Sudden Stroke, Hemiplegia, or Needle-Like Pains? Four Stroke Cases from Doctor Zhu Danxi
Patient search terms: suddenly collapsed and unconscious / numb hands and feet after a stroke / hemiplegia / pains like needles all over the body / how to recover from stroke paralysis
Medical terms: stroke (cerebrovascular accident) · qi deficiency / deficiency of both qi and blood · stroke-like syndrome from internal causes
Opening: Doctor Zhu Danxi’s book begins with stroke
In Doctor Luo Dalun’s series on Doctor Zhu Danxi, we have now reached the last few case records — once these are told, this whole chapter on Doctor Zhu Danxi comes to a close. And the closing topic happens to be stroke.
💬 Note from Doctor Luo: Many physicians of ancient times placed stroke first in their books — in Doctor Zhu Danxi’s book, the very first condition discussed is stroke. Why? Because in ancient times this disease was extraordinarily common and terrifying. A stroke back then most likely meant what we now call a cerebrovascular accident: cerebral infarction, cerebral hemorrhage, and the like. There was also a class of limb problems caused by cold wind from outside — the ancients called this “true wind stroke” (zhen zhong feng). But the strokes caused by internal reasons — insufficient qi and blood, phlegm-dampness — were called “stroke-like syndromes” (lei zhong feng). In the past some physicians fixated on external wind and paid too little attention to the internal causes. In fact the Huang Di Nei Jing (Yellow Emperor’s Inner Classic), when it discussed “pian ku” (paralysis of one side), had already pointed out the importance of the internal cause: when the upright qi is insufficient, the deficient, evil wind takes advantage and slips in. By the Jin-Yuan era, physicians began to discuss the internal causes: Liu Hejian said there was heat in the body, Li Dongyuan said it was qi deficiency, and Doctor Zhu Danxi said there was phlegm-dampness — dampness generates phlegm, phlegm generates fire, and eventually stroke results. From our present-day experience, the internal cause is indeed the main one.
Case one: eyes closed, thud to the ground, unconscious
The first patient suffered a stroke — his eyes closed, he collapsed and lost consciousness, completely insensible.
💬 Note from Doctor Luo: When someone suddenly faints and the mind goes completely blank, Doctor Zhu Danxi analyzed it as qi deficiency. Why? In a qi-deficient person, the upright qi is insufficient and lacks the strength to push the blood along; the head cannot get the blood supply it needs, and the qi cannot reach the crown of the head. At the same time, a qi-deficient person usually also has a weak spleen and stomach, which cannot transport and transform water-dampness — the dampness pools and forms phlegm. Qi deficiency and dampness heaviness are two sides of the same coin. The qi cannot push the blood, and on top of that phlegm-dampness is abundant, clouding the clear orifices — and the person goes “thud” and collapses.
How did he treat it? Doctor Zhu Danxi used Si Jun Zi Tang (Four Gentlemen Decoction) — Ren Shen (ginseng), Bai Zhu (atractylodes), Fu Ling (poria), Gan Cao (licorice) — the principal formula for tonifying qi, from the Song-dynasty Tai Ping Hui Min He Ji Ju Fang (Formulary of the Bureau of Taiping People’s Welfare Pharmacy). The later Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction), Gui Pi Tang (Restore the Spleen Decoction) and Liu Jun Zi Tang (Six Gentlemen Decoction) are all built on its foundation. On top of tonifying the qi he added two more things: Zhu Li (bamboo sap) and Jiang Zhi (ginger juice).
