Bleeding Won’t Stop and Short of Breath? Doctor Zhang Xichun’s Formula for Blood Collapse with Sinking Qi (Metrorrhagia)

Patient search terms: bleeding that won’t stop / blood collapse / unusually heavy periods / heavy bleeding / shortness of breath / waves of fever in the afternoon

Medical terms for this condition: blood collapse (xue beng; functional uterine bleeding) · sinking of the great qi (da qi xia xian) · qi failing to hold blood (qi bu she xue) · deficiency of both qi and yin

Opening: the final case in the Zhang Xichun series

“Dear friends, good morning. Today I will tell you the last medical case from Doctor Zhang Xichun’s book.” That is how Doctor Luo Dalun began. After all these months of studying Zhang Xichun, the entire series has now reached its finale.

💬 Note from Doctor Luo: After today, this Zhang Xichun series basically comes to a close — thank you so much for listening all the way through. But the case studies will continue: what I do is essentially the work of the TCM schools of thought and medical case studies — the very courses that are called “Various Schools of Chinese Medicine” and “Medical Cases” in TCM universities. When I studied at Beijing University of Chinese Medicine, Professor Lu Zhaolin taught the case-studies course, and I remember being deeply fascinated and loving every minute of it. In fact, I started learning Chinese medicine by reading medical cases. So from here on, we will go doctor by doctor, and I hope you will stay tuned.

Who was the patient? An 18-year-old girl in Tianjin, so ill that her name was never written down

The final case is about blood collapse (xue beng) — catastrophic uterine bleeding. In District 2 of Tianjin there lived a young woman surnamed Xu, only eighteen years old, who developed this condition. Curiously, Doctor Zhang Xichun almost always recorded his patients’ names and workplaces, but in this case no name was written. Why? Because the cause was disharmony in the family: anger stirred the liver fire, and the bleeding would not stop. The family quarreled and argued, emotions flared, the liver fire rose — and the blood simply would not be held back. It became a full-blown blood collapse. Because it was a family matter, Doctor Zhang could hardly write it out in black and white, so he discreetly left the name out.

💬 Note from Doctor Luo: This case shows you just how crucial emotion is for women. Women are sensitive, and they are especially vulnerable to emotional swings — a discordant atmosphere at home, arguments and quarrels, pressure at work, office politics and scheming — all of it stirs up emotional problems, which then turn into physical problems. I see an enormous number of such cases. I have said it again and again: for most people in modern society, physical illness is tied to bad emotions. In the old village days, you had no idea what was happening beyond your own fields. Today, one WeChat message connects you to people all across the country; add office conflicts on top, and the chances to get emotionally blocked multiply. So liver qi stagnation and bad mood are the source of ten thousand diseases in our time.

How sick was she? Heavy bleeding for over a month, and shortness of breath

At the start, this young woman bled heavily — real, serious hemorrhage. She was treated again and again; after more than a month the flow lessened but still would not stop. When Doctor Zhang Xichun was called in, his first read of the pulse was: soft and weak (ru ruo), slightly rapid. There were two more distinctive symptoms. First, shortness of breath — she felt short of breath and strained; breathing out required a little extra effort, not the easy, natural exhale of a healthy person. Second, afternoon tidal heat — after noon her body would run hot in waves, like a tide coming in; not severe, just a mild heat.

💬 Note from Doctor Luo: That shortness of breath is a hugely important clue — it is the classic sign of sinking of the great qi (da qi xia xian). Since I started telling this series of Zhang Xichun cases, I have found that the theory people benefit from most is exactly this theory of the sinking great qi. So many listeners have told me: “I went to the hospital for a year or two and never got better. After listening to you, I realized — isn’t this the sinking great qi? I got Zhang Xichun’s formula and after a few doses I was fine.” The sinking great qi is extremely common — everyone should master this idea.

What did Doctor Zhang think? Drawing the map like a detective

Doctor Zhang Xichun’s verdict: this was the great qi of the chest sinking downward. And like a master detective, he drew two clear lines on his map —

Line one: qi deficiency. This woman was certainly qi-deficient, with insufficient upright qi (zheng qi). Where does the great qi live? Between the heart and lungs. When the great qi sinks, breathing turns laborious — that is why she had to strain to breathe. And why was she bleeding? The qi could no longer hold the blood. There is a saying in Chinese medicine: “qi bu she xue” — she means to secure and contain. Qi commands the blood to run in its proper channels; when qi becomes deficient it loses the power to secure, and blood escapes its channels and flows out. That is why some women have unusually heavy periods — the qi is too weak to hold the blood in. Some people bleed from the bowel for the same reason. All kinds of bleeding, very often, trace back to this.

