A Nine-Year-Old Girl Burned for Twenty Days, Fell into a Coma, and Lost Her Voice — How Doctor Zhang Xichun Found the Hidden Cause

Opening: a nine-year-old girl, twenty days of fever, and even the doctors refused to go on

A high fever that will not break is frightening enough. But when it burns on to the point of coma, whole-body trembling, and eyes rolling upward, it can drive an entire family out of their minds. The little patient in today’s case was in exactly that state — she had been burning for more than twenty days, treated by both Chinese and Western doctors, and instead of improving she was getting worse by the day. Finally, even the doctors who had been called in firmly refused to continue: the case was too dangerous, they said — keep treating it and it would end up being blamed on them. It was at that moment that Doctor Zhang Xichun was brought to the bedside.

💬 Note from Doctor Luo: Republican-era case records are wonderfully “concrete.” Look at this one — it names the patient outright: the young daughter of Kang Guoping, a section chief of the Tianjin police bureau; her age, her father’s position, whose child she was — all written out in full. That is the hallmark of medical cases from that era: so real you cannot doubt them.

How did the child fall ill? Scolded by her mother, she hid in a small room and caught the wind

The patient was the nine-year-old daughter of Section Chief Kang, nicknamed Mengqiu — “first month of autumn,” which was exactly the season when she fell ill. It was the turn of summer into autumn; the weather was still hot, and at midday the heat was brutal. The child had done something wrong and been scolded by her mother. Frightened of being scolded again, she slipped away and hid in a room downstairs.

All four windows of that room stood wide open. In Doctor Zhang Xichun’s reconstruction, this almost certainly happened around midday — had it been evening, the family would have found her long before. At noon the heat was fierce, the child was already low on fluids, and as she sweated in the heat, the wind blew on her — and the external pathogen slipped in through the opened gate.

💬 Note from Doctor Luo: This is a warm disease (wen bing). When do warm diseases strike? In spring, autumn, and summer — and also in winter during those odd “cold weather that feels hot” spells. What do all these have in common? The weather is hot, people sweat, and the body’s fluids (jin ye) drain away. Our defense troops travel through the channels and collaterals by riding on those fluids; when the riverbed runs dry, the boats stop moving, the defense troops cannot reach their posts, and the external pathogen sneaks in. So the root of a warm disease is half weather, half insufficient body fluids.

Warm disease and cold damage are different from the very first step

When the girl fell ill with a warm disease, the first doctors’ prescriptions did not fit the case, the heat evil sank inward, and the child flared up at once. How high did the fever go? To shen hun bu yu — complete clouding of the mind, without a single word.

Here Doctor Luo Dalun spelled out the difference between warm disease and cold damage (shang han):

• Cold damage moves in stages: first the cold strikes and the person feels chilled; then the body starts to resist, entering the “external cold, internal heat” phase — only then does the high fever come, and only then does the throat swell and ache.
• Warm disease is different: it starts with high fever immediately. There is no shivering stage. From the very beginning the throat is swollen and painful and the fever is burning.

But once both reach the stage of high fever, their presentations converge — heat throughout the exterior and interior, the body resisting with everything it has. That is why Zhang Zhongjing’s formulas such as the White Tiger Decoction (Baihu Tang) were used just as readily by the warm-disease school: at a certain stage the two schools reach for the same prescriptions.

💬 Note from Doctor Luo: Everyone, take note: when a warm disease has just started — scanty urine, a suddenly sore throat, a bit of fever — there is a lovely little home remedy: the San Dou Wu Mei Bai Tang Tang (Three Beans, Black Plum and Sugar Decoction): black beans, mung beans, and soybeans, a few black plums (wu mei), and two spoonfuls of white sugar, boiled into a soup. It tastes wonderful, and it usually resolves the problem on the spot — it tops up the fluids, restores the upright qi, and the body clears the pathogen itself. But this child was not handled well at the start: Chinese and Western doctors piled on for twenty-odd days, and the illness was treated into a critical condition.

