more than half — but the pain in both legs grew worse! The old lady added: if her legs were kept warm, the pain eased a little — did you hear that? The legs were afraid of cold.

Round three: a warming, tonifying formula — the legs got better, but the arms flared up again

Doctor Zhang Xichun thought: since the heat above had been cleared, and below she was suffering from cold, then let us warm things up. So he changed the formula: Chinese angelica (dang gui), achyranthes root (niu xi), teasel root (xu duan), wolfberry (gou qi zi), drynaria (gu sui bu), myrrh (mo yao), acanthopanax bark (wu jia pi) — herbs that somewhat strengthen sinews and bones, leaning toward warmth. After two doses, the leg pain slowly improved — and the arm pain began to flare up again. Now Doctor Zhang Xichun was truly stumped (as they say in the northeast).

💬 Note from Doctor Luo: By the usual rule, when arms and legs both hurt, either both are affected by cold or both have heat. This lady had legs afraid of cold and arms afraid of heat — a classic upper-heat, lower-cold picture: the legs are cold and painful, so there must be cold congealing the qi and blood there; the arms are hot and painful, so there must be heat binding the qi and blood there. Cold cannot be cleared, heat cannot be warmed — this prescription was very hard to write.

The turning point: one press on the left guan pulse — the truth came out

Even a great physician could be stumped; the previous treatments had all been off the mark, so he took the pulse once more: the earlier heat signs were gone, and the left guan (bar) position could not bear heavy pressure.

💬 Note from Doctor Luo: On the left wrist, the guan (bar) position corresponds to the liver (left wrist: heart, liver, kidney — the bar in the middle is the liver). A left guan that cannot bear heavy pressure means liver deficiency — the liver’s qi and blood are deficient, with some stasis mixed in. The liver is in charge of free-flowing movement (shu xie); the upward and downward circulation of qi throughout the whole body depends on it. When the liver wood is deficient, the ministerial fire of the liver cannot travel downward, so the legs are cold; and the liver fire stagnates upward, so the upper body is hot. When above and below cannot communicate, you get upper heat with lower cold.

Huang Yuanyu’s circular movement of qi — the full explanation of upper heat with lower cold

Why do the qi movements stop communicating between upper and lower? What Doctor Zhang Xichun used here is precisely Huang Yuanyu’s theory: in a healthy person, qi circulates up and down — the spleen rises on the left, the stomach descends on the right; the liver rises with the spleen, the gallbladder descends with the stomach. The heart fire above follows the lung in a swift descent on the right, enters the kidney and warms the kidney water, so the kidney water is never too cold; the kidney water rises on the left with the liver and spleen into the heart, to supply the heart fire, so the heart fire is never too hot. The upper body not too hot, the lower body not too cold — that is the healthy person (ping ren).

💬 Note from Doctor Luo: If this pivotal mechanism goes wrong and the upper and lower qi stop turning, the heart fire does not go down and the kidney water does not come up — water and fire fail to meet and harmonize (shui huo bu ji ji) — then the upper body alone is hot and the lower body alone is cold. Where is the root cause? The spleen and stomach can no longer revolve; and one important reason the spleen and stomach cannot revolve is that the liver’s free-flowing function has broken down. That is why Doctor Zhang Xichun sighed: “To know the mechanism that revolves the upper heat and lower cold is nothing but regulating and tonifying the liver wood.” — the key to treating upper-heat lower-cold lies in tonifying the liver wood!

The masterstroke: heavy-dose shanzhuyu — cured within days

So Doctor Zhang Xichun wrote this formula: shanzhuyu (cornelian cherry fruit) 30 g (one liang — a heavy dose, core removed), plus Chinese angelica (dang gui), white peony (bai shao), frankincense (ru xiang), myrrh (mo yao), teasel root (xu duan) 12 g each (four qian), and forsythia (lian qiao) and licorice (gan cao) 9 g each (three qian), one dose decocted and taken daily, with a little aspirin dissolved in water each day. The result: cured within a few days — before long, the old lady’s arm pain and leg pain were both completely gone.

💬 Note from Doctor Luo: The core of this case is the heavy use of shanzhuyu. Doctor Zhang Xichun said that shanzhuyu gets the fullest wood qi; within its sour, astringent nature it possesses a great power of regulation and free movement — it is excellent at tonifying the liver and excellent at soothing the liver. Shanzhuyu tonifies the liver and kidney, and its power to tonify the liver is especially strong — Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) uses it precisely for that. What it tonifies is the essence of the liver — when the liver’s essence is sufficient, the liver’s qi, yin, blood, and yang all become sufficient, and the liver can again perform its free-flowing function. This is the same principle as Chinese yam tonifying the spleen’s essence and prepared rehmannia tonifying the kidney’s essence. When you meet a disease of liver deficiency with failure of free-flowing movement, tonifying the liver with heavy-dose shanzhuyu is Doctor Zhang Xichun’s special, private method — as I mentioned when we talked about shanzhuyu as both medicine and food, whenever he treated leg pain caused by liver problems, he used shanzhuyu.

Bonus story one: after a great fit of anger, leg pain so bad he could not get out of bed

Doctor Zhang Xichun recorded another case: in Huanglongzhuang (as it is pronounced) in Lin Village, there was a certain Mr. Zhou, in his thirties, who began to feel leg pain after a great fit of anger. It grew worse day by day, and two months later he could not get out of bed. The doctors before, knowing the illness came from anger, treated it by soothing the liver and moving qi — and the result was the more they soothed the liver and moved qi, the worse the illness became.

