Going Crazy, Raving and Raging? Doctor Zhang Xichun Treats Mania and Psychosis (Schizophrenia) by Draining Phlegm-Heat

What people search for: going crazy / mania / mental disturbance / talking nonsense / raging and violent / sleepless nights / inner restlessness / smashing things Medical terms: schizophrenia · mania with loss of reason · phlegm clouding the mind (tan mi xin qiao) · phlegm-heat rising · manic agitation

Opening: this disease is closer to us than we think

Today we continue with the stories of Doctor Zhang Xichun’s practice. This one is about an emotional illness, a mental illness — in Chinese medicine it is called dian kuang shi xin (mania with loss of reason), something close to what we today call schizophrenia.

💬 Note from Doctor Luo: Never underestimate mental illness. International medical statistics show that a very large number of Chinese people suffer from mental disorders — roughly one person in ten will have some kind of psychiatric illness at some point. Do you think that number is exaggerated? If we speak only of emotional disharmony, I think the number is actually too small — far more than one in ten people have emotional imbalances. So this case is well worth studying carefully.

Who was the patient? The son of a magistrate, who couldn’t do anything he wanted

The patient in this case was Du Fengchao, the son of Magistrate Du of Taochang. Taochang was a place in what is now Liaoning Province, established during the Republican era, and Magistrate Du was its local official. The son was about thirty years old when he developed mania with loss of reason. How did he get it?

Because he had failed in his studies — his books had led nowhere, so he wanted to try another trade: “I’ll stop studying and do something else — run a little business.” But his family discipline was extremely strict: his household kept him on a very short leash, especially because his father was a government official — he was watched and controlled, with no freedom. He could not steer his own fate; anything he wanted to do, he was not allowed to do. So frustration built up in his heart. Suppressed heat arose from the heart, and that stagnant heat bred phlegm — and then came mania with loss of reason.

💬 Note from Doctor Luo: When I finished reading this passage of Doctor Zhang’s, I let out a long sigh — there are so many cases like this! I have seen countless examples: because of studies, because of careers, because of all kinds of problems, the family controls the child, the child is miserable and does not want to be controlled, and in the end the mind collapses — as numerous as the hairs on an ox, only the severity of the symptoms differs. So a family environment and family education should teach according to the child’s nature and let things take their natural course. This kind of rigid, coercive upbringing ends up breaking many children — some can no longer go to school, some can no longer work, and it is heartbreaking to see. It happened in Republican times, and it happens here today.

How sick was he? Rambling speech, scratching his chest and singing at midnight

What were the young man’s symptoms? His speech was confused — he talked in a rambling way, you asked one thing and he answered another; his spirit was clouded — he was in a daze, vague and unfocused; he grew angry suddenly — fits of rage flared up for no reason; he burst into song — sometimes he would start singing at the top of his voice. His heart was restless, he could not sleep at night, and he would scratch at his own chest with his hand — he was so agitated and oppressed he could not bear it. Ask him what was wrong, and he could not tell you.

💬 Note from Doctor Luo: Look at the young man’s build — he seemed quite strong and sturdy. Doctor Zhang took his pulse: all six positions were slippery and full — the slippery pulse rolls along like a bead — especially in both cun positions (the inch positions at the wrist), and the heart was beating about five beats per breath, slightly fast. Is this symptom picture typical? Extremely typical — I have seen patients just like this. One step further, and those with truly manic agitation will smash things at home — they cannot sit still, and the family is in agony, because nobody can control them: a strapping young man, powerfully built, unreasonable, staring straight through you. The relatives who bring him in are basically at the end of their rope — they cannot take it anymore, they simply cannot manage him. So this kind of patient is very common.

Western medicine is studying it, but many mysteries remain

Schizophrenia is an extremely complex disease. How does it actually form? Western medicine has not fully worked it out yet; it is still being studied. Its manifestations are very varied: some patients have confused, disconnected speech; some are genuinely manic; some have auditory or visual hallucinations — hearing voices that are not there; some feel persecuted — “someone has been following me, someone wants to harm me,” imagining an enemy that does not exist.

