Sudden Dizziness and Collapse, Phlegm Surging, Numb Limbs?
Patient search terms: sudden dizziness / dizzy spell and fall / fainting / excess phlegm / numb hands and feet / dry mouth / flare-ups after exertion
Medical terms: kidney deficiency vertigo · kidney essence deficiency · spleen and kidney dual deficiency · deficiency fire flaring upward (false excess from true deficiency)
Opening: a big man crashes to the ground with a thud
Today’s physician is once again Doctor Xue Lizhai, head of the Imperial Academy of Medicine in the Ming dynasty — his personal name was Ji, courtesy name Xinfu, style name Lizhai. He came from a family of imperial physicians, saw an extraordinary number of patients in his lifetime, and left behind more than three thousand case records — one of the most prolific case-writers in the history of Chinese medicine. This particular case makes your heart skip a beat from the first line: a scholar is walking along, his head suddenly spins, and he crashes to the ground with a thud. Right after, phlegm comes gushing up in waves, and his hands and feet go numb — he cannot move. Who wouldn’t panic at a scene like that?
💬 Note from Doctor Luo: That fall was no small thing — in Cantonese slang, he had just “puk gai” (hit the pavement). Walk out the door, and boom, you’re on the ground — a disaster out of nowhere. Worse still, the man is down, phlegm surging upward, hands numb, feet numb, mouth so dry he longs for water. Then the pulse: large and deficient in all six positions — the pulse beats big and fast, as if full of force, but underneath it is truly empty. This is an extremely dangerous situation.
Who was the patient? A stout scholar whose two weaknesses were drink and pleasure
The scholar’s surname was Liu, Liu Yungong. Doctor Xue had a habit in his case notes — he described the person’s appearance first: stout and tall, big and heavy, and fat.
💬 Note from Doctor Luo: Notice how Doctor Xue Lizhai always looks at the body build first — just like Doctor Zhu Danxi! So much of Chinese medicine’s experience and theory is passed down this way: one physician summarizes, later physicians learn it, and the knowledge accumulates. So here’s the question: does being big, tall, and fat mean the condition must be excess? Not necessarily. Many big, tall, heavy people are actually deficient. Our “form” and our “qi” do not always match. Normally the ratio of form to qi is balanced — qi is able to drive the form, no problem. But some people have weak qi and a large form — the qi cannot drive the body — rather like a little horse pulling a big cart. So the moment you read “stout and tall in build,” you have to weigh both the excess and the deficiency possibilities.
Then Doctor Xue wrote four unsparing words: careless in drink and pleasure — fond of alcohol, a little loose with restraint, and unable to hold himself back when it came to women.
💬 Note from Doctor Luo: This is almost exactly like the patients Doctor Zhu Danxi treated! The moment the lifestyle is written down, you can guess the illness — drink brings damp-heat into the body and injures the spleen and stomach; pleasure injures the kidney essence. Lifestyle is the root of disease. The same is true for people today: drinkers, pleasure-seekers, and the overworked are everywhere.
Where was the root? A burst of labor and anger sent deficiency fire and phlegm rushing up together
So what triggered this attack? The original text gives four characters: yin lao nu — “lao” means exhaustion, extreme tiredness; “nu” means anger. The illness erupted after overwork combined with a violent fit of anger.
💬 Note from Doctor Luo: Remember these two words, “labor and anger” — they are crucial. Labor injures spleen qi — when you push yourself too hard, the spleen and stomach are hurt; anger injures the liver, and when liver fire flares up it attacks the spleen-earth — so the spleen and stomach are hurt again. On top of that, his drinking had already injured the spleen and stomach, and his indulgence had injured the kidney essence. Spleen and kidney deficiency had been planted long ago. This bout of labor and anger was the last straw that broke the camel’s back — deficiency fire, carrying phlegm with it, rushed upward, and the man collapsed.
Doctor Xue’s judgment was crystal clear: the kidney channel was exhausted and could no longer gather qi back to its source. When kidney qi is insufficient, it cannot restrain and gather the qi movement; qi floats to the surface, and a person gets dizzy. Deficiency fire rushes upward, charging into the head and eyes, and the dizziness becomes even worse.
