Numb Fingers, Bloating, Phlegm, Dizziness After Any Effort?
Patient search terms: numb fingers / hands falling asleep / bloated stomach / bloated belly / spitting phlegm / dizzy when tired / will numb hands cause a stroke?
Medical terms: fullness in the middle (spleen qi deficiency) · excess of phlegm-dampness · kidney yang deficiency (decline of the ming men fire)
Opening: the Ming-dynasty director of the Imperial Academy of Medicine left three thousand case records
The physician we meet today is Doctor Xue Lizhai (薛立斋) — director of the Imperial Academy of Medicine in the Ming dynasty, from a family of imperial physicians. In a lifetime of practice he treated everyone from high officials to ordinary folk, and he left behind more than three thousand case records. That is extraordinary. Study these cases properly, and you can dig out a great deal.
💬 Note from Doctor Luo: When we tell Doctor Xue Lizhai’s cases, it will actually go quite simply — because his way of using medicine is very clear, and easy to follow. I hope you will gradually absorb his method. The interesting thing about him is that he used only a handful of formulas — Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), Ba Wei Wan (Eight-Ingredient Pill), Xiao Yao Wan (Free and Easy Pill), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) — to treat all kinds of diseases, and he always seized the crux of the problem. He used them with dazzling skill. Today’s first case is a lesson worth pondering again and again.
Who was the patient? Magistrate Jiang Dayong — he looked tremendously strong
The patient in this case was Jiang Dayong, a state sub-prefect (zhou pan) — a local official of the region. Doctor Xue Lizhai begins by describing his physical state: of imposing, robust build — he looked mighty and solid.
💬 Note from Doctor Luo: Do you see? This is just like the case records of Doctor Zhu Danxi — the doctor first describes the patient’s physical condition. But note: looking robust does not mean he really was robust! As we will discover, this man was very likely a “puffy strongman” — overweight but with a weak constitution underneath. So when you read cases or see patients, never take the first impression at face value; wait for the pattern differentiation that follows.
How sick was he? Fullness in the middle, spitting phlegm, dizziness after any effort, numb fingers
What were Jiang Dayong’s symptoms? First, zhong man with spitting phlegm — “fullness in the middle” means the chest, the stomach region, the middle burner, all blocked and distended; on top of that, phlegm kept coming up. Second, dizziness on exertion (lao ze tou yun) — the slightest tiredness made him dizzy. Third, his fingers all went numb — that kind of tingling, dead feeling in the fingertips.
💬 Note from Doctor Luo: Fullness in the middle, spitting phlegm, dizziness when tired, numb fingers — put those symptoms together, and what is your first reaction? Most people would say “fire, phlegm, qi not flowing smoothly,” right? That is exactly what the previous doctors thought too.
What the previous doctors did: clear phlegm, move qi — and it only got worse
The doctors before him had all used the clear-the-phlegm, move-the-qi approach: you are full in the middle? Your stomach is blocked, so we’ll move the qi. You spit phlegm? We’ll transform the phlegm. It sounded perfectly reasonable — but it did not work. At wit’s end, they finally called in Doctor Xue Lizhai.
💬 Note from Doctor Luo: This is the first layer of error in seeing patients: seeing fullness, move the qi; seeing phlegm, transform the phlegm — that is “treating the symptom,” not “differentiating the pattern.” Why didn’t it work? Because they never found the root. Doctor Xue Lizhai took one look and immediately pointed it out — all of you treated it backwards.
Doctor Xue Lizhai’s one-sentence diagnosis: the fullness is deficiency, not excess
Doctor Xue Lizhai said: Why the fullness in the middle? Because the spleen qi is deficient (pi qi xu)! In other words — your spleen qi is insufficient, it lacks the strength to transport and transform, and the qi mechanism gets stuck inside, so you feel full. Everyone, note this: the fullness you see is deficiency, not excess!
