Two Arms Aching and Skin Itching Like Bugs Crawling?

What the patient is searching for: pain in both arms / numb arms / skin feels like bugs crawling / itchy skin / white flakes when scratched / drooling / slurred speech / always feeling tired

What the doctor calls it: spleen qi deficiency · sinking of middle qi · qi deficiency fever · blood deficiency generating wind (after mistreatment, symptoms multiplied)

Pain in both arms. Skin so itchy it feels like little bugs crawling under it — scratch, and a layer of white flakes comes off. Slurred speech, drooling at the corner of the mouth, dizzy and exhausted all day… Look at each of these separately, and every one is a baffling complaint that a hospital visit may never explain. But in the hands of the Ming-dynasty imperial physician Doctor Xue Lizhai, they were all strung together by a single thread — the root was the spleen and stomach.

💬 Note from Doctor Luo: This is why I keep telling you to read case records. Look at each symptom on its own — the itchy skin never heals, the arm pain never heals, they’re all stubborn disorders. But if you treat the body as one whole and connect these symptoms to a weak spleen and stomach, the logic suddenly opens up. Doctor Xue’s case here is a textbook example.

Who Was the Patient? An Old Relative of the Imperial Physician, and a Devoted Drinker

Doctor Xue Lizhai served as director of the Imperial Medical Academy in the Ming dynasty, born into a family of imperial physicians, a man of the highest medical ethics. After heading the academy for a time, he actually resigned and returned to the people, treating common folk. In his lifetime he left behind more than three thousand case records — one of the largest collections of medical cases left by any physician in ancient China.

Today’s patient was a relative — his wai jiu, an uncle on his mother’s side, past sixty years of age.

💬 Note from Doctor Luo: Doctor Xue had a distinctive way of practicing: his medicines were extremely gentle. No violent herbs — just a few simple formulas adjusted back and forth, yet he cured a great many diseases. We’ve now worked through most of his cases, and you should have a deep impression of these formulas: Buzhong Yiqi Tang, Liuwei Dihuang Wan, Guifu Dihuang Wan, Jisheng Shenqi Wan, Xiao Yao San — what symptoms call for which, and how to use them. This is worth studying carefully — because modern lives resemble those of pampered palace residents: we eat well and move little, so our diseases are quite similar to theirs.

The old uncle had a habit: su shan yin — he loved his wine, never going a lifetime without it. And as he drank on and on, his body began to fail.

💬 Note from Doctor Luo: Notice how Doctor Xue always reads the person first. The scholar in the previous case was described as “su qin ku” — worn out by hard, wearying labor. Today’s patient is “su shan yin” — his disease was brewed by decades of daily drinking. Different habits, different routes into illness — but both wound up injuring the spleen and stomach.

How Bad Was It? First the Arm Pain — Then Treatment Made Everything Worse

It began as liang bi zuo tong — pain in both arms, around the shoulders. This is extremely common today too; plenty of people have it. He decided for himself: must be wind. So he kept taking wind-dispelling, sinew-strengthening medicines — formulas to expel wind, unblock the channels and fortify the bones and sinews.

The result? Not better — worse. A whole crowd of symptoms burst out at once:

Numbness — the arms went numb (remember the earlier case where Doctor Xue treated “numbness in both arms”? Numbness points to qi deficiency);
Fever — waves of heat over the body;
Weak body, phlegm surging — no strength, phlegm constantly welling up;
Cramping pain in legs and knees — the legs and knees cramped and ached;
Tight mouth, slurred speech — the mouth pulled slightly crooked, words came out thick and tangled;
Dizzy, heavy head — the head felt foggy and heavy all day;
Drooling — saliva trickled from the corner of the mouth;
Skin crawling — an itching, creeping sensation as if bugs were moving under the skin;
White flakes on scratching — scratch, and a layer of white flakes rose on the skin.

