Missed Periods and a Hard Lump in the Belly? Doctor Zhang Xichun First Tonified Vital Qi, Then Removed Blood Stasis to Dissolve the Amenorrhea Mass

Search keywords: periods stopped coming / amenorrhea / hard lump in the belly / belly bulging with a hard mass / lump hard when pressed / alternating chills and fever / can’t eat / getting thinner

Opening: benign tumors in women are called zheng jia, and Doctor Zhang Xichun had a special gift for treating them

Doctor Luo Dalun continues with Doctor Zhang Xichun’s cases of women’s illnesses. Today’s subject is an abdominal mass caused by missed periods — in Chinese medicine, zheng jia (癥瘕). What is zheng jia? Doctor Luo explains: it is what we now call benign gynecological tumors in women. Many women today carry various benign lumps — uterine fibroids, ovarian cysts — all fall into this category. Studying Doctor Zhang Xichun’s way of thinking here will be of real help in regulating the body.

💬 Note from Doctor Luo: Many of the nodules and lumps that women carry in their bodies are tied to liver qi stagnation (gan qi bu shu) — that is the most fundamental cause: when liver qi cannot flow freely, qi and blood knot together, and all kinds of lumps appear. Indeed, so many nodules today are basically linked to emotional depression. Emotion is the most overlooked root cause of gynecological masses.

Who was this patient? At 25, her circumstances were hard and her heart full of worry — her period gradually stopped

This patient lived in Lin Zhuang Village, was surnamed Liu, and was 25 years old — note, not old at all. How did she fall ill? Doctor Zhang Xichun wrote it out plainly. When he examined a patient, he often recorded the person’s circumstances, body condition, even occupation. For this woman: her circumstances were hard and her heart was full of worry — a woman in her twenties whose household was filled with depressing affairs.

💬 Note from Doctor Luo: Doctor Zhang Xichun wrote it in just eight characters, very clearly: “Her circumstances were hard, her heart was full of depression, and so her menses gradually closed (chu jing bu shun, xin duo yi yu, yi zhi yue xin jian bi).” He put the emotional, psychological cause of the illness down on paper directly. His reasoning: when the menses cannot be discharged, it is bound to form a lump inside — hence “it knots into a zheng jia.”

How sick was she? From a walnut-sized lump to a spittoon-sized hard mass, wasting away

When the illness first began, the zheng jia was about the size of a walnut — not large. But repeated treatment failed to dissolve it, and her periods gradually stopped altogether. Three years later, this thing had changed: it was as large as an overturned yu (盂).

What is a “yu”? It is an open-mouthed vessel we use for holding things — like a spittoon, upturned and bulging, very hard when pressed (an zhi shen ying). At the same time: her appetite decreased — less and less food; alternating chills and fever — sometimes hot, sometimes cold; coughing with phlegm; and her body grew emaciated.

💬 Note from Doctor Luo: Why the alternating chills and fever? This is not the Shaoyang-pattern alternating chills and fever — this is deficiency: when yang is deficient, the exterior is cold; when yin is deficient, there is internal heat. This is the presentation of qi and yin both deficient (qi yin liang xu). Why the cough with phlegm? When upright qi is insufficient, phlegm is easily generated; spleen deficiency and kidney deficiency both generate phlegm. This is deficiency phlegm born from within, caused by insufficient upright qi.

By this point the body was very weak: she could barely eat, and on top of that a great mass was bulging from her belly. Everyone thought nothing more could be done — she was just waiting to die (wu ke yi zhi, dai si er yi). In the countryside back then, they would not necessarily think of going to a big city for surgery — and the surgical conditions of the era may not have been up to it anyway. Then word suddenly came that Doctor Zhang Xichun was good at treating this kind of illness — he had already treated many such patients by then — so they hurriedly summoned him.

One hand on the pulse: wiry, thin and weak on both positions, nearly six beats per respiration

When he arrived, he felt the pulse: wiry, thin and without force on both positions, nearly six beats per respiration (zuo you jie xian xi wu li, yi xi jin liu zhi) — the pulse was beating a little fast.

How would an ordinary person react to such a patient? “Oh my, a lump this big sitting there — quick, activate blood, break up the stasis, clear it out! Move qi!” But how did Doctor Zhang Xichun analyze it? He said: this illness arose from amenorrhea and turned into a zheng jia — it accumulated gradually inside and knotted into a mass; and from the zheng jia it gradually became a consumptive disease (xu lao).