Doctor Zhang Xichun looked and saw: eyes rolling up, body trembling, tongue shrunk back

Every finding of Doctor Zhang Xichun’s examination was alarming:

• Both eyes rolled upward — the pupils almost disappeared, leaving only two crescents of white;
• The spirit was already clouded and collapsed; the body seemed senseless yet trembled restlessly, with frequent belching;
• The skin was fiercely hot — the fever was severe;
• Prying the teeth apart to look at the tongue — the tongue had shrunk back inside, dry, with a thin, slightly yellow coating;
• When water or rice gruel was trickled in, she still knew to swallow — a remnant of consciousness remained;
• The breath was uneven, with occasional panting;
• The pulse ran to six beats per breath (extremely fast), and the left pulse was thin and floating — thin means qi and blood are insufficient and the yin is depleted, floating means external contraction, and wiry means liver wind stirring internally.

💬 Note from Doctor Luo: Doctor Zhang Xichun set great store by tongue diagnosis. Remember: when a person is ill to a certain depth, there is a critical warning sign — the tongue shrinks back. Look at the coating then: thin and slightly yellow means there is heat inside the body.

How did Doctor Zhang Xichun think it through? The pivotal insight of the whole case: heat, yin, and wind

Doctor Zhang Xichun’s judgment was this: the heat of the external contraction had gone on too long, scorching the true yin. This child was probably already of a fluid-deficient constitution, which made her more liable to warm disease in a hot environment; the heat evil then consumed the body’s yin fluids, and the damage deepened. The result was insufficiency of liver yin — when liver yin is deficient, the wood dries and generates wind, so liver wind stirs internally; and when the deficiency becomes extreme, the qi mechanism rushes upward and the person begins to collapse (zheng qi yu tuo — the upright qi about to scatter and be lost).

So the treatment had to move on three fronts at once: clear the heat (real heat must be cleared); nourish the true yin (replenish the fluids); and use sour, astringent herbs to restrain the liver — pull the stirring liver wind back down and stop it from moving; this was the most dangerous link of all.

💬 Note from Doctor Luo: At this point Doctor Zhang Xichun’s killer move comes out — raw gypsum (sheng shi gao). He had deep experience with raw gypsum, and in the prescription that follows every herb was added or subtracted for a reason — all of it his personal craft.

The prescription: a White Tiger Decoction reborn — 60 grams of gypsum for a nine-year-old

For the first formula, Doctor Zhang Xichun took the White Tiger Decoction from the Shang Han Lun (Treatise on Cold Damage) and “rebuilt” it:

• Raw gypsum, two liang (about 60 g), pounded into a fine powder — 60 grams of raw gypsum for a nine-year-old child! Many Chinese medicine practitioners today feel uneasy using even 30 grams. Doctor Zhang Xichun said it again and again: raw gypsum is an extremely stable, peaceful herb; when the pattern truly calls for it, use this amount and do not be afraid;
• Ye tai shen (wild codonopsis / dangshen), three qian (about 9 g) — Doctor Zhang Xichun’s rule: when children or the elderly use raw gypsum, they must be paired with ginseng or codonopsis to support the upright qi. He learned this from Zhang Zhongjing’s White Tiger Plus Ginseng Decoction (Baihu Jia Renshen Tang): when Zhongjing saw qi and yin both deficient, he added ginseng to the White Tiger formula. Doctor Zhang Xichun said that any debilitated person using gypsum should have a little ginseng added to assist. Doctor Luo Dalun has followed this lesson himself — whenever he uses raw gypsum for a child or an elderly person, he pairs it with codonopsis and Chinese yam, and has never had a problem;
• Sheng huai di huang (raw Rehmannia from Huaiqing), one liang (about 30 g) — the genuine huai di huang from Wen County, Jiaozuo, Henan. It nourishes yin and cools the blood even better than zhi mu (anemarrhena), so he used it to replace the zhi mu in the White Tiger formula;
• Jing yu rou (cornus fruit / shan zhu yu), one liang (about 30 g) — this is the sour, astringent herb that restrains the liver. Cornus fruit was one of Doctor Zhang Xichun’s signature weapons: when the liver is depleted to the extreme and the upright qi is about to scatter, the herb that can pull the dispersing qi back together is shan zhu yu. Whenever he met a patient at the point of collapse — trembling, qi about to be lost — he reached for cornus fruit;
• Sheng huai shan yao (Chinese yam), six qian (about 18 g) — the jing mi (rice) in the White Tiger Decoction is thick and can assist stomach qi, but its medicinal power is inferior to Huai yam, so the yam was used to replace the rice;
• Gan cao (licorice), two qian (about 6 g).

