Period Suddenly Stopped and She Kept Losing Weight? Doctor Zhang Xichun Started from the Spleen and Stomach, and Restored a Teenage Girl’s Period with Zisheng Tongmai Tang

Search keywords: period stopped coming / amenorrhea / missed periods / period gone after dieting / getting thinner and thinner / cold in the morning, fever in the afternoon

Opening: a 17-year-old girl, and her period had suddenly stopped for half a year

Doctor Luo Dalun continues with the medical cases of Doctor Zhang Xichun — and today’s subject is once again a woman’s illness: amenorrhea in a teenage girl (shao nv bi jing). Doctor Luo says this case is “extremely educational,” because the cause of her illness is exactly the mistake that so many modern girls are making.

💬 Note from Doctor Luo: This patient was a girl surnamed Chen, 17 years old, who lived right next to Nankai Middle School in Tianjin — see, this is exactly high-school age. She had started her periods, but after one period, they stopped for half a year. When the menses suddenly close for half a year, that is what Chinese medicine calls bi jing (amenorrhea, 闭经).

Where did the root of the illness lie? A little lump on her neck — and the medicine she swallowed

Why did this girl develop amenorrhea? Doctor Zhang Xichun wrote the cause out very clearly. On both sides of her neck (the lateral neck, xiang ce) she had developed luo li (瘰疬) — that is, scrofula, tuberculous lymphadenitis: a string of little lumps on the neck. This disease is rare now, but in the old days very many women suffered from it. She took medicine to treat the scrofula — and then what happened?

The medicine was too cold and cooling (han liang).

💬 Note from Doctor Luo: The medicine was so excessively cooling that it injured her spleen and stomach. Once the spleen and stomach are injured, appetite drops — she could not eat; and when appetite drops, the body no longer has enough raw material to transform into qi and blood — “sui zhi jing bi” — and so the menses stopped. Everyone see that? The root of the amenorrhea lay, of all places, in the spleen and stomach.

Why does injured spleen and stomach mean not enough blood?

Doctor Luo says this cause deserves a careful explanation, because there are so many girls like this today. Why is the spleen and stomach so crucial for women?

Where does blood come from? In Chinese medicine, blood is transformed by the spleen and stomach from the nutrients of the food they absorb — the spleen and stomach are the source of blood. This point is enormously important.

💬 Note from Doctor Luo: There is an old saying: “Women are raised by blood; men are raised by qi.” There is real truth in it. A woman’s physiological functions depend especially on blood — menstruation, pregnancy, everything relies on blood. So once the spleen and stomach are injured and blood becomes insufficient, women’s health problems arrive one after another. And yet — women’s spleen and stomach are particularly easy to injure, especially in modern society. I have seen countless girls ruin their health by dieting, and it matches Doctor Zhang Xichun’s case exactly: they take all kinds of diet pills, the kind that suppress appetite; after taking them they no longer want to eat, and later they develop anorexia — not eating all day, completely destroying the spleen and stomach. If you eat nothing all day, where is the blood supposed to come from? How can the period come? In the end the ovaries and uterus atrophy, premature aging sets in, and after marriage they cannot even have a child — the female functions are already lost. There are also those who starve themselves, eating only one cucumber a day — that is an attack on your own spleen and stomach. And then there is cold food and drink, and rich, greasy fare that damages the spleen and stomach. Once the spleen and stomach are injured, the body truly falls into trouble.