💬 Note from Doctor Luo: So where exactly does the problem lie? Western medicine is still researching it and has not fully figured it out. Anything involving the brain tends to be complicated. Western medicine has many theories — it relates to hormones, to heredity… there are many hypotheses. So let’s see how Doctor Zhang Xichun judged this case, and how Chinese medicine understood it.

What did Doctor Zhang think? Phlegm-heat had blocked the road between heart and brain

Doctor Zhang’s explanation has a flavor of integrating Chinese and Western medicine. He said: the yuan shen (original spirit) resides in the brain, and the shi shen (conscious spirit) resides in the heart — heart and brain are connected, communicating ceaselessly. When that heart–brain connection is normal, a person’s mental state is normal.

💬 Note from Doctor Luo: This is how Doctor Zhang explained it back then — the physiologists of his day said the heart has blood vessels leading to the brain, and the spirit travels back and forth along the pathway between heart and brain. He was building on the Western medicine of his era. Today we believe that beyond blood vessels, the heart and brain are also linked through nerves and many other complex channels of communication, including hormones and so on. The heart and brain really do influence each other, and really are connected.

So what was wrong with this patient? His pulse was slippery and full — this is phlegm-heat rising — there was phlegm in his body. What is phlegm? It is congealed fluid: when the body’s fluids are congealed by heat into a thick, sticky liquid, we call that phlegm. This is internal phlegm, formless phlegm; the phlegm you cough up is the visible kind. If this formless phlegm blocks the pipe connecting heart and brain, the mental system starts to malfunction and loses its normal order — and that is the origin of mania with loss of reason, the cause of this kind of mental illness.

So how to treat it? Doctor Zhang said: you must use medicines that open, settle and sink — driving downward, pressing down, leading the phlegm-fire downward. Once the heart–brain pathway is open again, the mental state naturally recovers.

First prescription: sheng zhe shi (hematite) in the lead, settling and sinking the phlegm-fire

Doctor Zhang wrote a prescription whose first herb was sheng zhe shi (hematite), 45 g, ground fine — that is a fairly large dose.

💬 Note from Doctor Luo: Sheng zhe shi — we have talked about this before; it is a medicine Doctor Zhang Xichun used with special skill. It is a mineral, in fact an iron ore (its main component is ferric oxide). Its nature is slightly cool, and it can send blood downward while also cooling blood; being a mineral, a metal-like substance, it is heavy and sinking, so it drives things down. Doctor Zhang believed hematite can suppress rebellious qi — when qi is surging upward, hematite presses it down; when there is phlegm in the body, it helps drive it downward; it also stops vomiting and opens stubborn constipation. Doctor Zhang was especially good with sheng zhe shi — whenever qi was moving abnormally upward, he would often use hematite to press it down. Sheng shi gao (gypsum), sheng huai shan yao (Chinese yam) and sheng zhe shi (hematite) were his three specialties, herbs he used with unique insight — this is something we must learn.

Here Doctor Zhang used sheng zhe shi in imitation of the Sheng Tie Luo Yin (Raw Iron Fillings Drink) from the Inner Canon of the Yellow Emperor (Huang Di Nei Jing) — a formula made specifically for mania.

💬 Note from Doctor Luo: What is Sheng Tie Luo Yin? When a blacksmith hammers hot iron, sparks fly — the iron is red-hot, and the sparks that fall to the ground become iron filings. That is sheng tie luo (raw iron fillings). Iron fillings are also a kind of iron-ore material. What do they do? Heavy settling. First, they settle the fire of the heart and liver — when the liver wood is restless and liver fire is rushing upward, they enter the liver channel and press down heavily; second, they settle the heart-spirit. So in the Inner Canon, when someone was manic with liver fire surging upward, they boiled iron fillings in water to give heavy settling to the spirit. When Doctor Zhang used sheng zhe shi, he was following that same line of thought — both are essentially iron ores; the main component of hematite is ferric oxide.

