Headache So Bad He Started Saying Goodbye to His Family?
What people search for: headache / unbearable headache / bulging veins / bloated belly / tonics that cause trouble
Medical terms for this case: liver-fire headache · liver qi stagnation · mixed excess and deficiency · middle burner fullness
Opening: yesterday’s tonifying cured someone; today’s tonifying nearly ruined someone
Yesterday we told the story of a patient who was cured by tonifying with astragalus. Today’s patient tripped over that very same word — “tonify” — but not because his doctor tonified wrongly. He secretly added astragalus to his own medicine.
💬 Note from Doctor Luo: Yesterday’s patient had an excess of yin and a deficiency of yang; Doctor Zhu Danxi first warmed the yang, then tonified the qi, and finished with a qi tonic — the illness cleared up quickly. Today’s case is the mirror image: astragalus should never have been used, yet someone added it on his own initiative — and it tonified the patient straight into a belly full of trapped qi. Reading the two cases side by side is fascinating.
Who was the patient? Doctor Zhu looked at his body first
The patient was Mr. Chen, from Dongyang (today’s Dongyang in Zhejiang). Doctor Zhu Danxi had a habit: he always recorded a person’s physical appearance first. This Mr. Chen was tall and lean, with veins standing out all over his arms and body — in Chinese medicine that’s called “exposed sinews” (lu jin).
💬 Note from Doctor Luo: People with prominent veins are usually thin, hard-working people. Bulging veins can mean several things: sometimes the blood circulation is poor and the vessels are congested, so they swell up; sometimes it’s the liver failing to spread and soothe (shu xie) — when liver qi is blocked, the sinews stand out. Where the veins bulge tells you different things. Mr. Chen was tall, thin and had labored for years — a body weakened by toil: his upright qi (zheng qi) was insufficient while his consumption was enormous. He was a hard-luck working man. Doctor Zhu also liked to quote an old saying: “the tall rarely outlast the short” — tall people’s bodies are often not as sturdy as short people’s. It’s a general rule, not an absolute.
How sick was he? Sick enough to arrange his own funeral
What was Mr. Chen suffering from? Headache — and not an ordinary one. It hurt so badly that “words of farewell were spoken”: he told his family, “I don’t think this illness can be cured. Whatever needs arranging after I’m gone, please sort it out among yourselves.”
💬 Note from Doctor Luo: When a patient starts planning his own funeral, the family panics. They rushed Doctor Zhu Danxi over. One touch of the pulse told him a lot: it was wiry, large and rapid — the wiry quality, taut like a plucked zither string, points to the liver; large and rapid means the liver fire is blazing and the heart is beating fast. Put that together with the exposed veins and Doctor Zhu understood at once: liver qi was knotted up, and liver fire was rushing upward — straight into the head, which is why the pain was unbearable.
Doctor Zhu’s reasoning: the most important move in the whole case
Liver fire rushing upward — by the book you should soothe the liver and drain the fire, push it downward. But Mr. Chen was weak from toil — tall, short of qi, worn out by years of labor. His foundation was already poor. If you hammer him with fire-draining herbs, his upright qi collapses first.
💬 Note from Doctor Luo: This is the moment that tests a doctor — mixed excess and deficiency (xu shi jia za). There is the “excess” of liver fire, and the “deficiency” of weak qi. Drain the fire and you wound the righteous qi; tonify the qi and you feed the fire. A genuine dilemma. Doctor Zhu’s measure was: make supporting the righteous qi the priority. The prescription had only four herbs — ginseng (ren shen) and atractylodes (bai zhu) as the sovereign pair, tonifying the spleen and stomach and propping up the righteous qi; plus chuan xiong (ligusticum), which regulates the qi within the blood, soothes and softens the liver, and harmonizes liver blood; plus chen pi (tangerine peel), which opens the chest and moves the qi, untangling the congested qi mechanism. Not a single bitter-cold herb to drain the liver fire — the point was to strengthen the foundation, not to let cold medicines wound the righteous qi any further.
Five or six days of silence, and everyone grew anxious
By Doctor Zhu’s usual skill, this case should have turned quickly. But after five or six days of the medicine, the symptoms hadn’t budged — the head still hurt. Everyone was surprised: had he written the wrong prescription?
💬 Note from Doctor Luo: Doctor Zhu wasn’t worried. He told them: “Medicinal strength works in stages” — herbs act layer by layer, little by little. Don’t be impatient; give it a day or two more and he’ll be better. This is a reminder to everyone: Chinese medicine moves at its own pace. Faster isn’t always better. Often “slow” is itself part of the treatment.
Enter the helpful brother: “Why not add a little astragalus?”
While they waited, Mr. Chen’s brother came to ask Doctor Zhu: “Your formula tonifies the qi — why not add a little astragalus (huang qi)? Isn’t astragalus good for tonifying qi?” The brother was a TCM enthusiast who knew just enough to be dangerous, and he wanted to improvise.
Doctor Zhu heard this and smiled without answering.
💬 Note from Doctor Luo: That smile planted a time bomb. Doctor Zhu didn’t realize that enthusiasts sometimes have astonishing nerve. You smile at them, treating it as nothing — but they take it seriously. What happened next, even Doctor Zhu didn’t foresee.