💬 Note from Doctor Luo: Did everyone see that? — he landed on consumptive disease. Because the qi and blood were stagnated, they could not circulate, and upright qi was gravely wounded: she could not eat, she wasted away, her whole state was one of consumption. So how to regulate? First treat the consumption, with herbs that dissolve the zheng jia as assistants — while activating blood and resolving stasis, as a side mission, to attack the mass. This is Doctor Zhang Xichun’s philosophy: keeping the person alive matters most; once the person is safe, then go after the disease. Not the reckless “I’ll attack the evil and the person is gone” — that is like digging straight through a river dike.

The first formula: three tonic herbs at heavy doses form the base; san leng and e zhu are added only in tiny amounts

Doctor Zhang Xichun wrote the prescription. The first formula tonified the consumption as the main task:

• Raw huai yam (sheng huai shan yao), 1 liang (about 30 g) — his signature move. Whenever he wanted to support upright qi, he first tonified the spleen and stomach; once spleen-stomach qi is sufficient, upright qi can be sufficient. This is dried huai yam slices, not fresh; and it stands in contrast to stir-fried yam — Doctor Zhang opposed frying the yam, so he used raw huai yam, at a somewhat generous 1 liang;
• Large sweet wolfberry (da gan gou qi), 1 liang (about 30 g) — tonifies the essence of the liver and kidneys. Yam tonifies the essence of the lung, spleen and kidneys; wolfberry tonifies the liver and kidneys — both are tonifying essence and supporting upright qi;
• Raw huai rehmannia (sheng huai di huang), 5 qian (about 15 g) — Doctor Zhang was extremely particular about Dao-di herbs (geo-authentic herbs); he even put the character “huai” in the name: huai rehmannia from Wenxian County, Jiaozuo, Henan. 5 qian, used to nourish yin;
• Scrophularia (xuan shen) and glehnia root (sha shen), 4 qian each (about 12 g) — while supporting upright qi, the tonics are somewhat warming; to keep them from generating heat, yin-nourishing herbs are added to balance;
• Raw astragalus (sheng huang qi), 3 qian (about 9 g) — begins tonifying qi;
• Tian dong (asparagus root), 3 qian (about 9 g) — joins rehmannia, scrophularia and glehnia in nourishing yin. Because huai yam, wolfberry and astragalus are all somewhat warming — we must not tonify and have fire flare up. This woman genuinely lacked fluids in the body, so yin must be nourished; once fluids are sufficient, she will not be running deficiency-heat all the time;
• San leng (triangular spurge) and e zhu (zedoary), 1.5 qian each (about 4.5 g) — small amounts, just a touch, to activate blood and resolve stasis;
• Raw chicken gizzard lining (sheng ji nei jin; yellow, crushed), 3.5 qian (about 10.5 g) — on one hand helps digestion and opens the appetite, on the other activates blood and resolves stasis.

💬 Note from Doctor Luo: San leng and e zhu are blood-activating, stasis-resolving herbs. Ordinary doctors do not dare use them — don’t they seem too fierce? Doctor Zhang Xichun said they are not fierce at all — they do break blood, but they do not harm upright qi. He paired them with qi-tonifying herbs like astragalus, yam, atractylodes and codonopsis, and the two sides bring out the best in each other: tonics alone tend to clog up inside — the tonic gets stuck, stagnation produces heat, “why did I break out in bumps on my face after taking tonics?” Add san leng and e zhu, and while you tonify, they open things up for you — tonified without stagnation. Conversely, blood-activating herbs joined with qi tonics move with more force and work better. And astragalus paired with san leng and e zhu has a special bonus — it opens the stomach, opening up the spleen and stomach.

When consumption reaches a certain depth, deficiency is always followed by blood stasis; the stasis blocks the inside, and qi and blood become more and more irregular — the more stasis, the more qi deficiency; it is a vicious circle. Such people usually eat very poorly, with very weak spleen-stomach function: thinner and thinner, weaker and weaker. So pairing qi tonics with san leng and e zhu to open the spleen and stomach is tremendously important. Doctor Zhang Xichun was especially skilled at this — his Li Chong Tang (Regulate the Chong Decoction) is exactly this pairing of san leng and e zhu with qi tonics.

This formula was decocted into one large cup, drunk warm, six doses in a row. The results: the chills and fever were cured — the alternating hot and cold feeling disappeared, showing the qi-yin deficiency state had been corrected; her appetite increased — the spleen and stomach grew strong; the coughing and phlegm were greatly reduced — when spleen qi thrives, deficiency phlegm diminishes; the zheng jia had not yet visibly shrunk, but where it had often hurt before, it no longer hurt — the stasis-resolving was taking effect; and the pulse showed considerable improvement over before.

