Fainting Right After Waking Up, Drifting In and Out of Consciousness? Doctor Miao Xiyong Treated Heart-Kidney Disharmony With Nourishing Pills and a Prescription for Living

Patient’s search words: fainting right after waking up in the morning / sudden fainting and loss of consciousness / dozing in and out of consciousness / fainting and only coming around after a long time / left foot turning cold Medical terms: heart-kidney disharmony (xin shen bu jiao) · syncope (jue zheng) · heart-kidney yin deficiency · deficiency fire flaring upward

Opening: the toes turned cold, and the man toppled over

In the last years of the Ming dynasty, the celebrated physician Doctor Miao Xiyong took on a strange patient. It was an October morning. The gentleman was just about to get out of bed — he had not even left the mattress — when suddenly he felt a chill race through the five toes of his left foot, and the cold shot “whoosh” up to his knee. The next moment he was unconscious, toppling straight back onto the bed, and did not come around for a long time.

💬 Note from Doctor Luo: This Doctor Miao Xiyong, courtesy name Zhongchun, was a great physician of the late Ming from Changshu, Jiangsu. He wrote the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening) and the Shen Nong Ben Cao Jing Shu (Commentary on the Divine Husbandman’s Classic of the Materia Medica), and he was one of the originators of the warm-pathogen (wen bing) school. An illness like “sudden fainting after waking in the morning,” in today’s terms, would most likely be connected to cerebrovascular problems.

Who was the patient? Years of disappointment, and a heart worn down by worry

The patient was a Mr. Gu — a gentleman of advanced years, and rather comfortably off. Doctor Miao had a habit when seeing patients: first ask what happened in your life before these symptoms appeared.

He asked. And the answer came out: this Mr. Gu had never been able to realize his ambitions — he carried ambitions he could not fulfill, and was perpetually unhappy; and on top of that, he had endless affairs to manage and worried constantly.

💬 Note from Doctor Luo: In the old books, this whole case is summed up in two words: heart-kidney disharmony (xin shen bu jiao). But that conclusion was drawn later. Everyone should learn this method of analysis — when examining your own body, first ask: in what month did this problem appear? What happened in your life just before it started? Were there any changes in the weather? This is the first step in analyzing the body. What does constant worrying and overthinking consume? Heart blood (xin xue). Once the heart is deficient, trouble follows.

More than ten episodes a day: a moment awake, a moment confused

After the attack, the family hastily summoned physicians. The earlier doctors all said this was phlegm syncope (tan jue) — a stroke-like condition caused by surging phlegm. But their treatments did nothing. Finally Doctor Miao Xiyong was invited. He looked once and said: this is pure deficiency fire.

💬 Note from Doctor Luo: Pay attention to this differentiation — when someone faints and loses consciousness, most people’s first thought is phlegm, or wind. But Doctor Miao said deficiency fire. Why? Because he grasped what no one else saw: this illness was not a matter of one or two days. It was years of thwarted ambition plus constant worry, and the heart blood had been burned dry.

Doctor Miao wrote one prescription — pills, made in generous quantity, honey pills the size of wutong tree seeds. The patient took fifty pills on an empty stomach every morning and sixty before bed, sent down with a shi hu (dendrobium) decoction and bamboo sap (zhu li).

Dissecting the prescription: yuan zhi leads, and suan zao ren is used at eight liang

The first herb in the formula was yuan zhi (polygala root). Yuan zhi is bitter, acrid and warm in nature, and enters the heart, kidney and lung channels — it tonifies heart qi and calms the spirit, and it also enters the kidney channel to let kidney qi rise upward. It is the herb that makes the heart and kidney communicate. Next came tian men dong (asparagus root) and mai men dong (ophiopogon root) to nourish yin and generate fluids; and bai fu shen (white poria grown around a pine root — especially powerful for calming the spirit) and bai fu ling (white poria, prepared by soaking and sun-drying in human milk — when adding poria to a yin-nourishing formula, one feared it might be too drying, so steeping it in milk removed the dryness and helped it enter the blood level more easily; physicians of the late Ming commonly used human milk, cow’s milk and goat’s milk for such preparations — a method no longer used today), six liang each.

The heaviest ingredient of all was suan zao ren (sour jujube seed), eight liang — to nourish the blood.

💬 Note from Doctor Luo: Using suan zao ren to nourish the blood was Doctor Miao Xiyong’s signature experience — he often said, “to nourish the blood, one must use suan zao ren.” Once he treated a woman with blood deficiency after childbirth with large doses of suan zao ren. Blood and body fluids interpenetrate in the human body, so while nourishing the blood one must also nourish the fluids. When the channels have no blood and no fluids, they cannot move freely — the limbs grow numb, and a person may even lose consciousness.