Cured overnight? Doctor Zhu grew suspicious
One more night passed, and suddenly the patient announced: “I’m cured! My head doesn’t hurt anymore!”
Doctor Zhu was doubtful — by his estimate it should have taken another day or two. He took the pulse: “the finger felt a little too vigorous” — the pulse was stronger than it had any right to be, out of step with the condition. Doctor Zhu’s heart skipped a beat.
Half a day later the patient came back: “My chest is full” — everything above the diaphragm was bloated, he felt no hunger, and there was an uncomfortable fullness inside. Doctor Zhu lifted his clothes and looked: the creases in his belly were gone — the abdominal creases had vanished. That meant distension — a textbook middle burner fullness (zhong man).
💬 Note from Doctor Luo: Doctor Zhu understood everything. He asked the patient: “When you were brewing the medicine at night, did you secretly add astragalus?” The patient couldn’t deny it: yes, they had — and heavily, three doses in two days. Doctor Zhu didn’t know whether to laugh or cry. No wonder the pulse was too strong, no wonder the belly was distended: the liver fire was already blazing, the qi mechanism was already congested in the middle burner, ginseng and atractylodes were tonifying — and on top of that came a heavy dose of astragalus. Too much tonifying force, and the qi got stuck entirely in the middle burner. Of course it swelled up.
The cleanup: Er Chen Tang plus hou po, zhi shi and huang lian — three doses to settle
Doctor Zhu wrote an emergency prescription: Er Chen Tang (Two Matured Ingredients Decoction) to resolve phlegm and move the qi, plus hou po (magnolia bark) and zhi shi (unripe bitter orange) to drive the qi and reduce the distension, plus huang lian (coptis) to clear the stomach heat — in other words, unload the qi that had been tonified in and bottled up in the middle burner. The result: three doses and he was completely settled — the illness was truly gone.
💬 Note from Doctor Luo: Here’s a crucial detail: after the brother secretly added astragalus, the headache did clear up immediately. That proves Doctor Zhu’s direction was right — the approach of tonifying the spleen and soothing the liver for a liver-fire headache was correct. What went wrong was proportion. On Doctor Zhu’s timetable, seven or eight days of gentle tonifying would have cured the disease naturally. But the brother got impatient and piled on the dose — the direction never changed, only the measure broke, and the side effect took another three days to clean up. This case tells us: using medicine is like using soldiers — measure is everything.
Doctor Luo’s closing note: astragalus isn’t bad — it’s about when not to use it
The lesson of this case cuts deep: astragalus is not forbidden — it must simply be used at the right time.
💬 Note from Doctor Luo: The ancients said long ago that misused astragalus causes fullness and distension — when the body’s qi mechanism is already congested and there’s an excess pattern present, adding astragalus to tonify the qi only makes the qi move even less, and up comes the swelling. Mr. Chen had blazing liver fire and congested qi — that’s the excess side; yet his body was also weak and needed support — that’s the deficiency side. Mixed excess and deficiency demands especially careful judgment. That’s why Doctor Zhu used only four herbs and tonified slowly; the patient added astragalus himself, and one addition caused the accident. Remember: every herb is a good herb — but misused, any of them will cause trouble. Yesterday astragalus was exactly right; today it was exactly wrong. One used, one not — read the two cases together, and you’re reading the art of measure.
Bonus: the old master’s “one-glance” diagnostic skill
In this case, Doctor Luo says, Doctor Zhu Danxi was really teaching something bigger — inspection (wang zhen): reading a person’s build and complexion, then matching them against the pulse and the constitution. Almost every case in Doctor Zhu’s records notes the patient’s body shape, facial color and skin tone. This is the essence of Chinese diagnosis.
💬 Note from Doctor Luo: Why are old TCM doctors so fast? They sweep the room with their eyes on the way in and they already know most of it. When I was studying medicine, there was a national-level master in Harbin, old Doctor Zhang Qi. A patient came in saying, “I’m always cold — is my yang deficient?” Without even lifting his head, the old man said: “Your lips are bright red.” Bright red lips mean internal heat; a yang-deficient person has pale lips. One sentence, and the patient was convinced. Then there was the great inspection master Doctor Wang Hongmo. When I was an editor at the Beijing TV health program Yang Sheng Tang, I invited him to give a talk. He swept his gaze over seven or eight producers and said: “Young lady, your periods are irregular — you need to regulate them. And you, sir, you should drink less.” A deputy editor jumped out of his chair on the spot: “Nobody knows I drink!” — he had a bottle every night before bed. You see — inspection, auscultation, inquiry, pulse: inspection comes first. These treasures must not be lost.
Conclusion: when form and complexion match, the big direction can’t be wrong
Doctor Zhu Danxi looked at a person’s build and coloring first, then checked them against the pulse and the pattern — reading constitution from both sides. That was one of his great contributions to diagnosis. The same applies to ordinary people keeping healthy: first figure out whether you’re qi deficient or qi excess, hot or cold — then hold the measure of tonifying vs. draining, warming vs. cooling. Don’t get the big direction wrong: a qi-deficient person shouldn’t be aggressively drained, and a qi-excess person shouldn’t be stuffed with tonics. Get the direction right, and the body will only get better.
Based on Doctor Luo Dalun’s lecture on Doctor Zhu Danxi’s case records (as recorded in the Danxi Xinfa and related collections).