A Top Student Cracking Under School Pressure? Doctor Zhang Xichun Treats Mania (Deficiency Pattern) by Settling Reversed Qi, Calming the Spirit and Nourishing the Essence

What people search for: school pressure / a child going crazy / nervous breakdown / talking nonsense / rambling speech / feeling oppressed in the chest / qi rushing upward / not wanting to eat Medical terms: mania (deficiency pattern) · psychosis · reversed qi rushing upward · liver fire attacking the stomach · kidney qi not secure

Opening: a good student who kept failing his exams

Today we continue with Doctor Zhang Xichun’s case records. Once again this is about dian kuang (mania) with loss of reason — a mental illness. But when Doctor Luo Dalun read who this patient was, he could only sigh again and again: the patient was a student, just twenty years old.

💬 Note from Doctor Luo: Dear friends, I have seen far too many cases like this! Countless children develop mental problems because of schoolwork, because their parents demand too much. Some of these children are not bad students at all — on the contrary, they usually do excellently, always near the top of the class. Then one day, by chance, they slip up on an exam — and from that point everything falls apart. I have met children in the severe stages: completely deranged, manic, smashing things at home, unable to attend school at all, the whole family in agony. And these are not one or two cases — there are so many of them! That is why I take family environment and family education so seriously: this kind of suffering is truly hard to relieve.

Who was the patient? A graduate who always underperformed in exams

The student’s name was Huang Xiangshan, a graduate of Beicang Middle School in Tianjin, twenty years old, who developed a mental derangement. How did it come about?

At school he had studied well — originally one of the best (ben shu qiao chu): a top student, ranking at the front. But at every examination he could not reach the top of the class. This young man dreaded exams: in daily study he performed excellently, but the moment an exam came he froze. So his heart filled with fury — both depressed and angry. After a long time of this, his mind broke down.

💬 Note from Doctor Luo: Look at this. Learning should be a process of gaining knowledge, preparing for the future. But many parents carry a huge utilitarian agenda: my child must be number one! He must grow up to be the biggest official, earn the most money, live in the biggest house! Parents make “what rank did you get” the whole purpose of learning. The moment their child tops the class, they are proud and boast to everyone they meet. That is your vanity — it has nothing to do with the child’s joy in learning.

How sick was he? The moment qi surged up, his words turned to chaos

What were the young man’s symptoms? His chest felt oppressed, stuffy and hot — his heart felt tight and hot; he had no appetite — he did not want to eat. Sometimes he felt qi rushing upward from the lower body, and the stomach qi followed it up. When the qi surged up, his spirit went dark and his speech became confused — he began to talk wildly, and when you spoke to him he could not answer coherently.

💬 Note from Doctor Luo: Actually this patient’s symptoms were still comparatively mild — he could still tell you, “I feel oppressed and hot in my chest,” “I feel qi rushing up from my lower body” — he could still communicate with you. I have seen many children who reach the point where they cannot communicate with their parents at all. You try to ask about symptoms and you cannot get an answer — they are simply manic, they will not reply. That is truly miserable.

Fortunately, there was a pattern: when the qi surged up he felt mentally dazed and could not speak well; after a while the qi subsided, he felt somewhat calmer, or coughed up a few mouthfuls of phlegm, and his spirit recovered. These were exactly the early-stage symptoms. On taking the pulse: the left pulse was wiry and hard, the right pulse wiry and long, and both chi positions (the deep, kidney positions at the wrist) were not solid when pressed heavily — both kidney pulses were very weak; the pulse beat about five times per breath, slightly fast.

What did Doctor Zhang think? Qi had reversed upward and struck the brain

Doctor Zhang Xichun said this illness involved the liver: liver fire had stirred repeatedly — liver fire kept rising. Why? Because he was constantly angry: “I usually do so well — how can I always underperform in exams?” So his liver fire was blazing! The liver fire rose again and again, dragging the chong (thoroughfare) qi and stomach qi up together with it — the qi moved upward. Meanwhile there was phlegm in the body, and when the chong qi surged up, it carried the phlegm up with it, blocking the throat; the qi pushed still higher and struck the brain — and that is why his nerves went into disorder.