💬 Note from Doctor Luo: Zhu Li is a phlegm-resolving agent — bamboo roasted over fire yields a juice, and that juice is Zhu Li; it is specifically for resolving heat-phlegm. When there is phlegm-stasis in the head, Zhu Li is exactly what should be used. I have said before: when a cough has heat-phlegm, with a touch of infection, drinking fresh Zhu Li oral liquid clears the phlegm very quickly. And there is an old physician’s experience: for patients with cerebral hemorrhage, persistent high fever, being rescued in the ICU, giving more than 100 ml of fresh Zhu Li by tube can bring the fever down — once the heat-phlegm dissolves and blood circulation improves, the person is saved. I have truly done this myself: a patient had intracranial bleeding and a high fever that would not come down; everyone thought it was hopeless. I dripped fresh Zhu Li in through the nose — the fever fell, and the person recovered completely. But fresh Zhu Li is rather cold in nature, so Doctor Zhu Danxi paired it with a little ginger juice — “phlegm will not transform without warmth” — using the ginger juice to warm things up. Tonify the qi on one side, resolve the phlegm on the other — and Doctor Zhu Danxi wrote “he recovered after taking it” (fu zhi yu).
Case two: limbs so numb that a needle could not be felt
The second person also suffered a stroke, with stranger symptoms: his four limbs were numb, feeling neither pain nor itch — his arms and legs were so dead that you could stick a needle in and he would feel nothing.
💬 Note from Doctor Luo: Doctor Zhu Danxi said: this is qi deficiency. Strange — this man clearly had both qi and blood insufficiency, so why did he only mention qi? There is a subtlety here: with the same deficiency of qi and blood, the focus differs depending on the location. Chinese medicine says “the spleen governs the four limbs” — the limbs are at the body’s far ends; only when spleen qi is sufficient can nourishment reach those ends. When the spleen weakens and can no longer supply them, the limbs waste away and go wrong. So when problems appear in the arms and legs, you often have to look to the spleen. Problems at the fingertips and toes are charged to the liver; joint problems are also often charged to the liver. Different locations correspond to different organs.
How did he treat it? A large-dose Si Jun Zi Tang — with the amounts given generously — plus Tian Ma (gastrodia), Mai Dong (ophiopogon), Huang Qi (astragalus) and Dang Gui (angelica). Huang Qi tonifies qi, and paired with Tian Ma it unblocks the channels — this is the “Huang Qi paired with Tian Ma” herb couple we discussed earlier; Mai Dong nourishes the fluids to prevent dryness and heat from injuring them; Dang Gui nourishes the blood. Tonifying the qi is the main move, lifting up the root — numbness of the limbs has qi deficiency at its root; once the qi is sufficient, nourishment can reach the hands and feet.
Case three: fond of women, four concubines, and a stroke that paralyzed half his body
The third case record — Doctor Luo Dalun says he laughed out loud reading it, because Doctor Zhu Danxi wrote it very bluntly: one man was fond of women and kept four concubines. Add his wife and there were five women in the house — how could such a body stay healthy? Sure enough, the man suffered a stroke: his four limbs were numb and weak, and he had hemiplegia — half his body could not move at all.
💬 Note from Doctor Luo: Doctor Zhu Danxi was an exceptionally direct man, of high standing and moral weight — when he criticized someone, he said it straight to their face, and in his case records he wrote “fond of women” without mincing words. Think about it: five women — draining kidney essence, qi and blood. How could the man not become deficient? But a deficient person has another trait — the fire of desire burns — plus deficiency heat. So Doctor Zhu Danxi’s formula: Si Wu Tang (Four Substances Decoction) as the base — Shu Di Huang (cooked rehmannia), Dang Gui (angelica), Bai Shao (white peony), Chuan Xiong (ligusticum), the ancestor of all blood-nourishing formulas, also from the Tai Ping Hui Min He Ji Ju Fang, and virtually every later blood-tonifying formula is built on it — then Ren Shen (ginseng), Huang Qi (astragalus) and Bai Zhu (atractylodes) to tonify qi and the spleen — that is the shadow of Ba Zhen Tang (Eight Treasures Decoction) — then Tian Ma to unblock the channels; Ku Shen (sophora flavescens), Huang Bai (phellodendron) and Zhi Mu (anemarrhena) to clear the deficiency heat — if you do not clear that heat, he cannot control himself; Mai Dong to nourish yin; and finally Jiang Can (silkworm), Di Long (earthworm) and Quan Xie (scorpion) to search out wind, unblock the channels and invigorate blood circulation. The whole formula does four things at once: tonify both qi and blood, unblock the channels, and clear a little deficiency fire.