Then came du zhong (eucommia bark) and niu xi (achyranthes root) to tonify the kidney and strengthen the lower back; huai sheng di (raw rehmannia), eight liang — because there was deficiency fire, he used the blood-cooling raw rehmannia rather than the prepared form (this patient’s tongue would have been on the red and dry side); bai shao yao (white peony root) paired with zhi gan cao (honey-fried licorice) — sour and sweet generating yin, precisely the formula Shao Yao Gan Cao Tang (Peony and Licorice Decoction), the classic for cramps and muscle twitching; plus huang bai (phellodendron bark) to clear the fire of the lower burner, and wu wei zi (schisandra berry) to hold in everything that had been tonified.

Why the left foot first? The distinction of qi and blood between left and right

Here is a piece of knowledge worth noting: the patient’s left foot toes went cold first.

💬 Note from Doctor Luo: Chinese medicine says “left and right are the roadways of yin and yang.” Broadly speaking, the right side governs qi and the left side governs blood — a person with qi deficiency develops problems on the right side first; a person with blood deficiency develops problems on the left side first. So the left foot going numb first points to insufficient heart blood and deficient yin blood. If it were the right side going numb first, then the treatment would mostly emphasize tonifying qi, together with activating blood, unblocking the channels and resolving phlegm — formulas like Bu Yang Huan Wu Tang (Yang-Supplementing and Five-Returning Decoction). Of course this rule cannot be applied to every case, but it holds true in many situations.

Better by spring — then one lapse undid everything

After the pills were finished, by spring his health was clearly improved. But after the fourth month, the pills were not made again — and this Mr. Gu made a serious mistake: he was immoderate in sexual activity.

Then on the tenth day of the sixth lunar month, he happened to go out, and the old illness suddenly returned — he fainted again, and only came around after a long time. This time it was milder: once a day. Six days later, when rain brought a chill, it struck twice more. The family had no choice but to invite Doctor Miao back. One look: both legs were weak, and he was afraid of cold — cold below the navel, but not above it.

The judgment in one sentence: thwarted will injures the heart; immoderate indulgence injures the kidney

Doctor Miao spoke a passage that is the very eye of this case:

💬 Note from Doctor Luo: He said: “The five organs each have their own cause of illness; examine them carefully, and you will not err” (ren zhi wu zang ge you zhi bing zhi you, jin er cha zhi, zi bu shuang ye). How do you examine? “When the will and intention cannot follow, the heart is diseased” (zhi yi bu sui ze xin bing) — wanting to do something and never being able to, years of thwarted ambition: that is a heart illness (today people say liver qi stagnation, but it is also a heart illness). “When sexual indulgence is immoderate, the kidney is diseased” (fang lao bu jie ze shen bing) — excessive sexual activity weakens the kidney. Heart diseased and kidney diseased — “when heart and kidney are both diseased, yin and yang are about to separate, and when they separate, a great illness must come” (xin shen jiao bing ze yin yang jiang li, li ze da bing bi zuo). How could a great illness not come?

Why must the heart and kidney communicate? Heart fire should descend into the kidney to warm the kidney water, so that the kidney is not cold; kidney water should rise to the heart to nourish the heart fire, so that the heart does not overheat. One fire and one water meeting in harmony is called shui huo ji ji — “water and fire in harmony.” But now the heart fire does not descend and the kidney water does not rise — above, deficiency fire runs wild, which is why each attack brought fainting (fire rushing upward); below, the kidney water is cold, which is why he felt cold below the navel.

The treatment: clear heat and tonify the heart, descend qi and resolve phlegm for the upper part; benefit the essence and strengthen the kidney, nourish yin and fill the essence for the lower part. Doctor Miao wrote a second prescription — this time a decoction.

The second formula: nourish yin and resolve phlegm, plus a “beef paste”

In the decoction, bei mu (fritillaria bulb) and bai fu ling (white poria) resolve phlegm; yuan zhi and suan zao ren calm the spirit and nourish the blood; su zi (perilla seed) descends the qi (Doctor Miao particularly loved using su zi to draw the qi downward); shi hu (dendrobium) and mai men dong nourish yin and replenish fluids; mu gua (papaya) with zhi gan cao is again sour and sweet generating yin — and mu gua also relaxes the channels, wonderfully suited to cramping and contraction; niu xi strengthens the sinews and bones; shi chang pu (acorus root) opens the orifices, resolves phlegm, and settles the spirit. The decoction was simmered in two cups of water down to eight tenths, then mixed with niu huang (ox bezoar) powder and tian zhu huang (bamboo concretion) powder, with a large cup of bamboo sap (zhu li) added — taken once before bed and once on an empty stomach in the morning.

💬 Note from Doctor Luo: What is tian zhu huang? It is the secretion of the bamboo plant, dried and concentrated — it resolves phlegm-heat. Zhu li (bamboo sap) is the juice that drips out when bamboo is burned — also for clearing phlegm-heat. The earlier physicians had all said phlegm syncope; Doctor Miao said pure deficiency fire — yet he too included phlegm-resolving herbs. When yin blood is insufficient and the channels are empty, phlegm really will crowd in — so he nourished on one side while opening it up on the other.

After three doses, he added ren shen (ginseng) to support the upright qi, three slices of pi pa ye (loquat leaf), one fen of niu huang, three fen of tian zhu huang — and one more thing: xia tian gao.