Checking the symptoms one by one: cold in the morning, fever in the afternoon, appetite halved, dry stools

Doctor Zhang Xichun recorded this girl’s symptoms in great detail:

• In the forenoon she felt slightly cold, and it got worse day by day (wu qian wei jue han liang, ri jia) — before noon she felt cold, and the cold grew worse each day. This is insufficient yang qi: when yang qi should be rising and spreading, it cannot be proclaimed and cannot fill the whole body, so the forenoon is cold;
• Tidal heat at shen shi (3–5 p.m., the mid-afternoon) — in the afternoon she had a slight fever, not severe. This is the sign of yin deficiency and blood deficiency;
• At dawn she sweated slightly, coughed with phlegm, a little worse at night (li ming wei wei chu han, ke sou you tan, ye jian lue shen) — signs of insufficient yin blood; the illness shows itself in the evening;
• Poor digestion, appetite cut in half (yin shi xiao hua bu liang, fan liang jian ban) — the appetite halved, showing that the root of the illness lies in the spleen and stomach: the spleen and stomach are injured and can no longer transport and transform;
• She constantly felt heat in her heart and always wanted cold food (xin zhong heng jue fa re) — when yin is deficient, internal heat arises;
• Dry stools, a bowel movement only once every three or four days (da bian gan zao, san si tian cai yi ci) — the body’s fluids and yin blood are insufficient; the intestines receive no moisture, so naturally everything dries and knots.

💬 Note from Doctor Luo: Look at all this — yang deficiency, yin deficiency, spleen and stomach deficiency — basically the whole picture is analyzed out. Why do cold and heat sometimes alternate? The cold is because yang qi is insufficient, the body is chilled and the limbs cold; the heat is because yin is deficient. This girl was the same: cold in the morning, a little fever in the afternoon — her yang qi was insufficient, and her yin qi was deficient too. The symptoms are very subtle.

What about the pulse? Left position wiry and slightly hard (zuo bu xian er wei ying) — the left-hand pulse governs the heart, liver and kidneys, indicating deficient heart blood that can no longer moisten the liver and nourish the kidneys — yin blood is insufficient; right position wiry and without force (you bu xian er wu li) — the right-hand pulse governs the spleen and stomach, indicating insufficient qi in the spleen and stomach.

Doctor Zhang Xichun finally made his diagnosis: “This is because her food intake decreased, so the production of blood was insufficient, and thus the menses closed (ci yin yin shi jian shao, sheng xue bu zu, yi zhi jing bi).” — an extremely accurate judgment.

The key move: other doctors rushed to move blood stasis; Doctor Zhang Xichun first tonified the spleen and stomach

Doctor Luo emphasizes this especially: if you do not think from the spleen and stomach angle, then an ordinary doctor, seeing “amenorrhea,” immediately thinks: the blood is blocked inside — let me activate blood, free the channels, and dissolve stasis! One with a little more insight will nourish blood and dissolve stasis, thinking “once the blood is nourished enough, a single unblocking will fix it.”

That is really not how it works.

💬 Note from Doctor Luo: To be honest, at this stage activating stasis alone only wounds upright qi the more you do it — the illness cannot be cured; and even if you add blood-nourishing herbs, nourishing blood plus dissolving stasis still will not cure it — because the root lies in the spleen and stomach. If the spleen and stomach are not started up again, you can try all you like to nourish the blood, but it will never come up. This girl was terribly thin, and if she stuck out her tongue it would certainly show signs of blood stasis (this is called gan xue lao — “liver-blood consumption,” the blood dried up and stasis sitting in the liver), and many people would want to activate blood and dissolve stasis right away. But Doctor Zhang Xichun’s approach went straight to the spleen and stomach from the start — that is the most critical and most brilliant stroke of this whole case.

Zisheng Tongmai Tang: tonify the spleen as the base, nourish blood and yin, and add only a tiny bit of blood-moving herbs

Doctor Zhang Xichun wrote a formula called Zi Sheng Tong Mai Tang (资生通脉汤, “Nourish Life and Unblock the Menses Decoction”), used with slight modification from the original. Where does the formula come from? Just look at its composition and you can see Doctor Zhang Xichun’s sense of proportion:

