Shortness of Breath, Head Shaking, and Flailing Limbs After Anger? Doctor Xue Lizhai Strengthens the Spleen to Calm a Distraught Woman
Patient search terms: can’t catch breath after getting angry / phlegm surging upward / head shaking non-stop / arms and legs moving uncontrollably / yellow face with a green tinge / always ate very little
Medical terms for this condition: liver wood overwhelming spleen earth · spleen deficiency generating phlegm · liver qi stagnation · liver wind stirring internally
Opening: the illness struck suddenly and alarmingly
Today’s case comes from Doctor Xue Lizhai, the imperial physician of the Ming dynasty. The original record tells of a woman who was weak in the spleen and stomach and ate very little — her digestive system had never been strong, her appetite was tiny, and she was a person of fragile constitution. Then, all of a sudden, phlegm surged up and she panted — phlegm rushed upward and she could not stop gasping; her head shook and her eyes twitched — her head swayed without stopping and her eyes were squeezed shut; her hands and feet moved restlessly, her arms flailed about — her pulse could not even be taken, because she could not hold her hand still on the table long enough for a doctor to feel it.
💬 Note from Doctor Luo: Look how sudden and frightening this illness was — the patient was already wildly agitated. Doctor Xue had been the director of the Imperial Medical Academy and a personal physician to the emperor; later he resigned and returned to practice among ordinary people. That is why his case records include ministers and grand secretaries, but also many common folk — this one is an ordinary villager. Such cases were extremely common in the countryside of old China. By the way, nearly ten thousand friends listen to my case-record lectures every day — in ancient times that was simply impossible; a few dozen students in a private academy was already a lot. Thanks to the internet, Chinese medicine knowledge can now reach this many people, and I am deeply grateful. I hope every listener picks up something useful from these stories.
When you can’t take the pulse — observation comes to the rescue
How do you diagnose an illness when you cannot feel the pulse? Doctor Xue used observation — he looked at her complexion. There it was: the woman’s face was yellow tinged with green — a waxy yellow with a bluish-green cast inside it.
💬 Note from Doctor Luo: What is the yellow? Yellow is the color of the spleen. When a person’s spleen deficiency becomes severe, the face turns sallow. As we said, her spleen and stomach had always been weak and her appetite tiny; with spleen earth insufficient, of course the face turns yellow. And the green? Green is the color of the liver channel. When liver wood runs sideways and overwhelms spleen earth, you see yellow tinged with green — a yellow face with a faint greenish halo inside it. In some people the green shows around the bridge of the nose, in others around the mouth — either way, it is a sign of liver wood overwhelming spleen earth.
Where did the illness come from? — it was brought on by anger
At this point the root of the illness is clear: it came from anger. This woman had suffered an emotional blow — life was hard for rural women in old China: difficult in-law relationships, village gossip, grievances with no outlet. She swallowed a bellyful of suppressed rage, liver fire had nowhere to go, and liver qi ran sideways and bullied her already fragile spleen and stomach.
💬 Note from Doctor Luo: Why do I keep saying such cases were everywhere in the old countryside? Women were the vulnerable group; they were mistreated, their emotions ran high, and they had nowhere to vent. Liver wood sees the spleen and stomach weak — and comes over to bully them. When the spleen and stomach are weak and middle qi is insufficient, dampness grows heavy and phlegm increases — the phlegm surges up and she pants. Liver wind stirs internally, so the head shakes and the hands and feet flail. Every one of these symptoms traces back to deficiency of the spleen and stomach.
Doctor Xue’s prescription: Six Gentlemen Decoction plus bupleurum and cimicifuga
For such an acute illness, Doctor Xue used a remarkably simple strategy: Liu Jun Zi Tang (Six Gentlemen Decoction) plus chai hu (bupleurum) and sheng ma (cimicifuga) — and she recovered. The patient woke up, and her mind returned to normal. He then finished with Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction) plus ban xia (pinellia), and the illness was completely cured.
💬 Note from Doctor Luo: What is the Six Gentlemen Decoction? It is Si Jun Zi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), and gan cao (licorice), which tonify the spleen and qi — plus chen pi (tangerine peel) and ban xia (pinellia) to resolve phlegm. What was Doctor Xue aiming at? Insufficient upright qi. Why could liver qi run sideways and overwhelm spleen earth so ferociously? Because the spleen and stomach qi were insufficient. So first fill the spleen qi back up, add chen pi and ban xia to resolve phlegm, and the surging phlegm and panting are pressed down. Then add chai hu and sheng ma: one purpose is to lift the qi upward in the manner of Bu Zhong Yi Qi Tang, and the other is to regulate the qi — after all, the illness is connected with liver qi stagnation. And Bu Zhong Yi Qi Tang plus ban xia is even cleverer: tonifying qi and lifting it is the upward movement; ban xia resolves phlegm and sends qi downward — one rising, one falling. After that adjustment, the illness simply resolved.
