Severe Stomach Pain in a 91-Year-Old, Resolved in Five Doses: A Fengyang Daoist TCM Case Study by Chen Qingzhen

Abstract: A 91-year-old male patient (Mr. Lu) presented with severe stomach pain. Fengyang Daoist physician Chen Qingzhen identified a pale-red tongue with thick greasy coating and severe sublingual varices (+++), differentiating the pattern as deficient righteous qi root, internal damp-turbidity obstruction, and stomach blood stasis. A five-dose formula integrating Four Gentlemen Decoction, Zuojin Wan (Left Metal Pill), and Shixiao San (Sudden Smile Powder) resolved the pain completely. This is a real academic case record for TCM study, with full formula analysis and safety notes.

⚠️ Case record for TCM academic reference only. Do not copy this prescription for self-medication.

I. Case Review: Stomach Pain in a Nonagenarian

Initial visit: August 17, 2026. Patient: Mr. Lu, male, 91 years old.

Chief complaint: Severe stomach pain.

Tongue observation: Pale-red tongue body, thick greasy coating, severe sublingual varices (+++).

In TCM geriatric practice, medication for patients over ninety requires exceptional clinical finesse. At this advanced age, righteous qi is fundamentally deficient and the spleen-stomach digestive function has gradually declined. Coupled with internal damp-turbidity obstruction—the middle burner behaving like a stagnant swamp with disordered ascending-descending—and long-standing qi-blood stagnation in the stomach region, the pain becomes intense.

Here lies the central clinical dilemma—

In the very elderly, aggression risks damaging righteous qi, while tonification risks clogging the stomach with greasy richness. Dosage and method must be precisely calibrated, constantly protecting the spleen-stomach root. This is the first principle of elderly TCM prescribing.

The brilliance of Physician Chen Qingzhen's approach lies in achieving "tonification without stagnation, clearing without injury, and blood-activation without harshness"—treating root and branch simultaneously, hence the remarkably swift result.

II. Pattern Differentiation & Prescription: A Three-Layer Strategy

Pattern Differentiation: Deficiency of righteous qi (root) + damp-turbidity obstruction + stomach blood stasis (branch).

Prescription:

Herb (Latin / Pinyin) Dose Herb (Latin / Pinyin) Dose Campanumoea pilosula (Shan Hailuo) 20g Pseudostellaria heterophylla (Taizishen) 10g Atractylodes Rhizome (Baizhu) 10g Poria Mushroom (Fuling) 10g Licorice Root (Gancao) 6g White Peony Root (Baishao) 10g Coptis Rhizome (Huanglian) 3g Evodia Fruit (Wuzhuyu) 3g Corydalis Tuber (Yuanhu) 10g Salvia Root (Danshen) 10g Cattail Pollen, wrapped (Puhuang) 6g Flying Squirrel Feces, wrapped (Wulingzhi) 6g Hyacinth Bean Flower, added near end (Biandouhua) 6g — —

Administration: 5 doses total; 1 dose daily, decocted in water and taken warm.

💡 > Formula Architecture:> This is a masterful > multi-formula combination> —the > Four Gentlemen> (Taizishen, Baizhu, Fuling, Gancao) tonify spleen qi as the foundation; combined with > Zuojin Wan> (Huanglian, Wuzhuyu) to clear liver and harmonize stomach; combined with > Shixiao San> (Puhuang, Wulingzhi) to transform stasis and stop pain; plus Corydalis and Salvia to activate blood, Campanumoea to boost qi and nourish yin, and Hyacinth Bean Flower to gently transform turbidity. One prescription, clearly layered.

III. Follow-Up: Resolved in Five Doses

On August 23, 2026, the patient's family was contacted via WeChat with welcome news:

> After taking the medicine, the elderly patient has returned to normal and the stomach pain has resolved.

Pain eliminated in five doses—for a 91-year-old with sublingual varices at (+++)—is remarkably swift. This outcome reflects the synergy of precise pattern differentiation and careful dosing.

IV. Formula Analysis: Three "Culpabilities," Dissected Layer by Layer

The physician attributed the elderly patient's stomach pain to three "culpabilities":

1️⃣ Culpability of Root Deficiency: Tonify Spleen, Secure the Foundation

> Pseudostellaria, Atractylodes, Poria, Licorice> — > Four Gentlemen> intent: tonify spleen qi and stabilize the deficient root.

> Campanumoea (Shan Hailuo)> — Boosts qi and nourishes yin; nourishes the stomach without causing stagnation, especially suited to advanced-age constitutions (simultaneously addressing qi and yin without burdening the diaphragm).

2️⃣ Culpability of Damp-Turbidity: Clear Liver, Harmonize Stomach, Transform Middle Burner

> Coptis with Evodia> — > Zuojin Wan> intent: clear liver-stomach stagnant heat and quell "wood qi invading the stomach" (liver-stomach disharmony).

> White Peony with Licorice> — Softens liver and relaxes acute tension, directly relieving stomach spasms (the intent of > Peony-Licorice Decoction> ).

3️⃣ Culpability of Blood Stasis: Transform Stasis, Unblock, Stop Pain

> Corydalis + Salvia> — Move qi, activate blood, unblock collaterals, and stop pain.

> Cattail Pollen + Flying Squirrel Feces> — This is > Shixiao San> (Sudden Smile Powder): specifically unblocks stomach blood collaterals and resolves severe sublingual blood stasis. > When unblocked, pain ceases.

🌿 Gentle Damp-Transformation: Protecting Elderly Qi

> Hyacinth Bean Flower> — A light, clear herb added near the end to preserve its aromatic damp-transforming quality; it disperses middle-burner damp-turbidity and resolves the thick coating. > Gently dispels dampness without consuming the elderly patient's righteous qi> —the finishing touch that "protects spleen-stomach" in the whole formula.

Overall assessment: Tonifies without stagnation, clears without injury, transforms stasis without harshness. Root and branch treated together—hence the swift efficacy.

V. Clinical Insights: Three Lessons for Treating the Elderly

Key Point Clinical Insight Protect spleen-stomach as root First principle in the elderly: constantly safeguard the middle burner—tonify without stagnation, nourish without greasiness Calibrate attack vs. tonify Attack/transformation (blood activation / liver clearing) must be gentle and gradual to avoid damaging righteousness; tonification should be mild, not aggressive Formula follows pattern, pattern follows evidence When root deficiency, damp-turbidity, and blood stasis coexist, combine multiple formulas to dismantle each layer—never attack blindly with a single brute-force method

VI. Important Cautions

⚠️ > This article is a real case record for TCM academic study only. TCM emphasizes "one person, one formula."

Stomach pain in the elderly has complex causes. > Some cardiac conditions (e.g., angina radiating to the epigastrium) and organic gastrointestinal diseases (ulcers, tumors) can also present as "stomach pain."> Do not copy this prescription directly—

> All medication must be prescribed by a qualified TCM practitioner after in-person pattern differentiation.