Line two: yin deficiency with heat. The afternoon tidal heat and the rapid pulse told him this woman was yin-deficient — in fact, the whole picture was deficiency of both qi and yin (qi yin liang xu). Yin deficiency breeds internal heat; heat forces the blood to run recklessly (re po xue wang xing) — it speeds up the blood’s movement and can itself cause bleeding. So the blood collapse was also tied to heat.

💬 Note from Doctor Luo: Chinese medicine at its best is exactly like a first-rate detective: lay out every clue, analyze what each symptom means, how they connect and how they developed, draw the map — and then treat according to the map. Some people say “yi zhe yi ye” — “the physician works by intuition,” meaning a doctor just senses the answer and scribbles a prescription. It is not that simple. A truly skilled doctor reasons so fast, in a split second, that it looks like intuition. But when you practice honestly, you line up the symptoms and draw the map: this symptom exists because of yin deficiency; that symptom exists because of qi deficiency — how do I adjust both? Once the map is drawn, treatment becomes straightforward. Watch Doctor Zhang: he listed the symptoms, explained why each one existed, drew his map — and then the treatment was simple.

Why both bleeding and shortness of breath? The rope-and-bag analogy

Doctor Luo offered a wonderful analogy for “qi failing to hold blood”: qi is like a rope held in a child’s hand, and tied to the other end of the rope is a bag. Why does the bag spin around your hand without flying off? Because the rope holds it — the rope is qi, the bag is blood. As long as the rope holds, no matter how hard you whirl it, the bag cannot fly away. But if the rope snaps — if qi becomes deficient and can no longer fix the bag in place — let go, and the bag flies off.

💬 Note from Doctor Luo: So once qi is deficient and loses its securing power, blood leaves its proper channels: unusually heavy periods, bloody stools, all kinds of bleeding — very often this is the thread running through them. Remember that line: qi deficiency. Now, why did the great qi sink in the first place? First, qi deficiency itself. The second major cause is anger. When the liver fire blazes and a person loses her temper, the liver fire runs wild in the chest and rushes upward — and it squeezes the great qi down. Doctor Zhang recorded several cases where people became angry, the great qi sank, and it could not return to its place — it stayed down below. So the root cause is: insufficient upright qi, plus liver fire, resulting in sinking of the great qi.

The prescription: qi tonics, yin nourishment, astringents, heat clearing — four armies converge

Doctor Zhang Xichun’s formula began with sheng huang qi (raw astragalus), 1 liang (30 g) — to supplement the great qi of the chest and support the upright qi. To it he joined chao bai zhu (stir-fried atractylodes), 5 qian (15 g). Why astragalus with atractylodes? Atractylodes strengthens the spleen — and whenever you are treating an emotion-driven illness, remember this rule: “When you see disease of the liver, know that it will transmit to the spleen — so first strengthen the spleen.” When the earth is weak, the wood shakes; by building up the spleen earth, you actually heal the liver wood. In fact, Doctor Zhang’s last several formulas all followed this pattern — and they were all women’s diseases. Treating gynecological problems, you must always take the spleen and stomach into account.

Then came the rest of the formula:

The illness had dragged on, so the picture was deficiency of both qi and yin with heat present: raw rehmannia nourished yin and cooled the blood. Calcined dragon bone and calcined oyster shell were used for astringency and fixation — Doctor Zhang usually prefers the uncalcined forms, but here he deliberately used the calcined ones to secure and hold. Trichosanthes root nourished yin and moistened dryness. Sophora root and phellodendron bark cleared heat: the liver fire had driven the qi downward and caused lower-burner bleeding, and sophora root is especially good at clearing damp-heat of the lower burner; phellodendron joined it to clear lower-burner heat. Once the heat was cleared, the force that had been “forcing the blood to run recklessly” was removed. Bupleurum did double duty: it soothed the liver on one hand and lifted upward on the other — working with the astragalus to raise the replenished qi.