In the formula, besides the sheng zhe shi pressing downward, he added chuan da huang (rhubarb). Rhubarb is well known — it is a purgative, draining accumulations downward, able to scour heat out of the intestines; the dose was not small — he wanted to clear the heat pathogen out of the body. Then qing ban xia (pinellia) was added for resolving phlegm. And mang xiao (mirabilite): mirabilite is also a purgative — it drains downward, lubricates the bowels, softens hardness, and also clears fire and reduces swelling. When there is damp-heat accumulation in the intestines we use mirabilite — in Zhang Zhongjing’s Da Cheng Qi Tang (Major Order the Qi Decoction) rhubarb and mirabilite appear together, two purgatives working to scour the heat out of the intestines.

💬 Note from Doctor Luo: Now, about this prescription — you should know that this patient’s body was strong and sturdy, able to withstand such purging. If you meet a frail scholar whose mind has also broken down, whose psyche has split, and you give him this, it may not be appropriate. It is only when the body is robust and the heat signs are clear that you take the route of scouring out phlegm-heat.

How was the medicine taken? Once every three days — because the purging is so fierce it cannot be taken daily; ordinary people could not stand it. He took it three times altogether. After each dose the bowels moved two or three times, with a sticky, phlegm-like mucus coming down with the stool. After the purging, his spirit seemed somewhat better than before. On the next pulse reading there was still a hint of slippery-full quality, but the body showed no weakness — the purging had not drained him.

Changing the formula: more rhubarb, and kansui brought in to pull out the stubborn phlegm

Doctor Zhang thought: what is going on here? The strength was not enough — I need to adjust this formula. How? Sheng zhe shi, 6 g, ground fine — reduced, because there was no longer any need for such heavy sinking; chuan da huang, 30 g — increased.

💬 Note from Doctor Luo: In general, here is how we use rhubarb: it depends on how much the person actually purges. Start with a small amount; if he does not purge, increase, increase again — some people really need a very large dose before anything moves, while others purge from a tiny amount. So normally you judge by the degree of purging how to adjust the rhubarb afterward. Sometimes the rhubarb is set aside separately and the patient adjusts it himself. In this case the earlier purging had not been dramatic — two or three bowel movements per dose is not a big purge — so he raised the dose.

Mirabilite was used at 12 g, and he added gan sui (kansui) powder, 4.5 g. Kansui is mildly toxic. What does it do? Mainly drains water and reduces swelling — when a person is severely swollen, kansui breaks up the water accumulation. There were particular rules for decocting this formula: first simmer the hematite a good while, for more than ten boils; then add the rhubarb and boil two or three more times; strain out one large cup of the liquid, and dissolve the mirabilite into it — it melts like alum the moment it goes in; and at the time of drinking, stir the kansui powder in.

💬 Note from Doctor Luo: Notice how precise the method of taking is — this is the standard way to use these medicines. One more thing you must remember: kansui must never be taken on consecutive days — you must skip several days between doses, otherwise the person will vomit and show toxic reactions.

He prepared and took the medicine exactly as directed: after the first dose, the bowels moved five or six times, bringing down a good deal of phlegm-mucus; two days later he took another dose, and again the bowels moved five or six times, and this time among the stool were many phlegm lumps, extremely sticky and tough — you could not even pry them apart, which shows how solid and viscous they were. Doctor Zhang said: this is what is meant by stubborn phlegm (wan tan). After these doses, the young man’s spirit became remarkably clear, and his pulse no longer showed the slippery-full quality — which shows that the phlegm in his body had been largely expelled.