💬 Note from Doctor Luo: So what was the cause? Qi reversing upward — moving abnormally upward — and striking the brain’s nerves. That is Doctor Zhang’s view; the spirit and the speech both went out of order. You must remember the pulse positions: on the left wrist, cun, guan and chi correspond to the heart, liver and kidney — the middle guan position is the liver; on the right wrist, cun, guan and chi correspond to the lung, spleen and ming men (the gate of life) — the guan position represents the spleen and stomach. When a person’s liver qi is bound up and liver fire is strong, the liver wood runs sideways and attacks the spleen-earth, and the right guan position shows it. In this patient the right pulse was wiry and long — wiry is the liver pulse — so the spleen and stomach were affected and the qi was rushing upward. And both chi positions, empty when pressed deeply, meant kidney qi was insufficient — the whole body’s qi was rushing upward while the lower origin showed signs of collapse; this is kidney qi not secure.

How to treat it? Doctor Zhang’s approach: use the descending strategy — lower the stomach qi and settle the chong qi, drawing the qi downward; at the same time use cooling, moistening, yin-nourishing herbs to nourish the liver blood and clear liver heat. That should work. So he wrote a prescription, and the first herb in it was: sheng zhe shi (hematite), ground to a fine powder, 30 g.

First prescription: hematite in the lead, magnetite and dragon bone pressing down together

Sheng zhe shi — we have discussed this before. Doctor Zhang was especially skilled with mineral medicines — sheng shi gao (gypsum) was one of his favorites, and sheng zhe shi was another. Sadly, people today do not use sheng zhe shi much, nowhere near as widely as Doctor Zhang did. In fact, when you meet qi reversing upward, rushing up, you can use sheng zhe shi to settle rebellious qi and press the chong downward — so Doctor Zhang used a fairly large dose, 30 g.

Then he added ling ci shi (magnetite), ground to a fine powder, 15 g. Chinese medicine is fascinating — do you know what ci shi is? It is magnetite — a lodestone, the kind of iron ore that attracts metal. Ling ci shi means the kind of magnet with especially strong attraction. People find it strange that Chinese medicine prescribes a magnet. Does it really do anything?

💬 Note from Doctor Luo: Chinese medicine holds that ling ci shi enters the liver, heart and kidney channels, and its main action is to settle the liver and subdue yang. Because it attracts and draws inward, it can settle the liver and subdue yang, reining in floating, deficient yang — when yang qi floats upward, if you use magnetite on the foundation of warming the kidney and tonifying it, it can draw the yang back in. It also calms the spirit and settles fright, since it is a mineral with a heavy, sinking nature. In addition it treats diseases of the orifices — the ears, the eyes — and in sores and ulcers it can pull out the root of a boil, which is why magnetite powder can also be applied externally.

You might think: isn’t this a bit far-fetched? Can a magnet really restrain the yang qi and liver fire inside the body? It is not mere intuition. The main component of magnetite is ferric oxide (Fe₃O₄). Indeed, many ancient formulas used ci shi. Modern researchers have studied it too: in animal experiments, water decocted from magnetite was shown to have a genuine anti-convulsant effect — induce convulsions in rats with medication, then inject or feed them the magnetite solution, and it genuinely counteracted the seizures. Magnetite water also has some regulating effect on the body’s white and red blood cells and so on. The mechanism is still being studied and is not yet fully understood — but at the very least, this shows that magnetite really does adjust the body.

How did the ancients use magnetite? Roughly like this: first, grind it to powder and make it into pills with other herbs — being a mineral, very little is absorbed, most passes out; it travels through the digestive tract and produces its effect there; second, add ci shi to a decoction and drink it; third, soak ci shi in water and use that water to decoct medicine or drink it; and fourth, steep it in wine. The ancients used magnetite in many ways.

The formula also contained sheng huai shan yao (Chinese yam), 24 g — dried yam slices, the lu tu (hard-loam soil) huai shan yao from Wen County, Jiaozuo, Henan Province. Why this herb?

💬 Note from Doctor Luo: As I have said before, when Doctor Zhang treated spirit and emotional disorders, because the problem originated in the liver channel, he always considered the spleen and stomach — he diagnosed this illness as stomach qi rushing upward, so the spleen and stomach had to be secured first. He used sheng huai shan yao to build up the spleen and stomach. This is an approach I especially admire: when regulating emotional illness, you must strengthen the spleen-earth!

Paired with it was sheng long gu (dragon bone), crushed, 24 g. What is long gu? It is the bones of ancient animals that sank into the earth and slowly turned to fossils — that fossil is dragon bone. Long gu has an astringent, contracting quality — touch it with your tongue and it feels slightly sticky, because it is astringent, instantly drawing in the saliva; it is extremely heavy, much heavier than ordinary bone.

💬 Note from Doctor Luo: What does long gu do? It calms the spirit and settles fright; and being astringent, it stops sweating and secures the essence. For emotional illnesses — restless spirit, palpitations and fright, mania — we use long gu. On the market today there are sheng long gu (raw dragon bone) and duan long gu (calcined dragon bone). Calcined dragon bone is more strongly astringent, but Doctor Zhang believed that calcination lowers its medicinal quality, so he especially preferred sheng long gu (raw dragon bone).