💬 Note from Doctor Luo: This situation is extremely common today — especially in older people. When the body’s upright qi starts on its downward slope, and the person still doesn’t practice restraint, draining the kidneys with excessive desire — disaster can strike in an instant. Some elderly men collapse suddenly during intercourse; we call it “ma shang feng” (the wind that strikes from the saddle). Some elderly people with exhausted kidney channels walk along, thud, hit the ground, and something serious has happened. When the kidney channel is deficient and cannot gather qi back to its source, deficiency fire rushes upward, and the upper burner fails first — dizziness.
Why the surging phlegm? Why the numb hands? Kidney deficiency plus spleen deficiency, one link after another
The patient had phlegm surging up, numb hands and feet, dry mouth, and dry gritty eyes. Doctor Xue took these symptoms apart one by one and explained how each was linked to the next:
First, where did the phlegm come from? The kidney channel was deficient and could no longer govern water. The kidneys oversee the transformation of body fluids. When the kidneys are weak, fluids are no longer metabolized and returned to their source; they spread uncontrolled through the body, become damp-pathogen, and overflow as phlegm — hence the phlegm gushing up in waves.
Second, why numb hands and feet? Yang qi was weak — more precisely, spleen qi was weak. The spleen governs the four limbs. When spleen yang is insufficient, qi cannot push blood to the ends of the limbs; qi and blood get blocked and cannot get through, and the arms go numb.
Third, why dry mouth and gritty eyes? The kidney channel was deficient — what was deficient was the “essence” (jing). When kidney essence is insufficient, kidney yin follows and is also insufficient. Water can no longer contain fire, water and fire cannot support each other, and deficiency fire flares up — the fire sits up top, so the mouth is dry, the throat is dry, and the person keeps wanting to drink.
💬 Note from Doctor Luo: Look at the whole picture: this man’s root problem is kidney deficiency above all — kidney deficiency fails to gather qi back to its source → dizziness; kidney deficiency fails to govern water → water overflows as phlegm; kidney deficiency, water failing to contain fire → deficiency fire flares upward and the mouth dries; plus spleen deficiency → dampness congeals into phlegm and the four limbs go numb. Cross-check the three angles — his personality, the trigger of the attack, and the symptoms — and you’ve basically located the problem: first, kidney deficiency, leaning toward kidney-yin insufficiency; second, spleen deficiency. So the prescription Doctor Xue wrote revolved around the spleen and kidneys, the two organs together.
The prescription: Liuwei Dihuang Wan paired with Buzhong Yiqi Tang — tonify the kidney and the spleen at the same time
What did Doctor Xue prescribe? Liuwei Wan liao — that is, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) — plus Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). The two formulas were used together, and the patient recovered.
💬 Note from Doctor Luo: Why Buzhong Yiqi Tang? Because this man’s spleen was weak too: drinking injured the spleen and stomach, overwork injured spleen qi, and a fit of anger let liver fire attack the spleen-earth. With the spleen weak, dampness spread and congealed into phlegm, and the four limbs got no nourishment of qi and blood. Buzhong Yiqi Tang tonifies spleen qi and raises the yang qi. Why Liuwei Dihuang Wan? Because the kidney deficiency was the main problem — it tonifies kidney yin and brings deficiency fire down. Once kidney water is sufficient, the deficiency fire naturally descends, and both the dizziness and the dry mouth are resolved. Tonify the spleen on one side and the kidney on the other — spleen yang and kidney yin gradually heal together.
There is a particular art to using these two formulas together. Doctor Xue wrote “two preparations” — two formulas, and they were usually taken separately: one in the morning, one in the evening, timed to the hours and to the flow of qi and blood through the meridians (the zi-wu liu zhu, the midnight-noon ebb-flow) — different medicines used to adjust the body at different times.
💬 Note from Doctor Luo: This “one in the morning, one at night” pattern was something Doctor Xue Lizhai, Doctor Ye Tianshi, and physicians of that caliber took very seriously — in the morning yang qi rises, so use Buzhong Yiqi Tang to raise the yang; at nightfall yin takes its turn, so use Liuwei Dihuang Wan to nourish yin. One tonifies the spleen and raises yang, the other tonifies the kidney and nourishes yin — spleen yang and kidney yin are both cultivated, and in this way you establish a rhythm of yin and yang, and the body slowly recovers. I’ve received tens of thousands of messages on social media — so many people say, “I’ve walked through hospitals for six or seven years, five or six years, no treatment worked, the more I treated the worse I got, I can barely move.” Patients like that have tried both Chinese and Western medicine without success, and I teach them a very simple self-care method: take Buzhong Yiqi Wan in the morning — daybreak, yang rising, help lift your yang qi; take Jiawei Xiaoyao Wan (Augmented Free and Easy Powder) at noon — to soothe the liver and settle the emotions; take Liuwei Dihuang Wan in the evening — night falling, let yin qi fill up, nourish yin and support the kidneys. If the yang deficiency is obvious, at night you can take Jingui Shenqi Wan (Kidney Qi Pill, also called Guifu Dihuang Wan) instead. Judge according to your own cold-heat condition. Many friends persisted for a month or two and truly felt their strength return, slowly climbing out of that low, depleted state — and if they also practiced standing meditation (zhan zhuang), walked outdoors every day, regulated their emotions, and ate properly, many of them really recovered.