The key idea: qi-regulating herbs consume qi and blood — when upright qi is deficient, don’t rush to soothe the liver
Doctor Luo says the essence of this case is read the complexion, tonify spleen earth — when liver wood overwhelms spleen earth, you tonify spleen earth. This is an extremely important principle for treating mental-emotional disorders and liver-qi-stagnation conditions.
💬 Note from Doctor Luo: Usually, the moment we hear “liver qi stagnation,” we think of soothing the liver and regulating the qi. But qi-regulating medicines tend to consume the body’s energy — for a medicine to dissolve and move through the body, it spends qi and blood. If you give such medicine to a person who is extremely weak, it does more harm than good. Take Jiao San Xian (the Three Charred Ingredients — hawthorn, medicated leaven, and radish seed), those digestion-promoting, appetite-opening herbs that are perfectly good in themselves — but when elderly people with severely deficient upright qi take them casually, the consequences can be serious: the upright qi cannot bear that kind of mobilization, and after a few days the spleen and stomach actually break down. So whenever you use wind-dispelling or liver-soothing medicines — anything that mobilizes qi and blood — the qi and blood must be sufficient. Think of it as an army: with strict discipline and full pay and provisions, you can move it wherever you like. But if provisions are short and pay is in arrears, and you still march it from the east to the west, then from the west to the east, that army will fall apart. That is why Doctor Xue’s case is a classic: he did not open with large doses of liver-soothing, mind-calming herbs at all. Instead he filled the spleen qi first, so that liver wood had nothing to bully; once the upright qi was restored, he added just a little qi-regulating, phlegm-resolving medicine, and slowly the patient moved back onto the right track.
This approach works especially well for children
Doctor Luo says that tonifying spleen earth is a particularly good strategy for children with emotional problems.
💬 Note from Doctor Luo: Today’s children carry enormous pressure, and a great many of them suffer liver qi stagnation. What to do? Tonify spleen earth — fill the spleen earth up, and once the upright qi is sufficient, the child can resist those negative emotions; his own energy field grows bigger and bigger, and gradually he keeps the bad moods in check. It works the same way for adults: people under intense pressure and chronic anxiety will always end up hurting their spleen and stomach. In fact, one of the major causes of modern spleen-stomach disease is precisely bad emotions producing liver wood overwhelming spleen earth. How do you fix it? Use only a tiny amount of liver-soothing medicine, and put the main strength into tonifying spleen earth. When spleen earth is full and the qi is sufficient, you will see the whole mood shift — when upright qi is deficient, everywhere you look seems full of misfortune and the sky is grey; once upright qi is sufficient, everywhere you look is bright and sunny, and the mood lifts on its own.
A bonus daily routine: Xiang Sha Liu Jun Wan with Eight Treasures Cake
What can you do at home for everyday care? Doctor Luo recommends a very practical combination.
💬 Note from Doctor Luo: You can try the patent medicine Xiang Sha Liu Jun Wan (Costusroot and Amomum Six Gentlemen Pill), combined with a bit of Ba Zhen Gao (Eight Treasures Cake) — made from shan yao (Chinese yam), lian zi (lotus seed), yi mi (Job’s tears), and qian shi (fox nut) — to build the spleen and stomach back up. Once the spleen and stomach are strong, the emotions begin to turn around. Modern gut research has found the same thing: spleen-tonifying herbs are, in effect, “nutrients” that help the beneficial bacteria in the gut microbiome grow; as the microbiome shifts in a healthy direction, a person’s mood changes too. Foreign researchers have discovered that the gut flora influences mood — and they cannot fully explain why. Our ancestors understood it perfectly well: it is the relationship between liver wood and spleen earth. The ancients had no microscopes and could not count how many bacteria live in the gut, but they found the pattern: the spleen and stomach, the emotions, and liver wood all influence one another.
Closing: emotions affect the spleen and stomach, and the spleen and stomach affect the emotions
The lesson of this case deserves to take root in your mind: remember that in situations like this — emotional problems affect the spleen and stomach, and the strength of the spleen and stomach in turn affects the emotions. So when anger or emotional stress produces physical symptoms, fixing the spleen and stomach first is often more effective than soothing the liver and regulating the qi alone.
💬 Note from Doctor Luo: We tend to reach instinctively for calming liver wind, settling the spirit, and soothing liver qi — but Doctor Xue went straight to tonifying spleen earth. This is not to say those other methods are wrong; it is that when you meet a person with insufficient upright qi, you must support the upright qi first — fill spleen earth up, then add a little qi-regulating medicine. That is the steady, safe road. Remember this idea, and tomorrow we will continue with Doctor Xue Lizhai’s case records.
Organized from Doctor Luo Dalun’s lecture explaining the case records of Doctor Xue Lizhai; the case comes from Records of Cases by Doctor Xue (《薛氏医案》).