Dizzy with Constant Phlegm — Must You Always Attack the Phlegm?
Patient’s search terms: dizziness / spitting phlegm / too much phlegm / dizziness with phlegm / resolving phlegm doesn’t work / kidney deficiency / kidney weakness
Medical terms: kidney deficiency · kidney failing to receive qi · water overflowing into phlegm · internal obstruction of phlegm-dampness · deficiency pattern
Opening: the same illness, the same pill — one man lived, one man died
Two men fell ill with exactly the same symptoms — dizziness and constant spitting of phlegm. Both took exactly the same medicine, Suhexiang Wan (Storax Pill). One survived. The other died. This is not a made-up story; it is a true case that Doctor Xue Lizhai, director of the Imperial Academy of Medicine in the Ming dynasty, recorded in his case books. And when he told it, he added a follow-up that makes your skin crawl — one of his own friends, with the same illness, was treated with the same method, and could not be saved either.
💬 Note from Doctor Luo: Xue Lizhai was the director of the Imperial Academy of Medicine in the Ming dynasty, and he left behind more than three thousand case records. The patients he saw were mostly officials and scholars in the capital — people who lived comfortably, overthought everything, and burned through kidney essence. That is why his case records are so relevant to us modern people. Today’s story is a little unusual: it is not one patient coming for treatment, but Doctor Xue Lizhai, at a dinner with friends, using the life-and-death lessons of two other scholars as his teaching case.
A dinner party: two gentlemen of the Imperial Academy, talking about two friends who stared death in the face
The story begins with a gathering. Two gentlemen — Gu Tongshi and Zhou Shangshe — the title “Shangshe” meaning a senior scholar of the Imperial Academy, the reserve corps of national officials — set out a meal and invited Doctor Xue Lizhai over for a chat. In the course of conversation, Gu Tongshi asked for his advice: in the past, there were two scholars, Meng Youya and Chen Donggu, both of the Imperial Academy, and neither had children. In the old days there were no such things as IVF. If the first wife could not bear a child, what could be done? One had to take a concubine. And not long after marrying young concubines, both men fell ill: jie tou yun tu tan — both dizzy, spitting phlegm all day long.
💬 Note from Doctor Luo: Notice the precondition for these two men falling ill — both were elderly scholars. To reach the rank of Shangshe, a man would be at least fifty or sixty, and then he took a young concubine: excessive sexual indulgence, overindulgence in desire, and all of it drains kidney essence. When kidney essence is insufficient, kidney qi is insufficient, and kidney yin and kidney yang both go wrong with it. So Doctor Xue Lizhai knew at once: this was a deficiency pattern — kidney deficiency producing dizziness and phlegm. He had seen far too many patients like this.
The same pill: Suhexiang Wan (Storax Pill) — it saved one man and killed the other
How were the two men treated at the time? Both households used the same medicine — Suhexiang Wan.
Suhexiang Wan is one of the most famous patent medicines in Chinese medicine, with a standing comparable to Angong Niuhuang Wan (Bezoar Resurrection Pill). It belongs to the category of aromatic orifice-opening formulas. Inside are all kinds of pungent, fragrant herbs — although the classical formula also contains rhinoceros horn (replaced today by water buffalo horn, which is similar in property), the main body is pungent, aromatic, warm and drying — the fragrant herbs open the orifices. It treats excess patterns such as wind stroke or phlegm clouding the heart orifices causing coma. And what was the result? Meng Youya, after a great struggle, lived. Chen Donggu was treated to death. One death, one life — the same illness, the same pill. How could the difference be so great?
💬 Note from Doctor Luo: Suhexiang Wan is an aromatic qi-moving medicine, full of pungent, fragrant, warm-drying herbs. Aromatic orifice-opening medicine works fine for the excess pattern of phlegm clouding the heart orifices — but people in deficiency must be very careful with it. It moves qi and opens the orifices on one hand, and consumes upright qi on the other. Both men took the same pill — why did one live and one die? The key was not the medicine; it was the treatment it was combined with: the man who lived had a physician who made tonifying fire and supplementing qi the main thrust, adding only a little Suhexiang Wan. The man who died had a physician whose whole strategy was attacking phlegm and moving qi, which dried up the upright qi completely.
