Numb Arms, Constant Phlegm, Watery Eyes?
Patient search terms: numb arms / arm numbness / arms going numb / too much phlegm / always have phlegm / watery eyes in the wind / eyes tearing / fingers cramping
Medical terms: excess of phlegm-dampness (phlegm from spleen deficiency) · liver-kidney yin deficiency · yin deficiency with fire (liver fire generating wind)
Opening: three complaints that an awful lot of people carry around
Today we continue with the story of how Doctor Xue Lizhai (薛立斋) treated his patients. Doctor Xue Lizhai was the director of the Imperial Academy of Medicine (tai yi yuan yuan zhang) in the Ming dynasty, born into a family of imperial physicians, with a very high level of skill. In his lifetime he left behind more than three thousand case records — a treasure house of material. Among those three thousand cases, many are “strange diseases” — but call them strange if you like; think about them carefully, and you will find that we still run into them all the time in everyday life. So listening to these cases can be very illuminating.
💬 Note from Doctor Luo: Today’s case is perfect for “finding yourself in the story”: people who always have phlegm, people whose two arms go numb, people whose eyes constantly water — these three complaints are incredibly common around us, and many people have struggled with them for years without ever understanding why. Listen to today’s case and you will understand.
Who was the patient? Liu Mengchun the dayin, who had always had phlegm
The patient in this case was named Liu Mengchun, and his title was dayin (大尹) — a term for a local official of the time. His first problem was that he habitually had phlegm (su you tan): he always had phlegm in his throat, and especially in the morning, when he woke up, there was first that mouthful of phlegm.
💬 Note from Doctor Luo: Do you see? Just those three characters — “habitually had phlegm” — match an enormous number of people. Some people are always coughing up phlegm; they wake in the morning with phlegm, and this has gone on for years without ever being resolved. So why does phlegm form? There is a great deal to analyze here, and we will get into it.
His two arms went numb, and his eyes constantly watered
Besides the phlegm, Liu Mengchun had two more symptoms. The second: liang bi zuo ma — both arms went numb. This too is something a great many people experience: you did not lie on it, you did not bump it — why should both arms just go numb? The third: liang mu liu lei — both eyes constantly teared, and the tearing was even more obvious when the wind blew.
💬 Note from Doctor Luo: Numb arms and watering eyes — what is that about? Let us set that aside for a moment; Doctor Xue Lizhai will analyze it for us shortly. Just remember these two symptoms, and in a little while you will see how important they were.
What the previous doctor did: dispel wind, transform phlegm — and it only got worse
At first, Liu Mengchun consulted another doctor. The doctor looked at him and thought: there is phlegm, so transform the phlegm; the two arms are numb, so the channels must be blocked — wind must have entered the channels — so dispel the wind. And so he prescribed wind-dispelling and phlegm-transforming herbs (qu feng hua tan zhi yao). On the face of it, that reasoning sounded perfectly on-target; the doctor probably felt confident. But what happened?
💬 Note from Doctor Luo: Everyone, mark this — it is the part of the whole case most worth pondering. It looked like the right approach, yet after taking the phlegm-transforming herbs, the phlegm only got worse; and after taking the wind-dispelling herbs, not only did the arms stay numb, they became painful and could not straighten (teng de shen bu zhi) — even his fingers cramped up (shou zhi dou juan luan)! The more he treated, the worse the disease became, and only then, with no other recourse, did he come to Doctor Xue Lizhai.
Doctor Xue Lizhai’s one-sentence diagnosis: numbness is qi deficiency!
How did Doctor Xue Lizhai judge it at a glance? He said: ma shu qi xu — numbness is qi deficiency. Why do the two arms go numb? Because the qi is deficient. Everyone, remember this sentence: numbness is qi deficiency.
💬 Note from Doctor Luo: Note that Doctor Zhu Danxi made very similar statements when he treated patients — when he met people with numb arms, he also worked from qi deficiency and blood deficiency, asking which was more prominent. In the end, Doctor Xue Lizhai and Doctor Zhu Danxi — a great deal of their scholarly thinking converges: when you keep treating patients, you discover that these symptoms are caused by these patterns, and eventually a settled conclusion emerges. Where did the previous doctor go wrong? He treated the disease as an excess pattern. If it had truly been excess, the wind-dispelling, phlegm-transforming herbs should have brought improvement; instead the condition worsened — which tells you the man’s body was deficient.