• Stir-fried atractylodes (chao bai zhu), 3 qian, + raw huai yam (sheng huai shan yao), 8 qian — this is the heart of the formula. Atractylodes tonifies the spleen, raw huai yam tonifies the spleen; these two are also the core herbs of his famous Zi Sheng Tang (资生汤) — the whole point is to tonify the spleen;
• Large sweet wolfberry (da gan gou qi) — tonifies the essence of the liver and kidneys; while tonifying the spleen it also nourishes yin and supports the liver and kidneys;
• Longan meat (long yan rou), 5 qian — nourishes heart blood and calms the spirit; sweet in taste, it enters the spleen to tonify spleen qi — this one is for nourishing blood;
• Raw huai rehmannia (sheng huai di huang), 5 qian, + scrophularia (xuan shen), 3 qian — nourish yin and clear deficient heat. This girl had qi and yin both deficient: on one side yang qi and qi were deficient, on the other side yin was deficient and yin blood insufficient — so on top of the wolfberry that tonifies kidney essence, rehmannia and scrophularia steer the formula toward the yin-deficiency direction and clear away the deficient heat;
• Raw white peony (sheng bai shao), 3 qian, + licorice (gan cao) — these two together make Shao Yao Gan Cao Tang (Peony and Licorice Decoction), which nourishes the body’s fluids. While nourishing blood, they also replenish fluids, so that the water in the body is transformed into jinye (body fluids), and only then can fluids and blood flow into each other and interchange — this is a very refined way of nourishing blood;
• Raw hematite (sheng zhe shi), 4 qian, ground fine — what is this for? To send the qi and blood downward. The menses have not come; once the qi and blood are nourished enough, they need this to guide them downward;
• Chinese angelica (dang gui), 3 qian — nourishes blood;
• Peach kernel (tao ren), 2 qian, and safflower (hong hua), 1.5 qian — activate blood and free the channels, but only in tiny amounts;
• Sometimes Doctor Zhang Xichun also added raw chicken gizzard lining (sheng ji nei jin) — chicken gizzard lining pairs perfectly with huai yam and atractylodes, and he often included it.

💬 Note from Doctor Luo: Do you see? Doctor Zhang Xichun’s formula shows remarkable restraint: mainly tonify the spleen, nourish yin, nourish blood and replenish fluids, and then add just a tiny bit of blood-activating, channel-freeing herbs — not a fierce attack on blood stasis from the very beginning. That is precisely the fundamental difference between his treatment of amenorrhea and that of ordinary doctors.

Twenty doses later: everything was cured — except the period still had not come

The formula was taken continuously for more than twenty doses, with a few small adjustments along the way (Doctor Zhang did not record the details).

What was the result? Her appetite increased — the stomach qi had opened up; her body grew strong and healthy (xing shen jian zhuang) — her body began to strengthen; all the other illnesses were cured (zhu bing jie yu) — the afternoon fever, the cough and everything else disappeared. After twenty-odd doses, the body was basically regulated.

Except for what? The period had not yet come through.

Only this last step remained. Doctor Zhang Xichun then wrote a small formula — and this small formula is very interesting.

The closing mini-formula: yam-and-brown-sugar tea taken with leech powder — after ten days or so, the period came

How was the aftercare formula used?

Raw leech ground to a fine powder, 1 liang; raw huai yam ground to a fine powder, half a jin. Each time take 7 qian (about 21 g) of the raw huai yam powder, mix with cold water and boil into something like a tea-soup, add a little brown sugar (brown sugar nourishes blood), and once melted, take with it 6 fen of the leech powder — 6 fen is a very small amount, less than one qian. Twice a day.

💬 Note from Doctor Luo: The leech certainly does not taste good, but mixed into the huai yam it is no longer unpleasant to eat. Doctor Zhang Xichun said that if you follow this formula, “persist and the menses will surely pass through (jiu ze yue jing bi tong)” — given time, the period will open. Why? Because the upright qi was already sufficient; he would keep tonifying the spleen and stomach a little longer, and add a bit of stasis-breaking herb, and it should be cured. And indeed, this girl followed the formula for xun ri — about ten days — and her period flowed down (yue jing guo ran tong xia). From then on her menses were harmonious and she had no illness (jing xue tiao he, wu bing) — her body returned to normal, the period came on time, and she was completely well.