Doctor Xue Lizhai reveals the secret: dizziness is the kidney failing to receive qi; excess phlegm is the kidney failing to govern water
Doctor Xue Lizhai explained it in one sentence: “Both symptoms arise because kidney deficiency makes the kidney unable to receive qi, and the qi therefore fails to return to its root — hence the dizziness.”
Chinese medicine teaches that the kidney governs receiving qi (shen zhu na qi) — for qi to be drawn back down into the body, the kidney qi must be sufficient. When kidney qi is insufficient, the qi cannot be held down; it escapes upward, and the person feels dizzy. Kidney-deficiency dizziness is extremely common: with kidney yin deficiency, deficiency fire flares upward and causes dizziness; with kidney yang deficiency, yang qi cannot rise and circulate through the body, and dizziness results; with kidney essence insufficiency — the root behind both yin and yang deficiency — dizziness is even more the rule. Chinese medicine says “the kidney governs the bones and generates marrow, and the brain is the sea of marrow (nao wei sui hai).” When kidney essence is insufficient, the sea of marrow empties, and of course the head spins. So dizziness is practically standard equipment for kidney-deficient people — ask almost any kidney-deficient patient and they will tell you they feel dizzy.
And the excess phlegm? The kidney governs water (shen zhu shui). When the kidney is deficient, it cannot properly move water out of the body; the water fails to be transformed, vaporized and circulated, and it all pools inside the body — and pooled water becomes phlegm.
💬 Note from Doctor Luo: You see — both symptoms, the dizziness and the phlegm, are caused by deficiency. What should be done? Tonify the kidney! But using an aromatic qi-moving medicine like Suhexiang Wan instead actually consumes upright qi. This is worth warning everyone about: many people today are addicted to taking medicine. For example, people with a weak heart take patent medicines containing borneol and aromatic herbs for years on end; at the moment it feels like the chest opens up and it is quite pleasant — but aromatic herbs consume qi and injure yin. Fine for opening the orifices in an emergency, but taken long-term they just burn up the upright qi, and in the end the heart qi is depleted and the body develops real problems. Aromatic herbs must be used when upright qi is sufficient — they are really only appropriate for excess patterns with heavy phlegm-dampness. People with insufficient upright qi must not take them long-term.
The difference between death and life: one attacked phlegm and moved qi, the other tonified fire and supplemented qi
The physician who treated the late Chen Donggu specialized in “attacking phlegm and moving qi” — resolve the phlegm, move the qi. But the more he attacked, the more deficient the qi became; the more he resolved, the more phlegm there was — because he only attacked the pathogen and never supported the upright qi, and the man died quickly.
What about Meng Youya? His physician made “tonifying fire and supplementing qi (yi huo bu qi)” the main approach — tonifying fire means tonifying kidney yang, supplementing qi means building the qi back up — and added just a touch of Suhexiang Wan. The man lived.
💬 Note from Doctor Luo: Although Doctor Xue Lizhai did not write out the exact formulas, his thinking is perfectly clear: tonify fire and supplement qi. The prescription would have been Bawei Dihuang Wan (Eight-Ingredient Pill) — the same formula as Jinkui Shenqi Wan / Gui Fu Di Huang Wan (Kidney Qi Pill from the Golden Cabinet) — to tonify kidney yang, paired with something like Buzhong Yiqi Tang (Tonifying the Middle and Replenishing Qi Decoction) to supplement qi. Could you resolve phlegm as well? Of course — but only as a small supporting move. The main force had to be tonifying the kidney and supplementing qi. That is why Doctor Xue Lizhai said the difference between the two men’s fates was directly tied to their treatment. And it reminds us: the moment you see phlegm and spend every day attacking it, you are only looking at the surface.
The pole and the shadow: phlegm and cough are only the shadow; kidney deficiency is the pole
Doctor Luo Dalun often uses a simple image: li gan jian ying — set up a pole, and a shadow appears. What are a cough and excess phlegm? The shadow. Under the shadow there has to be a pole holding it up — if the cause is an external contraction, the pole is the external contraction; clear the external pathogen and the cough and phlegm resolve by themselves. Trying to resolve phlegm and stop the cough alone never works well. If the cause is kidney deficiency, the pole is the kidney deficiency: the kidney cannot receive qi and cannot control water, water overflows and becomes phlegm — again, the phlegm is only the shadow, and the kidney deficiency is the pole. If you charge at the symptom and attack the phlegm, you are heading the wrong way. Fill up the kidney qi, support the upright qi, and the phlegm will diminish on its own.