Dragon bone together with hematite and magnetite — three heavy, settling minerals, which normally must be decocted first. Then bai shao (white peony), 18 g — what for? Softening the liver. When Doctor Zhang treated emotional disorders he especially liked the pairing of huai shan yao with bai shao: huai shan yao strengthens the spleen, bai shao softens the liver — when liver and spleen are in harmony, the illness resolves.

💬 Note from Doctor Luo: My own approach today is much the same: I generally use yam, bai zhu (atractylodes), lian zi rou (lotus seeds) and so on to strengthen the spleen, paired with bai shao, sheng mai ya (sprouted barley), long gu, mu li (oyster shell) and the like to regulate the liver. You can see this whole approach laid out in Doctor Zhang’s formula.

Then xuan shen (figwort) — to nourish yin, because this young man always felt hot, so some yin-nourishing medicine was needed. Bai zi ren (arborvitae seed), 15 g: this herb has several uses — first, nourishing the heart and calming the spirit, suitable for people with restless heart-spirit and deficient heart yin; second, astringing and softening the liver, moistening liver yin — so bai zi ren harmonizes both heart and liver in one herb, and here it fits perfectly. Then yun ling pian (poria), 6 g — this is fu ling: it drains dampness, and fu ling also has a spirit-calming effect; if the poria grows around a pine root it is called fu shen, which is especially good for nourishing the heart and calming the spirit. Paired with qing ban xia (pinellia), 9 g: ban xia dries dampness and resolves phlegm, and its nature moves downward — it settles rebellious qi, stops vomiting and sends the stomach qi down.

💬 Note from Doctor Luo: Speaking of fu ling with ban xia — the Qing dynasty physician Huang Yuanyu’s basic method always contained fu ling, ban xia and gan cao (licorice): fu ling drains dampness and lets the spleen qi rise; ban xia lets the stomach qi descend — one rising, one falling, and the body’s qi mechanism begins to turn. Doctor Zhang placed fu ling and ban xia together here with exactly the same intent.

Then shi chang pu (acorus) and sheng yuan zhi (polygala) — what for? Connecting heart and kidney, calming the spirit and settling the mind. This pair is one I use constantly: whenever regulating emotional problems — all kinds of insomnia, all kinds of liver qi constraint — the formula will include herbs like shi chang pu and yuan zhi. Finally mirror-face cinnabar — that is the fine zhu sha (cinnabar), ground fine, about 1 g — a very, very small amount. After all the other herbs are decocted, the cinnabar powder is taken mixed into the strained liquid.

💬 Note from Doctor Luo: Look at this formula: hematite, magnetite, dragon bone — heavy settlers of the heart-spirit that drive the qi downward; huai shan yao strengthening the spleen, bai shao softening the liver; bai zi ren astringing the liver and nourishing the heart, xuan shen nourishing yin; fu ling and ban xia, one rising and one falling; shi chang pu and yuan zhi connecting heart and kidney, calming the spirit and settling the mind — the logic is exceptionally clear.

Four doses brought clear improvement — but the chi pulses were still empty

After four doses of this formula: the oppression, stuffiness and heat all largely cleared — the effect was excellent; he could eat again, his appetite returned. Occasionally qi still surged up a little, but nothing like before — in the past, when the qi surged, his whole mind seemed to break and he talked wildly; now it no longer did. He was much better. The left and right pulses were much more moderate than before, but the chi positions were still not solid — the two kidney pulses were still somewhat deficient.

💬 Note from Doctor Luo: Doctor Zhang thought: this is kidney deficiency — I must still tonify the kidney, nourish the lower origin. So he changed the formula: sheng zhe shi still ground fine, 30 g, to keep pressing the qi downward; shu huai di huang (prepared rehmannia) — a herb Doctor Zhang excelled with, produced in Wen County, Jiaozuo, Henan, called huai di huang — 24 g; sheng huai shan yao (Chinese yam), 24 g.

Changing the formula: four tonics to replenish the essence of the five viscera

Prepared rehmannia tonifies the kidney essence; huai shan yao tonifies the spleen; paired with da gan gou qi (wolfberry), 18 g — wolfberry tonifies the essence of the liver and kidney; jing yu rou — shan yu rou (cornus), which tonifies the essence of the heart and liver. These four herbs — shu di huang, huai shan yao, gou qi zi and shan yu rou — are the tonics Doctor Zhang Xichun used with special skill: whenever he spoke of tonifying the five viscera, he used these four. Everyone should remember this — it is one of his signature insights.