💬 Note from Doctor Luo: This principle is enormously important. Today, countless people eat a meal and their stomach and belly swell up, and the swelling lingers for a long time. They assume it is “excess” and stuff themselves with digestive herbs and qi-moving herbs — and the more they take, the worse it gets. Friends, this is actually a deficiency pattern — the spleen and stomach qi is weak, unable to transport and transform, so the food goes in and simply blocks up inside. That is why they swell. People like this all have spleen-stomach qi deficiency. This is what is meant by “fullness in the middle from spleen qi deficiency” (zhong man pi qi xu).
Why the phlegm, the dizziness, the numb fingers? All of them root in spleen qi deficiency
And why so much phlegm? Yes, you can transform phlegm — but first ask why the phlegm is so abundant — it is still the spleen. When the spleen is deficient it cannot transport and transform water-dampness; the dampness pools and floods inside, and gradually turns into phlegm. Why the dizziness? Spleen qi deficiency means the clear qi cannot ascend; and with exertion the qi gets even weaker, the supply to the head is insufficient, and dizziness results. Why the numb fingers? Spleen qi deficiency means the qi cannot circulate through the whole body — when qi is deficient it loses the power to push the blood along; the qi and blood cannot reach the fingertips, so they go numb.
💬 Note from Doctor Luo: Do you see? Doctor Xue Lizhai put spleen qi deficiency in first place — the fullness, the phlegm, the dizziness, the numbness, all trace back to insufficient spleen qi. So when you see a patient, you must learn to think one layer deeper: phlegm, swelling, numbness, dizziness are all surface manifestations; spleen deficiency is the root. Why can Doctor Xue Lizhai always seize the crux? Because he always digs for the root.
The prescription: Bu Zhong Yi Qi Tang with Fu Ling and Ban Xia, to build up the spleen-earth first
How did he treat it? Doctor Xue Lizhai prescribed: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) plus Fu Ling (poria) and Ban Xia (pinellia), to build up the spleen-earth. Bu Zhong Yi Qi Tang was created by Doctor Li Dongyuan (李东垣); Doctor Zhu Danxi loved it, and Doctor Xue Lizhai used it even more widely — that alone shows how classic the formula is. Why add Fu Ling? Fu Ling drains dampness and helps the spleen qi rise and the spleen to be tonified. Why add Ban Xia? Ban Xia dries dampness and transforms it — another way of strengthening the spleen.
💬 Note from Doctor Luo: Bu Zhong Yi Qi Tang with Fu Ling and Ban Xia — one move to build up the spleen-earth and solve the problem of insufficient spleen qi. But Doctor Xue Lizhai’s prescription was not finished — he also gave Ba Wei Wan (Eight-Ingredient Pill) at the same time, and that single addition pushes the thinking one layer deeper. It is the most brilliant stroke in the whole case.
Why add Ba Wei Wan? Fire generates earth — tonify the mother of the spleen-earth
What is Ba Wei Wan? It is Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) — in other words, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus two more herbs: Rou Gui (cinnamon bark) and Fu Zi (aconite). What does it treat? The decline of the ming men fire — kidney yang deficiency. Why use kidney-tonifying medicine for spleen deficiency? Remember this: the kidney is the home of the ming men fire; and in the five-element cycle, fire generates earth (huo sheng tu). The spleen and stomach belong to earth. Where does spleen-earth come from? It is the earth generated by the fire of the life gate.
💬 Note from Doctor Luo: When the ming men fire declines, the spleen-earth is bound to become weak — resulting in spleen-stomach deficiency cold and insufficiency of spleen yang, and then loss of appetite (yin shi shao si), loose stools (da bian tang xie), pain around the navel (qi fu teng tong), aversion to cold, frequent urination — all of these are indications for Ba Wei Wan. Doctor Xue Lizhai used Ba Wei Wan to tonify the mother of the spleen-earth: on one side he built up the spleen-earth to generate yang qi, and on the other he went after the deeper root — tonifying the kidney qi. After middle age, kidney deficiency is common, and one of the consequences of kidney deficiency is that the spleen and stomach start to fail. What do you call this? Treating the disease at its root (zhi bing qiu ben).