The second formula: half tonify the consumption, half dissolve the mass — scrophularia swapped for white peony

Doctor Zhang Xichun said: I will adjust the formula again — half tonify the consumption, half dissolve the zheng jia. Previously the main task was tonifying the consumption with a light assist at dissolving; this time it is fifty-fifty.

• Raw huai yam 1 liang and large sweet wolfberry 1 liang — the base supporting upright qi is unchanged;
• Raw huai rehmannia 8 qian (about 24 g) and raw astragalus 4 qian (about 12 g) — both increased;
• Glehnia root and tian dong — still there;
• Scrophularia was changed to raw white peony (sheng hang shao) — white peony root, which softens and restrains the liver, and also nourishes yin;
• San leng and e zhu, 2 qian each (about 6 g) — slightly increased;
• Peach kernel (tao ren), 2 qian (about 6 g), with the skin removed — Doctor Zhang was particular: ordinarily he does not remove the tip of the peach kernel, because the germinating, ascending force lives in the tip; removing the tip weakens it. But this patient was too weak, so he removed the skin — a special usage of his;
• Raw chicken gizzard lining (yellow, crushed), 3.5 qian — as before.

Another six doses. The results: the coughing and the phlegm were both cured — upright qi was sufficiently tonified; the body gradually grew stronger; the pulse gradually gained force, and the rhythm returned to normal — the heartbeat was back to normal.

💬 Note from Doctor Luo: At this point Doctor Zhang judged that the consumption had been cured — while tonifying upright qi on one side, he had added just a little stasis-resolving on the other; qi and blood flowed, and the tonics went in. From this you can see Doctor Zhang Xichun’s heart method for treating consumption: it is not pure tonifying — first, add herbs that break stasis so the tonics can circulate; second, where the body has stagnation, open it so the tonifying force can enter. His Li Chong Tang was first used for postpartum zheng jia in women, and later expanded to treat all kinds of consumptive states — even tuberculosis-like conditions of extreme weakness. Even if there is no zheng jia, treating consumption this way also works.

The third formula: specifically dissolving the zheng jia — astragalus up to 6 qian, raw leech enters the stage

The consumption no longer needed treatment; the zheng jia had not visibly shrunk, but was a little softer than before. Now he used specific herbs to dissolve the mass:

• Raw astragalus, 6 qian (about 18 g) — the qi-tonifying dose increased;
• Trichosanthes root (tian hua fen), 5 qian (about 15 g) — pairs with astragalus, guarding against its dryness;
• Raw huai yam, 5 qian (about 15 g) — reduced; the consumption is cured, no need for heavy tonifying;
• San leng and e zhu, 3 qian each (about 9 g) — up from 2 qian;
• Huai achyranthes (huai niu xi), 3 qian (about 9 g) — why add huai achyranthes? Because the disease sits in the lower burner. Huai achyranthes tonifies the liver and kidneys, and at the same time guides the medicine downward and guides the blood downward, carrying the medicinal force down — treating a disease below;
• Lu codonopsis (lu dang shen), 3 qian (about 9 g) — tonifies qi, used in rotation with astragalus;
• Anemarrhena (zhi mu), 3 qian (about 9 g) — pairs with trichosanthes and codonopsis to guard against heat — many people eat tonics and get a sore throat or bumps on the face and quit; that is not being thoughtful enough. Doctor Zhang was very thorough: whenever he tonified qi, he added something yin-nourishing to balance it;
• Peach kernel, 2 qian, skin removed;
• Raw chicken gizzard lining (yellow, crushed), 2 qian;
• Raw leech (sheng shui zhi, crushed), 2 qian (about 6 g) — this is Doctor Zhang Xichun’s heart method: not the processed leech, but the raw one.

💬 Note from Doctor Luo: In the past, Chinese medicine used leech that had been fried or scalded. Why? People used to say the leech has tremendous vitality — if you do not fry it in oil or boil it in water, it will revive once placed in water: you swallow this thing, it gradually comes alive in your belly and eats your organs — you would be in real trouble. So few people used raw leech. But Doctor Zhang Xichun insisted on raw leech, saying the effect is especially good — once it passes through fire, its medicinal power drops sharply. Modern research confirms this: the active components in leech are destroyed by high heat, so processed leech is not as effective.

The formula was decocted into one large cup, drunk warm, twelve doses in a row. And then — his stagnant blood suddenly came down in quantity (qi yu xue hu ran jiang xia ruo gan): suddenly a great deal of stasis was passed, purple-black and clotted, mixed with membranous tissue (zi hei cheng kuai, za yi zhi mo) — and the zheng jia completely disappeared (quan xiao)!

A bonus story from the medical world: Master Yue Meizhong and the soaked leech

About raw leech, Doctor Luo told a true story.