💬 Note from Doctor Luo: Look at this long string of symptoms — from arms to legs, from the mouth to the skin, nothing seems right. But Doctor Xue saw it at once: this was never a wind problem. Those wind-dispelling, channel-unblocking medicines had pushed the man off course — the more wind was dispelled, the more upright qi was damaged, and the more symptoms appeared.

Doctor Xue’s Reasoning: The Most Crucial Line in the Whole Case — “The Spleen Has Lost Its Function”

The relative was in this state, so of course they hurried to Doctor Xue. He explained it first, line by line:

Why numb arms and a weak body? “Pi wu yong ye” — “the spleen has lost its function.” Chinese medicine holds that the spleen governs the four limbs — problems in the limbs should always make you think of the spleen. When spleen qi is weak, qi and blood cannot circulate, so the arms go numb; when the weak spleen cannot absorb nutrients and supply qi and blood to the whole body, a person feels drained of strength.

Why the drooling? “Pi bu neng she” — “the spleen cannot control.” Normally, spleen qi holds and governs the movement of fluids in the body. When the spleen is deficient it loses that grip, and fluids simply leak out — edema, urinary incontinence, drooling in sleep are all signs of spleen deficiency. When an adult is deficient to a certain point, saliva trickles from the corner of the mouth too.

Why the crooked mouth and slurred speech? The qi of the spleen and stomach has been injured. The stomach channel runs upward across the face, so problems like a crooked mouth and eye are usually treated by regulating the spleen and stomach — notice that when acupuncture treats facial paralysis, it needled the spleen and stomach channels.

Why the dizzy, heavy head? “Pi qi bu neng sheng ye” — “the spleen qi cannot lift.” Spleen qi fails to send the clear upward; energy cannot rise, qi and blood are insufficient, and the brain goes dizzy.

Why the itching and white flakes? “Pi qi bu neng ying ye” — “the spleen qi cannot fill.” Strictly speaking, the nutritive and defensive qi both originate from the middle burner — the spleen and stomach absorb nutrients from food, only then is body fluid sufficient and nutritive blood full. When nutritive blood is insufficient and cannot nourish the body, the skin dries and itches. Some might think: shouldn’t we then nourish yin and blood? But where does yin blood come from? Still the spleen and stomach! It is the spleen and stomach that absorb nutrients and produce yin blood.

💬 Note from Doctor Luo: This last point matters enormously. Every autumn, many elderly people itch all over, as if bugs were crawling under the skin; scratch and white flakes appear. They go to a dermatologist, who tells them to nourish the blood and dispel wind — and the medicines don’t help. Why? Because the root is the spleen and stomach — when the spleen is deficient, nutritive blood is deficient, and blood deficiency generates wind. “When the blood moves, the wind dies out on its own” — but where does blood come from? The spleen and stomach! If you don’t fortify the spleen and only treat the skin, it will never heal.

The Prescription: Buzhong Yiqi Tang Again — With Three Herbs Added

How to treat it? Doctor Xue stayed on his usual track — fortify the spleen. He used Li Dongyuan’s Buzhong Yiqi Tang, but added three herbs: Shenqu (medicated leaven), Banxia (pinellia), and Fuling (poria).

Why these three? Because this man’s root problem was drinking. A wine drinker’s body almost always harbors damp-heat and heavy dampness: Shenqu opens up the spleen and stomach and stimulates appetite; Banxia harmonizes the stomach and transforms phlegm; Fuling drains dampness and strengthens the spleen.

💬 Note from Doctor Luo: This is the difference between a master and a mediocre doctor. The mediocre doctor sees arm pain and dispels wind and unblocks channels — the more he treats, the more deficient the patient grows. Doctor Xue looked at the person — this man had drunk for decades, his spleen had long been wounded through. So Buzhong Yiqi Tang formed the base, and three herbs cleared the dampness. The formula was still the same simple one, but the adjustments were pure craft.