Not every case of schizophrenia can be purged like this

💬 Note from Doctor Luo: In fact, when Chinese medicine treated this kind of schizophrenia-like illness, mania with loss of reason, the ancients very often treated it through phlegm — approaching it as stubborn phlegm, saying that such patients surely harbor stubborn phlegm inside. This stubborn phlegm blocks and clouds the mind’s orifices — that is tan mi xin qiao (phlegm clouding the heart orifices) — and that is why the consciousness darkens and problems arise. Doctor Zhang’s “the heart–brain pathway is blocked” says the same thing — both approach it from stubborn phlegm and phlegm-heat; this is one major school in the Chinese treatment of mania. But be careful: not every case of schizophrenia is like this. You must look at what he is “selling” — if the pulse rolls along like a bead, slippery with force, beating powerfully; if the face is red and swollen-looking; if the body is sturdy and the person always feels fire churning inside; and if the tongue coating is thick and greasy, yellow on top — then phlegm-heat is clear. You can only purge in this way when tongue, pulse and symptoms all confirm phlegm-heat. Otherwise, if the person shows a thoroughly deficient picture and you purge him anyway, that is the classic error of making the deficient even more deficient (xu xu shi shi) — and the disease will never get better.

So Doctor Zhang first sized this man up: you have phlegm-heat, and I will use a few purging doses to transform and dissolve it. Notice how measured he was — one dose every three days, and as soon as he saw the phlegm was mostly expelled, he immediately switched to gentle regulation.

The recovery formula: sheng huai shan yao (Chinese yam), 30 g, in the lead — this is the real key to emotional illness

The next prescription began with sheng huai shan yao (Chinese yam), 30 g.

💬 Note from Doctor Luo: Friends, this formula is very telling. Why use sheng huai shan yao? And why exactly 30 g? At this point remember: strengthening the spleen is absolutely critical — build the spleen and support the upright qi. Why? Because in this kind of illness the heart and liver have fire, and that is why the person rages. Where does heart fire come from? When liver fire rises, heart fire naturally flares — so liver fire is the key. And who controls the liver? When the spleen-earth is sufficient, when the spleen-earth is strong, the liver wood cannot shake. We have said it again and again: when the earth is weak, the wood shakes (tu xu ze mu yao) — if your spleen-earth is insufficient, the wood that grows in that earth, when the earth is not enough, begins to sway, begins to move wildly, and wind begins to stir. So strengthening the spleen-earth is a very important way to control liver wind and internal movement. When Doctor Zhang regulated emotional illness, he would very often lead with sheng huai shan yao at 30 g — I give this approach both thumbs up! Why? Because it is clinical experience. If you lack this experience, you look at his herbs and cannot understand: why the Chinese yam? But truly — after you have seen many patients, hit many walls, tried every method — you finally discover that regulating the emotions absolutely requires building up the spleen-earth. So that’s how it is! Then you look at this formula again and you understand: this man is a master, and he has already walked this road.

Next came sheng hang shao (white peony), 18 g — what for? Softening the liver. On one side, strengthen the spleen; on the other, soften the liver.

💬 Note from Doctor Luo: Tell me, is that clever or not? With these two herbs alone, he has basically pointed out the whole strategy for treating emotional disorders. Nowadays I treat many children’s emotional problems — and there are far too many of them; children’s psychological disorders are as numerous as the hairs on an ox. When I watch how other people treat children’s emotional illness, the basic approach is almost always soothing the liver, calming the liver, settling the liver and extinguishing wind, nourishing yin and subduing yang and so on — and how well does it work? Honestly, most of the time, so-so. In the end I discovered that using these whole-grain, food-grade herbs — sheng huai shan yao, lian zi rou (lotus seeds), qian shi (fox nuts), yi mi (job’s tears) and so on — to build the spleen and stomach up fully, with just a little liver-soothing, liver-calming medicine on top, changes a child’s body and mental state very quickly. My usual pattern is: huai shan yao, lotus seeds, fox nuts, job’s tears, bai zhu (atractylodes) and so on to strengthen the spleen, paired with sheng mai ya (sprouted barley), white peony, mu li (oyster shell) and the like to soften and settle the liver — a little liver-regulating medicine on the side — about seventy to eighty percent for strengthening the spleen, twenty to thirty percent for regulating the liver, and you will find results appear fast. So when Doctor Zhang paired these two herbs, you can see how clear his thinking was.