The illness was cured — but Doctor Xue insisted on adding one more line
The illness was cured — but the case did not end there. Doctor Xue appended a sentence: qi hou huo lao yi, huo ru fang, qi bing ji zuo; yong qian yao sui yu — from that time on, whenever he was especially exhausted, or whenever he had intercourse, the illness flared up immediately; and each time it flared, the same medicine cured it again.
💬 Note from Doctor Luo: Why did Doctor Xue make a point of writing that sentence? He was telling us: some illnesses are hard to cure. The treatment method is laid out here, and the origin of the disease is written clearly — but some people, the moment they feel better, forget they were ever sick. They don’t keep taking the medicine, and they don’t change their habits. Think about it: the disease was made by the lifestyle — drink, pleasure, overwork. If the lifestyle doesn’t change, medicine can only solve part of the problem. In this case, the two characters “drink and pleasure” ruined him: Doctor Xue brought him most of the way back, but the man still had to “challenge himself” — a little overwork, one night of intercourse, and the illness flared again, repeatedly testing the power of the medicine and the reserves of his body. What does this show? Some things truly have to be nurtured. You know your own body’s state; taking medicine does not automatically fill your body back up to full. Medicinal tonics are only one part — your own care and restraint are the most crucial part. If you don’t practice restraint, you’re tonifying the kidneys on one side while draining them with excessive desire on the other — the loss still outweighs the gain.
Bonus: even the imperial physician could not cure the emperor’s “recklessness”
Why did Doctor Xue understand “restraint” so deeply? Because he had served the emperor.
💬 Note from Doctor Luo: Doctor Xue treated the emperor — yet the emperor still died young. Why? Because he was reckless! The emperor set up his famous “Leopard House,” filling it with beautiful women — beauties from the Western Regions, from Korea, all gathered in. Do you think he could live long? Doctor Xue treated him and recorded that he exhausted himself completely in the process. A doctor can write a prescription and treat your illness — but your own life must be cherished and maintained by you. That one extra line Doctor Xue wrote — “thereafter, whenever he overworked or had intercourse, the illness returned” — carries deep meaning; it was not written idly. Medicine can only correct your symptoms for a time; looking after your body is up to you: restraint, adjustment, exercise, and a settled mind — none of these can be omitted. Never think, “As long as I have my medicine, I’m fine.” That doesn’t work.
Conclusion: the kidneys govern the bones and produce marrow; the brain is the sea of marrow — begin your care early
From this case, we learn Doctor Xue’s classic strategy of combining Buzhong Yiqi Tang with Liuwei Dihuang Wan: treating spleen deficiency and kidney deficiency together. What is the basis? Kidney essence is depleted — the kidneys govern the bones and produce marrow, and the brain is the sea of marrow. When the kidneys are depleted, the sea of marrow empties; add deficiency fire rising, and a person becomes vertiginous. Numb hands and feet and surging phlegm are the evidence of spleen deficiency. With the two formulas combined, the man was restored. But after the restoration? Care is even more important — that is the real message this case is trying to deliver.
💬 Note from Doctor Luo: The people of Doctor Xue’s era drank, indulged, and overworked — exactly the same problems people face today. Our economy now runs at breakneck speed, and many people are overworked, perpetually at banquets and social obligations. The wisdom of health preservation and self-regulation that the ancients left us deserves serious study today. A perilous condition like collapsing with sudden dizziness is very often rooted in the spleen and kidneys being drained by drink, pleasure, and overwork. Medicine can rescue the emergency — but the days are yours to live. When your body needs nurturing, do not “challenge yourself.”
Organized from Doctor Luo Dalun’s lecture on Doctor Xue Lizhai’s cases. Source: Records of Cases by Doctor Xue (《薛氏医案》, by Xue Ji, Ming dynasty).