💬 Note from Doctor Luo: In the past there was an old master, Yue Meizhong (岳美中). When he was young, studying Chinese medicine, he was curious: can the leech really come back to life? He went to a pharmacy and bought dried raw leech — note, not live leech, but dried; “raw” here means unprocessed, in contrast to fried — the same logic as “raw yam.” He soaked it in water, soaked it for 7 days, and it did not revive — dead is dead. Only then did he dare use it on patients, and the results were outstanding. So many old practitioners do follow Doctor Zhang Xichun’s practice of using raw leech. One caution: raw leech is animal protein, and a tiny minority of people may be allergic — all animal medicines have rare allergic reactions — so start with a small dose and try it carefully, step by step. If the body can tolerate it, raw leech’s power to dissolve masses is extremely, extremely good — its hemolytic effect is outstanding.

Aftercare: hawthorn slices with brown sugar, drunk as tea

This illness took nearly a month to treat from start to finish. Because the disease had lasted so long — three years, with a great mass in the belly — Doctor Zhang feared the root was not fully cleared, so he gave aftercare:

💬 Note from Doctor Luo: How does the aftercare go? Every day, 1 liang (about 30 g) of hawthorn slices — note: dried, sliced and sun-dried hawthorn, not the candy kind — boiled into a soup with some brown sugar, drunk as tea every day. Doctor Zhang Xichun usually used huai yam for aftercare; this is the only time he used hawthorn slices. What does it do? The brown sugar nourishes the blood, and the hawthorn activates blood and resolves stasis, slowly clearing out the remaining stasis.

The narrator’s closing note: three things you can learn from this case

This case is finished. What have we learned?

💬 Note from Doctor Luo: First, when treating a patient, upright qi is the key; keeping the person alive is the key. Tonify upright qi fully, then slowly dissolve the stasis; once upright qi is sufficient, gradually shift to resolving stasis as the main task. The fine-tuning in between is where Doctor Zhang Xichun is exquisite: at the start, support upright qi as the main task with a touch of stasis-resolving; then fifty-fifty; then mainly resolve stasis with a little support of upright qi — that is the experienced Chinese physician’s process of adjustment. Second, san leng and e zhu paired with qi tonics open the stomach, and let the tonified qi circulate through the whole body. Third, the use of raw leech — it is not used much by doctors today, and few people truly use it well, but raw leech is genuinely a fine medicine. For example, Director Tong Xiaolin (仝小林) of Guang’anmen Hospital, attached to the China Academy of Chinese Medical Sciences in Beijing, is especially skilled with leech — for the blood stasis that appears in the late stage of diabetes, he likes to use leech to break up the stasis. These experiences are all important — you never know which piece of knowledge you will need someday.

Doctor Luo closed by saying: a master like Doctor Zhang Xichun was probably number one in the whole country during the Republican era; and to this day, no Chinese medicine figure of comparable stature has appeared again. The case records of such a man are full of things worth pondering — spending a little time each day talking about them, everyone gradually understands and gradually learns. Today’s recording environment was a little different — it was raining outside, and listeners may hear the sound of rain on banana leaves — recording in the natural environment is quite pleasant. Thank you all for listening; tomorrow we continue with Doctor Zhang Xichun’s clinical stories.

What to take away

• Amenorrhea leads to zheng jia. When the menses cannot be discharged, the retained blood knots into a mass — and if the person is already depleted and depressed, the mass grows year after year. The emotional root (liver qi stagnation, depression) is the most commonly overlooked cause.
• When consumption has developed, first treat the consumption — keep the person alive first, then go after the disease. Doctor Zhang Xichun’s rhythm: first tonify upright qi with a little stasis-resolving; then half and half; then mainly resolve stasis with a little support — a deliberate, staged approach, never a blind attack.
• San leng and e zhu are not fierce when paired with qi tonics (astragalus, yam, codonopsis): they break blood without harming upright qi, they open the stomach, and they let the tonics circulate instead of clogging — the structure at the heart of Li Chong Tang.
• Raw leech, not processed: high heat destroys its active components. Master Yue Meizhong soaked dried raw leech for seven days, found it would not revive, and then used it with excellent results. Start with a small dose — rare allergic reactions are possible — and its power to dissolve blood stasis and lumps is outstanding (hemolytic effect).
• Aftercare with hawthorn slices and brown sugar as tea — brown sugar nourishes blood, hawthorn resolves stasis — one of the few times Doctor Zhang used hawthorn instead of huai yam for aftercare.

Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s case records; the original case is from Medical Records of Integrating Chinese and Western Medicine (《医学衷中参西录》).