Why did the earlier medicine make things worse? Wind arises from fire; when fire blazes, the sinews cramp
Doctor Xue Lizhai analyzed further: because the previous medicine wounded the liver (yin qian yao er fu shang gan). Wind-dispelling and phlegm-transforming herbs tend to be warm and drying (wen zao) — and what do warm, drying herbs damage? They damage the yin and blood. When the yin and blood are injured, the first thing affected is the liver yin; when the liver yin is insufficient, liver fire flares up; and when fire blazes, the sinews cramp. Why? Because the liver governs the sinews (gan zhu jin) — when the yin and blood can no longer moisten and nourish the sinews and channels, the sinews hurt and go into spasm. So his painful arms and cramped fingers were entirely sinew problems — injuries inflicted by those warm, drying herbs.
💬 Note from Doctor Luo: Doctor Xue Lizhai also said four characters: feng zi huo chu — wind arises from fire. When you are yin-deficient with deficiency fire, the fiercer the deficiency fire, the more severely the yin fluids are damaged, the drier the heat grows, and eventually wind is generated. So this “wind” does not come from wind-pathogen blowing in from outside — its root is the deficiency fire inside the body. Remember: wind arises from fire — this is one of Doctor Xue Lizhai’s most important insights.
The treatment: tonify the spleen and lungs, enrich the kidney water — wind dies out, heat retreats, phlegm clears itself
So how to treat it? Doctor Xue Lizhai’s thinking is very clear: one should tonify the spleen and lungs (dang bu pi fei). Why tonify the spleen? Because this man’s copious phlegm came from insufficiency of upright qi and weakness of the spleen and stomach — when the spleen is deficient, water-dampness overflows and congeals into phlegm, and the person coughs up phlegm. Tonify the spleen qi fully, the phlegm-dampness dissolves, and the phlegm naturally disappears. At the same time, he was now deficient in yin fluids, so one should enrich the kidney water (zi shen shui) — enrich the kidney water fully, the yin and blood become sufficient, the wind naturally extinguishes, the heat naturally retreats, and the phlegm naturally clears.
💬 Note from Doctor Luo: Pay attention to one detail: Doctor Xue Lizhai said “enrich the kidney water,” but in some editions this is written “enrich the kidney fire” — that is a mistake. Look at the character “zi (滋)” in “enrich”: it has the three-dot water radical on the left, so of course what you enrich is water; and, judging from the prescription, the medicines used were also kidney-water-nourishing herbs, not kidney-fire ones. So when you read old books and copy old formulas, you cannot be careless with even a single character.
The prescription: Liu Wei Di Huang Wan with Bu Zhong Yi Qi Tang — cured in under three months
What formulas did he use? Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) — and in under three months, the disease was cured. Some editions say he used Liu Wei Di Huang Wan first and Bu Zhong Yi Qi Tang afterward — and that also makes good sense: the urgent problem at the time was cramped sinews and deficient yin fluids, so Liu Wei Di Huang Wan was given first to enrich the kidney water, making the yin and blood sufficient and releasing the cramping; then Bu Zhong Yi Qi Tang was given to tonify the spleen and stomach and gradually dissolve the phlegm-dampness. First this, then that — the thinking is crystal clear.
💬 Note from Doctor Luo: Why use Liu Wei Di Huang Wan even when phlegm is abundant? Because the fiercer the fire, the more easily dampness is “refined” into phlegm. First supplement the yin and bring the fire down, then tonify the spleen and transform phlegm — one step at a time. All in all, under three months of medicine and the disease was cured. Is this treatment not a classic? The formulas are very simple, but every step has its reasoning.
Doctor Luo’s key discussion: yin deficiency and phlegm-dampness at the same time — isn’t that a contradiction?
At this point many friends will ask: you say his spleen was deficient with heavy dampness and lots of phlegm — that means there was plenty of water in his body. How can he also be yin-deficient? Doesn’t yin deficiency mean insufficient yin fluids? If his fluids were insufficient, how could there be water-dampness? Aren’t the two contradictory?