💬 Note from Doctor Luo: Look at this formula: qi tonics, yin nourishment, astringents, heat clearers, plus one herb that lifts — four armies converging on the battlefield. Doctor Zhang usually uses bupleurum in very small doses, but here he used a full 3 qian, precisely so it could both soothe the liver and lift the qi. So the treatment strategy of this case comes down to two sentences: on one hand, build up the great qi and let it return to its place; on the other hand, nourish the true yin and clear the deficient heat — and add lifting and securing. Solve those two big problems, and the bleeding stops by itself.

A hemostatic pair straight from the Yellow Emperor’s Inner Classic: cuttlebone and madder

Two more herbs in the formula have a distinguished pedigree. Hai piao xiao (cuttlebone), 3 qian (9 g) — this is the little boat-shaped bone inside a cuttlefish (the squid-like creature). As children we used to play with these bones after eating cuttlefish, scraping them with our fingernails to make them squeak. In medicine it is a dedicated astringent: it stops bleeding, checks vaginal discharge, and secures the essence. Qian cao (madder root), 2 qian (6 g) — cool in nature, it cools the blood and stops bleeding, with a touch of blood-moving action besides. It is especially good for bleeding caused by heat forcing the blood to run recklessly: it cools and stops at the same time.

💬 Note from Doctor Luo: Cuttlebone paired with madder is a combination that already appears in the Yellow Emperor’s Inner Classic — the classic formula “Si Wu Zei Gu Yi Lu Ru Wan” (Four Cuttlebone, One Madder Pill) is exactly these two herbs, used to treat the disease of withered blood. In the Inner Classic, when bleeding was caused by insufficient upright qi, the ancients also added sparrow eggs and abalone to the formula — that is the wisdom of the ancients. You see, when Doctor Zhang used these two herbs, he was directly bringing an ancient formula from the Inner Classic back to life.

One Western drug, ergot: the open-mindedness of Republican-era Chinese medicine

The formula also contained an unusual item — mai jiao (ergot), 5 fen (1.5 g), and lactose, 5 fen (1.5 g), ground fine and swallowed together with the decoction. What is ergot? When wheat goes moldy, a parasitic fungus grows on it — ergot is the substance purified from that fungus, and it has a powerful hemostatic effect. At the time it was used as a Western drug.

💬 Note from Doctor Luo: Doctor Zhang’s book is titled Records of Chinese Medicine with Western Reference — zhong can xi means: not only does he use Chinese herbs, he also analyzes Western drugs by the same cold-hot-warm-cool framework, and combines Chinese and Western medicines together. How wonderful. Back in the Republican era, he already understood that Chinese medicine should embrace Western medicine — take the good things Western medicine offers and use them. That breadth of mind, even judged by today’s standards, is remarkably open.

The result: one dose, and the bleeding stopped

The effect of the formula was astonishing: after a single dose, the bleeding stopped completely — not a trace remained. A blood collapse that had defied treatment for over a month was halted with one dose. The shortness of breath and the afternoon tidal heat were cured as well. Doctor Zhang then said: let’s open a few more doses of a qi-and-blood building formula, take two to secure the recovery. And with that, the case closed.

💬 Note from Doctor Luo: You might think — this case is over much too quickly! But that is exactly how Doctor Zhang worked. He didn’t run patients through visit one, two, three, four, five, six — twenty-something consultations. Basically one dose solved the problem, then a few doses to secure it. That is why Doctor Zhang enjoyed such fame — in the Republican era he was essentially the number one physician in China, and he worked very fast indeed. Other doctors had treated the girl for over a month with little effect; Doctor Zhang settled it in one dose — which shows that the thinking is crucial, and the diagnosis is crucial.

Bonus: for emotion-driven illness, why strengthen the spleen and stomach first?

From this case Doctor Luo draws two takeaways. First: anger can cause the great qi to sink. Qi-deficient people are everywhere today — people who rarely exercise, who pant at the slightest exertion, who have scalloped tooth marks on the edges of their tongues. When such a person also runs into liver fire — a family quarrel, anger at the office — one burst of temper can easily push the great qi down.