💬 Note from Doctor Luo: Then he added sheng bai shao (white peony), 12 g — while tonifying the heart, liver and kidney, he used a single herb for the liver channel to astringe it a little more, tonifying and astringing at the same time; xuan shen, 12 g, to nourish yin; yun ling pian, 6 g, to drain dampness. How did this formula work? After six doses, all of the illness was cured — the young man recovered completely.

One deficient, one excess: two completely different treatments

Some friends will ask: yesterday’s case was also mania — how did that one purge so violently, while this one uses nothing but tonics?

💬 Note from Doctor Luo: Yesterday’s patient had the excess pattern — a sturdy, robust body; at first sight he was manic, so Doctor Zhang purged his phlegm-heat, drained it hard, transformed phlegm, then added a little tonifying. Today’s patient is a twenty-year-old student, pale and clean-cut, studying all day, with a somewhat weaker constitution — Doctor Zhang did not use anything so fierce. Yesterday was excess; today is mainly deficiency: tonification and astringency as the main strategy. One deficient, one excess — the treatments are completely different.

And in modern society, the excess pattern does exist — strapping boys who eat well, yes, they exist; but the majority are deficient. Of all the children I have seen with emotional disorders, more are of the deficient type. So this case — how Doctor Zhang regulated the liver, how he used heavy settling and astringency, and finally how he nourished and fortified to complete the cure — is worth our study and our thought.

When the essence is full, the spirit is calm

Some friends will ask again: how is it that once the essence of the five viscera was replenished, six doses worked so dramatically and everything was cured? How does that work?

💬 Note from Doctor Luo: Friends, this truly deserves our reflection. Modern people suffer essence deficiency in huge numbers — kidney essence deficiency, and deficiency of the essence of the other four viscera as well. When the essence of the five viscera is deficient, can the spirit possibly remain undisturbed? So when the essence is replenished, the spirit receives its nourishment and returns to normal — this is the method of tonifying deficiency to calm the spirit. It is like people with palpitations and agitation who live in constant anxiety — bang! you slap the table and their heart jumps. What is that? The heart-spirit is malnourished. How to regulate it? Nourish the heart — often with a little ren shen (ginseng) and similar herbs to support the upright qi, and gradually the heart-spirit settles. The human body is endlessly wondrous, and the relationship between essence and spirit is deeply interesting.

💬 Note from Doctor Luo: And finally, back to education: parents must raise their own level of awareness. Learning is for gaining knowledge and enjoying the pleasure of growth — you cannot make “what rank did I get” the goal. The Laozi (Dao De Jing) repeats this over and over: the more you fixate on the result, the worse the task itself goes; do the task well and enjoy the process, and the result often exceeds your expectations. Many parents do not understand this. They pile the pressure on their children, and the children crack under it — it happened in Doctor Zhang Xichun’s day, and it happens far more often today. To see a child destroyed, unable to attend school normally, unable even to communicate with his family — that pain is beyond words. So please, never push your child to be number one!

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. Qi reversing upward can strike the brain and derange the mind. In this young man, repeated exam failures bred anger, liver fire rose again and again, dragging the chong qi, stomach qi and phlegm upward together until they struck the head — and speech and spirit went out of order. The treatment strategy: lower the stomach qi, settle the chong qi, astringe the qi downward with heavy minerals (hematite, magnetite, dragon bone), and at the same time nourish liver blood and clear liver heat with cooling, moistening herbs.

2. Deficiency and excess demand opposite treatments. Yesterday’s mania patient was sturdy and phlegm-heat-full — he was purged hard. This patient was a frail, pale student — the main pattern was deficiency, so the treatment was tonify and astringe. In today’s world, children with emotional problems are far more often of the deficient type: build the foundation first, then calm.

3. Regulate the emotions by strengthening the spleen. Doctor Zhang paired huai shan yao (Chinese yam) with bai shao (white peony) — strengthen the spleen-earth, soften the liver, and the emotional illness resolves. His signature tonifying quartet for the five viscera — shu di huang (prepared rehmannia), huai shan yao, gou qi zi (wolfberry) and shan yu rou (cornus) — replenished the essence, and with the essence full the spirit received its nourishment and returned to calm.

4. Don’t use rank to pressure your child. This boy was an excellent student who always froze at exams — the fear and fury broke his mind. Learning is for gaining knowledge and enjoying growth; making “number one” the goal only creates suffering. In the words of the Laozi: do the task well and enjoy the process — the result takes care of itself.