💬 Note from Doctor Luo: Doctor Zhang Xichun saw at once that the left pulse was extremely weak — almost untouchable — and every place that hurt also felt hot. He suddenly understood: the Neijing (Yellow Emperor’s Inner Classic) says “anger injures the liver” — it is perfectly true. This man’s anger, on a liver that may already have been insufficient, completely wounded the qi and blood of the liver channel. This was not stagnation — this was injury. The liver became too weak to move qi and blood; the ministerial fire of the liver could not circulate and stagnated in the channels, which is why the legs hurt and also felt hot. At this point, continuing to use liver-soothing, qi-moving medicines was like adding frost to snow.

Doctor Zhang Xichun used shanzhuyu 30 g (one liang), with anemarrhena (zhi mu) to clear heat and Chinese angelica (dang gui) to nourish blood, plus salvia (dan shen), frankincense (ru xiang), and myrrh (mo yao) (the Huoluo Xiaoling Dan approach). After ten doses, the heat disappeared and the pain stopped — the illness was cured.

Bonus story two: a woman near seventy — the large pulse was an illusion; liver wood was too strong and bullying spleen earth

The third case is even more interesting. A good friend of Doctor Zhang Xichun’s in his hometown had a mother nearly seventy who suddenly developed leg pain so bad she could not walk and could not sleep at night from the pain. The friend hurriedly drove a horse cart to fetch Doctor Zhang Xichun, muttering all the way: the pulse is forceful — it seems like fire stagnation burning painfully, as if there is heat inside causing the pain.

💬 Note from Doctor Luo: This kind of illness tends to appear in weak people — those whose livers are too deficient to perform free-flowing movement are usually elderly people who were frail to begin with. Doctor Zhang Xichun took the pulse: large and wiry. He asked the old lady whether she felt heat in her heart; the answer was she did not feel heat. Doctor Zhang Xichun said: this large pulse is not fire — it is the false appearance of spleen and stomach being too deficient, with true qi leaking outward; press hard and it weakens. A wiry pulse, like a taut zither string, means the liver and gallbladder are out of harmony, with wood qi too exuberant — the liver qi is too strong and is bullying the spleen earth.

This time the liver was not deficient — the liver was too exuberant — so the formula is very telling: shanzhuyu was used at only 18 g (six qian) — far less than one liang — with the purpose of increasing the liver’s free-flowing power and harmonizing qi and blood. It was paired with atractylodes (bai zhu) 18 g to tonify the spleen and stomach, ginseng (ren shen) and white peony (bai shao) 9 g each — ginseng tonifies qi and, together with atractylodes, strengthens spleen-earth function, while white peony softens the liver; plus Chinese angelica (dang gui) to nourish liver blood and restrain the liver’s violent qi, tangerine peel (chen pi) and magnolia bark (hou po) 6 g each to regulate qi and transform damp, and frankincense (ru xiang) and myrrh (mo yao) 4.5 g each (one qian and a half) to unblock the channels. After a few doses, the old lady’s leg pain was cured too.

Doctor Luo’s closing: when the legs hurt, first think of the liver

From these three cases we learn a piece of knowledge most people never notice: a great many people’s leg pain is connected to the liver. Most often it is liver deficiency — the liver’s qi and blood are insufficient — and in that case you need large amounts of shanzhuyu to nourish and tonify the liver, plus some channel-unblocking herbs. But there is also liver qi in excess — liver wood running amok and attacking spleen earth — and in that case you use a small amount of shanzhuyu to increase the liver’s free-flowing movement, while simultaneously using medicine to tonify the spleen; when liver and spleen are harmonized, leg pain gets better all the same.

💬 Note from Doctor Luo: In my own clinical practice I have met leg-pain cases that began after anger or emotional upset, and I have also brought them to health with shanzhuyu — so Doctor Zhang Xichun’s insight is real and true. Listen to case studies often, widen your knowledge, and keep a seed in your heart — if one day you or a family member meets this situation, you open a book and know how to treat it. That is the way we popularize Chinese medicine. Tomorrow we continue with more of Doctor Zhang Xichun’s stories.

What to take away

• Legs afraid of cold plus arms afraid of heat (upper heat, lower cold) is often a liver problem. When the liver is deficient, its ministerial fire cannot travel downward (legs cold) and the liver fire stagnates upward (arms hot).
• The pivot of upper-heat lower-cold is the liver wood. According to Huang Yuanyu’s circle of qi, when the spleen and stomach cannot revolve and the liver’s free-flowing function fails, water and fire fail to meet. As Doctor Zhang Xichun put it: “To know the mechanism that revolves upper heat and lower cold is nothing but regulating and tonifying the liver wood.”
• Heavy-dose shanzhuyu (30 g or more) is Doctor Zhang Xichun’s special method for liver-deficiency leg pain. Shanzhuyu “gets the fullest wood qi” — astringent yet wonderfully regulating, it tonifies the liver and soothes the liver at the same time.
• Anger can injure the liver, not just bind it. When a great fit of anger wounds the liver channel’s qi and blood, soothing-liver and moving-qi medicines make things worse; you must tonify the liver with shanzhuyu and unblock the channels.
• A large pulse is not always fire. In weak elderly people a large, wiry pulse with no true heat signs can be a false appearance of spleen-stomach deficiency with liver wood too exuberant — then use only a small dose of shanzhuyu and tonify the spleen instead.

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.