How to take it? Bu Zhong Yi Qi in the morning, Ba Wei Wan at night
Even more refined was the method of taking the medicines: Bu Zhong Yi Qi Tang in the morning, Ba Wei Wan in the evening — separated, two routes advancing side by side.
💬 Note from Doctor Luo: This practice of “Bu Zhong Yi Qi in the morning, Liu Wei Di Huang at night,” dosing according to the hours of the day, is an idea I often talk about — and note, I did not invent it; I learned it from the ancient physicians, and Doctor Xue Lizhai was especially good at it. Sometimes he used it forward, sometimes he reversed it; he had many tricks, and we will discuss them gradually. For now, just remember: this style of dosing is something the ancients left us, and Doctor Xue Lizhai used exactly this.
The patient recovered — but the story was not over. He read a book.
How did the two medicines work together? Before long, Jiang Dayong was well again — every symptom gone. At that point this should have been a happy comedy — but the ending of this story is a tragedy.
💬 Note from Doctor Luo: What happened? After he recovered, Magistrate Jiang read a book called 《Qian Kun Sheng Yi》 (The Book of Creation and Nourishment) — another Ming-dynasty text. What did it say? It said: “Anyone whose fingers become numb and soft will suffer a stroke within three years.” In other words, anyone whose fingers go numb and soft is guaranteed to have a stroke within three years. And what to do about it? The book said you could prevent it by taking two pill medicines: Sou Feng Wan (Search Out Wind Pill) and Tian Ma Wan (Gastrodia Pill).
The book said: numb, soft fingers mean a stroke within three years
Jiang Dayong heard this and thought it made sense — “Oh no, my fingers were numb; what if I have a stroke in three years?” So he began taking Sou Feng Wan and Tian Ma Wan, morning and evening, very diligently. What are these pills made of? Herbs that transform phlegm, dispel wind, and unblock the channels — moving, dispelling, dissolving; almost nothing tonifying.
💬 Note from Doctor Luo: Pay attention to this detail — the pills the book recommended were entirely “attack” in approach, with not a trace of “tonify.” And who was Jiang Dayong? A deficient person who had only just been cured by tonifying the spleen qi and kidney qi! When a person with genuine deficiency takes attacking medicine, you can imagine the result.
He took the wind-dispelling pills — and died
What was the final result? As he kept taking them, he developed da bian bu jin — loss of bowel control; then yin shi bu jin — he could no longer take food or drink, and in the end he died. Doctor Xue Lizhai commented: loss of bowel control means the yuan qi (original qi) has dissolved and scattered — the qi can no longer hold things in; inability to eat means the stomach qi has failed completely — the stomach can no longer receive food. And so the man was gone.
💬 Note from Doctor Luo: This is an extraordinarily profound lesson. He had been tonifying his upright qi all along and had cured the problems caused by spleen qi deficiency; if he had simply consolidated a bit longer, this man should have been fine. But he read a book and started thinking to himself — “I ought to dispel wind and unblock the channels” — so he stopped the tonics and switched to Sou Feng Wan and Tian Ma Wan to drive out wind and open the collaterals. In the end he scattered his own yuan qi, the illness turned grave, and he died. Think about it: if he had kept on tonifying, would the outcome not have been completely different?
Doctor Xue Lizhai’s verdict: prevention means nourishing qi and blood — not eating wind-dispelling pills
Doctor Xue Lizhai commented on this case especially, and what he said is excellent. He said: prevention means nourishing qi and blood (yu fang dang yang qi xue) — if you build your qi and blood up fully, that is true prevention. Concretely: nourishing qi and blood and supporting the upright qi is the key; then moderate the diet (jie yin shi) — do not eat rich, greasy, sweet foods; you are already a “puffy strongman,” and if you do not control your diet, things will get worse; restrain the seven emotions (jie qi qing) — regulate your emotions, do not let joy, anger, worry, brooding, grief, fear, or fright run to extremes, because when emotions run wild the qi and blood go into disorder and problems follow; and also be moderate in sexual activity (shen fang shi) — preserve the kidney essence and kidney qi.