Together, this was White Tiger Decoction plus ginseng, with cornus fruit added. It was decocted and taken in three divided doses, and into each dose was stirred one raw egg yolk — another of Doctor Zhang Xichun’s habitual methods: the decoction still boiling hot, crack the yolk in, stir quickly, and drink it down — it greatly supplements the true yin. Zhang Zhongjing had used the same trick in his day.

💬 Note from Doctor Luo: Doctor Zhang Xichun wrote two extra lines about this formula on purpose. First: without the ginseng, this formula cannot drive out the pathogen — because it is only when the upright qi is strong enough that the pathogen can be pushed out. Second, my own practice after learning from him: when I use raw gypsum I also often pair it with Chinese yam, but I keep the rice in the formula as well. Raw gypsum with rice, raw gypsum with yam — I simply combine all of it. The effect is excellent; this has been verified in countless treatments.

Three doses later: the child was stable — but still could not speak

After three doses, the turn came: the eyes stopped rolling upward; the body settled and stopped trembling; the weeping and wailing ceased — the middle qi was beginning to fill, the breath became even, and the spirit was clearer than before. But she still could not speak, and the bowels had still not moved. The skin was still hot and the pulse still fast, though the rate had dropped and the pulse was no longer as floating and wiry as before; the right pulse on deep pressure was still forceful — the bowels were shut, and the right pulse corresponds to the spleen and stomach, which still held stagnation.

At the second visit, Doctor Zhang Xichun made fine adjustments: raw gypsum reduced to one and a half liang (about 45 g); ye tai shen unchanged at three qian; sheng di huang one liang; cornus fruit reduced to six qian; the Chinese yam removed and replaced with tian dong (asparagus root — it nourishes fluids and yin); licorice two qian. Still with the raw egg yolk stirred in. One dose a day for two days — the fever broke completely and the mind was clear, and it looked as if she would recover at any moment. But she still could not speak, and the bowels had not moved — though there now seemed to be a sensation of needing to go.

💬 Note from Doctor Luo: Everyone must remember this: when treating a warm disease, keep the bowels open. If the bowels are shut and the stool is dry and bound, it obstructs the movement of qi, generates more heat, and keeps burning the body’s fluids. Zhang Zhongjing called this yang ming fu shi (excess-heat repletion of the stomach-intestine system) and laid great stress on moving the bowels — ji xia cun yin: you must purge promptly in order to preserve the yin fluids and essence of the body.

The bowels opened — and Doctor Zhang Xichun had his revelation: this is sinking of the chest qi!

Doctor Zhang Xichun used an enema to open the child’s bowels. Once the bowels moved, he took the pulse again — all six positions were weak and strengthless! The forcefulness of the right pulse was gone.

And in that moment, Doctor Zhang Xichun understood everything: why couldn’t this child speak? Because of sinking of the chest qi (da qi xia xian)! Sinking of the chest qi changes the voice — the way one speaks, the tone of speech. Complete loss of voice like this is rare, but when the chest qi has truly sunk, the person has no strength at all, and the words simply will not come out.

💬 Note from Doctor Luo: Sinking of the chest qi is the theory Doctor Zhang Xichun lectured on for many episodes — and look how brilliant this diagnostic moment is: only after the bowels opened did the true pulse show itself. Before that, the forcefulness of the right pulse was the stagnation masking the deficiency. Take a child like this to a hospital today and you would hardly know which department to book; but the moment Doctor Zhang Xichun recognized sinking of the chest qi, the treatment plan was immediate.