The finer point about raw leech: stir-fried or processed leech will not do — it must be raw

In this formula, Doctor Zhang Xichun explained one important technical point in detail — how to use leech (shui zhi).

💬 Note from Doctor Luo: Doctor Zhang Xichun said that only raw leech works well — stir-fried or conventionally processed leech does not, and this is something he had tested himself. Moreover, raw leech is not as fierce as people imagine; it is not something you cannot tolerate. Its one drawback is that it is a little irritating — after taking it the stomach feels a bit uncomfortable — which is why it is taken together with yam powder, to protect the spleen and stomach. Doctor Zhang said the yam “rao you bu yi zhi li” — has abundant tonifying power, and since it is an everyday food (people eat yam all the time), using it to cook a porridge and send down the leech can both prevent the leech from breaking and wounding upright qi and is excellent at harmonizing the stomach and strengthening the spleen and stomach’s upright qi. Even a closing mini-formula hides such careful thinking.

A bonus master’s insight: why put hematite in the formula?

Doctor Luo says this case holds too many fine points to count — raw hematite (zhe shi), for instance. Someone might think: if you are tonifying, just tonify — why add hematite? It actually guides the medicinal nature downward, and this idea is especially critical.

💬 Note from Doctor Luo: In Beijing we have a famous gynecological master, Chai Songyan (柴松岩, “Chai lao”), a great authority in gynecology whose clinic is full of patients, with excellent treatment results. Chai lao has an experience: some tonics tonify the upper body — longan meat, for instance, nourishes heart blood, and huai yam tonifies the lung and spleen — so how do you make the tonifying action travel downward, enter the kidneys, nourish kidney essence, benefit gynecology, and let the period come back? Chai lao often adds a qi-lowering herb to the formula, such as apricot kernel (xing ren) or forsythia (lian qiao) — herbs that seem to have nothing to do with the formula at all, but their whole job is to send the medicinal nature downward: the lung belongs to metal, the kidney to water, and metal generates water (jin sheng shui); once the medicinal nature travels downward, the kidney is nourished and the period comes. When Doctor Zhang Xichun used raw hematite, it was the same reasoning — making the medicinal nature move downward. These are the little tricks of the masters.

Today’s main point: never injure the spleen and stomach

Doctor Luo finally draws the lesson together: the very core of this case is tonifying the spleen and stomach — and it tells us that the spleen and stomach hold a special importance for women.

💬 Note from Doctor Luo: Please, please never injure your spleen and stomach — don’t diet for the sake of beauty and wreck them; don’t wreck them by overeating rich foods or cold, cooling food and drink. Once the spleen and stomach are injured, many of a woman’s problems arrive one after another. There is one more thing this case does not state outright: tonifying the spleen and stomach can also regulate the emotions. Like in yesterday’s case, the patient’s emotions were depressed and later lumps and masses appeared; such amenorrhea girls usually have poor emotions too — sometimes they are on the verge of collapse. But how did Doctor Zhang Xichun handle it? He did not need to regulate the emotions separately — once the spleen and stomach grow strong, they in turn affect the liver-wood, letting it return to normal, and the bad emotions are naturally restrained and brought back to the normal track. That is the beauty of supporting upright qi. So when you study this case, study the way of thinking: Doctor Zhang Xichun’s formula can be used very gently and peacefully, but the most important thing is — keep the spleen and stomach well-nourished in daily life; do not wait until they are injured and then treat, by then it is already late. Do not injure the spleen and stomach, keep qi and blood vigorous, and a woman’s menses will naturally be normal.

Compiled from Doctor Luo Dalun’s lecture on Doctor Zhang Xichun’s medical cases. The case is from Medical Records of Integrating Chinese and Western Medicine (《医学衷中参西录》).