Then he added qing ban xia (pinellia) — to resolve phlegm; shi chang pu (acorus) — a very famous herb, it opens the orifices and dispels phlegm, resolves phlegm, awaken the mind and benefits the intellect, and is especially good for mental problems caused by heavy damp-phlegm; paired with yuan zhi (polygala), 6 g — it connects heart and kidney, and also opens the orifices and wakes the mind; plus zhu li (bamboo sap) — combined with the pinellia it clears phlegm-heat especially well. What is zhu li? It is the liquid that drips out when bamboo is held over a fire — excellent for resolving phlegm-heat. And finally mirror-face cinnabar, about 1 g, ground fine — what is mirror-face cinnabar? It is zhu sha (cinnabar) of very fine quality, lustrous like a mirror, slightly translucent. Cinnabar is a heavy settler of the heart-spirit; when Chinese physicians met mania, they very often used cinnabar. After the decoction is ready, the cinnabar powder is taken mixed into the bamboo sap — a very fine, very small amount of powder.

💬 Note from Doctor Luo: After a few doses of this medicine, the disease was completely cured — the mania, the schizophrenia, was gone.

Doctor Zhang’s brilliance: clear the road first, then strengthen the spleen and soften the liver

At this point, Doctor Luo Dalun spoke a few words straight from the heart.

💬 Note from Doctor Luo: I hesitated about whether to tell you this case. Because schizophrenia must be treated by a professional physician — this is not something you can regulate yourself; such patients can be violent, and you cannot manage them. But then I thought it over, and decided to tell it anyway. Why? Because emotional disorders are extremely common now. Some have not reached the level of schizophrenia, but very many people do have problems on the emotional front. Being able to look at a case like this, and see how Chinese medicine thinks about disease, is still of value — there are huge numbers of people in our society living in a state of psychological imbalance, and many people have some mental problems.

The example in today’s story is a person with a sturdy body and phlegm-heat inside. How did Doctor Zhang, a famous physician, treat him? Following the normal Chinese medical line of thinking: transform the phlegm-heat, clear it, drain it out; press the qi downward so the fire cannot crash upward — in this way, first dissolve the stubborn phlegm inside, clear away the obstacles in the circulation of qi and blood, and open the road for him. Then, with a few herbs, what does he do? Strengthen the spleen, soften the liver, add a little phlegm-resolving medicine, connect heart and kidney, dispel phlegm and open the orifices, and add a tiny bit of cinnabar to settle the heart-spirit heavily. Along this path, in just a few doses, he brought the man’s schizophrenia under control.

💬 Note from Doctor Luo: In this case Doctor Zhang did not use many doses at all — a handful in total. A disease we modern people consider extremely hard to treat, he cured in just a few doses. What does that tell us? It tells us his formula hit the mark, and this way of thinking is worth learning.

Compiled from Doctor Luo Dalun’s lectures on the case records of Doctor Zhang Xichun. Case source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments between 1918 and 1934.

What to take away

1. Mania and schizophrenia were classically treated through phlegm. When stubborn phlegm blocks the pathway between heart and mind, the spirit loses its order — clear the phlegm-heat, press the qi down, and the road opens again. But this “drain it hard” route is only for the strong-bodied patient with genuine phlegm-heat signs — slippery, forceful pulse, red swollen face, thick yellow greasy tongue coating. For a deficient person the same attack would only make things worse.

2. Strengthen the spleen to steady the emotions. After clearing the road, the recovery formula leads with sheng huai shan yao (Chinese yam) at 30 g. “When the earth is weak, the wood shakes” — build up the spleen-earth and the liver wood cannot run wild. For emotional illness in children, Doctor Luo’s experience: about seventy to eighty percent spleen-strengthening food-grade herbs (yam, lotus seeds, fox nuts, job’s tears), twenty to thirty percent liver-soothing herbs (sprouted barley, white peony, oyster shell) — the results come quickly.

3. Family environment matters. This young man broke because he was controlled at every turn — his studies failed, his business was forbidden, his fate was not his own. Rigid, coercive upbringing breaks children; teaching according to the child’s nature is the way to raise a sound mind.

4. Don’t try this at home. Violent, manic patients need a professional physician. The value of reading this case is to understand how Chinese medicine thinks — not to self-medicate.