💬 Note from Doctor Luo: Everyone, these two belong to different levels — you must understand that. The water that makes up the phlegm-dampness is water the body cannot use: it has already turned into pathogenic qi, stored up inside the body, a waste product. The yin deficiency, by contrast, is a shortage of the fluids and blood the body can use. Why did the body turn water into waste instead of fluids? Because of spleen deficiency — the qi-transformation function is impaired, the internal organs are not running properly, the water and fluids one drinks cannot be transformed into usable fluids and blood; instead they stay behind and overflow, becoming water-dampness. So the two can absolutely coexist. Take this Liu Mengchun: he already had a yin-deficient foundation (the constant tearing of his eyes is the evidence), and on top of that he had spleen deficiency with exuberant phlegm — qi-yin dual deficiency, tangled and complicated. And this is extremely common in daily life — no disease is ever born exactly according to the textbook. It is not that one patient is purely yin-deficient and the next purely spleen-deficient; they are usually mixed together. So what do you do? Untie the knots one by one: first enrich the kidney water to treat the urgent cramping, then tonify the spleen and transform phlegm to treat the root.
What watery eyes in the wind teach us: the liver opens into the eyes — tearing is a warning sign of liver-kidney yin deficiency
Look back now at that unremarkable symptom from the start — the tearing of both eyes. Doctor Xue Lizhai said that this man’s tearing was already exposing a sign of liver-kidney yin deficiency: the liver opens into the eyes (gan kai qiao yu mu), and kidney yin deficiency and liver yin deficiency are linked together. When the liver-kidney yin is insufficient, the eyes are usually dry — and yet when the wind blows, they tear.
💬 Note from Doctor Luo: So you see, a physician should have this in mind: the moment he sees a patient whose eyes tear constantly, he should know what kind of foundation that person has. But the previous doctor did not handle it that way — the moment he saw phlegm he transformed phlegm, the moment he saw numb arms he dispelled wind. His thinking was far too simple: he had heard of the disease, so he applied one concept and treated it, without ever looking at the person in front of him. That is a cardinal error in seeing patients. Look at the person, not just the disease — that is the first lesson Doctor Xue Lizhai’s case records teach us.
Why are Doctor Xue Lizhai’s cases worth studying? Three thousand cases, and only a handful of formulas
Finally, a word about the man himself: in his three thousand-plus case records, the medicines he used are actually just a few classic formulas — Liu Wei Di Huang Wan, Jin Gui Shen Qi Wan (Gui Fu Di Huang Wan, Cinnamon and Aconite Rehmannia Pill), Bu Zhong Yi Qi Tang, Xiao Yao Wan (Free and Easy Pill), and so on. Each formula represents one line of thinking, and with additions and subtractions he handled nearly every disease he met. Like a martial-arts master at the peak of his craft: only a few moves, yet endlessly varied — and capable of defeating most opponents.
💬 Note from Doctor Luo: Doctor Xue Lizhai’s cases are especially authentic and especially detailed — after all, who was he? Director of the Imperial Academy of Medicine, physician to the emperor himself. Case records could not be carelessly fabricated; every official title and every name in them is a real person. So I have always felt that if someone with genuine dedication would take Doctor Xue Lizhai’s case records and use a computer to tabulate every symptom, every pattern, and every diagnostic clue — when that work was finished, it would be an enormous contribution to the study of Liu Wei Di Huang Wan, Jin Gui Shen Qi Wan, Gui Fu Di Huang Wan, Bu Zhong Yi Qi Tang, and Xiao Yao Wan: the indications would expand greatly, and we could find extremely precise diagnostic criteria. Several of his cases I have not gone into in detail — his stroke cases, for instance, also used the spleen-tonifying approach: Bu Zhong Yi Qi Tang, Si Jun Zi Tang, and so on, with slight modifications, and the stroke was regulated and cured. For ordinary people this is wonderful — Liu Wei Di Huang Wan is available in the pharmacy, Bu Zhong Yi Qi Wan is available in the pharmacy; master Doctor Xue Lizhai’s methods and the general patterns, and you can resolve many of the problems around you.
Closing: this case tells us — numb arms, watery eyes, phlegm: first distinguish deficiency from excess
Today we told the case of dayin Liu Mengchun: habitual phlegm, numbness of both arms, tearing of both eyes, and later painful arms with cramped fingers — these symptoms are found on a great many people. After listening, you can compare yourself and analyze on your own: is your problem deficiency or excess? How should you regulate it?
💬 Note from Doctor Luo: The more you listen, the more you will find that Doctor Xue Lizhai’s few formulas gradually become yours, and you will basically be able to analyze the conditions around you. Even the small ready-made patent medicines carry great power — Doctor Xue Lizhai is the model of this. 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).