High Fever, Delirium, and Loss of Vision — What to Do? Doctor Zhang Xichun’s Yin-Nourishing Formula That Rescued a Dying Man

Patient search terms: fever with delirious speech / sudden loss of vision / unremitting high fever / unconsciousness / a patient near death — what to do

Medical terms for this condition: warm disease (wen bing) with yin deficiency · exhaustion of kidney yin · exterior contraction with high fever

Opening: two local famous doctors worked together for over ten days — and the patient only got closer to death

In a village in Hebei, at wheat-harvest time, a twenty-five-year-old farmer named Gao Chengxuan came down with a warm disease and took to his bed. His family invited two physicians — one was his uncle Gao Luxuan, the other his cousin-once-removed Mao Xiange. Both were celebrated old doctors in the area, each with more than twenty years of practice, and both were especially skilled at treating warm diseases. With two famous physicians working together, the result was astonishing: after more than ten days of treatment, there was no improvement at all — the patient only grew worse day by day, and it looked as though he would soon die.

💬 Note from Doctor Luo: Why have I been telling warm-disease cases one after another lately? Because external-contraction illnesses are something everyone must study hard. The pandemic has not fully passed — the more experience we gather in treating external-contraction diseases, the more knowledge we stockpile, the better we know how to protect ourselves and respond. Today’s case is one Doctor Zhang Xichun treated at the age of twenty-six, back in his hometown. Just look — at twenty-six his level of skill was already this high.

Who was the patient? A man hurrying home under the blazing sun at harvest time

Gao Chengxuan was one year younger than Doctor Zhang Xichun, a farmer. The origin of the illness, Zhang Xichun recorded precisely: in the first ten days of midsummer, just before the wheat harvest. He had gone out to handle business at a distance, and anxious to get back in time to harvest the wheat, he walked a very long way under the blazing sun, exhausting himself. He came home and fell ill with a warm disease.

💬 Note from Doctor Luo: When analyzing an external-contraction illness, you must always separate the internal and external causes. Walking a long distance under a scorching sun, he must have sweated enormously and damaged his fluids (jin ye) — that was injury from dry-heat pathogen. On top of that, hurrying and overexerting himself, his upright qi (zheng qi) became insufficient — that was the internal cause. Internal and external causes combined, and the illness took hold. When Zhang Xichun later wrote up the case he added a note: because the man had overworked, his upright qi was insufficient and could not push the pathogen out of the body (tuo bing wai chu) — which is exactly why the two famous doctors could not cure him no matter what they did.

How bad had it become? He couldn’t see, and his hands were searching the bedside

When Zhang Xichun arrived, the sight was alarming: his eyes were clear and whitish — he could no longer see at all (liang mu qing bai, jing wu suo jian); both hands searched at the edge of his clothes and his bed — endlessly stroking the seam of his clothing and the bedside, as if threading a needle in the air; he moved restlessly without stop; he raved deliriously, senselessly, completely unaware — talking nonsense, answering nothing when spoken to. His stools had earlier been slippery with diarrhea; now, though no longer pouring out, he still passed one or two loose stools a day.

💬 Note from Doctor Luo: What does “the eyes clear and whitish” mean? When a person is about to die, the black of the pupil fades, and the whole eye turns gray and lifeless — this is the sign of lost vitality (shi shen). Searching the clothes and bed, moving restlessly without stop — these are the critical symptoms the ancients summarized. Spend time around gravely ill patients and you will see it is exactly so: the hands keep stroking the edge of the clothing. This case was later collected by the Qing-dynasty famous physician He Lianchen into the Classified Case Records of Famous Physicians (《名医验案类编》). He Lianchen’s assessment: this truly was a fatal condition. What he never expected was that Zhang Xichun actually brought the man back to life.

What did Doctor Zhang Xichun think? The pivotal judgment: kidney yin was nearly exhausted — yet the pulse still floated

Zhang Xichun took the pulse: hidden and weak (fu er wu li); the right cun position (the lung pulse) floated especially strongly; both chi positions vanished the moment he pressed — the chi pulse represents the kidneys, and if it disappears under pressure, kidney qi is insufficient; the pulse was racing at about 120 beats a minute. Then the tongue: a thin yellow coating, dry in the center and slightly black — the heat inside the body was extremely heavy.