💬 Note from Doctor Luo: Second: when bad emotions trigger all kinds of illness in a qi-deficient person, strengthening the spleen and stomach should be the main strategy, and then adjust according to the other signs — nourish yin if there is yin deficiency, clear damp-heat if there is damp-heat. But the core idea of building up the upright qi and tonifying the spleen and stomach is a must. You can even add just a little liver-soothing herb; sometimes Doctor Zhang didn’t add any at all, and it still worked. Why? The spleen and stomach are the core of the body. When the spleen and stomach are strong, the liver wood can no longer bully them — and the liver wood will find its own way back to normal on its own. We make that wood grow more firmly, rooted in water and earth, by strengthening the spleen. This is a very important idea. Remember: Doctor Zhang’s last several formulas for women’s diseases all followed exactly this pattern.

Closing summary: why was Doctor Zhang Xichun so remarkable?

To close the series, Doctor Luo sums up Zhang Xichun’s greatness in three points. First, his thinking was extraordinarily clear. A friend of Doctor Zhang’s father remembered him as a boy: he was deeply versed in the Chinese classics, and he mastered the I Ching (Book of Changes) especially well. He thought about problems through the framework of the I Ching, and he thought with remarkable clarity — which is why his medical achievements ran so deep. Methodology propelled the development of technique. Second, his command of individual herbs was superb. He listed every single herb, pondered each one slowly, and grasped exactly what each did — Huai yam (huai shan yao) and raw gypsum (sheng shi gao) being perfect examples.

💬 Note from Doctor Luo: Why do I value Huai yam so much and treat it as a lifesaver? I learned that from Zhang Xichun. The ancients used raw gypsum too — some individual physicians used it in large doses — but nobody wrote about it with this clarity. Doctor Zhang studied and tested it: it is not really that cold, its heat-clearing effect is outstanding — he kept experimenting until he understood it thoroughly. So whenever you talk about Huai yam or raw gypsum, you must come to Zhang Xichun; you cannot skip him. His synthesis of individual herbs was a development the ancients never imagined. Third, he had a solid grasp of TCM theory and was brilliant at pondering, innovating, and synthesizing — combine the herbs within a theoretical framework, and power emerges. And Zhang Xichun was unusually willing to share. Most old doctors, once they had an effective method, would pass it only to their sons and tell nobody else. Zhang Xichun was nothing like that — he shared everything, for everyone to use. He said: “You all study Chinese medicine with great effort. If you study according to my system, you will be able to handle ordinary illnesses by yourselves.” At the time I half didn’t believe it. But now, seeing the feedback from listeners, I truly believe it — many people listen, recognize their own pattern, use Zhang Xichun’s original formula, and are better after a few doses.

Epilogue: 70% of China’s famous veteran TCM doctors were influenced by him

How great was Zhang Xichun’s influence? Doctor Luo says, this is not my assessment — it is the assessment of the entire academic world: from Zhang Xichun’s time to the present, no TCM physician of comparable influence has appeared in the Chinese medicine community. A relevant institution once surveyed famous veteran doctors, asking “who influenced your study of Chinese medicine the most,” and a great many of them wrote down Zhang Xichun — the number remembered at the time was around 70%.

💬 Note from Doctor Luo: Take the late veteran doctor Li Ke, for example — another old physician who wrote out all his insights for the world. Many of his formulas bear Zhang Xichun’s mark — how to add cornus (shan zhu yu) in the Poge Jiuxin Decoction, how to secure against collapse — all learned from Zhang Xichun. The most glorious days of Zhang Xichun’s life were spent in Shenyang, where he founded the Lida Hospital of Chinese Medicine — the very first TCM hospital in China — and ran correspondence courses teaching people Chinese medicine. I was born in Shenyang, and throughout my own medical studies I paid special attention to Zhang Xichun. Without even realizing it, I keep using his approach for many herbs and many formulas — I have benefited enormously. We should truly be grateful that someone like Zhang Xichun once existed in this world. My own knowledge is limited, and I cannot fully express the ingenious construction of so many of his formulas — I can only analyze them as best I can. But I hope that everyone — especially students and practitioners of Chinese medicine — will take every opportunity to study Zhang Xichun’s thinking closely. Let us analyze together, improve together, and use his wisdom to protect the health of ourselves and our families.

Case source: Records of Chinese Medicine with Western Reference by Doctor Zhang Xichun; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).