💬 Note from Doctor Luo: Doctor Xue Lizhai said that if you can do these things, that is real prevention. But if you do none of them, and before your qi and blood are even fully restored you start taking Sou Feng Wan and Tian Ma Wan, stirring up the qi and blood and dispelling wind — that is what he called zhao feng zhi zhong: “inviting the wind to cause a stroke.” Far from preventing a stroke, you make it easier for wind to enter, and the upright qi gets hurt even more! Jiang Dayong is the living example. The upright qi is the key — every physician we have discussed in this series has made the upright qi primary. When the upright qi is insufficient and you go attacking the pathogen, think about it: the man did not even have wind. He was just coaxed by a book — it sounded plausible — and so he dispelled wind and unblocked channels, achieved nothing, and damaged his upright qi instead.
Doctor Luo’s modern warning: one An Gong Niu Huang Wan at every solar term? It is the same mistake
This lesson has special relevance today. Doctor Luo gave an example: nowadays people often say you should take An Gong Niu Huang Wan (Peaceful Palace Bovine Bezoar Pill) — one pill at each change of solar term — to prevent a stroke.
💬 Note from Doctor Luo: I think this advice is exactly the same as the Qian Kun Sheng Yi advice in this case record! An Gong Niu Huang Wan is a heat-clearing, phlegm-transforming medicine; it genuinely treats heat-induced closure with unconsciousness. But taking one pill at every solar term to prevent a stroke — that is carving a mark on the boat to find a dropped sword (ke zhou qiu jian) — clinging to a fixed idea that has nothing to do with the actual situation. In particular, take a yang-deficient person: winter is about to arrive, and you swallow an An Gong Niu Huang Wan at the solar term — does it damage the yang qi? Of course it does. The yang qi is injured, the weather turns cold — can a yang-deficient person withstand that? It makes problems more likely, not less. Chinese medicine adjusts to the state of your body; it is not “whenever the season turns, everyone takes the same medicine.” The causes of numb fingers are also various: some are spleen deficiency, some are insufficiency of qi and blood, some are phlegm-dampness. You cannot lump them together and declare “numb fingers always call for Sou Feng Wan.” So anyone learning Chinese medicine must hold this principle: each person is different, and the treatment changes with the circumstances. The idea that “take this and you’ll be fine” or “this prevents everything” is absolutely wrong.
The key lesson: if you are the type who needs tonics, keep tonifying
This case could be titled “If you need tonics, keep tonifying.” What Doctor Xue Lizhai teaches us here is the combination of Bu Zhong Yi Qi Tang with Ba Wei Wan: Bu Zhong Yi Qi tonifies the spleen; Ba Wei Wan tonifies the mother of the spleen-earth. Why does the spleen-earth get injured? For many reasons — but one important one is insufficient kidney yang, insufficient ming men fire. If you can see that — this person’s kidney qi is declining — then while you tonify the spleen, take Ba Wei Wan separately in the morning and evening, and you have made the mother of the spleen-earth sufficient. The body naturally grows strong.
💬 Note from Doctor Luo: Liu Wei Di Huang Wan, Jin Gui Shen Qi Wan, Ba Wei Wan, Xiao Yao Wan, Bu Zhong Yi Qi Tang — these few patent medicines Doctor Xue Lizhai handled with total mastery. Let us follow him and learn this technique; once you have it, you will be able to use them with the same flair. Tomorrow, we continue with the story of how Doctor Xue Lizhai treated his patients.
Organized from Doctor Luo Dalun’s lecture on Doctor Xue Lizhai’s case records; the original case is from 《薛氏医案》 (Doctor Xue’s Case Records).