💬 Note from Doctor Luo: Zhang Xichun rarely described tongue appearances. That he described this one so clearly shows how deep an impression it made. A dry, slightly black tongue center tells you the heat had already become very serious.

The two older physicians asked him: how is this case — can he be saved? The twenty-six-year-old Zhang Xichun answered plainly: “The eyes clear and nearly sightless — that is kidney yin about to be exhausted (shen yin jiang jie). The two hands moving restlessly without stop — that is liver wind stirring internally (gan feng nei dong).” By this point the illness was dangerous to the extreme. But — the pulse still floated, which meant the pathogen was still at the exterior (the taiyang level); it had not penetrated deeper. Almost all of these problems came from insufficient upright qi.

The right cun pulse floating strongly corresponds to the Lungs, and it signaled that sweating was about to occur — once sweat broke, the pathogen could be resolved. So why wouldn’t the sweat come?

Why wouldn’t the sweat break? The sweat of the human body is like the rain between heaven and earth

Zhang Xichun offered a wonderful analogy: the sweat of the human body is exactly like the rain between heaven and earth — it takes the union of yin and yang for sweat to appear. Now both chi pulses were weak, and the kidney yin above all was insufficient. Yang qi wanted to rise, wanted to make sweat — but yin would not cooperate, so no sweat could break. It was like a drought praying for rain: cold air arrives, but the earth has no moisture, no water vapor rising — how can the rain fall?

💬 Note from Doctor Luo: So the mechanism of this illness becomes clear. Scorched by the sun and worn down by the long journey, his fluids were badly damaged — he was already yin-deficient. Then he caught a warm disease with high fever; the exterior was chilled and should have released through sweating, but with no fluid in the body, what was there to sweat with? The pathogen at the exterior simply could not be expelled. At this point one must greatly nourish the true yin (da zi zhen yin) — fill the yin back up, and when yang stirs, with fluid present, sweat will come naturally — sweat out, and the illness is cured (han chu ze bing yu). If instead, without nourishing yin, one forced the sweat out, the patient’s upright qi would surely collapse — certain death. So Zhang Xichun’s whole strategy was a single sentence: regulate yin and yang, and let the patient sweat on his own — no exterior-releasing herbs at all; nourish yin first.

The prescription: not a single pathogen-expelling herb — all yin-nourishing and essence-tonifying, in large doses

When the formula was written out, both famous physicians stared in astonishment:

• Prepared Huai rehmannia (shu huai di huang), 2 liang (60 g) — leads the formula; greatly tonifies the essence of Liver and Kidneys, above all the kidney essence
• Raw Huai Chinese yam (sheng huai shan yao), 1 liang (30 g) — greatly tonifies the Spleen and Stomach, nourishes earth to generate metal, making the lung qi stronger
• Figwort root (xuan shen), 1 liang (30 g) — nourishes yin and generates fluids, while clearing heat and resolving toxins
• Goji berry (da gou qi), 1 liang (30 g) — tonifies the essence of Liver and Kidneys
• Licorice (gan cao), 3 qian (9 g) — harmonizes all the herbs, with a detoxifying action of its own
• Genuine donkey-hide gelatin (zhen e jiao), 4 qian (12 g) — nourishes the blood and yin

Decoct into one large bowl, strain, melt the gelatin into the hot liquid, and drink it warm in several divided doses.

💬 Note from Doctor Luo: Look at this formula — there is not a single pathogen-expelling herb in it. Everything is yin-nourishing and essence-tonifying, and in generous amounts — this is concentrating all effort on nourishing the true yin. First, prepared rehmannia: the one from Wen County, Jiaozuo, Henan is called Huai di huang. What is “prepared” rehmannia? Fresh rehmannia must be steamed and sun-dried nine times to make it (today’s factories usually just steam it once; they no longer do the nine cycles). Prepared rehmannia greatly tonifies the essence of the Liver and Kidneys, especially the kidney essence — and kidney essence is the source of kidney yin, the root substance. Among all the herbs that tonify kidney essence, prepared rehmannia is the foremost. Raw Huai Chinese yam is also from Wen County, Jiaozuo, Henan — dried yam slices that tonify upright qi. Xuan shen (figwort root) has a special action: it can carry kidney yin upward — the kidney channel runs up to the throat, which is why for sore, swollen, or dry throats xuan shen is a standard herb: it can transport yin fluids upward.