💬 Note from Doctor Luo: What is xia tian gao? It is beef, simmered down into a thick paste! It was used often in the old days; nobody uses it now. It has two functions: first, it supports the upright qi and tonifies the spleen and stomach; second, when the channels are blocked by phlegm, or a limb is paralyzed after wind-stroke, it is used — nourishing the upright qi on one side while resolving the phlegm on the other. Ancient physicians made beef into a paste to treat illness — few people today know this.

The most brilliant stroke: in this formula, deliberately no kidney tonics

Any sharp observer will notice: this Mr. Gu was quite obviously kidney-deficient, yet in Doctor Miao’s formula there were almost no kidney-tonifying herbs.

💬 Note from Doctor Luo: Why no kidney tonics? Doctor Miao thought deeply: the moment you tonify the kidney, fire tends to rise. This gentleman was already heavy in desire and could not control himself; once the fire rose, there would be more sexual activity, and the tonics would be wasted. So I will nourish your heart blood, settle your spirit, replenish your fluids, nourish your yin, and resolve your phlegm — there are herbs to tonify qi and to tonify the spleen and stomach — but I will not tonify the kidney. The rest is up to you.

Doctor Miao also handed out a “prescription for living,” and it is wonderfully memorable: “In ordinary life, dwell alone in the open wilderness” — move to an out-of-the-way place; do not live on the banks of the Qinhuai River amid its lanterns and wine. Make friends with Daoist priests and eminent monks, and often discuss together “the way of leaving desire behind.”

💬 Note from Doctor Luo: Choosing your friends is tremendously important! If you spend your days with people who talk about beautiful women, reminding each other, can your desires stay under control? But if you keep company with people who talk about mountains and rivers, the qin (zither) and nourishing life — the moment a desire stirs, a friend says, “life is short, the body matters most” — would you still have the face to bring up anything else? Doctor Miao called this “rooting the source of life” (gen ji sheng ming zhi yuan): make the foundation of life solid, keep the mind clear and pure, and then “desire does not arise, the true essence holds itself firm, yin and yang hold each other in balance, and body and spirit are attuned” (qing nian bu qi, zhen jing zi gu, yin yang hu she, xing shen tiao shi): when desire does not arise, the kidney essence slowly firms up, and the body comes back.

The record ends here — healing is not only the doctor’s business

This case record stops right there. Whether he finally recovered or not, the book does not say.

💬 Note from Doctor Luo: With Doctor Miao Xiyong’s skill, treating this kind of illness was surely within easy reach. But whether he recovered was not entirely the doctor’s business — in the middle of it all, the gentleman had already been cured; then he relaxed, indulged again, and knocked himself straight back to square one. In Doctor Miao’s records there is another patient who dismissed all his concubines, saying, “the romance ends here; I am old now, and I want to nourish my life” — that one may well have lived well. Whether this Mr. Gu had that resolve, we do not know. The lesson of the story is: regulating the body cannot rely on medicine alone — self-regulation in daily life matters even more than the herbs.

Arranged from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s case; the case comes from the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening).

What to take away

1. When someone faints suddenly, do not jump straight to phlegm or wind. Doctor Miao saw “pure deficiency fire” because the illness had been building for years — thwarted ambition and constant worry had burned the heart blood dry. Ask what happened in the person’s life before the attack, and in what season it struck.
2. Heart-kidney disharmony means water and fire have stopped meeting. Heart fire should descend to warm the kidney; kidney water should rise to nourish the heart. Here the fire rushed upward (fainting, confusion) while the lower body turned cold (weak legs, cold below the navel but not above) — the classic upper-heat, lower-cold picture.
3. Left and right carry different messages. Broadly, the right side governs qi and the left governs blood. Left-side symptoms point to blood deficiency (nourish blood and fluids); right-side symptoms point more to qi deficiency with stasis and phlegm (tonify qi, activate blood, resolve phlegm — the Bu Yang Huan Wu Tang direction).
4. Suan zao ren nourishes blood; yuan zhi links heart and kidney; peony and licorice together generate yin. This is the architecture of Doctor Miao’s pill formula — nourish blood, calm the spirit, generate fluids, hold it all in with wu wei zi.
5. Do not tonify the kidney for someone who cannot control desire. Doctor Miao’s most subtle stroke was deliberately omitting kidney tonics — tonifying the kidney would fan the fire, and the fire would lead to more indulgence, and the tonics would be wasted. Nourish the heart, settle the spirit, resolve phlegm — and let the patient do his part.
6. The “prescription for living” is as important as the medicine. Dwell apart from temptation, choose friends who discuss cultivation rather than pleasure, keep desire quiet — then the true essence holds itself firm. Healing is not only the doctor’s business; self-regulation in daily life is often the deciding factor.
7. If you or a family member experience sudden fainting, especially with coldness and numbness of the limbs, seek proper medical evaluation — and consult a qualified practitioner of Chinese medicine for a diagnosis.