Thirty-Plus Doses, All Symptoms Receded; One More Paste, and It Was Done

How did it turn out? After thirty-odd doses, all symptoms gradually receded. Finally, a paste of ginseng (ren shen) and atractylodes (bai zhu) was prepared to slowly nourish the spleen qi. Once the spleen qi was sufficient, once upright qi was sufficient, the illness was completely resolved.

💬 Note from Doctor Luo: Notice an easily overlooked symptom in this case — fever. Doctor Xue didn’t explain it at length, but this is qi deficiency fever. Li Dongyuan wrote about it specifically: severely qi-deficient people can run a fever; when the spleen and stomach are weak to a certain degree, heat appears. It’s real — such people exist in everyday life; when they’re very deficient, they run waves of fever. Buzhong Yiqi Tang is the formula made precisely for qi deficiency fever.

Bonus One: Phlegm Is Not Necessarily Real Fire

There was a great deal of phlegm in this case. Today, countless people have phlegm every day — especially that first mouthful in the throat each morning.

The root of substantial phlegm (the phlegm you cough up) is the insubstantial phlegm inside the body — thick, sticky waste fluids that cannot be excreted, seeping out through the orifices as substantial phlegm. So when substantial phlegm appears, it’s likely that insubstantial phlegm is abundant within too. And when you see phlegm, don’t automatically assume excess heat and clear heat and transform phlegm — deficiency states also produce phlegm: spleen deficiency produces phlegm, and so does insufficient kidney qi. When the spleen is weak, dampness accumulates and condenses into phlegm, which rides on qi and blood to every corner; when spleen qi is too weak to hold things, phlegm and saliva even leak out on their own.

💬 Note from Doctor Luo: So remember: phlegm is not always an excess pattern — very often it’s a deficiency pattern. This old uncle’s phlegm came from spleen deficiency. Doctor Xue used Banxia and Fuling to transform phlegm and drain dampness, while Buzhong Yiqi Tang rebuilt the spleen — the phlegm was treated, but the root was nourished.

Bonus Two: Beauty and Itchy Skin Both Come Back to the Spleen and Stomach

This case opens up two big topics.

First: facial problems should be treated through the spleen and stomach. The stomach channel rises to the face. When spleen and stomach qi are sufficient, qi and blood rise to the face, and the complexion is rosy and lustrous. So for women working on their skin and complexion, everything finally lands on the spleen and stomach — nourish them well, and the face naturally looks well.

Second: the crawling sensation and white flakes. Many elderly people have this feeling and assume it’s just aging skin. Doctor Xue tells us: it’s the spleen qi failing to fill the nutritive blood, the nutritive blood failing to nourish the skin — blood deficiency generating wind. Before nourishing the blood, ask yourself: where does blood come from? Blood is transformed from the nutrients the spleen and stomach absorb from food. The moment spleen qi is deficient, blood is insufficient and body fluid cannot moisten the skin — so treating the root means fortifying the spleen and stomach.

Closing: Why Are So Many of Us Now “Sinking of Middle Qi”?

Doctor Xue’s case is done, and Doctor Luo Dalun has a reflection to share:

💬 Note from Doctor Luo: Modern people have too many ways to injure spleen qi — not just wine, but rich fatty foods, overtime and exhaustion, irregular meals. So people with weak spleen qi and sinking of middle qi are everywhere. And the symptoms of spleen deficiency are scattered far and wide: arm pain, itchy skin, drooling, dizziness, constant phlegm… Take any one alone and it can plague you for years; the hospital finds nothing, and it becomes a “baffling complaint.” But once you’ve read Doctor Xue’s cases, you understand: behind all these symptoms may lie the same root — a weak spleen and stomach. The most important thing in studying Chinese medicine is building holistic thinking: the body is one whole — when one organ fails, what changes appear on the outside? Master these patterns and you too can become skilled.

Compiled from Doctor Luo Dalun’s lectures on Doctor Xue Lizhai’s medical cases; the source is The Medical Cases of Doctor Xue (《薛氏医案》).

📋 Case Details