The two famous doctors’ amazement: “If you save this boy, he must be renamed ‘Reborn’”

Gao Luxuan listened and sighed deeply: “I have practiced medicine for twenty years — I have met cases like this more times than I can count, and I have never saved a single one — eyes that can no longer see, hands searching the bed, whole body trembling, raving incoherently — not one did I bring back.” He said to Zhang Xichun: “You are a brilliant young man. Faced with this most perilous of conditions, this dying man, you yet declare with confidence that he can be saved, and take the whole burden on your own shoulders. If he truly lives, the boy ought to be renamed ‘Reborn’ (zai sheng) — given a new name, in memory of the new life you have won him! Please, write the prescription at once.”

💬 Note from Doctor Luo: Why did the formula take this shape? In his youth Zhang Xichun read mostly the works of Zhang Jingyue — the Jing Yue Quan Shu (《景岳全书》), whose author loved prepared rehmannia and used it in very large doses. Zhang Jingyue’s nickname was “Zhang the Rehmannia-man” (Zhang Shu Di). At the time there was a Taoist lineage — physicians such as Chen Shiduo and Zhang Jingyue, both cultivators of the Tao — with a tradition: use large doses of prepared rehmannia to tonify the kidney essence and upright qi first, then treat whatever illness remains. Sadly, this tradition was lost by later generations. What is interesting: in the entire standard textbook of Chinese medicinal formulas, the most frequently cited author is first, Zhang Zhongjing; second, Zhang Jingyue; third, Zhang Xichun — all of the Zhang family. The Zhangs of Chinese medicine have deep roots indeed.

Two doses, within a single day, pulled a dying man back

At ten in the morning, the first dose was ready. Zhang Xichun watched the patient drink it, slowly, and by two in the afternoon it was finished — the man had grown calmer than before; the pulse was retaken, and it had noticeably improved. So the same formula was prepared again, and he continued drinking it at intervals. Then that evening, at candle-lighting time (bing zhu shi fen), a miracle: sweat broke out over his entire body — he was drenched from head to foot — and the illness was gone (qi bing huo ran). He was cured!

💬 Note from Doctor Luo: Think about it — a critically ill patient that two local famous physicians could not cure in over ten days, and Zhang Xichun cured with two doses drunk within a single day. What does that tell you? At twenty-six, Zhang Xichun already grasped the theory profoundly and wielded it with complete mastery. Gao Luxuan and Mao Xiange both later became close friends of Zhang Xichun.

Why wouldn’t He Lianchen believe it? The fashion of “predicting certain death”

After He Lianchen collected this case into the Classified Case Records of Famous Physicians, he was rather doubtful: a case like the one Zhang Xichun described — truly an unsalvageable condition — cured by one or two doses? Could it be genuine? When Zhang Xichun heard of this, he said: you doubt it, so I will write it out again — I will write down every detail of the scene, every question and answer of the consultation. Moreover, the patient’s son grew up and studied medicine under Zhang Xichun; his name was Xianzhuang, and he later practiced in Tianjin with a considerable reputation, often recalling these events with his father, full of gratitude. With all that, what room was there for fabrication?

💬 Note from Doctor Luo: Why did He Lianchen doubt? There is a very interesting background here. The approach Zhang Xichun used was precisely the path of Zhang Jingyue: many people are weak, their yin essence insufficient, and this produces all sorts of “false-heat” conditions — heat above and cold below, the “dragon-thunder fire” rushing upward. Both doctors treated these by tonifying kidney essence, with excellent results. But in the Qing dynasty the warm-disease school rose to prominence: clear heat, resolve toxins, cool the blood, vent the pathogen. They held that prepared rehmannia is cloying and would seal the pathogen inside — absolutely not to be used — and they mocked Zhang Jingyue for “reckless tonification.” In truth, in certain areas the warm-disease school took a very great wrong turn. By the late Qing and Republican era, physicians like He Lianchen basically no longer believed such a patient could be saved. There was even a prevailing fashion among doctors of “predicting certain death” (liao ren bi si) — “I declare you will die in such-and-such days; my prediction is accurate, but I will not treat you.” This was the result of discarding much of tradition and absorbing the fashion of mutual disparagement of the Qing. In fact, every physician has his own area of strength.