💬 Note from Doctor Luo: The famous Qing-dynasty physician Wang Qingren later created Bu Yang Huan Wu Tang (Tonify the Yang to Restore the Five Decoction) for hemiplegia, and the thinking runs in the same line: when the upright qi is insufficient, blood perfusion goes wrong and local stasis blocks things into a lesion — so you tonify the upright qi fully, let the blood flow again, and then flush the stasis away. This approach works extremely well for qi-deficiency-type paralysis. But remember: it is aimed at people with insufficient upright qi. If someone with blazing liver fire — red eyes, red face — has a stroke, tonifying them would be a mistake. Then you need to unblock the bowels, drain heat, resolve heat-phlegm — a completely different treatment. Chinese medicine treats each case according to what it finds.
Case four: after the stroke, pains like needles all over the body
The fourth case: one man suffered a stroke, and afterwards his whole body felt as if pierced by needles — “man shen ru ci.” After the stroke, his skin prickled and stabbed, point by point, all over.
💬 Note from Doctor Luo: Do not think only strokes do this — many elderly people come complaining that their skin hurts or itches like needle pricks for no obvious reason. This is tied to the local state of qi and blood: when qi and blood do not circulate smoothly, the skin loses its nourishment and either goes numb or stabs with pain. How did Doctor Zhu Danxi treat it? Si Wu Tang to nourish the blood, so the blood can perfuse the skin; then Jing Jie (schizonepeta), Fang Feng (saposhnikovia), Chan Tui (cicada slough) and Man Jing Zi (vitex) — wind-dispelling herbs that open the surface and the interstitial spaces and clear out the wind evil; plus Mai Men Dong (ophiopogon) to moisten dryness. Why moisten? When the local blood does not arrive, the part dries out; dryness opens a gap in the body’s defenses, the pores go wrong, external evils drill in, and you feel the stabbing. Nourish the blood on one side, dispel wind and scatter evil on the other, and moisten dryness too — when the blood is fully nourished and the wind is cleared, the pricking pains vanish by themselves.
The real lesson at the end: adjusting the body comes down to four words — “qi, blood, phlegm, stagnation”
Having told these four cases, Doctor Luo Dalun points to the great learning hidden behind Doctor Zhu Danxi’s work — the Four Injuries doctrine (si shang xue shuo).
💬 Note from Doctor Luo: Look — Doctor Zhu Danxi used stroke as his example to show us how to regulate qi and blood: when qi is deficient, tonify qi and add a little phlegm-resolving medicine; when blood is deficient, nourish blood and add a little channel-unblocking medicine; when both are deficient, supplement both; when blood deficiency is mixed with wind evil, nourish blood and then dispel wind. When all is said and done, adjusting the body is nothing more than getting the qi and blood in order, resolving the phlegm, and opening the stagnation — regulate these four aspects and most diseases can be resolved. This is Doctor Zhu Danxi’s famous Four Injuries doctrine, and it is why he excelled at miscellaneous diseases: he grasped these four words. “Stagnation” (yu) includes binding, blockage and blood stasis; “phlegm” (tan) is linked with dampness; add the regulation of the emotions on top, and internal-damage diseases are essentially all covered. This doctrine had enormous influence on later generations — once you pull out the disease mechanisms and look at internal-damage miscellaneous diseases through them, everything becomes much clearer.
💬 Note from Doctor Luo: So when we study case records, we find that the ancients were not writing randomly — they wrote deliberately, to teach later physicians how to treat disease. We owe our ancestors gratitude for leaving us such precious wealth, so that today we have knowledge to study, and once learned, it can protect us and regulate our bodies. Such good material, if ordinary people never learn it — that would be a real pity.
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhu Danxi’s stroke case records. The cases come from Doctor Zhu Danxi’s stroke cases (the Four Gentlemen and Four Substances decoctions both originate from the Tai Ping Hui Min He Ji Ju Fang).