💬 Note from Doctor Luo: Why did Doctor Xue Lizhai place such emphasis on supporting upright qi? It has to do with his era. In the mid-to-late Ming dynasty life was prosperous, and the Jinling region of Jiangnan was positively luxurious — scholars finished the imperial examinations and went straight to the pleasure quarters; a great many of them married singers and dancers. The whole social climate leaned toward pleasure-seeking. The patients Doctor Xue Lizhai saw were either the rich-food type (fei gan hou wei) — those he treated by tonifying the spleen, strengthening the stomach and transforming turbid phlegm — or the kidney-essence-depleted type — those he tonified the kidney for. His thought on supporting upright qi is especially clear: dizziness and excess phlegm are both caused by deficiency; support upright qi, tonify the kidney and supplement qi, and these symptoms resolve naturally. This is a very upright way of treating illness.
The most regrettable one: he understood the lesson, yet could not escape the same treatment
The story does not end there. Later, Doctor Xue Lizhai was invited away to Hangzhou. And Gu Tongshi — the very man who had listened to the whole discussion at that dinner — failed to learn the lesson. He too overindulged sexually, and fell ill with exactly the same illness as the other two: dizziness and spitting of phlegm. With Doctor Xue Lizhai away from home, the physician who was called in gave him qi-moving and phlegm-resolving treatment, and the more he treated, the worse the patient became.
Gu Tongshi himself had understood the principle Doctor Xue Lizhai explained, and said: “My case is kidney deficiency failing to receive qi and return it to its root — that is why I am dizzy and full of phlegm.” But what he said did not count — the physician treating him did not understand the illness, and went on moving qi and resolving phlegm all the same. Gu Tongshi died. When Doctor Xue Lizhai returned and recorded the case, he wrote “a pity, a pity” again and again.
💬 Note from Doctor Luo: Four people are involved in this case, all scholars; three of them fell ill with the same disease through sexual indulgence, and two of them died. That ratio is terrifying — a warning for all of us. Doctor Xue Lizhai recorded this affair to tell us: in the Song dynasty aromatic medicines were all the rage, and people took Suhexiang Wan and felt wonderful — but problems came with them. In the Jin-Yuan era people began to correct course, and by the time of Xue Lizhai the position was explicit: support upright qi. Many symptoms that look like excess patterns are actually caused by deficiency — you cannot just stare at the symptoms and attack the pathogen. The moment you see phlegm and attack it, you are usually wrong.
A bonus: why did Buzhong Yiqi Tang and Jinkui Shenqi Wan become such famous formulas? Doctor Xue Lizhai had a lot to do with it
Finally, here is something most people do not know: Buzhong Yiqi Tang and Jinkui Shenqi Wan are in every pharmacy today and everyone has heard of them — and their fame has a direct connection to Doctor Xue Lizhai’s tireless promotion. He talked about these formulas every day and used more than three thousand case records to prove they worked; that is how these medicines became so famous in later generations. In the history of Chinese patent medicines, Xue Lizhai is a figure who deserves whole chapters.
💬 Note from Doctor Luo: This is especially useful to us today. Modern people with too much phlegm are everywhere — sore throats and chronic pharyngitis are common as can be — and I basically attribute them to kidney deficiency. Poor air is one cause, but kidney deficiency is an important cause too. Using an approach like Yinhuo Tang (Guide Fire Decoction) — shu di huang (prepared rehmannia) paired with rou gui (cinnamon bark) — draws the deficiency fire down, fills up the kidney qi, and the phlegm naturally diminishes. Modern people are remarkably similar to Ming-dynasty people: comfortable lives, burning up essence with mental work on one side, indulging the appetites on the other — kidney-deficient people are everywhere. So when you see phlegm, first ask whether this is deficiency — learn to tonify, not just to resolve phlegm. Especially for elderly friends whose bodies are weak: make supporting upright qi the main thing; don’t go attacking phlegm as a specialty, or you can fall into exactly the error in this case record.
Compiled from Doctor Luo Dalun’s explanation of Doctor Xue Lizhai’s case records; the case comes from Xue’s Case Records (薛氏医案).