Zhang Xichun’s great summary: the qi transformation of heaven and earth changes every few decades — don’t carve your boat to find a lost sword

Using this case, Zhang Xichun wrote a passage of extraordinary value in his book. He said: I have experienced that the qi transformation of heaven and earth seems to change every few decades — it is always changing. When I first studied medicine, physicians treated cold damage and warm disease with purgatives: when heat entered the interior and the bowels would not move, a mild purge would settle it. I practiced this way for over twenty years; then, continuing to use it, I often did harm. At that time I read only Zhang Jingyue’s books and used prepared rehmannia, with excellent results — I recorded many cases of using heavy prepared rehmannia for the ruined, worsening stages of cold damage and warm disease. After I passed forty, I felt the qi transformation had changed again: patients more often had insufficient qi, collapse of the great qi (da qi xia xian), so I developed the theory of the collapse of the great qi and came to value tonifying qi above all — whenever I cleared heat I added ginseng or astragalus, with good effect. After the tenth year of the Republic (1921), diseases more often showed hyperactive yang — yangming heat syndromes were especially common — so I began using the White Tiger Decoction (Bai Hu Tang) a great deal, adding yin-nourishing herbs, and the doses grew larger and larger. That is why the later Zhang Xichun became famous for his use of raw gypsum (sheng shi gao).

💬 Note from Doctor Luo: Zhang Xichun says that a physician must grasp the changes of heaven-and-earth qi transformation and adjust with them — otherwise you are “carving the boat to mark where the sword fell” (ke zhou qiu jian), clinging rigidly to an old method long after the circumstances have moved on. The books of the great physicians of history are each somewhat biased — Zhang Jingyue toward rehmannia, others toward clearing heat — not because they were one-sided men, but because the qi transformation of their era was so. A few decades later, the qi transformation shifts, and the whole strategy of medication may change; yet you must not mock the earlier doctors, for their thinking was right for their time. In his fifty-odd years of practice Zhang Xichun himself saw the qi transformation change several times. The qi of heaven and earth undergoes a major change every twenty years (the sixty-year cycle, divided into upper, middle, and lower phases). But once it changes, does the old approach become useless? Not at all — Zhang Jingyue’s method with prepared rehmannia is still extremely commonly used today. Every physician’s thinking and experience matters; keep these lessons close — you never know when one of them will be exactly what you need.

In this case, Zhang Xichun’s vision was exceptionally high: the man was already dying, yet he did not rush in to clear heat — clear what heat? He thought of insufficient upright qi and insufficient kidney yin: the body lacked the energy of operation to expel the pathogen, so he nourished first, treating an external-contraction illness by changing the body’s internal pattern. This way of thinking is precious, and well worth our study.

💬 Note from Doctor Luo: Look at it: so grave a patient, one formula, two doses drunk within a single day — and a man who was about to die was brought back to life. What we also learned today is Zhang Xichun’s discussion of the changes of heaven-and-earth qi transformation — don’t carve your boat rigidly; respect the experience of all the physicians who came before. Reading this case, one feels deeply moved: at twenty-six Zhang Xichun already had this mastery — some people do start from a higher place. And in a time when the pandemic has not fully passed, studying the knowledge of Chinese medicine for external-contraction illnesses is truly necessary.

What to take away

• A near-death fever patient with “eyes clear and blank” (loss of vitality), carphologia (hands searching the clothes and bed), and constant restless movement is in grave danger — these are the classic critical signs the ancients used to judge that a patient’s vitality is failing.
• When the pulse is hidden and weak and the chi positions vanish under pressure, kidney qi is exhausted — but if the pulse still floats, the pathogen has not yet gone deep; the root problem is that upright qi is too weak to expel it.
• Sweat is like rain: it takes the union of yin and yang. When the body’s fluids are exhausted, forcing sweat will collapse the qi — the correct move is to greatly nourish the true yin first and let the sweat come on its own.
• Doctor Zhang Xichun’s formula contained not a single pathogen-expelling herb — only large doses of prepared rehmannia, Huai yam, figwort root, goji berry, licorice, and donkey-hide gelatin. Fill up the yin, and the body itself expels the pathogen.
• The qi transformation of heaven and earth changes every few decades. Zhang Jingyue’s heavy use of prepared rehmannia suited his era and remains useful today; the warm-disease school’s clearing-heat approach suited another. Respect every tradition — and adapt to the patient in front of you, not to a fixed doctrine.

Based on Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records; the original case is from Records of Chinese Medicine with Western Reference (《医学衷中参西录》).