The new formula: build up strength and lift — two doses and she could speak!

How to treat it? Add herbs that lift and supplement qi to a strongly tonifying prescription — give the qi an upward push:

• Sheng huai shan yao (Chinese yam), one liang — first secure the upright qi of the lung, spleen, and kidney; this was Doctor Zhang Xichun’s number-one method;
• Gou qi zi (goji berry), one liang — supplements the essence of the liver and kidney. The child’s liver yin was insufficient and liver wind was stirring, so the liver needed supplementing;
• Sha shen (glehnia root), one liang — nourishes yin and generates fluids;
• Tian dong (asparagus root) and mai dong (ophiopogon), six qian each — supplement the yin of the lung and kidney and generate fluids;
• Sheng huang qi (raw astragalus), three qian, plus ye tai shen (wild codonopsis), three qian — together with the Chinese yam, these three form the most important qi-supplementing combination;
• Sheng ma (cimicifuga) and jie geng (platycodon) — these two herbs have an upward-lifting action. Note: chai hu (bupleurum) was deliberately not used — bupleurum is slightly warm and disperses pathogens, which could aggravate the stirring liver wind; so Doctor Zhang Xichun set it aside in favor of sheng ma and jie geng.

A large dose was decocted, divided in two, and taken warm. After two doses, the child could actually speak! For aftercare, Doctor Zhang Xichun halved the sheng ma and added shan zhu yu (cornus fruit) and sheng mai ya (raw malt) at three qian each — the raw malt working with the platycodon to lift — and after several more doses the illness was completely cured.

💬 Note from Doctor Luo: The lessons in this story: first, when a warm disease and a cold damage both reach the stage of heat throughout the exterior and interior, their presentations match and the same formula — the White Tiger Decoction — is used; second, Doctor Zhang Xichun improved on the White Tiger formula, replacing zhi mu with sheng di huang and rice with Huai yam; third, cornus fruit restrains the upright qi when it is on the point of scattering; fourth, sinking of the chest qi causes changes in the voice — people whose upright qi is extremely weak speak with no breath behind their words, their voices change, grow hoarse, and in extreme cases are lost entirely. The treatment is to support the upright qi and lift it. Of these points, the loss-of-voice one is the most worth remembering — if you ever meet it, other people will be guessing in the dark, but having heard this case, you will know to think of sinking of the chest qi.

Bonus: the “concreteness” of Republican-era cases, and the legacy of Doctor Zhang Xichun

This case leaves us with two further thoughts:

One is the concreteness of the case records. Republican-era cases are written out in perfect detail: the young daughter of Kang Guoping, section chief of the Tianjin police bureau, nine years old — position, family, symptoms, nothing left vague. That is what lets later generations study every case with something solid to verify.

The other is the transmission of experience. Doctor Zhang Xichun’s method of using cornus fruit to restrain the upright qi on the point of scattering later inspired the celebrated modern physician Li Ke. In the formulas Li Ke created — most famously Poge Jiuxin Tang (Breakthrough-Dosage Heart-Rescue Decoction) — cornus fruit appears in large amounts, dozens of grams at a time, precisely to treat patients in the terminal stage when the upright qi is about to be lost. The results are excellent. Doctor Luo Dalun says: I learned from Doctor Zhang Xichun to use raw gypsum, Chinese yam, and cornus fruit, and the benefit has been inexhaustible; after I shared these methods with friends, countless readers found marked improvement from Huai yam — this truly is Doctor Zhang Xichun’s core method.

💬 Note from Doctor Luo: We are genuinely fortunate to have a master like Doctor Zhang Xichun, who treated so many patients and then wrote the cases down as demonstrations. If any of you can gain even a little from them, that is the greatest reward of learning. This case of “unbreakable fever, coma, and loss of voice” — now you have heard it, you have gained something: if you ever meet it, you know Doctor Zhang Xichun treated it, and you know how.

Case based on Doctor Luo Dalun’s (PhD, Beijing University of Chinese Medicine) public lectures on Doctor Zhang Xichun’s cases; the case itself is from Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments 1918–1934.